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Highlights for July 17, 2018

Mar, 17/07/2018 - 02:00

How HIPAA Harms Care, and How to Stop It

Mar, 17/07/2018 - 02:00
In this Viewpoint, Berwick and Gaines review common misconceptions about Health Insurance Portability and Accountability Act (HIPAA) requirements regarding personal health information and propose steps the Department of Health and Human Services (DHHS) can take to better balance privacy protections with the need to ensure health information is available for clinical care in reasonable time at reasonable expense.

HIPAA and Protecting Health Information in the 21st Century

Mar, 17/07/2018 - 02:00
This Viewpoint posits that HIPAA no longer fully protects health information in today’s big data era in which health data are collected and exchanged in nonclinical settings, such as social media, apps, and search engines, and proposes principles around which reform of health information privacy protections should be organized.

Health Data and Privacy in the Era of Social Media

Mar, 17/07/2018 - 02:00
This Viewpoint discusses personal health information on social media and other sites and ways in which this information can and should be protected.

Reality vs Hope in the Face of a Dire Prognosis

Mar, 17/07/2018 - 02:00
This narrative medicine essay explores the difference between understanding a dire prognosis and believing it.

Bridging the Evidence-to-Practice Gap in Stroke Care

Mar, 17/07/2018 - 02:00
Stroke is particularly devastating globally. Although much progress on stroke has been made, stroke is the second leading cause of death worldwide and the leading cause of death in China, a country with a population greater than 1.5 billion. Indeed, the burden of stroke is substantial in Asian countries because of a higher stroke incidence and evolving access to modern stroke care. Stroke care may be one area of medicine that has a particularly large evidence-to-practice gap. Modern stroke treatment requires technology including imaging equipment, as well as stroke units and rehabilitation units, all of which can be prohibitively expensive. Stroke care requires organization and team-based delivery, which simply are not in place in much of the world. Worldwide, many patients with stroke do not receive up-to-date care for acute stroke or treatment to prevent stroke. What is known is not applied for multiple reasons.

Digital Media and ADHD Symptoms in Adolescents

Mar, 17/07/2018 - 02:00
Over the past 10 years, the introduction of mobile and interactive technologies has occurred at such a rapid pace that researchers have had difficulty publishing evidence within relevant time frames. While software applications such as Angry Birds and Pokémon Go reached adoption by an estimated 50 million global users within 35 and 19 days, respectively, of their release, most research studies encompass years from inception to publication of findings. As a result, crafting evidence-based recommendations that address all of the technologies children and adolescents currently use has been challenging. It is therefore an important contribution when a large, well-designed, longitudinal study accounting for multiple sociodemographic confounders is published.

The Status of End-of Life Care in the United States

Mar, 17/07/2018 - 02:00
Almost everyone has a story about end-of-life care gone bad. The available data reveal many reasons for frustration with how care for dying patients is currently delivered. But rather than see the glass as half empty, the historical perspective offered by Teno and colleagues in this issue of JAMA is a reminder of how far the US health care system has come on end-of-life care. This study suggests 4 important messages about the status of end-of-life care.

USPSTF Recommendations for Assessment of Cardiovascular Risk With Nontraditional Risk Factors

Mar, 17/07/2018 - 02:00
Cardiovascular disease (CVD) remains the leading cause of death in the United States and a major source of morbidity. Individuals in the United States have a 1 in 3 chance of dying from CVD and a 2 in 3 chance of developing CVD before death. However, control of risk factors, such as with cholesterol-lowering statin medications, can substantially reduce the likelihood of mortality and morbidity among at-risk patients. Identifying individuals who will benefit from this highly efficacious class of medications has been a priority of CVD prevention. For the purposes of primary prevention, the estimation of absolute risk of developing a CVD event is used to assist clinicians in determining which patients are likely to benefit from statin therapy, because net benefit (well in excess of any potential harms) is clearly seen in patients with estimated absolute risk of 7.5% or greater over 10 years. Estimation of absolute risk is practical, because it can be performed rapidly in clinical practice with the use of clinical calculators. Furthermore, quantitative risk estimation allows for a direct comparison of the risks and benefits of statin therapy so clinicians and patients can make informed decisions about therapy.

Effect of a Multifaceted Intervention on Adherence to Performance Measures in Acute Ischemic Stroke Patients

Mar, 17/07/2018 - 02:00
This cluster randomized clinical trial determines whether a multifaceted quality improvement intervention can improve adherence to evidence-based performance measures in patients with acute ischemic stroke in China.

Digital Media Use and ADHD in Adolescents

Mar, 17/07/2018 - 02:00
This 24-month cohort study tracks high school students in Los Angeles County, California, who were not initially assessed as having ADHD symptoms to compare frequency of use of digital media platforms with experiencing ADHD symptoms.

Site of Death, Place of Care, and Health Care Transitions Among US Medicare Beneficiaries, 2000-2015

Mar, 17/07/2018 - 02:00
This population epidemiology study characterizes trends in care in the intensive care unit during the last 30 days of life and in posthospital transitions and site of death among Medicare beneficiaries who died between 2000 and 2015.

USPSTF Recommendation: Risk Assessment for CVD With Nontraditional Risk Factors

Mar, 17/07/2018 - 02:00
This 2018 Recommendation Statement from the US Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of adding ABI, hsCRP, or CAC score measures to traditional risk assessment for CVD in asymptomatic adults to prevent CVD events (I statement).

USPSTF Report: Nontraditional Risk Factors in CVD Risk Assessment

Mar, 17/07/2018 - 02:00
This systematic review to support the 2018 US Preventive Services Task Force Recommendation Statement on use of nontraditional risk factors in cardiovascular disease risk assessment summarizes published evidence on the benefits and harms of using ABI, hsCRP, and CAC score measures in CVD risk assessment and decisions about initiation of preventive therapy.

Carcinoembryonic Antigen for Diagnosis of Colorectal Cancer Recurrence

Mar, 17/07/2018 - 02:00
A 78-year-old man with a carcinoembryonic antigen (CEA) level of 11.0 ng/mL but no evidence of metastasis underwent a right hemicolectomy (surgical pathology showed a 5.5-cm adenocardinoma with 0 of 19 lymph nodes positive for cancer). At 6 months, CEA was 3.0 ng/mL. At 12 months, CEA was 5.1 ng/mL and then 6.1 ng/mL with repeat testing. What would you do next?

Clinical Trial Evidence Supporting FDA Approval of Drugs Granted Breakthrough Therapy Designation

Mar, 17/07/2018 - 02:00
This study used the Drugs@FDA database to review FDA-approved “breakthrough” therapies from 2012 to 2017 (characterizing the pivotal clinical trials that serve as the basis of FDA approval), and premarket development and review times to assess the strength of evidence supporting breakthrough approvals.

Prophylactic Haloperidol for Critically Ill Adults

Mar, 17/07/2018 - 02:00
To the Editor Dr van den Boogaard and colleagues examined the effect of haloperidol on survival among critically ill adults at high risk of delirium. We have a number of concerns.

Prophylactic Haloperidol for Critically Ill Adults

Mar, 17/07/2018 - 02:00
To the Editor The Prophylactic Haloperidol Use for Delirium in ICU Patients at High Risk for Delirium (REDUCE) trial found that prophylactic haloperidol did not improve survival at 28 days compared with placebo. Despite the authors’ attempt to capture an at-risk patient population, the enrolled patients did not have many of the risk factors known to be associated with the development of delirium. The mean age of enrolled patients was 67 years, baseline hypertension was not reported, and patients with a history of dementia, alcohol abuse, and psychiatric disorders were excluded. The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 19. Two-thirds of patients were mechanically ventilated with 41% having acute respiratory failure. One-third of patients had sepsis, and the mean prediction of delirium in ICU patients score was 26. These variables suggest that patients may not have been at high risk of delirium.

Prophylactic Haloperidol for Critically Ill Adults

Mar, 17/07/2018 - 02:00
In Reply Drs Strik and Schieveld ask why survival was the primary outcome of the REDUCE study. We chose survival based on a previous study and because this is an unequivocal, clinically relevant outcome. We hypothesized that prophylactic haloperidol would improve ICU patients’ 28-day survival compared with placebo by 15%.

Diagnosis and Treatment of Acute Respiratory Distress Syndrome

Mar, 17/07/2018 - 02:00
To the Editor In the review article on acute respiratory distress syndrome (ARDS) by Dr Fan and colleagues, the authors mentioned that “more-direct and reproducible methods of measuring pulmonary vascular permeability and extravascular lung water are needed.” Although they implied that these variables are not available yet, 2 hemodynamic monitoring systems that allow bedside estimation of extravascular lung water (EVLW) and pulmonary vascular permeability index (PVPI) are currently available worldwide.

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