PERC criteria for ruling out pulmonary embolism

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].

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)].

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)].

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).

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.

Dr. John Pemberton discusses a cohort study of patients with acute diverticulitis followed for 4 years for recurrence rates and need for surgery following the initial episode, published in Diseases of the Colon & Rectum in March 2018. Dr. Nancy Sokol hosts. Dr. Pemberton is Professor of Surgery at the Mayo Clinic and Mayo Medical School, and authors several topics on diverticular disease for UpToDate. Reference: El-Sayed C, Radley S, Mytton J, et al. Risk of Recurrent Disease and Surgery Following an Admission for Acute Diverticulitis. Dis Colon Rectum 2018; 61:382. Contributor Disclosure: Nothing to disclose

Dr. Brian Olshansky discusses a paper in the February 2018 New England Journal of Medicine regarding a trial of catheter ablation for atrial fibrillation with heart failure. Dr. Nancy Sokol hosts. Dr. Olshansky is Professor Emeritus of Internal Medicine at the University of Iowa, Adjunct Professor of Medicine at Des Moines University, and Section Editor for UpToDate cardiology topics. Reference: Marrouche NF, Brachmann J, Andresen D, et al. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med 2018; 378:417. Contributor Disclosure: Speaker’s Bureau: Lundbeck [Orthostatic hypotension (Droxidopa)]; CryoLife [Heart Valve Replacement (On-X Aortic Valves)]. Consultant/Advisory Boards: Lundbeck [Orthostatic hypotension (Droxidopa)]; CryoLife [Heart Valve Replacement (On-X Aortic Valves)]. Other Financial Interest: Amarin [Hypertriglyceridemia (EPA; Chair, Data and Safety Monitoring Board)]; Boerhringer Ingelheim [Atrial fibrillation (GLORIA AF trial)].

This episode features Dr. Kenneth Schmader discussing new guidelines from the Advisory Committee on Immunization Practices regarding the herpes zoster vaccines. Dr. Sadhna Vora hosts. Dr. Schmader is a Professor of Medicine and Chief of the Division of Geriatrics at Duke University. He is Section Editor in Primary Care and Editor-in-Chief of the Geriatrics specialty at UpToDate. Reference: Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep 2018; 67:103. Contributor Disclosure: Grant/Research/Clinical Trial Support: Merck [Herpes zoster (Zoster vaccine)]; GlaxoSmithKline [Herpes zoster (Zoster vaccine)].

This episode features Dr. Joseph Wolfsdorf discussing advances in devices to manage children and adolescents with type 1 diabetes. Dr. Sadhna Vora hosts. Dr. Wolfsdorf is a Professor of Pediatrics at Harvard Medical School and Director of the Diabetes Program at Boston Children's Hospital. He is also Section Editor in Pediatric Endocrinology at UpToDate. Reference: Abraham MB, Nicholas JA, Smith GJ, et al. Reduction in Hypoglycemia with the Predictive Low-Glucose Management System: A Long-term Randomized Controlled Trial in Adolescents With Type 1 Diabetes. Diabetes Care 2018; 41:303. Contributor Disclosure: Nothing to disclose.

This episode features Dr. Sheldon Kaplan discussing the use of a third dose of the MMR vaccine for the prevention of mumps in an outbreak setting. Dr. Jennifer Mitty hosts. Dr. Kaplan is Professor of Pediatrics and head of the Pediatric Infectious Disease section at Baylor College of Medicine, and he is Chief of the Infectious Disease service and head of the Department of Pediatric Medicine at Texas Children's Hospital in Houston. References: Marin M, Marlow M, Moore KL, et al. Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus-Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak. MMWR Morb Mortal Wkly Rep 2018; 67:33. Cardemil CV, Dahl RM, James L, et al. Effectiveness of a Third Dose of MMR Vaccine for Mumps Outbreak Control. N Engl J Med 2017; 377:947. Contributor Disclosure: Grant/Research/Clinical Trial Support: Pfizer [Streptococcus pneumonia (PCV13, linezolid)]; Merck [Staphylococcus aureus (Tedizolid)]; Allergen [Osteomyelitis (Ceftaroline)]. Consultant/Advisory Boards: Pfizer [Staphylococcus aureus (vaccine development); linezolid]. Other Financial Interest: Pfizer [Speaker on PCV13, linezolid]; Medscapre [Video discussion on bacterial meningitis]; Elsevier [Co-editor (Feigin and Cherry Textbook of Pediatric Infectious Diseases)].