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FOR THE PRESS

Annals of Internal Medicine Tip Sheet
September 20, 2016


Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.


1. Swine flu vaccine not likely to increase risk for overall birth defects

Researchers could not completely rule out an increased risk for specific defects

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M16-0139

The H1N1 influenza vaccine, Pandemrix, administered in pregnant women does not seem to be associated with an increased risk for overall birth defects when genetic and environmental factors are considered. However, risk increases for specific birth defects could not be ruled out completely. The findings are published in Annals of Internal Medicine.

Pregnant women are a high-risk group for severe H1N1 influenza and the World Health Organization recommends vaccination for them. Research has shown conflicting risk estimates for birth defects in pregnant women receiving Pandemrix in the first trimester. Although several studies have attempted to adjust for confounding factors, none has studied siblings discordant for vaccination exposure, which, by design, would control for familial confounding (genetic and shared early environmental factors).

Researchers examined the risk for any birth defects, and specifically congenital heart disease, oral cleft, and limb deficiency, in a large population-based cohort that included more than 40,000 children of mothers exposed to Pandemrix. To minimize the influence of intrafamilial confounding, siblings were also used as comparators. The researchers found that vaccination during pregnancy did not seem to be associated with an increased risk for overall birth defects when controls from the general population were used. They also did not see an association with overall birth defects when intrafamilial confounding was taken into account. However, risk increases for specific birth defects could not be ruled out completely.

2. Hospitals are employing more physicians, but this does not necessarily improve care

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M16-0125

The proportion of hospitals employing physicians has increased over the past decade, but there is no evidence that this model improves quality of care. The findings are published in Annals of Internal Medicine.

Historically, U.S. hospitals were seen as “workshops” for physicians, and efforts to employ doctors were discouraged or prohibited. In more recent years, this thinking has changed and hospitals have begun to integrate a physician workforce that could be incentivized to focus on quality metrics, share common information systems, and comply with clinical guidelines. It is not known if switching to this integration model improves quality of care.

Researchers studied the mortality rates, 30-day readmission rates, length of stay, and patient satisfaction scores for common medical conditions for 803 switching hospitals compared with 2,085 non-switching control hospitals. They also looked at characteristics of hospitals that switched. They found that more hospitals are hiring physicians (29 percent in 2003 vs 42 percent in 2012), but there was no association between switching to the employment model and improved outcomes in any of the quality metrics examined. Switching hospitals were more likely to be large or major teaching hospitals and less likely to be for-profit institutions.

Also new in this issue:

GRADE Methods for Guideline Development: Time to Evolve?

Susan L. Norris, MD, MPH, MSc, and Lisa Bero, PhD
Ideas and Opinions
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M16-1254

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