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Todd MacKenzie, PhD; Alex H. Gifford, MD; Kathryn A. Sabadosa, MPH; Hebe B. Quinton, MS; Emily A. Knapp, BA; Christopher H. Goss, MD, MSc; and Bruce C. Marshall, MD

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.

Topics: cystic fibrosis, longevity, life span, cystic fibrosis foundation patient registry
Y. Joseph Hwang, MSc; Stephanie N. Dixon, PhD; Jeffrey P. Reiss, MD, MSc; Ron Wald, MD, MPH; Chirag R. Parikh, MD, PhD; Sonja Gandhi, BSc; Salimah Z. Shariff, PhD; Neesh Pannu, MD, SM; Danielle M. Nash, MSc; Faisal Rehman, MD; and Amit X. Garg, MD, PhD

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.

Topics: renal failure, acute, adverse effects of medication, atypical antipsychotic, elderly, hospitalization
S. Mitchell Harman, MD, PhD; Dennis M. Black, PhD; Frederick Naftolin, MD, DPhil; Eliot A. Brinton, MD; Matthew J. Budoff, MD; Marcelle I. Cedars, MD; Paul N. Hopkins, MD, MSPH; Rogerio A. Lobo, MD; JoAnn E. Manson, MD, DrPH; George R. Merriam, MD; Virginia M. Miller, PhD; Genevieve Neal-Perry, MD, PhD; Nanette Santoro, MD; Hugh S. Taylor, MD, PhD; Eric Vittinghoff, PhD; Mingzhu Yan, MD, PhD; and Howard N. Hodis, MD

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.

Topics: estrogen replacement therapy, hormone replacement therapy, cardiovascular diseases, menopause, cardiovascular disease risk ...
Devan Kansagara, MD, MCR; Joel Papak, MD; Amirala S. Pasha, DO, MS; Maya O’Neil, PhD; Michele Freeman, MPH; Rose Relevo, MLIS, MS; Ana Quiñones, PhD; Makalapua Motu’apuaka, BS; and Janice H. Jou, MD, MHS

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.

Topics: ultrasonography, liver disease, chronic, hepatitis, hepatitis c, carcinoma, hepatocellular, liver cancer screening, ...
Daniella A. Zipkin, MD; Craig A. Umscheid, MD, MS; Nancy L. Keating, MD, MPH; Elizabeth Allen, MD; KoKo Aung, MD, MPH; Rebecca Beyth, MD, MSc; Scott Kaatz, DO, MSc; Devin M. Mann, MD, MS; Jeremy B. Sussman, MD, MS; Deborah Korenstein, MD; Connie Schardt, MLS; Avishek Nagi, MS; Richard Sloane, MPH; and David A. Feldstein, MD

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.

Topics: decision making, graphical displays, risk perception, evidence-based practice, comparative effectiveness research, absolute ...

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.

Topics: abdominal aortic aneurysm, ultrasonography, rupture, ruptured abdominal aortic aneurysm

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.

Topics: medicare, physician payment

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.

Topics: health care costs, medicare, physician payment, Billing and payment

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.

Topics: cervical cancer, human papillomavirus, vaginal smears, hpv - human papillomavirus test, cervical ...
Joseph M. Pilewski, MD; and Darren B. Taichman, MD, PhD, Executive Deputy Editor

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.

Topics: cystic fibrosis, longevity, life span, cystic fibrosis foundation patient registry
David Atkins, MD, MPH; David Ross, MD, PhD, MBI; and Michael Kelley, MD

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.

Topics: ultrasonography, liver diseases, liver cirrhosis, hepatitis, hepatitis b, hepatitis c, carcinoma, hepatocellular, ...

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.

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Martin Eklund, PhD; Cristina O'Donoghue, MD, MPH; and Laura J. Esserman, MD, MBA
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J. Walden Retan, MD
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Robert Newman, MD, MPH
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Neil Kirschner, PhD; and Thomas G. Tape, MD
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Phillip Coffin, MD, MIA; and Caleb Banta-Green, PhD
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Ibiayi Dagogo-Jack, MD
Includes: Audio/Video
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Topics: angiotensin-converting enzyme inhibitors, antihypertensive agents, hypertension, diabetes mellitus, angiotensin receptor antagonists, diabetes ...
Topics: diabetes mellitus, type 2, cognitive-behavioral therapy, depressive disorders, glucose control, cbt-ad trial ...
Topics: obesity, diabetes mellitus, type 2, hemoglobin a, glycosylated, glucohemoglobin measurement, glucose control, ...
Topics: aspirin, myocardial infarction, hemorrhage, death, postoperative period, surgical procedures, operative, poise trial ...
Topics: knee region, knee joint, methotrexate, osteoarthritis, knee, pain, synovitis, knee pain, physical ...
Topics: atrial fibrillation, warfarin, hemorrhage, glomerular filtration rate, dabigatran etexilate, re-ly trial
Topics: chronic obstructive airway disease, budesonide, pneumonia, fluticasone
Topics: chlorhexidine, gastrointestinal system, intensive care unit, digestive tract decontamination
Topics: heart failure, natriuretic peptides
Topics: cervical cancer, human papillomavirus, specimen collection, hpv - human papillomavirus test, cancer ...
Topics: statins, cardiovascular disease risk factors, risk assessment, cardiovascular event, initiation of drug ...
Topics: cardiovascular diseases, cardiovascular disease risk factors, elderly

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: hemoglobin, hemoglobin measurement
Topics: cystic fibrosis, longevity, life span, cystic fibrosis foundation patient registry
Topics: hormone replacement therapy, cardiovascular diseases, menopause, cardiovascular disease risk factors, estrogen, hormone, ...
Topics: abdominal aortic aneurysm, ultrasonography, ruptured abdominal aortic aneurysm
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