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Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery.
Obstetrics and Gynecology;

Oct 24th, 2017 - Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal delivery the possibility of achieving that goal-a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient's preference for vaginal delivery, at an ...

Immune Status and Associated Mortality After Cancer Treatment Among Individuals With HIV in the Antiretroviral Therapy Era
JAMA Oncology; Calkins KL, et al

Dec 4th, 2019 - What is the association between cancer treatment and CD4 count and HIV RNA level, and how are these markers associated with all-cause mortality among people with HIV?

FDA approves system for the delivery of ear tubes under local anesthesia to treat ear infection

Nov 30th, 2019 - The U.S. Food and Drug Administration today approved a new system for the delivery of tympanostomy tubes, commonly referred to as ear tubes, that can be inserted into the eardrum to treat recurrent ear infections (i.e., otitis media). The Tubes Under Local Anesthesia (Tula) System is the first ear tube delivery system that can be performed in young children using local anesthesia in a physician...

Breast Cancer Screening and Diagnosis: A Synopsis of the European Breast Guidelines
Annals of Internal Medicine; Holger J. Schünemann, et al

Nov 30th, 2019 - This synopsis of the European Breast Guidelines provides recommendations regarding organized screening programs for women aged 40 to 75 years who are at average risk. The recommendations address digital mammography screening and the addition of hand-held ultrasonography, automated breast ultrasonography, or magnetic resonance imaging compared with mammography alone. The recommendations also dis...

Supplemental MRI Screening for Women with Extremely Dense Breast Tissue
NEJM Bakker MF, et al

Nov 27th, 2019 - Extremely dense breast tissue is a risk factor for breast cancer and limits the detection of cancer with mammography. Data are needed on the use of supplemental magnetic resonance imaging (MRI) to improve early detection and reduce interval breast cancers in such patients.

2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; P...
Circulation Soar J et al

Nov 16th, 2019 - The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the m...

FDA approves first contact lens indicated to slow the progression of nearsightedness in children

Nov 16th, 2019 - The U.S. Food and Drug Administration today approved the first contact lens indicated to slow the progression of myopia (nearsightedness) in children between the ages of 8 and 12 years old at the initiation of treatment. The MiSight contact lens is a single use, disposable, soft contact lens that is discarded at the end of each day, and is not intended to be worn overnight.

2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest...
Circulation Panchal AR et al

Nov 16th, 2019 - The fundamentals of cardiac resuscitation include the immediate provision of high-quality cardiopulmonary resuscitation combined with rapid defibrillation (as appropriate). These mainstays of therapy set the groundwork for other possible interventions such as medications, advanced airways, extracorporeal cardiopulmonary resuscitation, and post–cardiac arrest care, including targeted temperature...

Preexposure Prophylaxis for the Prevention of HIV Infection: Recommendation Statement

Nov 16th, 2019 - Summary of Recommendation and Evidence The USPSTF recommends that clinicians offer preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition (Table 1). A recommendation.

Subclinical Cardiovascular Disease in HIV Controller & Long‐term Nonprogressor Populations
HIV Medicine; Brusca RM, et al

Nov 13th, 2019 - Elite controllers (ECs), viraemic controllers (VCs), and long‐term nonprogressors (LTNPs) control HIV viral replication or maintain CD4 T‐cell counts without antiretroviral therapy, but may have increased cardiovascular disease (CVD) risk compared to HIV‐uninfected persons. We evaluated subclinical carotid and coronary atherosclerosis and inflammatory biomarker levels among HIV controllers, LTN...

Is There a Difference in Breast Cancer Recurrence Rates After Surgery With Regional vs General Anesthesia?
ASCO Post; Stenger M

Nov 11th, 2019 - In a trial reported in The Lancet, Sessler et al found no difference in breast cancer recurrence after surgery with regional anesthesia-analgesia using paravertebral block and propofol vs general anesthesia with the volatile anesthetic sevoflurane and opioid analgesia. They also found no difference in persistent incisional pain between approaches.

Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices
Pediatrics Armstrong, S. et. al.

Oct 27th, 2019 - Severe obesity among youth is an “epidemic within an epidemic” and portends a shortened life expectancy for today’s children compared with those of their parents’ generation. Severe obesity has outpaced less severe forms of childhood obesity in prevalence, and it disproportionately affects adolescents. Emerging evidence has linked severe obesity to the development and progression of multiple co...

Asthma in Adults
Medical Clinics of North America; Nanda A, et al

Oct 27th, 2019 - Asthma affects approximately 300 million people worldwide and approximately 7.5% of adults in the United States. Among adults, asthma results in about 10.5 million physician office visits per year and affects approximately 8.7% of blacks, 7.6% of whites, and 5.8% of Hispanics. Asthma is characterized by inflammation of airways, variable airflow obstruction, and bronchial hyperresponsiveness.3 I...

Breast Implants - Certain Labeling Recommendations to Improve Patient Communication

Oct 23rd, 2019 - This draft guidance contains recommendations concerning the content and format for certain labeling information for saline and silicone gel-filled breast implants. FDA is issuing this draft guidance to help ensure that a patient receives and understands the benefits and risks of these devices. The recommendations are being made based on concerns that some patients are not receiving and/or under...

Breast Implants: Additional Resources

Oct 23rd, 2019 - This page suggests other resources for more information on breast implant issues

Statement on the agency’s continued efforts to protect women’s health and enhance safety information available to patients considering breast implants

Oct 22nd, 2019 - The U.S. Food and Drug Administration is taking another significant step in protecting women’s health by helping to ensure patients have complete information about the benefits and risks of breast implants. In a draft guidance issued today, we are providing proposed labeling recommendations to manufacturers of these devices to help ensure women receive and understand information regarding the b...

Risks and Complications of Breast Implants

Oct 22nd, 2019 - The webpage provides information about some of the complications and adverse outcomes of breast implants

Acne Vulgaris: Diagnosis and Treatment
American Family Physician;

Oct 14th, 2019 - Acne vulgaris is the most prevalent chronic skin disease in the United States, affecting nearly 50 million people per year, mostly adolescents and young adults. Potential sequelae of acne, such as scarring, dyspigmentation, and low self-esteem, may result in significant morbidity. Typical acne lesions involve the pilosebaceous follicles and the interrelated processes of sebum production, Cutiba...

Breast Cancer Treatment (Adult) (PDQ®)–Health Professional Version

Oct 3rd, 2019 - Breast cancer is the most common noncutaneous cancer in U.S. women, with an estimated 62,930 cases of in situ disease and 268,600 cases of invasive disease in 2019.[1] Thus, fewer than one of six women diagnosed with breast cancer die of the disease. By comparison, it is estimated that about 66,020 American women will die of lung cancer in 2019. Men account for 1% of breast cancer cases and bre...

FDA Approves Abbott’s "Low Dose," Recharge-Free Spinal Cord Stimulation System with up to Ten Year Battery Life for People Living with Chronic Pain

Sep 25th, 2019 - Proclaim XR neurostimulation system uses Abbott’s proprietary, low energy BurstDR™ therapy coupled with the BoldXR™ low dosing protocol for safe, effective pain relief and a battery that lasts up to 10 Years*

Over-the-Counter Access to Hormonal Contraception: ACOG Committee Opinion Summary, Number 788
Obstetrics & Gynecology;

Sep 24th, 2019 - ABSTRACT: Barriers to access are one reason for inconsistent or nonuse of contraception. The requirement for a prescription can be an obstacle for some contraceptive users. Several studies have demonstrated that women are capable of using self-screening tools to determine their eligibility for hormonal contraceptive use. Pelvic and breast examinations, cervical cancer screening, and sexually tr...

Breast Cancer Screening in High-Risk Men: A 12-Year Longitudinal Observational Study of Male Breast Imaging Utilization and Outcomes

Sep 16th, 2019 - Background Male breast cancer incidence is rising. There may be a potential role in selective screening in men at elevated risk for breast cancer, but the effectiveness of such screening remains unexplored. Purpose To evaluate patterns of male breast imaging utilization, to determine high-risk screening outcomes, and to delineate risk factors associated with cancer diagnosis. Materials ...

Do We Need an Apgar Score for Older Adults?

Sep 15th, 2019 - The Apgar (appearance, pulse, grimace, activity, and respiration) is a 1-minute test done shortly after birth to indicate whether the neonate requires medical attention. It focuses on the condition of the infant immediately after delivery and has survived the test of time for more than a half century.1 Similarly, a 3-item, 10-point surgical Apgar score immediately postoperatively can identify p...

Risk of rhabdomyolysis with donepezil compared with rivastigmine or galantamine: a population-based cohort study

Sep 15th, 2019 - BACKGROUND: Donepezil, rivastigmine and galantamine are popular cholinesterase inhibitors used to manage the symptoms of Alzheimer disease and other dementias; regulatory agencies in several countries warn about a possible risk of rhabdomyolysis with donepezil, based on information from case reports. Our goal was to investigate the 30-day risk of admission to hospital with rhabdomyolysis associ...

Urinary Incontinence in Women: Evaluation and Management
American Family Physician;

Sep 14th, 2019 - Urinary incontinence is a common problem among women worldwide, resulting in a substantial economic burden and decreased quality of life. The Women's Preventive Services Initiative is the only major organization that recommends annual screening for urinary incontinence in all women despite low to insufficient evidence regarding effectiveness and accuracy of methods. No other major organization ...

Advanced MRI brain scan may help predict stroke-related dementia

Sep 11th, 2019 - An advanced Magnetic Resonance Imaging (MRI) brain scan analysis in patients with stroke-related, small vessel disease helped predict problems with thinking, memory and even dementia, according to new research published in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.

Menopausal Estrogen-Alone Therapy and Health Outcomes in Women With and Without Bilateral Oophorectomy: A Randomized Trial
Annals of Internal Medicine;

Sep 9th, 2019 - Background: Whether health outcomes of menopausal estrogen therapy differ between women with and without bilateral salpingo-oophorectomy (BSO) is unknown. Objective: To examine estrogen therapy outcomes by BSO status, with additional stratification by 10-year age groups. Design: Subgroup analyses of the randomized Women's Health Initiative Estrogen-Alone Trial. (ClinicalTrials.gov: NCT...

Discover More About Core Needle Biopsy | Susan G. Komen®

Sep 5th, 2019 - If you have a lump or abnormal mammogram, you may need a core needle biopsy to diagnose, or rule out breast cancer. Learn more about the procedure at Susan G. Komen.

Laparoscopic management of a migrated intragastric balloon causing mechanical small bowel obstruction: a case report and review of the literature
Annals of The Royal College of Surgeons of England; Hay D, et al

Sep 5th, 2019 - Intragastric balloons have been used as an invasive non-surgical treatment for obesity for over 30 years. Within the last 37 years, we have found only 27 cases reported in the literature of intestinal obstruction caused by a migrated intragastric balloon. We report the laparoscopic management of such a case and make observations from similar case presentations published in the literature. A ...

Phase II Study of Proton Beam Radiation Therapy for Patients With Breast Cancer Requiring Regional Nodal Irradiation
Jimenez, R. et. al.

Aug 25th, 2019 - PURPOSE To evaluate the safety and efficacy of proton beam radiation therapy (RT) for patients with breast cancer who require regional nodal irradiation. METHODS Patients with nonmetastatic breast cancer who required postoperative RT to the breast/chest wall and regional lymphatics and who were considered suboptimal candidates for conventional RT were eligible. The primary end point was th...

Preparing for a colonoscopy

Aug 12th, 2019 - If you shudder at the thought of having a colonoscopy to check for hidden colon cancer, chances are it's the "prep" that's stoking your apprehension. It's certainly a major inconvenience: getting ready for the procedure takes much longer — an average of 16 hours, according to one study — than the three hours or so you'll spend at a medical center the day of your colonoscopy. But what's most off...

How to Prepare for Your Colonoscopy Using MiraLAX

Aug 5th, 2019 - This information will help you get ready for your colonoscopy using polyethylene glycol (MiraLAX®). A colonoscopy is an exam of your colon (large intestine). Your doctor will use a colonoscope (flexible tube with a camera on the end) to see the inside of your colon on a video monitor. During your procedure, your doctor can:

ACG Clinical Guideline: Hereditary Hemochromatosis
Kowdley, K. et. al.

Aug 1st, 2019 - Hereditary hemochromatosis (HH) is one of the most common genetic disorders among persons of northern European descent. There have been recent advances in the diagnosis, management, and treatment of HH. The availability of molecular diagnostic testing for HH has made possible confirmation of the diagnosis for most patients. Several genotype-phenotype correlation studies have clarified the diffe...

Joint Statement on Pediatric Dental Sedation

Jul 29th, 2019 - The late 20th and early 21st centuries have seen a continuous reduction in mortality and morbidity from intraoperative and periprocedural accidents involving sedation and general anesthesia for children. In the last 31 years, the American Society of Anesthesiologists (ASA) and the American Academy of Pediatrics (AAP) have separately created guidelines for the management of children and adults b...

Adnexal Torsion in Adolescents
Adnexal Torsion in Adolescents

Jul 24th, 2019 - Adnexal torsion is the fifth most common gynecologic emergency. The most common ovarian pathologies found in adolescents with adnexal torsion are benign functional ovarian cysts and benign teratomas. Torsion of malignant ovarian masses in this population is rare. In contrast to adnexal torsion in adults, adnexal torsion in pediatric and adolescent females involves an ovary without an associated...

FDA takes action to protect patients from risk of certain textured breast implants; requests Allergan voluntarily recall certain breast implants and tissue expanders from market

Jul 23rd, 2019 - The U.S. Food and Drug Administration today took significant action to protect women from breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) by requesting that Allergan, the manufacturer of a specific type of textured implant, recall specific models of its textured breast implants from the U.S. market due to the risk of BIA-ALCL. Following the agency’s request, Allergan has not...

Staging β-Amyloid Pathology With Amyloid Positron Emission Tomography
JAMA Neurology; Mattsson, N. et. al.

Jul 16th, 2019 - Question Can a longitudinally valid in vivo β-amyloid staging system be constructed for Alzheimer disease? Findings In this multicenter longitudinal cohort study, a 4-level staging system using fluorine 18–labeled florbetapir positron emission tomography was defined using a combination of cerebrospinal fluid and positron emission tomography data. The β-amyloid stages had distinct associati...

Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache

Jun 25th, 2019 - This clinical policy from the American College of Emergency Physicians addressed key issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical questions: (1) In the adult emergency departm...

Preexposure Prophylaxis for the Prevention of HIV Infection: Evidence Report and Systematic Review for the US Preventive Services Task Force
JAMA US Preventive Services Task Force

Jun 10th, 2019 - Importance Effective prevention strategies for HIV infection are an important public health priority. Preexposure prophylaxis (PrEP) involves use of antiretroviral therapy (ART) daily or before and after sex to decrease risk of acquiring HIV infection. Objective To synthesize the evidence on the benefits and harms of PrEP, instruments for predicting incident HIV infection, and PrEP adheren...

Screening for HIV Infection in Asymptomatic, Nonpregnant Adolescents and Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force
JAMA US Preventive Services Task Force

Jun 10th, 2019 - Importance Untreated HIV infection can result in significant morbidity, mortality, and HIV transmission. A 2012 review for the US Preventive Services Task Force (USPSTF) found antiretroviral therapy (ART) associated with improved clinical outcomes and decreased transmission risk in persons with CD4 cell counts less than 500/mm3. Objective To update the 2012 review on HIV screening to infor...

Screening for HIV Infection in Pregnant Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force
JAMA US Preventive Services Task Force

Jun 10th, 2019 - Objective To update the 2012 review on prenatal HIV screening to inform the USPSTF. Data Sources Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from 2012 to June 2018, with surveillance through January 2019. Study Selection Pregnant persons 13 years and older; randomized clinical trials and cohort studies of screening v...

What Is the Role of Intravenous and Intraoral Contrast in CT Evaluation of Acute Appendicitis?

Jun 6th, 2019 - Patients presenting to the emergency department (ED) with abdominal pain and concern for appendicitis typically require diagnostic imaging to confirm the diagnosis. Computer tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) are the imaging modalities that can be used to diagnosis appendicitis. For non-pregnant adult appendicitis, CT of the abdomen and pelvis is commonly...

Varicose Veins: Diagnosis and Treatment.
American Family Physician; Raetz, J. et. al.

May 31st, 2019 - Varicose veins are twisted, dilated veins most commonly located on the lower extremities. The exact pathophysiology is debated, but it involves a genetic predisposition, incompetent valves, weakened vascular walls, and increased intravenous pressure. Risk factors include family history of venous disease; female sex; older age; chronically increased intra-abdominal pressure due to obesity, pregn...

Management of Acute Obstructive Uterovaginal Anomalies

May 22nd, 2019 - ABSTRACT: Obstructive uterovaginal anomalies may present after puberty with amenorrhea, dysmenorrhea, pelvic pain, recurrent vaginal discharge, or infertility. The evaluation of a patient with a suspected obstructive reproductive anomaly should include a detailed medical history, physical examination, and imaging. The genital examination is critical to differentiate a patient with an imperforat...

Diagnosis and Management of Hymenal Variants

May 22nd, 2019 - ABSTRACT: At puberty, a patient with an imperforate hymen typically presents with a vaginal bulge of thin hymenal tissue with a dark or bluish hue caused by the hematocolpos behind it. Other findings that may be present include an abdominal mass, urinary retention, dysuria, constipation, and dyschezia. On evaluation, the goal is to differentiate an imperforate hymen from other obstructing anato...

A four‐group urine risk classifier for predicting outcomes in patients with prostate cancer
BJU International; Connell, S. et. al.

May 19th, 2019 - To develop a risk classifier using urine‐derived extracellular vesicle (EV)‐RNA capable of providing diagnostic information on disease status prior to biopsy, and prognostic information for men on active surveillance (AS). Patients and Methods Post‐digital rectal examination urine‐derived EV‐RNA expression profiles (n = 535, multiple centres) were interrogated with a curated NanoString pane...

Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening
JAMA Network Open; Hsiang, E. et. al.

May 9th, 2019 - Question Are breast and colorectal cancer screening rates associated with the time of day a patient visits the primary care clinician? Findings In this quality improvement study analysis of 33 primary care practices including 19 254 patients eligible for breast cancer screening and 33 468 patients eligible for colorectal cancer screening, both clinician ordering and patient completion of c...

Adjuvant and Salvage Radiotherapy after Prostatectomy: ASTRO/AUA Guideline
Thompson, I. et. al.

Apr 29th, 2019 - The purpose of this guideline is to provide direction to clinicians and patients regarding the use of radiotherapy after radical prostatectomy in the adjuvant or salvage setting. The strategies and approaches recommended in the guideline were derived from evidence-based and consensus-based processes. This document constitutes a clinical strategy; therefore, the most effective treatment approac...

Strategies to improve adherence and continuation of shorter‐term hormonal methods of contraception
The Cochrane Database of Systematic Reviews; Mack, N. et. al.

Apr 22nd, 2019 - Worldwide, hormonal contraceptives are among the most popular reversible contraceptives. Despite high perfect‐use effectiveness rates, typical‐use effectiveness rates for shorter‐term methods such as oral and injectable contraceptives are much lower. In large part, this disparity reflects difficulties in ongoing adherence to the contraceptive regimen and low continuation rates. Correct use of c...

Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians

Apr 15th, 2019 - The purpose of this guidance statement is to provide advice to clinicians on breast cancer screening in average-risk women based on a review of existing guidelines and the evidence they include.

Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the administration of electroconvulsive therapy

Apr 8th, 2019 - Objectives: To provide guidance for the optimal administration of electroconvulsive therapy, in particular maintaining the high efficacy of electroconvulsive therapy while minimising cognitive side-effects, based on scientific evidence and supplemented by expert clinical consensus. Methods: Articles and information were sourced from existing guidelines and the published literature. Informa...

Diagnostic Tests for Low Back Disorders

Mar 31st, 2019 - This article summarizes ACOEM's evidence-based diagnostic guidelines for low back disorders. Recommendations are given for these diagnostic tests: functional capacity evaluations, roentgenograms (x-rays), magnetic resonance imaging (MRI), computerized tomography, myelography, bone scans, single proton emission computed tomography, electromyography, surface electromyography, ultrasound, thermogr.

Pubic Hair Removal Practices in Cross-Cultural Perspective
Cross-Cultural Research;

Mar 31st, 2019 - The literature on pubic hair removal (PHR) practices primarily focuses on women in Western societies and attributes recent increases in PHR to product marketing, pornography, and pop culture. Here, we explore PHR and retention practices outside the cultural West through content coding of societies in the Human Relations Area Files’ database, eHRAF World Cultures. Thirty-one societies noted dist...

Abdominal Exam - StatPearls
Mealie, C. et. al.

Mar 30th, 2019 - The abdominal examination can be not only diagnostic to help rule pathology in or out, for example, the cause of the patient's pain, but it can be therapeutic as in a reduction of an umbilical or ventral wall abdominal hernia.

Breast Implants: A Research and Regulatory Summary

Mar 28th, 2019 - More than 300,000 women and teenagers underwent breast implant augmentation surgeries in 2017. In addition, approximately 106,000 women underwent breast implant surgery for reconstruction after mastectomy. The popularity of breast implants has risen dramatically in the last 20 years, and is now more than three times the 1997 rate of 101,176. The increase in breast implant surgery, however, does...

Center for Male Contraceptive Research & Development

Mar 25th, 2019 - The Center for Male Contraceptive Research & Development is your official source for information and regular updates on Male Hormonal Contraception

Nonobstetric Surgery During Pregnancy

Mar 25th, 2019 - The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice acknowledges that the issue of nonobstetric surgery during pregnancy is an important concern for physicians who care for women. Because of the difficulty of conducting large-scale randomized clinical trials in this population, there are no data to allow for specific recommendations.

Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention

Mar 25th, 2019 - Opportunistic salpingectomy may offer obstetrician–gynecologists and other health care providers the opportunity to decrease the risk of ovarian cancer in their patients who are already undergoing pelvic surgery for benign disease. By performing salpingectomy when patients undergo an operation during which the fallopian tubes could be removed in addition to the primary surgical procedure (eg, h.

Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism
The New England Journal of Medicine; van der Pol, L. et. al.

Mar 20th, 2019 - Pulmonary embolism is one of the leading causes of maternal death in the Western world. Because of the low specificity and sensitivity of the d-dimer test, all pregnant women with suspected pulmonary embolism undergo computed tomographic (CT) pulmonary angiography or ventilation–perfusion scanning, both of which involve radiation exposure to the mother and fetus. Whether a pregnancy-adapted alg...

A New Trio of Genes Enters the Risk Assessment Equation in Hereditary Breast Cancer
Euhus, D.

Mar 12th, 2019 - For many years after the commercialization of multigene panel testing for hereditary breast and ovarian cancer syndrome, BRCA1 and BRCA2 remained the most commonly identified pathologic variants. Recent studies have found that variants in genes other than BRCA1 or BRCA2 now account for 56% to 71% of pathogenic variants identified among women recently diagnosed with breast cancer. The majority o...

FDA Warns Thermography Should Not Be Used in Place of Mammography to Detect, Diagnose, or Screen for Breast Cancer: FDA Safety Communication

Feb 24th, 2019 - The FDA is alerting women, health care providers, and people getting breast cancer screening, that thermography is not an effective alternative to mammography and should not be used in place of mammography for breast cancer screening or diagnosis.

Temporary Tattoos, Henna/Mehndi, and "Black Henna": Fact Sheet

Feb 22nd, 2019 - FDA has received reports of adverse reactions to some “decal,” henna, and “black henna” temporary tattoos. Here is information about the safety of these products and how they are regulated.

Laboratory Tests | HIV Testing | HIV Infection | CDC

Feb 20th, 2019 - Resources for all FDA-approved diagnostic HIV tests for use in moderate and high complexity laboratories, and provide the most recent guidance on HIV Laboratory Testing.

HIV Antiretroviral Therapy - StatPearls

Feb 14th, 2019 - The first therapy to work against HIV was the nucleoside reverse transcriptase inhibitor zidovudine. The FDA approved this in 1987. By 1996, research showed the advantages of combining medicines to treat HIV. Using HIV medicines for treatment is called antiretroviral therapy (ART). This form of therapy is recommended for all patients with HIV by the Department of Health and Human Services (DHHS...

Management of the Ingrown Toenail
American Family Physician; Heidelbaugh, J. et. al.

Feb 14th, 2019 - Ingrown toenail, or onychocryptosis, most commonly affects the great toenail. Many anatomic and behavioral factors are thought to contribute to ingrown toenails, such as improper trimming, repetitive or inadvertent trauma, genetic predisposition, hyperhidrosis, and poor foot hygiene. Conservative treatment approaches include soaking the foot in warm, soapy water; placing cotton wisps or dental ...

Use of Active Surveillance or Watchful Waiting for Low-Risk Prostate Cancer and Management Trends Across Risk Groups in the United States, 2010-2015
Mahal, B. et. al.

Feb 10th, 2019 - Historically, most patients with low-risk prostate cancer (clinical category T1c-T2a, prostate-specific antigen level <10 ng/mL, and Gleason 6 disease) were treated with radical prostatectomy, while radiotherapy-based treatment was the favored approach for high-risk localized prostate cancer. However, conservative management of low-risk prostate cancer with active surveillance or watchful waiti...

Overstated Harms of Breast Cancer Screening? A Large Outcomes Analysis of Complications Associated With 9-Gauge Stereotactic Vacuum-Assisted Breast Biopsy Read More: https://www.ajronline.org/doi...

Feb 10th, 2019 - OBJECTIVE. The purpose of this study was to assess the rate, type, and severity of complications related to 9-gauge stereotactic vacuum-assisted breast biopsy (SVAB) and to delineate associated factors that may contribute to a higher rate of complications. MATERIALS AND METHODS. This retrospective study included 4776 patients who underwent SVAB between 2003 and 2016. A total of 319 patients wit...

Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents
Brigo, F. et. al.

Feb 7th, 2019 - Absence seizures (AS) are brief epileptic seizures which present in childhood and adolescence. Depending on clinical features and electroencephalogram (EEG) findings they are divided into typical, atypical absences, and absences with special features. Typical absences are characterised by sudden loss of awareness and an EEG typically shows generalised spike wave discharges at three cycles per s...

Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) - Letter to Health Care Providers

Feb 5th, 2019 - The Food and Drug Administration (FDA) wants to increase awareness about an association between all breast implants, regardless of filling or texture, and Breast Implant Associated- Anaplastic Large Cell Lymphoma (BIA-ALCL). The FDA received reports indicating that patients with breast implants have an increased risk of developing this disease within the scar capsule adjacent to the implant.

Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi
Ordonez, M. et. al.

Feb 5th, 2019 - Ureteroscopy combined with laser stone fragmentation and basketing is a common approach for managing renal and ureteral stones. This procedure is associated with some degree of ureteral trauma. Ureteral trauma may lead to swelling, ureteral obstruction, and flank pain and may require subsequent interventions such as hospital admission or secondary ureteral stent placement. To prevent such issue...

Rapid initiation of antiretroviral therapy at HIV diagnosis: definition, process, knowledge gaps
Boyd, M. et. al.

Feb 5th, 2019 - nitiating antiretroviral therapy (ART) as early as the day of HIV diagnosis is a strategy of increasing global interest to control the HIV epidemic and optimize the health of people living with HIV (PLWH). No detrimental effects of rapid‐start ART have been identified in randomized controlled trials undertaken in low‐ or middle‐income countries, or in cohort studies performed in high‐income cou...

FDA approves Cablivi® (caplacizumab-yhdp), the first Nanobody®-based medicine, for adults with acquired thrombotic thrombocytopenic purpura (aTTP)

Feb 5th, 2019 - The U.S. Food and Drug Administration (FDA) has approved Cablivi® (caplacizumab-yhdp) in combination with plasma exchange and immunosuppression for the treatment of acquired thrombotic thrombocytopenic purpura (aTTP) in adults. Cablivi is the first FDA approved therapy specifically indicated for the treatment of aTTP.

Guidelines for Performing a Comprehensive Transesophageal Echocardiographic Examination in Children and All Patients with Congenital Heart Disease
American Society of Echocardiography

Jan 31st, 2019 - Since its introduction nearly four decades ago, transesophageal echocardiography (TEE) has witnessed a remarkable evolution. The important strides made in improving TEE technology – including development of multiplane phased array transducers, matrix array transducers for threedimensional (3D) imaging, and extensive improvements in echocardiographic imaging platform technology – have catalyzed ...

Reducing Cesarean Delivery Surgical Site Infections
Kawakita, T. et. al.

Jan 31st, 2019 - OBJECTIVE: To examine the association of a resident-driven quality initiative with cesarean delivery surgical site infections. METHODS: This was a quasi-experimental, preintervention and postintervention study of women undergoing cesarean delivery at 23 weeks of gestation or greater between January 2015 and June 2018 at a single tertiary care center. We implemented a resident-driven, evidence-b...

Hepatitis, Nonalcoholic Steatohepatitis
Sharma, B. et. al.

Jan 31st, 2019 - Nonalcoholic, fatty liver disease (NAFLD) is defined as the ectopic accumulation of fat in the liver (hepatic steatosis) when no other causes of secondary, liver fat accumulation are present. As minor deposition of fat can occur in healthy adults, deposition of fat in at least 5% of hepatocytes is considered pathologic. Nonalcoholic steatohepatitis (NASH) is diagnosed via a liver biopsy when th...

Clinical Practice Guideline: Tonsillectomy in Children (Update)
Mitchell, R.,et al

Jan 31st, 2019 - This update of a 2011 guideline developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children 1 to 18 years of age under consideration for tonsillectomy. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely remo.

American Academy of Nursing on Policy position statement: Disaster preparedness for older ad...
Spurlock W

Jan 31st, 2019 - The American Academy of Nursing recognizes the significant impact of natural disasters on older adults. Unfortunately, despite decades of planning, deficiencies continue to exist in disaster preparedness for this population.

Genetics of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
Oishi, N. et. al.

Jan 30th, 2019 - Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a newly included provisional entity in the 2016 revision of the World Health Organization classification, is a distinct form of CD30-positive T-cell non-Hodgkin lymphoma that arises in association with a breast implant after reconstructive or cosmetic surgery. In addition to its characteristic clinical presentation, recent stu...

2019 NCCN Consensus Guidelines on the Diagnosis and Treatment of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
Clemens, M. et. al.

Jan 30th, 2019 - National Comprehensive Cancer Network (NCCN) guidelines represent the consensus standard of care for diagnosis and management of the majority of known cancers. NCCN guidelines on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) have been recognized by the US Food and Drug Administration and widely advocated by national specialty societies. Consensus guidelines have helped cre...

Duration of Electrocardiographic Monitoring of Emergency Department Patients with Syncope
Thiruganasambandamoorthy, V. et. al.

Jan 20th, 2019 - The optimal duration of cardiac rhythm monitoring following emergency department (ED) presentation for syncope is poorly described. We sought to describe the incidence and time to arrhythmia occurrence to inform decisions regarding duration of monitoring based on ED risk-stratification.

Association of Magnetic Resonance Imaging and a 12-Gene Expression Assay With Breast Ductal Carcinoma In Situ Treatment
Lehman, C. et. al.

Jan 16th, 2019 - Question What is the association of breast magnetic resonance imaging and a 12-gene expression assay with the treatment of women with ductal carcinoma in situ of the breast who are candidates for breast conservation surgery and radiotherapy? Findings In this nonrandomized clinical trial of a prespecified primary outcome among 339 women with pure ductal carcinoma in situ, after magnetic resona...

Use of Orthokeratology for the Prevention of Myopic Progression in Children OTA - IN PRESS
AAO OTAC Pediatric Ophthalmology/Strabismus Panel,

Jan 16th, 2019 - Orthokeratology may be effective in slowing myopic progression for children and adolescents, with a potentially greater effect when initiated at an early age (6–8 years). Safety remains a concern because of the risk of potentially blinding microbial keratitis from contact lens wear.

Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease

Jan 7th, 2019 - This document is the second of 2 companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed ...

Point-of-Care Ultrasound for Hospitalists: A Position Statement of the Society of Hospital M...
Soni, N.

Jan 1st, 2019 - Many hospitalists incorporate point-of-care ultrasound (POCUS) into their daily practice to answer specific diagnostic questions or to guide performance of invasive bedside procedures. However, standards for hospitalists in POCUS training and assessment are not yet established.

Five-Year Contraceptive Efficacy and Safety of a Levonorgestrel 52-mg Intrauterine System

Dec 31st, 2018 - A phase 3 study of a levonorgestrel 52-mg intrauterine system in U.S. females shows high 5-year contraceptive efficacy and low hormonal adverse effect rates. In the United States, 45% of pregnancies each year are unintended.1 Females who use long-acting reversible contraception (LARC) methods, specifically the currently available copper intrauterine device, levonorgestrel intrauterine system (L...

Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)...
Blanke, P.,et al

Dec 31st, 2018 - Since the publication of the first expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR) by the Society of Cardiovascular Computed Tomography (SCCT) in 20121, there has been tremendous advancement in the field. Significant technological advancements and a wealth of trial data have led to deep.

NAPNAP Position Statement on Pediatric-Focused Advanced Practice Registered Nurses’ Role in ...
Children in Disasters Special Interest Group

Dec 31st, 2018 - The National Association of Pediatric Nurse Practitioners (NAPNAP) acknowledges the central role of pediatric nurse practitioners (PNPs) and their fellow pediatric-focused advanced practice registered nurses (APRNs) in disaster preparedness to provide guidance and care before, during, and after local, national, and global disasters that affect children and families. The term disaster encompasse.

Medical management of abortion

Dec 30th, 2018 - Medical abortion care encompasses the management of various clinical conditions including spontaneous and induced abortion (both viable and non-viable pregnancies), incomplete abortion and intrauterine fetal demise, as well as post-abortion contraception.

HIV Treatment as Prevention | HIV Risk and Prevention | CDC

Dec 17th, 2018 - People with HIV should take medicine to treat HIV as soon as possible. HIV medicine is called antiretroviral therapy, or ART. If taken as prescribed, HIV medicine reduces the amount of HIV in the body (viral load) to a very low level, which keeps the immune system working and prevents illness. This is called viral suppression—defined as having less than 200 copies of HIV per milliliter of blood...

Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
Office of AIDS Research Advisory Council

Dec 13th, 2018 - The Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection (Pediatric Guidelines) address the use of antiretroviral therapy (ART) for children living with HIV, including adolescents with sexual maturity rating (SMR, formerly Tanner staging) I to III (the guidelines developed by the Panel on Antiretroviral Guidelines for Adults and Adolescents are suitable for the care and ma.

Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and...
Office of AIDS Research Advisory Council

Dec 6th, 2018 - Recommendations regarding HIV screening in pregnancy, treatment of pregnant women who are living with HIV, and the use of antiretroviral (ARV) drugs for prevention of perinatal transmission of HIV have evolved considerably in the United States since the mid-1990s, reflecting changes in both the epidemic and also in the science of prevention and treatment. With the implementation of recommendati.

Evolving indications and long‐term oncological outcomes of risk‐reducing bilateral nipple‐sparing mastectomy
BJS Open; Grobmyer, S. et. al.

Nov 25th, 2018 - Bilateral nipple‐sparing mastectomy (NSM) is a technically feasible operation and is associated with excellent cosmetic outcomes. The aim of this study was to evaluate trends in patient characteristics, indications for surgery and long‐term outcomes of bilateral NSM for breast cancer risk reduction over time.

Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review

Nov 18th, 2018 - The Public Health Agency of Canada reviewed sexual transmission of HIV between serodiscordant partners to support examination of the criminal justice system response to HIV nondisclosure by the Department of Justice of Canada. We sought to determine HIV transmission risk when an HIV-positive partner takes antiretroviral therapy, has a suppressed viral load or uses condoms. suppressive ART

Ketogenic diets for drug‐resistant epilepsy.
The Cochrane Database of Systematic Reviews;

Nov 6th, 2018 - Ketogenic diets (KDs), being high in fat and low in carbohydrates, have been suggested to reduce seizure frequency in people with epilepsy. At present, such diets are mainly recommended for children who continue to have seizures despite treatment with antiepileptic drugs (AEDs) (drug‐resistant epilepsy). Recently, there has been interest in less restrictive KDs, including the modified Atkins di...

Breast Cancer Screening and Diagnosis, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology

Oct 31st, 2018 - The NCCN Guidelines for Breast Cancer Screening and Diagnosis have been developed to facilitate clinical decision making. This manuscript discusses the diagnostic evaluation of individuals with suspected breast cancer due to either abnormal imaging and/or physical findings. For breast cancer screening recommendations, please see the full guidelines on NCCN.org.

Guidelines for the safe practice of total intravenous anaesthesia (TIVA)
Nimmo, A.,et al

Oct 30th, 2018 - Guidelines are presented for safe practice in the use of intravenous drug infusions for general anaesthesia. When maintenance of general anaesthesia is by intravenous infusion, this is referred to as total intravenous anaesthesia.

Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV
Office of AIDS Research Advisory Council

Oct 27th, 2018 - Antiretroviral therapy (ART) for the treatment of HIV infection has improved steadily since the advent of potent combination therapy in 1996. ART has dramatically reduced HIV-associated morbidity and mortality and has transformed HIV infection into a manageable chronic condition.

Nurse Staffing in Interventional Radiology
ARIN Clinical Practice and Research Committee

Oct 27th, 2018 - The role of the nurse in procedural areas is collaborative and care is provided simultaneously with other members of the procedure room team which differs from settings where nursing care is often delivered independently. Procedural nursing care is multidisciplinary with a proceduralist, a nurse, a radiologic technologist and, if the patient is receiving general anesthesia or monitored anesthes.

Distinguishing Monitored Anesthesia Care (“MAC”) From Moderate Sedation/Analgesia (Consciou...
American Society of Anesthesiologists (ASA)

Oct 16th, 2018 - Moderate Sedation/Analgesia (Conscious Sedation, hereinafter known as Moderate Sedation) is a physician service recognized in the CPT procedural coding system. During Moderate Sedation, a physician supervises or personally administers sedative and/or analgesic medications that can allay patient anxiety and control pain during a diagnostic or therapeutic procedure.

ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia
Sotiriadis, A.

Oct 14th, 2018 - Hypertensive disease of pregnancy affects up to 10% of pregnant women1 and the pooled global incidence of pre?eclampsia (PE) is approximately 3%2. Significant variations between developed and developing countries can be attributed to true differences or differences arising from data acquisition.