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Zika Virus

by jmiller on April 14, 2016

In an “online first” series from the NEJM this week, this segment includes general information:  Zika Virus; The Zika Challenge; Zika Virus in the Americas: Yet another arbovirus threat.  Click here to read full text.

Zika virus as a cause of neurologic disorders

by jmiller on April 14, 2016

In a series of “online first: articles published in the NEJM this week, the focus is on Zika virus in the United States.  The articles in this set include:  Zika virus as a cause of neurologic disorders and Zika virus associated with meningoencephalitis.  Click here to read full text.

Mediterranean diet and fracture risk in postmenopausal women

by jmiller on March 29, 2016

This early online article and editorial (JAMA Intern Med) concludes, “Higher adherence to a Mediterranean diet is associated with a lower risk for hip fractures.  These results support that a healthy dietary pattern may play a role in maintaining bone health in postmenopausal women.”  Click here to read article and editorial.

Effect of mindfulness-based stress reduction vs. cognitive behavioral therapy or usual care on back pain

by jmiller on March 22, 2016

From this week’s JAMA (Mar 22/29), article concludes, “Among adults with chronic low back pain, treatment with MBSR or CBT, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT.  These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.”  Click here to read full text.

CDC guideline for prescribing opioids for chronic pain: United States, 2016: A proactive response to prescription opioid abuse

by jmiller on March 17, 2016

The CDC guidelines, with accompanying editorials attached (JAMA, March 15) and the FDA’s response (NEJM, Feb 4 early online), provide a blueprint for opioid prescribing for primary care clinicians treating adult patients with chronic pain “outside of active cancer treatment, palliative care and end-of-life care.”  “There are 12 recommendations. Of primary importance, non-opioid therapy is preferred for treatment of chronic pain. “Opioids should be used only when benefits for pain and function are expected to outweigh risks. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every three months or more frequently. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone. The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.” The FDA supports the CDC guidelines and has crafted its own responses for addressing these issues by refining these goals and “ensuring that all available effective tools are brought to bear on this epidemic,” and that “the evidence base for proper pain management and appropriate opioid use is optimized and translated into practice.” Of note (and addressed in an editorial attached), this guideline does not adequately address children. Click here to read the full text.

Uber’s Message for Healthcare

by jmiller on March 14, 2016

Perspective from NEJM, 3/3:  “Unreliable service, inconvenience, uncomfortable surroundings, and high prices make customers unhappy, and given the opportunity, they will go elsewhere. Uber, Silicon Valley’s response to the shortcomings of urban taxi and limousine services, has managed to upend an established industry by offering an appealing alternative. Uber’s technology-enabled incursion into a highly regulated market suggests that if consumers gain enough from a new solution, it can overcome powerfully entrenched economic and political interests.  Is U.S. healthcare ripe for disruption by a medical Uber? This perspective is thought provoking…”  Click here to read the full text.

“New sepsis diagnostic guidelines shift focus to organ dysfunction”‘ Assessment of clinical criteria for sepsis for the third International Consensus definitions for sepsis and septic shock”; Developing a new definition and assessing new clinical criteria for septic shock”; and “The Third International Consensus Definitions for Sepsis and Septic Shock”

by jmiller on February 24, 2016

“Definitions of sepsis and septic shock were last revised in 2001.  These updated definitions and clinical criteria should replace previous definitions, offer greater consistency for epidemiologic studies and clinical trials, and facilitate earlier recognition and more timely management of patients with sepsis or at risk for developing sepsis.”  (JAMA, Feb)  Click here to read full text.

“Proton pump inhibitor use and the risk of chronic kidney disease” and editorial “Adverse effects associate with proton pump inhibitors”

by jmiller on February 17, 2016

(Jama Intern Med, early online) The article concludes: “Proton pump inhibitor use is associated with a higher risk of incident CKD.”  See separate entry on PPIs  causing dementia.  Click here to read full text.

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