522. Health as a Human Right: A Position Paper From the American College of Physicians.
The relationship of health to rights or human rights is complex. Although many find no right of any kind to health or health care, and others view health care as a right or human right, the American College of Physicians (ACP) instead sees health as a human right. The College, in the ACP Ethics Manual, has long noted the interrelated nature of health and human rights. Health as a human right also has implications for the social and structural determinants of health, including health care. Any rights framework is imperfect, and rights, human rights, and ethical obligations are not synonymous. Individual physicians and the profession have ethical obligations to patients, and these obligations can go beyond matters of rights. Society, too, has responsibilities-the equitable and universal access to appropriate health care is an ethical obligation of a just society. By recognizing health as a human right based in the intrinsic dignity and equality of all patients and supporting the patient-physician relationship and health systems that promote equitable access to appropriate health care, the United States can move closer to respecting, protecting, and fulfilling for all the opportunity for health.
526. 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 527. 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.
532. COVID-19.
COVID-19, the illness caused by SARS-CoV-2, became a worldwide pandemic in 2020. Initial clinical manifestations range from asymptomatic infection to mild upper respiratory illness but may progress to pulmonary involvement with hypoxemia and, in some cases, multiorgan involvement, shock, and death. Older adults, pregnant persons, those with common comorbidities, and those with immunosuppression are at greatest risk for progression. Vaccination is effective in preventing symptomatic infection and reducing risk for severe disease, hospitalization, and death. Antiviral treatment and immunomodulators have been shown to benefit certain patients. This article summarizes current recommendations on prevention, diagnosis, management, and treatment of COVID-19.
533. Suspected Bronchiectasis and Mortality in Adults With a History of Smoking Who Have Normal and Impaired Lung Function : A Cohort Study.
作者: Alejandro A Diaz.;Wei Wang.;Jose L Orejas.;Rim Elalami.;Wojciech R Dolliver.;Pietro Nardelli.;Ruben San José Estépar.;Bina Choi.;Carrie L Pistenmaa.;James C Ross.;Diego J Maselli.;Andrew Yen.;Kendra A Young.;Gregory L Kinney.;Michael H Cho.;Raul San José Estépar.
来源: Ann Intern Med. 2023年176卷10期1340-1348页
Bronchiectasis in adults with chronic obstructive pulmonary disease (COPD) is associated with greater mortality. However, whether suspected bronchiectasis-defined as incidental bronchiectasis on computed tomography (CT) images plus clinical manifestation-is associated with increased mortality in adults with a history of smoking with normal spirometry and preserved ratio impaired spirometry (PRISm) is unknown.
536. Quality Indicators for Osteoporosis in Adults: A Review of Performance Measures by the American College of Physicians.
作者: Amir Qaseem.;Cristin A Mount.;Karen Campos.;Robert M McLean.;Samantha Tierney.;J Thomas Cross.;Nick Fitterman.; .;Rebecca A Andrews.;Peter Basch.;Caroline L Goldzweig.;Scott T MacDonald.;Catherine H MacLean.;Suja M Mathew.;Rhea E Powell.;Sameer D Saini.
来源: Ann Intern Med. 2023年176卷10期1386-1391页
Primary osteoporosis is characterized by decreasing bone mass and density and reduced bone strength that leads to a higher risk for fracture, especially hip and spine fractures. The prevalence of osteoporosis in the United States is estimated at 12.6% for adults older than 50 years. Although it is most frequently diagnosed in White and Asian females, it still affects males and females of all ethnicities. Osteoporosis is considered a major health issue, which has prompted the development and use of several performance measures to assess and improve the effectiveness of screening, diagnosis, and treatment. These performance measures are often used in accountability, public reporting, and/or payment programs. However, the reliability, validity, evidence, attribution, and meaningfulness of performance measures have been questioned. The purpose of this paper is to present a review of current performance measures on osteoporosis and inform physicians, payers, and policymakers in their selection of performance measures for this condition. The Performance Measurement Committee identified 6 osteoporosis performance measures relevant to internal medicine physicians, only 1 of which was found valid at all levels of attribution. This paper also proposes a performance measure concept to address a performance gap for the initial approach to therapy for patients with a new diagnosis of osteoporosis based on the current American College of Physicians guideline.
538. Ethical Guidance for Physicians and Health Care Institutions on Grateful Patient Fundraising: A Position Paper From the American College of Physicians.
作者: Lois Snyder Sulmasy.;T Brian Callister.;Isaac O Opole.;Noel N Deep.; .
来源: Ann Intern Med. 2023年176卷10期1392-1395页
Physician solicitation of charitable contributions from patients-also known among other things as grateful patient fundraising-raises significant ethical concerns. These include pressure on patients to donate and the effects of this on the patient-physician relationship, potential expectations of donor patients for treatment that is not indicated or preferential care, justice and fairness issues, disclosure and use of confidential patient information for nontreatment purposes, and conflicts of interest. The patient-physician relationship and knowledge of the patient's medical history, clinical status, personal information, and financial circumstances are some of the reasons development and administrative officials might see physicians as strong potential fundraisers. But those are among the reasons grateful patient fundraising is ethically problematic. This American College of Physicians position paper explores these issues and offers guidance.
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