Assessment of Clinical Conditions Associated With Splenic Infarction in Adult Patients.

This case series examines the clinical conditions associated with splenic infarction of adult patients between 2010 and 2015 from computed tomographic imaging scans.

Charity Care Characteristics and Expenditures Among US Tax-Exempt Hospitals in 2016.

To examine content of financial assistance polices (FAPs) among US tax-exempt hospitals and determine whether restrictive policies were associated with reduced charity care spending. Using hospital tax filings with the Internal Revenue Service in 2016 and FAPs obtained from hospital Web sites, we examined characteristics of FAPs and associated expenditures for charity care in a representative sample of 170 tax-exempt hospitals. We identified common eligibility requirements and used them to define restrictiveness of FAPs.

A Clinical Overview of Off-label Use of Gabapentinoid Drugs.

Background: The gabapentinoid drugs gabapentin and pregabalin were originally developed as antiseizure drugs but now are prescribed mainly for treatment of pain. For gabapentin, the only pain-related indication approved by the US Food and Drug Administration (FDA) is postherpetic neuralgia. For pregabalin, FDA-approved indications related to pain are limited to postherpetic neuralgia, neuropathic pain associated with diabetic neuropathy or spinal cord injury, and fibromyalgia.

Getting Past Words: Futility and the Professional Ethics of Life-Sustaining Treatment.

For nearly three decades, clinicians and bioethicists have debated about use of the term futile to describe end-of-life medical interventions that clinicians believe are no longer warranted. In clinical practice, the term is most often invoked when a family of a dying or permanently unconscious patient insists upon such interventions, despite the medical team's belief or recommendation that they be withheld or withdrawn. This essay argues that each of the commonly used terms for these interventions (futile, inappropriate, and nonbeneficial) captures an important, different, and complementary facet of these conflicts in end-of-life medical care.

Splenic infarction associated with sickle cell trait at low altitude.

Objective And Importance: Sickle cell trait is widely known to be associated with splenic infarction at high altitudes. Although textbooks and reviews imply that this complication does not occur at low altitudes, we encountered such a case and identified several previous cases in the literature.

Clinical Presentation: An 18-year-old woman with sickle cell trait who resided near sea level presented with left upper quadrant abdominal pain and was found to have multiple splenic infarcts.

The case against identifying carotid stenosis in asymptomatic patients.

Carotid ultrasonography is performed frequently to identify carotid stenosis in patients with no history of carotid-territory cerebrovascular ischemia. The premises of such testing are that the potential benefit of endarterectomy or stenting exceeds the potential harm in patients with asymptomatic stenosis and that discovery of asymptomatic stenosis may trigger beneficial changes in lifestyle or medical management that otherwise would not have occurred. However, given low contemporary rates of stroke in medically managed patients with asymptomatic carotid stenosis, invasive carotid procedures cannot be justified in this population.

Quantification of the transverse carpal ligament elastic properties by sex and region.

Background: The transverse carpal ligament is an integral factor in the etiology of carpal tunnel syndrome. The purpose of this study was to report the biomechanical properties of this ligament and quantify sex-based differences and regional variation in tissue response. We hypothesized that the mechanical response would not be uniform across the surface, and that female ligament properties would have higher strain profiles and lower mechanical properties.

Cardiovascular safety of long acting beta agonist-inhaled corticosteroid combination products in adult patients with asthma: a systematic review.

Introduction: Long-acting beta agonists and inhaled corticosteroids combination products (LABA-ICS) are widely used in the treatment of asthma. However, there appears to be little data on their cardiovascular safety. The purpose of this study was to conduct a systematic review of the available studies and trials on the cardiovascular safety of LABA-ICS in adults with asthma.

A 40-day water-only fast by a Pentecostal woman: clinical and religious observations.

A 57-year-old woman presented to the hospital after a 40-day acaloric (water-only) fast, which was motivated by her Christian beliefs and Pentecostal affiliation. She exhibited hyponatremia on admission, and developed hypokalemia, hypophosphatemia and hypomagnesemia during refeeding. The authors are unaware of other published case reports describing medical and religious aspects of prolonged fasting by Christians for spiritual reasons.

Physicians have a responsibility to meet the health care needs of society.

People often need medical care unexpectedly and through no fault of their own. Although the system of health care in the United States is seriously flawed, our beliefs and values nevertheless commit us to rescue people with urgent medical needs. The medical profession - society's primary instrument for provision of health services - shoulders a responsibility to meet society's health care needs.