PURPOSE

Anticholinergic burden (ACB), the cumulative effect of anticholinergic medications, is associated with adverse outcomes in older people but is less studied in middle-aged populations. Numerous scales exist to quantify ACB. The aims of this study were to quantify ACB in a large cohort using the 10 most common anticholinergic scales, to assess the association of each scale with adverse outcomes, and to assess overlap in populations identified by each scale.

PURPOSE

General practitioners (GPs) are part of the US physician workforce, but little is known about who they are, what they do, and how they differ from family physicians (FPs). We describe self-identified GPs and compare them with board-certified FPs.

Background:

Unnecessary antibiotic use in the community in Canada is not well defined. Our objective was to quantify unnecessary antibiotic prescribing in a Canadian primary care setting.

Background:

The number of medical undergraduate and postgraduate students completing palliative care clinical rotations in Canadian medical schools is currently unknown. The aim of this study was to assess the proportion of Canadian medical trainees completing clinical rotations in palliative care and to determine whether changes took place between 2008 and 2018.

We are already a couple of months into 2020 and I hope you had a good start to the new year. I wish you, our readers, reviewers, authors and editors, happiness, success and health in this new decade.

It is a source of frustration to many clinicians: you know what the patient's problem is, you know that effective and safe treatment is available, you've explained the disease and its causative mechanisms, the treatment and its principles, and the importance of taking the controller medication daily, you've prescribed this highly effective therapy and you've approached the patient with respect and patience, yet somehow the patient does not take the medication. When this patient has another exacerbation, you know it could have been prevented by following your advice and taking the medication.

Balamuthia mandrillaris is an under-reported, pathogenic free-living amoeba that causes Balamuthia amoebic encephalitis (BAE) and cutaneous skin infections. Although cutaneous infections are not typically lethal, BAE with or without cutaneous involvement is usually fatal. This is due to the lack of drugs that are both efficacious and can cross the blood-brain barrier. We aimed to discover new leads for drug discovery by screening the open-source Medicines for Malaria Venture (MMV) Malaria Box and MMV Pathogen Box, with 800 compounds total. From an initial single point screen at 1 and 10 μM, we identified 54 hits that significantly inhibited the growth of B. mandrillaris in vitro. Hits were reconfirmed in quantitative dose-response assays and 23 compounds (42.6%) were confirmed with activity greater than miltefosine, the current standard of care.

We report a systematic, cellular phenotype-based antimalarial screening of the Medicines for Malaria Venture Pathogen Box collection, which facilitated the identification of specific blockers of late-stage intraerythrocytic development of Plasmodium falciparum. First, from standard growth inhibition assays, we identified 173 molecules with antimalarial activity (50% effective concentration [EC₅₀] ≤ 10 μM), which included 62 additional molecules over previously known antimalarial candidates from the Pathogen Box. We identified 90 molecules with EC₅₀ of ≤1 μM, which had significant effect on the ring-trophozoite transition, while 9 molecules inhibited the trophozoite-schizont transition and 21 molecules inhibited the schizont-ring transition (with ≥50% parasites failing to proceed to the next stage) at 1 μM. We therefore rescreened all 173 molecules and validated hits in microscopy to prioritize 12 hits as selective blockers of the schizont-ring transition. Seven of these molecules inhibited the calcium ionophore-induced egress of Toxoplasma gondii, a related apicomplexan parasite, suggesting that the inhibitors may be acting via a conserved mechanism which could be further exploited for target identification studies. We demonstrate that two molecules, MMV020670 and MMV026356, identified as schizont inhibitors in our screens, induce the fragmentation of DNA in merozoites, thereby impairing their ability to egress and invade. Further mechanistic studies would facilitate the therapeutic exploitation of these molecules as broadly active inhibitors targeting late-stage development and egress of apicomplexan parasites relevant to human health.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc. (ACP), and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an initiative of the Cleveland Clinic’s internal medicine residents to improve diabetes care and outcomes within an underserved patient population at an East Cleveland, OH, health center.

Background:

We assessed the ability to supplement existing epidemiologic/etiologic studies with data on treatment and clinical outcomes by linking to publicly available cancer registry and administrative databases.

Consistently, the field of genetic counseling has advocated that parents be advised to defer elective genetic testing of minors until adulthood to prevent a range of potential harms, including stigma, discrimination, and the loss of the child's ability to decide for him- or herself as an adult. However, consensus around the policy of "defer-when-possible" obscures the extent to which this norm is currently under siege. Increasingly, routine use of full or partial genome sequencing challenges our ability to control what is discovered in childhood or, when applied in a prenatal context, even before birth. The expansion of consumer-initiated genetic testing services challenges our ability to restrict what is available to minors. As the barriers to access crumble, medical professionals should proceed with caution, bearing in mind potential risks and continuing to assess the impact of genetic testing on this vulnerable population.

A military exercise in Australia demonstrates how small drones can airdrop critical medical supplies to soldiers in combat

New York City study shows that drones could deliver life-saving medical supplies several minutes before an ambulance arrives

Researchers have developed a set of recommendations to manage the mental health of frontline medical workers during viral outbreaks, such as COVID-19.

Miniature devices that could be developed into safe, high-resolution imaging technology, with uses such as helping doctors identify potentially deadly cancers and treat them early, have been created.

The covid-19 pandemic has led to rushed guidelines for doctors making treatment decisions, and has encouraged more people to make advance decisions on CPR and ventilation

An American doctor operating out of Philadelphia made clinical observations that where patients lived, not how they lived, was at the root of the problem

As interest in the application of plasma medicine -- the use of low-temperature plasma (LTP) created by an electrical discharge to address medical problems -- continues to grow, so does the need for research advancements proving its capabilities and potential impacts on the health care industry. Across the world, many research groups are investigating plasma medicine for applications including cancer treatment and the accelerated healing of chronic wounds, among others.

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Defiant US healthcare workers have been praised after silently blocking cars during coronavirus anti-lockdown demonstrations in Colorado.

RAF plane still awaiting go-ahead for flight to Turkey to collect supplies

Spies with medical qualifications have been switched from fighting terrorism to join the national fight against coronavirus, the head of MI5 revealed today.

A paramedic was left unable to go to work after a brick was thrown through their car window.

The crisis over protective equipment in hospitals turned into farce today as a minister insisted "we will not run out" at the same time that doctors on London's front line protested they do not have enough life-saving masks, gowns and visors.

A London brewery is donating the income from two new beers brewed in honour of frontline healthcare workers to NHS charities.

Disruptive social distancing measures are expected to remain in place to combat coronavirus in the UK until a vaccine or effective treatment is available, England's chief medical officer has said.

Frontline health workers at a UK hospital have become the first in the country to be widely kitted out with a pioneering respirator hood when treating Covid-19 patients.

The Deputy Chief medical officer has revealed she "knocked off for about a week" when she believed she had coronavirus.

Trials of drones delivering medical supplies amid the coronavirus pandemic will begin next week, Grant Shapps announced at today's Downing Street press conference.

The NHS is launching a campaign encouraging ill people to seek urgent care during the coronavirus outbreak after A&E visits dropped by 50 per cent this month.

A coronavirus vaccine might not be ready until later next year, the former deputy chief medical officer for England has said.

Medical students from University College London who were fast-tracked onto the NHS coronavirus frontline donned "lockdown costumes" for an online graduation ceremony.

Medical experts have hit out at Donald Trump after he suggested that research should be carried out into whether the coronavirus might be treated by injecting disinfectant into the body.

Global health experts are investigating reports of a rare but serious illness affecting children and its links to coronavirus after UK medics raised the alarm.

Pub visits should be avoided when social distancing measures are eased, one of the UK's top medics has said.

People have lined the streets to pay their respects to a "fantastic" paramedic and "great family man" who died after contracting coronavirus.