In a systematic review and meta-analysis, Rolfe and Burton examined the effect of diagnostic tests on reassurance in symptomatic patients with a low pretest probability of serious disease. After reviewing 14 trials in which patients were randomized to diagnostic test or not, they found no evidence that investigations diminished illness concern, reduced symptoms, or reduced nonspecific anxiety. They found a small effect of fewer primary care visits, with the number needed to investigate to prevent 1 visit of between 16 and 26.
Calling on behalf of a hypothetical uninsured patient, Rosenthal et al conducted a telephone survey of 20 top-ranked and 100 non–top-ranked US hospitals to assess their ability to provide price estimates for a common elective surgical procedure—total hip arthroplasty (THA). The authors found that 40% of top-ranked and 36% of non–top-ranked hospitals were unable to provide an estimated price (physician plus hospital fee). Price estimates for THA ranged from $11 100 to $125 798. In total, the study provided a window into hospitals' abilities to provide and patients' abilities to obtain price estimates for THA and other procedures.
Sadr-Azodi et al investigated the association between oral glucocorticoid use and acute pancreatitis using a large population-based case-control study of 6161 cases of acute pancreatitis diagnosed between 2006 and 2008 in Sweden and 61 637 controls. Oral glucocorticoid use was associated with 73% (odds ratio, 1.73; 95% CI, 1.31-2.28) increased risk of acute pancreatitis 4 to 14 days after initiation of drug use. This risk decreased thereafter, and declined to levels comparable to never-users after 1 month of oral glucocorticoid use. Importantly, there was no increased risk (odds ratio, 1.03; 95% CI, 0.60-1.70) of acute pancreatitis within the first 3 days of drug therapy initiation, reducing the probability of confounding by indication as explanatory for the findings.
The role of sex in relationship to implant failure after hip arthroplasty is critically important for patient management and device innovation, but current evidence is limited. Using a cohort of 35 140 hip arthroplasties from a US total joint replacement registry, Inacio et al evaluated the risk of revision in women compared with men. After considering patient-, surgical-, surgeon-, volume-, and implant-specific risk factors, the authors found that at a median 3.0 years follow-up, women had a 29% higher risk of implant failure than men in this community-based sample.
Kaplan-Meier survival plot of primary total hip arthroplasty survival by sex.
In This Issue of JAMA Internal Medicine. JAMA Intern Med. 2013;173(6):404. doi:10.1001/jamainternmed.2013.2710