The American College of Physicians (ACP) calls for policy changes to slow the rising cost of prescription drugs. Recommendations include price transparency, patient cost-sharing, and novel approaches such as price negotiation by Medicare. While some studies suggest potential prevention methods, more research is needed.
The American College of Physicians recommends various policies to stem the rising cost of prescription drugs, including transparency in pricing and comparative effectiveness research. The ACP also supports value-based decision-making and encourages competition through approaches like price negotiation by Medicare.
A study found that pathologists agree on invasive breast cancer diagnoses but not on non-invasive lesions like DCIS and atypia. Women with borderline findings may benefit from revised guidelines for clinical treatment and management.
A study published in Annals of Internal Medicine found that quitting smoking abruptly is more likely to lead to lasting abstinence compared to quitting gradually. The researchers found that patients who quit abruptly were 25% more likely to stop smoking in both the short and long term.
Direct-to-consumer genetic testing raises concerns about physicians' preparedness to discuss test results and potential downstream effects on the healthcare system. A study found that only a minority of consumers share their results with their doctor, often due to physician's inability to answer questions and address patient concerns.
A study published in Annals of Internal Medicine found that women undergoing transcatheter aortic valve replacement (TAVR) had better survival rates than men at one year. However, women also experienced a higher rate of vascular complications and major bleeding after the procedure.
A randomized controlled trial found that threatening to lose a reward is more effective than earning one in increasing physical activity among overweight and obese adults. The study also suggests that the way financial incentives are framed is important to their effectiveness.
A report published in Annals of Internal Medicine describes the first known case of Zika virus in a US resident following travel to Costa Rica. The traveler exhibited symptoms and had test results that indicated Zika infection, highlighting the need for travelers to avoid day-biting mosquitoes.
The American College of Physicians recommends using either cognitive behavioral therapy or second-generation antidepressants to treat adults with major depressive disorder. Both treatments are found to be similarly effective for treating depression, and physicians should consider a discussion with the patient about treatment effects, a...
The American College of Physicians recommends cognitive behavioral therapy (CBT) and second-generation antidepressants (SGAs) as similarly effective treatments for adults with major depressive disorder. CBT is a reasonable approach for initial treatment, particularly when discussing treatment effects and patient preferences.
Experts offer guidance for pregnant women to avoid mosquitoes, while debating the need for annual physicals in patients. The ACIP releases its 2016 Recommended Adult Immunization Schedule with major changes to HPV and pneumococcal vaccines.
The American College of Physicians (ACP) offers guidance on evaluating blood in the urine, emphasizing the importance of referring patients with gross hematuria and confirming heme-positive results. For adults with microscopically confirmed hematuria, urology referral for cystoscopy and imaging is recommended.
The American College of Physicians issues guidelines for evaluating blood in the urine as a sign of cancer. Doctors should confirm heme-positive results with microscopic urinalysis before initiating further evaluation in asymptomatic adults. Urology referral is recommended for cystoscopy and imaging in adults with microscopically confi...
Leading medical journals propose a mandate on clinical data sharing to improve the benefit to society from clinical trials. The ICMJE defines a clinical trial as any research project that prospectively assigns people to an intervention, and believes there is an ethical obligation to share data generated by interventional clinical trials.
The American College of Physicians (ACP) and Centers for Disease Control and Prevention (CDC) issued advice for prescribing antibiotics for acute respiratory tract infections in adults. Inappropriate antibiotic use contributes to antibiotic-resistant infections, posing a public health threat. Guidelines recommend symptomatic therapy fo...
The American College of Physicians (ACP) and Centers for Disease Control and Prevention (CDC) issue advice on prescribing antibiotics for acute respiratory tract infections, citing unnecessary use that can lead to $3 billion in excess costs. The guidelines recommend reserving antibiotics for serious illnesses only.
The USPSTF recommends regular mammography screening for women aged 50-74, with a recommended frequency of every two years. Women in their 40s should make an individual decision with their doctor about starting screening, considering factors like health history and preferences. The Task Force also notes that screening is less effective ...
Cardiovascular disease is prevalent among adult survivors of childhood cancer, presenting at an earlier age and causing substantial morbidity. The American College of Physicians emphasizes the need for systematic assessment and potential value of routine physical exams to identify cardiac abnormalities.
After a nonfatal overdose, nearly 3,000 patients continued to be prescribed opioids, with 70% receiving prescriptions from the same provider who wrote them before. Patients taking high dosages were twice as likely to experience another overdose after discontinuing opioid use.
A recent study published in Annals of Internal Medicine found that patients with sudden cardiac arrest who received medical attention shortly after exhibiting warning signs had a significantly higher chance of survival compared to those who ignored their symptoms. Researchers collected data from survivors, family members, and medical r...
Experts discuss real-world use of PrEP (preexposure prophylaxis) for HIV prevention, highlighting a substantial reduction in transmission among patients on a daily combination of tenofovir and emtricitabine. Non-pharmacologic alternatives to reduce risk are also explored.
Once-weekly GLP-1RAs lack clear-cut benefits and harms, making it challenging to choose the most suitable medication. The medications share similar outcomes for blood pressure and lipids but have differences in terms of HbA1c reduction and body weight, as well as risk of nausea and heart rate increase.
The American College of Physicians recommends prescribing generic medications whenever possible to reduce costs and improve adherence to therapy. Generic medications are as effective as their branded counterparts, but underuse is a significant issue due to misconceptions about safety and efficacy.
The American College of Physicians recommends prescribing generic medications when available, as it improves health outcomes, reduces harm, and eliminates wasteful practices. Generic substitution can lead to better long-term medication adherence and save patients $1.4 billion annually.
A systematic evidence review and meta-analysis found that peripheral thermometers have poor clinical accuracy and sensitivity compared to central thermometers. Central thermometers, such as rectal or bladder thermometers, are considered the gold standard for accurate temperature measurement.
The American College of Physicians (ACP) released a position paper exploring the factors driving growth of 'concierge' and other direct patient contracting practices. The paper offers nine recommendations to mitigate potential adverse impacts on access for lower-income patients.
A study published in Annals of Internal Medicine found that normal-weight individuals with central obesity have twice the mortality risk as those who are overweight or obese. Researchers examined data from over 15,000 participants and concluded that lifestyle modification strategies may be crucial for this population.
A randomized, controlled trial found both acupuncture and the Alexander Technique led to significant long-term reductions in neck pain and associated disability compared with usual care. The interventions also showed high acceptability rates and greater adherence, leading to improved self-efficacy and outcomes.
The USPSTF recommends screening overweight and obese adults between 40-70 for abnormal blood sugar, referring those with high blood sugar to intensive behavioral counseling. Abnormal blood sugar levels increase risk of developing type 2 diabetes, which has risen in prevalence over the past 15 years.
Patients with well-controlled type 2 diabetes who drank red wine daily for two years showed improved cardiac health and cholesterol management. The study suggests that moderate alcohol intake may have specific benefits for lipid variables, but the authors caution against potential risks.
The Guidelines International Network has issued 9 principles to address financial, intellectual, and personal conflicts of interest in clinical practice guideline development. The principles emphasize the importance of disclosure and management of COI to ensure trustworthiness of guidelines.
The American College of Physicians recommends against routine pelvic exams for asymptomatic adult women due to low diagnostic accuracy. In contrast, the American College of Obstetrics and Gynecology maintains that annual exams are necessary for recognizing issues like incontinence and sexual dysfunction.
For patients with low pre-test probability of PE, applying PERC rule should guide diagnostic strategy. Imaging and testing can be reserved for those with high pre-test probability or contraindications to CT pulmonary angiography.
Physicians should use validated clinical prediction rules to estimate pre-test probability of PE. In low-risk patients, D-dimer testing can provide additional risk stratification. Imaging is indicated for high-risk patients or those with a high clinical presentation. Age-adjusted D-dimer thresholds can help determine imaging necessity.
The American College of Physicians task force recommends counseling and pharmaceutical interventions to help adults and pregnant women quit smoking. Behavioral therapy or medications with FDA approval are recommended for nonpregnant adults, while pregnant women receive only behavioral interventions.
The American College of Physicians released a guide for appropriate use of peripherally inserted central catheters (PICCs) to address growing concerns over their use in hospitals. The guide highlights the potential for complications like thrombosis and infection, as well as variation in their use among patients.
The American College of Physicians recommends policies for the use of telemedicine in primary care settings, aiming to improve access to care while balancing benefits and risks. The position paper offers more than a dozen policy statements and recommendations for utilization and reimbursement.
A population-based case-control study found that long-term, continuous use of low-dose aspirin and nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with decreased colorectal cancer risk. The study also suggests that higher COX-2 selectivity in nonaspirin NSAIDs may offer greater protection.
A provocative essay in Annals of Internal Medicine exposes doctors' disrespect towards vulnerable patients, highlighting shocking clinical experiences. The author's anonymity protects patient privacy, but raises questions about medical ethics and accountability.
A clinical scoring system could identify patients at low risk for colon cancer, allowing them to be screened with less invasive methods. The study found that patients classified as low-risk had far fewer advanced adenomas compared to those classified as high-risk.
Researchers found limited evidence that web-based interventions reduced alcohol consumption in adults and college students who screened positive for hazardous alcohol use. Higher intensity interventions with human support are suggested to have greater benefits.
A systematic evidence review published in Annals of Internal Medicine finds that the way a placebo is delivered affects how patients respond to therapy. The study suggests that some placebos have stronger effects than others, potentially impacting the effectiveness of medical treatments.
A systematic evidence review suggests that cognitive decline following invasive heart procedures is unlikely in older adults, with little to no difference found between treatment groups. However, individual study quality was low and more research is needed to confirm these findings.
The American College of Physicians recommends combined diet and physical activity promotion programs to prevent type 2 diabetes in at-risk patients. These interventions have been shown to be effective in reducing new onset diabetes and are also cost-effective.
A study published in Annals of Internal Medicine found that even very small brain lesions (less than 3 mm) detected by MRI triples the risk for stroke and death in asymptomatic patients. Having both small and larger lesions increases the risk to eight-fold, highlighting the importance of considering all lesion sizes in clinical practice.
Cardiovascular disease remains a leading cause of death in the US, with elevated cholesterol, diabetes, hypertension, obesity, and smoking contributing to half of heart disease deaths. Despite decades of progress, reducing these modifiable risk factors has not led to significant reductions in cardiovascular mortality.
The VA/DoD guidelines differ from the ACC/AHA guidelines in several aspects, including treatment targets and risk prediction tests. The guidelines also recommend a shared decision-making approach to determine medication benefits versus harms for each patient.
A randomized trial found that patients assigned a diet they liked lost less weight and reported lower dietary adherence than those assigned a diet by their physician. The study suggests that choosing a diet based on food preferences may make it difficult for dieters to scale down on the amount they eat.
Cognitive behavior therapy (CBT) is an evidence-based treatment for chronic insomnia that addresses the underlying causes of insomnia. Studies have shown that CBT improves sleep quality by reducing time spent awake after falling asleep, increasing sleep efficiency, and helping patients enter REM sleep faster.
ER revisit rates exceed expectations, with one in five patients returning within 30 days and one in 12 after three days. Total cost of revisits is higher than initial visits, highlighting the need to understand what leads to these repeated visits.