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Integrative Physical Medicine – Medical News

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Medical News

  • Mepolizumab or Placebo for Eosinophilic Granulomatosis with Polyangiitis
    Posted on May 18, 2017 at 12:00 am

    Eosinophilic granulomatosis with polyangiitis (formerly known as the Churg–Strauss syndrome) is characterized by asthma, sinusitis, pulmonary infiltrates, neuropathy, and eosinophilic vasculitis of one or more end-organs. Eosinophils are thought to induce pathogenic effects in patients wit […]

  • Targeting Eosinophils in Eosinophilic Granulomatosis with Polyangiitis
    Posted on May 18, 2017 at 12:00 am

    Eosinophilic granulomatosis with polyangiitis, first described in the early 1950s by Dr. Jacob Churg and Dr. Lotte Strauss (hence the original name, the Churg–Strauss syndrome), is a rare condition that can affect many organ systems, most commonly the lung, with the majority of patients presenting […]

  • Case 15-2017 — A 27-Year-Old Woman with Anemia, Thrombocytosis, and Skin Lesions after Travel Abroad
    Posted on May 18, 2017 at 12:00 am

    Presentation of Case. Dr. Alyssa R. Letourneau: A 27-year-old woman was evaluated in the infectious disease clinic of this hospital because of skin lesions, anemia, thrombocytosis, and an elevated blood alkaline phosphatase level. Eleven months before this presentation, the patient traveled abroad […]

  • Case 14-2017: A 20-Year-Old Man with Pain and Swelling of the Left Calf and a Purpuric Rash
    Posted on May 11, 2017 at 12:00 am

    Presentation of Case. Dr. Lauren R. Zeitels (Medicine): A 20-year-old man was seen in an outpatient clinic of this hospital because of pain and swelling of the left calf and a purpuric rash. The patient had been well until 3 weeks before presentation to this hospital, when sore throat, […]

  • GGPS1 Mutation and Atypical Femoral Fractures with Bisphosphonates
    Posted on May 4, 2017 at 12:00 am

    To the Editor: Atypical femoral fractures have been associated with long-term bisphosphonate treatment. However, the underlying mechanisms remain obscure. We studied three sisters who had atypical femoral fractures after receiving various oral bisphosphonates for 6 years. Two of the sisters had a […]

  • Back to the History
    Posted on May 4, 2017 at 12:00 am

    Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors’ commentary follows. Stage. An 82-year-old man presented to […]

  • Overexpression of the Cytokine BAFF and Autoimmunity Risk
    Posted on April 27, 2017 at 12:00 am

    Multiple sclerosis and systemic lupus erythematosus (SLE) are autoimmune diseases caused by largely unknown environmental factors acting in genetically susceptible persons. Genomewide association studies have provided statistical support for more than 110 independent signals for multiple sclerosis […]

  • Adalimumab plus Methotrexate for Uveitis in Juvenile Idiopathic Arthritis
    Posted on April 27, 2017 at 12:00 am

    Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. Children with JIA are at risk for inflammation of the uvea (uveitis). Uveitis develops in approximately 12 to 38% of patients with JIA within 7 years after the onset of arthritis. Despite current screening and […]

  • Adalimumab in the Treatment of Uveitis in Juvenile Idiopathic Arthritis
    Posted on April 27, 2017 at 12:00 am

    Uveitis encompasses a collection of ocular diseases that are characterized by intraocular inflammation and categorized according to the anatomical location of the inflammation in the eye. In the United States, uveitis is estimated to be the fifth or sixth leading cause of blindness and affects a […]

  • A Bare-Bones Approach
    Posted on April 6, 2017 at 12:00 am

    Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors’ commentary follows. Stage. A 60-year-old woman with type 1 […]

  • Psoriatic Arthritis
    Posted on March 9, 2017 at 12:00 am

    Psoriasis is a common skin disease that is associated with multiple coexisting conditions. The most prevalent coexisting condition, psoriatic arthritis, develops in up to 30% of patients with psoriasis and is characterized by diverse clinical features, often resulting in delayed diagnosis and […]

  • Inhibiting Plasma Kallikrein for Hereditary Angioedema Prophylaxis
    Posted on February 23, 2017 at 12:00 am

    Hereditary angioedema with C1 inhibitor deficiency is a rare genetic disease that is characterized by recurrent swelling episodes, typically affecting the subcutaneous or submucosal tissues of the hands and feet, abdomen, face, larynx, or genitourinary tract. Swelling of the larynx can b […]

  • Case 6-2017: A 57-Year-Old Woman with Fatigue, Sweats, Weight Loss, Headache, and Skin Lesions
    Posted on February 23, 2017 at 12:00 am

    Presentation of Case. Dr. Kevin J. Heaton (Medicine): A 57-year-old woman was seen in the outpatient rheumatology clinic of this hospital because of fatigue, night sweats, weight loss, headache, diffuse abdominal pain, and skin lesions. The patient had been well until approximately 24 months befor […]

  • Kallikrein Inhibition for Hereditary Angioedema
    Posted on February 23, 2017 at 12:00 am

    Management of hereditary angioedema due to C1 inhibitor deficiency has evolved. During the past 10 years, those affected have progressed from underrecognized disability and premature death, through evidence-based hospital treatment, toward self-administration and independence from unscheduled […]

  • Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis
    Posted on February 16, 2017 at 12:00 am

    Rheumatoid arthritis is a systemic autoimmune disease characterized by inflammatory synovitis and progressive joint destruction, which are associated with severe disability and increased mortality. Progress in treatment with the use of conventional synthetic disease-modifying antirheumatic drugs […]

  • AA Amyloidosis and IgG4-Related Disease
    Posted on February 9, 2017 at 12:00 am

    To the Editor: Here, we describe a patient with renal amyloid A (AA) amyloidosis that was apparently associated with IgG4-related disease. A 53-year-old man with long-standing malaise and fatigue had a slow-growing mesenteric mass (5 cm in diameter) that had been present 16 years earlier on t […]

  • Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis
    Posted on December 29, 2016 at 12:00 am

    Nonsteroidal antiinflammatory drugs (NSAIDs) were introduced in the 1960s and became the most widely prescribed class of drugs in the world, with more than 100 million prescriptions issued annually in the United States alone. NSAIDs inhibit cyclooxygenase (COX), which reduces pain and inflammation […]

  • Safety of Nonsteroidal Antiinflammatory Drugs
    Posted on December 29, 2016 at 12:00 am

    Nonsteroidal antiinflammatory drugs (NSAIDs), one of the most widely used classes of drugs in the world, are effective antiinflammatory, analgesic, and antipyretic agents. Although they differ from one another in chemical class, all inhibit the synthesis of prostaglandins. Because prostaglandins […]

  • Acute Rheumatic Fever with Erythema Marginatum
    Posted on December 22, 2016 at 12:00 am

    Figure 1. […]

  • Fulminant Myocarditis with Combination Immune Checkpoint Blockade
    Posted on November 3, 2016 at 12:00 am

    Immune checkpoint inhibitors have transformed the treatment of several cancers by releasing restrained antitumor immune responses. Ipilimumab, an anti–cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4) antibody, and nivolumab, an anti–programmed death-1 (PD-1) antibody, have individually improved […]

  • Hunt for an HIV Vaccine Intensifies
    Posted by Lyon J. on June 27, 2017 at 12:00 am

    A preventive vaccine against HIV infection would be so “transformative” that even if it was only 50% effective, it would reduce the number of people worldwide living with the virus by 36%, according to a statement from Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), and Carl W. Dieffenbach, PhD, director of NIAID’s Division of AIDS, that was issued on May 18, HIV Vaccination Awareness Day. The estimate is based on a new modeling study funded by the National Institutes of Health (NIH). […]

  • Evolving State-Based Contraceptive and Abortion Policies
    Posted by Mallampati D, Simon MA, Janiak E. on June 27, 2017 at 12:00 am

    This Viewpoint discusses the importance of US state-based contraceptive and abortion policies given renewed focus by the Trump administration on restrictions to federal funding for reproductive services. […]

  • Incorrect Statement in Text
    Posted on June 27, 2017 at 12:00 am

    In the Reply Letter entitled “Physician Charges and Medicare Payments,” published in the May 2, 2017, issue of JAMA, there were errors in the text. In the second column, the second sentence of the first complete paragraph stated, “Data from FAIR Health is contingent on the physician voluntarily contracting with FAIR Health.” This should read, “Data from FAIR Health are provided by health care insurance plans and payers that voluntarily contract with FAIR Health.” This article was corrected online. […]

  • Defending Biomedical Science in an Era of Threatened Funding
    Posted by Ioannidis JA. on June 27, 2017 at 12:00 am

    In this Viewpoint, John Ioannidis discusses how the medical community, other scientists, and the public can defend science under the mounting pressure of threatened funding. […]

  • JAMA
    Posted on June 27, 2017 at 12:00 am

    […]

  • Direct-to-Consumer Medical Testing and Value-Based Care
    Posted by Rockwell K. on June 27, 2017 at 12:00 am

    This Viewpoint documents the growing market share of direct-to-consumer (DTC) medical testing despite growing recognition that it represents low-value or harmful care and proposes policy options to increase accountability and protect patients from adverse consequences of DTC testing. […]

  • Pill Reminders Don’t Improve Adherence
    Posted by Slomski A. on June 27, 2017 at 12:00 am

    Simple medication reminder devices don’t improve patients’ adherence to medication regimens, found a study in JAMA Internal Medicine. The trial tested a pill bottle strip with toggles for each day, a pill bottle cap with a digital timer displaying time elapsed since the medication was taken, and a standard pillbox with 1 compartment for each day. […]

  • Porous Boundaries
    Posted by Caruso Brown AE. on June 27, 2017 at 12:00 am

    Each fall, first-year medical students are introduced to the basics of confidentiality. The question is posed: “How many of you would friend a patient?” Watching from the back of the auditorium, I have yet to see a single hand flutter, much less shoot confidently into the air. […]

  • NIH-Kennedy Center Initiative to Explore Music and the Mind
    Posted by Collins FS, Fleming R. on June 27, 2017 at 12:00 am

    In this Arts and Medicine essay, soprano Renee Fleming and NIH Director Francis Collins describe the Sound Health initiative, a program by the NIH and the John F. Kennedy Center for the Performing Arts in association with the National Endowment for the Arts exploring connections between music, health, and neuroscience. […]

  • Acupuncture and the Complex Connections Between the Mind and the Body
    Posted by Briggs JP, Shurtleff D. on June 27, 2017 at 12:00 am

    Almost 50 years ago, New York Times reporter James Reston had an emergency appendectomy while traveling in China. His subsequent report that acupuncture produced substantial relief from his postoperative discomfort is widely credited with launching Western interest in acupuncture, although many Western medical practitioners have remained skeptical. Nevertheless, there has been steady progress in application of the methods of evidence-based medicine and modern neuroscience to these ancient practices, suggesting that acupuncture may have therapeutic benefit. […]

  • Complications of Diabetes Diagnosed in Children and Adolescents
    Posted by Ibanez-Bruron M, Solebo A, Rahi J. on June 27, 2017 at 12:00 am

    To the Editor Dr Dabelea and colleagues provided much needed data on the natural history of complications in adolescents and young adults with diabetes. We agree that the increasing number of children and adolescents living with diabetes calls for strategies to reduce the development of diabetic complications in early adulthood. With regards to diabetic eye disease, such strategies require a deeper understanding than currently available of the natural history of diabetic retinopathy. Specifically, analyses of the prevalence of and progression to retinopathy requiring treatment are needed. […]

  • ICMJE Requirement for Clinical Trial Data Sharing
    Posted by Taichman DB, Sahni P, Pinborg A, et al. on June 27, 2017 at 12:00 am

    The International Committee of Medical Journal Editors (ICMJE) believes there is an ethical obligation to responsibly share data generated by interventional clinical trials because trial participants have put themselves at risk. In January 2016 we published a proposal aimed at helping to create an environment in which the sharing of deidentified individual participant data becomes the norm. In response to our request for feedback we received many comments from individuals and groups. Some applauded the proposal while others expressed disappointment it did not more quickly create a commitment […]

  • Neonatal Abstinence Syndrome Better Treated With Buprenorphine
    Posted by Slomski A. on June 27, 2017 at 12:00 am

    Buprenorphine was significantly more effective than morphine in treating infants with neonatal abstinence syndrome (NAS), according to a study published in the New England Journal of Medicine. Most infants with NAS are currently treated with morphine. […]

  • Electroacupuncture Stress Urinary Incontinence in Women
    Posted by Liu Z, Liu Y, Xu H, et al. on June 27, 2017 at 12:00 am

    This randomized clinical trial compares the effects of electroacupuncture vs sham electroacupuncture on urinary leakage among women with stress urinary incontinence. […]

  • Teens Who Were Breastfed Are Heavier
    Posted by Slomski A. on June 27, 2017 at 12:00 am

    Breastfeeding doesn’t protect against obesity in adolescence, nor does it lower blood pressure (BP), according to a secondary analysis of the Cluster-randomized Promotion of Breastfeeding Intervention Trial (PROBIT) published in JAMA Pediatrics. […]

  • Effects of Acupuncture and Clomiphene on Fertility in Chinese Women With PCOS
    Posted by Wu X, Stener-Victorin E, Kuang H, et al. on June 27, 2017 at 12:00 am

    This 2 × 2 factorial trial compared the effects of active vs sham acupuncture and of clomiphene vs placebo on live births among Chinese women with polycystic ovary syndrome (PCOS). […]

  • Changing the Weight-loss Subject
    Posted on June 27, 2017 at 12:00 am

    Health researchers have suggested a technique that might help clinicians address obesity when talking with patients: change the subject. […]

  • Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China
    Posted by Wang L, Gao P, Zhang M, et al. on June 27, 2017 at 12:00 am

    This population epidemiology study uses national survey data to estimate the prevalence and ethnic patterns of diabetes and prediabetes in China in 2013. […]

  • Some Problems of Wartime Neurology
    Posted on June 27, 2017 at 12:00 am

    In the total war in which we are now engaged, to quote Dr. Wilder Penfield, “one civilian population is brought face to face with another civilian population in a war of labor, of self denial and of wits.” In this situation academic abstraction must give place to pragmatic efforts toward the solution of present day tasks. What can neurology contribute? Speaking before the Medical Research Committee of the National Research Council at Ottawa, Dr. Penfield enumerated some of the problems which demand solution and which come within the province of the neurologist, the neurosurgeon […]

  • Quality of Care After Health Plan Exit From Medicaid Managed Care
    Posted by Ndumele CD, Schpero WL, Schlesinger MJ, et al. on June 27, 2017 at 12:00 am

    This study uses Medicaid administrative data to quantify health plan exit from Medicaid managed care between 2006 and 2014 and to evaluate the change in health care quality associated with plan exit. […]

  • Regulating Drug Company Promotion in an Era of Unprecedented Advertisement
    Posted by Mailankody S, Prasad V. on June 27, 2017 at 12:00 am

    This Viewpoint uses the recent instance of disease awareness promotion on a television soap opera to discuss questions about the role and regulation of novel forms of direct-to-consumer disease awareness marketing. […]

  • The Diagnosis and Treatment of Prostate Cancer
    Posted by Litwin MS, Tan H. on June 27, 2017 at 12:00 am

    This review summarizes advances in risk classification methods, imaging techniques, biomarkers for diagnosis, and treatments for prostate cancer. […]

  • Complications of Diabetes Diagnosed in Children and Adolescents—Reply
    Posted by Dabelea D, D’Agostino R, Jr, Mayer-Davis EJ. on June 27, 2017 at 12:00 am

    In Reply Dr Peng and colleagues raise the concern that we did not adjust for potential differences in “socioeconomic factors such as insurance, household income, or parental education,” which might be associated with a higher prevalence of complications in adolescents and young adults with type 1 and type 2 diabetes. We did not adjust for these factors for 2 main reasons. First, our main purpose was to identify whether common biologic risk factors known to influence complications accounted for the excess prevalence in adolescents and young adults with type 2 diabetes compared with […]

  • Use of High-Intensity Statins and Guideline Expectations
    Posted by Laing ST. on June 27, 2017 at 12:00 am

    This commentary discusses a study published in JAMA Cardiology that examined the association between intensity of statin therapy in patients with atherosclerotic cardiovascular disease and all-cause mortality among patients in the Veterans Affairs health care system. […]

  • Robots Help Patients Change Behaviors
    Posted by Abbasi J. on June 27, 2017 at 12:00 am

    This Medical News article is a Q&A with University of Southern California robotics expert Maja Matarić. […]

  • Chromosomal Microarray Testing for Children With Neurodevelopmental Disorders
    Posted by Martin C, Ledbetter DH. on June 27, 2017 at 12:00 am

    This Genomics and Precision Health article discusses the advantages of chromosomal microarray analysis over G-banded karotyping for evaluating neurodevelopmental disorders in children. […]

  • Nocebo Effect May Account for Statin Adverse Events
    Posted by Slomski A. on June 27, 2017 at 12:00 am

    Muscle pain and weakness reported by patients taking statins may be due to the nocebo effect rather than a direct cause of statin therapy, according to a new trial in The Lancet that examined adverse events (AEs) of statins. […]

  • Assessment of Head Collision Events in World Cup Soccer Players
    Posted by Cusimano MD, Casey J, Jing R, et al. on June 27, 2017 at 12:00 am

    This study uses video footage observations of all 64 matches of the 2014 FIFA World Cup to assess the incidence, characteristics, and sideline outcome assessments of player head collisions. […]

  • Silk Offers No Relief From Eczema
    Posted by Slomski A. on June 27, 2017 at 12:00 am

    Silk clothing provided no clinical benefits to children with moderate to severe eczema compared with standard care, according to a trial published in PLOS Medicine. […]

  • Maternal Obesity and Cerebral Palsy in Offspring—Reply
    Posted by Villamor E, Tedroff K, Cnattingius S. on June 27, 2017 at 12:00 am

    In Reply Mr Li and Dr Li raise 3 points. First, they note that the analyses did not adjust for important confounding factors including maternal diabetes and hypertension. Gestational diabetes and pregnancy-induced hypertensive diseases are not confounders of the association between early pregnancy BMI and cerebral palsy because they are generally regarded as consequences, not causes, of maternal obesity. Similarly, overweight and obesity increase risks of manifest (type 1 or type 2) diabetes and essential hypertension in a dose-response manner. […]

  • Effort to Relax School Lunch Guidelines
    Posted by Lyon J. on June 27, 2017 at 12:00 am

    Sonny Perdue, the new US Secretary of Agriculture, has launched an effort to “make school meals great again,” according to the US Department of Agriculture (USDA). […]

  • Maternal Obesity and Cerebral Palsy in Offspring
    Posted by Li Y, Li Y. on June 27, 2017 at 12:00 am

    To the Editor Dr Villamor and colleagues investigated the association between maternal body mass index (BMI) and incidence of cerebral palsy in offspring and found that overweight and obesity in early pregnancy was associated with an increased rate of cerebral palsy. Important confounding factors, including maternal diabetes and hypertension, were not considered in their statistical analyses. […]

  • National Plan for COPD Care
    Posted by Lyon J. on June 27, 2017 at 12:00 am

    The final version of a coordinated nationwide plan to address chronic obstructive pulmonary disease (COPD), the third leading cause of death in the United States, was unveiled last month by the National Heart, Lung, and Blood Institute (NHLBI) at the American Thoracic Society conference in Washington, DC. […]

  • Administration of Fibrinogen Concentrate During Cardiac Surgery
    Posted by Meesters M, von Heymann C, Boer C. on June 27, 2017 at 12:00 am

    To the Editor The randomized clinical trial by Dr Bilecen and colleagues showed no benefit of fibrinogen (factor I) concentrate use compared with placebo on intraoperative blood loss in patients with bleeding following high-risk cardiac procedures. We believe that the results may unfairly characterize fibrinogen concentrate use. […]

  • Drug-Resistant Fungus Arrives in US
    Posted on June 27, 2017 at 12:00 am

    Multidrug-resistant Candida auris is making its way through US health care facilities, according to reports submitted to the CDC from 7 states. It was only a year ago that the agency warned of international outbreaks with high mortality rates and the possibility of similar cases cropping up in the United States. […]

  • Administration of Fibrinogen Concentrate During Cardiac Surgery
    Posted by Muggleton E, Muggleton T. on June 27, 2017 at 12:00 am

    To the Editor A number of issues regarding the use of fibrinogen for bleeding during cardiac surgery are raised by the study by Dr Bilecen and colleagues. […]

  • Shared Vision
    Posted by Wicks I. on June 27, 2017 at 12:00 am

    Two globes to see the world,each in its lashed and shuttered orbit,looking out, like identical twinstracking parallel lives. […]

  • Administration of Fibrinogen Concentrate During Cardiac Surgery
    Posted by Bilecen S, Nierich A. on June 27, 2017 at 12:00 am

    In Reply Dr Meesters and colleagues are concerned about our choice of primary vs secondary outcomes. In our trial, patients with clinically relevant intraoperative bleeding after removal of cardiopulmonary bypass were randomized to receive placebo or fibrinogen concentrate. The moment of intervention was the start of the primary outcome, ending with closure of the chest. We expected that patients with severe coagulopathic bleeding would have relevant blood loss within this period, so it was chosen as the primary outcome. Because blood loss continues postoperatively, the cumulative 24-hour […]

  • Groin Hernia
    Posted by Hewitt D. on June 27, 2017 at 12:00 am

    […]

  • Complications of Diabetes Diagnosed in Children and Adolescents
    Posted by Peng S, Li C, Sun X. on June 27, 2017 at 12:00 am

    To the Editor The study by Dr Dabelea and colleagues focused on the prevalence of complications among teenagers and young adults who had been diagnosed with type 1 diabetes vs type 2 diabetes during childhood and adolescence. Although the base model (adjusted for age, sex, race/ethnicity, duration of diabetes, and clinical site) showed a significantly higher prevalence of complications for type 2 diabetes compared with type 1 diabetes, the authors did not adjust for socioeconomic factors such as insurance, household income, or parental education, which might be associated with a higher […]

  • Highlights for June 27, 2017
    Posted on June 27, 2017 at 12:00 am

    […]

  • Coronary-Artery Vasospasm
    Posted on June 22, 2017 at 12:00 am

    Figure 1. […]

  • Post-Traumatic Stress Disorder
    Posted on June 22, 2017 at 12:00 am

    Reports of violence, injury, and death appear daily on headline news. More than 70% of adults worldwide experience a traumatic event at some time in their lives, and 31% experience four or more events. Post-traumatic stress disorder (PTSD) is the most prevalent psychopathological consequence of […]

  • Case 19-2017 — A 53-Year-Old Woman with Leg Numbness and Weakness
    Posted on June 22, 2017 at 12:00 am

    Presentation of Case. Dr. Kristyn M. Spera (Neurology): A 53-year-old woman with rheumatoid arthritis was admitted to this hospital because of progressive asymmetric hypoesthesia and weakness in the legs. The patient had been in her usual health until 4 months before this admission, when […]

  • Efficacy of Recombinant Influenza Vaccine in Adults 50 Years of Age or Older
    Posted on June 22, 2017 at 12:00 am

    Reducing the burden of influenza disease requires improved vaccines, and a recombinant influenza vaccine may contribute to this public-health goal. This vaccine contains recombinant hemagglutinin (HA) proteins produced in a serum-free medium by expresSF+ cells. These cells contain recombinant […]

  • Perirenal Extramedullary Hematopoiesis
    Posted on June 22, 2017 at 12:00 am

    Figure 1. […]

  • Implementation of Medical Homes in Federally Qualified Health Centers
    Posted on June 21, 2017 at 12:00 am

    A strong primary care delivery system is critical to improving population health and controlling health care spending. The use of the patient-centered medical home — a care-delivery model that emphasizes enhanced access along with comprehensive and coordinated primary care — has spread widely […]

  • Strongyloides stercoralis Hyperinfection
    Posted on June 15, 2017 at 12:00 am

    Figure 1. […]

  • Case 18-2017 — An 11-Year-Old Girl with Difficulty Eating after a Choking Incident
    Posted on June 15, 2017 at 12:00 am

    Presentation of Case. Dr. Lazaro V. Zayas (Psychiatry): An 11-year-old girl was seen in an outpatient clinic of this hospital because of difficulty eating solid food and associated weight loss after an acute choking incident. The patient had been in her usual health until 14 days before this […]

  • Diabetic Foot Ulcers and Their Recurrence
    Posted on June 15, 2017 at 12:00 am

    Complications of diabetes that affect the lower extremities are common, complex, and costly. Foot ulceration is the most frequently recognized complication. In a community-based study in the northwestern United Kingdom, the prevalence of active foot ulcers identified at screening among persons wit […]

  • A Tale of Two Doctors — Structural Inequalities and the Culture of Medicine
    Posted on June 15, 2017 at 12:00 am

    I recently had two doctor’s appointments in the same week, one in general medicine and the other in orthopedics, both at the same highly ranked medical institution. Occurring so close together, these visits quickly morphed in my mind from personal experiences with individual doctors into metaphors […]

  • The Waiting Game — Why Providers May Fail to Reduce Wait Times
    Posted on June 15, 2017 at 12:00 am

    When patients wait weeks or months for physician’s appointments, bad things happen. Some adverse consequences are emotional: patients become anxious and even angry. Some are clinical, such as medical issues that worsen, especially if patients don’t show up when their appointments finally ro […]

  • Seesaw Nystagmus
    Posted on June 15, 2017 at 12:00 am

    Figure 1. […]

  • Management of Septic Shock
    Posted on June 8, 2017 at 12:00 am

    Ms. Jones has been admitted to the ICU with septic shock and is receiving vasopressors to elevate her mean arterial pressure. Shortly after her arrival, her condition deteriorates, and intubation and mechanical ventilation are initiated because of acute lung injury. The increased lactate level and […]

  • Case 17-2017: A 14-Year-Old Boy with Acute Fear of Choking while Swallowing
    Posted on June 8, 2017 at 12:00 am

    Presentation of Case. Dr. Juliana Mariani (Pediatrics): A 14-year-old boy was seen in the emergency department of this hospital because of fear of choking while swallowing. The patient had been well until 2 days before admission, when he choked while eating a piece of chicken during dinner. H […]

  • Large Arachnoid Cyst
    Posted on June 8, 2017 at 12:00 am

    Figure 1. […]

  • Social Anxiety Disorder
    Posted on June 8, 2017 at 12:00 am

    Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. Stage. A 26-year-old […]

  • Health Effects of Dramatic Societal Events — Ramifications of the Recent Presidential Election
    Posted on June 8, 2017 at 12:00 am

    A small but growing body of evidence suggests that election campaigns can have both positive and negative effects on health. Campaigns that give voice to the disenfranchised have been shown to have positive but short-term effects on health. Such associations have been observed among black Sout […]

  • Mondor’s Disease
    Posted on June 8, 2017 at 12:00 am

    Figure 1. […]

  • Spiraling Out of Control
    Posted on June 1, 2017 at 12:00 am

    Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors’ commentary follows. Stage. A 22-year-old man presented to t […]

  • The Other Victims of the Opioid Epidemic
    Posted on June 1, 2017 at 12:00 am

    I’d seen Jerry in pain before, but never like this. He lay prostrate on the gurney in the emergency department, his hands clenched in silent prayer. I laid an apologetic hand on his shoulder and told him we would do what we could to help. Then I logged in to the bedside computer to order his pain […]

  • Hunt for an HIV Vaccine Intensifies
    Posted by Lyon J. on June 27, 2017 at 12:00 am

    A preventive vaccine against HIV infection would be so “transformative” that even if it was only 50% effective, it would reduce the number of people worldwide living with the virus by 36%, according to a statement from Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), and Carl W. Dieffenbach, PhD, director of NIAID’s Division of AIDS, that was issued on May 18, HIV Vaccination Awareness Day. The estimate is based on a new modeling study funded by the National Institutes of Health (NIH). […]

  • Evolving State-Based Contraceptive and Abortion Policies
    Posted by Mallampati D, Simon MA, Janiak E. on June 27, 2017 at 12:00 am

    This Viewpoint discusses the importance of US state-based contraceptive and abortion policies given renewed focus by the Trump administration on restrictions to federal funding for reproductive services. […]

  • Incorrect Statement in Text
    Posted on June 27, 2017 at 12:00 am

    In the Reply Letter entitled “Physician Charges and Medicare Payments,” published in the May 2, 2017, issue of JAMA, there were errors in the text. In the second column, the second sentence of the first complete paragraph stated, “Data from FAIR Health is contingent on the physician voluntarily contracting with FAIR Health.” This should read, “Data from FAIR Health are provided by health care insurance plans and payers that voluntarily contract with FAIR Health.” This article was corrected online. […]

  • Defending Biomedical Science in an Era of Threatened Funding
    Posted by Ioannidis JA. on June 27, 2017 at 12:00 am

    In this Viewpoint, John Ioannidis discusses how the medical community, other scientists, and the public can defend science under the mounting pressure of threatened funding. […]

  • JAMA
    Posted on June 27, 2017 at 12:00 am

    […]

  • Direct-to-Consumer Medical Testing and Value-Based Care
    Posted by Rockwell K. on June 27, 2017 at 12:00 am

    This Viewpoint documents the growing market share of direct-to-consumer (DTC) medical testing despite growing recognition that it represents low-value or harmful care and proposes policy options to increase accountability and protect patients from adverse consequences of DTC testing. […]

  • Pill Reminders Don’t Improve Adherence
    Posted by Slomski A. on June 27, 2017 at 12:00 am

    Simple medication reminder devices don’t improve patients’ adherence to medication regimens, found a study in JAMA Internal Medicine. The trial tested a pill bottle strip with toggles for each day, a pill bottle cap with a digital timer displaying time elapsed since the medication was taken, and a standard pillbox with 1 compartment for each day. […]

  • Porous Boundaries
    Posted by Caruso Brown AE. on June 27, 2017 at 12:00 am

    Each fall, first-year medical students are introduced to the basics of confidentiality. The question is posed: “How many of you would friend a patient?” Watching from the back of the auditorium, I have yet to see a single hand flutter, much less shoot confidently into the air. […]

  • NIH-Kennedy Center Initiative to Explore Music and the Mind
    Posted by Collins FS, Fleming R. on June 27, 2017 at 12:00 am

    In this Arts and Medicine essay, soprano Renee Fleming and NIH Director Francis Collins describe the Sound Health initiative, a program by the NIH and the John F. Kennedy Center for the Performing Arts in association with the National Endowment for the Arts exploring connections between music, health, and neuroscience. […]

  • Acupuncture and the Complex Connections Between the Mind and the Body
    Posted by Briggs JP, Shurtleff D. on June 27, 2017 at 12:00 am

    Almost 50 years ago, New York Times reporter James Reston had an emergency appendectomy while traveling in China. His subsequent report that acupuncture produced substantial relief from his postoperative discomfort is widely credited with launching Western interest in acupuncture, although many Western medical practitioners have remained skeptical. Nevertheless, there has been steady progress in application of the methods of evidence-based medicine and modern neuroscience to these ancient practices, suggesting that acupuncture may have therapeutic benefit. […]

  • Complications of Diabetes Diagnosed in Children and Adolescents
    Posted by Ibanez-Bruron M, Solebo A, Rahi J. on June 27, 2017 at 12:00 am

    To the Editor Dr Dabelea and colleagues provided much needed data on the natural history of complications in adolescents and young adults with diabetes. We agree that the increasing number of children and adolescents living with diabetes calls for strategies to reduce the development of diabetic complications in early adulthood. With regards to diabetic eye disease, such strategies require a deeper understanding than currently available of the natural history of diabetic retinopathy. Specifically, analyses of the prevalence of and progression to retinopathy requiring treatment are needed. […]

  • ICMJE Requirement for Clinical Trial Data Sharing
    Posted by Taichman DB, Sahni P, Pinborg A, et al. on June 27, 2017 at 12:00 am

    The International Committee of Medical Journal Editors (ICMJE) believes there is an ethical obligation to responsibly share data generated by interventional clinical trials because trial participants have put themselves at risk. In January 2016 we published a proposal aimed at helping to create an environment in which the sharing of deidentified individual participant data becomes the norm. In response to our request for feedback we received many comments from individuals and groups. Some applauded the proposal while others expressed disappointment it did not more quickly create a commitment […]

  • Neonatal Abstinence Syndrome Better Treated With Buprenorphine
    Posted by Slomski A. on June 27, 2017 at 12:00 am

    Buprenorphine was significantly more effective than morphine in treating infants with neonatal abstinence syndrome (NAS), according to a study published in the New England Journal of Medicine. Most infants with NAS are currently treated with morphine. […]

  • Electroacupuncture Stress Urinary Incontinence in Women
    Posted by Liu Z, Liu Y, Xu H, et al. on June 27, 2017 at 12:00 am

    This randomized clinical trial compares the effects of electroacupuncture vs sham electroacupuncture on urinary leakage among women with stress urinary incontinence. […]

  • Teens Who Were Breastfed Are Heavier
    Posted by Slomski A. on June 27, 2017 at 12:00 am

    Breastfeeding doesn’t protect against obesity in adolescence, nor does it lower blood pressure (BP), according to a secondary analysis of the Cluster-randomized Promotion of Breastfeeding Intervention Trial (PROBIT) published in JAMA Pediatrics. […]

  • Effects of Acupuncture and Clomiphene on Fertility in Chinese Women With PCOS
    Posted by Wu X, Stener-Victorin E, Kuang H, et al. on June 27, 2017 at 12:00 am

    This 2 × 2 factorial trial compared the effects of active vs sham acupuncture and of clomiphene vs placebo on live births among Chinese women with polycystic ovary syndrome (PCOS). […]

  • Changing the Weight-loss Subject
    Posted on June 27, 2017 at 12:00 am

    Health researchers have suggested a technique that might help clinicians address obesity when talking with patients: change the subject. […]

  • Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China
    Posted by Wang L, Gao P, Zhang M, et al. on June 27, 2017 at 12:00 am

    This population epidemiology study uses national survey data to estimate the prevalence and ethnic patterns of diabetes and prediabetes in China in 2013. […]

  • Some Problems of Wartime Neurology
    Posted on June 27, 2017 at 12:00 am

    In the total war in which we are now engaged, to quote Dr. Wilder Penfield, “one civilian population is brought face to face with another civilian population in a war of labor, of self denial and of wits.” In this situation academic abstraction must give place to pragmatic efforts toward the solution of present day tasks. What can neurology contribute? Speaking before the Medical Research Committee of the National Research Council at Ottawa, Dr. Penfield enumerated some of the problems which demand solution and which come within the province of the neurologist, the neurosurgeon […]

  • Quality of Care After Health Plan Exit From Medicaid Managed Care
    Posted by Ndumele CD, Schpero WL, Schlesinger MJ, et al. on June 27, 2017 at 12:00 am

    This study uses Medicaid administrative data to quantify health plan exit from Medicaid managed care between 2006 and 2014 and to evaluate the change in health care quality associated with plan exit. […]

  • Regulating Drug Company Promotion in an Era of Unprecedented Advertisement
    Posted by Mailankody S, Prasad V. on June 27, 2017 at 12:00 am

    This Viewpoint uses the recent instance of disease awareness promotion on a television soap opera to discuss questions about the role and regulation of novel forms of direct-to-consumer disease awareness marketing. […]

  • The Diagnosis and Treatment of Prostate Cancer
    Posted by Litwin MS, Tan H. on June 27, 2017 at 12:00 am

    This review summarizes advances in risk classification methods, imaging techniques, biomarkers for diagnosis, and treatments for prostate cancer. […]

  • Complications of Diabetes Diagnosed in Children and Adolescents—Reply
    Posted by Dabelea D, D’Agostino R, Jr, Mayer-Davis EJ. on June 27, 2017 at 12:00 am

    In Reply Dr Peng and colleagues raise the concern that we did not adjust for potential differences in “socioeconomic factors such as insurance, household income, or parental education,” which might be associated with a higher prevalence of complications in adolescents and young adults with type 1 and type 2 diabetes. We did not adjust for these factors for 2 main reasons. First, our main purpose was to identify whether common biologic risk factors known to influence complications accounted for the excess prevalence in adolescents and young adults with type 2 diabetes compared with […]

  • Use of High-Intensity Statins and Guideline Expectations
    Posted by Laing ST. on June 27, 2017 at 12:00 am

    This commentary discusses a study published in JAMA Cardiology that examined the association between intensity of statin therapy in patients with atherosclerotic cardiovascular disease and all-cause mortality among patients in the Veterans Affairs health care system. […]

  • Robots Help Patients Change Behaviors
    Posted by Abbasi J. on June 27, 2017 at 12:00 am

    This Medical News article is a Q&A with University of Southern California robotics expert Maja Matarić. […]

  • Chromosomal Microarray Testing for Children With Neurodevelopmental Disorders
    Posted by Martin C, Ledbetter DH. on June 27, 2017 at 12:00 am

    This Genomics and Precision Health article discusses the advantages of chromosomal microarray analysis over G-banded karotyping for evaluating neurodevelopmental disorders in children. […]

  • Nocebo Effect May Account for Statin Adverse Events
    Posted by Slomski A. on June 27, 2017 at 12:00 am

    Muscle pain and weakness reported by patients taking statins may be due to the nocebo effect rather than a direct cause of statin therapy, according to a new trial in The Lancet that examined adverse events (AEs) of statins. […]

  • Assessment of Head Collision Events in World Cup Soccer Players
    Posted by Cusimano MD, Casey J, Jing R, et al. on June 27, 2017 at 12:00 am

    This study uses video footage observations of all 64 matches of the 2014 FIFA World Cup to assess the incidence, characteristics, and sideline outcome assessments of player head collisions. […]

  • Silk Offers No Relief From Eczema
    Posted by Slomski A. on June 27, 2017 at 12:00 am

    Silk clothing provided no clinical benefits to children with moderate to severe eczema compared with standard care, according to a trial published in PLOS Medicine. […]

  • Maternal Obesity and Cerebral Palsy in Offspring—Reply
    Posted by Villamor E, Tedroff K, Cnattingius S. on June 27, 2017 at 12:00 am

    In Reply Mr Li and Dr Li raise 3 points. First, they note that the analyses did not adjust for important confounding factors including maternal diabetes and hypertension. Gestational diabetes and pregnancy-induced hypertensive diseases are not confounders of the association between early pregnancy BMI and cerebral palsy because they are generally regarded as consequences, not causes, of maternal obesity. Similarly, overweight and obesity increase risks of manifest (type 1 or type 2) diabetes and essential hypertension in a dose-response manner. […]

  • Effort to Relax School Lunch Guidelines
    Posted by Lyon J. on June 27, 2017 at 12:00 am

    Sonny Perdue, the new US Secretary of Agriculture, has launched an effort to “make school meals great again,” according to the US Department of Agriculture (USDA). […]

  • Maternal Obesity and Cerebral Palsy in Offspring
    Posted by Li Y, Li Y. on June 27, 2017 at 12:00 am

    To the Editor Dr Villamor and colleagues investigated the association between maternal body mass index (BMI) and incidence of cerebral palsy in offspring and found that overweight and obesity in early pregnancy was associated with an increased rate of cerebral palsy. Important confounding factors, including maternal diabetes and hypertension, were not considered in their statistical analyses. […]

  • National Plan for COPD Care
    Posted by Lyon J. on June 27, 2017 at 12:00 am

    The final version of a coordinated nationwide plan to address chronic obstructive pulmonary disease (COPD), the third leading cause of death in the United States, was unveiled last month by the National Heart, Lung, and Blood Institute (NHLBI) at the American Thoracic Society conference in Washington, DC. […]

  • Administration of Fibrinogen Concentrate During Cardiac Surgery
    Posted by Meesters M, von Heymann C, Boer C. on June 27, 2017 at 12:00 am

    To the Editor The randomized clinical trial by Dr Bilecen and colleagues showed no benefit of fibrinogen (factor I) concentrate use compared with placebo on intraoperative blood loss in patients with bleeding following high-risk cardiac procedures. We believe that the results may unfairly characterize fibrinogen concentrate use. […]

  • Drug-Resistant Fungus Arrives in US
    Posted on June 27, 2017 at 12:00 am

    Multidrug-resistant Candida auris is making its way through US health care facilities, according to reports submitted to the CDC from 7 states. It was only a year ago that the agency warned of international outbreaks with high mortality rates and the possibility of similar cases cropping up in the United States. […]

  • Administration of Fibrinogen Concentrate During Cardiac Surgery
    Posted by Muggleton E, Muggleton T. on June 27, 2017 at 12:00 am

    To the Editor A number of issues regarding the use of fibrinogen for bleeding during cardiac surgery are raised by the study by Dr Bilecen and colleagues. […]

  • Shared Vision
    Posted by Wicks I. on June 27, 2017 at 12:00 am

    Two globes to see the world,each in its lashed and shuttered orbit,looking out, like identical twinstracking parallel lives. […]

  • Administration of Fibrinogen Concentrate During Cardiac Surgery
    Posted by Bilecen S, Nierich A. on June 27, 2017 at 12:00 am

    In Reply Dr Meesters and colleagues are concerned about our choice of primary vs secondary outcomes. In our trial, patients with clinically relevant intraoperative bleeding after removal of cardiopulmonary bypass were randomized to receive placebo or fibrinogen concentrate. The moment of intervention was the start of the primary outcome, ending with closure of the chest. We expected that patients with severe coagulopathic bleeding would have relevant blood loss within this period, so it was chosen as the primary outcome. Because blood loss continues postoperatively, the cumulative 24-hour […]

  • Groin Hernia
    Posted by Hewitt D. on June 27, 2017 at 12:00 am

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  • Complications of Diabetes Diagnosed in Children and Adolescents
    Posted by Peng S, Li C, Sun X. on June 27, 2017 at 12:00 am

    To the Editor The study by Dr Dabelea and colleagues focused on the prevalence of complications among teenagers and young adults who had been diagnosed with type 1 diabetes vs type 2 diabetes during childhood and adolescence. Although the base model (adjusted for age, sex, race/ethnicity, duration of diabetes, and clinical site) showed a significantly higher prevalence of complications for type 2 diabetes compared with type 1 diabetes, the authors did not adjust for socioeconomic factors such as insurance, household income, or parental education, which might be associated with a higher […]

  • Highlights for June 27, 2017
    Posted on June 27, 2017 at 12:00 am

    […]

 

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