Cover photograph by Garrett M. Chinn, MD, MS
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Whether the Mediterranean diet is more effective than other low-fat diets in decreasing the risk for type 2 diabetes is unknown. Investigators randomly assigned older adults at high risk for heart disease to a Mediterranean diet supplemented with either extra-virgin olive oil or mixed nuts or to a low-fat control diet. Participants did not receive counseling regarding energy intake or physical activity. Fewer persons in the Mediterranean diet groups developed diabetes after 4 years. Changes in dietary patterns that do not necessarily lead to weight loss could help prevent diabetes in some older adults.
Most childhood cancer survivors receive health care from primary care physicians as adults. In this survey of general internists, half provided care for adult childhood cancer survivors, and most had never received a treatment summary from a referring cancer center. Internists were “somewhat uncomfortable” caring for survivors of Hodgkin lymphoma, acute lymphoblastic leukemia, and osteosarcoma and were “somewhat unfamiliar” with available surveillance guidelines. This survey suggests that education and communication with oncologists might improve internists' familiarity with the appropriate care of childhood cancer survivors.
Diabetic macular edema (DME) is a major cause of diabetes-related morbidity. Current DME therapies include laser treatment, intraocular injections of triamcinolone or vascular endothelial growth factor (VEGF) inhibitors, and combinations of laser treatment plus triamcinolone or VEGF inhibitor injections. Using mathematical models, investigators compared the lifetime costs and effectiveness of these treatments. The most effective treatment was VEGF inhibitor injection with or without laser treatment, and it compared favorably with other interventions considered to be cost- effective.
Invasive meningococcal disease is life-threatening, and current recommendations for meningococcal vaccine do not include HIV-infected adults. Investigators linked databases of HIV infection and invasive meningococcal disease in New York City and found that, compared with the general population, people living with HIV/AIDS had a relative risk for invasive meningococcal disease of 10. Risk was greatest in those with CD4+ counts less than 0.200 × 109 cells/L. Adults with HIV infection may be appropriate candidates for routine immunization with meningococcal vaccine.
High-quality guidelines could help clinicians mitigate the risks of opioid therapy. The authors identified and evaluated 13 guidelines that address opioid therapy for chronic pain management in adults. Evidence supporting the guidelines was limited, and development methods varied. However, the guidelines agree on several opioid risk mitigation strategies, including upper dosing thresholds; cautions with certain medications; attention to drug–drug and drug–disease interactions; and use of risk assessment tools, treatment agreements, and urine drug testing.
The meaningful use program has increased adoption of health information technology. This review examined evidence on functionalities prescribed in meaningful use regulations and found that 60% of the included studies evaluated clinical decision support and computerized provider order entry, lities were rarely evaluated. Uniformly positive results were reported in 58%, and mixed-positive effects in an additional 20%. Context and implementation details were poorly reported. Health information technology literature is expanding but not producing sufficient useful knowledge.
The U.S. Preventive Services Task Force updates its recommendation on screening for oral cancer. The recommendation focuses on oral cavity screening performed by primary care providers, not by dental providers or otolaryngologists. The Task Force concludes that the evidence is insufficient to assess the balance of benefits and harms of screening by primary care providers for oral cancer in asymptomatic adults.
Chronic health problems in persons with behavioral health conditions and high rates of early death have motivated efforts to integrate behavioral health and primary care services. Efforts include cross-referral or bidirectional efforts to add some features of primary care to specialty behavioral health care settings or vice versa. The authors propose a third approach based on full service and financial integration and discuss how it differs from the other models.
In this issue, Henderson and colleagues surveyed U.S. internists caring for adult survivors of childhood cancer, highlighting some issues that compromise the care they provide to such patients. The editorialists discuss the survey's findings and conclude that successful care of childhood cancer survivors is a shared responsibility among pediatric oncology care providers, patients acting as their own advocates, and internists who will care for this growing patient population.
I must admit to a certain admiration for the chutzpah of those who simply recycle an old idea and then take credit for inventing it, and I stand amazed that the medical establishment applauds them for it.