Cover photograph by Darren B. Taichman, MD, PhD
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Disease management becomes difficult when patients do not adhere to prescribed medications. This study examined the incidence of medication nonadherence in primary care and the factors associated with it. The authors found that primary nonadherence, meaning that the patient never fills the prescription, is common and associated with high drug costs.
With the widespread use of central venous catheters, the incidence of upper extremity deep venous thrombosis is increasing. This diagnostic management study evaluated the safety and feasibility of a new algorithm that included an assessment of clinical probability; d-dimer testing; and, when indicated, ultrasonography in patients with clinically suspected upper extremity deep venous thrombosis. The authors concluded that this noninvasive approach can safely and effectively exclude this disorder.
This cross-sectional study explores whether HIV infection or treatment increases a person's risk for coronary artery disease and other chronic illnesses. The authors used cardiac computed tomography on HIV-infected and uninfected men and discovered that infected men had a greater prevalence and extent of coronary artery plaque than uninfected men. Their findings support the hypothesis that HIV infection or treatment may increase the risk for coronary artery disease.
This systematic review summarizes evidence about the benefits and harms of lower-intensity statin combination therapy compared with higher-intensity statin monotherapy in adults at high risk for atherosclerotic cardiovascular disease. Low-intensity statins plus bile acid sequestrant therapy decreased low-density lipoprotein cholesterol levels more than mid-intensity monotherapy, and mid-intensity statin plus ezetimibe therapy decreased such levels more than high-intensity monotherapy. Evidence on other combination therapies, long-term clinical outcomes, adherence, and harms for all regimens was scant and insufficient.
Although ClinicalTrials.gov has the potential to be a great asset for clinicians, patients, and researchers, the validity of the posted results is questionable because of frequent discrepancies between the database and corresponding peer-reviewed journal publications. In this report, the authors assessed the consistency of results reported in the database compared with those in publications. Which source contains the more accurate results is unclear, but the authors' findings suggest that ClinicalTrials.gov may provide more comprehen-sive descriptions of adverse events.
There is scant evidence about the benefits and harms of surveillance and management options for women with ductal carcinoma in situ. This article describes the development of a prioritized research agenda that addresses major evidence gaps rank-ordered by a diverse stakeholder group. The prioritized gaps included incorporating patient-centered outcomes into future research, developing better methods to predict risk for invasive cancer, evaluating a strategy of active surveillance, and testing decision-making tools.
This article describes the development of a prioritized agenda for research about the benefits and harms of antipsychotic medication use for adolescents and young adults with bipolar disorder. Stakeholders prioritized 10 of 23 identified evidence gaps as high-priority. The 10 prioritized evidence gaps related to 3 areas: the comparative effectiveness of intervention strategies, the effect of antipsychotics on patient-centered outcomes, and the influence of various patient characteristics on the effectiveness of antipsychotics.
Of millions of persons chronically infected since the HIV epidemic began, only 1 is alive and free of the virus. HIV infection has reemerged in 2 more persons previously believed to be cured. This commentary discusses why a cure remains elusive but concludes that there is room for optimism.
This commentary discusses issues surrounding direct-to-consumer genetic testing. It urges physicians to insist on data-driven testing and seek a health care infrastructure for the delivery of effective genome-based patient care as the number of valid uses for genomic data increases.
The 2014 guideline for the management of high blood pressure in adults from the panel appointed to the Eighth Joint National Committee includes a recommendation to increase the target systolic blood pressure from 140 to 150 mm Hg in persons aged 60 years or older without diabetes mellitus or chronic kidney disease. However, a minority of the panel disagreed with this recommendation. In this article, these panel members discuss why they believe that the target should remain less than 140 mm Hg for persons aged 60 years or older.
In this issue, Post and colleagues explore whether HIV infection or its treatment increases a person's risk for coronary artery disease and other chronic illnesses. The editorialists discuss the strengths of the study and the prevalence of noncalcified plaque in those infected with HIV. To ensure the best long-term outcomes for this vulnerable population, the authors call for continued diligence in ongoing treatment efforts.
This issue includes a report of the Patient-Centered Outcomes Research Institute's effort to identify research priorities related to ductal carcinoma in situ. The editorialists comment on the identified priorities and look forward to evidence that will help manage risk in women diagnosed with ductal carcinoma in situ rather than treating them all as if they have cancer.