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Jeffrey T. Kullgren, MD, MS, MPH; Andrea B. Troxel, ScD; George Loewenstein, PhD; David A. Asch, MD, MBA; Laurie A. Norton, MA; Lisa Wesby, MS; Yuanyuan Tao, MS; Jingsan Zhu, MS, MBA; and Kevin G. Volpp, MD, PhD

Studies have shown that financial incentives can prompt people to lose weight, but uncertainty exists about the most effective way to structure incentives. This trial compared an employer-based, weight-loss incentive strategy that paid persons $100 for each month that they met their weight-loss goals with one that offered groups of 5 persons a $500 incentive each month divided evenly among group members who met their goals. The group incentive led to greater weight loss than the individual incentive, at the same cost to the employer.

Topics: obesity, weight reduction, employer health costs, incentives, financial incentives
  
Dariush Mozaffarian, MD, DrPH; Rozenn N. Lemaitre, PhD, MPH; Irena B. King, PhD; Xiaoling Song, PhD; Hongyan Huang, PhD; Frank M. Sacks, MD; Eric B. Rimm, ScD; Molin Wang, PhD; and David S. Siscovick, MD, MPH

Studies on the health effects of long-chain ω-3 polyunsaturated fatty acids (ω3-PUFAs) have focused on cardiovascular risk factors or secondary prevention and assessed supplement use or self-reported dietary intake rather than objective biomarkers. Thus, the relationship of ω3-PUFAs on total and cause-specific mortality is uncertain, as are the potential benefits for preventing cardiovascular disease. In this cohort of older individuals without known cardiovascular disease at baseline, higher baseline levels of specific individual and total ω3-PUFAs were associated with decreased total mortality, primarily because of fewer cardiovascular events.

Topics: fatty acids, omega-3 fatty acids, polyunsaturated fatty acid, diet, phospholipids, mortality, elderly, ...
  
Huabing Zhang, MD; Jorge Plutzky, MD; Stephen Skentzos, BA, BS; Fritha Morrison, MPH; Perry Mar, PhD; Maria Shubina, ScD; and Alexander Turchin, MD, MS

Investigators used an electronic medical record system to analyze statin discontinuation in a large cohort of patients who took statins over 8 years. More than half of the patients discontinued their statin, at least temporarily, and approximately one fifth had a statin-related event that may have prompted discontinuation. One half of these patients restarted a statin, and more than 90% were taking a statin 1 year later. These observations suggest that many patients who discontinue statins can subsequently resume and tolerate them.

Topics: statins, withdrawing treatment
  
Howard A. Fink, MD, MPH; Timothy J. Wilt, MD, MPH; Keith E. Eidman, DO; Pranav S. Garimella, MD, MPH; Roderick MacDonald, MS; Indulis R. Rutks, BS; Michelle Brasure, PhD, MSPH, MLIS; Robert L. Kane, MD; Jeannine Ouellette; and Manoj Monga, MD

Effective strategies for preventing recurrence are important in the care of patients with kidney stones. This review evaluated the evidence on benefits and harms of treatments to prevent recurrent kidney stones and the effects of patient and stone characteristics and biochemistry measures on treatment outcomes. It found that increased fluid intake reduced risk for recurrence in patients with a single prior calcium stone and that addition of thiazide, citrate, or allopurinol further reduced risk in patients with multiple prior calcium stones.

Topics: calcium calculus, nephrolithiasis, struvite stone, medical management, kidney calculi, thiazide, clinical practice ...
  
Yemisi Takwoingi, DVM; Mariska M.G. Leeflang, PhD; and Jonathan J. Deeks, PhD

Meta-analyses that compare the accuracy of diagnostic tests often include studies that do not directly compare the tests. Thus, much of what is known about the comparative accuracy of tests is based on indirect rather than direct comparisons. Authors evaluated 248 systematic reviews comparing test accuracy and found that summary estimates of accuracy differed significantly between meta-analyses of indirect and direct comparative studies. These observations suggest that robustly designed studies that directly compare diagnostic tests are needed.

Topics: positron-emission tomography, electrocardiogram, magnetic resonance imaging, echocardiography, ultrasonography, computed tomography, ultrasonography, doppler, ...
  

Infection control and exposure to environmental fungi are growing concerns in outpatients with chronic immunosuppression, but guidelines on prevention after hospital discharge in such patients are lacking. Thiscommentary discusses the issue and emphasizes that further research is needed to ensure the well-being of patients with chronic immunosuppression.

Topics: mycoses, immunocompromised host, outpatients, fungus
  
Kelly J. Caverzagie, MD; William F. Iobst, MD; Eva M. Aagaard, MD; Sarah Hood, MS; Davoren A. Chick, MD; Gregory C. Kane, MD; Timothy P. Brigham, PhD; Susan R. Swing, PhD; Lauren B. Meade, MD; Hasan Bazari, MD; Roger W. Bush, MD; Lynne M. Kirk, MD; Michael L. Green, MD; Kevin T. Hinchey, MD; and Cynthia D. Smith, MD

The Accreditation Council for Graduate Medical Education (ACGME) developed the Milestones Project to facilitate more synthetic and narrative-based assessments of educational outcomes. This commentary describes the development and use of the reporting milestones, which provide standardized language for reporting the development of competence in 6 ACGME general competencies and a framework for structuring faculty development and providing feedback to trainees.

Topics: accreditation, internal medicine, physician competencies
  

Incentive-based programs for weight loss are increasingly popular. In this issue, Kullgren and colleagues compared 2 such incentive schemes. The editorialist discusses the study and its findings and concludes that it sets the standard for how randomized, controlled trials of incentives should be conducted.

Topics: obesity, weight reduction, employer health costs, incentives, financial incentives
  

Statins are among the most widely prescribed drugs, but discontinuation rates are relatively high. In this issue, Zhang and colleagues used electronic health records to explore statin discontinuations among patients in 1 hospital system and found that many patients who discontinue statins could tolerate them if rechallenged. The editorialist discusses the study and advocates for better strategies to promote statin adherence.

Topics: statins, withdrawing treatment
  
Joel Stein, MD
Includes: Audio/Video

I walk into hospital rooms every day, but this time was different. My father was in this particular hospital room, trying to recover from total hip arthroplasty. As physicians, my father and I both knew that surgery is never risk-free, but neither of us anticipated this much postoperative drama.

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Christopher A.K.Y. Chong, MD
Includes: Audio/Video

Does anyone actually read all of the studies relevant to his or her practice? And perhaps more important, does the average clinician really need to? This is my guide to, and defense of, talking about articles you haven't read.

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Robert P. Young, MD; Raewyn J. Hopkins, MD; and David E. Midthun, MD
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John K. Field, PhD; Olaide Y. Raji, PhD; and Stephen W. Duffy, MSc
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Allen D. Seftel, MD; and Geoffrey Hackett, MD
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Antonio Aversa, MD, PhD; Emmanuele A. Jannini, MD; Mario Maggi, MD; and Andrea Lenzi, MD
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Matthew Spitzer, MD; Shehzad Basaria, MD; Thomas G. Travison, PhD; and Shalender Bhasin, MD
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Lynn S. Bemiller, MD, MPH
Includes: Audio/Video
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Benjamin Perin, BA
Includes: Audio/Video
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Joshua Uy, MD; and Mary Ann Forciea, MD
Includes: CME
Topics: hearing impairment
  
Topics: statins, withdrawing treatment
  
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