Although the relationship between preceding viral illness and subsequent Guillain-Barre isn’t proven, it is a commonly observed pattern. The severity of GBS ranges from mild sensory disturbances to life-threatening loss of function requiring intubation.

A 63-year-old man is seen in the ER for new onset confusion. He has been taking codeine-guaifenesin as directed for a URI. Respirations are shallow and the rate is 10/min. Pupils are miotic and the patient is somnolent. Exam and vitals are otherwise normal. The confusion resolves with administration of naloxone. Why did this patient most likely have the drug reaction?

In a study of 37,887 men 50 to 60 years old, those with PSA of >= 3 ng/ml underwent MRI imaging of the prostate and were randomized to systematic biopsy plus targeted biopsy or MRI-targeted biopsy only. MRI-directed targeted biopsy reduced the risk of overdiagnosis by half but did delay detection of intermediate-risk tumors in a small proportion of patients.

The new proposed rules are being cheered by caregivers and are in response to complaints from patients and providers that the PA process is often burdensome, disruptive to care, delaying care, costly, and a major source of frustration and burnout for providers.

Many prior studies associated enrollment in Medicare Advantage with lower use of health care services, greater performance of recommended preventive services, and higher scores for some measures of patient experience. This and other studies over the last decade suggest that “the association between Medicare Advantage and higher quality of care is modest at best.”

An important development in patient treatment occurs when indolent lymphomas develop an aggressive histology, which necessitates a shift in therapy. Although the prevalence of transformation is generally falling, it is still a very dangerous situation with a poor prognosis when compared to patients who do not have transformation. CAR-T has helped, but overall, the prognosis for patients with transformed lymphomas is still quite poor, especially if hematopoietic stem cell transplant (HSCT) or cellular therapy methods are not accessible or are ineffective. The top priority at this time should be to enroll the patient in a clinical trial.