“The American College of Cardiology and American Heart Association (ACC/AHA) practice guidelines for perioperative cardiovascular evaluation for noncardiac surgery aim to improve the effectiveness of perioperative care, optimize patient outcomes, and improve resource use. The guidelines have consistently deemphasized preoperative cardiac testing prompted solely by the upcoming surgery in the absence of signs or symptoms that would warrant testing outside of the preoperative setting. [..] Using MarketScan inpatient claims data from 2003 to 2017, we selected patients according to International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM, … Read More
All posts by Anupam
“Superbugs are not a unique problem to COVID-19, of course; they already kill 35,000 Americans every year. If bacteria continue evolving to outwit antibiotics, however, the World Health Organization estimates they will become the leading global cause of death by 2050. [..] The ability of biotech upstarts to earn revenue clashes with the basics of evolutionary biology. Superbugs develop as bacteria accumulate mutations over time, forming strains that elegantly evade our existing antibiotic arsenal. The more consistently a bug goes up against one of our trusted antibiotics, the more likely it is to evolve to escape it. Accordingly, to prevent … Read More
“In the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study (July 9 issue), Bhasin et al. evaluated the effectiveness of individualized recommendations to prevent fall injuries. We find the lack of significant success with this strategy to be wholly unsurprising. Referrals or recommendations alone are insufficient to reduce falls. The STRIDE intervention successfully expanded the role of primary care providers to include fall-risk screening, assessment, and individualized care plans. It did not include any direct procedural interventions (e.g., exercise, medication management, home safety modifications, and vision care) or the necessary extensive support to ensure their receipt. [..] … Read More
“Our randomized controlled trial (RCT) found a physician-focused decision support tool to be effective in increasing CVD risk assessment when embedded within the primary care clinical record system. In particular, personalized risk score information that is explained on a visually interesting interface, can make the impact of improving biometric risk factor values (for example, blood pressure), or behaviors (for example, smoking cessation), more compelling. Hypothesized as a useful springboard to more engagement by patients with CVD risk factor control, the concept was adapted to a consumer-facing resource in the current trial. Other trials have demonstrated the benefits of apps for … Read More
“First described in 1975 by economist Charles Goodhart, Goodhart’s Law states that “when a measure becomes the target, it ceases to be a good measure.” The famous, and possibly apocryphal, example of Goodhart’s Law is the story of nail factories in the Soviet Union. To boost output, the factory performance was pegged to the number of nails produced, leading to the manufacturing of millions of tiny and useless nails. In response, the performance metric was changed to the nails’ weight. The factories, in turn, adjusted their approach and produced a small number of giant, and equally useless, nails. Hospitals, too, … Read More
Published 2020.9.30 I am involved in several health information technology (health IT) interoperability efforts including the Da Vinci project (a private sector initiative that addresses the needs of the Value Based Care community by leveraging the HL7 [a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services] FHIR platform), Office of the National Coordinator for Health IT Fast Healthcare Interoperability Resources (FHIR) at Scale Taskforce (ONC FAST, a group of “motivated … Read More
“Annually, about 10 million people develop TB, and an estimated 1.5 million die from their disease, which makes it the leading infectious killer worldwide, even in the time of COVID-19. [..] Key factors can significantly increase an individual’s risk. In particular, 2.3 million cases of TB were worldwide attributable to undernutrition in 2018: That’s one in five cases. By comparison, 1.2 million cases were attributable to HIV and 0.8 million cases to diabetes—risk factors that receive considerably more attention and funding. Undernutrition blunts the function of the immune system and increases the risk for TB so much so that it … Read More
“Technology-enabled eHealth programs represent potentially cost-efficient and practical means for customized PA [physical activity] guidance to diverse groups. Most people targeted by eHealth, however, are well educated, younger than 50 years, and of non-Hispanic White ancestry, potentially intensifying health disparities. [..] This investigation tested whether a virtual advisor could increase 12-month walking to an extent similar to a comparably structured human advisor program among Latino adults. The human advisor program was delivered by trained peer advisors—a resource-efficient approach that is well accepted by Latino and other diverse groups but may be less convenient and scalable than computer-based programs. [..] Both … Read More
“Intermittent fasting (IF) has gained attention as a simple weight loss method. Intermittent fasting refers to eating windows separated by defined periods of fasting (>12 hours and up to 48 hours, or more). Most of the reported benefits of IF are either untested or undertested in humans. Time-restricted eating (TRE) is a specific IF protocol involving consistent fasting and eating periods within a 24-hour cycle. [..] We conducted a randomized clinical trial (RCT) designed to determine the effect of TRE on weight and comprehensive metabolic outcomes in overweight and obese patients. We hypothesized that 8-hour TRE prescribed to individuals with … Read More
Suggestions to improve the FDA’s system to detect safety issues with medical devices