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 Showing 1-20 of 49 Articles
Teachable Moment 
Anne-Laure Sennesael, MSc; Jean-Michel Dogné, PhD; Anne Spinewine, PhD

While direct oral anticoagulants (DOACs) hold some advantages over vitamin K antagonists, DOAC adverse effects, including bleeding, present a clinical challenge in frail older patients.

Original Investigation 
Karen E. Hansen, MD, MS; R. Erin Johnson, BS; Kaitlin R. Chambers, BS; Michael G. Johnson, MS; Christina C. Lemon, MS, RD, CD; Tien Nguyen Thuy Vo, MS; Sheeva Marvdashti, BS
Includes: Supplemental Content

Importance  Experts debate optimal 25-hydroxyvitamin D (25[OH]D) levels for musculoskeletal health.

Objective  To compare the effects of placebo, low-dose cholecalciferol, and high-dose cholecalciferol on 1-year changes in total fractional calcium absorption, bone mineral density, Timed Up and Go and five sit-to-stand tests, and muscle mass in ...

Editor's Note: How Much Vitamin D Is Enough?; Deborah Grady, MD, MPH
Invited Commentary 
Donna M. Polk, MD, MPH; Patrick T. O’Gara, MD

Comprehensive, multidisciplinary cardiac rehabilitation programs reduce cardiovascular morbidity and mortality. They also improve exercise capacity, atherosclerotic risk markers, quality of life (QOL), and patient adherence to medication and lifestyle recommendations. They are best viewed as aggressive programs of secondary prevention. The multifaceted interventions these programs offer include exercise ...

Editor's Note 
Deborah Grady, MD, MPH

There is ongoing controversy regarding the definition of vitamin D insufficiency and the optimal treatment goal: should treatment aim to maintain a serum vitamin D level above 20 ng/mL or above 30 ng/mL? We found the randomized clinical trial by Hansen et al1 informative because it enrolled ...

Challenges in Clinical Electrocardiography 
Jordan C. Ray, MD; Fred Kusumoto, MD; Nora Goldschlager, MD

Test your knowledge with an electrocardiogram quiz case involving P-wave mimicry.

Research Letter 
Jacob A. Doll, MD; Anne Hellkamp, MS; P. Michael Ho, MD, PhD; Michael C. Kontos, MD; Mary A. Whooley, MD; Eric D. Peterson, MD, MPH; Tracy Y. Wang, MD, MHS, MSc

This analysis of clinical data linked to Medicare claims finds the cardiac rehabilitation rate for older patients after acute myocardial infarction is low in the United States and suggests efforts be made for increasing referrals, and addressing attendance barriers, to rehabilitation sessions.

Invited Commentary: Closing the Treatment Gap for Cardiac Rehabilitation; Donna M. Polk, MD, MPH; Patrick T. O’Gara, MD
Ofer Merin, MD; Avraham Yitzhak, MD; Tarif Bader, MD

This Viewpoint identifies strategies for the appropriate and efficient emergency medical team assistance to other countries following natural disasters.

Mary K. Brennan-Taylor, BA

At 88 years of age, my mother, Alice, felt nagging pain in her neck and shoulders. She had been invited to several parties on July 4th and did not want the pain to crimp her enjoyment of the holiday. Her primary care physician’s office was closed for the ...

Original Investigation 
Steven B. Zeliadt, PhD, MPH; Jaimee L. Heffner, PhD; George Sayre, PsyD; Deborah E. Klein, MD; Carol Simons, BA; Jennifer Williams, BA; Lynn F. Reinke, PhD, APRN; David H. Au, MD, MS

Importance  Broad adoption of lung cancer screening may inadvertently lead to negative population health outcomes if it is perceived as a substitute for smoking cessation.

Objective  To understand views on smoking cessation from current smokers in the context of being offered lung cancer screening as a ...

Invited Commentary: The Psychological Effects of Lung Cancer Screening on Heavy Smokers ; Russell P. Harris, MD, MPH
Invited Commentary 
Russell P. Harris, MD, MPH

This Invited Commentary discusses the potential harms to heavy smokers undergoing screening for lung cancer.

The Belmont Report1 formally established ethical principles and guidelines in 1979 for the protection of human research subjects in the United States. Summarizing discussions among the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research from an initial 4-day meeting at the Smithsonian ...

Our awareness of the potential adverse effects (AEs) of newly approved drugs and devices is limited. Premarket trials are often small and of limited duration, and the patients in clinical trials are healthier than unselected patients in routine clinical practice. Thus, the public and physicians rely on the ...

Research Letter 
Tanya Bhattacharya, BS; Debra G. Tice, MS; Pranathi Lingam, MD; Aleksandra Florek, MD; Eileen M. Yates, MS; Sigmund Weitzman, MD; Steven M. Belknap, MD

This database review assesses the disclosure to study participants of boxed warning risks on consent forms.

Editor's Note: Informed Consent and Research on Higher-Risk Medications; Joseph S. Ross, MD, MHS
Research Letter 
Paul Ma, PhD; Iván Marinovic, PhD; Pinar Karaca-Mandic, PhD

This study investigates patient and event characteristics associated with manufacturers’ delayed submission of expedited adverse event reports to the US Food and Drug Administration.

Editor's Note: Improving Manufacturer Reporting of Adverse Events to the FDA ; Rita F. Redberg, MD, MSc
Teachable Moment 
Christopher Worsham, MD; Jason Ackrivo, MD; Anthony C. Breu, MD

The earliest safe withdrawal of sedation and mechanical ventilation leads to reduced risk of complications, reduced ICU and hospital stay, as well as reduced costs and utilization of resources.

Original Investigation 
Chang-Fu Kuo, MD, PhD; Matthew J. Grainge, PhD; Ana M. Valdes, PhD; Lai-Chu See, PhD; Shue-Fen Luo, MD; Kuang-Hui Yu, MD; Weiya Zhang, PhD; Michael Doherty, MD
Includes: Supplemental Content

Importance  Relatives of patients with systemic lupus erythematosus (SLE) appear to be at higher risk of SLE and other autoimmune diseases, but estimates of individual familial risks are largely unavailable or unreliable. Furthermore, relative contributions of genetic, shared, and unshared environmental factors to SLE susceptibility remain unclear....

Invited Commentary: Nationwide Population Science: Lessons From Taiwan; Ann W. Hsing, PhD; John P. A. Ioannidis, MD, DSc
Original Investigation 
Chien-Yi Yang, BS; Chi-Hua Chen, MS; Shin-Tarng Deng, MS; Chi-Shan Huang, MS; Yu-Jr Lin, BA; Yi-Ju Chen, MD, PhD; Chun-Ying Wu, MD, PhD; Shuen-Iu Hung, PhD; Wen-Hung Chung, MD, PhD

Importance  Allopurinol, a first-line drug used for treating gout, is increasingly prescribed worldwide to patients with asymptomatic hyperuricemia and comorbid renal or cardiovascular diseases. Nevertheless, allopurinol use has been associated with fatal hypersensitivity reactions, including drug rash with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal ...

Editor's Note: Reducing Life-Threatening Allopurinol Hypersensitivity; Rachel J. Stern, MD
Invited Commentary 
Ann W. Hsing, PhD; John P. A. Ioannidis, MD, DSc

Large population-based studies can inform us on the prevalence, incidence, natural history, treatment, correlates, and associations of disease, as well as the pattern of health care utilization. A special type of large population study encompasses the population of an entire nation. Advantages include enormous sample size and lack ...

Editor's Note 
Joseph S. Ross, MD, MHS

Promoting evidence-based high-value health care remains one of the foremost challenges in medicine today. Increasing scrutiny of the real-world effectiveness, safety, and costs of medical care, including therapeutics, diagnostic tests, procedures, operations, and even decisions regarding whether to admit a patient to the hospital or schedule an outpatient ...

Editor's Note 
Rachel J. Stern, MD

Allopurinol is the cornerstone of pharmacologic urate-lowering therapy for recurrent gouty arthritis. Although this drug is inexpensive and efficacious, it may cause rare, but life-threatening, cutaneous drug eruptions: the allopurinol hypersensitivity syndrome.1 Mortality rates for individuals experiencing allopurinol hypersensitivity can exceed 30% and long-term morbidity is common....

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