Annals of internal medicine
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Previous observational studies have suggested an association between coffee intake and reduced risk for death, but these studies did not distinguish between coffee consumed with sugar or artificial sweeteners and coffee consumed without. ⋯ National Natural Science Foundation of China, Young Elite Scientist Sponsorship Program by CAST, and Project Supported by Guangdong Basic and Applied Basic Research Foundation.
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Bipolar disorder (BD) affects approximately 2% of U. S. adults and is the most costly mental health condition for commercial insurers nationwide. ⋯ Thus, screening in these high-risk groups is indicated. Effective treatments exist, and many can be safely and effectively administered by primary care clinicians.
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Genomic tests expand diagnostic and screening opportunities but also identify genetic variants of uncertain clinical significance (VUSs). Only a minority of VUSs are likely to prove pathogenic when later reassessed, but resolution of the uncertainty is rarely timely. That uncertainty adds complexity to clinical decision making and can result in harms and costs to patients and the health care system, including the time-consuming analysis required to interpret a VUS and the potential for unnecessary treatment and adverse psychological effects. ⋯ Additional strategies can help mitigate the potential harms of VUSs, including testing protocols that limit identification or reporting of VUSs, subclassification of VUSs according to the likelihood of pathogenicity, routine family-based evaluation of variants, and enhanced counseling efforts. All involve tradeoffs, and the appropriate balance of measures is likely to vary for different test uses and clinical settings. Cross-specialty deliberation and public input could contribute to systematic and broadly supported policies for managing VUSs.
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Hospital medicine has grown as a field. However, no study has examined trends in career choices by internists over the past decade. ⋯ This study did not receive direct funding.
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Comment Randomized Controlled Trial
In former smokers with COPD, HEPA and carbon filter air cleaners improved moderate exacerbations but not QoL.
Hansel NN, Putcha N, Woo H, et al. Randomized clinical trial of air cleaners to improve indoor air quality and chronic obstructive pulmonary disease health: results of the CLEAN AIR study. Am J Respir Crit Care Med. 2022;205:421-30. 34449285.