In December 2014, the US Department of Veterans Affairs and Department of Defense (VA/DoD) published an independent clinical practice guideline for the management of dyslipidemia and cardiovascular disease risk, adding to the myriad of recently published guidelines on this topic. The VA/DoD guidelines differ from major US guidelines published by the American College of Cardiology/American Heart Association (ACC/AHA) in 2013 in several ways. In this review, the authors appraise the VA/DoD recommendations with a focus on the evidence base for each area where the VA/DoD guidelines differ from the ACC/AHA guidelines. They call for harmonization of lipid treatment guidelines to ensure high-quality and consistent care for patients with or at risk for atherosclerotic cardiovascular disease.

Acute lactic acidosis due to sepsis or low-flow states is associated with cellular dysfunction and high mortality. Currently, the only effective therapy is the elimination or control of the triggering conditions. In this month's AJKD, Kraut and Madias explore current treatments and potential therapies for lactic acidosis by introducing the case of a 54-year-old man who was admitted with palpitations, hyperventilation, and altered mental status. They stress that resuscitative efforts to support the circulation and ventilation are the first steps in treating lactic acidosis, and prompt initiation of cause-specific measures is key to managing the condition.

This study gives a voice to both contemporary transgender youth and their caregivers on the topic of barriers to gender-affirming health care. Their perspectives and recommendations emphasize the need for multidisciplinary gender clinics, which currently exist in only a handful of US cities.

Compelling evidence has shown chronic widespread and exaggerated pain experience in chronic musculoskeletal pain (MSKP) conditions. In addition, neuroimaging research has revealed both morphological and functional brain alterations in these patients. It is hypothesized that brain alterations play a role in the persistent pain, but a lack of overview exists regarding the relations between brain alterations and clinical pain measures. This systematic review investigated the relations between structural or functional brain alterations, using magnetic resonance imaging scans and clinical pain measures in patients with chronic MSKP. The authors conclude that preliminary to moderate evidence shows relations between clinical pain measures and alterations within brain regions involved in somatosensory, affective, and cognitive processing of pain in chronic MSKP. Yet, inconclusive results exist regarding the direction of these relations. Further research is warranted to explore this topic.

A prediction model for obstetric anal sphincter injury was developed and validated using risk factors identified among consecutive term vaginal deliveries at one institution.

Clinical guidelines recommend smoking-cessation medications, but they are subject to safety warnings from the FDA. This study investigated trends in smoking-cessation medication use in Medicare from 2007 to 2012. The use of smoking-cessation medications was found to be low, with only 16% of tobacco users filling a prescription during this time frame. The proportion of beneficiaries who filled prescriptions for varenicline increased in 2007 but sharply declined corresponding to public warnings about adverse effects, although the same trends did not occur for bupropion or nicotine-replacement therapy.

Although it is known that infants exposed to antenatal corticosteroids have a decreased incidence of severe intraventricular hemorrhage (IVH), there are questions about the duration of the beneficial effects and whether retreatment is required. This prospective observational study found that the risk of severe IVH increased in infants born at <28 weeks' gestation who delivered ≥10 days after the first dose of antenatal betamethasone (BMZ). A repeat course of BMZ was associated with lower incidence of severe IVH in infants who delivered remote from their first course; the incidence in these infants was similar to that of infants born <10 days after the first course. Replication of these results could help guide recommendations on the timing of repeat courses of BMZ.

Adults who experience a heart attack before age 50 have almost twice the mortality risk within the year as the general population, and risk was higher for women than men, researchers report in the journal Circulation. However, the study, which looked at nearly 22,000 Danes who had experienced an early heart attack, found outcomes have improved over time, with premature death rates down substantially within the first month, year and decade after a heart attack.

High levels of systolic blood pressure and LDL cholesterol are independent and cumulative risk factors for cardiovascular disease, according to a study presented at the European Society of Cardiology 2016 Congress. Researchers said long-term exposure to lowered blood pressure and LDL cholesterol levels could significantly reduce the risk of cardiovascular events.

Denver-area hospitals using the physician wellness program Lumunos to reduce burnout send doctors weekly email messages to help them reflect on work and life, and hold monthly meetings hosted by facilitators who continue the discussion. Some hospitals also use the Finding Meaning in Medicine model to reduce burnout, which includes evening dinner meetings for physicians, while others host retreats for physicians and families.

The CME Finder is a searchable, sortable web-based tool launched by the American Board of Internal Medicine and the Accreditation Council for Continuing Medical Education. The tool will allow physicians to search for activities registered for Maintenance of Certification credit and is based on the 2015 collaboration between the two groups that expanded physicians' MOC options.

A Commonwealth Fund report that used 2009 to 2011 Medicare survey data found 5% of US adults -- about 12 million people -- had three or more chronic conditions plus a functional impairment. The authors said this group had significantly higher health care costs, while a second report found many of them also had unmet medical needs.

The percentage of Americans who say they cannot afford to fill a prescription has declined as the Affordable Care Act has been implemented. However, an estimated 16.4 million Americans still struggle to afford prescription drugs, according to a study published in the American Journal of Public Health.