The American journal of medicine
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In the United States, 12,000 women are diagnosed with cervical cancer each year, even though the screening for this disease is safe and effective. There are 3 types of screening options available: cervical cytology (Papanicolaou or "Pap" test), Pap/HPV (human papillomavirus) co-test, and HPV-only test. With simplified options such as HPV-only screening, providers who have been reluctant to incorporate cervical cancer screening into their primary care practice may feel more comfortable with offering these services to women. In this article we review the different cervical cancer screening options that are now available and summarize the various changes in guidelines over the last decade.
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Digoxin has been shown to reduce heart failure hospitalizations with a neutral effect on mortality. It is unknown whether there is heterogeneity of treatment effect for digitalis therapy according to predicted risk of heart failure hospitalization. ⋯ Participants in the DIG study at higher risk of hospitalization as identified by a multistate model were considerably more likely to benefit from digoxin therapy to reduce heart failure hospitalization.
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Optimal cardiovascular risk factors control among individuals with diabetes remains a challenge. We evaluated changes in glucose, lipid, and blood pressure control among diabetes patients after implementation of a large-scale population management program, known as Preventing Heart Attacks and Strokes Everyday, at Kaiser Permanente Northern California (KPNC), during 2004-2013. ⋯ Relative to national benchmarks, a substantially greater improvement in risk factor control among adults with diabetes was observed after implementation of a comprehensive population management program.
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Injuries are more morbid and complicated to manage in patients with cirrhosis. However, data are limited regarding the relative risk of injury and severity of injury from falls in patients with cirrhosis compared with those without cirrhosis. ⋯ We identified 102,977 visits involving patients with cirrhosis and 26,996,120 involving patients without cirrhosis who presented with a fall. Overall and compared with patients with congestive heart failure, the adjusted risk of severe injury was higher for patients with cirrhosis. These included intracranial hemorrhage (2.33; 95% confidence interval [CI], 2.02-2.68), skull fracture (1.75; 95% CI, 1.53-2.00), and pelvic fracture (1.71; 95% CI, 1.56-1.88). Risk was lower for less-severe injuries, such as concussion (0.95; 95% CI, 0.86-1.06) and lower-leg fracture (0.86; 95% CI, 0.80-0.91). Risk factors significantly positively associated with severe injury on multivariate analysis were hepatic encephalopathy, alcohol abuse, and infection. Cirrhosis was associated with increased risk of in-hospital death, longer length of stay, and higher costs after a fall. All outcomes were worse compared with those for patients with congestive heart failure CONCLUSION: Falls are common in patients with cirrhosis, and they are more likely to incur severe injuries, with increased hospital costs and risk of death. Poor outcomes are most associated with ascites, hepatic encephalopathy, alcohol abuse, and infection, highlighting the subgroups at highest risk and most likely to benefit from preventative interventions.