Geriatric Training and the Internal Medicine Residency

Letter to the Department of Veterans Administration regarding the Advanced Practice Registered Nurses Proposed Rule

Joint Letter to FDA Regarding Modifications to Compliance Policy for Certain Deemed Products Draft Guidance

Joint Letter with Comments in Response to Notice of Proposed Rule Making, Public Charge Ground of Inadmissibility

Joint Letter Requesting to Delay Mandatory Reporting CQMs and Implement Changes to the Medicare Shared Savings Program Quality Overhaul

Joint Letter in Response to DHS"s Proposed Rulemaking Regarding Public Charge Ground of Inadmissibility

Comments on the HITPC proposal for Stage 2 of the Meaningful Use of EHRs

Comments on the HITPC proposal for Stage 2 of the Meaningful Use of EHRs

America's Frontline Physicians on Health Care Priorities for Biden Administration

FDA Letter: Risk Evaluation and Mitigation Strategies of Certain Opioids

When Epidemics Collide: Coronavirus Disease 2019 (COVID-19) and the Opioid Crisis

An Epidemic in the Midst of a Pandemic: Opioid Use Disorder and COVID-19

Supporting Clinicians During the COVID-19 Pandemic

Occult Overdose Masquerading as Sudden Cardiac Death: From the POstmortem Systematic InvesTigation of Sudden Cardiac Death Study

Restoring the Story and Creating a Valuable Clinical Note

Knowledge and Perceptions of COVID-19 Among the General Public in the United States and the United Kingdom: A Cross-sectional Online Survey

How Should U.S. Hospitals Prepare for Coronavirus Disease 2019 (COVID-19)?

Delayed Denosumab Injections and Fracture Risk Among Patients With Osteoporosis: A Population-Based Cohort Study: Annals of Internal Medicine: Vol 173, No 7

Background: Denosumab is effective for osteoporosis, but discontinuation leads to rapid reversal of its therapeutic effect. Objective: To estimate the risk for fracture among users of denosumab who delayed subsequent doses compared with users who received doses on time. Design: Population-based cohort study. Setting: The Health Improvement Network U.K. primary care database, 2010 to 2019. Patients: Persons aged 45 years or older who initiated denosumab therapy for osteoporosis. Measurements: Observational data were used to emulate an analysis of a hypothetical trial with 3 dosing intervals: subsequent denosumab injection given within 4 weeks after the recommended date (“on time”), delay by 4 to 16 weeks (“short delay”), and delay by more than 16 weeks (“long delay”). The primary outcome was a composite of all fracture types at 6 months after the recommended date. Secondary outcomes were major osteoporotic fracture, vertebral fracture, hip fracture, and nonvertebral fracture. Results: Investigators identified 2594 patients initiating denosumab therapy. The risk for composite fracture over 6 months was 27.3 in 1000 for on-time dosing, 32.2 in 1000 for short delay, and 42.4 in 1000 for long delay. Compared with on-time injections, short delay had a hazard ratio (HR) for composite fracture of 1.03 (95% CI, 0.63 to 1.69) and long delay an HR of 1.44 (CI, 0.96 to 2.17) (P for trend = 0.093). For vertebral fractures, short delay had an HR of 1.48 (CI, 0.58 to 3.79) and long delay an HR of 3.91 (CI, 1.62 to 9.45). Limitation: Dosing schedules were not randomly assigned. Conclusion: Although delayed administration of subsequent denosumab doses by more than 16 weeks is associated with increased risk for vertebral fracture compared with on-time dosing, evidence is insufficient to conclude that fracture risk is increased at other anatomical sites with long delay. Primary Funding Source: National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation.

Coronavirus Disease 2019 (COVID-19): Protecting Hospitals From the Invisible

Missing the Forest for the Trees