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Typically, patients receiving warfarin undergo international normalized ratio (INR) monitoring with dose adjustment every 4 weeks. Longer intervals between INR measurement would make warfarin therapy easier, but the effectiveness and safety of such an approach is uncertain. In this trial, patients who had been receiving a stable warfarin dose for at least 6 months were randomly assigned to monitoring either every 4 or every 12 weeks. The proportion of time that patients were within the target INR range and adverse events did not significantly differ between the groups. Longer monitoring intervals may be reasonable for selected patients receiving warfarin.
Whether CHADS2 scores are useful for predicting thromboembolic and bleeding complications in patients treated with anticoagulants for atrial fibrillation is not known. In this analysis of data from a randomized clinical trial in which patients received anticoagulant therapies for atrial fibrillation, the risks for stroke or thromboembolism, major and intracranial bleeding, and vascular mortality increased with higher CHADS2 scores. These data may be helpful in assessing the risks and benefits of anticoagulant therapy in patients with atrial fibrillation.
Whole-body vibration (WBV) therapy, which involves standing on an oscillating platform, has been hypothesized and marketed to prevent bone loss, but data on its efficacy are limited and conflicting. This 12-month trial examined whether WBV therapy has beneficial effects on bone health in postmenopausal women without osteoporosis who were receiving calcium and vitamin D supplementation. The investigators found that daily, low-magnitude WBV at either of 2 frequencies had no measurable effect on bone mineral density or bone structure.
This review provides an overview of WBV therapy. The authors describe the various available WBV platforms and protocols for their use, identify potential benefits and harms of the therapy, and summarize evidence from published literature relevant to bone outcomes.
The U.S. Preventive Services Task Force commissioned this systematic review to inform the upcoming update of its recommendation on cervical cancer screening. The review focused on liquid-based cytology (LBC) and human papillomavirus (HPV) screening for women aged 30 years or older. It found that LBC and conventional cytology had similar sensitivity and specificity for detecting cervical intraepithelial neoplasia. One-time HPV testing was more sensitive, but less specific, than cytology, and the overall harms and costs of work-up for false-positive HPV test results were unclear.
Questions remain about the appropriate ages to begin and end cervical cancer screening. This review, commissioned to inform the Task Force's forthcoming updated recommendation on cervical cancer screening, explores epidemiologic and contextual data on cervical cancer screening to inform decisions about the age range during which screening will maximize benefit and minimize harms. The authors conclude that available evidence suggests that the benefits of screening begin to outweigh harms at age 21 years. The benefit of screening diminishes in women older than 65 years who have had regular screening and no history of cervical intraepithelial neoplasia or cervical cancer.
In recent years, stem cell–based therapies have generated increasing excitement, with frequent claims that they will revolutionize medicine. This article discusses the 3 main varieties of stem cells—adult, embryonic, and induced pluripotent—and compares the potential promises and pitfalls of each for clinical medicine.
Should dabigatran replace warfarin in patients with nonvalvular atrial fibrillation? In this issue, Oldgren and colleagues address whether outcomes with dabigatran and warfarin differ according to baseline risk for stroke and provide novel data on all-cause mortality, and Schulman and colleagues compared warfarin dosing assessment every 12 weeks versus every 4 weeks. The editorialists discuss these articles and describe how they can help physicians choose whether to use dabigatran or warfarin to reduce the risk for stroke or systemic embolism in patients with nonvalvular atrial fibrillation.
Standing there with the sun against my back, I understood—deeply, for the first time since I donned my white coat and swore that sacred oath as a hopeful, wide-eyed, first-year medical student—that the practice of medicine needed to be about more than correct diagnoses and management.
On the bureau was a simple ringed notebook—the kind I used in high school biology class—summarizing Marie's care. In its pages, I reviewed entries detailing every medication dose, periodic vital signs, observations of the hospice nurse on their visits, and notes entered by her daughter. It was an informal medical record, yes—but one recorded with great detail, care, and devotion.