Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
1. Older adults trust online reviews almost as much as word-of-mouth recommendations when choosing a physician
Online reviews were viewed as more important than where the physician trained or attended medical school
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A nationally representative survey found that more than 4 in 10 U.S. adults aged 50 to 80 years have now used online physician rating sites and trust them almost as much as recommendations from family or friends for choosing a physician. These sources of information are more likely to be used by women, persons with higher levels of education, and those with a chronic medical condition. The findings are published in Annals of Internal Medicine.
Online physician ratings and reviews are increasingly available to the public through commercial rating sites and health systems. Although older adults visit physicians more than any other age group in the United States, little is known about how they use and perceive online ratings and reviews when choosing physicians.
Researchers from the University of Michigan and the VA Center for Clinical Management Research used data from a nationally representative survey (the National Poll on Healthy Aging) of 50 to 80 year-olds to measure and identify characteristics associated with use and perceptions of online physician ratings and reviews. They found that many factors were much more influential among older adults when selecting a physician, yet online ratings and reviews were still perceived to be important. Other factors that older adults rated as very important ranged from whether the physician accepted their health insurance (93.0%) to whether the physician had the same race/ethnicity (2.4%). Among the range of factors, online physician ratings and reviews ranked ninth. Online ratings were perceived to be very important more often among racial/ethnic minorities and less often among respondents with at least a bachelor's degree.
According to the researchers, these findings should prompt policymakers and clinicians to ensure the validity and reliability of online rating information and educate patients about how to best use this information in their decision-making.
2. Physicians debate best management strategy for patient with severe aortic stenosis
'Beyond the Guidelines' features are based on the Department of Medicine Grand Rounds at Beth Israel Deaconess Medical Center
URL goes live when the embargo lifts
In a new Annals 'Beyond the Guideline's feature, a cardiologist and a cardiothoracic surgeon debate the risks and benefits of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) for a patient with severe symptomatic aortic stenosis who is at low risk for surgical death. All 'Beyond the Guidelines' features are based on the Department of Medicine Grand Rounds at Beth Israel Deaconess Medical Center (BIDMC) in Boston and include print, video, and educational components published in Annals of Internal Medicine.
Aortic stenosis is common among the elderly and severe symptomatic disease is typically fatal without intervention. Surgical aortic valve replacement (SAVR) was the standard of care until transcatheter aortic valve replacement (TAVR) was shown to have lower mortality rates in patients at the highest surgical risk. Recent recommendations suggest that TAVR may have benefits for patients at intermediate risk, as well. Whether or not these benefits extend to low-risk patients is a subject of debate.
BIDMC Grand Rounds discussants, Suzanne J. Baron, MD, MSc, an interventional and structural cardiologist as well as the Director of Interventional Cardiology Research at Lahey Hospital and Medical Center, Burlington, Mass., and Tsuyoshi Kaneko, MD, Surgical Director of the Structural Heart Program at Brigham and Women's Hospital recently debated the case of a 62-year old man with symptomatic aortic stenosis and several comorbid conditions yet considered at low risk for surgical death.
In their assessment, both Drs. Baron and Kaneko recommend CT imaging as a next step to determine the patient's candidacy for TAVR. If the patient met anatomical criteria, Dr. Baron would engage the patient in a deliberate, shared decision-making process to ensure that his values drive an informed choice between TAVR and SAVR. Because the patient is young and very likely to need a second valve procedure sometime in the future, Dr. Kaneko would work with the heart team to highlight the durability and subsequent valve replacement challenges with TAVR. Both discussants agree that the patient is likely to have a good outcome whether he chooses TAVR or SAVR.
A complete list of 'Beyond the Guidelines' topics is available at http://www.
Also in this issue:
Pulmonary Hypertension Update
David Poch, MD
In the Clinic