In this study, more than 368 000 patients with diabetes mellitus had most of their care provided by a physician assistant, nurse practitioner, or physician. The researchers investigated whether hemoglobin A1c, systolic blood pressure, and serum lipoprotein cholesterol values differed among patients depending on the type of clinician providing their care.
Recent studies of state-level data suggest that the United States is transitioning from heart disease to cancer as the leading cause of death. This analysis provides data on this “new epidemiologic transition” at the county level and by socioeconomic characteristics.
In this observational, longitudinal, before–after study using 10 years of data from a large national health insurer, the authors sought to determine whether a transition from low-deductible to high-deductible insurance is associated with delayed medical care for macrovascular complications of diabetes.
for the eSPEED Investigators of the KP CREST Network
Despite the well-established safety of outpatient treatment for pulmonary embolism in appropriately selected, low-risk patients, most of these patients continue to be hospitalized to start treatment. This multicenter clinical trial tested whether delivery of a focused clinical decision support system could safely increase the number of patients with acute pulmonary embolism who are discharged to home from the emergency department.
In this special article, the authors posit that diagnostic and therapeutic models derived from machine learning can and should be designed and implemented with principles of justice to ensure that the models benefit all patients.
Public concern about the safety of medicines has been heightened with the recent recall of more than half of all valsartan products on the market in the United States after the Food and Drug Administration identified a probable cancer-causing chemical in the active pharmaceutical ingredient, which was made in China. This commentary discusses the increased reliance of the United States on China as a supplier of generic drugs, active pharmaceutical ingredients, and the chemical building blocks and raw materials to make them.
Jackson and colleagues showed that patients with diabetes who received care from nurse practitioners and physician assistants working in the Veterans Affairs health system had outcomes equivalent to those of patients cared for by physicians in a primary care setting. The editorialist discusses the findings and the importance of team-based care for persons with diabetes.
A combination of increased prevention and improved medical treatment of cardiovascular disease has allowed cancer to gradually replace heart disease as the leading cause of death in high-income countries over the past decade. The study by Hastings and colleagues provides a lens for interpreting the population dynamics related to the epidemiologic transition. The editorialists discuss the findings from a social epidemiology perspective.
In their study, Wharam and colleagues take a useful step in evaluation of high-deductible health insurance plans. The editorialist discusses the findings and the difficulty of determining the value of these plans, particularly for patients with chronic illness.
Vinson and colleagues' study adds to mounting evidence for the safety of home treatment of selected patients with pulmonary embolism. The editorialists discuss the findings and speculate why few patients receive home treatment despite evidence of safety and cost-effectiveness.
Rajkomar and colleagues warn us that the introduction of machine-learned predictive algorithms into medicine might inadvertently reinforce or create inequitable treatment of protected groups, for which the computer science community has adopted the terminology of “fairness.” The editorialists discuss the authors' proposals and conclude that no formulaic solution will be sufficient to achieve fairness.
On 8 November 2018, the National Rifle Association (NRA) took to Twitter to admonish doctors to “stay in their lane.” The NRA does not believe firearm-related injury and prevention are within the purview of physicians. We could not disagree more.
Annals Consult Guys brings a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations. They address medically relevant topics—whether they be poignant, thought-provoking, or just plain entertaining.
Aggressive care at the end of life is generally considered low value. Hospitalists, as nonexpert leaders, are perfectly positioned to shine a light on the negative effects of such care. Team-based reflection can help move away from the reflex to provide aggressive care to everyone and toward an approach that helps everyone choose the care they really want.
In this episode of Annals On Call, Dr. Centor discusses the unintended consequences of the U.S. health care delivery and payment system on quality of care, physician wellness, patient satisfaction, and health care costs with Dr. Maria Maldonado. Dr. Maldonado is the author of a recent Annals “On Being a Doctor” essay that poignantly illustrates these issues.