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Survivors of childhood cancer are at increased risk for subsequent gastrointestinal (GI) cancer, but specific factors related to this increased risk have not been defined. In this large cohort, GI cancer developed in survivors of childhood cancer as soon as 5.5 years after the initial cancer diagnosis. The highest risks were seen in survivors of childhood Hodgkin lymphoma or Wilms tumor and those whose initial cancer treatment included abdominal radiation, procarbazine, or platinum chemotherapies. Screening for GI cancer earlier than is currently recommended may be warranted in childhood cancer survivors.
Computer models to predict the risk for short-term mortality among patients presenting to the emergency department (ED) with acute heart failure have been developed using factors derived among patients who were hospitalized. A model applicable to patients before the decision to hospitalize or discharge could help guide such decisions. This study developed a model that predicted the 7-day mortality of patients presenting to an ED with an acute episode of heart failure regardless of whether they were discharged or hospitalized.
The Medicare Part D coverage gap places financial burden on patients and could influence decision making regarding prescriptions. In this study using Medicare Part D administrative data, beneficiaries receiving prescriptions for antihypertensive or antidyslipidemia drugs who had no or generic-only gap coverage were less likely to fill these prescriptions, had more continuous prescription gaps, and were less likely to have prescription refills consistent with appropriate medication schedules than those without a coverage gap. Prescription filling varied less by type of plan for drugs used to treat symptomatic conditions. Unfavorable prescription-filling patterns for some drugs may be associated with coverage gaps.
Multiple methods are used to estimate glomerular filtration rate (GFR) from serum creatinine levels. Among cross-sectional studies that compared 2 or more creatinine-based GFR estimating equations with a reference measurement, those from North America, Europe, and Australia showed that the Chronic Kidney Disease Epidemiology Collaboration equation performed better at higher GFRs and the Modification of Diet in Renal Disease Study equation performed better at lower GFRs. Neither equation performed as well in Asian or African populations. This review documents variation in performance of GFR estimating equations across populations and kidney function.
The U.S. Preventive Services Task Force commissioned this systematic review to inform the upcoming update of its recommendation on intimate partner violence (IPV). The review focused on the effectiveness of screening and interventions for women in health care settings in reducing IPV and related health problems, the diagnostic accuracy of screening instruments, and adverse effects of screening and interventions. It found that screening instruments designed for health care settings can accurately identify women experiencing IPV, screening women for IPV can provide benefits that vary by population, and potential adverse effects have minimal impact on most women.
Whether experts with financial conflicts of interest (COIs) should have a role in clinical guideline development is debated. The authors examined COI identification, management, and effect on voting among 34 experts participating in the development of a clinical practice guideline on upper GI bleeding. More than 60% of the experts reported at least 1 COI. Those with conflicts recused themselves from discussions for 6 of the 8 recommendations relevant to COIs, leaving a majority of nonconflicted discussants for the 6 recommendations. Recusals did not affect voting outcomes, but qualitative assessment suggested that recusals diluted discussions. This report underscores challenges to COI management during guideline development.
The International Association of Physicians in AIDS Care convened a panel to develop evidence-based recommendations to optimize entry into and retention in care and antiretroviral therapy (ART) adherence for people with HIV infection. This article discusses the panel's recommendations, which cover entry into and retention in HIV medical care; monitoring ART adherence; ART strategies; adherence tools for patients; education and counseling interventions; health system and service delivery interventions; and issues pertaining to pregnant women, incarcerated individuals, homeless and marginally housed individuals, children and adolescents, as well as substance use and mental health disorders.
In this issue, Li and colleagues examined the association of the Medicare Part D coverage gap on prescription adherence. The editorialist discusses the study's findings, proposes a multifactorial approach to help patients identify and adopt low-cost alternatives to maintain adherence, and argues that government agencies must also be part of the solution to the effects of the Medicare Part D “doughnut hole.”
“It must be hard being on the other side,” a surgical resident said. I was learning that this wasn't a question, but more of a shamanistic incantation by fellow doctors eager to ward themselves against my fate. I had no cardiac risk factors, exercised regularly, and flossed enough. Yet, here I was, wilting before puzzled faces straining to fit my illness into an unaccommodating cautionary tale.