Search

A personal narrative is presented in which the author being a primary care physician, dealt with a patient with adrenal insufficiency.

A personal narrative is presented which explores the author's experiences when Hurricane Sandy struck the U.S. and affected Bellevue Hospital Center in New York City.

A personal narrative is presented which explores the author's experience of treating an elderly male patient with diabetes and advanced liver cancer.

The article comments on the effectiveness of using quality report card to distinguish good physicians. According to the author, there is a need to have good evidence that the report card measures the true quality of physicians and that the data will help improve patients' care. She adds that it is difficult to understand the baseline assumption about the performance of doctors if the goal of report card is to help improve physicians' care. She suggests ways to improve his patients' medical care.

The author reflects on the patterns of the emotional reaction of people to the H1N1 influenza vaccination. The author states that patients were in a panic when the 2009 H1N1 influenza virus first came to the attention of medical professionals from around the world. However, when the vaccines for the virus were launched, the people who were eager to get influenza shots began to question their safety and efficacy. She asserts the importance for practicing clinicians to be equipped with the essential clinical tools for the coming influenza season.

BACKGROUND Insulin icodec is an investigational once-weekly basal insulin analogue for diabetes management. METHODS We conducted a 78-week randomized, open-label, treat-to-target phase 3a trial (including a 52-week main phase and a 26-week extension phase, plus a 5-week follow-up period) involving adults with type 2 diabetes (glycated hemoglobin level, 7 to 11%) who had not previously received insulin. Participants were randomly assigned in a 1:1 ratio to receive once-weekly insulin icodec or once-daily insulin glargine U100. The primary end point was the change in the glycated hemoglobin level from baseline to week 52; the confirmatory secondary end point was the percentage of time spent in the glycemic range of 70 to 180 mg per deciliter (3.9 to 10.0 mmol per liter) in weeks 48 to 52. Hypoglycemic episodes (from baseline to weeks 52 and 83) were recorded. RESULTS Each group included 492 participants. Baseline characteristics were similar in the two groups. The mean reduction in the glycated hemoglobin level at 52 weeks was greater with icodec than with glargine U100 (from 8.50% to 6.93% with icodec [mean change, -1.55 percentage points] and from 8.44% to 7.12% with glargine U100 [mean change, -1.35 percentage points]); the estimated between-group difference (-0.19 percentage points; 95% confidence interval [CI], -0.36 to -0.03) confirmed the noninferiority (P<0.001) and superiority (P=0.02) of icodec. The percentage of time spent in the glycemic range of 70 to 180 mg per deciliter was significantly higher with icodec than with glargine U100 (71.9% vs. 66.9%; estimated between-group difference, 4.27 percentage points [95% CI, 1.92 to 6.62]; PcO.001), which confirmed superiority. Rates of combined clinically significant or severe hypoglycemia were 0.30 events per person-year of exposure with icodec and 0.16 events per person-year of exposure with glargine U100 at week 52 (estimated rate ratio, 1.64; 95% CI, 0.98 to 2.75) and 0.30 and 0.16 events per person-year of exposure, respectively, at week 83 (estimated rate ratio, 1.63; 95% CI, 1.02 to 2.61). No new safety signals were identified, and incidences of adverse events were similar in the two groups. CONCLUSIONS Glycemic control was significantly better with once-weekly insulin icodec than with once-daily insulin glargine U100. (Funded by Novo Nordisk; ONWARDS 1 ClinicaITrials.gov number, NCT04460885.). [ABSTRACT FROM AUTHOR]

Describes the author's thoughts while preparing to give a patient bad news from a presurgical-testing clinic. The health history of Ramonita Ortega, a middle-age woman who had given up a smoking habit several year earlier, and come to the author's office for a routine visit; The issue of whether "they" (those in authority) had withheld information; The patient and doctor's reactions to a possible lung cancer diagnosis.

The author presents her views on regulations and standards surrounding resident physicians. The author notes that many residents are resistant to the changes brought on by new regulations hospitals are placing on physicians. Some of the rules discussed pertain to vacation time, weekend call and attending rounds.

Presents an essay on how the author begins to filter out complaints of a chronically complaining patient. How the patients resistance to the doctor's suggestions make it impossible for the doctor to do anything for the patient and makes the doctor start to resent the patient; How in frustration she tells the patient there is nothing really wrong; Reaction of the patient's daughter who paints a different picture for the doctor; Reminder to the physician that patients lives are lived outside of appointments and that the illnesses impact more than the doctor.

Presents the author's thoughts on treating an elderly woman in a coma. Discussion the author had with the patient's sister that made him realize that the patient was a person; Time the author spent sitting by the woman's bedside; Reaction to the woman's death.

Background: Establishing cardiovascular safety of new therapies for type 2 diabetes is important. Safety data are available for the subcutaneous form of the glucagon-like peptide-1 receptor agonist semaglutide but are needed for oral semaglutide.Methods: We assessed cardiovascular outcomes of once-daily oral semaglutide in an event-driven, randomized, double-blind, placebo-controlled trial involving patients at high cardiovascular risk (age of ≥50 years with established cardiovascular or chronic kidney disease, or age of ≥60 years with cardiovascular risk factors only). The primary outcome in a time-to-event analysis was the first occurrence of a major adverse cardiovascular event (death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke). The trial was designed to rule out 80% excess cardiovascular risk as compared with placebo (noninferiority margin of 1.8 for the upper boundary of the 95% confidence interval for the hazard ratio for the primary outcome).Results: A total of 3183 patients were randomly assigned to receive oral semaglutide or placebo. The mean age of the patients was 66 years; 2695 patients (84.7%) were 50 years of age or older and had cardiovascular or chronic kidney disease. The median time in the trial was 15.9 months. Major adverse cardiovascular events occurred in 61 of 1591 patients (3.8%) in the oral semaglutide group and 76 of 1592 (4.8%) in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.57 to 1.11; P<0.001 for noninferiority). Results for components of the primary outcome were as follows: death from cardiovascular causes, 15 of 1591 patients (0.9%) in the oral semaglutide group and 30 of 1592 (1.9%) in the placebo group (hazard ratio, 0.49; 95% CI, 0.27 to 0.92); nonfatal myocardial infarction, 37 of 1591 patients (2.3%) and 31 of 1592 (1.9%), respectively (hazard ratio, 1.18; 95% CI, 0.73 to 1.90); and nonfatal stroke, 12 of 1591 patients (0.8%) and 16 of 1592 (1.0%), respectively (hazard ratio, 0.74; 95% CI, 0.35 to 1.57). Death from any cause occurred in 23 of 1591 patients (1.4%) in the oral semaglutide group and 45 of 1592 (2.8%) in the placebo group (hazard ratio, 0.51; 95% CI, 0.31 to 0.84). Gastrointestinal adverse events leading to discontinuation of oral semaglutide or placebo were more common with oral semaglutide.Conclusions: In this trial involving patients with type 2 diabetes, the cardiovascular risk profile of oral semaglutide was not inferior to that of placebo. (Funded by Novo Nordisk; PIONEER 6 ClinicalTrials.gov number, NCT02692716.). [ABSTRACT FROM AUTHOR]

The article presents a study which examines the safety and efficacy of saxagliptin, a dipeptidyl peptidase 4 (DPP-4) inhibitor, in the cardiovascular outcomes of patients with type 2 diabetes mellitus. Samples include 16,492 patients who had history of cardiovascular events were randomly assigned to administer saxagliptin or placebo. Results show that a primary end point occurred in 609 patients assigned to placebo and in 613 patients assigned to saxagliptin.