Cover photograph by Lindsey C. Wu, MD
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Knowledge of the number of persons with chronic hepatitis C virus (HCV) infection in the United States is critical for public health and policy planning. Using data from a nationally representative household survey conducted between 2003 and 2010, the authors estimated the prevalence of chronic HCV infection, which has decreased. Risk factors seem to be similar to previous periods but were reported by only about one half of infected persons.
Statin-related myalgia compared with myalgia due to other causes is difficult to distinguish and may often lead to statin discontinuation. This proof-of-concept study involved patients who previously reported symptoms while taking statins. Patients received several pairs of double-blind statin or placebo challenges (n-of-1 trials). There were no statistically significant differences between myalgia and other pain measures during statin therapy versus placebo. Most patients resumed statin therapy after reviewing their results. In select patients, n-of-1 trials are feasible and potentially useful in examining myalgia during statin rechallenge.
This comparative modeling study provides estimates of the benefits and harms of computed tomography screening for lung cancer in persons aged 45 through 90 years with various pack-year exposures to smoking. Estimates suggested that annual screening for persons aged 55 through 80 years with 30 or more pack-years of exposure to smoking has a favorable benefit–harm ratio.
This systematic review summarizes evidence about the benefits and harms of ultrasonography screening for abdominal aortic aneurysms (AAAs) in asymptomatic primary care patients. A one-time invitation for screening in men aged 65 years or older reduced AAA rupture and AAA-related mortality rates but had no statistically significant effect on all-cause mortality rates up to 15 years. Screening increased numbers of overall and elective surgeries but reduced emergency procedures and associated operative mortality. These findings will inform updated U.S. Preventive Services Task Force (USPSTF) recommendations on ultrasonography screening for AAAs.
The USPSTF now recommends annual screening for lung cancer with low-dose computed tomography in adults
aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the
past 15 years. It recommends discontinuing screening once a person has not smoked for 15 years or
develops a health problem that substantially limits life expectancy or the ability or willingness to have
curative lung surgery.
In November 2013, the American College of Cardiology and American Heart Association (ACC/AHA) released a clinical practice guideline on the treatment of blood cholesterol to reduce cardiovascular risk in adults. This synopsis summarizes key features of the guidelines, including lifestyle, groups shown to benefit from statins, statin safety, decision making, and estimation of cardiovascular disease risk.
This survey asked young physician researchers about time spent on professional and domestic activities. Among married couples with children, the authors found that women spent more time on domestic activities and less time on research than men after adjustment for work hours, spousal employment, and other factors. The authors urge that these trends be recognized to ensure the success of women in the medical profession.
In November 2013, the ACC/AHA issued long-awaited clinical guidelines on assessment of cardiovascular risk and cholesterol treatment. This commentary discusses the controversial guidelines, applauds the simpler approach, and calls for improved methods of cardiovascular risk calculation.
In November 2013, the ACC/AHA issued clinical guidelines on assessment of cardiovascular risk and cholesterol treatment. This commentary highlights core concepts of the guidelines that rest on widespread consensus and discusses controversial aspects. The authors suggest a potential middle ground for clinicians and patients making treatment decisions in the midst of this controversy.
In this issue, Jagsi and colleagues report sex disparities in time spent on domestic activities among high-achieving young physician researchers. The editorialists discuss the article and speculate that the disparities may simply reflect preferences.
In November 2013, the ACA/AHA issued controversial clinical guidelines on the assessment of cardiovascular risk and cholesterol treatment. This commentary explores why guidelines generate controversy and considers ways to avoid controversies that leave patients and clinicians perplexed and distrustful of guidelines.
The editorialists comment on the recent USPSTF recommendations on screening for lung cancer and note the many practical aspects of putting the USPSTF guidance into practice.
The editorialist uses the publication of the 2013 USPSTF recommendations on screening for lung cancer as an opportunity to take stock of the Task Force's processes.