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The Intention-to-Treat Analysis Is Not Always the Conservative Approach

The randomized trial design can be thought of as a means to answer 2 types of general questions: 1) what is the effect of assigning a treatment?; or 2) what is the effect of receiving a treatment? In public health, we are normally concerned with the first question—the effect of assigning a treatment. If we […]

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Dr. Joseph S. Alpert

Will Physicians Stop Performing Physical Examinations?

In the 21st century, debate continues concerning the value of the physical examination.1, 2, 3, 4 That such a hallowed and respected ritual of clinical medicine should even be questioned is the result of the remarkable advances during the last 50 years in imaging technology and laboratory medicine. When I was a student and resident in the late 1960s […]

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Transverse Lines of the Nails

Four distinct, transverse, depressed lines (Figure, A) developed on the fingernails of a 73-year-old man with castration-resistant prostate cancer after 4 cycles of docetaxel-based chemotherapy; the lines were parallel and evenly spaced (Beau’s lines). Three transverse white bands (Figure, B) appeared on the fingernails of a 62-year-old woman with recurrent metastatic soft tissue sarcoma after […]

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doctor putting on gloves

Digital Rectal Exam: Still Relevant After All These Years (video)

In the world of high-tech medicine, the digital rectal exam still has a place. In this current study, researchers showed that performing the digital rectal exam on patients with acute gastrointestinal bleeding provided valuable clinical information. American Journal of Medicine Editor-in-Chief Dr. Joseph S. Alpert explains the clinical implications of this research. (Get out your exam […]

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Immunotherapy in Squamous Cell Skin Carcinoma: A Game Changer?

  A 74-year-old white male was diagnosed with squamous cell carcinoma in 2013. Six months after Mohs surgery, he underwent a left superficial parotidectomy, left neck dissection, and excision of the left postauricular lymph node after confirmation of lymphatic spread. Pathology from the left parietal scalp lesion revealed multifocal invasive squamous cell carcinoma. Extranodal tumor […]

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