1. For some, screening for colorectal cancer should continue well past age 75
Colorectal cancer (CRC) screening is cost-effective in elderly patients and should continue well past age 75 for those who have not already been screened, according to an article being published in Annals of Internal Medicine. Current CRC screening guidelines by the United States Preventive Services Task Force recommend screening with fecal occult blood testing, sigmoidoscopy, or colonoscopy from ages 50 to 75 years. The Task Force Recommends against screening after age 75 for those with an adequate screening history, but many in the medical community have interpreted that to mean that no one over the age of 75 should be screened for CRC. Researchers sought to determine up to what age elderly persons without previous CRC screening should be tested, and which test should be used at which age. Using a computer simulation, they compared screening a cohort of 10 million elderly patients between 76 and 90 years with no, moderate, and severe comorbid conditions to a cohort of adequately screened elderly persons. Each cohort had a one-time screening with colonoscopy, sigmoidoscopy, or fecal immunochemical test (FIT) and cost-effectiveness was assessed for each method. The researchers found that in previously unscreened elderly patients with no comorbid conditions, CRC screening was effective and cost-effective up to age 86 years. Screening effectiveness and cost-effectiveness declined as comorbid conditions increased. Among the screening tools, colonoscopy as most effective and still cost-effective up to 83 years, sigmoidoscopy was indicated at age 84 years, and FIT was indicated at ages 85 and 86 years. According to the authors of an accompanying editorial, these findings have important clinical implications because colonoscopy should now be considered in every patient aged 75 and older who has not had colorectal cancer screening previously.
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2. Practices using patient-centered medical home with EHRs have improved quality of care
Physician practices using a patient-centered medical home (PCMH) model that relies on electronic health records (EHRs) achieve better quality of care than non-PCMH practices using EHRs or paper health records, according to an article being published in Annals of Internal Medicine. The PCMH is a model of care that emphasizes a team-based approach to care coordination and management of diseases. This model relies heavily on EHRs. Researchers sought to determine the effect of the PCMH on quality of care. They compared claims across 10 quality measures, such as lipid testing for patients with diabetes, breast cancer screening, and appropriate testing for children with pharyngitis. The researchers found that, over time, practices using the PCMH model improved their quality of care at a rate significantly higher than non-PCMH practices. It was noted that quality improved in some measures, but not others. However, the adjusted odds of receiving recommended care in the PCMH practice were 7 percent higher than in the paper group and 6 percent higher than in the EHR group. The PCMH effect was independent of EHR technology, which, on its own, seemed to be insufficient to achieve improvements in care. The authors suggest that changes to organizational culture necessitated by the PCMH seem to play a role in improving quality. PCMH transformation requires a changing culture toward population management, building a team by defining roles and responsibilities, and becoming accountable for performance. While none of those changes focus specifically on information technology, at least two – population management and performance accountability – are enabled by it.
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3. Observation: Tanning beds associated with vitamin D toxicity?
Tanning beds may be associated with vitamin D toxicity, according to an observation being published in Annals of Internal Medicine . The authors describe the case of a 26-year-old white woman who was referred to the endocrinology clinic for asymptomatic vitamin D toxicity. The patient did not excessively consume milk or take over-the-counter vitamin D supplements, and reported minimal sun exposure. However, the patient admitted to using a tanning bed a minimum of three times a week for at least six months. The clinicians advised the patient to stop using the tanning bed since another cause of her elevated vitamin D levels could not be identified. One month later, the patient's serum vitamin D levels had decreased. The authors observed that tanning beds could be an alternative source of vitamin D for deficient patients that cannot get adequate vitamin D from oral sources. However, the risks for skin cancer would have to be weighed against the benefits of increased vitamin D.
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