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An Lehouck, PhD; Chantal Mathieu, MD, PhD; Claudia Carremans, MS; Femke Baeke, PhD; Jan Verhaegen, MD, PhD; Johan Van Eldere, MD, PhD; Brigitte Decallonne, MD, PhD; Roger Bouillon, MD, PhD; Marc Decramer, MD, PhD; and Wim Janssens, MD, PhD

Low serum vitamin D levels have been associated with inflammation and infection and occur in many patients with severe chronic obstructive pulmonary disease (COPD). This randomized trial assigned 182 patients with COPD to vitamin D supplementation or placebo. Vitamin D supplementation did not reduce the number of acute exacerbations of COPD nor improve lung function. Although a post hoc analysis suggested possible benefit in patients with very low baseline vitamin D levels, further study is warranted to definitively determine whether vitamin D supplementation might help selected patients with COPD.

Topics: chronic obstructive airway disease, vitamin d, monocytes
  
Francisco Campos-Rodriguez, MD; Miguel A. Martinez-Garcia, MD; Ines de la Cruz-Moron, MD; Carmen Almeida-Gonzalez, MD; Pablo Catalan-Serra, MD; and Josep M. Montserrat, MD

The cardiovascular consequences of obstructive sleep apnea (OSA) have been documented in men but not in women. Among 1116 women referred for evaluation to 2 sleep medicine clinics, untreated OSA was associated with increased cardiovascular mortality. The mortality observed among women with severe OSA who were treated with continuous positive airway pressure was similar to that among women without OSA.

Topics: cardiovascular system, polysomnography, mortality, obstructive sleep apnea, women, continuous positive airway pressure, ...
  
Dominic Wichmann, MD, DTM; Frieder Obbelode; Hermann Vogel, MD; Wilhelm Wolfgang Hoepker, MD; Axel Nierhaus, MD; Stephan Braune, MD, MPH; Guido Sauter, MD; Klaus Pueschel, MD; and Stefan Kluge, MD

Although autopsy is a useful tool for education and quality assessment, traditional autopsies have declined dramatically. Virtual autopsy using radiographic imaging might be an alternative to medical autopsy. This study performed traditional medical and virtual autopsies on 47 patients who died in an intensive care unit. Like traditional autopsy, virtual autopsy confirmed most premortem clinical diagnoses. Although virtual autopsy identified several fractures and cases of pneumothorax not seen at medical autopsy, it missed some cardiovascular and oncologic diagnoses.

Topics: autopsy, intensive care unit
  
Thomas M. Gill, MD; Evelyne A. Gahbauer, MD, MPH; Terrence E. Murphy, PhD; Ling Han, MD, PhD; and Heather G. Allore, PhD

Little is known about the risks for and precipitants of impaired mobility among older adults. This study followed 641 nondisabled, driving, community-dwelling adults aged 70 years or older for about 12 years. Inability to walk a quarter mile or to drive developed in 56% and 53% of participants, respectively. Older age and poor physical performance were the risk factors most strongly associated with both types of disbility. Other risk factors for disability were cognitive impairment, low physical activity, intervening illnesses and injuries, and hospitalization.

Topics: disability, elderly, mobility, hospitalization
  
Nancy Greer, PhD; Michelle Brasure, PhD, MSPH, MLIS; and Timothy J. Wilt, MD, MPH

Evidence on the effectiveness of recommended steps for wheeled mobility service delivery is sparse. Several issues complicate delivery and may limit the ability of persons with complex rehabilitation needs to obtain the best equipment to maximize their functional abilities. This review outlines currently recommended approaches and models, describes research evaluating the effectiveness of the process, and identifies potential issues that influence the effectiveness of matching mobility-impaired persons with appropriate wheeled mobility devices.

Topics: wheelchair, mobility
  
Amir Qaseem, MD, PhD, MHA; Patrick Alguire, MD; Paul Dallas, MD; Lawrence E. Feinberg, MD; Faith T. Fitzgerald, MD; Carrie Horwitch, MD, MPH; Linda Humphrey, MD, MPH; Richard LeBlond, MD; Darilyn Moyer, MD; Jeffrey G. Wiese, MD; and Steven Weinberger, MD

To begin to identify ways that practicing clinicians can contribute to the delivery of high-value, cost-conscious health care, the American College of Physicians convened a workgroup of physicians to identify common clinical situations in which screening and diagnostic tests are used in ways that do not reflect high-value care. This article discusses high-value, cost-conscious health care and identifies 37 common clinical situations that the workgroup believes represent low-value care.

Topics: diagnosis, appropriate use
  

Henry K. Beecher and Maurice H. Pappworth were prominent medical whistleblowers in research ethics during the 1960s. Although they shared much in common, they differed radically in the strategies they adopted. This article tracks their correspondence and publications as an important juncture in the genesis of modern clinical research ethics.

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In this issue, Lehouck and colleagues found no overall benefit of vitamin D supplementation on time to COPD exacerbation or exacerbation rates, except among a few participants who had very low vitamin D levels at baseline. The editorialists discuss the study and how it and other ongoing studies will help to elucidate the balance of benefits and risks of vitamin D supplementation among patients with respiratory dysfunction.

Topics: chronic obstructive airway disease, vitamin d deficiency, vitamin d
  
Elizabeth C. Burton, MD; and Mahmud Mossa-Basha, MD

In this issue, Wichmann and coworkers compared findings of virtual and traditional autopsies in patients who died in an intensive care unit. The editorialists believe that further study is warranted before widespread use of virtual autopsy can be adopted as an alternative to conventional autopsy.

Topics: autopsy
  

Gill and colleagues' study in this issue confirms 2 “inconvenient truths” of aging: Losing the ability to walk even short distances and drive cars is common toward the end of life, and these outcomes are strongly associated with being very old, having previous physical limitations, and being sick enough to require hospitalization. Greer and colleagues' article in this issue discusses wheeled mobility services. The editorialist comments on both articles and emphasizes that maximizing the ability of all disabled persons to participate in and contribute to their communities should be an urgent public priority.

Topics: disability
  
Christine Laine, MD, MPH, Editor in Chief

In this issue, Qaseem and colleagues' commentary presents 37 scenarios that the authors believe represent clinical situations in which testing provides little or no value to the patient. The editorialist acknowledges that many readers will disagree with the items the authors list and presents common-sense questions that physicians should ask before ordering any test.

Topics: quality of care, budgets, health care costs, health personnel, health resources
  
Devan Kansagara, MD, MCR
Includes: Audio/Video
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Chong-Zhi Wang, PhD; Ping Li, PhD; and Chun-Su Yuan, MD, PhD
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Chen Wang, MD, PhD; Bin Cao, MD; and Qing-Quan Liu, MD
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Louella Vaughan, DPhil; Derek Bell, MD; and Graeme McAlister
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John Q. Young, MD, MPP; Andrew D. Auerbach, MD; and Sumant R. Ranji, MD
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Giuliano Giusti, MD; Anna Coerezza, MD; and Giulia Cernuschi, MD
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Wim Lucassen, MD; Henk C. van Weert, MD, PhD; and Harry Büller, MD, PhD
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Anthony O. Ogedegbe, MD
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Neil A. Louwrens, MD
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David M. Zlotnick, MD; and Armin Helisch, MD
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Kalyan Banda, MBBS
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Topics: atrial fibrillation, warfarin, cerebrovascular accident, ischemic stroke, embolism, apixaban
  
Topics: atrial fibrillation, warfarin, cerebrovascular accident, ischemic stroke, embolism, rivaroxaban
  
Topics: dietary sodium chloride, morbidity, mortality
  
Topics: dietary fats, cardiovascular event
  
Topics: smoking cessation, cytisine
  
Topics: metformin, diabetes mellitus, type 2, mortality, insulin secretagogue
  
Topics: angiogram, acetylcysteine, renal trauma
  
Topics: renal trauma
  
Topics: azithromycin, chronic obstructive airway disease
  
Topics: pulmonary embolism, prediction rule
  
Topics: preventive health services, electronic medical records
  
Topics: mortality, elderly
  
Topics: chronic obstructive airway disease, vitamin d
  
Topics: cardiovascular disease in women, obstructive sleep apnea
  
Topics: disabled persons, elderly
  
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