This episode of UpToDate Talk begins with Dr. Scott Kasner, who outlines three recent NEJM studies investigating the effects of PFO device closure on recurrent stroke risk. The second segment features Dr. James O’Dell, discussing the cost effectiveness of triple therapy in the treatment of rheumatoid arthritis. Dr. Helen Hollingsworth hosts.

PFO closure for prevention of recurrent stroke; Cost-effectiveness of triple therapy in RA

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Science

This episode features Dr. Robert Wood discussing the results of a trial of oral immunotherapy with a manufactured peanut protein product for peanut desensitization, and its potential role in clinical practice. Dr. Nancy Sokol hosts.

Dr. Wood is Professor of Pediatrics and Director of Pediatric Allergy and Immunology at the Johns Hopkins University School of Medicine and Professor of International Health at the Johns Hopkins Bloomberg School of Public Health. He is Editor-in-Chief of the Allergy and Immunology specialty at UpToDate.

Reference: Bird JA, Spergel JM, Jones SM, et al. Efficacy and Safety of AR101 in Oral Immunotherapy for Peanut Allergy: Results of ARC001, a Randomized, Double-Blind, Placebo-Controlled Phase 2 Clinical Trial. J Allergy Clin Immunol Pract 2018; 6:476.

Contributor Disclosure: Grant/Research/Clinical Trial Support: DBV Technologies; Aimmune; Astellas; HAL-Allergy [Food allergy].

Peanut oral immunotherapy in children and young adults

Dr. Leonard Ganz discusses pharmacologic rate control of atrial fibrillation (AF) and findings of a recent study published in the Journal of the American College of Cardiology regarding the use of digoxin and mortality in patients with AF. Dr. Nancy Sokol hosts.

Dr. Ganz is a clinical cardiologist and Director of Cardiac Electrophysiology at the Heritage Valley Health System, in Western Pennsylvania, and Section Editor of the cardiac arrhythmias section in UpToDate.

Reference: Lopes RD, Rordorf R, De Ferrari GM, et al. Digoxin and Mortality in Patients With Atrial Fibrillation. J Am Coll Cardiol 2018; 71:1063.

Contributor Disclosure: Speaker’s Bureau: Amgen [Heart failure (Ivabradine)]; Pfizer, BMS [Anticoagulation (Apixaban)]; St. Jude Medical, Biotronik [Cardiac rhythm (Pacemaker/ICD)]; Lundbeck [Orthostatic hypotension (Northera)]. Consultant/Advisory Boards: Unequal Technologies [Commotio cordis (Protective equipment)]. Equity Ownership/Stock Options: Unequal Technologies [Commotio cordis (Protective equipment/apparel)].

Digoxin levels and mortality in patients with atrial fibrillation

Dr. Christopher Kabrhel discusses the PERC rule for evaluating patients with suspected pulmonary embolism and a trial exploring the effects of implementing the PERC rule in emergency departments in France, published in JAMA in February 2018. Dr. Nancy Sokol hosts.

Dr. Kabrhel is Associate Professor at Harvard Medical School, an Emergency Medicine physician at Massachusetts General Hospital, and author of several topics on pulmonary embolism for UpToDate.

Reference: Freund Y, Cachanado M, Aubry A, et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. JAMA 2018; 319:559.

Contributor Disclosure: Grant/Research Support: Siemens [Venous thromboembolism (D-dimer test)]; Janssen [Venous thromboembolism (Rivaroxaban)]; Diagnostica Stago [Venous thromboembolism (D-dimer test)]. Consultant/Advisory Board: Siemens [Venous thromboembolism (D-dimer test)]; Janssen [Venous thromboembolism (Rivaroxaban)].

PERC criteria for ruling out pulmonary embolism

This episode features Dr. Carol Weitzman discussing a recent study showing a higher incidence of fetal alcohol spectrum disorders in children than previously thought, as well as methods to raise awareness and improve detection. Dr. April Eichler hosts.

Dr. Weitzman is Professor of Pediatrics and Director of the Developmental-Behavioral Pediatrics Program at the Yale School of Medicine. She is an author in the Pediatrics specialty at UpToDate.

Reference: 
May PA, Chambers CD, Kalberg WO, et al. Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities. JAMA 2018; 319:474.

Contributor disclosure: HeartFlow (Investor).

Under-recognition of fetal alcohol spectrum disorders

This episode features Dr. Jose Biller discussing two recent studies showing that intra-arterial mechanical thrombectomy improves neurologic outcomes when performed up to 24 hours after symptom onset for selected patients with ischemic stroke. Dr. April Eichler hosts.

Dr. Biller is a Professor of Neurology and Neurological Surgery and Chairman of the Department of Neurology at the Loyola University Chicago Stritch School of Medicine. He is Section Editor in the Neurology specialty at UpToDate.

References: 
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 2018; 378:11.

Albers GW, Marks MP, Kemp S, et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med 2018; 378:708.

Contributor disclosure: Nothing to disclose.

PFO closure for prevention of recurrent stroke; Cost-effectiveness of triple therapy in RA

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