Jefferson G. Williams; Michael W. Bachman; Michael D. Lyons; Benjamin B. Currie; Lawrence H. Brown; A. Wooten Jones; Jose G. Cabanas; Alan K. Kronhaus; J. Brent Myers
Falling is a frequent problem for residents of assisted living facilities. The problem is aggravated when institutional policy requires transport to an emergency department after every fall, even when there is minimal injury or no injury. The paramedics who provide emergency medical services and some of the primary care physicians who provide care in 1 geographic area worked together to address this problem. The result was a remarkable improvement.
Neda Laiteerapong; Jennifer M. Cooper; M. Reza Skandari; Philip M. Clarke; Aaron N. Winn; Rochelle N. Naylor; Elbert S. Huang
Intensive glycemic control (glycated hemoglobin level <7%) is an established, cost-effective standard of care for patients with type 2 diabetes, but guidelines recommend individualizing glycemic goals on the basis of age, comorbidity, diabetes duration, and complications. In this study, the authors sought to estimate the cost-effectiveness of individualized control versus uniform intensive control for U.S. adults with diabetes diagnosed at age 30 years or older.
Matthew E. Growdon; Sharon K. Inouye
Williams and colleagues present the results of a prospective cohort study of an intervention to avoid unnecessary transport to the emergency department for residents in assisted living facilities residents who fall. The editorialists discuss the findings and conclude that the study provides an example of a much-needed health care innovation pushing our health system toward the triple aim of improving patient experience, population health, and costs of care.
Sneh Lata; Maddalena Marasa; Yifu Li; David A. Fasel; Emily Groopman; Vaidehi Jobanputra; Hila Rasouly; Adele Mitrotti; Rik Westland; Miguel Verbitsky; Jordan Nestor; Lindsey M. Slater; Vivette D'Agati; Marcin Zaniew; Anna Materna-Kiryluk; Francesca Lugani; Gianluca Caridi; Luca Rampoldi; Aditya Mattoo; Chad A. Newton; Maya K. Rao; Jai Radhakrishnan; Wooin Ahn; Pietro A. Canetta; Andrew S. Bomback; Gerald B. Appel; Corinne Antignac; Glen S. Markowitz; Christine K. Garcia; Krzysztof Kiryluk; Simone Sanna-Cherchi; Ali G. Gharavi
Whole-exome sequencing (WES) enables evaluation of protein-coding regions of the genome enriched for disease-associated gene variants. Although WES is emerging as a useful tool in the evaluation of pediatric disorders, little is known of its utility among adult patients. This study evaluated the utility of WES to assist in the diagnosis and management of adults with chronic kidney disease.
Eric A. Secemsky; Marc Schermerhorn; Brett J. Carroll; Kevin F. Kennedy; Changyu Shen; Linda R. Valsdottir; Bruce Landon; Robert W. Yeh
Limited data suggest high rates of unplanned rehospitalization after endovascular and surgical revascularization for peripheral arterial disease, but the overall burden of readmissions has not been comprehensively explored. The authors conducted this retrospective cohort study to evaluate nationwide readmissions after peripheral arterial revascularization for peripheral arterial disease and to assess whether readmission risk varies among hospitals.
Risa B. Burns; Kelly Graham; Mandeep S. Sawhney; Eileen E. Reynolds
The U.S. Preventive Services Task Force has concluded that for adults aged 50 to 59 years with a 10-year risk for cardiovascular disease (CVD) of 10% or greater, the benefit of aspirin for both CVD and colorectal cancer prevention moderately outweighs the risk for harm. Here, 2 experts discuss whether to recommend aspirin for a 57-year-old man who has a CVD risk greater than 10% but has concerns about gastrointestinal side effects.
Jordana B. Cohen; Raymond R. Townsend
The most notable recommendation in the 2017 American College of Cardiology and American Heart Association hypertension guidelines is the reduced threshold for the diagnosis of hypertension, from ≥140/90 mm Hg to ≥130/80 mm Hg in the general population. This commentary discusses the guidelines and why they create as many questions as they answer.
Frank A. Lederle
When I was called out of a morbidity and mortality conference to receive the fateful imaging results, my life expectancy collapsed from decades to months and I entered a surreal dystopia from which I've never fully emerged.
Jessica Schorr Saxe
No longer able to hide from the dual realities that dementia has struck my family and that it begets suffering, I see now that denial has been a stubborn undercurrent in my life.
Darren B. Taichman
Laurie Kopin; Charles Lowenstein
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.
Lurdes Y.T. Inoue; Daniel W. Lin; Lisa F. Newcomb; Amy S. Leonardson; Donna Ankerst; Roman Gulati; H. Ballentine Carter; Bruce J. Trock; Peter R. Carroll; Matthew R. Cooperberg; Janet E. Cowan; Laurence H. Klotz; Alexandre Mamedov; David F. Penson; Ruth Etzioni
Active surveillance of biopsy-proven low-risk prostate cancer, rather than immediate treatment with surgery or radiation, is increasingly popular. However, there is no consensus about optimal protocols and intervals for such surveillance. The authors estimated the risk for biopsy upgrading in 4 large cohorts of patients enrolled in active surveillance studies and predicted the effects of annual versus biennial biopsies.
Philip E. Castle; Walter K. Kinney; Xiaonan Xue; Li C. Cheung; Julia C. Gage; Fang-Hui Zhao; Barbara Fetterman; Nancy E. Poitras; Thomas S. Lorey; Nicolas Wentzensen; Hormuzd A. Katki; Mark Schiffman
The optimal interval for concurrent high-risk human papillomavirus (HPV) and cytology testing (co-testing) to detect cervical cancer and its precursors is a question of great interest. Data from a large regional integrated health system was analyzed to determine whether a history of negative high-risk HPV and cytology co-testing at 3 or 5 years has an effect on such detection.
Eric T. Roberts; Alan M. Zaslavsky; J. Michael McWilliams
Programs designed to improve quality of care by paying medical practices according to measures of their performance might inadvertently contribute to health care disparities. This study estimated differences in practices' performance associated with exposure to Medicare's Value-Based Payment Modifier and assessed the effect of adjusting for patient characteristics on performance differences between practices serving higher-risk and those serving lower-risk patients.
Roger Chou; P. Todd Korthuis; Dennis McCarty; Phillip O. Coffin; Jessica C. Griffin; Cynthia Davis-O'Reilly; Sara Grusing; Mohamud Daya
This systematic review examines whether the route of administration and dosing of naloxone affects clinical outcomes in adults with suspected opioid overdose.
Dana V. Wallace; Mark S. Dykewicz; John Oppenheimer; Jay M. Portnoy; David M. Lang
This synopsis of guidance from the Joint Task Force on Practice Parameters provides 3 recommendations for the initial pharmacologic treatment of seasonal allergic rhinitis.
Guglielmo Ronco; Silvia Franceschi
In their current Annals report, Castle and colleagues provide essential new information on the effectiveness of repeated rounds of human papillomavirus–based screening to prevent invasive cervical cancer and high-grade cervical intraepithelial neoplasia. The editorialists discuss the implications of the findings for modifying cervical cancer screening strategies.
Elizabeth M. Oliva; Mark Bounthavong
In this issue, Chou and colleagues report the results of a systematic review of management of suspected opioid overdose with naloxone in out-of-hospital settings. The editorialists discuss the gaps in research that were identified by the review and propose areas that would benefit from rigorous study.
Austin B. Frakt; Ashish K. Jha
McWilliams and colleagues found that the Medicare Value-Based Payment Modifier, which measures quality and costs among physician group practices and provides bonuses or levies penalties accordingly, had no beneficial effect on the quality or cost of care. The editorialists discuss why these findings show us that it is time to abandon stand-alone pay-for-performance programs as an approach to improve care.
Emanuel Krebs; Benjamin Enns; Elizabeth Evans; Darren Urada; M. Douglas Anglin; Richard A. Rawson; Yih-Ing Hser; Bohdan Nosyk
Similar to other chronic illnesses, opioid use disorder is characterized by frequent relapse, with an extraordinarily high risk for death in the 2-week period after treatment interruption. Currently, many patients are provided access only to time-limited treatment. The authors did a cost-effectiveness analysis comparing opioid agonist therapy for all individuals presenting with opioid use disorder with the current standard of time-limited medically managed withdrawal.
Linda J.W. Bosch; Meike de Wit; Thang V. Pham; Veerle M.H. Coupé; Annemieke C. Hiemstra; Sander R. Piersma; Gideon Oudgenoeg; George L. Scheffer; Sandra Mongera; Jochim Terhaar Sive Droste; Frank A. Oort; Sietze T. van Turenhout; Ilhame Ben Larbi; Joost Louwagie; Wim van Criekinge; Rene W.M. van der Hulst; Chris J.J. Mulder; Beatriz Carvalho; Remond J.A. Fijneman; Connie R. Jimenez; Gerrit A. Meijer
Fecal immunochemical tests detecting hemoglobin are widely used for noninvasive colorectal cancer (CRC) screening, but their sensitivity leaves room for improvement. This proof-of-concept study identified novel protein biomarkers in stool that outperform or complement hemoglobin-based tests in detecting CRC and advanced adenomas, indicating the potential of these biomarkers to be applied in population screening.
David C. Classen; Frances A. Griffin; Donald M. Berwick
The continuing evidence of preventable deaths due to medical error has led to recent calls to improve measurement of safety in hospitals. In this opinion piece, the authors discuss the ways that electronic health records can be harnessed to measure harm and better guide and monitor the real effect of patient safety efforts.
Jeanette M. Tetrault; David A. Fiellin
Krebs and colleagues report an analysis showing that immediate access to opioid agonist treatment (OAT) for all patients with opioid use disorder seeking treatment in California's publicly funded treatment programs is cost-effective compared with the current state-level standard of time-limited medically supervised withdrawal. The editorialists discuss the findings and conclude that it is vital that we use less health care resources on medically supervised withdrawal “beds” and more on outpatient “chairs” for OAT.
Michelle M. Graham; Daniel I. Sessler; Joel L. Parlow; Bruce M. Biccard; Gordon Guyatt; Kate Leslie; Matthew T.V. Chan; Christian S. Meyhoff; Denis Xavier; Alben Sigamani; Priya A. Kumar; Marko Mrkobrada; Deborah J. Cook; Vikas Tandon; Jesus Alvarez-Garcia; Juan Carlos Villar; Thomas W. Painter; Giovanni Landoni; Edith Fleischmann; Andre Lamy; Richard Whitlock; Yannick Le Manach; Meylin Aphang-Lam; Juan P. Cata; Peggy Gao; Nicolaas C.S. Terblanche; Pamidimukkala V. Ramana; Kim A. Jamieson; Amal Bessissow; Gabriela R. Mendoza; Silvia Ramirez; Pierre A. Diemunsch; Salim Yusuf; P.J. Devereaux
This substudy from a large multicenter trial examines benefits and harms of perioperative aspirin in patients with prior percutaneous coronary intervention undergoing noncardiac surgery.
Alan S. Go; Daniel E. Singer; Sengwee Toh; T. Craig Cheetham; Marsha E. Reichman; David J. Graham; Mary Ross Southworth; Rongmei Zhang; Rima Izem; Margie R. Goulding; Monika Houstoun; Katrina Mott; Sue Hee Sung; Joshua J. Gagne
Clinical trials indicate that, compared with warfarin, dabigatran therapy is associated with lower rates of stroke in patients with atrial fibrillation. This study of data from a large cohort of patients with atrial fibrillation seen in ambulatory practice settings compares clinical outcomes among those who initiated therapy with dabigatran or warfarin.
Katherine R. Courtright; J. Brian Cassel; Scott D. Halpern
Demand for palliative care has quickly outstripped the supply of palliative care specialists. The authors of this commentary propose a research agenda organized around 5 key questions on the optimal organization and allocation of limited resources in specialty palliative care to close the gap between the workforce and patient need.
Monika M. Safford
Mafi and colleagues report the findings of a qualitative study on having patients contribute to writing the note that documents what occurred in a health care encounter. The editorialist discusses the implications for patient-centered care and shared decision making.
Raffaele Piccolo; Stephan Windecker
Graham and colleagues report the results of a post hoc analysis of the POISE-2 trial to compare outcomes when aspirin was continued in the subgroup of patients with a history of previous percutaneous coronary intervention (PCI) who had noncardiac surgery. The editorialists discuss the implications of the findings for perioperative care of patients with prior PCI.
Ryan T. Demmer; Jeremiah A. Barondess
The World Health Organization now classifies chronic diseases, including cancer, heart disease, and type 2 diabetes, as noncommunicable. The authors present an alternative way to characterize such disorders, arguing that such reframing might improve their prevention and control.
Veda N. Giri; Matthew B. Yurgelun; Mark E. Robson
With the advent of increasingly affordable genetic sequencing technology, commercial laboratories have begun to offer an array of multigene panels for hereditary cancer assessment. Further, precision medicine efforts aimed at identifying mutational drug targets through tumor (somatic) sequencing are also uncovering inherited mutations. Germline alterations themselves are increasingly being considered as therapeutic targets. Genetic counseling for inherited cancer risk must rapidly evolve to keep pace, and internists are often on the front lines for identifying patients who could benefit from genetic consultation.
Ellicott C. Matthay; Jessica Galin; Kara E. Rudolph; Kriszta Farkas; Garen J. Wintemute; Jennifer Ahern
Although gun shows are an important source of firearms, it is not known whether they are associated with increases in firearm-related injuries or whether this association differs by state. This study assesses changes in the rates of firearm-related injuries after gun shows in 2 states with among the most and least restrictive firearm regulations.
Ali Rowhani-Rahbar; Frederick P. Rivara
Matthay and colleagues evaluate differences in firearm-related deaths and nonfatal injuries after gun shows in California and Nevada. The editorialists discuss the findings, why they matter, what more needs to be learned, and the challenges that must be overcome to do so.
Garen J. Wintemute
Calls for action in the wake of the Las Vegas mass shooting have been made not just with profound sadness and outrage but with a here-we-go-again sense of futility. This is entirely appropriate if action by Congress and the White House is being called for; those institutions have abdicated their responsibility on this complex and pressing problem as on so many others. But there is a critically important and beneficial action that we physicians can take, right now and on our own initiative.
Christine Laine; Darren B. Taichman
Regardless of whether one believes guns hurt people or that people hurt people with guns, we have a public health crisis and health care professionals have an obligation to do what we can to combat it. This editorial discusses Wintemute's call for health care professionals to make a commitment to ask our patients about firearms when, in our judgment, it is appropriate and to follow through.
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use