Journal Cover Annals of Internal Medicine
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   ISSN (Print) 0003-4819 - ISSN (Online) 1539-3704
   Published by American College of Physicians Homepage  [4 journals]
  • Association of E-Cigarette Use With Smoking Cessation Among Smokers Who
           Plan to Quit After a Hospitalization A Prospective Study
    • Authors: Rigotti NA; Chang Y, Tindle HA, et al.
      Abstract: Background:Many smokers report using e-cigarettes to help them quit smoking, but whether e-cigarettes aid cessation efforts is uncertain.Objective:To determine whether e-cigarette use after hospital discharge is associated with subsequent tobacco abstinence among smokers who plan to quit and are advised to use evidence-based treatment.Design:Secondary data analysis of a randomized controlled trial. ( NCT01714323 [parent trial])Setting:3 hospitals.Participants:1357 hospitalized adult cigarette smokers who planned to stop smoking, received tobacco cessation counseling in the hospital, and were randomly assigned at discharge to a tobacco treatment recommendation (control) or free tobacco treatment (intervention).Measurements:Self-reported e-cigarette use (exposure) was assessed 1 and 3 months after discharge; biochemically validated tobacco abstinence (outcome) was assessed 6 months after discharge.Results:Twenty-eight percent of participants used an e-cigarette within 3 months after discharge. In an analysis of 237 propensity score–matched pairs, e-cigarette users were less likely than nonusers to abstain from tobacco use at 6 months (10.1% vs. 26.6%; risk difference, −16.5% [95% CI, −23.3% to −9.6%]). The association between e-cigarette use and quitting varied between intervention patients, who were given easy access to conventional treatment (7.7% vs. 29.8%; risk difference, −22.1% [CI, −32.3% to −11.9%]), and control patients, who received only treatment recommendations (12.0% vs. 24.1%; risk difference, −12.0% [CI, −21.2% to 2.9%]) (P for interaction = 0.143).Limitations:Patients self-selected e-cigarette use. Unmeasured confounding is possible in an observational study.Conclusion:During 3 months after hospital discharge, more than a quarter of smokers attempting to quit used e-cigarettes, mostly to aid cessation, but few used them regularly. This pattern of use was associated with less tobacco abstinence at 6 months than among smokers who did not use e-cigarettes. Additional study is needed to determine whether regular use of e-cigarettes aids or hinders smoking cessation.Primary Funding Source:National Heart, Lung, and Blood Institute.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Evaluating Vaccination Strategies for Zika Virus in the Americas
    • Authors: Durham DP; Fitzpatrick MC, Ndeffo-Mbah ML, et al.
      Abstract: Background:Mosquito-borne and sexually transmitted Zika virus has become widespread across Central and South America and the Caribbean. Many Zika vaccine candidates are under active development.Objective:To quantify the effect of Zika vaccine prioritization of females aged 9 to 49 years, followed by males aged 9 to 49 years, on incidence of prenatal Zika infections.Design:A compartmental model of Zika transmission between mosquitoes and humans was developed and calibrated to empirical estimates of country-specific mosquito density. Mosquitoes were stratified into susceptible, exposed, and infected groups; humans were stratified into susceptible, exposed, infected, recovered, and vaccinated groups. Age-specific fertility rates, Zika sexual transmission, and country-specific demographics were incorporated.Setting:34 countries and territories in the Americas with documented Zika outbreaks.Target Population:Males and females aged 9 to 49 years.Intervention:Age- and sex-targeted immunization using a Zika vaccine with 75% efficacy.Measurements:Annual prenatal Zika infections.Results:For a base-case vaccine efficacy of 75% and vaccination coverage of 90%, immunizing females aged 9 to 49 years (the World Health Organization target population) would reduce the incidence of prenatal infections by at least 94%, depending on the country-specific Zika attack rate. In regions where an outbreak is not expected for at least 10 years, vaccination of women aged 15 to 29 years is more efficient than that of women aged 30 years or older.Limitation:Population-level modeling may not capture all local and neighborhood-level heterogeneity in mosquito abundance or Zika incidence.Conclusion:A Zika vaccine of moderate to high efficacy may virtually eliminate prenatal infections through a combination of direct protection and transmission reduction. Efficiency of age-specific targeting of Zika vaccination depends on the timing of future outbreaks.Primary Funding Source:National Institutes of Health.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Applicability of Publicly Reported Hospital Readmission Measures to
           Unreported Conditions and Other Patient Populations A Cross-sectional
           All-Payer Study
    • Authors: Butala NM; Kramer DB, Shen C, et al.
      Abstract: Background:Readmission rates after hospitalizations for heart failure (HF), acute myocardial infarction (AMI), and pneumonia among Medicare beneficiaries are used to assess quality and determine reimbursement. Whether these measures reflect readmission rates for other conditions or insurance groups is unknown.Objective:To investigate whether hospital-level 30-day readmission measures for publicly reported conditions (HF, AMI, and pneumonia) among Medicare patients reflect those for Medicare patients hospitalized for unreported conditions or non-Medicare patients hospitalized with HF, AMI, or pneumonia.Design:Cross-sectional.Setting:Population-based.Participants:Hospitals in the all-payer Nationwide Readmissions Database in 2013 and 2014.Measurements:Hospital-level 30-day all-cause risk-standardized excess readmission ratios (ERRs) were compared for 3 groups of patients: Medicare beneficiaries admitted for HF, AMI, or pneumonia (Medicare reported group); Medicare beneficiaries admitted for other conditions (Medicare unreported group); and non-Medicare beneficiaries admitted for HF, AMI, or pneumonia (non-Medicare group).Results:Within-hospital differences in ERRs varied widely among groups. Medicare reported ratios differed from Medicare unreported ratios by more than 0.1 for 29% of hospitals and from non-Medicare ratios by more than 0.1 for 46% of hospitals. Among hospitals with higher readmission ratios, ERRs for the Medicare reported group tended to overestimate ERRs for the non-Medicare group but underestimate those for the Medicare unreported group.Limitation:Medicare groups and risk adjustment differed slightly from those used by the Centers for Medicare & Medicaid Services.Conclusion:Hospital ERRs, as estimated by Medicare to determine financial penalties, have poor agreement with corresponding measures for populations and conditions not tied to financial penalties. Current publicly reported measures may not be good surrogates for overall hospital quality related to 30-day readmissions.Primary Funding Source:Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Cardiovascular Disease and Risk Management: Review of the American
           Diabetes Association Standards of Medical Care in Diabetes 2018
    • Authors: Chamberlain JJ; Johnson EL, Leal S, et al.
      Abstract: Description:The American Diabetes Association (ADA) annually updates its Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes.Methods:For the 2018 standards, the ADA Professional Practice Committee searched MEDLINE through November 2017 to add, clarify, or revise recommendations on the basis of new evidence. The committee rated the recommendations as A, B, or C depending on the quality of evidence or E for expert consensus or clinical experience. The standards were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions.Recommendations:This synopsis focuses on guidance relating to cardiovascular disease and risk management in nonpregnant adults with diabetes. Recommendations address diagnosis and treatment of cardiovascular risk factors (hypertension and dyslipidemia), aspirin use, screening for and treatment of coronary heart disease, and lifestyle interventions.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Ethical Obligations Regarding Short-Term Global Health Clinical
           Experiences: An American College of Physicians Position Paper
    • Authors: DeCamp M; Lehmann L, Jaeel P, et al.
      Abstract: This American College of Physicians position paper aims to inform ethical decision making surrounding participation in short-term global health clinical care experiences. Although the positions are primarily intended for practicing physicians, they may apply to other health care professionals and should inform how institutions, organizations, and others structure short-term global health experiences. The primary goal of short-term global health clinical care experiences is to improve the health and well-being of the individuals and communities where they occur. In addition, potential benefits for participants in global health include increased awareness of global health issues, new medical knowledge, enhanced physical diagnosis skills when practicing in low-technology settings, improved language skills, enhanced cultural sensitivity, a greater capacity for clinical problem solving, and an improved sense of self-satisfaction or professional satisfaction. However, these activities involve several ethical challenges. Addressing these challenges is critical to protecting patient welfare in all geographic locales, promoting fair and equitable care globally, and maintaining trust in the profession. This paper describes 5 core positions that focus on ethics and the clinical care context and provides case scenarios to illustrate them.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Balancing the Benefits and Harms of E-Cigarettes: A National Academies of
           Science, Engineering, and Medicine Report
    • Authors: Rigotti NA.
      Abstract: E-cigarettes have the potential for benefit if they help smokers quit, but this must be balanced against potential harm. This commentary discusses the National Academies of Sciences, Engineering, and Medicine report on the public health consequences of e-cigarettes and provides advice on how to counsel patients who ask about them.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • A Cautionary Tale of Warning Messages on Food Products: The Case of
           Sugar-Sweetened Beverages
    • Authors: Kahn R.
      Abstract: To protect public health, the government may mandate placement of warnings on products that it believes cause health risks. However, as a recent legal case demonstrates, such mandates require fulfillment of specific standards for compelled speech.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Engaging Survivors of Human Trafficking: Complex Health Care Needs and
           Scarce Resources
    • Authors: Judge AM; Murphy JA, Hidalgo J, et al.
      Abstract: Human trafficking, also known as modern-day slavery, is an egregious human rights violation associated with wide-ranging medical and mental health consequences. Because of the extensive health problems related to trafficking, health care providers play a critical role in identifying survivors and engaging them in ongoing care. Although guidelines for recognizing affected patients and a framework for developing response protocols in health care settings have been described, survivors' ongoing engagement in health care services is very challenging. High rates of disengagement, lost contact, premature termination, and attrition are common outcomes. For interventions to be effective in this marginalized population, challenges in engaging survivors in long-term therapeutic primary and mental health care must be better understood and overcome. This article uses the socioecological model of public health to identify barriers to engagement; offers evidence- and practice-based recommendations for overcoming these barriers; and proposes an interdisciplinary call to action for developing more flexible, adaptable models of care.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Publicly Reported Readmission Measures and the Hospital Readmissions
           Reduction Program: A False Equivalence'
    • Authors: Khera R; Horwitz LI, Lin Z, et al.
      Abstract: The editorialists discuss Butala and colleagues' findings on whether a hospital's performance on the 3 Hospital Readmissions Reduction Program conditions reflects readmission rates for other conditions or for insurance groups other than Medicare. They also discuss the need to evaluate and improve current readmission measures and policies.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Ethical Obligations in Short-Term Global Health Clinical Experiences: The
           Devil Is in the Details
    • Authors: Farquhar C; Nduati RW, Wasserheit JN.
      Abstract: This issue includes the American College of Physicians ethics recommendations for physicians considering participation in short-term global health experiences. The editorialists commend the effort and identify additional issues that are pertinent to the ethics of such experiences and valuable to the host locations.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Human Trafficking: A Health and Human Rights Agenda
    • Authors: Henry A; Grodin MA.
      Abstract: In their article, Judge and colleagues analyzed the nature, scope, and challenges associated with caring for victims of human trafficking. The editorialists discuss the report and the need for empirical evidence to define how best to care for this vulnerable population.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • A Physician's Place in the #MeToo Movement
    • Authors: Peters AL.
      Abstract: I differ slightly from the others who have come forward in the #MeToo movement because, as a physician, I am legally unable to name the patient who harassed me.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Accuracy of Cardiovascular Risk Prediction Varies by Neighborhood
           Socioeconomic Position
    • Authors: Spence J.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Accuracy of Cardiovascular Risk Prediction Varies by Neighborhood
           Socioeconomic Position
    • Authors: Perzynski AT; Rothberg MB, Dawson NV, et al.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • After Curing Hepatitis C Virus Infection
    • Authors: Debes JD.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • After Curing Hepatitis C Virus Infection
    • Authors: Belperio PS; Chartier M, Ross DB.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • The Slippery Slope of Legalization of Physician-Assisted Suicide
    • Authors: Schiller G.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • The Slippery Slope of Legalization of Physician-Assisted Suicide
    • Authors: Weiser JK.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • The Slippery Slope of Legalization of Physician-Assisted Suicide
    • Authors: Kussmaul WG; III.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Correction: Hot Tea Consumption and Its Interactions With Alcohol and
           Tobacco Use on the Risk for Esophageal Cancer: A Population-Based Cohort
    • PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Correction: Incorrect Photographer Name
    • PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Cirrhosis
    • Authors: Feingold-Link M.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Annals for Educators - 1 May 2018
    • Authors: Taichman DB.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Acute Colonic Diverticulitis
    • Authors: Swanson SM; Strate LL.
      Abstract: Acute colonic diverticulitis is a gastrointestinal condition frequently encountered by primary care practitioners, hospitalists, surgeons, and gastroenterologists. Clinical presentation ranges from mild abdominal pain to peritonitis with sepsis. It can often be diagnosed on the basis of clinical features alone, but imaging is necessary in more severe presentations to rule out such complications as abscess and perforation. Treatment depends on the severity of the presentation, presence of complications, and underlying comorbid conditions. Medical and surgical treatment algorithms are evolving. This article provides an evidence-based, clinically relevant overview of the epidemiology, diagnosis, and treatment of acute diverticulitis.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Annals Graphic Medicine - Finding the Funny: Diagnosis/Surgery
    • Authors: Blue JR.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Use of E-Cigarettes Among Smokers Who Plan to Quit After a Hospitalization
    • PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Opioids and Chest Wall Rigidity During Mechanical Ventilation
    • Authors: Roan JP; Bajaj N, Davis FA, et al.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
  • Remission of Psoriasis After Treatment of Chronic Hepatitis C Virus
           Infection With Direct-Acting Antivirals
    • Authors: Enomoto M; Tateishi C, Tsuruta D, et al.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
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