Showing papers in "Annals of Internal Medicine in 2014"
TL;DR: Although lung cancer screening is not an alternative to smoking cessation, the USPSTF found adequate evidence that annual screening for lung cancer with LDCT in a defined population of high-risk persons can prevent a substantial number of lung cancerrelated deaths.
Abstract: The USPSTF now recommends annual screening for lung cancer with low-dose computed tomography in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit w...
2,164 citations
TL;DR: Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.
Abstract: Primary Funding Source: British Heart Foundation, Medical Research Council, Cambridge National Institute for Health Research Biomedical Research Centre, and Gates Cambridge.
993 citations
794 citations
TL;DR: In this article, a retrospective cohort of patients with thirty-day rehospitalization is presented, and the authors suggest that programs to better support vulnerable patients may help prevent some rehospitalizations.
Abstract: Thirty-day rehospitalizations are costly for both patients and hospitals, and programs to better support vulnerable patients may help prevent some rehospitalizations. In this retrospective cohort s...
712 citations
TL;DR: The estimated prevalence of chronic HCV infection in the United States has decreased and risk factors for infection are essentially unchanged from previous periods and were reported by only about one half of infected persons.
Abstract: Knowledge of the number of persons with chronic hepatitis C virus (HCV) infection in the United States is critical for public health and policy planning. Using data from a nationally representative...
668 citations
TL;DR: Whether gender differences exist in time allocation within a population in which differences may not be expected and, if present, would lend insights about the causes of gender differences in domestic labor more generally and relevant information for policy development specifically within the medical profession is investigated.
Abstract: This survey asked young physician researchers about time spent on professional and domestic activities. Among married couples with children, the authors found that women spent more time on domestic...
547 citations
TL;DR: In this paper, a quantitative meta-analysis of the diagnostic accuracy (sensitivity and specificity) of FITs for CRC was performed, where the authors explored potential sources of heterogeneity by analyzing subgroups classified by FIT sample number, cutoff value for a positive test result, FIT brand, and the reference standard.
Abstract: Colorectal cancer (CRC) is the second-leading cause of cancer-related deaths in the United States (1). Randomized, controlled trials have shown that annual or biennial fecal occult blood tests (FOBTs) are associated with a 15% to 33% decrease in CRC mortality rates (2–4). However, FOBTs only detect approximately 13% to 50% of cancer with 1 round of screening in asymptomatic patients (5, 6). In addition, adherence to repeated rounds of FOBTs in real-world screening programs is low, raising concern about their effectiveness as screening tests (7, 8).
Fecal immunochemical tests (FITs) are more sensitive at detecting both CRC and adenomas than FOBTs (9, 10). Many FITs require only 1 or 2 stool samples, and none require dietary or medication restrictions, increasing ease of use. In 2008, several U.S. professional societies endorsed the use of FITs to replace FOBTs because of the former's improved performance characteristics and potential for higher participation rates (10, 11). Countries in Europe and Asia have also adopted widespread CRC screening programs using FITs (12, 13). However, the diagnostic characteristics of these tests have been difficult to estimate, with reported sensitivities ranging from 25% to 100% for CRC and specificities usually exceeding 90% (9, 14, 15). The lack of a precise estimate of sensitivity has resulted in confusion among health care providers about the sources of this variation, how best to apply FITs for CRC screening, the optimal number of stool samples for testing, optimal cutoff value for a positive test result, and whether any brand of FIT is superior to others. Our analysis provides a quantitative meta-analysis of the diagnostic accuracy (sensitivity and specificity) of FITs for CRC. In addition, we explored potential sources of heterogeneity by analyzing subgroups classified by FIT sample number, cutoff value for a positive test result, FIT brand, and the reference standard.
543 citations
TL;DR: A systematic review of transitional care interventions for persons with HF for the Effective Health Care Program of the Agency for Healthcare Research and Quality (AHRQ) and a broad range of intervention types applicable to adults transitioning from hospital to home that aimed to prevent readmissions are conducted.
Abstract: Background Nearly 25% of patients hospitalized with heart failure (HF) are readmitted within 30 days. Purpose To assess the efficacy, comparative effectiveness, and harms of transitional care interventions to reduce readmission and mortality rates for adults hospitalized with HF. Data sources MEDLINE, Cochrane Library, CINAHL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (1 January 1990 to late October 2013). Study selection Two reviewers independently selected randomized, controlled trials published in English reporting a readmission or mortality rate within 6 months of an index hospitalization. Data extraction One reviewer extracted data, and another checked accuracy. Two reviewers assessed risk of bias and graded strength of evidence (SOE). Data synthesis Forty-seven trials were included. Most enrolled adults with moderate to severe HF and a mean age of 70 years. Few trials reported 30-day readmission rates. At 30 days, a high-intensity home-visiting program reduced all-cause readmission and the composite end point (all-cause readmission or death; low SOE). Over 3 to 6 months, home-visiting programs and multidisciplinary heart failure (MDS-HF) clinic interventions reduced all-cause readmission (high SOE). Home-visiting programs reduced HF-specific readmission and the composite end point (moderate SOE). Structured telephone support (STS) interventions reduced HF-specific readmission (high SOE) but not all-cause readmissions (moderate SOE). Home-visiting programs, MDS-HF clinics, and STS interventions produced a mortality benefit. Neither telemonitoring nor primarily educational interventions reduced readmission or mortality rates. Limitations Few trials reported 30-day readmission rates. Usual care was heterogeneous and sometimes not adequately described. Conclusion Home-visiting programs and MDS-HF clinics reduced all-cause readmission and mortality; STS reduced HF-specific readmission and mortality. These interventions should receive the greatest consideration by systems or providers seeking to implement transitional care interventions for persons with HF. Primary funding source Agency for Healthcare Research and Quality.
510 citations
TL;DR: The final results on diabetes incidence in the whole multicenter trial after a median follow-up of 4.1 years are provided.
Abstract: Background Interventions promoting weight loss can reduce the incidence of type 2 diabetes mellitus. Whether dietary changes without calorie restriction also protect from diabetes has not been evaluated. Objective To assess the efficacy of Mediterranean diets for the primary prevention of diabetes in the Prevencion con Dieta Mediterranea trial, from October 2003 to December 2010 (median follow-up, 4.1 years). Design Subgroup analysis of a multicenter, randomized trial. (Current Controlled Trials: ISRCTN35739639) SETTING: Primary care centers in Spain. Participants Men and women without diabetes (3541 patients aged 55 to 80 years) at high cardiovascular risk. Intervention Participants were randomly assigned and stratified by site, sex, and age but not diabetes status to receive 1 of 3 diets: Mediterranean diet supplemented with extra-virgin olive oil (EVOO), Mediterranean diet supplemented with nuts, or a control diet (advice on a low-fat diet). No intervention to increase physical activity or lose weight was included. Measurements Incidence of new-onset type 2 diabetes mellitus (prespecified secondary outcome). Results During follow-up, 80, 92, and 101 new-onset cases of diabetes occurred in the Mediterranean diet supplemented with EVOO, Mediterranean diet supplemented with mixed nuts, and control diet groups, respectively, corresponding to rates of 16.0, 18.7, and 23.6 cases per 1000 person-years. Multivariate-adjusted hazard ratios were 0.60 (95% CI, 0.43 to 0.85) for the Mediterranean diet supplemented with EVOO and 0.82 (CI, 0.61 to 1.10) for the Mediterranean diet supplemented with nuts compared with the control diet. Limitations Randomization was not stratified by diabetes status. Withdrawals were greater in the control group. Conclusion A Mediterranean diet enriched with EVOO but without energy restrictions reduced diabetes risk among persons with high cardiovascular risk. Primary funding source Instituto de Salud Carlos III.
510 citations
TL;DR: In a study of patients hospitalized with suspected Middle East respiratory syndrome coronavirus infection, those with confirmed disease had preexisting comorbid conditions and required mechanical treatment for these conditions.
Abstract: In a study of patients hospitalized with suspected Middle East respiratory syndrome coronavirus infection, those with confirmed disease had preexisting comorbid conditions and required mechanical v...
484 citations
TL;DR: The objective was to update national trends in total diabetes (undiagnosed and diagnosed), prediabetes, and glycemic control in persons with diagnosed diabetes over the past 2 decades using data from the 19881994 (NHANES III) and 19992010 (continuous NHANES) survey periods based on calibrated HbA1c and fasting glucose levels.
Abstract: The prevalence of diabetes in the United States has increased over the past 2 decades. The authors examined these trends using NHANES data and explored the roles of hemoglobin A1c and fasting plasm...
Journal Article•
TL;DR: In this paper, a systematic review of 47 trials examined the efficacy of transitional care interventions to reduce re-hospitalization of patients with heart failure within 30 days in a hospital setting.
Abstract: Almost 25% of patients hospitalized with heart failure (HF) are readmitted within 30 days. This systematic review of 47 trials examined the efficacy of transitional care interventions to reduce rea...
TL;DR: A systematic assessment of the reporting practices in analyses involving the NRI is provided and some controversies relating to its use and interpretation are addressed.
Abstract: The net reclassification improvement (NRI) is an increasingly popular measure for evaluating improvements in risk predictions. This article details a review of 67 publications in high-impact general clinical journals that considered the NRI. Incomplete reporting of NRI methods, incorrect calculation, and common misinterpretations were found. To aid improved applications of the NRI, the article elaborates on several aspects of the computation and interpretation in various settings. Limitations and controversies are discussed, including the effect of miscalibration of prediction models, the use of the continuous NRI and “clinical NRI,” and the relation with decision analytic measures. A systematic approach toward presenting NRI analysis is proposed: Detail and motivate the methods used for computation of the NRI, use clinically meaningful risk cutoffs for the category-based NRI, report both NRI components, address issues of calibration, and do not interpret the overall NRI as a percentage of the study population reclassified. Promising NRI findings need to be followed with decision analytic or formal cost-effectiveness evaluations.
TL;DR: This review examines recent evidence that relates health IT functionalities prescribed in meaningful use regulations to health care quality, safety, and efficiency, and abstracted information about the following: study design; clinical setting, health care conditions, and aspects of care assessed.
Abstract: The meaningful use program has increased adoption of health information technology. This review examined evidence on functionalities prescribed in meaningful use regulations and found that 60% of t...
TL;DR: This study estimates future harms and benefits of lung cancer screening and identifies a set of possible efficient lung cancer Screening policies by using 5 separately developed microsimulation models calibrated to the 2 largest randomized, controlled trials on lung cancer screenings.
Abstract: This comparative modeling study provides estimates of the benefits and harms of computed tomography screening for lung cancer in persons aged 45 through 90 years with various pack-year exposures to...
TL;DR: In this paper, a systematic review identified and evaluated studies that compared suicide and homicide victimization, and concluded that access to firearms in the home increases the risk for violent death. But, they did not consider the risk of suicide.
Abstract: Debate surrounds whether access to firearms in the home increases the risk for violent death. This systematic review identified and evaluated studies that compared suicide and homicide victimizatio...
TL;DR: This systematic review conducted to support the U.S. Preventive Services Task Force (USPSTF) in updating its 1996 recommendation, which is no longer active, addressed 3 key questions: is low-dose aspirin effective for reducing adverse maternal and perinatal health outcomes among women at increased risk for preeclampsia?
Abstract: Preeclampsia is a leading cause of maternal and perinatal death. This systematic review, conducted to support the U.S. Preventive Services Task Force, assessed the benefits and harms of low-dose as...
TL;DR: The USPSTF recommends that primary care providers screen women who have family members with breast, ovarian, tubal, or peritoneal cancer with 1 of several screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2).
Abstract: The U.S. Preventive Services Task Force (USPSTF) recommends that primary care providers screen women who have family members with breast, ovarian, tubal, or peritoneal cancer to identify a family h...
TL;DR: The decision to calculate a summary estimate in a meta-analysis should be based on clinical judgment, the number of studies, and the degree of variation among studies, as well as on a random-effects model that incorporates study-to-study variability beyond what would be expected by chance.
Abstract: A primary goal of meta-analysis is to improve the estimation of treatment effects by pooling results of similar studies. This article discusses the problems associated with using the DerSimonian–La...
TL;DR: In this paper, the reduction in HIV-1 reservoirs observed following allogeneic hematopoietic stem cell transplantation (HSCT) with susceptible donor cells is shown to achieve sustained HIV1 remission.
Abstract: Background
It is unknown if the reduction in HIV-1 reservoirs observed following allogeneic hematopoietic stem cell transplantation (HSCT) with susceptible donor cells is sufficient to achieve sustained HIV-1 remission.
TL;DR: Survival in the United States between 2000 and 2010 is characterized in order to project survival for children born and diagnosed with CF in 2010 and thereby improve the clarity of prognostic dialogue and inform adult care needs.
Abstract: Background
Advances in treatments for cystic fibrosis (CF) continue to extend survival. An updated estimate of survival is needed for better prognostication and to anticipate evolving adult care needs.
TL;DR: The objective of the current study was to systematically search for and evaluate the quality of guidelines addressing the use of opioids for chronic pain, and compare guidelines recommendations related to mitigating the risk for accidental overdose and misuse.
Abstract: High-quality guidelines could help clinicians mitigate the risks of opioid therapy. The authors identified and evaluated 13 guidelines that address opioid therapy for chronic pain management in adu...
TL;DR: The 2014 Evidence-Based Guideline for the Management of High Blood Pressure In Adults recommends several major changes from the JNC 7 report, including the recommendation to increase the target systolic blood pressure (SBP) from 140 to 150 mm Hg in persons aged 60 years or older without diabetes mellitus or chronic kidney disease.
Abstract: The 2014 guideline for the management of high blood pressure in adults from the panel appointed to the Eighth Joint National Committee includes a recommendation to increase the target systolic bloo...
TL;DR: The USPSTF recommends the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia.
Abstract: This updated U.S. Preventive Services Task Force recommen-dation on aspirin prophylaxis in pregnancy applies to asymptomatic pregnant women who are at increased risk for preeclampsia and who have n...
TL;DR: This multicenter, double-blind, placebo-controlled, randomized trial found that rituximab alleviated some symptoms at week 6 but did not alleviate symptoms or improve global activity score at month 6 in adults with recent-onset or systemic pSS.
Abstract: BACKGROUND: Primary Sjogren syndrome (pSS) is an autoimmune disorder characterized by ocular and oral dryness or systemic manifestations. OBJECTIVE: To evaluate efficacy and harms of rituximab in adults with recent-onset or systemic pSS. DESIGN: Randomized, placebo-controlled, parallel-group trial conducted between March 2008 and January 2011. Study personnel (except pharmacists), investigators, and patients were blinded to treatment group. (ClinicalTrials.gov: NCT00740948). SETTING: 14 university hospitals in France. PATIENTS: 120 patients with scores of 50 mm or greater on at least 2 of 4 visual analogue scales (VASs) (global disease, pain, fatigue, and dryness) and recent-onset (< 10 years) biologically active or systemic pSS. INTERVENTION: Randomization (1:1 ratio) to rituximab (1 g at weeks 0 and 2) or placebo. MEASUREMENTS: Primary end point was improvement of at least 30 mm in 2 of 4 VASs by week 24. RESULTS: No significant difference between groups in the primary end point was found (difference, 1.0% [95% CI, -16.7% to 18.7%]). The proportion of patients with at least 30-mm decreases in at least two of the four VAS scores was higher in the rituximab group at week 6 (22.4% vs. 9.1%; P = 0.036). An improvement of at least 30 mm in VAS fatigue score was more common with rituximab at weeks 6 (P < 0.001) and 16 (P = 0.012), and improvement in fatigue from baseline to week 24 was greater with rituximab. Adverse events were similar between groups except for a higher rate of infusion reactions with rituximab. LIMITATION: Low disease activity at baseline and a primary outcome that may have been insensitive to detect clinically important changes. CONCLUSION: Rituximab did not alleviate symptoms or disease activity in patients with pSS at week 24, although it alleviated some symptoms at earlier time points.
TL;DR: No other metric has proven to be superior to the apneahypopnea index in assessing the overall effect of obstructive sleep apnea, even though it may prove to be inappropriate for characterizing obstructiveSleep apnea in specific subsets of patients.
Abstract: Obstructive sleep apnea (OSA) is very common but is frequently undiagnosed Symptoms include loud snoring, nocturnal awakening, and daytime sleepiness Motor vehicle accidents due to drowsy driving are a particular concern Evaluation and treatment should focus on symptomatic patients, both to alleviate symptoms and to potentially decrease cardiovascular risk In recent years, a strategy of home sleep apnea testing followed by initiation of autotitrating continuous positive airway pressure therapy in the home has greatly reduced barriers to diagnosis and treatment and has also facilitated routine management of OSA by primary care providers
TL;DR: In this article, the authors evaluate the effect of introducing primary care patients to smartphone applications for weight loss, and find that the effectiveness of these applications is limited, but little is known about their effectiveness.
Abstract: Background: Many smartphone applications (apps) for weight loss are available, but little is known about their effectiveness. Objective: To evaluate the effect of introducing primary care patients ...
Duke University1, University of Pennsylvania2, Harvard University3, Veterans Health Administration4, University of Texas Health Science Center at San Antonio5, Hurley Medical Center6, Boston University7, American College of Physicians8, University of North Carolina at Chapel Hill9, University of Wisconsin-Madison10
TL;DR: In this paper, the authors explored the use of icon arrays to communicate probabilistic information about benefits and harms to patients, and some methods are more effective than others, such as icon arrays.
Abstract: Physicians can use many methods to communicate probabilistic information about benefits and harms to patients, and some are more effective than others. The authors explored the use of icon arrays a...
TL;DR: For example, this article found that Type 2 diabetes mellitus is associated with dementia risk, however evidence is limited for possible associations of diabetes and pre-diabetes with cognitive decline.
Abstract: Background
Type 2 diabetes mellitus is associated with dementia risk, however evidence is limited for possible associations of diabetes and pre-diabetes with cognitive decline.
TL;DR: In this article, a systematic review, conducted to inform the U.S. Preventive Services Task Force, summarizes evidence about risk assessment and genetic counseling and testing for BRCA-related cancer in women.
Abstract: This systematic review, conducted to inform the U.S. Preventive Services Task Force, summarizes evidence about risk assessment and genetic counseling and testing for BRCA-related cancer in women. F...