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Barbara Ellen Jones, MD, MSc; Brian Sauer, PhD; Makoto M. Jones, MD, MSc; Jose Campo, MD; Kavitha Damal, PhD, CCRC; Tao He, MS; Jian Ying, PhD, MStat; Tom Greene, PhD; Matthew Bidwell Goetz, MD; Melinda M. Neuhauser, PharmD, MPH; Lauri A. Hicks, DO; and Matthew H. Samore, MD

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.

Topics: antibiotics, prescribing behavior, respiratory tract infections, veterans
Allison M. Liddell, MD; Richard T. Davey Jr., MD; Aneesh K. Mehta, MD; Jay B. Varkey, MD; Colleen S. Kraft, MD, MSc; Gebre K. Tseggay, MD; Oghenetega Badidi, MD; Andrew C. Faust, PharmD; Katia V. Brown, MD; Anthony F. Suffredini, MD; Kevin Barrett, RN; Mark J. Wolcott, PhD; Vincent C. Marconi, MD; G. Marshall Lyon III, MD, MMSc; Gary L. Weinstein, MD; Kenney Weinmeister, MD; Shelby Sutton, MD; Munir Hazbun, MD; César G. Albariño, PhD; Zachary Reed, MPH; Debi Cannon; Ute Ströher, PhD; Mark Feldman, MD; Bruce S. Ribner, MD, MPH; H. Clifford Lane, MD; Anthony S. Fauci, MD; and Timothy M. Uyeki, MD, MPH, MPP

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.

Topics: ebola virus disease, fever, rna, polymerase chain reaction, diarrhea, transaminases
Philip J. Molloy, MD; Sam R. Telford III, ScD; Hanumara Ram Chowdri, MD; Timothy J. Lepore, MD; Joseph L. Gugliotta, MD; Karen E. Weeks, BS; Mary Ellen Hewins, BS; Heidi K. Goethert, ScD; and Victor P. Berardi

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.

Topics: new england, serologic tests, polymerase chain reaction, borrelia miyamotoi, dna, immunoglobulin g, ...

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.

Topics: sexual orientation, human papilloma virus vaccine, health disparity, female homosexuality, heterosexuality
Howard A. Fink, MD, MPH; Laura S. Hemmy, PhD; Roderick MacDonald, MS; Maureen H. Carlyle, MPH; Carin M. Olson, MD, MS; Maurice W. Dysken, MD; J. Riley McCarten, MD; Robert L. Kane, MD; Santiago A. Garcia, MD; Indulis R. Rutks, BS; Jeannine Ouellette; and Timothy J. Wilt, MD, MPH

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.

Topics: coronary artery bypass surgery, cardiovascular surgical procedures, cognitive impairment, elderly, carotid revascularization, ...
Frederick A. Spencer, MD; Manya Prasad, MBBS; Per O. Vandvik, MD, PhD; Devin Chetan, HBA; Qi Zhou, PhD; and Gordon Guyatt, MD
Includes: CME

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.

Topics: myocardial infarction, hemorrhage, cerebrovascular accident, ischemic stroke, drug-eluting stents, dual antiplatelet therapy ...
Hajime Uno, PhD; Janet Wittes, PhD; Haoda Fu, PhD; Scott D. Solomon, MD; Brian Claggett, PhD; Lu Tian, ScD; Tianxi Cai, ScD; Marc A. Pfeffer, MD, PhD; Scott R. Evans, PhD; and Lee-Jen Wei, PhD

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.

Topics: safety, celecoxib, saxagliptin, precision, risk, attributable, follow-up, absolute risk reduction
Hilary Daniel, BS; Renee Butkus, BA, for the Health and Public Policy Committee of the American College of Physicians
Includes: CME

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.

Topics: health disparity, gay and lesbian health, lgbt persons, american college of physicians ...

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.

Topics: growth rate, incentives, medicare

Health disparities in the LGBT community are the topic of this issue's discussion from the Annals archive.

Topics: lgbt persons

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.

Topics: ticks, borrelia miyamotoi

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.

Topics: lgbt persons
Richard Allen, MD, MPH
Includes: Audio/Video

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.

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Michael Lubrano, MD, MPH; Jonathan P. Wanderer, MD, MPhil; and Jesse M. Ehrenfeld, MD, MPH
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William V. Padula, PhD, MS; Heidi M. Wald, MD, MSPH; and David O. Meltzer, MD, PhD
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Joyce Black, PhD, RN, CWCN
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Yecai Liu, MS; Drew L. Posey, MD, MPH; Martin S. Cetron, MD; and John A. Painter, DVM, MS
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Paul Zimmermann, MD
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Roger Chou, MD
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Sukhchain Singh, MD; Amandeep Singh, MD; and Sandeep Khosla, MD
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Gautam R. Shroff, MB, BS
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Topics: antiplatelet agents, mortality, dual antiplatelet therapy, stent thrombosis
Topics: cardiac event, dual antiplatelet therapy
Topics: delirium, inpatient
Topics: erythrocytes, critical illness, mortality, transfusion, follow-up
Topics: varenicline
Topics: lung diseases, inflammatory bowel disease, arthritis, psoriatic, methotrexate, psoriasis
Topics: enalapril, hypertension, ischemic stroke, folic acid, follow-up
Topics: clindamycin, skin diseases, infectious, trimethoprim-sulfamethoxazole combination, follow-up
Topics: acetaminophen, low back pain, osteoarthritis, knee, hip pain
Topics: overdose, chronic pain, short-acting opioid analgesics, opioids
Topics: internship and residency, medical residencies, adverse event, follow-up, intensive care unit
Topics: cardiovascular diseases, cardiovascular event

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: consultation, hand
Topics: sexual orientation, human papilloma virus vaccine
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