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Efavirenz is used to treat HIV infection, but has an association with suicidality that is not well-defined. This analysis compared suicidal ideation or attempted or completed suicide in participants receiving efavirenz-containing versus efavirenz-free antiretroviral regimens. They concluded that treatments containing efavirenz were associated with twice the hazard of suicidal thoughts or behavior than were treatments without it.
The use of tenofovir alone or in combination with emtricitabine in preexposure prophylaxis (PrEP) reduces the risk for HIV-1 acquisition, and tenofovir also has in vitro activity against herpes simplex virus type 2 (HSV-2). This subgroup analysis of a randomized, placebo-controlled trial assessed the efficacy of tenofovir-based PrEP in preventing HSV-2 acquisition. Participants receiving tenofovir were less likely to acquire HSV-2 than those receiving placebo. Protection against HSV-2 acquisition may be an added benefit of using tenofovir for HIV-1 PrEP.
When clinical practice is governed by evidence-based guidelines, variation in care of similar patients should be minimal. This multi-institutional cohort study found that management decisions for patients with 4 common types of cancer (non-Hodgkin lymphoma or breast, colorectal, or lung cancer) varied greatly among major cancer centers. This high variation in management decisions reveals a lack of consensus about optimal management for common clinical scenarios.
This updated review for the U.S. Preventive Services Task Force (USPSTF) summarizes data from trials and observational studies about the possible benefits and harms of screening for hepatitis B virus (HBV) infection in nonpregnant adolescents and adults. Studies showed that antiviral treatment for chronic HBV infection can improve intermediate outcomes and that HBV vaccination can decrease the risk for infection in high-risk populations.
Pelvic examination (excluding cervical cancer screening) has been a regular part of preventive care in women for decades. This systematic review for the American College of Physicians (ACP) evaluated the diagnostic accuracy, benefits, and harms of pelvic examination in asymptomatic, nonpregnant, average-risk women. No data supporting the use of pelvic examination in such women were found, and low-quality data suggest that pelvic examinations may cause pain, discomfort, fear, anxiety, or embarrassment in some women.
This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of nephrology. Topics include hypertension, chronic kidney disease, hemodialysis, and kidney transplantation.
The USPSTF recommends that persons at high risk for HBV infection should be screened for it. This recommendation applies to asymptomatic, nonpregnant adolescents and adults who have not been vaccinated and other persons at high risk for HBV infection.
Pelvic examination (excluding cervical cancer screening) is often used to screen women for pathology. After weighing the benefits and harms presented in an evidence review, the ACP recommends against performing screening pelvic examinations in asymptomatic, nonpregnant adult women.
The importance of health care professionals partnering with patients and families has been recognized as an essential component of a high-quality, cost-efficient health care system. In this commentary, the authors propose changes in medical education and the training environment that have the potential to produce clinicians who are better able to address the needs of patients and their families.
In this issue, the USPSTF recommends screening for HBV infection in persons at high risk for infection. The editorialists discuss the recommendation and explain why they believe it lags behind the evidence by a decade.
In the issue, the ACP recommends against screening pelvic examination and the review by Bloomfield and colleagues found no evidence of its benefit. The editorialists discuss the “ritual” of the pelvic examination and conclude that clinicians should clarify the goals of the pelvic examination and quantify its benefits and harms.
I was diagnosed 2 years ago, at the age of 51. The symptoms had come on slowly: muscle spasms, fatigue, weakness in my left leg and my hands. Once down, I could not get up from the floor.