J. Marc Overhage, MD, PhD; David McCallie Jr., MD
The amount of time providers spend using electronic health records (EHRs) to support care delivery is a concern for the U.S. health care system. This study describes the amount of time ambulatory medical subspecialists and primary care physicians across several U.S. health care systems spend on various EHR functions.
Ann Intern Med. 2020;172(3):169-174. doi:10.7326/M18-3684
Joan Walter, MD, PhD; Jeanne du Fay de Lavallaz, MD, PhD; Luca Koechlin, MD; Tobias Zimmermann, MD; Jasper Boeddinghaus, MD; Ursina Honegger, MSc; Ivo Strebel, MSc; Raphael Twerenbold, MD; Melissa Amrein, MSc; Thomas Nestelberger, MD; Desiree Wussler, MD; Christian Puelacher, MD, PhD; Patrick Badertscher, MD; Michael Zellweger, MD; Gregor Fahrni, MD; Raban Jeger, MD; Christoph Kaiser, MD; Tobias Reichlin, MD; Christian Mueller, MD
Previous work has shown that very low blood concentrations of high-sensitivity cardiac troponin can exclude inducible myocardial ischemia in most patients who have asymptomatic coronary artery disease. This study examined whether this strategy is also effective when used for patients with symptoms.
Ann Intern Med. 2020;172(3):175-185. doi:10.7326/M19-0080
Michael Fralick, MD, PhD, SM; Sarah K. Chen, MD, MPH; Elisabetta Patorno, MD, DrPH; Seoyoung C. Kim, MD, ScD, MSCE
Sodium–glucose cotransporter-2 (SGLT2) inhibitors block the reabsorption of glucose in the kidneys, resulting in glucosuria and increased excretion of uric acid. The association between SGLT2 inhibitor use and risk for gout is unclear. This analysis of health insurance claims data compares the risk for gout with use of SGLT2 inhibitors versus another second-line medication for type 2 diabetes mellitus.
Ann Intern Med. 2020;172(3):186-194. doi:10.7326/M19-2610
Neil M. Paige, MD, MSHS; Eric A. Apaydin, PhD, MPP, MS; Jeremy D. Goldhaber-Fiebert, PhD; Selene Mak, PhD, MPH; Isomi M. Miake-Lye, PhD; Meron M. Begashaw, MPH; Jessica M. Severin, BS; Paul G. Shekelle, MD, PhD
In this systematic review of 28 studies, the authors review the evidence about the association of primary care panel size with health care outcomes and provider burnout.
Ann Intern Med. 2020;172(3):195-201. doi:10.7326/M19-2491
Howard Libman, MD; Joshua D. Safer, MD; Jennifer R. Siegel, MD; Eileen E. Reynolds, MD
Transgender patients experience discrimination in the health care setting and may not have access to medical professionals who can provide competent care. In addition to primary medical and preventive health care, transgender patients need access to gender-affirming interventions, including hormone therapy and surgeries. Here, 2 expert clinicians debate whether psychological evaluation is warranted in a transgender patient requesting gender-affirming hormone therapy or surgery, the potential risks and benefits of estrogen therapy, and the primary care practitioner's role in the care of the transgender population.
Ann Intern Med. 2020;172(3):202-209. doi:10.7326/M19-3813
Michael Klompas, MD, MPH; Tiffany M. Osborn, MD, MPH; Chanu Rhee, MD, MPH
The popular conception of sepsis is dominated by the perspective of critical care physicians, given their experiences treating the sickest subset of patients. In this commentary, the authors argue for bringing more awareness and balance to the plurality of patients with sepsis who are diagnosed and treated outside the intensive care unit in order to address the full spectrum of illness encompassed by sepsis.
Ann Intern Med. 2020;172(3):210-211. doi:10.7326/M19-2966
Julia Adler-Milstein, PhD
Overhage and McCallie add to a growing number of studies that quantify the amount of time outpatient physicians spend using EHRs. The editorialist discusses the findings and the questions these data raise in the quest to make the EHR a tool that productively serves its many masters.
Ann Intern Med. 2020;172(3):212-213. doi:10.7326/M19-3921
Katy J.L. Bell, MBChB, MMed(Clin Epi), PhD; Christopher Semsarian, MBBS, PhD, MPH; Jenny Doust, BMBS, PhD
Walter and colleagues investigated whether high-sensitivity cardiac troponin tests could be used to rule out inducible ischemia in patients with stable angina and conclude that they cannot. The editorialists discuss the findings and question whether stable obstructive disease needs to be excluded in the first place.
Ann Intern Med. 2020;172(3):214-215. doi:10.7326/M19-3731
Christine A. Sinsky, MD; Marie T. Brown, MD
Paige and colleagues' systematic review found surprisingly thin evidence about the association between primary care panel size and aims of health care. The editorialists believe that the right question is not whether the optimal panel size is 500 patients, 2500 patients, or somewhere in between. Instead, we should be asking what resources and practice models could enable primary care physicians and their teams to optimally manage a patient population.
Ann Intern Med. 2020;172(3):216-217. doi:10.7326/M19-3673
Ronald V. Loge, MD
Today, I am making my last house call and closing my career as a rural physician.
Ann Intern Med. 2020;172(3):218-219. doi:10.7326/M19-2664
Ann Intern Med. 2020;172(3):221-222. doi:10.7326/L19-0481
Ann Intern Med. 2020;172(3):222-224. doi:10.7326/L19-0483
Ann Intern Med. 2020;172(3):224-225. doi:10.7326/L19-0674
Ann Intern Med. 2020;172(3):225. doi:10.7326/L19-0675
Ann Intern Med. 2020;172(3):225-226. doi:10.7326/L19-0681
Ann Intern Med. 2020;172(3):226. doi:10.7326/L19-0682
Ann Intern Med. 2020;172(3):226-227. doi:10.7326/L19-0731
Ann Intern Med. 2020;172(3):227. doi:10.7326/L19-0679
Ann Intern Med. 2020;172(3):227. doi:10.7326/L19-0680
Ann Intern Med. 2020;172(3):228. doi:10.7326/L19-0822
Anthony Khoo, MBBS, SpecCertCR(Neuro)
Ann Intern Med. 2020;172(3):219. doi:10.7326/M19-2094
Lawrence J. Hergott, MD
Ann Intern Med. 2020;172(3):220. doi:10.7326/M19-1008
Camille P. Vaughan, MD, MS; Alayne D. Markland, DO, MSc
Ann Intern Med. 2020;172(3):ITC17-ITC32. doi:10.7326/AITC202002040
Darren B. Taichman, MD, PhD
Ann Intern Med. 2020;172(3):ED3. doi:10.7326/AWED202002040
Robert M. Centor, MD; Katherine R. Tuttle, MD
In this episode of Annals On Call, Dr. Centor discusses the role of glucagon-like peptide-1 receptor agonists in the treatment of patients with type 2 diabetes with Dr. Tuttle of Providence Health Care and University of Washington School of Medicine.
Ann Intern Med. 2020;172(3):OC1. doi:10.7326/A19-0023
Grace E. Farris, MD
Dr. Mom explores the challenges and ups and downs of juggling life as a hospitalist and mother. The feature appears monthly in Annals Graphic Medicine at Annals.org.
Ann Intern Med. 2020;172(3):W1-W2. doi:10.7326/G19-0091
Michael U. Antonucci, MD
Annals Graphic Medicine brings together original graphic narratives, comics, animation/video, and other creative forms by those who provide or receive health care. They address medically relevant topics—whether they be poignant, thought-provoking, or just plain entertaining.
Ann Intern Med. 2020;172(3):W49-W54. doi:10.7326/G19-0033
Sharon Rosenzweig, BFA, MFA; Peggy Mason, PhD
Ann Intern Med. 2020;172(3):W55-W60. doi:10.7326/G19-0018
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