JAMA Clinical Reviews

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Drug Treatment for Primary Prevention of Breast Cancer Some of the nearly 40 deaths each year in the US from breast cancer might be avoided through use of medications to prevent breast cancer in high-risk women. Whether the SARS-CoV-2 virus is transmitted by droplets or aerosol influences which public health interventions might slow its spread.

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Michael Klompas, MD, professor of medicine at Harvard Medical School, explains evidence to date about mechanisms of coronavirus transmission and implications for pandemic containment and mitigation efforts. Although complications from them are not common because so many people take these medications, physicians will inevitably see problems such as dependence and withdrawal, hyponatremia, bleeding disorders, and even the uncommon but severe SSRI syndrome.

To learn about these potential complications, we spoke with David Juurlink, MD, PhD, an internist and clinical pharmacologist at the University of Toronto.

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They're generally safe, but they can cause acute kidney injury, and it's important for clinicians to be aware of this potential complication. David Juurlink, MD, PhD, internist and clinical pharmacologist from the University of Toronto, discusses this important potential complication. Diagnosis and Management of Amyloidosis Although there are only about new cases of amyloidosis in the US per year, it can cause preserved ejection fraction heart failure, kidney and liver failure, and neuropathy.

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Amyloidosis is easily diagnosed and treatable, and it should be considered in the differential diagnosis for these diseases. Morie A. A Clinical Pharmacologist's Perspective on Penicillin Allergy Although frequently reported, penicillin allergy is actually uncommon. Penicillins are very effective against a wide variety of infections, and when they can't be used, problems arise. Sample Size Calculation for a Hypothesis Test One of the most common causes for problems we see in manuscripts at JAMA is an inappropriately calculated study sample size.

Understanding Pragmatic Trials Generalizability of randomized all reviews of dealing centers is always limited because of the super-selectivity of the patients enrolled in these trials and the very controlled conditions in which clinical care is delivered.

Pragmatic trials are all reviews of dealing centers in order to provide guidance for how to best deliver clinical care in situations that more closely resemble actual clinical scenarios. Although usually mild, when depression is severe the consequences can be serious.

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Tom Garrick, MD, professor of Psychiatry at the University of Southern California, discusses the diagnosis and treatment of depression. If true, early intervention with hearing aids might help people have better cognitive performance. Gas exchange is severely compromised with little reduction in lung compliance. How the unique pathophysiology of respiratory failure should be treated is discussed by John J.

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Marini, MD, professor of medicine at the University of Minnesota. Parkinson Disease Information for Patients More than 6 million people worldwide have Parkinson disease. Even though it is classically associated with tremors, the disease has many manifestations and is very treatable for most patients.

Michael S. Okun, MD, from the Department of Neurology at the University of Florida, Gainesville, discusses the pathophysiology, clinical presentation, diagnosis, and treatment of Parkinson disease. Treating Pediatric Eczema Eczema is extremely common in children. Most the time it is easily treated with topical steroids but on occasion it requires systemic therapies. Coronavirus COVID Update: Safe Shopping at Stores and Pharmacies Food and medicine shopping is essential during the COVID pandemic, but requires getting out and standing close to strangers at a time when social distancing and sheltering-in-place are recommended to slow spread of disease.

The disease was spread through the hospital with more than 40 people becoming infected with it before anyone knew what was happening. Allison McGeer, MD, was one of the clinicians taking care of these patients who ultimately got the disease herself.

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This is not a benign problem, and NASH can ultimately lead to cirrhosis and liver failure. It is thought that NASH will ultimately become the most common cause for liver transplant. NASH is usually diagnosed as an incidental finding, but once found requires careful monitoring and patient counseling.

Lisa N. The Diagnosis and Management of Primary Hyperparathyroidism Hyperparathyroidism is a fairly common disease that causes elevated calcium levels and bone depletion, resulting in fractures and kidney problems. There are medications that can effectively manage hyperparathyroidism, and in some cases surgery is indicated. While doing research for the government during World War II, he observed that populations that had extremely limited food availability because of the war had substantially reduced mortality from cardiovascular disease—something unexpected at a time when cardiovascular disease was thought to be due to stress.

After the war when food became more available CVD death rates went back up, resulting in Pritikin concluding that CVD was related to diet. Pritikin devised his own very low-fat diet that bears his name and the diet is still in use 65 years later.

However, many people who tested positive for the novel coronavirus never became ill, and in some the clinical illness was indistinguishable from influenza.

John Lynch, MD, MPH, an infectious disease physician and medical director for infection prevention and control at the Harborview Medical Center, summarizes his hospital's experience managing the patients and outbreak. Doug Paauw, MD, professor of medicine at the University of Washington, in Seattle, describes the UW primary care clinic experience as this pandemic evolved.

All reviews of dealing centers lessons learned included accommodating for significant numbers of staff not available to work in the clinic because of school closures, change in workflow because of shortages of personal protective equipment, physicians having to accommodate very large numbers of patient queries via telephone, email, or electronic health record, and the importance of the rapid development of local ability to test for SARS-CoV-2 independent of public health agencies.

In recent weeks, there has been an increasing number of cases and trezor wallet in the US. As concern about the virus increases, there is an increasing need for algorithmic trading training information about the disease and how much concern we should have.

Unprofessional Behavior Leads to Complications Physicians who act out cause all sorts of problems. Fortunately, only a few clinicians have behavior problems and in the modern era, bad behaviors are not tolerated. Bad behaviors get reported these days and actions are taken against these sorts of clinicians.

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Clinicians who act out frequently say they are doing so to protect their patients. But are they? Hickson, MD, from Vanderbilt University Medical Center in Nashville, Tennessee, discuss a study they published in relating bad behaviors to having more complications of surgical care.

But even substantial viral suppression leaves some virus behind, causing chronic inflammation. Many chronic diseases, including atherosclerotic coronary vascular disease, are worsened by this chronic inflammatory state. Because HIV patients are now living very long lives, they are also developing chronic diseases at a more rapid rate than their non-HIV-infected peers because of this chronic inflammation.

Parkinson Disease More than 6 million people worldwide have Parkinson disease. Management of Chronic Stable Angina in Controversy exists regarding how to best manage chronic stable angina. Intuitively, it seems that because it is usually caused by coronary artery lesions, addressing those lesions either via percutaneous coronary angiography or coronary artery bypass operations would be the best way to manage this problem.

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Several studies have suggested that this is not the case and that results of these interventions are no better than optimal medical management. Recently, a very large trial examining this clinical question has provided results suggesting that any approach works about the same.

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Treating Conjunctivitis and Dry Eye Disease Conjunctivitis and dry eye disease are some of the most common conditions patients present with. They are usually benign entities that respond well to conservative measures and usually do not require medications.

However, if medications are necessary, clinicians can find a comprehensive assessment of these drugs recently published in the December 2,issue of The Medical Letter.

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An excerpt from this article summarizing information about conjunctivitis and dry eye disease was published in the February 4, issue of JAMA. The rapid spread and severity of this illness are worrisome and the possibility that it develops into a pandemic is very real.

JAMA Clinical Reviews

Football Players and Erectile Dysfunction Associated With Repetitive Head Injury American football is a dangerous sport and is characterized by violent contact between people that often leads to repetitive head injury. A multitude of health effects may result from this sort of head injury, but a new finding reported in the December issue of JAMA Neurology maintains that football players are at risk for developing low testosterone levels and erectile dysfunction.

Chan School of Public Health and the Football Players Health Study at Harvard Medical School discusses the findings regarding the relationship between head injury and erectile dysfunction.