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Annals of Internal Medicine
Journal Prestige (SJR): 7.466
Citation Impact (citeScore): 4
Number of Followers: 358  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0003-4819 - ISSN (Online) 1539-3704
Published by American College of Physicians Homepage  [4 journals]
  • Annals for Educators - 7 January 2020
    • Authors: Taichman DB.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Annals On Call - Approach to UGI Bleeding
    • Authors: Centor RM; Burski C.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Annals Graphic Medicine - Dr. Mom: A Glossary of Electronic Medical Record
           Alerts
    • Authors: Farris GE.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Annals Graphic Medicine - More Than Suturing Wounds
    • Authors: Zhu A; Agarwal A.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Celiac Disease
    • Authors: Rubin J; Crowe SE.
      Abstract: Gluten-related disorders, including celiac disease, wheat allergy, and nonceliac gluten sensitivity (NCGS), are increasingly reported worldwide. Celiac disease is caused by an immune-mediated reaction to ingested gluten in genetically susceptible persons. NCGS is largely a diagnosis of exclusion when other causes of symptoms have been ruled out. All patients with celiac disease should be referred to a registered dietitian nutritionist with expertise in celiac disease and a gastroenterologist who specializes in celiac disease and malabsorptive disorders, and they should remain on a strict gluten-free diet indefinitely. This article provides an overview of gluten- and wheat-related disorders.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • In Shackles
    • Authors: Dohlman JC.
      Abstract: Was it the weight of the shackles that prevented him from wiping the tear away, or was it something else'
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Rise Up
    • Authors: Collins LF.
      Abstract: We must do better. These men deserve better.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Effects of Nutritional Supplements and Dietary Interventions on
           Cardiovascular Outcomes
    • Authors: Cornell JE; Mulrow CD.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Effects of Nutritional Supplements and Dietary Interventions on
           Cardiovascular Outcomes
    • Authors: Mayer M.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Effects of Nutritional Supplements and Dietary Interventions on
           Cardiovascular Outcomes
    • Authors: Kivelä JM.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Development of the European Commission Initiative on Breast Cancer
           Guidelines
    • Authors: Schünemann HJ; Alonso-Coello P, Gräwingholt A, et al.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Development of the European Commission Initiative on Breast Cancer
           Guidelines
    • Authors: Watine J.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Annals Graphic Medicine - Broken Speech
    • Authors: Wu CA; Myers KR, Schein ZS, et al.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Should Health Care Demand Interpretable Artificial Intelligence or Accept
           “Black Box” Medicine'
    • Authors: Wang F; Kaushal R, Khullar D.
      Abstract: Health care applications of artificial intelligence (AI) have recently emerged. Artificial intelligence approaches, such as deep learning, rely on vast amounts of data and complex model structures with millions of parameters, making them difficult to understand. Thus, these models are often called “black boxes.” Should physicians and other stakeholders demand greater insight into how AI algorithms work'
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Correction: Effects of Nutritional Supplements and Dietary Interventions
           on Cardiovascular Outcomes
    • PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Accurately Predicting Cardiovascular Risk—and Acting on It
    • Authors: Kazi DS; Bibbins-Domingo K.
      Abstract: In this issue, Dodson and colleagues report the development of a prediction model for all-cause mortality 6 months after myocardial infarction among older adults that incorporates measures of functional impairment. The editorialists discuss the models; the increasing use of prediction models to identify patients at the highest risk; and the need to develop, test, and deploy interventions to help address their needs.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Effectiveness and Cost-Effectiveness of Human Papillomavirus Vaccination
           Through Age 45 Years in the United States
    • Authors: Laprise J; Chesson HW, Markowitz LE, et al.
      Abstract: Background:In the United States, the routine age for human papillomavirus (HPV) vaccination is 11 to 12 years, with catch-up vaccination through age 26 years for women and 21 years for men. U.S. vaccination policy on use of the 9-valent HPV vaccine in adult women and men is being reviewed.Objective:To evaluate the added population-level effectiveness and cost-effectiveness of extending the current U.S. HPV vaccination program to women aged 27 to 45 years and men aged 22 to 45 years.Design:The analysis used HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation), an individual-based transmission dynamic model of HPV infection and associated diseases, calibrated to age-specific U.S. data.Data Sources:Published data.Target Population:Women aged 27 to 45 years and men aged 22 to 45 years in the United States.Time Horizon:100 years.Perspective:Health care sector.Intervention:9-valent HPV vaccination.Outcome Measures:HPV-associated outcomes prevented and cost-effectiveness ratios.Results of Base-Case Analysis:The model predicts that the current U.S. HPV vaccination program will reduce the number of diagnoses of anogenital warts and cervical intraepithelial neoplasia of grade 2 or 3 and cases of cervical cancer and noncervical HPV-associated cancer by 82%, 80%, 59%, and 39%, respectively, over 100 years and is cost saving (vs. no vaccination). In contrast, extending vaccination to women and men aged 45 years is predicted to reduce these outcomes by an additional 0.4, 0.4, 0.2, and 0.2 percentage points, respectively. Vaccinating women and men up to age 30, 40, and 45 years is predicted to cost $830 000, $1 843 000, and $1 471 000, respectively, per quality-adjusted life-year gained (vs. current vaccination).Results of Sensitivity Analysis:Results were most sensitive to assumptions about natural immunity and progression rates after infection, historical vaccination coverage, and vaccine efficacy.Limitation:Uncertainty about the proportion of HPV-associated disease due to infections after age 26 years and about the level of herd effects from the current HPV vaccination program.Conclusion:The current HPV vaccination program is predicted to be cost saving. Extending vaccination to older ages is predicted to produce small additional health benefits and result in substantially higher incremental cost-effectiveness ratios than the current recommendation.Primary Funding Source:Centers for Disease Control and Prevention.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Predicting 6-Month Mortality for Older Adults Hospitalized With Acute
           Myocardial Infarction A Cohort Study
    • Authors: Dodson JA; Hajduk AM, Geda M, et al.
      Abstract: Background:Older adults with acute myocardial infarction (AMI) have higher prevalence of functional impairments, including deficits in cognition, strength, and sensory domains, than their younger counterparts.Objective:To develop and evaluate the prognostic utility of a risk model for 6-month post-AMI mortality in older adults that incorporates information about functional impairments.Design:Prospective cohort study. (ClinicalTrials.gov: NCT01755052).Setting:94 hospitals throughout the United States.Participants:3006 persons aged 75 years or older who were hospitalized with AMI and discharged alive.Measurements:Functional impairments were assessed during hospitalization via direct measurement (cognition, mobility, muscle strength) or self-report (vision, hearing). Clinical variables associated with mortality in prior risk models were ascertained by chart review. Seventy-two candidate variables were selected for inclusion, and backward selection and Bayesian model averaging were used to derive (n = 2004 participants) and validate (n = 1002 participants) a model for 6-month mortality.Results:Participants' mean age was 81.5 years, 44.4% were women, and 10.5% were nonwhite. There were 266 deaths (8.8%) within 6 months. The final risk model included 15 variables, 4 of which were not included in prior risk models: hearing impairment, mobility impairment, weight loss, and lower patient-reported health status. The model was well calibrated (Hosmer–Lemeshow P > 0.05) and showed good discrimination (area under the curve for the validation cohort = 0.84). Adding functional impairments significantly improved model performance, as evidenced by category-free net reclassification improvement indices of 0.21 (P = 0.008) for hearing impairment and 0.26 (P < 0.001) for mobility impairment.Limitation:The model was not externally validated.Conclusion:A newly developed model for 6-month post-AMI mortality in older adults was well calibrated and had good discriminatory ability. This model may be useful in decision making at hospital discharge.Primary Funding Source:National Heart, Lung, and Blood Institute of the National Institutes of Health.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • What Do the European Breast Cancer Screening Guidelines Portend for U.S.
           Practice'
    • Authors: Elmore JG; Lee CI.
      Abstract: This issue includes a summary of the European Breast Guidelines, developed by an international multidisciplinary panel and based on a high-quality evidence review of breast cancer screening in the context of European organized screening programs. The editorialists discuss the recommendations and their implications for women and clinicians in the United States.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Breast Cancer Screening and Diagnosis: A Synopsis of the European Breast
           Guidelines
    • Authors: Schünemann HJ; Lerda D, Quinn C, et al.
      Abstract: Description:The European Commission Initiative for Breast Cancer Screening and Diagnosis guidelines (European Breast Guidelines) are coordinated by the European Commission's Joint Research Centre. The target audience for the guidelines includes women, health professionals, and policymakers.Methods:An international guideline panel of 28 multidisciplinary members, including patients, developed questions and corresponding recommendations that were informed by systematic reviews of the evidence conducted between March 2016 and December 2018. GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests by enhancing transparency. Questions and recommendations, expressed as strong or conditional, focused on outcomes that matter to women and provided a rating of the certainty of evidence.Recommendations:This synopsis of the European Breast Guidelines provides recommendations regarding organized screening programs for women aged 40 to 75 years who are at average risk. The recommendations address digital mammography screening and the addition of hand-held ultrasonography, automated breast ultrasonography, or magnetic resonance imaging compared with mammography alone. The recommendations also discuss the frequency of screening and inform decision making for women at average risk who are recalled for suspicious lesions or who have high breast density.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • A Process for Assessing Products for Infection Prevention in Health Care
           Settings: A Framework From the Healthcare Infection Control Practices
           Advisory Committee of the Centers for Disease Control and Prevention
    • Authors: Chopra V; Janssen L, Bryant K, et al.
      Abstract: Infection control is a complex task that spans people, products, and practices in diverse settings. For years, the Healthcare Infection Control Practices Advisory Committee (HICPAC) has provided advice and guidance to the Centers for Disease Control and Prevention (CDC) on how best to prevent infections. These recommendations have focused largely on health care delivery practices and occasionally on general categories of products. With an influx of novel infection control products and growing use of these products by frontline clinicians, an efficient process for developing transparent, rigorous product recommendations that includes myriad data sources was necessary. To address this gap, the CDC asked HICPAC to develop a process that would help inform committees considering product-related recommendations. This article describes the process to develop this approach and provides an outline of how the tool may be used when products with infection control claims are recommended in guidelines or recommendations for infection prevention.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the
           3 Wishes Project
    • Authors: Vanstone M; Neville TH, Clarke FJ, et al.
      Abstract: Background:The 3 Wishes Project (3WP) is an end-of-life program that aims to honor the dignity of dying patients by creating meaningful patient- and family-centered memories while promoting humanistic interprofessional care.Objective:To determine whether this palliative intervention could be successfully implemented—defined as demonstrating value, transferability, affordability, and sustainability—beyond the intensive care unit in which it was created.Design:Mixed-methods formative program evaluation. (ClinicalTrials.gov: NCT04147169)Setting:4 North American intensive care units.Participants:Dying patients, their families, clinicians, hospital managers, and administrators.Intervention:Wishes from dying patients, family members, and clinicians were elicited and implemented.Measurements:Patient characteristics and processes of care; the number, type, and cost of each wish; and semistructured interviews and focus groups with family members, clinicians, and managers.Results:A total of 730 patients were enrolled, and 3407 wishes were elicited. Qualitative data were gathered from 75 family members, 72 clinicians, and 20 managers or hospital administrators. Value included intentional comforting of families as they honored the lives and legacies of their loved ones while inspiring compassionate clinical care. Factors promoting transferability included family appreciation and a collaborative intensive care unit culture committed to dignity-conserving end-of-life care. Staff participation evolved from passive support to professional agency. Program initiation required minimal investment for reusable materials; thereafter, the mean cost was $5.19 (SD, $17.14) per wish. Sustainability was demonstrated by the continuation of 3WP at each site after study completion.Limitation:This descriptive formative evaluation describes tertiary care center–specific experiences rather than aiming for generalizability to all jurisdictions.Conclusion:The 3WP is a transferrable, affordable, and sustainable program that provides value to dying patients, their families, clinicians, and institutions.Primary Funding Source:Greenwall Foundation.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Advancing Personalized Medicine Through Prediction
    • Authors: Localio A; Mulrow CD, Griswold ME.
      Abstract: Kent and colleagues describe 2 alternatives to subgroup analyses to help personalize clinical trial results: “risk modeling” and “effect modeling.” The editorialists commend the authors for moving beyond subgroup analyses and look forward to methodological enhancements that address the substantial complexities of identifying and evaluating treatment effect heterogeneity.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • The Predictive Approaches to Treatment effect Heterogeneity (PATH)
           Statement: Explanation and Elaboration
    • Authors: Kent DM; van Klaveren D, Paulus JK, et al.
      Abstract: The PATH (Predictive Approaches to Treatment effect Heterogeneity) Statement was developed to promote the conduct of, and provide guidance for, predictive analyses of heterogeneity of treatment effects (HTE) in clinical trials. The goal of predictive HTE analysis is to provide patient-centered estimates of outcome risk with versus without the intervention, taking into account all relevant patient attributes simultaneously, to support more personalized clinical decision making than can be made on the basis of only an overall average treatment effect. The authors distinguished 2 categories of predictive HTE approaches (a “risk-modeling” and an “effect-modeling” approach) and developed 4 sets of guidance statements: criteria to determine when risk-modeling approaches are likely to identify clinically meaningful HTE, methodological aspects of risk-modeling methods, considerations for translation to clinical practice, and considerations and caveats in the use of effect-modeling approaches. They discuss limitations of these methods and enumerate research priorities for advancing methods designed to generate more personalized evidence. This explanation and elaboration document describes the intent and rationale of each recommendation and discusses related analytic considerations, caveats, and reservations.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • The Predictive Approaches to Treatment effect Heterogeneity (PATH)
           Statement
    • Authors: Kent DM; Paulus JK, van Klaveren D, et al.
      Abstract: Heterogeneity of treatment effect (HTE) refers to the nonrandom variation in the magnitude or direction of a treatment effect across levels of a covariate, as measured on a selected scale, against a clinical outcome. In randomized controlled trials (RCTs), HTE is typically examined through a subgroup analysis that contrasts effects in groups of patients defined “1 variable at a time” (for example, male vs. female or old vs. young). The authors of this statement present guidance on an alternative approach to HTE analysis, “predictive HTE analysis.” The goal of predictive HTE analysis is to provide patient-centered estimates of outcome risks with versus without the intervention, taking into account all relevant patient attributes simultaneously. The PATH (Predictive Approaches to Treatment effect Heterogeneity) Statement was developed using a multidisciplinary technical expert panel, targeted literature reviews, simulations to characterize potential problems with predictive approaches, and a deliberative process engaging the expert panel. The authors distinguish 2 categories of predictive HTE approaches: a “risk-modeling” approach, wherein a multivariable model predicts the risk for an outcome and is applied to disaggregate patients within RCTs to define risk-based variation in benefit, and an “effect-modeling” approach, wherein a model is developed on RCT data by incorporating a term for treatment assignment and interactions between treatment and baseline covariates. Both approaches can be used to predict differential absolute treatment effects, the most relevant scale for clinical decision making. The authors developed 4 sets of guidance: criteria to determine when risk-modeling approaches are likely to identify clinically important HTE, methodological aspects of risk-modeling methods, considerations for translation to clinical practice, and considerations and caveats in the use of effect-modeling approaches. The PATH Statement, together with its explanation and elaboration document, may guide future analyses and reporting of RCTs.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • An Emerging Crisis: Vaping-Associated Pulmonary Injury
    • Authors: Hooper RW; II, Garfield JL.
      Abstract: In the context of the emergence of vaping-associated pulmonary injury (VAPI), this commentary discusses what we know about the health effects of vaping and, more important, what we need to learn. Research on the respiratory toxicity of vaporized e-cigarette compounds and cannabis extracts, population studies on consumption patterns, and increased physician attention are urgently needed to mitigate the effects of VAPI.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
  • Prescription Bias in the Treatment of Chronic Systolic Heart Failure
    • Authors: Arfsten H; Goliasch G, Pavo N, et al.
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
       
 
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