Cover photograph by Parsh Mehta
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IN THIS ISSUE
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Many patients with seasonal allergic rhinitis seek alternative therapies. This randomized trial evaluated the effects of acupuncture in patients with seasonal allergic rhinitis that was inadequately controlled with antihistamine therapy. Measures of rhinitis-specific quality of life and antihistamine use improved after 8 weeks of acupuncture compared with sham acupuncture. Acupuncture exhibited statistically significant improvements in symptoms compared with sham acupuncture, but the clinical significance and mechanism of the observed improvements are uncertain.
Persons of African ancestry are less likely than others to have spontaneous clearance of hepatitis C virus (HCV) infection. This genome-wide association study identified genes that were independently associated with spontaneous clearance of HCV infection and explained a substantial amount of the variation in HCV clearance seen among patients of different ancestries. Genetic testing may predict the likelihood of spontaneous resolution of HCV infection, thus allowing tailored therapy for individual patients.
The threshold to define a positive result on chest computed tomography (CT) screening for lung cancer will affect the number of patients who undergo subsequent evaluation. This retrospective analysis of a large lung cancer screening cohort study found that increasing the definition of a positive screen to nodules larger than 7 or 8 mm would have substantially reduced the number of false-positive results. Delays in diagnosing cancer would have occurred in a few patients, but the clinical significance of these delays is unclear. Alternative thresholds for positive results on lung cancer CT screening should be evaluated prospectively.
This review was done to update the 2003 U.S. Preventive Services Task Force recommendation on counseling interventions to prevent initiation and promote cessation of tobacco use in children and adolescents. Among the 19 trials that met inclusion criteria, behavior-based interventions reduced smoking initiation among young nonsmoking persons, but neither behavior-based nor bupropion interventions improved cessation rates among those who smoked. Most studies included in the review, however, were published 5 to 15 years ago and were generally of fair quality. These findings suggest that the best strategy to reduce tobacco use in children and adolescents is to prevent tobacco initiation.
Debate remains regarding the optimal timing of invasive therapy for patients with non–ST-segment elevation acute coronary syndrome. This meta-analysis assessed available evidence on early versus delayed invasive treatment. Among 7 trials and 4 observational studies, early intervention was associated with a nonsignificant decrease in mortality, a nonsignificant increase in myocardial infarction, and a decrease in major bleeding, compared with delayed intervention. The findings indicate that early intervention offers little or no statistically significant clinical benefit compared with a delayed invasive approach.
This systematic review, conducted to inform an upcoming U.S. Preventive Services Task Force recommendation on screening for glaucoma, examined the comparative effectiveness of medical, laser, and incisional surgery treatments for open-angle glaucoma. It found high-level evidence suggesting that these treatments decrease intraocular pressure and that medical treatment and trabeculectomy reduce the risk for optic nerve damage and visual field loss compared with no treatment. The direct effect of treatments on visual impairment and the comparative efficacy of treatments, however, are not clear.
Well-conducted prognostic research can help to inform clinical decision making, and critical appraisal of prognostic studies is essential to assess and identify biases that could distort study results. This article describes the development and use of the Quality In Prognosis Studies (QUIPS) tool, which assesses risk of bias in studies of prognostic factors.
In this issue, Brinkaus and colleagues evaluated the effectiveness of acupuncture in the treatment of seasonal allergic rhinitis. The editorialists discuss the study and its findings and envision future research to compare acupuncture with proven medical therapies that can inform patients, clinicians, policymakers, payers, and other stakeholders of the potential role of acupuncture in our health care system.
In this issue, Henschke and colleagues examined the tradeoff between a larger threshold for nodule size to define a positive lung cancer screen on CT and the risk for delayed diagnoses. The editorialists discuss the study and its findings and call for sophisticated modeling studies to define the tradeoffs of different thresholds for a positive CT screen for lung cancer.
When I decided to become a trauma surgeon, I never knew that I would be anyone's family doctor. My story isn't unusual among trauma surgeons and emergency physicians at urban hospitals, but it doesn't have to be.
I had never been a match for her, not in all the years of our friendship and too-infrequent contacts. What, I wondered to myself, would be apt for discussion on this, a landmark birthday? “Have you checked in with your Watcher?" she asked.