Medscape Medical News Meta-analysis showed small significant reductions in burnout with existing interventions; organization-directed interventions, although rare, have the greatest treatment effect.
Medscape Medical News A breakdown of winners — and a few losers — in the sprawling Cures Act approved by the House.
Kaiser Health News The ConvertX nephroureteral stent system converts from a catheter to a stent in a short office procedure, eliminating the need for a second interventional procedure.
FDA Approvals Pivotal registration trials for CAR T cell therapies have now been completed, and two products could be approved by the end of 2017.
Medscape Medical News If adopted, this bill would ban information blocking, require the use of application programming interfaces for EHR interoperability, and convene stakeholders to facilitate information exchange.
Medscape Medical News Scripted answers, branding, fear of job loss, malnutrition, injuries in unusual places, and payments made with cash are all signs that physicians need to watch to identify human trafficking victims.
Medscape Medical News New randomized trials of an oral formulation of cannabidiol show reduced seizures in children with Dravet and Lennox-Gastaut syndromes.
Medscape Medical News New technologies can help surgeons visualize malformations in the fetus and give parents a better understanding of what is going on with their child.
Medscape Medical News A large database analysis of women of childbearing age with diabetes suggests intrauterine devices and subdermal contraceptives pose the lowest thrombotic risk.
Medscape Medical News Physician-assisted dying is controversial, but this physician says that it is humane to help people with terminal diseases who are suffering terribly.
Medscape Business of Medicine Cases of colon and rectal cancer are on the rise in people under the age of 50, a group that’s rarely screened for them.
WebMD Health News Drs Mandrola and Piccini compare the SMAC AF trial with the ARREST-AF trial on risk factor modification to improve catheter ablation success rates in patients with atrial fibrillation.
theheart.org on Medscape The American Optometric Association annual survey shows doctors of optometry pick up an amazing number of people with diabetes who don't know they have it and are thus at risk for complications.
Medscape Medical News Thyroid disease in children is surprisingly common -- and frequently missed. Dr Andrew Bauer provides key strategies to be sure these kids do not fall through the cracks.
CHOP Expert Commentary Obinutuzumab for induction and maintenance was better than the current standard of care for follicular lymphoma, but caution is warranted with chemotherapy used as part of induction.
Medscape Medical News At baseline, more than 30% of patients with early axial spondyloarthritis were already on trajectories associated with persistent high disease activity and greater work disability.
Medscape Medical News What should be done when a unordered subset of laboratory tests generates critical or potentially clinically significant results?
Laboratory Medicine The illegal practice of 'dumping' is a significant and distressing issue for nursing home residents and their families. What's the solution?
American Nurse Today A survey of parents highlights some common reasons why they may choose to defer the administration of the HPV vaccine.
Journal of Pediatric Health Care
Launching a plan for the Cancer Moonshot.
Lancet. 2016 Sep 17;388(10050):1130
Authors: The Lancet
PMID: 27650078 [PubMed - indexed for MEDLINE]
An unusual extranodal T-cell non-Hodgkin lymphoma.
Lancet. 2016 Sep 10;388(10049):1127-8
Authors: Coats JT, Mackie AD, Kernohan NM, Ramkumar PG, McMahon LM, Goodlad JR, Tauro S
PMID: 27628520 [PubMed - indexed for MEDLINE]
Oil dependence and terrorism in Europe.
Lancet. 2016 Sep 10;388(10049):1055
Authors: Guerrier G
PMID: 27628518 [PubMed - indexed for MEDLINE]
Routine molecular profiling of patients with NSCLC.
Lancet. 2016 Sep 10;388(10049):1054
Authors: Schildgen V, Schildgen O
PMID: 27628517 [PubMed - indexed for MEDLINE]
Hepatitis C: the path towards effective universal therapy.
Lancet. 2016 Sep 10;388(10049):1051-2
Authors: Piroth L, Rabaud C, Rey D, Schmit JL, Chirouze C, Beck-Wirth G, Robineau O, Bani-Sadr F, ICONE Study Group
PMID: 27628513 [PubMed - indexed for MEDLINE]
Inuit take action towards suicide prevention.
Lancet. 2016 Sep 10;388(10049):1036-8
Authors: Crawford A
PMID: 27628510 [PubMed - indexed for MEDLINE]
Zika's emerging threat for the Asia-Pacific region.
Lancet. 2016 Sep 10;388(10049):1026
Authors: The Lancet
PMID: 27628509 [PubMed - indexed for MEDLINE]
Robotic surgery evaluation: 10 years too late.
Lancet. 2016 Sep 10;388(10049):1026
Authors: The Lancet
PMID: 27628508 [PubMed - indexed for MEDLINE]
The 2016 US Election: a platform for improving health.
Lancet. 2016 Sep 10;388(10049):1025
Authors: The Lancet
PMID: 27628507 [PubMed - indexed for MEDLINE]
Against the odds, Sri Lanka eliminates malaria.
Lancet. 2016 Sep 10;388(10049):1038-9
Authors: Senaratne R, Singh PK
PMID: 27613520 [PubMed - indexed for MEDLINE]
Profile: Istituto Superiore di Sanità, Rome, Italy.
Lancet. 2016 Sep 10;388(10049):1044
Authors: Paterleni M
PMID: 27590219 [PubMed - indexed for MEDLINE]
Protect Syria's doctors: an open letter to world leaders.
Lancet. 2016 Sep 10;388(10049):1056
Authors: Ghaleb S, Mukwege DM, Roberts R, Sulkowicz KJ, Vlassov VV, 23 signatories, a full list of signatories is available in the appendix
PMID: 27581530 [PubMed - indexed for MEDLINE]
Improving outcomes in dialysis fistulae.
Lancet. 2016 Sep 10;388(10049):1029-30
Authors: Mamode N, Calder F
PMID: 27492882 [PubMed - indexed for MEDLINE]
Innovation and surgical clinical trials.
Lancet. 2016 Sep 10;388(10049):1027-8
Authors: Mayer E, Darzi A
PMID: 27474377 [PubMed - indexed for MEDLINE]
Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study.
Lancet. 2016 Sep 10;388(10049):1057-66
Authors: Yaxley JW, Coughlin GD, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, Dunglison N, Carter R, Williams S, Payton DJ, Perry-Keene J, Lavin MF, Gardiner RA
BACKGROUND: The absence of trial data comparing robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy is a crucial knowledge gap in uro-oncology. We aimed to compare these two approaches in terms of functional and oncological outcomes and report the early postoperative outcomes at 12 weeks.
METHOD: In this randomised controlled phase 3 study, men who had newly diagnosed clinically localised prostate cancer and who had chosen surgery as their treatment approach, were able to read and speak English, had no previous history of head injury, dementia, or psychiatric illness or no other concurrent cancer, had an estimated life expectancy of 10 years or more, and were aged between 35 years and 70 years were eligible and recruited from the Royal Brisbane and Women's Hospital (Brisbane, QLD). Participants were randomly assigned (1:1) to receive either robot-assisted laparoscopic prostatectomy or radical retropubic prostatectomy. Randomisation was computer generated and occurred in blocks of ten. This was an open trial; however, study investigators involved in data analysis were masked to each patient's condition. Further, a masked central pathologist reviewed the biopsy and radical prostatectomy specimens. Primary outcomes were urinary function (urinary domain of EPIC) and sexual function (sexual domain of EPIC and IIEF) at 6 weeks, 12 weeks, and 24 months and oncological outcome (positive surgical margin status and biochemical and imaging evidence of progression at 24 months). The trial was powered to assess health-related and domain-specific quality of life outcomes over 24 months. We report here the early outcomes at 6 weeks and 12 weeks. The per-protocol populations were included in the primary and safety analyses. This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), number ACTRN12611000661976.
FINDINGS: Between Aug 23, 2010, and Nov 25, 2014, 326 men were enrolled, of whom 163 were randomly assigned to radical retropubic prostatectomy and 163 to robot-assisted laparoscopic prostatectomy. 18 withdrew (12 assigned to radical retropubic prostatectomy and six assigned to robot-assisted laparoscopic prostatectomy); thus, 151 in the radical retropubic prostatectomy group proceeded to surgery and 157 in the robot-assisted laparoscopic prostatectomy group. 121 assigned to radical retropubic prostatectomy completed the 12 week questionnaire versus 131 assigned to robot-assisted laparoscopic prostatectomy. Urinary function scores did not differ significantly between the radical retropubic prostatectomy group and robot-assisted laparoscopic prostatectomy group at 6 weeks post-surgery (74·50 vs 71·10; p=0·09) or 12 weeks post-surgery (83·80 vs 82·50; p=0·48). Sexual function scores did not differ significantly between the radical retropubic prostatectomy group and robot-assisted laparoscopic prostatectomy group at 6 weeks post-surgery (30·70 vs 32·70; p=0·45) or 12 weeks post-surgery (35·00 vs 38·90; p=0·18). Equivalence testing on the difference between the proportion of positive surgical margins between the two groups (15 [10%] in the radical retropubic prostatectomy group vs 23 [15%] in the robot-assisted laparoscopic prostatectomy group) showed that equality between the two techniques could not be established based on a 90% CI with a Δ of 10%. However, a superiority test showed that the two proportions were not significantly different (p=0·21). 14 patients (9%) in the radical retropubic prostatectomy group versus six (4%) in the robot-assisted laparoscopic prostatectomy group had postoperative complications (p=0·052). 12 (8%) men receiving radical retropubic prostatectomy and three (2%) men receiving robot-assisted laparoscopic prostatectomy experienced intraoperative adverse events.
INTERPRETATION: These two techniques yield similar functional outcomes at 12 weeks. Longer term follow-up is needed. In the interim, we encourage patients to choose an experienced surgeon they trust and with whom they have rapport, rather than a specific surgical approach.
FUNDING: Cancer Council Queensland.
PMID: 27474375 [PubMed - indexed for MEDLINE]
US prisons missing opportunities to tackle HIV in inmates.
Lancet. 2016 Sep 10;388(10049):1041-2
Authors: Rubin R
PMID: 27427458 [PubMed - indexed for MEDLINE]
Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees.
Lancet. 2016 Sep 10;388(10049):1089-102
Authors: Dolan K, Wirtz AL, Moazen B, Ndeffo-Mbah M, Galvani A, Kinner SA, Courtney R, McKee M, Amon JJ, Maher L, Hellard M, Beyrer C, Altice FL
The prison setting presents not only challenges, but also opportunities, for the prevention and treatment of HIV, viral hepatitis, and tuberculosis. We did a comprehensive literature search of data published between 2005 and 2015 to understand the global epidemiology of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV), and tuberculosis in prisoners. We further modelled the contribution of imprisonment and the potential impact of prevention interventions on HIV transmission in this population. Of the estimated 10·2 million people incarcerated worldwide on any given day in 2014, we estimated that 3·8% have HIV (389 000 living with HIV), 15·1% have HCV (1 546 500), 4·8% have chronic HBV (491 500), and 2·8% have active tuberculosis (286 000). The few studies on incidence suggest that intraprison transmission is generally low, except for large-scale outbreaks. Our model indicates that decreasing the incarceration rate in people who inject drugs and providing opioid agonist therapy could reduce the burden of HIV in this population. The prevalence of HIV, HCV, HBV, and tuberculosis is higher in prison populations than in the general population, mainly because of the criminalisation of drug use and the detention of people who use drugs. The most effective way of controlling these infections in prisoners and the broader community is to reduce the incarceration of people who inject drugs.
PMID: 27427453 [PubMed - indexed for MEDLINE]
On both sides of the prison walls-prisoners and HIV.
Lancet. 2016 Sep 10;388(10049):1032-3
Authors: Das P, Horton R
PMID: 27427449 [PubMed - indexed for MEDLINE]
Prisoners, prisons, and HIV: time for reform.
Lancet. 2016 Sep 10;388(10049):1033-5
Authors: Beyrer C, Kamarulzaman A, McKee M, Lancet HIV in Prisoners Group
PMID: 27427447 [PubMed - indexed for MEDLINE]