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The Supreme Court Decision in the Hobby Lobby Case Conscience, Complicity, and Contraception

from ArchInte - 01 Oct 14

In June 2014, the US Supreme Court ruled that some employers can decide for themselves whether the contraceptive mandate in the Affordable Care Act (ACA) is a substantial burden on the exercise of religious freedom (BoxBox) and sue for an exemption on that basis. What are the broader implications of this decision for medical care?



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Human Papillomavirus Testing for Primary Cervical Cancer Screening Is It Time to Abandon Papanicolaou Testing?

from ArchInte - 01 Oct 14

In the 1920s, when George Papanicolaou began to develop the screening test that now bears his name, the cause of cervical cancer was not known, and the cancer was a common cause of death among women. Since Papanicolaou testing entered clinical practice in the 1950s, however, cervical cancer incidence and mortality have markedly decreased in the United States. In 2014, there will be an estimated 12?360 new cases of cervical cancer and 4020 deaths attributable to the disease.



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Lessons From the Swiss Medical Board Recommendation Against Mammography Screening Programs

from ArchInte - 01 Oct 14

When the US Preventive Services Task Force (USPSTF) in 2009 recommended against universal breast cancer screening with mammography in women aged 40 to 49 years, some scientists, radiologists, politicians, and patients strongly objected. The controversy has been called the “mammography wars.”



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Proposed US Food and Drug Administration Guidance for Industry on Distributing Medical Publications About the Risks of Prescription Drugs and Biological Products A Misguided Approach

from ArchInte - 01 Oct 14

A newly proposed US Food and Drug Administration guidance could undermine the agency's drug safety laws and regulations by allowing pharmaceutical companies to claim their drugs are less risky than stated in the approved label.







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Effect of Bisphosphonate Use on Risk of Postmenopausal Breast Cancer Results From the Randomized Clinical Trials of Alendronate and Zoledronic Acid

from ArchInte - 01 Oct 14

ImportanceStudies have shown that bisphosphonates may have antitumor and antimetastatic properties. Recently, observational studies have suggested a possible protective effect of bisphosphonates on breast cancer, but the effect of bisphosphonate use on risk of breast cancer has not been tested in randomized trials.ObjectiveTo assess the relationship of postmenopausal breast cancer incidence and bisphosphonate use using data from 2 randomized (1:1), double-blind, placebo-controlled trials.Design,



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Cancer Screening Rates in Individuals With Different Life Expectancies

from ArchInte - 01 Oct 14

ImportanceRoutine cancer screening has unproven net benefit for patients with limited life expectancy.ObjectiveTo examine the patterns of prostate, breast, cervical, and colorectal cancer screening in the United States in individuals with different life expectancies.Design, Setting, and ParticipantsData from the population-based National Health Interview Survey (NHIS) from 2000 through 2010 were used and included 27?404 participants aged 65 years or older. Using a validated mortality index speci



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The Appropriateness of More Intensive Colonoscopy Screening Than Recommended in Medicare Beneficiaries A Modeling Study

from ArchInte - 01 Oct 14

ImportanceMany Medicare beneficiaries undergo more intensive colonoscopy screening than recommended. Whether this is favorable for beneficiaries and efficient from a societal perspective is uncertain.ObjectiveTo determine whether more intensive colonoscopy screening than recommended is favorable for Medicare beneficiaries (ie, whether it results in a net health benefit) and whether it is efficient from a societal perspective (ie, whether the net health benefit justifies the additional resources



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Hospital Performance for Pharmacologic Venous Thromboembolism Prophylaxis and Rate of Venous Thromboembolism A Cohort Study

from ArchInte - 01 Oct 14

ImportanceHospitalization for acute medical illness is associated with increased risk of venous thromboembolism (VTE). Although efforts designed to increase use of pharmacologic VTE prophylaxis are intended to reduce hospital-associated VTE, whether higher rates of prophylaxis reduce VTE in medical patients is unknown.ObjectiveTo examine the association between pharmacologic VTE prophylaxis rates and hospital-associated VTE.Design, Setting, and ParticipantsRetrospective, multicenter cohort study



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Trends in Dietary Quality Among Adults in the United States, 1999 Through 2010

from ArchInte - 01 Oct 14

ImportanceMany changes in the economy, policies related to nutrition, and food processing have occurred within the United States since 2000, and the net effect on dietary quality is not clear. These changes may have affected various socioeconomic groups differentially.ObjectiveTo investigate trends in dietary quality from 1999 to 2010 in the US adult population and within socioeconomic subgroups.Design, Setting, and ParticipantsNationally representative sample of 29?124 adults aged 20 to 85 year



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Association of Treatment With Carvedilol vs Metoprolol Succinate and Mortality in Patients With Heart Failure

from ArchInte - 01 Oct 14

ImportanceThe ß-blockers carvedilol and metoprolol succinate both reduce mortality in patients with heart failure (HF), but the comparative clinical effectiveness of these drugs is unknown.ObjectiveTo investigate whether carvedilol is associated with improved survival compared with metoprolol succinate.Design, Setting, and ParticipantsCohort study of patients with incident HF with reduced left ventricular ejection fraction (LVEF) (=40%) who received carvedilol (n?=?6026) or metoprolol succinate



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Hypoglycemia After Antimicrobial Drug Prescription for Older Patients Using Sulfonylureas

from ArchInte - 01 Oct 14

ImportanceCertain antimicrobial drugs interact with sulfonylureas to increase the risk of hypoglycemia.ObjectiveTo determine the risk of hypoglycemia and associated costs in older patients prescribed glipizide or glyburide who fill a prescription for an antimicrobial drug.Design, Setting, and ParticipantsThis was a retrospective cohort study of Texas Medicare claims from 2006 to 2009 for patients 66 years or older who were prescribed glipizide or glyburide and who also filled a prescription for



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How Cardiologists Present the Benefits of Percutaneous Coronary Interventions to Patients With Stable Angina A Qualitative Analysis

from ArchInte - 01 Oct 14

ImportancePatients with stable coronary artery disease (CAD) attribute greater benefit to percutaneous coronary interventions (PCI) than indicated in clinical trials. Little is known about how cardiologists’ presentation of the benefits and risks may influence patients’ perceptions.ObjectivesTo broadly describe the content of discussions between patients and cardiologists regarding angiogram and PCI for stable CAD, and to describe elements that may affect patients’ understanding.Design, Setting,



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The Effect of Information Presentation on Beliefs About the Benefits of Elective Percutaneous Coronary Intervention

from ArchInte - 01 Oct 14

ImportanceFor stable angina, the benefits of percutaneous coronary intervention (PCI) are limited to symptom relief, but patients often believe that PCI prevents myocardial infarction (MI). Whether presenting accurate information about the benefits of PCI would dispel these beliefs remains unknown. We hypothesized that explanatory information would be more effective for influencing volunteers’ beliefs.ObjectiveTo assess the effect of explicit and explanatory information on participants’ beliefs



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Patient Selection for Diagnostic Coronary Angiography and Hospital-Level Percutaneous Coronary Intervention Appropriateness Insights From the National Cardiovascular Data Registry

from ArchInte - 01 Oct 14

ImportanceDiagnostic coronary angiography in asymptomatic patients may lead to inappropriate percutaneous coronary intervention (PCI) due to a diagnostic-therapeutic cascade. Understanding the association between patient selection for coronary angiography and PCI appropriateness may inform strategies to minimize inappropriate procedures.ObjectiveTo determine if hospitals that frequently perform coronary angiography in asymptomatic patients, a clinical scenario in which the benefit of angiography



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The Association Between Residency Training and Internists’ Ability to Practice Conservatively

from ArchInte - 01 Oct 14

ImportanceGrowing concern about rising costs and potential harms of medical care has stimulated interest in assessing physicians’ ability to minimize the provision of unnecessary care.ObjectiveTo assess whether graduates of residency programs characterized by low-intensity practice patterns are more capable of managing patients’ care conservatively, when appropriate, and whether graduates of these programs are less capable of providing appropriately aggressive care.Design, Setting, and Participa



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Prevalence of Anginal Symptoms and Myocardial Ischemia and Their Effect on Clinical Outcomes in Outpatients With Stable Coronary Artery Disease Data From the International Observational CLARIFY Regist

from ArchInte - 01 Oct 14

ImportanceIn the era of widespread revascularization and effective antianginals, the prevalence and prognostic effect of anginal symptoms and myocardial ischemia among patients with stable coronary artery disease (CAD) are unknown.ObjectiveTo describe the current clinical patterns among patients with stable CAD and the association of anginal symptoms or myocardial ischemia with clinical outcomes.Design, Setting, and ParticipantsThe Prospective Observational Longitudinal Registry of Patients With



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Infection Management and Multidrug-Resistant Organisms in Nursing Home Residents With Advanced Dementia

from ArchInte - 01 Oct 14

ImportanceInfection management in advanced dementia has important implications for (1) providing high-quality care to patients near the end of life and (2) minimizing the public health threat posed by the emergence of multidrug-resistant organisms (MDROs).Design, Setting, and ParticipantsProspective cohort study of 362 residents with advanced dementia and their health care proxies in 35 Boston area nursing homes for up to 12 months.Main Outcomes and MeasuresData were collected to characterize su



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Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010

from ArchInte - 01 Oct 14

ImportanceOpioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain. Because chronic pain is a major indication for medical cannabis, laws that establish access to medical cannabis may change overdose mortality related to opioid analgesics in states that have enacted them.ObjectiveTo determine the association between the presence of state medical cannabis laws and opioid analgesic overdose mortality.Design, Setting, and Partic



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Surveillance Colonoscopy in Elderly Patients A Retrospective Cohort Study

from ArchInte - 01 Oct 14

ImportanceThe risks and benefits of surveillance colonoscopy in elderly patients have not been well characterized.ObjectiveTo investigate the relative impact of surveillance colonoscopy in elderly patients compared with a reference cohort.Design, Setting, and ParticipantsRetrospective cohort study from 2001 through 2010 of patients 50 years and older undergoing surveillance colonoscopy for a history of colorectal cancer (CRC) or adenomatous polyps at an integrated health care system in southern



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Symptomatic Hepatocellular Liver Injury With Hyperbilirubinemia in Two Patients Treated With Rivaroxaban

from ArchInte - 01 Oct 14

ImportanceTreatment with the new oral anticoagulant rivaroxaban can be associated with severe liver injury.ObservationsWe report 2 patients with predominantly hepatocellular liver injury that had onset during treatment with rivaroxaban. Both were symptomatic, had massively elevated transaminase activity levels and hyperbilirubinemia, and fulfilled the criteria of Hy’s law. Liver biopsy in 1 patient revealed centroacinar hepatocyte necrosis as the predominant finding. Both patients showed a rapid


 

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