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Hermann Brenner, MD, MPH; Jenny Chang-Claude, PhD; Lina Jansen, PhD; Christoph M. Seiler, MD, MSc; and Michael Hoffmeister, PhD

Risk for subsequent colon cancer after polyp removal is known to be associated with biological characteristics of the polyps removed. However, this case–control study found that colonoscopy-related factors, such as interval until next colonoscopy and completeness of polyp removal, also predicted subsequent cancer. Future studies should evaluate whether improving colonoscopy performance may reduce risk for subsequent colorectal cancer after polyp removal.

Topics: colonoscopy, colorectal cancer, polyp colorectal, adenoma of large intestine
  
Eswar Krishnan, MD, MPhil; Bharathi Lingala, PhD; and Vivek Bhalla, MD

Current U.S. national standards consider blood lead levels less than 1.21 μmol/L (<25 μg/dL) to be acceptable. However, evidence suggests that some lead-associated diseases occur at lower levels. In this large population-based study, the risk for gout increased with rising blood lead levels even within the range considered acceptable. The findings suggest that there no “safe” level of lead exposure, and very low levels may still be associated with health risks. Future studies should assess whether efforts at further reduction of exposure will result in health benefits.

Topics: gout, lead poisoning, lead level, hyperuricemia
  
Olaide Y. Raji, PhD; Stephen W. Duffy, MSc; Olorunshola F. Agbaje, PhD; Stuart G. Baker, ScD; David C. Christiani, MD, MPH; Adrian Cassidy, PhD; and John K. Field, PhD, FRCPath

Useful strategies to determine which patients will benefit from computed tomography–based lung cancer screening are lacking. This study validated the Liverpool Lung Project risk model in 3 populations of patients who underwent computed tomography screening for lung cancer and then used decision-analysis methods to determine the model's performance with regard to maximizing net benefit of screening. The model performed well in predicting clinical benefit across a range of thresholds of possible risk compared with other approaches to risk stratification. Such analyses may help in planning the implementation of lung cancer screening programs.

Topics: computed tomography, lung cancer, lung cancer screening, prediction rule, accuracy, smoking
  
Ashish Upadhyay, MD; Amy Earley, BS; Jenny L. Lamont, MS; Shana Haynes, DHSc, MS; Christoph Wanner, MD; and Ethan M. Balk, MD, MPH

Although cardiovascular disease and dyslipidemia are common in patients with chronic kidney disease (CKD), many patients with CKD do not receive lipid-lowering therapy. This review summarizes evidence from 18 trials that reported on cardiovascular, kidney, and adverse outcomes associated with lipid-lowering therapy in persons with CKD. It found that lipid-lowering therapy does not improve kidney outcomes but decreases the risk for cardiac mortality, cardiovascular events (including revascularization), and myocardial infarction. Significant benefit seen for all-cause mortality was limited by a high degree of heterogeneity.

Topics: kidney failure, chronic, lipids, lipid-lowering therapy, cardiovascular event, hemodialysis
  
Suetonia C. Palmer, MBChB, PhD; Jonathan C. Craig, MBChB, MM, MPH, PhD; Sankar D. Navaneethan, MD, MPH; Marcello Tonelli, MD, PhD; Fabio Pellegrini, MSc; and Giovanni F.M. Strippoli, MD, MM, MPH, PhD

Whether effects of statin therapy in persons with CKD vary with severity of CKD is uncertain. This review of 89 trials summarizes evidence on the benefits and harms of statin therapy for adults with CKD and examines whether effects of statins vary by stage of kidney disease. It found that statins decrease mortality and cardiovascular events in persons with early stages of CKD, have little or no effect in persons receiving dialysis, and have uncertain effects in kidney transplant recipients.

Topics: statins, kidney failure, chronic, hemodialysis, cardiovascular event
  
Marc J. Kahn, MD, MBA; Alice D. Ma, MD; and Lawrence N. Shulman, MD

This Update summarizes studies published in 2011 that the authors consider highly relevant to the practice of hematology and medical oncology. Topics include benign and malignant hematology; chronic myelogenous leukemia; prostate, lung, and breast cancers; and melanoma.

Topics: atrial fibrillation, warfarin, leukemia, myelocytic, chronic, medical oncology, hematology, breast cancer, prostate ...
  
Cynthia D. Smith, MD, on behalf of the Alliance for Academic Internal Medicine–American College of Physicians High Value, Cost-Conscious Care Curriculum Development Committee*

Postgraduate trainees have historically received little specific training in the stewardship of health care resources and minimal feedback on resource utilization and its effect on the cost of care. This article describes a new curriculum developed by the Alliance for Academic Internal Medicine and the American College of Physicians to address this training gap. The curriculum introduces a framework for delivering high-value care and focuses on teaching trainees to incorporate high-value, cost-conscious care principles into their clinical practice.

Topics: health care costs, internal medicine, curriculum, medical residencies
  
Humayun J. Chaudhry, DO, MS, SM; Lance A. Talmage, MD; Patrick C. Alguire, MD; Frances E. Cain, BA; Sandra Waters, MEM; and Janelle A. Rhyne, MD, MA

In 2010, the Federation of State Medical Boards adopted a framework for Maintenance of Licensure (MOL) under which actively licensed physicians will be required to periodically participate in a program of continuous professional development in order to renew their license. This commentary describes how the framework is likely to be implemented and discusses recommendations about a timeline for MOL and implementation as well as pilot implementation projects under way.

Topics: certification, education, medical, continuing, licensure
  
Christine K. Cassel, MD; Virginia Hood, MBBS, MPH; and Werner Bauer, MD

The ABIM Foundation, ACP Foundation, and European Federation of Internal Medicine aimed to promote contemporary principles of medical professionalism released when they published Medical Professionalism in the New Millennium: A Physician Charter in February 2002. This commentary takes stock of the Charter's accomplishments 10 years later and evaluates where challenges persist.

Topics: conflict of interest, academic medical centers, health care systems, professionalism, health services ...
  

In this issue, Krishnan and colleagues show that blood levels of lead considered to be within the acceptable range by U.S. standards are independently associated with gout. The editorialist discusses the study's findings and implications for setting new standards for safety with regard to lead exposure.

Topics: lead poisoning, lead level
  

In this issue, Raji and colleagues evaluate strategies based on alternative risk-prediction models for the use of computed tomography screening for lung cancer. The editorialists applaud the study because it illustrates that a test's ability to predict or diagnose a disease is not an adequate determination of its clinical usefulness. The relevant question is whether people are better or worse off if the test is used as part of clinical care.

Topics: health care decision making, prediction rule, accuracy
  
Theresa E. Vettese, MD
Includes: Audio/Video

We are taught to be nonjudgmental, to respect and be professional with all patients, at all times, regardless of the patient's background. Regardless of our background. How young, naive, and arrogant I was to think that I could actually pull it off.

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Athanase D. Protogerou, MD; Evangelia Zampeli, MD; and Petros P. Sfikakis, MD
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Johannes W.G. Jacobs, PhD, MD; Marije F. Bakker, PhD; and Johannes W.J. Bijlsma, PhD, MD
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Morris Sherman, MBBCh, PhD; and Jordi Bruix, MD
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Frank A. Lederle, MD; and Christine Pocha, MD, PhD
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Giovanni F.M. Strippoli, MD, PhD, MPH, MM; Suetonia C. Palmer, MBChB, PhD; and Jonathan C. Craig, MBChB, DCh, MM, PhD
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John W. Chu, MBChB, MMedSc; Victor H.T. Chen, MBChB; and Richard Bunton, MBChB
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Jonathan Reisman, MD
Includes: Audio/Video
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Daniela Matei, MD
Includes: Audio/Video
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Heather C. Yun, MD
Includes: Audio/Video
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Topics: smoking cessation, cardiovascular event, varenicline
  
Topics: cardiovascular diseases, omega-3 fatty acids, secondary prevention of cardiovascular disease
  
Topics: superficial thrombophlebitis, fondaparinux, venous thromboembolism
  
Topics: deep vein thrombosis, low-molecular-weight heparin, hip replacement arthroplasty, knee replacement arthroplasty, thromboprophylaxis, ...
  
Topics: hemorrhage, rivaroxaban, venous thromboembolism
  
Topics: aspirin, warfarin, ischemic stroke, heart failure, sinus rhythm
  
Topics: antiplatelet agents, kidney failure, chronic
  
Topics: antiplatelet agents, percutaneous transluminal coronary angioplasty, stents, vascular, coronary
  
Topics: migraine disorders, botulinum toxins, type a, headache, chronic, chronic daily headache
  
Topics: septic shock, sepsis, severe, drotrecogin alfa
  
Topics: ultrasonography, abdominal injuries, abdominal injury, blunt, bedside testing
  
Topics: clostridium difficile infection, proton pump inhibitors
  
Topics: gout, lead poisoning, lead level
  
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