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Cardiac assessment every 1 to 5 years for childhood cancer survivors is recommended to detect asymptomatic left ventricular dysfunction. The authors estimated the clinical benefits and cost-effectiveness of these assessments with subsequent treatment with angiotensin-converting inhibitors and β-blockers for patients with positive test results to reduce the incidence of symptomatic congestive heart failure. They concluded that less frequent assessment than currently recommended may be more cost-effective.

Topics: beta-blocker, echocardiography, ventricular dysfunction, left, congestive heart failure, childhood cancer, cancer survivorship, ...
F. Lennie Wong, PhD; Smita Bhatia, MD, MPH; Wendy Landier, PhD, RN; Liton Francisco, BS; Wendy Leisenring, ScD; Melissa M. Hudson, MD; Gregory T. Armstrong, MD; Ann Mertens, PhD; Marilyn Stovall, PhD; Leslie L. Robison, PhD; Gary H. Lyman, MD, MPH; Steven E. Lipshultz, MD; and Saro H. Armenian, DO, MPH

Childhood cancer survivors treated with anthracyclines are at high risk for asymptomatic left ventricular dysfunction, subsequent symptomatic heart failure, and death. The authors developed a cost-effectiveness model to evaluate the cost-effectiveness of the Children's Oncology Group Long-Term Follow-up Guidelines, which recommend lifetime echocardiographic screening every 1 to 5 years in this population. They conclude that less-frequent screening is more cost-effective than current guidelines and maintains 80% of the health benefits.

Topics: angiotensin-converting enzyme inhibitors, anthracycline antibiotics, beta-blocker, echocardiography, ventricular dysfunction, left, heart failure, ...

Large-scale vaccination did not occur until 9 months into the 2009 influenza A (H1N1) pandemic. Researchers developed a model to estimate the reduction in morbidity, mortality, and health care costs that could be achieved during a pandemic by more rapid vaccination and more aggressive nonpharmaceutical strategies, such as school closings and hand washing, to mitigate infection. The results suggest that more rapid vaccination (by 4 to 6 months) would yield substantial reductions in infections, deaths, and health care costs. Nonpharmaceutical strategies that reduced contacts by 8% yielded similar results to delivering vaccine by 4 months.

Topics: influenza, communicable disease control, immunization programs, influenza virus vaccine, vaccination, influenzavirus a, ...
Jillian T. Henderson, PhD, MPH; Evelyn P. Whitlock, MD, MPH; Elizabeth O’Connor, PhD; Caitlyn A. Senger, MPH; Jamie H. Thompson, MPH; and Maya G. Rowland, MPH
Includes: CME

Preeclampsia is a leading cause of maternal and perinatal death. This systematic review, conducted to support the U.S. Preventive Services Task Force, assessed the benefits and harms of low-dose aspirin for preventing morbidity and mortality from preeclampsia. Its findings suggest that daily low-dose aspirin can prevent clinically important health outcomes, although potential rare or long-term harms could not be ruled out.

Topics: aspirin, pre-eclampsia, maternal mortality, morbidity, perinatal death
Silvio Danese, MD, PhD; Gionata Fiorino, MD, PhD; Laurent Peyrin-Biroulet, MD, PhD; Ersilia Lucenteforte, ScD, PhD; Gianni Virgili, MD; Lorenzo Moja, MD, MSc, DrPH; and Stefanos Bonovas, MD, MSc, PhD

Biological agents, including adalimumab, golimumab, infliximab, and vedolizumab, are emerging treatment options for ulcerative colitis. This systematic review found that all biological agents were superior to placebo for induction therapy and had greater efficacy than placebo for maintenance therapy for moderately to severely active ulcerative colitis. Indirect comparisons suggested that infliximab is more likely to induce a favorable clinical outcome than adalimumab. Biological agents are more effective than placebo, but head-to-head trials are needed to determine the best treatment option.

Topics: ulcerative colitis, biological products, adalimumab, infliximab

This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of hematology and oncology.

Topics: medical oncology, hematology

This recommendation from the U.S. Preventive Services Task Force found insufficient evidence to assess the balance of benefits and harms of screening for suicide risk in adolescents, adults, and older adults in a primary care setting.

Topics: primary health care, suicide, suicidal behavior, suicide risk assessment, elderly
Christine A. Sinsky, MD; John W. Beasley, MD; Greg E. Simmons, MA; and Richard J. Baron, MD

Use of electronic health records (EHRs) has grown over the past decade. The authors of this commentary believe that EHRs are inconsistently aligned with the needs of primary care patients and physicians. They propose a set of design, implementation, and policy principles for EHRs that support higher-value primary care.

Topics: primary health care, electronic medical records

Hospitals have remained consistent in their share of health care expenditures despite dramatic changes in the payment and financing of care, including the passage of the Patient Protection and Affordable Care Act. This commentary discusses how they have done this and what it portends for health care reform.

Topics: economics, hospital, health care reform, hospital costs, reimbursement mechanisms, Billing and payment, ...

In this issue, 2 articles examine the cost-effectiveness of routine screening to detect asymptomatic left ventricular dysfunction and reduce risks for congestive heart failure in childhood cancer survivors. The editorialists discuss the findings and stress that clinicians and patients should weigh the benefits and risks when determining the screening method and frequency.

Topics: anthracycline antibiotics, beta-blocker, echocardiography, ventricular dysfunction, left, cost effectiveness, childhood cancer, cancer ...

In this issue, Danese and colleagues review the efficacy and safety of biological treatment options for ulcerative colitis. The editorialists discuss the review's findings and believe that, although the data are helpful in making clinical decisions, biological agents need to be compared directly.

Topics: ulcerative colitis, biological products
Janani Rangaswami, MD
Includes: Audio/Video

I walked into the hospital on Monday morning not knowing what to expect in the aftermath of a long weekend. Among those admitted for asthma, stroke, and pneumonia, one patient's description caught my eye.

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Laxmaiah Manchikanti, MD; Frank J.E. Falco, MD; and Joshua A. Hirsch, MD
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Teryl J. Nuckols, MD, MSHS; and Roger Chou, MD
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Richard Blakely, MD
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Edward Volpintesta, MD
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James H. King, MD
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Koichi Tsunoda, MD, PhD; Yohko Morita, MD, PhD; Takao Yabe, MD, PhD; Atsunobu Tsunoda, MD, PhD; and Maiko Saito, MD
Includes: Audio/Video
Topics: hyoid bone, tongue, muscle of tongue, myoclonus, palatal, involuntary vocalization, rhythm
Jo Persoon-Gundy, MD
Includes: Audio/Video
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Topics: hospital mortality, noninvasive ventilation, prehospital emergency care, respiratory distress, noninvasive positive-pressure ventilation ...
Topics: antibiotics, ventilator-associated pneumonia, duration of treatment
Topics: myocardial infarction, minerals, cardiovascular event, multivitamins, tact trial
Topics: anti-arrhythmia agents, atrial fibrillation, atrial tachycardia, paroxysmal atrial fibrillation, ablation, raaft study ...
Topics: abdominal aortic aneurysm, ultrasonography
Topics: mammography, breast cancer, breast neoplasm screening, physical breast examination, cnbss trial
Topics: myocardial infarction, statins, cardiovascular diseases, cerebrovascular accident, ischemic stroke, elderly
Topics: acute coronary syndromes, st segment elevation, renal failure, acute, rosuvastatin, non-st-segment acute ...
Topics: statins, alzheimer's disease, dementia, cognitive impairment
Topics: statins, dementia, cognitive impairment
Topics: kidney failure, chronic, kidney, kidney donor, kidney transplantation, living donor
Topics: atrial fibrillation, anticoagulants, oral, hemorrhage, chads2 score, has-bled score, cha2ds2-vasc score

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.

Topics: heart valve prosthesis, warfarin
Topics: primary health care, suicide, suicidal behavior, suicide risk assessment, elderly
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