Journal of general internal medicine
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Human papillomavirus (HPV) infection is the causative agent in cervical cancer, and is associated with numerous other genital cancers, including vulvar, vaginal, and anal cancer. Primary prevention with HPV vaccination is safe and efficacious, and a recently approved HPV vaccine will provide even more extensive protection against several oncogenic HPV strains. ⋯ This article highlights new evidence regarding the efficacy of the recently approved 9-valent HPV (9vHPV) vaccine and the use of primary high-risk HPV testing in cervical cancer screening. We consider the utility of urinary HPV testing in routine clinical practice and review current guidelines regarding anal HPV screening.
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Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known. ⋯ In this screening program using core PHM principles, CRC screening increased markedly in all racial/ethnic groups, but disparities persisted for some groups and developed in others, which correlated with levels of adoption of mailed FIT.
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Obtaining cancer screening on patients with limited life expectancy has been proposed as a measure for low quality care for primary care physicians (PCPs). However, administrative data may underestimate life expectancy in patients who undergo screening. ⋯ Receipt of cancer screening is a powerful marker of health status that is not captured by comorbidity measures in administrative data. Because life expectancy algorithms using administrative data underestimate the life expectancy of patients who undergo screening, they can overestimate the problem of cancer screening in patients with limited life expectancy.
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The widespread adoption of medical practices without a firm evidence base is common and the current growing enthusiasm for atrial fibrillation screening offers a real-time example of this phenomenon. Although no randomized trials supporting the utility of screening for atrial fibrillation exist, proponents suggest that such screening should be considered. Atrial fibrillation is a common condition that is often asymptomatic. ⋯ Screening for atrial fibrillation may be beneficial but there is also a reasonable likelihood that its harms will outweigh it benefits. In this article we make the case that adopting this practice prior to data from randomized controlled trial would be a mistake. If screening for atrial fibrillation is adopted without such a robust evidence base we may well later discover that this course of action was wrong.
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The Chronic Care Initiative (CCI) was a large state-wide patient-centered medical home (PCMH) initiative in Pennsylvania in place from 2008-2011. ⋯ The CCI was associated with substantial cost savings, attributable primarily to reduced inpatient costs, among a high-risk group of Medicaid patients, who may disproportionally benefit from care management in patient-centered medical homes.