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Annals of Internal Medicine
Journal Prestige (SJR): 7.466
Citation Impact (citeScore): 4
Number of Followers: 300  
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ISSN (Print) 0003-4819 - ISSN (Online) 1539-3704
Published by American College of Physicians Homepage  [4 journals]
  • Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and
           Association With Mortality A Cohort Study
    • Authors: Larochelle MR; Bernson D, Land T, et al.
      Abstract: Background:Opioid overdose survivors have an increased risk for death. Whether use of medications for opioid use disorder (MOUD) after overdose is associated with mortality is not known.Objective:To identify MOUD use after opioid overdose and its association with all-cause and opioid-related mortality.Design:Retrospective cohort study.Setting:7 individually linked data sets from Massachusetts government agencies.Participants:17 568 Massachusetts adults without cancer who survived an opioid overdose between 2012 and 2014.Measurements:Three types of MOUD were examined: methadone maintenance treatment (MMT), buprenorphine, and naltrexone. Exposure to MOUD was identified at monthly intervals, and persons were considered exposed through the month after last receipt. A multivariable Cox proportional hazards model was used to examine MOUD as a monthly time-varying exposure variable to predict time to all-cause and opioid-related mortality.Results:In the 12 months after a nonfatal overdose, 2040 persons (11%) enrolled in MMT for a median of 5 months (interquartile range, 2 to 9 months), 3022 persons (17%) received buprenorphine for a median of 4 months (interquartile range, 2 to 8 months), and 1099 persons (6%) received naltrexone for a median of 1 month (interquartile range, 1 to 2 months). Among the entire cohort, all-cause mortality was 4.7 deaths (95% CI, 4.4 to 5.0 deaths) per 100 person-years and opioid-related mortality was 2.1 deaths (CI, 1.9 to 2.4 deaths) per 100 person-years. Compared with no MOUD, MMT was associated with decreased all-cause mortality (adjusted hazard ratio [AHR], 0.47 [CI, 0.32 to 0.71]) and opioid-related mortality (AHR, 0.41 [CI, 0.24 to 0.70]). Buprenorphine was associated with decreased all-cause mortality (AHR, 0.63 [CI, 0.46 to 0.87]) and opioid-related mortality (AHR, 0.62 [CI, 0.41 to 0.92]). No associations between naltrexone and all-cause mortality (AHR, 1.44 [CI, 0.84 to 2.46]) or opioid-related mortality (AHR, 1.42 [CI, 0.73 to 2.79]) were identified.Limitation:Few events among naltrexone recipients preclude confident conclusions.Conclusion:A minority of opioid overdose survivors received MOUD. Buprenorphine and MMT were associated with reduced all-cause and opioid-related mortality.Primary Funding Source:National Center for Advancing Translational Sciences of the National Institutes of Health.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Depression and Suicidal Ideation Among HIV-Infected Adults Receiving
           Efavirenz Versus Nevirapine in Uganda A Prospective Cohort Study
    • Authors: Chang JL; Tsai AC, Musinguzi N, et al.
      Abstract: Background:Evidence regarding potential adverse neuropsychiatric effects of efavirenz is conflicting, and data from sub-Saharan Africa, where 70% of persons living with HIV (PLHIV) reside and efavirenz is used as first-line therapy, are limited.Objective:To estimate associations between efavirenz use and depression and suicidal ideation among PLHIV in Uganda.Design:Prospective observational cohort study. ( NCT01596322)Setting:Mbarara, Uganda.Participants:Adult PLHIV enrolled at the start of antiretroviral therapy (ART) and observed every 3 to 4 months from 2005 to 2015.Measurements:The exposure of interest was time-varying efavirenz use, defined as use during the 7 days and in 60 or more of the 90 days before a study visit, compared with nevirapine use. Self-reported outcomes were depression, defined as a mean score greater than 1.75 on the Hopkins Symptom Checklist depression subscale, and suicidal ideation. Multivariable-adjusted generalized estimating equations (GEE) logistic regression, Cox proportional hazards regression, and marginal structural models were fit to estimate the association between efavirenz use and the risk for depression and suicidal ideation.Results:694 participants (median age, 33 years; median pretreatment CD4+ count, 1.8 × 109 cells/L) contributed 1200 person-years of observation (460 person-years receiving efavirenz). No baseline differences in depression or suicidal ideation were found between patients ever exposed to efavirenz and those never exposed to efavirenz and receiving nevirapine (P > 0.80 for both). Of 305 participants ever-exposed to efavirenz, 61 (20.0%) and 19 (6.2%) had depression and suicidal ideation, respectively, on at least 1 follow-up visit, compared with 125 (32.1%) and 47 (12.1%) of the 389 who received nevirapine. In adjusted GEE models, efavirenz use was associated with decreased odds of depression compared with nevirapine use (adjusted odds ratio, 0.62 [95% CI, 0.40 to 0.96]) and was not significantly associated with suicidal ideation (adjusted odds ratio, 0.61 [CI, 0.30 to 1.25]). Time-to-event and marginal structural models yielded similar estimates.Limitation:Nonrandom assignment to treatment and substantial differences between the efavirenz and nevirapine groups.Conclusion:No evidence was found that use of efavirenz in first-line ART increased the risk for depression or suicidal ideation compared with nevirapine use among PLHIV in Uganda.Primary Funding Source:National Institutes of Health.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Prognostic Implications of Single-Sample Confirmatory Testing for
           Undiagnosed Diabetes A Prospective Cohort Study
    • Authors: Selvin E; Wang D, Matsushita K, et al.
      Abstract: Background:Current clinical definitions of diabetes require repeated blood work to confirm elevated levels of glucose or hemoglobin A1c (HbA1c) to reduce the possibility of a false-positive diagnosis. Whether 2 different tests from a single blood sample provide adequate confirmation is uncertain.Objective:To examine the prognostic performance of a single-sample confirmatory definition of undiagnosed diabetes.Design:Prospective cohort study.Setting:The ARIC (Atherosclerosis Risk in Communities) study.Participants:13 346 ARIC participants (12 268 without diagnosed diabetes) with 25 years of follow-up for incident diabetes, cardiovascular outcomes, kidney disease, and mortality.Measurements:Confirmed undiagnosed diabetes was defined as elevated levels of fasting glucose (≥7.0 mmol/L [≥126 mg/dL]) and HbA1c (≥6.5%) from a single blood sample.Results:Among 12 268 participants without diagnosed diabetes, 978 had elevated levels of fasting glucose or HbA1c at baseline (1990 to 1992). Among these, 39% had both (confirmed undiagnosed diabetes), whereas 61% had only 1 elevated measure (unconfirmed undiagnosed diabetes). The confirmatory definition had moderate sensitivity (54.9%) but high specificity (98.1%) for identification of diabetes cases diagnosed during the first 5 years of follow-up, with specificity increasing to 99.6% by 15 years. The 15-year positive predictive value was 88.7% compared with 71.1% for unconfirmed cases. Confirmed undiagnosed diabetes was significantly associated with cardiovascular and kidney disease and mortality, with stronger associations than unconfirmed diabetes.Limitation:Lack of repeated measurements of fasting glucose and HbA1c.Conclusion:A single-sample confirmatory definition of diabetes had a high positive predictive value for subsequent diagnosis and was strongly associated with clinical end points. Our results support the clinical utility of using a combination of elevated fasting glucose and HbA1c levels from a single blood sample to identify undiagnosed diabetes in the population.Primary Funding Source:National Institute of Diabetes and Digestive and Kidney Diseases and National Heart, Lung, and Blood Institute.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Comparative Benefits and Harms of Basal Insulin Analogues for Type 2
           Diabetes A Systematic Review and Network Meta-analysis
    • Authors: Madenidou A; Paschos P, Karagiannis T, et al.
      Abstract: Background:Basal insulin analogues aim for protracted glycemic control with minimal adverse effects.Purpose:To assess the comparative efficacy and safety of basal insulin analogues for adults with type 2 diabetes mellitus (T2DM).Data Sources:Several databases from inception to April 2018 without language restrictions, to April 2018, references of reviews, and meeting abstract books.Study Selection:Randomized trials lasting at least 12 weeks that compared efficacy (change in hemoglobin A1c [HbA1c] level from baseline [primary outcome]; percentage of patients with HbA1c level <7% at end of study and change in body weight [secondary outcomes]) and safety (hypoglycemia) of basal insulin analogues.Data Extraction:Two authors independently extracted data and assessed risk of bias for each outcome. All authors evaluated overall confidence in the evidence.Data Synthesis:Thirty-nine trials (26 195 patients) assessed 10 basal insulin analogues. Low- to very-low-quality evidence indicated that thrice-weekly degludec (Deg-3TW) was inferior to most other regimens for reducing HbA1c level, with mean differences ranging from 0.21% (vs. degludec, 100 U/mL [Deg-100]) to 0.32% (vs. glargine, 300 U/mL [Glar-300]). High- to moderate-quality evidence suggested that detemir had a favorable weight profile versus all comparators, and Glar-300 was associated with less weight gain than glargine, 100 U/mL (Glar-100); Deg-100; degludec, 200 U/mL (Deg-200); Deg-3TW; and LY2963016. Low- and very-low-quality evidence suggested that Deg-100, Deg-200, and Glar-300 were associated with lower incidence of nocturnal hypoglycemia than detemir, Glar-100, LY2963016, and neutral protamine lispro (NPL). Incidence of severe hypoglycemia did not differ among regimens, except NPL, which was associated with increased risk versus Deg-100, detemir, Glar-100, and Glar-300.Limitations:Results are based mostly on indirect comparisons. Confidence in summary estimates is low or very low due to individual-study limitations, imprecision, or inconsistency.Conclusion:Low-quality evidence suggests that basal insulin analogues for T2DM do not substantially differ in their glucose-lowering effect. Low- and very-low-quality evidence suggests some regimens may be associated with lower risk for nocturnal hypoglycemia (Deg-100, Deg-200, and Glar-300) or less weight gain (detemir and Glar-300).Primary Funding Source:None. (PROSPERO: CRD42016037055)
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • What Should Be the Target Blood Pressure for This Older Patient With
           Hypertension' Grand Rounds Discussion From Beth Israel Deaconess
           Medical Center
    • Authors: Smetana GW; Beach J, Lipsitz L, et al.
      Abstract: Hypertension is prevalent and the most important risk factor for cardiovascular disease. Controversy exists regarding the optimum threshold above which to begin antihypertensive therapy and the optimum target blood pressure once medication is begun. This controversy is particularly true for older patients, who may be more likely to benefit from treatment because of their higher risk for cardiovascular events, but may also be more at risk for adverse effects of treatment. Two guidelines published in 2017 address this issue. The American College of Physicians/American Academy of Family Physicians guideline recommends initiating antihypertensive therapy for older patients (aged 60 years or older) if systolic blood pressure is 150 mm Hg or higher and to treat to the same target. They recommend a lower threshold for starting treatment and a lower target systolic blood pressure (140 mm Hg) for patients with cerebrovascular disease and potentially those at high risk for cardiovascular events. The American College of Cardiology/American Heart Association guideline, which is based primarily on SPRINT (Systolic Blood Pressure Intervention Trial), advises a target systolic blood pressure of 130 mm Hg for community-dwelling ambulatory patients aged 65 years or older. This article presents the case of a 79-year-old man who is contemplating antihypertensive therapy. Two experts discuss the optimal approach for the patient and suggest how to apply the 2 guidelines to his care.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Fulfilling the Promise of Unique Device Identifiers
    • Authors: Dhruva SS; Ross JS, Schulz WL, et al.
      Abstract: Medical devices are required to have unique identifiers, which have the potential to provide data to improve patient safety. The authors discuss why this potential is not being realized and suggest ways to overcome the barriers.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Guidelines Versus Guidelines: What's Best for the Patient'
    • Authors: Draznin B; Nathan DM, Korytkowski MT, et al.
      Abstract: Expert clinicians counter some of the recommendations regarding hemoglobin A1c targets for type 2 diabetes that were proposed in a recent American College of Physicians guideline.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Opioid Use Disorder, Stigma, and Transplantation: A Call to Action
    • Authors: Wakeman SE; Ladin K, Brennan T, et al.
      Abstract: Should people with opioid use disorder who are being treated with opioid agonist therapy be deemed ineligible for organ transplant' This commentary proposes an answer.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Overdose Prevention Through Medical Treatment of Opioid Use Disorders
    • Authors: Volkow ND; Wargo EM.
      Abstract: In their article, Larochelle and colleagues provided convincing evidence of the benefits of methadone and buprenorphine in preventing opioid-related deaths in patients with a history of nonfatal opioid overdose. The editorialists discuss the findings and what they reveal about the challenges of overcoming barriers to broader use of medication-assisted treatment of opioid use disorder.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Two in One: Diagnosing Type 2 Diabetes With Single-Sample Testing
    • Authors: Narayan K; Jagannathan R.
      Abstract: Selvin and colleagues reported the prognostic capability of “single-sample” definitions of confirmed (elevated levels of both fasting glucose and hemoglobin A1c) and unconfirmed (elevated level of fasting glucose level or hemoglobin A1c) undiagnosed diabetes to identify future risk for diagnosed diabetes and its complications. The editorialists discuss the promise of these findings (if they are confirmed in other populations) to improve the timing and efficiency of diabetes diagnosis.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • A Beautiful Death
    • Authors: Weatherly L.
      Abstract: That morning, I became more aware than ever of the limits of medicine.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Risk-Targeted Lung Cancer Screening
    • Authors: Cressman S; ten Haaf K, Lam S, et al.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Risk-Targeted Lung Cancer Screening
    • Authors: Kumar V; Cohen JT, Neumann PJ, et al.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Provider Types and Outcomes in Obstructive Sleep Apnea Case Finding and
    • Authors: Parthasarathy S; Combs D, Patel SN, et al.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Provider Types and Outcomes in Obstructive Sleep Apnea Case Finding and
    • Authors: Wilt TJ; Greer N, Kunisaki KM.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Hormone Therapy for Menopausal Symptoms
    • Authors: Reynolds EE; Bates C, Richardson M, et al.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Hormone Therapy for Menopausal Symptoms
    • Authors: Robbins J.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Politics and Professionalism
    • Authors: Berger W.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Politics and Professionalism
    • Authors: Sexauer WP.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • A Physician's Grammar
    • Authors: Sgro G.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Annals for Educators - 7 August 2018
    • Authors: Taichman DB.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Herpes Zoster
    • Authors: Schmader K.
      Abstract: Primary care providers and hospitalists frequently encounter older or immunocompromised patients with herpes zoster accompanied by debilitating pain. Atypical presentations and zosteriform herpes simplex may present diagnostic challenges to clinicians. This article summarizes the background, evidence, and guidelines for the diagnosis, complications, treatment, and prevention of herpes zoster. Diagnosis of challenging cases relies on polymerase chain reaction as the preferred test. Treatment focuses on optimal use of antiviral therapy and analgesics. Prevention emphasizes utilization of a new recombinant zoster vaccine, which reduces the incidence of herpes zoster by more than 90% and is preferred to the live attenuated herpes zoster vaccine.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Annals On Call - The Gout Wars: When Guidelines Collide
    • Authors: Centor RM; McLean RM.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Annals Graphic Medicine - Critical Space
    • Authors: Myers KR; Osborne M, Wu CA, et al.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Medicines for Patients After an Opioid Overdose
    • PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia Syndrome
           Treated With Sirolimus
    • Authors: Russier M; Plantier L, Derot G, et al.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
  • Storing and Disposing of Opioid Analgesics: What Does Our Medicine Tell
    • Authors: Doucette ML; Shields WC, Haring R, et al.
      PubDate: Tue, 07 Aug 2018 00:00:00 GMT
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