Cover photograph by Gautam Pandey, MD
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Long-term exposure to high levels of inorganic arsenic in water and food is associated with increased risk for cardiovascular disease, but risk from lower levels of exposure has been unclear. This prospective cohort study found that long-term exposure to low to moderate levels of arsenic, as measured by testing urine levels, was associated with increased risk for fatal and nonfatal cardiovascular events.
The use of vascular closure devices to prevent arterial bleeding in patients after transfemoral percutaneous coronary intervention is controversial. This study of patients who had percutaneous coronary intervention found that those with vascular closure devices had fewer hematomas and pseudoaneurysms but more retroperitoneal bleeding events. Patients with lean or moderate body mass indexes and those receiving glycoprotein IIb/IIIa inhibitors did not benefit from the devices. These findings should guide the appropriate use of vascular closure devices.
Guidelines recommend considering health status and life expectancy when making cancer screening decisions in elderly persons, but accurate estimation of an individual patient's life expectancy is challenging. This study aimed to estimate life expectancy of Medicare beneficiaries with and without comorbid conditions. Compared with U.S. population-based estimates, life expectancies at age 75 years were about 3 years longer for persons with no comorbidity and 3 years shorter for those with high comorbidity. Comorbidity-adjusted life expectancy could help physicians tailor cancer screening recommendations.
Patient portals tied to electronic health record systems give patients secure access to health information and methods for communication and information sharing. This systematic review found mixed evidence of their effect on patient outcomes and satisfaction, although they may be more effective when used with case management. Their effect on utilization and efficiency is unclear, although patient race and ethnicity, education level or literacy, and degree of comorbid conditions may influence use. Patient portals represent a new technology with benefits that are still unclear.
This systematic review examined the association between statin therapy and cognitive function. Low-quality evidence suggests no increased incidence of Alzheimer disease and no difference in cognitive performance in procedural memory, attention, or motor speed, and moderate-quality evidence suggests no increased incidence of dementia or mild cognitive impairment nor any change in cognitive performance related to global cognitive performance scores, executive function, declarative memory, processing speed, or visuoperception. Larger and better-designed studies are needed to definitively determine the effect of statins on cognition.
The U.S. Preventive Services Task Force updated its recommendation on medications to reduce breast cancer risk. The Task Force recommends that clinicians engage in shared, informed decision making with women who are at increased risk for breast cancer and recommends against the routine use of medications for women who are not at increased risk.
This commentary discusses the shortage of primary care physicians, framed by encounters where mentors have asserted that students are “too smart” for primary care. The authors discuss how this assertion discourages medical students from seeking careers in primary care.
This commentary discusses the shortage of primary care physicians and its implications. The author asks whether specialists shun primary care because it is too difficult— perhaps some physicians are too lazy for primary care?
In this issue, Moon and colleagues report results from the Strong Heart Study, documenting an association between urinary arsenic levels and cardiovascular disease. The editorialists discuss the study and ask questions about the effect of this common exposure not only from water but from foods, such as grains, and about populations in which arsenic exposure presents the highest risks.
I chose to volunteer in a primary care clinic serving a residential men's substance abuse treatment center. As I turned a corner near the building, I caught a glimpse of the houses lining the street. My anxiety was finally hitting me, along with a fear that as a new medical student, I wouldn't be much help to these patients.
The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.