Combining Fluoxetine and rTMS in Poststroke Motor Recovery: A Placebo-Controlled Double-Blind Randomized Phase 2 Clinical Trial.

. Although recent evidence has shown a new role of fluoxetine in motor rehabilitation, results are mixed. We conducted a randomized clinical trial to evaluate whether combining repetitive transcranial magnetic stimulation (rTMS) with fluoxetine increases upper limb motor function in stroke.

Opioid Consumption Rate Following Foot and Ankle Surgery.

Background: The rapid increase in the consumption of prescription opioids has become one of the leading medical, economic, and sociological burdens in North America. In the United States, orthopedic surgery is the fourth leading specialty in the number of opioids prescribed, and the largest among all operative specialties. There is insufficient evidence to guide surgeons about appropriate opioid prescription amounts after orthopedic foot and ankle (F&A) procedures.

Workforce Cost Model for Expanding Congenital and Rheumatic Heart Disease Services in Kenya.

Background: Cardiovascular disease is the number one global killer, with over three quarters of these deaths arising from the populations of low- and middle-income countries (LMICs). Addressing the burden of cardiovascular disease in LMICs must include medical and surgical services for these patients. In this article, we model the needs and costs to scale up the cardiac provider workforce in Kenya, which can be adapted to other LMICs based on country-specific workforce hours and workforce salaries.

Sound-Alike Look-Alike Confusion and Matching Medication Product Attributes: Simulated Case-Control Studies.

Sound-alike look-alike (SALA) medication confusions harm as many as 250 000 Americans annually. Most preventive strategies focus on medication name similarities. To evaluate the association between matching medication product attributes and SALA confusion.

Noteworthy Literature Published in 2018 for Cardiothoracic Anesthesiologists.

The year 2018 was marked by high-quality, impactful articles spanning the basic, translational, and clinical spectrum in the field of cardiothoracic anesthesia. In this article, we present several hand-picked articles from the past year that we feel were the most significant in shaping our specialty. Large multicenter, randomized controlled trials presenting clinical outcome data dominated the publishing arena: is a restrictive red blood cell transfusion strategy superior to a liberal red blood cell transfusion strategy during cardiopulmonary bypass? Does a low mean arterial blood pressure strategy during cardiopulmonary bypass increase stroke incidence? Does the obesity paradox apply to cardiac surgery? Advancing technology continues to revolutionize our field: can the MitraClip be used to effectively treat secondary mitral regurgitation? Can stem cells improve cardiac function in patients with left ventricular assist devices? These studies allow us to shape our practice in an evidence-based manner, so that we may evolve as a specialty and deliver the best care to our patients.

Short Communication: Bioequivalence of Tenofovir Component of Tenofovir/Rilpivirine/Emtricitabine in Digital Pills.

Digital pills, gelatin capsules with radiofrequency transmitters activated by stomach chloride ions, directly measure antiretroviral therapy adherence. In individuals with substance use disorders and HIV, real-time nonadherence detected by digital pills creates a platform to deliver substance use and adherence interventions. In this study, we determined the bioequivalence of tenofovir (TFV), administered as tenofovir disoproxil fumarate (TDF) in healthy human volunteers administered a commercial drug product and a digital pill formulation.

Correlation of Soft Tissue Swelling and Timing to Surgery With Acute Wound Complications for Operatively Treated Ankle and Other Lower Extremity Fractures.

Background: Considerable debate exists regarding how soft-tissue edema should influence timing of surgery for ankle and other lower extremity fractures. Assessment of swelling is subjective, and timing varies among surgeons. However, timing of surgery is one of the few modifiable factors in fracture care.

Healthcare access and services use among US children with autism spectrum disorder.

This study aimed to determine associations of healthcare access problems with services use among US children with autism spectrum disorder. We analyzed 2011-2014 National Health Interview Survey data on 651 children with autism spectrum disorder aged 2-17 years. There were three measures of healthcare access problems: (1) delays accessing healthcare, (2) difficulty affording healthcare, and (3) trouble finding a primary care provider.

Variation in restricted and repetitive behaviors and interests relates to inhibitory control and shifting in children with autism spectrum disorder.

Symptoms of restricted and repetitive behaviors and interests in autism are theoretically linked to executive functioning, which includes problem-solving abilities such as inhibition and cognitive flexibility. This study examined whether inhibition and flexibility are related to higher order restricted and repetitive behaviors and interests (e.g.

Mesenchymal Lesions of the Breast: What Radiologists Need to Know.

Objective: Mesenchymal breast tumors originate from the various components of mammary stroma. The aim of this review is to discuss the clinical presentation, imaging appearance, and management of mesenchymal breast lesions.

Conclusion: Although many mesenchymal tumors exhibit characteristic findings on imaging, others show nonspecific characteristics and require tissue biopsy for diagnosis.

Disparities in Initiation of Direct-Acting Antiviral Agents for Hepatitis C Virus Infection in an Insured Population.

Objectives: The cost of direct-acting antiviral agents (DAAs) for hepatitis C virus (HCV) infection may contribute to treatment disparities. However, few data exist on factors associated with DAA initiation.

Methods: We conducted a retrospective cohort study of HCV-infected Kaiser Permanente Northern California members aged ≥18 during October 2014 to December 2016, using Poisson regression models to evaluate demographic, behavioral, and clinical factors associated with DAA initiation.

Prevalence of Potential Adult Chronic Rhinosinusitis Symptoms in the United States.

Objective To determine the prevalence of chronic rhinosinusitis-related symptoms in the United States. Study Design Cross-sectional analysis of a national database. Setting Representative sampling of the US adult population.

Phase II Randomized Controlled Trial of Constraint-Induced Movement Therapy in Multiple Sclerosis. Part 2: Effect on White Matter Integrity.

Background: Constraint-induced movement therapy (CIMT) is a method of physical rehabilitation that has demonstrated clinical efficacy in patients with chronic stroke, cerebral palsy, and multiple sclerosis (MS).

Objective: This pilot randomized controlled trial tested whether CIMT can also induce increases in white matter integrity in patients with MS.

Methods: Twenty adults with chronic hemiparetic MS were randomized to receive either CIMT or complementary and alternative medicine (CAM) treatment (reported in the first article of this pair).

Mechanical and Oral Antibiotic Bowel Preparation in the Era of Minimally Invasive Surgery and Enhanced Recovery.

Introduction: In the modern era of minimally invasive colorectal surgery and enhanced recovery pathways, the value of preoperative bowel preparation remains debated. In this review, we evaluate evidence regarding the use of mechanical bowel preparation (MBP) and oral antibiotic bowel preparation to make recommendations for their application in contemporary practice.

Methods: We searched the PubMed database through December 2017 for relevant randomized controlled trials, Cochrane Reviews, American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database studies, and other reviews pertaining to MBP and oral antibiotic bowel preparation in elective colorectal surgery and conducted a narrative review.

The Ongoing U.S. Health Care Crisis: A Data Update.

While efforts to repeal the Affordable Care Act were narrowly defeated, grave problems in health care persist. Twenty-eight million remain uninsured, a number that is likely to increase. Millions more who have coverage cannot afford care because of high cost-sharing requirements.

Enhanced Recovery Pathways for Minimally Invasive Esophageal Surgery.

Introduction: The outcomes for enhanced recovery after surgery (ERAS) have yet to be thoroughly studied in minimally invasive esophageal surgery. In this review, we examine the literature to provide an overview of the current state of ERAS in minimally invasive esophageal surgery.

Methods: We searched the PubMed database up to January 2018 for relevant literature.

When Old Habits Train a New Generation: Findings From a National Survey of Internal Medicine Program Directors on Procedural Training.

Resident physicians routinely perform bedside procedures that pose substantial risk to patients. However, no standard programmatic approach to supervision and procedural competency assessment among residents currently exists. The authors performed a national survey of internal medicine (IM) program directors to examine procedural assessment and supervision practices of IM residency programs.

Integration Site Analysis in Gene Therapy Patients: Expectations and Reality.

Integration site (IS) analysis is one of the major tools for addressing the safety of gene therapy clinical protocols based on the use of integrating vectors. Over the past years, the study of viral insertions in gene therapy-treated patients has allowed identifying insertional mutagenesis events, evaluating the safety of new viral vector platforms and tracking the in vivo clonal dynamics of genetically engineered cell products. While gene therapy is progressively expanding its impact on a broader area of clinical applications, increasingly more accessible, faster, and more reliable safety readouts are required from IS analysis.

Obesity in Women: Insights for the Clinician.

As a leading cause of morbidity and mortality in the United States and worldwide, obesity is a disease that is frequently encountered in clinical practice today and requires a range of medical interventions. While obesity affects both men and women across all ages, multiple issues are particularly germane to women's health, particularly as obesity is more prevalent among women than men in the United States and obesity among women of reproductive health relates to the growing issue of childhood obesity. Discussed herein are the epidemiology and pathophysiology of obesity along with the impact of perinatal obesity on fetal programming.

The Effect of Priming With Questionnaire Content on Grip Strength in Patients With Hand and Upper Extremity Illness.

Background: Grip strength is a performance-based measure of upper extremity function that might be influenced by priming (the influence of a response to a stimulus by exposure to another stimulus). This study addressed the influence of questionnaire content on performance measurements such as grip strength between patients who complete the standard Pain Catastrophizing Scale (PCS) compared with patients who complete a positively adjusted PCS.

Methods: Between June 2015 and August 2015, we enrolled 122 patients who presented to 3 hand surgeons at 3 outpatient offices.

Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework.

Objective: The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region.

Methods: A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa.