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Recent case reports and series have identified a subgroup of atypical femoral-shaft fractures associated with bisphosphonate use. This study analyzed data from three large, randomized bisphosphonate trials. Subtrochanteric or diaphyseal femur fractures were very rare, even among women who had been treated with bisphosphonates for as long as 10 years. In patients with osteoporosis, proven benefits for fracture reduction appear to outweigh the possible risk of femoral-shaft fractures.
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In this randomized study evaluating rehabilitative therapies in patients with long-term upper-limb impairment after stroke, outcomes at 12 weeks were similar with robot-assisted therapy, intensive comparison therapy, and usual care. In secondary analyses, modest improvements were observed over 36 weeks in both intensive-therapy groups, as compared with the usual-care group.
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In this article, the investigators examined a subgroup of children whose mothers had participated in a trial of prenatal vitamin A supplementation that was performed in an area of Nepal where traditionally there is suboptimal nutrition. The lung function of children whose mothers had received vitamin A supplementation during pregnancy was 2 to 3% better than that of children whose mothers had received placebo.
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In this large study of colorectal-cancer screening, the endoscopist's rate of adenoma detection was associated with the risk of interval colorectal cancer after screening colonoscopy. Colorectal cancers were less likely to be diagnosed between screening examinations when colonoscopies were performed by endoscopists with an adenoma detection rate of 20% or more.
Hospital-acquired infections are most commonly associated with mechanical ventilation, invasive medical devices, or surgical procedures. Gram-negative bacteria are responsible for more than 30% of hospital-acquired infections and predominate in hospital-acquired pneumonia. They are highly efficient at up-regulating or acquiring mechanisms of antibiotic drug resistance, especially in the presence of antibiotic selection pressure. This review updates what clinicians should know about these often life-threatening infections.
A 54-year-old woman was admitted to this hospital because of 2 months of episodes of dizziness resulting in falls, which occurred only when standing and were associated with diaphoresis, weakness in the legs, and palpitations. She had a history of borderline hypertension and atrial fibrillation. Physical and neurologic examinations were normal. Orthostatic vital signs showed decreased blood pressure and increased heart rate on standing. Symptoms persisted despite treatment with meclizine, metoprolol, fluid administration, and fludrocortisone. A diagnostic test result was received.
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The authors interviewed 26 whistle-blowers who had initiated qui tam cases against pharmaceutical companies that were successfully prosecuted for health care fraud. The whistle-blowers reported undergoing substantial personal hardships during their legal cases, which lasted an average of 5 years. They were paid a median of $3 million.
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