- The recent Food and Drug Administration–approved drug Rytary is a novel designed capsule and delivery system containing both standard- and extended-release levodopa/carbidopa components that were designed to reduce the number of dosages taken per day. A recent randomized, double-blind, placebo-controlled study of Rytary in levodopa-naïve Parkinson disease (PD) patients showed significant improvements in the Unified Parkinson Disease Rating Scale and in quality of life measurements at 30 weeks compared with placebo. Rytary will need time in clinical practice to better define its role in therapy.
Latest Updates
Practicing Evidence-Based Medicine
- Even the most competent physician can be prone to misusing epidemiologic concepts. An example of inaccurate decision making, resting on Bayes’s theorem, occurred in a recent study in which primary care physicians were given clinical scenarios. Although the clinicians confidently provided their estimates of the probabilities of given disorders, no consensus could be found among the estimates. Another study assessed the ability of medical students, residents, and attending physicians to correctly determine the positive predictive value of a hypothetical screening test. The vast majority of respondents not only got the question wrong but also had an answer that would have led to the opposite clinical conclusions, guessing an incorrect positive predictive value of 95% when the true answer was 2%.
Practicing Evidence-Based Medicine
- Even the most competent physician can be prone to misusing epidemiologic concepts. An example of inaccurate decision making, resting on Bayes’s theorem, occurred in a recent study in which primary care physicians were given clinical scenarios. Although the clinicians confidently provided their estimates of the probabilities of given disorders, no consensus could be found among the estimates. Another study assessed the ability of medical students, residents, and attending physicians to correctly determine the positive predictive value of a hypothetical screening test. The vast majority of respondents not only got the question wrong but also had an answer that would have led to the opposite clinical conclusions, guessing an incorrect positive predictive value of 95% when the true answer was 2%.
- The recent Food and Drug Administration–approved drug Rytary is a novel designed capsule and delivery system containing both standard- and extended-release levodopa/carbidopa components that were designed to reduce the number of dosages taken per day. A recent randomized, double-blind, placebo-controlled study of Rytary in levodopa-naïve Parkinson disease (PD) patients showed significant improvements in the Unified Parkinson Disease Rating Scale and in quality of life measurements at 30 weeks compared with placebo. Rytary will need time in clinical practice to better define its role in therapy.
Rare Tumors of the Colorectal Region
- Immunotherapy and targeted therapy represent innovative medical therapies to improve survival in anorectal melanoma.
- Clinical trials are under way examining medical therapy options in imatinib-resistant GISTs.
- Safety and effectiveness of transanal minimally invasive surgery are being studied for rectal GISTs.
Rare Tumors of the Colorectal Region
- Immunotherapy and targeted therapy represent innovative medical therapies to improve survival in anorectal melanoma. Pembrolizumab is a PD-1 inhibitor used as immunotherapy in melanoma.
- Clinical trials are under way examining medical therapy options in imatinib-resistant GISTs.
- Safety and effectiveness of transanal minimally invasive surgery are being studied for rectal GISTs.
Overview of Substance Use Disorders
- Discussion of the evolution of DSM substance use disorder diagnoses over time
- Overview of the biological, environmental, and personal factors implicated in the development of substance use disorders
- Critical reviews of the current diagnostic criteria, epidemiology, and clinical presentation of the major substances of misuse
Injuries to the Upper Urogenital Tract
- Most grade III and IV injuries, including those with devitalized parenchymal fragments and urinary extravasation, are managed nonoperatively
- Angioembolization of persistent or delayed kidney bleeding (pseudoaneurysm) obviates the need for exploration in a majority of cases
- A high index of suspicion is necessary to diagnose a ureteral injury to prevent late complications such as urinoma, sepsis, and nephrectomy
