1. On guns, docs tell the NRA #ThisisOurLane
Tweet from @AnnalsofIM in response to @NRA sparks online movement
Abstract: http://annals.org/aim/article/doi/10.7326/M18-3207
URLs go live when the embargo lifts
A tweet from @AnnalsofIM in response to the National Rifle Association (@NRA) sparked an online movement of physicians who say that firearms are, indeed, "their lane." Physicians tweeted first-hand accounts of dealing with the aftermath of gun violence. Some even shared bloody photos illustrating the horrors of firearm injury. An editorial on the "Twitter war" and its aftermath is published in Annals of Internal Medicine.
On November 8 2018, the National Rifle Association (NRA) took to Twitter to admonish doctors to "stay in their lane" after Annals published "Reducing Firearm Injuries and Deaths in the United States: A Position Paper from the American College of Physicians" along with editorials and a research report that also focused on firearm injury. The NRA does not believe firearm-related injury and its prevention is within the purview of physicians, and said so boldly on Twitter. Apparently, physicians disagree. The Tweet storm that followed attracted national media attention, and encouraged scores of physicians to formally pledge to speak to their patients about gun violence whenever risk factors are present.
According to the authors, gun violence is a national health care crisis that lacks funding for research. To fix this, Annals and the American College of Physicians are collaborating with the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM), a non-profit organization of healthcare professionals and researchers working to provide funding for research to answer important questions related to firearm injury and its prevention. In addition to raising funds to support research, AFFIRM aims to sponsor the development of practice recommendations based on sound science, and the education and training to implement them.
Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org">laevans@acponline.org">laevans@acponline.org">laevans@acponline.org. To interview an author, please contact Angela Collom at acollom@acponline.org">acollom@acponline.org">acollom@acponline.org">acollom@acponline.org.
2. NPs and PAs can effectively manage chronic conditions, fill gaps in primary care
Abstract: http://annals.org/aim/article/doi/10.7326/M17-1987
Editorial: http://annals.org/aim/article/doi/10.7326/M18-2941
URLs go live when the embargo lifts
Researchers found no significant differences in common diabetes outcomes between patients cared for by a primary care physician (PCP) versus those cared for by a nurse practitioner (NP) or physician assistant (PA). The findings are published in Annals of Internal Medicine.
Almost one third of adults who say they have a regular health care provider visit a PA or advanced practice (including NPs) at least once each year, and almost half of U.S. patients with diabetes see an NP or a PA for some part of their care. Greater use of NPs and PAs in primary care has been proposed as a way to address expected shortages of primary care physicians. However, concerns have long been expressed as to whether the outcomes achieved by NPs and PAs are equivalent to those of physicians.
Researchers from the Durham VA Medical Center used data from the U.S. Department of Veterans Affairs (VA) electronic health record to examine potential differences in intermediate diabetes outcomes among patients seen by the three different type of health care provider. They compared management of hemoglobin A1C, systolic blood pressure, and low-density lipoprotein cholesterol for 361,481 adult patients taking medication for diabetes under the care of either a primary care physician, NP, or PA. The researchers did not find any clinically significant differences in outcomes that were related to the care provider.
According to the researchers, this study provides further evidence that using NPs and PAs as primary care providers may represent a mechanism for expanding access to primary care while maintaining quality standards.
Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org">laevans@acponline.org">laevans@acponline.org">laevans@acponline.org. To interview the lead author, George L. Jackson, PhD, MHA, please contact Sarah Avery at sarah.avery@duke.edu">sarah.avery@duke.edu">sarah.avery@duke.edu">sarah.avery@duke.edu.
3. Diabetes patients with high-deductible health care plans may delay seeking crucial care
Abstract: http://annals.org/aim/article/doi/10.7326/M17-3365
Editorial: http://annals.org/aim/article/doi/10.7326/M18-2825
URLs go live when the embargo lifts
Mandated enrollment in high-deductible health insurance plans may cause patients with diabetes to delay seeking care for serious macrovascular complications. The findings are published in Annals of Internal Medicine.
People with diabetes are at risk for life threatening macrovascular diseases such as coronary heart disease, cerebrovascular disease, and peripheral vascular disease. These conditions can lead to complications such as heart attack, stroke, and amputation. An increasing proportion of Americans, including people with diabetes, have "high-deductible" health insurance policies, or plans requiring them to pay up to about $1000 to $7000 out-of-pocket per year if they use health care services. It is not known how switching to these types of plans will affect the diagnosis and treatment of macrovascular disease among patients with diabetes.
Research from the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute used data from a large national health insurance plan to determine whether having diabetes and high-deductible insurance was associated with delays in medical care for symptoms of cardiovascular, cerebrovascular, and peripheral vascular disease and related testing and treatment. The data showed that mandated enrollment in a high-deductible insurance plan was associated with delays in seeking care for concerning symptoms such as cardiac chest pain and transient ischemic attack. In addition, patients in high-deductible plans delayed diagnostic testing and procedure-based treatments for macrovascular disease.
According to the researchers, these findings may be useful for informing the design of health insurance plans that prevent participants from delaying crucial care.
Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org">laevans@acponline.org">laevans@acponline.org">laevans@acponline.org. To interview the lead author, J. Frank Wharam, MB, BCh, BAO, MPH, please contact Maya Dutta-Linn at Maya_Dutta-Linn@harvardpilgrim.org">Maya_Dutta-Linn@harvardpilgrim.org">Maya_Dutta-Linn@harvardpilgrim.org">Maya_Dutta-Linn@harvardpilgrim.org or Frank Wharam at jwharam@post.harvard.edu">jwharam@post.harvard.edu">jwharam@post.harvard.edu">jwharam@post.harvard.edu.
4. Omalizumab could be a new rescue option for status asthmaticus
Abstract: http://annals.org/aim/article/doi/10.7326/L18-0359
URLs go live when the embargo lifts
Omalizumab, a human monoclonal antibody against IgE, could be a new rescue option for refractory status asthmaticus. Findings from a brief case study are published in Annals of Internal Medicine.
Despite advances in asthma therapy, asthma mortality is stable in recent years. One of the reasons for this is status asthmaticus,that remains unresponsive to initial treatment, potentially leading to hypercapnic respiratory failure. This can occur after allergen exposure.
Clinicians at Ludwig-Maximilians-University of Munich, Munich, Germany, saw a 41-year-old man with a history of asthma with pollen allergy who developed severe dyspnea and required intubation upon respiratory failure. After being admitted to the hospital, the patient received maximum asthma treatment, which included steroids, bronchodilators, and sedation as well as mechanical ventilation and extracorporal membrane oxygenation (ECMO). One week into treatment, the patient had not improved and mechanical ventilation remained difficult. Omalizumab was administered subcutaneously at 600mg on day 8. A rapid improvement was noted the following day, the ECMO therapy was ended and the patient was weaned from mechanical ventilation within the next 2 weeks. Five weeks after the initial event, the patient was discharged to an inpatient rehabilitation facility and returned home 4 weeks later after tapering off oral prednisone. The patient made a rapid and complete recovery.
According to the authors, this case suggests that clinicians taking care of similar patients may consider targeted biological therapies, such as omalizumab, when maximum treatment with standard options is not sufficient.
Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org">laevans@acponline.org">laevans@acponline.org">laevans@acponline.org. To interview the lead author, Dr. med. Katrin Milger-Kneidinger, please contact email her directly at Katrin.Milger@med.uni-muenchen.de">Katrin.Milger@med.uni-muenchen.de">Katrin.Milger@med.uni-muenchen.de">Katrin.Milger@med.uni-muenchen.de.
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Also in this issue:
Inpatient Notes: How I Changed My Practice--Perioperative Bridging Anticoagulation
Paul J. Grant, MD
Hospitalist Commentary
Abstract: http://annals.org/aim/article/doi/10.7326/M18-2734
Losing Embryos, Finding Justice: Life, Liberty, and the Pursuit of Personhood
I. Glenn Cohen, JD; Dov Fox, JD, DPhil, LLM; Eli Y. Adashi, MD, MS
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M18-2483
Pitfalls and Potential in Medicare's Move Toward Outpatient Care Episodes
Amol S. Navathe, MD, PhD; Ezekiel J. Emanuel, MD, PhD; Joshua M. Liao, MD, MSc
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M18-2563
Journal
Annals of Internal Medicine