Letter Responding to the IOM Pay for Performance Report

Letter on Direct Cost Data Resource Based Practice Expense Methodologies

Letter on Direct Cost Data Resource Based Practice Expense Methodologies (2)

Letter to Congressional Leaders: Health Reform Bill

CMS Letter: Medicare Program; Reporting and Returning of Overpayments

Clinical Laboratory Improvement Act (CLIA) of 1988. Letter to Health Care Financing Administration.

ACP Statement for the Record to the Subcommittee on Employment and Workplace Safety of the Senate HELP Committee for the Hearing “Recruiting, Revitalizing & Diversifying: Examining the Health Care Workforce Shortage”

ACP Response to the Ways and Means and Energy and Commerce Committees on Bipartisan Medicare Part D Drug Pricing Legislation

ACP response letter to Energy & Commerce Committee June 28 SGR Legislative Draft Proposal

ACP Letter to UnitedHealth Group on Long-Term COVID-19 Telehealth and Regulatory Flexibilites

Review: In chronic hepatitis C virus infection, oral direct-acting antivirals have high sustained virologic response

Source Citation Falade-Nwulia O, Suarez-Cuervo C, Nelson DR, et al. Oral direct-acting agent therapy for hepatitis C virus infection: a systematic review. Ann Intern Med. 2017;166:637-48. 28319996

In cancer-associated VTE, apixaban was noninferior to dalteparin for recurrence and did not increase major bleeding

Source Citation Agnelli G, Becattini C, Meyer G, et al. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med. 2020;382:1599-607. 32223112

In high-risk patients with acute upper GI bleeding, urgent vs. early endoscopy did not differ for 30-day mortality

Source Citation Lau JY, Yu Y, Tang RS, et al. Timing of endoscopy for acute upper gastrointestinal bleeding. N Engl J Med. 2020;382:1299-308. 32242355

Effect of Acupuncture on Neurogenic Claudication Among Patients With Degenerative Lumbar Spinal Stenosis: A Randomized Clinical Trial: Annals of Internal Medicine: Vol 177, No 8

Background: Acupuncture may improve degenerative lumbar spinal stenosis (DLSS), but evidence is insufficient. Objective: To investigate the effect of acupuncture for DLSS. Design: Multicenter randomized clinical trial. (ClinicalTrials.gov: NCT03784729) Setting: 5 hospitals in China. Participants: Patients with DLSS and predominantly neurogenic claudication pain symptoms. Intervention: 18 sessions of acupuncture or sham acupuncture (SA) over 6 weeks, with 24-week follow-up after treatment. Measurements: The primary outcome was change from baseline in the modified Roland–Morris Disability Questionnaire ([RMDQ] score range, 0 to 24; minimal clinically important difference [MCID], 2 to 3). Secondary outcomes were the proportion of participants achieving minimal (30% reduction from baseline) and substantial (50% reduction from baseline) clinically meaningful improvement per the modified RMDQ. Results: A total of 196 participants (98 in each group) were enrolled. The mean modified RMDQ score was 12.6 (95% CI, 11.8 to 13.4) in the acupuncture group and 12.7 (CI, 12.0 to 13.3) in the SA group at baseline, and decreased to 8.1 (CI, 7.1 to 9.1) and 9.5 (CI, 8.6 to 10.4) at 6 weeks, with an adjusted difference in mean change of –1.3 (CI, –2.6 to –0.03; P = 0.044), indicating a 43.3% greater improvement compared with SA. The between-group difference in the proportion of participants achieving minimal and substantial clinically meaningful improvement was 16.0% (CI, 1.6% to 30.4%) and 12.6% (CI, –1.0% to 26.2%) at 6 weeks. Three cases of treatment-related adverse events were reported in the acupuncture group, and 3 were reported in the SA group. All events were mild and transient. Limitation: The SA could produce physiologic effects. Conclusion: Acupuncture may relieve pain-specific disability among patients with DLSS and predominantly neurogenic claudication pain symptoms, although the difference with SA did not reach MCID. The effects may last 24 weeks after 6-week treatment. Primary Funding Source: 2019 National Administration of Traditional Chinese Medicine “Project of building evidence-based practice capacity for TCM-Project BEBPC-TCM” (NO. 2019XZZX-ZJ).

Oral Prednisolone in the Treatment of Acute Gout: A Pragmatic, Multicenter, Double-Blind, Randomized Trial: Annals of Internal Medicine: Vol 164, No 7

Background: Two recent double-blind, randomized, controlled trials (RCTs) showed that oral steroids and nonsteroidal anti-inflammatory drugs have similar analgesic effectiveness for management of gout, but the trials had small sample sizes and other methodological limitations. Objective: To compare the effectiveness and safety of oral prednisolone versus oral indomethacin in patients presenting to emergency departments (EDs) with acute gout. Design: Multicenter, double-blind, randomized equivalence trial. Patients were randomly assigned (1:1 ratio) to receive either indomethacin or prednisolone. (ISRCTN registry number: ISRCTN45724113) Setting: Four EDs in Hong Kong. Participants: 416 patients aged 18 years or older. Measurements: Analgesic effectiveness was defined as changes in pain (at rest or with activity) greater than 13 mm on a 100-mm visual analogue scale. Outcomes were measured during the first 2 hours in the ED and from days 1 to 14. Results: 376 patients completed the study. Equivalent and clinically significant within-group reductions in mean pain score were observed with indomethacin and prednisolone in the ED (approximately 10 mm [rest] and 20 mm [activity]) and from days 1 to 14 (approximately 25 mm [rest] and 45 mm [activity]). No major adverse events occurred during the study. During the ED phase, patients in the indomethacin group had more minor adverse events than those in the prednisolone group (19% vs. 6%; P < 0.001). During days 1 to 14, 37% of patients in each group had minor adverse events. Limitation: Diagnosis of gout was usually based on clinical criteria rather than examination of joint fluid. Conclusion: Oral prednisolone and indomethacin had similar analgesic effectiveness among patients with acute gout. Prednisolone is a safe, effective first-line option for treatment of acute gout. Primary Funding Source: Health and Health Services Research Grant Committee of the Hong Kong Government.

Review: Dapagliflozin increases, and empagliflozin reduces, adverse renal events in type 2 diabetes

Source Citation Tang H, Li D, Zhang J, et al. Sodium–glucose cotransporter 2 inhibitors and risk of adverse renal outcomes among type 2 diabetes patients: a network and cumulative meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2017 Feb 27 [Epub ahead of print]. 28240446

Antibiotic, Glucocorticoid, and Opioid Prescribing in Urgent Cares: An Opportunity for Reducing Medication Overuse

Self-reported Physical Health of Women Who Did and Did Not Terminate Pregnancy After Seeking Abortion Services: A Cohort Study: Annals of Internal Medicine: Vol 171, No 4

Background: Research demonstrates worse short-term morbidity and mortality associated with childbirth than with abortion, but little research has examined long-term physical health in women with unwanted pregnancies after abortion versus childbirth. Objective: To examine the physical health of women who seek and receive or are denied abortion. Design: Prospective cohort study. Setting: 30 U.S. abortion facilities from 2008 to 2010. Participants: Of 1132 women seeking abortion who consented to participate, 874 were included in this analysis (328 who had first-trimester abortion, 383 who had second-trimester abortion, and 163 who gave birth). Measurements: Self-reported overall health; chronic abdominal, pelvic, back, and joint pain; chronic headaches or migraines; obesity; asthma; gestational and nongestational hypertension and diabetes; and hyperlipidemia were assessed semiannually for 5 years. Mortality was assessed by using verbal autopsy and public records. Results: No significant differences were observed in self-rated health or chronic pain after first-trimester versus second-trimester abortion. At 5 years, 27% (95% CI, 21% to 34%) of women who gave birth reported fair or poor health compared with 20% (CI, 16% to 24%) of women who had first-trimester abortion and 21% (CI, 18% to 25%) who had second-trimester abortion. Women who gave birth also reported more chronic headaches or migraines and joint pain, but experienced similar levels of other types of chronic pain and obesity. Gestational hypertension was reported by 9.4% of participants who gave birth. Eight of 1132 participants died during follow-up, 2 in the postpartum period. Maternal mortality did not differ statistically by group. Limitation: Self-reported outcome measures, uncertain generalizability, and 41% loss to follow-up at 5 years. Conclusion: Although some argue that abortion is detrimental to women's health, these study data indicate that physical health is no worse in women who sought and underwent abortion than in women who were denied abortion. Indeed, differences emerged suggesting worse health among those who gave birth. Primary Funding Source: An anonymous foundation.

Annals Understanding Clinical Research: Implications of Missing Data Due to Dropout

Annals Consult Guys - Perioperative Management of Patients Receiving Glucocorticoids

Personal risk-based screening for lung cancer may be more cost-effective than recommended cutoffs

Postexposure prophylaxis drug, vaccine complications, and anticoagulation in COVID-19

Stopping preventive aspirin associated with 37% increased risk of cardiovascular events

E-cigarette users may be exposed to fewer carcinogens, toxins than smokers, study finds

Evidence does not support giving renin angiotensin system inhibitors to all patients with stable CAD, review finds

Discharge ed, doctor harassment, and more | ACP Hospitalist

A call to action: Align well-being and antiracism strategies | ACP Hospitalist

The impact of deferred hospital care during COVID-19 | ACP Hospitalist

Do you need a checklist? | ACP Hospitalist

Study finds high burnout among ACP members | ACP Hospitalist

Study finds burnout even before the pandemic | ACP Hospitalist

Sepsis, cardiac arrest, and more | ACP Hospitalist

COVID-19 and antibiotics: Less is more | ACP Hospitalist

The face of COVID | ACP Hospitalist

The battle against COVID-19 | ACP Hospitalist