Sur le Web, ces 30 derniers jours

mercredi 14 août 2019

mardi 13 août 2019

  • Reductions in Rotavirus Infections
    Widespread use of the rotavirus vaccine has shortened the rotavirus season from 26 to 9 weeks and has drastically reduced the number of children testing positive for infections, according to a CDC report.

  • Tuberculin Antigen Shortage
    The CDC recently warned clinicians of a potential 3- to 10- month shortage of Aplisol (tuberculin PPD), 1 of 2 tuberculin antigens approved by the US Food and Drug Administration for tuberculosis skin tests.

  • JAMA
  • Extracorporeal Life Support for Adults With Respiratory Failure and Related Indications
    This narrative review summarizes the mechanisms and set-up of extracorporeal life support (ECLS) including extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R), its indications, complications, goals of treatment, and the need to build on evidence base (...)

  • Supporting the Delicate Infant-Mother Bond
    In this narrative medicine essay, a pediatrician realizes after her infant daughter undergoes treatment for elevated bilirubin that until then her advice to new parents may have interfered with the infant-mother bond yet forgives herself the distress she may have (...)

  • Neither Pause nor Gaze at What Is Passing
    For weeks, she said little, hummed moans in sweet chords, pale florets blooming on cheeks, chest, breasts.

  • Small Kidney Tumors
    This JAMA Patient Page describes small kidney tumor diagnoses and treatment options.

  • Association of Midlife to Late-Life Blood Pressure Patterns With Incident Dementia
    Over 24 years plus follow-up, this community-based cohort study monitored individuals categorized by midlife and late-life blood pressure levels to evaluate association between blood pressure levels and incident dementia.

  • Association Between Intensive vs Standard Blood Pressure Control and Cerebral White Matter Lesions
    This substudy of the SPRINT randomized clinical trial evaluates the association between intensive (systolic blood pressure <120 mm Hg) vs standard (<140 mm Hg) blood pressure control and changes in cerebral white matter lesion and total brain volumes among hypertensive (...)

  • Gluten Intake in First 5 Years and Incidence of Celiac Disease and Autoimmunity in At-Risk Children
    This cohort study investigates the association between gluten intake in the first 5 years of life and celiac disease autoimmunity and biopsy-confirmed celiac disease in genetically at-risk children over a median 9-year follow-up.

  • Long-term Exposure to Ambient Air Pollution and Change in Emphysema and Lung Function
    This cohort study examines the association between long-term exposure to ambient ozone, black carbon, and other air pollutants and progression of CT-defined percent emphysema and decline in lung function in adults in 6 US metropolitan (...)

  • Strategies to Adjust Positive End-Expiratory Pressure in Patients With ARDS—Reply
    In Reply Using esophageal manometry to estimate pleural pressure helps delineate contribution of lung vs chest wall mechanics to clinically observed airway pressures. Transpulmonary pressure provides a truer estimate of distension of aerated lung parenchyma (ie, stress of the ventilated lung (...)

  • Time Horizons in Cost Analyses—Reply
    In Reply Dr Majer and colleagues point out the need to encompass heterogeneity of time horizons. We did not cover the topic of heterogeneity in our article, nor did we intend to say that all cohorts, for instance those with different starting ages, should have the same time horizon in a (...)

  • Sex Differences in Grant Funding—Reply
    In Reply Using public data, we found that first-time female PIs received significantly smaller median NIH grant awards than their male counterparts. The median difference was $39 106, with a range by grant type and institution. There were no statistically significant differences in research (...)

  • Strategies to Adjust Positive End-Expiratory Pressure in Patients With ARDS
    To the Editor In the EPVent-2 study of patients with ARDS, PEEP in the PES-guided group was titrated based on the assumption that end-expiratory PES is directly representative of pleural pressure and that positive end-expiratory PES with concomitant negative PL indicates that the chest wall (...)

  • Strategies to Adjust Positive End-Expiratory Pressure in Patients With ARDS
    To the Editor Dr Beitler and colleagues for the EPVent-2 Study Group conducted a randomized clinical trial of titrating positive end-expiratory pressure (PEEP) according to end-expiratory pleural pressure estimated from esophageal pressure (PES) in patients with acute respiratory distress (...)

  • Strategies to Adjust Positive End-Expiratory Pressure in Patients With ARDS
    To the Editor No benefit in death or days free from mechanical ventilation were reported with PES-guided PEEP titration vs an empirical high PEEP-Fio2 strategy in patients with moderate to severe ARDS. What was the racial/ethnic composition of the patients included in the 2 groups of the study, (...)

  • Time Horizons in Cost Analyses
    To the Editor Drs Basu and Maciejewski discussed time horizons in economic models, which should be long enough to capture all potential differences in outcomes associated with the treatments compared. For therapies extending survival over the entire life span, a lifetime horizon is recommended. (...)

  • Sex Differences in Grant Funding
    To the Editor A recent study described sex differences in the amount of NIH funds awarded to comparable first-time male and female PIs. Concerns have been raised previously about sex differences in grant attainment, compensation, and well-being of physician-scientists funded by the NIH. (...)

  • Sex Differences in Grant Funding
    To the Editor Dr Oliveira and colleagues compared National Institutes of Health (NIH) grant amounts to first-time male and female principal investigators (PIs). The authors suggested that their data indicate that there are “[f]unding disparities favoring men” among certain grant types. However, (...)

  • Perceived Bullying Among Internal Medicine Residents
    This study uses IM-ITE survey data to characterize the proportion of internal medicine residents in 2016 who self-reported having been bullied during their residency training.

  • Pulmonary Embolism Hospitalization, Readmission, and Mortality Rates in Older Adults
    This study uses Medicare billing codes to characterize trends in readmission and mortality rates for Medicare fee-for-service beneficiaries with pulmonary embolism (PE) between 1999 and 2015 to assess changes accompanying recent diagnostic and therapeutic changes in management of the (...)

  • Gomers
    The Dean was a gentle, bearded man, a pipe-smoking neurologist. He loved to sail in the San Juan islands. He was a far-seeing person and was not given to anger. The failures, large and small, of his medical students were duly noted, but the Dean always saw past these failures to the future (...)

  • Bringing It Home: The Shift in Where Health Care Is Delivered
    Many health care organizations give little more than lip service to becoming “patient-centered.” Perhaps it’s because our legal and regulatory environments preclude true system transformation that focuses on what patients need and want. But laws and regulations are changing, albeit slowly, and we (...)

  • Highlights for August 13, 2019
  • Blood Pressure and Dementia
    Alzheimer disease and related dementias affect nearly 10% of US adults older than 65 years. With an aging population, the prevalence of dementia is likely to increase, adding to the enormous burden on affected patients, their caregivers, and the health care system. Besides Alzheimer pathology (...)

  • Gluten and Celiac Disease Risk
    Celiac disease provides a unique model for autoimmune research because the following key elements are known: the specific genes involved in its pathogenesis and the environmental trigger. Substantial genetic research has uncovered the strong influence of the HLA antigen and its mechanistic role (...)

  • Meditation App Improves Attention in Young Adults
    Healthy young adults had significant improvements in sustained attention on cognitive tasks after using a meditation-inspired mobile app for 6 weeks in a recent randomized clinical trial, which appeared in Nature Human Behavior.

  • Smart Devices Detect Agonal Breathing in Cardiac Arrest
    Roughly half of people who experience a cardiac arrest demonstrate agonal breathing, a brainstem reflex during severe hypoxia. Researchers at the University of Washington in Seattle are teaching smart devices to detect this audible biomarker, often described as gasping breaths. Agonal breathing (...)

  • Detecting Circulating Tumor Cells Through the Skin
    Today’s methods of detecting circulating tumor cells (CTCs) in blood are hampered by poor sensitivity, which limits the so-called liquid biopsies’ usefulness for catching low-level CTCs present before metastasis, when prognosis is better. A new photoacoustic liquid biopsy approach that peers (...)

  • For Mortality, Busting the Myth of 10 000 Steps per Day
    This Medical News article discusses a recent study in JAMA Internal Medicine on the association of daily steps with all-cause mortality.

  • Mounting Evidence and Netflix’s Decision to Pull a Controversial Suicide Scene
    In this Medical News article, experts discuss an association between the Netflix series 13 Reasons Why and increases in adolescent suicides, suicide attempts, and suicide-related hospital admissions.

  • Promoting Trust Between Patients and Physicians in the Era of Artificial Intelligence
    This Viewpoint discusses the use of artificial intelligence in health care and its potential effect on how patients access care and how physicians and patients make decisions.

  • Building Trust in Health Care—Why, Where, and How
    Trust in US health care has declined precipitously in the past half century. In 1966, 73% of US residents had confidence in medical leaders, whereas in 2012, only 34% did. In a survey of 1009 participants in 2017, only 18% expressed high levels of confidence in the US health system, and in a (...)

  • Use of Bone Turnover Markers in Clinical Practice
    This JAMA Insights Clinical Update reviews bone turnover markers measurable in blood and urine and summarizes evidence supporting their use to predict osteoporosis and osteoporotic fractures, assess treatment adherence and efficacy, and monitor bone loss after drug (...)

  • Basch Unbound— The House of God and Fiction as Resistance at 40
    In this Arts and Medicine feature, author Samuel Shem (pen name of Stephen Bergman, MD) reflects on the origins of his classic novel The House of God, the people and events that inspired its stories, the notion of “fiction as resistance,” and the evolving meaning of the book given developments in (...)

  • The House of God at Age 40—An Appreciation
    In this Arts and Medicine feature, an early-career physician discusses the ongoing relevance of Samuel Shem’s novel, The House of God, to contemporary health care and medical education on the occasion of its 40th anniversary of (...)

  • Advances in Understanding the Pathophysiology of Chronic Fatigue Syndrome
    This Viewpoint reviews new findings presented at a 2019 NIH conference about neuroendocrine, metabolic, immunologic, and physiologic abnormalities that contribute to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

  • A Woman With Dyspnea and Bronchiectasis
    A 41-year-old woman with an 8–pack-year history of tobacco use had 4 years of progressive cough and dyspnea. She had no history of neonatal respiratory distress or nasal congestion and no family history of COPD or cystic fibrosis; pulmonary function testing showed a severe obstruction and chest (...)

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