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Integrative Physical Medicine – Medical News

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Medical News

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • Dissecting a Case of Abdominal Pain
    Posted on October 27, 2016 at 12:00 am

    A 43-year-old man with no notable medical history presented to the emergency department within 1 hour after the abrupt onset of abdominal pain. The patient stated that he had been dressing for work when severe, "crampy" abdominal pain occurred in the left upper quadrant. On a scale of 0 to 10, wit […]

  • Cutaneous Lupus — "The Pimple That Never Went Away"
    Posted on October 20, 2016 at 12:00 am

    Figure 1. […]

  • Case 31-2016: A 53-Year-Old Man with Diplopia, Polydipsia, and Polyuria
    Posted on October 13, 2016 at 12:00 am

    Presentation of Case. Dr. Thomas N. Byrne: A 53-year-old man was seen in the neurology, neurosurgery, and neuroendocrinology clinics of this hospital because of diplopia, polydipsia, and polyuria. The patient had been well until approximately 1 year before this evaluation, when nasal congestion and […]

  • Takayasu’s Arteritis
    Posted on August 18, 2016 at 12:00 am

    Figure 1. […]

  • Raynaud’s Phenomenon
    Posted on August 11, 2016 at 12:00 am

    In his 1862 thesis, Maurice Raynaud describes the condition afflicting a 26-year-old female patient: "Under the influence of a very moderate cold . . . she sees her fingers become ex-sanguine, completely insensible, and of a whitish yellow color. This phenomenon happens often without reason, lasts […]

  • Case 22-2016: A 65-Year-Old Man with Syncope, Dyspnea, and Leg Edema
    Posted on July 21, 2016 at 12:00 am

    Presentation of Case. Dr. David K. Rhee (Cardiology): A 65-year-old man was admitted to this hospital because of syncope, dyspnea, and leg edema. The patient had been in his usual health until approximately 1 month before admission, when cough occurred. One week later, his legs became swollen and […]

  • Milk of Urate Bulla
    Posted on July 14, 2016 at 12:00 am

    Figure 1. […]

  • A Bruising Loss
    Posted on July 7, 2016 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 32-year-old woman presented to […]

  • Ankylosing Spondylitis and Axial Spondyloarthritis
    Posted on June 30, 2016 at 12:00 am

    Chronic back pain is common worldwide and is cared for by a variety of providers, but specific, satisfactory treatment is often lacking. Ankylosing spondylitis, an inflammatory disorder that in its extreme form can lead to the bony fusion of vertebral joints, is an uncommon but well-established […]

  • Calcium Pyrophosphate Deposition Disease
    Posted on June 30, 2016 at 12:00 am

    Calcium pyrophosphate deposition (CPPD) disease is arthritis caused by calcium pyrophosphate (CPP) crystals (Figure 1). Until recently, CPPD disease has been referred to as pseudogout. This term stems from an early description of this disease in patients with an acute goutlike arthritis whos […]

  • First Corticosteroid Approved for Duchenne Muscular Dystrophy
    Posted by Voelker R. on March 21, 2017 at 12:00 am

    Deflazacort has become the first corticosteroid to receive FDA approval to treat patients aged 5 years and older who have Duchenne muscular dystrophy. […]

  • Transitions in House Staff Care and Patient Mortality
    Posted by Denson JL, Horwitz LI, Sherman SE. on March 21, 2017 at 12:00 am

    In Reply We acknowledge that the definition of a transition patient in the main analysis could have produced immortal time bias, as Dr Sadhu discusses in his letter. Immortal time bias is typically considered a bias in favor of lower mortality in the exposed group, because it excludes patients who die before the event of interest. The direction of such a bias is therefore not necessarily toward a sicker cohort. In our study, it is also plausible that the transition cohort was affected not only by immortal time bias, as could be seen for any arbitrary transition (such as change in hospital […]

  • Implementing Peanut Allergy Prevention Guidelines at a Population Level
    Posted by Turner PJ, Campbell DE. on March 21, 2017 at 12:00 am

    This Viewpoint summarizes the National Institute of Allergy and Infectious Diseases’ guideline for prevention of peanut allergies in US infants and argues that the complexity and narrow scope of the recommendations could prevent population-wide implementation and uptake. […]

  • Highlights for March 21, 2017
    Posted on March 21, 2017 at 12:00 am

    […]

  • Exercise During Pregnancy
    Posted by Perales M, Artal R, Lucia A. on March 21, 2017 at 12:00 am

    This Viewpoint summarizes the American Congress of Obstetrics and Gynecology (ACOG) guideline recommendations and more recent evidence about the benefits of exercise during pregnancy. […]

  • Value-Based Purchasing: Time for Reboot or Time to Move on?
    Posted by Jha AK. on March 21, 2017 at 12:00 am

    These are difficult days for those of us who have advocated for pay-for-performance (P4P) as a policy tool to improve health care quality. The idea behind P4P has always been simple: physicians and hospitals should be financially rewarded for providing high-quality care and financially penalized for providing low-quality care. Although this idea has been around for some time, it gained national traction over the past decade, as policy makers pushed toward paying for “value” and not just volume. […]

  • Non–Vitamin K Oral Anticoagulants in Atrial Fibrillation
    Posted by Potpara TS, Lip GH. on March 21, 2017 at 12:00 am

    This Viewpoint discusses use of non–vitamin K oral anticoagulants in treating atrial fibrillation. […]

  • Sedimentation Rate
    Posted by Wicks I. on March 21, 2017 at 12:00 am

    Draw blood—a thick red drop, falling, laden with erythrocytes,those journeymen made in the marrowfor their brief season, spent working the blood, streaming in pale yellow plasma through the heart and its arch of great vessels, riding the pulse down arterial arcades, branching to tissue and territory, milling in fine capillaries while holding tidal breath in the deep red pockets of hemoglobin, loaded with its cargo of agile oxygenfor the electron transport chain, without which nothing. Then returning, depletedalong reticulated veins to do it all again. Fellow travelers, in […]

  • The Joint Commission’s Pain Standards and the Prescription Opioid Epidemic
    Posted by Baker DW. on March 21, 2017 at 12:00 am

    This Viewpoint discusses the history of The Joint Commission standards for pain management and lessons learned that might inform current efforts to address the prescription opioid epidemic and prevent unintended consequences of future similar standard-setting initiatives. […]

  • Sedation vs Intubation for Patients With Acute Stroke Undergoing Thrombectomy—Reply
    Posted by Bösel J, Schöneberger S. on March 21, 2017 at 12:00 am

    In Reply Drs See and Ducruet raise a number of concerns about our trial. The study was designed to investigate short-term clinical outcomes, whereas longer-term outcomes, which are also important, should be addressed in a multicenter trial. The MR CLEAN data that See and Ducruet cite to question our design and sample size were not published at the time of planning the SIESTA trial. We acknowledge that in settings with higher interventional speed and efficacy, the results may have been different. However, our trial population better reflected broad practice than other randomized thrombectomy […]

  • Medical Care of Detainees in US Military Facilities
    Posted by Chalela JA. on March 21, 2017 at 12:00 am

    […]

  • Misstated Text
    Posted on March 21, 2017 at 12:00 am

    In the Editorial entitled “Sublingual Immunotherapy for Allergic Rhinitis: Is 2-Year Treatment Sufficient for Long-term Benefit?” published in the February 14, 2017, issue, there was an error in the text. In the first paragraph, the third sentence should have read, “The proportion of patients treated with AIT who do not maintain sustained allergen-specific tolerance varies from 0% to 55%, depending on factors including type of allergen, treatment duration, and the definition of relapse.” This article was corrected online. […]

  • Patient-Reported Outcomes Following Treatment for Localized Prostate Cancer
    Posted by Hamdy FC, Donovan JL. on March 21, 2017 at 12:00 am

    When treatments are known to be successful with good oncological outcomes for specific cancers, most patients will be prepared to accept the proposed therapy and its consequences on quality of life. But when multiple, equally effective treatments are available and uncertainty about their benefits prevails with a substantial risk of overtreatment, the balance of risks between benefit and harm from adverse effects can dominate decision making. Such is the case in clinically localized prostate-specific antigen (PSA)–detected prostate cancer. Men affected by prostate cancer realize […]

  • Cervicovaginal Bacteria and HIV Risk
    Posted by Friedrich MJ. on March 21, 2017 at 12:00 am

    Healthy South African women whose cervicovaginal (CV) microbiome is dominated by a high diversity of anaerobic bacteria but is deficient in Lactobacillus species have a higher risk of acquiring HIV than women who have CV bacterial communities of low diversity that are dominated by Lactobacillis crispatus, according to a report by researchers from the United States and South Africa. […]

  • Direct-to-Consumer Advertising of Androgen Replacement Therapy
    Posted by Kravitz RL. on March 21, 2017 at 12:00 am

    The Kefauver-Harris Amendment to the Food, Drug and Cosmetic Act, enacted by Congress in 1962, required pharmaceutical manufacturers to provide proof of prescription drug effectiveness as well as safety and to obtain preapproval of their marketing plans. Over the next 35 years, manufacturers promoted their products largely to physicians through ads in medical journals and in-office “detailing.” Print advertising directed toward patients was unusual and broadcast advertising was rare, owing to the US Food and Drug Administration’s (FDA’s) insistence that ads on […]

  • New Rare Diseases Screening Test
    Posted by Voelker R. on March 21, 2017 at 12:00 am

    The first screening tool to detect 4 rare lysosomal storage disorders in newborns has received FDA approval. […]

  • Outcomes of Radiation, Surgery, or Observation for Localized Prostate Cancer
    Posted by Barocas DA, Alvarez J, Resnick MJ, et al. on March 21, 2017 at 12:00 am

    This cohort study uses SEER registry data to compare adverse functional effects of managing localized prostate cancer with radical prostatectomy, external beam radiation, and active surveillance. […]

  • Cystoscopy
    Posted by Matulewicz RS, DeLancey JO, Meeks JJ. on March 21, 2017 at 12:00 am

    […]

  • Association Between Prostate Cancer Treatment and Quality of Life
    Posted by Chen RC, Basak R, Meyer A, et al. on March 21, 2017 at 12:00 am

    This cohort study compares quality of life among men with prostate cancer treated with radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance. […]

  • Sedation vs Intubation for Patients With Acute Stroke Undergoing Thrombectomy
    Posted by Buerkle H, Goebel U. on March 21, 2017 at 12:00 am

    To the Editor The Sedation vs Intubation for Endovascular Stroke Treatment (SIESTA) trial found no difference in the primary outcome (change in the NIHSS score after 24 hours) in patients receiving general anesthesia vs conscious sedation. However, there were differences in secondary outcomes, with patients receiving general anesthesia having a 10-minute delay in the door-to-needle interval and increased postinterventional complications, including hypothermia, delayed extubation, and pneumonia. […]

  • Dabigatran vs Warfarin and Risk of Osteoporotic Fractures Among Patients With Nonvalvular Atrial Fibrillation
    Posted by Lau WY, Chan EW, Cheung C, et al. on March 21, 2017 at 12:00 am

    This cohort study uses national electronic medical record data from Hong Kong to compare risk of osteoporotic fracture among patients prescribed dabigatran or warfarin for newly diagnosed nonvalvular atrial fibrillation. […]

  • Transitions in House Staff Care and Patient Mortality
    Posted by Sadhu JS. on March 21, 2017 at 12:00 am

    To the Editor Dr Denson and colleagues reported that patients whose hospitalizations spanned transitions in house staff care had higher mortality rates than control patients. The methods used to construct the transition and control cohorts may explain the findings. For patients admitted on a given day, only those patients who remained hospitalized until the end-of-rotation transition were eligible for inclusion in the transition group; patients who died or were discharged before the transition period were assigned to the control group. This method resulted in fundamentally unbalanced groups, […]

  • Direct-to-Consumer Advertising and Testosterone Testing and Initiation
    Posted by Layton J, Kim Y, Alexander G, et al. on March 21, 2017 at 12:00 am

    This ecologic study investigates associations between televised direct-to-consumer advertising and testosterone testing and initiation in the United States between 2009 and 2013. […]

  • Error in Text
    Posted on March 21, 2017 at 12:00 am

    In the Editorial entitled “Scalp Cooling to Prevent Chemotherapy-Induced Alopecia: The Time Has Come,” published in the February 14, 2017, issue, there was an error in the text. In the ninth paragraph, the second sentence should have read, “The DigniCap scalp cooling system (used in the study by Rugo et al) is cleared by the US Food and Drug Administration (FDA) and the Paxman scalp cooling system (used in the study by Nangia et al) is under evaluation by the FDA.” This article was corrected online. […]

  • Definitive Management of Primary Hyperparathyroidism
    Posted by Campbell MJ. on March 21, 2017 at 12:00 am

    This commentary discusses 2016 American Association of Endocrine Surgeons Guidelines for management of primary hyperparathyroidism published in JAMA Surgery. […]

  • Syrians Seek Care Abroad
    Posted by Abbasi J. on March 21, 2017 at 12:00 am

    This Medical News article is an interview with an Israeli physician whose hospital staff treats sick and wounded Syrians. […]

  • A Tender Rash on the Hand
    Posted by Vangipuram R, Tong Y, Tyring SK. on March 21, 2017 at 12:00 am

    A healthy 36-year-old man had 5 days of an intensely painful vesicular eruption on an erythematous base at the base of his thumb after a suspected spider bite, with no other physical signs. What would you next? […]

  • Boosting Cognitive Development in Children
    Posted by Friedrich MJ. on March 21, 2017 at 12:00 am

    Taking prenatal maternal multiple micronutrients (MMNs) during pregnancy along with a nurturing environment during childhood have long-term benefits for a child’s cognitive development, according to a follow-up study of the Supplementation With Multiple Micronutrients Intervention Trial (SUMMIT) published recently in Lancet Global Health. […]

  • Metformin for Prediabetes
    Posted on March 21, 2017 at 12:00 am

    This Medical Letter review summarizes the clinical study evidence and adverse effects of metformin treatment for individuals at risk for type 2 diabetes. […]

  • No Guinea Worm Disease in Mali
    Posted by Friedrich MJ. on March 21, 2017 at 12:00 am

    Mali reported no cases of Guinea worm disease (dracunculiasis) in 2016, according to provisional figures reported by the country’s ministry of health and tracked by the Carter Center. Worldwide, only 25 cases of the disease were reported in 2016 in 3 countries—Chad (16), Ethiopia (3), and South Sudan (6)—and these occurred in 19 isolated villages. The 2016 figure is up slightly from the 22 cases that occurred in 2015. […]

  • Seven-Year Follow-up of Offspring of Women Taking Prenatal DHA in an RCT
    Posted by Gould JF, Treyvaud K, Yelland LN, et al. on March 21, 2017 at 12:00 am

    This study reports neurodevelopmental outcomes at 7 years of children whose mothers participated in a randomized trial of docosahexaenoic acid supplementation during pregnancy to improve their child’s intelligence. […]

  • Morcellator Risk Was Known
    Posted by Voelker R. on March 21, 2017 at 12:00 am

    The FDA was aware that laparoscopic power morcellators could spread cancerous tissue when the agency approved the first such device in 1991, according to a recent report from the US General Accountability Office (GAO). […]

  • Time to Endovascular Thrombectomy for Acute Stroke
    Posted by Kansagra AP. on March 21, 2017 at 12:00 am

    To the Editor In an individual-patient meta-analysis using data from 5 randomized clinical trials, Dr Saver and colleagues reported improved outcomes following mechanical thrombectomy initiated up to 7.3 hours after the onset of acute ischemic stroke due to large vessel occlusion. This result represents a meaningful extension of the current 6-hour treatment guideline and would expand access to life-altering treatments. However, the challenges of interpreting these data must be acknowledged. Only 3 of the 5 trials allowed intervention beyond 6 hours, and these 3 trials used more stringent […]

  • The Healing Power of Paint
    Posted by Toll E, Melfi B. on March 21, 2017 at 12:00 am

    This Arts and Medicine essay describes the experience of an outpatient clinic's staff, patients, and families who collaborated to paint self-portrait tiles to decorate the clinical space. […]

  • Time to Endovascular Thrombectomy for Acute Stroke—Reply
    Posted by Saver JL, Goyal M, Hill MD, et al. on March 21, 2017 at 12:00 am

    In Reply We concur with Dr Kansagra that it is important to take into account that special penumbral and collateral imaging selection criteria were used in a minority of the participating trials, but we note that special imaging selection was used less often than Kansagra suggests. Of the 3 trials enrolling patients for intervention beyond 6 hours, 2 (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands [MR CLEAN] and Randomized Trial of Revascularization With Solitaire FR Device vs Best Medical Therapy in the Treatment of Acute Stroke […]

  • Why I Favor Compulsory Health Insurance
    Posted on March 21, 2017 at 12:00 am

    To the Editor:—I favor compulsory health insurance: […]

  • Sedation vs Intubation for Patients With Acute Stroke Undergoing Thrombectomy
    Posted by See AP, Ducruet AF. on March 21, 2017 at 12:00 am

    To the Editor Dr Schönenberger and colleagues investigated whether anesthetic choice influenced outcome following endovascular thrombectomy for large-vessel stroke by conducting a randomized blinded trial enrolling 150 thrombectomy patients over a 2-year period. Interpretation of the results is limited by the choice of primary outcome measure, an underpowered trial design, and the relative ineffectiveness of the intervention. […]

  • JAMA
    Posted on March 21, 2017 at 12:00 am

    […]

  • Trial of Pregabalin for Acute and Chronic Sciatica
    Posted on March 23, 2017 at 12:00 am

    Sciatica is characterized by radiating posterior or posterolateral leg pain, which is sometimes accompanied by back pain, sensory loss, weakness, or reflex abnormalities. Few clinical guidelines for the treatment of sciatica exist, and evidence regarding effective medical treatments is limited. […]

  • Fournier’s Gangrene
    Posted on March 23, 2017 at 12:00 am

    Figure 1. […]

  • Treatment of Benzodiazepine Dependence
    Posted on March 23, 2017 at 12:00 am

    Traditionally, various terms have been used to define substance use–related disorders. These include "addiction," "misuse" (in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition [DSM-IV]), "harmful use" (in the International Classification of Diseases, 10th Revision […]

  • Management of Sciatica
    Posted on March 23, 2017 at 12:00 am

    Mr. Winston’s case represents a common scenario in the management of symptomatic lumbar disk herniation. In this particular case, the patient’s symptoms and the physical examination are consistent with nerve-root compression and inflammation directly from an L4–L5 herniated disk on his left side. […]

  • Is Pregabalin Ineffective in Acute or Chronic Sciatica?
    Posted on March 23, 2017 at 12:00 am

    Sciatica with or without low back pain is not easily managed, and few treatments have established efficacy for these conditions. Although the antiepileptic drug pregabalin has been recommended for the treatment of neuropathic pain (i.e. the broad category of pain associated with a lesion or diseas […]

  • Adopting Innovations in Care Delivery — The Case of Shared Medical Appointments
    Posted on March 23, 2017 at 12:00 am

    Transformative innovations in care delivery often fail to spread. Consider shared medical appointments, in which patients receive one-on-one physician consultations in the presence of others with similar conditions. Shared appointments are used for routine care of chronic conditions, patient […]

  • Incidental Finding of Oleothorax
    Posted on March 23, 2017 at 12:00 am

    Figure 1. […]

  • Case 9-2017: A 27-Year-Old Woman with Nausea, Vomiting, Confusion, and Hyponatremia
    Posted on March 23, 2017 at 12:00 am

    Presentation of Case. Dr. Meaghan E. Colling (Medicine): A 27-year-old woman was admitted to this hospital because of nausea, vomiting, confusion, and hyponatremia. The patient had been well until 1 week before admission, when she had nausea and nonbloody, nonbilious emesis. She did not seek […]

  • Lessons from Oregon in Embracing Complexity in End-of-Life Care
    Posted on March 16, 2017 at 12:00 am

    Under the incentives of fee-for-service Medicare, the utilization trends among persons with chronic progressive medical illness include more care in the intensive care unit (ICU), more hospitalizations, and often late or no referrals to hospice care (Figure 1). These utilization patterns ar […]

  • Protruding Iris Collarette
    Posted on March 16, 2017 at 12:00 am

    Figure 1. […]

  • Acute Lower Gastrointestinal Bleeding
    Posted on March 16, 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 71-year-old […]

  • Plasmacytomas and Plasma-Cell Leukemia
    Posted on March 16, 2017 at 12:00 am

    Figure 1. […]

  • Another Senseless Death — The Case for Supervised Injection Facilities
    Posted on March 16, 2017 at 12:00 am

    Frankie liked to tell people "we made our bones together." He must have said that a hundred times, to every new medical student I introduced to him, to every nurse, and during every one of our many visits. I had a general sense of what he meant, but on the morning I heard that he’d died from an […]

  • Case 7-2017: A 73-Year-Old Man with Confusion and Recurrent Epistaxis
    Posted on March 9, 2017 at 12:00 am

    Presentation of Case. Dr. Jeffrey L. Greenwald: A 73-year-old man with multiple chronic medical illnesses was admitted to this hospital because of confusion and irritability. Two days before this admission, increasing weakness, lethargy, chills, and diarrhea developed. The patient became less […]

  • 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 […]

  • Realizing the Potential of Cancer Prevention — The Role of Implementation Science
    Posted on March 9, 2017 at 12:00 am

    In the past two decades, we and others have estimated that more than half of cancers could have been prevented by applying knowledge that we already have. Tobacco use, inactivity, and obesity are modifiable causes of cancer, and evidence now suggests that vaccination against the human […]

  • At Risk for Serious Mental Illness — Screening Children of Patients with Mood Disorders or Schizophrenia
    Posted on March 9, 2017 at 12:00 am

    A 10-year-old boy has cognitive deficits, and his school performance and social skills have been deteriorating gradually since he was 7. Neither his 12-year-old brother nor his 14-year-old sister has similar problems. Their mother, a 37-year-old schoolteacher, has been treated for bipolar disorder […]

  • Glucagonoma-Associated Rash
    Posted on March 9, 2017 at 12:00 am

    Figure 1. […]

  • Care for Autism and Other Disabilities — A Future in Jeopardy
    Posted on March 9, 2017 at 12:00 am

    The false belief that vaccines cause autism has been forcefully countered by the scientific community, which recognizes that vaccines are among the most valuable medical innovations of our time. President Donald Trump’s apparent openness to a long-debunked link between vaccines and autism risks […]

  • Grouped Pustules on an Erythematous Base
    Posted on March 9, 2017 at 12:00 am

    Figure 1. […]

  • First Corticosteroid Approved for Duchenne Muscular Dystrophy
    Posted by Voelker R. on March 21, 2017 at 12:00 am

    Deflazacort has become the first corticosteroid to receive FDA approval to treat patients aged 5 years and older who have Duchenne muscular dystrophy. […]

  • Transitions in House Staff Care and Patient Mortality
    Posted by Denson JL, Horwitz LI, Sherman SE. on March 21, 2017 at 12:00 am

    In Reply We acknowledge that the definition of a transition patient in the main analysis could have produced immortal time bias, as Dr Sadhu discusses in his letter. Immortal time bias is typically considered a bias in favor of lower mortality in the exposed group, because it excludes patients who die before the event of interest. The direction of such a bias is therefore not necessarily toward a sicker cohort. In our study, it is also plausible that the transition cohort was affected not only by immortal time bias, as could be seen for any arbitrary transition (such as change in hospital […]

  • Implementing Peanut Allergy Prevention Guidelines at a Population Level
    Posted by Turner PJ, Campbell DE. on March 21, 2017 at 12:00 am

    This Viewpoint summarizes the National Institute of Allergy and Infectious Diseases’ guideline for prevention of peanut allergies in US infants and argues that the complexity and narrow scope of the recommendations could prevent population-wide implementation and uptake. […]

  • Highlights for March 21, 2017
    Posted on March 21, 2017 at 12:00 am

    […]

  • Exercise During Pregnancy
    Posted by Perales M, Artal R, Lucia A. on March 21, 2017 at 12:00 am

    This Viewpoint summarizes the American Congress of Obstetrics and Gynecology (ACOG) guideline recommendations and more recent evidence about the benefits of exercise during pregnancy. […]

  • Value-Based Purchasing: Time for Reboot or Time to Move on?
    Posted by Jha AK. on March 21, 2017 at 12:00 am

    These are difficult days for those of us who have advocated for pay-for-performance (P4P) as a policy tool to improve health care quality. The idea behind P4P has always been simple: physicians and hospitals should be financially rewarded for providing high-quality care and financially penalized for providing low-quality care. Although this idea has been around for some time, it gained national traction over the past decade, as policy makers pushed toward paying for “value” and not just volume. […]

  • Non–Vitamin K Oral Anticoagulants in Atrial Fibrillation
    Posted by Potpara TS, Lip GH. on March 21, 2017 at 12:00 am

    This Viewpoint discusses use of non–vitamin K oral anticoagulants in treating atrial fibrillation. […]

  • Sedimentation Rate
    Posted by Wicks I. on March 21, 2017 at 12:00 am

    Draw blood—a thick red drop, falling, laden with erythrocytes,those journeymen made in the marrowfor their brief season, spent working the blood, streaming in pale yellow plasma through the heart and its arch of great vessels, riding the pulse down arterial arcades, branching to tissue and territory, milling in fine capillaries while holding tidal breath in the deep red pockets of hemoglobin, loaded with its cargo of agile oxygenfor the electron transport chain, without which nothing. Then returning, depletedalong reticulated veins to do it all again. Fellow travelers, in […]

  • The Joint Commission’s Pain Standards and the Prescription Opioid Epidemic
    Posted by Baker DW. on March 21, 2017 at 12:00 am

    This Viewpoint discusses the history of The Joint Commission standards for pain management and lessons learned that might inform current efforts to address the prescription opioid epidemic and prevent unintended consequences of future similar standard-setting initiatives. […]

  • Sedation vs Intubation for Patients With Acute Stroke Undergoing Thrombectomy—Reply
    Posted by Bösel J, Schöneberger S. on March 21, 2017 at 12:00 am

    In Reply Drs See and Ducruet raise a number of concerns about our trial. The study was designed to investigate short-term clinical outcomes, whereas longer-term outcomes, which are also important, should be addressed in a multicenter trial. The MR CLEAN data that See and Ducruet cite to question our design and sample size were not published at the time of planning the SIESTA trial. We acknowledge that in settings with higher interventional speed and efficacy, the results may have been different. However, our trial population better reflected broad practice than other randomized thrombectomy […]

  • Medical Care of Detainees in US Military Facilities
    Posted by Chalela JA. on March 21, 2017 at 12:00 am

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  • Misstated Text
    Posted on March 21, 2017 at 12:00 am

    In the Editorial entitled “Sublingual Immunotherapy for Allergic Rhinitis: Is 2-Year Treatment Sufficient for Long-term Benefit?” published in the February 14, 2017, issue, there was an error in the text. In the first paragraph, the third sentence should have read, “The proportion of patients treated with AIT who do not maintain sustained allergen-specific tolerance varies from 0% to 55%, depending on factors including type of allergen, treatment duration, and the definition of relapse.” This article was corrected online. […]

  • Patient-Reported Outcomes Following Treatment for Localized Prostate Cancer
    Posted by Hamdy FC, Donovan JL. on March 21, 2017 at 12:00 am

    When treatments are known to be successful with good oncological outcomes for specific cancers, most patients will be prepared to accept the proposed therapy and its consequences on quality of life. But when multiple, equally effective treatments are available and uncertainty about their benefits prevails with a substantial risk of overtreatment, the balance of risks between benefit and harm from adverse effects can dominate decision making. Such is the case in clinically localized prostate-specific antigen (PSA)–detected prostate cancer. Men affected by prostate cancer realize […]

  • Cervicovaginal Bacteria and HIV Risk
    Posted by Friedrich MJ. on March 21, 2017 at 12:00 am

    Healthy South African women whose cervicovaginal (CV) microbiome is dominated by a high diversity of anaerobic bacteria but is deficient in Lactobacillus species have a higher risk of acquiring HIV than women who have CV bacterial communities of low diversity that are dominated by Lactobacillis crispatus, according to a report by researchers from the United States and South Africa. […]

  • Direct-to-Consumer Advertising of Androgen Replacement Therapy
    Posted by Kravitz RL. on March 21, 2017 at 12:00 am

    The Kefauver-Harris Amendment to the Food, Drug and Cosmetic Act, enacted by Congress in 1962, required pharmaceutical manufacturers to provide proof of prescription drug effectiveness as well as safety and to obtain preapproval of their marketing plans. Over the next 35 years, manufacturers promoted their products largely to physicians through ads in medical journals and in-office “detailing.” Print advertising directed toward patients was unusual and broadcast advertising was rare, owing to the US Food and Drug Administration’s (FDA’s) insistence that ads on […]

  • New Rare Diseases Screening Test
    Posted by Voelker R. on March 21, 2017 at 12:00 am

    The first screening tool to detect 4 rare lysosomal storage disorders in newborns has received FDA approval. […]

  • Outcomes of Radiation, Surgery, or Observation for Localized Prostate Cancer
    Posted by Barocas DA, Alvarez J, Resnick MJ, et al. on March 21, 2017 at 12:00 am

    This cohort study uses SEER registry data to compare adverse functional effects of managing localized prostate cancer with radical prostatectomy, external beam radiation, and active surveillance. […]

  • Cystoscopy
    Posted by Matulewicz RS, DeLancey JO, Meeks JJ. on March 21, 2017 at 12:00 am

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  • Association Between Prostate Cancer Treatment and Quality of Life
    Posted by Chen RC, Basak R, Meyer A, et al. on March 21, 2017 at 12:00 am

    This cohort study compares quality of life among men with prostate cancer treated with radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance. […]

  • Sedation vs Intubation for Patients With Acute Stroke Undergoing Thrombectomy
    Posted by Buerkle H, Goebel U. on March 21, 2017 at 12:00 am

    To the Editor The Sedation vs Intubation for Endovascular Stroke Treatment (SIESTA) trial found no difference in the primary outcome (change in the NIHSS score after 24 hours) in patients receiving general anesthesia vs conscious sedation. However, there were differences in secondary outcomes, with patients receiving general anesthesia having a 10-minute delay in the door-to-needle interval and increased postinterventional complications, including hypothermia, delayed extubation, and pneumonia. […]

  • Dabigatran vs Warfarin and Risk of Osteoporotic Fractures Among Patients With Nonvalvular Atrial Fibrillation
    Posted by Lau WY, Chan EW, Cheung C, et al. on March 21, 2017 at 12:00 am

    This cohort study uses national electronic medical record data from Hong Kong to compare risk of osteoporotic fracture among patients prescribed dabigatran or warfarin for newly diagnosed nonvalvular atrial fibrillation. […]

  • Transitions in House Staff Care and Patient Mortality
    Posted by Sadhu JS. on March 21, 2017 at 12:00 am

    To the Editor Dr Denson and colleagues reported that patients whose hospitalizations spanned transitions in house staff care had higher mortality rates than control patients. The methods used to construct the transition and control cohorts may explain the findings. For patients admitted on a given day, only those patients who remained hospitalized until the end-of-rotation transition were eligible for inclusion in the transition group; patients who died or were discharged before the transition period were assigned to the control group. This method resulted in fundamentally unbalanced groups, […]

  • Direct-to-Consumer Advertising and Testosterone Testing and Initiation
    Posted by Layton J, Kim Y, Alexander G, et al. on March 21, 2017 at 12:00 am

    This ecologic study investigates associations between televised direct-to-consumer advertising and testosterone testing and initiation in the United States between 2009 and 2013. […]

  • Error in Text
    Posted on March 21, 2017 at 12:00 am

    In the Editorial entitled “Scalp Cooling to Prevent Chemotherapy-Induced Alopecia: The Time Has Come,” published in the February 14, 2017, issue, there was an error in the text. In the ninth paragraph, the second sentence should have read, “The DigniCap scalp cooling system (used in the study by Rugo et al) is cleared by the US Food and Drug Administration (FDA) and the Paxman scalp cooling system (used in the study by Nangia et al) is under evaluation by the FDA.” This article was corrected online. […]

  • Definitive Management of Primary Hyperparathyroidism
    Posted by Campbell MJ. on March 21, 2017 at 12:00 am

    This commentary discusses 2016 American Association of Endocrine Surgeons Guidelines for management of primary hyperparathyroidism published in JAMA Surgery. […]

  • Syrians Seek Care Abroad
    Posted by Abbasi J. on March 21, 2017 at 12:00 am

    This Medical News article is an interview with an Israeli physician whose hospital staff treats sick and wounded Syrians. […]

  • A Tender Rash on the Hand
    Posted by Vangipuram R, Tong Y, Tyring SK. on March 21, 2017 at 12:00 am

    A healthy 36-year-old man had 5 days of an intensely painful vesicular eruption on an erythematous base at the base of his thumb after a suspected spider bite, with no other physical signs. What would you next? […]

  • Boosting Cognitive Development in Children
    Posted by Friedrich MJ. on March 21, 2017 at 12:00 am

    Taking prenatal maternal multiple micronutrients (MMNs) during pregnancy along with a nurturing environment during childhood have long-term benefits for a child’s cognitive development, according to a follow-up study of the Supplementation With Multiple Micronutrients Intervention Trial (SUMMIT) published recently in Lancet Global Health. […]

  • Metformin for Prediabetes
    Posted on March 21, 2017 at 12:00 am

    This Medical Letter review summarizes the clinical study evidence and adverse effects of metformin treatment for individuals at risk for type 2 diabetes. […]

  • No Guinea Worm Disease in Mali
    Posted by Friedrich MJ. on March 21, 2017 at 12:00 am

    Mali reported no cases of Guinea worm disease (dracunculiasis) in 2016, according to provisional figures reported by the country’s ministry of health and tracked by the Carter Center. Worldwide, only 25 cases of the disease were reported in 2016 in 3 countries—Chad (16), Ethiopia (3), and South Sudan (6)—and these occurred in 19 isolated villages. The 2016 figure is up slightly from the 22 cases that occurred in 2015. […]

  • Seven-Year Follow-up of Offspring of Women Taking Prenatal DHA in an RCT
    Posted by Gould JF, Treyvaud K, Yelland LN, et al. on March 21, 2017 at 12:00 am

    This study reports neurodevelopmental outcomes at 7 years of children whose mothers participated in a randomized trial of docosahexaenoic acid supplementation during pregnancy to improve their child’s intelligence. […]

  • Morcellator Risk Was Known
    Posted by Voelker R. on March 21, 2017 at 12:00 am

    The FDA was aware that laparoscopic power morcellators could spread cancerous tissue when the agency approved the first such device in 1991, according to a recent report from the US General Accountability Office (GAO). […]

  • Time to Endovascular Thrombectomy for Acute Stroke
    Posted by Kansagra AP. on March 21, 2017 at 12:00 am

    To the Editor In an individual-patient meta-analysis using data from 5 randomized clinical trials, Dr Saver and colleagues reported improved outcomes following mechanical thrombectomy initiated up to 7.3 hours after the onset of acute ischemic stroke due to large vessel occlusion. This result represents a meaningful extension of the current 6-hour treatment guideline and would expand access to life-altering treatments. However, the challenges of interpreting these data must be acknowledged. Only 3 of the 5 trials allowed intervention beyond 6 hours, and these 3 trials used more stringent […]

  • The Healing Power of Paint
    Posted by Toll E, Melfi B. on March 21, 2017 at 12:00 am

    This Arts and Medicine essay describes the experience of an outpatient clinic's staff, patients, and families who collaborated to paint self-portrait tiles to decorate the clinical space. […]

  • Time to Endovascular Thrombectomy for Acute Stroke—Reply
    Posted by Saver JL, Goyal M, Hill MD, et al. on March 21, 2017 at 12:00 am

    In Reply We concur with Dr Kansagra that it is important to take into account that special penumbral and collateral imaging selection criteria were used in a minority of the participating trials, but we note that special imaging selection was used less often than Kansagra suggests. Of the 3 trials enrolling patients for intervention beyond 6 hours, 2 (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands [MR CLEAN] and Randomized Trial of Revascularization With Solitaire FR Device vs Best Medical Therapy in the Treatment of Acute Stroke […]

  • Why I Favor Compulsory Health Insurance
    Posted on March 21, 2017 at 12:00 am

    To the Editor:—I favor compulsory health insurance: […]

  • Sedation vs Intubation for Patients With Acute Stroke Undergoing Thrombectomy
    Posted by See AP, Ducruet AF. on March 21, 2017 at 12:00 am

    To the Editor Dr Schönenberger and colleagues investigated whether anesthetic choice influenced outcome following endovascular thrombectomy for large-vessel stroke by conducting a randomized blinded trial enrolling 150 thrombectomy patients over a 2-year period. Interpretation of the results is limited by the choice of primary outcome measure, an underpowered trial design, and the relative ineffectiveness of the intervention. […]

  • JAMA
    Posted on March 21, 2017 at 12:00 am

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