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The U.S. Preventive Services Task Force recently recommended against prostate-specific antigen (PSA)–based screening for prostate cancer. This modeling study compared 35 screening strategies that differed by ages to start and stop screening, screening intervals, and thresholds for biopsy. Compared with standard screening, using higher thresholds for biopsy referral for older men and screening men with initially low PSA levels less frequently seems to reduce harms of screening while saving lives. The findings may help in clinician–patient discussions about whether and how to be screened.

Topics: prostate-specific antigen, prostate cancer, prostate-specific antigen screening, prostate biopsy, prostate cancer screening, ...
  
Thomas M. Kerkering, MD; Marissa L. Grifasi, PharmD; Anthony W. Baffoe-Bonnie, MD; Ekta Bansal, MD; Dorothy C. Garner, MD; Jean A. Smith, MD; Deborah D. Demicco, MD; Charles J. Schleupner, MD; Rabia A. Aldoghaither, MD; and Vipul A. Savaliya, MD

In fall 2012, an outbreak of fungal meningitis caused by contaminated epidural steroid injections occurred in the United States. This article discusses the successful response at a Virginia hospital and reports the early observations on patients found to have meningitis. Hospital staff rapidly set up a telephone screening program for patients presenting with a history of possible exposure and developed uniform protocols for diagnosis, treatment, and follow-up in real time. Patients continue to be followed, and long-term outcomes, including optimum treatment duration, are unknown.

Topics: meningitis, amphotericin b, fungal meningitis, leukocyte count, methylprednisolone, cerebrospinal fluid, voriconazole, epidural ...
  
Laura F. DeFina, MD; Benjamin L. Willis, MD, MPH; Nina B. Radford, MD; Ang Gao, MS; David Leonard, PhD; William L. Haskell, PhD; Myron F. Weiner, MD; and Jarett D. Berry, MD, MS

Identification of modifiable risk factors is important for public health efforts to prevent dementia. This observational study in healthy community-dwelling adults found that higher treadmill-measured levels of physical fitness in middle age were associated with lower hazards of developing all-cause dementia after age 65 years, independent of previous stroke. If the findings are verified, a lower physical fitness level may be a modifiable risk factor for dementia.

Topics: physical fitness, dementia, elderly
  
George L. Jackson, PhD, MHA; Benjamin J. Powers, MD, MHS; Ranee Chatterjee, MD, MPH; Janet Prvu Bettger, ScD; Alex R. Kemper, MD, MPH, MS; Vic Hasselblad, PhD; Rowena J. Dolor, MD, MHS; R. Julian Irvine, MCM; Brooke L. Heidenfelder, PhD; Amy S. Kendrick, RN, MSN; Rebecca Gray, DPhil; and John W. Williams Jr., MD, MHS

The patient-centered medical home (PCMH) model seeks to meet the health care needs of patients and improve patient and staff experiences, outcomes, safety, and system efficiency. This review of PCMH implementation and its effects found evidence that PCMH interventions have a positive effect on patient experiences (small), preventive care services (small to moderate), and staff experiences (small to moderate). The PCMH holds promise for improving the experiences of patients and staff and care processes, but current evidence is insufficient to determine effects on clinical and economic outcomes.

Topics: medical home
  
Shelley S. Selph, MD; Christina Bougatsos, MPH; Ian Blazina, MPH; and Heidi D. Nelson, MD, MPH
Includes: CME

In 2004, the U.S. Preventive Services Task Force found insufficient evidence to recommend behavioral interventions and counseling to prevent child abuse and neglect. This systematic review summarizes studies published since the 2004 recommendation. It found evidence that risk assessment and behavioral interventions in pediatric clinics reduced abuse and neglect outcomes for children aged 5 years or younger. Early childhood home visitation also reduced abuse and neglect, but results were inconsistent. Additional research on such interventions is needed.

Topics: behavior therapy, counseling, child abuse, neglect, neglect of child
  
An-Wen Chan, MD, DPhil; Jennifer M. Tetzlaff, MSc; Douglas G. Altman, DSc; Andreas Laupacis, MD; Peter C. Gøtzsche, MD, DrMedSci; Karmela Krleža-Jerić, MD, DSc; Asbjørn Hróbjartsson, PhD; Howard Mann, MD; Kay Dickersin, PhD; Jesse A. Berlin, ScD; Caroline J. Doré, BSc; Wendy R. Parulekar, MD; William S.M. Summerskill, MBBS; Trish Groves, MBBS; Kenneth F. Schulz, PhD; Harold C. Sox, MD; Frank W. Rockhold, PhD; Drummond Rennie, MD; and David Moher, PhD

The protocol of a clinical trial plays a key role in study planning, conduct, reporting, and appraisal, but protocols and existing protocol guidelines vary greatly in content and quality. This article describes the systematic development and scope of SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013, a guideline to facilitate the drafting of high-quality protocols.

Topics: clinical trials, institutional review board, guidelines, clinical trial protocol document
  
Advisory Committee on Immunization Practices†
Includes: Audio/Video

The Advisory Committee on Immunization Practices (ACIP) presents the recommended Adult Immunization Schedule for 2013. This schedule has been approved by the ACIP, American Academy of Family Physicians, American College of Physicians, American College of Obstetrics and Gynecology, and American College of Nurse-Midwives.

Topics: adult immunization, influenza virus vaccine, vaccination, vaccines, 13-valent pneumococcal vaccine, measles-mumps-rubella vaccine ...
  

As of 10 December 2012, there were 368 cases of meningitis, 192 cases of paraspinal/spinal infections, and 21 cases of arthritis clustered in 19 states, with 37 deaths, due to contaminated methylprednisolone acetate injections. This article focuses on questions likely to be on clinicians' minds: how should clinicians approach exposed persons, treat presumed or documented fungal infection, and move forward with so many unknowns.

Topics: meningitis, mycoses, fungal meningitis, iatrogenic disorders, mold
  

Although recommendations on the optimal approach to prostate cancer screening are conflicting and controversial, screening with PSA has been adopted widely. In this issue, Gulati and colleagues provide a simulation model that estimates PSA trajectory and disease progression under 35 screening strategies. The editorialist discusses PSA-based prostate cancer screening and the study's findings.

Topics: prostate-specific antigen, prostate cancer, prostate-specific antigen screening, prostate cancer screening
  

Physical fitness is beneficial in several health areas. In this issue, DeFina and colleagues find that cardiorespiratory fitness levels in midlife were associated with lower risk for dementia later in life. The editorialist discusses the study's findings, concluding that physical activity does seem to be a reasonable prescription for dementia prevention.

Topics: physical fitness, dementia, physical activity, cognition
  
Joe Chiovaro, MD
Includes: Audio/Video

I thought about the Shakespeare quote and the roles I play to different audiences throughout the day. I thought about how we all move through the paces of short productions from moment to moment, using props, scripted dialogue, and more than a little improvisation.

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Erin N. Wilmer, BS
Includes: Audio/Video

Do you have any idea how frustrating you were? You refused to take certain medications; contested every blood draw; limited all your responses to “yes,” “no,” or “I don't know.” Nonadherence was the reason you were admitted to the hospital in the first place.

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Paul Kempen, MD, PhD
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Marc S. Frager, MD
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James J. Glazier, MD
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Connie Nugent, MLS; and Kenneth M. Nugent, MD
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Humayun J. Chaudhry, DO, MS, SM; Lance A. Talmage, MD; and Janelle A. Rhyne, MD, MA
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Jennifer A. Meddings, MD, MSc; and Laurence F. McMahon Jr., MD, MPH
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Russell H. Horwitz, MD, PhD; Laura W. Roberts, MD; David W. Seal, PhD; Patrice Joseph, MD; Karen J. Maschke, PhD; Rose I. Verdier, MD; Sandy Nerette, MD; Jean W. Pape, MD; and Daniel W. Fitzgerald, MD
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Brenda Butka, MD
Includes: Audio/Video
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Ramin Ahmadi, MD, MPH
Includes: Audio/Video
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Kimberly Workowski, MD
Topics: gonococcal infection, sexually transmitted diseases, chlamydia
  
Topics: prostate-specific antigen, prostate cancer, prostate-specific antigen screening, prostate cancer screening
  
Topics: physical fitness, dementia
  
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