RESUMO
SOURCE CITATION: Aggarwal R, Charles-Schoeman C, Schessl J, et al. Trial of intravenous immune globulin in dermatomyositis. N Engl J Med. 2022;387:1264-78. 36198179.
Assuntos
Dermatomiosite , Imunoglobulinas Intravenosas , Adulto , Humanos , Dermatomiosite/tratamento farmacológico , Imunoglobulinas Intravenosas/uso terapêuticoRESUMO
SOURCE CITATION: So H, Lam TO, Meng H, et al. Time and dose-dependent effect of systemic glucocorticoids on major adverse cardiovascular event in patients with rheumatoid arthritis: a population-based study. Ann Rheum Dis. 2023;82:1387-1393.37487608.
Assuntos
Antirreumáticos , Artrite Reumatoide , Humanos , Glucocorticoides/efeitos adversos , Prednisolona/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Antirreumáticos/uso terapêuticoRESUMO
SOURCE CITATION: Huss V, Bower H, Hellgren K, et al; ARTIS group. Cancer risks with JAKi and biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis or psoriatic arthritis: a national real-world cohort study. Ann Rheum Dis. 2023;82:911-919. 36868796.
Assuntos
Antirreumáticos , Inibidores de Janus Quinases , Neoplasias Cutâneas , Humanos , Inibidores de Janus Quinases/efeitos adversos , Inibidores do Fator de Necrose Tumoral , Estudos de Coortes , Antirreumáticos/efeitos adversos , Neoplasias Cutâneas/tratamento farmacológicoRESUMO
In contrast with the rapid advances in medical knowledge and technology, the clinical encounter may often appear as perfunctory, impersonal, and unworthy to both patient and practitioner who is often immersed in the computer screen rather than the patient, stressed by improbable time constraints, and often finds deceptive relief in inappropriate test-ordering, prescriptions, and referrals. We suggest routinely adopting six attitudes to achieve a more balanced, personal, and patient-centred encounter: conducting a curiosity-driven encounter; emphasizing humanistic values; performing a complete physical examination; increasing patients' face time; addressing the patient's health as a whole; and rational test-ordering and judicious prescribing.
Assuntos
Assistência Centrada no Paciente , Relações Médico-Paciente , Humanos , Comunicação , Participação do Paciente , Satisfação do PacienteRESUMO
SOURCE CITATION: Lin I, Glinsky J, Dean C, et al. Effectiveness of home-based exercise for improving physical activity, quality of life and function in older adults after hospitalisation: a systematic review and meta-analysis. Clin Rehabil. 2022;36:1170-85. 35522200.
Assuntos
Alta do Paciente , Qualidade de Vida , Idoso , Exercício Físico , Terapia por Exercício , Hospitais , HumanosRESUMO
A healthy young man presented to the emergency department with mild hemoptysis associated with cannabis abuse. He was on no medications and cocaine abuse was ruled out by both history and negative toxicology screens. There were neither signs of an infection, nor of a systemic or cardiac disease. Imaging studies were consistent with diffuse alveolar hemorrhage, a reported, albeit rare adverse drug reaction of tetrahydrocannabinol (Naranjo score 6). The patient improved spontaneously within a few days, hemoptysis stopped and repeat imaging was entirely normal. With the increase in cannabis abuse and enhanced cannabis potency worldwide clinicians may increasingly encounter even unusual cannabis-associated adverse drug reactions, including associated diffuse alveolar hemorrhage.
Assuntos
Hemoptise/etiologia , Abuso de Maconha/complicações , Alvéolos Pulmonares/anormalidades , Humanos , Masculino , Alvéolos Pulmonares/fisiopatologia , Fumantes , Adulto JovemRESUMO
BACKGROUND: ED referral of older adults on the initiative of their family or paid live-in caregiver is common but not previously studied. METHODS: ED-presenting community-dwelling patients ≥65 years were studied, emphasizing the referring agent, and correct (admitted or discharged +changed diagnosis/treatment) vs. incorrect referral (discharged, no change made). RESULTS: Of 448 consecutive patients (median age 83 years), 231 were referred by their primary physician (PCP) (73% admitted, 17% discharged +change). 117 ED referrals were initiated by their family (78% admitted, 6% discharged +change), and 100 by their paid caregiver (66% admitted, 21% discharged +change). Differences were non-significant, as was the distribution of main diagnoses. CONCLUSIONS: ED referral of older adults from the community by laymen who know the patient well (family or caregiver) is non-inferior to a referral by their PCP. ED physicians should regard non-physician ED presentations as seriously as a referral by a physician, pending confirmation in future studies.
Assuntos
Cuidadores , Serviço Hospitalar de Emergência , Vida Independente , Encaminhamento e Consulta/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Atenção Primária à Saúde/estatística & dados numéricosRESUMO
Diagnostic errors, were given relatively little attention, compared with the effort invested in treatment errors. However, erroneous diagnoses continue to be quite prevalent (10%-15% in every setting investigated), and are often associated with substantial patient harm including increased mortality and frequent permanent disability. Physicians may not be aware of the fact that despite the wide availability of sophisticated diagnostic imaging and new and sensitive tests, diagnosis remains far from infallible, because of a complex interplay of physician, patient and illness factors. Research devoted to misdiagnosis remains difficult to perform and insufficient in scope, but the search for the optimal means to improve diagnostic accuracy continues. Newly achieved insights regarding diagnostic errors are presented, and essential system and individual approaches to improve diagnostic accuracy are proposed.
Assuntos
Médicos , Erros de Diagnóstico , HumanosRESUMO
SOURCE CITATION: Singh JA, Cleveland JD. Hypersensitivity reactions with allopurinol and febuxostat: a study using the Medicare claims data. Ann Rheum Dis. 2020;79:529-35. 32024648.
Assuntos
Febuxostat , Gota , Idoso , Alopurinol/efeitos adversos , Colchicina/efeitos adversos , Febuxostat/efeitos adversos , Gota/tratamento farmacológico , Supressores da Gota/efeitos adversos , Humanos , Medicare , Estados Unidos/epidemiologiaRESUMO
SOURCE CITATION: Mease PJ, Rahman P, Gottlieb AB, et al. Guselkumab in biologic-naive patients with active psoriatic arthritis (DISCOVER-2): a double-blind, randomised, placebo-controlled phase 3 trial. Lancet. 2020;395:1126-36. 32178766.