Joint Letter to U.S. House of Representatives Appropriation Committee Supporting Funding for the CDC Office on Smoking and Health

Joint Letter to Senate Appropriation Committee Supporting Funding for the CDC Office on Smoking and Health

Joint letter to Congressional appropriators supporting funding for the Centers for Disease Control and Prevention Office on Smoking and Health

Joint Letter to Senate Appropriations Committees Supporting Funding for Centers for Disease Control and Prevention Tobacco Cessation and Prevention Activities

Joint Letter on National Adult Hepatitis B Vaccination Awareness Day Resolution

Joint Letter to Congress Asking for Support for Primary Care Practices in Upcoming COVID-19 Legislation

Long-Term Care of the Elderly

Inner-City Health Care

Individual Mandates in Health Insurance Reform

Research in the Physician's Office: Navigating the Ethical Minefields

Should We Abandon Routine Visits? There Is Little Evidence for or Against

Warning Symptoms Are Associated With Survival From Sudden Cardiac Arrest

Background: Survival after sudden cardiac arrest (SCA) remains low, and tools for improved prediction of patients at long-term risk for SCA are lacking. Alternative short-term approaches aimed at preemptive risk stratification and prevention are needed. Objective: To assess characteristics of symptoms in the 4 weeks before SCA and whether response to these symptoms is associated with better outcomes. Design: Ongoing prospective population-based study. Setting: Northwestern United States (2002 to 2012). Patients: Residents aged 35 to 65 years with SCA. Measurement: Assessment of symptoms in the 4 weeks preceding SCA and association with survival to hospital discharge. Results: Of 839 patients with SCA and comprehensive assessment of symptoms (mean age, 52.6 years [SD, 8]; 75% men), 430 (51%) had warning symptoms (50% of men vs. 53% of women; P  = 0.59), mainly chest pain and dyspnea. In most symptomatic patients (93%), symptoms recurred within the 24 hours preceding SCA. Only 81 patients (19%) called emergency medical services (911) to report symptoms before SCA; these persons were more likely to be patients with a history of heart disease (P < 0.001) or continuous chest pain (P < 0.001). Survival when 911 was called in response to symptoms was 32.1% (95% CI, 21.8% to 42.4%) compared with 6.0% (CI, 3.5% to 8.5%) in those who did not call (P < 0.001). Limitation: Potential for recall and response bias, symptom assessment not available in 24% of patients, and missing data for some patients and SCA characteristics. Conclusion: Warning symptoms frequently occur before SCA, but most are ignored. Emergent medical care was associated with survival in patients with symptoms, so new approaches are needed for short-term prevention of SCA. Primary Funding Source: National Heart, Lung, and Blood Institute.

Autopsy Findings and Venous Thromboembolism in Patients With COVID-19

A Central Venous Catheter That Cannot Be Dislodged Easily by a Confused Patient

Tattoo Pigment–Induced Granulomatous Lymphadenopathy Mimicking Lymphoma

In osteoporosis or osteopenia, exercise interventions improve BMD; effects vary by exercise type and BMD site

Source Citation Zhang S, Huang X, Zhao X, et al. Effect of exercise on bone mineral density among patients with osteoporosis and osteopenia: a systematic review and network meta-analysis. J Clin Nurs. 2021. [Epub ahead of print]. 34725872

Annals for Educators - 17 September 2019

Annals for Educators - 7 May 2019

How Would You Manage This Patient With Iron Deficiency Anemia? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Iron deficiency anemia (IDA) is the most common cause of anemia worldwide and a major cause of disability, manifesting with symptoms including fatigue, weakness, exercise intolerance, worsening heart failure, impaired concentration, irritability, and depression. Women of reproductive age are disproportionately affected due to menstrual blood loss and gynecologic disorders. Iron deficiency anemia is diagnosed in patients who have both iron deficiency (ID), noted by low ferritin level and/or transferrin saturation, and anemia. Notably, iron deficiency (ID) can also occur in the absence of anemia, and overreliance on hemoglobin thresholds may risk missing the diagnosis in menstruating women due to flawed sex-specific reference ranges. Work-up for ID and IDA should focus on identifying the underlying cause of anemia, and may include a gynecologic work-up, bidirectional endoscopy, testing for Helicobacter pylori infection and celiac disease, as well as administering a trial of iron. Iron deficiency can be treated with either oral or intravenous iron. Although several guidelines address the diagnosis or management of ID and IDA, they differ in their recommendations based on the population studied, the clinical context, and the quality of the underlying evidence. Here, 2 hematologists and coauthors of the 2025 Iron Consortium Guideline published in Lancet Haematology discuss areas of guideline uncertainty relating to the diagnosis, evaluation, and treatment of patients with IDA and for Ms. B, a young woman diagnosed with ID.

Q&A: Ezekiel Emanuel’s simple rules