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Alcoholic cirrhosis increases risk for hepatocellular carcinoma (HCC), but whether patients with alcoholic cirrhosis should undergo screening for HCC is uncertain. This cohort study using data from Denmark shows that patients with alcoholic cirrhosis have a low absolute risk for HCC and that HCC contributes little to the high mortality rate. These data suggest that HCC screening of patients with alcoholic cirrhosis would be unlikely to have any noticeable effect on mortality.
Hospitalization can have devastating consequences for patients with Alzheimer disease. In this large prospective registry of patients with Alzheimer disease, hospitalization was associated with a substantial increase in the risk for death and institutionalization. The occurrence of delirium during hospitalization further increased these risks. Delirium was also associated with an increased risk for further cognitive decline.
This case series describes 4 adults who developed symptoms and signs of liver injury within 3 months after initiating flavocoxid—a proprietary prescription medical food used to treat osteoarthritis. Manifestations included marked elevations in alanine aminotransferase, alkaline phosphatase, and serum bilirubin levels that resolved within 3 to 12 weeks after flavocoxid was stopped. People who use flavocoxid should be aware that liver injury is a potential adverse effect.
Urinary incontinence (UI) in women is common and adversely affects quality of life. This review of studies on the benefits and harms of drugs for UI in community-dwelling women found strong evidence that rates of continence and clinically important improvement in UI were greater with drugs than with placebo and drugs seem to have similar effectiveness. However, improvements were modest and drug discontinuation due to adverse effects was common. Definitions of improvement in UI and quality of life were inconsistent among the studies, and evidence on long-term adherence and safety of treatments is lacking.
This Update summarizes studies published in 2011 that the authors consider highly relevant to the practice of hospital medicine. Topics include acute decompensated heart failure, pulmonary embolism, atrial fibrillation, telemedicine, cardiopulmonary resuscitation, chronic obstructive pulmonary disease, inpatient care, and the acute alcohol withdrawal syndrome.
This recommendation on cervical cancer screening from the U.S. Preventive Services Task Force considers evidence on liquid cytology, human papillomavirus testing, and a computer model of optimal screening ages and intervals that has become available since its 2003 recommendation.
The lipid-lowering drug atorvastatin converted from brand only (Lipitor) to generic in late 2011. Certain insurers have reportedly instructed some pharmacies to fill prescriptions with Lipitor, even if patients present with a prescription for generic atorvastatin. This commentary discusses Lipitor versus the generic atorvastatin and the unusual pricing situation and provides advice for physicians whose patients have been taking Lipitor.
Food supplements and medical foods have gained popularity among consumers who often assume that they are safer than drugs. In this issue, Chalasani and colleagues report 4 cases of acute liver injury associated with the medical food flavocoxid. The editorialists discuss the case series and emphasize that clinical evidence from well-designed studies should be required of any health care intervention, including food supplements and medical foods.
This issue includes the updated Task Force recommendations on screening for cervical cancer. The editorialists discuss this recommendation as well as the joint guideline from the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology. They highlight several key public health messages and advocate for embracing these guidelines and incorporating them into routine practice.
When I reflect on my role with patients at the end of life, I wonder if I have been using the wrong approach. “Do you want to be put on the ventilator?” “Should we perform CPR?” Maybe these are the wrong questions.