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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.

Topics: primary health care, prescribing behavior, medication nonadherence, copayment, chronic disease, physician demographics ...
Ankie Kleinjan, MD, PhD; Marcello Di Nisio, MD, PhD; Jan Beyer-Westendorf, MD; Giuseppe Camporese, MD; Benilde Cosmi, MD, PhD; Angelo Ghirarduzzi, MD; Pieter W. Kamphuisen, MD, PhD; Hans-Martin Otten, MD, PhD; Ettore Porreca, MD; Anita Aggarwal, MD, PhD; Marianne Brodmann, MD; Maria Domenica Guglielmi, MD; Matteo Iotti, MD; Karin Kaasjager, MD; Virginia Kamvissi, MD; Teresa Lerede, MD; Peter Marschang, MD; Karina Meijer, MD, PhD; Gualtiero Palareti, MD; Frederick R. Rickles, MD; Marc Righini, MD, PhD; Anne W.S. Rutjes, MD, PhD; Chiara Tonello, MD; Peter Verhamme, MD, PhD; Sebastian Werth, MD; Sanne van Wissen, MD, PhD; and Harry R. Büller, MD, PhD

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.

Topics: deep vein thrombosis, ultrasonography, arm, superficial thrombophlebitis, fibrin d-dimer assay
Wendy S. Post, MD, MS; Matthew Budoff, MD; Lawrence Kingsley, PhD; Frank J. Palella Jr., MD; Mallory D. Witt, MD; Xiuhong Li, MS; Richard T. George, MD; Todd T. Brown, MD, PhD; and Lisa P. Jacobson, ScD

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.

Topics: atherosclerosis, hiv, acquired immunodeficiency syndrome, coronary arteriosclerosis, hiv infection, coronary heart disease ...
Kimberly A. Gudzune, MD, MPH; Anne K. Monroe, MD, MSPH; Ritu Sharma, BSc; Padmini D. Ranasinghe, MD, MPH; Yohalakshmi Chelladurai, MBBS, MPH; and Karen A. Robinson, PhD

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.

Topics: statins, antilipemic agents, combined modality therapy, lipid-lowering therapy, ldl cholesterol lipoproteins, lipids ...
Daniel M. Hartung, PharmD, MPH; Deborah A. Zarin, MD; Jeanne-Marie Guise, MD, MPH; Marian McDonagh, PharmD; Robin Paynter, MLS; and Mark Helfand, MD, MS, MPH

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.

Topics: clinical trials, peer review, publications, clinical trials, controlled, measures of outcome
Jennifer M. Gierisch, PhD, MPH; Evan R. Myers, MD, MPH; Kristine M. Schmit, MD, MPH; Matthew J. Crowley, MD; Douglas C. McCrory, MD, MHS; Ranee Chatterjee, MD, MPH; Remy R. Coeytaux, MD, PhD; Amy Kendrick, RN, MSN; and Gillian D. Sanders, PhD

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.

Topics: ductal carcinoma in situ, clinical research, medical management
Matthew J. Crowley, MD; Douglas C. McCrory, MD, MHS; Ranee Chatterjee, MD, MPH; Jennifer M. Gierisch, PhD; Evan R. Myers, MD, MPH; Kristine M. Schmit, MD, MPH; Remy R. Coeytaux, MD, PhD; Christoph U. Correll, MD; Amy S. Kendrick, RN, MSN; and Gillian D. Sanders, PhD

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.

Topics: bipolar disorder, antipsychotic agents, clinical research

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.

Topics: hiv, acquired immunodeficiency syndrome, hiv infection

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.

Topics: genome, genetic screening, direct-to-consumer advertising
Jackson T. Wright Jr., MD, PhD; Lawrence J. Fine, MD, DrPH; Daniel T. Lackland, DrPH; Gbenga Ogedegbe, MD, MPH, MS; and Cheryl R. Dennison Himmelfarb, PhD, RN, ANP

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.

Topics: hypertension, systolic blood pressure, hypertension guidelines

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.

Topics: atherosclerosis, hiv, acquired immunodeficiency syndrome, coronary arteriosclerosis, hiv infection, coronary heart disease ...

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.

Topics: ductal carcinoma in situ, clinical research, medical management
Jean-Philippe Chaput, PhD; and Arya M. Sharma, MD, PhD
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Dorit Samocha-Bonet, PhD; Antony D. Karelis, PhD; and Rémi Rabasa-Lhoret, MD, PhD
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Nathalie Esser, MD; André J. Scheen, MD, PhD; and Nicolas Paquot, MD, PhD
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Juhee Cho, PhD; Yoosoo Chang, MD; and Seungho Ryu, MD, PhD
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Caroline K. Kramer, MD, PhD; Bernard Zinman, CM, MD; and Ravi Retnakaran, MD
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Jo Persoon-Gundy, MD
Includes: Audio/Video
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Gary Pasternak, MD
Includes: Audio/Video
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Daniel M. Harrison, MD
Includes: CME
Topics: magnetic resonance imaging, multiple sclerosis, disability, multiple sclerosis, relapsing-remitting, interferons
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