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Diabetes increases risk for cardiovascular disease (CVD), but how metformin and sulfonylureas affect that risk is not clear. In this analysis of U.S. veterans who initiated metformin or sulfonylurea therapy for diabetes, new use of sulfonylureas seemed to increase the incidence of and risk for CVD events (acute myocardial infarction or stroke) and death compared with metformin. Whether sulfonylureas are harmful, metformin is protective, or both remains unclear.
After an initial negative result on colonoscopy, guidelines recommend repeating the procedure every 10 years. This simulation study found that rescreening every 5 years with computed tomographic colonography or every year with fecal occult blood testing or fecal immunochemical testing yielded similar life expectancy as rescreening in 10 years with colonoscopy but with fewer complications and lower cost. This model suggests that techniques other than colonoscopy may be reasonable alternatives for subsequent screening after an initial negative screening colonoscopy.
Rotavirus gastroenteritis is generally considered a childhood disease but can also occur in older adults. Using surveys and medical chart abstraction, investigators examined diarrheal disease outbreaks reported in 2 Illinois retirement facilities in 2011. At both facilities, rotavirus genotype G2P was detected. Attack rates were high, a substantial percentage of patients were hospitalized, viral shedding was prolonged in some individuals, and some employees were also infected. Rotavirus should be considered as a cause of acute gastroenteritis in adults.
This review evaluated the effectiveness of available physical therapy interventions for adults with knee osteoarthritis. It found low-strength evidence that interventions that empower patients to actively self-manage knee osteoarthritis (such as aerobic, aquatic, strengthening, and proprioception exercise) improved selected patient-centered outcomes. No single intervention, however, improved all outcomes.
This review examined the effectiveness of screening followed by behavioral counseling, with or without referral, for alcohol misuse in primary care settings. Among 23 included trials, brief multicontact interventions had the strongest evidence for effectiveness. Among adults receiving behavioral interventions, consumption decreased, fewer reported heavy drinking episodes, and more reported drinking less than the recommended limits. Evidence was insufficient to draw conclusions about accidents, injuries, or alcohol-related liver problems.
This U.S. Preventive Services Task Force recommendation updates its 1996 recommendation statement on screening for hearing impairment in older adults. The Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in asymptomatic adults aged 50 years or older.
Drug treatment of asymptomatic hypertriglyceridemia has long been controversial. In the absence of evidence that drug treatment of moderate hypertriglyceridemia reduces vascular events, guidelines have stopped short of recommending it. However, unproven hypotheses that triglyceride levels of 500 mg/dL or greater (≥5.65 mmol/L) carry a substantial risk for pancreatitis in asymptomatic persons and that drugs can reduce this risk seem to have been incorporated into medical practice without question. This commentary argues that this practice should cease.
In this invited commentary, David Blumenthal provides his perspective on the impact of the 2012 presidential election on health care. He believes that the next President will profoundly influence the future of the U.S. health system. Although voters' views on the economy will probably determine the outcome of the election, he urges the electorate to focus on health care.
In this invited commentary, Robert Berenson provides his perspective on the impact of the 2012 presidential election on health care. He believes that, regardless of who the next President is, politics will likely work to reinforce the status quo. He also notes that there is broad consensus that payment approaches need to evolve from “volume” to “value.”
In this invited commentary, Gail Wilensky provides her perspective on the impact of the 2012 presidential election on health care. She outlines important differences on how each candidate would expand coverage and slow spending. She believes that the most daunting challenges will remain no matter who is elected: how to fix the resource-based relative value scale/sustainable growth rate reimbursement conundrum and the looming threats from sequestration.
In this issue, Roumie and colleagues' study renews the controversy about the safety of sulfonylureas for diabetes. The editorialist notes that knowledge about the comparative effectiveness of drugs to treat type 2 diabetes is beginning to emerge from a 40-year era of stagnation, unveiling important lessons about the use of surrogate end points in drug development, regulatory oversight, and the hazards associated with reliance on commercial funding for pivotal clinical trials.
In this issue, Knudsen and colleagues examine the effectiveness and costs of colonoscopy versus other rescreening strategies in a hypothetical average-risk population whose first colonoscopy at age 50 years is normal. The editorialists discuss the study findings and conclude that it emphasizes an important lesson: Any effective screening test is better than no test.
As an internal medicine residency program director, I read hundreds of personal statements every year. I hate them all. Not the candidates, but their personal statements: There's really very little that's personal about them.