Annals of internal medicine
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To systematically review the methodologic rigor of the research on volume and outcomes and to summarize the magnitude and significance of the association between them. ⋯ High volume is associated with better outcomes across a wide range of procedures and conditions, but the magnitude of the association varies greatly. The clinical and policy significance of these findings is complicated by the methodologic shortcomings of many studies. Differences in case mix and processes of care between high- and low-volume providers may explain part of the observed relationship between volume and outcome.
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Questions remain about the importance of smoking and smoking cessation after incident myocardial infarction. ⋯ After incident myocardial infarction, smoking was associated with an elevated risk for recurrent coronary events. In persons who quit smoking after infarction, the risk declined to equal that of nonsmokers by 3 years after cessation.
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Methadone is an effective treatment for opioid dependency and chronic pain. A methadone derivative, levacetylmethadol, was withdrawn from the European market after being associated with torsade de pointes. To date, no association between methadone and this arrhythmia has been described. ⋯ This series raises concern that very-high-dose methadone may be associated with torsade de pointes. Given the likely expansion of methadone treatment into primary care, further investigation of these findings is warranted.
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Meta Analysis
Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force.
To synthesize new data on breast cancer screening for the U.S. Preventive Services Task Force. ⋯ In the randomized, controlled trials, mammography reduced breast cancer mortality rates among women 40 to 74 years of age. Greater absolute risk reduction was seen among older women. Because these results incorporate several rounds of screening, the actual number of mammograms needed to prevent one death from breast cancer is higher. In addition, each screening has associated risks and costs.