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Annals of Internal Medicine
Journal Prestige (SJR): 7.466
Citation Impact (citeScore): 4
Number of Followers: 308  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0003-4819 - ISSN (Online) 1539-3704
Published by American College of Physicians Homepage  [4 journals]
  • Effect of Variation in Published Stroke Rates on the Net Clinical Benefit
           of Anticoagulation for Atrial Fibrillation
    • Authors: Shah SJ; Eckman MH, Aspberg S, et al.
      Abstract: Background:Stroke rates in patients with nonvalvular atrial fibrillation (AF) who are not receiving anticoagulant therapy vary widely across published studies; the resulting effect on the net clinical benefit of anticoagulation in AF is unknown.Objective:To determine the effect of variation in published AF stroke rates on the net clinical benefit of anticoagulation.Design:Markov model decision analysis. Warfarin was the base case, and non–vitamin K antagonist oral anticoagulants (NOACs) were modeled in a secondary analysis.Setting:Community-dwelling adults.Patients:33 434 adults with incident AF.Measurements:Quality-adjusted life-years (QALYs).Results:Of the 33 434 patients, 27 179 had a CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke, and vascular disease) score of 2 or more. The population benefit of warfarin anticoagulation for these patients was least using stroke rates from the ATRIA (AnTicoagulation and Risk Factors In Atrial Fibrillation) study and greatest using those from the Danish National Patient Registry (6290 QALYs [95% CI, ±2.3%] vs. 24 110 QALYs [CI, ±1.9%]; P < 0.001). The optimal CHA2DS2-VASc score threshold for anticoagulation was 3 or more using stroke rates from ATRIA, 2 or more using those from the Swedish AF cohort study, 1 or more using those from the SPORTIF (Stroke Prevention using ORal Thrombin Inhibitor in atrial Fibrillation) study, and 0 or more using those from the Danish National Patient Registry. Accounting for lower rates of NOAC-associated intracranial hemorrhage decreased optimal CHA2DS2-VASc score thresholds, but these thresholds still varied widely.Limitation:Measured benefit may not generalize to other populations.Conclusion:Variation in published AF stroke rates for patients not receiving anticoagulant therapy results in multifold variation in the net clinical benefit of anticoagulation. Guidelines should better reflect the uncertainty in current thresholds of stroke risk score for recommending anticoagulation.Primary Funding Source:None.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Persistence and Drivers of High-Cost Status Among Dual-Eligible Medicare
           and Medicaid Beneficiaries An Observational Study
    • Authors: Figueroa JF; Lyon Z, Zhou X, et al.
      Abstract: Background:Little is known about the persistence of high-cost status among dual-eligible Medicare and Medicaid beneficiaries, who account for a substantial proportion of expenditures in both programs.Objective:To determine what proportion of this population has persistently high costs.Design:Observational study.Setting:Medicare–Medicaid Linked Enrollee Analytic Data Source data for 2008 to 2010.Participants:1 928 340 dual-eligible Medicare and Medicaid beneficiaries who were alive all 3 years.Measurements:Medicare and Medicaid payments for these beneficiaries were calculated for each year. Beneficiaries were categorized as high-cost for a given year if their spending was in the top 10% for that year. Differences in spending were then examined for those who were persistently high-cost (all 3 years) versus those who were transiently high-cost (2008 but not 2009 or 2010) and those who were non–high-cost in all 3 years.Results:In the first year, 192 835 patients were high-cost. More than half (54.8%) remained high-cost across all 3 years. These patients were younger than transiently high-cost patients, with fewer medical comorbidities and greater intellectual impairment. Persistently high-cost patients spent $161 224 per year compared with $86 333 per year for transiently high-cost patients and $22 352 per year for non–high-cost patients. Most of the spending among persistently high-cost patients (68.8%) was related to long-term care, and very little (<1%) was related to potentially preventable hospitalizations for ambulatory care–sensitive conditions.Limitation:Potential misclassification of preventable spending and lack of detailed clinical data in administrative claims.Conclusion:A substantial majority of high-cost dual-eligible beneficiaries had persistently high costs over 3 years, with most of the cost related to long-term care and very little related to potentially preventable hospitalizations.Primary Funding Source:Peterson Center on Healthcare.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Relationship of Interleukin-1β Blockade With Incident Gout and Serum Uric
           Acid Levels Exploratory Analysis of a Randomized Controlled Trial
    • Authors: Solomon DH; Glynn RJ, MacFadyen JG, et al.
      Abstract: Background:Although studies have shown that interleukin-1β (IL-1β) inhibitors can shorten gout attacks, whether they can prevent gout attacks is unclear.Objective:To examine the relationship among canakinumab, a monoclonal antibody targeting IL-1β; serum uric acid levels; and the incidence of gout attacks.Design:Secondary exploratory analysis of a randomized controlled trial. (ClinicalTrials.gov: NCT01327846)Setting:Many clinical sites in 39 countries.Participants:10 059 patients with a prior myocardial infarction and a high-sensitivity C-reactive protein (hsCRP) level of at least 19.1 nmol/L.Intervention:Random allocation to canakinumab (50 mg, 150 mg, or 300 mg) versus placebo, administered subcutaneously every 3 months.Measurements:Rates of gout attacks were compared across patients with different baseline concentrations of serum uric acid (≤404.5 µmol/L, 404.6 to 535.3 µmol/L, and ≥535.4 µmol/L) and in different intervention groups in Cox proportional hazards regression models.Results:The median baseline concentration of serum uric acid was 362.9 µmol/L (interquartile range, 309.3 to 428.3 µmol/L), and median follow-up was 3.7 years. Among participants receiving placebo, incidence rates of gout attacks for serum uric acid concentrations of 404.5 µmol/L or lower, 404.6 to 535.3 µmol/L, and 535.4 µmol/L or higher were 0.28, 1.36, and 5.94, respectively, per 100 person-years. Canakinumab did not affect serum uric acid levels over time yet significantly reduced rates of gout attacks at all baseline concentrations of serum uric acid: Hazard ratios were 0.40 (95% CI, 0.22 to 0.73) for concentrations of 404.5 µmol/L or lower, 0.48 (CI, 0.31 to 0.74) for those between 404.6 and 535.3 µmol/L, and 0.45 (CI, 0.28 to 0.72) for those of 535.4 µmol/L or higher.Limitation:No adjudication of gout attacks.Conclusion:Quarterly canakinumab administration was associated with significantly reduced risk for gout attacks without any change in serum uric acid levels. These data have relevance for the development of agents for gout that target the IL-1β pathway of innate immunity.Primary Funding Source:Novartis.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Statins and Multiple Noncardiovascular Outcomes Umbrella Review of
           Meta-analyses of Observational Studies and Randomized Controlled Trials
    • Authors: He Y; Li X, Gasevic D, et al.
      Abstract: Background:Many effects of statins on non–cardiovascular disease (non-CVD) outcomes have been reported.Purpose:To evaluate the quantity, validity, and credibility of evidence regarding associations between statins and non-CVD outcomes and the effects of statins on these outcomes.Data Sources:MEDLINE and EMBASE (English terms only, inception to 28 May 2018).Study Selection:Meta-analyses (published in English) of observational studies and of randomized controlled trials (RCTs) that examined non-CVD outcomes of statin intake.Data Extraction:Two investigators extracted data from meta-analyses and individual studies. Credibility assessments based on summary effect sizes from a random-effects model, between-study heterogeneity, 95% prediction interval, small-study effect, excess significance, and credibility ceilings were devised to classify evidence.Data Synthesis:This review explored 278 unique non-CVD outcomes from 112 meta-analyses of observational studies and 144 meta-analyses of RCTs. For observational studies, no convincing (class I) evidence, 2 highly suggestive (class II) associations (decreased cancer mortality in patients with cancer and decreased exacerbation in patients with chronic obstructive pulmonary disease), 21 suggestive (class III) associations, and 42 weak (class IV) associations were identified. One outcome from the RCTs (decreased all-cause mortality in patients with chronic kidney disease) attained a sufficient amount of evidence with no hints of bias. For adverse events, observational studies showed suggestive evidence that statins increase the risk for diabetes and myopathy. Among the RCTs, no statistically significant effects were found on myopathy, myalgia, or rhabdomyolysis.Limitations:Studies with relevant data and outcomes not included in the meta-analyses may have been missed. Credibility assessments relied on several assumptions and arbitrary thresholds.Conclusion:The absence of convincing evidence of an association between statins and non-CVD outcomes supports leaving the current recommendations unchanged.Primary Funding Source:None.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Researcher Requests for Inappropriate Analysis and Reporting: A U.S.
           Survey of Consulting Biostatisticians
    • Authors: Wang M; Yan AF, Katz RV.
      Abstract: Background:Inappropriate analysis and reporting of biomedical research remain a problem despite advances in statistical methods and efforts to educate researchers.Objective:To determine the frequency and severity of requests biostatisticians receive from researchers for inappropriate analysis and reporting of data during statistical consultations.Design:Online survey.Setting:United States.Participants:A randomly drawn sample of 522 American Statistical Association members self-identifying as consulting biostatisticians.Measurements:The Bioethical Issues in Biostatistical Consulting Questionnaire soliciting reports about the frequency and perceived severity of specific requests for inappropriate analysis and reporting.Results:Of 522 consulting biostatisticians contacted, 390 provided sufficient responses: a completion rate of 74.7%. The 4 most frequently reported inappropriate requests rated as “most severe” by at least 20% of the respondents were, in order of frequency, removing or altering some data records to better support the research hypothesis; interpreting the statistical findings on the basis of expectation, not actual results; not reporting the presence of key missing data that might bias the results; and ignoring violations of assumptions that would change results from positive to negative. These requests were reported most often by younger biostatisticians.Limitations:The survey provides information on the reported frequency of inappropriate requests but not on how such requests were handled or whether the requests reflected researchers' maleficence or inadequate knowledge about statistical and research methods. In addition, other inappropriate requests may have been made that were not prespecified in the survey.Conclusion:This survey suggests that researchers frequently make inappropriate requests of their biostatistical consultants regarding the analysis and reporting of their data. Understanding the reasons for these requests and how they are handled requires further study.Primary Funding Source:U.S. Department of Health and Human Services.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • A Student Reflection on Doctoring With Confidence: Mind the Gap
    • Authors: Treadway N.
      Abstract: This commentary discusses ways in which the field of medicine can work to close the “confidence gap,” the discrepancy in confidence between male and female physicians and trainees.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Medical Education and the Public Service Loan Forgiveness Program:
           Unnecessary Uncertainties
    • Authors: Grischkan JA; George BP, Dorsey E, et al.
      Abstract: In this commentary, the authors discuss how the federal Public Loan Forgiveness program affects affordability of medical school and distribution of the physician workforce. It also considers the possible effect of proposed changes, including its elimination.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Dying Healthy: Public Health Priorities for Fixed Population Life
           Expectancies
    • Authors: Annas GJ; Galea S.
      Abstract: Recent evidence suggests that the human lifespan has an unalterable biological limit of approximately 115 years and that virtually all humans will die before age 90 years. The authors suggest shifting research priorities and resources toward identifying ways to improve quality of life throughout the lifespan and to delay illness to the shortest period possible near the end of life.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Bold Proposed Rule for the 2019 Medicare Physician Fee Schedule: Can
           Physicians Afford to Abandon Documentation Burdens'
    • Authors: Manaker S; Leahy M.
      Abstract: This commentary discusses the advantages and disadvantages of the 2019 Medicare Physician Fee Schedule and why we should proceed with caution.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • When Centers for Medicare &amp; Medicaid Services Treats Throat Cancer
           Like Pharyngitis
    • Authors: Grover A; Lee G.
      Abstract: The changes to Medicare payment documentation guidelines proposed by the Centers for Medicare & Medicaid Services may simplify documentation requirements. However, this commentary argues that the proposal to condense rates under the physician fee schedule is more likely to result in reductions in payments to many physicians for services provided to medically vulnerable patients.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Oversight of Patient-Centered Outcomes Research: Recommendations From a
           Delphi Panel
    • Authors: Gelinas L; Weissman JS, Lynch H, et al.
      Abstract: A key aim of patient-centered outcomes research (PCOR) is to generate data that are important to patients by deliberately and extensively involving them in all aspects of research, from design to dissemination. However, certain elements of PCOR raise challenging and potentially novel ethical and regulatory issues for institutional review boards and oversight bodies. These challenges stem primarily from the engagement of patients in roles other than research subject, such as advisors, study personnel, and co-investigators, which gives rise to questions about appropriate levels of protection, training, and education, as well as identifying and managing conflicts of interest. This article presents and discusses recommendations from a Delphi expert panel that was convened to address these and other PCOR-related oversight challenges.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Atrial Fibrillation and Anticoagulation: One Size Fits All'
    • Authors: Wright JM; January CT.
      Abstract: In their article, Shah and colleagues demonstrated vulnerability in the assumption of a universal net benefit of anticoagulation for a specific CHA2DS2-VASc score by applying analytic models of the score to 4 cohorts. The editorialists discuss the findings and their implications.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Inappropriate Statistical Analysis and Reporting in Medical Research:
           Perverse Incentives and Institutional Solutions
    • Authors: Localio A; Stack CB, Meibohm AR, et al.
      Abstract: The editorialists, who are all Annals statistical editors, discuss Wang and colleagues' findings and possible strategies to improve the conduct, reporting, and reproducibility of biomedical research.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • A Beginning to Principles of Ethical and Regulatory Oversight of
           Patient-Centered Research
    • Authors: Califf RM.
      Abstract: The editorialist discusses the ethical and regulatory recommendations presented by the Patient-Centered Outcomes Research Institute and explains why direct, continuous involvement of patients in designing, conducting, and reporting clinical research is a notable improvement in clinical trial methodology.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Data Sharing Statements for Clinical Trials: One Step Down the Road
    • Authors: Taichman DB; Laine C.
      Abstract: The editorialists discuss Tannenbaum and colleagues' findings, the recently adopted requirement for data sharing statements, and how each relates to efforts to ensure that the scientific community learns all it can from clinical trials.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • The Jumbo Man in the Jumbo Mart
    • Authors: Fitzgerald FT.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Ethical Obligations Regarding Short-Term Global Health Clinical
           Experiences
    • Authors: Brinks M; Denny J, Khilji S.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Ethical Obligations Regarding Short-Term Global Health Clinical
           Experiences
    • Authors: Good CB; Kolb N, Nakaishi L, et al.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Ethical Obligations Regarding Short-Term Global Health Clinical
           Experiences
    • Authors: Jones RG.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Ethical Obligations Regarding Short-Term Global Health Clinical
           Experiences
    • Authors: DeCamp M; Lehmann L, Jaeel P, et al.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Achieving Gender Equity in Physician Compensation and Career Advancement
    • Authors: Ertle AR.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Achieving Gender Equity in Physician Compensation and Career Advancement
    • Authors: Hingle S; Kane GC, Butkus R, et al.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Balancing Innovation and Safety When Integrating Digital Tools Into Health
           Care
    • Authors: Barr J.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Balancing Innovation and Safety When Integrating Digital Tools Into Health
           Care
    • Authors: Auerbach AD; Neinstein A, Khanna R.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • After surgery for stage II or III colorectal cancer, more vs less frequent
           follow-up did not differ for 5-year mortality
    • Authors: Clarke WT; Feuerstein JD.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Procalcitonin-guided antibiotic prescribing did not reduce antibiotic use
           in suspected LRTI in the ED
    • Authors: Tansarli GS; Mylonakis E.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • First-attempt success of emergency intubation with bougie was higher than
           with endotracheal tube plus stylet
    • Authors: Innes ME.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • In myocardial injury after noncardiac surgery, dabigatran reduced vascular
           events without increasing major bleeding
    • Authors: Bates ER.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Review: Evidence is inconclusive on dual- vs mono-antiplatelet therapy
           after transcatheter aortic valve implantation
    • Authors: Sharma R.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Review: In trigeminal neuralgia, carbamazepine, botulinum toxin type A, or
           lidocaine improve response rate vs placebo
    • Authors: Steinberg DI.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Review: Folic acid may reduce risk for CVD and stroke, and B-vitamin
           complex may reduce risk for stroke
    • Authors: Aung K; Htay T.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • In primary biliary cholangitis, adding bezafibrate to ursodeoxycholic acid
           increased complete biochemical response
    • Authors: Korula J.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • A rapid diagnostic algorithm had > 98% sensitivity and specificity for
           detecting active pulmonary tuberculosis
    • Authors: Glatt AE.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Metformin use was linked to hospitalization for acidosis at 6 y only in
           patients with eGFR < 30 mL/min/1.73 m 2
    • Authors: Leung AA; Padwal RS.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Annals Consult Guys - Should Your Patient's Surgery Be Stopped for
           Hypertension' The Pressure Is On
    • Authors: Merli GJ; Weitz HH.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Annals for Educators - 16 October 2018
    • Authors: Taichman DB.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Annals for Hospitalists - 16 October 2018
    • Authors: Wesorick DH; Chopra V.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Annals for Hospitalists Inpatient Notes - Clinical Pearls—A Middle-Aged
           Man With Pneumonia and Elevated High-Sensitivity Troponin Levels
    • Authors: Petrilli CM; Giacherio DA.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Annals On Call - Diuretic Resistance
    • Authors: Centor RM; Topf JM.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Stroke Rates, Atrial Fibrillation, and Drugs to Prevent Blood Clots
    • PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Firearm Involvement in Violent Victimization and Mental Health: An
           Observational Study
    • Authors: Kagawa RC; Cerdá M, Rudolph KE, et al.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
  • Early Experiences With Journal Data Sharing Policies: A Survey of
           Published Clinical Trial Investigators
    • Authors: Tannenbaum S; Ross JS, Krumholz HM, et al.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
       
 
 
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