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Nancy R. Cook, ScD; I-Min Lee, ScD; Shumin M. Zhang, ScD; M. Vinayaga Moorthy, PhD; and Julie E. Buring, ScD

Daily aspirin seems to decrease risk for cancer, but evidence in women and for alternate-day aspirin use is lacking. This observational follow-up of the Women's Health Study found that long-term use of alternate-day, low-dose (100-mg) aspirin was associated with reduced risk for colorectal cancer; increased risk for gastrointestinal bleeding and peptic ulcers; and no association with risk for total, breast, or lung cancer. These data suggest that, in healthy women, long-term use of alternate-day, low-dose aspirin may reduce risk for colorectal cancer but increase risk for gastrointestinal bleeding.

Topics: aspirin, cancer
Mark S. Sulkowski, MD; Kenneth E. Sherman, MD, PhD; Douglas T. Dieterich, MD; Mohammad Bsharat, PhD; Lisa Mahnke, MD, PhD; Jürgen K. Rockstroh, MD; Shahin Gharakhanian, MD, DPH; Scott McCallister, MD; Joshua Henshaw, PhD; Pierre-Marie Girard, MD, PhD; Bambang Adiwijaya, PhD; Varun Garg, PhD; Raymond A. Rubin, MD; Nathalie Adda, MD; and Vincent Soriano, MD, PhD

In this small randomized trial of patients with both genotype 1 hepatitis C virus and HIV, adding telaprevir to peginterferon-α2a (PEG-IFN-α2a)–ribavirin therapy produced a greater sustained virologic response than PEG-IFN-α2a–ribavirin alone. No HIV breakthroughs occurred, but adverse events were more common in patients treated with telaprevir plus PEG-IFN-α2a–ribavirin. These promising preliminary results await confirmation in an ongoing, larger randomized trial and in patients receiving other HIV treatment regimens.

Topics: combined modality therapy, genotype, ribavirin, viruses, hepatitis c virus, anti-retroviral agents, telaprevir, ...
Julia Adler-Milstein, PhD; Claudia Salzberg, MSc; Calvin Franz, PhD; E. John Orav, PhD; Joseph P. Newhouse, PhD; and David W. Bates, MD, MSc

Although some proponents of electronic health records (EHRs) speculate that EHR use will result in cost savings due to increased efficiency, evidence to support this hypothesis is lacking. This analysis of EHR implementation by 806 ambulatory care clinicians in 3 Massachusetts communities did not identify statistically significant cost savings, but the results suggest that EHRs in community-based outpatient practices will not decrease but might slow the increase in health care costs.

Topics: community health services, efficiency, health care costs, electronic medical records
Walid F. Gellad, MD, MPH; Julie M. Donohue, PhD; Xinhua Zhao, PhD; Maria K. Mor, PhD; Carolyn T. Thorpe, PhD, MPH; Jeremy Smith, MPH; Chester B. Good, MD, MPH; Michael J. Fine, MD, MSc; and Nancy E. Morden, MD, MPH

The use of generic instead of brand-name drugs could reduce health care costs. This study compared the use of brand-name diabetes drugs within Medicare Part D and the U.S. Department of Veterans Affairs (VA). It found that the use of brand-name drugs for treating patients with diabetes, including oral hypoglycemics, long-acting insulins, angiotensin-converting enzyme inhibitors, and statins, was 2 to 3 times higher in Medicare Part D than in the VA. The authors estimate that more than $1 billion could have been saved if Medicare use of generic drugs had mirrored that of the VA during the study.

Topics: diabetes mellitus, type 2, medicare, veterans, prescription drug, medicare part d, statins, ...
Lois Donovan, MD; Lisa Hartling, PhD; Melanie Muise, MA; Alyssa Guthrie, MSSc; Ben Vandermeer, MSc; and Donna M. Dryden, PhD
Includes: CME

This systematic review for the U.S. Preventive Services Task Force examined the accuracy of screening tests for gestational diabetes. The authors found that the oral glucose challenge test and the fasting plasma glucose test were good at ruling out gestational diabetes in pregnant women, but the former test was better at identifying women with gestational diabetes.

Topics: gestational diabetes, screening test

This systematic review for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research evaluated 11 studies that addressed maternal or fetal benefits and harms of therapies, including diet modification, glucose monitoring, and insulin, for gestational diabetes. Moderate-quality evidence showed that treatment resulted in less preeclampsia, shoulder dystocia, and macrosomia. Evidence was low or insufficient for other outcomes, such as maternal weight gain, cesarean delivery, birth injury, neonatal hypoglycemia, or admission to a neonatal intensive care unit.

Topics: gestational diabetes, united states national institutes of health, mothers, glucose, shoulder dystocia ...
Andrea Cipriani, PhD; Julian P.T. Higgins, PhD; John R. Geddes, MD; and Georgia Salanti, PhD

Standard meta-analyses compare only 2 interventions at a time. Network meta-analyses enable assessment of the relative effectiveness of multiple interventions. This article elucidates the main characteristics of network meta-analysis, focuses on questions about its main conceptual and technical challenges, and offers advice on addressing these challenges.

Topics: heterogeneity, comparative effectiveness research, mania, acute
A. Scott Keller, MD, MS; Tamara E. Buechler, MD, MHA; and James S. Newman, MD

This Update summarizes studies published in 2012 that the authors consider highly relevant to the practice of hospital medicine. Topics include perioperative myocardial infarction, anticoagulation, inpatient care, and transfusion medicine.

Topics: patient readmission, hospital care, hemorrhage, warfarin

An emergency medicine physician discusses how being prepared helped him and his colleagues save lives after the Boston Marathon bombing.

Topics: explosions, disasters, dehydration, operating room, disasters and emergency preparedness
Deborah Cotton, MD, MPH

A Boston physician comments on the striking contrast between Boston's health care climate before and after the Boston Marathon bombing.

Topics: insurance carriers, nurses, care of intensive care unit patient, resource based relative ...
Anne M. Stack, MD

A physician involved in the care of the youngest victims of the 2010 Haiti earthquake as well as the Boston Marathon bombing reflects on the differences in the outcomes of disasters when well-trained first responders are available.

Topics: explosions, face, operating room, wounds and injuries, mass casualty setting, nurses, pediatrics ...

In this issue, Cook and colleagues examined treatment with alternate-day, low-dose aspirin in middle-aged women in the Women's Health Study. The editorialist discusses the study's findings and concludes that they should temper any recommendations for widespread use of aspirin in healthy middle-aged women and reinforce the need to consider the risks and benefits of aspirin separately in men and women.

Topics: aspirin, cancer risk

In this issue, Adler-Milstein and colleagues address the relationship between the use of EHRs and the costs of health care and found that EHRs in a community-based setting seem to slow ambulatory cost growth. The editorialist discusses the study's findings as well as the questions it raises.

Topics: electronic medical records
Mary Bascom Migeon, MD
Includes: Audio/Video

I am a supporter of Washington Death with Dignity Act, but I had not anticipated that I would become an enactor of such a death, and not in a patient who I had come to love.

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Guglielmo M. Trovato, MD; Marco Sperandeo, MD; and Daniela Catalano, MD
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Peter B. Bach, MD, MAPP; Michael K. Gould, MD, MS; and Gerard A. Silvestri, MD, MS
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Claudia I. Henschke, PhD, MD; Rowena Yip, MPH; David F. Yankelevitz, MD; and James P. Smith, MD
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Karen Devon, MD; and Sabha Ganai, MD, PhD
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Joy L. Lee, MS; and Albert W. Wu, MD, MPH
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Jeanne M. Farnan, MD, MHPE; Lois Snyder Sulmasy, JD; and Humayun Chaudhry, DO, MS, SM
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Yuehua Ke, PhD, MD; Yufei Wang, PhD, MD; Wenyi Zhang, MD; Liuyu Huang, PhD; and Zeliang Chen, PhD, MD
Topics: china, avian influenza, viruses, influenza a virus, h7n9 subtype
Topics: statins, cardiovascular diseases
Topics: atorvastatin, diabetes mellitus, type 2, coronary heart disease, cardiovascular event, symptom onset ...
Topics: percutaneous coronary intervention, coronary artery bypass surgery, coronary arteriosclerosis
Topics: percutaneous coronary intervention, coronary artery bypass surgery, syntax trial
Topics: percutaneous coronary intervention, cardiac surgery procedures
Topics: anticoagulants, oral, hemorrhage, cardiovascular event
Topics: atrial fibrillation, warfarin, ischemic stroke, embolism, apixaban
Topics: frail elderly, elderly, thromboprophylaxis, venous thromboembolism, hemorrhage
Topics: ultrasonography, catheterization, diagnostic spinal puncture
Topics: abdominal aortic aneurysm, elderly
Topics: allopurinol, citrates, kidney calculi, thiazide
Topics: osteoarthritis, knee, knee meniscus tears
Topics: aspirin, colorectal cancer
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