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Prevalence of Genetic Variant Reclassification After Hereditary Genes Testing

Mar, 25/09/2018 - 02:00
This genetic epidemiology study uses data from a commercial genetic test laboratory to characterize the proportion of genes of uncertain clinical significance that were reclassified into more determinate benign or pathogenic categories of risk based on emerging evidence among patients undergoing hereditary cancer risk assessment between 2006 and 2016.

Fractional Flow Reserve Measurement for Assessing Coronary Artery Stenosis

Mar, 25/09/2018 - 02:00
This Clinical Update explains the uses and interpretation of fractional flow reserve (FFR) measures that quantify the pressure gradient proximal and distal to intracoronary lesions and determine the clinical significance of angiographically detected coronary artery stenoses.

Breast Reconstruction Following Breast Cancer Treatment—2018

Mar, 25/09/2018 - 02:00
This Clinical Update summarizes contemporary prosthetic and autologous breast reconstruction options for women undergoing lumpectomy or mastectomy for breast cancer, and reviews data on indications, safety, and timing for the procedures.

Esophageal Manometry for Diagnosing GERD

Mar, 25/09/2018 - 02:00
A 22-year-old man with a 10-year history of gastroesophageal reflux disease (GERD)–like symptoms and taking 20 mg/d of omeprazole had a normal esophagogastroduodenoscopy (EGD) and was diagnosed with achalasia following a high-resolution manometry (HRM) study. What would you do next?

Temporal Trends and Characteristics of Reportable Health Data Breaches

Mar, 25/09/2018 - 02:00
This study uses public data to examine the nature and extent of health data confidentiality breaches from 2010 through 2017

The Path to the First FDA-Approved Cannabis-Derived Treatment and What Comes Next

Mar, 25/09/2018 - 02:00
This Medical News story discusses the history of Epidiolex and whether its approval to treat 2 rare epilepsy syndromes will foster the development of more cannabis-derived therapies.

Disability and Access to Care

Mar, 25/09/2018 - 02:00
One in 4 US adults—61 million individuals—lives with a disability and many of them report difficulties accessing health care, according to a CDC report.

Opioid Use Disorder During Pregnancy

Mar, 25/09/2018 - 02:00
National rates of opioid use disorders (OUD) among new mothers has quadrupled between 1999 and 2014, according to a CDC report.

Antipsychotics May Affect Metabolism

Mar, 25/09/2018 - 02:00
Youth with disruptive behavior disorders who were treated with antipsychotic medications for the first time had increases in body fat and decreases in insulin sensitivity over 12 weeks, found a trial published in JAMA Psychiatry.

Direct-mail FIT Improves Cancer Screening Rates

Mar, 25/09/2018 - 02:00
An outreach program that mailed fecal immunochemical test (FIT) to patients as part of standard care significantly improved rates of FIT test completion and colorectal cancer screening, according to a study in JAMA Internal Medicine.

Informing Physicians of Fatal Overdose Curbs Opioid Prescribing

Mar, 25/09/2018 - 02:00
A letter from a medical examiner notifying clinicians that their patients had died of opioid overdose curtailed subsequent opioid prescriptions, found a randomized trial published in Science.

Mosaic HIV Vaccine Shows Promise

Mar, 25/09/2018 - 02:00
An experimental HIV-1 vaccine generated robust immune responses against HIV in both healthy adults and rhesus monkeys and protected monkeys against infection with an HIV-like virus, according to a phase 1 and 2a clinical trial published in the Lancet. The mosaic adenovirus serotype 26–based vaccine combines antigens from different HIV-1 group M strains to improve its ability to elicit a broader immune response.

Study Lays Foundation for TB Vaccine

Mar, 25/09/2018 - 02:00
An experimental vaccine or revaccination with primary bacille Calmette-Guérin (BCG) did not protect against tuberculosis (TB) infection in South African adolescents, according to a phase 2 trial published in the New England Journal of Medicine. But participants who received either vaccine had lower rates of sustained QuantiFERON-TB Gold In-tube assay (QFT) conversion, suggesting that they had a lower risk of developing TB.

Diversifying the NIH-Funded Workforce

Mar, 25/09/2018 - 02:00
Applicants who are women, African American, American Indian/Alaska Native, or Native Hawaiian/Pacific Islander are less likely to receive large National Institutes of Health (NIH) grants than those who are men or members of other racial or ethnic groups, according to a recent study by the US Government Accountability Office (GAO).

Indian Health Service Launches Opioids Website

Mar, 25/09/2018 - 02:00
A new Indian Health Service (IHS) opioid website launched in July is designed to share information and increase communication with key stakeholders, including patients, health care professionals, tribal leaders, and tribal and urban program administrators.

Obesity and Influenza A Shedding

Mar, 25/09/2018 - 02:00
Obesity is associated with an increase in the duration of influenza A shedding in adults, according to a recently published study funded by the National Institute of Allergy and Infectious Diseases (NIAID).

Antibiotic Treatment for Uncomplicated Urinary Tract Infections

Mar, 25/09/2018 - 02:00
To the Editor In a randomized clinical trial, 5 days of nitrofurantoin resulted in higher rates of clinical resolution of uncomplicated lower urinary tract infection (UTI) in women compared with a single dose of fosfomycin.

Antibiotic Treatment for Uncomplicated Urinary Tract Infections—Reply

Mar, 25/09/2018 - 02:00
In Reply Dr Barros refers to unpublished data on clinical cure rates for fosfomycin mentioned in the article. These data are from a randomized clinical trial conducted by the makers of fosfomycin in the 1990s. The data were evaluated extensively by the US Food and Drug Administration, which had to send a warning letter to the company because it was selectively advertising fosfomycin’s “successful clinical cure rate in over 700 women” of 70% without disclosing that the women were enrolled in a comparative trial in which the success rates for ciprofloxacin and trimethoprim-sulfamethoxazole were 96% and 94%, respectively. The trial sponsor’s decision never to publish these results is not surprising, but lack of publication does not mean that the data are not valid. The narrative reviews cited by Barros included only published articles, inflating fosfomycin’s presumed success rate.

Use of a Wearable Activity Monitor in a Home-Based Exercise Intervention for Peripheral Artery Disease

Mar, 25/09/2018 - 02:00
To the Editor Dr McDermott and colleagues investigated the effect of a home-based exercise intervention combining wearable technology and telephone coaching compared with usual care on walking performance in patients with peripheral artery disease (PAD). Although the authors acknowledged limitations regarding the participants’ use of the wearable technology in the study, detailed information is lacking to allow a full understanding of the results and a precise reproduction of the study.

Use of a Wearable Activity Monitor in a Home-Based Exercise Intervention for Peripheral Artery Disease—Reply

Mar, 25/09/2018 - 02:00
In Reply The Home-Based Monitored Exercise for PAD (HONOR) trial tested whether telephone coaching combined with a wearable step counter device improved adherence to prescribed walking exercise activity and improved 6-minute walk distance in people with lower-extremity PAD. Dr de Müllenheim and colleagues raise methodological questions regarding use of the wearable device and the accelerometer in the trial.