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Comparative Effectiveness and Harms of Antibiotics for Outpatient Diverticulitis
Charles E. Gaber, MPH, Alan C. Kinlaw, PhD, MSPH, Jessie K. Edwards, PhD, MSPH, Jennifer L. Lund, PhD, MSPH, Til Stürmer, MD, PhD, Sharon Peacock Hinton, MPA, Virginia Pate, MS, Luther A. Bartelt, MD, Robert S. Sandler, MD, MPH, Anne F. Peery, MD, MSCR
doi : 10.7326/M20-6315
Pages:737–746
Outpatient diverticulitis is commonly treated with either a combination of metronidazole and a fluoroquinolone (metronidazole-with-fluoroquinolone) or amoxicillin–clavulanate alone. The U.S. Food and Drug Administration advised that fluoroquinolones be reserved for conditions with no alternative treatment options. The comparative effectiveness of metronidazole-with-fluoroquinolone versus amoxicillin–clavulanate for diverticulitis is uncertain.
The Value of Total Knee Replacement in Patients With Knee Osteoarthritis and a Body Mass Index of 40 kg/m2 or Greater
Angela T. Chen, MA, Corin I. Bronsther, BA, Elizabeth E. Stanley, BSE, A. David Paltiel, MBA, PhD, James K. Sullivan, BA, Jamie E. Collins, PhD, Tuhina Neogi, MD, PhD, Jeffrey N. Katz, MD, MSc, Elena Losina, PhD
doi : 10.7326/M20-4722
Pages:747–757
Total knee replacement (TKR) is an effective and cost-effective strategy for treating end-stage knee osteoarthritis. Greater risk for complications among TKR recipients with a body mass index (BMI) of 40 kg/m2 or greater has raised concerns about the value of TKR in this population.
Weight and Metabolic Changes After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in People Living With HIV
Bernard Surial, MD, Catrina Mugglin, MD, MSc, Alexandra Calmy, MD, PhD, Matthias Cavassini, MD, Huldrych F. Günthard, MD, Marcel St?ckle, MD, Enos Bernasconi, MD, Patrick Schmid, MD, Philip E. Tarr, MD, Hansjakob Furrer, MD, Bruno Ledergerber, PhD, Gilles Wandeler, MD, MSc, Andri Rauch, MD
doi : 10.7326/M20-4853
Pages:758–767
Tenofovir-based antiretroviral therapy (ART) has become first-line in all major HIV treatment guidelines. Compared with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF) has a favorable renal and bone safety profile, but concerns about metabolic complications remain.
Risk for Non–AIDS-Defining and AIDS-Defining Cancer of Early Versus Delayed Initiation of Antiretroviral Therapy
Frédérique Chammartin, PhD, Sara Lodi, PhD, Roger Logan, PhD, Lene Ryom, MD, PhD, Amanda Mocroft, PhD, Ole Kirk, DMSc, Antonella d’Arminio Monforte, PhD, Peter Reiss, PhD, Andrew Phillips, PhD, Wafaa El-Sadr, MD, MPH, Camilla I. Hatleberg, MD, PhD, Christian Pradier, PhD, Fabrice Bonnet, PhD, Matthew Law, PhD, Stéphane De Wit, PhD, Caroline Sabin, PhD, Jens D. Lundgren, MD, DMSc, Heiner C. Bucher, MD, MPH, for the D:A:D Study Group
doi : 10.7326/M20-5226
Pages:768–776
Immediate initiation of antiretroviral therapy (ART) regardless of CD4 cell count reduces risk for AIDS and non–AIDS-related events in asymptomatic, HIV-positive persons and is the standard of care. However, most HIV-positive persons initiate ART when their CD4 count decreases below 500 × 109 cells/L. Consequences of delayed ART on risk for non–AIDS-defining and AIDS-defining cancer, one of the most common reasons for death in HIV, are unclear.
Development of Severe COVID-19 Adaptive Risk Predictor (SCARP), a Calculator to Predict Severe Disease or Death in Hospitalized Patients With COVID-19
Shannon Wongvibulsin, PhD, Brian T. Garibaldi, MD, MEHP, Annukka A.R. Antar, MD, PhD, Jiyang Wen, BS, Mei-Cheng Wang, PhD, Amita Gupta, MD, MHS, Robert Bollinger, MD, MPH, Yanxun Xu, PhD, Kunbo Wang, MS, Joshua F. Betz, MS, John Muschelli, PhD, Karen Bandeen-Roche, PhD, Scott L. Zeger, PhD, Matthew L. Robinson, MD See less
doi : 10.7326/M20-6754
Pages:777–785
Predicting the clinical trajectory of individual patients hospitalized with coronavirus disease 2019 (COVID-19) is challenging but necessary to inform clinical care. The majority of COVID-19 prognostic tools use only data present upon admission and do not incorporate changes occurring after admission.
Racial Disparities in COVID-19 Testing and Outcomes
Gabriel J. Escobar, MD, Alyce S. Adams, PhD, Vincent X. Liu, MD, MS, Lauren Soltesz, MS, Yi-Fen Irene Chen, MD, Stephen M. Parodi, MD, G. Thomas Ray, MBA, Laura C. Myers, MD, MPH, Charulata M. Ramaprasad, MD, MPH, Richard Dlott, MD, Catherine Lee, PhD See less
doi : 10.7326/M20-6979
Pages:786–793
Racial disparities exist in outcomes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
A SARS-CoV-2 Cluster in an Acute Care Hospital
Michael Klompas, MD, MPH, Meghan A. Baker, MD, ScD, Chanu Rhee, MD, MPH, Robert Tucker, MPH, CIC, Karen Fiumara, PharmD, Diane Griesbach, NP, Carin Bennett-Rizzo, RN, Hojjat Salmasian, MD, PhD, Rui Wang, PhD, Noah Wheeler, MPH, Glen R. Gallagher, PhD, Andrew S. Lang, PhD, Timelia Fink, MPH, Stephanie Baez, Sandra Smole, PhD, Larry Madoff, MD, Eric Goralnick, MD, MS, Andrew Resnick, MD, Madelyn Pearson, DNP, Kathryn Britton, MD, Julia Sinclair, MBA, Charles A. Morris, MD, MPH
doi : 10.7326/M20-7567
Pages:794–802
Little is known about clusters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in acute care hospitals.
Clinical and Economic Effects of Widespread Rapid Testing to Decrease SARS-CoV-2 Transmission
A. David Paltiel, PhD, Amy Zheng, BA, Paul E. Sax, MD
doi : 10.7326/M21-0510
Pages:803–810
The value of frequent, rapid testing to reduce community transmission of SARS-CoV-2 is poorly understood.
Antibody Response After SARS-CoV-2 Infection and Implications for Immunity
Irina Arkhipova-Jenkins, MD, MBA, Mark Helfand, MD, MPH, Charlotte Armstrong, BA, Emily Gean, PhD, Joanna Anderson, MPH, Robin A. Paynter, MLIS, Katherine Mackey, MD, MPP See less
doi : 10.7326/M20-7547
Pages:811–821
The clinical significance of the antibody response after SARS-CoV-2 infection remains unclear.
Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians
Rachael A. Lee, MD, MSPH, Robert M. Centor, MD, Linda L. Humphrey, MD, MPH, Janet A. Jokela, MD, MPH, Rebecca Andrews, MS, MD, Amir Qaseem, MD, PhD, MHA, for the Scientific Medical Policy Committee of the American College of Physicians
doi : 10.7326/M20-7355
Pages:822–827
Antimicrobial overuse is a major health care issue that contributes to antibiotic resistance. Such overuse includes unnecessarily long durations of antibiotic therapy in patients with common bacterial infections, such as acute bronchitis with chronic obstructive pulmonary disease (COPD) exacerbation, community-acquired pneumonia (CAP), urinary tract infections (UTIs), and cellulitis. This article describes best practices for prescribing appropriate and short-duration antibiotic therapy for patients presenting with these infections.
What Is the Antibody Response and Role in Conferring Natural Immunity After SARS-CoV-2 Infection? Rapid, Living Practice Points From the American College of Physicians (Version 1)
Amir Qaseem, MD, PhD, MHA, Jennifer Yost, RN, PhD, Itziar Etxeandia-Ikobaltzeta, PharmD, PhD, Mary Ann Forciea, MD, George M. Abraham, MD, MPH, Matthew C. Miller, MD, Adam J. Obley, MD, Linda L. Humphrey, MD, MPH, for the Scientific Medical Policy Committee of the American College of Physicians
doi : 10.7326/M20-7569
Pages:828–835
The widespread availability of SARS-CoV-2 antibody tests raises important questions for clinicians, patients, and public health professionals related to the appropriate use and interpretation of these tests. The Scientific Medical Policy Committee (SMPC) of the American College of Physicians developed these rapid, living practice points to summarize the current and best available evidence on the antibody response to SARS-CoV-2 infection, antibody durability after initial infection with SARS-CoV-2, and antibody protection against reinfection with SARS-CoV-2.
How Would You Manage This Patient With Nonvariceal Upper Gastrointestinal Bleeding?
Zahir Kanjee, MD, MPH, Akwi W. Asombang, MD, MPH, Tyler M. Berzin, MD, MS, Risa B. Burns, MD, MPH
doi : 10.7326/M21-1206
Pages:836–843
no abstract
Ethical and Professionalism Implications of Physician Employment and Health Care Business Practices: A Policy Paper From the American College of Physicians
Matthew DeCamp, MD, PhD, Lois Snyder Sulmasy, JD, for the American College of Physicians Ethics, Professionalism and Human Rights Committee
doi : 10.7326/M20-7093
Pages:844–851
The environment in which physicians practice and patients receive care continues to change. Increasing employment of physicians, changing practice models, new regulatory requirements, and market dynamics all affect medical practice; some changes may also place greater emphasis on the business of medicine. Fundamental ethical principles and professional values about the patient–physician relationship, the primacy of patient welfare over self-interest, and the role of medicine as a moral community and learned profession need to be applied to the changing environment, and physicians must consider the effect the practice environment has on their ethical and professional responsibilities. Recognizing that all health care delivery arrangements come with advantages, disadvantages, and salient questions for ethics and professionalism, this American College of Physicians policy paper examines the ethical implications of issues that are particularly relevant today, including incentives in the shift to value-based care, physician contract clauses that affect care, private equity ownership, clinical priority setting, and physician leadership. Physicians should take the lead in helping to ensure that relationships and practices are structured to explicitly recognize and support the commitments of the physician and the profession of medicine to patients and patient care.
“We Do Not Want Him Because He Is a Jew”: The Montreal Interns' Strike of 1934
Edward C. Halperin, MD, MA
doi : 10.7326/M20-7121
Pages:852–857
Risk Compensation and COVID-19 Vaccines
Brit Trogen, MD, MS, Arthur Caplan, PhD
doi : 10.7326/M20-8251
Pages:858–859
Modify Centers for Medicare & Medicaid Services' Sepsis Core Measure (SEP-1) Now to Optimize Care for COVID-19
Harry Peled, MD, Nhu Quyen Dau, PharmD, BCCP, Shelley Schoepflin Sanders, MD
doi : 10.7326/M20-8266
Pages:860–861
Another Two Mass Shootings: Déjà Vu All Over Again
Douglas M. DeLong, MD
doi : 10.7326/M21-1505
Pages:862–863
Déjà Vu: Coronaviruses and Transmission in Health Care Settings
Minji Kang, MD, Trish M. Perl, MD, MSc
doi : 10.7326/M21-0526
Pages:864–865
Judging Medicine's Past: A Lesson in Professionalism
Barron H. Lerner, MD, PhD
doi : 10.7326/M21-0648
Pages:866–867
MuSK Antibody–Associated Myasthenia Gravis With SARS-CoV-2 Infection: A Case Report
Louwai Muhammed, BMBCh, MA, EdM, Aravindhan Baheerathan, MBChB, Michelangelo Cao, MD, Maria Isabel Leite, MD, DPhil, Stuart Viegas, MBBS, DPhil, FRCp
doi : 10.7326/L20-1298
Pages:872–873
Background: Reports about the neurologic consequences of coronavirus disease 2019 (COVID-19) describe more cases of central than peripheral nervous system involvement. Myasthenia gravis is an autoimmune neuromuscular disorder that affects the peripheral nervous system. Other observers recently described 3 patients who developed myasthenia gravis with antibodies against the acetylcholine receptor (AChR) after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (1). Acetylcholine receptor antibodies are found in more than 80% of patients with generalized myasthenia gravis, whereas muscle-specific kinase (MuSK) antibodies are found in approximately 8% of cases. The pathogenic mechanisms of AChR antibody myastheniagravis (AChR-MG) are different from those of MuSK antibody myasthenia gravis (MuSK-MG). In addition, the 2 types of myasthenia gravis have important epidemiologic, clinical, therapeutic, immunologic, and pathologic features (2–4), and they should be considered distinct entities (Table).
Preterm Birth and Stillbirth During the COVID-19 Pandemic in Sweden: A Nationwide Cohort Study
Bj?rn Pasternak, MD, PhD, Martin Neovius, PhD, Jonas S?derling, PhD, Mia Ahlberg, RNM, PhD, Mikael Norman, MD, PhD, Jonas F. Ludvigsson, MD, PhD, Olof Stephansson, MD, PhD
doi : 10.7326/M20-6367
Pages:873–875
Background: A recent Danish study reported that the rate of extremely preterm birth was reduced during the lockdown period of the coronavirus disease 2019 (COVID-19) pandemic; the odds ratio (OR) was 0.09 (95% CI, 0.01 to 0.40) compared with previous years (1). Given the lockdown measures, potential mechanisms might include reduced exposure to various infectious agents, physical work strain, or stress; another explanation might be an increase in stillbirth, as the Danish study was based on live births. A study from the United Kingdom reported that stillbirth was more common during the pandemic; the difference was 6.93 (CI, 1.83 to 12.0) cases per 1000 births, corresponding to a 4-fold risk increase (2).
Primary Care Physicians and Spending on Low-Value Care
Aaron Baum, PhD, Andrew Bazemore, MD, MPH, Lars Peterson, MD, PhD, Sanjay Basu, MD, PhD, Keith Humphreys, PhD, Robert L. Phillips, MD, MPH
doi : 10.7326/M20-6257
Pages:875–878
Background: Low-value services account for $75 billion to $100 billion of U.S. health care spending (1). Primary care physicians (PCPs) have been conceptualized as potential gatekeepers for efforts to reduce low-value spending, but the share of low-value spending directly related to their services and referral decisions remains unclear (2, 3).
Reported Adverse Drug Reactions Associated With the Use of Hydroxychloroquine and Chloroquine During the COVID-19 Pandemic
Justine Perez, PharmD, Matthieu Roustit, PharmD, PhD, Marion Lepelley, PharmD, Bruno Revol, PharmD, PhD, Jean-Luc Cracowski, MD, PhD, Charles Khouri, PharmD, PhD
doi : 10.7326/M20-7918
Pages:878–880
Background: A few weeks after the beginning of the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), uncontrolled trials and in vitro studies suggested that chloroquine and hydroxychloroquine may have efficacy in treating coronavirus disease 2019 (COVID-19) (1). Although very preliminary, the results of these studies received extraordinary media coverage, and several high-profile figures, including some health regulatory authorities, endorsed the use of chloroquine and hydroxychloroquine to treat COVID-19. This led to a huge demand for and substantial use of these drugs; the Centers for Disease Control and Prevention identified an 80-fold increase in new prescriptions for hydroxychloroquine, particularly by nondermatologists and nonrheumatologists, between March 2019 and March 2020 (2). However, major clinical trials have concluded that hydroxychloroquine and chloroquine are unlikely to be effective in treating or preventing COVID-19, leading the U.S. Food and Drug Administration (FDA) to suspend its emergency use authorization for these drugs on 15 June 2020 (3). Nevertheless, little is known about the impact of this massive use of chloroquine and hydroxychloroquine on the number and nature of induced adverse drug reactions (ADRs).
Examining Population Health During the COVID-19 Pandemic: All-Cause, Pneumonia and Influenza, and Road Traffic Deaths in Taiwan
Wayne Gao, PhD, Mattia Sanna, PhD, Garry Huang, PhD, Marita Hefler, PhD, Min-Kuang Tsai, MS, Chi-Pang Wen, PhD
doi : 10.7326/M20-7788
Pages:880–882
Background: Initially projected to be the fourth most at-risk country for coronavirus disease 2019 (COVID-19) because of its close ties with China (1), Taiwan, on 21 December 2020, marked 253 consecutive days without a locally transmitted case, and a cumulative total of 770 cases (675 imported) and 7 deaths (2). Despite imported cases, Taiwan has successfully contained COVID-19 without a national lockdown (Figure 1).
Cross-sectional Assessment of COVID-19 Vaccine Acceptance Among Health Care Workers in Los Angeles
Adva Gadoth, MPH, PhD, Megan Halbrook, MPH, Rachel Martin-Blais, MD, Ashley Gray, MD, Nicole H. Tobin, MD, Kathie G. Ferbas, PhD, Grace M. Aldrovandi, MD, Anne W. Rimoin, MPH, PhD
doi : 10.7326/M20-7580
Pages:882–885
Background: The rise of vaccine hesitancy poses real and existential threats to the prevention and control of vaccine-preventable diseases and will hinder efforts to mitigate the coronavirus disease 2019 (COVID-19) pandemic (1, 2). In the context of a highly publicized coronavirus vaccine rollout, initial uptake by health care workers (HCWs) is critical for safety, health system functioning, and public opinion.
Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection
Fabian Sanchis-Gomar, MD, PhD, Carl J. Lavie, MD, Abhishek Sharma, MD, Brandon M. Henry, MD, Giuseppe Lippi, MD
doi : 10.7326/L21-0014
Pages:885–886
Response
Michaela R. Anderson, MD, MS, Anthony W. Ferrante, MD, PhD, Matthew R. Baldwin, MD, MS
doi : 10.7326/L21-0015
Page:886
Obesity and Mortality Among Patients Diagnosed With COVID-19-comment
Anastasios Kollias, MD, PhD, Konstantinos G. Kyriakoulis, MD, Konstantinos Syrigos, MD, PhD
doi : 10.7326/L21-0063
Pages:886–887
Obesity and Mortality Among Patients Diagnosed With COVID-19-comment
Andrew N. Bamji, MB
doi : 10.7326/L21-0062
Page:887
Obesity and Mortality Among Patients Diagnosed With COVID-19-comment
Johannes Burtscher, PhD, Grégoire P. Millet, PhD, Martin Burtscher, PhD, MD
doi : 10.7326/L21-0065
Page:887
Obesity and Mortality Among Patients Diagnosed With COVID-19-response
Sara Y. Tartof, PhD, MPH, Sameer B. Murali, MD, Debbie E. Malden, DPhil, MSc
doi : 10.7326/L21-0064
Pages:887–888
Update Alert 8: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults
Katherine Mackey, MD, MPP, Devan Kansagara, MD, MCR, Kathryn Vela, MLIS, AHIP
doi : 10.7326/L21-0223
Pages:W54–W55
Correction: Participation of African American Persons in Clinical Trials Supporting U.S. Food and Drug Administration Approval of Cancer Drugs
doi : 10.7326/L21-0146
Page:888
Correction: Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19
doi : 10.7326/L21-0148
Page:888
Correction: Revisiting the National Institutes of Health Fair Pricing Condition
doi : 10.7326/L21-0149
Page:888
USPSTF recommends against screening adults in the general population for asymptomatic carotid artery stenosis
Michael Tanner, MD
doi : 10.7326/ACPJ202106150-062
Page:JC62
In COVID-19, tocilizumab reduces all-cause mortality at 28 d
Shannon M. Fernando, MD, MSc, Bram Rochwerg, MD, MSc
doi : 10.7326/ACPJ202106150-063
Page:JC63
In patients hospitalized with COVID-19, adding azithromycin to usual care did not reduce 28-d mortality
Simon O’Connor, MBBS
doi : 10.7326/ACPJ202106150-064
Page:JC64
In recurrent C difficile infection, oral FMT capsules have a pooled cure rate of 82% (low-quality evidence)
Laura C. Horton, MD, Joseph D. Feuerstein, MD
doi : 10.7326/ACPJ202106150-065
Page:JC65
In COPD, prophylactic macrolides, but not tetracyclines or quinolones, reduce exacerbations, with fewer serious adverse events
Sandra G. Adams, MD, MS, Jay I. Peters, MD
doi : 10.7326/ACPJ202106150-066
Page:JC66
In type 2 diabetes, SGLT2 inhibitors reduce all-cause, but not cardiovascular, mortality vs. GLP-1 RAs
Michael Tanner, MD
doi : 10.7326/ACPJ202106150-067
Page:JC67
In HFrEF, adding empagliflozin to medical therapy reduced a composite outcome, regardless of CKD status
Carlos G. Santos-Gallego, MD, Harriette G.C. Van Spall, MD, MPH
doi : 10.7326/ACPJ202106150-068
Page:JC68
In older patients with permanent AF and HF, digoxin and bisoprolol did not differ for QoL at 6 mo
Kaveh Karimzad, MD, Anita Deswal, MD, MPH
doi : 10.7326/ACPJ202106150-069
Page:JC69
In obesity with T2DM, biliopancreatic diversion increased T2DM remission vs. medical and lifestyle therapy at 10 y
Shohinee Sarma, MD, MPH, Lorraine L. Lipscombe, MD, MSc
doi : 10.7326/ACPJ202106150-070
Page:JC70
Rapid antigen test had up to 98% sensitivity and 100% specificity for detecting COVID-19 in persons with mild symptoms
Christopher Sampson, MD
doi : 10.7326/ACPJ202106150-071
Page:JC71
Annals Graphic Medicine - Dr. Mom: Who Is Watching Your Kids?
Grace E. Farris, MD
doi : 10.7326/G21-0026
Pages:W56–W57
Annals Graphic Medicine - Last Human Contact in COVID-19
Pooja Gandhi, MSpPathSt, Arnav Agarwal, MD
doi : 10.7326/G20-0090
Pages:W58–W59
Annals Graphic Medicine - The Social Impact of COVID-19
Sujal Manohar, BS, BA
doi : 10.7326/G21-0022
Pages:W60–W62
Annals for Hospitalists Inpatient Notes - A Critical Look at Procalcitonin Testing in Pneumonia
Michael S. Pulia, MD, MS, Peter K. Lindenauer, MD, MSc
doi : 10.7326/M21-1913
Pages:HO2–HO3
Summary for Patients: Weight and Metabolic Changes After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in People Living With HIV
doi : 10.7326/P21-0002
Page:I21
Summary for Patients: Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians
doi : 10.7326/P21-0003
Page:I22
Summary for Patients: What Is the Antibody Response and Role in Conferring Natural Immunity After SARS-CoV-2 Infection? Rapid, Living Practice Points From the American College of Physicians (Version 1)
doi : 10.7326/P21-0004
Page:I26
