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Comprehensive Nicotine Regulation to End the Combustible Tobacco Epidemic.

Comprehensive Nicotine Regulation to End the Combustible Tobacco Epidemic.

Ann Intern Med. 2017 Aug 15;:

Authors: Benowitz NL

PMID: 28806818 [PubMed - as supplied by publisher]




The Effects of Cannabis Among Adults With Chronic Pain and an Overview of General Harms: A Systematic Review.

The Effects of Cannabis Among Adults With Chronic Pain and an Overview of General Harms: A Systematic Review.

Ann Intern Med. 2017 Aug 15;:

Authors: Nugent SM, Morasco BJ, O'Neil ME, Freeman M, Low A, Kondo K, Elven C, Zakher B, Motu'apuaka M, Paynter R, Kansagara D

Abstract
Background: Cannabis is increasingly available for the treatment of chronic pain, yet its efficacy remains uncertain.
Purpose: To review the benefits of plant-based cannabis preparations for treating chronic pain in adults and the harms of cannabis use in chronic pain and general adult populations.
Data Sources: MEDLINE, Cochrane Database of Systematic Reviews, and several other sources from database inception to March 2017.
Study Selection: Intervention trials and observational studies, published in English, involving adults using plant-based cannabis preparations that reported pain, quality of life, or adverse effect outcomes.
Data Extraction: Two investigators independently abstracted study characteristics and assessed study quality, and the investigator group graded the overall strength of evidence using standard criteria.
Data Synthesis: From 27 chronic pain trials, there is low-strength evidence that cannabis alleviates neuropathic pain but insufficient evidence in other pain populations. According to 11 systematic reviews and 32 primary studies, harms in general population studies include increased risk for motor vehicle accidents, psychotic symptoms, and short-term cognitive impairment. Although adverse pulmonary effects were not seen in younger populations, evidence on most other long-term physical harms, in heavy or long-term cannabis users, or in older populations is insufficient.
Limitation: Few methodologically rigorous trials; the cannabis formulations studied may not reflect commercially available products; and limited applicability to older, chronically ill populations and patients who use cannabis heavily.
Conclusion: Limited evidence suggests that cannabis may alleviate neuropathic pain in some patients, but insufficient evidence exists for other types of chronic pain. Among general populations, limited evidence suggests that cannabis is associated with an increased risk for adverse mental health effects.
Primary Funding Source: U.S. Department of Veterans Affairs. (PROSPERO: CRD42016033623).

PMID: 28806817 [PubMed - as supplied by publisher]




The Determinants of Dying Where We Choose: An Analysis of Coordinate My Care.

The Determinants of Dying Where We Choose: An Analysis of Coordinate My Care.

Ann Intern Med. 2017 Aug 15;:

Authors: Callender T, Riley J, Droney J, Broadhurst H, Wiggins N, Shaw A, Archer S, Darzi A

PMID: 28806816 [PubMed - as supplied by publisher]




Annals for Hospitalists - 15 August 2017.

Annals for Hospitalists - 15 August 2017.

Ann Intern Med. 2017 Aug 15;167(4):HO1

Authors: Wesorick DH, Chopra V

PMID: 28806815 [PubMed - in process]




Annals for Educators - 15 August 2017.

Annals for Educators - 15 August 2017.

Ann Intern Med. 2017 Aug 15;167(4):ED4

Authors: Taichman DB

PMID: 28806814 [PubMed - in process]




Annals Consult Guys - Is It Statin Myalgia? What a Pain!

Annals Consult Guys - Is It Statin Myalgia? What a Pain!

Ann Intern Med. 2017 Aug 15;167(4):CG1

Authors: Merli GJ, Weitz HH

PMID: 28806813 [PubMed - in process]




Annals for Hospitalists Inpatient Notes - Sensemaking-Fostering a Shared Understanding in Clinical Teams.

Annals for Hospitalists Inpatient Notes - Sensemaking-Fostering a Shared Understanding in Clinical Teams.

Ann Intern Med. 2017 Aug 15;167(4):HO2-HO3

Authors: Leykum LK, O'Leary K

PMID: 28806812 [PubMed - in process]




Correction: Effectiveness of a Multicomponent Quality Improvement Strategy to Improve Achievement of Diabetes Care Goals.

Correction: Effectiveness of a Multicomponent Quality Improvement Strategy to Improve Achievement of Diabetes Care Goals.

Ann Intern Med. 2017 Aug 15;167(4):292

Authors:

PMID: 28806811 [PubMed - in process]




Correction: The Relationship of Obesity to Hospice Use and Expenditures.

Correction: The Relationship of Obesity to Hospice Use and Expenditures.

Ann Intern Med. 2017 Aug 15;167(4):292

Authors:

PMID: 28806810 [PubMed - in process]




Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older.

Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older.

Ann Intern Med. 2017 Aug 15;167(4):288-289

Authors: Weiss J, Kansagara D

PMID: 28806809 [PubMed - in process]




Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older.

Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older.

Ann Intern Med. 2017 Aug 15;167(4):288

Authors: Bahat G, Ilhan B, Tufan A, Karan MA

PMID: 28806808 [PubMed - in process]




Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older.

Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older.

Ann Intern Med. 2017 Aug 15;167(4):291-292

Authors: Kansagara D, Wilt TJ, Frost J, Qaseem A

PMID: 28806807 [PubMed - in process]




Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older.

Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older.

Ann Intern Med. 2017 Aug 15;167(4):289-290

Authors: Rabi DM, Daskalopoulou SS, Leung AA, Dresser G, Padwal R, Khan N

PMID: 28806806 [PubMed - in process]




Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older.

Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older.

Ann Intern Med. 2017 Aug 15;167(4):290-291

Authors: Cushman WC, Johnson KC, Applegate WB, Cutler JA

PMID: 28806805 [PubMed - in process]




Review: A single hs-cTnT with a cutpoint < limit of detection plus a nonischemic ECG can rule out acute MI.

Review: A single hs-cTnT with a cutpoint < limit of detection plus a nonischemic ECG can rule out acute MI.

Ann Intern Med. 2017 Aug 15;167(4):JC23

Authors: Rymer JA, Granger CB

PMID: 28806804 [PubMed - in process]




In patients with chest pain, HEART score-guided and usual care did not differ for MACE or health care use.

In patients with chest pain, HEART score-guided and usual care did not differ for MACE or health care use.

Ann Intern Med. 2017 Aug 15;167(4):JC22

Authors: Hunter BR

PMID: 28806803 [PubMed - in process]




In nonvalvular AF, DOAC-related risk for GI bleeding was lower with apixaban than dabigatran or rivaroxaban.

In nonvalvular AF, DOAC-related risk for GI bleeding was lower with apixaban than dabigatran or rivaroxaban.

Ann Intern Med. 2017 Aug 15;167(4):JC21

Authors: Koretz RL

PMID: 28806802 [PubMed - in process]




Short-term use of oral corticosteroids was linked to increased risk for sepsis, VTE, and fractures.

Short-term use of oral corticosteroids was linked to increased risk for sepsis, VTE, and fractures.

Ann Intern Med. 2017 Aug 15;167(4):JC20

Authors: Rowland K

PMID: 28806801 [PubMed - in process]




Review: Osteoporosis drugs may improve BMD and reduce fractures in some patients with CKD.

Review: Osteoporosis drugs may improve BMD and reduce fractures in some patients with CKD.

Ann Intern Med. 2017 Aug 15;167(4):JC19

Authors: Ott SM

PMID: 28806800 [PubMed - in process]




Review: CPAP improves QoL in obstructive sleep apnea; effects not as clear for mandibular advancement devices.

Review: CPAP improves QoL in obstructive sleep apnea; effects not as clear for mandibular advancement devices.

Ann Intern Med. 2017 Aug 15;167(4):JC18

Authors: O'Donoghue F, McDonald C

PMID: 28806799 [PubMed - in process]




In high-risk patients with arthritis and previous upper GI bleeding, celecoxib vs naproxen reduced recurrent bleeding.

In high-risk patients with arthritis and previous upper GI bleeding, celecoxib vs naproxen reduced recurrent bleeding.

Ann Intern Med. 2017 Aug 15;167(4):JC17

Authors: Chan N, Weitz J

PMID: 28806798 [PubMed - in process]




Dexamethasone did not increase resolution of acute sore throat symptoms at 24 hours.

Dexamethasone did not increase resolution of acute sore throat symptoms at 24 hours.

Ann Intern Med. 2017 Aug 15;167(4):JC16

Authors: Fekete T

PMID: 28806797 [PubMed - in process]




In type 1 diabetes, education with either insulin pumps or daily injections did not differ for HbA1c at 2 y.

In type 1 diabetes, education with either insulin pumps or daily injections did not differ for HbA1c at 2 y.

Ann Intern Med. 2017 Aug 15;167(4):JC15

Authors: Lipscombe LL

PMID: 28806796 [PubMed - in process]




In older adults with subclinical hypothyroidism, levothyroxine did not improve symptoms or tiredness.

In older adults with subclinical hypothyroidism, levothyroxine did not improve symptoms or tiredness.

Ann Intern Med. 2017 Aug 15;167(4):JC14

Authors: Shah R

PMID: 28806795 [PubMed - in process]




Benefits and Harms of Plant-Based Cannabis for Posttraumatic Stress Disorder: A Systematic Review.

Benefits and Harms of Plant-Based Cannabis for Posttraumatic Stress Disorder: A Systematic Review.

Ann Intern Med. 2017 Aug 15;:

Authors: O'Neil ME, Nugent SM, Morasco BJ, Freeman M, Low A, Kondo K, Zakher B, Elven C, Motu'apuaka M, Paynter R, Kansagara D

Abstract
Background: Cannabis is available from medical dispensaries for treating posttraumatic stress disorder (PTSD) in many states of the union, yet its efficacy in treating PTSD symptoms remains uncertain.
Purpose: To identify ongoing studies and review existing evidence regarding the benefits and harms of plant-based cannabis preparations in treating PTSD in adults.
Data Sources: MEDLINE, the Cochrane Library, and other sources from database inception to March 2017.
Study Selection: English-language systematic reviews, trials, and observational studies with a control group that reported PTSD symptoms and adverse effects of plant-based cannabis use in adults with PTSD.
Data Extraction: Study data extracted by 1 investigator was checked by a second reviewer; 2 reviewers independently assessed study quality, and the investigator group graded the overall strength of evidence by using standard criteria.
Data Synthesis: Two systematic reviews, 3 observational studies, and no randomized trials were found. The systematic reviews reported insufficient evidence to draw conclusions about benefits and harms. The observational studies found that compared with nonuse, cannabis did not reduce PTSD symptoms. Studies had medium and high risk of bias, and overall evidence was judged insufficient. Two randomized trials and 6 other studies examining outcomes of cannabis use in patients with PTSD are ongoing and are expected to be completed within 3 years.
Limitation: Very scant evidence with medium to high risk of bias.
Conclusion: Evidence is insufficient to draw conclusions about the benefits and harms of plant-based cannabis preparations in patients with PTSD, but several ongoing studies may soon provide important results.
Primary Funding Source: U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. (PROSPERO: CRD42016033623).

PMID: 28806794 [PubMed - as supplied by publisher]




Holding Providers Accountable for Health Care Outcomes.

Holding Providers Accountable for Health Care Outcomes.

Ann Intern Med. 2017 Aug 15;:

Authors: Baker DW, Chassin MR

Abstract
Federal public reporting and payment programs have increasingly emphasized the measurement of outcomes (such as readmission, health care-associated infections, and mortality). Yet, the criteria for assessing whether outcome measures are accurate and valid enough to use for public reporting, payment, and accreditation are not well-defined. An outcome measure should be used only if the outcome can be influenced substantially by providers (that is, a strong process-outcome link exists) and statistical adjustment can be made for differences in patient populations across providers so that differences in outcomes are truly attributable to differences in the care provided. Validly distinguishing differences in quality of care across providers requires precision in both the design of the outcome measure and the actual recording of all the measure's elements. Four criteria are proposed to assess outcome measures. First, strong evidence should exist that good medical care leads to improvement in the outcome within the time period for the measure. Second, the outcome should be measurable with a high degree of precision. Third, the risk-adjustment methodology should include and accurately measure the risk factors most strongly associated with the outcome. Fourth, implementation of the outcome measure must have little chance of inducing unintended adverse consequences. These criteria were applied to 10 outcome measures currently used or proposed for accountability programs. Three measures met all 4 criteria; 5, including all 4 claims-based 30-day mortality measures, failed to meet 1 or more criteria. Patient-reported outcome measures are problematic, because low response rates may cause bias. These findings raise concerns and suggest the need for a national dialogue about how to judge outcome measures currently in use or proposed for the future.

PMID: 28806793 [PubMed - as supplied by publisher]




Moving to Measures That Matter and Motivate Change.

Moving to Measures That Matter and Motivate Change.

Ann Intern Med. 2017 Aug 15;:

Authors: Burstin H, Agrawal S, Qaseem A

PMID: 28806792 [PubMed - as supplied by publisher]




Effect of Access to an Electronic Medical Resource on Performance Characteristics of a Certification Examination: A Randomized Controlled Trial.

Effect of Access to an Electronic Medical Resource on Performance Characteristics of a Certification Examination: A Randomized Controlled Trial.

Ann Intern Med. 2017 Aug 15;:

Authors: Lipner RS, Brossman BG, Samonte KM, Durning SJ

Abstract
Background: Electronic resources are increasingly used in medical practice. Their use during high-stakes certification examinations has been advocated by many experts, but whether doing so would affect the capacity to differentiate between high and low abilities is unknown.
Objective: To determine the effect of electronic resources on examination performance characteristics.
Design: Randomized controlled trial.
Setting: Medical certification program.
Participants: 825 physicians initially certified by the American Board of Internal Medicine (ABIM) who passed the Internal Medicine Certification examination or sat for the Internal Medicine Maintenance of Certification (IM-MOC) examination in 2012 to 2015.
Intervention: Participants were randomly assigned to 1 of 4 conditions: closed book using typical or additional time, or open book (that is, UpToDate [Wolters Kluwer]) using typical or additional time. All participants took the same modified version of the IM-MOC examination.
Measurements: Primary outcomes included item difficulty (how easy or difficult the question was), item discrimination (how well the question differentiated between high and low abilities), and average question response time. Secondary outcomes included examination dimensionality (that is, the number of factors measured) and test-taking strategy. Item response theory was used to calculate question characteristics. Analysis of variance compared differences among conditions.
Results: Closed-book conditions took significantly less time than open-book conditions (mean, 79.2 seconds [95% CI, 78.5 to 79.9 seconds] vs. 110.3 seconds [CI, 109.2 to 111.4 seconds] per question). Mean discrimination was statistically significantly higher for open-book conditions (0.34 [CI, 0.32 to 0.35] vs. 0.39 [CI, 0.37 to 0.41] per question). A strong single dimension showed that the examination measured the same factor with or without the resource.
Limitation: Only 1 electronic resource was evaluated.
Conclusion: Inclusion of an electronic resource with time constraints did not adversely affect test performance and did not change the specific skill or factor targeted by the examination. Further study on the effect of resource inclusion on other examinations is warranted.
Primary Funding Source: ABIM Foundation.

PMID: 28806791 [PubMed - as supplied by publisher]




Opening the Book on Maintenance of Certification.

Opening the Book on Maintenance of Certification.

Ann Intern Med. 2017 Aug 15;:

Authors: Weinberger SE

PMID: 28806790 [PubMed - as supplied by publisher]




Cannabis for Pain and Posttraumatic Stress Disorder: More Consensus Than Controversy or Vice Versa?

Cannabis for Pain and Posttraumatic Stress Disorder: More Consensus Than Controversy or Vice Versa?

Ann Intern Med. 2017 Aug 15;:

Authors: Patel S

PMID: 28806789 [PubMed - as supplied by publisher]