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Interventions to increase adherence to recommendations for colorectal cancer screening are needed. This randomized trial found that, compared with usual care, patients completed recommended screening more often when electronic health record–linked reminders and fecal occult blood testing kits were sent to them. Follow-up telephone calls by medical assistants and, if required, nursing assistance led to additional but smaller improvements in adherence. Whether these effects would persist beyond 2 years is not known, but the rapid growth of electronic health records may present opportunities to improve adherence to cancer screening.
The effectiveness of screening for colorectal cancer with colonoscopy in average-risk adults has not been defined in randomized trials. However, this observational study found that colonoscopy was associated with an approximately 70% reduction in the risk for late-stage colorectal cancer. Screening sigmoidoscopy was also associated with a reduced risk for incident late-stage disease overall. Of note, a decrease in left-sided but not right-sided cancer contributed to the overall decrease observed with sigmoidoscopy. These findings provide estimates that will be useful in comparing the cost-effectiveness of colorectal cancer screening strategies.
First-line treatment for gonorrhea is ceftriaxone plus either azithromycin or doxycycline. In this study, antimicrobial susceptibility testing was done on more than 34 000 urethral isolates from U.S. men with symptomatic gonococcal urethritis. Isolates of Neisseria gonorrhoeae from men who have sex with men were significantly more likely than isolates from men who have sex exclusively with women to exhibit elevated cephalosporin minimal inhibitory concentrations and antimicrobial resistance. This testing is not usually done in routine practice, but clinicians should actively follow men who have sex with men after first-line treatment for gonorrhea for possible treatment failure.
This article uses the graphic novel format to tell the story of a missed diagnosis that haunts a physician throughout his professional life.
Hepatitis C virus (HCV) is a leading cause of hepatocellular carcinoma (HCC). This systematic review summarized moderate-quality evidence from 30 observational studies examining the risk for HCC among HCV-infected persons who have been treated and either achieved a sustained virologic response or did not respond to therapy. It found that attaining treatment-related sustained virologic response among HCV-infected persons is associated with a reduction in the relative risk for HCC.
Atrial fibrillation (AF) has been linked with an increased risk for cognitive impairment and dementia, but whether this risk was due to stroke has been uncertain. This systematic review of 21 studies found that AF was significantly associated with a higher risk for cognitive impairment independent of stroke history in patients with first-ever or recurrent stroke, as well as in a broader population of patients with or without a history of stroke. Further studies are required to elucidate the association between AF and subtypes of dementia as well as the mechanism of AF-associated cognitive impairment.
The outcome of the presidential election has put immigration reform back on the national agenda. Once the coverage expansions of the Patient Protection and Affordable Care Act take effect in the states that implement the law's Medicaid provisions, undocumented migrants will be the only large group without coverage. This commentary shares some policy options based on experiences from European countries where provisions to provide access to care for undocumented migrants are in place.
The Editors discuss 2 atypical aspects of this issue: an accompanying supplement issue on patient safety and Annals' first article in graphic novel format.
Accompanying this issue is a supplement, “Making Health Care Safer: A Critical Review of Evidence Supporting Strategies to Improve Patient Safety,” that includes evidence reviews underpinning patient safety strategies studied in a new report commissioned by the Agency for Healthcare Research and Quality. The editorialists, who led the project, discuss the background for the project and hope that the supplement will contribute to efforts in identifying strategies that help keep patients safe.
In the supplement on patient safety that accompanies this issue, an expert panel has rated the strength of evidence for each safety strategy and recommended 10 patient safety strategies that should be “strongly encouraged” for adoption and 12 strategies that should be “encouraged” for adoption. The editorialist discusses the supplement and the implications and questions it raises and concludes that the articles provide important opportunities for the future.
The town road opened up to long rows of ginkgo trees—the oldest tree on earth, I marveled, and still ubiquitous—the lustrous lemony leaves fluttering in the wind, vying with the sun for the final glory of an Indian summer.