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Kieren A. Marr, MD; Haran T. Schlamm, MD; Raoul Herbrecht, MD; Scott T. Rottinghaus, MD; Eric J. Bow, MD, MSc; Oliver A. Cornely, MD; Werner J. Heinz, MD; Shyla Jagannatha, PhD; Liang Piu Koh, MBBS; Dimitrios P. Kontoyiannis, MD; Dong-Gun Lee, MD; Marcio Nucci, MD; Peter G. Pappas, MD; Monica A. Slavin, MD; Flavio Queiroz-Telles, MD, PhD; Dominik Selleslag, MD; Thomas J. Walsh, MD; John R. Wingard, MD; and Johan A. Maertens, MD, PhD

This randomized, controlled trial assessed the safety and efficacy of voriconazole and anidulafungin compared with voriconazole monotherapy for invasive aspergillosis (IA). Overall mortality was the same in both groups, and no differences in safety were identified. Mortality was lower with combination therapy in a subgroup of patients whose IA diagnosis was established by radiographic findings and galactomannan positivity. In the absence of definitive trial results, clinicians may decide to choose therapy for IA on the basis of individual patient characteristics.

Topics: antifungal agent, aspergillosis, hematopoietic stem cell transplantation, aspergillus, combined modality therapy, hematologic ...
  
Ingrid T. Katz, MD, MHS; Erin Leister, MS; Deborah Kacanek, ScD; Michael D. Hughes, PhD; Arlene Bardeguez, MD; Elizabeth Livingston, MD; Alice Stek, MD; David E. Shapiro, PhD; and Ruth Tuomala, MD
Includes: Audio/Video

Highly active antiretroviral therapy (HAART) that suppresses viral replication is used to manage HIV in pregnant women and decrease the risk for mother-to-child transmission at delivery. This cohort study identified factors associated with detectable viral load at delivery despite the initiation of HAART during pregnancy. The authors concluded that the timing of HAART initiation and prenatal care, as well as medication adherence during pregnancy, were associated with detectable viral load at delivery.

Topics: hiv, antiretroviral therapy, highly active, obstetric delivery, viral load result, hiv and ...
  
Allen Kachalia, MD, JD; Aaron Berg, MD; Angela Fagerlin, PhD; Karen E. Fowler, MPH; Timothy P. Hofer, MD, MSc; Scott A. Flanders, MD; and Sanjay Saint, MD, MPH

Health care reform efforts and initiatives seek to improve quality and reduce costs by eliminating unnecessary care. In this study, the authors randomly selected and surveyed physicians practicing adult hospital medicine to assess the extent of and factors associated with overuse of testing in preoperative evaluation and in evaluation of syncope. The results suggest that testing is substantially overused and that a desire to provide reassurance to patients, family members, or themselves may motivate physicians to override clinical guidelines and evidence.

Topics: syncope, hospitalists, preoperative medical evaluation, appropriate use, hospital care
  
Erin S. LeBlanc, MD, MPH; Bernadette Zakher, MBBS; Monica Daeges, BA; Miranda Pappas, MA; and Roger Chou, MD

This systematic review for the U.S. Preventive Services Task Force (USPSTF) examined the benefits and harms of screening for vitamin D deficiency in asymptomatic adults. Treatment for vitamin D deficiency reduced mortality risk in institutionalized elderly adults and the risk for falls but not fractures.

Topics: vitamin d deficiency, vitamin d, screening
  
Aviroop Biswas, BSc; Paul I. Oh, MD, MSc; Guy E. Faulkner, PhD; Ravi R. Bajaj, MD; Michael A. Silver, BSc; Marc S. Mitchell, MSc; and David A. Alter, MD, PhD

Physical activity has many health-enhancing benefits, but it may not be enough to reduce the risk for disease and illness. This systematic review and meta-analysis evaluated the association between sedentary time and health outcomes, independent of physical activity, in adults. Prolonged sedentary time was associated with an increased risk for all-cause, cardiovascular disease, and cancer mortality; cardiovascular disease; cancer; and type 2 diabetes.

Topics: sedentary lifestyle, lack of exercise, chronic disease, hospitalization, sitting position, cardiovascular diseases, ...
  

This new USPSTF recommendation on screening for vitamin D deficiency applies to community-dwelling, nonpregnant adults aged 18 years or older who are seen in primary care settings and are not known to have signs or symptoms of vitamin D deficiency or conditions for which vitamin D treatment is recommended. The USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in such persons.

Topics: vitamin d deficiency, vitamin d, screening
  

A World Health Organization advisory panel recently concluded that it is ethical to use experimental medications and vaccines that have not been formally approved or tested in humans to treat persons with Ebola. The authors of this commentary urge the medical community to focus on implementing the current standard of care fairly while maintaining principled experimentation to provide a better future standard.

Topics: ebola virus, ebola virus disease, epidemic, experimental treatment, compassionate use, ebola vaccines ...
  
Deborah Cotton, MD, MPH, Deputy Editor

Therapy for invasive aspergillosis is the topic of this issue's article from the Annals Archive.

Topics: disseminated aspergillosis, aspergillus, hematologic neoplasms, aspergillosis, invasive, voriconazole, anidulafungin, leukemia, neutropenia, drug-induced, ...
  

In this issue, the USPSTF recommendation statement and evidence review report insufficient evidence for or against testing for vitamin D deficiency. The editorialists urge practitioners to measure vitamin D status in patients to provide them with individual, personally applicable information that will hopefully improve adherence.

Topics: vitamin d deficiency, nutritional requirements, science of nutrition, disease prevention, screening, nutrients, ...
  

In this issue, Biswas and colleagues examined the association between sedentary behavior and risk for disease and death. The editorialists discuss the results of the review and assert that device-based measurement may be more effective in evaluating sedentary time than the self-reporting method currently used in most studies.

Topics: chronic disease, lifestyle changes, biomedical research, sitting position, sedentary lifestyle, lack of ...
  

In this issue, Langleben and colleagues suggest that idiopathic pulmonary arterial hypertension may manifest as 2 different vascular phenotypes and perhaps different diseases, depending on whether affected patients have a hemodynamic response to an acute vasodilator challenge. The editorialists discuss the study's limitations and the implications of its findings.

Topics: primary pulmonary hypertension, vasodilators
  

Before seeing my first patient, I took time to review his chart and the C & P disability forms I needed to complete to provide a medical opinion about his disability. Unfortunately, I was forming an opinion about the disability evaluation before I even saw the patient.

Topics: #
  
E. Wesley Ely, MD, MPH
Includes: Audio/Video

Recently after rounds, I looked through the kaleidoscope. Immediately, I again saw flashes of color and light built on endless combinations of personal values, faiths, family structures, races, and life choices.

Topics: #
  
Gaetan Sgro, MD
Includes: Audio/Video
Topics: #
  
Topics: influenza, influenza virus vaccine, orthomyxoviridae, vaccination, elderly, dose
  
Topics: ischemic stroke, alteplase, time-to-treatment
  
Topics: diagnostic radiologic examination, ultrasonography, computed tomography, radiation exposure, nephrolithiasis
  
Topics: bisphosphonates, postmenopause, breast cancer, cancer prevention, fracture intervention trial
  
Topics: hypoglycemia, diabetes mellitus, type 2, basal insulin, hemoglobin a, glycosylated, glucohemoglobin measurement, ...
  
Topics: hypertension, cardiovascular disease risk factors, blood pressure monitoring, ambulatory, blood pressure monitoring, ...
  
Topics: hemorrhage, ulcer, proton pump inhibitors
  
Topics: enteral nutrition, critical illness, nutrients, infection prophylaxis, enteral formula, high protein enteral ...
  
Topics: bladder neck obstruction, lower urinary tract symptoms
  
Topics: atrial fibrillation, cardiac surgery procedures, ischemic stroke, surgical procedures, operative, stroke risk ...
  
Topics: polymyalgia rheumatica, cardiovascular event
  
Topics: hospital mortality, knee replacement arthroplasty
  

The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.

Topics: anticoagulants, epidural anesthesia
  
Topics: vitamin d deficiency, vitamin d, screening
  
David Langleben, MD; Stylianos E. Orfanos, MD; Michele Giovinazzo, BSc; Robert D. Schlesinger, MD; Andrew M. Hirsch, MD; Fay Blenkhorn, RN; Lyda Lesenko, RN; Apostolos Armaganidis, MD; and John D. Catravas, PhD
Topics: primary pulmonary hypertension, vasodilators
  
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