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Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Idiopathic granulomatous mastitis is a rare inflammatory breast disease that affects Middle Eastern, Latino, and Asian women of childbearing age. The disease is clinically manifest by recurrent and progressive inflammation of the breast with subsequent scarring and deformity. Evidence has linked the disease to endocrine and autoimmune conditions.
Treatments have included mastectomy, antibiotics, corticosteroids, and immunosuppressive drugs; there is no consensus for a single treatment approach. This article reported a prospective randomized trial that compared three treatments in a cohort of 318 patients: best supportive care, corticosteroids, and low dose steroids plus methotrexate.
The data analysis showed that there was no improvement in patients with best supportive care. In the corticosteroid group, complete or partial responses were observed in 14.1% of patients; 78.2% of patients in this group showed disease progression. The corticosteroid plus methotrexate group showed complete response or partial remission in 97.3% of patients (94.3% complete remission and 3% partial remission).
The authors concluded that the best treatment for refractory and recurrent granulomatous mastitis was a combination of corticosteroids and an antirheumatic drug such as methotrexate.
Surgical Decompression Reduces Pain in Diabetic Peripheral Neuropathy
This prospective, randomized, placebo surgical procedure-controlled trial compared outcomes of lower extremity nerve decompression with a placebo operative procedure performed in the opposite extremity for patients with unilateral painful diabetic neuropathy.
Patients (n = 78) who had failed 1 year of treatment were randomized to surgical nerve decompression with placebo surgery in the opposite leg or observation only. Pain was quantified using a standard pain score scale; pain levels were assessed out to 56 months.
Pain improved in the surgically decompressed group; in the early phases of follow up, there was improvement in the placebo procedure leg, as well. At 56 months, pain reduction was significantly better in the surgically decompressed extremities.
The authors concluded that surgical decompression was effective but there was evidence of a placebo effect because of symptom improvement in the placebo procedure extremity during the early phase of follow up.
Surgeons should note that there are multiple ethical questions regarding the use of placebo surgical procedures. Valuable perspectives on the ethical concerns can be found in this article and the accompanying editorial: Abbasi A, Cifu AS. Why Some Patients Benefit from Participating in a Sham Surgery Trial. Ann Surg. 2023; Angelos P, Applewhite MK. Should There be More Sham Surgery Trials of High-Risk Procedures? Ann Surg. 2023.
Ambient Artificial Intelligence Scribes May Alleviate Burden of Clinical Documentation
Clinical documentation in the electronic health record (EHR) has become an increasingly significant burden for clinicians and has been recognized as a major contributor to physician burnout. The time necessary for completing EHR entries also adversely affects patient-physician communication. Artificial Intelligence has the potential to assist in the development of “Scribes” that can accept information via a cell phone connection and transfer this information to the EHR as an accurate data entry.
This article described the experience of one health system that developed and implemented such an application. A detailed and multi-formatted training program was developed including “at the elbow” personal technical support that trains healthcare professionals to use the application. Currently, system-wide experience has shown that nearly 3,500 physicians used the system to record over 303,000 patient encounters.
Physician responses to a survey on value and utility of the system were favorable. The available data also suggest that meticulous scrutiny of accuracy, relevance, and alignment with the physician-patient relationship will be necessary to ensure continued benefit of this approach.
