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Girard TD, Burns KA.
Every year, more than 1 million patients throughout the world receive mechanical ventilation for acute respiratory failure. One of the most important decisions clinicians make in managing these critically ill patients is how to liberate them from invasive ventilation. Ventilator liberation poses an important dilemma for clinicians because premature or failed attempts at extubation, which typically necessitate reintubation, increase rates of ventilator-associated pneumonia, mortality, and other adverse outcomes. Conversely, delaying extubation also increases a patient’s risk of being oversedated and developing delirium or ventilator-associated events.
Ranji U, Salganicoff A, Rousseau D, et al.
Scott H, Volberding PA.
Physicians practicing in rapidly evolving areas of medical care, and policy makers charged with supporting that care, both benefit from informed guidance regarding testing, new treatments, and innovations in disease prevention. Approaches to HIV care and prevention have both been improved by access to such guidance. Clinicians who care for patients with HIV follow newly published or presented data, the opinion of respected experts, and guidelines created by governmental or private organizations. Guideline groups have various “rules” regarding the inclusion of expert opinion, which publications are allowed, and how critically those research reports are evaluated. Clinicians expect guidelines to rapidly incorporate new data, and many immediately use guidelines to improve care for their patients.
Barker CM, Reardon MJ.
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis. A series of trials in which patients were randomized to receive TAVR or surgical valve replacement have provided arguably the best data collected for this intervention. The 2 most recent randomized clinical trials involving patients who have less than 3% risk of surgical operative mortality suggest that TAVR might be the preferred treatment strategy for this particular patient group. The patient group tested is a critical factor for all randomized clinical trials and determines the potential for generalizability. The data from the trials involving low-risk patients are compelling and should lead to both a class I indication for TAVR in low-risk patients as well as commercial approval in the United States. When this occurs, the clinicians who provide care for patients with structural heart disease will need to grapple with patient age and whether TAVR is appropriate for patients who had been excluded from previous TAVR trials because of their bicuspid aortic valves. The mean age of the patients in the 2 randomized clinical trials involving patients at lower risk of surgical mortality was 10 years younger than patients at higher risk of surgical mortality (73-74 years). The prevalence of bicuspid aortic valves in the patient group older than age 80 years is about 20% but is approximately 60% among younger patients aged 60 through 80 years and will represent a greater percentage of the patients who are evaluated for severe aortic stenosis. Understanding the ability to treat bicuspid aortic valve in its various phenotypes with TAVR and the risks involved is a primary concern for the subspecialty area of structural heart disease.
Meyers DJ, Durfey SM, Gadbois EA, et al.
Following CMS’ 2018 expansion of supplemental benefits available to HMO and PPO Medicare Advantage enrollees, this study assesses enrollee adoption by type of benefit (eg, caregiver support, in-home personal care, palliative nursing, and social work) and specific plan characteristics in the first year.
Oren O, Kebebew E, Ioannidis JA.
In Reply Dr Simeone argues that the litigious medical milieu in the United States is a key driver of overutilization of diagnostic imaging compared with a litigation-free environment like Finland. We agree that defensive medicine may contribute to the rise in the use of diagnostic imaging, including nonindicated testing. However, liability fear may not explain most of the excess medical tests. An economic analysis suggested that, in the no-liability model of the military in which patients can seek treatment from medical institutions but are barred from suing for negligent care, health care spending decreased by only 5% in active-duty compared with non–active-duty patients and the clinical outcomes (mortality and readmission rates) were similar. Nevertheless, systemic efforts to reduce litigation are worth exploring, even if a legislative landscape similar to Finland is unlikely to happen in the United States any time soon.
Zheng SL, Roddick AJ.
In Reply Mr Syn and Mr Wee questioned the rationale for excluding studies from our meta-analysis based on numbers of participants. Of 1385 articles identified in the systematic search, no studies were excluded based on the number of participants enrolled. However, there are several reasons for excluding small studies. Small studies are often of poorer methodological quality and have a higher risk of bias, and including them can exaggerate treatment effects and lead to misleading conclusions. Furthermore, small studies have negligible contributions when 2 or more adequately powered studies are included in a meta-analysis. These factors may justify the exclusion of small and underpowered studies from meta-analyses in which adequately powered studies already exist.
Costello SP, Conlon MA, Andrews JM.
In Reply We agree with Dr Benech and colleagues that, in our trial, ideally both donor and autologous FMT should have been processed under anaerobic conditions. Aerobic stool processing results in loss of many beneficial obligate anaerobic organisms such as Faecalibacterium prausnitzii. However, ours was an investigator-led trial with limited access to a single anaerobic chamber at only 1 center, making it impossible to process autologous FMT stool anaerobically at each trial site. We believe, however, that the risk of bias from this is minimal.
Benech N, Kapel N, Sokol H.
To the Editor Dr Costello and colleagues assessed the efficacy of a short duration of fecal microbiota transplantation (FMT) therapy to induce remission in patients with moderately active ulcerative colitis using anaerobically prepared stool pooled from different donors compared with aerobically prepared autologous FMT. They observed a higher rate of steroid-free remission of ulcerative colitis at 8 weeks (primary outcome) for patients receiving donor FMT compared with patients treated with autologous FMT. The anaerobic stool preparation may allow use of a less intensive administration protocol than those described in previous studies. However, some biases that could overestimate the effectiveness of donor FMT need to be discussed.
Bevan GH, Zidar DA, Josephson RA, et al.
This study uses US National Center for Health Statistics data to describe trends in mortality due to aortic stenosis between 2008 and 2017, when use of transcatheter aortic valve replacement (TAVR) in older adults was becoming more common.
In the Special Communication entitled “Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome and Posterior Probability of Mortality Benefit in a Post Hoc Bayesian Analysis of a Randomized Clinical Trial,” published in the December 4, 2018, issue of JAMA, the prior probabilities of RR
The Original Investigation entitled “Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events: A Systematic Review and Meta-analysis,” published in the January 22, 2019, print issue, included errors in the Results section because 2 studies (the Prevention of Arterial Disease and Diabetes Trial and the Thrombosis Prevention Trial) that were identified in the search and included in the meta-analysis were unintentionally omitted from the analysis for the primary composite cardiovascular outcome. The Results have been corrected and now include these studies in all other outcome analyses.
None of the 25 patients with refractory B cell lymphoma who received a modified anti-CD19 chimeric antigen receptor (CAR) T-cell therapy in a phase 1 trial experienced serious neurological toxicity or cytokine-release syndrome, researchers recently reported in Nature Medicine.
Researchers seeking a less invasive, more objective way to classify posttraumatic stress disorder (PTSD) have become interested in speech-based biomarkers, building on previous work associating vocal changes with mood disorders. The current gold standard method for diagnosing PTSD, a structured interview called the Clinician-Administered PTSD Scale (CAPS), is lengthy, challenging for patients, and subject to the clinician’s interpretation.
Writing in Nature, researchers at the University of California, San Francisco (UCSF) described a system that synthesizes intelligible speech from brain activity recorded during speaking or mimed speaking. Although their study involved people without speech impairments, the technology could be a stepping stone toward restoring communication for people with stroke, amyotrophic lateral sclerosis, or other neurological disorders that impede speech, the researchers said.
This Medical News article discusses a recent meta-analysis comparing high-intensity interval training, sprint interval training, and moderate-intensity continuous training for fat loss.
This Medical News article discusses trimethylamine N-oxide, or TMAO, a dietary metabolite that’s increasingly associated with cardiovascular disease.
On May 2, 2019, the US Department of Health and Human Services (HHS) and Office of Civil Rights (OCR) released a final rule that heightens the rights of hospitals and health workers to refuse to participate in patients’ medical care based on religious or moral grounds. The rule covers OCR’s authority to investigate and enforce violations of 25 federal “conscience protection” laws. Tied to the US Constitution’s spending power, the rule applies to state and local governments, as well as public and private health care professionals and entities if they receive federal funds such as Medicare or Medicaid. The rule applies to a range of important health services such as abortions, sterilizations, assisted suicide, and advance directives—extending to sex reassignment and HIV treatment.
Ayers JW, Caputi T, Leas EC.
This Viewpoint uses the commercial rise of MedMen, a US company that operates licensed cannabis facilities and uses youth-oriented media campaigns to advance unproven health claims for marijuana, to highlight the health risks for young people and to argue for evidence-based regulation of marijuana marketing and sales.
Northern European Conference on Travel Medicine (NECTM) 2020
Mødet udskudt på grund af COVID-19
3.06.2020 - 5.06.2020
ASM Microbe 2020
Aflyst på grund af COVID-19
18.06.2020 - 22.06.2020
Ph.d. forsvar ved Kristina Langholz Kristensen
International AIDS Conference (AIDS) 2020
6.07.2020 - 10.07.2020
International Liver Congress (ILC) 2020
27.08.2020 - 29.08.2020
COVID-19 retningslinje (2020)
National handlingsplan for antibiotika til mennesker (2017)
Retningslinjer til sundhedsprofessionelle vedr. håndtering af infektion med zikavirus (2019)
Antiviral behandling af hiv smittede personer (2019)
Ratio, rate, or risk?
28.05.2020The Lancet Infectious Diseases
Reducing transmission of SARS-CoV-2
27.05.2020Science Express TOC RSS Feed
Device-Associated Menstrual Toxic Shock Syndrome [Reviews]
27.05.2020CMR Current Issue
Taenia solium Cysticercosis and Its Impact in Neurological Disease [Reviews]
27.05.2020CMR Current Issue
Evaluation of World Health Organization–Recommended Hand Hygiene Formulations
27.05.2020Emerging Infectious Diseases Journal
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