Cover photograph by Richard Gascho, MD
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IN THIS ISSUE
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Daily aspirin seems to decrease risk for cancer, but evidence in women and for alternate-day aspirin use is lacking. This observational follow-up of the Women's Health Study found that long-term use of alternate-day, low-dose (100-mg) aspirin was associated with reduced risk for colorectal cancer; increased risk for gastrointestinal bleeding and peptic ulcers; and no association with risk for total, breast, or lung cancer. These data suggest that, in healthy women, long-term use of alternate-day, low-dose aspirin may reduce risk for colorectal cancer but increase risk for gastrointestinal bleeding.
In this small randomized trial of patients with both genotype 1 hepatitis C virus and HIV, adding telaprevir to peginterferon-α2a (PEG-IFN-α2a)–ribavirin therapy produced a greater sustained virologic response than PEG-IFN-α2a–ribavirin alone. No HIV breakthroughs occurred, but adverse events were more common in patients treated with telaprevir plus PEG-IFN-α2a–ribavirin. These promising preliminary results await confirmation in an ongoing, larger randomized trial and in patients receiving other HIV treatment regimens.
Although some proponents of electronic health records (EHRs) speculate that EHR use will result in cost savings due to increased efficiency, evidence to support this hypothesis is lacking. This analysis of EHR implementation by 806 ambulatory care clinicians in 3 Massachusetts communities did not identify statistically significant cost savings, but the results suggest that EHRs in community-based outpatient practices will not decrease but might slow the increase in health care costs.
The use of generic instead of brand-name drugs could reduce health care costs. This study compared the use of brand-name diabetes drugs within Medicare Part D and the U.S. Department of Veterans Affairs (VA). It found that the use of brand-name drugs for treating patients with diabetes, including oral hypoglycemics, long-acting insulins, angiotensin-converting enzyme inhibitors, and statins, was 2 to 3 times higher in Medicare Part D than in the VA. The authors estimate that more than $1 billion could have been saved if Medicare use of generic drugs had mirrored that of the VA during the study.
This systematic review for the U.S. Preventive Services Task Force examined the accuracy of screening tests for gestational diabetes. The authors found that the oral glucose challenge test and the fasting plasma glucose test were good at ruling out gestational diabetes in pregnant women, but the former test was better at identifying women with gestational diabetes.
This systematic review for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research evaluated 11 studies that addressed maternal or fetal benefits and harms of therapies, including diet modification, glucose monitoring, and insulin, for gestational diabetes. Moderate-quality evidence showed that treatment resulted in less preeclampsia, shoulder dystocia, and macrosomia. Evidence was low or insufficient for other outcomes, such as maternal weight gain, cesarean delivery, birth injury, neonatal hypoglycemia, or admission to a neonatal intensive care unit.
Standard meta-analyses compare only 2 interventions at a time. Network meta-analyses enable assessment of the relative effectiveness of multiple interventions. This article elucidates the main characteristics of network meta-analysis, focuses on questions about its main conceptual and technical challenges, and offers advice on addressing these challenges.
This Update summarizes studies published in 2012 that the authors consider highly relevant to the practice of hospital medicine. Topics include perioperative myocardial infarction, anticoagulation, inpatient care, and transfusion medicine.
An emergency medicine physician discusses how being prepared helped him and his colleagues save lives after the Boston Marathon bombing.
A Boston physician comments on the striking contrast between Boston's health care climate before and after the Boston Marathon bombing.
A physician involved in the care of the youngest victims of the 2010 Haiti earthquake as well as the Boston Marathon bombing reflects on the differences in the outcomes of disasters when well-trained first responders are available.
In this issue, Cook and colleagues examined treatment with alternate-day, low-dose aspirin in middle-aged women in the Women's Health Study. The editorialist discusses the study's findings and concludes that they should temper any recommendations for widespread use of aspirin in healthy middle-aged women and reinforce the need to consider the risks and benefits of aspirin separately in men and women.
In this issue, Adler-Milstein and colleagues address the relationship between the use of EHRs and the costs of health care and found that EHRs in a community-based setting seem to slow ambulatory cost growth. The editorialist discusses the study's findings as well as the questions it raises.
I am a supporter of Washington Death with Dignity Act, but I had not anticipated that I would become an enactor of such a death, and not in a patient who I had come to love.