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Journal of General Internal Medicine

By Nirav Shah and Jason Wang

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Journal Article

Effectiveness and Cost Effectiveness of Expanding Harm Reduction Programs and HIV Antiretroviral Therapy in a Mixed HIV epidemic: An Analysis for Ukraine

Sabina S. Alistar, Douglas Owens, Margaret Brandeau
PLoS Med , 2011

Background Injection drug use (IDU) and heterosexual virus transmission both contribute to the growing mixed HIV epidemics in Eastern Europe and Central Asia. In Ukraine—chosen in this study as a representative country—IDU-related risk behaviors cause half of new infections, but few injection drug users (IDUs) receive methadone substitution therapy. Only 10% of eligible individuals receive antiretroviral therapy (ART). The appropriate resource allocation between these programs has not been studied.

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Journal Article

Results of Antiretroviral Treatment Interruption and Intensification in Advanced Multi-drug Resistant HIV Infection from the OPTIMA trial

Mark Holodniy, Sheldon T. Brown, D. William Cameron, Tassos C. Kyriakides, Brian Angus, Abdel Babiker Abdel Babiker, Joel Singer, Douglas K. Owens, Aslam Anis, Ruth Goodall, Fleur Hudson, Mirek Piaseczny, John Russo, Martin Schechter, Lawrence Deyton, Janet Darbyshire
PLoS ONE , 2011

Background Guidance is needed on best medical management for advanced HIV disease with multidrug resistance (MDR) and limited retreatment options. We assessed two novel antiretroviral (ARV) treatment approaches in this setting.

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Journal Article

The Behavioural Economics of Exercise Habits

Jeremy Goldhaber-Fiebert, Alan M. Garber
VoxEU , 2011

Obesity – and its related illnesses – endangers the lives of millions across the world. While healthier, more physically active lifestyles can mitigate this, the question remains of how policymakers can get people to switch from being couch potatoes to keen runner beans. This column presents new evidence suggesting that for many even a nudge may suffice.

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Journal Article

Diagnostic Imaging for Low Back Pain: Advice for High-value Health Care from the American College of Physicians

Roger Chou, Amir Qaseem, Douglas K. Owens, Paul Shekelle
Annals of Internal Medicine , 2011

Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. In other patients, evidence indicates that routine imaging is not associated with clinically meaningful benefits but can lead to harms. Addressing inefficiencies in diagnostic testing could minimize potential harms to patients and have a large effect on use of resources by reducing both direct and downstream costs. In this area, more testing does not equate to better care.

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Journal Article

High-value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate Benefits, Harms, and Costs of Medical Interventions

Douglas K. Owens, Amir Qaseem, Roger Chou, Paul Shekelle
Annals of Internal Medicine , 2011

Health care costs in the United States are increasing unsustainably, and further efforts to control costs are inevitable and essential. Efforts to control expenditures should focus on the value, in addition to the costs, of health care interventions. Whether an intervention provides high value depends on assessing whether its health benefits justify its costs. High-cost interventions may provide good value because they are highly beneficial; conversely, low-cost interventions may have little or no value if they provide little benefit.

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Journal Article

Diabetes Mellitus and Tuberculosis in Countries with High Tuberculosis Burdens: Individual Risks and Social Determinants

Jeremy Goldhaber-Fiebert, Christie Y Jeon, Ted Cohen, Megan B Murray
International Journal of Epidemiology , 2011
Background A growing body of evidence supports the role of type 2 diabetes as an individual-level risk factor for tuberculosis (TB), though evidence from developing countries with the highest TB burdens is lacking. In developing countries, TB is most common among the poor, in whom diabetes may be less common. We assessed the relationship between individual-level risk, social determinants and population health in these settings.
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Journal Article

Effectiveness and Cost-effectiveness of HIV Antiretroviral Regimens Recommended in the World Health Organization’s Guidelines for Resource-limited Settings

Eran Bendavid, Philip Grant, Annie Talbot, Douglas Owens, Andrew Zolopa
AIDS (Official Journal of the International AIDS Society) , 2011

Objective: The World Health Organization (WHO) recently changed its first-line antiretroviral treatment guidelines in resource-limited settings. The cost-effectiveness of the new guidelines is unknown.

Design: Comparative effectiveness and cost-effectiveness analysis using a model of HIV disease progression and treatment.

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Journal Article

Rifaximin for Irritable Bowel Syndrome Without Constipation

Nayer Khazeni, Daniella Perlroth
New England Journal of Medicine , 2011

BACKGROUND: Evidence suggests that gut flora may play an important role in the pathophysiology of the irritable bowel syndrome (IBS). We evaluated rifaximin, a minimally absorbed antibiotic, as treatment for IBS.

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