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Evidence defining the role of oral steroids in the treatment of chronic rhinosinusitis with nasal polyposis is limited. In this trial, patients with at least moderate-sized nasal polyps and chronic rhinosinusitis who had inadequate response to intranasal steroids were randomly assigned to receive 2 weeks of oral steroids or placebo, followed in both groups by sequential steroid nasal drops and spray. Over 28 weeks of therapy, greater reduction in polyp size and greater improvement in olfaction were observed after induction therapy with oral steroids, but clinicians should consider adverse effects when using this treatment approach.
At similar fasting glucose levels, hemoglobin A1c values are higher in black persons than white persons. Whether this reflects differences in postprandial glycemia or physiologic differences in hemoglobin glycation and erythrocyte turnover is unclear. This study of 343 persons with and 1376 persons without diabetes found that differences between black patients and white patients in glycated albumin, fructosamine, and 1,5-anhydroglucitol paralleled differences in hemoglobin A1c values. These observations suggest that differences in hemoglobin glycation and erythrocyte turnover do not explain racial disparities in these serum markers.
Renal disease is a risk factor for cardiovascular events, and some hypothesize that markers of renal function could improve on risk prediction with traditional cardiac risk factors alone. This prospective cohort study found that adding estimated glomerular filtration rate and albuminuria to conventional coronary risk factors provided little clinically useful information over and above that from conventional coronary risk factors in terms of predicting risk for cardiovascular events.
Current estimates of the prevalence of hepatitis B virus (HBV) infection, exposure, and immunity are needed to assess the effectiveness of programs to prevent transmission. This study of 39 787 participants in the National Health and Nutrition Examination Survey (1999 to 2008) found that among persons aged 6 years or older, 0.27% (approximately 704 000) had chronic HBV infection and 4.6% (approximately 11 993 000) had been exposed to HBV. Infection and past exposure were uncommon among persons aged 6 to 19 years, and 68.6% of children aged 2 years had immunity. The investigator concludes that vaccination of high-risk adults should continue to be emphasized.
Although vaccination has made tetanus uncommon in the developed world, tetanus is an expected complication after natural disasters in developing countries. The emergency response to tetanus in this setting requires a multidisciplinary approach in the absence of an intensive care unit, readily available resources, and a functioning cold-chain system. Successful treatment of tetanus depends on prompt diagnosis; treatment to neutralize circulating toxin, eliminate infection, and control spasms and convulsions; airway maintenance; and management of respiratory failure and autonomic dysfunction.
Wendler and Rid reviewed studies of the effects of treatment decisions on the surrogates who make them. Eleven quantitative studies and 29 qualitative studies involving surrogates, most of whom had made end-of-life decisions for incapacitated adults, found that many surrogates experienced a negative emotional burden associated with the decision. Negative effects typically lasted months or years and included stress, guilt, and doubt. Future research should evaluate ways to reduce the emotional burden that surrogates experience after decision making.
This review was developed to inform the update of the 1996 U.S. Preventive Services Task Force (USPSTF) recommendations on screening for hearing loss in adults aged 50 years or older who present to primary care settings. Screening was associated with increased hearing aid use at 1 year but not with improvements in hearing-related function in one trial, and immediate hearing aids were effective compared with wait-list control in improving hearing-related quality of life in patients with mild or moderate hearing loss and severe hearing-related handicap in another trial. Good-quality evidence suggests that common screening tests can help identify patients at higher risk for hearing loss. No direct evidence was found on harms of screening or treatments with hearing aids.
This recommendation statement updates the 2002 USPSTF recommendation on screening for osteoporosis. The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is the same as or greater than that of a 65-year-old white woman who has no additional risk factors.
In this issue, Vaidyanathan and colleagues' trial demonstrates the effectiveness of a short course of oral steroids for patients with chronic rhinosinusitis with nasal polyposis who have not had an adequate response to intranasal steroids alone. The editorialists assert that the strategy for oral steroid courses in patients with severe or uncontrolled chronic rhinosinusitis with nasal polyposis should be an initial daily dose of 0.5 to 1.0 mg/kg, followed by tapered administration for 2 to 3 weeks. Long-term intranasal corticosteroids, given after or in addition to oral steroids, should be the main therapeutic strategy, and clinicians should be alert to adverse effects of oral steroid use.
Last year, I took the great leap forward to a totally electronic medical record. My project manager at the software company guided me through thickets of timetable confirmations, equipment inventories, data migration assessments, benchmark checklists, and conference calls. She also sent me regular e-mails that included an invitation to the national users' conference in Las Vegas. I didn't make it to Vegas, but I did survive my first year.