Faculty Bibliography

The blue rubber bleb nevus syndrome, a rare condition characterized by lesions of the skin, gastrointestinal tract, and other parts of the body, can result in serious gastrointestinal bleeding and other adverse results and be challenging to manage. The clinical features and treatment of this rare disorder are reviewed here

The US healthcare system has engendered many attempts at incremental fixes and largescale overhauls. Practitioners of evidence-based medicine have developed the tools that can measure the effects of these attempts on improvement in healthcare by dissecting the strengths and weaknesses of the different means of evidence generation, such as observational studies, randomized trials, and systematic reviews. Randomized clinical trials have emerged as the de facto gold standard for creating medical knowledge; they are used primarily to define whether a drug or intervention is beneficial in an artificially optimized clinical setting, not whether it makes sense for most patients or for a specific patient. Because of the limitations of clinical trials and their exclusionary patient-selection criteria, relying on a single study is likely to lead to an incomplete answer; using a range of randomized and observational studies, or aggregation of studies, is therefore recommended. This article reviews the historical development of evidence creation in medicine, including the strengths and weaknesses of the current state of the science, focusing on outcomes needed for decision-making relevant to the various stakeholders, as well as on the emerging field of comparative effectiveness research