What's New | Decker

Randomized trials studying medical therapies to improve walking performance in patients with PAD have traditionally used treadmill walking performance as the primary outcome measure. Clinical trials of medical therapies in PAD have also measured changes in quality of life, patient perceived walking performance in daily life, the 6-minute walk, and other functional outcomes.
Two medications are FDA-approved for treating claudication symptoms in people with PAD: pentoxifylline and cilostazol. Pentoxifylline, a methylxanthine derivative, was FDA-approved in 1984 for treating intermittent claudication symptoms due to PAD. Pentoxifylline lowers blood viscosity by increasing red blood cell deformability and flexibility. Cilostazol is a phosphodiesterase III inhibitor that was FDA-approved in 1999 for treating walking impairment due to intermittent claudication symptoms in patients with PAD.

Use of HVPG to accurately diagnose portal hypertension
Child-Pugh score and MELD score in risk stratification and decision-making
Fibroelastography, multidetecter row CT scan, and capsule endoscopy as emerging modalities in detection of varices.

Use of HVPG to accurately diagnose portal hypertension
Child-Pugh score and MELD score in risk stratification and decision-making
Fibroelastography, multidetecter row CT scan, and capsule endoscopy as emerging modalities in detection of varices.

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.

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.

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%.

Cardiovascular