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Shifts in Health Law Jurisprudence With A Realigned US Supreme Court

Mar, 09/10/2018 - 02:00
This Viewpoint reviews what little is known about US Supreme Court nominee Judge Brett Kavanaugh’s jurisprudence on issues related to health care and health law in cases that could come before the US Supreme Court nominee in coming sessions.

Antibiotics for Sepsis

Mar, 09/10/2018 - 02:00
This Viewpoint makes the case that the importance of early detection of sepsis and the need for rapid antibiotics in patients with definite infection and possible septic shock has likely led to overuse of antibiotics in patients who might not need them, and argues for testing to confirm infection in non-shock patients in place of rapid empirical antimicrobial treatment.

The Giving Tree , the Giving Body

Mar, 09/10/2018 - 02:00
In this narrative medicine essay, a young physician diagnosed with stage III kidney cancer realized with the progressive loss of systems and organs through treatment that he grew to identify with Shel Silverstein’s The Giving Tree, about a tree who gives the boy it loves every part of itself until as a stump all it can offer the now old man is a seat.

Politics and Health Care

Mar, 09/10/2018 - 02:00
On March 30, 1981, as he was about to undergo surgery at George Washington University Hospital for his life-threatening bullet wound, President Ronald Reagan is alleged to have quipped to the attending physicians and nurses, “I hope you are all Republicans.” Everyone laughed. In fact, his surgeon was a liberal Democrat; but, of course, that did not matter.

Immediate vs Delayed Pushing During the Second Stage of Labor

Mar, 09/10/2018 - 02:00
Efforts to optimize cesarean delivery rates have prompted research regarding the optimal approach to the management of labor. The second stage of labor, defined as the interval from complete cervical dilation until delivery of the fetus, is a critical period in labor management. Whether the mother should push immediately or delay pushing for 1 or more hours has been the subject of debate and several observational studies and randomized clinical trials. Although the data may be mixed as a result of efforts to control for mode of delivery and insufficient sample size, prolonged duration of the second stage of labor is associated with both adverse maternal and neonatal outcomes. Delayed pushing (also known as laboring down, passive descent, or rest and descend) has not been studied in a high-quality, adequately powered, contemporary randomized clinical trial.

Epidemiology and Management of Spontaneous Pneumothorax

Mar, 09/10/2018 - 02:00
Spontaneous pneumothorax represents air trapped within the pleural space that develops without antecedent trauma. Current understanding regarding the epidemiology of spontaneous pneumothorax has been informed by small studies performed at single medical centers or retrospective reviews of national data registries. The overall incidence of spontaneous pneumothorax has been estimated at 17 to 24/100?000 in the male population and 1 to 6/100?000 in the female population. Spontaneous pneumothorax recurrence rates have primarily been extrapolated from retrospective case series, with 1- to 6-year recurrence rates ranging from 17% to 54%.

Effect of Immediate vs Delayed Pushing on Spontaneous Vaginal Delivery

Mar, 09/10/2018 - 02:00
This randomized clinical trial compares the effects of immediate vs delayed pushing on spontaneous vaginal delivery and maternal and neonatal morbidities among nulliparous women at or beyond 37 weeks’ gestation admitted for spontaneous or induced labor.

Effect of Polymyxin B Hemoperfusion on Septic Shock and Elevated Endotoxin Level

Mar, 09/10/2018 - 02:00
This clinical trial involving patients with septic shock and high endotoxin activity compares the effect of treatment with polymyxin B hemoperfusion vs sham therapy and usual care on mortality.

Third-Trimester Tdap Immunization and Neonatal Pertussis Antibody Concentration

Mar, 09/10/2018 - 02:00
This prospective cohort study assesses whether maternal immunization with tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, compared with no immunization, is associated with high concentrations of pertussis toxin antibodies at birth and if there is an optimal gestational age for maternal immunization.

Trends in the Incidence and Recurrence of Spontaneous Pneumothorax, 1968-2016

Mar, 09/10/2018 - 02:00
This population epidemiological study uses English national hospital data sets to characterize trends in the incidence and recurrence of hospital admissions for spontaneous pneumothorax to identify risk factors for recurrence.

Management of Chronic Wounds—2018

Mar, 09/10/2018 - 02:00
This Clinical Update summarizes options for chronic wound management in ambulatory settings, including use of standard gauze, negative-pressure wound therapy, advanced dressings (alginates, foams, hydrocolloids, and hydrogels), and adjuvant wound therapies.

Bisphosphonates for Patients Diagnosed With Multiple Myeloma

Mar, 09/10/2018 - 02:00
This Clinical Evidence Synopsis summarizes a Cochrane review of randomized trials comparing the effects of bisphosphonate therapy vs placebo or no treatment on mortality, vertebral fractures, nonvertebral fractures, and skeletal-related events among patients with multiple myeloma.

Coagulation Test in Oral Anticoagulant Therapy

Mar, 09/10/2018 - 02:00
A 74-year-old man taking rivaroxaban for atrial fibrillation developed a subdural hematoma and had an elevated prothrombin time (PT) with normal activated partial thromboplastin time (aPTT) and platelets prior to planned surgical evacuation. How do you interpret the results?

Campaign Contributions From PACs to Congressional Committee Members Responding to the Opioid Crisis

Mar, 09/10/2018 - 02:00
This study examines recent campaign contributions to members of US congressional committees responsible for legislating on the opioid crisis by political action committees (PACs) associated with firms under investigation for having contributed to the crisis.

Vital Statistics Death Counts Calculation of Excess Deaths in Puerto Rico Following Hurricane Maria

Mar, 09/10/2018 - 02:00
This study calculates the number of excess deaths following Hurricane Maria through December 2017, using death counts from vital statistics records, to update a previous estimate.

Unproven but Profitable: The Boom in US Stem Cell Clinics

Mar, 09/10/2018 - 02:00
This Medical News & Perspectives article examines the proliferation of US clinics offering unproven stem cell therapies.

The Surprising Resiliency of the Affordable Care Act

Mar, 09/10/2018 - 02:00
Ever since the passage of the Affordable Care Act (ACA) in 2010, Republicans (and, more recently, President Trump) have made their opposition to the ACA a rallying cry. The focus on “repeal and replace” during the 2014 Congressional election and again in the November 2016 full election led many Republicans to expect a rapid replacement of this key Obama administration legislative victory. House Republicans had even proposed a general legislative strategy before the 2016 election called “A Better Way,” which included changes in several areas of public policy, including health care.

Breastfeeding Report Card

Mar, 09/10/2018 - 02:00
More than 80% of US infants start out life breastfeeding, but many still stop earlier than recommended, the CDC’s 2018 Breastfeeding Report Card found.

More Youth Vaccinated for HPV

Mar, 09/10/2018 - 02:00
About two-thirds of adolescents had received their first dose of the human papillomavirus (HPV) vaccine in 2017 and 48.6% completed all recommended doses, according to a CDC report. This represents a 5-percentage point increase in youth who’ve completed the HPV vaccine series since 2016.

In-home Robots Improve Social Skills in Children With Autism

Mar, 09/10/2018 - 02:00
In a recent open-label pilot study, Yale University researchers demonstrated that children with autism have improved social skills after a month of daily 30-minute interactions at home with an autonomous socially assistive robot.