JAMA network open
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Comparative Study
Comparison of Conventional TNM and Novel TNMB Staging Systems for Non-Small Cell Lung Cancer.
Improved staging for non-small cell lung cancer (NSCLC) represents a critical unmet need. External validations of the eighth edition of the TNM staging system have yielded disappointing results, with persistently high mortality observed in early-stage disease. ⋯ The TNMB staging system was associated with improved estimation of disease-free survival compared with conventional TNM staging. Incorporation of a molecular prognostic classifier into staging for NSCLC may lead to better identification of high-risk patients.
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Observational Study
Trends in Prescription Analgesic Use Among Adults With Musculoskeletal Conditions in the United States, 1999-2016.
Monitoring trends in prescription analgesic use among adults with musculoskeletal conditions provides insight into how changing prescribing practices, guidelines, and policy measures may affect those who need pain management. ⋯ The substitution of opioids for nonopioid analgesics between 2003 and 2006 may have occurred as evidence emerged on the cardiovascular risks associated with nonopioid analgesics. Reductions in opioid use between 2013 and 2016 were most substantial among those with low socioeconomic status, who may encounter barriers in accessing alternatives. Despite those decreases, opioid use remained more prevalent in 2015 to 2016 than in 1999 to 2000, suggesting a potentially long tail for the opioid epidemic.
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Observational Study
Association of Suicide and Other Mortality With Emergency Department Presentation.
Emergency departments (EDs) have the potential to play a pivotal role in suicide risk detection and prevention, yet little is known about the profile of risk of suicide after ED visits in the United States. ⋯ These findings suggest that ED patients with deliberate self-harm or suicidal ideation are associated with substantially increased risk of suicide and other mortality during the year after ED presentation. The process of planning for ED discharge may present opportunities to help ensure safe transitions to continuing outpatient mental health care and to consider broader risk for unintentional injury and other causes of premature mortality.
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Although palliative care (PC) historically focused on patients with cancer and those near the end of life, evidence increasingly demonstrates a benefit to patients with a broad range of serious illnesses and to those earlier in their illness. The field of PC has expanded and evolved rapidly, resulting in a need to characterize practice over time to understand whether it reflects evolving evidence and guidelines. ⋯ Inpatient PC teams cared for an increasing percentage of patients with diagnoses other than cancer and saw more patients discharged alive, consistent with guidelines recommending specialty PC for all patients with serious illness earlier in their illnesses. Most patients with symptoms improved quickly. Variation in practice and outcomes among PCQN members suggests that there are opportunities for further improvements in care.
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Comparative Study
Comparison of Rural vs Urban Direct-to-Physician Commercial Promotion of Medications for Treating Opioid Use Disorder.
In the United States, access to medications prescribed for opioid use disorder (OUD) is lower in rural counties than in urban counties. Considering the positive associations between direct-to-physician promotion of opiates and OUD medications and their prescribing rates, a study examining the association between pharmaceutical promotion of these medications and county-level rurality has merit. ⋯ The study findings suggest that promotion for OUD medications is less likely to occur in rural counties and that this difference in promotion of OUD medications may be associated with differential commercial costs and benefits of promotion in rural settings.