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Highlights for April 17, 2018

Mar, 17/04/2018 - 02:00

Charter on Physician Well-being

Mar, 17/04/2018 - 02:00
This Viewpoint discusses a 2018 Charter on Physician Well-being, a proposal by the Alliance for Internal Medicine’s Collaborative for Healing and Renewal in Medicine (CHARM) to identify guiding principles and key commitments physician groups and others might use as a framework for addressing physician burnout and dissatisfaction.

Physician Well-Being and the Regenerative Power of Caring

Mar, 17/04/2018 - 02:00
This Viewpoint explores the root causes of physician dissatisfaction and burnout in contemporary health systems and proposes reforms that could restore physicians’ ability to care for patients in reciprocal relationships to reclaim professional satisfaction.

Overcoming Challenges to US Payment Reform

Mar, 17/04/2018 - 02:00
This Viewpoint describes a “place-based” approach to health care organization and how it could improve health care and costs in the United States, using England’s National Health Service sustainability and transformation partnerships as an example.

How to Mentor Millennials

Mar, 17/04/2018 - 02:00
In this narrative medical essay, the authors present 3 scenarios exemplifying the collision between mentoring expectations among millennials and older generation faculty and proposes strategies to bridge generational divides and engage the next generation of physicians.

Challenges in Interpreting the Lipid Lowering Trials

Mar, 17/04/2018 - 02:00
The past quarter century has witnessed a series of randomized clinical trials that defined contemporary cholesterol treatment algorithms. The first two of these trials, WOSCOPS and 4S, demonstrated the efficacy of statin therapy vs placebo in persons with very elevated low-density lipoprotein cholesterol (LDL-C) levels (???190 mg/dL). Subsequent studies identified the benefits of statin therapy in populations with progressively lower starting LDL-C levels. As equipoise shifted, trial designs changed from placebo-controlled interventions to evaluating more- vs less-intensive lipid-lowering strategies.

Preventing Fractures and Falls

Mar, 17/04/2018 - 02:00
Vitamin D and calcium are key nutrients to support bone development in children and young adults and to maintain muscle strength and neuromuscular coordination throughout the life span. Vitamin D deficiency is a well-defined risk factor for falls and hip fractures among older adults. It is unclear if supplementation with these nutrients is effective for the primary prevention of fractures among healthy community-dwelling adults.

Uterosacral Ligament Suspension (ULS) vs Sacrospinous Ligament Fixation (SSLF) for Pelvic Organ Vaginal Prolapse

Mar, 17/04/2018 - 02:00
This 2?×?2 factorial randomized clinical trial compares outcomes in women randomized to ULS vs SSLF and perioperative behavioral therapy and pelvic floor muscle training vs usual care for vaginal apical prolapse.

Association Between Magnitude of LDL Lowering and CV Mortality by Baseline LDL

Mar, 17/04/2018 - 02:00
This meta-analysis of randomized trials compares reductions in all-cause and cardiovascular mortality achieved with more vs less intensive LDL cholesterol lowering stratified by baseline LDL level.

Mortality Associated With Use of SGLT-2 Inhibitors, GLP-1 Agonists, and DPP-4 Inhibitors for Type 2 Diabetes

Mar, 17/04/2018 - 02:00
This network meta-analysis of randomized clinical trials that involved compares the effect of SGLT-2 inhibitors vs DPP-4 inhibitors vs GLP-1 agonists on mortality and cardiovascular events among patients with type 2 diabetes.

USPSTF Recommendation: Vitamin D, Calcium, or Both for Primary Prevention of Fractures

Mar, 17/04/2018 - 02:00
This 2018 US Preventive Services Task Force guideline concludes that current evidence is insufficient to assess the balance of benefits and harms of vitamin D and calcium supplementation, alone or combined, for primary prevention of fractures in community-dwelling, asymptomatic men and premenopausal women (I statement) and recommends against daily supplementation for primary prevention of fractures in community-dwelling, postmenopausal women (D recommendation).

USPSTF Evidence Report: Vitamin D and Calcium for Primary Prevention of Fractures

Mar, 17/04/2018 - 02:00
This systematic review to support the 2018 US Preventive Services Task Force Recommendation Statement on use of supplemental vitamin D and calcium for fracture prevention summarizes published evidence on the benefits and harms of vitamin D, calcium, or their combination for primary prevention of fractures in community-dwelling adults.

Evaluation and Treatment of Hirsutism in Premenopausal Women

Mar, 17/04/2018 - 02:00
This JAMA Clinical Guidelines Synopsis summarizes the 2018 multisociety guideline on evaluation and treatment of hirsutism in premenopausal women.

Trends in Post–Acute Care Use Among Medicare Beneficiaries: 2000 to 2015

Mar, 17/04/2018 - 02:00
This study uses MedPAR data to characterize trends in use of skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) after acute care hospitalizations and trends in hospital and SNF/IRF lengths of stay among Medicare beneficiaries.

Diagnosis and Treatment of Hidradenitis Suppurativa

Mar, 17/04/2018 - 02:00
To the Editor Drs Saunte and Jemec performed an illustrative review focused on the advances in diagnosis and treatment of hidradenitis suppurativa (HS). However, the advances in imaging of the disease were not discussed.

Diagnosis and Treatment of Hidradenitis Suppurativa

Mar, 17/04/2018 - 02:00
To the Editor The article on HS reviewed old and new medical and surgical treatments but omitted any mention of radiation therapy.

Diagnosis and Treatment of Hidradenitis Suppurativa—Reply

Mar, 17/04/2018 - 02:00
In Reply Dr Wortsman stresses the need for accurate characterization of lesions and the potential role for high-frequency ultrasonography. The introduction of high-frequency ultrasonography has led to greater diagnostic accuracy in many fields of clinical medicine and may also do so in dermatology, particularly in HS, in which lesions occur in the dermis or the subcutaneous tissues. We agree with Wortsman that high-frequency ultrasonography is a strong candidate for the preferred imaging technology, although additional validation is necessary before it is fully integrated into daily clinical practice.

Government Actions to Curb the Opioid Epidemic

Mar, 17/04/2018 - 02:00
To the Editor Drs Kolodny and Frieden outlined steps the government should take to curb the opioid epidemic, such as improving surveillance of prescribers through the use of databases, improving reporting and responses to overdoses, promoting more cautious guidelines for use of narcotics, increasing access and reimbursement for nonopioid and nonpharmacologic management of pain, interrupting supply of heroin and illicitly produced synthetic opioids, increasing access to addiction treatment, and reducing harm to current users. However, they left out the role the Drug Enforcement Administration (DEA) can play in its ability to block drug manufacturers and drug distributors from shipping suspiciously large narcotic shipments.

Government Actions to Curb the Opioid Epidemic

Mar, 17/04/2018 - 02:00
To the Editor In their Viewpoint, Drs Kolodny and Frieden advanced 10 priorities for addressing the US opioid crisis. Although some of the proposed steps, such as expanding access to opioid agonist treatment and naloxone, rest on solid evidentiary ground, other suggestions risk doing more harm than good. First, Kolodny and Frieden proposed using Prescription Drug Monitoring Programs (PDMPs) to identify incident trends in opioid addiction by tracking newly filled prescriptions for a 30-day or longer supply as a marker of addiction. This approach is prone to type I error and renders the substantial (and growing) proportion of opioid-addicted individuals who access opioids outside of prescription channels completely hidden. Although better surveillance for opioid addiction is imperative, PDMPs are poorly suited for this purpose.

Government Actions to Curb the Opioid Epidemic—Reply

Mar, 17/04/2018 - 02:00
In Reply Dr van den Berg-Wolf writes about the Ensuring Patient Access and Effective Drug Enforcement Act of 2016, which makes it more difficult for the DEA to suspend registration of manufacturers, distributors, retailers, and prescribers when evidence suggests they are involved in drug diversion. We agree that, in the midst of an addiction epidemic fueled in large part by prescription opioids, the DEA’s ability to regulate distribution of legal narcotics should not be hindered.

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