Annals of internal medicine
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Although an increased risk for death after hip fracture is well established, whether this excess mortality persists over time is unclear. ⋯ Fund for Scientific Research and Willy Gepts Foundation, Universitair Ziekenhuis Brussel.
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Concierge medical practices, which advertise expanded access to care and individualized attention, collect charges both from insurance companies and directly from their patients. Some bill hundreds of dollars for one-time "executive" physicals, whereas others have patients pay annual retainer fees. Yet, virtually no data are available about these "luxury" practices. ⋯ Although some have voiced concern that concierge physicians create a 2-tiered system and may contribute to the difficulty that many patients have with access to care, the medical community has largely remained silent on the matter. The mere existence of concierge medicine may reflect our need as physicians to do better by our patients. Yet our responsibility as a professional community is to engage in--not run from--that monumental challenge.
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Review Meta Analysis
Systematic review: Vitamin D and cardiometabolic outcomes.
Vitamin D may modify risk for cardiometabolic outcomes (type 2 diabetes, hypertension, or cardiovascular disease). ⋯ National Institute of Diabetes and Digestive and Kidney Disease, the National Institutes of Health Office of Dietary Supplements, U.S. Food and Drug Administration, Agency for Healthcare Research and Quality, and Public Health Agency of Canada.
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The myeloproliferative disorders polycythemia vera, essential thrombocytosis, and primary myelofibrosis are clonal disorders arising in a pluripotent hematopoietic stem cell, causing an unregulated increase in the number of erythrocytes, leukocytes, or platelets, alone or in combination; eventual marrow dominance by the progeny of the involved stem cell; and a tendency to arterial or venous thrombosis, marrow fibrosis, splenomegaly, or transformation to acute leukemia, albeit at widely varying frequencies. The discovery of an activating mutation (V617F) in the gene for JAK2 (Janus kinase 2), a tyrosine kinase utilized by hematopoietic cell receptors for erythropoietin, thrombopoietin, and granulocyte colony-stimulating factor, provided an explanation for the shared clinical features of these 3 disorders. Constitutive JAK2 activation provides a growth and survival advantage to the hematopoietic cells of the affected clone. ⋯ Because the erythropoietin, thrombopoietin, and granulocyte colony-stimulating factor receptors are all constitutively activated, polycythemia vera is the potential ultimate clinical phenotype of the JAK2 V617F mutation and, as a corollary, is the most common of the 3 disorders. The number of cells expressing the JAK2 V617F mutation (the allele burden) seems to correlate with the clinical phenotype. Preliminary results of clinical trials with agents that inhibit the mutated kinase indicate a reduction in splenomegaly and alleviation of night sweats, fatigue, and pruritus.
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Review Meta Analysis
Systematic review: Vitamin D and calcium supplementation in prevention of cardiovascular events.
Vitamin D and calcium may affect the cardiovascular system independently and interactively. ⋯ The American Heart Association and the National Heart, Lung, and Blood Institute.