Humans

Abstract Background Brain metastases are a common cause of disabling neurologic complications and death in patients with metastatic melanoma. Previous studies of nivolumab combined with ipilimumab in metastatic melanoma have excluded patients with untreated brain metastases. We evaluated the efficacy and safety of nivolumab plus ipilimumab in patients with melanoma who had untreated brain metastases.
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Abstract Background The use of tranexamic acid reduces mortality due to postpartum hemorrhage. We investigated whether the prophylactic administration of tranexamic acid in addition to prophylactic oxytocin in women with vaginal delivery would decrease the incidence of postpartum hemorrhage. Methods In a multicenter, double-blind, randomized, controlled trial, we randomly assigned women in labor who had
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Primary care is the bedrock of reform of the US health system. New payment and care delivery models emphasize the importance of primary care medical homes with reimbursement prioritizing value over volume. It remains unclear how best to restructure US health care spending to attain the Triple Aim (ie, improving the experience of care, improving
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In Reply The USPSTF shares the frustration of Dr Svoboda and colleagues that there is insufficient evidence to recommend for or against counseling adults to perform routine self-skin examination. Skin cancer is the most common cancer, and melanoma will result in 9320 deaths in 2018.1 We want to address 2 concerns raised about our recommendation
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The risk of many serious chronic health conditions, including coronary heart disease, type 2 diabetes, and cancer, can be substantially reduced by protective health behaviors, such as regular physical activity and healthy dietary intake. To attain significant health benefits, however, these health-protective behaviors should be performed consistently and regularly (ie, every day or multiple times
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The US Preventive Services Task Force (USPSTF) has recently published updated recommendations on screening for cervical cancer. What Is Cervical Cancer? The cervix is the bottom part of the uterus (womb) in women. The main symptom of cervical cancer is abnormal vaginal bleeding; however, very often, cervical cancer in its early stages causes no symptoms.
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The deaths of children in developing countries from the leading bacterial causes of pneumonia and meningitis—Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib)—declined between 2000 and 2015, according to a recent report in the Lancet Global Health. Researchers calculated annual, country-specific estimates of pneumococcal and Hib morbidity and mortality rates in children for each
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The recently revised Medicare coverage policy for implantable cardioverter-defibrillators (ICDs) requires patients to participate in a shared decision-making interaction with their physician or a designated nonphysician practitioner before undergoing a primary prevention implantation.1 This is the third instance in which the Centers for Medicare & Medicaid Services (CMS) has required shared decision making as a
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With warmer weather come the annual warnings about tick-borne infections and, in particular, about Lyme disease. There has been considerable publicity about substantial increases in the incidence of Lyme disease; however, even though the incidence of Lyme disease has increased from 2007 to 2016, there has not been a statistically significant increase in the number
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The FDA’s recently announced Biosimilars Action Plan will take steps to increase access for patients who need biologic medication to biosimilar drugs that are nearly identical to but potentially much less expensive than the original product. In announcing the 11-point plan, FDA Commissioner Scott Gottlieb, MD, said the market for biosimilars still isn’t established and
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Poor air quality is responsible for 1 in 5 infant deaths in sub-Saharan Africa, according to a study published in Nature. To quantify the effect of breathable air pollutants on premature deaths among infants in Africa, the investigators examined recent satellite-based estimates of air pollutant particles (ambient respirable particulate matter with an aerodynamic diameter less
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Research suggests that you’re more likely to find a narcissist in the corner office than just about anywhere else. As psychoanalyst leadership expert Michael Maccoby has argued, that’s because narcissists often thrive in leadership roles, since so-called “productive narcissists” are super comfortable with risk and charming enough to get people’s backing for their ideas. “Narcissists
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In December 2017, the Boston radio station WBUR chronicled the case of the first patient at Massachusetts General Hospital to receive axicabtagene ciloleucel (Yescarta, Gilead) outside a clinical trial. The chimeric antigen receptor T cells (CAR-Ts) were made from 71-year-old Barbara Kearney’s own T cells, which after genetic modification ex vivo were turned on to
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Patients Eligible patients were at least 18 years of age and had either locally advanced breast cancer that had not been amenable to curative therapy or metastatic breast cancer. Patients had a deleterious or suspected deleterious germline BRCA1/2 mutation detected by central testing with BRACAnalysis (Myriad Genetics). Patients had received no more than three previous
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The Medicare payment policy for evaluation and management services — the most commonly billed type of physician services in the United States — has long attracted scrutiny. Tasked with rewarding cognitive work by physicians that is commensurate with patients’ needs while minimizing the potential for fraud, Medicare pays for office visits using five levels of
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To the Editor In the article by the Dry Eye Assessment and Management (DREAM) Study Research Group about n−3 fatty acid supplementation in the treatment of dry eye disease (May 3 issue),1 no significant benefit was shown in the group receiving high-dose fish oil over the group receiving olive oil, although both oils markedly improved
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In Reply Our study used death certificate data to describe geographic variation among counties in levels and trends of mortality due to alcohol use disorders, drug use disorders, self-harm, and interpersonal violence. Drs Rockett and Connery identify cause-of-death misclassification as a potential limitation of these data and note that the degree and effect of misclassification
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Massachusetts is the latest of state highest courts to address the issue of “innovator liability”: brand-name pharmaceutical manufacturers who are exposed to legal liability for generic forms of their brand products that cause injuries to consumers. In Rafferty v Merck & Co Inc (2018),1 the Massachusetts Supreme Judicial Court addressed a claim against Merck based
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In the Original Contribution entitled “Effect of Vitamin D Supplementation on Recurrent Wheezing in Black Infants Who Were Born Preterm: The D-Wheeze Randomized Clinical Trial,”1 published in the May 22/29, 2018, issue of JAMA, one of the authors, Kristie Ross, MD, MS, had an undisclosed conflict of interest. She recently discovered that Otsuka Pharma/Pharmavite donated
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To the Editor In the study of 21 US government personnel who experienced a suspected sonic weapon attack in Cuba,1 the patients’ symptoms could be explained by unilateral or bilateral peripheral labyrinthine injury, and further investigation is warranted. Our differential diagnosis includes (1) labyrinthine concussion, (2) delayed endolymphatic hydrops, (3) benign paroxysmal positional vertigo, (4)
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A pioneering surgery could give people with amputated limbs something they’ve been missing in their prosthetic limbs: proprioception. Cameron Taylor/Massachusetts Institute of Technology Today, “people with amputated limbs cannot feel the position, speed, and torque of their prosthetic joints without looking at them, making it difficult to control their movement,” said Hugh Herr, PhD, the
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Recent trends in preventable fatalities related to opioids, motor vehicle crashes, and firearms suggest that it is time to refocus public health efforts targeting injury prevention. Injury prevention, since the 1970s, has largely been a US success story.1 In recent decades, motor vehicle crash fatalities substantially decreased from 51 436 deaths (21.3 deaths per 100 000 individuals)
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Scabies is a contagious skin infestation caused by tiny mites. The microscopic, 8-legged human itch mite digs into the skin to feed and lay eggs; however, it cannot survive outside human skin for more than 2 to 3 days. Scabies is transmitted by direct person-to-person contact or through objects that carry the mites, such as
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Increasing public attention has recently been paid to the opioid epidemic and attendant effects on prenatally exposed infants and children.1 Current literature has emerged proposing marijuana as a safe alternative to opioids in addressing pain2 and cannabis legalization as a way to decrease opioid fatalities.3 As a result, perceptions of cannabis safety have increased, and
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