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Jeanne M. Ferrante, MD, MPH; Ji-Hyun Lee, DrPH; Ellen P. McCarthy, PhD, MPH; Kate J. Fisher, MA; Ren Chen, MD, MPH; Eduardo C. Gonzalez, MD; Kymia Love-Jackson, MBA; and Richard G. Roetzheim, MD, MSPH

Many people who could benefit are not screened for colorectal cancer (CRC) in the United States, but primary care may play an important role in increasing screening rates. This study examined the association of utilization of primary care with CRC incidence and death among Medicare beneficiaries and found that beneficiaries who had more primary care visits had lower CRC incidence, CRC-specific mortality, and all-cause mortality. Improving access to primary care and encouraging people to use primary care may help decrease the national burden of CRC.

Topics: colorectal cancer, medicare, pentachlorophenol, primary health care, mortality, polypectomy, colorectal cancer screening ...
  
Jason Wagner, MD, MSHP; Nicole B. Gabler, PhD; Sarah J. Ratcliffe, PhD; Sydney E.S. Brown, PhD; Brian L. Strom, MD, MPH; and Scott D. Halpern, MD, PhD

Intensive care units (ICUs) may have no open beds or inadequate staffing at times; thus, ICU patients may be discharged sooner than desired. This study examined how >3 metrics of ICU capacity strain influence ICU length of stay and post–ICU discharge outcomes. When ICUs were strained, patients stayed for a shorter time and were somewhat more likely to be readmitted to the ICU. However, there were no increases in patient mortality rates, no greater overall length of hospital stay, and no reductions in the odds of being discharged from the hospital to home.

Topics: intensive care unit, hospitals
  
Alicia L. Cooper, MPH, PhD; Lewis E. Kazis, ScD; David D. Dore, PharmD, PhD; Vincent Mor, PhD; and Amal N. Trivedi, MD, MPH

Hospitals, managed care plans, and other providers are required to publicly report quality indicators and other performance measures, but these efforts are not routinely audited and their accuracy is unknown. This study compared the calculated and reported rates of high-risk drug prescribing among elderly patients in Medicare Advantage plans. Investigators found that most plans underreported their enrollees' use of high-risk drugs. The findings suggest a need for routine audits to ensure the validity of publicly reported quality measures and additional studies to determine their accuracy.

Topics: elderly, prescribing behavior, medicare advantage, healthcare effectiveness data information set, cross-sectional studies, ...
  
Meng Lee, MD; Jeffrey L. Saver, MD; Keun-Sik Hong, MD, PhD; Neal M. Rao, MD; Yi-Ling Wu, MS; and Bruce Ovbiagele, MD, MS

This meta-analysis examined the risk for recurrent stroke and intracranial hemorrhage (ICH) with long-term dual- and single-antiplatelet therapy among patients with ischemic stroke and transient ischemic attack (TIA). Recurrent stroke risk did not differ between patients receiving dual-antiplatelet therapy versus aspirin or clopidogrel monotherapy. Risk for ICH did not differ between patients receiving dual-antiplatelet therapy versus aspirin monotherapy but was greater with dual-antiplatelet therapy than with clopidogrel monotherapy. Long-term dual-antiplatelet therapy after an index ischemic stroke or TIA is not associated with a greater reduction in overall risk for recurrent stroke.

Topics: aspirin, ischemic stroke, clopidogrel, transient ischemic attack
  
Amir Qaseem, MD, PhD, MHA; Jon-Erik C. Holty, MD, MS; Douglas K. Owens, MD, MS; Paul Dallas, MD; Melissa Starkey, PhD; Paul Shekelle, MD, PhD, and Clinical Guidelines Committee of the American College of Physicians
Includes: CME | Audio/Video

The American College of Physicians recommends that all overweight and obese patients diagnosed with obstructive sleep apnea (OSA) should be encouraged to lose weight. It also recommends continuous positive airway pressure (CPAP) treatment as initial therapy and mandibular advancement devices as an alternative therapy for patients who prefer them or have adverse effects associated with CPAP treatment.

Topics: continuous positive airway pressure
  
Virginia A. Moyer, MD, MPH, and U.S. Preventive Services Task Force

The U.S. Preventive Services Task Force concluded that the evidence is insufficient to recommend for or against screening for primary open-angle glaucoma in asymptomatic adults. This recommendation applies to adults who do not have vision symptoms and are seen in a primary care setting.

Topics: glaucoma, prevention, screening test
  

Mounting evidence is fueling excitement over the possibility of curing HIV infection. Research aimed at eliminating the need for continuous antiretroviral therapy includes a range of approaches, from bone marrow transplantation and aggressive early treatment of HIV infection to withdrawal of antiretroviral therapy to permit the killing of HIV in biological reservoirs. This commentary discusses the complex ethical issues associated with such research.

Topics: hiv, ethics
  
Zackary D. Berger, MD, PhD; and Samuel M. Brown, MD, MS

Modern hospitals represent the pinnacle of technologic medicine, but this commentary argues that such technical proficiency has created distance between the goals of health care and healing. The authors discuss how hospitals can be made less like airports and more like healing spaces that encourage patients and providers to recognize their particular needs as individuals.

Topics: hospitals
  

In this issue, Ferrante and colleagues offer further evidence that contact between a patient and a primary care provider results in higher rates of CRC screening. The editorialists discuss the study and its findings and conclude that increasing access to health care to everyone is likely to be one of the most effective interventions to reduce morbidity and mortality from such preventable diseases as CRC.

Topics: primary health care
  
Matthew L. Maciejewski, PhD; and Joseph T. Hanlon, PharmD, MS

In this issue, Cooper and colleagues compared rates of high-risk prescribing reported by Medicare Advantage plans with those they calculated using the same data. They found that nearly 95% of plans underreported rates of high-risk prescribing. The editorialists discuss the study and its findings and conclude that accuracy of publicly reported quality measures is an underexamined area that requires more attention.

Topics: outpatients, inappropriate drug prescribing
  
Jessica A. Gold, MS
Includes: Audio/Video

Heart racing, I had no clue what was going on in the operating room. The attending filled me in on my role: “You make your hands like an alligator, and you put the heart in between them and you pump it |PO that's how you do cardiac massage. Go.”

Topics: #
  
Jeremy D. Graham, MA, DO
Includes: Audio/Video

For the individual, a joke may release and redirect repressed feelings of stress. Within a social group, gibes about outsiders communicate collective self-image of group superiority. Our utterances about “Outside Hospital” probably serve both functions in teaching centers.

Topics: #
  
Serena Granziera, MD; and Alexander T. Cohen, MD, MBBS, MSc
Topics: #
  
David R. Anderson, MD; Michael J. Dunbar, MD; and Susan R. Kahn, MD
Topics: #
  
Donald J. Martin, MD; Brett J. Partridge, MD; and William Shields, DO
Topics: dietary supplements, hepatotoxicity, liver, injury of
  
Noelle M. Northcutt, MD
Includes: Audio/Video
Topics: #
  
Corey D. Fogleman, MD
Includes: Audio/Video
Topics: #
  
Marianthi Kiriakidou, MD
Includes: CME
Topics: encephalitis, st. louis, lupus nephritis, lupus vulgaris, therapeutics, systemic lupus erythematosus
  
Topics: colorectal cancer, primary health care
  
Topics: glaucoma, advisory committees, united states preventive services task force, prevention
  
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