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David J.D. Earn, PhD; Daihai He, PhD; Mark B. Loeb, MD, MSc; Kevin Fonseca, PhD; Bonita E. Lee, MD, MSc; and Jonathan Dushoff, PhD

Controversy exists as to whether schools should close during influenza epidemics. Researchers developed a mathematical model of H1N1 influenza transmission in Alberta, Canada, by using virologic data, census data, climate records, and school calendars. The model suggests that school closure reduced influenza transmission among schoolchildren by more than 50%, attenuating the first peak of the H1N1 influenza epidemic. Reopening of schools initiated the second peak. Closing schools may be an effective strategy to slow the spread of influenza during epidemics.

Topics: influenza, alberta, pandemic, school closure
Laura-Mae Baldwin, MD, MPH; Katrina F. Trivers, PhD; Barbara Matthews, MBA; C. Holly A. Andrilla, MS; Jacqueline W. Miller, MD; Donna L. Berry, RN, PhD; Denise M. Lishner, MSW; and Barbara A. Goff, MD

No professional organization recommends routine screening of asymptomatic women for ovarian cancer. Using case vignettes, researchers surveyed primary care physicians about ovarian cancer screening beliefs and practices. One in 3 physicians believed that ovarian cancer screening with ultrasonography or cancer antigen 125 was effective. Substantial proportions of physicians indicated that they would offer ovarian cancer screening to low-risk (6.3%) and medium-risk (24%) women. These data suggest that some physicians may screen women for ovarian cancer despite the lack of evidence of net benefit to patients, which potentially leads to patient harm and unnecessary use of health care resources.

Topics: ovarian cancer, screening test
Derek R. MacFadden, MD; Eugene Crystal, MD; Andrew D. Krahn, MD; Iqwal Mangat, MD; Jeffrey S. Healey, MD, MSc; Paul Dorian, MD; David Birnie, MBChB; Christopher S. Simpson, MD; Yaariv Khaykin, MD; Arnold Pinter, MD; Kumaraswamy Nanthakumar, MD; Andrew J. Calzavara, MSc; Peter C. Austin, PhD; Jack V. Tu, MD, PhD; and Douglas S. Lee, MD, PhD

Differences in the use and outcomes of implantable cardioverter-defibrillators (ICDs) between men and women have not been fully examined. Data from a registry in Ontario, Canada, indicate that women were just as likely as men to have ICDs implanted after referral to a cardiac electrophysiologist. However, women were more likely than men to have complications after implantation and were less likely to receive appropriate ICD-delivered shocks and therapies. The risks and benefits of ICDs differ between women and men. Future studies should consider sex-stratified reporting of results and aim to better identify women at risk for sudden death.

Topics: implantable defibrillators, sex characteristics, defibrillator, implantable defibrillator insertion
Jennifer W. Mack, MD, MPH; Angel Cronin, MS; Nathan Taback, PhD; Haiden A. Huskamp, PhD; Nancy L. Keating, MD, MPH; Jennifer L. Malin, MD, PhD; Craig C. Earle, MD, MSc; and Jane C. Weeks, MD, MSc

Guidelines recommend end-of-life care planning for patients with incurable cancer and a life expectancy of less than 1 year. This study of 2155 patients with stage IV lung or colorectal cancer found that, although nearly three quarters of patients discussed end-of-life care with physicians before they died, discussions generally occurred late in the course of the disease, during acute hospitalizations, and with physicians other than oncologists. Oncologists documented end-of-life care discussions with only 27% of the patients they saw. These results suggest opportunities to improve end-of-life care planning for patients with advanced cancer.

Topics: end-of-life care, cancer, cancer, advanced, colorectal cancer
Advisory Committee on Immunization Practices
Includes: CME

The Advisory Committee on Immunization Practices (ACIP) presents the recommended Adult Immunization Schedule for 2012. This schedule has been approved by the ACIP, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Physicians, and American College of Nurse-Midwives.

Topics: adult immunization, vaccination, vaccines, thoracodorsal artery perforator flap, hepatitis b vaccine, measles-mumps-rubella ...
Amir Qaseem, MD, PhD, MHA; Linda L. Humphrey, MD, MPH; Donna E. Sweet, MD; Melissa Starkey, PhD; Paul Shekelle, MD, PhD, for the Clinical Guidelines Committee of the American College of Physicians*

The American College of Physicians (ACP) considered evidence for the comparative effectiveness and safety of oral type 2 diabetes drugs to develop guidelines for the use of these agents. The ACP recommends that clinicians prescribe an oral drug for patients diagnosed with type 2 diabetes when diet and exercise fail to adequately control hyperglycemia, use monotherapy with metformin as first-line oral therapy unless contraindications exist, and add a second drug to metformin therapy when monotherapy fails. The ACP found no strong evidence to support that one class of drug is better than another as a second drug.

Topics: metformin, diabetes mellitus, type 2, sulfonylurea compounds, thiazolidinedione, clinical practice guideline

A physician working at the urgent care clinic at the New Orleans Veterans Administration Hospital after Hurricane Katrina observed that clinical evaluations that previously took weeks to complete in traditional outpatient settings could be accomplished in a few hours or days. The author proposes duplicating this experience in academic medical centers by affiliating an urgent care clinic with an ambulatory procedure unit and quick access to subspecialty consultants.

Topics: urgent care

Frederick Novy was a U.S. physician, medical researcher, and microbiologist who devised culture techniques to visualize anaerobic bacteria, parasites, and spirochetes. This essay describes how Novy's research on the cause of unexplained deaths in his laboratory rats, begun in 1909, was halted in 1918 when study materials mysteriously vanished from his laboratory. Persistence, excellent laboratory notes, and new technological discoveries enabled Novy to return to his experiments in 1951 at age 88 when a box containing the missing test tubes was found. Novy identified that a virus rather than a bacterium had killed his laboratory rats.

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Earn and colleagues' article in this issue demonstrates that school closure may be an effective strategy for reducing the spread of influenza during pandemics. The editorialist notes that decision makers will need to consider the virulence of future pandemics and weigh the benefits and costs of social distancing to limit the spread of influenza.

Topics: age distribution, pandemic, school closure, influenza
Pamela S. Douglas, MD; and Lesley H. Curtis, PhD

MacFadden and colleagues' study in this issue demonstrates similar ICD implantation rates among men and women after referral for electrophysiologic evaluation but higher rates of complications in women. The editorialists note that available research limits our ability to fully assess the value of ICDs in women and that a one-size-fits-all approach to ICDs may not be appropriate.

Topics: death, sudden, implantable defibrillators, academic medical centers, cardiac resynchronization therapy, cardiomyopathy, non-ischemic, ...
Sandra Adamson Fryhofer, MD
Includes: Audio/Video

In this issue, the ACIP presents the recommended Adult Immunization Schedule for 2012. The editorialist discusses the rationale behind key changes between this and previous ACIP recommendations.

Topics: adult immunization, hypoxic pulmonary vasoconstriction, politics, vaccination, vaccines, hepatitis b vaccine, human ...

One of my first patients as a medical intern was an avowed racist. His body failing, he turned to our hospital for help only to find me, a black man, as one of the doctors entrusted to extend his life. The year was 2003, but for a time, it felt more like 1963.

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Alan C. Moses, MD; Yehuda Handelsman, MD; and Daniel Einhorn, MD
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Erin S. LeBlanc, MD, MPH; and Elizabeth O'Connor, PhD
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Karla Kerlikowske, MD; and Rebecca Hubbard, PhD
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Lewis G. Sandy, MD, MBA
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Luke O. Hansen, MD, MHS; and Mark V. Williams, MD
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Keith M. Swetz, MD; and Arif H. Kamal, MD
Includes: CME
Topics: palliative care
Topics: influenza, alberta, pandemic, school closure
Topics: implantable defibrillators
Topics: end-of-life care, cancer, advanced
Topics: diabetes mellitus, type 2, clinical practice guideline, antidiabetics
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