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News From The Annals Of Internal Medicine: Dec. 4, 2012

Computer Alerts to Improve in

Interactive computer alerts to warn providers of virologic failure improve patient outcomes in HIV. can be used to improve quality and safety of health care, yet such clinical decision-support systems () are lacking in HIV care. Researchers designed a randomized, controlled trial to test the efficacy of a that generates alerts to notify HIV out-patient care providers of adverse events or missed appointments through the provider’s electronic medical record (EMR) home page, patient-specific EMR page, and bi-weekly emails. The alerts provided key clinical information and provided a mechanism for providers to request appointments and/or lab work. Thirty-three HIV care providers followed 1,011 patients with HIV for one year. Patients were randomly assigned to receive either “static” alerts or alerts from the . Patients in the group had a clinically significantly greater increase in mean CD4 cell count compared with the static alert group. The improved provider follow-up practices and satisfaction with the interactive alert system was high.

Tracking Tumor Size Identifies Lung Cancer Cases Overdiagnosed by Screening

Tracking volume-doubling time (VDT) could help to distinguish aggressive tumors from nonaggressive tumors, alleviating some of the overdiagnosis concerns related to lung cancer screening, such as overtreatment leading to unnecessary morbidity, stress, and cost. Researchers used VDT to track tumor growth in 175 high-risk patients diagnosed with primary lung cancer using low-dose computed tomography (LDCT). The researchers found that most cases (75 percent) of cancer were fast-growing. These findings suggest that a reasonable threshold to separate aggressive from nonaggressive lesions is a VDT of 200 days. In even fast-growing cancer, early treatment resulted in good long-term survival. However, overtreatment is a possibility, as 29 of the 175 patients diagnosed with cancer underwent surgical biopsy for benign disease. The researchers suggest further studies to assess whether VDT can help reduce overdiagnosis in lung cancer screening programs.


American College of Physicians