Sean M. Murphy, PhD; Kathryn E. McCollister, PhD, MA; Jared A. Leff, MS; Xuan Yang, MPH, MHS; Philip J. Jeng, MS; Joshua D. Lee, MD, MSc; Edward V. Nunes, MD; Patricia Novo, MPA, MPH; John Rotrosen, MD; Bruce R. Schackman, PhD, MBA
The U.S. Food and Drug Administration approved 3 medications for first-line treatment of opioid use disorder: methadone, available only in strictly regulated clinics, and buprenorphine and naltrexone, which may be prescribed in an office setting. Buprenorphine is usually combined with naloxone to prevent misuse. The combination is administered orally once daily, and treatment may begin without detoxification as the first withdrawal symptoms appear. Naltrexone is frequently administered as an injection once a month and, according to current treatment guidelines, should be delayed until detoxification from opioids is complete. Evidence regarding the economic value of these treatments is limited. This study analyzes how the differences in measures of effectiveness and cost between buprenorphine–naloxone and extended-release naltrexone interact to determine whether either medication provides better value.
Nareg H. Roubinian, MD, MPHTM; Edward L. Murphy, MD, MPH; Dustin G. Mark, MD; Darrell J. Triulzi, MD; Jeffrey L. Carson, MD; Catherine Lee, PhD; Patricia Kipnis, PhD; Steven Kleinman, MD; Vincent X. Liu, MD; Gabriel J. Escobar, MD
Randomized clinical trials have shown similar outcomes with less frequent transfusions in hospitalized patients with moderate anemia. Longer-term clinical outcomes associated with a restrictive approach to transfusion have not been well described. This analysis of data from Kaiser Permanente Northern California describes the prevalence of moderate anemia among patients discharged from the hospital as well as 6-month outcomes in these patients.
Arthur Chang, MD, MS; Jerry Thomas, MD; Rudolph Johnson, PhD; Susan E. Gorman, PharmD, MS; Josh Schier, MD, MPH; Luke Yip, MD
Recent international events remind us that nerve agents can be used to attack individuals and pose a public health threat. This article provides an overview of the information health care providers who find themselves at the scene of a potential attack would need to know, resources to gain that knowledge ahead of time for preparedness, and the emergency response programs to be mobilized in case of an actual incident.
Rosemary Gibson, MSc
Public concern about the safety of medicines has been heightened with the recent recall of more than half of all valsartan products on the market in the United States after the Food and Drug Administration identified a probable cancer-causing chemical in the active pharmaceutical ingredient, which was made in China. This commentary discusses the increased reliance of the United States on China as a supplier of generic drugs, active pharmaceutical ingredients, and the chemical building blocks and raw materials to make them.
Joshua A. Barocas, MD; Richard Saitz, MD, MPH
Murphy and colleagues report a cost-effectiveness analysis of sublingual buprenorphine with naloxone versus extended-release naltrexone to treat opioid use disorder. The editorialists believe the analysis is an eloquent demonstration of how cost-effectiveness analysis forces us to be explicit about the factors that influence our decisions.
Aryeh Shander, MD; Lawrence Tim Goodnough, MD
Roubinian and colleagues report that parallel to a decrease in red blood cell transfusions, the prevalence of anemia at hospital discharge and at 6 months increased from 2010 to 2014 without a corresponding increase in 6-month mortality, rehospitalization, or transfusion. The editorialists look forward to future studies that evaluate the management of anemia during the postdischarge period.
Carl E. Bartecchi, MD
They worked under tremendous hardships, often under enemy fire, for lengthy periods, separated from family and friends.
Katharine Lawrence, MD
Bradley E. Borsari, MD
Anupam Goel, MD, MBA, FACP
Bruno P. Granwehr, MD, MS, FACP
Andrew Dunn, MD, MPH, MACP, SFHM; Henry S. Sacks, PhD, MD, FACP
Fred Arthur Zar, MD
James Brophy, MD, PhD
Gaetano Santulli, MD
Christopher R. Carpenter, MD, MSc
Alexander T. Limkakeng, Jr, MD; Christopher B. Granger, MD
Michael P. Hudson, MD
Taylor Oliver, MD; Heather Murray, MD, FRCPC
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
Nauzley Christy Abedini, MD
Aggressive care at the end of life is generally considered low value. Hospitalists, as nonexpert leaders, are perfectly positioned to shine a light on the negative effects of such care. Team-based reflection can help move away from the reflex to provide aggressive care to everyone and toward an approach that helps everyone choose the care they really want.
Robert M. Centor, MD; Maria Maldonado, MD
In this episode of Annals On Call, Dr. Centor discusses the unintended consequences of the U.S. health care delivery and payment system on quality of care, physician wellness, patient satisfaction, and health care costs with Dr. Maria Maldonado. Dr. Maldonado is the author of a recent Annals “On Being a Doctor” essay that poignantly illustrates these issues.
Hazel B. Nichols, PhD; Minouk J. Schoemaker, PhD; Jianwen Cai, PhD; Jiawei Xu, BS; Lauren B. Wright, MSc; Mark N. Brook, PhD; Michael E. Jones, PhD; Hans-Olov Adami, MD, PhD; Laura Baglietto, PhD; Kimberly A. Bertrand, ScD; William J. Blot, PhD; Marie-Christine Boutron-Ruault, MD, PhD; Miren Dorronsoro, MD; Laure Dossus, PhD; A. Heather Eliassen, ScD; Graham G. Giles, PhD; Inger T. Gram, MD, PhD; Susan E. Hankinson, ScD; Judy Hoffman-Bolton, AA; Rudolf Kaaks, PhD; Timothy J. Key, DPhil; Cari M. Kitahara, PhD; Susanna C. Larsson, PhD; Martha Linet, MD; Melissa A. Merritt, PhD; Roger L. Milne, PhD; Valeria Pala, DrSc; Julie R. Palmer, ScD; Petra H. Peeters, MD, PhD; Elio Riboli, MD; Malin Sund, MD, PhD; Rulla M. Tamimi, ScD; Anne Tjønneland, MD, PhD, DMSc; Antonia Trichopoulou, MD, PhD; Giske Ursin, MD; Lars Vatten, MD, PhD; Kala Visvanathan, MD; Elisabete Weiderpass, MD, PhD; Alicja Wolk, DrMedSc; Wei Zheng, MD, PhD; Clarice R. Weinberg, PhD; Anthony J. Swerdlow, DM, DSc; Dale P. Sandler, PhD
Parity is widely recognized as protective for breast cancer, but there is evidence that breast cancer risk may increase shortly after childbirth. Whether this risk varies with such factors as breastfeeding, family history of breast cancer, or specific tumor subtype has rarely been evaluated. To characterize breast cancer risk in relation to recent childbirth, this study pooled individual-level data for women younger than 55 years from 15 prospective cohort studies.
Antoine Meyer, MD; Jérémie Rudant, MD, PhD; Jérôme Drouin; Alain Weill, MD; Franck Carbonnel, MD, PhD; Joël Coste, MD, PhD
CT-P13 is a biosimilar of the reference product, infliximab and is an approved treatment for Ankylosing spondylitis and Rheumatoid arthritis. Regulatory agencies extended the approval of CT-P13 to other inflammatory conditions, including Crohn's disease. This analysis of French nationwide health administrative data compares outcomes among patients with Crohn's disease treated with CT-P13 or infliximab.
Ole Haagen Nielsen, MD, DMSc; Mark Andrew Ainsworth, MD, PhD, DMSc
In this issue, Meyer and colleagues report a large and well-conducted cohort study that demonstrates that the effectiveness of the biosimilar CT-P13 is equivalent to that of infliximab in infliximab-naive patients with Crohn disease. The editorialists discuss the results and the assurance they provide about the effectiveness and safety of biosimilars.
Katrina Armstrong, MD, MSCE
In their article, Nichols and colleagues report the results of a large and sophisticated analysis of the relationship between childbirth and breast cancer risk. The editorial discusses the insight the study provides into this complex relationship. Although the clinical implications of these findings are limited, the temporal relationship between childbirth and breast cancer risk offers an important clue for the ongoing effort to identify the mechanisms linking reproductive history and breast cancer risk.
Henock G. Yebyo, MSc; Hélène E. Aschmann, MSc; Milo A. Puhan, MD, PhD
Most guidelines recommend statins for primary prevention of cardiovascular disease (CVD) if 10-year risk exceeds 7.5% to 10%. However, use of statins for primary prevention of CVD is controversial and varies greatly among countries. The authors performed a quantitative benefit–harm balance modeling study among persons aged 40 to 75 years with no history of CVD to identify the expected risk level above which statins provide net benefit.
Asher J. Schranz, MD; Aaron Fleischauer, PhD; Vivian H. Chu, MD, MHS; Li-Tzy Wu, RN, ScD, MA; David L. Rosen, MD, PhD
The opioid epidemic has led to an increase in hospital admissions for drug use–associated infective endocarditis (DUA-IE). The authors used a statewide database to examine 10-year trends in the characteristics and outcomes of patients hospitalized with DUA-IE, including the proportion undergoing valve surgery.
Alysse G. Wurcel, MD, MS
Schranz and colleagues studied the epidemiology of infective endocarditis (IE) in North Carolina between 2007 and 2017 and found a remarkable increase in drug use–associated IE. The editorialist discusses the findings and the need for innovative research on how to prevent endocarditis and to provide equitable, evidence-based treatment focusing not only on the microbe, but also on the underlying substance use disorder.
Ilana B. Richman, MD; Joseph S. Ross, MD, MHS
In this issue, Yebyo and colleagues challenge the risk thresholds in current guidelines for use of statins for primary prevention of cardiovascular disease. The editorialists discuss how the findings can support patient-centered decision making, particularly for older adults or those who are more concerned about harms of treatment.
Hila Milo Rasouly, PhD; Emily E. Groopman, BA; Reuben Heyman-Kantor, BA; David A. Fasel, BS; Adele Mitrotti, MD; Rik Westland, MD, PhD; Louise Bier, MSc; Chunhua Weng, PhD; Zhong Ren, BS; Brett Copeland, BS; Priya Krithivasan, MSc; Wendy K. Chung, MD, PhD; Simone Sanna-Cherchi, MD; David B. Goldstein, PhD; Ali G. Gharavi, MD
Genome-wide sequencing is increasingly used for clinical diagnostics, with an impetus to expand reporting of secondary findings across a wide range of disorders. Analysis of population cohorts can help clarify the potential for variant misclassification and resultant unnecessary referrals to subspecialists. This study examines the burden of candidate pathogenic variants for kidney and genitourinary disorders emerging from genome-wide sequencing.
Jason L. Vassy, MD, MPH
Rasouly and colleagues' study shows that the filters and other automated components of current bioinformatics pipelines alone are insufficient to make a clinically valid determination of whether a genetic variant is disease-causing. The editorialist discusses the findings and the improvements to automated variant interpretation that are needed before entire genomes can be interpreted at scale with clinical validity.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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