martes, 3 de abril de 2012

Table of Contents — April 3, 2012, 156 (7)

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Table of Contents — April 3, 2012, 156 (7)

Original Research

  • Three cases of genetically related hepatitis C virus (HCV) were identified at a health care facility that had close genetic relatedness to HCV identified in a technician at an interventional radiology unit where the patients had received fentanyl. The technician admitted to diverting fentanyl in a manner that could cause contamination of syringes used for patient care. Almost 3500 of nearly 4000 potentially exposed patients still living were screened, and 2 additional cases were identified.
  • The gap between the supply of organs available for transplantation and the demand for them is growing. In this cluster randomized trial, motor vehicle department patrons who viewed a short video about organ donation while waiting were more likely to identify themselves as organ donors on their driver's licenses, learner's permits, or state identification cards than patrons who did not view the video. This approach could substantially increase the number of potential organ donors, but how this might translate into a greater organ supply is unclear.
  • Mammography screening can detect breast cancer that would never have been clinically significant in a woman's lifetime, but the extent of this overdiagnosis is not known. In Norway, mammography screening was rolled out over a decade by county. Investigators compared the number of cases of invasive breast cancer found in screened women with that in matched unscreened women. An estimated 15% to 25% of detected breast cancer cases represented overdiagnosis (or 6 to 10 women overdiagnosed for every 2500 women invited to screening). These data suggest that mammography screening entails a substantial amount of overdiagnosis.


  • Rapid influenza diagnostic tests (RIDTs) are immunochromatographic assays that detect influenza viral antigens. This review examined the accuracy of RIDTs in adults and children with influenza-like illness and evaluated factors associated with higher accuracy. Among 159 studies involving 26 RIDTs, RIDTs have a high specificity and positive likelihood ratio and modest and highly variable sensitivity for detecting influenza. Influenza can be ruled in but not ruled out through the use of RIDTs.
  • Antiviral therapy may reduce complications and mortality associated with influenza, but there have been concerns that randomized trials might not reflect that. This review of 74 observational studies found that oral oseltamivir may reduce mortality in high-risk populations compared with no treatment. Either oral oseltamivir or inhaled zanamivir might reduce hospitalizations and symptom duration. Costs and targeting strategies, however, were not evaluated. The studies focused on drug-sensitive infections, so the results may not be applicable if antiviral-resistant viruses are prevalent. Antivirals might improve outcomes in some situations, but more evidence is needed to guide decision making about when and in whom to use particular agents.

Ideas and Opinions

  • On 5 December 2011, the Centers for Medicare & Medicaid Services announced that it will make its claims data available to rate health care providers on their quality of care so that consumers can make more informed choices. Many have hailed this as an important and necessary step to improve health care in the United States. This commentary discusses the data release and asks whether it could achieve the goal of increasing competition, accountability, and quality while lowering costs.

Clinical Guidelines

  • Guideline development processes vary substantially, and many guidelines do not meet basic quality criteria. The Guidelines International Network includes guideline developers from 93 organizations and 89 individual members representing 46 countries. Its board of trustees reviewed the current literature and used a consensus process to propose a set of key components for guideline development, presented here. The intent is to initiate global discussion and consensus about minimal standards for guideline development.


  • In this issue, Hellinger and colleagues report an example of drug diversion as the source of transmission of health care–associated HCV infection. The editorialists discuss the case, as well as the challenges in prevention, control, and investigation of health care–associated hepatitis infections.
  • In this issue, Kalager and colleagues use data from Norway to estimate that 15% to 25% of breast cancer cases identified on mammography would never have been clinically significant in a woman's lifetime. The editorialists discuss these results and call for serious efforts to reduce the frequency of overdiagnosis.

On Being a Doctor

  • This is the day we get down to work. Yesterday, the guideline panel sat through lectures on guideline methodology, debated the quality rating criteria for the individual studies, and approved the recommendation grading system. My job doesn't have an official title. As a general internist, I am almost never a clinical expert on the panels I facilitate. I am chosen for my guideline methods experience.


Ad Libitum

Summaries for Patients

In the Clinic

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