“[Introduction] [..] Privileged US citizens—including thought and physician leaders—may tolerate this underperformance as applying to “others,” dismissing comparisons as mean values that do not reflect the quality of their own personal care. Privileged US citizens believe that their social connections and financial resources allow them to choose the best physicians and hospitals for their own care, thereby ensuring excellent health outcomes. One study showed that the wealthiest quintile receive 43% more health care than the poorest quintile and 23% more than middle-income US citizens. Privileged US citizens may believe that their resources ensure that they receive the world’s best health … Read More
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“[Methods] [..] We included studies that reported LCS [lung cancer screening] adherence rates in the US and/or determinants of LCS adherence. We considered prospective or retrospective studies that screened adult patients at any risk level of developing cancer who opted to initiate LCS and continued to undergo additional screening after the first LDCT (low-dose computed tomography). [Results] [..] Fifteen studies (19 publications) involving a total of 16 863 individuals were included in this systematic review. [..] 12 studies (80%) did not have a follow-up time that was long enough to adequately assess periodic adherence beyond 1 year. All of the studies … Read More
“Enthusiasm for the potential impact of AI [artificial intelligence] on hospital operations is often based on its impact in other industries. However, non-health care companies invest in AI after having digitized and optimized their operations with a variety of older mathematical methods. In contrast, hospitals may invest in AI while still scheduling patient appointments using fax machines and allocating resources based largely on anecdotal experience. [..] For decades before the advent of modern AI, the operational management of capital, labor, and resources of large manufacturing, retail, airline, and most other large-scale industries were being designed and refined with rigorous methods … Read More
“[Introduction] The American Heart Association (AHA), American College of Cardiology (ACC), and the US Preventive Services Task Force (USPSTF) all recommend hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) for primary prevention of cardiovascular events in adults aged 40 to 75 years who have an elevated risk (most often defined as ≥7.5% risk of major adverse cardiovascular event [MACE] within 10 years). [..] Although the benefits of statins to decrease cardiovascular events such as myocardial infarction and stroke have been well documented for adults younger than 75 years, when these benefits occur is unclear. In contrast, the burdens of statins appear … Read More
“Skin cancers represent the most common malignant neoplasms in the United States and account for more than $8 billion of health expenditure annually. Because the US population is aging, the incidence of skin cancers is increasing. In addition to topical chemotherapy, procedural treatments for skin cancers include Mohs micrographic surgery (MMS), simple surgical excision, and shave excision as well as destructive modalities including laser surgery, electrosurgery, and cryosurgery. [Results] From 2012 to 2017, MMS services had the highest mean payment ($378.71; range, $41.24-$466.93) and shave excisions had the lowest ($70.99; range, $15.58-$135.24). During this period, payment rates declined for each … Read More
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
“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