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Currently, no proven treatment options exist for patients with familial Mediterranean fever (FMF) who are intolerant of or resistant to colchicine therapy. This small randomized trial assessed the efficacy of the interleukin-1 antagonist rilonacept in decreasing the frequency of FMF attacks in such patients. Researchers found that patients had fewer attacks of FMF during rilonacept therapy than placebo. Rilonacept may be a treatment option for patients with colchicine-resistant or -intolerant FMF.
Costs make implantable cardioverter-defibrillators (ICDs) inaccessible for many people in low- and middle-income countries who might benefit from ICD use. Yet, ICDs with substantial remaining battery life are discarded after explantation or patient death. Authors report their 7-year experience of reimplanting donated, used ICDs in patients at a single hospital in India. The outcomes compared favorably with those of similar patients in the United States with new ICDs. If the safety and efficacy of this approach are confirmed, reuse of ICDs could be a life-saving option for patients who otherwise could not afford such devices.
The molecular mechanisms by which impaired sleep increases insulin resistance are not fully understood. In this study, cellular insulin sensitivity was reduced in adipocytes from subcutaneous fat samples collected in healthy volunteers after 4 nights of sleep restriction compared with 4 nights of normal sleep. These observations suggest that sleep seems to play an important role in regulating metabolism in peripheral tissues. Understanding the molecular mechanism behind this phenomenon may help prevent diabetes.
This review assessed evidence on the diagnostic performance of rapid diagnostic and point-of-care tests to screen for hepatitis C. Reviewers stratified the 18 included studies by type of specimen or test. Data suggest that point-of-care tests of serum, plasma, or whole blood have the highest accuracy, followed by rapid diagnostic tests of serum or plasma and point-of-care tests of oral fluids. Given their accuracy, convenience, and quick turnaround time, rapid diagnostic and point-of-care tests may be useful in expanding screening initiatives for hepatitis C.
This U.S. Preventive Services Task Force recommendation statement on screening for chronic kidney disease (CKD) in healthy, asymptomatic adults concludes that the evidence is insufficient to assess the balance of benefits and harms of routine screening for CKD in this population. These recommendations do not apply to testing and monitoring patients with diabetes or hypertension.
This commentary discusses computed tomography screening of patients at risk for lung cancer, examining the magnitude of benefit for prototypical persons who may be offered screening. It concludes that the underlying chance of benefit from this screening should be taken into account when counseling patients who are considering computed tomography to screen for lung cancer.
This commentary discusses the overuse of diagnostic imaging tests and approaches to limit imaging studies
and other tests and treatments that are inappropriate, unnecessary, wasteful, or redundant. It addresses
issues that clinicians must confront to reduce overuse of imaging tests.
This commentary discusses the Supreme Court's decision to uphold the Patient Protection and Affordable Care Act and how the decision to allow states to opt out of expanding Medicaid could result in coverage gaps for the most vulnerable patients, rather than the seamless expansion of coverage originally expected.
The Centers for Medicare & Medicaid Services will introduce measures of adherence to oral hypoglycemic, antihypertensive, and cholesterol-lowering drugs into its Medicare Advantage quality program. The author discusses how, in order to achieve these adherence goals, front-line clinicians, interdisciplinary teams, organizational leaders, and policymakers will need to coordinate efforts in ways that exemplify the underlying principles of health care reform.
The United States spent $2.6 trillion on health care in 2011. This article discusses how price and volume both contribute to high and increasing health care costs, along with high administrative costs, supply issues, and the fee-for-service payment system. It also suggests initial strategies to contain costs, including implementation and expansion of bundled payment systems and competitive bidding.
In this issue, Pavri and colleagues report on their experience of implanting reused, resterilized ICDs donated from the United States to India. They address the question of the usefulness of ICDs with 3 or more years of battery life remaining after explantation or patient death. This editorial discusses the use of ICDs, and how the deployment of such devices would contribute to “global health equity”—the just distribution of the fruits of scientific and medical research.
In this issue, Broussard and colleagues show that cellular insulin sensitivity was reduced in adipocytes from subcutaneous fat samples collected after 4 nights of sleep restriction compared with 4 nights of normal sleep. This editorial discusses how the study's findings challenge traditional views that the purpose of sleep is confined to its restorative effects on the central nervous system.
Seven years ago on Halloween, my mother died. Maybe she held out until then, knowing that the anniversary of her death would coincide with a day of fun and make-believe.