Todd MacKenzie, PhD; Alex H. Gifford, MD; Kathryn A. Sabadosa, MPH; Hebe B. Quinton, MS; Emily A. Knapp, BA; Christopher H. Goss, MD, MSc; 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.
Ann Intern Med. 2014;161(4):233-241. doi:10.7326/M13-0636
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; 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.
Ann Intern Med. 2014;161(4):242-248. doi:10.7326/M13-2796
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; 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.
Ann Intern Med. 2014;161(4):249-260. doi:10.7326/M14-0353
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; 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.
Ann Intern Med. 2014;161(4):261-269. doi:10.7326/M14-0558
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; 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.
Ann Intern Med. 2014;161(4):270-280. doi:10.7326/M14-0295
Michael L. LeFevre, MD, MSPH; on behalf of the U.S. Preventive Services Task Force
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.
Ann Intern Med. 2014;161(4):281-290. doi:10.7326/M14-1204
Eric M. Horwitz, MD; David S. Weinberg, MD, MSc
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.
Ann Intern Med. 2014;161(4):291-292. doi:10.7326/M14-0913
Gail R. Wilensky, PhD
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.
Ann Intern Med. 2014;161(4):293-294. doi:10.7326/M14-1080
Rebecca B. Perkins, MD, MSc; Elizabeth A. Stier, MD
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.
Ann Intern Med. 2014;161(4):295-297. doi:10.7326/M14-1043
Joseph M. Pilewski, MD; 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.
Ann Intern Med. 2014;161(4):298-299. doi:10.7326/M14-1534
David Atkins, MD, MPH; David Ross, MD, PhD, MBI; 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.
Ann Intern Med. 2014;161(4):300-301. doi:10.7326/M14-1344
John C. Benson, MD
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.
Ann Intern Med. 2014;161(4):302-303. doi:10.7326/M14-0279
Ann Intern Med. 2014;161(4):304. doi:10.7326/L14-5016
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Ibiayi Dagogo-Jack, MD
Ann Intern Med. 2014;161(4):269. doi:10.7326/M14-1379
Ann Intern Med. 2014;161(4):JC2. doi:10.7326/0003-4819-161-4-201408190-02002
Ann Intern Med. 2014;161(4):JC3. doi:10.7326/0003-4819-161-4-201408190-02003
Ann Intern Med. 2014;161(4):JC4. doi:10.7326/0003-4819-161-4-201408190-02004
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Ann Intern Med. 2014;161(4):JC7. doi:10.7326/0003-4819-161-4-201408190-02007
Ann Intern Med. 2014;161(4):JC8. doi:10.7326/0003-4819-161-4-201408190-02008
Ann Intern Med. 2014;161(4):JC9. doi:10.7326/0003-4819-161-4-201408190-02009
Ann Intern Med. 2014;161(4):JC10. doi:10.7326/0003-4819-161-4-201408190-02010
Ann Intern Med. 2014;161(4):JC11. doi:10.7326/0003-4819-161-4-201408190-02011
Ann Intern Med. 2014;161(4):JC12. doi:10.7326/0003-4819-161-4-201408190-02012
Ann Intern Med. 2014;161(4):JC13. doi:10.7326/0003-4819-161-4-201408190-02013
Geno J. Merli, MD; Howard H. Weitz, MD
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.
Ann Intern Med. 2014;161(4):CG8. doi:10.7326/G14-3008
Ann Intern Med. 2014;161(4):I-15. doi:10.7326/P14-9026
Ann Intern Med. 2014;161(4):I-19. doi:10.7326/P14-9027
Ann Intern Med. 2014;161(4):I-26. doi:10.7326/P14-9028
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