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David M. Levine, MD, MPH, MA; Kei Ouchi, MD, MPH; Bonnie Blanchfield, ScD; Agustina Saenz, MD, MPH; Kimberly Burke, BA; Mary Paz, BA; Keren Diamond, RN, MBA; Charles T. Pu, MD; Jeffrey L. Schnipper, MD, MPH

Studies suggest that hospital-level care provided in the patient's home may have beneficial effects on outcomes, but few trials of home hospital care have been done in the United States. This randomized controlled trial compared the effects of home hospital versus usual hospital care on direct costs and other outcomes among patients who required hospital admission.

Fei Wang, PhD; Rainu Kaushal, MD, MPH; Dhruv Khullar, MD, MPP

Health care applications of artificial intelligence (AI) have recently emerged. Artificial intelligence approaches, such as deep learning, rely on vast amounts of data and complex model structures with millions of parameters, making them difficult to understand. Thus, these models are often called “black boxes.” Should physicians and other stakeholders demand greater insight into how AI algorithms work?

Albert W. Wu, MD, MPH; Victor J. Dzau, MD

Lessons learned from patient safety initiatives may be applied to reducing clinician burnout and alleviating the current crisis. Research on burnout has focused primarily on hospitals and trainees. Relatively little is known about the status of clinicians in ambulatory practice and the factors contributing to burnout in that setting. Research is needed on the most effective tools to identify burnout, as well as incentives to motivate change. Here, the authors identify 4 key lessons learned from successes in research, implementation, and policy.

John B. Wong, MD; Joshua T. Cohen, PhD

In their article, Levine and colleagues report a clinical trial that compared in-hospital care with potentially less expensive hospital care at home, finding that at-home care resulted in less health care use and more benefits, including less sedentary time, fewer readmissions within 30 days, and 38% lower mean direct costs. The editorialists discuss the findings and speculate about barriers to wider adoption of home hospital care.

Serena Auñón-Chancellor, MD, MPH

NASA pulls from several professions for the astronaut corps. On my crew, we had geophysicists; a military test pilot; a teacher; and me, an internist.

Sharon Ostfeld-Johns, MD

Taking responsibility for this patient, the right amount, was the right thing.

D.A. Frater, MD

D.A. Frater, MD

Geno J. Merli, MD; Howard H. Weitz, MD

Annals Consult Guys brings a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations. They address medically relevant topics—whether they be poignant, thought-provoking, or just plain entertaining.

Darren B. Taichman, MD, PhD

David H. Wesorick, MD; Vineet Chopra, MD, MSc

Isaac Ghinai, MBBS, MSc; Jennifer E. Layden, MD, PhD

This commentary provides clinical pearls for hospital medicine physicians caring for patients who present with symptoms that might indicate vaping-related lung injury.

Robert M. Centor, MD; Lisa H.Y. Kim, MD

In this episode of Annals On Call, Dr. Centor discusses the use of supplemental oxygen in hospitalized patients with Dr. Lisa Kim.

Michael Natter, MD

Progress Notes explores the everyday emotional, clinical, humorous, and ethical challenges of the medical residency training process. It appears monthly in Annals Graphic Medicine at Annals.org.

Stefan Tigges, 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.

Jean-François Laprise, PhD; Harrell W. Chesson, PhD; Lauri E. Markowitz, MD; Mélanie Drolet, PhD; Dave Martin, PhD; Élodie Bénard, MSc; Marc Brisson, PhD

In the United States, the vaccine against human papillomavirus is usually administered to girls and boys beginning just before the start of adolescence. Studies have shown that the vaccine prevents cancer and saves money when it is given this way. The U.S. Food and Drug Administration recently approved the vaccine for use in women and men up to age 45, and this article estimates the cost-effectiveness of the vaccine in these adults.

John A. Dodson, MD, MPH; Alexandra M. Hajduk, PhD, MPH; Mary Geda, RN, MSN; Harlan M. Krumholz, MD; Terrence E. Murphy, PhD; Sui Tsang, MS; Mary E. Tinetti, MD; Michael G. Nanna, MD; Richard McNamara, MD; Thomas M. Gill, MD; Sarwat I. Chaudhry, MD

Older adults have increased risk for death after acute myocardial infarction (AMI). This article describes the development and initial validation of a risk prediction model that incorporates information on functional impairments and its utility in predicting 6-month mortality among older adults who were hospitalized with AMI and discharged alive.

Dhruv S. Kazi, MD, MSc, MS; Kirsten Bibbins-Domingo, PhD, MD, MAS

In this issue, Dodson and colleagues report the development of a prediction model for all-cause mortality 6 months after myocardial infarction among older adults that incorporates measures of functional impairment. The editorialists discuss the models; the increasing use of prediction models to identify patients at the highest risk; and the need to develop, test, and deploy interventions to help address their needs.

Holger J. Schünemann, MD, PhD, MSc; Donata Lerda, PhD; Cecily Quinn, MD; Markus Follmann, MD, MPH, MSc; Pablo Alonso-Coello, MD, PhD; Paolo Giorgi Rossi, PhD; Annette Lebeau, MD; Lennarth Nyström, PhD; Mireille Broeders, PhD; Lydia Ioannidou-Mouzaka, MD; Stephen W. Duffy, BSc, MSc, CStat; Bettina Borisch, MD; Patricia Fitzpatrick, MD; Solveig Hofvind, PhD; Xavier Castells, MD, PhD; Livia Giordano, MD; Carlos Canelo-Aybar, MD, MSc; Sue Warman, MEd; Robert Mansel, MD; Francesco Sardanelli, MD; Elena Parmelli, PhD; Axel Gräwingholt, MD; Zuleika Saz-Parkinson, PhD; for the European Commission Initiative on Breast Cancer (ECIBC) Contributor Group

This synopsis of the European Breast Guidelines discusses 15 key recommendations related to organized programs for breast cancer screening in women aged 40 to 75 years at average risk. Recommendations address the method and frequency of screening; the addition of hand-held ultrasonography, automated breast ultrasonography, or magnetic resonance imaging compared with mammography screening alone; and tests for women who are recalled for suspicious lesions or who have high breast density.

Joann G. Elmore, MD, MPH; Christoph I. Lee, MD, MS

Annals has published a summary of the European Breast Guidelines, developed by an international multidisciplinary panel and based on a high-quality evidence review of breast cancer screening in the context of European organized screening programs. The editorialists discuss the recommendations and their implications for women and clinicians in the United States.

Scott R. Evans, PhD; Robert Bigelow, PhD; Christy Chuang-Stein, PhD; Susan S. Ellenberg, PhD; Paul Gallo, PhD; Weili He, PhD; Qi Jiang, PhD; Frank Rockhold, PhD

Data monitoring committees (DMCs) protect clinical trial participants by conducting benefit–risk assessments during the course of a clinical trial. To be effective, DMCs should have access to all data, including efficacy data, at each interim review and should produce reports with graphical summaries that clearly integrate the benefits and harms of interventions.

Vineet Chopra, MD, MSc; Lynn Janssen, MS, CIC, CPHQ; Kristina Bryant, MD; Loretta Fauerbach, MS, CIC; Thomas R. Talbot III, MD, MPH; Hillary M. Babcock, MD, MPH

With an influx of new infection control products, the Centers for Disease Control and Prevention asked the Healthcare Infection Control Practices Advisory Committee to develop a process to inform committees considering product-related recommendations. This article describes the development of that process and a tool that may be used when guidelines or recommendations for such products are being developed.

Meredith Vanstone, PhD; Thanh H. Neville, MD, MSHS; France J. Clarke, RRT; Marilyn Swinton, MSc; Marina Sadik, MA; Alyson Takaoka, MSc; Orla Smith, RN, PhD; Andrew J. Baker, MD; Allana LeBlanc, RN, MScN; Denise Foster, RN; Vinay Dhingra, MD; Peter Phung, MD, MBA; Xueqing (Sherry) Xu, RN, MSN, CCRN; Yuhan Kao, RN, MSN; Diane Heels-Ansdell, MSc; Benjamin Tam, MD, MSc; Feli Toledo, MDiv; Anne Boyle, MD; Deborah J. Cook, MD, MSc

The 3 Wishes Project was pioneered in an academic medical center's intensive care unit to promote compassionate end-of-life care by eliciting and fulfilling the wishes of dying patients or their families. This study evaluates the implementation and value of this project in various intensive care units and medical centers.

David M. Kent, MD, MS; David van Klaveren, PhD; Jessica K. Paulus, ScD; Ralph D'Agostino, PhD; Steve Goodman, MD, MHS, PhD; Rodney Hayward, MD; John P.A. Ioannidis, MD, DSc; Bray Patrick-Lake, MFS; Sally Morton, PhD; Michael Pencina, PhD; Gowri Raman, MBBS, MS; Joseph S. Ross, MD, MHS; Harry P. Selker, MD, MSPH; Ravi Varadhan, PhD; Andrew Vickers, PhD; John B. Wong, MD; Ewout W. Steyerberg, PhD

The PATH (Predictive Approaches to Treatment effect Heterogeneity) Statement presents modeling approaches that facilitate prediction of individualized treatment effects. This explanation and elaboration document details PATH recommendations, underpinning concepts, and implications.

David M. Kent, MD, MS; Jessica K. Paulus, ScD; David van Klaveren, PhD; Ralph D'Agostino, PhD; Steve Goodman, MD, MHS, PhD; Rodney Hayward, MD; John P.A. Ioannidis, MD, DSc; Bray Patrick-Lake, MFS; Sally Morton, PhD; Michael Pencina, PhD; Gowri Raman, MBBS, MS; Joseph S. Ross, MD, MHS; Harry P. Selker, MD, MSPH; Ravi Varadhan, PhD; Andrew Vickers, PhD; John B. Wong, MD; Ewout W. Steyerberg, PhD

Subgroup analyses contrasting effects in groups of patients defined “1 variable at a time” are typically used to examine heterogeneity of treatment effects in randomized trials. This guidance—the PATH (Predictive Approaches to Treatment effect Heterogeneity) Statement—presents alternative modeling approaches that account for multiple variables simultaneously to better identify individualized treatment effects.

A. Russell Localio, PhD; Cynthia D. Mulrow, MD, MSc; Michael E. Griswold, PhD

Kent and colleagues describe 2 alternatives to subgroup analyses to help personalize clinical trial results: “risk modeling” and “effect modeling.” The editorialists commend the authors for moving beyond subgroup analyses and look forward to methodological enhancements that address the substantial complexities of identifying and evaluating treatment effect heterogeneity.

Michelle M. Mello, JD, PhD

In this issue, Delamater and colleagues project the percentage of California schoolchildren with a vaccination exemption under 3 scenarios: California law as it has stood since the 2015 passage of Senate Bill 277, which permits medical but not personal belief exemptions; the law as amended by Senate Bill 276, an attempt to tighten the circumstances for medical exemptions; and a hypothetical world in which neither law was implemented. The editorialist discusses the findings and proposes 5 provisions that laws narrowing vaccination exemptions should include.

Randol W. Hooper II, MBBS, MS; Jamie L. Garfield, MD

In the context of the emergence of vaping-associated pulmonary injury (VAPI), this commentary discusses what we know about the health effects of vaping and, more important, what we need to learn. Research on the respiratory toxicity of vaporized e-cigarette compounds and cannabis extracts, population studies on consumption patterns, and increased physician attention are urgently needed to mitigate the effects of VAPI.

John R. Stone, MD, PhD

Steinberg and colleagues report high but slowly declining U.S. mortality trends in patients with antineutrophil cytoplasmic autoantibody–associated vasculitides. The editorialist discusses the findings and why he believes that the apparently better outcomes observed in typically disadvantaged patient groups may hold clues to structural causes of health disparities.