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Wei Liu, MD; Hao Li, PhD; Qing-Bin Lu, MD; Ning Cui, BS; Zhen-Dong Yang, BS; Jian-Gong Hu, MS; Ya-Di Fan, MS; Chen-Tao Guo, MS; Xiao-Kun Li, MS; Ya-Wei Wang, MS; Kun Liu, PhD; Xiao-Ai Zhang, PhD; Lan Yuan, MS; Pu-Yu Zhao, BS; Shu-Li Qin, BS; and Wu-Chun Cao, PhD

Severe fever with thrombocytopenia syndrome (SFTS) is caused by a tick-borne virus that is now endemic in eastern China. The authors investigated whether another emerging pathogen, Candidatus Rickettsia tarasevichiae (CRT), might be identified alone or as a co-infection in patients hospitalized with SFTS. Differentiation of CRT from SFTS is important because the former can be treated with antibiotics.

Topics: polymerase chain reaction, china, ticks, severe fever with thrombocytopenia syndrome, candidatus rickettsia ...
Joann G. Elmore, MD, MPH; Heidi D. Nelson, MD, MPH; Margaret S. Pepe, PhD; Gary M. Longton, MS; Anna N.A. Tosteson, ScD; Berta Geller, EdD; Tracy Onega, PhD; Patricia A. Carney, PhD; Sara L. Jackson, MD, MPH; Kimberly H. Allison, MD; and Donald L. Weaver, MD
Includes: Audio/Video

The effect of physician diagnostic variability on accuracy at a population level depends on the prevalence of diagnoses. This study estimates how diagnostic variability affects accuracy from the perspective of a U.S. woman aged 50 to 59 years having breast biopsy. It finds that, based on interpretation of a single slide, the likelihood that a diagnosis of atypia or DCIS would be verified by a reference consensus diagnosis is low.

Topics: ductal carcinoma in situ, biopsy of breast, consensus, atypical, breast, biopsy, breast ...
Juan Ángel Bellón, MD, PhD; Sonia Conejo-Cerón, PhD; Patricia Moreno-Peral, PhD; Michael King, MD, PhD; Irwin Nazareth, MD, PhD; Carlos Martín-Pérez, MD, PhD; Carmen Fernández-Alonso, MD, PhD; Antonina Rodríguez-Bayón, MD, PhD; Anna Fernández, PhD; José María Aiarzaguena, MD, PhD; Carmen Montón-Franco, MD, PhD; Inmaculada Ibanez-Casas, PhD; Emiliano Rodríguez-Sánchez, MD, PhD; María Isabel Ballesta-Rodríguez, MD, PhD; Antoni Serrano-Blanco, MD, PhD; María Cruz Gómez, PhD; Pilar LaFuente, MD; María del Mar Muñoz-García, PhD; Pilar Mínguez-Gonzalo, PhD; Luz Araujo, PhD; Diego Palao, MD, PhD; Paola Bully, PhD; Fernando Zubiaga, PhD; Desirée Navas-Campaña, PhD; Juan Mendive, MD, PhD; Jose Manuel Aranda-Regules, MD, PhD; Alberto Rodriguez-Morejón, PhD; Luis Salvador-Carulla, MD, PhD; and Juan de Dios Luna, PhD

Depression is common. Current practice is to treat depression after it develops, but some clinicians believe that it can be prevented. These researchers developed a way to predict which persons are likely to develop depression, and they conducted a cluster randomized trial to determine whether a program to prevent depression in adults worked.

Topics: depressive disorders, primary health care, major depressive disorder, follow-up
Ludovic Trinquart, PhD; Nassima Attiche, MSc; Aïida Bafeta, PhD; Raphaël Porcher, PhD; and Philippe Ravaud, MD, PhD

Ranking interventions is an appealing feature of network meta-analysis. The authors of this analysis evaluated the extent of uncertainty in intervention rankings from network meta-analysis and found a substantial degree of imprecision. They advise authors and readers to interpret such rankings with caution.

Topics: costa rica, heterogeneity, medline, embase
Benjamin Rouse, MHS; Andrea Cipriani, MD, PhD; Qiyuan Shi, MHS; Anne L. Coleman, MD, PhD; Kay Dickersin, MA, PhD; and Tianjing Li, MD, MHS, PhD

Network meta-analysis compares many treatment options for the same condition and may be useful for developing clinical practice guidelines. This cumulative network meta-analysis compared treatment recommendations for firstline medical therapy for primary open angle-glaucoma from major updates of American Academy of Ophthalmology guidelines with evidence available at the time.

Topics: open-angle glaucoma, clinical practice guideline, medical management, guidelines, intraocular pressure

The 2013 lipid guidelines from the American College of Cardiology and the American Heart Association recommend that statin therapy be guided by cardiovascular risk rather than by a specific low-density lipoprotein cholesterol level or target. The authors discuss the guidelines and other recent evidence to support adoption of benefit-based, tailored treatment.

Topics: ldl cholesterol lipoproteins, american heart association, guidelines, lipids, american college of cardiology, ...

The U.S. Alcohol and Tobacco Tax and Trade Bureau recently approved a formulation of powdered alcohol for sale. The authors discuss the paucity of data on product safety, potential harms on an individual and public health basis, and how local advocacy led to a ban of its sale and distribution in Baltimore, Maryland.

Topics: alcohol, powdered, ethanol

A recently proposed quality measure, “Non-Recommended PSA-Based Screening,” has generated considerable debate. It would be one of the first U.S. quality metrics to focus on the delivery of too much rather than too little care. The authors discuss their concerns about the proposed measure.

Topics: prostate-specific antigen screening
Federico Costa, PhD; Manoel Sarno, MD, PhD; Ricardo Khouri, PhD; Bruno de Paula Freitas, MD; Isadora Siqueira, MD, PhD; Guilherme S. Ribeiro, MD, PhD; Hugo C. Ribeiro, MD; Gubio S. Campos, PhD; Luiz C. Alcântara, PhD; Mitermayer G. Reis, MD, PhD; Scott C. Weaver, PhD; Nikos Vasilakis, PhD; Albert I. Ko, MD; and Antonio Raimundo Almeida, MD, PhD

Several months after the introduction of Zika virus into northeastern Brazil, obstetricians noticed an increased number of fetuses with congenital malformations during ultrasound screening. Microcephaly has now risen in other regions along with the spread of Zika virus. The authors discuss their investigation from the front lines.

Topics: zika virus, zika virus disease, microcephaly

The randomized trial SPRINT (Systolic Blood Pressure Intervention Trial) compared aggressive treatment to a target systolic blood pressure less than 120 mm Hg versus less than 140 mm Hg in patients with increased cardiovascular risk and found a 25% relative risk reduction in cardiovascular events. This commentary discusses the trial and its implications.

Topics: blood pressure, judgment, cardiovascular disease risk factors, systolic blood pressure

A report from the B-Path (Breast Pathology) study reveals problems with the gold standard for breast cancer diagnosis. The data show significant interpretation discordance. The editorialists discuss the implications of diagnostic uncertainty.

Topics: gold standard

Whatever happened to my patient belonged completely to me, and I would have to live with it. It wasn't a bad feeling but rather a deep, visceral sense of responsibility I had never felt before.

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When a patient threatened to kill me 4 years ago, the experience changed my thoughts and actions about life and death.

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Scott Manaker, MD, PhD
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Michael W. Drazer, MD; and Scott E. Eggener, MD
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Veneta Masson, RN, MA
Includes: Audio/Video
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Tolulope Kehinde, BA
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Topics: antibiotics, respiratory tract infections, time symptom lasts, follow-up
Topics: indomethacin, arthritis, gouty, acute, pain, prednisolone, follow-up
Topics: fibrinolytic agents, chest, evidence-based practice, venous thromboembolism
Topics: deep vein thrombosis, postphlebitic syndrome, leg, stockings, compression
Topics: nicotine patches, smoking cessation, varenicline, follow-up
Topics: chronic fatigue syndrome, fatigue, exercise therapy
Topics: sexual function, testosterone topical gel, elderly, walking distance, testosterone, fatigue, follow-up
Topics: ischemic stroke, thrombectomy, disability, large blood vessels, follow-up
Topics: non-st-segment elevation mi, unstable angina, follow-up
Topics: heart failure, hospitalization, patient readmission, telemonitoring, follow-up

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: stent, consultation, hemorrhage
Topics: stent, doxycycline, fever, exanthema, rocky mountain spotted fever, biopsy of breast, hospital ...
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