Новости за 19.02.2019

This Medical News article discusses recent studies that question the one-size-fits-all approach to probiotic supplementation for gastrointestinal health, arguing for a more personalized approach.

A 26-year-old white man had recurrent episodes of ocular redness and blurry vision coincident with nodular skin elevation in a left-arm tattoo. Slit lamp examination revealed inflammatory cells in the anterior chamber of the left eye; punch biopsy of the tattooed skin revealed pigment-containing macrophages. What is the diagnosis and what would you do next?

This Viewpoint reviews potential adverse consequences of US state and insurer policy initiatives to limit opioid prescription duration for patients with acute pain and proposes that condition-specific prescribing guidelines and patient-centered approaches could maintain pain control while reducing the risk of diversion and misuse.

This Viewpoint questions recent US state regulations authorizing the use of cannabis as a substitute for opioids in treatment of opioid addiction and chronic pain, citing the absence of evidence of cannabis equivalency, the risks of marijuana use, and ample evidence supporting the use of methadone and buprenorphine for management of opioid use disorder (OID).

This Viewpoint assesses the prospects for reform of maintenance of certification (MOC) programs administered by physician specialty boards, distinguishing between reforms in summative knowledge testing using formal examination and formative programs that support ongoing incremental and personalizable education.

What is the best approach for resuscitation of a patient with septic shock? Despite considerable investigation over several decades, this important question still has no clear answer. There is agreement that resuscitation should proceed quickly, for the longer the delay, the greater the physiologic stress and end-organ injury. However, treatment options are principally intravenous fluids and vasoactive agents, which have the capacity to both help or harm the patient. Thus, these therapies must be... Читать дальше...

This randomized trial compares the effects of resuscitation strategies targeting normalization of capillary refill time vs normalization or decrease of serum lactate levels on 28-day mortality among patients with septic shock.

This cancer epidemiology study uses SEER data to examine US trends in use of active surveillance, watchful waiting, radiotherapy, and surgical management of localized prostate cancer among men with low-, intermediate-, and high-risk disease treated between 2010 and 2015.

Admission to the intensive care unit (ICU) represents a time when patients and families are at high risk for a variety of poor outcomes, including physical and psychological morbidity. However, studies of interventions to improve these outcomes have resulted in high-profile, high-quality clinical trials that show no statistically significant benefit of the intervention (ie, trials with “negative” or “null” results). Several reasons may explain the preponderance of these negative trials. First, critical... Читать дальше...

This cluster-randomized clinical trial compares the effect of a nurse-led intervention intended to alleviate acute stress and memories of frightening intensive care unit (ICU) experiences vs usual care on patient-reported posttraumatic stress disorder (PTSD) symptom severity 6 months after ICU discharge.

This Arts and Medicine feature reviews the American Ballet Theatre’s 2017 production of Richard Strauss’ Whipped Cream (Schlagobers), a collaboration between choreographer Alexei Ratmansky and pop surrealist Mark Ryden, which tells the story of a boy’s admission to and rescue from a nightmarish hospitalization.

In the Original Investigation entitled “Association Between Learning Environment Interventions and Medical Student Well-being: A Systematic Review,” published in the December 6, 2016, issue of JAMA, the Funding/Support statement was incomplete. The final sentence should have read “Ms Falzon was supported by the National Institutes of Health Science of Behavior Change Common Fund Program through an award administered by the National Institute on Aging (U24AG052175) and contract S15-0142 by Columbia... Читать дальше...

The Research Letter titled “Trends in First Gabapentin and Pregabalin Prescriptions in Primary Care in the United Kingdom, 1993-2017,” published in the November 27, 2018, issue includes errors in the Introduction. This included indicating that gabapentin is approved for epilepsy, neuropathic pain, and migraines and that pregabalin is approved for generalized anxiety disorder. It was also indicated that in 2017, the UK government reclassified gabapentinoids as class C controlled substances. The Introduction... Читать дальше...

In this issue of JAMA, Rollman et al report concerning findings regarding US Food and Drug Administration (FDA) stewardship of the Risk Evaluation and Mitigation Strategies (REMS) system, raising further uncertainty as to its utility in ensuring the safe use of prescription drugs. Created under the 2007 FDA Amendments Act, this system was intended to address the FDA’s limited powers over approved drugs, authorizing the agency to require manufacturers to develop and implement REMS for drugs or drug classes posing special safety risks. Читать дальше...

A noninvasive test that doesn’t require comparison with a baseline assessment before an injury occurred has received FDA approval to help diagnose concussion in children and adults.

The first US clinical trial of intravenously administered bacteriophage therapy has received FDA approval. Physician researchers at the University of California San Diego (UCSD) School of Medicine will conduct the trial in collaboration with AmpliPhi Biosciences Corporation, a San Diego–based biotechnology company.

A recently approved diagnostic test will help health care professionals measure the nutrient content of breast milk to guide care for infants that may be at risk of growth failure.

A more productive work environment and a more satisfied workforce often go hand in hand. As the burden of documentation required by electronic health records (EHRs) increases, clinicians’ frustrations and lists of obligations grow. Medical scribes may offer reprieve.

A country physician with large practice, was deploring his inability, from constant work, to make original researches, or to read books, and expressed the opinion that no one with a large country ride could contribute much to the science of medicine. This is a common error which a little reflection will quickly disprove. As an illustration take the common theme of all conversation, the weather. The physician with long rides in the country, and time for observation and reflection, can be an expert... Читать дальше...

To the Editor The study by Dr Salminen and colleagues compared antibiotic therapy alone vs appendectomy to treat uncomplicated acute appendicitis. The cumulative incidence of appendicitis recurrence after 5 years was 39.1% in the antibiotic group. The complication rate was 6.5% in the antibiotic group and 24.4% in the surgical group. We have several concerns about these results.

To the Editor In the cohort study by Dr Lowe and colleagues, the association of gestational diabetes with later maternal diabetes and childhood adiposity was explored. The authors reported that gestational diabetes was associated with the development of maternal diabetic disorders (type 2 diabetes and prediabetes) but was not significantly associated with the development of childhood overweight or obesity.

In Reply In the 5-year follow-up of the Appendicitis Acuta (APPAC) trial, our main objective was to determine the late recurrence rate of appendicitis after antibiotic therapy for uncomplicated acute appendicitis. The inferiority of antibiotic therapy compared with appendectomy was reported at 1-year follow-up. However, fair comparison of these 2 very different treatments needs to include other parameters, such as complications, patient preference, and follow-up over a longer time. The somewhat high... Читать дальше...

In Reply Mr Bradshaw and colleagues raised 3 primary concerns related to the findings of our recent study: (1) oral glucose tolerance test results may vary within individuals, leading to identification of women with gestational diabetes who may not meet criteria in a subsequent oral glucose tolerance test; (2) the IADPSG criteria as accepted by WHO may be too sensitive and not associated with long-term child outcomes; and (3) the HAPO Follow-up Study failed to meet its recruitment target, which reduced... Читать дальше...

This study uses FDA documents to describe transmucosal immediate-release fentanyl (TIRF) prescribing patterns after the agency’s 2011 REMS intended to reduce the rate of TIRF-related adverse outcomes, misuse, abuse, addiction, and overdose.