Cover photograph by Perry Pong, MD
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IN THIS ISSUE
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How often and at what ages women should receive mammography screening are subjects of great debate. Cost differences also exist among screening recommendations by professional organizations, varying by at least $8 billion per year. This study describes a model that estimates the cost of annual, biennial, and U.S. Preventive Services Task Force guideline strategies to determine which would provide the most efficient use of resources.
Little is known about the frequency of repeated esophago-gastroduodenoscopy (EGD) and the diagnoses that drive it. This retrospective analysis describes the frequency of repeated EGD in the Medicare population and determines the diagnoses most often associated with it. One third of Medicare beneficiaries who have EGD are likely to have a repeated examination within 3 years. Almost one half of these procedures seem unjustified by the diagnosis at index or repeated EGD, which suggests overuse of the procedure.
Adults are at risk for vaccine-preventable disease, but vaccination rates in adults remain low. This article reports a survey of U.S. general internists and family physicians to evaluate barriers to stocking and administering vaccines; practices in assessing vaccination status; and practices, experiences, and attitudes about vaccination outside of physician practices.
Fecal immunochemical tests are used to screen for colorectal cancer, but their performance characteristics have been inconsistent. This review examines the diagnostic accuracy of these tests by analyzing subgroups classified by sample numbers, cutoff values for a positive test result, test brands, and reference standards. Investigators found that these tests have high accuracy, high specificity, and moderately high sensitivity for detection of colorectal cancer and that performance depends on the cutoff value for a positive test result.
The Kidney Disease: Improving Global Outcomes organization developed a clinical practice guideline in 2013 to provide guidance on lipid management and treatment for all adults and children with chronic kidney disease. This synopsis focuses on 8 key recommendations from the guideline pertinent to lipid management and monitoring in adults with chronic kidney disease, including those receiving chronic dialysis or those who have had kidney transplants.
The Advisory Committee on Immunization Practices (ACIP) presents the recommended Immunization Schedule for Adults Aged 19 Years or Older for 2014. This schedule has been approved by the ACIP, American Academy of Family Physicians, American College of Physicians, American College of Obstetrics and Gynecology, and American College of Nurse-Midwives.
Prescription drug abuse is a serious public health problem. Physicians and other health professionals with prescribing privileges are entrusted with the authority to use medications in the treatment of their patients and therefore have an important role to play in helping to ensure safe and effective use of prescription drugs and to deter abuse. The American College of Physicians developed this position paper to provide guidance to prescribers and policymakers about measures to effectively address the problem of prescription drug abuse.
Although the hospital offers sophisticated and often life-prolonging diagnostic and treatment methods to frail elderly patients, it can also be a dangerous environment for them. This commentary discusses viable alternatives to hospitalization that could provide safe and excellent care for this patient population.
In this issue, O'Donoghue and colleagues assess the cost of various breast cancer screening strategies in the United States. The editorialists commend the assessment and emphasize the need to include rather than ignore costs when discussing potential the benefits and harms of screening options.
In this issue, Pohl and colleagues analyzed the use of repeated upper endoscopy in the Medicare population between 2004 and 2006. The editorialist discusses potential reasons for overuse of this procedure and makes recommendations to improve practice.
A position paper from the American College of Physicians in this issue discusses the public health problem created by prescription drug abuse. To achieve the dual goals of reducing iatrogenic opioid use disorders and protecting the ability to care for existing patients, the editorialists suggest several adjustments to opioid prescribing practice, including limiting the reasons for prescribing opioid medications and relying on functional status, rather than reported pain, as the metric of success for management of chronic, nonmalignant pain.
Tammy lay sprawled on the mattress in her hospital room. She was a heroin addict. Every inch of her skin was covered with tattoos. A passerby could easily have written them off as a statement of rebellion.