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Michelle C. Odden, PhD; Mark J. Pletcher, MD, MPH; Pamela G. Coxson, PhD; Divya Thekkethala, BS; David Guzman, MS; David Heller, MD; Lee Goldman, MD, MPH; and Kirsten Bibbins-Domingo, MD, PhD

More than 40% of adults aged 75 years or older use statins, but there is little evidence to guide their use for primary prevention in this population. In this study, the authors evaluated the population benefit and cost-effectiveness of statins in U.S. adults aged 75 years or older without a history of cardiovascular disease. They projected statins to be cost-effective for primary prevention but found that even a small increase in geriatric-specific adverse effects could offset the cardiovascular benefit.

Topics: primary prevention, statins, cost effectiveness, cardiovascular diseases
Tannaz Moin, MD, MBA, MSHS; Jinnan Li, MPH; O. Kenrik Duru, MD, MSHS; Susan Ettner, PhD; Norman Turk, MS; Abigail Keckhafer, MBA, MPH; Sam Ho, MD; and Carol M. Mangione, MD, MSPH

Evidence shows that lifestyle changes or metformin can delay the progression of prediabetes to overt diabetes. This retrospective cohort study examined the prescription of metformin in a large sample group of insured U.S. adults with prediabetes. Only 3.7% were prescribed metformin over a 3-year period, which suggests infrequent prescription for diabetes prevention. Future studies are needed to understand why metformin is rarely prescribed as prediabetes therapy.

Topics: metformin, prediabetes, diabetes mellitus, diabetes mellitus, type 2
Michael M. Mohareb, MD; Feng Qiu, MSc; Warren J. Cantor, MD; Kori J. Kingsbury, MSN, MPA; Dennis T. Ko, MD, MSc; and Harindra C. Wijeysundera, MD, PhD

In this cohort study, the authors sought to validate the 2012 appropriate use criteria for diagnostic catheterization by examining the relationship between the appropriateness of cardiac catheterization in patients with suspected stable ischemic heart disease and the proportion of obstructive coronary artery disease and subsequent revascularization. Their findings raise concerns about the ability of these criteria to guide use of the procedure in this clinical setting.

Topics: angina pectoris, angiogram, coronary angiography, cardiovascular stress test, exercise stress test, diagnostic ...
Caroline Lubick Goldzweig, MD, MS; Greg Orshansky, MD; Neil M. Paige, MD, MSHS; Isomi M. Miake-Lye, BA; Jessica M. Beroes, BS; Brett A. Ewing, MS; and Paul G. Shekelle, MD, PhD

This systematic review examined interventions that use the computerized clinical decision-support capabilities of electronic health records to improve appropriate use of diagnostic radiologic test ordering. Reviewers found that computerized clinical decision support integrated with the electronic health record can improve appropriate use by a moderate amount and decrease overall use by a small amount, but more data are needed on potential harms before widespread adoption can be recommended.

Topics: diagnostic imaging, electronic medical records, radiology specialty, appropriateness

This systematic review for the U.S. Preventive Services Task Force updates evidence about the benefits and harms of routine screening and supplementation for iron deficiency anemia in asymptomatic, nonanemic pregnant women living in developed countries. There were no relevant screening trials. Trials and observational studies showed that iron supplementation improved some maternal hematologic indices, but these studies provided inconclusive evidence that routine prenatal supplementation improved maternal or infant clinical outcomes.

Topics: pregnancy, iron, mothers

In December 2013, the U.S. Preventive Services Task Force recommended screening for lung cancer with lowdose computed tomography (LDCT) for selected current and former smokers. This paper summarizes a conference during which an internist and a radiologist discussed the application of the Task Force recommendation to an individual patient.

Topics: lung cancer, lung cancer screening, nlst trial, low-dose spiral ct, grand rounds, ...

Electronic nicotine delivery systems (ENDS), which include electronic cigarettes, or e-cigarettes, are growing in popularity, but their safety and efficacy as a smoking cessation aid are not well-understood. In this position paper, the American College of Physicians offers policy recommendations on ENDS regulation and oversight,taxation, flavorings, promotion and marketing, indoor and public use, and research.

Topics: smoking cessation, tobacco, cigarettes, nicotine, american college of physicians, electronic nicotine delivery ...

The American College of Physicians celebrates its 100th anniversary in 2015. This commentary highlights 3 leading issues for internal medicine and for the College as it enters its second century and strives to continue to meet the needs of internists and their patients.

Topics: internal medicine, job satisfaction, health care systems, health care cost containment, american ...
Thomas Daschle, BA; and E. Ray Dorsey, MD, MBA

This commentary discusses the decline of the house call and its resurgence in the form of telemedicine and virtual visits. While acknowledging that a “digital divide” persists, the authors emphasize virtual providers' ability to reduce geographic disparities in care.

Topics: house calls

Lung cancer screening is the topic of this issue's discussion from the Annals archive.

Topics: lung cancer screening

In this issue, Odden and colleagues evaluated the population benefit and cost-effectiveness of statins in older U.S. adults without a history of cardiovascular disease. The editorialist acknowledges the strengths of the study but posits that “less is more” in the prescription of statins for primary prevention in older adults.

Topics: statins, cost effectiveness, elderly

In this issue, Mohareb and colleagues sought to validate the 2012 appropriate use criteria for diagnostic catheterization. The editorialists discuss the opportunities and challenges of applying these criteria to large data sets. They also urge physicians to embrace the opportunity for self-regulation that appropriate use criteria offer to ensure that they remain advocates for patients and stewards of the health system.

Topics: social control, informal, appropriate use, catheterization
Ellen J. Plumb, MD
Includes: Audio/Video
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Joanne Lynn, MD
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Sarah L. Szanton, PhD, ANP; Bruce Leff, MD; and Laura N. Gitlin, PhD
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Frank Davidoff, MD
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Marysia S. Tweet, MD; Sharonne N. Hayes, MD; Rajiv Gulati, MD, PhD; Carl H. Rose, MD; and Patricia J.M. Best, MD
Topics: pregnancy, spontaneous coronary artery dissection
Gregory E. Skipper, MD; Julius Cuong Pham, MD, PhD; and Peter J. Pronovost, MD, PhD
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Topics: hemorrhage, mortality, vitamin k antagonist, apixaban
Topics: anticoagulants, hemorrhage, renal impairment, apixaban
Topics: atrial fibrillation, warfarin, left auricular appendage, follow-up
Topics: respiratory failure, acute, intubation, mortality, continuous positive airway pressure
Topics: antiplatelet agents, drug-eluting stents, follow-up
Topics: atrial fibrillation, heart failure, mortality, sinus rhythm
Topics: obstructive sleep apnea, continuous positive airway pressure
Topics: exercise, follow-up, hand, hand function
Topics: rheumatoid arthritis, tumor necrosis factor blockers, adverse event
Topics: kidney failure, chronic, heart failure, diabetes mellitus, type 2, hospitalization, saxagliptin, follow-up ...
Topics: acute cerebrovascular accidents, nitroglycerin, hypertension, follow-up, antihypertensive agents
Topics: demyelinating diseases, multiple sclerosis, human papilloma virus vaccine

The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.

Topics: neck, consultation, pain, carotid bruit
Topics: primary prevention, statins, elderly
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