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The Lynch syndrome is the most common genetic cause of colorectal cancer, but the best way to identify affected individuals and families remains uncertain. This cost-effectiveness analysis examines the clinical and economic consequences of competing strategies for identifying families with the Lynch syndrome, beginning with persons with newly diagnosed colorectal cancer. It suggests that testing everyone with colorectal cancer for mutations associated with the syndrome and then screening healthy first-degree relatives of persons with cancer who test positive is a cost-effective strategy.
In this analysis of mortality among veterans hospitalized for an exacerbation of chronic obstructive pulmonary disease, study participants living in isolated rural areas were at higher risk for death than those living in nonisolated rural and urban areas. The study sample was limited to mostly men, and results were based on administrative data. Future research should investigate whether providing appropriate health care resources to isolated rural areas would reduce the difference in death from chronic obstructive pulmonary disease between isolated and nonisolated areas.
Studies have suggested that lay people better understand the potential benefits and harms of drug therapies when these data are reported as absolute risks rather than relative risks or percents. This randomized trial involving 2944 adults compared 5 numeric formats for presenting the risks and benefits of 2 hypothetical drug treatments. Participants seemed to best understand information that was presented as a simple percentage. However, about one third of participants had difficulty understanding data on benefits and harms even in the percent format. Presenting probable treatment outcomes as a simple percentage might improve comprehension.
Health literacy has been associated with health-related knowledge and patient comprehension. This systematic review updates a 2004 review and found 96 eligible studies that suggest that low health literacy is associated with less ability to understand and follow medical advice, poorer health outcomes, and differential use of some health care services. Policymakers, clinicians, and other stakeholders need to find ways to reduce the effects of low health literacy on health outcomes.
Around 2000, the Netherlands reorganized the country's system for providing after-hours primary care, shifting from small rotation groups to large-scale cooperatives. This narrative review examines studies about after-hours primary care in the Netherlands, including experiences of health care professionals and patients, patient safety incidents, adherence to practice guidelines, waiting times, and quality of telephone triage. The Dutch system might set an example for other countries struggling to find a good solution for the problems that they encounter with delivery of after-hours primary care.
Ethical controversy, legal restrictions, and immunologic rejection hamper embryonic stem cell research. Laboratory techniques have been developed to reprogram normal body cells to enter an embryonic stem cell–like state. These techniques are believed to hold promise as a way to circumvent problems associated with research and therapies that rely on embryonic stem cells. This article examines the potential advantages of cell reprogramming for regenerative and reproductive medicine; explores medical, ethical, and political hurdles faced by this field; and discusses why cell reprogramming may become as controversial as embryonic stem cell research.
Compassionate release allows eligible, seriously ill prisoners to die outside of prison before completing their sentence. Many policy experts are calling for broader use of compassionate release owing to an aging prison population, overcrowding, increasing deaths in custody, and the soaring medical costs of the criminal justice system. The authors propose changes to the medical eligibility criteria of many compassionate-release guidelines to address clinical flaws and procedural barriers.
Determining who should have genetic testing for the Lynch syndrome remains problematic. In this issue, Ladabaum and colleagues' cost-effectiveness analysis concluded that the preferred approach was tumor immunohistochemistry for all persons with colorectal cancer, followed by genetic testing of first-degree relatives if results from the index patient are positive. The editorialist discusses this and other modeling studies and examines what the present approach to genetic testing for the Lynch syndrome should be.
In this issue, the study by Woloshin and Schwartz suggests that lay people understand percents better than natural frequencies when considering information about drug therapies, and Berkman and colleagues' findings address conventional wisdom about the associations between health literacy and some health-related outcomes. This editorial discusses these 2 articles in light of currently accepted ideas about health literacy. The editorialists assert that the findings reinforce a fundamental principle of health literacy: the need to pretest communication materials with the target audience.
In this issue, Giesen and colleagues review after-hours care in the Netherlands. The editorialists find the review particularly timely, as the United States faces a long road in improving the provision of primary care. Currently, many U.S. practices provide suboptimal after-hours care and might learn something from the Netherlands.
I ran to the emergency department, perfunctorily examined the patient, and then moved on to the hundred-and-one other things I needed to do on a call night. In the midst of all this frantic activity, I frequently felt uneasy. What was I becoming? Was I losing sight of the patient as a person? Had the art of medicine for me become the efficient and safe discharge of patients?