Taking blood pressure in a public or noisy settings does not affect reading

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.          
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1. Taking blood pressure in a public or noisy settings does not affect reading   

Findings support implementation of mass hypertension screening programs in public settings  

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00873 

URL goes live when the embargo lifts            

A randomized crossover trial found minimal difference between blood pressure (BP) readings obtained in public spaces versus those taken in private offices. These findings suggest that public spaces can be an acceptable setting for BP screenings, despite prior clinical guideline recommendations advising quiet settings for BP measurement. The results are published in Annals of Internal Medicine.   

  

Researchers from Johns Hopkins University randomly assigned 108 adults in Baltimore, MD to  the order in which they had triplicate BP measurements in each of 3 settings: 1) private quiet office (private quiet [reference]); 2) noisy public space (public loud); and 3) noisy public space plus earplugs  (public quiet) to evaluate the effect of noise and public environment on BP readings. The primary outcomes were differences between the mean BPs obtained in each public setting with those obtained in the private setting. The average noise level in the private quiet setting was 37 decibels (dB) and the average noise level in the public setting was 74 dB. In the private quiet setting, the average systolic BP (SBP) and diastolic BP (DBP) were 128.9 and 74.2 mm Hg, respectively. In the public loud setting, the mean SBP and DBP were 128.3 and 75.9 mm Hg and in the public quiet setting, the mean SBP and DPB were 129.0 and 75.7 mm Hg. The results indicate that the differences in BP readings in public, loud spaces versus the clinically recommended setting of a private office are small and not clinically significant. The researchers say these results support the implementation of mass hypertension-screening programs in settings including supermarkets, places of worship and schools.   

  

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Tammy M. Brady, MD, PhD, please email Kim Polyniak at kpolyni1@jhmi.edu.  

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2. Bariatric surgery with sleeve gastrectomy and gastric bypass both substantially lower health care expenses for patients with diabetes  

Total expense reductions driven by medication expenses that decreased by more than 50% in the 5 years post surgery  

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00480  

URL goes live when the embargo lifts           

A retrospective cohort study compared health expenditures three years before and five and a half years after bariatric surgery in patients with diabetes. The study found that overall expenses decreased significantly in the postsurgical period, with no differences in patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) except in the first six months post-surgery. The study is published in Annals of Internal Medicine.   

  

Researchers from Duke University and Kaiser Permanente studied data from 6,690 patients with type 2 diabetes (T2D) and a BMI of 35 kg/m2 or greater who had undergone RYGB (n=3,175) or SG (3,515) at Kaiser Permanente Southern California and Kaiser Permanente Washington between January 2012 and December 2019. The researchers examined inpatient, outpatient and medication expenditures three years before surgery and up to five-and-a-half years after surgery between both patient cohorts. They found that average total expenses did not meaningfully differ between the RYGB and SG groups during the three-year presurgical period through the five-and-a-half-year post-surgical period. During the first six months after surgery, total expenditures were higher in the RYGB group than in the SG group but decreased in the next 5 years by a similar amount in both groups. Outpatient expenses in the three years before surgery were around $4,000 for both groups and were around $1,900 six months before surgery were for both groups and decreased to about $800 per 6-month period in the two years after surgery and to about $600 per six-month period three to five-and-a-half-years after surgery for RYGB and around $550 for SG five-and-a-half-years after surgery. Total expenditure decreases were driven by the reduction in medication expenses, which decreased by more than 50% in the five-and-a-half-year postsurgical period to about $1,000 per 6-month period for both RYGB and SG. The results suggest that both RYGB and SG are effective for reducing long-term health care costs for patients with T2D and the cost reductions were similar.  

  

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Matthew L. Maciejewski, PhD, please call or email Sarah Avery at 919-724-5343 or sarah.avery@duke.edu. 

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3. Donor-derived Epstein-Barr Virus infection increases the risk for posttransplant lymphoproliferative disorder by 5- to 10-fold higher than previous estimates among kidney transplant recipients 

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00165  

URL goes live when the embargo lifts           

A retrospective cohort study aimed to determine the associations between pre-transplant Epstein–Barr virus (EBV)–seronegative recipients of EBV-seropositive donor (EBV D+ /R-) and recipient EBV-seropositive status (R+) and incidence of posttransplant lymphoproliferative disorder (PTLD) among adult kidney transplant recipients. This is important because PTLD is a type of cancer/lymphoma that has high mortality rate. The study found that EBV D+/R- kidney recipients face a 5- to 10-fold higher cumulative incidence of PTLD than prior registry-based studies. The results are published in Annals of Internal Medicine.  

  

Researchers from the University of Pennsylvania and colleagues studied data from two groups of adult kidney transplant recipients at the Hospital of the University of Pennsylvania and the University of Pittsburgh Medical Center who had a transplant between 1 January 2010 and 30 June 2022. The cohort included 104 EBV D+/R- and 312 EBV R+ kidney transplant recipients. The researchers sought to determine the cumulative incidence and clinical characteristics of patients who develop PTLD and evaluate the effect of EBV D+/R- serostatus on all-cause graft loss and mortality. Patients were followed for up to three years post-transplant or until 30 June 2023, the last day of the study follow-up. The researchers used an optimal multivariable matching algorithm to determine the relative risk for PTLD for EBV D+/R- compared with EBV R+ kidney transplant recipients. The researchers found that 22.1% of EBV D+/R- recipients developed PTLD at around 202 days post-transplant, which is 5-to-10 times higher than several prior reports. None of the EBV R+ recipients developed PTLD. EBV D+/R- had a higher risk for all-cause graft loss and 8.7% died during the study follow-up, whereas 4.2% of EBV R+ recipients died during follow up. The results suggest the need for strategies to mitigate the effect of donor-derived EBV infection among EBV seronegative recipients, improved reporting of PTLD to national registries, as well as the need for patient-clinician discussions on the elevated risk of early PTLD among EBV D+/R- kidney transplant recipients.   

  

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Vishnu S. Potluri, please email Alex Gardner at Alex.Gardner@Pennmedicine.upenn.edu. 

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4. International scientific association, GIN, publishes principles for using AI to develop clinical guidelines   

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02338 

URL goes live when the embargo lifts          

The Guidelines International Network (GIN) has developed principles for the use of artificial intelligence (AI) tools or processes when developing clinical guidelines. A GIN working group conducted a scoping review and analysis of practical examples inform the recommendations. To the authors’ knowledge, this is the first time the use of AI in health guidelines has been addressed in a framework for AI in health care. A summary of the development process and principles are published in Annals of Internal Medicine.  

 

The working group used a consensus-based process to develop eight principles for using AI in a clinical guideline context. These principles are transparency, preplanning, additionality, credibility, ethics, accountability, compliance and evaluation. To ensure transparency, all AI tools should be clearly documented and made accessible to all users. The decision to use AI must be carefully planned before beginning the guideline development process and all members of the guideline development group must be made aware of the advantages, risks and limitations. The use of AI in the guideline enterprise should also bring about more benefits than risks, and the AI tools used should demonstrate sufficient quality and credibility. Using AI in guideline development must follow current ethical principles, and humans must oversee all AI outputs to ensure accountability. The use of AI must be compliant with legal and regulatory frameworks and continuous evaluation of the use of AI in the guideline enterprise based on these principles should be completed. Members of the working group suggest that anyone developing guidelines should refer to these principles and involve AI experts who can hold the AI tools and their outputs accountable during the guideline development process. 

 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Holger J. Schünemann, MD, MSc, PhD, please email hchuneh@mcmaster.ca.  

 

 

 

 

 

 

 

 

 

 

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