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Jessie L. Juusola, MS; Margaret L. Brandeau, PhD; Douglas K. Owens, MD, MS; and Eran Bendavid, MD, MS

Preexposure chemoprophylaxis (PrEP) with antiretroviral drugs significantly reduces the risk for HIV infection in HIV-negative men who have sex with men (MSM), but its cost-effectiveness is uncertain. In a dynamic model of HIV transmission and progression, a strategy that targeted PrEP to the 20% of MSM considered to be at highest risk for HIV prevented twice as many infections over the long term, and at better economic value, than one that provided PrEP to 20% of all HIV-negative MSM. Targeted PreP could have a substantial impact on the U.S. HIV epidemic at an acceptable cost.

Topics: hiv, antimicrobial chemoprophylaxis, chemoprevention, hiv infection, cost-effectiveness analysis, hiv prevention, hiv transmission, ...
Steven P. Cohen, MD; Ronald L. White, MD; Connie Kurihara, RN; Thomas M. Larkin, MD; Audrey Chang, PhD; Scott R. Griffith, MD; Christopher Gilligan, MD; Ralph Larkin, PhD; Benny Morlando, RN; Paul F. Pasquina, MD; Tony L. Yaksh, PhD; and Conner Nguyen, MD

This randomized trial involving 84 adults with lumbosacral radiculopathy of less than 6 months' duration compared 2 epidural injections, separated by 2 weeks, of steroids, etanercept, or saline, mixed with bupivacaine. Leg pain, measured 1 month after the second injection, was reduced more with steroids than with etanercept or saline, but the differences were not significant. Differences in back pain and function associated with steroids versus saline also were also not significant. Larger, longer trials are needed to establish the benefits of epidural steroids for this condition.

Topics: sciatica, steroids, epidural steroid injection, saline solution, etanercept, pain
Ying Y. Zhao, MD; Matthew A. Weir, MD; Michael Manno, MSc; Peter Cordy, MD; Tara Gomes, MHSc; Daniel G. Hackam, MD, PhD; David N. Juurlink, MD, PhD; Muhammad Mamdani, PharmD, MPH; Louise Moist, MD, MSc; Chirag R. Parikh, MD, PhD; J. Michael Paterson, MSc; Ron Wald, MD, MPH; Zhan Yao, MSc; and Amit X. Garg, MD, PhD

Fibrates have been shown to increase serum creatinine levels in randomized trials. In a population-based cohort of community-dwelling older adults, new fibrate (primarily fenofibrate) prescriptions were associated with increases in serum creatinine levels and a small absolute increase in the use of health services (hospitalizations and consultations with nephrologists). The mechanisms by which fibrates increase creatinine levels and result in the need for hospitalization and nephrology consultation are not clearly understood.

Topics: fibric acid derivatives, kidney, elderly, serum creatinine level, ezetimibe
Howard A. Fink, MD, MPH; Areef Ishani, MD, MS; Brent C. Taylor, PhD, MPH; Nancy L. Greer, PhD; Roderick MacDonald, MS; Dominic Rossini, MD; Sameea Sadiq, MD; Srilakshmi Lankireddy, MD; Robert L. Kane, MD; and Timothy J. Wilt, MD, MPH

Screening and monitoring for chronic kidney disease (CKD) could lead to earlier interventions that improve clinical outcomes. This review summarizes evidence on the benefits and harms of screening for, monitoring, and treating CKD stages 1 to 3 in adults. The evidence shows that the role of CKD screening or monitoring in improving outcomes is uncertain. Evidence for CKD treatment benefit is strongest for angiotensin-converting enzyme inhibitors and angiotensin II–receptor blockers and in patients with albuminuria and underlying diabetes or cardiovascular disease.

Topics: kidney failure, chronic, preventive medicine, angiotensin-converting enzyme inhibitors, clinical practice guideline, kidney, ...
Issa J. Dahabreh, MD, MS; Mei Chung, PhD, MPH; Ethan M. Balk, MD, MPH; Winifred W. Yu, PhD, MS; Paul Mathew, MD; Joseph Lau, MD; and Stanley Ip, MD
Includes: CME

Conducted to support the National Institutes of Health's State-of-the-Science Conference, this systematic review summarizes evidence on the role of active surveillance in the management of early-stage, low-risk prostate cancer. Reviewers found insufficient evidence to assess whether active surveillance is an appropriate option for men with localized prostate cancer. Protocols were not standardized across centers, and studies lacked clear definitions of observational management strategies. A standard definition of active surveillance that clearly distinguishes it from watchful waiting is needed to clarify scientific discourse.

Topics: watchful waiting, prostate cancer, prostate cancer stage i, comparative effectiveness research, prostate-specific ...
Patricia A. Ganz, MD; John M. Barry, MD; Wylie Burke, MD, PhD; Nananda F. Col, MD, MPP, MPH; Phaedra S. Corso, PhD, MPA; Everett Dodson; M. Elizabeth Hammond, MD; Barry A. Kogan, MD; Charles F. Lynch, MD, PhD, MS; Lee Newcomer, MD, MHA; Eric J. Seifter, MD; Janet A. Tooze, PhD, MPH; Kasisomayajula Viswanath, PhD; and Hunter Wessells, MD

The National Cancer Institute, Centers for Disease Control and Prevention, and the Office of Medical Applications of Research of the National Institutes of Health convened a State-of-the-Science Conference on 5–7 December 2011 to assess the available scientific evidence about active surveillance for men with localized prostate cancer. This article provides the panel's assessment.

Topics: watchful waiting, prostate cancer, prostate cancer stage i, united states national institutes ...

Scientific advances have dramatically increased the value of stored human biological samples, generating debate about the appropriate consent process for these samples for research not specified at the time of sample collection. The recent Advance Notice of Proposed Rulemaking raises the possibility of incorporating one-time general consent into U.S. federal regulations governing research with human biological samples. Some have proposed that a gift model may be more appropriate. This commentary compares how well each model addresses 5 central challenges faced by investigators and concludes that one-time general consent is preferred.

Topics: specimen collection, informed consent, institutional review board

In this issue, Fink and colleagues summarize the evidence on screening for CKD and monitoring and treatment of persons who are found to have CKD. The editiorialists discuss this review and conclude that we need more research to develop outcome measures that will comprehensively capture the effect of CKD treatments on the outcomes encountered in this complex patient population.

Topics: kidney failure, chronic
Richard B. Weinberg, MD
Includes: Audio/Video

Jewish tradition dictates that the body of the deceased is never left alone from the moment of death until it is laid to rest in the earth. The Shomerim—watchmen—stand a constant vigil through the night, praying and reading psalms to comfort and honor its soul. But these customs are not usually practiced in the Reform Jewish tradition in which I was brought up. Yet, I had unknowingly stood as a Shomer once before.

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Guglielmo Ronco, MD; Chris J.L. Meijer, MD; Jack Cuzick, PhD; Paolo Giorgi-Rossi, PhD; Julian Peto, TSc; Nereo Segnan, MD; and Joakim Dillner, MD
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Evelyn P. Whitlock, MD, MPH; Kimberly K. Vesco, MD, MPH; Jennifer S. Lin, MD, MCR; Michelle Eder, PhD; and Brittany U. Burda, MPH
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Marcel G.M. Olde Rikkert, MD, PhD; Henk J. Schers, MD, PhD; and Rene J.F. Melis, MD, PhD
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Joseph M. Cerimele, MD; and Lauren A. Peccoralo, MD, MPH
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Richard W. Grant, MD, MPH; Clemens S. Hong, MD, MPH; and Steven J. Atlas, MD, MPH
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Topics: prostate-specific antigen, mortality, prostate cancer
Topics: watchful waiting, quality of life, radical prostatectomy, prostate cancer stage i
Topics: mortality, prostate cancer, antiandrogen therapy
Topics: mortality, prostate cancer, antiandrogen therapy
Topics: enoxaparin, mortality
Topics: statins, cardiovascular diseases, cardiovascular disease risk factors, morbidity, mortality
Topics: dyslipidemias, simvastatin, cardiovascular diseases, treatment outcome, niacin
Topics: vancomycin, clostridium difficile infection, clostridium difficile (bacteria), lipiarmycin
Topics: mutation, cystic fibrosis, pulmonary function, ivacaftor
Topics: hypertension, hyponatremia, hospitalization, thiazide
Topics: pulmonary embolism, troponin t
Topics: anticoagulants, atrial fibrillation, hemorrhage
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