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The shoulder impingement syndrome is often treated with corticosteroid injections or manual physical therapy. This randomized trial compared the effectiveness of these treatments and found that patients receiving 1 to 3 injections and those receiving 6 sessions of manual physical therapy had similar improvements in shoulder pain and function. Patients who received a corticosteroid injection sought more shoulder-related health care throughout the 1-year follow-up.

Topics: adrenal corticosteroids, shoulder impingement syndrome, corticosteroid injections, local, manual therapies, injection of ...
Mina Kabiri, MS; Alison B. Jazwinski, MD; Mark S. Roberts, MD; Andrew J. Schaefer, PhD; and Jagpreet Chhatwal, PhD

Chronic hepatitis C virus (HCV) infection causes a substantial health and economic burden in the United States. The authors used an individual-level, state-transition model to predict the effect of new therapies and screening on chronic HCV infection and associated disease outcomes. They concluded that new therapies and widespread implementation of screening and treatment will play an important role in reducing the burden of HCV infection.

Topics: hepatitis c, chronic, hepatitis c, united states, hepatitis c virus
Matteo Goldoni, PhD; Silvia Bonini, MD; Maria L. Urban, MD; Alessandra Palmisano, MD; Giuseppe De Palma, MD, PhD; Elisa Galletti, MD; Marco Coggiola, MD; Carlo Buzio, MD; Antonio Mutti, MD; and Augusto Vaglio, MD, PhD

Idiopathic retroperitoneal fibrosis (RPF) is a rare disease that has an unclear but probably multifactorial pathogenesis. This case–control study examined the role of exposure to occupational and environmental agents as potential risk factors for the disease. Asbestos exposure and smoking were strong risk factors for RPF that had a multiplicative effect on risk.

Topics: smoking, retroperitoneal fibrosis, risk factors, asbestos exposure
Christina D. Wirth, MD; Manuel R. Blum, MD; Bruno R. da Costa, PhD; Christine Baumgartner, MD; Tinh-Hai Collet, MD; Marco Medici, MD, MSc; Robin P. Peeters, MD, PhD; Drahomir Aujesky, MD, MSc; Douglas C. Bauer, MD; and Nicolas Rodondi, MD, MAS

The association between subclinical thyroid dysfunction and fractures remains unclear. This meta-analysis of 7 population-based, prospective cohort studies assessed associations between hip and nonspine fractures and subclinical thyroid dysfunction. The findings suggested a possibly increased risk for fracture associated with subclinical hyperthyroidism, but to prove causality, the authors call for large, high-quality randomized trials.

Topics: fracture, thyroid diseases, hyperthyroidism, subclinical, osteoporotic fracture risk, subclinical hypothyroidism
E. Blair Solow, MD; Salahuddin Kazi, MD; and Una E. Makris, MD

This Update summarizes studies published in 2013 that the authors consider highly relevant to the practice of rheumatology. Topics include osteoarthritis, rheumatoid arthritis, psoriatic arthritis, and alternative approaches to health care delivery.

Topics: rheumatoid arthritis, arthritis, fish oil, arthritis, psoriatic, methotrexate, osteoarthritis, rheumatology, knee meniscus ...

This update summarizes studies published in 2013 that the authors consider highly relevant to the practice of gastroenterology and hepatology. Topics include esophageal diseases, gastrointestinal bleeding and peptic ulcer disease, lower gastrointestinal disorders, and liver disease.

Topics: anticoagulants, oral, antibiotic resistance, bacterial, diet, esophageal disease, gastrointestinal bleeding, hepatic encephalopathy, ...
Amir Qaseem, MD, PhD, MHA; Paul Dallas, MD; Douglas K. Owens, MD, MS; Melissa Starkey, PhD; Jon-Erik C. Holty, MD, MS; Paul Shekelle, MD, PhD, for the Clinical Guidelines Committee of the American College of Physicians

In this guideline on the diagnosis of obstructive sleep apnea in adults, the American College of Physicians recommends a sleep study for patients with unexplained daytime sleepiness, polysomnography for diagnostic testing in patients with suspected obstructive sleep apnea, and portable sleep mon-itors in patients without serious comorbid conditions when polysomnography is not available for diagnostic testing.

Topics: obstructive sleep apnea, clinical practice guideline, polysomnography: apnea-hypopnea index, sleep, polysomnography, hypertension, ...

Recent changes in the board certification process are a topic of much debate. This commentary presents the American Board of Internal Medicine's perspective on changes in the certification process and their importance to professional self-regulation.

Topics: certification, credentialing, internal medicine, professional autonomy, social control, informal, specialty boards

In this issue, Rhon and colleagues compared the effective-ness of corticosteroid injections and manual physical therapy in treating the shoulder impingement syndrome and found that clinical outcomes are similar. The editorialists discuss the study and stress that physicians should discuss patient preferences, the availability of practitioners, and other care options when choosing a plan to manage shoulder pain.

Topics: adrenal corticosteroids, shoulder impingement syndrome, shoulder pain, corticosteroid injections, local, manual therapies, ...
Robert M. Centor, MD; David A. Fleming, MD, MA; and Darilyn V. Moyer, MD

In this issue, American Board of Internal Medicine leaders discussed recent changes in the certification process. The editorialists describe why many believe that the current process is burdensome and not beneficial and offer suggestions for an assessment process that better reflects the skills necessary to be a good internist.

Topics: certification, internal medicine, specialty boards, professional development

We had just finished rounds at the Hospital Universitario del Valle in Cali, Colombia. To my surprise, the resident turned to me and said, “I have to go now—the strike is beginning.”

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Claude Bachmeyer, MD; Milène Buffo, MD; and Bérénice Soyez, MD
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Charlene A. Wong, MD; David A. Asch, MD, MBA; Cjloe M. Vinoya, BS; Carol A. Ford, MD; Tom Baker, JD; Robert Town, PhD; and Raina M. Merchant, MD, MSHP
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Peter V. Rabins, MD, MPH; and David M. Blass, MD
Includes: CME
Topics: alzheimer's disease, vascular dementia, dementia, lewy body disease, frontotemporal dementia, dementia screening ...
Topics: adrenal corticosteroids, shoulder impingement syndrome, shoulder pain, corticosteroid injections, local, manual therapies, ...
Topics: hypertension, obstructive sleep apnea, polysomnography, preoperative care, sleep, clinical practice guideline, polysomnography: ...
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