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Debate continues regarding the optimal frequency for screening mammography. In this analysis of national data on screening mammography, investigators estimated the cumulative probability of false-positive recall and biopsy recommendation after 10 years of annual or biennial screening. They found that a high proportion of women had false-positive results with a need for additional imaging. Biennial screening reduced false-positive results but was associated with a small, statistically insignificant increase in diagnoses of late-stage breast cancer.
Few studies have examined the comparative effectiveness of digital versus film-screen mammography in U.S. community practice. In a large sample of women screened in community settings, digital and film-screen mammography yielded similar cancer detection rates and proportion of early-stage cancer diagnosed. Digital screening had higher sensitivity in women with dense breasts and was better at detecting estrogen receptor–negative cancer, but specificity was lower for ages 40 to 49 years than for other decades. Screening methods are similarly effective, but sensitivity and specificity tradeoffs were observed in some subgroups.
To better understand how liver transplant centers make decisions to list patients for liver transplantation, researchers observed selection committee meetings at 4 centers in the United States and interviewed committee members. They found discussions to be consistent and well-intentioned but note that more formal written policies and clearer description of committee member roles could improve the process.
Babesiosis, a parasitic infection transmitted through tick bites or blood transfusion, may result in life-threatening disease. No Babesia test for screening blood donors has been licensed. This case series describes how the risk for transfusion-associated Babesia infection may be increasing: Cases have occurred year-round and in states where Babesia species are not endemic. Improvements in the prevention and detection of transfusion-associated babesiosis are urgently needed.
About 1 in 5 Medicare fee-for-service patients discharged from the hospital is rehospitalized within 30 days. In this systematic review of 43 studies evaluating interventions to reduce readmission within 30 days of discharge, no one intervention alone was regularly associated with reduced risk for 30-day rehospitalization. Overall, observational designs predominated and studies had significant heterogeneity of intervention content and context.
The QUADAS tool for systematic reviews of diagnostic accuracy studies was developed in 2003. Experience, anecdotal reports, and feedback suggested areas for improvement to the tool. This article describes the improved and redesigned QUADAS-2. This tool will allow for more transparent rating of bias and applicability of primary diagnostic accuracy studies.
Transient loss of consciousness (TLoC) is common and often leads to incorrect diagnosis, unnecessary investigation, and inappropriate choice of specialist referral. In August 2010, the United Kingdom's National Institute for Health and Clinical Excellence published a guideline addressing the initial assessment of persons who have experienced TLoC. This synopsis describes the principal recommendations from the guideline.
The bedside evaluation was once the primary means of diagnosis and clinical monitoring, but technologic advances in imaging and laboratory testing often lead physicians to bypass such evaluation. This commentary discusses how, in addition to being an essential diagnostic tool, the bedside evaluation is a ritual worthy of teaching, testing, refining, and preserving.
The National Lung Screening Trial showed a 20% reduction in lung cancer–specific deaths in high-risk persons having screening with low-dose computed tomography (LDCT) of the chest compared with chest radiography. Physicians will be faced with whether to begin ordering LDCT of the chest to screen for lung cancer in patients with a history of tobacco use.
Data are lacking regarding the optimal frequency of screening mammography and the comparative effectiveness of digital versus film-screen mammography. Articles in this issue by Hubbard and colleagues and by Kerlikowske and colleagues examine these issues. The editorialist discusses whether these studies' findings help us increase the efficiency of screening mammography.
Babesiosis is often described as an emerging infectious disease in the United States. Concomitant with its emergence as a public health concern has been a proliferation of cases of transfusion-associated babesiosis. In this issue, Herwaldt and colleagues have compiled a list of 162 known cases of transfusion-associated babesiosis from 1979 to 2009. The editorialist discusses the case series and its implication for public health and transfusion medicine.