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Annals of Internal Medicine
Journal Prestige (SJR): 7.466
Citation Impact (citeScore): 4
Number of Followers: 306  
  Full-text available via subscription Subscription journal
ISSN (Print) 0003-4819 - ISSN (Online) 1539-3704
Published by American College of Physicians Homepage  [4 journals]
  • Receipt of Overlapping Opioid and Benzodiazepine Prescriptions Among
           Veterans Dually Enrolled in Medicare Part D and the Department of Veterans
           Affairs A Cross-sectional Study
    • Authors: Carico R; Zhao X, Thorpe CT, et al.
      Abstract: Background:Overlapping use of opioids and benzodiazepines is associated with increased risk for overdose. Veterans receiving medications concurrently from the U.S. Department of Veterans Affairs (VA) and Medicare may be at higher risk for such overlap.Objective:To assess the association between dual use of VA and Medicare drug benefits and receipt of overlapping opioid and benzodiazepine prescriptions.Design:Cross-sectional.Setting:VA and Medicare.Participants:All veterans enrolled in VA and Medicare Part D who filled at least 2 opioid prescriptions in 2013 (n = 368 891).Measurements:Outcomes were the proportion of patients with a Pharmacy Quality Alliance (PQA) measure of opioid–benzodiazepine overlap (≥2 filled prescriptions for benzodiazepines with ≥30 days of overlap with opioids) and the proportion of patients with high-dose opioid–benzodiazepine overlap (≥30 days of overlap with a daily opioid dose >120 morphine milligram equivalents). Augmented inverse probability weighting regression was used to compare these measures by prescription drug source: VA only, Medicare only, or VA and Medicare (dual use).Results:Of 368 891 eligible veterans, 18.3% received prescriptions from the VA only, 30.3% from Medicare only, and 51.4% from both VA and Medicare. The proportion with PQA opioid–benzodiazepine overlap was larger for the dual-use group than the VA-only group (23.1% vs. 17.3%; adjusted risk ratio [aRR], 1.27 [95% CI, 1.24 to 1.30]) and Medicare-only group (23.1% vs. 16.5%; aRR, 1.12 [CI, 1.10 to 1.14]). The proportion with high-dose overlap was also larger for the dual-use group than the VA-only group (4.7% vs. 2.3%; aRR, 2.23 [CI, 2.10 to 2.36]) and Medicare-only group (4.7% vs. 2.9%; aRR, 1.06 [CI, 1.02 to 1.11]).Limitation:Data are from 2013 and cannot capture medications purchased without insurance; unmeasured confounding may remain in this cross-sectional study.Conclusion:Among a national cohort of veterans dually enrolled in VA and Medicare, receiving prescriptions from both sources was associated with greater risk for receiving potentially unsafe overlapping prescriptions for opioids and benzodiazepines.Primary Funding Source:U.S. Department of Veterans Affairs.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Divergent Long-Term Detection Rates of Proximal and Distal Advanced
           Neoplasia in Fecal Immunochemical Test Screening Programs A Retrospective
           Cohort Study
    • Authors: Zorzi M; Hassan C, Capodaglio G, et al.
      Abstract: Background:Short-term studies have reported that the fecal immunochemical test (FIT) is less accurate in detecting proximal than distal colorectal neoplasia.Objective:To assess the long-term detection rates for advanced adenoma and colorectal cancer (CRC), according to anatomical location.Design:Retrospective study.Setting:Population-based, organized screening program in the Veneto region of Italy.Participants:Persons aged 50 to 69 years who completed 6 rounds of FIT screening.Measurements:At each screening round, the detection rates for advanced adenoma and cancer, as well as the proportional interval cancer rate (PICR), were calculated by anatomical location (proximal colon, distal colon, or rectum).Results:Between 2002 and 2014, a total of 123 347 participants had 441 647 FITs. The numbers of advanced adenomas and cancer cases detected, respectively, were 1704 and 200 in the proximal colon, 3703 and 324 in the distal colon, and 1220 and 209 in the rectum. Although the detection rate for proximal colon cancer declined only from the first to the second screening round (0.63 to 0.36 per 1000 screenees), the rate for both distal colon and rectal cancer steadily decreased across 6 rounds (distal colon, 1.65 in the first round to 0.17 in the sixth; rectum, 0.82 in the first round to 0.17 in the sixth). Similar trends were found for advanced adenoma (proximal colon, 5.32 in the first round to 4.22 in the sixth; distal colon, 15.2 in the first round to 5.02 in the sixth). Overall, 150 cases of interval cancer were diagnosed. The PICR was higher in the proximal colon (25.2% [95% CI, 19.9% to 31.5%]) than the distal colon (6.0% [CI, 3.9% to 8.9%]) or rectum (9.9% [CI, 6.9% to 13.7%]).Limitations:Participants with irregular attendance were censored. Those who had a false-positive result on a previous FIT but negative colonoscopy results were included in subsequent rounds.Conclusion:This FIT-based, multiple-round, long-term screening program had a negligible reduction in detection rates for neoplastic lesions in the proximal versus the distal colon after the first round. This was related to a higher PICR in the proximal colon and suboptimal efficacy in preventing the age-related proximal shifting of CRC.Primary Funding Source:None.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Kidney Damage Biomarkers and Incident Chronic Kidney Disease During Blood
           Pressure Reduction A Case–Control Study
    • Authors: Zhang WR; Craven TE, Malhotra R, et al.
      Abstract: Background:Whether the increased incidence of chronic kidney disease (CKD) during intensive systolic blood pressure (SBP) lowering is accompanied by intrinsic kidney injury is unknown.Objective:To compare changes in kidney damage biomarkers between incident CKD case participants and matched control participants as well as between case participants in the intensive (<120 mm Hg) versus the standard (<140 mm Hg) SBP management groups of SPRINT (Systolic Blood Pressure Intervention Trial).Design:Nested case–control study within SPRINT.Setting:Adults with hypertension without baseline kidney disease.Participants:Case participants (n = 162), who developed incident CKD during trial follow-up (128 in the intensive and 34 in the standard group), and control participants (n = 162) without incident CKD, who were matched on age, sex, race, baseline estimated glomerular filtration rate, and randomization group.Measurements:9 urinary biomarkers of kidney damage were measured at baseline and at 1 year. Linear mixed-effects models were used to estimate 1-year biomarker changes.Results:Higher concentrations of urinary albumin, kidney injury molecule-1, and monocyte chemoattractant protein-1 at baseline were significantly associated with greater odds of incident CKD (adjusted odds ratio per doubling: 1.50 [95% CI, 1.14 to 1.98], 1.51 [CI, 1.05 to 2.17], and 1.70 [CI, 1.13 to 2.56], respectively). After 1 year of blood pressure intervention, incident CKD case participants in the intensive group had significantly greater decreases in albumin–creatinine ratio (ACR), interleukin-18, anti–chitinase-3-like protein 1 (YKL-40), and uromodulin than the matched control participants. Compared with case participants in the standard group, those in the intensive group had significantly greater decreases in ACR, β2-microglobulin, α1-microglobulin, YKL-40, and uromodulin.Limitation:Biomarker measurements were available only at baseline and 1 year.Conclusion:Incident CKD in the setting of intensive SBP lowering was accompanied by decreases, rather than elevations, in levels of kidney damage biomarkers and thus may reflect benign changes in renal blood flow rather than intrinsic injury.Primary Funding Source:National Institute for Diabetes and Digestive and Kidney Diseases.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Clinical Outcomes Associated With Sickle Cell Trait A Systematic Review
    • Authors: Naik RP; Smith-Whitley K, Hassell KL, et al.
      Abstract: Background:Although sickle cell trait (SCT) is largely a benign carrier state, it may increase risk for certain clinical outcomes.Purpose:To evaluate associations between SCT and clinical outcomes in children and adults.Data Sources:English-language searches of PubMed, CINAHL, the Cochrane Library, Current Contents Connect, Scopus, and Embase (1 January 1970 to 30 June 2018) and bibliographies of review articles.Study Selection:Observational controlled studies (published in English) in children or adults that examined an association between SCT and any of 24 clinical outcomes specified a priori in the following 6 categories: exertion-related injury; renal, vascular, pediatric, and surgery- or trauma-related outcomes; and overall mortality.Data Extraction:A single reviewer extracted study data, which was checked by another; 2 reviewers independently assessed study quality; and strength of evidence was assessed by consensus.Data Synthesis:Of 7083 screened studies, 41 met inclusion criteria. High-strength evidence supported a positive association between SCT and risk for pulmonary embolism, proteinuria, and chronic kidney disease. Moderate-strength evidence supported a positive association between SCT and exertional rhabdomyolysis and a null association between SCT and deep venous thrombosis, heart failure or cardiomyopathy, stroke, and pediatric height or weight. Absolute risks for thromboembolism and rhabdomyolysis were small. For the remaining 15 clinical outcomes, data were insufficient or strength of evidence was low.Limitation:Publication bias was possible, and high-quality evidence was scant.Conclusion:Sickle cell trait is a risk factor for a few adverse health outcomes, such as pulmonary embolism, kidney disease, and exertional rhabdomyolysis, but does not seem to be associated with such complications as heart failure and stroke. Insufficient data or low-strength evidence exists for most speculated complications of SCT.Primary Funding Source:National Human Genome Research Institute.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Ten Principles for More Conservative, Care-Full Diagnosis
    • Authors: Schiff GD; Martin SA, Eidelman DH, et al.
      Abstract: Physicians must navigate a balance between under- and overdiagnosis, both of which may harm patients. The authors discuss core principles to help find this balance and foster a thoughtful, patient-centered, more conservative approach to diagnosis.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Reconciling the Discrepancies in Medicine's Relationship to Medical
    • Authors: Braun I; Tulsky J.
      Abstract: Despite medical marijuana's increasing use and acceptance, physician understanding of the risks and benefits of its use, guidance from medical associations, and accommodations for documentation in electronic health records are lacking. The authors discuss these gaps, why they exist, and what can be done to address them.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Disappearance of the National Guideline Clearinghouse: A Huge Loss for
           Evidence-Based Health Care
    • Authors: Munn Z; Qaseem A, .
      Abstract: Evidence-based guidelines play a pivotal role in optimizing quality of care and improving clinical outcomes for patients. In recognition of this important role, the National Guideline Clearinghouse (NGC) was created in 1998. In July 2018, the NGC went dark because of the federal government's budgetary cuts. This commentary discusses the potential negative consequences of this action.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • The Next Stage of Buprenorphine Care for Opioid Use Disorder
    • Authors: Martin SA; Chiodo LM, Bosse JD, et al.
      Abstract: Buprenorphine has been used internationally for the treatment of opioid use disorder (OUD) since the 1990s and has been available in the United States for more than a decade. Initial practice recommendations were intentionally conservative, were based on expert opinion, and were influenced by methadone regulations. Since 2003, the American crisis of OUD has dramatically worsened, and much related empirical research has been undertaken. The findings in several important areas conflict with initial clinical practice that is still prevalent. This article reviews research findings in the following 7 areas: location of buprenorphine induction, combining buprenorphine with a benzodiazepine, relapse during buprenorphine treatment, requirements for counseling, uses of drug testing, use of other substances during buprenorphine treatment, and duration of buprenorphine treatment. For each area, evidence for needed updates and modifications in practice is provided. These modifications will facilitate more successful, evidence-based treatment and care for patients with OUD.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Swan, Ganz, and Their Catheter: Its Evolution Over the Past Half Century
    • Authors: Thakkar AB; Desai SP.
      Abstract: Jeremy Swan and William Ganz developed their eponymous pulmonary artery (PA) catheter in the 1970s and, in the process, revolutionized measurement of cardiac output, pressures within the left side of the heart, and resistance in systemic and pulmonary circulations. Their invention enabled diagnostic measurements at the bedside and contributed to the birth of critical care medicine; technologic advances preceding the PA catheter generally could not be used at the bedside and required patients to be stable enough to be taken to the catheterization laboratory. Swan and Ganz worked in the same department but had quite dissimilar backgrounds and personalities. This article describes their lives and careers, the state of intensive care before and after their catheter was introduced, and the natural life cycle the PA catheter faced as new, less invasive technology arrived to replace it.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • In Screening for Colorectal Cancer, Is the FIT Right for the Right Side of
           the Colon'
    • Authors: Doubeni CA; Levin TR.
      Abstract: Zorzi and colleagues reported on the yield from 6 rounds of biennial colorectal cancer screening with the fecal immunochemical test (FIT) from 2002 to 2015 in a fixed cohort. The editorialists discuss the study findings, the advantages of FIT, and the need for studies to examine whether screening with FIT prevents right colon cancer deaths.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Time to Change the Way We Approach Opioid Use Disorder: A Challenge to the
           Status Quo
    • Authors: Hawk K; D'Onofrio G.
      Abstract: In their article, Martin and colleagues address buprenorphine treatment for opioid use disorder. The editorialists discuss the findings and why they believe that we need to disrupt current practice and change our approach to treatment of persons with opioid use disorder.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Unequal Pay for Equal Work: Where Are We Now'
    • Authors: Saunders MR; Turner BJ.
      Abstract: Read and colleagues' cross-sectional survey of internists showed that the salary gap between women and men in the medical profession has long been an unfortunate, unconscionable norm that persists in internal medicine. The editorialists discuss the findings and speculate about strategies that could promote gender equity in physician compensation.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Want Fries With That'
    • Authors: Loper P; Jr..
      Abstract: How might we be delivered from both this fast-food addiction and the addictions promoted by our health care system'
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Interactions Between Physicians and Skilled Home Health Care Agencies in
           Certification of Plans of Care
    • Authors: Zheng B; Niu P.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Interactions Between Physicians and Skilled Home Health Care Agencies in
           Certification of Plans of Care
    • Authors: Boyd CM; Leff B, Wolff JL, et al.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine
    • Authors: Davies T.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine
    • Authors: Duru UB; Pawar G, Barash JA, et al.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Long-Term Effectiveness of Sigmoidoscopy Screening in Women and Men
    • Authors: Shaukat A; Church TR.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Long-Term Effectiveness of Sigmoidoscopy Screening in Women and Men
    • Authors: Holme Ø; Løberg M, Kalager M, et al.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Correction: Disappearance of the National Guideline Clearinghouse
    • PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Annals for Educators - 6 November 2018
    • Authors: Taichman DB.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Nonalcoholic Fatty Liver Disease
    • Authors: Wang X; Malhi H.
      Abstract: Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease. Most cases are diagnosed incidentally in the primary care or hospital setting on the basis of elevated liver enzyme levels or hepatic steatosis on imaging. NAFLD encompasses a wide spectrum: The vast majority of patients have nonprogressive nonalcoholic fatty liver, and a few of those develop progressive liver injury, inflammation, and fibrosis, a condition termed nonalcoholic steatohepatitis. Cardiovascular disease is the leading cause of death in patients with nonalcoholic fatty liver disease. Persons with nonalcoholic steatohepatitis have increased liver-related mortality. In the absence of regulatory agency–approved drugs, lifestyle modification and weight loss remain the cornerstones of NAFLD therapy.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Annals On Call - Improving Estimation of Cardiovascular Risk
    • Authors: Centor RM; Hayward RA.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Annals Graphic Medicine - Paused
    • Authors: Steinberg E.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Fecal Immunochemical Test Screening for Colon and Rectal Cancer
    • PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Recurrent Renal Cysts in a Transplanted Kidney
    • Authors: Park M; Nussbaum RL.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
  • Compensation Disparities by Gender in Internal Medicine
    • Authors: Read S; Butkus R, Weissman A, et al.
      PubDate: Tue, 06 Nov 2018 00:00:00 GMT
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