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Tom Delbanco, MD*; Jan Walker, RN, MBA*; Sigall K. Bell, MD; Jonathan D. Darer, MD, MPH; Joann G. Elmore, MD, MPH; Nadine Farag, MS; Henry J. Feldman, MD; Roanne Mejilla, MPH; Long Ngo, PhD; James D. Ralston, MD, MPH; Stephen E. Ross, MD; Neha Trivedi, BS; Elisabeth Vodicka, BA; and Suzanne G. Leveille, PhD, RN
Includes: Audio/Video

In this study, doctors and patients participated in a 1-year program that provided patients with electronic links to their doctors' notes. Most patients reported that the ability to read the notes was beneficial and wanted the program to continue. Most doctors reported little or no impact on workload. Although doctors had concerns that reading the notes could increase patient anxiety or confusion, these concerns decreased during the program. Providing patients with access to their doctors' notes may have benefits without substantially increasing doctors' workload or patient anxiety and confusion.

Topics: electronic medical records, patient knowledge, medical record entry, primary care physicians
  
Elke S. Schaeffner, MD, MS*; Natalie Ebert, MD, MPH*; Pierre Delanaye, MD, PhD; Ulrich Frei, MD; Jens Gaedeke, MD; Olga Jakob; Martin K. Kuhlmann, MD; Mirjam Schuchardt, PhD; Markus Tölle, MD; Reinhard Ziebig, PhD; Markus van der Giet, MD; and Peter Martus, PhD

Accurate assessment of kidney function can assist appropriate clinical care, but most estimates of creatinine clearance were developed in populations that included no or few older adults and do not perform well in this group. Researchers developed and validated 2 estimates of glomerular filtration rate (GFR), one based on creatinine only and another based on both creatinine and cystatin C measurements, in a sample of adults aged 70 years or older. Both estimates showed excellent agreement with directly measured GFR and may provide more accurate assessment of kidney function in older adults than currently used measures.

Topics: renal function, creatinine, glomerular filtration rate, iohexol, cystatin c measurement, elderly
  
Mary Reed, DrPH; Jie Huang, PhD; Ilana Graetz, BA; Richard Brand, PhD; John Hsu, MD, MBA, MSCE; Bruce Fireman, MA; and Marc Jaffe, MD

Electronic health records (EHRs) increase the availability of clinical information and facilitate decision making at the point of care, but little is known about how they influence clinical care. This study examined the association between implementing a commercially available outpatient EHR and clinical care pathways and outcomes in patients with diabetes. While a health care system sequentially introduced an EHR into multiple outpatient practices, researchers compared patients with diabetes before and after each introduction. They found improvements in monitoring, treatment, glucose control, and cholesterol levels.

Topics: ldl cholesterol lipoproteins, diabetes mellitus, hemoglobin a, outpatients, electronic medical records, diabetes ...
  

Antiretrovirals for preexposure prophylaxis (PrEP) among high-risk persons without HIV infection has emerged as an effective HIV prevention strategy. With the recent approval of oral tenofovir–emtricitabine for PrEP in high-risk populations, clinicians can now prescribe PrEP to their at-risk patients and thus should become familiar with it. This review outlines current knowledge about PrEP in primary care, including identifying persons likely to benefit from PrEP; counseling to maximize adherence and reduce potential increases in risky behavior; and monitoring for potential drug toxicities, HIV acquisition, and antiretroviral drug resistance.

Topics: tenofovir/emtricitabine, hiv prevention, iprex trial, caprisa trial, voice trial, primary care provider, ...
  
Lisa Hartling, PhD; Ahmed M. Abou-Setta, MD, PhD; Serdar Dursun, MD, PhD; Shima S. Mousavi, MD; Dion Pasichnyk, BSc; and Amanda S. Newton, RN, PhD

This systematic review compares the benefits and harms of first- versus second-generation antipsychotics for treating adults aged 18 to 64 years with schizophrenia. Overall, few differences of clinical importance were found among agents in 114 identified studies. However, the quality of the evidence was generally low or insufficient, with considerable variation in scales and subscales used to measure symptoms. The authors conclude that the current evidence base is inadequate for clinicians and patients to make informed decisions about treatment.

Topics: schizophrenia, olanzapine, atypical antipsychotic, haloperidol, antipsychotic agents, comparative effectiveness research, positive and ...
  

This U.S. Preventive Services Task Force recommendation updates its 2004 recommendation statement on screening for coronary heart disease (CHD). The Task Force recommends against screening with resting or exercise electrocardiography for the prediction of CHD events in asymptomatic adults at low risk for CHD events and concludes that the evidence is insufficient to assess the balance of benefits and harms of screening asymptomatic adults at intermediate or high risk.

Topics: electrocardiogram, exercise stress test, coronary heart disease, united states preventive services task ...
  
Lauren V. Wood, MD

On 10 May 2012, the U.S. Food and Drug Administration Antiviral Drugs Advisory Committee met to consider the use of 2 antiretroviral drugs, tenofovir and emtricitabine (Truvada), for PrEP against HIV infection. This commentary by a member of the committee discusses the data considered and why she voted against approval.

Topics: hiv transmission, tenofovir/emtricitabine, hiv prevention, iprex trial, voice trial, fem-prep, partners prep, ...
  
Judith Feinberg, MD

On 10 May 2012, the U.S. Food and Drug Administration Antiviral Drugs Advisory Committee met to consider the use of 2 antiretroviral drugs, tenofovir and emtricitabine (Truvada), for PrEP against HIV infection. This commentary by a member of the committee discusses the data considered and why she voted for approval.

Topics: hiv, tenofovir/emtricitabine, hiv prevention, iprex trial, voice trial, fem-prep, partners prep
  
Michael Meltsner, AB, JD, Doctor of Laws (Hon)
Includes: Audio/Video

In this issue, Delbanco and colleagues' study involved a program that allowed patients direct access to their primary care providers' electronic progress notes through patient portals. This editorial by a patient who participated in the study discusses the issue of sharing doctors' office notes and medical records from a patient's perspective.

Topics: medical records, patient knowledge, medical record entry, accountability, electronic medical records
  

In this issue, Delbanco and colleagues' study involved a program that allowed patients direct access to their primary care providers' electronic progress notes through patient portals. The editorialist highlights implications for practice and concludes that sharing office notes will become the norm and physicians should embrace the concept.

Topics: medical records, attitude to health, electronic medical records, primary care provider, health ...
  
Edward O. McFalls, MD, PhD
Includes: Audio/Video

Growing up in a tiny village in upstate New York, I was fortunate to have experienced the real meaning of the expression “Family Doc.” It just so happened that our “Family Doc” was not only our physician, but was also a close friend of the family. I felt privileged to experience that narrow distinction between a family friend and a family physician.

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Heidi D. Nelson, MD, MPH; Bernadette Zakher, MBBS; and Amy Cantor, MD, MPH
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R. William Vandivier, MD; Derek J. Linderman, MD; and Patricia B. Koff, RRT, Med
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Vincent S. Fan, MD, MPH; Dennis E. Niewoehner, MD; and Robert Lew, PhD
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Kah Leng Ho, MBBS; Mohammad Al Beshir, MBBS; Hala El-Zimaity, MD; Louis W.C. Liu, MD, PhD; and Louise Harris, MBChB
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Abigail Van Wyk
Includes: Audio/Video
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D. L. Longworth
Includes: Audio/Video
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Elisabeth J. Woodhams, MD; and Melissa Gilliam, MD, MPH
Includes: CME
Topics: contraceptives, oral, hormonal, intrauterine devices, sterilization, sexual, contraception, postcoital, unplanned pregnancy, injectable ...
  
Topics: electrocardiogram, coronary heart disease, united states preventive services task force
  
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