Cover photograph by Binh Le Tran-Lei, MD
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Young women with breast cancer are increasingly undergoing contralateral prophylactic mastectomy. In this survey of women aged 40 years or younger with unilateral breast cancer who had undergone bilateral mastectomy, common reasons for choosing contralateral prophylactic mastectomy were desires to avoid contralateral breast cancer and to improve survival. Women often overestimated the risk for contralateral breast cancer, but few believed that bilateral mastectomy improved survival.
A previous randomized trial showed that tolvaptan reduced kidney volume growth and loss of kidney function over 3 years in persons with autosomal dominant polycystic kidney disease. This modeling study simulated outcomes and cost-effectiveness if tolvaptan's benefits persisted indefinitely. The researchers estimated that tolvaptan would slow progression to end-stage renal disease and reduce mortality rates, but its cost-effectiveness would not compare favorably with other common medical interventions.
Varenicline increases quit rates in smokers, but its efficacy and safety in patients with psychiatric disorders are unclear. This trial randomly assigned smokers with stable treated current or past major depression and no recent cardiovascular disease to varenicline or placebo for 12 weeks. More varenicline recipients stopped smoking. It may be suitable for smoking cessation in some smokers with stable depression without exacerbating depression or anxiety.
Little is known about noninfectious complications resulting from urethral catheter use. This systematic review and meta-analysis examined studies describing such complications and pooled data to estimate their frequency. It found that noninfectious complications are common. The most frequent complications are minor (such as urine leakage), but serious complications (such as urethral strictures and gross hematuria) occur in a substantial proportion of catheter recipients.
Early-stage lung cancer is associated with lower mortality than late-stage disease; thus, early detection and treatment may be beneficial. This systematic review updates evidence on the effectiveness and harms of low-dose computed tomography screening for lung cancer for the U.S. Preventive Services Task Force. It found that screening high-risk smokers who had at least a 30–pack-year history with low-dose computed tomography reduced lung cancer–related and all-cause mortality.
In the U.S. debate about gun control, concern has centered on the safety of people, particularly children, who live in homes with guns. However, gun safety is also an issue in homes in which elderly people reside. This commentary presents an argument for why physicians should routinely ask older patients about their access to guns and address safety concerns when they exist.
Mental illness has figured prominently in the public dialogue about gun violence. This commentary expresses concern regarding the conflation of mental illness and gun violence—not only in the popular press but also in the academic literature. The authors believe that rhetoric too often portrays people with mental disorders as a greater part of the problem of gun violence than they actually are.
Diagnosis of acute HIV-1 infection is infrequently considered and rarely made, but an estimated 50 000 persons in the United States are newly infected each year. This commentary discusses the diagnosis and treatment of this disease. The authors believe that making the diagnosis, counseling patients about their diagnosis, and considering therapy to prevent virus transmission should serve as a “call to action” in managing patients with acute HIV-1.
In this issue, Rosenberg and colleagues evaluated preferences, knowledge, decision making, and experiences of young women with breast cancer who chose contralateral prophylactic mastectomy and found that these women markedly overestimate their risk for contralateral breast cancer. The editorialists discuss the study and its findings and conclude that the discordance between patient perceptions and realistic expectations provides a teachable opportunity for physicians treating patients newly diagnosed with breast cancer.
In this issue, Erickson and colleagues add to the discussion of health care value by studying the cost-effectiveness of tolvaptan, a new medication for persons with autosomal dominant polycystic kidney disease. The editorialists discuss the study and its findings but conclude that regardless of tolvaptan's cost-effectiveness, questions about appropriate use remain.
In a psychiatry department specializing in affective disorders, lectures and seminars on depression are nothing unusual. Over the years we had learned what to expect: stories of fragile recovery, reflected by the patient's ability to participate in such an event, and the inherent risk for symptom relapse.
Influenza rocked our community hospital for weeks this winter just as the first snowstorms came. On reflection, the experience left me feeling less like a doctor and more like a hapless worker bee in a buzzing but somehow misguided hive, fraught with unnecessary and avoidable endeavors.
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