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Patient-Guided Decision Making in Papillary Thyroid Cancer

Mar, 02/01/2018 - 01:00
This commentary discusses a cohort study published in JAMA Otolaryngology–Head & Neck Surgery examining the probability, rate, and magnitude of tumor growth in patients with papillary thyroid cancer during active surveillance.

A 59-Year-Old Woman With a Large Finger Nodule

Mar, 02/01/2018 - 01:00
A 59-year-old African American woman had a rapidly enlarging, nonfluctuant, noninflamed nodule with central ulceration on one finger. She had no history of hand trauma, joint pain, stiffness, or lymphadenopathy; results of a recent complete blood cell count and comprehensive metabolic profile were unremarkable. What would you do next?

Prevalence of Autism Spectrum Disorder Among US Children and Adolescents, 2014-2016

Mar, 02/01/2018 - 01:00
This study estimates the current prevalence of autism spectrum disorder among US children and adolescents from 2014 to 2016 using nationally representative data from the National Health Interview Survey.

Recurrence of Reflux After Laparoscopic Antireflux Surgery

Mar, 02/01/2018 - 01:00
To the Editor Dr Maret-Ouda and colleagues assessed the outcome of laparoscopic antireflux surgery among 2655 patients who underwent the operation in Sweden between 2005 and 2014. They defined failure as postoperative use of antireflux medications or need for secondary antireflux surgery. The overall failure rate was 17.7%, and female sex, older age, and comorbidities were risk factors. Hospital volume of laparoscopic antireflux surgery was not associated with risk of recurrent reflux. They concluded that the high rate of recurrent reflux diminishes some of the benefits of the operation. The study has significant limitations that raise questions about the validity of the findings and the soundness of the conclusions.

Recurrence of Reflux After Laparoscopic Antireflux Surgery—Reply

Mar, 02/01/2018 - 01:00
In Reply We do not believe that our view of the use of antireflux surgery is very different from that of Drs Patti and Schlottmann, but we would like to respond to the 4 potential limitations of the study that were brought to our attention.

Self-regulation of the Medical Profession and Maintenance of Certification

Mar, 02/01/2018 - 01:00
To the Editor The Viewpoint regarding maintenance of certification (MOC) requirements and Texas Senate bill (SB) 1148 asked practicing physicians to make a leap of faith that many cannot accommodate. Unfortunately, that leap of faith is central to the author’s argument.

Self-regulation of the Medical Profession and Maintenance of Certification

Mar, 02/01/2018 - 01:00
To the Editor Dr Johnson opposed Texas SB 1148, legislation negating most economic and professional consequences of MOC nonparticipation. Several statements presented in support of this position are debatable.

Self-regulation of the Medical Profession and Maintenance of Certification—Reply

Mar, 02/01/2018 - 01:00
In Reply I agree with Dr Cardenas’ statement that self-regulation is a “core attribute of the learned professions.” No doubt it is one of the principal reasons why more than 800?000 licensed US physicians have elected to be certified by a board of the American Board of Medical Specialties. I also agree with him and with Dr Freeman that there is a level of disaffection with the certifying boards that stems in part from concerns related to the relevancy of MOC as well as board “processes, finances, and lack of transparency.” To that end, certifying boards are making concerted efforts to improve the MOC experience and to respond to these valid concerns. For example, the American Board of Internal Medicine (ABIM) recently reorganized its governance structure. This effort was undertaken in part to enhance program relevancy by increasing the number of practicing nonacademic physicians participating at all levels of governance. More than 70% of current ABIM governance members spend more than half their time in clinical care. Over the past 3 years, ABIM staff has changed examination blueprints in all disciplines based on critical review by thousands of physicians across the country. Earlier this year, in response to diplomate feedback, ABIM announced plans to roll out 2-year Knowledge Check-Ins taken at home or in the office as an option to the traditional MOC examination. To ensure full transparency, comprehensive ABIM financial information—including tax form 990 and the audited financial statement—is freely available online, along with a reader’s guide to help interested parties find the information of interest. Of note, ABIM carries a platinum rating for transparency from Guidestar, a designation attained by less than 0.1% of all nonprofit organizations. I believe these actions are indicative of the good faith efforts certifying boards are pursuing to address the specific concerns outlined by Cardenas and Freeman.

The Nuremberg Code and Informed Consent for Research

Mar, 02/01/2018 - 01:00
To the Editor The Viewpoint by Dr Moreno and colleagues understated the precedential value of the International Medical Tribunal's decision in the trial of Nazi doctors accused of war crimes that established the Nuremberg Code and the code’s influence on common law development of the legal duty of researchers to secure informed consent from their research participants. The refusal in 1987 of the US Supreme Court, in the case of an army sergeant who had secretly been dosed 4 times and claimed to have been injured in an lysergic acid diethylamide (LSD) experiment, to adopt or apply the code is noninformative because the majority on the Court held that soldiers may not sue the government or military leadership for monetary damages for injuries sustained while serving. My review of case law identified 19 published opinions from state and federal courts (applying federal law as well as the laws of Arizona, Florida, California, Illinois, Maryland, Massachusetts, Michigan, New York, and Pennsylvania) that recognize the duty of researchers to secure an informed consent from research participants. Four of those courts favorably recited the International Medical Tribunal decision or the code among other sources for establishing the duty. Other sources cited include the Declaration of Helsinki, other professional codes of ethics, federal regulations, the special nature of the participant-researcher relationship, and perhaps most importantly, concerns about nonconsensual invasions of bodily integrity.

The Nuremberg Code and Informed Consent for Research—Reply

Mar, 02/01/2018 - 01:00
In Reply Dr Merz claims that we understated the “precedential value” of the Nuremberg Code on the common law development of the “legal duty” of medical scientists to secure informed consent. Our Viewpoint made clear that the Code has been a “milestone in the history of biomedical research ethics” and has served as an important “guideline” for courts in the United States and possibly in other countries, but we also stated that the Code has not been adopted by any government, “with the partial exception of the US Department of Defense in 1953 regarding defensive experiments concerning atomic, biological, and chemical agents.”

New Inroads Against Multiple Sclerosis

Mar, 02/01/2018 - 01:00
This Medical News story discusses recent breakthroughs in the long fight against multiple sclerosis.

Smart Artificial Beta Cells May Help Treat Diabetes

Mar, 02/01/2018 - 01:00
In experiments conducted in diabetic mice lacking beta cells, a single injection of artificial beta cells (A?Cs) automatically and efficiently controlled blood glucose levels. The cells were able to respond to blood glucose levels rapidly and keep levels normal for up to 5 days. The research, which is published in Nature Chemical Biology, indicates that it may be possible to overcome a major challenge in the design of synthetic therapeutic cells: mimicking beta cell function in vivo to precisely sense the external environment, make internal decisions, and trigger feedback.

Housing as Health

Mar, 02/01/2018 - 01:00
Envision a society that fully connects the usually disparate worlds of health and housing. Clinicians would implement strategies that feature “housing as a vaccine” to prevent illness and disability. Professionals from both worlds would routinely link lodging with counseling, case management, and other services to ensure that supportive housing more robustly meets the needs of vulnerable people. Officials would blend funding streams from health departments and the US Department of Housing and Urban Development (HUD) to address health equity and affordability challenges for the estimated 38.9 million households (2015) that are spending more than 30% of income on housing.

Digital Pill Gains Approval

Mar, 02/01/2018 - 01:00
The first drug in the United States that contains a sensor to track whether patients take their medication has received FDA approval.

Electrical Device Calms Opioid Withdrawal

Mar, 02/01/2018 - 01:00
An electrical device approved for use in acupuncture has received an expanded indication to help reduce opioid withdrawal symptoms.

Treatment for Rare Enzyme Disorder

Mar, 02/01/2018 - 01:00
The FDA has approved the first treatment in the United States for patients with mucopolysaccharidosis type VII (MPS VII), a rare genetic enzyme disorder that affects an estimated 200 people in developed countries.

Love’s Muse

Mar, 02/01/2018 - 01:00
What is the heart but rote-learnt pump and drum?And the breath expires like a love letter in firethat burns brighter unrequited. Some dimsitting rooms’ four chambers that require

Hamstringing the Army

Mar, 02/01/2018 - 01:00
The forces arrayed against scientific medicine are many and various. They range from the honest but deluded crank with an obsession through the various cults and ’pathies to the downright quacks and medical fakers. The American Medical Association as representative of scientific medicine in this country has, naturally enough, been the target for many of the verbal poison-gas attacks made by these different interests. In general, the Association and the profession have ignored such outbursts, for in many instances one of the obvious objects of the attackers has been to obtain, through a reply, a publicity they could never get through the avenues normally open to them. In this matter, as in many others, war brings about changed conditions. Vilifying scientific medicine in times of peace was a matter that affected chiefly only the physician, and he, knowing its source, ignored it. With the entry of our country into war, medicine, in common with other sciences, was called on to do its “bit” in successfully prosecuting the gigantic task the nation had undertaken. How well it has responded we will leave others to say. The facts are that the lives and health of the hundreds of thousands of young Americans who form the new National Army have been entrusted to the care of the representatives of scientific medicine.

Postsepsis Morbidity

Mar, 02/01/2018 - 01:00
This JAMA Patient Page describes common long-term health problems associated with sepsis as well as management of postsepsis care.

JAMA

Mar, 02/01/2018 - 01:00

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