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Zoë Hyde, MPH; Leon Flicker, MBBS, PhD; Graeme J. Hankey, MD; Osvaldo P. Almeida, MD, PhD; Kieran A. McCaul, MPH, PhD; S.A. Paul Chubb, PhD; and Bu B. Yeap, MBBS, PhD

Data on sexuality and aging are scarce. This survey gathered data from Australian men aged 75 to 95 years about social and medical factors, hormone levels, and self-reports of sexual activity over 13 years. One half of respondents considered sex important, and one third reported at least 1 sexual encounter in the previous year. Men without health problems were more likely than men with health problems to report sexual activity. Although endogenous testosterone levels were associated with sexual activity, this study did not evaluate the role of testosterone therapy in maintenance of sexual activity.

Topics: sex behavior
  
Jari Halonen, MD; Pertti Loponen, MD; Otso Järvinen, MD, PhD; Jari Karjalainen, MD, PhD; Ilkka Parviainen, MD, PhD; Pirjo Halonen, PhD; Jarkko Magga, MD, PhD; Anu Turpeinen, MD, PhD; Mikko Hippeläinen, MD, PhD; Juha Hartikainen, MD, PhD; and Tapio Hakala, MD, PhD

Clinical guidelines recommend β-blocker therapy to prevent atrial fibrillation after cardiac surgery, but physicians also use amiodarone for this purpose. This randomized trial found that starting β-blocker or amiodarone therapy within 24 hours and continuing it for 48 hours after cardiac surgery resulted in similar rates of atrial fibrillation. However, the study was too small to definitively establish equivalence of these therapies.

Topics: amiodarone, atrial fibrillation, metoprolol, cardiac surgery procedures, antifungal agent
  
Gerhard E. Feurle, MD; Verena Moos, PhD; Katina Schinnerling, Dipl Biol; Anika Geelhaar, Dipl Biol; Kristina Allers, PhD; Federico Biagi, MD; Hendrik Bläker, MD; Annette Moter, MD; Christoph Loddenkemper, MD; Andreas Jansen, MD; and Thomas Schneider, MD, PhD

Some patients with suspected relapsed or refractory Whipple disease have no organisms in tissue and respond to treatment with steroids rather than antibiotics. This observation suggests that such patients may have the immune reconstitution inflammatory syndrome (IRIS) rather than active Whipple disease. According to a case definition of IRIS in Whipple disease that the authors devised, IRIS developed in 15 of 142 patients with Whipple disease in this series. Clinicians should consider possible IRIS in patients who seem to have relapsed or refractory Whipple disease.

Topics: whipple disease, immune reconstitution inflammatory syndrome
  
Amy J.H. Kind, MD; Christie Bartels, MD; Matthew W. Mell, MD; John Mullahy, PhD; and Maureen Smith, MD, MPH, PhD

Higher-than-expected rehospitalization rates have come to be an indicator of quality-of-care problems. This study of 16 222 Medicare beneficiaries rehospitalized within 30 days of an acute care hospital stay found that 22% were admitted to a different acute care hospital from the one they had been discharged from. Risk factors for admission to a different hospital included initial hospitalization at a for-profit, teaching, or low-volume hospital and having a Medicare-defined disability. Although mortality was similar for patients admitted to a different versus the same hospital, costs were higher for readmissions to a different hospital.

Topics: hospitals, medicare, hospitalization
  
Louisa L. Lam, MPH; Peter A. Cameron, MBBS, MD; Hans G. Schneider, MBBS, MD; Michael J. Abramson, MBBS, PhD; Christian Müller, MD; and Henry Krum, MBBS, PhD

This systematic review of 5 randomized trials in 2513 patients compared usual care with B-type natriuretic (BNP) testing to distinguish heart failure from other diagnoses in adults presenting to emergency departments with dyspnea. Evidence from these trials suggests that BNP testing reduced hospital length of stay by about 1 day and possibly reduced admission rates but did not affect readmission or mortality rates.

Topics: dyspnea, brain natriuretic peptide, treatment outcome, hospitals
  

This systematic review of 73 studies was done to inform the update of the U.S. Preventive Services Task Force's recommendations on counseling about physical activity and diet to prevent cardiovascular disease. Long-term observational follow-up of intensive sodium reduction counseling showed a decrease in the incidence of cardiovascular disease; otherwise, direct evidence for improvement in health outcomes is lacking. However, available evidence suggests that counseling seems to favorably influence some cardiovascular risk factors.

Topics: physical activity, cardiovascular diseases, diet, behavior therapy, counseling, preventive medicine, advisory committees ...
  
Steven E. Weinberger, MD; Anne G. Pereira, MD, MPH; William F. Iobst, MD; Alex J. Mechaber, MD; Michael S. Bronze, MD, the Alliance for Academic Internal Medicine Education Redesign Task Force II

Efforts to improve medical education include adopting a new framework based on 6 broad competencies defined by the Accreditation Council for Graduate Medical Education. In this article, members of the Alliance for Academic Internal Medicine (AAIM) Education Redesign Task Force II examine the advantages and challenges of a competency-based educational framework for medical residents. Challenges include teaching and evaluating the competencies related to practice-based learning and improvement and systems-based practice, as well as implementing a flexible time frame to achieve competencies.

Topics: competency-based education, internal medicine, medical residencies
  
Stephen F. Jencks, MD, MPH

In this issue, Kind and colleagues report that patients discharged from for-profit hospitals were more likely to be rehospitalized elsewhere than patients discharged from nonprofit hospitals, and the investigators speculate on possible profit motives. The editorialist proposes that rehospitalization may be better viewed as a health care system problem than as a hospital problem and discusses a 4-step approach to help overcome an imperfect hospital system and poor communication between hospital and other health care providers.

Topics: hospitalization, hospitals, medicare, caregiver
  

This issue includes a report of the AAIM Education Redesign Task Force II deliberations on a competency-based educational framework for medical residents. The editorialist discusses some of the underlying assumptions and potential pitfalls of this approach.

Topics: internal medicine, internship and residency
  
Adam B. Possner, MD

I had barely shaken her hand before Ms. Williams cut to the chase. “Doc,” she declared in a hoarse voice surprisingly large for her size, “I haven't always followed up, but I'm gonna follow up now.”

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Marya J. Cohen, MD

It had been a few years, but I soon remembered the feeling of the vinyl pillow slipping out from its thin cotton case, the weight of industrial-issue clothes laced with sweat, and the pink irritation on the backs of my hands from the sterilizing soap. This time, I was the patient, and I couldn't sleep.

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Bert A. Govig, MD; and Sepehr Javaheri, MD
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Sameer Siddique, MD; Harris V. Naina, MD; and Samar Harris, MD
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Moxie Stratton-Loeffler, DO
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Robert E. Jackson, MD
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Marc P. van der Schee, MSc; Lisette N. Venekamp, MD; and Peter W.A. Kunst, MD, PhD
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Maarten J. Deenen, PharmD; Wim E. Terpstra, MD, PhD; Annemieke Cats, MD, PhD; Henk Boot, MD, PhD; and Jan H.M. Schellens, MD, PhD
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Jack Coulehan, MD, MPH
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Peter Zimetbaum, MD
Topics: atrial fibrillation
  
Topics: sex behavior
  
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