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Combination antiretroviral therapy has increased life expectancy among HIV-infected persons in the United States and northern Europe, but its effect in resource-constrained countries is unknown. This study demonstrated that combination regimens increased life expectancy to nearly normal in HIV-infected persons in Uganda. Women derived greater benefit than men, as did patients who began therapy at higher CD4 cell counts. Antiretroviral therapy can dramatically increase life expectancy in Africa, where the burden of HIV is greatest.
Treatment with the Chinese herbal therapy maxingshigan–yinqiaosan has been associated with reduced influenza symptoms. This randomized trial compared maxingshigan–yinqiaosan with oseltamivir alone, oseltamivir plus maxingshigan–yinqiaosan, and no treatment in mildly ill patients with confirmed H1N1 influenza. Fever resolved sooner in all 3 therapeutic groups than in the group that received no treatment. That ephedra is an ingredient of maxingshigan–yinqiaosan and it is not known whether maxingshigan–yinqiaosan exerts its effects though antipyretic or antiviral mechanisms are some cautions about the study.
It is unclear from previous studies whether delays to surgery in patients with hip fracture lead to poor outcomes. In this study, some association between very delayed surgery (>120 hours) and worse outcomes was found, but after adjustment for acute medical conditions, shorter operative delays were not associated with in-hospital mortality or medical complications other than urinary tract infections. These data suggest that the medical conditions leading to the delay, not the delay itself, account for poor outcomes in patients with hip fracture.
This systematic review of pharmacologic and nonpharmacologic interventions for pain after hip fracture included 83 unique studies on various procedures. Moderate evidence suggests that nerve blockades are effective for relieving acute pain and are associated with less delirium. Although evidence is limited, preoperative traction does not seem to reduce acute pain. Evidence was insufficient about the benefits and harms for the remainder of the interventions in managing hip fracture pain.
This recommendation from the U.S. Preventive Services Task Force (USPSTF) updates their 2004 statement on screening for bladder cancer. After a targeted literature search for new evidence on the benefits and harms of screening, the accuracy of screening tests that are feasible in primary care, and the benefits and harms of treatment, the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for bladder cancer in asymptomatic adults.
This article, from the United Kingdom's National Institute for Health and Clinical Excellence (NICE), summarizes the updated NICE guideline on diagnosis, treatment, and monitoring of heart failure. It describes the role of serum natriuretic peptide measurement, echocardiography, and specialist assessment in the diagnosis of heart failure; presents a pathway for pharmacologic treatment, rehabilitation, and pacing therapy for patients with heart failure and left ventricular systolic dysfunction and those with heart failure and preserved ejection fraction; and explains the recommendation to monitor patients with heart failure by using serial measurement of serum natriuretic peptide.
In certain cases, institutional volume has become a proxy for quality, yet physicians have been unsure of how to approach this information and interpret it for their patients. Even more challenging has been deciding whether the data oblige physicians to direct patients to high-volume centers for care or to discuss the data with patients as part of informed consent. This article reviews the ethical arguments for including disparities in hospital outcomes as part of informed consent and examines whether legal precedent can shed light on this debate.
In this issue, Mills and colleagues, using models based on patient-level data, conclude that life expectancy for young HIV-infected adults in Uganda who initiate combination antiretroviral therapy approaches that of all Ugandan adults. The editorialist elucidates the study's key findings and caveats and concludes that because we now have the tools to comprehensively control AIDS in Africa, we must rise to the challenge.
In this issue, Vidáan and colleagues present data showing that in-hospital mortality and complications were not significantly associated with surgical delay of less than 120 hours after adjustment for the presence of acute medical conditions that caused the delay. The editorialists caution that this study should not be viewed as license not to take medically stable patients to surgery as soon as possible and discuss the challenges in providing care for patients with hip fracture that is multidisciplinary, patient-centered, and outcomes-driven and operates seamlessly across care settings.
This issue includes a summary of the updated NICE heart failure guidelines. The editorialists discuss the foci that must be embraced for guidelines to affect clinical care and conclude that leading guidelines are making a necessary move toward emphasizing shared decision making, implementation, and cost-effectiveness.
As I lagged behind to sign the code blue worksheet, the gray-haired cardiologist offered two suggestions that have always stuck with me: Remember that in-house ventricular fibrillation arrest has a better prognosis, and be careful of my spoken words, as you never know who might be listening.
As a third-year medical student on my medicine rotation, I was eager to begin learning the art of differential diagnosis and medical management. However, during my time on the wards, I learned not only what it takes to be great doctor but what it means to be a healer.