Cover photograph by Joshua E. Levenson, MD
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Advances in treatments for cystic fibrosis continue to extend survival. In this registry-based study, the authors sought to characterize trends in cystic fibrosis survival between 2000 and 2010 and to project survival for children born and diagnosed with the disease in 2010. Their results suggest that children born and diagnosed with cystic fibrosis in 2010 can expect to live longer than those born earlier, which has important implications for prognosis discussions and suggests that the health care system should anticipate greater numbers of adults with the disease.
Acute kidney injury (AKI) has been attributed to atypical antipsychotic drugs, such as quetiapine, risperidone, and olanzapine. This population-based, retrospective cohort study of older adults in Ontario, Canada, found that persons who received a prescription for any of these drugs in the previous 90 days had an elevated risk for hospitalization with AKI. These drugs increased the risk for hypotension, acute urinary retention, and death, thereby raising safety concerns about the use of atypical antipsychotic drugs in older adults.
Although a randomized, controlled trial of predominantly older women did not find cardioprotective effects of menopausal hormone therapy (MHT), observational studies suggest possible benefit when MHT is initiated in younger women closer to the onset of menopause. This randomized, controlled trial of recently menopausal women found no effect of up to 4 years of MHT on progression of carotid artery intima–media thickness or coronary artery calcium, but some blood markers of cardiovascular risk did improve. Whether longer-term use alters cardiovascular events is unknown.
Although some professional societies recommend routine screening for hepatocellular carcinoma (HCC) in high-risk patients, the strength of evidence supporting these recommendations is unclear. This systematic review summarizes evidence from 22 studies about routine screening for HCC in patients with chronic liver disease. These studies show that tests are available that can identify early-stage HCC, but potential harms of routine screening and whether such screening leads to a survival advantage are unclear.
Physicians can use many methods to communicate probabilistic information about benefits and harms to patients, and some are more effective than others. The authors explored the use of icon arrays and bar graphs and the presentation of risk reductions, numbers needed to treat, rates, and frequencies to compare their effectiveness in maximizing patients' understanding, satisfaction, and decision-making ability. No single option was superior, but several good methods are available to help clinicians communicate with patients.
This U.S. Preventive Services Task Force recommendation addresses screening asymptomatic adults for abdominal aortic aneurysm. Recommendations include 1-time screening with ultrasonography in men aged 65 to 75 years who have ever smoked, selectively offering screening in men aged 65 to 75 years who have never smoked, and no routine screening in women who have never smoked.
A cursory evaluation of recently released Medicare data highlights wide variations in payments to individual physicians. The authors of this commentary caution against superficial evaluation of these data without a deeper understanding of what they can and cannot indicate and point to their potential value in understanding variations in health care.
In April 2014, the Centers for Medicare & Medicaid Services (CMS) published detailed information on the $77 billion that 880 000 health care practitioners billed for some 6000 Medicare Part B services in 2012. This commentary by a former CMS administrator discusses how these data can be helpful, what is missing that might lead to misinterpretation, and why such transparency is here to stay.
In April 2014, the U.S. Food and Drug Administration approved the Cobas HPV [human papillomavirus] test to be used alone to screen for cervical cancer in women aged 25 years or older. This commentary discusses the advantages and disadvantages of the newly approved test. The authors emphasize that increasing screening rates should be the major focus of efforts to reduce invasive cervical cancer regardless of which test is used.
Remarkable progress has been made in the care and survival of patients with cystic fibrosis. In this issue, MacKenzie and colleagues project survival for children born and diagnosed with cystic fibrosis in 2010. The editorialists discuss the study and applaud the advances made in cystic fibrosis care but caution that continued progress will not be simple or inexpensive.
In this issue, Kansagara and colleagues' review finds that evidence of a mortality benefit of screening high-risk patients for HCC remains insufficient to support a strong recommendation for or against screening. The editorialists discuss what to do in the face of this uncertainty, what research is needed, and the policy options necessary to consider while waiting for better evidence.
A few hours later, the patient in room 8 lay on his side, facing the wall. His shackles and mask had been removed. Thinking he was asleep, I put my hand on his arm to wake him, to find that his shoulders were shaking. He was crying.
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.