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This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of endocrinology. Topics include thyroid disease, diabetes, and bone disease.
Topics: obesity, diabetes mellitus, diabetes mellitus, type 2, weight reduction, endocrinology, thyroxine, bariatric surgery, glucose, hypoparathyroidism, selumetinib, dementia, medical management, cardiovascular event, obesity, morbid, glucose control, malignant neoplasm of thyroid, estrogen deficiency
Updates | 
Carl J. Pepine, MD
This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of cardiology. Topics include hypertension, percutaneous coronary intervention, echocardiography, cardiovascular disease prevention, and hypercholesterolemia.
Topics: percutaneous coronary intervention, hypertension, cardiovascular diseases, cardiology, ischemic stroke, hypertension, refractory, obesity, diabetes mellitus, diabetes mellitus, type 2, atrial fibrillation, renal denervation, echocardiography, cerebrovascular accident, anticoagulants, oral, guidelines, kidney failure, chronic
Updates | 
William J. Hall, MD
This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of geriatric medicine. Topics include cognitive impairment, hospital readmissions, adverse drug events, and falls.
Topics: dementia, geriatrics, patient readmission, acute care, elderly, cataract surgery, cognitive impairment, hospitalization, multivitamins, proton pump inhibitors
Updates | 
Maria-Eleni Roumelioti, MD; and Mark Unruh, MD, MS
This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of nephrology. Topics include hypertension, chronic kidney disease, hemodialysis, and kidney transplantation.
Topics: angiotensin-converting enzyme inhibitors, hemodialysis, nephrology, renal transplantation, kidney failure, chronic, polycystic kidney, autosomal dominant, rituximab, diabetic nephropathy, anca-associated vasculitis, hypertension, cyst
This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of hematology and oncology.
Topics: aspirin, deep vein thrombosis, warfarin, hemorrhage, cerebrovascular accident, ischemic stroke, anticoagulation, chemotherapy regimen, non-small-cell lung carcinoma, medical oncology, hematology, transfusion, lenalidomide, abiraterone, apixaban, venous thromboembolism, crizotinib, progression-free survival, artificial cardiac pacemaker, b-cell lymphoma, low-molecular-weight heparin, dimers, maintenance chemotherapy, pneumatic compression therapy, dexamethasone, hospice, metastatic prostate cancer, defibrillator, myeloma, smoldering, gastrointestinal bleeding, upper, acute, thromboprophylaxis, lung cancer, castration, diagnostic radiologic examination, normal saline, r-chop, operative procedure on hip, r-chop regimen, pretest probability of disease
Updates | 
E. Blair Solow, MD; Salahuddin Kazi, MD; and Una E. Makris, MD
This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of rheumatology. Topics include osteoarthritis, rheumatoid arthritis, psoriatic arthritis, and alternative approaches to health care delivery.
Topics: rheumatoid arthritis, arthritis, fish oil, arthritis, psoriatic, methotrexate, osteoarthritis, rheumatology, knee meniscus tears, ustekinumab, antirheumatic drugs, disease-modifying, therapeutics, biological products, adjunctive therapy, cardiovascular event, osteoarthritis, knee
Updates | 
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 include breast cancer, cervical cancer screening, menopause, menorrhagia, osteoporosis, ovarian cancer, and reproductive health.
Topics: women's health, breast cancer, ovarian cancer, menorrhagia, levonorgestrel, oral contraceptives, tamoxifen, bariatric surgery, brca1 protein, menopause, mammography, endocrine therapy, neoplasms
Updates | 
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: aspirin, heart failure, gastrointestinal bleeding, upper, acute, inpatient, intensive care unit, respiratory distress syndrome, adult, steroids, hip replacement arthroplasty, obstructive airways disease, chronic, exacerbation, acute, hospital care, venous thromboembolism, transfusion, low-molecular-weight heparin, sodium, cardiac arrest, diabetes mellitus, type 2, argipressin, vasopressins, insulin, hospitals, prone position, vancomycin, glucose control, prevention, diarrhea, mortality, mineralocorticoids, adrenal corticosteroids, diabetes mellitus, infection, fluid restriction, probiotics, feces, glucocorticoids
This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of pulmonary, sleep, and critical care medicine.
Topics: chronic obstructive airway disease, care of intensive care unit patient, lung, sleep, colloids, crystalloid, apixaban, respiratory distress syndrome, adult, transfusion, cardiac arrest, venous thromboembolism, macrolides, bronchiectasis, hypovolemic shock, argipressin, vasopressins, cystic fibrosis, prednisone, steroids, hospitals, intensive care unit, prone position, gastrointestinal bleeding, upper, acute, primary health care
Updates | 
Prateek Sharma, MD; and Norton J. Greenberger, MD
This update summarizes studies published in 2013 that the authors consider highly relevant to the practice of gastroenterology and hepatology. Topics include esophageal diseases, gastrointestinal bleeding and peptic ulcer disease, lower gastrointestinal disorders, and liver disease.
Topics: diet, gastrointestinal bleeding, hepatic encephalopathy, gastroenterology, hepatology, irritable bowel syndrome, transfusion, lactulose, diverticulosis, gastroesophageal reflux disease, eosinophilic esophagitis, rifaximin, helicobacter pylori, feces, combined modality therapy, clarithromycin, metronidazole
Original Research | 
Renee Butkus, BA; and Arlene Weissman, PhD
Includes: Supplemental Content
Background:Professional organizations have called for the medical community's attention to the prevention of firearm injury. However, little is known about physicians' attitudes and practices in preventing firearm injury. Objective:To determine internists' attitudes and practices about firearms and to assess whether opinions differ according to whether there are gun owners in a physician's home. Design:Cross-sectional survey. Setting:Internal medicine practices. Participants:573 internists representative of American College of Physicians members. Measures:Respondents' experiences and reported practice behaviors related to firearms and their opinions about contributors to and public policies related to firearm violence, as well as physician education and training in firearm safety. Results:The survey response rate was 56.5%. Eighty-five percent of respondents believed that firearm injury is a public health issue and 71% believed that it is a bigger problem today than a decade ago. Seventy-six percent of respondents believed that stricter gun control legislation would help reduce the risks for gun-related injuries or deaths. Although 66% of respondents believed that physicians should have the right to counsel patients on preventing deaths and injuries from firearms, 58% reported never asking whether patients have guns in their homes. Limitations:The generalizability of these findings to non–American College of Physicians member internists and other physicians is unknown. Responses may not reflect actual behavior. Conclusion:Most respondents believed that firearm-related violence is a public health issue and favored policy initiatives aimed at reducing it. Although most internists supported a physician's right to counsel patients about gun safety, few reported currently doing it. Primary Funding Source:None.
Topics: attitude, firearms, violence
Position Papers | 
Renee Butkus, BA; Robert Doherty, BA; Hilary Downey, BS, for the ACP Health and Public Policy Committee*
In 1995, the American College of Physicians issued its first statement that raised concern about the epidemic of firearm violence in the United States and advocated for policies to reduce the rate of firearm injuries and deaths. Nineteen years later, firearm-related mortality rates in the United States remain the highest among industrialized countries. This position paper presents updated recommendations from the American College of Physicians for reducing firearm-related injuries and deaths in the United States.
Topics: firearms
Reviews | 
Jillian T. Henderson, PhD, MPH; Evelyn P. Whitlock, MD, MPH; Elizabeth O'Connor, PhD; Caitlyn A. Senger, MPH; Jamie H. Thompson, MPH; and Maya G. Rowland, MPH
Background:Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality. Purpose:To systematically review benefits and harms of low-dose aspirin for preventing morbidity and mortality from preeclampsia. Data Sources:MEDLINE, Database of Abstracts of Reviews of Effects, PubMed, and Cochrane Central Register of Controlled Trials (January 2006 through June 2013); previous systematic reviews, clinical trial registries, and surveillance searches for large studies (June 2013 to February 2014). Study Selection:Randomized, controlled trials (RCTs) to assess benefits among women at high preeclampsia risk and RCTs or large cohort studies of harms among women at any risk level. English-language studies of fair or good quality were included. Data Extraction:Dual quality assessment and abstraction of studies. Data Synthesis:Two large, multisite RCTs and 13 smaller RCTs of high-risk women (8 good-quality) were included, in addition to 6 RCTs and 2 observational studies of average-risk women to assess harms (7 good-quality). Depending on baseline risk, aspirin use was associated with absolute risk reductions of 2% to 5% for preeclampsia (relative risk [RR], 0.76 [95% CI, 0.62 to 0.95]), 1% to 5% for intrauterine growth restriction (RR, 0.80 [CI, 0.65 to 0.99]), and 2% to 4% for preterm birth (RR, 0.86 [CI, 0.76 to 0.98]). No significant perinatal or maternal harms were identified, but rare harms could not be ruled out. Evidence on long-term outcomes was sparse, but 18-month follow-up from the largest trial found no developmental harms. Limitations:Benefits may have been overestimated due to small-study effects. Predictive intervals were not statistically significant. Future studies could shift findings toward the null. Conclusion:Daily low-dose aspirin beginning as early as the second trimester prevented clinically important health outcomes. No harms were identified, but long-term evidence was limited. Primary Funding Source:Agency for Healthcare Research and Quality.
Topics: aspirin, pre-eclampsia, morbidity, mortality, pregnancy, prevention, advisory committees
Ideas and Opinions | 
Michael D. Stillman, MD
The Accreditation Council on Graduate Medical Education's Next Accreditation System aims to move residency evaluations from an episodic to more continuous process that requires evaluation of a resident's achievement of “milestones” indicative of competencies necessary for the practice of medicine. The author raises concern that the requirements are untested and that the balance of milestones to be evaluated deemphasizes medical knowledge and diagnostic skills.
Topics: education, medical, graduate, internal medicine, internship and residency, diagnosis, medical residencies, health care systems, medical knowledge, program directors, acgme, professionalism, patient safety, cost effectiveness
A recently published update of the Canadian National Breast Screening Study found that annual screening mammography did not reduce breast cancer deaths. This commentary discusses those findings and argues that it is time to reframe our thinking about breast cancer.
Topics: breast cancer, breast neoplasm screening
Ideas and Opinions | 
Peter Jüni, MD; and Marcel Zwahlen, PhD
Recent reports, including a technology assessment issued by the Swiss Medical Board and an update from the Canadian National Breast Screening Study, found that mammography screening did not reduce deaths from breast cancer. This commentary discusses the conclusiveness of evidence about the benefits and harms of screening and argues that it is time to initiate another breast cancer screening trial.
Topics: breast neoplasm screening, breast cancer
Clinical Guidelines | 
Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force*
Description:Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for dementia. Methods:The USPSTF reviewed the evidence on the benefits, harms, and sensitivity and specificity of screening instruments for cognitive impairment in older adults and the benefits and harms of commonly used treatment and management options for older adults with mild cognitive impairment or early dementia and their caregivers. Population:This recommendation applies to universal screening with formal screening instruments in community-dwelling adults in the general primary care population who are older than 65 years and have no signs or symptoms of cognitive impairment. Recommendation:The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment. (I statement)
Topics: cognitive impairment, elderly, united states preventive services task force, prevention, dementia, advisory committees
Topics: advisory committees, cognitive impairment, elderly, united states preventive services task force, prevention
Ideas and Opinions | 
Sarah Y. Zheng, AB; and Rita F. Redberg, MD
The U.S. Food and Drug Administration assesses the safety and effectiveness of new high-risk medical devices via a process known as “premarket approval” (PMA), whereas modifications of existing devices may be approved by a less rigorous procedure known as “PMA supplement.” The authors discuss safety concerns for this alternate pathway and its implications for clinicians and policymakers.
Topics: safety, defibrillator, implantation procedure, adverse event, implantable defibrillators, fracture, cochlear implants, follow-up, infusion pump, treatment outcome, knee region, knee joint
Clinical Guidelines | 
Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force*
Description:Update of the 2008 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for illicit drug use. Methods:The USPSTF reviewed the evidence on interventions to help adolescents who have never used drugs to remain abstinent and interventions to help adolescents who are using drugs but do not meet criteria for a substance use disorder to reduce or stop their use. Population:This recommendation applies to children and adolescents younger than age 18 years who have not been diagnosed with a substance use disorder. Recommendation:The USPSTF concludes that the current 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. (I statement)
Topics: behavior therapy, pharmacy (field), illicit drugs, united states preventive services task force, prevention, primary health care, advisory committees
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