Reducing Unnecessary Vitamin D Screening in an Academic Health System: What Works and When

Vitamin D deficiency is relatively common, with an estimated prevalence between 19% and 77% in the United States.1,2 Low serum 25(OH)D levels have been associated with increased cardiovascular and all-cause mortality3 and other adverse outcomes.4,5 Further, vitamin D supplementation is safe and low cost. However, associations between vitamin D supplementation and various outcomes have been mixed or have not been definitive,6 and there is limited evidence that population-based screening for vitamin D deficiency improves outcomes.

A New Option for Reversing the Anticoagulant Effect of Factor Xa Inhibitors: Andexanet Alfa (ANDEXXA)

The use of direct oral anticoagulants over traditional warfarin has increased in the United States over the past 10 years because of advantages such as ease of use, predictable pharmacokinetic response, and safety. In 2015, the U.S. Food and Drug Administration approved idarucizumab (Praxbind) for the reversal of the direct thrombin inhibitor dabigatran, but no reversal agent has been available for oral factor Xa (FXa) inhibitors until recently. Andexanet alfa was approved in May 2018, under the brand name ANDEXXA, for the reversal of 2 of FXa inhibitors, apixaban and rivaroxaban, when life-threatening or uncontrolled bleeding occurs.

Should Patients Infected with Borrelia burgdorferi No Longer Be Referred to as Having Lyme Disease?

In 1977, a seminal paper described what was subsequently called Lyme arthritis.1 The name ‘Lyme’ originated from the initial investigation of the disease that was conducted in the Connecticut towns of Lyme, Old Lyme, and East Haddam.1 As more of the clinical manifestations of this illness were discovered, the condition became referred to as Lyme disease.2-4 In 1983, the principal etiologic agent for Lyme disease in North America was identified in patients.3,5 The etiologic agent became known as Borrelia burgdorferi and until fairly recently was the only species of Lyme borrelia identified to cause Lyme disease in the United States.

Medical Principles in Obstetrical Consults

The ideal pregnancy should be medically uncomplicated. In contrast, maternal mortality in the United States equates to approximately 3 deaths per day and averages approximately 1 in 4000 live births (a total of 1063 deaths in 2015).1 Moreover, the annual number of maternal deaths has nearly doubled in the last 25 years for the United States, unlike most other causes of mortality in young adults.1 Of course, the majority of women survive, yet 1 in 10 will suffer from some illness during pregnancy, amounting to approximately 800,000 total cases in 2015 for the United States.

Medical Tourists: Incoming and Outgoing

Patients who travel to another country to seek health care are referred to as medical tourists. The term arose because many Americans seek less expensive elective surgical, dental, or cosmetic procedures while vacationing abroad.1 Of course, US hospitals and physicians have also long cared for medical tourists from other countries. Now, many medical tourists are going the other way—from the United States to other countries to receive health care. In 2007, it is estimated that 750,000 Americans traveled to other countries for health care.

The Physician’s Prayer

I first met John on my fourth day in Cape Coast, Ghana, as a volunteer assisting in medical outreach. We had driven out to a residential leper colony—a harrowingly inhumane concept—for individuals and families of those who have been cured of leprosy. Unfortunately, most of the leprosy victims continued to suffer from flesh wounds sustained during their sickness. These wounds often manifested in the feet of the survivors. Our group of volunteers came twice a week to clean, disinfect, and rebandage the wounds of these patients.

Modern Trends in Dental Medicine: An Update for Internists

Traumatic injuries, genetic diseases, and external harmful agents such as bacteria and acids often compromise tooth integrity. There is an unmet medical need to develop alternative, innovative dental treatments that complement traditional restorative and surgery techniques. Stem cells have transformed the medical field in recent years. The combination of stem cells with bioactive scaffolds and nanostructured materials turns out to be increasingly beneficial in regenerative dental medicine. Stem cell–based regenerative approaches for the formation of dental tissues will significantly improve treatments and will have a major impact in dental practice.

When Guidelines Cause Hypertension

The 2017 ACC/AHA Hypertension Guidelines1 lowered the threshold for diagnosing hypertension from a blood pressure of ≥140/90 mm Hg to ≥130/80 mm Hg. In the United States, this effectively increases the number of adults diagnosed as “hypertensive” from 72 to 103 million.2 It has been stated that “by reclassifying people formerly considered to have pre-hypertension as having hypertension, the Guidelines create a new level of disease affecting people previously deemed healthy.”2

Altruism: A Story in Three Acts

As regulatory and technological forces increasingly impact bedside care, some clinical educators have raised the concern that altruism in medicine, one of the core pillars of the physician-patient relationship, if not dying, is at least threatened.1 Decreasing altruism may reflect the diminished empathy, compassion, and patient-centered care that accompany physician burnout, particularly among residents in graduate medical education programs.2 Over the past year, however, 3 acts of altruism occurred in the course of routine care by medical residents at Rhode Island Hospital.