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David S. Weinberg, MD, MSc; Ronald E. Myers, PhD; Eileen Keenan, MA; Karen Ruth, MS; Randa Sifri, MD; Barry Ziring, MD; Eric Ross, ScM, PhD; and Sharon L. Manne, PhD

Genetic and environmental risk assessment (GERA) uses genetic and environmental information to identify an individual's risk for a disease, and it has been suggested as a means to motivate adherence to recommended cancer screening. This 2-group, randomized, controlled trial evaluated whether individualized GERA of colorectal cancer susceptibility improves adherence to screening in average-risk persons and found that screening uptake was not positively associated with feedback from a single personalized GERA.

Topics: colon cancer, rectal carcinoma, genetic testing for cancer risk, cancer screening, genetic ...
  

More than 500 000 incarcerated persons in the United States have chronic hepatitis C virus (HCV) infection. The recent availability of short-duration, highly efficacious treatments may enable incarcerated patients to receive a full course of treatment while in prison. The authors analyzed the cost-effectiveness of sofosbuvir for HCV treatment in incarcerated populations. Their results suggest that sofosbuvir-based treatment is cost-effective for this population, although affordability may be an issue.

Topics: hepatitis c, antiviral agents, prisoners, sensitivity analysis, sofosbuvir, hepatitis c virus, reinfection, ...
  
Edward R. Marcantonio, MD, SM; Long H. Ngo, PhD; Margaret O'Connor, PhD; Richard N. Jones, ScD; Paul K. Crane, MD, MPH; Eran D. Metzger, MD; and Sharon K. Inouye, MD, MPH

Delirium occurs regularly among hospitalized patients and is associated with adverse outcomes but often goes unrecognized. The Confusion Assessment Method (CAM) is the most widely used diagnostic tool for delirium. This study validated a 3-minute version of the CAM (called 3D-CAM) against a reference standard and found it to be a sensitive and specific diagnostic tool in hospitalized patients, including those with and without dementia.

Topics: elderly, confusion assessment method, delirium, reference standards, patient interview, dementia
  
Vineet Chopra, MD, MSc; Sushant Govindan, MD; Latoya Kuhn, MPH; David Ratz, MS; Randy F. Sweis, MD; Natalie Melin, BA; Rachel Thompson, MD; Aaron Tolan, MD; James Barron, MD; and Sanjay Saint, MD, MPH
Includes: Audio/Video

Complications associated with central venous catheters (CVCs) increase over time, and the extent to which clinicians are aware that their patients have a CVC is unknown. This multicenter, cross-sectional study assessed how often clinicians were aware of the presence of triple-lumen or peripherally inserted central catheters in hospitalized patients and found that many interns, residents, and attending physicians were unaware that their patients had indwelling catheters.

Topics: catheterization, central venous, infection prophylaxis, peripherally inserted central catheter, triple lumen catheter, ...
  

This systematic review of 74 trials for the U.S. Preventive Services Task Force assesses benefits of lifestyle counseling interventions for persons with cardiovascular risk factors. Intensive interventions that promoted healthy diets and physical activity helped persons lose weight and reduce their lipid levels, blood pressure, and glucose levels.

Topics: obesity, cardiovascular diseases, diet, counseling, lifestyle changes, changes in diet, risk reduction ...
  

Physical symptoms lead to more than half of all outpatient visits, yet the current disease-focused model of care inadequately addresses this problem. This narrative review discusses 4 common epidemiologic questions about a clinical condition (cause, diagnosis, prognosis, and therapy) to promote an evidence-based and practical approach to handling common symptoms.

Topics: signs and symptoms, evidence-based practice, narrative review, patient evaluation
  

This updated U.S. Preventive Services Task Force recommen-dation applies to adults aged 18 years or older in primary care settings who are overweight or obese and have known risk factors for cardiovascular disease. It recommends offering or referring such patients to intensive behavioral counseling interventions to promote a healthful diet and physical activity for prevention of cardiovascular disease.

Topics: diet, lifestyle changes, health outcomes, changes in diet, risk reduction counseling, healthy ...
  

The National Quality Forum recently convened on whether to risk-adjust health care performance measures for sociodemographic factors in addition to clinical factors present at the initiation of care. This commentary discusses why the panel chose to recommend such adjustment and why the topic is so hotly debated.

Topics: risk adjustment, socioeconomic factors, poverty, patient characteristics, performance measures, patient readmission
  

This commentary describes the Veterans Health Administration's demonstration project that aims to assess initial experience in implementing lung screening programs at select sites. It will assess the results to inform whether, and how, to proceed with broader implementation.

Topics: veterans, lung cancer, lung cancer screening, low-dose spiral ct
  
Ilana Graetz, PhD; Cameron M. Kaplan, PhD; Erin K. Kaplan, PhD; James E. Bailey, MD, MPH; and Teresa M. Waters, PhD
Includes: Audio/Video

The Affordable Care Act aims to expand health care coverage in part by providing subsidies to individuals with low incomes. This study assessed the cost of purchasing the least expensive health insurance plans after accounting for these subsidies. It found that the penalty for not buying health insurance would be lower than buying the least expensive insurance for many individuals and some young persons would pay more than older ones.

Topics: income, patient protection and affordable care act, health insurance exchanges, government subsidies, ...
  

In this issue, Weinberg and colleagues conclude that colorectal cancer screening uptake in average-risk persons was not positively associated with feedback from a single personalized GERA. The editorialists explore the difficulties of using personalized genomics to improve health and evaluate how to use risk estimates to motivate positive behaviors.

Topics: colorectal cancer, risk assessment, genomic medicine, genetic testing for cancer risk, genetic ...
  
Darren B. Taichman, MD, PhD, Executive Deputy Editor

In this issue, Chopra and colleagues determined that clinicians are often unaware of the presence of central venous catheters in hospitalized patients. The editorialist discusses the complications associated with devices that might no longer be needed and the role of programmatic interven-tions aimed at fostering a culture of safety-mindedness.

Topics: catheterization, central venous, infection prophylaxis, central venous catheter, central line-associated bloodstream infection, ...
  

Recently revealed safety lapses in U.S. government facilities that work with deadly pathogens suggest another grave bioterror threat: the risk emanating from biocontainment laboratories themselves. This commentary discusses possible factors contributing to the safety lapses and strategies to prevent future incidents.

Topics: bioterrorism, containment of biohazards, biomedical research, laboratory biosafety level, biocontainment laboratories
  
Elizabeth Lawrence, MD
Includes: Audio/Video
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Stéphanie Roberge, MSc; Suzanne Demers, MD; and Emmanuel Bujold, MD, MSc
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Jillian T. Henderson, PhD, MPH; Elizabeth O'Connor, PhD; and Evelyn P. Whitlock, MD, MPH
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Hilda J.I. de Jong, MSc; Ronald H.B. Meyboom, MD; Markku J. Helle, MD; Olaf H. Klungel, PharmD; Leo Niskanen, MD; and Jan Willem Cohen Tervaert, MD
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Jenna Thomason, MD, MPH
Includes: Audio/Video
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Topics: influenza, clinical trials, antiviral agents, hospitalization, economics, oseltamivir, antiviral prophylaxis, neuraminidase inhibitor, ...
  
Topics: myocardial ischemia, cardiovascular disease risk factors, lifestyle changes, risk reduction counseling, inter99 ...
  
Topics: disease progression, idiopathic pulmonary fibrosis, pirfenidone, ascend trial
  
Topics: forced vital capacity, idiopathic pulmonary fibrosis, nintedanib, inpulsis trial
  
Topics: spironolactone, heart failure with preserved ejection fraction, topcat trial, heart failure
  
Topics: naltrexone, alcohol or other drug disorder relapse, acamprosate, alcohol use disorder
  
Topics: atorvastatin, kidney diseases, kidney, adverse effects of medication
  
Topics: vancomycin, skin diseases, bacterial, dalbavancin
  
Topics: stent, coronary artery bypass surgery, coronary arteriosclerosis, medical management
  
Topics: hypertension, hypokalemia, hyponatremia, thiazide, adverse effects of medication, renal trauma, elderly
  
Topics: pulmonary embolism, ultrasonography, multislice computed tomography, fibrin d-dimer assay, wells dvt score ...
  
Topics: pulmonary embolism, ultrasonography, brain natriuretic peptide, brain natriuretic peptide measurement, deep vein ...
  

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: clothing
  
Topics: obesity, physical activity, cardiovascular diseases, diabetes mellitus, cardiovascular disease risk factors, diabetes ...
  
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