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Matthew Spitzer, MD; Shehzad Basaria, MD; Thomas G. Travison, PhD; Maithili N. Davda, MPH; Amanda Paley, BA; Beth Cohen, MD; Norman A. Mazer, MD, PhD; Philip E. Knapp, MD; Samson Hanka, MD; Kishore M. Lakshman, MD; Jagadish Ulloor, PhD; Anqi Zhang, PhD; Katie Orwoll, BS; Richard Eder, BA; Lauren Collins, RNP; Nurahmed Mohammed, MD; Raymond C. Rosen, PhD; Leonard DeRogatis, PhD; and Shalender Bhasin, MD

Some physicians prescribe sildenafil plus testosterone to treat erectile dysfunction (ED) in men who also have low testosterone levels. In this randomized trial, men with ED and low testosterone levels who received a replacement dose of testosterone with sildenafil did not have greater improvement in erectile function than men who received sildenafil plus placebo. Adding testosterone did not improve sexual function, frequency of total or satisfactory sexual encounters, vitality, ED-related quality of life, or marital intimacy. Sildenafil alone is sufficient to treat ED in men who have low testosterone levels.

Topics: sildenafil, testosterone, testosterone measurement, erectile dysfunction
Ronald I. Shorr, MD, MS; A. Michelle Chandler; Lorraine C. Mion, RN, PhD; Teresa M. Waters, PhD; Minzhao Liu, MS; Michael J. Daniels, ScD; Lori A. Kessler, PharmD; and Stephen T. Miller, MD
Includes: Audio/Video

Hospital bed alarms intended to prevent falls alert health care personnel when a patient rises from a chair or bed. A multifactorial intervention, providing education, training, and technical support, that encouraged the use of bed alarms greatly increased use but had no apparent effect on the number or rate of falls, injurious falls, or use of physical restraints. Although bed alarms may be a useful part of a hospital's fall prevention program, they are unlikely to be simple and cost-effective fall prevention solutions.

Topics: alarm device, fall prevention, physical restraint
Adrienne S. Allen, MD, MPH; and Thomas D. Sequist, MD, MPH

Most physicians who use electronic health records do not routinely transmit medication discontinuation orders to the pharmacy. This study assessed the frequency of and potential harm associated with pharmacy dispensing of discontinued medications in a multispecialty group practice. Researchers found that pharmacists dispensed discontinued medication for 1.5% of prescriptions for antihypertensive, antiplatelet, anticoagulant, oral diabetes, and statin medications. This important patient safety concern should be addressed by using electronic health records to facilitate better communication between clinicians and pharmacists.

Topics: pharmacies, withdrawing treatment, drug dispensing error, electronic medical records
Roger Chou, MD; Shelley Selph, MD, MPH; Tracy Dana, MLS; Christina Bougatsos, MPH; Bernadette Zakher, MBBS; Ian Blazina, MPH; and P. Todd Korthuis, MD, MPH
Includes: CME

This systematic review of the benefits and harms of HIV screening in adolescents and adults found no direct evidence on the effects of screening for HIV infection versus no screening on clinical outcomes. Previous studies have shown that HIV screening is accurate, targeted screening misses a substantial proportion of cases, and treatments are effective in patients with advanced immunodeficiency. Evidence indicates that antiretroviral therapy reduces risk for AIDS-defining events and death in persons with less advanced immunodeficiency and reduces sexual transmission of HIV. These findings will inform updated U.S. Preventive Services Task Force recommendations on screening for HIV infection.

Topics: hiv, hiv screen, anti-retroviral agents, cd4 count determination procedure, acquired immunodeficiency syndrome ...
Roger Chou, MD; Amy G. Cantor, MD, MHS; Bernadette Zakher, MBBS; and Christina Bougatsos, MPH

This systematic review of the benefits and harms of prenatal HIV screening found no direct evidence on the effects of prenatal screening versus no screening on risk for mother-to-child transmission or maternal or infant clinical outcomes. It found that antiretroviral therapy combined with avoidance of breastfeeding and elective cesarean section in women with viremia reduces risk for mother-to-child transmission. Use of certain antiretroviral therapy regimens during pregnancy may increase risk for preterm delivery. These findings will inform updated U.S. Preventive Services Task Force recommendations on screening for HIV infection.

Topics: pregnancy, hiv, hiv screen, anti-retroviral agents, prenatal care
Amir Qaseem, MD, PhD, MHA; Stephan D. Fihn, MD, MPH; Sankey Williams, MD; Paul Dallas, MD; Douglas K. Owens, MD, MS; Paul Shekelle, MD, PhD, for the Clinical Guidelines Committee of the American College of Physicians*

The American College of Physicians developed this guideline summary in collaboration with 5 other organizations to helpclinicians diagnose known or suspected stable ischemic heart disease (SIHD). The guideline includes 28 recommendations that address the initial diagnosis of the patient who might have SIHD, cardiac stress testing to assess the risk for death or myocardial infarction in patients diagnosed with SIHD, and coronary angiography for risk assessment.

Topics: myocardial ischemia
Amir Qaseem, MD, PhD, MHA; Stephan D. Fihn, MD, MPH; Paul Dallas, MD; Sankey Williams, MD; Douglas K. Owens, MD, MS; Paul Shekelle, MD, PhD, for the Clinical Guidelines Committee of the American College of Physicians*

The American College of Physicians developed this guideline summary in collaboration with 5 other organizations to present the available evidence on the management of SIHD. The guideline includes 48 recommendations addressing patient education, management of risk factors, medical therapy to prevent myocardial infarction and death and to relieve symptoms, alternative therapy, revascularization to improve survival and symptoms, and patient follow-up.

Topics: myocardial ischemia
A. David Paltiel, PhD; and Rochelle P. Walensky, MD, MPH

In July 2012, the U.S. Food and Drug Administration approved the first truly over-the-counter home HIV testing kit. This commentary discusses the public's enthusiastic response to the approval of the test but concludes that although home HIV testing may be useful, its expectations in eliminating barriers to expanded HIV detection seem unrealistic. Ultimately, routine HIV screening in health care settings is our best hope for identifying the 235 000 Americans who remain unaware of their HIV infection and linking them to effective care.

Topics: hiv, hiv screen, home diagnostic devices, oraquick rapid hiv-1 antibody test
Erik A. Wallace, MD; John H. Schumann, MD; and Steven E. Weinberger, MD
Includes: Audio/Video

Recent publications have emphasized the importance of physicians taking a lead role in delivering patient-centered, high-value, cost-conscious care. However, the increasing availability of direct-to-consumer screening tests undermines these efforts. This commentary discusses how the marketing of unindicated preventive services may lead to increased cost and harm and suggests that medical entities and physicians withdraw from the unethical business of promoting unproven and potentially harmful screening tests.

Topics: ethics, screening test, direct-to-consumer advertising, commercial product

This issue includes guidelines from the American College of Physicians on the diagnosis and management of patients with SIHD. The editorialist discusses the complexity of the recommendations, how clinicians can best approach the guidelines, and several areas where important clinical questions remain unanswered.

Topics: myocardial ischemia
Isaiah Kletenik, BA
Includes: Audio/Video

I worked as a chaplain at the county hospital and regional trauma center. At the close of any encounter, I would offer to pray with the patient or the family members. I then asked a seemingly innocuous question: “How would you like to direct our prayers?” As with so many simple questions in medicine, I would be surprised at the power of what it revealed.

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Diane B. Wayne, MD; Aashish K. Didwania, MD; and William C. McGaghie, PhD
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Gavin D. Perkins, MD; Andrew Lockey, MMEd; and Ian Bullock, PhD
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Harvey G. Klein, MD; and Charles Natanson, MD
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Jeffrey L. Carson, MD; Sunil V. Rao, MD; and Louis M. Katz, MD
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Carsten Lennerz, MD; Clemens Jilek, MD; Verena Semmler, MD; Isabel Deisenhofer, PhD; and Christof Kolb, PhD
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Rajendra Kadari, MD, MPH; Michael A. Sarche, MD; and Mori J. Krantz, MD, MPH
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Amy F. Chai, MD, MS
Includes: Audio/Video
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Topics: angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, pneumonia
Topics: hiv, heterosexuality, hiv-1, tenofovir, tenofovir/emtricitabine, hiv prevention, partners prep trial
Topics: hemodialysis, statins, kidney failure, chronic, cardiovascular event
Topics: cholestyramine, colestipol, antilipemic agents, niacin, ezetimibe, cardiovascular event, statins, kidney failure, chronic ...
Topics: kidney diseases, kidney failure, chronic, diabetes mellitus, type 2, microalbuminuria, glucose control, ...
Topics: acute cerebrovascular accidents, cerebrovascular accident, alteplase
Topics: catheter device, catheterization of internal jugular vein, catheterization of subclavian vein, femoral ...
Topics: percutaneous coronary intervention, coronary arteriosclerosis, fractional coronary flow reserve, revascularization
Topics: colorectal cancer, colorectal neoplasms, fecal immunochemical test, colonoscopy, adenoma
Topics: cardiac surgery procedures, blood transfusion, refusal of treatment
Topics: kidney failure, chronic, glomerular filtration rate, estimated, serum creatinine level, diet, kidney ...
Topics: hemorrhage, wounds and injuries, hemorrhage, traumatic
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