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Amy S. Kelley, MD, MSHS; Kathleen McGarry, PhD; Rebecca Gorges, MA; and Jonathan S. Skinner, PhD

Previous studies have described the cost of providing medical care during the last years of life in the United States, including the cost of such specific conditions as heart disease, cancer, and dementia. This study examines who pays those costs, how much of the burden falls on families, and whether that burden differs by condition.

Topics: dementia, spending, hrs trial
Kim Wadt Hansen, MD; Rikke Sorensen, MD; Mette Madsen, MSc; Jan Kyst Madsen, DMSc; Jan Skov Jensen, DMSc; Lene Mia von Kappelgaard, MScPH; Poul Erik Mortensen, MD; Theis Lange, MSc; and Soren Galatius, DMSc

In clinical trials, an early invasive strategy for acute coronary syndromes has been associated with more favorable outcomes than a conservative approach. This observational study of national health care data from Denmark compared outcomes for patients who had early coronary angiography (≤72 hours after the event) versus those for whom a conservative strategy was used (angiography >3 days after the event or not at all).

Topics: acute coronary syndromes, hospitals, patient readmission, heart, hospitalization, cardiac catheterization, coronary angiography, ...
Vedant S. Pargaonkar, MD; Marco V. Perez, MD; Akash Jindal, BS; Maya B. Mathur, MS; Jonathan Myers, PhD; and Victor F. Froelicher, MD

Studies differ on the prognosis of early repolarization with J waves and QRS slurs on resting electrocardiograms. The authors manually coded the electrocardiograms of 20 661 patients to identify J waves and QRS slurs, and they compared the long-term risks for cardiovascular death among patients with and without signs of early repolarization.

Topics: j waves, ecg early repolarization, electrocardiogram, cardiovascular death
Michael Miligkos, MD, MS; Raveendhara R. Bannuru, MD, PhD; Hadeel Alkofide, MS, PhD; Sucharita R. Kher, MD; Christopher H. Schmid, PhD; and Ethan M. Balk, MD, MPH
Includes: CME

Leukotriene-receptor antagonists (LTRAs) are recommended as an alternative treatment in patients with mild asthma, but their effect compared with placebo is unclear. This systematic review of 50 trials summarizes clinical and physiologic benefits and harms of LTRAs for adolescents and adults with asthma.

Topics: asthma, leukotriene receptor, antagonists, diamond, add-on code, inhaled corticosteroid, agonists
Daniel J. Niven, MD, MSc; Jonathan E. Gaudet, MD, MSc; Kevin B. Laupland, MD, MSc; Kelly J. Mrklas, MSc; Derek J. Roberts, MD, PhD; and Henry Thomas Stelfox, MD, PhD

The accuracy of peripheral thermometers in measuring body temperature is not well-defined. This systematic review of prospective studies compares the accuracy of peripheral (tympanic membrane, temporal artery, axillary, or oral) thermometers with central (pulmonary artery catheter, urinary bladder, esophageal, or rectal) thermometers for estimating body temperature in children and adults.

Topics: thermometer, device, body temperature, fever, temperature

This updated guideline from the U.S. Preventive Services Task Force addresses methods for and timing of hypertension screening in adults.

Topics: hypertension, blood pressure determination, blood pressure monitoring, ambulatory

Telemedicine—the use of technology to deliver care at a distance—is rapidly growing. This position paper from the American College of Physicians (ACP) highlights an approach to telemedicine policies and regulations that the ACP believes will have a positive effect on patient care.

Topics: telemedicine

This commentary discusses genome engineering and pandemic pathogen research. The authors call for appropriate transparency, safeguards, and limits to such research and advise that scientific, clinical, and public health communities become involved in such deliberations.

Topics: engineering, genome, pathogenic organism, pandemic

Many physicians dislike the use of patient satisfaction scores to evaluate the quality of care. This commentary explains why physicians should pay attention to patient satisfaction and the process by which it is assessed.

Topics: client satisfaction, hate

The survival of patients who have sudden cardiac arrest may differ markedly among communities. The Institute of Medicine recently evaluated the causes for such disparities and issued a “call to action” for improvement. The authors discuss the steps that should help bring about the improvements needed.

Topics: sudden cardiac death, institute of medicine (u.s.)
Alison Bateman-House, PhD, MPH, MA; Laura Kimberly, MSW, MBE; Barbara Redman, PhD, MBE; Nancy Dubler, LLB; and Arthur Caplan, PhD

Some states have recently passed “right-to-try” laws that authorize terminally ill patients to request drugs and devices that are too early in their development to be approved by the U.S. Food and Drug Administration. Other states are considering similar legislation. This commentary discusses right-to-try laws and whether they deliver on their promises.

Topics: statutes and laws, double effect
Topics: acute coronary syndromes

In this issue, Hansen and colleagues' observational study compared outcomes for patients who had early versus conservative invasive treatment for acute coronary syndromes. The editorialists discuss whether comparative effectiveness research using observational data can be strong enough to influence practice.

Topics: comparative effectiveness research

This issue contains a position paper from the American College of Physicians on telemedicine. The editorialist discusses this paper and how telemedicine will awaken us to many things that we believed required face-to-face contact but actually do not.

Topics: telemedicine, economics
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Sherry L. Pagoto, PhD; and Brad Appelhans, PhD
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William S. Yancy Jr., MD; Megan A. McVay, PhD; and Corrine I. Voils, PhD
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Jennifer R. Hartmark-Hill, MD
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Robert L. Carolla, MD
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John S. Brownstein, PhD; Jane E. Huston, MPH; Lauren Steingold, BA; and Meghan Verena Joyce, MBA
Topics: influenza virus vaccine
D.A. Frater, MD
Includes: Audio/Video
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D.A. Frater, MD
Includes: Audio/Video
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Mary Bascom Migeon, MD
Includes: Audio/Video
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D.A. Frater, MD
Includes: Audio/Video
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Topics: exercise, follow-up, community
Topics: domestic violence, patient referral
Topics: atrial fibrillation, hemorrhage, thrombus, elderly, venous thromboembolism
Topics: anticoagulation, atrial fibrillation, warfarin, thromboembolism, follow-up
Topics: warfarin, hemorrhage, therapeutics, vitamin k antagonist, venous thromboembolism, follow-up
Topics: hypertension, blood pressure, pharmacist, prescribing behavior, follow-up
Topics: pain, fasciitis, plantar, extracorporeal shockwave therapy, follow-up
Topics: venous thromboembolism, occult cancer, cancer diagnosis, follow-up
Topics: delirium, agitation, sedation procedure, elderly
Topics: statins, cardiovascular diseases, guidelines, adult treatment panel iii
Topics: percutaneous coronary intervention, creatinine-based formula (ckd-epi)
Topics: inpatient, mortality

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: hypertension, consultation
Topics: dementia, health care costs, terminally ill
Topics: hypertension
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