Basic View  |  Expanded View
Alexander C. Tsai, MD, PhD; Michel Lucas, PhD, RD; Ayesha Sania, PhD; Daniel Kim, MD, DrPH; and Ichiro Kawachi, MD, PhD

Suicide is increasing in incidence, especially among middle-aged men. Individual-level studies have lacked sufficient statistical power to investigate suicide in general population samples. In this study, the authors used data from the Health Professionals Follow-up Study to estimate the association between social integration and suicide over 24 years of follow-up. They found a more than 2-fold reduced risk for suicide among men who were socially well-integrated.

Topics: suicide, suicide precautions, hpfs trial, social integration, health personnel
Aaron S. Kesselheim, MD, JD, MPH; Katsiaryna Bykov, PharmD, MS; Jerry Avorn, MD; Angela Tong, MS; Michael Doherty, MS; and Niteesh K. Choudhry, MD, PhD
Includes: Audio/Video

Generic prescription drugs made by different manufacturers may vary in color or shape, and switching among these products may interrupt medication use. This cohort and nested case–control study found that variation in the appearance of generic drug pills is associated with lapses in use of essential drugs among patients with cardiovascular disease after myocardial infarction.

Topics: myocardial infarction, cardiovascular agents, color, generic drugs, tablet dosage form, chemical or ...
Iris Lansdorp-Vogelaar, PhD; Roman Gulati, MS; Angela B. Mariotto, PhD; Clyde B. Schechter, MD, MA; Tiago M. de Carvalho, MSc; Amy B. Knudsen, PhD; Nicolien T. van Ravesteyn, PhD; Eveline A.M. Heijnsdijk, PhD; Chester Pabiniak, MSc; Marjolein van Ballegooijen, MD, PhD; Carolyn M. Rutter, PhD; Karen M. Kuntz, ScD; Eric J. Feuer, PhD; Ruth Etzioni, PhD; Harry J. de Koning, MD, PhD; Ann G. Zauber, PhD; and Jeanne S. Mandelblatt, MD, MPH

The net benefit of cancer screening depends on the patient's age and comorbid conditions, but reliable methods of evaluating when to cease screening are lacking. This modeling study estimated the harms and benefits of screening with mammography, prostate-specific antigen, and fecal immunochemical testing at various ages and comorbid conditions and demonstrates how the presence and severity of comorbid conditions might be included in decisions about cancer screening.

Topics: cancer, comorbidity, cancer screening, age appropriate screening, screening cessation
Ryan J. Shaw, PhD, RN; Jennifer R. McDuffie, PhD; Cristina C. Hendrix, DNS, NP; Alison Edie, DNP, FNP; Linda Lindsey-Davis, PhD, RN; Avishek Nagi, MS; Andrzej S. Kosinski, PhD; and John W. Williams Jr., MD, MHSc

The Patient Protection and Affordable Care Act has resulted in more access to medical care for patients with chronic disease. Nurse-managed protocols for outpatient management of patients with chronic conditions may help meet the increased demand for care. This systematic review identified and evaluated 18 studies and concluded that these protocols can have a positive effect on the outpatient management of adults with chronic conditions.

Topics: chronic disease, clinical protocols, nurses, outpatients, medical home, diabetes mellitus, diabetes mellitus, ...
Rachael L. Fleurence, PhD; Laura P. Forsythe, PhD, MPH; Michael Lauer, MD; Jason Rotter, MHS; John P.A. Ioannidis, DSc, MD; Anne Beal, MD, MPH; Lori Frank, PhD; and Joseph V. Selby, MD, MPH
Includes: Audio/Video

The Patient-Centered Outcomes Research Institute conducted a merit review in November 2012 that included patients, other stakeholders, and scientists. The authors examined the differences between and relationships among the scores given to research applications by each reviewer group. Patient and stakeholder perspectives and scores differed significantly from those of scientists, but in-person discussion led to closer agreement among reviewers.

Topics: patients, peer review, comparative effectiveness research

Instrumental variable analysis is an increasingly popular method in comparative effectiveness research, but results of such analyses may be biased if the instrument and outcome are related through an unadjusted third variable (an “instrument–outcome confounder”). The authors examined 187 studies that used instrumental variable analysis and concluded that many effect estimates may have been biased by failure to adjust for instrument–outcome confounding.

Topics: confounding factors (epidemiology), bias (epidemiology), comparative effectiveness research
Aaron J. Calderon, MD; James S. Newman, MD; and Neil H. Winawer, MD

This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of hospital medicine. Topics include Clostridium difficile infection; issues in the intensive care unit; inpatient management of diabetes, chronic obstructive pulmonary disease exacerbations, and heart failure; and venous thromboembolism prophylaxis in hip replacement.

Topics: heart failure, clostridium difficile infection, intensive care unit, hip replacement arthroplasty, nosocomial ...

Measles incidence in the United States is increasing due to vaccination refusal and disease importation. Yet, many currently practicing clinicians have never seen a case. It is crucial that clinicians become familiar with this potentially fatal disease and apply measures necessary to contain it.

Topics: disease outbreaks, infectious disease prevention / control, measles vaccine, measles virus, measles ...
Ronald O. Valdiserri, MD, MPH; and Howard K. Koh, MD, MPH
Includes: Audio/Video

Viral hepatitis is a major public health problem in the United States. In this commentary, officials from the U.S. Department of Health and Human Services address current challenges and opportunities for the control of viral hepatitis and comment on the updated version of the Viral Hepatitis Action Plan for 2014–2016.

Topics: hepatitis viruses, viral hepatitis vaccines, public health medicine, viral hepatitis

This commentary discusses the difficulty in ceasing practices that physicians have come to believe in despite evidence showing that those practices have little value. The authors suggest several approaches to lessen patient dissatisfaction when attempting to discontinue entrenched low-value practices.

Topics: evidence-based medicine, economics

In this issue, Tsai and colleagues present the results of a longitudinal cohort study of men that examined the relationship of social integration and suicide. The editorialist discusses the study and the recent U.S. Preventive Services Task Force recommendation statement on suicide screening and stresses the importance of a public health approach to suicide prevention.

Topics: health personnel, social isolation, public health medicine, suicide, suicide precautions, hpfs trial ...

In this issue, Shaw and colleagues describe how nurse-managed protocols can have a positive effect on the outpatient management of adults with chronic conditions. The editorialists discuss the study and its findings, as well as causes of the shortage of primary care physicians despite an increasing need for their services.

Topics: nurses, primary health care
Katherine C. Chretien, MD
Includes: Audio/Video

It was midday on a spring Wednesday, my pager was on, and I had to be back at the hospital later to check in with my resident team. Now I was on a mission to find a funeral home.

Topics: #
Eran Kopel, MD, MPH; Yechezkel Sidi, MD; and Shaye Kivity, MD
Topics: #
Miguel A. Martínez-González, MD, PhD; Ramón Estruch, MD, PhD; Dolores Corella, DPharm, PhD; Emilio Ros, MD, PhD; and Jordi Salas-Salvadó, MD, PhD
Topics: #
Tomoe Hayashi, MD, PhD; Noriharu Nakagawa, MD; Yasuko Kadohira, MD; Eriko Morishita, MD, PhD; and Hidesaku Asakura, MD, PhD
Topics: aortic aneurysm, disseminated intravascular coagulation, rivaroxaban
Topics: #
Jack Coulehan, MD, MPH
Includes: Audio/Video
Topics: #
Topics: smoking cessation, postoperative complications, behavior therapy, preoperative care
Topics: statins
Topics: vitamin d, vitamin supplement, patient-focused outcomes
Topics: cholecalciferol, ergocalciferols, vitamin d, vitamin supplement
Topics: albumins, sepsis, severe, crystalloid
Topics: septic shock, mean arterial pressure
Topics: cancer, neutropenia, mycoses, voriconazole, infection prophylaxis
Topics: deep vein thrombosis, fibrin d-dimer assay, wells dvt score
Topics: colorectal cancer, dna analysis, fecal, for colorectal cancer screening, statistical sensitivity, fecal ...
Topics: anti-anxiety agents, hypnotics
Topics: hyponatremia, polyethylene glycols, bowel preparation, sodium picosulfate
Topics: pulmonary embolism, fibrin fragment d substance, fibrin d-dimer assay

The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.

Topics: consultation, anesthesia, general
Topics: health personnel, suicide, suicide precautions, hpfs trial, social integration
Topics: cancer, comorbidity, cancer screening, age appropriate screening, screening cessation
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.