On October 27th, the United States Preventive Services Task Force (USPSTF) issued a draft recommendation to extend colorectal cancer screening to individuals 45-49 years of age (Grade B recommendation). Assuming the public comment period does not uncover any surprises, the recommendation will be finalized by the end of the year. The recommendation includes the group’s modeling of benefits and harms with the proposed screening strategy. Compared to our current screening recommendations (screening individuals 50-75 years of age), the new recommendation will add 22-27 additional life-years at a cost of 0.2-2 additional gastrointestinal and cardiovascular complications per 1000 individuals screened. Given … Read More
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“In recent years, a worldwide increase in the incidence of thyroid cancer has been acknowledged and has primarily been attributed to overdiagnosis of small, low-risk papillary thyroid cancers. Observational evidence suggests that active surveillance is a safe and effective management option for carefully selected patients with low-risk papillary thyroid cancers. In light of this contemporary data, guidelines now include more conservative treatment options for patients diagnosed with papillary thyroid cancer. Ultimately, these guidelines help to avoid potential overtreatment and improve quality-of-life outcomes. Yet despite all this, the willingness to accept less invasive management options, specifically the uptake and acceptability of … Read More
“Surgeons were recruited from the Illinois Surgical Quality Improvement Collaborative in 2016 for a video-based technical skills assessment program.4 Each surgeon submitted 1 representative video of a laparoscopic right hemicolectomy that they performed. Videos were reviewed by 12 or more surgeons, including 2 colorectal surgeons with video evaluation experience. Skill scores were assigned using the American Society of Colon & Rectal Surgeons Video Assessment Tool, and the mean score from all raters was used. Skill score was analyzed separately by terciles and as a continuous variable. Patients who underwent any minimally invasive colectomy for stage I to III epithelial-origin colon … Read More
“Clopidogrel, prasugrel, and ticagrelor are oral platelet P2Y12 receptor inhibitors that decrease the risk of platelet-mediated coronary artery thrombosis. [..] A 1-year composite end point of death, MI [myocardial infarction], and stroke is often used to evaluate efficacy in ACS [acute coronary syndrome] trials. However, death can be defined as all-cause death, cardiovascular death, or death from vascular causes (cardiovascular plus cerebrovascular deaths). Although ticagrelor was associated with a reduction in death in the PLATO trial, no subsequent trial with ticagrelor and no trials with clopidogrel or prasugrel have shown a mortality benefit with DAPT [dual antiplatelet therapy] compared with … Read More
“The effects of steroid shots on acute URTIs [upper respiratory tract infections] are largely unknown. Widespread use of these drugs belies the scant published evidence that they have any effect at all on the natural courses of acute sinusitis, pharyngitis, or the common cold. What is understood is that even short-term use of systemic steroids carries the potential for troubling and sometimes dire adverse effects, including cataracts, psychosis, immunodeficiency, thromboembolism, and avascular necrosis of the hip. Acute symptomatic relief notwithstanding, the balance of efficacy vs toxicity remains speculative. Yet the consumers of health care—the public—may be so allured by the … Read More
“Approximately one in five adults and one in six children experience mental illness each year in the U.S. [..] Patients who require admission to a psychiatric hospital are either acutely suicidal or homicidal due to a psychiatric condition or have experienced a significant decline in their ability to function such that they cannot safely care for themselves in the community due to psychiatric illness. [..] Mood disorders are the most common reason for hospitalization for individuals in the U.S. under the age of 45, aside from hospitalizations related to pregnancy and birth. [..] to provide coverage for inpatient psychiatric hospitalization, … Read More
As we stagger through the first (and possibly second) wave of the COVID-19 pandemic in America, there have been proclamations of transforming healthcare delivery with technology alternating with arguments that healthcare will quickly return to normal with in-office encounters and its associated hassles (i.e., co-payments, waiting rooms, exposure to other patients who might be infected). I have been skeptical of telemedicine’s potential to move beyond urgent care for primarily self-limited conditions. I am optimistic that telemedicine (and/or remote patient monitoring) could augment physical offices managing patients with chronic disease, but we as an industry have not generated the evidence to … Read More
“Total knee arthroplasty is a common procedure for end stage osteoarthritis of the knee, with more than 100,000 knee arthroplasties performed each year in the United Kingdom and more than 700,000 in the United States. Projections of future surgical volumes suggest further substantial increases. Although total knee arthroscopy is effective at reducing pain and improving physical function for most patients, around 20% report dissatisfaction with the postoperative outcome. [..] Meta-analyses suggest that uniform postoperative physiotherapy for all patients after total knee arthroplasty compared with no treatment offers short term benefit but is not effective at improving patient outcomes at one … Read More
“Use of noninvasive ventilation (NIV), such as continuous or bilevel positive airway pressure, has increased in select populations of patients with respiratory failure (eg, those with acute exacerbations of chronic obstructive pulmonary disease [COPD] or congestive heart failure [CHF]) because of improved outcomes (ie, increased survival, shorter length of stay, and lower costs) compared with IMV [invasive mechanical ventilation]. As a result of the expanded use of NIV, use of IMV among these populations has substantially decreased over time. Use of NIV to improve survival has been established; however, its use has also been suggested to achieve palliation in persons … Read More
“After 2 decades of efforts relying largely on quality measurement and performance-linked payment incentives, we need new ideas and new conversations. As revealed by health care workers’ response to the Covid-19 pandemic, professionalism in health care may be an underused resource. Reframing quality improvement around the linchpin of care delivery — physician agency — could provide much-needed direction by elucidating strategies that address problems of information or motivation when professionals act as agents on their patients’ behalf. [..] A central concept in health economics is that the physician acts as an agent for the patient, determining what the patient’s problem … Read More