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Amanda Idan, BSc, MHSc; Kaye A. Griffiths, AMS, DMU; D. Tim Harwood, PhD; Markus J. Seibel, MD, PhD; Leo Turner, MMed, RN; Ann J. Conway, MBBS; and David J. Handelsman, MBBS, PhD

Many of the risks and benefits of testosterone replacement therapy in older men remain undefined. In this trial, 114 middle-aged men were assigned to receive placebo or transdermal dihydrotestosterone (DHT) for 2 years to see whether DHT reduces late-life prostate growth. Average prostate size increased over time in all men, with no significant difference between the groups. The trial does not support the use of nonamplifiable pure androgens to delay or prevent prostate growth and progression of presymptomatic benign prostatic hypertrophy.

Topics: stanolone, prostate, prostate disease, body composition, androgens, estradiol
  
William H. Shrank, MD, MSHS; Niteesh K. Choudhry, MD, PhD; Michael A. Fischer, MD, MPH; Jerry Avorn, MD; Mark Powell, MA, MEd; Sebastian Schneeweiss, MD, ScD; Joshua N. Liberman, PhD; Timothy Dollear, MS; Troyen A. Brennan, MD, JD; and M. Alan Brookhart, PhD

In this cross-sectional study, investigators merged a database from a retail pharmacy chain with a database from a pharmacy benefits manager to assess rates and predictors of prescription abandonment. The percentage of prescriptions that were abandoned at the pharmacy was low. Prescriptions for initial therapy, those that required high copayments, and those delivered electronically were significantly more likely to be abandoned. As electronic delivery of prescriptions increases, health care providers should seek strategies to prevent prescription abandonment.

Topics: pharmacies, pharmacy (field)
  
Lucy D. Horvat, MSc; Meaghan S. Cuerden, MSc; S. Joseph Kim, MD, PhD; John J. Koval, PhD; Ann Young, PhD; and Amit X. Garg, MD, PhD

Some countries require explicit consent from organ donors, whereas others have laws that presume that persons are willing to donate unless they have explicitly stated otherwise. Whether explicit or presumed consent results in more organ donation is unclear. This study of 44 countries from 1997 to 2007 found that countries with presumed consent had higher rates of kidney transplantation from deceased donors but lower rates from living donors. Countries with or considering adopting presumed consent for kidney donation should also consider strategies to encourage kidney donation from living donors.

Topics: renal transplantation, presumed consent, transplantation
  
Serena Guiducci, MD; Francesco Porta, MD; Riccardo Saccardi, MD; Stefano Guidi, MD; Lidia Ibba-Manneschi, MD; Mirko Manetti, PhD; Benedetta Mazzanti, BSc; Simone Dal Pozzo, BSc; Anna Franca Milia, PhD; Silvia Bellando-Randone, MD; Irene Miniati, MD; Ginevra Fiori, MD; Rossana Fontana, MD; Laura Amanzi, HP; Francesca Braschi, HP; Alberto Bosi, MD; and Marco Matucci-Cerinic, MD, PhD

This case report describes a young woman with systemic sclerosis and acute occlusive ischemia and gangrene of the upper and lower limbs. After intravenous infusions of autologous bone marrow–derived mesenchymal stem cells, skin necrosis decreased. Postinfusion angiography showed new vessel networks in the upper limbs and distal vascularization with blood flow in the lower limbs. This preliminary observation suggests that systematic evaluation of the benefits and harms of mesenchymal stem-cell infusion in complicated systemic sclerosis is warranted.

Topics: ischemia, systemic scleroderma, limb, stem cell, mesenchymal, revascularization, infusion procedures, hematopoietic stem ...
  
Joseph Millum, PhD; and Jerry Menikoff, MD, JD

In the United States, the ethical review process for studies of human subjects has been criticized for requirements that delay research without protecting human subjects. The authors discuss available options for speeding review of some studies, including expedited review for studies that need not be classified as human subjects research, studies that can be exempt from ethical review, and studies that require review by a single institutional review board (IRB) member. Researchers can also simplify the review process for multicenter research by using the IRB of 1 institution.

Topics: ethical review, ethics, institutional review board
  

The health care response to the Chilean earthquake provided an opportunity to reflect on how the health profession can ready itself to better serve society when disasters occur. This article discusses how medical and other health professional schools must encourage a spirit of solidarity, enthusiasm, compassion, and societal commitment in their students and ensure that all graduates have basic skills that will enable them to be helpful when society needs them most.

Topics: disasters, chile
  
Barak Gaster, MD; Kelly Edwards, PhD; Susan Brown Trinidad, MA; Thomas H. Gallagher, MD; and Clarence H. Braddock III, MD, MPH

National guidelines recommend that primary care providers discuss the risks and benefits of prostate cancer screening with their patients, but little guidance is available on how to fit the discussion into a busy clinic encounter. The authors propose a process-oriented approach (Ask-Tell-Ask) that promotes tailored conversations and value-based recommendations. It includes diagnosing a patient's informational needs, providing targeted education based on those needs, and making a shared decision about testing.

Topics: patient-centered care, prostate cancer screening
  
Eugenia L. Siegler, MD

The author examined the influence of medical record structure on physician narrative over more than a century at The New York Hospital. She describes the variation in quality and structure from freeform patient records to real-time recording of cases and discusses how these changes, and physicians' responses to them, parallel contemporary threats to documentation posed by EHRs.

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Ronald S. Swerdloff, MD; and Christina Wang, MD

In this issue, Idan and colleagues report a randomized trial that examined the long-term effects of DHT treatment on prostate growth in healthy, middle-aged men without prostate disease. The editorialists discuss the study's contribution to our understanding of androgen pharmacology and insights into androgen biology in multiple target organs. They conclude that DHT acts as a hormone in tissues without high concentrations of 5α-reductase enzymes but acts mainly in an autocrine–paracrine manner in such tissues as the prostate, where 5α-reductase is abundant.

Topics: hormone, stanolone, autocrine, paracrine
  
Michael D. Murray, PharmD, MPH; and Jeff Harrison, PhD

In this issue, Shrank and colleagues examine abandonment of prescriptions and identify modifiable factors associated with abandonment. The editorialists discuss the article's findings, including strategies to reduce prescription abandonment.

Topics: pharmacies, new zealand, pharmacy (field)
  

In this issue, Siegler examines the evolution of medical records at The New York Hospital and Maxson and colleagues describe federal efforts to support the broad implementation and meaningful use of EHRs through RECs. The editorialist discusses how these articles provide an opportunity to learn from the past as we design a future that provides new approaches to clinical information management and patient care.

Topics: electronic medical records, american college of physicians
  
Eric J. Warm, MD
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Joseph F. Majdan, MD
Includes: Audio/Video
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Francesco Dentali, MD; Monica Gianni, MD; and Alessandro Squizzato, MD
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Jose A. Nieto, PhD; Reina Valle, PhD; and Juan B. Lopez-Saez, PhD
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Russell D. Hull, MBBS, the EXCLAIM Steering Committee
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David A. Shewmon, MD; and John M. Craig, BA
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Jack Coulehan, MD, MPH
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Topics: hemodialysis, kidney failure, chronic, dialysis procedure, mortality
  
Topics: hemoglobin measurement, erythropoiesis-stimulating agents
  
Topics: migraine disorders
  
Topics: aspirin, pain, acute migraine
  
Topics: exercise, shoulder pain, steroids, disability
  
Topics: myocardial infarction, cerebrovascular accident, ischemic stroke, calcium, mortality
  
Topics: enoxaparin, hemorrhage, venous thromboembolism
  
Topics: diabetes mellitus, type 2, glucose control
  
Topics: simvastatin, diabetes mellitus, type 2, retinal diseases, fenofibrate, glucose control
  
Topics: fibric acid derivatives, cardiovascular system
  
Topics: stent, endarterectomy, carotid stenosis, ischemic stroke
  
Topics: liver cirrhosis, variceal hemorrhage
  
Topics: gel, stanolone, prostate
  
Topics: pharmacies, pharmacy (field)
  
Topics: renal transplantation
  
Emily Maxson, BS; Sachin Jain, MD, MBA; Mat Kendall, MPH; Farzad Mostashari, MD, MPH; and David Blumenthal, MD, MPP

The 2009 Health Information Technology for Economic and Clinical Health Act included provisions to facilitate the transition from paper to electronic health records (EHRs), including Medicare and Medicaid incentive payments to support the adoption and meaningful use of EHR systems. It also created the Health Information Technology Regional Extension Center (REC) program. This article describes the rationale for the RECs and how they will promote the meaningful use of EHR systems.

Topics: electronic medical records, health information technology, hospitals
  
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