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A surprise medical bill refers to unexpected charges incurred when a patient with health insurance receives care from a physician, hospital, or medical transport service that is not part of the insurer’s network. These charges can arise in an emergency, when a patient may not have the ability to choose the emergency department, the physicians, or the ambulance service. Or they can arise as part of otherwise routine in-network care, such as when a patient is treated at an in-network hospital or outpatient facility. A common reason is that certain physicians, such as an anesthesiologist, an emergency department physician, a pathologist, or a radiologist, may not participate in a health insurer’s network and bill the patient directly. Dependin.
Pancreatic cancer can be a devastating disease. Fewer than 9% of patients with ductal adenocarcinoma of the pancreas are living 5 years after diagnosis. It is estimated that in 2019, about 57 000 people will be diagnosed with pancreatic cancer in the United States and that it may soon overtake colon cancer to become the second-most common cause of cancer-related death. Based on recent progress in the treatment of colon cancer, the best hope for reducing the cancer-specific mortality of pancreatic cancer may be early diagnosis and treatment.
To the Editor We read with interest the recently published Original Investigation by Lee and colleagues tallying performance measures of ultrasonography from the Breast Cancer Surveillance Consortium (BCSC). With increased legislation at the state and now federal level, women with mammographically dense breasts and/or high risk of breast carcinoma are to consider supplemental screening in addition to screening with digital mammography or tomosynthesis.
To the Editor We applaud the recently published report by Schnabel and colleagues documenting increased mortality risk in study participants who regularly consumed high levels of ultraprocessed food products. This newest evidence reinforces US dietary guideline recommendations to limit consumption of food products that are high in saturated fat, sugar, and sodium.
In Reply We thank McCarthy and May for their letter regarding our Original Investigation. Consistent with the US dietary guidelines, the French nutritional recommendations also promote the consumption of unprocessed and minimally processed foods. As McCarthy and May point out in their response, on average, the nutritional quality of ultraprocessed food is lower than that of minimally or unprocessed food: the food often contains more salt, added sugar, and saturated fatty acids, and fewer dietary fibers and vitamins.
In the Original Investigation titled “Association of Radioactive Iodine Treatment With Cancer Mortality in Patients With Hyperthyroidism,” published online July 1, 2019, there was an error in the Importance section of the Abstract. The term “hypothyroidism” should have been “hyperthyroidism.” This article was corrected online.
In 2016, following an evaluation of publication trends over the last few decades, Ioannidis declared that “the production of systematic reviews and meta-analyses has reached epidemic proportions.” In particular, he estimated that the annual number of published systematic reviews and meta-analyses increased approximately 2700% from 1991 to 2014. Systematic reviews and meta-analyses, which are fundamental tools of evidence-based medicine, aim to accumulate, synthesize, and evaluate evidence across individual studies, with the goal of resolving uncertainties, reducing biases, and informing practice. However, the production of reviews has far outpaced the 150% increase in annual publications across all PubMed–indexed article types between 1991
Hematuria is prevalent in up to a third of the US population. Approximately 2% to 5% of patients with microscopic hematuria and 12% of patients with macroscopic or gross hematuria will be diagnosed with urinary tract cancer, most cases of which are superficial bladder tumors detected through cystoscopy. Screening asymptomatic persons for bladder cancer with urinalysis to detect microscopic hematuria is not recommended by the US Preventive Services Task Force because of insufficient evidence of the advantage of treatment of screen-detected bladder cancer, as well as insufficient data on the harms of screening for and evaluating hematuria. There are also no acceptable screening tests for renal cell carcinoma, the predominant cancer detected t.

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