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Indomethacin, Ibuprofen, or Acetaminophen for Closure of Hemodynamically Significant PDA in Preterm Infants

Mar, 27/03/2018 - 02:00
This network meta-analysis of randomized trials compares the efficacy and safety of indomethacin, ibuprofen, and acetaminophen for closure of clinically or echocardiographically diagnosed hemodynamically significant patent ductus arteriosus (PDA) in preterm infants.

Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural US Counties, 2004-2014

Mar, 27/03/2018 - 02:00
This cohort study investigates the association between loss of hospital-based obstetric services between 2004 and 2014 and changes in location of childbirth and preterm births in rural counties in the United States.

Trends in Infectious Disease Mortality Among US Counties, 1980-2014

Mar, 27/03/2018 - 02:00
This population epidemiology study estimates county-level patterns in mortality rates from infectious diseases in the United States between 1980 and 2014.

HIV Preexposure Prophylaxis (PrEP)

Mar, 27/03/2018 - 02:00
This narrative review summarizes evidence on the use of tenofovir disoproxil fumarate (TDF)/emtricitabine for HIV preexposure prophylaxis (PrEP) and calls for increased prescribing of PrEP and research on measures to identify individuals at high risk for HIV to ensure their access to PrEP and maximize medication adherence.

?-Blockers in Myocardial Infarction

Mar, 27/03/2018 - 02:00
This JAMA Performance Improvement article uses the case of a patient with acute myocardial infarction and heart failure who developed cardiogenic shock after being given carvedilol as part of a standard STEMI admission order set to discuss the limits of orders sets and of guideline-based care and the need to optimize each for individual patient circumstances.

Interpreting Gastroesophageal Reflux Monitoring

Mar, 27/03/2018 - 02:00
A 56-year-old woman with persistent GERD symptoms on 40 mg esomeprazole had a normal EGD and 24-hour ambulatory reflux monitoring results. What would you do next?

Long-term Outcomes of Close Contact Casting vs Surgery for Unstable Ankle Fractures in Older Adults

Mar, 27/03/2018 - 02:00
This study reports 3-year outcomes of a randomized trial that compared close contact casting vs the usual surgery for unstable ankle fractures in older adults and that found equivalent ankle function outcomes at 6 months.

EHR Usability Issues and Potential Contribution to Patient Harm

Mar, 27/03/2018 - 02:00
This study analyzed patient safety reports in and near Pennsylvania from 2013 through 2016 to identify those that contained explicit language associating possible patient harm with an electronic health record usability issue.

Genotype vs Clinically Guided Dosing of Warfarin to Prevent Adverse Events

Mar, 27/03/2018 - 02:00
To the Editor Dr Gage and colleagues found that genotype-guided warfarin dosing compared with clinically guided dosing reduced clinical events and improved anticoagulation control among patients undergoing hip or knee arthroplasty. I have a few concerns about the research and statistical methods.

Genotype vs Clinically Guided Dosing of Warfarin to Prevent Adverse Events—Reply

Mar, 27/03/2018 - 02:00
In Reply Mr Han-You asks about subgroup analyses by type of arthroplasty (hip vs knee), site, and race in the Genetic Informatics Trial (GIFT) of Warfarin to Prevent Deep Venous Thrombosis. Randomization was stratified by medical center, type of arthroplasty (knee or hip), and race (black vs other races).

Vaccination Strategies During Shortages of Yellow Fever Vaccine

Mar, 27/03/2018 - 02:00
To the Editor Drs Chen and Hamer summarized public health challenges posed by global shortages of yellow fever (YF) virus vaccines and new vaccination strategies adopted to control deadly ongoing YF outbreaks. A single subcutaneous dose of live-attenuated YF vaccine will elicit lifelong protective immunity within 10 days in nearly all vaccinees. This is the rationale for the vaccination requirements from the World Health Organization (WHO) for cross-border travel. But, as Chen and Hamer noted, depletion of international YF vaccine stockpiles necessitated vaccine dose-sparing methods to control epidemics. The most widely adopted method is to administer a fraction of the standard vaccine dose in the usual subcutaneous manner.

Vaccination Strategies During Shortages of Yellow Fever Vaccine—Reply

Mar, 27/03/2018 - 02:00
In Reply Although some guidelines and studies have been published that address the questions from Drs Norton and Morens regarding fractional dosing of YF vaccine, actual practice may deviate.

Table and Figure Errors

Mar, 27/03/2018 - 02:00
In the Original Investigation entitled “Effect of Genotype-Guided Warfarin Dosing on Clinical Events and Anticoagulation Control Among Patients Undergoing Hip or Knee Arthroplasty: The GIFT Randomized Clinical Trial,” published in the September 26, 2017, issue of JAMA, there were a few errors in Table 4 and in Figures 2 and 3. In Figure 2, the log-rank P value should be .04. Figure 3 was revised to fix the Kaplan-Meier plot and the No. at patients at each time point, which were slightly off. In addition, the log-rank P value should be .09. In Table 4, for the “genotype-guided warfarin dosing” group, row for “absolute difference between algorithms in predicted warfarin use,” high-risk group (?1.0 mg/d), the mean PTTR remained at 55.3% but the 95% CI was changed to “52.7% to 57.9%.” This article was corrected online.

BMI Cutoffs Might Be Too High in Postmenopausal Women

Mar, 27/03/2018 - 02:00
This Medical News article examines why BMI-based definitions of overweight and obese might misclassify postmenopausal women as normal weight.

How the Economy Affects Health

Mar, 27/03/2018 - 02:00
In the long term, growing economies are associated with longer and healthier lives. In the short term, that may not be the case—economic booms can boost mortality rates and busts can reduce them. There are many theories why, and some evidence to suggest the health system may have something to do with it.

Benefits of Moderate Physical Activity Despite Frailty

Mar, 27/03/2018 - 02:00
A moderate-intensity physical activity program reduced major mobility disability (MDD) in both frail and nonfrail sedentary older adults found a secondary analysis of the LIFE (Lifestyle Interventions and Independence for Elders) trial published in Annals of Internal Medicine. The physical activity intervention, however, did not reduce risk of frailty among the study’s participants.

Brief Psychotherapy for PTSD

Mar, 27/03/2018 - 02:00
Posttraumatic stress disorder (PTSD) can effectively be treated with 5-session psychotherapy, a briefer treatment than first-line cognitive processing therapy (CPT), according to a noninferiority trial published in JAMA Psychiatry.

Exercise Remodels Heart in Middle Age

Mar, 27/03/2018 - 02:00
Middle-aged adults who engaged in high-intensity exercise for 2 years reversed left ventricular (LV) stiffness associated with sedentary aging, according to a trial published in Circulation.

Similar IVF Birth Rates for Frozen and Fresh Embryos

Mar, 27/03/2018 - 02:00
Two recent trials published in the New England Journal of Medicine found that otherwise healthy infertile women without polycystic ovaries had similar rates of ongoing pregnancy and live births from in vitro fertilization (IVF) regardless of whether the transferred embryos were fresh or frozen.

CMS to Improve Drug Programs and Opioid Overuse Oversight

Mar, 27/03/2018 - 02:00
The Centers for Medicare & Medicaid Services (CMS) has proposed changing the Medicare health and drug programs in 2019 to cover services that improve quality of life and improving oversight of opioid overutilization by patients enrolled in Medicare Part D prescription drug coverage.

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