Distribuir contenido
Actualizado: hace 6 horas 7 mins

NIH Helping to End Addiction Over the Long-term Initiative

Mar, 10/07/2018 - 02:00
This Viewpoint discusses the National Institutes of Health’s Helping to End Addiction Long-term, an interdisciplinary program aimed at advancing addiction and pain research in the United States.

Philip Morris International Foundation and Tobacco Control

Mar, 10/07/2018 - 02:00
This Viewpoint discusses the Philip Morris International–funded Foundation for a Smoke-Free World, whose stated mission is to end cigarette smoking within a generation, and explains why the effort is likely a distraction from true evidence-based tobacco control.

Transition to the ICD-10 in the United States

Mar, 10/07/2018 - 02:00
This Viewpoint proposes strategies to manage code linkage gaps and other sources of error in the transition in the United States from use of the International Classification of Diseases, Ninth Revision (ICD-9) to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10).

Thoughtful Ways of Relating Bad News Makes All the Difference

Mar, 10/07/2018 - 02:00
In this narrative medicine essay, a medical student relates how bad news is shared with humanity or as a bungled communication can deeply affect how the hearer of the bad news reacts, grieves, moves forward or is stuck too long in bitterness and pain.

Evaluating Health Technology Through Pragmatic Trials

Mar, 10/07/2018 - 02:00
Information technology (IT), including digital technologies, wearable sensors, and advanced computational methods, is rapidly transforming the world. From banking, shopping, socializing, and even driving, IT is disrupting nearly every facet of modern life. Despite initial resistance, medical care is finally, albeit slowly, bending to the transformative power of technological innovations. Investments in health technology have increased substantially; in 2017, an estimated $6 billion was invested in digital health IT companies, and an estimated $40 billion was spent by consumers on wearables and health monitoring devices.

Screening for Atrial Fibrillation With a Wearable Device

Mar, 10/07/2018 - 02:00
The formative, landmark descriptions of the prevalence and risk of atrial fibrillation (AF) in the Framingham Heart Study were based on “spot” 12-lead electrocardiograms. In terms of surveillance, this was largely unchanged from centuries of recording an irregular pulse by palpation and required a very high frequency of sustained arrhythmia to detect AF. However, the last decade has seen a substantial increase in the potential tools available for detection of infrequent AF, including a variety of “wearable” technologies. The ready availability of both medical and consumer-based technologies for diagnosis of AF is driving a major shift in the approach from characterizing AF as a binary diagnosis—present or absent—to one on a continuum (based more on frequency of arrhythmia).

Intravenous Alteplase for Mild Nondisabling Acute Ischemic Stroke

Mar, 10/07/2018 - 02:00
Treatment of patients with stroke has changed substantially during the past 25 years. In 1995, the NINDS rt-PA trial showed among selected patients with acute ischemic stroke who were treated with intravenous alteplase within 3 hours of known stroke onset or last known well time had reduced disability at 3 months. In 2008, the ECASS III trial demonstrated benefit of intravenous alteplase among selected patients treated up to 4.5 hours after known stroke onset or last known well time. Benefit from alteplase treatment occurred despite higher rates of symptomatic intracranial hemorrhage compared with placebo (6.4% vs 0.6% in the NINDS rt-PA trial; 2.4% vs 0.3% in ECASS III). More recently, thrombectomy has been shown to substantially reduce morbidity in selected patients with ischemic stroke.

Ankle Brachial Index Screening and Improving Peripheral Artery Disease Detection and Outcomes

Mar, 10/07/2018 - 02:00
Lower extremity peripheral artery disease (PAD) affects an estimated 8.5 million adults in the United States and 202 million adults worldwide. PAD consists of atherosclerosis of the lower extremity arteries, resulting in inadequate oxygen supply to lower extremity muscles during walking activity. People with PAD typically walk only 1 to 3 blocks before having to stop and rest because of ischemic leg symptoms. PAD is also a marker for the presence of atherosclerotic disease in the coronary and cerebrovascular arteries. Consistent with this phenomenon, people with PAD have higher rates of acute coronary events, ischemic stroke, and mortality, compared with people without PAD.

Effect of a Home-Based Wearable Electrocardiographic Patch on Detecting Atrial Fibrillation

Mar, 10/07/2018 - 02:00
This randomized clinical trial and matched cohort study compares the effects of immediate vs delayed use of a self-applied adhesive continuous ECG monitoring patch on new diagnoses of atrial fibrillation in patients at high risk of atrial fibrillation.

Alteplase vs Aspirin and Functional Outcome in Ischemic Stroke With Minor Nondisabling Neurologic Deficits

Mar, 10/07/2018 - 02:00
This randomized trial compares the effects of intravenous alteplase vs oral aspirin treatment on functional outcomes in patients with minor nondisabling acute ischemic stroke.

Acupuncture vs Control for Joint Pain Related to Aromatase Inhibitor Treatment for Breast Cancer

Mar, 10/07/2018 - 02:00
This randomized clinical trial compares true acupuncture with sham acupuncture and with waitlist control on the reduction of joint pain related to aromatase inhibitor use in postmenopausal women with early-stage breast cancer.

USPSTF Recommendation: Screening for PAD and CVD Risk Assessment With the ABI

Mar, 10/07/2018 - 02:00
This 2018 Recommendation Statement from the US Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for peripheral artery disease and cardiovascular disease risk with the ankle-brachial index in asymptomatic adults (I statement).

USPSTF Evidence Report: Screening for Peripheral Artery Disease Using the Ankle-Brachial Index

Mar, 10/07/2018 - 02:00
This systematic review to support the 2018 US Preventive Services Task Force Recommendation Statement on screening for peripheral artery disease (PAD) using the ankle-brachial index (ABI) summarizes published evidence on the diagnostic accuracy of the ABI test and the benefits and harms of treatment of screen-detected PAD.

Progressive Weakness and Memory Impairment in a Middle-aged Man

Mar, 10/07/2018 - 02:00
A 61-year-old man presented with 4 weeks of progressive weakness and paresthesias, cognitive impairment, difficulty ambulating independently, and hyperreflexia with diminished vibratory sensation and proprioception in his lower extremities. A complete blood cell count revealed macrocytic anemia; magnetic resonance imaging revealed prolonged T2 signal in the posterior columns of the spinal cord. What would you do next?

Testosterone Prescribing in the United States, 2002-2016

Mar, 10/07/2018 - 02:00
This study uses commercial claims database data to characterize trends in testosterone prescribing in the United States from 2002 to 2016.

Low-Fat vs Low-Carbohydrate Diets and Weight Loss

Mar, 10/07/2018 - 02:00
To the Editor In the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) randomized clinical trial, the investigators concluded that there was no significant difference in weight change between a healthy low-fat diet vs a healthy low-carbohydrate diet. At baseline, both groups consumed a comparable percentage of daily calories from fat: 34.8% for the low-fat group and 36.0% for the low-carbohydrate group. At the conclusion of the 12-month study period, the percentage of daily calories from fat was 28.7% in the low-fat group and 44.6% in the low-carbohydrate group. Although the percentage of daily calories from fat was reduced from 34.8% to 28.7% in the low-fat group, a diet composed of 28.7% of the daily calories from fat is a high-fat diet.

Low-Fat vs Low-Carbohydrate Diets and Weight Loss

Mar, 10/07/2018 - 02:00
To the Editor In a 12-month, behavior modification diet intervention study, Dr Gardner and colleagues compared the effects of a healthy low-fat diet with a healthy low-carbohydrate diet on weight loss among 609 overweight adults. The authors did not find a significant difference in weight loss between the 2 diet intervention groups, in line with results from several previous studies. Different from traditional diet intervention trials, 1 of the primary aims of the DIETFITS study was to test diet?×?genotype pattern interactions on weight loss in response to the diet intervention. The authors did not observe significant diet?×?genotype pattern interactions and concluded that there was no significant difference in genotype pattern associated with the dietary effects on weight loss.

Low-Fat vs Low-Carbohydrate Diets and Weight Loss—Reply

Mar, 10/07/2018 - 02:00
In Reply Dr Rahman questions whether the DIETFITS healthy low-fat diet can be considered a low-fat diet with a mean reported 12-month intake of 28.7% energy from fat. A similar question could be raised regarding the healthy low-carbohydrate diet, with a mean reported 12-month intake of 29.8% energy from carbohydrates. The approach of defining and communicating to study participants “how low is low?” was very intentional.

Importance of Intelligence and Emotional Intelligence for Physicians

Mar, 10/07/2018 - 02:00
To the Editor In a Viewpoint, Dr Emanuel and Ms Gudbranson outlined the need to consider applicant abilities beyond surrogate measures of IQ when selecting medical school applicants. Although the authors highlighted emotional intelligence (EQ) as an alternative to IQ, other predictors of success in medicine should be considered as well.

Importance of Intelligence and Emotional Intelligence for Physicians

Mar, 10/07/2018 - 02:00
To the Editor Dr Emanuel and Ms Gudbranson suggested that medical school admissions committees should explicitly assess EQ and deemphasize IQ. Ideally, the anticipated outcome would be an increased number of students who have the potential to become effective, compassionate physicians able to collaborate, communicate, and integrate care for their patients. However, EQ is a measure of ability that can improve with formal training. EQ training has been shown to be a critical component of leadership development, although the optimal type and timing of training in a person’s education or career has yet to be determined. Some groups suggest that medical professionalism and leadership education should be modeled around EQ competencies. Additionally, Cabello et al found that the total ability EQ score changes with age, increasing from adolescence to middle life before trending downward. If EQ scores become the main criteria for admission, age could become an influential factor in who is admitted. Because of its growth potential and inherent plasticity, EQ may not be a reliable factor to consider during admissions decisions in the absence of documented prior training.

Listado de eventos