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In this narrative medicine essay, a critical care physician works through lessons he learned from his experience with a man with end-stage lung disease going into terminal respiratory failure who consented to intubation only if he had a chance for a lung transplant and considers how to balance patient autonomy with medical paternalism when good outcomes are unlikely and the best decisions are uncertain.
This systematic review to support the 2019 US Preventive Services Task Force Recommendation Statement on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer summarizes published evidence on the benefits and harms of assessment, counseling, and testing in women without recently diagnosed BRCA1/2-related cancer.
With the swinging of the pendulum in the science of medicine has come the fashion of neglecting pathology, the pathology of the type called, in the olden days, morbid anatomy. This neglect is shown in many ways: in a diminution in the volume of published work; in the lessened number of necropsies performed, and in the smaller number of men who are actively interested in the subject. It may be that the great days of Rokitansky, of Virchow and of Cohnheim have passed never to return; but it is more likely that the next swing of the pendulum will bring with it a renewed interest in the study of the anatomic changes which accompany disease.
Smoking cessation improves cardiovascular health, but not right away. Studies have come to different conclusions about how long it takes for the excess risk associated with smoking to subside to the level of a never smoker, with estimates varying widely, from 2 to 20 years. The study by Duncan et al, which was based on repeated assessments of tobacco exposure, other risk factors, and cardiovascular disease (CVD) outcomes, provides estimates of cardiovascular risk among former smokers that are likely to be more precise and accurate than those of previous studies. This information is important for clinicians and patients. According to these new analyses, a former smoker’s risk of CVD does not approximate the risk of a never smoker until 10 to.
Psychotic features, such as delusions of guilt or persecution, in major depressive disorder (MDD) attracted little research interest before the observation that patients with psychotic depression responded poorly to tricyclic antidepressants. Subsequent work showed that other depressive symptoms, particularly those of the melancholic subtype, are substantially more severe in this condition than they are in MDD without psychotic features. Second only to those with catatonic features, patients with psychotic features are most likely to experience hyperactivity of the hypothalamic-pituitary-adrenal axis and are much less likely than those without psychotic features to respond to placebo or to hospitalization alone.
In the Original Investigation entitled "Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial," published in the June 11, 2019, issue of JAMA, patient numbers were transposed in a sentence in the Results section of the text.
The FDA recently approved bremelanotide for acquired generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. It’s the first “as-needed” treatment for HSDD, a common condition characterized by low libido that causes distress or interpersonal difficulty and isn’t attributed to a coexisting medical or psychiatric condition, relationship problems, or medications.
In Reply We agree with Ms Leasure and Dr Sheth that there is no firm evidence to support timing of restarting anticoagulation therapy following IPH, particularly for new-generation anticoagulants. We stated in our review that restarting anticoagulation therapy should be delayed by 1 to 2 months in patients with nonlobar IPH unrelated to amyloid angiopathy, but we did not state that anticoagulation therapy must be restarted in all cases at this time. In patients with a correctable etiologic cause of IPH and stronger indications for anticoagulation therapy, such as mechanical heart valves, anticoagulation therapy may need to be restarted even sooner. As Leasure and Sheth acknowledge, we summarized the available evidence to date, including a m.

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