“It is unclear whether adjuvant or early salvage radiotherapy following radical prostatectomy is more appropriate for men who present with localised or locally advanced prostate cancer. We aimed to prospectively plan a systematic review of randomised controlled trials (RCTs) comparing these radiotherapy approaches. [..] We identified three eligible trials and were able to obtain updated results for event-free survival for 2153 patients recruited between November, 2007, and December, 2016. Median follow-up ranged from 60 months to 78 months, with a maximum follow-up of 132 months. 1075 patients were randomly assigned to receive adjuvant radiotherapy and 1078 to a policy of … Read More
“High-quality health data research and the development of ML [machine learning] models requires meaningful data at a sufficient scale. Such data undoubtedly exist. Most health institutions hold clinical imaging data at a scale ranging from tens of thousands to tens of millions of scans. However, these data are often inaccessible to researchers, even where there is an intention to make them available for research, because of barriers of access and usability. Barriers of access can include: governance barriers (difficulties in understanding and working through governance frameworks regulating data usage); cost barriers (there can be considerable overhead costs to datasets and … Read More
“During the active phase of treatment for a patient with cancer in Medicare’s Oncology Care Model, antineoplastic drug costs represented more than 50% of the total cost of care in 2018 and are expected to contribute nearly 70% of the total cost of active care by 2025 and more than 80% by 2030, 10 years from now. [..] Any solution that relies solely on one of the actors in the drug distribution and delivery system is doomed to failure because no one wants to be the “bad guy.” What is needed is a convener with power (likely the US federal … Read More
“The United States spends significantly more on healthcare than comparable countries, and yet has worse health outcomes. Much of the national conversation has focused on spending on prescription drugs and administrative costs as the primary drivers of health spending in the U.S. [..] While it is true that many brand-name prescription drugs are priced higher in the U.S. than in peer countries, health spending data indicates that other spending categories – particularly hospital and physician payments – are greater drivers of health spending. [..] In 2018, the U.S. spent nearly twice as much per capita on health as comparable countries. … Read More
“Genome-wide association studies have shown that common diseases are polygenic, ie, thousands of DNA variants contribute to risk, and most of these have very small effect. In spite of this complexity, it is now possible to estimate the degree to which an individual is at risk of common illnesses owing to their genetic makeup. The so-called polygenic risk scores (PRS) are generated from DNA taken from a saliva or blood sample with DNA variants measured using genotyping technologies that are inexpensive (< US $100 per person). From these data, PRS can be calculated for a wide range of diseases (by … Read More
“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
“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