1. Being thin and carrying fat around the midsection more deadly than being obese
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M14-2525
Editorial: http://www.annals.org/article.aspx?doi=10.7326/M15-2435
URL live when embargo lifts
Normal-weight people who carry fat around their midsections have a greater mortality risk than those who are overweight or obese but have normal fat distribution, according to an article published in Annals of Internal Medicine.
Studies have shown that central obesity is associated with increased total and cardiovascular mortality. However, no studies have specifically focused on assessing the mortality risk in persons with normal body mass index (BMI) and central obesity compared with those who are overweight or obese according to BMI. Researchers examined data from a large cohort of Third National Health and Nutrition Examination Survey (NHANES III) participants to compare the total and cardiovascular mortality risks for persons with different combinations of body mass index (BMI) and waist-to-hip ratios (WHR). They found that normal-weight adults with central obesity have the worst long-term survival compared with any group, regardless of BMI. The data showed that a normal-weight person with central obesity had twice the mortality risk of participants who were overweight or obese according to BMI only.
The researchers conclude that persons with normal-weight central obesity may represent an important target population for lifestyle modification and other preventive strategies.
Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Dr. Francisco Lopez-Jimenez, please contact Traci Klein at Klein.Traci@mayo.edu or 507-990-1182.
2. ACP policy paper offers recommendations for the ethical practice of 'concierge' medicine
Regardless of practice type, docs should honor their professional obligation to care for the poor
Free content: http://www.annals.org/article.aspx?doi=10.7326/M15-0366
URL live when embargo lifts
A new policy position paper from the American College of Physicians (ACP) reviews the limited evidence on the impact of direct patient contracting practices (DPCPs) on quality, cost, access, and workforce, and discusses potential benefits and concerns about how growing interest in 'concierge' medicine and other DPCPs may impact access to care for low-income patients. To help mitigate the effect, ACP also offers practical recommendations for physicians who are considering such practice models. A summary of the paper, Assessing the Policy and Patient Care Implications of 'Concierge' and Other Direct Patient Contracting Practices is published in Annals of Internal Medicine.
ACP defines a DPCP as any practice where patients pay out-of-pocket for some or all of the services provided by the practice, in lieu of, or in addition to, traditional insurance arrangements. In a DPCP arrangement, the physician may charge an administrative fee to patients, sometimes called a retainer or concierge fee, in return for a promise of more personalized and accessible care. Concierge, boutique, cash-only, direct primary care, and direct -specialty-care practices are all considered DPCPs under ACP's definition.
While a review of the literature notes that there are potential benefits to DPCP models--including providing patients with better access and more time with physicians and fewer administrative burdens on the practice -- there are concerns that DPCPs may cause access issues for patients, especially among patients who cannot afford to pay directly for care. ACP offers nine recommendations covering policy, practical, and ethical issues for physicians who are considering entering into such a practice model, as well as steps they should take if they are already in a DPCP, to ensure that lower-income and other vulnerable patients are not disadvantaged. Bob Doherty (https://twitter.com/bobdohertyacp), ACP's senior vice president for governmental affairs and public policy, will host a Twitter chat about this topic on Thurs., Nov. 12 from 5:00 to 6:00 p.m. ET. Join the conversation by using hashtag #ACPInternistschat.
Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Robert Doherty, please contact David Kinsman at dkinsman@acponline.org or 202-261-4554.
3. Evidence inconclusive on the health effects of silicone breast implants
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1169
Editorial: http://www.annals.org/article.aspx?doi=10.7326/M15-2427
Editorial: http://www.annals.org/article.aspx?doi=10.7326/M15-2307
URL live when embargo lifts
Evidence is still lacking about the safety of silicone gel breast implants, according to an article published in Annals of Internal Medicine.
Silicone gel breast implants were removed from the U.S. market in 1992 due to safety concerns. While they were reintroduced in 2006, concerns persist about their association with a variety of diseases. Researchers reviewed 31 longitudinal studies comparing health outcomes in women with and without silicone breast implants. The researchers looked at specific long-term health outcomes, including cancer; connective tissue, rheumatologic, and autoimmune diseases; neurologic diseases; reproductive issues, including lactation; offspring issues; and mental health issues. They found insufficient evidence of an association between breast implants and any health outcome. Experts suggest that further investigation is required to determine whether any true associations exist between silicone gel implants and long-term health outcomes.
Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Dr. Ethan Balk, please contact David Orenstein at david_orenstein@brown.edu or 401-863-1862.
4. Arm access reduces mortality and bleeding compared to leg access for invasive heart procedures
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1277
Editorial: http://www.annals.org/article.aspx?doi=10.7326/M15-2444
URLs live when embargo lifts
Pooled evidence suggests that accessing the heart through an artery in the arm reduces death and major bleeding events in patients with acute coronary syndrome (ACS) compared to using an artery in the groin. The evidence review is published in Annals of Internal Medicine.
Strategies to avoid bleeding are key to improving the outcomes of patients with ACS who are managed with invasive procedures. Radial access sites are associated with a lower incidence of vascular bleeding complications, but conclusions about whether this approach reduces mortality and ischemic events are inconsistent.
Researchers reviewed four high-quality multicenter trials involving more than 17,000 patients to compare clinical outcomes occurring with radial versus femoral access in invasively managed adults with ACS. The evidence showed that radial access reduced morality, major coronary adverse events, and major bleeding in patients with ACS. The author of an accompanying editorial suggests that cardiologists should become adept at using both approaches.
Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Dr. Giuseppe Ando, please contact him directly at giuseppeando1975@gmail.com. The author of the editorial, Dr. Michael Savage, can be reached through Gail Benner at gail.benner@jefferson.edu or 215-955-2240.
Also in this issue: Two articles on Sofosbuvir/Velpatasvir for the treatment of Hep C
Sofosbuvir Plus Velpatasvir Combination Therapy for Treatment-Experienced Patients With Genotype 1 or 3 Hepatitis C Virus Infection: A Randomized Trial
Stephen Pianko, MD, PhD; Steven L. Flamm, MD; Mitchell L. Shiffman, MD; Sonal Kumar, MD; Simone I. Strasser, MD; Gregory J. Dore, MD; John McNally, PhD; Diana M. Brainard, MD; Lingling Han, PhD; Brian Doehle, PhD; Erik Mogalian, PhD; John G. McHutchison, MD; Mordechai Rabinovitz, MD; William J. Towner, MD; Edward J. Gane, MD; Catherine A.M. Stedman, MD; K. Rajender Reddy, MD; and Stuart K. Roberts, MD
Original Research
http://www.annals.org/article.aspx?doi=10.7326/M15-1014
Sofosbuvir With Velpatasvir in Treatment-Naive Noncirrhotic Patients With Genotype 1 to 6 Hepatitis C Virus Infection: A Randomized Trial
Gregory T. Everson, MD; William J. Towner, MD; Mitchell N. Davis, DO; David L. Wyles, MD; Ronald G. Nahass, MD; Paul J. Thuluvath, MD; Kyle Etzkorn, MD; Federico Hinestrosa, MD; Myron Tong, MD, PhD; Mordechai Rabinovitz, MD; John McNally, PhD; Diana M. Brainard, MD; Lingling Han, PhD; Brian Doehle, PhD; John G. McHutchison, MD; Timothy Morgan, MD; Raymond T. Chung, MD; and Tram T. Tran, MD
Original Research
http://www.annals.org/article.aspx?doi=10.7326/M15-1000
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Journal
Annals of Internal Medicine