Cover photographer: Joseph Gascho, MD
Subject: Michael J. Green, MD, MS, FACP
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Prescribing antibiotics for acute respiratory infections contributes to overall overuse. In this cross-sectional study, the authors examined the trends in antibiotic prescribing for acute respiratory infections in veterans and identified patient, provider, and setting sources of variation. They found that veterans with acute respiratory infections often received antibiotics, regardless of patient, provider, or setting.
Detailed clinical data are limited on the clinical course and management of patients with Ebola virus disease (EVD) outside western Africa. In this retrospective clinical case series, the authors describe the clinical characteristics and management of a cluster of patients with EVD, including the first cases of infection acquired in the United States.
The first recognized cases of Borrelia miyamotoi disease (BMD) in North America were reported in the northeastern United States in 2013. In this case series, the authors examined clinical features of acutely febrile patients with suspected tick-transmitted infections to further describe the clinical spectrum and laboratory findings for BMD. Their findings suggest that BMD should be part of the differential diagnosis of febrile patients from areas where deer tick–transmitted infections are endemic.
This survey examined the association between sexual orientation identity and human papillomavirus (HPV) vaccination among U.S. women and girls. The authors found that adolescent and young adult lesbians may be less likely to initiate HPV vaccination than their heterosexual counterparts.
This systematic review summarized the evidence about cognitive outcomes in adults aged 65 years or older at least 3 months after cardiovascular procedures. The authors found that intermediate- and long-term cognitive impairment in older adults attributable to the studied cardiovascular procedures may be uncommon.
This systematic review of longer- versus shorter-duration dual-antiplatelet therapy (DAPT) in patients receiving drug-eluting stents found that extended DAPT was associated with fewer myocardial infarctions but more major bleeding events than shorter-duration DAPT.
Noninferiority studies are often used to investigate whether a treatment's efficacy or safety profile is acceptable compared with another therapy. When time to a clinical event is of interest, treatment difference is routinely quantified using the hazard ratio (HR). The HR may be difficult to interpret, especially when the proportional hazards assumption is violated, and its precision does not depend directly on exposure times or sample size. This article provides alternative strategies that offer more meaningful interpretations of results.
This position paper from the American College of Physicians (ACP) offers recommendations on how to reduce health disparities for lesbian, gay, bisexual, and transgender (LGBT) persons in the health care system.
On 16 April 2015, President Obama signed the Medicare Access and Children's Health Insurance Program Reauthorization Act, or MACRA. In addition to repealing the sustainable growth rate formula, this act promises to transform Medicare physician payments from a system that rewards volume to one that recognizes value. This commentary discusses how MACRA offers physicians more stability and potentially more control over reimbursement.
Health disparities in the LGBT community are the topic of this issue's discussion from the Annals archive.
In this issue, Molloy and colleagues report the first large case series of Borrelia miyamotoi infection in the United States. The editorialists discuss the epidemiology and clinical presentation of the illness, as well as treatment options that can alleviate symptoms and prevent complications.
In this issue, the ACP makes recommendations on addressing the health disparities in the LGBT community and Agènor and colleagues report on the underuse of the HPV vaccine in lesbian women. The editorialist discusses these important articles and argues that it is time that the medical profession mobilizes to ensure that the health needs of LGBT persons are met.
The contrasts of old age can be stark: once competent, now totally dependent; once a servant, now in constant need. Once he trusted Western medicine to diagnose and cure, now he was skeptical as we urged them to give 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.