Showing papers in "Annals of Internal Medicine in 2011"
TL;DR: The QUADAS-2 tool will allow for more transparent rating of bias and applicability of primary diagnostic accuracy studies.
Abstract: In 2003, the QUADAS tool for systematic reviews of diagnostic accuracy studies was developed. Experience, anecdotal reports, and feedback suggested areas for improvement; therefore, QUADAS-2 was developed. This tool comprises 4 domains: patient selection, index test, reference standard, and flow and timing. Each domain is assessed in terms of risk of bias, and the first 3 domains are also assessed in terms of concerns regarding applicability. Signalling questions are included to help judge risk of bias. The QUADAS-2 tool is applied in 4 phases: summarize the review question, tailor the tool and produce review-specific guidance, construct a flow diagram for the primary study, and judge bias and applicability. This tool will allow for more transparent rating of bias and applicability of primary diagnostic accuracy studies.
8,370 citations
TL;DR: Low health literacy was consistently associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications appropriately; poorer able to interpret labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates.
Abstract: Health literacy has been associated with health-related knowledge and patient comprehension. This systematic review updates a 2004 review and found 96 eligible studies that suggest that low health ...
3,457 citations
TL;DR: No single intervention implemented alone was regularly associated with reduced risk for 30-day rehospitalization, and several common interventions have not been studied outside of multicomponent "discharge bundles."
Abstract: About 1 in 5 Medicare fee-for-service patients discharged from the hospital is rehospitalized within 30 days In this systematic review of 43 studies evaluating interventions to reduce readmission
1,075 citations
TL;DR: The value of history and physical examination for predicting airflow obstruction; the value of spirometry for screening or diagnosis of COPD; and COPD management strategies, specifically evaluation of various inhaled therapies, pulmonary rehabilitation programs, and supplemental oxygen therapy are addressed.
Abstract: This guideline from 4 medical societies updates the 2007 American College of Physicians clinical practice guideline on diagnosis and management of stable chronic obstructive pulmonary disease (COPD...
966 citations
TL;DR: In this paper, the authors assessed the association between previous colonoscopy and risk for colorectal cancer (CRC) in a population-based case-control study.
Abstract: Background Colonoscopy with detection and removal of adenomas is considered a powerful tool to reduce colorectal cancer (CRC) incidence. However, the degree of protection achievable in a population setting with high-quality colonoscopy resources remains to be quantified. Objective To assess the association between previous colonoscopy and risk for CRC. Design Population-based case-control study. Setting Rhine-Neckar region of Germany. Patients A total of 1688 case patients with colorectal cancer and 1932 control participants aged 50 years or older. Measurements A detailed lifetime history of CRC risk factors and preventive factors, including history and results of previous colonoscopies, and of medical data obtained by self-reports and medical records. Odds ratios of CRC associated with colonoscopy in the preceding 10 years were estimated, after adjustment for sex, age, education level, participation in a general health screening examination, family history of CRC, smoking status, body mass index, and use of nonsteroidal anti-inflammatory drugs or hormone replacement therapy. Results Overall, colonoscopy in the preceding 10 years was associated with 77% lower risk for CRC. Adjusted odds ratios for any CRC, right-sided CRC, and left-sided CRC were 0.23 (95% CI, 0.19 to 0.27), 0.44 (CI, 0.35 to 0.55), and 0.16 (CI, 0.12 to 0.20), respectively. Strong risk reduction was observed for all cancer stages and all ages, except for right-sided cancer in persons aged 50 to 59 years. Risk reduction increased over the years in both the right and the left colon. Limitation The study was observational, with potential for residual confounding and selection bias. Conclusion Colonoscopy with polypectomy can be associated with strongly reduced risk for CRC in the population setting. Aside from strong risk reduction with respect to left-sided CRC, risk reduction of more than 50% was also seen for right-sided colon cancer. Primary funding source German Research Council and German Federal Ministry of Education and Research.
666 citations
TL;DR: Making treatment decisions has a negative emotional effect on at least one third of surrogates, which is often substantial and typically lasts months (or sometimes years).
Abstract: Wendler and Rid reviewed studies of the effects of treatment decisions on the surrogates who make them. Eleven quantitative studies and 29 qualitative studies involving surrogates, most of whom had...
542 citations
TL;DR: Routine monitoring of troponin levels in at-risk patients is needed after surgery to detect most MIs, which have an equally poor prognosis regardless of whether they are symptomatic or asymptomatic.
Abstract: Background: Each year, millions of patients worldwide have a perioperative myocardial infarction (MI) after noncardiac surgery. Objective: To examine the characteristics and short-term outcome of perioperative MI. Design: Cohort study. (ClinicalTrials.gov registration number: NCT00182039) Setting: 190 centers in 23 countries. Patients: 8351 patients included in the POISE (PeriOperative ISchemic Evaluation) trial. Measurements: Four cardiac biomarker or enzyme assays were measured within 3 days of surgery. The definition of perioperative MI included either autopsy findings of acute MI or an elevated level of a cardiac biomarker or enzyme and at least 1 of the following defining features: ischemic symptoms, development of pathologic Q waves, ischemic changes on electrocardiography, coronary artery intervention, or cardiac imaging evidence of MI. Results: Within 30 days of random assignment, 415 patients (5.0%) had a perioperative MI. Most MIs (74.1 %) occurred within 48 hours of surgery; 65.3% of patients did not experience ischemic symptoms. The 30-day mortality rate was 11.6% (48 of 415 patients) among patients who had a perioperative MI and 2.2% (178 of 7936 patients) among those who did not (P < 0.001). Among patients with a perioperative MI, mortality rates were elevated and similar between those with (9.7%; adjusted odds ratio, 4.76 [95% CI, 2.68 to 8.43]) and without (12.5%; adjusted odds ratio, 4.00 [CI, 2.65 to 6.06]) ischemic symptoms. Limitation: Cardiac markers were measured only until day 3 after surgery, and additional asymptomatic MIs may have been missed. Conclusion: Most patients with a perioperative MI will not experience ischemic symptoms. Data suggest that routine monitoring of troponin levels in at-risk patients is needed after surgery to detect most MIs, which have an equally poor prognosis regardless of whether they are symptomatic or asymptomatic.
541 citations
TL;DR: Evidence supports metformin as a first-line agent to treat type 2 diabetes and most 2-drug combinations similarly reduce hemoglobin A(1c) levels, but some increased risk for hypoglycemia and other adverse events.
Abstract: This systematic review compared the effectiveness of the vast array of treatment regimens for type 2 diabetes and found little evidence on the relative effects of various antihyperglycemic therapie...
532 citations
TL;DR: Prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary.
Abstract: This systematic review was conducted to inform an update of U.S. Preventive Services Task Force recommendations on prostate cancer screening. The authors searched MEDLINE and Cochrane databases fro...
524 citations
TL;DR: Adding twice-daily exenatide injections improved glycemic control without increased hypoglycemia or weight gain in participants with uncontrolled type 2 diabetes who were receiving insulin glargine treatment.
Abstract: This randomized trial tested whether twice-daily exenatide reduces hemoglobin A1c levels more than placebo in people with type 2 diabetes who are receiving insulin glargine. After 30 weeks, exenati...
518 citations
TL;DR: The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians, including PIER (Physicians’ Information and Education Resource) and MKSAP (Medical Knowledge and SelfAssessment Program).
Abstract: Physician Writers Rita V. Patel, MD Mark Lebwohl, MD The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians’ Information and Education Resource) and MKSAP (Medical Knowledge and SelfAssessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP’s Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://pier.acponline.org, http://www.acponline.org/products_services/ mksap/15/?pr31, and other resources referenced in each issue of In the Clinic.
Journal Article•
TL;DR: Colonoscopy with polypectomy can be associated with strongly reduced risk for CRC in the population setting, and strong risk reduction was observed for all cancer stages and all ages, except for right-sided cancer in persons aged 50 to 59 years.
Abstract: The degree of protection against colorectal cancer (CRC) that colonoscopy can achieve in a population setting is uncertain. In this study from Germany, colonoscopy in the preceding 10 years was ass...
TL;DR: The prevalence of knee pain has increased substantially over 20 years, independent of age and BMI, and Obesity accounted for only part of this increase.
Abstract: Whether the dramatic increase in knee replacement surgery over recent years corresponds to an increase in knee osteoarthritis has been unknown. Using data from NHANES (National Health and Nutrition...
TL;DR: Dabigatran may be a cost-effective alternative to warfarin depending on pricing in the United States and improved with increasing risk for stroke and intracranial hemorrhage in patients aged 65 years or older with nonvalvular AF.
Abstract: Background: Warfarin reduces the risk for ischemic stroke in patients with atrial fibrillation (AF) but increases the risk for hemorrhage. Dabigatran is a fixed-dose, oral direct thrombin inhibitor with similar or reduced rates of ischemic stroke and intracranial hemorrhage in patients with AF compared with those of warfarin. Objective: To estimate the quality-adjusted survival, costs, and cost-effectiveness of dabigatran compared with adjusted-dose warfarin for preventing ischemic stroke in patients 65 years or older with nonvalvular AF. Design: Markov decision model. Data Sources: The RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial and other published studies of anticoagulation. The cost of dabigatran was estimated on the basis of pricing in the United Kingdom. Target Population: Patients aged 65 years or older with nonvalvular AF and risk factors for stroke (CHADS2 score 1 or equivalent) and no contraindications to anticoagulation.
Journal Article•
TL;DR: In this article, the characteristics and short-term prognosis of perioperative myocardial infarction (MI) in the setting of noncardiac surgery were studied.
Abstract: Little is known about the characteristics and short-term prognosis of perioperative myocardial infarction (MI) in the setting of noncardiac surgery. In this multinational study of 8351 patients und...
TL;DR: Omalizumab provided additional clinical benefit for patients with severe allergic asthma that is inadequately controlled with high-dose ICS and LABA therapy, and the rate of protocol-defined asthma exacerbations was significantly reduced.
Abstract: Background Inhaled corticosteroids (ICS) and long-acting β(2)-agonists (LABAs) are recommended in patients with asthma that is not well-controlled; however, many patients continue to have inadequately controlled asthma despite this therapy. Objective To evaluate the efficacy and safety of omalizumab in patients with inadequately controlled severe asthma who are receiving high-dose ICS and LABAs, with or without additional controller therapy. Design Prospective, multicenter, randomized, parallel-group, double-blind, placebo-controlled trial. (ClinicalTrials.gov registration number: NCT00314575). Setting 193 investigational sites in the United States and 4 sites in Canada. Patients 850 patients aged 12 to 75 years who had inadequately controlled asthma despite treatment with high-dose ICS plus LABAs, with or without other controllers. Intervention Omalizumab (n = 427) or placebo (n = 423) was added to existing medication regimens for 48 weeks. Measurements The primary end point was the rate of protocol-defined exacerbations over the study period. Secondary efficacy end points included the change from baseline to week 48 in mean daily number of puffs of albuterol, mean total asthma symptom score, and mean overall score on the standardized version of the Asthma Quality of Life Questionnaire (AQLQ[S]). Safety end points included the frequency and severity of treatment-emergent adverse events. Results During 48 weeks, the rate of protocol-defined asthma exacerbations was significantly reduced for omalizumab compared with placebo (0.66 vs. 0.88 per patient; P = 0.006), representing a 25% relative reduction (incidence rate ratio, 0.75 [95% CI, 0.61 to 0.92]). Omalizumab improved mean AQLQ(S) scores (0.29 point [CI, 0.15 to 0.43]), reduced mean daily albuterol puffs (-0.27 puff/d [CI, -0.49 to -0.04 puff/d]), and decreased mean asthma symptom score (-0.26 [CI, -0.42 to -0.10]) compared with placebo during the 48-week study period. The incidence of adverse events (80.4% vs. 79.5%) and serious adverse events (9.3% vs. 10.5%) were similar in the omalizumab and placebo groups, respectively. Limitations The results are limited by early patient discontinuation (20.8%). The study was not powered to detect rare safety events or the treatment effect in the oral corticosteroid subgroup. Conclusion In this study, omalizumab provided additional clinical benefit for patients with severe allergic asthma that is inadequately controlled with high-dose ICS and LABA therapy. Primary funding source Genentech and Novartis Pharmaceuticals.
TL;DR: Implementing a selective approach to low back imaging, as suggested by the American College of Physicians and American Pain Society guideline on low back pain, would provide better care to patients, improve outcomes, and reduce costs.
Abstract: Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. In other patients, evidence indicates that routine imaging is not associated with clinically meaningful benefits but can lead to harms. Addressing inefficiencies in diagnostic testing could minimize potential harms to patients and have a large effect on use of resources by reducing both direct and downstream costs. In this area, more testing does not equate to better care. Implementing a selective approach to low back imaging, as suggested by the American College of Physicians and American Pain Society guideline on low back pain, would provide better care to patients, improve outcomes, and reduce costs. Ann Intern Med. 2011;154:181-189. www.annals.org For author affiliations, see end of text.
TL;DR: Ugandan patients receiving cART can expect an almost normal life expectancy, although there is considerable variability among subgroups of patients.
Abstract: BACKGROUND: Little is known about the effect of combination antiretroviral therapy (cART) on life expectancy in sub-Saharan Africa. OBJECTIVE: To estimate life expectancy of patients once they initiate cART in Uganda. DESIGN: Prospective cohort study. SETTING: Public sector HIV and AIDS disease-management program in Uganda. PATIENTS: 22 315 eligible patients initiated cART during the study period of whom 1943 were considered to have died. MEASUREMENTS: All-cause mortality rates were calculated and abridged life tables were constructed and stratified by sex and baseline CD4 cell count status to estimate life expectancies for patients receiving cART. The average number of years remaining to be lived by patients who received cART at varying age categories was estimated. RESULTS: After adjustment for loss to follow-up crude mortality rates (deaths per 1000 person-years) ranged from 26.9 (95% CI 25.4 to 28.5) in women to 43.9 (CI 40.7 to 47.0) in men. For patients with a baseline CD4 cell count less than 0.050 x 10(9) cells/L the mortality rate was 67.3 (CI 62.1 to 72.9) deaths per 1000 person-years whereas among persons with a baseline CD4 cell count of 0.250 x 10(9) cells/L or more the mortality rate was 19.1 (CI 16.0 to 22.7) deaths per 1000 person-years. Life expectancy at age 20 years for the overall cohort was 26.7 (CI 25.0 to 28.4) additional years and at age 35 years was 27.9 (CI 26.7 to 29.1) additional years. Life expectancy increased substantially with increasing baseline CD4 cell count. Similar trends are observed for older age groups. LIMITATIONS: A small (6.4%) proportion of patients were lost to follow-up and it was imputed that 30% of these patients had died. Few patients with a CD4 cell count greater than 0.250 x 10(9) cells/L initiated cART. CONCLUSION: Ugandan patients receiving cART can expect an almost normal life expectancy although there is considerable variability among subgroups of patients. PRIMARY FUNDING SOURCE: Canadian Institutes of Health Research.
TL;DR: Whereas hemorrhage is an infrequent complication of transthoracic needle lung biopsy, pneumothorax is common and often necessitates chest tube placement and these population-based data should help patients and physicians make more informed choices about whether to perform biopsy of a pulmonary nodule.
Abstract: Results: Although hemorrhage was rare, complicating 1.0% (95% CI, 0.9% to 1.2%) of biopsies, 17.8% (CI, 11.8% to 23.8%) of patients with hemorrhage required a blood transfusion. In contrast, the risk for any pneumothorax was 15.0% (CI, 14.0% to 16.0%), and 6.6% (CI, 6.0% to 7.2%) of all biopsies resulted in pneumothorax requiring a chest tube. Compared with patients without complications, those who experienced hemorrhage or pneumothorax requiring a chest tube had longer lengths of stay (P 0.001) and were more likely to develop respiratory failure requiring mechanical ventilation (P 0.020). Patients aged 60 to 69 years (as opposed to younger or older patients), smokers, and those with chronic obstructive pulmonary disease had higher risk for complications. Limitations: Estimated risks may be inaccurate if coding of complications is incomplete. The analyzed databases contain little clinical detail (such as information on nodule characteristics or biopsy pathology) and cannot indicate whether performing the biopsy produced useful information. Conclusion: Whereas hemorrhage is an infrequent complication of transthoracic needle lung biopsy, pneumothorax is common and often necessitates chest tube placement. These population-based data should help patients and physicians make more informed choices about whether to perform biopsy of a pulmonary nodule.
TL;DR: Combined vitamin D and calcium supplementation can reduce fracture risk, but the effects may be smaller among community-dwelling older adults than among institutionalized elderly persons, and Appropriate dose and dosing regimens require further study.
Abstract: Data Synthesis: 19 RCTs (3 for cancer and 16 for fracture outcomes) and 28 observational studies (for cancer outcomes) were analyzed. Limited data from RCTs suggested that high-dose (1000 IU/d) vitamin D supplementation can reduce the risk for total cancer, and data from observational studies suggested that higher blood 25-hydroxyvitamin D (25-[OH]D) concentrations might be associated with increased risk for cancer. Mixed-effects dose– response meta-analyses showed that each 10-nmol/L increase in blood 25-(OH)D concentration was associated with a 6% (95% CI, 3% to 9%) reduced risk for colorectal cancer but no statistically significant dose–response relationships for prostate and breast cancer. Random-effects model meta-analysis showed that combined vitamin D and calcium supplementation reduced fracture risk (pooled relative risk, 0.88 [CI, 0.78 to 0.99]) in older adults, but the effects differed according to study setting: institution (relative risk, 0.71 [CI, 0.57 to 0.89]) versus community-dwelling (relative risk, 0.89 [CI, 0.76 to 1.04]). One RCT showed adverse outcomes associated with supplementation, including increased risk for renal and urinary tract stones. Limitations: Most trial participants were older (aged 65 years) postmenopausal women. Observational studies were heterogeneous and were limited by potential confounders. Conclusion: Combined vitamin D and calcium supplementation can reduce fracture risk, but the effects may be smaller among community-dwelling older adults than among institutionalized elderly persons. Appropriate dose and dosing regimens, however, require further study. Evidence is not sufficiently robust to draw conclusions regarding the benefits or harms of vitamin D supplementation for the prevention of cancer.
TL;DR: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men.
Abstract: Description Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for osteoporosis. Methods The USPSTF evaluated evidence on the diagnostic accuracy of risk assessment instruments for osteoporosis and fractures, the performance of dual-energy x-ray absorptiometry and peripheral bone measurement tests in predicting fractures, the harms of screening for osteoporosis, and the benefits and harms of drug therapy for osteoporosis in women and men. Recommendations The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. (Grade B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men. (I statement).
TL;DR: A framework for considering an appropriate and safe HbA(1c) target range for each patient is proposed and explored, with the aim of preventing complications over the many years of life.
Abstract: One of the first steps in the management of patients with type 2 diabetes mellitus is setting glycemic goals. Professional organizations advise setting specific hemoglobin A(1c) (HbA(1c)) targets for patients, and individualization of these goals has more recently been emphasized. However, the operational meaning of glycemic goals, and specific methods for individualizing them, have not been well-described. Choosing a specific HbA(1c) target range for a given patient requires taking several factors into consideration, including an assessment of the patient's risk for hyperglycemia-related complications versus the risks of therapy, all in the context of the overall clinical setting. Comorbid conditions, psychological status, capacity for self-care, economic considerations, and family and social support systems also play a key role in the intensity of therapy. The individualization of HbA(1c) targets has gained more traction after recent clinical trials in older patients with established type 2 diabetes mellitus failed to show a benefit from intensive glucose-lowering therapy on cardiovascular disease (CVD) outcomes. The limited available evidence suggests that near-normal glycemic targets should be the standard for younger patients with relatively recent onset of type 2 diabetes mellitus and little or no micro- or macrovascular complications, with the aim of preventing complications over the many years of life. However, somewhat higher targets should be considered for older patients with long-standing type 2 diabetes mellitus and evidence of CVD (or multiple CVD risk factors). This review explores these issues further and proposes a framework for considering an appropriate and safe HbA(1c) target range for each patient.
TL;DR: Biennial screening appears to reduce the cumulative probability of false-positive results after 10 years but may be associated with a small absolute increase in the probability of late-stage cancer diagnosis.
Abstract: Background False-positive mammography results are common. Biennial screening may decrease the cumulative probability of false-positive results across many years of repeated screening but could also delay cancer diagnosis. Objective To compare the cumulative probability of false-positive results and the stage distribution of incident breast cancer after 10 years of annual or biennial screening mammography. Design Prospective cohort study. Setting 7 mammography registries in the National Cancer Institute-funded Breast Cancer Surveillance Consortium. Participants 169,456 women who underwent first screening mammography at age 40 to 59 years between 1994 and 2006 and 4492 women with incident invasive breast cancer diagnosed between 1996 and 2006. Measurements False-positive recalls and biopsy recommendations stage distribution of incident breast cancer. Results False-positive recall probability was 16.3% at first and 9.6% at subsequent mammography. Probability of false-positive biopsy recommendation was 2.5% at first and 1.0% at subsequent examinations. Availability of comparison mammograms halved the odds of a false-positive recall (adjusted odds ratio, 0.50 [95% CI, 0.45 to 0.56]). When screening began at age 40 years, the cumulative probability of a woman receiving at least 1 false-positive recall after 10 years was 61.3% (CI, 59.4% to 63.1%) with annual and 41.6% (CI, 40.6% to 42.5%) with biennial screening. Cumulative probability of false-positive biopsy recommendation was 7.0% (CI, 6.1% to 7.8%) with annual and 4.8% (CI, 4.4% to 5.2%) with biennial screening. Estimates were similar when screening began at age 50 years. A non-statistically significant increase in the proportion of late-stage cancers was observed with biennial compared with annual screening (absolute increases, 3.3 percentage points [CI, -1.1 to 7.8 percentage points] for women age 40 to 49 years and 2.3 percentage points [CI, -1.0 to 5.7 percentage points] for women age 50 to 59 years) among women with incident breast cancer. Limitations Few women underwent screening over the entire 10-year period. Radiologist characteristics influence recall rates and were unavailable. Most mammograms were film rather than digital. Incident cancer was analyzed in a small sample of women who developed cancer. Conclusion After 10 years of annual screening, more than half of women will receive at least 1 false-positive recall, and 7% to 9% will receive a false-positive biopsy recommendation. Biennial screening appears to reduce the cumulative probability of false-positive results after 10 years but may be associated with a small absolute increase in the probability of late-stage cancer diagnosis. Primary funding source National Cancer Institute.
Journal Article•
TL;DR: In this paper, a randomized trial evaluated the efficacy of inhaled corticosteroids (ICS) and long-acting β2-agonists (LABAs) for severe asthma in some patients.
Abstract: Despite therapy with inhaled corticosteroids (ICS) and long-acting β2-agonists (LABAs), severe asthma remains inadequately controlled in some patients. This randomized trial evaluated the efficacy ...
TL;DR: Behaviorally based treatments are safe and effective for weight loss and maintenance and reduced diabetes incidence in participants with prediabetes.
Abstract: This systematic review of primary care–based weight loss interventions for adults was done to inform a U.S. Preventive Services Task Force recommendation. Recipients of behavioral interventions los...
Journal Article•
TL;DR: Current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy, but differences in onset of action and adverse events may be considered when choosing a medication.
Abstract: BACKGROUND: Second-generation antidepressants dominate the management of major depressive disorder (MDD), but evidence on the comparative benefits and harms of these agents is contradictory.PURPOSE ...
TL;DR: M mammography screening should be personalized on the basis of a woman's age, breast density, history of breast biopsy, family history of Breast Cancer Prevention, and beliefs about the potential benefit and harms of screening.
Abstract: The optimal timing and frequency of screening mammography are controversial. This analysis found that the cost-effectiveness of screening mammography depended on a woman's age, breast density, fami...
TL;DR: This guideline grades the evidence and recommendations by using the ACP clinical practice guidelines grading system and recommends not using intensive insulin therapy to normalize blood glucose in SICU/MICU patients with or without diabetes mellitus.
Abstract: This American College of Physicians (ACP) guideline addresses the effectiveness of intensive insulin therapy (IIT) in improving outcomes in hospitalized patients with or without diabetes mellitus. ...
TL;DR: Widespread colorectal tumor testing to identify families with the Lynch syndrome could yield substantial benefits at acceptable costs, particularly for women with a mutation associated with thelyn syndrome who begin regular screening and have risk-reducing surgery.
Abstract: The Lynch syndrome is the most common genetic cause of colorectal cancer, but the best way to identify affected individuals and families remains uncertain. This cost-effectiveness analysis examines...