Kimon Stamatelopoulos, MD; Matthias Mueller-Hennessen, MD; Georgios Georgiopoulos, MD; Marco Sachse; Jasper Boeddinghaus, MD; Kateryna Sopova, MD; Aikaterini Gatsiou, MSc; Carolin Amrhein; Moritz Biener, MD; Mehrshad Vafaie, MD; Fani Athanasouli, MD; Dimitrios Stakos, MD; Konstantinos Pateras, MSc; Raphael Twerenbold, MD; Patrick Badertscher, MD; Thomas Nestelberger, MD; Stefanie Dimmeler, PhD; Hugo A. Katus, MD; Andreas M. Zeiher, MD; Christian Mueller, MD; Evangelos Giannitsis, MD; Konstantinos Stellos, MD
Risk stratification is important in managing patients with non–ST-segment elevation acute coronary syndrome (NSTE-ACS). Currently recommended approaches to risk stratification do not include markers of inflammation despite its role in ACS pathophysiology. This study evaluated the prognostic value of an inflammatory biomarker to predict outcomes in patients with NSTE-ACS and compared the biomarker's performance with a widely recommended risk-stratification tool.
Lilia Cervantes, MD; Sara Richardson, RN; Rajeev Raghavan, MD; Nova Hou; Romana Hasnain-Wynia, PhD; Matthew K. Wynia, MD; Catherine Kleiner, PhD, RN; Michel Chonchol, MD; Allison Tong, PhD
In the United States, nearly half of undocumented immigrants with end-stage kidney disease receive hemodialysis only when they are evaluated in an emergency department and are found to have life-threatening renal failure (“emergency-only hemodialysis” [EOHD]). Little is known about how providing EOHD affects the clinicians involved. In this qualitative study, the authors used semistructured interviews to understand the experiences and perspectives of interdisciplinary clinicians providing direct care for undocumented patients who rely on EOHD.
Colleen M. Carey, PhD; Anupam B. Jena, MD, PhD; Michael L. Barnett, MD, MS
Providers increasingly are expected to examine their patients' opioid treatment histories before writing new opioid prescriptions. This study uses data from 2008 to 2012 from a 5% sample of Medicare beneficiaries with an opioid prescription and no cancer diagnosis to explore the relationship between a range of patterns of potential opioid misuse and adverse outcomes.
Boris Draznin, MD, PhD; David M. Nathan, MD; Mary T. Korytkowski, MD; Marie E. McDonnell, MD; Sherita Hill Golden, MD, MHS; Mark H. Schutta, MD; William T. Cefalu, MD
This commentary by expert clinicians counters some of the recommendations regarding hemoglobin A1c targets for type 2 diabetes that were proposed in a recent American College of Physicians guideline.
Ashwini R. Sehgal, MD
The study by Cervantes and colleagues in this issue is the first to provide empirical evidence about the effects of emergency-only hemodialysis (EOHD) on professionalism. The editorialist discusses the findings, draws parallels between providing standard dialysis to undocumented immigrants and providing universal health coverage to U.S. citizens, and proposes an approach to address the problem of EOHD.
Lynn E. Fiellin, MD; David A. Fiellin, MD
Carey and colleagues report a study examining the relationship between various opioid prescription patterns and opioid overdose and all-cause mortality. The editorialists discuss the findings and the need to improve prescription drug monitoring programs to better serve the needs of prescribers and, in turn, the patients to whom they provide care.
Hormuzd A. Katki, PhD; Stephanie A. Kovalchik, PhD; Lucia C. Petito, PhD; Li C. Cheung, PhD; Eric Jacobs, PhD; Ahmedin Jemal, PhD; Christine D. Berg, MD; Anil K. Chaturvedi, PhD
Guidelines recommend the use of individualized risk models to refer ever-smokers for lung cancer screening, but the performance of different models in selecting ever-smokers for screening is unknown. In this study, the authors compared the U.S. screening populations selected by 9 lung cancer risk models and examined the predictive performance of the models in 2 large, population-based U.S. cohorts.
Neeraj Sood, PhD; Diane Ung, JD; Anil Shankar, JD; Brian L. Strom, MD, MPH
This commentary proposes a novel strategy for increasing access to treatment for hepatitis C virus infection for Medicaid beneficiaries. It posits a drug purchasing strategy that encourages competition among drug manufacturers that could save money for states and vastly expand treatment.
Martin C. Tammemägi, DVM, MSc, PhD
In this issue, Katki and colleagues compare the performance of 9 lung cancer risk models in a representative sample of the U.S. population and investigate the similarities and differences in the populations of ever-smokers selected for screening by each model. The editorialist discusses issues that will require attention if the models are to be implemented in routine clinical practice.
Patrick Yachimski, MD, MPH
Details of the deaths of patients I cared for during medical training are seared into the joint tableaux of my memory and manner.
KoKo Aung, MD, MPH
John Marshall, MD
Louise Moist, MD
Hertzel Gerstein, MD, MSc, FRCPC
Ali S. Raja, MD, MBA, MPH
Brian Greet, MD; Paul Schurmann, MD; Anita Deswal, MD, MPH
Anupam Goel, MD
Ian Rabinowitz, MD
Monica Guzman-Limon, MD; Donald Molony, MD
Sharon E. Straus, MD, MSc, FRCPC; Lisa Dolovich, BScPhm, PharmD, MSc
Darren B. Taichman, MD, PhD
David H. Wesorick, MD; Vineet Chopra, MD, MSc
Christine D. Jones, MD, MS; Robert E. Burke, MD, MS
Hospitalists often lack clarity about available resources, processes of care, and outcomes for patients discharged to postacure care. This is important, because patients transitioning from the hospital to postacute care have higher readmission rates than patients discharged home, and evidence suggests that suboptimal care transitions play a significant role in these cases. In this article, the authors outline 3 key problems with postacute transitions and offer potential solutions.
Meredith S. Shiels, PhD, MHS; Jessica Y. Islam, MPH; Philip S. Rosenberg, PhD; H. Irene Hall, PhD, MPH; Evin Jacobson, PhD, MS; Eric A. Engels, MD, MPH
Persons living with HIV (PLWH) have a greatly improved life expectancy due to the introduction of potent antiretroviral drug therapies. Projecting future rates and number of incident diagnoses of both AIDS-defining and non–AIDS-defining cancer in PLWH is important in order to inform the design of programs for prevention, screening, and treatment.
David S. Fink, MPH; Julia P. Schleimer, BS; Aaron Sarvet, MPH; Kiran K. Grover, BA; Chris Delcher, PhD; Alvaro Castillo-Carniglia, PhD; June H. Kim, PhD; Ariadne E. Rivera-Aguirre, MPP; Stephen G. Henry, MD; Silvia S. Martins, MD, PhD; Magdalena Cerdá, DrPH
This systematic review examines whether implementation of prescription drug monitoring programs is associated with changes in nonfatal and fatal overdoses; identifies features of programs differentially associated with those outcomes; and investigates potential unintended consequences of the programs.
Marian E. Betz, MD, MPH; Alexander D. McCourt, JD, MPH; Jon S. Vernick, JD, MPH; Megan L. Ranney, MD, MPH; Donovan T. Maust, MD, MS; Garen J. Wintemute, MD, MPH
Many persons in the United States support limiting firearm access for those whose mental illness would place them or others at heightened risk, but less attention has been paid to progressive cognitive impairment and firearm access. For persons with dementia, their family members, and their health care providers, discussions about firearm access strongly parallel discussions about driving. This commentary discusses when persons with dementia need to “give up the keys,” be they to a gun safe or a car, and how to do so.
N. Lance Downing, MD; David W. Bates, MD, MSc; Christopher A. Longhurst, MD, MS
The widespread adoption of electronic health records (EHRs) has been perceived as driving physician dissatisfaction and burnout. The authors of this essay present data comparing EHR use in other countries with that in the United States and offer a possible explanation of, and solutions to, a root cause of dissatisfaction with the EHR.
Wilson M. Compton, MD, MPE; Eric M. Wargo, PhD
All 50 states and the District of Columbia have prescription drug monitoring programs (PDMPs), but their implementation varies and research assessing their effect on opioid misuse, diversion, and overdose is sparse. Thus, the systematic review by Fink and colleagues is a welcome contribution. The editorialists discuss the review, the challenge of assessing PDMP effectiveness, and the reason PDMPs should be viewed as 1 component of a complex strategy to address the opioid crisis.
Karla Kerlikowske, MD; Christopher G. Scott, MS; Amir P. Mahmoudzadeh, MScEng; Lin Ma, MS; Stacey Winham, PhD; Matthew R. Jensen, BS; Fang Fang Wu, BS; Serghei Malkov, PhD; V. Shane Pankratz, PhD; Steven R. Cummings, MD; John A. Shepherd, PhD; Kathleen R. Brandt, MD; Diana L. Miglioretti, PhD; Celine M. Vachon, PhD
The Breast Imaging Reporting and Data System (BI-RADS) density categories, estimated subjectively by radiologists, are the standard for reporting breast density in the United States. Variation in these clinical categories across and within radiologists has led to discussion about whether automated BI-RADS density should be reported instead. This case–control study examines whether breast cancer risk and detection are similar for automated and clinical BI-RADS density measures.
Kelly L. Graham, MD, MPH; Andrew D. Auerbach, MD, MPH; Jeffrey L. Schnipper, MD, MPH; Scott A. Flanders, MD; Christopher S. Kim, MD, MBA; Edmondo J. Robinson, MD, MBA; Gregory W. Ruhnke, MD, MS, MPH; Larissa R. Thomas, MD, MPH; Sunil Kripalani, MD, MSc; Eduard E. Vasilevskis, MD, MPH; Grant S. Fletcher, MD, MPH; Neil J. Sehgal, PhD, MPH; Peter K. Lindenauer, MD, MSc; Mark V. Williams, MD; Joshua P. Metlay, MD, PhD; Roger B. Davis, ScD; Julius Yang, MD, PhD; Edward R. Marcantonio, MD, SM; Shoshana J. Herzig, MD, MPH
The Centers for Medicare & Medicaid Services requires that hospitals pay financial penalties when they have too many readmissions within 30 days of discharge. However, this 30-day window has little scientific basis. As a result, others have proposed windows of 3, 7, or 14 days, but no direct evidence was given for these shorter periods. The aim of this study was to determine whether readmissions within 7 days of hospital discharge are more preventable than readmissions 8 to 30 days after discharge.
Wendy L. Bennett, MD, MPH; Renee F. Wilson, MS; Allen Zhang, BS; Eva Tseng, MD, MPH; Emily A. Knapp, MHS; Hadi Kharrazi, MHI, MD, PhD; Elizabeth A. Stuart, PhD; Oluwaseun Shogbesan, MD; Eric B. Bass, MD, MPH; Lawrence J. Cheskin, MD
This systematic review identifies and describes the methodology of 294 studies that reported effects of programs, policies, or built environment changes on obesity prevention and control.
Karen M. Emmons, PhD; Chyke A. Doubeni, MD, MPH; Maria E. Fernandez, PhD; Diana L. Miglioretti, PhD; Jonathan M. Samet, MD, MS
This report of a National Institutes of Health Pathways to Prevention Workshop addresses methods of evaluating natural experiments to reduce obesity and research needs for advancing the field.
Adrienne D. Mishkin, MD, MPH; Markus Y. Mapara, MD, PhD; Ran Reshef, MD, MSc
Allogeneic hematopoietic stem cell transplantation (HSCT), the only known cure for sickle cell disease, involves pretransplantation regimens (alkylating agents and radiation) that may cause sterility. This commentary proposes equitable access to assisted reproductive technology for patients with sickle cell disease who are undergoing HSCT.
Ian A. Scott, MBBS, MHA, MEd
This commentary discusses intersections between machine learning and evidence-based medicine.
Joann G. Elmore, MD, MPH; Jill Wruble, DO
In their recent study, Kerlikowske and colleagues evaluated whether, given the variability of radiologists' subjective assessment of breast density, machine measurements should be introduced. The editorialists discuss the findings and what we need to know before deciding whether machine measurement of breast density provides health care value.
Øyvind Holme, MD, PhD; Magnus Løberg, MD, PhD; Mette Kalager, MD, PhD; Michael Bretthauer, MD, PhD; Miguel A. Hernán, MD, DrPH; Eline Aas, PhD; Tor J. Eide, MD, PhD; Eva Skovlund, MSc, PhD; Jon Lekven, MD, PhD; Jörn Schneede, MD, PhD; Kjell Magne Tveit, MD, PhD; Morten Vatn, MD, PhD; Giske Ursin, MD, PhD; Geir Hoff, MD, PhD; for the NORCCAP Study Group
Four randomized trials found that sigmoidoscopy screening reduces colorectal cancer incidence and mortality. Some of these also indicated that the effect might be smaller in women than men, but the differences varied by study and type of outcome (incidence or mortality). This population-based, randomized trial in Norway had a longer follow-up and more events, and it reached a clear conclusion.
Aubrey C. Chan, MD, PhD; Christopher A. Burke, MD; Ellen M. Coffey, MD; David R. Hilden, MD, MPH; Diego L. Coira, MD; Jessy Warner-Cohen, PhD, MPH; Margaret Grady, MSN, APN-C; Philip R. Muskin, MD, MA; Gen Shinozaki, MD
Some hospitalized patients with comorbid, chronic medical and psychiatric illnesses may benefit from admission to an integrated unit that can provide care for both conditions. This commentary describes integrated medical–psychiatric inpatient care units implemented in 5 U.S. institutions, the facilitators of and barriers to this model, and the benefits in terms of patient outcomes and provider satisfaction.
Kirsten Bibbins-Domingo, PhD, MD, MAS; John Inadomi, MD
Holme and colleagues offer the latest evidence that adds to and challenges our understanding of the optimal screening approach for colorectal cancer (CRC). The study confirms the effectiveness of screening sigmoidoscopy to reduce CRC incidence and mortality among men but not among women. The editorialist discusses the findings and why more research is needed.
Katrina Armstrong, MD, MSCE
The quest to eliminate uncertainty in clinical decision making has become central to biomedical research over the past 50 years, driving the emergence of evidence-based medicine, precision medicine, and most recently, biomedical artificial intelligence. This commentary discusses how, despite being a source of discomfort, the handling of uncertainty can also have an important positive effect on medical care.
Gianna Zuccotti, MD; Lipika Samal, MD, MPH; Francine L. Maloney, MPH; Angela Ai, BA; Adam Wright, PhD
The authors observe that their hospital performed approximately equal numbers of screening mammographies and Pap smears each year. Follow-up was appropriate for more than 99% of abnormal mammograms but only 91% of abnormal Pap smears. They examine the reasons for these differences and propose improvements for follow-up of abnormal results from other diagnostic tests.
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