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Recurrent pericarditis can be difficult to treat. This randomized trial evaluated the efficacy and safety of colchicine for the secondary prevention of recurrent pericarditis. At 18 months, the recurrence rate was 24% in the colchicine group and 55% in the placebo group. Colchicine also reduced the persistence of symptoms at 72 hours and mean number of recurrences, increased the remission rate at 1 week, and prolonged the time to subsequent recurrence.
This study evaluated the safety of 1.5-T magnetic resonance imaging (MRI) in 438 patients with implanted cardiac devices before, during, and after imaging. Only 3 patients acutely experienced the device reverting to a transient back-up programming mode: One event occurred during cardiac MRI in a patient with a single-chamber defibrillator and required discontinuation of the examination, and 2 patients with pacemakers experienced pacing inhibition during brain and cervical spine MRI, but the examination could be completed. Observed changes in device variables in other patients did not require device revision or reprogramming. With electrophysiologic monitoring, MRI can be done safely in patients with selected cardiac devices.
Pentraxin-3 (PTX3) may be a useful biomarker of disease activity in Takayasu arteritis. This study found that PTX3 levels were higher in patients with Takayasu arteritis than in healthy patients and those with acute infection. A plasma PTX3 level greater than 1 ng/mL was more accurate than normal thresholds of C-reactive protein or erythrocyte sedimentation rate for distinguishing active from inactive disease. Confirmation of these findings in patients with unknown or equivocal disease activity is necessary before PTX3 measurement can be more broadly recommended.
This systematic review of primary care–based weight loss interventions for adults was done to inform a U.S. Preventive Services Task Force recommendation. Recipients of behavioral interventions lost 3 kg more than control participants after 12 to 18 months. Orlistat plus behavioral intervention resulted in 3-kg more weight loss than placebo after 12 months. Metformin resulted in less weight loss. Data on the effects of weight loss treatment on long-term health outcomes were insufficient. Participants often withdrew from studies because of gastrointestinal symptoms, but data on serious harms were insufficient.
This systematic review of 52 studies involving 55 268 patients compared gestalt (a physician's unstructured estimate) and clinical decision rules for evaluating adults with suspected pulmonary embolism and assessed the failure rate of these methods when used in combination with d-dimer testing. Combining a decision rule or gestalt with d-dimer testing seemed safe for most strategies. The authors recommend standardized rules because gestalt has lower specificity, but the choice of a particular rule and d-dimer test depends on prevalence and setting.
Funding for graduate medical education (GME) has come under scrutiny. Although indirect medical education expenses may have decreased over the past 25 years, direct medical education expenses have increased. This commentary examines the adequacy of current funding and recommends reexamining GME financing and considering options that ensure appropriate government support and participation of other health care insurers.
Six weeks after the May 2010 general election in the United Kingdom, a white paper proposing profound changes to the structure and organization of the National Health Service (NHS) was published. The change that generated the most discussion was the proposal that general practitioners be placed at the center of the system and given control of about 80% of the NHS's £100 billion budget. This article outlines the current organization of the NHS and the rationale for government proposals for change.
Nazarian and colleagues' report in this issue represents the largest published experience to date of MRI in patients with standard, contemporary cardiac rhythm management devices. The editorialists review the concerns regarding use of MRI in patients with these devices, discuss the strengths and limitations of the current study's findings, and explore how the results should influence clinical practice and regulatory policy.
Losing a parent in childhood isn't just the loss of the parent you knew; it's also the melancholy vacuum of the future you might have had. This was the measure that choreographed my life, and at the core of it, always that insistent question: What happened?
In the beginning, she was the same age, the same height, and the same weight as the young doctor. She had come into the hospital for a broken foot that had somehow become leukemia. She wore strange hats and swore she would write a book when all of this was finished.