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This trial failed to demonstrate that the addition of surgery to radiation therapy improved outcome of patients with a single brain metastasis. Thus, the efficacy of surgery plus radiation compared with radiation alone needs to be addressed by further clinical trials and/or a meta-analysis.

Diabetes mellitus affects about 7% of the populations of Canada and the United States -some 23 million people -and accounts for direct annual health care costs of about $105 billion.1,2 At least 90% of people with diabetes have type 2 diabetes. In addition to being a major risk factor for cardiovascular disease (whereby the risks of myocardial infarction and stroke are 2-4 times those in the nondiabetic population), diabetes is the primary cause of renal failure, blindness and nontraumatic limb amputation.1,2 International guidelines recommend interventions to prevent these complications, mainly on the basis of evidence from large randomized clinical trials.3-7 These interventions include control of glucose, blood pressure and lipids; vascular protection with acetylsalicylic acid; diet; exercise; renal protection; smoking cessation for smokers; prevention and treatment of retinopathy; and education about foot surveillance. In a recent study, intensive intervention to address multiple risk factors was associated with lower rates of mortality (by 56%), cardiovascular events (by 59%), nephropathy (by 56%) and retinopathy (by 55%) over 13 years relative to conventional therapy. 8 These major changes in the frequency of events occurred despite the small differences (0.3% for glycated hemoglobin, 6 mm Hg for systolic blood pressure and 0.2 mmol/L for low-density lipoprotein [LDL] cholesterol) between groups by the end of the open follow-up period. However, optimal care of patients with diabetes in the community has been difficult to achieve, because it can be difficult to sustain regular monitoring and attention to many risk factors over many years, especially for patients with multiple health care providers. 9,10 Most diabetes care takes place in the community, largely managed in the primary care setting. In this environment, short visits, competing visit objectives, lack of proactive systems for disease surveillance and alerting support, difficulties staying up to date on ever-shifting targets, challenges associated with managing multiple medications and inertia related to chronic disease (on the part of both patient and physician)

The most efficacious interventions for reducing pain from single painful events were the pacifier with sucrose and the pacifier with sterile water. Research on the efficacy and safety of implementing these interventions, alone and in combination, for repeated painful procedures is needed. In addition, research is needed on the influence of implementing these interventions on pain response and clinical outcomes (e.g., health status and neurodevelopmental status) in VLBW neonates in the NICU.

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Background:In patients with venous thromboembolism (VTE), identifying clinical risk factors for recurrence during the initial 3 months of anticoagulant therapy and knowledge of the time course of recurrence may help clinicians decide about the frequency of clinical surveillance and the appropriateness of outpatient treatment.

Substantial gaps between recommended and current care exist in the management of COPD patients in primary care practice. Undertreatment of patients with severe COPD has potential clinical implications, including loss of autonomy and hospitalization.

BackgroundWe describe the early experiences of adults with systemic rheumatic disease who received the COVID-19 vaccine.MethodsFrom 2 April to 30 April 2021, we conducted an online, international survey of adults with systemic rheumatic disease who received COVID-19 vaccination. We collected patient-reported data on clinician communication, beliefs and intent about discontinuing disease-modifying antirheumatic drugs (DMARDs) around the time of vaccination, and patient-reported adverse events after vaccination.ResultsWe analysed 2860 adults with systemic rheumatic diseases who received COVID-19 vaccination (mean age 55.3 years, 86.7% female, 86.3% white). Types of COVID-19 vaccines were Pfizer-BioNTech (53.2%), Oxford/AstraZeneca (22.6%), Moderna (21.3%), Janssen/Johnson & Johnson (1.7%) and others (1.2%). The most common rheumatic disease was rheumatoid arthritis (42.3%), and 81.2% of respondents were on a DMARD. The majority (81.9%) reported communicating with clinicians about vaccination. Most (66.9%) were willing to temporarily discontinue DMARDs to improve vaccine efficacy, although many (44.3%) were concerned about rheumatic disease flares. After vaccination, the most reported patient-reported adverse events were fatigue/somnolence (33.4%), headache (27.7%), muscle/joint pains (22.8%) and fever/chills (19.9%). Rheumatic disease flares that required medication changes occurred in 4.6%.ConclusionAmong adults with systemic rheumatic disease who received COVID-19 vaccination, patient-reported adverse events were typical of those reported in the general population. Most patients were willing to temporarily discontinue DMARDs to improve vaccine efficacy. The relatively low frequency of rheumatic disease flare requiring medications was reassuring.