Jose F. Figueroa, MD, MPH; Karen E. Joynt Maddox, MD, MPH; Nancy Beaulieu, PhD; Robert C. Wild, MS, MPH; Ashish K. Jha, MD, MPH
Finding areas of care where we can save money and improve quality has proved difficult. One approach has focused on high-need, high-cost patients. However, we know little about how much of the spending for these patients is preventable. Therefore, this study sought to identify preventable spending in clinically distinct subpopulations of high-cost patients, to identify care settings where preventable spending is more likely to occur, and to identify specific types of hospitalizations that drive preventable spending.
Kalyani Sonawane, PhD; Ryan Suk, MS; Elizabeth Y. Chiao, MD, MPH; Jagpreet Chhatwal, PhD; Peihua Qiu, PhD; Timothy Wilkin, MD, MPH; Alan G. Nyitray, PhD; Andrew G. Sikora, MD, PhD; Ashish A. Deshmukh, PhD, MPH
The prevalence of human papillomavirus (HPV)-positive oropharyngeal cancer is disproportionately high among men. Data from the National Health and Nutritional Examination Survey (2011 to 2014) were used to determine the prevalence of oral HPV infection and the concordance of oral and genital HPV infection among U.S. men and women. This information is critically important in designing HPV detection and prevention efforts.
Xin-Lin Zhang, MD; Qing-Qing Zhu, MD; Li-Na Kang, MD; Xue-Ling Li, MD; Biao Xu, MD, PhD
Percutaneous coronary interventions to implant bioresorbable vascular scaffolds (BVSs) were designed to reduce the late thrombotic events that occur with metallic stents. This meta-analysis of 7 trials and 38 observational studies provides important data regarding the incidence of thrombosis after BVS implantation and compares everolimus-eluting BVSs with everolimus-eluting metallic stents in terms of mid- and long-term safety and efficacy.
Kevin Selby, MD; Christine Baumgartner, MD; Theodore R. Levin, MD; Chyke A. Doubeni, MD, MPH; Ann G. Zauber, PhD; Joanne Schottinger, MD; Christopher D. Jensen, PhD; Jeffrey K. Lee, MD; Douglas A. Corley, MD, PhD
Follow-up of asymptomatic adults with positive screening test results is sometimes poor. This systematic review of 23 studies details evidence about the effectiveness of patient-, provider-, and system-level inventions aimed at improving rates of follow-up colonoscopy after a positive result on a fecal test (guaiac or immunochemical).
Anna S. Lok, MD; Raymond T. Chung, MD; Hugo E. Vargas, MD; Arthur Y. Kim, MD; Susanna Naggie, MD, MHS; William G. Powderly, MD
Emerging data show that direct-acting antivirals (DAAs) improve clinical outcomes in hepatitis C virus (HCV). This commentary discusses these benefits in light of a recent systematic review suggesting that evidence is insufficient to confirm or reject an effect of DAA therapy on HCV-related illness.
Garen J. Wintemute, MD, MPH
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.
Bruce Leff, MD; Arnold Milstein, MD
Figueroa and colleagues' finding that potentially preventable health care spending is highly concentrated among frail elderly persons resonates with the experience of clinicians. The editorialists discuss the findings in light of the shift in health care culture toward value-based care under the Patient Protection and Affordable Care Act.
Sanket S. Dhruva, MD; Jeptha P. Curtis, MD
The current Annals systematic review by Zhang and colleagues adds to a growing body of literature highlighting safety concerns regarding bioresorbable vascular scaffolds. The editorialists discuss the findings in light of one company's recent announcement that it is halting sales of the device.
Christine Laine, MD, MPH; Darren B. Taichman, MD, PhD
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.
Patti E. Gravitt, PhD, MS
Sonawane and colleagues used data from the National Health and Nutrition Examination Survey, 2011 to 2014, to analyze differences between men and women in the prevalence of oral human papillomavirus (HPV) infection and the concordance of oral and genital HPV infection. Here, the editorialist discusses the study's findings and why standard epidemiologic analyses are fraught with inferential limitations. Advancing understanding will require dynamic, agent-based, and mechanistic mathematical models to fully capture the complexity of the natural history of HPV infection.
Christine A. Sinsky, MD
Jack Coulehan, MD, MPH
Erica C. Nakajima
Chris Del Mar, MD
Christopher A. Feddock, MD
Fred Arthur Zar, MD
Nikolaos Andreatos, MD; Eleftherios Mylonakis, MD
Matthew B. Stanbrook, MD, PhD
Diego J. Maselli, MD; Jay I. Peters, MD
Dennis Yang, MD; Christopher E. Forsmark, MD
Graeme J. Hankey, MD, FRACP
Harvey J. Murff, MD, MPH
Indranil Dasgupta, MBBS, MD, DM, FRCP; Ajay K. Singh, MBBS, FRCP, MBA
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.g
Darren B. Taichman, MD, PhD
David H. Wesorick, MD; Vineet Chopra, MD, MSc
Gurpreet Dhaliwal, MD
Diagnostic errors are an important quality and safety issue in health care. Systems improvements often take years to unfold, but cognitive improvement can begin today. This issue of Annals for Hospitalists explores how motivated clinicians can improve diagnostic performance now.
Hans Wouters, PhD; Jessica Scheper, MD; Hedi Koning, MSc; Chris Brouwer, MSc; Jos W. Twisk, PhD; Helene van der Meer, MSc; Froukje Boersma, MD, PhD; Sytse U. Zuidema, MD, PhD; Katja Taxis, PhD
Inappropriate prescribing of medications is a common problem that is associated with increased risk for adverse outcomes in older adults. The effectiveness of medication management in improving prescribing in nursing home residents is uncertain. This randomized controlled trial examined the effect of a multidisciplinary medication review performed by physicians and pharmacists on the discontinuation of inappropriate medication use and clinical outcomes among nursing home residents.
Jenifer M. Brown, MD; Cassianne Robinson-Cohen, PhD; Miguel Angel Luque-Fernandez, MSc, MPH, PhD; Matthew A. Allison, MD, MPH; Rene Baudrand, MD; Joachim H. Ix, MD, MS; Bryan Kestenbaum, MD, MS; Ian H. de Boer, MD, MS; Anand Vaidya, MD, MMSc
Primary aldosteronism is the most common and modifiable form of secondary hypertension and is usually considered when the classic phenotype of severe hypertension or hypokalemia is encountered. This study assessed whether a spectrum of subclinical primary aldosteronism that increases risk for hypertension exists among normotensive persons.
Yumi T. DiAngi, MD; Tzielan C. Lee, MD; Christine A. Sinsky, MD; Bryan D. Bohman, MD; Christopher D. Sharp, MD
Myriad financial, quality, and service metrics pervade the professional lives of ambulatory care providers. These include measurements from the electronic health record (EHR), which include practice efficiency scores that create a window on the clinician's workflow. In this article, the authors propose a set of EHR-related metrics that provide further insight into the clinician experience.
Darren B. Taichman, MD, PhD; Howard Bauchner, MD; Jeffrey M. Drazen, MD; Christine Laine, MD, MPH; Larry Peiperl, MD
Editors from Annals of Internal Medicine, JAMA (Journal of the American Medical Association), New England Journal of Medicine, and PLOS Medicine offer a shortlist of what health care professionals can do to fight the threat that firearms present to health in the United States.
Holly M. Holmes, MD, MS; Greg A. Sachs, MD
Wouters and colleagues report the results of a trial of an intervention to reduce potentially inappropriate medication use in a nursing home population. The editorialists discuss the study and highlight the important messages for clinicians who practice in the nursing home setting.
E. Victor Adlin, MD
The editorialist discusses the study of Brown and colleagues, noting that primary aldosteronism may occur frequently before development of hypertension and deserves more diagnostic attention than it now receives.
Òscar Miró, PhD; Xavier Rossello, MD; Víctor Gil, PhD; Francisco Javier Martín-Sánchez, PhD; Pere Llorens, PhD; Pablo Herrero-Puente, PhD; Javier Jacob, PhD; Héctor Bueno, PhD; Stuart J. Pocock, PhD; on behalf of the ICA-SEMES Research Group
The emergency department (ED) plays a central role in the management of acute heart failure, but emergency physicians require additional tools to stratify patients by risk. In this prospective cohort study involving patients from 34 Spanish EDs, the authors sought to develop a model that could predict mortality using data that are readily available at ED admission.
Gregory E. Simon, MD, MPH; Gloria Coronado, PhD; Lynn L. DeBar, PhD, MPH; Laura M. Dember, MD; Beverly B. Green, MD, MPH; Susan S. Huang, MD, MPH; Jeffrey G. Jarvik, MD, MPH; Vincent Mor, PhD; Joakim Ramsberg, PhD; Edward J. Septimus, MD; Karen L. Staman, MS; Miguel A. Vazquez, MD; William M. Vollmer, PhD; Douglas Zatzick, MD; Adrian F. Hernandez, MD, MHS; Richard Platt, MD, MS
Sharing the data generated in clinical trials aims to maximize what may be learned from each study. Although the need to safeguard the confidentiality of patients whose data might be shared is widely recognized, the authors discuss the similar need to consider the risks to health care systems and physicians when the data from pragmatic clinical trials are shared.
Carol J. Hogue, PhD, MPH; Kelli Stidham Hall, PhD, MS; Melissa Kottke, MD, MPH, MBA
Several prominent voices in federal leadership positions have recently disseminated misinformation on contraception. Allegations range from the statement that hormonal contraceptives cause cancer and abortion to the most egregious claim that providers who prescribe any hormonal contraceptives are conducting medical malpractice. This misinformation runs counter to widely accepted, evidence-based research and may cause harm by discouraging beneficial contraceptive use.
Peter S. Rahko, MD
Miró and colleagues report the development of a tool to predict 30-day mortality in patients with acute heart failure presenting to the emergency department. The editorialist discusses the findings and notes the need to test the performance of this and other models in diverse populations. This information could guide development of an infrastructure to successfully identify patients who can be safely treated out of the hospital.
Daniel R. Lucey, MD, MPH; Halsie Donaldson, MS
Yellow fever is associated with substantial illness and mortality, and no specific therapy exists. Although a safe and effective vaccine is available, it is currently in very short supply. The author discusses the global implications of this shortage and outlines scientific and programmatic initiatives needed to ensure a future robust vaccine supply.
Helen W. Boucher, MD; Barbara E. Murray, MD; William G. Powderly, MD
Increasing resistance to antimicrobial agents has led to international pledges to increase funding for public health initiatives as well as for research and development to combat this grave threat. The authors discuss their views of the probable effect of proposals by the Trump administration on these efforts and on the leadership role of the United States in antimicrobial stewardship.
Rochelle P. Walensky, MD, MPH; Ethan D. Borre, BA; Linda-Gail Bekker, MD, PhD; Emily P. Hyle, MD, MSc; Gregg S. Gonsalves, PhD; Robin Wood, MMed, DSc (Med); Serge P. Eholié, MD, MSc; Milton C. Weinstein, PhD; Xavier Anglaret, MD, PhD; Kenneth A. Freedberg, MD, MSc; A. David Paltiel, PhD, MBA
Anticipating significant cuts in global foreign aid, researchers estimate the likely clinical, epidemiologic, and economic impact of reduced investment in HIV prevention and care. The study considers both the long-term savings likely to accrue to donor nations and how recipient nations might tailor their response to minimize adverse health effects.
Neal L. Benowitz, MD
In late July 2017, the U.S. Food and Drug Administration announced a new plan for tobacco regulation that focuses on regulating nicotine itself to reduce the nicotine content of cigarettes to nonaddictive levels. This commentary discusses the rationale behind this move and the promise it holds for reducing premature deaths due to combustible cigarette smoking.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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