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MEDICAL JOURNALS – DECEMBER 2020

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Annals of Internal Medicine Vol. 173 No. 8 October 20 2020

Qaseem A, Etxeandia-Ikobaltzeta I, Yost J, et al.

Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians (Version 1).

pp642-649. doi:10.7326/M20-3234. PMID: 32551813; PMCID: PMC7357230.

Controversy exists around the appropriate types of masks and the situations in which they should be used in community and health care settings for the prevention of SARS-CoV-2 infection. In this article, the American College of Physicians (ACP) provides recommendations based on the best available evidence through 14 April 2020 on the effectiveness of N95 respirators, surgical masks, and cloth masks in reducing transmission of infection. The ACP plans periodic updates of these recommendations on the basis of ongoing surveillance of the literature for 1 year from the initial search date.

Skipper CP, Pastick KA, Engen NW, et al.

Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19 : A Randomized Trial.


Background: No effective oral therapy exists for early coronavirus disease 2019 (COVID-19).

Objective: To investigate whether hydroxychloroquine could reduce COVID-19 severity in adult outpatients.

Design: Randomized, double-blind, placebo-controlled trial conducted from 22 March through 20 May 2020. Setting: Internet-based trial across the United States and Canada (40 states and 3 provinces).

Participants: Symptomatic, nonhospitalized adults with laboratory-confirmed COVID-19 or probable COVID-19 and high-risk exposure within 4 days of symptom onset.

Intervention: Oral hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 more days) or masked placebo.

Measurements: Symptoms and severity at baseline and then at days 3, 5, 10, and 14 using a 10-point visual analogue scale. The primary end point was change in overall symptom severity over 14 days.

Results: Of 491 patients randomly assigned to a group, 423 contributed primary end point data. Of these, 341 (81%) had laboratory-confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or epidemiologically linked exposure to a person with laboratory-confirmed infection; 56% (236 of 423) were enrolled within 1 day of symptoms starting. Change in symptom severity over 14 days did not differ between the hydroxychloroquine and placebo groups (difference in symptom severity: relative, 12%; absolute, -0.27 point [95% CI, -0.61 to 0.07 point]; P = 0.117). At 14 days, 24% (49 of 201) of participants receiving hydroxychloroquine had ongoing symptoms compared with 30% (59 of 194) receiving placebo (P = 0.21). Medication adverse effects occurred in 43% (92 of 212) of participants receiving hydroxychloroquine versus 22% (46 of 211) receiving placebo (P < 0.001). With placebo, 10 hospitalizations occurred (2 non-COVID-19-related), including 1 hospitalized death. With hydroxychloroquine, 4 hospitalizations occurred plus 1 nonhospitalized death (P = 0.29).

Limitation: Only 58% of participants received SARS-CoV-2 testing because of severe U.S. testing shortages.

Conclusion: Hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19.

Cheng SY, Wang CJ, Shen AC, et al.

How to Safely Reopen Colleges and Universities During COVID-19: Experiences From Taiwan.


Reopening colleges and universities during the coronavirus disease 2019 (COVID-19) pandemic poses a special challenge worldwide. Taiwan is one of the few countries where schools are functioning normally. To secure the safety of students and staff, the Ministry of Education in Taiwan established general guidelines for college campuses. The guidelines delineated creation of a task force at each university; school-based risk screening based on travel history, occupation, contacts, and clusters; measures on self-management of health and quarantine; general hygiene measures (including wearing masks indoors); principles on ventilation and sanitization; regulations on school assemblies; a process for reporting suspected cases; and policies on school closing and make-up classes. It also announced that a class should be suspended if 1 student or staff member in it tested positive and that a school should be closed for 14 days if it had 2 or more confirmed cases. As of 18 June 2020, there have been 7 confirmed cases in 6 Taiwanese universities since the start of the pandemic. One university was temporarily closed, adopted virtual classes, and quickly reopened after 14 days of contact tracing and quarantine of possible contacts. Taiwan's experience suggests that, under certain circumstances, safely reopening colleges and universities this fall may be feasible with a combination of strategies that include containment (access control with contact tracing and quarantine) and mitigation (hygiene, sanitation, ventilation, and social distancing) practices.

Caturegli G, Materi J, Howard BM, et al.

Clinical Validity of Serum Antibodies to SARS-CoV-2 : A Case-Control Study.


Background: The clinical utility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies remains undefined.

Objective: To determine the clinical validity and utility of SARS-CoV-2 antibodies. Design: Case-control study.

Setting: First month of testing for coronavirus disease 2019 (COVID-19) by using a nucleic acid amplification test (NAAT) on nasopharyngeal swabs at the Johns Hopkins Hospital, Baltimore, Maryland (11 066 persons).

Participants: Of the 11 066 tested persons, 115 (1%) were hospitalized adults investigated for COVID-19. Clinical record review was performed to classify them into a COVID-19 case group (n = 60) or a non-COVID-19 control group (n = 55). The laboratory control groups comprised 513 persons not tested by NAAT: 160 healthy laboratory employees, 101 persons positive for IgG antibodies against Epstein-Barr virus capsid antigen, 215 positive for thyroperoxidase antibody, and 37 positive for rheumatoid factor.

Measurements: Serum IgG and IgA antibodies against SARS-CoV-2 spike protein were detected by using enzyme-linked immunosorbent assay.

Results: Sensitivity and specificity of the SARS-CoV-2 IgG assay were 0.976 (95% CI, 0.928 to 0.995) and 0.988 (CI, 0.974 to 0.995), respectively, when performed 14 days or later after symptom onset, but sensitivity decreased at earlier time points. Immunoglobulin G developed rapidly and was sustained at high levels throughout follow-up (up to 58 days). Antibodies to SARS-CoV-2 predicted the odds of developing acute respiratory distress syndrome, which increased by 62% (CI, 48% to 81%; P < 0.001) for every 2-fold increase in IgG. Of 11 066 NAAT-tested patients, 457 were repeatedly NAAT-negative, and serum samples were obtained for 18 such patients (6 COVID-19 case patients and 12 non-COVID-19 control patients). Antibodies were present in 5 of 6 case patients and none of the 12 control patients (P = 0.001).

Limitations: The study was retrospective and performed at a single center; the sample was small; follow-up was limited; and selection bias may have occurred.

Conclusion: Antibodies to SARS-CoV-2 demonstrate infection when measured at least 14 days after symptom onset, are associated with clinical severity, and provide valuable diagnostic support in patients who test negative by NAAT but remain clinically suspicious for COVID-19.

McCaw ZR, Tian L, Vassy JL, et al.

How to Quantify and Interpret Treatment Effects in Comparative Clinical Studies of COVID-19.


Clinical trials of treatments for coronavirus disease 2019 (COVID-19) draw intense public attention. More than ever, valid, transparent, and intuitive summaries of the treatment effects, including efficacy and harm, are needed. In recently published and ongoing randomized comparative trials evaluating treatments for COVID-19, time to a positive outcome, such as recovery or improvement, has repeatedly been used as either the primary or key secondary end point. Because patients may die before recovery or improvement, data analysis of this end point faces a competing risk problem. Commonly used survival analysis techniques, such as the Kaplan-Meier method, often are not appropriate for such situations. Moreover, almost all trials have quantified treatment effects by using the hazard ratio, which is difficult to interpret for a positive event, especially in the presence of competing risks. Using 2 recent trials evaluating treatments (remdesivir and convalescent plasma) for COVID-19 as examples, a valid, well-established yet underused procedure is presented for estimating the cumulative recovery or improvement rate curve across the study period. Furthermore, an intuitive and clinically interpretable summary of treatment efficacy based on this curve is also proposed. Clinical investigators are encouraged to consider applying these methods for quantifying treatment effects in future studies of COVID-19.

Lechien JR, Chiesa-Estomba CM, Hans S, et al.

Loss of Smell and Taste in 2013 European Patients With Mild to Moderate COVID-19.


Doyle TJ.

COVID-19, Prison Visits, and the Value of a Cup of Coffee.

pp666-667. doi:10.7326/M20-3073. PMID: 32479164.

Chow EJ, Rolfes MA, O'Halloran A, et al.

Acute Cardiovascular Events Associated With Influenza in Hospitalized Adults : A Cross-sectional Study.

pp605-613. doi:10.7326/M20-1509. PMID: 32833488.

Schluger NW.

The Saga of Hydroxychloroquine and COVID-19: A Cautionary Tale.


Tanael M.

Point-of-Care Ultrasonography, Primary Care, and Prudence.

pp650-651. doi:10.7326/M20-1840. PMID: 32687742.

Ludvigsson JF, Winell H, Sandin S, et al.

Maternal Influenza A(H1N1) Immunization During Pregnancy and Risk for Autism Spectrum Disorder in Offspring : A Cohort Study.

pp597-604. doi:10.7326/M20-0167. PMID: 32866418.

Background: There are concerns that influenza vaccine exposure during pregnancy may be associated with increased risk for autism spectrum disorder (ASD).

Objective: To examine the risk for ASD in offspring of mothers who were vaccinated against influenza A(H1N1)pdm09 ("swine flu") during pregnancy.

Design: Population-based cohort study using nationwide registers.

Setting: Seven health care regions in Sweden.

Participants: Live births between October 2009 and September 2010, with follow-up through December 2016. In total, 39 726 infants were prenatally exposed to H1N1 vaccine (13 845 during the first trimester) and 29 293 infants were unexposed.

Measurements: Cox regression was used to estimate hazard ratios (HRs) for the primary outcome, ASD, before and after adjustment for potential confounders. The secondary outcome was autistic disorder (AD).

Results: Mean follow-up was 6.7 years in both unexposed and exposed children. During follow-up, 394 (1.0%) vaccine-exposed and 330 (1.1%) unexposed children had a diagnosis of ASD. In adjusted analyses, prenatal exposure to H1N1 vaccination was not associated with a later diagnosis of ASD (adjusted HR [aHR], 0.95 [95% CI, 0.81 to 1.12]) or AD (aHR, 0.96 [CI, 0.80 to 1.16]). The 6-year standardized cumulative incidence difference between the unexposed and exposed children was 0.04% (CI, -0.09% to 0.17%) for ASD and 0.02% (CI, -0.09% to 0.14%) for AD. Restricting the analysis to vaccination in the first trimester of pregnancy did not influence risk estimates (aHR, 0.92 [CI, 0.74 to 1.16] for ASD and 0.91 [CI, 0.70 to 1.18] for AD).

Limitation: Data on H1N1 influenza infection are lacking.

Conclusion: This large cohort study found no association between maternal H1N1 vaccination during pregnancy and risk for ASD in the offspring.

Schoergenhofer C, Jilma B, Stimpfl T, et al.

Pharmacokinetics of Lopinavir and Ritonavir in Patients Hospitalized With Coronavirus Disease 2019 (COVID-19).


Rousseau P.

Immigrant COVID.

p667. doi:10.7326/M20-4732. PMID: 32744866.

Prioleau P.

After the Night Shift.

p684. doi:10.7326/M19-1177. PMID: 33075269.

Wrighton MS, Lawrence SJ.

Reopening Colleges and Universities During the COVID-19 Pandemic.


Tigges S, Ward PJ.

Annals Graphic Medicine - How the Virus Stole Anatomy.

W135-W142. doi:10.7326/G20-0048. PMID: 32614641.

Addis A, Genazzani A, Trotta MP, et al.

Promoting Better Clinical Trials and Drug Information as Public Health Interventions for the COVID-19 Emergency in Italy.


Sacks HS.

Accuracy of point-of-care diagnostic tests for SARS-CoV-2 antibodies (IgM/IgG) is heterogeneous.

JC47. doi:10.7326/ACPJ202010200-047. PMID: 33075255.

Centor RM, Brown JM.

Web Exclusive. Annals On Call - Underdiagnosis of Primary Aldosteronism.

OC1. doi:10.7326/A19-0040. PMID: 33075251.

Piaditis GP, Kaltsas G, Markou A, et al.

The Unrecognized Prevalence of Primary Aldosteronism.

p681. doi:10.7326/L20-1096. PMID: 33075252.

Vaidya A, Brown JM, Carey RM, et al.


p683. doi:10.7326/L20-1097. PMID: 33075250.

Sosa Barrios RH, Menacho-Román M, Mataix AL, et al.


pp682-683. doi:10.7326/L20-1095. PMID: 33075253.

Pilz S, Grübler MR, Theiler-Schwetz V, et al.


pp681-682. doi:10.7326/L20-1094. PMID: 33075254.

Chou R, Dana T, Buckley DI, et al.

Update Alert 4: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers.

pp143-144. doi:10.7326/L20-1134. PMID: 32915642; PMCID: PMC7505020.

Stone VE.

White Coats for Black Lives: The Time Has Come for Action.

pp656-657. doi:10.7326/M20-4280. PMID: 32551811.

Tuite AR, Greer AL, De Keninck S, et al.

Risk for COVID-19 Resurgence Related to Duration and Effectiveness of Physical Distancing in Ontario, Canada.


Griffin TP, Dinneen SF.

SGLT2 inhibitors increase risk for diabetic ketoacidosis in type 2 diabetes.

JC40. doi:10.7326/ACPJ202010200-040. PMID: 33075260.

Kimmel SE, Califf RM, Dean NE, et al.

COVID-19 Clinical Trials: A Teachable Moment for Improving Our Research Infrastructure and Relevance. pp652-653. doi:10.7326/M20-2959. PMID: 32543881; PMCID: PMC7322771.

Trowbridge RL, Rencic JJ, Wijesekera TP, et al.

Avoiding Cognitive Errors in Clinical Decision Making.

pp678-679. doi:10.7326/L20-1059. PMID: 33075248.

Laine C.

Annals for Educators - 20 October 2020.

ED8. doi:10.7326/AWED202010200. PMID: 33075273.

Restrepo D, Armstrong KA, Metlay JP.


p679. doi:10.7326/L20-1060. PMID: 33075247.

Musher DM.


p679. doi:10.7326/L20-1058. PMID: 33075249.

Jacobs ZG.

Web Exclusive. Annals Graphic Medicine - Hats.

W133-W134. doi:10.7326/G20-0012. PMID: 33075256.

DePew R.

Memory Care Unit.

p637. doi:10.7326/M19-2736. PMID: 33075265.

Nanna MG, Granger CB.

In ACS, ticagrelor and prasugrel each reduce some ischemic events but increase major bleeding vs. clopidogrel.

JC44. doi:10.7326/ACPJ202010200-044. PMID: 33075264.

Bavishi C.

In ACS treated with drug-eluting stents and 3 mo of DAPT, ticagrelor monotherapy reduced clinical events at

1 y vs. DAPT.

JC43. doi:10.7326/ACPJ202010200-043. PMID: 33075261.

Wesorick DH, Chopra V.

Annals for Hospitalists - 20 October 2020.

ED8. doi:10.7326/AWHO202010200. PMID: 33075266.

Horton LC, Feuerstein JD.

In adults with severe acute GI bleeding, tranexamic acid did not reduce death due to bleeding at 5 days.

JC46. doi:10.7326/ACPJ202010200-046. PMID: 33075257.

MacIntyre CR.

Influenza Vaccine: Routine Secondary Prevention for Patients With Cardiovascular Disease?

pp660-661. doi:10.7326/M20-5810. PMID: 32833491.

Stern RH.

Locally Informed Simulation to Predict Hospital Capacity Needs During the COVID-19 Pandemic.

pp679-680. doi:10.7326/L20-1061. PMID: 33075246.

Weissman GE, Crane-Droesch A, Chivers C, et al.

Locally Informed Simulation to Predict Hospital Capacity Needs During the COVID-19 Pandemic.

pp680-681. doi:10.7326/L20-1062. PMID: 33075245.

Nightingale TE, Tejpar T, O'Connell C, et al.

Using Cannabis to Control Blood Pressure After Spinal Cord Injury: A Case Report.

pp668-670. doi:10.7326/L20-0090. PMID: 32539443.

Holbrook AM.

USPSTF recommends asking adults screening questions about unhealthy drug use.

JC38. doi:10.7326/ACPJ202010200-038. PMID: 33075271.

Merli GJ, Weitz HH.

Web Exclusive. Annals Consult Guys – Preoperative Cannabis: Reason to Postpone Surgery?

CG1. doi:10.7326/W19-0043. PMID: 33075267.

Haley SP, Chessman A.

Treatment effect of aspirin for primary prevention does not differ according to baseline ASCVD risk.

JC39. doi:10.7326/ACPJ202010200-039. PMID: 33075272.

Singh A, Sonpar A.

In adults exposed to COVID-19, hydroxychloroquine did not reduce confirmed or probable COVID-19; trial stopped for futility.

JC41. doi:10.7326/ACPJ202010200-041. PMID: 33075259.

Alvarado F, Borzak S.

After PCI and short-term DAPT, P2Y12 inhibitors alone vs. ongoing DAPT reduce major bleeding; CV events do not differ.

JC42. doi:10.7326/ACPJ202010200-042. PMID: 33075262.

Davenport MS, Weinreb JC.

Web Exclusive. Annals for Hospitalists Inpatient Notes - What Hospitalists Need to Know About Risk for Contrast-Induced Acute Kidney Injury From Contrast-Enhanced Computed Tomography.

HO2-HO3. doi:10.7326/M20-6296. PMID: 33075258.

Hviid A.

Vaccine Safety in Pregnancy: Going Beyond the Perinatal Period.

pp658-659. doi:10.7326/M20-5489. PMID: 32866416.

Brophy J.

In adults with chest pain, a troponin limit of detection strategy did not increase early discharge rate.

JC45. doi:10.7326/ACPJ202010200-045. PMID: 33075263.

Annals of Internal Medicine Vol. 173 No. 9 November 3 2020

Qaseem A, McLean RM, O'Gurek D, et al.

Nonpharmacologic and Pharmacologic Management of Acute Pain From Non-Low Back, Musculoskeletal Injuries in Adults: A Clinical Guideline From the American College of Physicians and American Academy of Family Physicians.

pp739-748. doi:10.7326/M19-3602. PMID: 32805126.

Description: The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) developed this guideline to provide clinical recommendations on nonpharmacologic and pharmacologic management of acute pain from non-low back, musculoskeletal injuries in adults in the outpatient setting. The guidance is based on current best available evidence about benefits and harms, taken in the context of costs and patient values and preferences. This guideline does not address noninvasive treatment of low back pain, which is covered by a separate ACP guideline that has also been endorsed by AAFP.

Methods: This guideline is based on a systematic evidence review on the comparative efficacy and safety of nonpharmacologic and pharmacologic management of acute pain from non-low back, musculoskeletal injuries in adults in the outpatient setting and a systematic review on the predictors of prolonged opioid use. We evaluated the following clinical outcomes using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system: pain (at ≤2 hours and at 1 to 7 days), physical function, symptom relief, treatment satisfaction, and adverse events.

Target audience and patient population: The target audience is all clinicians, and the target patient population is adults with acute pain from non-low back, musculoskeletal injuries.

Recommendation 1: ACP and AAFP recommend that clinicians treat patients with acute pain from non-low back, musculoskeletal injuries with topical nonsteroidal anti-inflammatory drugs (NSAIDs) with or without menthol gel as first-line therapy to reduce or relieve symptoms, including pain; improve physical function; and improve the patient's treatment satisfaction (Grade: strong recommendation; moderate-certainty evidence).

Recommendation 2a: ACP and AAFP suggest that clinicians treat patients with acute pain from non-low back, musculoskeletal injuries with oral NSAIDs to reduce or relieve symptoms, including pain, and to improve physical function, or with oral acetaminophen to reduce pain (Grade: conditional recommendation; moderate-certainty evidence).

Recommendation 2b: ACP and AAFP suggest that clinicians treat patients with acute pain from non-low back, musculoskeletal injuries with specific acupressure to reduce pain and improve physical function, or with transcutaneous electrical nerve stimulation to reduce pain (Grade: conditional recommendation; low-certainty evidence).

Recommendation 3: ACP and AAFP suggest against clinicians treating patients with acute pain from non-low back, musculoskeletal injuries with opioids, including tramadol (Grade: conditional recommendation; low-certainty evidence).

Busse JW, Sadeghirad B, Oparin Y, et al.

Management of Acute Pain From Non-Low Back, Musculoskeletal Injuries : A Systematic Review and Network

Meta-analysis of Randomized Trials.

pp730-738. doi:10.7326/M19-3601. PMID: 32805127.

Background: Patients and clinicians can choose from several treatment options to address acute pain from non-low back, musculoskeletal injuries.

Purpose: To assess the comparative effectiveness of outpatient treatments for acute pain from non-low back, musculoskeletal injuries by performing a network meta-analysis of randomized clinical trials (RCTs).

Data sources: MEDLINE, EMBASE, CINAHL, PEDro (Physiotherapy Evidence Database), and Cochrane Central Register of Controlled Trials to 2 January 2020.

Study selection: Pairs of reviewers independently identified interventional RCTs that enrolled patients presenting with pain of up to 4 weeks' duration from non-low back, musculoskeletal injuries.

Data extraction: Pairs of reviewers independently extracted data. Certainty of evidence was evaluated by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.

Data synthesis: The 207 eligible studies included 32 959 participants and evaluated 45 therapies. Ninety-nine trials (48%) enrolled populations with diverse musculoskeletal injuries, 59 (29%) included patients with sprains, 13 (6%) with whiplash, and 11 (5%) with muscle strains; the remaining trials included various injuries ranging from nonsurgical fractures to contusions. Topical nonsteroidal anti-inflammatory agents (NSAIDs) proved to have the greatest net benefit, followed by oral NSAIDs and acetaminophen with or without diclofenac. Effects of these agents on pain were modest (around 1 cm on a 10-cm visual analogue scale, approximating the minimal important difference). Regarding opioids, compared with placebo, acetaminophen plus an opioid improved intermediate pain (1 to 7 days) but not immediate pain (≤2 hours), tramadol was ineffective, and opioids increased the risk for gastrointestinal and neurologic harms (all moderate-certainty evidence).

Limitations: Only English-language studies were included. The number of head-to-head comparisons was limited.

Conclusion: Topical NSAIDs, followed by oral NSAIDs and acetaminophen with or without diclofenac, showed the most convincing and attractive benefit-harm ratio for patients with acute pain from non-low back, musculoskeletal injuries. No opioid achieved benefit greater than that of NSAIDs, and opioids caused the most harms.

Sudharsanan N, Didzun O, Bärnighausen T, et al.

The Contribution of the Age Distribution of Cases to COVID-19 Case Fatality Across Countries : A Nine-Country Demographic Study.


Background: There is wide variation in coronavirus disease 2019 (COVID-19) case-fatality rates (CFRs) across countries, leading to uncertainty about the true lethality of the disease. A large part of this variation may be due to the ages of individuals who are tested and identified.

Objective: To measure the contribution of distortions from the age distributions of confirmed cases to CFRs within and across populations.

Design: Cross-sectional demographic study using aggregate data on COVID-19 cases and deaths by age.

Setting: Population-based data from China, France, Germany, Italy, the Netherlands, South Korea, Spain, Switzerland, and the United States.

Participants: All individuals with confirmed COVID-19, as reported by each country as of 19 April 2020

(n = 1 223 261).

Measurements: Age-specific COVID-19 CFRs and age-specific population shares by country.

Results: The overall observed CFR varies widely, with the highest rates in Italy (9.3%) and the Netherlands (7.4%) and the lowest rates in South Korea (1.6%) and Germany (0.7%). Adjustment for the age distribution of cases explains 66% of the variation across countries, with a resulting age-standardized median CFR of 1.9%. Among a larger sample of 95 countries, the observed variation in COVID-19 CFRs is 13 times larger than what would be expected on the basis of just differences in the age composition of countries.

Limitation: The age-adjusted rates assume that, conditional on age, COVID-19 mortality among diagnosed cases is the same as that among undiagnosed cases and that individuals of all ages are equally susceptible to severe acute respiratory syndrome coronavirus 2 infection.

Conclusion: Selective testing and identification of older cases considerably warps estimates of the lethality of COVID-19 within populations and comparisons across countries. Removing age distortions and focusing on differences in age-adjusted case fatality will be essential for accurately comparing countries' performance in caring for patients with COVID-19 and for monitoring the epidemic over time.

Tison GH, Avram R, Kuhar P, et al.

Worldwide Effect of COVID-19 on Physical Activity: A Descriptive Study.


Schiavon CA, Bhatt DL, Ikeoka D, et al.

Three-Year Outcomes of Bariatric Surgery in Patients With Obesity and Hypertension : A Randomized Clinical Trial.

pp685-693. doi:10.7326/M19-3781. PMID: 32805133.

Background: Midterm effects of bariatric surgery on patients with obesity and hypertension remain uncertain.

Objective: To determine the 3-year effects of Roux-en-Y gastric bypass (RYGB) on blood pressure (BP) compared with medical therapy (MT) alone.

Design: Randomized clinical trial. (ClinicalTrials.gov: NCT01784848).

Setting: Investigator-initiated study at Heart Hospital (HCor), São Paulo, Brazil.

Participants: Patients with hypertension receiving at least 2 medications at maximum doses or more than 2 medications at moderate doses and with a body mass index (BMI) between 30.0 and 39.9 kg/m2 were randomly assigned (1:1 ratio).

Intervention: RYGB plus MT or MT alone.

Measurements: The primary outcome was at least a 30% reduction in total number of antihypertensive medications while maintaining BP less than 140/90 mm Hg. Key secondary outcomes were number of antihypertensive medications, hypertension remission, and BP control according to current guidelines (<130/80 mm Hg).

Results: Among 100 patients (76% female; mean BMI, 36.9 kg/m2 [SD, 2.7]), 88% from the RYGB group and 80% from the MT group completed follow-up. At 3 years, the primary outcome occurred in 73% of patients from the RYGB group compared with 11% of patients from the MT group (relative risk, 6.52 [95% CI, 2.50 to 17.03]; P < 0.001). Of the randomly assigned participants, 35% and 31% from the RYGB group and 2% and 0% from the MT group achieved BP less than 140/90 mm Hg and less than 130/80 mm Hg without medications, respectively. Median (interquartile range) number of medications in the RYGB and MT groups at 3 years was 1 (0 to 2) and 3 (2.8 to 4), respectively (P < 0.001). Total weight loss was 27.8% and -0.1% in the RYGB and MT groups, respectively. In the RYGB group, 13 patients developed hypovitaminosis B12 and 2 patients required reoperation.

Limitation: Single-center, nonblinded trial.

Conclusion: RYGB is an effective strategy for midterm BP control and hypertension remission, with fewer medications required in patients with hypertension and obesity.

Williams AR, Hill KP.

Care of the Patient Using Cannabis.

ITC65-ITC80. doi:10.7326/AITC202011030. PMID: 33137270.

Riva JJ, Noor ST, Wang L, et al.

Predictors of Prolonged Opioid Use After Initial Prescription for Acute Musculoskeletal Injuries in Adults : A Systematic Review and Meta-analysis of Observational Studies.

pp721-729. doi:10.7326/M19-3600. PMID: 32805130.

Background: Opioids are frequently prescribed for acute musculoskeletal injuries and may result in long-term use and consequent harms.

Purpose: To explore factors associated with persistent opioid use after its prescription for acute musculoskeletal injury.

Data sources: Searches of multiple electronic databases, without language restrictions, from inception to 6 January 2020, and reference lists of selected articles.

Study selection: Observational studies of adults with opioid prescriptions for outpatient acute musculoskeletal injuries, in an adjusted model, that explored risk factors for prolonged use.

Data extraction: 6 reviewers, working in pairs, independently extracted data, rated the quality of studies, and evaluated the certainty of evidence.

Data synthesis: 14 cohorts with 13 263 393 participants were included. The overall prevalence of prolonged opioid use after musculoskeletal injury for high-risk populations (that is, patients receiving workers' compensation benefits, Veterans Affairs claimants, or patients with high rates of concurrent substance use disorder) was 27% (95% CI, 18% to 37%). The prevalence among low-risk populations was 6% (CI, 4% to 8%; P for interaction < 0.001). Moderate-certainty evidence showed increased odds of persistent opioid use with older age (absolute risk increase [ARI] for every 10-year increase, 1.1% [CI, 0.7% to 1.5%]) and physical comorbidity (ARI, 0.9% [CI, 0.1% to 1.7%]). Low-certainty evidence suggested increased risk for persistent opioid use with past or current substance use disorder (ARI, 10.5% [CI, 4.2% to 19.8%]), prescriptions lasting more than 7 days (median ARI, 4.5%), and higher morphine milligram equivalents per day.

Limitation: Sparse, heterogeneous data with suboptimal adjustment for potential confounders.

Conclusion: Avoiding prescribing opioids for acute musculoskeletal injuries to patients with past or current substance use disorder, and restricting duration to 7 days or less and using lower doses when they are prescribed, are potentially important targets to reduce rates of persistent opioid use.

Twahirwa Rwema JO, Diouf D, Phaswana-Mafuya N, et al.

COVID-19 Across Africa: Epidemiologic Heterogeneity and Necessity of Contextually Relevant Transmission Models and Intervention Strategies.


Dau NQ, Peled H, Lau H, et al.

Why N95 Should Be the Standard for All COVID-19 Inpatient Care.


Doumouras AG, Hong D, Lee Y, et al.

Association Between Bariatric Surgery and All-Cause Mortality: A Population-Based Matched Cohort Study in a Universal Health Care System.

pp694-703. doi:10.7326/M19-3925. PMID: 32805135.

Background: Mortality after bariatric surgery has been previously studied, but cohort selection bias, completeness of follow-up, and collection of confounders have limited the inference of results.

Objective: To determine the association between bariatric surgery and all-cause mortality.

Design: Population-based matched cohort study. Setting: Ontario, Canada.

Participants: 13 679 patients who underwent bariatric surgery from January 2010 to December 2016 and 13 679 matched nonsurgical patients.

Intervention: Bariatric surgery.

Measurements: The primary outcome was all-cause mortality, with cause-specific mortality as the secondary outcome. Patients were matched according to age, sex, body mass index, and diabetes duration.

Results: 13 679 patients who underwent bariatric surgery were matched to 13 679 nonsurgical patients. After a median follow-up of 4.9 years, the overall mortality rate was 1.4% (n = 197) in the surgery group and 2.5% (n = 340) in the nonsurgery group, with a lower adjusted hazard ratio (HR) of overall all-cause mortality (HR, 0.68 [95% CI, 0.57 to 0.81]). Patients aged 55 years or older had an absolute risk reduction of 3.3% (CI, 2.3% to 4.3%), with a lower HR of mortality in the surgery group (HR, 0.53 [CI, 0.41 to 0.69]). Observed relative effects were similar across sex; however, the observed association in absolute terms was greater in men. Surgery also was associated with lower cardiovascular mortality (HR, 0.53 [CI, 0.34 to 0.84]) and lower cancer mortality (HR, 0.54 [CI, 0.36 to 0.80]).

Limitation: The observational design limits causal inference.

Conclusion: Bariatric surgery was associated with substantially lower all-cause, cardiovascular, and cancer mortality. The lowered observed mortality of surgery was significant across most subgroups. The largest absolute effects were for men and patients aged 55 years or older.

Fisman DN, Greer AL, Tuite AR.

Age Is Just a Number: A Critically Important Number for COVID-19 Case Fatality.


Lu MT, Raghu VK, Mayrhofer T, et al.

Deep Learning Using Chest Radiographs to Identify High-Risk Smokers for Lung Cancer Screening Computed Tomography: Development and Validation of a Prediction Model.

pp704-713. doi:10.7326/M20-1868. PMID: 32866413.

Background: Lung cancer screening with chest computed tomography (CT) reduces lung cancer death. Centers for Medicare & Medicaid Services (CMS) eligibility criteria for lung cancer screening with CT require detailed smoking information and miss many incident lung cancers. An automated deep-learning approach based on chest radiograph images may identify more smokers at high risk for lung cancer who could benefit from screening with CT.

Objective: To develop and validate a convolutional neural network (CXR-LC) that predicts long-term incident lung cancer using data commonly available in the electronic medical record (EMR) (chest radiograph, age, sex, and whether currently smoking).

Design: Risk prediction study. Setting: U.S. lung cancer screening trials.

Participants: The CXR-LC model was developed in the PLCO (Prostate, Lung, Colorectal, and Ovarian) Cancer Screening Trial (n = 41 856). The final CXR-LC model was validated in additional PLCO smokers (n = 5615, 12-year follow-up) and NLST (National Lung Screening Trial) heavy smokers (n = 5493, 6-year follow-up). Results are reported for validation data sets only.

Measurements: Up to 12-year lung cancer incidence predicted by CXR-LC.

Results: The CXR-LC model had better discrimination (area under the receiver-operating characteristic curve [AUC]) for incident lung cancer than CMS eligibility (PLCO AUC, 0.755 vs. 0.634; P < 0.001). The CXR-LC model's performance was similar to that of PLCOM2012, a state-of-the-art risk score with 11 inputs, in both the PLCO data set (CXR-LC AUC of 0.755 vs. PLCOM2012 AUC of 0.751) and the NLST data set (0.659 vs. 0.650). When compared in equal-sized screening populations, CXR-LC was more sensitive than CMS eligibility in the PLCO data set (74.9% vs. 63.8%; P = 0.012) and missed 30.7% fewer incident lung cancers. On decision curve analysis, CXR-LC had higher net benefit than CMS eligibility and similar benefit to PLCOM2012.

Limitation: Validation in lung cancer screening trials and not a clinical setting.

Conclusion: The CXR-LC model identified smokers at high risk for incident lung cancer, beyond CMS eligibility and using information commonly available in the EMR.

Law AC, Weissman GE, Iwashyna TJ.

A Dangerous Myth: Does Speaking Imply Breathing?

pp754-755. doi:10.7326/M20-4186. PMID: 32584592.

Gaffney AW, Himmelstein D, Woolhandler S.

Risk for Severe COVID-19 Illness Among Teachers and Adults Living With School-Aged Children.


Farris GE.

Web Exclusive. Annals Graphic Medicine - Dr. Mom: 2015 Versus 2020.

W145-W146. doi:10.7326/G20-0102. PMID: 33137268.

Hellfritzsch M, Christensen J, Nielsen LP.

Rivaroxaban Plasma Levels and Levetiracetam.

p771. doi:10.7326/L20-1064. PMID: 33137273.

Punia V.


pp771-772. doi:10.7326/L20-1065. PMID: 33137272.

Brouwer MA, van Vugt SPG, Focks JJ, et al.


pp770-771. doi:10.7326/L20-1063. PMID: 33137266.

Mackey K, Kansagara D, Vela K.

Update Alert 4: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults.

W147-W148. doi:10.7326/L20-1177. PMID: 32956599; PMCID: PMC7516553.

Centor RM, Sehgal AR.

Web Exclusive. Annals On Call - Should Race Be Part of Glomerular Filtration Rate Estimation?

OC1. doi:10.7326/A19-0041. PMID: 33137269.

Harkin T, Buckingham-Schutt L.

Thirty Years After Passage of the Americans With Disabilities Act: Has the Medical Community Done Enough?

pp756-757. doi:10.7326/M20-4554. PMID: 32716702.

Laine C.

Annals for Educators - 3 November 2020.

ED9. doi:10.7326/AWED202011030. PMID: 33137267.

Pinsky P.

Artificial Intelligence and Data Mining to Assess Lung Cancer Risk: Challenges and Opportunities.

pp760-761. doi:10.7326/M20-5673. PMID: 32866415.

Wee CC.

Bariatric Surgery for Patients With Obesity: The Earlier the Better?

pp758-759. doi:10.7326/M20-5199. PMID: 32805129.

Summary for Patients: Association Between Bariatric Surgery and All-Cause Mortality.

I22. doi:10.7326/P20-0010. PMID: 32815376.

Lutz J, Dunaj-Kazmierowska M, Arcan S, et al.

Chylomicronemia From GPIHBP1 Autoantibodies Successfully Treated With Rituximab: A Case Report.

pp764-765. doi:10.7326/L20-0327. PMID: 32777186.

Paciullo F, Costa C, Gresele P.


p772. doi:10.7326/L20-1066. PMID: 33137271.

Summary for Patients: Three-Year Outcomes of Bariatric Surgery in Patients With Obesity and Hypertension. I10. doi:10.7326/P20-0007. PMID: 32805132.

CMAJ Canadian Medical Assoc Journal Vol. 192 No. 41 October 13 2020

Merkeley H, Bolster L.

Thalassemia.

E1210. doi:10.1503/cmaj.191613. PMID: 33051316; PMCID: PMC7588257.

Daeschler SC, Manson N, Joachim K, et al.

Effect of moist heat reprocessing of N95 respirators on SARS-CoV-2 inactivation and respirator function.

E1189-E1197. doi:10.1503/cmaj.201203. PMID: 32732229; PMCID: PMC7588253.

Chaikof M, Hobson S, Sobel M.

Fundal intramural ectopic pregnancy.


Orser BA, Wilson CR.

The authors respond to "Nurse anesthesiologists".


Bland R.

Nurse anesthesiologists.


Krishnan RJ, Mukarram M, Ghaedi B, et al.

Benefit of hospital admission for detecting serious adverse events among emergency department patients with syncope: a propensity-score-matched analysis of a multicentre prospective cohort.


Veltri NL, Chan M, Awad S.

Undetectable measured serum bicarbonate associated with hypertriglyceridemia-induced pancreatitis.


Skarsgard ED; Pediatric Surgical Chiefs of Canada.

Prioritizing specialized children's surgery in Canada during the COVID-19 pandemic.


The tobacco reliquary.


Booth J.

Anesthesia assistants - a failed solution since 2005.


Eggertson L.

Review uncovers fatal flaws in long-term care infection control.


Vogel L.

Record gift to University of Toronto faculty of medicine supports AI, equity.


Khare N, Shroff F, Nkennor B, et al.

Reimagining safety in a pandemic: the imperative to dismantle structural oppression in Canada.



Gomez D, Saunders N, Greene B, et al.

Firearm-related injuries and deaths in Ontario, Canada, 2002-2016: a population-based study.


Cleminson K, Cunningham N.

Acute generalized exanthematous pustulosis.


Chin-Yee B, Solh Z, Hsia C.

Erythrocytosis induced by sodium-glucose cotransporter-2 inhibitors.


Hui K, Sukhera J, Vigod S, et al.

Recognizing and addressing implicit gender bias in medicine.


Hapuhennedige S.

Public health experts are learning from Canada's anti-mask protests.


Hong A, Varshney V, Hare GMT, et al.

Spinal cord stimulation: a nonopioid alternative for chronic pain management.


Warren V.

Let's talk about the "S" word.



Biondi MJ, Marchand-Austin A, Cronin K, et al.

Prenatal hepatitis B screening, and hepatitis B burden among children, in Ontario: a descriptive study.


Tomes N.

Managing the modern infodemic.


Gao PR, Yen H, Chen WT.

Acute hemorrhagic edema of infancy.


Vogel L.

Increasing safety concerns over medical licensing exam.


Bandara NA, Herath J, Mehrnoush V.

Addressing the intersection between COVID-19 and young people vaping: timely resources needed.


Halani S, Andany N, Shah R.

Pneumocystis jirovecii pneumonia prophylaxis in a 42-year-old woman on immunosuppressive therapy.


CMAJ Canadian Medical Assoc Journal Vol. 192 No. 44 November 2 2020

Wang J, Vahid S, Eberg M, et al.

Clearing the surgical backlog caused by COVID-19 in Ontario: a time series modelling study.

E1347-E1356. doi:10.1503/cmaj.201521. PMID: 32873541.

Shaw J, Day T, Malik N, et al.

Working in a bubble: How can businesses reopen while limiting the risk of COVID-19 outbreaks?

E1362-E1366. doi:10.1503/cmaj.201582. PMID: 32998942.

Kiritoshi S, Soma T.

Corneal perforation secondary to gonococcal keratoconjunctivitis.

E1361. doi:10.1503/cmaj.200506. PMID: 33139425.

Pai NP, Thomas R.

Time for HIV self-testing in Canada: a vision and an action plan.

E1367-E1368. doi:10.1503/cmaj.201160. PMID: 33139426.

Cukier A.

Driven to distraction, doctors and patients are renegotiating virtual visits.

E1372-E1373. doi:10.1503/cmaj.1095903. PMID: 33139429.

Ambler M, Wodecki L, Amass T.

Virtual bedside concerts for patients with COVID-19: a trio of perspectives.

E1370-E1371. doi:10.1503/cmaj.201662. PMID: 33139428.

Tan C, Howard JL, Bondy L.

Prosthetic joint infection after total hip arthroplasty caused by Lactobacillus paracasei.

E1357-E1360. doi:10.1503/cmaj.201106. PMID: 33139424.

Bandara NA, Mehrnoush V, Herath J.

Addressing a dual public health emergency: supporting physicians to prescribe opioid medications.

E1369. doi:10.1503/cmaj.76776. PMID: 33139427.

CMAJ Canadian Medical Assoc Journal Vol. 192 No. 45 November 9 2020

Kuenzig ME, Manuel DG, Donelle J, et al.

Life expectancy and health-adjusted life expectancy in people with inflammatory bowel disease.

E1394-E1402. doi:10.1503/cmaj.190976. PMID: 33168761.

Gómez-Arias PJ, García-Nieto AJV.

Rupioid psoriasis on the hands.

E1407. doi:10.1503/cmaj.200517. PMID: 33168763.

Vogel L. Controversial medical licensing exam cancelled.

E1417-E1418. doi:10.1503/cmaj.1095904. PMID: 33168767.

Persad ARL.

Unmatched medical students: a missed opportunity for the Canadian physician workforce.

E1413. doi:10.1503/cmaj.76837. PMID: 33168765.

Persaud N, Butts H, Berger P.

William Osler: saint in a "White man's dominion".

E1414-E1416. doi:10.1503/cmaj.201567. PMID: 33168766.

Naylor CD, Boozary A, Adams O.

Canadian federal-provincial/territorial funding of universal health care: fraught history, uncertain future.

E1408-E1412. doi:10.1503/cmaj.200143. PMID: 33168764.

Pham H, Gosselin-Lefebvre S, Pourshahnazari P, et L.

Recurrent thunderclap headaches from reversible cerebral vasoconstriction syndrome associated with

duloxetine, xylometazoline and rhinitis medicamentosa.

E1403-E1406. doi:10.1503/cmaj.201234. PMID: 33168762.

Current Medical Research and Opinion Vol. 36 No. 11 November 2020

Decullier E, Tourmente B, Dessez B, et al.

Paramedical students' perceptions of research: a survey.

pp1783-1790. doi:10.1080/03007995.2020.1815685. PMID: 32847420.

Chen S, Zhou A, Emmanuel B, et al.

Systematic literature review of the epidemiology and clinical burden of chronic rhinosinusitis with nasal polyposis.

pp1897-1911. doi:10.1080/03007995.2020.1815682. Sep 25. PMID: 32847417.

Objectives: We conducted a systematic literature review (SLR) to determine the epidemiology and clinical burden of chronic rhinosinusitis with nasal polyps (CRSwNP) and to describe how the addition of biologics has affected outcomes for patients with CRSwNP.

Methods: The SLR adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Embase, MEDLINE, and Evidence-Based Medicine Reviews databases were searched using OVID. Relevant studies published between 1 January 2008 and 8 February 2019, for epidemiology, and 1 January 2008 and 16 February 2019, for clinical burden, and relevant conference abstracts from 1 January 2017 to 7 March 2019, for epidemiology and 1 January 2017-16 February 2019 for clinical burden were included.

Results: For the epidemiology and clinical burden SLR, 147 and 119 records, respectively, met the inclusion criteria. We found the prevalence of CRSwNP was 1-2.6% and was greater in men. Asthma, allergy, and allergic rhinitis were the most common comorbidities identified. Reported risk factors included asthma, gene polymorphisms, age, and eosinophilia. Studies indicated that dupilumab, mepolizumab, and omalizumab each improved different clinical outcomes. Non-biologics (drugs such as corticosteroids or antibiotics, surgery, or aspirin desensitization) improved clinical outcomes as well.

Conclusions: CRSwNP is fairly prevalent in the general population. Despite the significant efficacy of existing treatments, several unmet needs remain. The high burden of uncontrolled symptoms, frequent recurrence of nasal polyps after surgery, and long-term adverse effects of oral corticosteroids indicate that new therapies addressing these unmet needs should be developed. Although data on biologics from randomized controlled trials look promising, the efficacy of biologics in the real world has yet to be established. The SLR of the epidemiology and clinical burden of CRSwNP revealed key gaps in the literature. There was a paucity of prevalence data across many geographic areas, and no prevalence projections could be determined. Studies showed varying efficacy of non-biologics and no studies directly compared biologics for efficacy. Data regarding clinical efficacy of agents for eosinophilic CRSwNP or severe CRSwNP were lacking, and these patient populations would be served by more trials.

Aly A, Malangone-Monaco E, Noxon V, et al.

Treatment patterns and direct medical costs among patients with advanced hepatocellular carcinoma.

pp1813-1823. doi:10.1080/03007995.2020.1824899. PMID: 32969741.

Numan S, Kaluza K.

Systematic review of guidelines for the diagnosis and treatment of iron deficiency anemia using intravenous iron across multiple indications.

pp1769-1782. doi:10.1080/03007995.2020.1824898. PMID: 32936683.

Objective: To explore current recommendations for intravenous (IV) iron use in clinical guidelines for iron deficiency anemia (IDA) across different therapeutic areas and identify recommendations, if any, for the treatment of IDA.

Methods: A literature search was conducted in Medline, EMBASE, BIOSIS, Cochrane Collaboration, and on websites of relevant professional associations. Searches were limited to English publications. 1292 citations were identified, 219 papers were assessed, and 35 guidelines were identified for inclusion.

Results: The guidelines covered a variety of geographies: United States (US; n = 10); Europe (n = 11); "Rest-of-World" (n = 9); and "Other" organizations (n = 5). These covered a variety of specialties. Guidelines defined iron deficiency and IDA generally by serum ferritin and transferrin saturation levels. One-fifth of the reviewed guidelines (7 of 35) included no mention or recommendation regarding parenteral iron's utility in the management of IDA. Fifteen guidelines recommended using parenteral iron in the management of IDA. Fewer US guidelines included recommendations around IV iron than in Europe or the rest of the world. Approximately 60% of the guidelines have not been updated in ≥5 years and consequently do not reflect current evidence on the safety and efficacy of IV iron.

Conclusions: While national and international guidelines for management of IDA exist, many are outdated and do not reflect current evidence including, but not limited to, parenteral iron use. Urgent consideration should be given to updating and clarifying management guidelines for IDA using the latest treatment modalities and options, particularly in the US.

Wang C, Cheng SF, Hung JL, et al.

Highly frequent utilization of outpatient services in a national health insurance system - analysis of associated factors and underlying co-morbidity.

pp1761-1767. doi:10.1080/03007995.2020.1832057. PMID: 33017273.

Tian J, Xu Q, Liu S, et al.

Comparison of clinical characteristics between coronavirus disease 2019 pneumonia and community-acquired pneumonia.

pp1747-1752. doi:10.1080/03007995.2020.1830050. PMID: 32986475.

Objective: Coronavirus disease 2019 (COVID-19) has high morbidity and mortality, and spreads rapidly in the community to result in a large number of infection cases. This study aimed to compare clinical features in adult patients with coronavirus disease 2019 (COVID-19) pneumonia to those in adult patients with community-acquired pneumonia (CAP).

Methods: Clinical presentations, laboratory findings, imaging features, complications, treatment and outcomes were compared between patients with COVID-19 pneumonia and patients with CAP. The study group of patients with COVID-19 pneumonia consisted of 120 patients. One hundred and thirty-four patients with CAP were enrolled for comparison.

Results: Patients with COVID-19 pneumonia had lower levels of abnormal laboratory parameters (white blood cell count, lymphocyte count, procalcitonin level, erythrocyte sedimentation rate and C-reactive protein level) and more extensive radiographic involvement. More severe respiratory compromise resulted in a higher rate of intensive care unit admission, acute respiratory distress syndrome (ARDS) and mechanical ventilation (36% vs 15%, 34% vs 15% and 32% vs 12%, respectively; all p < .05). The 30 day mortality was more than twice as high in patients with COVID-19 pneumonia (12% versus 5%; p = .063), despite not reaching a statistically significant difference.

Conclusions: Lower levels of abnormal laboratory parameters, more extensive radiographic involvement, more severe respiratory compromise, and higher rates of ICU admission, ARDS and mechanical ventilation are key characteristics that distinguish patients with COVID-19-associated pneumonia from patients with CAP.

Li J, Qiu H, Yan L, et al.

Efficacy and safety of ticagrelor and clopidogrel in East Asian patients with coronary artery disease undergoing percutaneous coronary intervention.

pp1739-1745. doi:10.1080/03007995.2020.1825364. PMID: 32945695.

Miller PD, Bilezikian JP, Fitzpatrick LA, et al.

Abaloparatide: an anabolic treatment to reduce fracture risk in postmenopausal women with osteoporosis.

pp1861-1872. doi:10.1080/03007995.2020.1824897. PMID: 32969719.

Objective: Fractures due to osteoporosis represent a serious burden on patients and healthcare systems. The objective of this review is to provide an overview of the anabolic agent abaloparatide (ABL) for the treatment of postmenopausal women with osteoporosis at high risk for fracture.

Methods: A literature review was conducted using PubMed to identify articles focused on ABL published prior to February 10, 2020, using the search term "abaloparatide".

Results: ABL, a synthetic analog of human parathyroid hormone-related protein, increased bone mineral density (BMD), improved bone microarchitecture, and increased bone strength in preclinical and clinical studies. The pivotal phase 3 trial ACTIVE and its extension (ACTIVExtend) demonstrated the efficacy of initial treatment with ABL for 18 months followed by sequential treatment with alendronate (ALN) for an additional 24 months to reduce the risk of vertebral, nonvertebral, clinical, and major osteoporotic fractures and to increase BMD in postmenopausal women with osteoporosis. Discontinuations from ACTIVE were slightly more common in ABL-treated patients due to dizziness, palpitations, nausea, and headache. Post hoc analyses of ACTIVE and ACTIVExtend support the efficacy and safety of ABL in relevant subpopulations including postmenopausal women with various baseline risk factors, women ≥80 years, women with type 2 diabetes mellitus, and women with renal impairment.

Conclusions: ABL is an effective and well-tolerated treatment for women with postmenopausal osteoporosis at high risk for fracture. Its therapeutic effects are sustained with subsequent ALN therapy.

Jandhyala R.

Delphi, non-RAND modified Delphi, RAND/UCLA appropriateness method and a novel group awareness and consensus methodology for consensus measurement: a systematic literature review.

pp1873-1887. doi:10.1080/03007995.2020.1816946. PMID: 32866051.

Chen S, Zhou A, Emmanuel B, et al.

Systematic literature review of humanistic and economic burdens of chronic rhinosinusitis with nasal polyposis. pp1913-1926. doi:10.1080/03007995.2020.1815683. PMID: 32851882.

Objectives: We conducted a systematic literature review (SLR) of randomized controlled trials and real-world evidence (RWE) studies to determine the humanistic (e.g. health-related/disease-specific quality of life [QOL]) and economic (e.g. direct and indirect costs) burdens of chronic rhinosinusitis with nasal polyposis (CRSwNP).

Methods: The SLR adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Embase, MEDLINE and Evidence-Based Medicine Reviews databases were searched using OVID. Relevant studies involving adult patients with CRSwNP published between 1 January 2008 and 16 February 2019 were included, with relevant conference abstracts from 1 January 2017, onward.

Results: Sino-Nasal Outcomes Test (SNOT)-22 was the most frequently used disease-specific health-related QOL/patient-reported outcomes instrument for patients with CRSwNP. Baseline SNOT-22 scores ranged from 25 to 73 for surgical candidates and from 14 to 56 for medically managed patients with CRSwNP. Mean baseline EuroQol-5 Dimensions (EQ-5D) index for patients with CRSwNP ranged from 0.81 to 0.86, and mean baseline Short Form-6 Dimensions (SF-6D) ranged from 0.67 to 0.75. Three months (EQ-5D) and 5 years (SF-6D) post-endoscopic sinus surgery (ESS), rates increased from 0.81 to 0.89 and from 0.69 to 0.80, respectively. One year post-diagnosis, patients with CRSwNP had significantly more systemic prescriptions, underwent significantly more medical procedures, demonstrated greater health care resource utilization and had significantly greater mean health care costs compared with matched controls (all p < .001). Overall, for patients with initial ESS, CRSwNP was associated with higher disease-related expenditures compared with CRS without nasal polyposis (NP), even for patients who did not undergo revision surgery.

Conclusions: This SLR identified substantial humanistic burden among surgery candidates. RWE shows that surgeries were used to treat relatively more severe CRSwNP patients as recommended by guidelines. Patient QOL is improved significantly after surgery; however, there is a lack of evidence on patients with revision surgery. Surgery is also associated with higher costs, and the presence of NP was a predictor of revision surgery. Patients with CRSwNP demonstrate greater health care resource utilization and costs compared to those with CRS without NP. Costs associated with different severity of CRSwNP and revision surgery need to be assessed further.

Zhou J, Huang L, Chen J, et al.

Clinical features predicting mortality risk in older patients with COVID-19.

pp1753-1759. doi:10.1080/03007995.2020.1825365. PMID: 32945707.

Background: Since December 2019, the cumulative number of coronavirus disease 2019 (COVID-19) deaths worldwide has reached 1,013,100 and continues to increase as of writing. Of these deaths, more than 90% are people aged 60 and older. Therefore, there is a need for an easy-to-use clinically predictive tool for predicting mortality risk in older individuals with COVID-19.

Objective: To explore an easy-to-use clinically predictive tool that may be utilized in predicting mortality risk in older patients with COVID-19.

Methods: A retrospective analysis of 118 older patients with COVID-19 admitted to the Union Dongxihu Hospital, Huazhong University of Science and Technology, Wuhan, China from 12 January to 26 February 2020. The main results of epidemiological, demographic, clinical and laboratory tests on admission were collected and compared between dying and discharged patients.

Results: No difference in major symptoms was observed between dying and discharged patients. Among the results of laboratory tests, neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase, albumin, urea nitrogen and D-dimer (NLAUD) show greater differences and have better regression coefficients (β) when using hierarchical comparisons in a multivariate logistic regression model. Predictors of mortality based on better regression coefficients (β) included NLR (OR = 31.2, 95% CI 6.7-144.5, p < .0001), lactate dehydrogenase (OR = 73.4, 95% CI 11.8-456.8, p < .0001), albumin (OR < 0.1, 95% CI <0.1-0.2, p < .0001), urea nitrogen (OR = 12.0, 95% CI 3.0-48.4, p = .0005), and D-dimer (OR = 13.6, 95% CI 3.4-54.9, p = .0003). According to the above indicators, a predictive NLAUD score was calculated on the basis of a multivariate logistic regression model to predict mortality. This model showed a sensitivity of 0.889, specificity of 0.984 and a better predictive ability than CURB-65 (AUROC = 0.955 vs. 0.703, p < .001). Bootstrap validation generated the similar sensitivity and specificity.

Conclusions: We designed an easy-to-use clinically predictive tool for early identification and stratified treatment of older patients with severe COVID-19.

Uemura Y, Sone T, Tanaka S, et al.

Randomized head-to-head comparison of minodronic acid and raloxifene for fracture incidence in postmenopausal Japanese women: the Japanese Osteoporosis Intervention Trial (JOINT)-04.

pp1847-1859. doi:10.1080/03007995.2020.1816537. PMID: 32870712.

Aims: We conducted a head-to-head randomized trial of minodronate, a bisphosphonate, and raloxifene, a selective estrogen receptor modulator, to obtain clinical evidence and information about their efficacy and safety.

Methods: The Japanese Osteoporosis Intervention Trial protocol number 4 (JOINT-04) trial is a multi-center, open-labeled, blinded endpoints, head-to-head randomized trial of minodronate and raloxifene. Ambulatory elderly women with osteoporosis (age, >60 years) were randomly allocated to the raloxifene or minodronate group by central registration. The co-primary endpoints included any one of osteoporotic fractures (vertebral, humeral, femoral, and radial fractures), vertebral fractures, and major osteoporotic fractures (clinical vertebral, humeral, femoral, and radial fractures). The biological effects of each drug, patients' quality of life, and drug safety were assessed based on the secondary outcomes. This study was registered at the University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) under trial identification number UMIN000005433.

Results: A total of 3896 patients were randomized to the minodronate and raloxifene groups, and drug efficacy assessments were performed for 3247 patients (1623 and 1624 patients, respectively). Among these patients, 1176 and 1187 patients received allocated treatment for 2 years. The incidence rate ratios for osteoporotic, vertebral, and major osteoporotic fractures in the minodronate group were 0.94 (95% CI: 0.78-1.13, p = .494), 0.86 (95% CI: 0.70-1.05, p = .147), and 1.22 (95% CI: 0.86-1.74, p = .274), respectively. Compared to the raloxifene group, the minodronate group showed significantly increased bone mineral density of the lumbar spine for each visit (6 months: p = .007, 12 months: p = .0003, 24 months: p<.0001). Also, serious adverse reactions were observed for four and six patients in the minodronate and raloxifene groups, respectively.

Conclusions: Overall, there were no statistical differences in the incidence rates of osteoporotic, vertebral, or major osteoporotic fractures between the two groups. Serious adverse reactions were rare in both groups.

Mayer B, Tadler S, Rothenbacher D, et al.

A hierarchical algorithm for multicentric matched cohort study designs.

pp1889-1896. doi:10.1080/03007995.2020.1808453. PMID: 32783543.

Clemow DB, Baygani SK, Hauck PM, et al.

Lasmiditan in patients with common migraine comorbidities: a post hoc efficacy and safety analysis of two phase 3 randomized clinical trials.

pp1791-1806. doi:10.1080/03007995.2020.1808780. PMID: 32783644.

Objective: Determine whether common migraine comorbidities affect the efficacy and safety of lasmiditan, a 5-HT1F receptor agonist approved in the United States for the acute treatment of migraine.

Methods: In SPARTAN and SAMURAI (double-blind Phase 3 clinical trials), patients with migraine were randomized to oral lasmiditan 50 mg (SPARTAN only), 100mg, 200 mg, or placebo. Lasmiditan increased the proportion of pain-free and most bothersome symptom (MBS)-free patients at 2 h after dose compared with placebo. Most common treatment-emergent adverse events (TEAEs) were dizziness, paraesthesia, somnolence, fatigue, nausea, muscular weakness, and hypoesthesia. Based upon literature review of common migraine comorbidities, Anxiety, Allergy, Bronchial, Cardiac, Depression, Fatigue, Gastrointestinal, Hormonal, Musculoskeletal/Pain, Neurological, Obesity, Sleep, and Vascular Comorbidity Groups were created. Using pooled results, efficacy and TEAEs were assessed to compare patients with or without a given common migraine comorbidity. To compare treatment groups, p-values were calculated for treatment-by-subgroup interaction, based on logistic regression with treatment-by-comorbidity condition status (Yes/No) as the interaction term; study, treatment group, and comorbidity condition status (Yes/No) were covariates. Differential treatment effect based upon comorbidity status was also examined. Trial registration at clinicaltrials.gov: SAMURAI (NCT02439320) and SPARTAN (NCT02605174).

Results: Across all the Comorbidity Groups, with the potential exception of fatigue, treatment-by-subgroup interaction analyses did not provide evidence of a lasmiditan-driven lasmiditan versus placebo differential treatment effect dependent on Yes versus No comorbidity subgroup for either efficacy or TEAE assessments.

Conclusions: The efficacy and safety of lasmiditan for treatment of individual migraine attacks appear to be independent of comorbid conditions.

Cheng J, Liao Y, Bin T, et al.

Secondary chronic myeloid leukemia following acute myeloid leukemia treated with autologous hematopoietic stem cell transplantation: a case report.

pp1807-1812. doi:10.1080/03007995.2020.1808452. PMID: 32936052.

Park SK, Park JA, Yang SY, et al.

The economic impact of disease progression and death in hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) advanced breast cancer patients: using Korean nationwide health insurance claims data.

pp1825-1833. doi:10.1080/03007995.2020.1826917. PMID: 32965131.

Objectives: Recognizing the value of anticancer treatments based on progression-free survival and overall survival may help decision making in healthcare policy. We aimed to measure and compare the impact of disease progression and terminal state prior to death on healthcare costs in HR+, HER2- ABC patients.

Methods: We conducted a retrospective study using Korean nationwide health insurance claims database between 1 September 2012 and 31 August 2017. The impact of disease progression was estimated by measuring the average incremental monthly cost per patient during 1 year after progression compared to 1 year before progression. Death-related costs per patient per month (PPPM) were measured for those who died within 1 year after progression. Generalized estimating equation (GEE) was used to estimate the variations in PPPM costs by progression and death with adjustment for clinical factors.

Results: After progression, 1,636 patients expensed $2,892 per month more on average than before progression ($3762 vs. $870). The GEE analysis with adjustment for baseline characteristics showed that PPPM costs increased by 3.46 folds (95% CI = 3.06-3.93) after progression. Also, PPPM costs were 1.74 (95%CI = 1.43-2.12) times higher in patients who died within 1 year after progression relative to survived patients. When considering the interaction between progression and death, deceased patients showed higher increased ratio of PPPM costs after progression (4.91; p=value<.0001) than survived patients (2.95; 95% CI = 2.61-3.34).

Conclusions: From the payer's perspective, more healthcare costs incurred during the progression state than terminal state in HR+, HER2- ABC patients. The impact of disease progression emphasizes the importance of effectively treating HR+, HER2- ABC patients.

Chitnis AS, Mantel J, Ruppenkamp J, et al.

Survival analysis for all-cause revision following primary total hip arthroplasty with a medial collared, triple-tapered primary hip stem versus other implants in real-world settings.

pp1839-1845. doi:10.1080/03007995.2020.1822309. PMID: 32910700.

Huang JF.

RE: De Meo D, Zucchi B, Castagna V, et al. Validity and reliability of the Unified Classification System applied to periprosthetic femur fractures: a comparison with the Vancouver system. Curr Med Res Opin. 2020.

DOI:10.1080/03007995.2020.1776232.

pp1835-1836. doi:10.1080/03007995.2020.1810007. PMID: 32787588.

De Meo D, Zucchi B, Castagna V, et al.

Reply: RE: De Meo D, Zucchi B, Castagna V, et al. Validity and reliability of the Unified Classification System applied to periprosthetic femur fractures: a comparison with the Vancouver system. Curr Med Res Opin. 2020. DOI:10.1080/03007995.2020.1776232.

p1837. doi:10.1080/03007995.2020.1810008. PMID: 32787594.

Journal of General Internal Medicine Vol. 35 No. 10 October 2020

Gandhi M, Beyrer C, Goosby E.

Masks Do More Than Protect Others During COVID-19: Reducing the Inoculum of SARS-CoV-2 to Protect the Wearer.

pp3063-3066. doi:10.1007/s11606-020-06067-8. PMID: 32737790; PMCID: PMC7393808.

Jiang DH, McCoy RG.

Planning for the Post-COVID Syndrome: How Payers Can Mitigate Long-Term Complications of the Pandemic.


Somani SS, Richter F, Fuster V, et al.

Characterization of Patients Who Return to Hospital Following Discharge from Hospitalization for COVID-19.


Goss E, Iyer S, Arnsten J, et al.

Liberation Medicine: a Community Partnership and Health Advocacy Curriculum for Internal Medicine Residents.


Sherrington C, Fairhall N, Kirkham C, et al.

Exercise to Reduce Mobility Disability and Prevent Falls After Fall-Related Leg or Pelvic Fracture: RESTORE Randomized Controlled Trial.


Mangione S.

When Disease Strikes Leaders: What Should We Know?


Santosa KB, Lai YL, Brummett CM, et al.

Higher Amounts of Opioids Filled After Surgery Increase Risk of Serious Falls and Fall-Related Injuries Among Older Adults.


McNairy M, Bullington B, Bloom-Feshbach K.

Searching for Human Connectedness During COVID-19.


Dryden EM, Hyde JK, Wormwood JB, et al.

Assessing Patients' Perceptions of Clinician Communication: Acceptability of Brief Point-of-Care Surveys in Primary Care.

pp2990-2999. doi:10.1007/s11606-020-06062-z. PMID: 32748346; PMCID: PMC7572926.

Smith CJ, Matthias T, Beam E, et al.

A Mixed-Methods Evaluation of Medical Residents' Attitudes Towards Interprofessional Learning and Stereotypes Following Sonography Student-Led Point-of-Care Ultrasound Training.


Griffith DM, Jaeger EC, Bergner EM, et al.

Determinants of Trustworthiness to Conduct Medical Research: Findings from Focus Groups Conducted with Racially and Ethnically Diverse Adults.


Manivannan A, Adkins-Hempel M, Shippee ND, et al.

Experiences with Work and Participation in Public Programs by Low-Income Medicaid Enrollees Using

Qualitative Interviews.


Bunting SR, Garber SS, Goldstein RH, et al.

Student Education About Pre-exposure Prophylaxis (PrEP) Varies Between Regions of the United States.

pp2873-2881. doi:10.1007/s11606-020-05736-y. PMID: 32080792; PMCID: PMC7573046.

Robinson SA, Zocchi MS, Netherton D, et al.

Secure Messaging, Diabetes Self-management, and the Importance of Patient Autonomy: a Mixed Methods Study.

pp2955-2962. doi:10.1007/s11606-020-05834-x. PMID: 32440998; PMCID: PMC7572993.

Khullar D, Zhang Y, Kaushal R.

Potentially Preventable Spending Among High-Cost Medicare Patients: Implications for Healthcare Delivery.


Nelson HD, Cantor A, Wagner J, et al.

Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis.


Soylu TG, Cuellar AE, Goldberg DG, et al.

Readiness and Implementation of Quality Improvement Strategies Among Small- and Medium-Sized Primary Care Practices: an Observational Study.

pp2882-2888. doi:10.1007/s11606-020-05978-w. PMID: 32779136; PMCID: PMC7573036.

Schiltz NK, Dolansky MA, Warner DF, et al.

Impact of Instrumental Activities of Daily Living Limitations on Hospital Readmission: an Observational Study Using Machine Learning.


Kenny JD, Karliner LS, Kerlikowske K, et al.

Organization Communication Factors and Abnormal Mammogram Follow-up: a Qualitative Study Among Ethnically Diverse Women Across Three Healthcare Systems.


Shannon EM, Schnipper JL, Mueller SK.

Identifying Racial/Ethnic Disparities in Interhospital Transfer: an Observational Study.


Chedid NR, Udit S, Solhjou Z, et al.

COVID-19 and Rhabdomyolysis.


Smith KA, Bishop FL, Dambha-Miller H, et al.

Improving Empathy in Healthcare Consultations-a Secondary Analysis of Interventions.


Newell S, O'Brien B, Brienza R, et al.

Experiences of Patient-Centered Medical Home Staff Team Members Working in Interprofessional Training Environments.


Nicosia FM, Spar MJ, Neumann A, et al.

"The More They Know, the Better Care They Can Give": Patient Perspectives on Measuring Functional Status in Primary Care.


Alfian SD, Annisa N, Fajriansyah F, et al.

Modifiable Factors Associated with Non-adherence to Antihypertensive or Antihyperlipidemic Drugs Are Dissimilar: a Multicenter Study Among Patients with Diabetes in Indonesia.


Anderson N, Boatright D, Reisman A.

Blackface in White Space: Using Admissions to Address Racism in Medical Education.


Blazey-Martin D, Barnhart E, Gillis J, et al.

Primary Care Population Management for COVID-19 Patients.


Scholcoff C, Farkas A, Machen JL, et al.

Sexual Harassment of Female Providers by Patients: a Qualitative Study.


Hoffman RM, Atallah RP, Struble RD, et al.

Lung Cancer Screening with Low-Dose CT: a Meta-Analysis.

pp3015-3025. doi:10.1007/s11606-020-05951-7.PMID: 32583338; PMCID: PMC7573097.

Wayant C, Aran G, Johnson BS, et al.

Evaluation of Selective Outcome Reporting Bias in Efficacy Endpoints in Print and Television Advertisements for Oncology Drugs.


Wang B, Luo QQ, Li Q, et al.

Daily Short Message Service Reminders Increase Treatment Compliance and Efficacy in Outpatients with

Functional Dyspepsia: a Prospective Randomized Controlled Trial.


Spelman JF, Brienza R, Walsh RF, et al.

A Model for Rapid Transition to Virtual Care, VA Connecticut Primary Care Response to COVID-19.


Zheutlin AR, Niforatos J, Stulberg E, et al.

Research Waste in Randomized Clinical Trials: a Cross-Sectional Analysis.


Anderson TS, Krieger MS, Marshall BDL, et al.

Financial Payments to Teaching Hospitals by Companies Marketing Opioids.


Presley C, Agne A, Shelton T, et al.

Mobile-Enhanced Peer Support for African Americans with Type 2 Diabetes: a Randomized Controlled Trial.


Caverly TJ, Hayward RA.

Dealing with the Lack of Time for Detailed Shared Decision-making in Primary Care: Everyday Shared Decision-making.


Vanjani R, Martino S, Wunsch C.

Health Equity During COVID-19.


Schuttner L, Wong ES, Rosland AM, et al.

Association of the Patient-Centered Medical Home Implementation with Chronic Disease Quality in Patients with Multimorbidity.


Lee B, Patel S, Rachocki C, et al.

Advanced Notification Calls Prior to Mailed Fecal Immunochemical Test in Previously Screened Patients: a Randomized Controlled Trial.


Gross CP, Essien UR, Pasha S, et al.

Racial and Ethnic Disparities in Population-Level Covid-19 Mortality.


Brooks KC.

The Climate Crisis and the Exam Room.


Goede DL, Hagen MG, Meenrajan S, et al.

When Is It Safe to See the Doctor?


Scannell CA, Oronce CIA, Tsugawa Y.

Association Between County-Level Racial and Ethnic Characteristics and COVID-19 Cases and Deaths in the USA.


Zhu JM, Grande D, Jones DK, et al.

Health Policy Perspective: Medicaid and State Politics Beyond COVID.


Zipursky JS, Redelmeier DA.

Mobility and Mortality During the COVID-19 Pandemic.


Redelmeier DA, Ross LD.

Pitfalls from Psychology Science that Worsen with Practice.


Mukhtar NA, Fox RK.

Hepatitis C Virus Cure and Obesity: Watch the Weight.


DePuccio MJ, Di Tosto G, Walker DM, et al.

Patients' Perceptions About Medical Record Privacy and Security: Implications for Withholding of Information During the COVID-19 Pandemic.


Gerber MR.

The Things They Carry: Veterans and the COVID-19 Pandemic.

pp3093-3094. doi:10.1007/s11606-020-06048-x. PMID: 32725472; PMCID: PMC7386600.

Phadke NA, Del Carmen MG, Goldstein SA, et al.

Trends in Ambulatory Electronic Consultations During the COVID-19 Pandemic.


Olson A, Barrick J, Tayler WB, et al.

Lobbying Expenditures of the Health Sector During the COVID-19 Pandemic.


Goli RR, Manesh R, Landry-Wegener B.

Bilateral Sialolithiasis in a Patient with Sjögren Syndrome.


Chaitoff A, Volovetz J, Mitchell-Handley B.

Reply-Acknowledging Intersectionality and Historical Context in Medical Education Research.

p3096. doi:10.1007/s11606-020-06072-x. PMID: 32754781; PMCID: PMC7573026.

Tiako MJN, Green S, Essien UR.

Acknowledging Intersectionality and Historical Context in Medical Education Research.

p3095. doi:10.1007/s11606-020-06037-0. PMID: 32705472; PMCID: PMC7573090.

Rothberg MB, Martinez KA.

Influenza Management via Direct to Consumer Telemedicine: an Observational Study.


Khera R, Dhingra LS, Jain S, et al.

An Evaluation of the Vulnerable Physician Workforce in the USA During the Coronavirus Disease-19 Pandemic.


D Rosenberg K, Metz S.

Will Voters Support Higher Taxes to Fund Universal Health Care? Oregon, 2019.


Wheeler SG.

Steroid Knee Injections for Arthritis Are No Better than Placebo in a Randomized Controlled Trial.


Anderson TS, Stevens JP, Pinheiro A, et al.

Hospitalizations for Emergent Medical, Surgical, and Obstetric Conditions in Boston During the COVID-19 Pandemic.


Bates CK.

From the Editors Desk: Climate Change in Clinic.

p2835. doi:10.1007/s11606-020-06092-7. PMID: 32789618; PMCID: PMC7572955.

Journal of Interprofessional Care Vol. 34 No. 5 September – October 2020

Winship JM, Falls K, Gregory M, et al.

A case study in rapid adaptation of interprofessional education and remote visits during COVID-19.

pp702-705. doi:10.1080/13561820.2020.1807921. PMID: 32838597.

Bautista CA, Huang I, Stebbins M, et al.

Development of an interprofessional rotation for pharmacy and medical students to perform telehealth outreach to vulnerable patients in the COVID-19 pandemic.

pp694-697. doi:10.1080/13561820.2020.1807920. PMID: 32917114.

Nyashanu M, Pfende F, Ekpenyong M.

Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic:

experiences of frontline workers in the English Midlands region, UK.

pp655-661. doi:10.1080/13561820.2020.1792425. PMID: 32674701.

The first cases of Coronavirus (COVID-19) were reported in Wuhan, China in December 2019. Globally millions of people have been diagnosed with the virus whilst thousands have died. As the virus kept spreading health and social care frontline workers (HSCFW) were faced with difficulties when discharging their duties. This paper was set out to explore the challenges faced by different frontline workers in health and social care during the COVID-19 pandemic. The research utilized an explorative qualitative approach. A total of forty (N = 40) in-depth one-to-one semi-structured interviews were undertaken with HSCFW who included support workers (n = 15), nurses (n = 15), and managers (N = 10). Health and social care workers were drawn from domiciliary care and care homes (with and without nursing services). All the interviews were done online. The data were thematically analyzed, and the emergent themes were supported by quotes from the interviews held with participants. Following data analysis the research study found that lack of pandemic preparedness, shortage of Personal Protective Equipment (PPE), anxiety and fear amongst professionals, challenges in enforcing social distancing, challenges in fulfilling social shielding responsibility, anxiety and fear amongst residents and service users, delay in testing, evolving PPE guidance and shortage of staff were challenges faced by frontline health and social care workers during COVID-19 pandemic. The results of the current study point to a need for adequate pandemic preparedness within the health and social care sector to protect both frontline workers and the individuals they look after.

Bluteau JM, Bluteau PA.

Call of interprofessional duty: an ethnographically informed discussion on preparing students to be digitally resilient.

pp662-667. doi:10.1080/13561820.2020.1791807. PMID: 32674649.

Stifter J, Terry A, Phillips J, et al.

A short report on an interprofessional mobilizer team: innovation and impact during the COVID-19 pandemic.

pp716-718. doi:10.1080/13561820.2020.1813696. PMID: 32935613.

Jones TA, Vidal G, Taylor C.

Interprofessional education during the COVID-19 pandemic: finding the good in a bad situation.

pp633-646. doi:10.1080/13561820.2020.1801614. PMID: 32811228.

COVID-19 restrictions necessitated wholescale conversion of curricula

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