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Highlights for October 16, 2018

Mar, 16/10/2018 - 02:00

J. Marion Sims and the Historical Aspects of Race and Medicine

Mar, 16/10/2018 - 02:00
This Viewpoint uses controversy over the status of statues commemorating J. Marion Sims, a Southern gynecologist who developed operative techniques for vesicovaginal fistulae on enslaved women, to discuss changing the history of attitudes toward race and discrimination in medicine and society.

Race, Ancestry, and Reporting in Medical Journals

Mar, 16/10/2018 - 02:00
This Viewpoint discusses the appropriateness of documentation of race in the medical history and record, and discusses the challenge of taking the effects of race on patient health seriously without overemphasizing it as an unalterable source of difference at the individual or population level.

The Use of Race, Ethnicity, and Ancestry Data in Biomedical Research

Mar, 16/10/2018 - 02:00
This Viewpoint discusses the need for a consensus on how race, ethnicity, and ancestry data are reported in biomedical research to avoid inappropriately describing racial and ethnic groups as discrete population groups.

NIH Policy for Inclusion Across the Lifespan in Clinical Research

Mar, 16/10/2018 - 02:00
This Viewpoint summarizes provisions of the National Institutes of Health’s Inclusion Across the Lifespan policy scheduled for implementation in 2019 for clinical trials, which will require written plans to recruit younger and older participants as a part of grant applications and documentation of participant age in trial progress reports.

Resistance to the Normalization of the Sadness of Patients’ Reality

Mar, 16/10/2018 - 02:00
In this narrative medicine essay, a pediatric hospitalist resists accepting as normal the deep economic desparities among the children living in poverty even if she is at risk of burnout.

Race, Ancestry, and Medical Research

Mar, 16/10/2018 - 02:00
The discussion of race and medicine in the United States is challenging and emotionally charged. Substantial disparities in health outcomes, based on race, ethnicity, and socioeconomic status, continue to exist; additional reports of racial bias and profound insensitivity in research continue to emerge in the popular media. A renewed discussion of race as a biological vs social construct has begun and is complicated by emerging data on genetics, race, and ancestry.

Failure of Low-Dose Theophylline to Prevent Exacerbations in Patients With COPD

Mar, 16/10/2018 - 02:00
Exacerbations drive morbidity, mortality, and the costs of care in patients with chronic obstructive pulmonary disease (COPD). Inhaled therapy with long-acting bronchodilators, with or without inhaled glucocorticoids, can help prevent further exacerbations, but some patients continue to experience them despite optimal inhaled medical therapy. These patients are most prone to hospitalization and death with limited pharmacological alternatives to decrease future exacerbations. Long-term macrolide therapy and phosphodiesterase type 4 inhibitors may be options for some patients with recurrent exacerbations, but use of these agents can be cost prohibitive, or cannot be tolerated by all patients. This population represents a large clinical unmet need that requires additional therapeutic options.

Setting Appropriate Expectations After Bariatric Surgery

Mar, 16/10/2018 - 02:00
Bariatric surgery is the most effective intervention available for treating obesity and its numerous associated comorbid conditions, and for improving the quality and length of life for patients with severe obesity. Given the initial cost and risk of bariatric operations, defining the long-term benefits of bariatric surgery is critical for justifying its utility as an obesity treatment. Inadequate follow-up and lack of standardization of how to define failure of bariatric operations have limited the ability to fully assess their clinical utility. In this issue of JAMA, King et al provide recommendations for how to best measure clinically important weight regain after bariatric surgery based on Longitudinal Assessment of Bariatric Surgery (LABS) study outcomes.

Preventing Macrovascular Events With Bariatric Surgery

Mar, 16/10/2018 - 02:00
Obesity and type 2 diabetes are associated with an increased incidence of macrovascular disease events, including coronary artery and cerebrovascular disease. The mainstay for treating type 2 diabetes is lifestyle modification for weight loss and pharmaceutical control of lipids, blood pressure, and glucose. These treatments have largely been shown to reduce microvascular disease, with less effect on development of macrovascular disease. It has always been known that bariatric surgery improves microvascular disease and in this issue of JAMA, Fisher et al report that bariatric surgery is associated with substantial improvements in macrovascular disease, begging the question: why is bariatric surgery not as well accepted as medications for treatment of type 2 diabetes?

Effect of Theophylline as an Adjunct to Inhaled Corticosteroids on COPD Exacerbations

Mar, 16/10/2018 - 02:00
This randomized clinical trial compares the effects of adding theophylline vs placebo to inhaled corticosteroids (ICS) treatment on prevention of exacerbations in patients with chronic obstructive pulmonary disease (COPD).

Comparison of Common Measures of Weight Regain With Outcomes Following Bariatric Surgery

Mar, 16/10/2018 - 02:00
This cohort study compares associations between 13 measures of weight gain and progression of diabetes, hyperlipidemia, and hypertension 5 or more years after Roux-en-Y gastric bypass surgery.

Association Between Bariatric Surgery and 5-Year Macrovascular Outcomes in Patients With Type 2 Diabetes

Mar, 16/10/2018 - 02:00
This cohort study investigates associations between bariatric surgery and incident macrovascular events (coronary artery and cerebrovascular diseases) in patients with type 2 diabetes.

Advances in Diagnosis and Treatment of Venous Thromboembolism

Mar, 16/10/2018 - 02:00
This narrative review summarizes advances in diagnosis and treatment of venous thromboembolism (VTE), including use of age-adjusted D-dimer levels and rule-out criteria (PERC) to exclude the diagnosis, use of newer oral anticoagulants (NOACs) as treatment, and indications for thrombolysis.

Comparison of Oral Anticoagulants for Venous Thromboembolism

Mar, 16/10/2018 - 02:00
This Medical Letter review summarizes approved indications, doses, adverse effects, and costs of warfarin and newer oral anticoagulants used to treat venous thromboembolism.

Use of ED Radiography to Diagnose Bronchiolitis

Mar, 16/10/2018 - 02:00
This epidemiology study uses National Hospital Ambulatory Medical Care Survey data to characterize trends in use of radiography to diagnose bronchiolitis in children younger than 24 months evaluated in emergency departments between 2007 and 2015.

Availability of Corn Masa Flour and Tortillas Fortified With Folic Acid in Atlanta

Mar, 16/10/2018 - 02:00
This study examines the availability of folic acid–fortified corn masa flour and tortilla products in Atlanta following 2016 FDA rule changes allowing voluntary fortification of these products.

Vulnerability to Pandemic Flu Could Be Greater Today Than a Century Ago

Mar, 16/10/2018 - 02:00
Infectious disease threats expert Michael Osterholm, PhD, MPH, discusses how the United States and the rest of the world may fare if another 1918-like influenza epidemic strikes.

Device Approved to Seal Coronary Artery Perforations

Mar, 16/10/2018 - 02:00
A stent system designed to treat acute coronary artery perforations has received FDA approval, the first such device the agency has cleared in 17 years. Approval was through the humanitarian device exemption process, which is used for devices that treat or diagnose a condition that affects no more than 8000 people a year in the United States.

New Hairy Cell Leukemia Therapy

Mar, 16/10/2018 - 02:00
The FDA has approved a new treatment for adults with hairy cell leukemia who have received at least 2 prior systemic therapies, including a purine nucleoside analog.