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The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?

The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?

Ann Intern Med. 2017 Jun 27;:

Authors: Woolhandler S, Himmelstein DU

Abstract
About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine's conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

PMID: 28655034 [PubMed - as supplied by publisher]




CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration (Traditional Chinese Version).

CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration (Traditional Chinese Version).

Ann Intern Med. 2017 Jun 27;:

Authors: Cheng CW, Wu TX, Shang HC, Li YP, Altman DG, Moher D, Bian ZX, CONSORT-CHM Formulas 2017 Group

PMID: 28654988 [PubMed - as supplied by publisher]




CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration.

CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration.

Ann Intern Med. 2017 Jun 27;:

Authors: Cheng CW, Wu TX, Shang HC, Li YP, Altman DG, Moher D, Bian ZX, CONSORT-CHM Formulas 2017 Group

Abstract
Chinese herbal medicine (CHM) formulas are the major components of traditional Chinese medicine (TCM) interventions. The general reporting quality of randomized controlled trials (RCTs) of CHM formulas is disappointing, although CONSORT (Consolidated Standards of Reporting Trials) Statement extensions for herbal medicinal interventions and acupuncture interventions are available. A group of TCM clinical experts, methodologists, epidemiologists, and editors has developed this CONSORT Extension for CHM Formulas (CONSORT-CHM Formulas 2017) through a comprehensive process, including publication of the draft version, solicitation of comments, revision, and finalization. The CONSORT 2010 Statement was extended by introducing the idea of TCM Pattern and the features of CHM formulas. One new checklist subitem, keywords, was added to facilitate indexing and data searching. Seven of the 25 CONSORT checklist items, namely title and abstract, background and objectives, participants, interventions, outcomes, generalizability, and interpretation, are now elaborated, and the explanation of harms specific to CHM formulas is revised. Illustrative examples and explanations are also provided. The group hopes that CONSORT-CHM Formulas 2017 can improve the reporting quality of RCTs of CHM formulas.

PMID: 28654980 [PubMed - as supplied by publisher]




Erosive Rheumatoid Arthritis After Bilateral Hand Transplantation.

Erosive Rheumatoid Arthritis After Bilateral Hand Transplantation.

Ann Intern Med. 2017 Jun 27;:

Authors: Adler BL, Albayda J, Shores JT, Lee WPA, Brandacher G, Bingham CO

PMID: 28654973 [PubMed - as supplied by publisher]




Incorporating Whole-Genome Sequencing Into Primary Care: Falling Barriers and Next Steps.

Incorporating Whole-Genome Sequencing Into Primary Care: Falling Barriers and Next Steps.

Ann Intern Med. 2017 Jun 27;:

Authors: Manolio TA

PMID: 28654971 [PubMed - as supplied by publisher]




Randomized Trials of Chinese Herbal Medicine: A New Extension of the CONSORT Statement.

Randomized Trials of Chinese Herbal Medicine: A New Extension of the CONSORT Statement.

Ann Intern Med. 2017 Jun 27;:

Authors: Linde K, Brinkhaus B

PMID: 28654966 [PubMed - as supplied by publisher]




The Impact of Whole-Genome Sequencing on the Primary Care and Outcomes of Healthy Adult Patients: A Pilot Randomized Trial.

The Impact of Whole-Genome Sequencing on the Primary Care and Outcomes of Healthy Adult Patients: A Pilot Randomized Trial.

Ann Intern Med. 2017 Jun 27;:

Authors: Vassy JL, Christensen KD, Schonman EF, Blout CL, Robinson JO, Krier JB, Diamond PM, Lebo M, Machini K, Azzariti DR, Dukhovny D, Bates DW, MacRae CA, Murray MF, Rehm HL, McGuire AL, Green RC, MedSeq Project

Abstract
Background: Whole-genome sequencing (WGS) in asymptomatic adults might prevent disease but increase health care use without clinical value.
Objective: To describe the effect on clinical care and outcomes of adding WGS to standardized family history assessment in primary care.
Design: Pilot randomized trial. (ClinicalTrials.gov: NCT01736566).
Setting: Academic primary care practices.
Participants: 9 primary care physicians (PCPs) and 100 generally healthy patients recruited at ages 40 to 65 years.
Intervention: Patients were randomly assigned to receive a family history report alone (FH group) or in combination with an interpreted WGS report (FH + WGS group), which included monogenic disease risk (MDR) results (associated with Mendelian disorders), carrier variants, pharmacogenomic associations, and polygenic risk estimates for cardiometabolic traits. Each patient met with his or her PCP to discuss the report.
Measurements: Clinical outcomes and health care use through 6 months were obtained from medical records and audio-recorded discussions between PCPs and patients. Patients' health behavior changes were surveyed 6 months after receiving results. A panel of clinician-geneticists rated the appropriateness of how PCPs managed MDR results.
Results: Mean age was 55 years; 58% of patients were female. Eleven FH + WGS patients (22% [95% CI, 12% to 36%]) had new MDR results. Only 2 (4% [CI, 0.01% to 15%]) had evidence of the phenotypes predicted by an MDR result (fundus albipunctatus due to RDH5 and variegate porphyria due to PPOX). Primary care physicians recommended new clinical actions for 16% (CI, 8% to 30%) of FH patients and 34% (CI, 22% to 49%) of FH + WGS patients. Thirty percent (CI, 17% to 45%) and 41% (CI, 27% to 56%) of FH and FH + WGS patients, respectively, reported making a health behavior change after 6 months. Geneticists rated PCP management of 8 MDR results (73% [CI, 39% to 99%]) as appropriate and 2 results (18% [CI, 3% to 52%]) as inappropriate.
Limitation: Limited sample size and ancestral and socioeconomic diversity.
Conclusion: Adding WGS to primary care reveals new molecular findings of uncertain clinical utility. Nongeneticist providers may be able to manage WGS results appropriately, but WGS may prompt additional clinical actions of unclear value.
Primary Funding Source: National Institutes of Health.

PMID: 28654958 [PubMed - as supplied by publisher]




CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration (Simplified Chinese Version).

CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration (Simplified Chinese Version).

Ann Intern Med. 2017 Jun 27;:

Authors: Cheng CW, Wu TX, Shang HC, Li YP, Altman DG, Moher D, Bian ZX, CONSORT-CHM Formulas 2017 Group

PMID: 28654957 [PubMed - as supplied by publisher]




Are Antiplatelet Agents Beneficial in Essential Thrombocythemia? Maybe Yes, Probably No.

Are Antiplatelet Agents Beneficial in Essential Thrombocythemia? Maybe Yes, Probably No.

Ann Intern Med. 2017 Jun 27;:

Authors: Bennett JS

PMID: 28654952 [PubMed - as supplied by publisher]