JAMA : the journal of the American Medical Association
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Randomized Controlled Trial
Effect of testosterone supplementation with and without a dual 5α-reductase inhibitor on fat-free mass in men with suppressed testosterone production: a randomized controlled trial.
Steroid 5α-reductase inhibitors are used to treat benign prostatic hyperplasia and androgenic alopecia, but the role of 5α-dihydrotestosterone (DHT) in mediating testosterone's effects on muscle, sexual function, erythropoiesis, and other androgen-dependent processes remains poorly understood. ⋯ Changes in fat-free mass in response to graded testosterone doses did not differ in men in whom DHT was suppressed by dutasteride from those treated with placebo, indicating that conversion of testosterone to DHT is not essential for mediating its anabolic effects on muscle.
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Dr A is a senior primary care physician who recently moved from a small private practice to a larger group-model practice. He believes he was able to provide higher-quality and more individualized care for his patients in his small practice. ⋯ However, the perspective of patients and experienced physicians like Dr A also should be incorporated into quality measurement and management systems. Dr A clearly has the welfare of his patients at heart, and his experience and perspective could help improve his organization's systems of care and identify resources to deliver the best care.
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Randomized Controlled Trial Multicenter Study
Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial.
Despite reported success, surgery for pharmacoresistant seizures is often seen as a last resort. Patients are typically referred for surgery after 20 years of seizures, often too late to avoid significant disability and premature death. ⋯ Among patients with newly intractable disabling MTLE, resective surgery plus AED treatment resulted in a lower probability of seizures during year 2 of follow-up than continued AED treatment alone. Given the premature termination of the trial, the results should be interpreted with appropriate caution.
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Record numbers of Iraq and Afghanistan veterans survive their war injuries and yet continue to experience pain and mental health problems, particularly posttraumatic stress disorder (PTSD). Little is known about the association of mental health disorders and prescription opioid use. ⋯ Among US veterans of Iraq and Afghanistan, mental health diagnoses, especially PTSD, were associated with an increased risk of receiving opioids for pain, high-risk opioid use, and adverse clinical outcomes.