Making changes: when is VVC appropriate?

when appropriate statistical analysis is dismissed

When Appropriate Statistical Analysis is Dismissed

We read with interest the paper entitled “Prevalence of Hepatitis D Virus Infection among Hepatitis B Virus Infected Patients in Qom Province, Center of Iran” by Ghadir et al. (1) which was performed to determine the prevalence of hepatitis D in the general population of Qom province and the potential risk factors for acquiring HDV. They found 48 subjects (1.3%) suffered from hepatitis B and on...

Mitral valve surgery: when is it appropriate?

Mitral regurgitation (MR) is a frequent complication of end-stage cardiomyopathy. Historically, these patients were managed either medically or with mitral valve replacement, both associated with poor outcomes. We studied 150 patients with cardiomyopathy and severe MR who were managed with mitral reconstruction. One hundred fifty patients with 4+ MR, left ventricular ejection fractions of 8%-24...

Refusal of Therapy: When Is It Appropriate?

I n our last issue, I talked about care in the context of end of life, in particular the expense and futility of care given in the last months of life or when patients are facing an incurable condition. I believe that it is entirely appropriate to refuse care or decline aggressive therapies at the end of life. Recently, the news has been full of reports detailing the story of Cassandra Fortin, ...

When is proton pump inhibitor use appropriate?

Proton pump inhibitor (PPI) therapy is commonly used outside of Food and Drug Administration indication for a broad range of conditions such as extra-esophageal reflux and PPI-responsive esophageal eosinophilia. While this may be appropriate in some scenarios, it has also resulted in widespread inappropriate PPI use. At the same time, data suggesting adverse effects of long-term PPI therapy are...