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Studies completed after the 2006 Massachusetts health reform law examined many changes in health care but none examined the relationship of reform with mortality. This quasi-experimental study found that all-cause and health care–amenable mortality decreased after the reform. Although they could not establish cause and effect, the authors assert that the association between more insurance coverage and fewer deaths is consistent with other evidence that expanding insurance coverage can improve health.

Topics: massachusetts, health care reform
Joshua A. Roth, PhD, MHA; Ruth Etzioni, PhD; Teresa M. Waters, PhD; Mary Pettinger, MS; Jacques E. Rossouw, MD; Garnet L. Anderson, PhD; Rowan T. Chlebowski, MD, PhD; JoAnn E. Manson, MD, DrPH; Mark Hlatky, MD; Karen C. Johnson, MD, MPH; and Scott D. Ramsey, MD, PhD

Findings from the Women's Health Initiative estrogen plus progestin trial led to a reduction in use of combined hormone therapy among postmenopausal women in the United States. This study estimates the economic impact of this $260 million trial considering costs related to less hormone use and related changes in clinical outcomes. The authors conclude that this trial is an example of high-value use of public funds.

Topics: estrogen, costs and benefits, cost savings, economics, women's health initiative, research funding, ...
Frederick A. Masoudi, MD, MSPH; Xiaojuan Mi, PhD; Lesley H. Curtis, PhD; Pamela N. Peterson, MD, MSPH; Jeptha P. Curtis, MD; Gregg C. Fonarow, MD; Stephen C. Hammill, MD; Paul A. Heidenreich, MD; Sana M. Al-Khatib, MD, MHS; Jonathan P. Piccini, MD, MHS; Laura G. Qualls, MS; and Adrian F. Hernandez, MD, MHS

Trials comparing implantable cardioverter-defibrillator (ICD) therapy with cardiac resynchronization therapy with a defibrillator (CRT-D) are limited to selected patients treated at centers with extensive experience. This retrospective cohort study compares outcomes after CRT-D versus ICD therapy in contemporary practice outside of the trial setting. In older patients with reduced left ventricular ejection fraction and prolonged QRS duration, CRT-D was associated with lower risks for death and readmission than ICD therapy alone.

Topics: implantable defibrillators, patient readmission, cardiac resynchronization therapy, defibrillator, comparative effectiveness research, cardiac ...

Illicit drug use has negative health and social consequences for youths. This systematic review, conducted to inform the U.S. Preventive Services Task Force, critiques and summarizes 6 trials that evaluated primary care–relevant behavioral interventions aimed at reducing illicit and pharmaceutical drug use in children and adolescents and found that evidence is inadequate.

Topics: drug abuse, behavior therapy, drugs, non-prescription, primary health care, drug usage, prescription ...

This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of pulmonary, sleep, and critical care medicine.

Topics: care of intensive care unit patient, evidence-based medicine, pulmonology, sleep medicine
Janet P. Pregler, MD; and Carolyn J. Crandall, MD, MS

This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of women's health.

Topics: evidence-based medicine, women's health

The U.S. Preventive Services Task Force finds that the evidence is insufficient to assess the balance of benefits and harms of primary care–based behavioral interventions to prevent or reduce illicit drug or nonmedical pharmaceutical use in children and adolescents.

Topics: drug abuse, behavior therapy, prescription drug, substance abuse prevention, illicit drugs, prescription ...

Such Web sites as Facebook and Netflix use sophisticated algorithms to create user-focused content. The authors of this commentary discuss how a similar method could be used to improve medical education through a neutral, data-driven, Web- and mobile-learning platform.

Topics: education, medical, educational technology, students, medical, data mining, social media

Recent studies suggest that patient safety is not improving. The authors of this commentary believe that external top-down efforts to measure safety contribute to this lack of improvement. They call for efforts to redirect attention to developing tools to detect local safety problems and training frontline caregivers to improve patient safety.

Topics: medical errors, patient safety, patient safety indicators
Yossi Rosman, MD; Arik Eisenkraft, MD; Nadav Milk, MD; Arthur Shiyovich, MD; Nimrod Ophir, MD; Shai Shrot, MD; Yitshak Kreiss, MD; and Michael Kassirer, MD

On 21 August 2013, sarin was dispersed in the eastern outskirts of Damascus, killing 1400 civilians and severely affecting thousands more. The authors analyzed YouTube videos uploaded of this attack to delineate the clinical presentation and treatment of a mass casualty event and compared their findings with the current paradigm for such an event.

Topics: sarin, syria, wars, mass casualty setting, social media, decontamination, nerve agent, poisoning, ...

In this issue, Sommers and colleagues' study on mortality changes after the 2006 Massachusetts health care reform found that for every 830 adults who gained insurance after the reform, 1 death was prevented. The editorialist draws on other studies with similar findings to contend that basic health insurance coverage improves health, especially for low-income Americans.

Topics: health, insurance coverage, health insurance, medicaid, epidemiologic causality, public health medicine, medicare ...

In this issue, Roth and colleagues assess the clinical and economic effects of the Women's Health Initiative estrogen plus progestin trial. The editorialist discusses the findings and notes that large investments in such trials should be given a chance because no one can know which trials will yield the greatest returns.

Topics: hormone replacement therapy, investments, economics, women's health initiative, research funding, clinical research ...
Sarab Sodhi, BS
Includes: Audio/Video

I stood in the room, gowned and gloved, waiting for the woman to push. The baby was nearly ready to be born.

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Mark J. Bolland, MBChB, PhD; Andrew Grey, MD; and Ian R. Reid, MD
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Stephen P. Fortmann, MD; Evelyn P. Whitlock, MD, MPH; and Brittany U. Burda, MPH
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Thomas E. Finucane, MD
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Jane T. Broxterman, MD
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Niels van der Hoeven, MD; Ieke Visser, MD; Aart Schene, MD, PhD; and Bert-Jan van den Born, MD, PhD
Topics: hypertension, coffee, caffeine, monoamine oxidase inhibitors, tranylcypromine
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Daniel Bosch
Includes: Audio/Video
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David S. Weinberg, MD, MSc; and Robert E. Schoen, MD, MPH
Includes: CME
Topics: colonoscopy, colorectal cancer, cancer screening, colorectal cancer screening, fecal occult blood test ...
Topics: drug abuse, primary health care, drug usage, prescription drug, substance abuse prevention, ...
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