Andrew D. Wiese, PhD; Marie R. Griffin, MD, MPH; William Schaffner, MD; C. Michael Stein, MB, ChB; Robert A. Greevy, PhD; Edward F. Mitchel Jr., MS; Carlos G. Grijalva, MD, MPH
Certain opioids are reported to be immunosuppressive in vitro, and animal studies have suggested an increased risk for serious infection with opioid administration. Using linked databases, the authors examined whether opioid use is associated with an increased risk for laboratory-confirmed invasive pneumococcal disease, an entity with a high case-fatality rate.
Paul G. Shekelle, MD, PhD; Ian A. Cook, MD; Isomi M. Miake-Lye, PhD; Marika Suttorp Booth, MS; Jessica M. Beroes, BS; Selene Mak, MPH
This systematic review of 26 randomized trials examines evidence about the benefits and harms of cranial electrical stimulation for adults with chronic painful conditions, depression, anxiety, and insomnia.
Richard Kahn, PhD
To protect public health, the government may mandate the placement of warnings on products that it believes pose health risks. However, as a recent legal case demonstrates, such mandates require fulfillment of specific standards for compelled speech.
Nancy A. Rigotti, MD
Electronic cigarettes present a conundrum. They have the potential for benefit if they help smokers quit, but this must be balanced against potential harm if e-cigarettes entice youths who would otherwise not have become cigarette smokers to try e-cigarettes, then become addicted to nicotine and switch to combustible cigarettes. This commentary discusses the National Academies of Sciences, Engineering, and Medicine report Public Health Consequences of E-Cigarettes and provides advice on how to counsel patients who ask about e-cigarettes.
Ge Bai, PhD, CPA; Aditi P. Sen, PhD; Gerard F. Anderson, PhD
The prices patients pay for brand-name medications are rising faster than many other medical care costs. Some observers claim that the business practices of pharmaceutical benefit managers are partly responsible. How this process works is complicated, and this article explains what is happening.
Paul Sorum, MD, PhD
Clinicians know what is wrong with U.S. health care: It costs too much. They spend too much time negotiating with insurance companies, and too much of their remaining time is spent documenting what they did so the practice gets paid. Today's electronic health record makes documenting worse by invading the clinician's private time outside the office. This commentary suggests a possible solution.
Wayne B. Jonas, MD
Cranial electrical stimulation (CES) is a form of brain stimulation that uses low levels of alternating current. The review by Shekelle and colleagues found limited and inconclusive evidence from randomized trials on the effectiveness and safety of CES for chronic pain, depression, anxiety, and insomnia. The editorialist discusses the findings and wonders whether the failure to demonstrate efficacy is due to inadequate studies or true lack of effectiveness. Regardless, he believes that this review should caution clinicians and patients to be more circumspect in CES use.
Sascha Dublin, MD, PhD; Michael Von Korff, ScD
In their current Annals report, Wiese and colleagues provide evidence that prescription opioids are associated with an increased risk for serious infections. The editorialists discuss the study and what clinicians and researchers should do in light of its findings.
Canqing Yu, PhD; Haijing Tang, PhD; Yu Guo, MSc; Zheng Bian, MSc; Ling Yang, PhD; Yiping Chen, DPhil; Aiyu Tang, MD; Xue Zhou, PhD; Xu Yang, PhD; Junshi Chen, MD; Zhengming Chen, DPhil; Jun Lv, PhD; Liming Li, MD, MPH; on behalf of the China Kadoorie Biobank Collaborative Group
Although some studies have suggested that the temperature at which tea is consumed may be a risk factor for esophageal cancer, previous analyses did not adequately adjust for patterns of smoking and alcohol use. This large population-based study simultaneously adjusted for tea temperature, smoking, and alcohol consumption to assess their associations with esophageal cancer.
Shannon M. Fernando, MD, MSc; Alexandre Tran, MD; Monica Taljaard, PhD; Wei Cheng, PhD; Bram Rochwerg, MD, MSc; Andrew J.E. Seely, MD, PhD; Jeffrey J. Perry, MD, MSc
This systematic review of 38 studies compares the accuracy of the quick Sequential Organ Failure Assessment and the systemic inflammatory response syndrome criteria for prediction of in-hospital or 28- or 30-day mortality in adult patients with suspected infection.
Eileen E. Reynolds, MD; Carol Bates, MD; Martha Richardson, MD; Risa B. Burns, MD, MPH
Use of hormone therapy (HT) for the vasomotor symptoms of menopause has been controversial since publication of the Women's Health Initiative in the early 2000s. However, the 2017 guideline from the North American Menopause Society recommends HT for these symptoms. Here, 2 experts discuss the guideline and whether to prescribe HT to a 52-year-old woman with severe hot flashes, sleep disturbance, and irritability.
David K. Kim, MD, MA; Laura E. Riley, MD; Paul Hunter, MD; on behalf of the Advisory Committee on Immunization Practices
The Advisory Committee on Immunization Practices (ACIP) presents the recommended Immunization Schedule for Adults Aged 19 Years or Older for 2018. This schedule has been approved by the ACIP, American College of Physicians, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and American College of Nurse-Midwives.
Jessie M. Gaeta, MD; Melanie Racine, MPH
With the explosion of highly potent fentanyl and its analogues in the illicit drug supply, overdose fatalities are occurring with alarming frequency and speed, leaving little time for first responders to find and resuscitate victims. Supervised injection facilities can help combat this problem. In addition to other benefits, these facilities offer sterile equipment and a hygienic environment for medically supervised drug injection.
Farin Kamangar, MD, PhD; Neal D. Freedman, PhD, MPH
In their current Annals report, Yu and colleagues show that drinking high-temperature tea, when combined with tobacco or alcohol use, is associated with an increased risk for esophageal cancer. The editorialists discuss these findings in light of what is known about thermal irritation and cancer.
Mervyn Singer, MD; Manu Shankar-Hari, MD
In this issue, a systematic review by Fernando and colleagues compares the prognostic accuracy of the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and the systemic inflammatory response syndrome (SIRS) criteria for identification of patients with sepsis. The editorialists discuss the confusion surrounding sepsis scores and note that neither qSOFA nor the SIRS criteria are diagnostic for infection or sepsis, although they do offer information on the host's inflammatory reaction to an insult and the degree of physiologic perturbation.
A. Russell Localio, PhD; Steven N. Goodman, MD, PhD; Anne Meibohm, PhD; John E. Cornell, PhD; Catharine B. Stack, PhD; Eric A. Ross, PhD, ScM; Cynthia D. Mulrow, MD, MSc
Assel and Vickers report the shortcomings of statistical code supporting research reports in high-impact medical journals. In this editorial, Annals' statistical editors argue that clearly presented and transparently reported statistical code is a sine qua non for reproducible research. They describe the attributes of code that communicates clearly to readers the path that researchers took to arrive at their findings.
Phillip D. Bertram, MD
The letter was on my desk when I returned from lunch. Although the envelope was unremarkable, the name on the return address caught my attention and unlocked a distant memory.
Darren B. Taichman, MD, PhD
Rachel Bystritsky, MD; Henry Chambers, MD
Kevin Dueck, MD, MSc
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.
Linda M. O'Keeffe, PhD; Anna Ramond, DPharm; Clare Oliver-Williams, PhD; Peter Willeit, MD; Ellie Paige, PhD; Patrick Trotter, MBChB; Jonathan Evans, MBChB; Jonas Wadström, MD; Michael Nicholson, MD; Dave Collett, PhD; Emanuele Di Angelantonio, MD
This systematic review of 52 observational studies details health risks for adults who donate kidneys.
Emilio D. Poggio, MD; Peter P. Reese, MD, MSCE
O’Keeffe and colleagues report a meta-analysis that concludes that living kidney donors face elevated relative risks for end-stage renal disease, preeclampsia, and high diastolic blood pressure. The editorialists discuss the findings and believe that, despite the important contributions of this analysis, the field is still a long way from offering precise estimates to individuals about risk attributable to kidney donation.
Gi Hyeon Seo, MD; Tae Hyuk Kim, MD, PhD; Jae Hoon Chung, MD, PhD
Using a national database of nearly 3 million completed pregnancies, the authors analyzed the risk for congenital malformations associated with different antithyroid drugs used to treat Graves disease during the first trimester.
Robert M. Carey, MD; Paul K. Whelton, MB, MD, MSc; for the 2017 ACC/AHA Hypertension Guideline Writing Committee
In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a clinical practice guideline for the prevention, detection, evaluation, and treatment of high blood pressure in adults. This synopsis summarizes the major recommendations from the guideline.
Robert M. Carey, MD; Paul K. Whelton, MB, MD, MSc
The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults is the first comprehensive clinical practice guideline for hypertension since the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) in 2003. This commentary discusses the four ACC/AHA recommendations that differ substantially from those in JNC-7.
Timothy J. Wilt, MD, MPH; Devan Kansagara, MD, MCR; Amir Qaseem, MD, PhD; for the Clinical Guidelines Committee of the American College of Physicians
The recent hypertension guideline from the American College of Cardiology and the American Heart Association raises important questions about hypertension diagnosis and treatment but differs substantially from guidelines issued by other organizations. The editorialists discuss the ways in which the guideline falls short in weighing the potential benefits against potential harms, costs, and anticipated variation in individual-patient preferences, specifically for adults older than 60 years.
Steven M. Teutsch, MD, MPH; Timothy S. Naimi, MD, MPH
Despite decades of progress, more than 10 000 alcohol-related driving fatalities occur each year. To identify ways of reinvigorating efforts to stem these tragic events, the National Highway Traffic Safety Administration asked the National Academies of Sciences, Engineering, and Medicine to form a committee to do a rigorous study of the problem and make recommendations. This commentary highlights the recommendations.
Malin Hultcrantz, MD, PhD; Magnus Björkholm, MD, PhD; Paul W. Dickman, MSc, PhD; Ola Landgren, MD, PhD; Åsa R. Derolf, MD, PhD; Sigurdur Y. Kristinsson, MD, PhD; Therese M.L. Andersson, MSc, PhD
Patients with myeloproliferative neoplasms (MPNs) have been reported to be at increased risk for thrombotic events, but no population-based study has estimated this excess risk compared with matched control participants. In this cohort study, the authors analyzed data on patients reported to the Swedish Cancer Register between 1987 and 2009 to assess risk for arterial and venous thrombosis among patients with MPNs compared with matched control participants.
Per E. Lønning, MD, PhD; Elisabet O. Berge, PhD; Merete Bjørnslett, PhD; Laura Minsaas, PhD; Ranjan Chrisanthar, PhD; Hildegunn Høberg-Vetti, MD; Cécile Dulary, MSc; Florence Busato, MSc; Silje Bjørneklett, MSc; Christine Eriksen, MSc; Reidun Kopperud, PhD; Ulrika Axcrona, MD; Ben Davidson, MD, PhD; Line Bjørge, MD, PhD; D. Gareth Evans, MD, PhD; Anthony Howell, MD, PhD; Helga B. Salvesen, MD, PhD; Imre Janszky, MD, PhD; Kristian Hveem, MD, PhD; Pål R. Romundstad, PhD; Lars J. Vatten, MD, PhD; Jörg Tost, PhD; Anne Dørum, MD, PhD; Stian Knappskog, PhD
Women who carry germline BRCA1 mutations have an increased risk for ovarian cancer, particularly the high-grade serous type. The authors conducted 2 large case–control studies to examine the association between normal tissue BRCA1 methylation and the risk for ovarian cancer overall as well as for high-grade serous ovarian cancer, low-grade serous ovarian cancer, and nonserous ovarian cancer.
Alison R. Moliterno, MD; Elizabeth V. Ratchford, MD
In this issue, Hultcrantz and colleagues report a study that examined thrombosis patterns in Swedish patients with myeloproliferative neoplasms (MPNs) diagnosed between 1987 and 2009 compared with matched control participants. The editorialists discuss the implications of the study's findings and highlight the keys to a personalized, precision medicine approach to primary and secondary thrombosis prevention for patients with MPNs.
Alexander Dobrovic, PhD
In their current Annals article, Lønning and colleagues report substantially increased BRCA1 promoter region methylation in patients with ovarian cancer relative to a control population in 2 independent case–control studies. The editorialist believes that this and previous studies make it clear that BRCA1 constitutional methylation is strongly associated with the same tumor types as BRCA1 mutation and thus may be seen as an alternate mechanism of BRCA1 inactivation, leading to an increased risk for breast or ovarian cancer in which tumors are methylated for BRCA1.
Andrea Trombetti, MD; Mélany Hars, PhD; Fang-Chi Hsu, PhD; Kieran F. Reid, PhD; Timothy S. Church, MD, PhD; Thomas M. Gill, MD; Abby C. King, PhD; Christine K. Liu, MD; Todd M. Manini, PhD; Mary M. McDermott, MD; Anne B. Newman, MD; W. Jack Rejeski, PhD; Jack M. Guralnik, MD, PhD; Marco Pahor, MD; Roger A. Fielding, PhD; for the LIFE Study Investigators
Studies suggest that exercise-based interventions may improve physical functioning and prevent disability among frail older adults. This secondary analysis of a large multicenter randomized controlled trial involving sedentary older adults compared the effects of a structured physical activity program with those of health education on the risk for frailty. The authors also examined whether the participants' baseline frailty status modified the positive effects of the physical activity intervention on reducing major mobility disability.
Rahman Shah, MD; Mannu Nayyar, MD; Ion S. Jovin, MD, ScD; Abdul Rashid, MD; Beatrix R. Bondy, MD; Tai-Hwang M. Fan, MD, PhD; Michael P. Flaherty, MD, PhD; Sunil V. Rao, MD
This meta-analysis of recent landmark trials examines the benefits and harms of percutaneous closure of patent foramen ovale compared with medical therapy alone in patients with cryptogenic stroke.
Salvatore De Rosa, MD, PhD; Horst Sievert, MD; Jolanda Sabatino, MD; Alberto Polimeni, MD; Sabato Sorrentino, MD, PhD; Ciro Indolfi, MD
This meta-analysis of recent landmark trials examined the benefits and harms of percutaneous closure of patent foramen ovale compared with medical therapy alone in patients with cryptogenic stroke.
David L. Brody, MD, PhD
Chronic traumatic encephalopathy (CTE) has recently been the focus of extensive attention. To date, CTE has been found exclusively in persons with a history of head injuries, although not all have been diagnosed with concussions. This commentary addresses CTE diagnosis, prevention, treatment, and financial compensation for patients with a history of head trauma and their families.
Kenneth G. Castro, MD; Dabney P. Evans, PhD, MPH; Carlos Del Rio, MD; James W. Curran, MD, MPH
Recently, it was reported that Centers for Disease Control and Prevention (CDC) staff were advised to avoid using the following 7 words in budget documents: “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based,” and “science-based.” This commentary discusses the implications of such censorship on the work and credibility of the CDC and other U.S. government health organizations.
Austin B. Frakt, PhD; Craig Garthwaite, PhD
Through mergers and acquisitions, health care organizations are making large bets about the future of the U.S. medical landscape and the types of organizations that can ultimately succeed in it. There's been a recent uptick in vertical integration, such as hospitals buying physician practices and insurers buying providers. This commentary discusses the recently announced merger of CVS and Aetna and whether it will benefit consumers.
Rebecca T. Brown, MD, MPH; Kenneth E. Covinsky, MD, MPH
Studies suggest that exercise-based interventions may improve physical functioning and prevent disability among frail older adults. This secondary analysis of a large multicenter randomized controlled trial involving sedentary older adults compared the effects of a structured physical activity program versus health education on the risk of frailty. The authors also examined whether the participants' baseline frailty status modified the positive effects of the physical activity intervention on reducing major mobility disability.
William G. Kussmaul III, MD
Two meta-analyses in the current Annals make a case that the totality of available data favors patent foramen ovale (PFO) closure to prevent recurrent stroke in patients who, after work-up, are found to have a PFO and no other apparent cause. The editorialist discusses the findings and how they should be incorporated into clinical practice.
John Weiser, MD, MPH; Alejandro Perez, MPH; Heather Bradley, PhD; Hope King, PhD, MSPH; R. Luke Shouse, MD, MPH
Persons with HIV infection are at increased risk for hepatitis B virus infection. In this study, the authors used a nationally representative cross-sectional survey to estimate the prevalence of hepatitis B vaccination among U.S. patients receiving medical care for HIV infection.
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