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Although transthoracic needle biopsy is frequently considered for evaluation of a solitary pulmonary nodule, the risks of this procedure are not well-defined. In this assessment of national administrative databases, pneumothorax and hemorrhage were not rare after transthoracic needle biopsy. Patients often required treatment for these complications that included blood transfusion, chest tube placement, or mechanical ventilation. Patients aged 60 to 69 years and those who smoked or had chronic obstructive pulmonary disease were at increased risk. These data may be helpful when considering whether to perform biopsy of a solitary pulmonary nodule.
Rates of primary and secondary syphilis in the United States have been steadily increasing since 2001. This analysis of syphilis in 27 states from 2005 to 2008 found that black and Hispanic men who have sex with men (MSM) had significantly greater absolute increases in the rate of primary and secondary syphilis than white men. The greatest absolute increase in rate by age was seen among MSM in their 20s. These data can help to identify approaches to reversing the rise in syphilis infections.
Most studies of hospitalist care have focused on the inpatient stay. This study compared hospitalized patients who were cared for by primary care physicians with those cared for by hospitalists. Hospitalists' patients had shorter and less expensive hospitalizations. During the 30 days after discharge, however, hospitalists' patients had more visits to the emergency department, more readmissions to the hospital, and higher total expenses. Savings during hospitalization that are associated with hospitalist care may be offset by higher expenses after discharge.
The role of long-chain ω-3 fatty acids in congestive heart failure (CHF) is uncertain, and prior studies of this topic have relied on diet questionnaires to estimate exposure. In this cohort of patients who did not have heart disease at baseline, baseline plasma levels of total ω-3 fatty acids, and eicosapentaenoic acid specifically, were associated with a lower incidence of CHF. Further study is required to evaluate whether this relationship is causal.
Treatment options for localized prostate cancer are numerous and include radiation therapy. This comparative effectiveness review investigated the clinical and biochemical outcomes of radiation therapies for localized prostate cancer. It included 10 randomized, controlled trials (RCTs) and 65 nonrandomized studies of initial radiation therapy versus no initial therapy. Two RCTs compared combinations of radiation therapies, 7 compared doses and fractions of external-beam radiation therapy (EBRT), and 1 compared low-dose rate radiation therapies. Overall, moderate-strength evidence consistently showed that a higher EBRT dose was associated with increased rates of long-term biochemical control compared with lower EBRT dose. The authors found the body of evidence to be inadequate for all other comparisons.
This guideline from 4 medical societies updates the 2007 American College of Physicians clinical practice guideline on diagnosis and management of stable chronic obstructive pulmonary disease (COPD). It addresses the value of history and physical examination for predicting airflow obstruction; the value of spirometry in screening for or diagnosis of COPD; and COPD management strategies, specifically various inhaled therapies (anticholinergics, long-acting β-agonists, and corticosteroids), pulmonary rehabilitation programs, and supplemental oxygen therapy.
In this issue, Su and colleagues report that compared with white MSM, black MSM are more than 8 times more likely and Hispanic MSM are more than twice as likely to have syphilis infection. The editorialists examine why syphilis is now increasingly prevalent among younger MSM of ethnic and racial minority groups in the United States and describe why this new syphilis epidemic warrants novel public health approaches.
In this issue, Kuo and Goodwin present data suggesting that savings during a hospital stay that are associated with hospitalist care may be offset by higher expenses after discharge. The editorialists discuss the cautions that are needed in interpreting these findings and speculate on why hospitalist care would be associated with greater use of postdischarge services.
I was working on my research at a university hospital in Tokyo when the earthquake hit eastern Japan. Two weeks later, I went to Minami-Sanriku township as part of a medical assistance team.
I remember standing in a ragged line of seven young men, pants stripped to my ankles. This was the crux of the clinical trial, the procedure that had seemed so trivial a few weeks earlier when I had agreed to participate.