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Jeffrey H. Silber, MD, PhD; Paul R. Rosenbaum, PhD; Richard N. Ross, MS; Bijan A. Niknam, BS; Justin M. Ludwig, MA; Wei Wang, PhD; Amy S. Clark, MD; Kevin R. Fox, MD; Min Wang, MHS; Orit Even-Shoshan, MS; and Bruce J. Giantonio, MD

The incidence of colon cancer is highest among black persons, and there are racial disparities in survival among patients with colon cancer. In this study, the authors aimed to determine the extent to which this disparity is due to differences in characteristics at diagnosis or in treatment. They concluded that the racial disparity in 5-year survival seemed to be more related to the patients' characteristics at diagnosis than to differences in treatment.

Topics: colorectal cancer, colon cancer, cancer survivorship, racial disparities
  
David Grande, MD, MPA; Nandita Mitra, PhD; Anand Shah, MD, MSHP; Fei Wan, MS; and David A. Asch, MD, MBA

The increased availability of patient information through electronic health records has fueled debate about secondary use of these data. The authors report results from a national survey of patients' reactions to hypothetical scenarios of different uses of electronic health data. Reponses were complex, but indicate that the purpose of use was as important to patients as whether they had an opportunity to consent to the specific secondary use.

Topics: confidentiality, demography, electronic medical records, biomedical research, appropriateness, marketing, hispanics or latinos, ...
  
Elizabeth C. Oelsner, MD, MPH; Eric A. Hoffman, PhD; Aaron R. Folsom, MD, MPH; J. Jeffrey Carr, MD; Paul L. Enright, MD; Steven M. Kawut, MD, MS; Richard Kronmal, PhD; David Lederer, MD, MS; Joao A.C. Lima, MD; Gina S. Lovasi, PhD; Steven Shea, MD, MS; and R. Graham Barr, MD, DrPH
Includes: Audio/Video

Low lung function is known to predict mortality in the general population, but the prognostic significance of emphysema on computed tomography (CT) in persons without chronic obstructive pulmonary disease is uncertain. This prospective cohort study examined mortality among participants without airflow obstruction on spirometry who did and did not have emphysematous changes in the lungs on cardiac CT. The results suggest that emphysematous lung changes on CT were associated with increased mortality, particularly among smokers.

Topics: airway obstruction, cardiac ct, lung, emphysema, pulmonary, mortality, smoking, spirometry
  
Elizabeth A. O'Connor, PhD; Jennifer S. Lin, MD, MCR; Brittany U. Burda, MPH; Jillian T. Henderson, PhD; Emily S. Walsh, MPH; and Evelyn P. Whitlock, MD, MPH

This updated systematic review for the U.S. Preventive Services Task Force (USPSTF) summarized data from 31 trials that addressed the efficacy of sexual risk-reduction counseling to prevent sexually transmitted infections (STIs) in adolescents or adults. Most trials targeted persons at increased risk for STIs. High-intensity (\g2 hours) interventions reduced STI incidence, and lower-intensity interventions were generally not effective.

Topics: counseling, primary health care, sexually transmitted diseases, risk reduction, infection risk, risk ...
  
Bernadette Zakher, MBBS; Amy G. Cantor, MD, MHS; Miranda Pappas, MA; Monica Daeges, BA; and Heidi D. Nelson, MD, MPH

This updated systematic review for the USPSTF examined trials and observational studies relevant to screening for gonorrhea and chlamydia in asymptomatic men and women. Several studies found that nucleic acid amplification tests had reasonable sensitivity and specificity for diagnosing gonor-rhea and chlamydia, regardless of specimen type or test. Trial findings suggested that chlamydia screening in young women reduced the incidence of pelvic inflammatory disease.

Topics: chlamydia infection, gonococcal infection, neisseria gonorrhoeae, sexually transmitted diseases, chlamydia, gonorrhea guidelines, ...
  

These recommendations from the USPSTF address behavioral counseling interventions to prevent STIs. Such interventions include those targeting risky sexual behaviors to prevent STIs in persons of any sexual orientation or level of reported sexual activity. The USPSTF recommends intensive behavioral counseling for all sexually active adolescents and for adults who are at increased risk for STIs.

Topics: sexually transmitted diseases, risk reduction counseling, infection risk, counseling
  

These recommendations from the USPSTF address screening for chlamydia and gonorrhea in sexually active, asymptomatic adolescents and adults, including pregnant women. The USPSTF recommends screening for chlamydia and gonorrhea in sexually active females aged 24 years or younger and in older women who are at increased risk for infection. Current evidence is insufficient to assess the balance of benefits and harms of screening in men.

Topics: chlamydia infection, gonococcal infection, neisseria gonorrhoeae, sexually transmitted diseases, chlamydia, gonorrhea guidelines, ...
  
Stephanie R. Morain, MPH, PhD; Charles Flexner, MD; Nancy E. Kass, ScD; and Jeremy Sugarman, MD, MPH, MA

The Physician Payment Sunshine Act was intended to bring greater transparency to physician–industry relationships by establishing the Open Payments database. This commentary discusses areas where disclosure of payments related to research may be prone to misinterpretation.

Topics: health care financing administration, disclosure, drug costs, research funding, physician payments sunshine ...
  

The recent publication of a study conducted by Facebook, which manipulated the amount of positive or negative material that users saw in their Facebook newsfeeds, has provoked much critical comment. This commentary explores the role of the academic researchers and editors in publishing the study and evaluates their responsibility to protect research participants.

Topics: publishing, ethics, research
  

On 4 November 2014, California residents voted against Proposition 46, which involved increasing the cap on noneconomic damages in medical liability cases, mandating that physicians check the state's database on prescription drug history before prescribing certain controlled substances, and requiring hospitals to perform drug and alcohol testing of physicians. This commentary discusses why the manner in which Proposition 46 mandated physician drug and alcohol testing is cause for concern.

Topics: alcohol abuse, ethanol, california, mandatory testing, physician impairment, substance abuse detection, medical ...
  

On 4 November 2014, California residents voted against Proposition 46, which proposed to increase the cap on noneconomic damages in medical liability cases, mandate that physicians check the state's database on prescription drug history before prescribing certain controlled substances, and require hospitals to perform drug and alcohol testing of physicians. This commentary argues that, if it had been enacted, the initiative's unintended consequences would have likely exceeded its benefits.

Topics: alcohol abuse, ethanol, california, mandatory testing, physician impairment, statutes and laws, medical ...
  

In this issue, Grande and colleagues and Simon explore the topics of patient consent and corporate research ethics, respectively. The editorialist reflects on these related issues and discusses how we need to rethink the ethical framework to better protect study participants and increase public trust that research ethics are matching the pace of information technology.

Topics: ethics, information sciences, trust and distrust, ethics, research, consent, communication and information ...
  

A knot of dread formed in my stomach as 11:00 a.m. neared. I had nothing to offer: I had never been to India, and I certainly didn't know anything about treating tuberculosis.

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Carl Chartrand-Lefebvre, MD; Madeleine Durand, MD, MSc; and Cécile Tremblay, MD
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Wendy S. Post, MD, MS; Richard T. George, MD; and Matthew Budoff, MD
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John C. Jennings, MD; and Jennifer Blake, MD, MSC
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Hanna E. Bloomfield, MD, MPH; Andrew Olson, MD; and Timothy J. Wilt, MD, MPH
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Samuel Metz, MD; and Debra Gussman, MD
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Carol Bates, MD; and Jennifer Potter, MD
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Thomas D. Denberg, MD, PhD; Russell Harris, MD, MPH; Linda L. Humphrey, MD, MPH; and Amir Qaseem, MD, PhD
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Lisa I. Backus, MD, PhD; Pamela S. Belperio, PharmD; Timothy P. Loomis, PhD; Steven-Huy Han, MD; and Larry A. Mole, PharmD
Topics: hepatitis b, united states department of veterans affairs, veterans, screening, hepatitis b ...
  
Ada C. Rahn, MD
Includes: Audio/Video
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Topics: colorectal cancer, mortality, flexible fiberoptic sigmoidoscopy, colorectal cancer screening, follow-up
  
Topics: emergency service, hospital, metoclopramide, ondansetron, nausea and vomiting, nausea
  
Topics: antibiotics, cholecystitis, cholecystectomy
  
Topics: antihypertensive agents, cardiovascular event, cardiovascular disease risk factors
  
Topics: blood pressure, hemoglobin a, outpatients, nursing care, glucohemoglobin measurement, glucose control
  
Topics: cardiovascular disease risk factors, diet, exercise, counseling, lifestyle changes, health outcomes, changes ...
  
Topics: rheumatoid arthritis, antirheumatic drugs, disease-modifying, biosimilar pharmaceuticals
  
Topics: antirheumatic drugs, disease-modifying, biosimilar pharmaceuticals, infection risk
  
Topics: implantable defibrillators, heart failure, cardiac event, mortality, telemonitoring, cardiac resynchronization therapy defibrillator ...
  
Topics: fibrinolytic agents, hematoma, subdural, vitamin k antagonist
  
Topics: atrial fibrillation, warfarin, cardiac ablation, thromboembolic event, thromboembolism
  
Topics: intracranial hemorrhages, gastrointestinal bleeding, qbleed score
  

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: myocardial infarction, smoking cessation, surgical procedures, operative
  
Topics: counseling, sexually transmitted diseases, risk reduction, risk reduction counseling, infection risk
  
Topics: chlamydia infection, gonococcal infection, neisseria gonorrhoeae, sexually transmitted diseases, chlamydia, gonorrhea guidelines, ...
  
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