1501. Changes in Induced Medical and Procedural Abortion Rates in a Commercially Insured Population, 2018 to 2022 : An Interrupted Time-Series Analysis.
作者: Catherine S Hwang.;Aaron S Kesselheim.;Ameet Sarpatwari.;Krista F Huybrechts.;Gregory Brill.;Benjamin N Rome.
来源: Ann Intern Med. 2023年176卷11期1508-1515页
During the COVID-19 pandemic, access to in-person care was limited, and regulations requiring in-person dispensing of mifepristone for medical abortions were relaxed. The effect of the pandemic and accompanying regulatory changes on abortion use is unknown.
1507. Does Screening for Opioid Use Disorder in Primary Care Increase the Percentage of Patients With a New Diagnosis?
作者: John C Fortney.;Anna D Ratzliff.;Brittany E Blanchard.;Morgan Johnson.;Lori Ferro.;Elizabeth J Austin.;Emily C Williams.;Mark H Duncan.;Joseph O Merrill.;Jennifer Thomas.;Brandon Kitay.;Michael Schoenbaum.;Patrick J Heagerty.;Andrew J Saxon.
来源: Ann Intern Med. 2023年176卷10期1431-1433页 1511. Telemedicine Versus In-Person Primary Care: Treatment and Follow-up Visits.
作者: Mary Reed.;Jie Huang.;Madeline Somers.;Loretta Hsueh.;Ilana Graetz.;Andrea Millman.;Emilie Muelly.;Anjali Gopalan.
来源: Ann Intern Med. 2023年176卷10期1349-1357页
Beyond initial COVID-19 pandemic emergency expansions of telemedicine use, it is unclear how well primary care telemedicine addresses patients' needs.
1512. Information About Provision of Abortion on U.S. Hospital Websites: A Cross-Sectional Analysis.
作者: Ari B Friedman.;Miriam R Singer.;Katherine L Blanton.;Caroline N Goldfarb.;Tiwadeye Lawal.;Deborah Bartz.;Aaron L Schwartz.
来源: Ann Intern Med. 2023年176卷10期1434-1436页 1516. Regulatory Review Duration and Differences in Submission Times of Drugs in the United States and Europe, 2011 to 2020.
作者: Kerstin N Vokinger.;Miquel Serra-Burriel.;Camille E G Glaus.;Ulrich-Peter Rohr.;Thomas J Hwang.;Simon Dalla Torre di Sanguinetto.;Aaron S Kesselheim.
来源: Ann Intern Med. 2023年176卷10期1413-1418页
The speed of drug regulatory agencies in the United States and Europe is often a source of discussion. The objective of this research was to assess regulatory review duration of first and supplementary indications approved between 2011 and 2020 in the United States and Europe (European Union [EU] and Switzerland) and differences in submission times between the United States and Europe. Descriptive statistics were applied to review times between the jurisdictions and across the therapeutic areas. A regression analysis was done to estimate the association between approval agency and review times. The primary analysis cohort included 241 drugs approved in the United States, the EU, and Switzerland. Of these, 128 drugs had supplemental indications (331 in total) in the United States and 87 had supplemental indications (206 in total) in the EU. Overall median review duration from submission to approval subtracting the clock stop period was 39 weeks in the United States, 44 weeks in the EU, and 44 weeks in Switzerland. When review times within each drug were compared, the European Medicines Agency took a median of 3.7 weeks (IQR, -6.7 to 14.9 weeks) longer than the U.S. Food and Drug Administration and Swissmedic a median of 0.3 weeks (IQR, -10.6 to 15.3 weeks) longer. Median total review duration for supplemental indications was 26 weeks in the United States and 40 weeks in the EU. Applications were submitted a median of 1.3 and 17.9 weeks later in the EU and Switzerland, respectively, than in the United States. The regression analysis showed small differences in submission times between the United States and the EU (-2.1 weeks [95% CI, -11.7 to 7.6 weeks]) and larger differences between the United States and Switzerland (33.0 weeks [CI, 23.1 to 42.8 weeks]). It would be beneficial for patients if differences in submission times between the United States and Europe continue to be minimized.
1519. Implications of the Use of Artificial Intelligence Predictive Models in Health Care Settings : A Simulation Study.
作者: Akhil Vaid.;Ashwin Sawant.;Mayte Suarez-Farinas.;Juhee Lee.;Sanjeev Kaul.;Patricia Kovatch.;Robert Freeman.;Joy Jiang.;Pushkala Jayaraman.;Zahi Fayad.;Edgar Argulian.;Stamatios Lerakis.;Alexander W Charney.;Fei Wang.;Matthew Levin.;Benjamin Glicksberg.;Jagat Narula.;Ira Hofer.;Karandeep Singh.;Girish N Nadkarni.
来源: Ann Intern Med. 2023年176卷10期1358-1369页
Substantial effort has been directed toward demonstrating uses of predictive models in health care. However, implementation of these models into clinical practice may influence patient outcomes, which in turn are captured in electronic health record data. As a result, deployed models may affect the predictive ability of current and future models.
1520. Would You Screen This Patient for Cognitive Impairment? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center.
作者: Risa B Burns.;Michael J Barry.;Deborah Blacker.;Zahir Kanjee.
来源: Ann Intern Med. 2023年176卷10期1405-1412页
Dementia, according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is defined by a significant decline in 1 or more cognitive domains that interferes with a person's independence in daily activities. Mild cognitive impairment (MCI) differs from dementia in that the impairment is not sufficient to interfere with independence. For the purposes of this discussion, cognitive impairment (CI) includes both dementia and MCI. Various screening tests are available for CI. These tests ask patients to perform a series of tasks that assess 1 or more domains of cognitive function or ask a caregiver to report on the patient's abilities. A positive result on a screening test does not equate to a diagnosis of CI; rather, it should lead to additional testing to confirm the diagnosis. On review of the evidence, the U.S. Preventive Services Task Force (USPSTF) concluded in 2020 that the evidence was insufficient to assess the balance of benefits and harms of screening for CI in older adults ("I statement"). The USPSTF did clarify that although there is insufficient evidence, there may be important reasons to identify CI. In this article, 2 experts review the available evidence to answer the following questions: What screening tools are available, and how effective are they in identifying patients with CI? What interventions are available for patients found to have CI, to what extent do they improve patient outcomes, and what, if any, negative effects occur? And, would they recommend screening for CI, and why or why not?
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