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Evidence from small, short-term studies suggests that yoga may benefit patients with low back pain. In this study, patients with chronic or recurrent low back pain participated in a 12-week yoga program or received usual care. The yoga group had better back function than the usual care group at 3, 6, and 12 months, but back pain and general health scores were similar. Two usual care and 12 yoga participants reported adverse events, mostly increased pain.
Randomized trial evidence shows that warfarin is superior to aspirin and clopidogrel to prevent stroke in patients with atrial fibrillation. This study sought to quantify the net benefit of adding clopidogrel to aspirin in patients who could not receive warfarin. Adding clopodigrel resulted in a modest net benefit in these patients, but the study cannot definitively rule out the possibility of no benefit or a small net harm.
Case reports suggest that the hand-held metal detectors used for security screening may interfere with pacemaker and implantable cardioverter-defibrillator (ICD) function. However, in this study of 388 patients, no change in pacemaker or ICD function was observed in any patient when 2 commonly used hand-held metal detectors were applied for 30 seconds. Security screening with hand-held metal detectors is probably safe for patients with pacemakers and ICDs, but these findings require confirmation.
Quality cancer care requires addressing patients' emotions. This trial evaluated the effectiveness of a computerized intervention in improving oncologists' responses to patients' expressions of negative emotion. Oncologists in the intervention group used a greater number of empathic statements, were more likely to respond empathically to negative emotions, and had patients who reported greater trust in them compared with control oncologists.
This systematic review assesses the benefits and harms of venous thromboembolism (VTE) prophylaxis in hospitalized nonsurgical patients and supports the American College of Physicians clinical practice guideline in this issue. In medical patients, heparin prophylaxis did not reduce total mortality but resulted in fewer pulmonary embolisms (PEs) and an increase in all bleeding events. When trials of medical patients and those with stroke were considered together, heparin prophylaxis reduced PE but increased bleeding. No improvements in clinical outcomes were seen in the 3 studies of mechanical prophylaxis in patients with stroke, but more patients had lower-extremity skin damage.
This systematic review identified 57 studies of magnetic resonance imaging (MRI) under loading stress for musculoskeletal conditions, most commonly of the spine and the knee. Most studies had a cross-sectional or case–control design and reported on anatomical measurements rather than clinical outcomes. In 10 studies that included information on adverse effects, 5% to 15% of participants reported new-onset or worsening pain and neuropathy during MRI under loading stress. Overall, evidence is insufficient to support the clinical utility of MRI under loading stress for musculoskeletal conditions.
The ACP developed this clinical practice guideline on prophylaxis of VTE in hospitalized nonsurgical patients. It recommends assessing the risk for thromboembolism and bleeding in medical (including stroke) patients before initiation of VTE prophylaxis. It also recommends that clinicians administer prophylaxis with heparin or a related drug only when the likely benefits outweigh the risk for bleeding complications and against mechanical prophylaxis with graduated compression stockings.
Retainer medicine is an important but controversial form of primary care practice in the United States. Some ethicists urge that society should restrict or ban retainer medicine. This commentary argues that retainer medicine is compatible with professional ethics and could help address rather than exacerbate the difficulties facing primary care.
Connolly and colleagues' study in this issue suggests that adding clopidogrel to aspirin results in a modest net benefit in patients with atrial fibrillation who cannot take warfarin. This editorial discusses the role of dual-antiplatelet therapy in atrial fibrillation and argues that the study shows that intracerebral hemorrhage is considerably more morbid than ischemic stroke.
In this issue, an ACP clinical practice guideline and background review raise concerns about performance measurement for prophylaxis of VTE in patients hospitalized for medical conditions or stroke. The editorial comments on the disconnect between evidence-based guidelines and the Joint Commission's current performance measure for VTE prophylaxis and makes recommendations on how to mitigate the unintended consequences of performance measurement.
In response to Huddle and Centor's defense of retainer medicine in this issue, this editorial argues that physicians, more so than other citizens, should take action to address access to care and health disparities and discusses how a physician's responsibility should be balanced with diverse countervailing interests.