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Integrative Physical Medicine – Medical News

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Medical News

  • All That Wheezes…
    Posted on August 3, 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 20-year-old woman presented to […]

  • Giant-Cell Arteritis — More Ecstasy, Less Agony
    Posted on July 27, 2017 at 12:00 am

    If Irving Stone had written a book about giant-cell arteritis rather than about Michelangelo, he might have chosen The Ecstasy and the Agony as the more appropriate title. As many physicians know, diagnosing giant-cell arteritis and witnessing the patient’s dramatic initial response to treatment […]

  • All That Wheezes...
    Posted on July 27, 2017 at 12:00 am

    A 20-year-old woman with a history of allergic rhinitis presented to her physician in the autumn with persistent cough and shortness of breath. She had been seen 6 weeks earlier for nasal congestion, rhinorrhea, postnasal drip, and cough that had bothered her on and off throughout the summer. Her […]

  • Trial of Tocilizumab in Giant-Cell Arteritis
    Posted on July 27, 2017 at 12:00 am

    Giant-cell arteritis causes headaches, ischemic visual symptoms, vision loss, claudication of the jaw, claudication of the arms and legs, polymyalgia rheumatica, aortic aneurysm, myocardial infarction, and stroke. Giant-cell arteritis generally occurs in adults older than 50 years of age and is 3 […]

  • Salt-and-Pepper Skin Changes
    Posted on July 13, 2017 at 12:00 am

    Figure 1. […]

  • Decision Aids and Elective Joint Replacement — How Knowledge Affects Utilization
    Posted on June 29, 2017 at 12:00 am

    The health care market is undergoing rapid transformation, spurred in part by the Affordable Care Act (ACA) and recent payment reforms introduced by the Centers for Medicare and Medicaid Services (CMS). The industry is shifting from a business-to-business model involving insurers, health car […]

  • Achenbach’s Syndrome
    Posted on June 29, 2017 at 12:00 am

    Figure 1. […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • Lethal Heat Waves Expected to Increase
    Posted by Friedrich MJ. on August 15, 2017 at 12:00 am

    Heat-related deaths around the world will increase as deadly heat waves become more common with rising global temperatures that are associated with climate change, according to 2 new reports. […]

  • New Leukemia, Lymphoma Diagnostic
    Posted by Voelker R. on August 15, 2017 at 12:00 am

    A new test used with flow cytometry to aid in diagnosing several forms of leukemia and lymphoma has received FDA approval. […]

  • Half-century After “Summer of Love,” Free Clinics Still Play Vital Role
    Posted by Rubin R. on August 15, 2017 at 12:00 am

    This Medical News story discusses the founding of the first free clinics in the United States and the role free clinics continue to play in communities across the country. […]

  • Effect of Malaria Initiative
    Posted by Friedrich MJ. on August 15, 2017 at 12:00 am

    Launched in 2005 by President George W. Bush and expanded by President Barack Obama, the US President’s Malaria Initiative (PMI) has been one of the main sources of funding for malaria prevention interventions in sub-Saharan Africa. A new report in PLoS Medicine shows that the PMI has reduced child mortality and the burden of malaria in those countries that have received its funding, primarily by increasing access to insecticide-treated nets, artemisinin-based combination therapy, and indoor residual spraying. […]

  • Alveolar Recruitment Strategies After Cardiac Surgery
    Posted by Li G, Shi X. on August 15, 2017 at 12:00 am

    To the Editor Dr Costa Leme and colleagues reported that an intensive alveolar recruitment strategy resulted in less-severe pulmonary complications than a moderate alveolar recruitment strategy among patients with hypoxemia after cardiac surgery. However, we have several concerns about the study. […]

  • Alveolar Recruitment Strategies After Cardiac Surgery
    Posted by Amato MP, Volpe MS, Hajjar LA. on August 15, 2017 at 12:00 am

    In Reply Drs Li and Shi raised concerns about which of our study groups actually provided intensive alveolar recruitment. In Supplement 2, eFigure 4 and eTable 1 showed that the intensive maneuver resulted in better reversal of atelectasis (our main target). At arrival in the intensive care unit, electrical impedance tomography maps showed reduced ventilation and compliance of dependent lung regions for all patients (upper:lower ventilation ratio above 1:1), but a larger improvement occurred after the intensive maneuvers (upper:lower ventilation ratio decreased to 0.6 vs 1.2 in the moderate […]

  • Shared Decision Making and Improving Health Care
    Posted by Montori VM, Kunneman M, Brito JP. on August 15, 2017 at 12:00 am

    Achieving health care of higher quality at lower cost has fueled policy interest in shared decision making (SDM). In SDM, clinicians and patients work together to understand the patient’s situation and determine how best to address it. Programs are in place in the United States to promote SDM using legal and financial incentives, mostly by implementing patient decision aids (PtDAs). The Cochrane review of SDM tools for people facing treatment or screening decisions is the key evidence cited in policy statements that propose to implement, distribute, and use certified PtDAs. […]

  • A Proposal for Dental, Vision, and Hearing Service Coverage Under Medicare
    Posted by Willink A, Schoen C, Davis K. on August 15, 2017 at 12:00 am

    This Viewpoint argues that Medicare coverage should be expanded to include dental, vision, and hearing services, and discusses ways to structure the benefit. […]

  • Trials and Tribulations
    Posted by Brown JL. on August 15, 2017 at 12:00 am

    Reviewing malpractice cases as a medical expert was an unexpected consequence of testifying as a defendant. I and other physicians in our group practice had been named in a medical malpractice lawsuit. My testimony was required when the case went to trial. After the legal issues were resolved, our attorney suggested that my credentials and demeanor would make me a credible expert witness. Despite having initial reservations, I accepted her offer to review cases because participating in the process seemed preferable to passively accepting any future legal intrusions. […]

  • Balancing Needs for Access and Empirical Evidence of Benefit and Risk
    Posted by Califf RM. on August 15, 2017 at 12:00 am

    When people use medical products, they generally expect that the benefits of doing so will outweigh the risks in terms of living longer, feeling better, or improving their functional status. However, most drugs and biologics and many medical devices that enter early evaluation in humans are found either to have no benefit or to have risks that outweigh the observed benefits when proper clinical trials are conducted. The complexity and high failure rates of medical product development have appropriately led to a regulatory system that requires compelling evidence of safety and efficacy from […]

  • Climate Change—WWLD
    Posted by Kaelin WG, Jr. on August 15, 2017 at 12:00 am

    Twenty-five years as a physician-scientist have taught me a few things about science and scientists that help me when viewing the climate change debate. For example, some scientists really are, as frequently portrayed in the media, a bit eccentric. They are often curiosity-driven loners with an insatiable need to explore, to know. Scientists are skeptical of the scientific findings of others, and the best of them are equally distrustful of their own work. Most are truth seekers who know that their legacies will be determined by whether their discoveries withstand the test of time. […]

  • Value-Based Pricing and State Reform of Prescription Drug Costs
    Posted by Hwang TJ, Kesselheim AS, Sarpatwari A. on August 15, 2017 at 12:00 am

    This Viewpoint discusses a New York law that allows the state to negotiate rebates with manufacturers to obtain value-based prices for drugs in its Medicaid program and assesses the potential effects of value-based pricing. […]

  • Diagnostic Stewardship to Improve Antimicrobial Use
    Posted by Morgan DJ, Malani P, Diekema DJ. on August 15, 2017 at 12:00 am

    This Viewpoint discusses the potential benefits and harms of diagnostic stewardship—modifying the ordering, performance, and reporting of diagnostic tests to improve treatment—as a means of reducing inappropriate antibiotic use. […]

  • A Song of Hope
    Posted by Halberstadt C. on August 15, 2017 at 12:00 am

    I will playthe last fugue of my lifeon the melting ice and rising seasas they stroke their furythrough organs and bones,on the ivory keys of an elephant’s tuskand curl through a pangolin’s scales.They will sound in the fossil cochlea of a whale,its vertebra holding a shelletched in a lost language by expired hands.And the trees who still stand will protect useven as sea turtles drownand the ears of dolphins bleed from the noise.But the birds who still fly will sing me to restand the chords they still playwill be heard. […]

  • Characteristics of Studies Used for FDA Approval of High-Risk Device Supplements
    Posted by Zheng SY, Dhruva SS, Redberg RF. on August 15, 2017 at 12:00 am

    This study characterizes the quality of clinical studies and data used to support US Food and Drug Administration approval of modifications to high-risk medical devices. […]

  • Eye Emergencies
    Posted by Muth CC. on August 15, 2017 at 12:00 am

    […]

  • Characteristics of Drug Trials Before and After FDA Accelerated Approval
    Posted by Naci H, Smalley KR, Kesselheim AS. on August 15, 2017 at 12:00 am

    This study uses public US Food and Drug Administration (FDA) data to characterize drug trials used to obtain FDA accelerated approval and to describe the existence, timing, and characteristics of postapproval trials mandated by the FDA as part of the accelerated approval decision. […]

  • Maternal Antidepressant Use and Pregnancy Outcomes
    Posted by D’Onofrio BM, Sujan AC. on August 15, 2017 at 12:00 am

    In Reply We examined the associations between maternal antidepressant use during the first trimester and offspring birth and neurodevelopmental problems. We explored whether the observed associations were consistent with a causal influence or due to alternative processes, such as confounding by indication, genetic factors, environmental factors, or some combination. […]

  • Effect of a Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes
    Posted by Johansen M, MacDonald C, Hansen K, et al. on August 15, 2017 at 12:00 am

    This randomized clinical trial compared the effects of an intensive lifestyle intervention vs standard care on glycemic control and medication reduction among participants with non–insulin-dependent type 2 diabetes. […]

  • Alveolar Recruitment Strategies After Cardiac Surgery
    Posted by Patel JJ, Pfeifer K. on August 15, 2017 at 12:00 am

    To the Editor The study by Dr Costa Leme and colleagues evaluated the effect of intensive (PEEP, 13 cm H2O) vs moderate (PEEP, 8 cm H2O) alveolar recruitment on reducing postoperative pulmonary complications in patients who had undergone cardiac surgery. The use of an intensive alveolar recruitment strategy compared with a moderate recruitment strategy resulted in less-severe postoperative pulmonary complications. We have some concerns about the research methods in this study. […]

  • Celiac Disease and Nonceliac Gluten Sensitivity
    Posted by Leonard MM, Sapone A, Catassi C, et al. on August 15, 2017 at 12:00 am

    This review discusses the the role of a gluten-free diet in the clinical management of celiac disease and nonceliac gluten sensitivity and highlights the importance for long-term therapy of distinguishing between these conditions. […]

  • Incomplete Financial Disclosure
    Posted on August 15, 2017 at 12:00 am

    The A Piece of My Mind article entitled “No Perfect Choice” published in the July 4, 2017, issue of JAMA, published an incomplete financial disclosure. The full statement should read as follows: “All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Dossett reports that she is on the advisory board for Sage Pharmaceuticals. Dr Burt reports that she is a consultant, advisor, and speaker for Takeda Pharmaceuticals, Lundbeck Pharmaceuticals, Otsuka Pharmaceuticals, and Sunovion. No other disclosures were reported.” […]

  • Patient Decision Aids to Engage Adults in Treatment or Screening Decisions
    Posted by Stacey D, Légaré F, Lewis KB. on August 15, 2017 at 12:00 am

    This Clinical Evidence Synopsis summarizes a Cochrane review of clinical trials evaluating patient decision aids designed to help patients understand their treatment options. […]

  • Reforming Medicaid
    Posted by Slavitt A, Wilensky G. on August 15, 2017 at 12:00 am

    We are 2 former Administrators of the Medicare and Medicaid programs, under Presidents Barack Obama and George H. W. Bush. Although we represent different political parties, we take pride in the accomplishments of these 2 programs, which collectively help millions of US residents get the health care they need. […]

  • Bezlotoxumab (Zinplava) for Prevention of Recurrent Clostridium Difficile Infection
    Posted on August 15, 2017 at 12:00 am

    This Medical Letter review summarizes the indications, risks, and benefits of bezlotoxumab, a monoclonal antibody to be used with antibacterial drug treatment to reduce recurrence of Clostridium difficile infection in adults at high risk. […]

  • Global Obesity Epidemic Worsening
    Posted by Friedrich MJ. on August 15, 2017 at 12:00 am

    The prevalence of obesity has doubled in 73 countries around the world and steadily increased in others since 1980, and health problems resulting from being overweight or obese now affect more than 2 billion people, according to a study by an international group of researchers published in the New England Journal of Medicine. […]

  • Public Response to a Field Trial of Genetically Engineered Mosquitoes
    Posted by Bloss CS, Stoler J, Brouwer KC, et al. on August 15, 2017 at 12:00 am

    This study assesses public response to a proposed field trial in the United States of genetically engineered mosquito (OX513A) designed to suppress wild-type Aedes aegypti mosquitoes, which can transmit diseases such as Zika, dengue, and chikungunya. […]

  • Faster Orphan Drug Decisions
    Posted by Voelker R. on August 15, 2017 at 12:00 am

    The FDA has announced that it will eliminate the backlog of existing requests for orphan drug designation by September 21. Going forward, the agency also pledged to respond to all requests for the designation within 90 days of receipt. […]

  • Prenatal Antidepressant Use and Autism Spectrum Disorder
    Posted by Singal D, Chateau D, Brownell M. on August 15, 2017 at 12:00 am

    To the Editor The study by Dr Brown and colleagues concluded that in utero serotonergic antidepressant exposure was not associated with the development of autism spectrum disorder in children. However, we conclude that the opposite may be true. […]

  • Sickle Cell Therapy Drought Ends
    Posted by Voelker R. on August 15, 2017 at 12:00 am

    After nearly 20 years without new treatments for sickle cell disease, the FDA has approved L-glutamine oral powder to reduce severe complications of the blood disorder in patients aged 5 years or older. It also is the first sickle cell disease treatment approved for pediatric patients. […]

  • Prenatal Antidepressant Use and Autism Spectrum Disorder—Reply
    Posted by Vigod SN, Gomes T, Ray JG. on August 15, 2017 at 12:00 am

    In Reply Ms Singal and colleagues raise some points about analysis and interpretation of epidemiological research and our study. The relationship between antenatal serotonergic reuptake inhibitor antidepressant use and child autism spectrum disorder is a complex area about which there is ongoing need for high-quality research. […]

  • Politics and the Medical Profession
    Posted on August 15, 2017 at 12:00 am

    Whatever may be one’s private opinions as to public questions, to whichever party he may have belonged in the past, it is clear to all independent intellects that there are other duties to one’s fellow-men and to the future far more imperative and binding than allegiance to any political party—so far at least as such parties are at present constituted and used. Both great parties in American politics have at times fallen away from their principles and have wallowed in such bogs of corruption that they have nauseated their best members into a condition of alienation and […]

  • Maternal Antidepressant Use and Pregnancy Outcomes
    Posted by Yonkers K, Forray A, Smith MV. on August 15, 2017 at 12:00 am

    To the Editor Maternal antidepressant use has become a commonly explored pregnancy exposure, with investigators using large registry databases to investigate associations with a variety of pregnancy outcomes. Ms Sujan and colleagues investigated outcomes previously associated with maternal antidepressant use, including preterm birth, small for gestational age, autism spectrum disorder, and attention-deficit/hyperactivity disorder, using Swedish registries. A sibling design controlled for confounding and reduced estimates associating maternal antidepressant use with all exposures. The authors […]

  • JAMA
    Posted on August 15, 2017 at 12:00 am

    […]

  • Highlights for August 15, 2017
    Posted on August 15, 2017 at 12:00 am

    […]

  • Acute Ocular Graft-versus-Host Disease
    Posted on August 17, 2017 at 12:00 am

    Figure 1. […]

  • Eczema Herpeticum
    Posted on August 17, 2017 at 12:00 am

    Figure 1. […]

  • Case 25-2017: A 45-Year-Old Man with Headache, Fever, and Lymphadenopathy
    Posted on August 17, 2017 at 12:00 am

    Presentation of Case. Dr. Max W. Adelman (Medicine): A 45-year-old man with Tourette’s syndrome and a ventriculoperitoneal shunt for the management of hydrocephalus was admitted to this hospital because of headache and fever. The patient had been well until 3 days before admission, when he awok […]

  • Signs
    Posted on August 17, 2017 at 12:00 am

    Not long after my mother died, my father lay disconsolate in a darkened hotel room begging his deceased wife to send him a sign. Wherever she was in her ghostly habitat, would she please smuggle him some affirmation of their enduring love? Suddenly, the overhead light switched on. Other peo […]

  • Insulin-Mediated Lipohypertrophy
    Posted on August 10, 2017 at 12:00 am

    Figure 1. […]

  • Left-Middle-Lobe Pneumonia
    Posted on August 10, 2017 at 12:00 am

    Figure 1. […]

  • Influenza Vaccine Effectiveness in the United States during the 2015–2016 Season
    Posted on August 10, 2017 at 12:00 am

    The effectiveness of influenza vaccination and the corresponding effect of vaccination programs on the burden of influenza can vary considerably from year to year. In light of this variability, annual observational studies of influenza vaccine effectiveness are critical as ongoing evaluations of […]

  • Case 24-2017: An 8-Month-Old Girl with Fever and an Abdominal Mass
    Posted on August 10, 2017 at 12:00 am

    Presentation of Case. Dr. Rajitha Venkatesh (Pediatrics): An 8-month-old girl was admitted to this hospital because of fever and an abdominal mass. The patient had been in her usual good health until approximately 6 days before admission, when she passed a large stool surrounded by clotted blood. […]

  • Migraine
    Posted on August 10, 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 author’s clinical recommendations. Stage. A 23-year-old […]

  • Xanthomas in Familial Hypercholesterolemia
    Posted on August 3, 2017 at 12:00 am

    Figure 1. […]

  • End-of-Life Decisions in the Netherlands over 25 Years
    Posted on August 3, 2017 at 12:00 am

    To the Editor: In the Netherlands, the much debated practice of physician assistance in dying has been legally regulated since 2002. Such assistance may include physician-assisted suicide or euthanasia, in which a physician administers lethal medication at the explicit request of a patient. Bot […]

  • All That Wheezes…
    Posted on August 3, 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 20-year-old woman presented to […]

  • Crusted Scabies
    Posted on August 3, 2017 at 12:00 am

    Figure 1. […]

  • Gabapentin and Pregabalin for Pain — Is Increased Prescribing a Cause for Concern?
    Posted on August 3, 2017 at 12:00 am

    Treatment of chronic noncancer pain during the opioid epidemic has become challenging for clinicians. Patients want their pain to be adequately managed, and clinicians are searching for safe, effective alternatives to opioids. Recent guidelines from the Centers for Disease Control and Prevention […]

  • Nystagmus from Wernicke’s Encephalopathy
    Posted on July 27, 2017 at 12:00 am

    Figure 1. […]

  • All That Wheezes...
    Posted on July 27, 2017 at 12:00 am

    A 20-year-old woman with a history of allergic rhinitis presented to her physician in the autumn with persistent cough and shortness of breath. She had been seen 6 weeks earlier for nasal congestion, rhinorrhea, postnasal drip, and cough that had bothered her on and off throughout the summer. Her […]

  • Cholelithiasis
    Posted on July 27, 2017 at 12:00 am

    Figure 1. […]

  • The Role of Science in Addressing the Opioid Crisis
    Posted on July 27, 2017 at 12:00 am

    Opioid misuse and addiction is an ongoing and rapidly evolving public health crisis, requiring innovative scientific solutions. In response, and because no existing medication is ideal for every patient, the National Institutes of Health (NIH) is joining with private partners to launch an […]

  • Case 23-2017: A 9-Day-Old Girl with Vomiting, Acidosis, and Azotemia
    Posted on July 27, 2017 at 12:00 am

    Presentation of Case. Dr. Katherine L. Tuttle (Pediatrics): A 9-day-old girl was admitted to this hospital because of nonbilious vomiting, acidosis, and azotemia. The patient had been born at another hospital by induced vaginal delivery after 41 weeks 3 days of gestation. The pregnancy had been […]

  • Subarachnoid Hemorrhage
    Posted on July 20, 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 17-year-old […]

  • Lethal Heat Waves Expected to Increase
    Posted by Friedrich MJ. on August 15, 2017 at 12:00 am

    Heat-related deaths around the world will increase as deadly heat waves become more common with rising global temperatures that are associated with climate change, according to 2 new reports. […]

  • New Leukemia, Lymphoma Diagnostic
    Posted by Voelker R. on August 15, 2017 at 12:00 am

    A new test used with flow cytometry to aid in diagnosing several forms of leukemia and lymphoma has received FDA approval. […]

  • Half-century After “Summer of Love,” Free Clinics Still Play Vital Role
    Posted by Rubin R. on August 15, 2017 at 12:00 am

    This Medical News story discusses the founding of the first free clinics in the United States and the role free clinics continue to play in communities across the country. […]

  • Effect of Malaria Initiative
    Posted by Friedrich MJ. on August 15, 2017 at 12:00 am

    Launched in 2005 by President George W. Bush and expanded by President Barack Obama, the US President’s Malaria Initiative (PMI) has been one of the main sources of funding for malaria prevention interventions in sub-Saharan Africa. A new report in PLoS Medicine shows that the PMI has reduced child mortality and the burden of malaria in those countries that have received its funding, primarily by increasing access to insecticide-treated nets, artemisinin-based combination therapy, and indoor residual spraying. […]

  • Alveolar Recruitment Strategies After Cardiac Surgery
    Posted by Li G, Shi X. on August 15, 2017 at 12:00 am

    To the Editor Dr Costa Leme and colleagues reported that an intensive alveolar recruitment strategy resulted in less-severe pulmonary complications than a moderate alveolar recruitment strategy among patients with hypoxemia after cardiac surgery. However, we have several concerns about the study. […]

  • Alveolar Recruitment Strategies After Cardiac Surgery
    Posted by Amato MP, Volpe MS, Hajjar LA. on August 15, 2017 at 12:00 am

    In Reply Drs Li and Shi raised concerns about which of our study groups actually provided intensive alveolar recruitment. In Supplement 2, eFigure 4 and eTable 1 showed that the intensive maneuver resulted in better reversal of atelectasis (our main target). At arrival in the intensive care unit, electrical impedance tomography maps showed reduced ventilation and compliance of dependent lung regions for all patients (upper:lower ventilation ratio above 1:1), but a larger improvement occurred after the intensive maneuvers (upper:lower ventilation ratio decreased to 0.6 vs 1.2 in the moderate […]

  • Shared Decision Making and Improving Health Care
    Posted by Montori VM, Kunneman M, Brito JP. on August 15, 2017 at 12:00 am

    Achieving health care of higher quality at lower cost has fueled policy interest in shared decision making (SDM). In SDM, clinicians and patients work together to understand the patient’s situation and determine how best to address it. Programs are in place in the United States to promote SDM using legal and financial incentives, mostly by implementing patient decision aids (PtDAs). The Cochrane review of SDM tools for people facing treatment or screening decisions is the key evidence cited in policy statements that propose to implement, distribute, and use certified PtDAs. […]

  • A Proposal for Dental, Vision, and Hearing Service Coverage Under Medicare
    Posted by Willink A, Schoen C, Davis K. on August 15, 2017 at 12:00 am

    This Viewpoint argues that Medicare coverage should be expanded to include dental, vision, and hearing services, and discusses ways to structure the benefit. […]

  • Trials and Tribulations
    Posted by Brown JL. on August 15, 2017 at 12:00 am

    Reviewing malpractice cases as a medical expert was an unexpected consequence of testifying as a defendant. I and other physicians in our group practice had been named in a medical malpractice lawsuit. My testimony was required when the case went to trial. After the legal issues were resolved, our attorney suggested that my credentials and demeanor would make me a credible expert witness. Despite having initial reservations, I accepted her offer to review cases because participating in the process seemed preferable to passively accepting any future legal intrusions. […]

  • Balancing Needs for Access and Empirical Evidence of Benefit and Risk
    Posted by Califf RM. on August 15, 2017 at 12:00 am

    When people use medical products, they generally expect that the benefits of doing so will outweigh the risks in terms of living longer, feeling better, or improving their functional status. However, most drugs and biologics and many medical devices that enter early evaluation in humans are found either to have no benefit or to have risks that outweigh the observed benefits when proper clinical trials are conducted. The complexity and high failure rates of medical product development have appropriately led to a regulatory system that requires compelling evidence of safety and efficacy from […]

  • Climate Change—WWLD
    Posted by Kaelin WG, Jr. on August 15, 2017 at 12:00 am

    Twenty-five years as a physician-scientist have taught me a few things about science and scientists that help me when viewing the climate change debate. For example, some scientists really are, as frequently portrayed in the media, a bit eccentric. They are often curiosity-driven loners with an insatiable need to explore, to know. Scientists are skeptical of the scientific findings of others, and the best of them are equally distrustful of their own work. Most are truth seekers who know that their legacies will be determined by whether their discoveries withstand the test of time. […]

  • Value-Based Pricing and State Reform of Prescription Drug Costs
    Posted by Hwang TJ, Kesselheim AS, Sarpatwari A. on August 15, 2017 at 12:00 am

    This Viewpoint discusses a New York law that allows the state to negotiate rebates with manufacturers to obtain value-based prices for drugs in its Medicaid program and assesses the potential effects of value-based pricing. […]

  • Diagnostic Stewardship to Improve Antimicrobial Use
    Posted by Morgan DJ, Malani P, Diekema DJ. on August 15, 2017 at 12:00 am

    This Viewpoint discusses the potential benefits and harms of diagnostic stewardship—modifying the ordering, performance, and reporting of diagnostic tests to improve treatment—as a means of reducing inappropriate antibiotic use. […]

  • A Song of Hope
    Posted by Halberstadt C. on August 15, 2017 at 12:00 am

    I will playthe last fugue of my lifeon the melting ice and rising seasas they stroke their furythrough organs and bones,on the ivory keys of an elephant’s tuskand curl through a pangolin’s scales.They will sound in the fossil cochlea of a whale,its vertebra holding a shelletched in a lost language by expired hands.And the trees who still stand will protect useven as sea turtles drownand the ears of dolphins bleed from the noise.But the birds who still fly will sing me to restand the chords they still playwill be heard. […]

  • Characteristics of Studies Used for FDA Approval of High-Risk Device Supplements
    Posted by Zheng SY, Dhruva SS, Redberg RF. on August 15, 2017 at 12:00 am

    This study characterizes the quality of clinical studies and data used to support US Food and Drug Administration approval of modifications to high-risk medical devices. […]

  • Eye Emergencies
    Posted by Muth CC. on August 15, 2017 at 12:00 am

    […]

  • Characteristics of Drug Trials Before and After FDA Accelerated Approval
    Posted by Naci H, Smalley KR, Kesselheim AS. on August 15, 2017 at 12:00 am

    This study uses public US Food and Drug Administration (FDA) data to characterize drug trials used to obtain FDA accelerated approval and to describe the existence, timing, and characteristics of postapproval trials mandated by the FDA as part of the accelerated approval decision. […]

  • Maternal Antidepressant Use and Pregnancy Outcomes
    Posted by D’Onofrio BM, Sujan AC. on August 15, 2017 at 12:00 am

    In Reply We examined the associations between maternal antidepressant use during the first trimester and offspring birth and neurodevelopmental problems. We explored whether the observed associations were consistent with a causal influence or due to alternative processes, such as confounding by indication, genetic factors, environmental factors, or some combination. […]

  • Effect of a Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes
    Posted by Johansen M, MacDonald C, Hansen K, et al. on August 15, 2017 at 12:00 am

    This randomized clinical trial compared the effects of an intensive lifestyle intervention vs standard care on glycemic control and medication reduction among participants with non–insulin-dependent type 2 diabetes. […]

  • Alveolar Recruitment Strategies After Cardiac Surgery
    Posted by Patel JJ, Pfeifer K. on August 15, 2017 at 12:00 am

    To the Editor The study by Dr Costa Leme and colleagues evaluated the effect of intensive (PEEP, 13 cm H2O) vs moderate (PEEP, 8 cm H2O) alveolar recruitment on reducing postoperative pulmonary complications in patients who had undergone cardiac surgery. The use of an intensive alveolar recruitment strategy compared with a moderate recruitment strategy resulted in less-severe postoperative pulmonary complications. We have some concerns about the research methods in this study. […]

  • Celiac Disease and Nonceliac Gluten Sensitivity
    Posted by Leonard MM, Sapone A, Catassi C, et al. on August 15, 2017 at 12:00 am

    This review discusses the the role of a gluten-free diet in the clinical management of celiac disease and nonceliac gluten sensitivity and highlights the importance for long-term therapy of distinguishing between these conditions. […]

  • Incomplete Financial Disclosure
    Posted on August 15, 2017 at 12:00 am

    The A Piece of My Mind article entitled “No Perfect Choice” published in the July 4, 2017, issue of JAMA, published an incomplete financial disclosure. The full statement should read as follows: “All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Dossett reports that she is on the advisory board for Sage Pharmaceuticals. Dr Burt reports that she is a consultant, advisor, and speaker for Takeda Pharmaceuticals, Lundbeck Pharmaceuticals, Otsuka Pharmaceuticals, and Sunovion. No other disclosures were reported.” […]

  • Patient Decision Aids to Engage Adults in Treatment or Screening Decisions
    Posted by Stacey D, Légaré F, Lewis KB. on August 15, 2017 at 12:00 am

    This Clinical Evidence Synopsis summarizes a Cochrane review of clinical trials evaluating patient decision aids designed to help patients understand their treatment options. […]

  • Reforming Medicaid
    Posted by Slavitt A, Wilensky G. on August 15, 2017 at 12:00 am

    We are 2 former Administrators of the Medicare and Medicaid programs, under Presidents Barack Obama and George H. W. Bush. Although we represent different political parties, we take pride in the accomplishments of these 2 programs, which collectively help millions of US residents get the health care they need. […]

  • Bezlotoxumab (Zinplava) for Prevention of Recurrent Clostridium Difficile Infection
    Posted on August 15, 2017 at 12:00 am

    This Medical Letter review summarizes the indications, risks, and benefits of bezlotoxumab, a monoclonal antibody to be used with antibacterial drug treatment to reduce recurrence of Clostridium difficile infection in adults at high risk. […]

  • Global Obesity Epidemic Worsening
    Posted by Friedrich MJ. on August 15, 2017 at 12:00 am

    The prevalence of obesity has doubled in 73 countries around the world and steadily increased in others since 1980, and health problems resulting from being overweight or obese now affect more than 2 billion people, according to a study by an international group of researchers published in the New England Journal of Medicine. […]

  • Public Response to a Field Trial of Genetically Engineered Mosquitoes
    Posted by Bloss CS, Stoler J, Brouwer KC, et al. on August 15, 2017 at 12:00 am

    This study assesses public response to a proposed field trial in the United States of genetically engineered mosquito (OX513A) designed to suppress wild-type Aedes aegypti mosquitoes, which can transmit diseases such as Zika, dengue, and chikungunya. […]

  • Faster Orphan Drug Decisions
    Posted by Voelker R. on August 15, 2017 at 12:00 am

    The FDA has announced that it will eliminate the backlog of existing requests for orphan drug designation by September 21. Going forward, the agency also pledged to respond to all requests for the designation within 90 days of receipt. […]

  • Prenatal Antidepressant Use and Autism Spectrum Disorder
    Posted by Singal D, Chateau D, Brownell M. on August 15, 2017 at 12:00 am

    To the Editor The study by Dr Brown and colleagues concluded that in utero serotonergic antidepressant exposure was not associated with the development of autism spectrum disorder in children. However, we conclude that the opposite may be true. […]

  • Sickle Cell Therapy Drought Ends
    Posted by Voelker R. on August 15, 2017 at 12:00 am

    After nearly 20 years without new treatments for sickle cell disease, the FDA has approved L-glutamine oral powder to reduce severe complications of the blood disorder in patients aged 5 years or older. It also is the first sickle cell disease treatment approved for pediatric patients. […]

  • Prenatal Antidepressant Use and Autism Spectrum Disorder—Reply
    Posted by Vigod SN, Gomes T, Ray JG. on August 15, 2017 at 12:00 am

    In Reply Ms Singal and colleagues raise some points about analysis and interpretation of epidemiological research and our study. The relationship between antenatal serotonergic reuptake inhibitor antidepressant use and child autism spectrum disorder is a complex area about which there is ongoing need for high-quality research. […]

  • Politics and the Medical Profession
    Posted on August 15, 2017 at 12:00 am

    Whatever may be one’s private opinions as to public questions, to whichever party he may have belonged in the past, it is clear to all independent intellects that there are other duties to one’s fellow-men and to the future far more imperative and binding than allegiance to any political party—so far at least as such parties are at present constituted and used. Both great parties in American politics have at times fallen away from their principles and have wallowed in such bogs of corruption that they have nauseated their best members into a condition of alienation and […]

  • Maternal Antidepressant Use and Pregnancy Outcomes
    Posted by Yonkers K, Forray A, Smith MV. on August 15, 2017 at 12:00 am

    To the Editor Maternal antidepressant use has become a commonly explored pregnancy exposure, with investigators using large registry databases to investigate associations with a variety of pregnancy outcomes. Ms Sujan and colleagues investigated outcomes previously associated with maternal antidepressant use, including preterm birth, small for gestational age, autism spectrum disorder, and attention-deficit/hyperactivity disorder, using Swedish registries. A sibling design controlled for confounding and reduced estimates associating maternal antidepressant use with all exposures. The authors […]

  • JAMA
    Posted on August 15, 2017 at 12:00 am

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  • Highlights for August 15, 2017
    Posted on August 15, 2017 at 12:00 am

    […]

 

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