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Echinacea is a popular herbal treatment for the common cold, but its efficacy continues to be debated. In this randomized, controlled trial, illness duration and severity did not significantly decrease in participants who received either blinded or open-label echinacea compared with those who received blinded placebo or no pills. Although this study suggests that echinacea is ineffective at reducing cold symptoms or duration, higher-than-expected variability in cold symptoms limited its power to provide a definitive answer to the question about the effectiveness of echinacea.
The incidence of HIV infections in the United States has remained steady over many years. This cost-effectiveness analysis found that expanding HIV testing and treatment simultaneously was more beneficial and cost-effective in reducing new infections than using either method alone but only modestly decreased new infections. However, halving risk behavior among patients tested and treated markedly decreased the number of new infections. This analysis suggests that substantial reductions in the magnitude of the U.S. HIV epidemic will require a multimodal approach of testing, treatment, and behavior change.
The effects of fatty acids on metabolic outcomes are complex and may be influenced by such factors as whether they are endogenously produced or obtained exogenously from specific dietary sources. This observational study found that self-reported consumption of whole-fat dairy was associated with higher levels of circulating trans-palmitoleate (a fatty acid obtained primarily from dairy consumption), a more favorable metabolic profile, and a lower incidence of type 2 diabetes among adults in the Cardiovascular Health Study. Further study is required to evaluate whether trans-palmitoleate has positive health effects.
This meta-analysis of 20 large randomized, controlled trials of statins found a significant inverse association between high-density lipoprotein cholesterol (HDL-C) levels and risk for myocardial infarction in both statin recipients and control participants after adjustment for on-treatment low-density lipoprotein cholesterol levels, age, hypertension, diabetes, and tobacco use. These findings suggest that low HDL-C levels or other factors associated with such levels may explain the remaining risk for cardiovascular disease observed in statin recipients and highlight the need for additional research about optimizing HDL-C levels in this context.
The U.S. Preventive Services Task Force (USPSTF) bases its recommendations on an evidence-based model of clinical prevention that focuses on specific diseases, well-defined interventions, and evidence of improved health outcomes. Applying this model to the elderly population has been problematic for several reasons. In 2005, the USPSTF convened a geriatrics workgroup to refine USPSTF methodology and processes to better address the preventive needs of older adults. This article discusses how the USPSTF has begun to apply these new approaches by using fall prevention as an example.
Falls among older adults are prevalent and preventable. To support the USPSTF recommendation process, this systematic review describes the benefits and harms of outpatient interventions available to primary care clinicians to prevent falls in older adults. The review found that current research suggests that clinical interventions, such as vitamin D supplementation, exercise or physical therapy programs, and some comprehensive multifactorial fall assessment and management interventions, can reduce falls and seem to be safe for community-dwelling older adults.
In 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented a single duty-hour standard for resident physicians nationwide. The evidence to date suggests that this neither improved nor worsened patient outcomes, and the ACGME proposed a new set of duty-hour standards in June 2010 for implementation in July 2011. This article discusses the many unanswered questions about how to design duty-hour standards and suggests that a more flexible, dynamic policy emphasizing that ongoing testing and evaluation would be more likely to improve clinical and educational outcomes.
As training programs begin to implement the ACGME's most recent duty-hour rules, it is useful to review evidence supporting the new rules. This systematic review assessed studies on the associations of shift length, protected sleep time, and night float with patient care, residents' health, and education among residents in practice settings. Studies showed some benefits of reduced shift length but did not adequately address the optimal shift duration. Studies had methodological limitations and unclear generalizability for most outcomes, and specific recommendations about shift length, protected sleep time, and night float should acknowledge the limitations of this evidence.
In this issue, a systematic review that will serve as the basis for the USPSTF recommendations on fall prevention examines the benefits and harms of fall prevention interventions and an accompanying article describes the USPSTF's efforts to make its reviews and recommendations relevant to older adults and the primary care providers who care for them. This editorial discusses these articles and how the USPSTF has taken a major step toward ensuring that its work remains relevant.
As a subspecialist, my knowledge of general medicine isn't what it used to be. But neither is the entire inpatient medicine experience. Changes on the inpatient medicine wards have been unfolding over the past several years, but recently these changes hit me hard.