Robert B. Saper, MD, MPH; Chelsey Lemaster, MS, MPH; Anthony Delitto, PhD, PT; Karen J. Sherman, PhD, MPH; Patricia M. Herman, ND, PhD; Ekaterina Sadikova, MPH; Joel Stevans, PhD, DC; Julia E. Keosaian, MPH; Christian J. Cerrada, BS; Alexandra L. Femia, MS; Eric J. Roseen, DC; Paula Gardiner, MD, MPH; Katherine Gergen Barnett, MD; Carol Faulkner, BS; Janice Weinberg, ScD
Several clinical trials indicate that yoga is an effective treatment for chronic low back pain. It is uncertain how the efficacy of yoga compares to that of standard therapies for low back pain. In this trial, yoga was compared to a standardized program of physical therapy and education in a group of low income, racially diverse patients with chronic low back pain symptoms.
Isabelle Boutron, MD, PhD; Douglas G. Altman, DSc; David Moher, PhD; Kenneth F. Schulz, PhD, MBA; Philippe Ravaud, MD, PhD; for the CONSORT NPT Group
In 2008, the CONSORT (Consolidated Standards of Reporting Trials) Group published an extension to the CONSORT trial statement to address methodological issues specific to trials of nonpharmacologic treatments. This article describes updates to this extension and an extension for reporting abstracts of trials of nonpharmacologic treatments.
Douglas G. Chang, MD, PhD; Stefan G. Kertesz, MD, MSc
A randomized trial by Saper and colleagues examines whether yoga is noninferior to physical therapy for treating patients with low back pain. The editorialists discuss the findings and highlight the importance of recognizing both the varying pathophysiology of low back pain and the modesty of treatment benefits when studying the effectiveness of interventions.
David Muller, MD
Mustafa Al-Shamsi, MD
Veneta Masson, RN, MA
Jack Coulehan, MD, MPH
Simon Somerville, MBBS, MSc, FRCGP, GP
Brian Budenholzer, MD
Raj Padwal, MD
Andrew Dunn, MD, MPH, FACP, SFHM
Brent Wagner, MD, FACP, FASN
Owen D. Williamson, MBBS
Frederick A. Spencer, MD; Gordon H. Guyatt, MD
Peter E. Wu, MD, MSc, FRCPC; Andrew M. Morris, MD, SM, FRCPC
Paul Kruger, MBBS; John Eikelboom, MBBS
Alex Gallus, MB, FRACP, FRCPA
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.
Darren B. Taichman, MD, PhD
David H. Wesorick, MD; Vineet Chopra, MD, MSc
Robert Burke, MD, MS; Andrew Auerbach, MD, MPH
This year's Society of Hospital Medicine (SHM) Annual Meeting was the largest ever, with close to 5000 attendees from all over the world. This month's Inpatient Notes summaries 5 of the best research posters from the meeting.
Richard M. Bergenstal, MD; Robin L. Gal, MSPH; Crystal G. Connor, MS, MPH; Rose Gubitosi-Klug, MD, PhD; Davida Kruger, MSN, APRN-BC, BC-ADM; Beth A. Olson, BAN, RN, CDE; Steven M. Willi, MD; Grazia Aleppo, MD; Ruth S. Weinstock, MD, PhD; Jamie Wood, MD; Michael Rickels, MD, MS; Linda A. DiMeglio, MD, MPH; Kathleen E. Bethin, MD, PhD; Santica Marcovina, PhD; Andreana Tassopoulos, BS; Sooji Lee, MS, MSPH; Elaine Massaro, MS; Suzan Bzdick, RN, CCRC; Brian Ichihara, BA; Eileen Markmann, BSN; Paul McGuigan, BSN; Stephanie Woerner; Michelle Ecker, RD, CDN, CDE; Roy W. Beck, MD, PhD; for the T1D Exchange Racial Differences Study Group
Interpreting observed differences between hemoglobin A1c values in black and white patients may have important implications for population health as well as the care of individual patients. This study used continuous glucose monitoring to assess whether higher hemoglobin A1c levels among black patients reflects worse glycemic control or biological differences in the glycation of hemoglobin.
Raffaele Piccolo, MD; Giuseppe Gargiulo, MD; Anna Franzone, MD; Andrea Santucci, MD; Sara Ariotti, MD; Andrea Baldo, MD; Carlo Tumscitz, MD; Aris Moschovitis, MD; Stephan Windecker, MD; Marco Valgimigli, MD, PhD
The dual-antiplatelet therapy (DAPT) score is a new standardized tool to identify patients more likely to derive harm or benefit from prolonged DAPT after percutaneous coronary intervention (PCI). However, the efficacy and safety of basing DAPT duration on the score have been assessed in only 1 study to date. In this retrospective assessment, the authors apply the DAPT score to another study that enrolled a broadly inclusive sample of patients randomly assigned to a prolonged (24 months) versus a short (≤6 months) DAPT regimen after PCI.
Brian J. Hemens, BScPhm, MSc, RPh; Alfonso Iorio, MD, PhD
Shekelle and colleagues describe important refinements to machine-learning software designed to reduce the need for human activity to identify relevant studies for a systematic review update. The editorialists discuss their findings and call on reviewers to evaluate these efficiency-boosting methods and reevaluate their approach to updating reviews.
J. Dawn Abbott, MD
In this issue, Piccolo and colleagues evaluate the dual-antiplatelet therapy (DAPT) score to assist in decision making about the duration of DAPT after implantation of cardiac stents. The editorialist discusses the history of DAPT in percutaneous coronary intervention, the findings of the current study, and strategies that could help to better individualize future decision making about DAPT duration.
Elizabeth Selvin, PhD, MPH; David B. Sacks, MBChB
Bergenstal and colleagues report a study that contributes to our understanding of racial differences in hemoglobin A1c (HbA1c). The editorialists discuss the findings, explain why they do not suggest limited utility of HbA1c in blacks, and call for studies that enable better understanding of populations that may be prone to discordant HbA1c and glucose measures.
Abraham J. Kandathil, PhD; Florian P. Breitwieser, PhD; Jaiprasath Sachithanandham, PhD; Matthew Robinson, MD; Shruti H. Mehta, PhD; Winston Timp, PhD; Steven L. Salzberg, PhD; David L. Thomas, MD, MPH; Ashwin Balagopal, MD
Next-generation metagenomic sequencing (NGMS), in which all of the DNA or RNA in a tissue is sequenced and interpreted with novel bioinformatics tools, has opened a new frontier of microbial discovery. In this study, the authors used NGMS to explore the plasma virome of injection drug users and characterized its sensitivity and accuracy compared with quantitative clinical standards. The findings included presence of a novel RNA virus (human hepegivirus-1) in several participants.
Ajay Malhotra, MD, MMM; Xiao Wu, BS; Howard P. Forman, MD, MBA; Holly K. Grossetta Nardini, MLS; Charles C. Matouk, MD; Dheeraj Gandhi, MD; Christopher Moore, MD; Pina Sanelli, MD, MPH
Small intracranial aneurysms are sometimes detected incidentally on brain imaging. This systematic review of 26 observational studies assesses and summarizes evidence about the growth and rupture risk of small and very small intracranial aneurysms.
Darren B. Taichman, MD, PhD; Peush Sahni, MBBS, MS, PhD; Anja Pinborg, MD; Larry Peiperl, MD; Christine Laine, MD, MPH; Astrid James, MBBS; Sung-Tae Hong, MD, PhD; Abraham Haileamlak, MD; Laragh Gollogly, MD, MPH; Fiona Godlee, FRCP; Frank A. Frizelle, MBChB, FRACS; Fernando Florenzano, MD; Jeffrey M. Drazen, MD; Howard Bauchner, MD; Christopher Baethge, MD; Joyce Backus, MSLS
Participants in clinical trials often place themselves at risk in order to help the medical community learn how to improve care. To help make the most of participants' efforts, the editors of 13 major medical journals have adopted new criteria regarding plans to share the data generated in clinical trials.
Robert M. Starke, MD, MSc
In this issue, Malhotra and colleagues review the literature to determine the risk for growth and rupture of small unruptured intracranial aneurysms. The editorialist discusses the importance of the clinical question the review attempts to answer, but he believes that the poor quality of the available evidence makes the answer elusive. He advocates that all patients with aneurysms be evaluated by an expert who can assess risk factors and determine the optimal management plan.
Nick Bansback, PhD; Ciaran S. Phibbs, PhD; Huiying Sun, PhD; James R. O'Dell, MD; Mary Brophy, MD, MPH; Edward C. Keystone, MD; Sarah Leatherman, PhD; Ted R. Mikuls, MD, MSPH; Aslam H. Anis, PhD; for the CSP 551 RACAT Investigators
Studies have shown that triple therapy—a combination of 3 disease-modifying antirheumatic drugs—is as safe and effective as adding a biologic to methotrexate in treating active rheumatoid arthritis. This study used data from a recently published randomized controlled trial to examine the cost-effectiveness of using triple therapy versus adding etanercept to methotrexate as a first-line strategy in patients with rheumatoid arthritis not controlled by methotrexate monotherapy.
Julia Wynn, MS; Wendy K. Chung, MD, PhD
In April 2017, the U.S. Food and Drug Administration authorized 23andMe's direct-to-consumer (DTC) genetic test. This commentary discusses its limited clinical utility and raises concerns that its approval creates a pathway that could lead to expansive DTC genetic testing of similarly low clinical utility that the public will misunderstand and misuse.
A. Thomas McLellan, PhD
The Department of Veterans Affairs and the Department of Defense recently revised guidelines on prescribing opioids for the management of chronic noncancer pain. This is a timely update because the growth of opioid prescribing has been associated with parallel growth in diversion, overdose deaths, and addiction. However, clinicians will need more guidance on how to present and discuss all short- and long-term options with patients with chronic noncancer pain and on how to monitor, manage, and transition patients from the short-term to the long-term phase of pain management.
Samyukta Mullangi, MD, MBA; Andrew M. Ibrahim, MD, MSc; Vineet Chopra, MD, MSc
As much as health care providers advocate for “patient-centered care,” hospitals are still behind when it comes to implementing patient-friendly process redesign to improve the access or layout of hospital services. Could hospitals learn from airports in meeting the needs of patients?
Elena Losina, PhD; Jeffrey N. Katz, MD, MSc
In this issue, Bansback and colleagues report a cost-effectiveness analysis using data from the RACAT (Rheumatoid Arthritis Comparison of Active Therapies) trial, which established the noninferiority of triple therapy with conventional disease-modifying antirheumatic drugs (sulfasalazine, hydroxychloroquine, and methotrexate) compared with etanercept and methotrexate. The editorialists discuss the findings suggesting that the difference in effectiveness between the strategies may be too small to justify the large cost difference, noting that if biosimilars can deliver similar clinical benefit at lower cost, they may offer new treatment opportunities that would not strain limited health care resources.
Aïda Bafeta, PhD; Amelie Yavchitz, MD, PhD; Carolina Riveros, MSc; Rui Batista, PharmD; Philippe Ravaud, MD, PhD
Fecal microbiota transplantation is a novel treatment option for some chronic diseases with altered gut microbiota. This analysis of 85 published reports examines studies in humans that assessed the efficacy or safety of fecal microbiota transplantation.
Jean P. Hall, PhD
High-risk pools are included as a state option in the American Health Care Act recently passed by the U.S. House of Representatives. These plans segregate persons with preexisting conditions from the broader insurance pool to a much smaller pool with others who have potentially high costs. This commentary discusses what we know about the past performance of high-risk pools and why reinstituting them would constitute a huge step backward for American health care policy.
Vincent B. Young, MD, PhD
Research on the human microbiome has opened new avenues to understanding the pathogenesis of a variety of conditions and to pursuing novel therapeutics that change the microbiome to restore health. Bafeta and colleagues report a systematic review that examined the methods described in 85 studies of fecal microbiota transplantation (FMT). The editorialist discusses the findings and proposes strategies for establishing standards for FMT research that will help ensure that we realize the potential effect that an understanding of the microbiome will have on health.
Emily P. Hyle, MD, MSc; Sowmya R. Rao, PhD; Emily S. Jentes, PhD, MPH; Amy Parker Fiebelkorn, MSN, MPH; Stefan H.F. Hagmann, MD, MSc; Allison Taylor Walker, PhD, MPH; Rochelle P. Walensky, MD, MPH; Edward T. Ryan, MD; Regina C. LaRocque, MD, MPH
Measles outbreaks in the United States are mostly due to index infections occurring in returning U.S. travelers. In a study of more than 40 000 travelers presenting to U.S. pretravel clinics, the authors assessed why those eligible for measles vaccination were not offered it or, if it was offered, why they refused it.
J. Michael McWilliams, MD, PhD
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) aims to improve health care by rewarding clinicians providing higher-quality and lower-cost care who would receive increases in their Medicare reimbursement rates. Poorer performers would receive reductions in their rates. The author discusses how the design of MACRA will, however, result in unintended consequences and incentives that will increase health care disparities without reducing costs.
Lori K. Handy, MD, MSCE; Paul A. Offit, MD
In this issue, Hyle and colleagues report that only 47% of adults eligible for measles vaccine at a pretravel clinic visit were vaccinated. The editorialists note that efforts to increase measles immunization rates are focused mainly on young children and that the need to immunize unvaccinated travelers at risk for transmitting measles within the United States after international travel often is overlooked. They argue that vigilance is needed to ensure that travelers do not bring the virus back from overseas.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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