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Benno Brinkhaus, MD; Miriam Ortiz, MD; Claudia M. Witt, MD, MBA; Stephanie Roll, PhD; Klaus Linde, MD; Florian Pfab, MD; Bodo Niggemann, MD; Josef Hummelsberger, MD; András Treszl, PhD; Johannes Ring, MD, PhD; Torsten Zuberbier, MD; Karl Wegscheider, PhD; and Stefan N. Willich, MD, MPH

Many patients with seasonal allergic rhinitis seek alternative therapies. This randomized trial evaluated the effects of acupuncture in patients with seasonal allergic rhinitis that was inadequately controlled with antihistamine therapy. Measures of rhinitis-specific quality of life and antihistamine use improved after 8 weeks of acupuncture compared with sham acupuncture. Acupuncture exhibited statistically significant improvements in symptoms compared with sham acupuncture, but the clinical significance and mechanism of the observed improvements are uncertain.

Topics: acupuncture procedure, hay fever
  
Priya Duggal, PhD; Chloe L. Thio, MD; Genevieve L. Wojcik, MHS; James J. Goedert, MD; Alessandra Mangia, MD; Rachel Latanich, BS; Arthur Y. Kim, MD; Georg M. Lauer, PhD; Raymond T. Chung, MD; Marion G. Peters, MD; Gregory D. Kirk, MD, PhD; Shruti H. Mehta, PhD; Andrea L. Cox, MD, PhD; Salim I. Khakoo, MD; Laurent Alric, MD, PhD; Matthew E. Cramp, MD; Sharyne M. Donfield, PhD; Brian R. Edlin, MD; Leslie H. Tobler, DrPH; Michael P. Busch, MD, PhD; Graeme Alexander, MD; Hugo R. Rosen, MD; Xiaojiang Gao, PhD; Mohamed Abdel-Hamid, MD, PhD; Richard Apps, PhD; Mary Carrington, PhD; and David L. Thomas, MD

Persons of African ancestry are less likely than others to have spontaneous clearance of hepatitis C virus (HCV) infection. This genome-wide association study identified genes that were independently associated with spontaneous clearance of HCV infection and explained a substantial amount of the variation in HCV clearance seen among patients of different ancestries. Genetic testing may predict the likelihood of spontaneous resolution of HCV infection, thus allowing tailored therapy for individual patients.

Topics: hepatitis c, single nucleotide polymorphism, hepatitis c virus, genome-wide association study, alleles, ...
  
Claudia I. Henschke, PhD, MD; Rowena Yip, MPH; David F. Yankelevitz, MD; James P. Smith, MD, for the International Early Lung Cancer Action Program Investigators*

The threshold to define a positive result on chest computed tomography (CT) screening for lung cancer will affect the number of patients who undergo subsequent evaluation. This retrospective analysis of a large lung cancer screening cohort study found that increasing the definition of a positive screen to nodules larger than 7 or 8 mm would have substantially reduced the number of false-positive results. Delays in diagnosing cancer would have occurred in a few patients, but the clinical significance of these delays is unclear. Alternative thresholds for positive results on lung cancer CT screening should be evaluated prospectively.

Topics: computed tomography, lung cancer, pulmonary nodule, i-elcap trial, lung cancer screening, false-positive ...
  
Carrie D. Patnode, PhD, MPH; Elizabeth O'Connor, PhD; Evelyn P. Whitlock, MD, MPH; Leslie A. Perdue, MPH; Clara Soh, MPA; and Jack Hollis, PhD

This review was done to update the 2003 U.S. Preventive Services Task Force recommendation on counseling interventions to prevent initiation and promote cessation of tobacco use in children and adolescents. Among the 19 trials that met inclusion criteria, behavior-based interventions reduced smoking initiation among young nonsmoking persons, but neither behavior-based nor bupropion interventions improved cessation rates among those who smoked. Most studies included in the review, however, were published 5 to 15 years ago and were generally of fair quality. These findings suggest that the best strategy to reduce tobacco use in children and adolescents is to prevent tobacco initiation.

Topics: smoking cessation, primary health care, tobacco use cessation, tobacco use, smoking, bupropion ...
  
Eliano P. Navarese, MD, PhD; Paul A. Gurbel, MD; Felicita Andreotti, MD, PhD; Udaya Tantry, PhD; Young-Hoon Jeong, MD, PhD; Marek Kozinski, MD, PhD; Thomas Engstrøm, MD; Giuseppe Di Pasquale, MD; Waclaw Kochman, MD; Diego Ardissino, MD; Elvin Kedhi, MD; Gregg W. Stone, MD; and Jacek Kubica, MD, PhD
Includes: CME

Debate remains regarding the optimal timing of invasive therapy for patients with non–ST-segment elevation acute coronary syndrome. This meta-analysis assessed available evidence on early versus delayed invasive treatment. Among 7 trials and 4 observational studies, early intervention was associated with a nonsignificant decrease in mortality, a nonsignificant increase in myocardial infarction, and a decrease in major bleeding, compared with delayed intervention. The findings indicate that early intervention offers little or no statistically significant clinical benefit compared with a delayed invasive approach.

Topics: acute coronary syndromes, st segment elevation, non-st-segment acute coronary syndromes, revascularization
  
Michael V. Boland, MD, PhD; Ann-Margret Ervin, PhD, MPH; David S. Friedman, MD, MPH, PhD; Henry D. Jampel, MD; Barbara S. Hawkins, PhD; Daniela Vollenweider, MD; Yohalakshmi Chelladurai, MBBS, MPH; Darcy Ward, BA; Catalina Suarez-Cuervo, MD; and Karen A. Robinson, PhD
Includes: CME

This systematic review, conducted to inform an upcoming U.S. Preventive Services Task Force recommendation on screening for glaucoma, examined the comparative effectiveness of medical, laser, and incisional surgery treatments for open-angle glaucoma. It found high-level evidence suggesting that these treatments decrease intraocular pressure and that medical treatment and trabeculectomy reduce the risk for optic nerve damage and visual field loss compared with no treatment. The direct effect of treatments on visual impairment and the comparative efficacy of treatments, however, are not clear.

Topics: glaucoma, open-angle glaucoma, lasers, trabeculectomy, intraocular pressure, comparative effectiveness research, blindness, timolol, ...
  
Jill A. Hayden, DC, PhD; Danielle A. van der Windt, PhD; Jennifer L. Cartwright, MSc; Pierre Côté, DC, PhD; and Claire Bombardier, MD

Well-conducted prognostic research can help to inform clinical decision making, and critical appraisal of prognostic studies is essential to assess and identify biases that could distort study results. This article describes the development and use of the Quality In Prognosis Studies (QUIPS) tool, which assesses risk of bias in studies of prognostic factors.

Topics: bias (epidemiology), prognostic factors, prognostic study
  
Remy R. Coeytaux, MD, PhD; and Jongbae J. Park, DKM, PhD, LAc

In this issue, Brinkaus and colleagues evaluated the effectiveness of acupuncture in the treatment of seasonal allergic rhinitis. The editorialists discuss the study and its findings and envision future research to compare acupuncture with proven medical therapies that can inform patients, clinicians, policymakers, payers, and other stakeholders of the potential role of acupuncture in our health care system.

Topics: hay fever, acupuncture procedure, comparative effectiveness research
  
Stephen Lam, MD; Annette McWilliams, MB; John Mayo, MD; and Martin Tammemagi, PhD

In this issue, Henschke and colleagues examined the tradeoff between a larger threshold for nodule size to define a positive lung cancer screen on CT and the risk for delayed diagnoses. The editorialists discuss the study and its findings and call for sophisticated modeling studies to define the tradeoffs of different thresholds for a positive CT screen for lung cancer.

Topics: computed tomography, lung cancer, pulmonary nodule, i-elcap trial, lung cancer screening, nlst ...
  

When I decided to become a trauma surgeon, I never knew that I would be anyone's family doctor. My story isn't unusual among trauma surgeons and emergency physicians at urban hospitals, but it doesn't have to be.

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Faith T. Fitzgerald, MD; and Michael A. LaCombe, MD
Includes: Audio/Video

I had never been a match for her, not in all the years of our friendship and too-infrequent contacts. What, I wondered to myself, would be apt for discussion on this, a landmark birthday? “Have you checked in with your Watcher?" she asked.

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Preston K. Andrews, PhD
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Crystal Smith-Spangler, MD, MS; Margaret L. Brandeau, PhD; Ingram Olkin, PhD; and Dena M. Bravata, MD, MS
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Topics: myocardial infarction, hormone replacement therapy, heart failure, postmenopause, cardiovascular event
  
Topics: dementia, cholinesterase inhibitors, minimal cognitive impairment
  
Topics: respiratory tract infections, treatment failure, antibiotic therapy, procalcitonin
  
Topics: heart failure, chronic, heart failure, exercise, oxygen consumption, quality of life
  
Topics: cardiovascular event, multivitamins
  
Topics: systemic infection, adrenal gland hypofunction, etomidate, septicemia, mortality, rapid-sequence intubation
  
Topics: dementia, caregiver, neurobehavioral manifestations
  
Topics: heart failure, systolic, heart failure, diet, diet, sodium-restricted, mortality, sodium
  
Topics: chronic obstructive airway disease, glucocorticoids, inhaler, inhaled corticosteroid, long-acting inhaled beta-agonist, morbidity ...
  
Topics: feedback, guideline adherence, medical audit, patient-focused outcomes
  
Topics: ambulatory surgical procedures, venous thromboembolism
  
Topics: acute cerebrovascular accidents, ischemic stroke, disability, prediction rule
  
Topics: hay fever, acupuncture procedure
  
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