Cover photograph by Joseph Gascho, MD
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Steroid injections are often used to alleviate symptoms of the carpal tunnel syndrome (CTS) and prevent the need for surgery. This trial randomly assigned patients with mild to moderate CTS who were unsuccessfully treated with wrist splinting to 1 of 2 doses of methylprednisolone or placebo. The methylprednisolone recipients were somewhat less likely to have had surgery at the 1-year follow-up than the placebo recipients, but 3 out of 4 of them did have surgery within 1 year. In most patients with CTS, methylprednisolone temporarily improves symptoms but does not obviate the need for surgery.
HIV infection is a major health concern for men who have sex with men (MSM). Because social media use is high in this population, it may be a tool for HIV education and intervention. In this trial of a peer-led HIV education intervention delivered through social media (Facebook), MSM in the intervention group were more likely to request, complete, and return home HIV testing kits than were those in the control group. They indicated high satisfaction, engagement, and retention with the intervention. Social media may be effective for HIV prevention and diagnosis in MSM.
Clinical management of thyroid neoplasms is often based on light microscopic diagnosis. This multicenter study examined concordance between preoperative cytopathologic and postoperative histopathologic thyroid diagnoses made by local pathologists versus those made by independent central expert panelists. Local versus central cytopathology and histopathology diagnoses were concordant in 64% and 91% of cases, respectively. Intraobserver concordance for diagnoses made by central cytopathologists and histopathologists were 75% and 90%, respectively, and central cytopathologists made fewer indeterminate diagnoses than local pathologists. The substantial variability found confirms an inherent limitation of visual microscopic diagnosis.
This review informs the updated U.S. Preventive Services Task Force (USPSTF) recommendation on screening for peripheral artery disease (PAD) and cardiovascular disease (CVD) risk assessment with the ankle–brachial index (ABI) in adults. It found limited evidence on the added value of the ABI in current coronary artery disease or CVD risk prediction, as well as limited trial evidence for treatment of CVD in persons with asymptomatic or minimally symptomatic PAD.
The USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of PAD screening and does not recommend for or against screening with the ABI. This recommendation applies to asymptomatic adults who do not have a known diagnosis of PAD, CVD, severe chronic kidney disease, or diabetes.
The USPSTF now recommends screening for hepatitis C virus (HCV) infection in all asymptomatic persons at high risk for infection and recommends offering 1-time screening for adults born between 1945 and 1965. This recommendation applies to all asymptomatic adults without known liver disease or functional abnormalities.
Agreeing with a U.S. senator that an Organ Procurement and Transplantation Network policy discriminates against children, a District Court judge in Philadelphia issued a 10-day restraining order, which enabled a 10-year-old child to receive a lung transplant from an adult. This commentary discusses the implications of this decision and provides suggestions on changes that would improve the supply and allocation of transplantable organs.
The recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is regarded as the primary source of information for psychiatric diagnostic criteria, but criticisms have arisen. In this commentary, a practicing internist-psychiatrist highlights important improvements in the DSM-5 that he believes make it more user-friendly for primary care providers.
This issue includes the updated USPSTF recommendation on ABI screening for PAD and CVD risk assessment, as well as the systematic review used to inform it. The USPSTF concluded that the current evidence is insufficient and recommended neither for nor against screening with the ABI. The editorialist discusses the recommendation and review and calls for a definitive randomized, controlled trial to determine whether ABI screening improves health outcomes in persons at risk for PAD.
This issue includes the USPSTF recommendation on screening for HCV infection, which recommends screening all asymptomatic persons at high risk and offering 1-time screening for adults born between 1945 and 1965. The editorialists discuss the recommendation and conclude that it is a critical step forward in increasing the number of persons living with HCV who are aware of their infection status so that they may seek treatment and avoid infecting others.
As a community pharmacist, I cannot be expected to be a patient's primary care provider. However, it seems that improving the patient-centeredness rather than the profit-centeredness of pharmacy care would prevent lost opportunities for patient–provider dialogue.