Susan N. Hocevar, MD; Christopher D. Paddock, MD; Cedric W. Spak, MD; Randall Rosenblatt, MD; Hector Diaz-Luna, MD; Isabel Castillo, RN, BSN; Sergio Luna, RN; Glen C. Friedman, MD; Suresh Antony, MD; Robyn A. Stoddard, DVM, PhD; Rebekah V. Tiller, MPH; Tammie Peterson, RN, MSN/MPH, CPTC; Dianna M. Blau, DVM, PhD; Rama R. Sriram, BS; Alexandre da Silva, PhD; Marcos de Almeida, PhD; Theresa Benedict, BS; Cynthia S. Goldsmith, MGS; Sherif R. Zaki, MD, PhD; Govinda S. Visvesvara, PhD; Matthew J. Kuehnert, MD; for the Microsporidia Transplant Transmission Investigation Team
Encephalitozoon cuniculi, a microsporidial species most commonly recognized as a cause of renal, respiratory, and central nervous system infections in immunosuppressed patients, was identified as the cause of an illness cluster among 3 solid organ transplant recipients from a common donor. In this public health investigation, the authors tested specimens for microsporidia, reviewed donor medical records, and developed a questionnaire to assess for microsporidia infection. They concluded that microsporidiosis should be considered in febrile transplant recipients when tests for routinely encountered agents are unrevealing.
Ann Intern Med. 2014;160(4):213-220. doi:10.7326/M13-2226
Dhruv S. Kazi, MD, MSc, MS; Alan M. Garber, MD, PhD; Rashmee U. Shah, MD, MS; R. Adams Dudley, MD, MBA; Matthew W. Mell, MD; Ceron Rhee, MBA; Solomon Moshkevich, MBA; Derek B. Boothroyd, PhD; Douglas K. Owens, MD; Mark A. Hlatky, MD
Choosing an antiplatelet therapy for acute coronary syndrome is complicated, particularly for percutaneous coronary intervention patients. Clopidogrel has been the standard of care, but 2 more expensive drugs, prasugrel and ticagrelor, are now approved for this disorder. This cost-effectiveness analysis compares 5 strategies involving these drugs, both with and without genotyping for polymorphisms of CYP2C19 before treatment.
Ann Intern Med. 2014;160(4):221-232. doi:10.7326/M13-1999
Valérie Devauchelle-Pensec, MD, PhD; Xavier Mariette, MD, PhD; Sandrine Jousse-Joulin, MD; Jean-Marie Berthelot, MD; Aleth Perdriger, MD, PhD; Xavier Puéchal, MD, PhD; Véronique Le Guern, MD, PhD; Jean Sibilia, MD, PhD; Jacques-Eric Gottenberg, MD, PhD; Laurent Chiche, MD, PhD; Eric Hachulla, MD, PhD; Pierre Yves Hatron, MD; Vincent Goeb, MD, PhD; Gilles Hayem, MD; Jacques Morel, MD, PhD; Charles Zarnitsky, MD; Jean Jacques Dubost, MD; Jacques Olivier Pers, MD, PhD; Emmanuel Nowak, PhD; Alain Saraux, MD, PhD
Primary Sjögren syndrome (pSS) is an autoimmune disorder that causes ocular and oral dryness and usually affects women aged 40 to 50 years. In this randomized trial conducted at 14 university hospitals in France, rituximab compared with placebo did not alleviate disease activity in patients with pSS. Although rituximab alleviated some symptoms during early treatment, it did not provide lasting benefit.
Ann Intern Med. 2014;160(4):233-242. doi:10.7326/M13-1085
Caroline A. Kim, MD, MS; Suraj P. Rasania, MD; Jonathan Afilalo, MD, MSc; Jeffrey J. Popma, MD; Lewis A. Lipsitz, MD; Dae Hyun Kim, MD, MPH
For years, surgical aortic valve replacement has been used to treat aortic stenosis and has decreased mortality rates and improved quality of life. Transcatheter aortic valve replacement has recently surfaced as an alternative, but benefit has not been established. This review evaluates the changes in functional status and quality of life in patients after receiving transcatheter aortic valve replacement.
Ann Intern Med. 2014;160(4):243-254. doi:10.7326/M13-1316
Heidi D. Nelson, MD, MPH; Miranda Pappas, MA; Bernadette Zakher, MBBS; Jennifer Priest Mitchell, BA; Leila Okinaka-Hu, MD; Rongwei Fu, PhD
This systematic review, conducted to inform the U.S. Preventive Services Task Force, summarizes evidence about risk assessment and genetic counseling and testing for BRCA-related cancer in women. Findings include referral models that accurately estimate individual risk for BRCA mutations and several possible benefits of genetic counseling, including increased accuracy of risk perception, decreased intention for genetic testing among unlikely carriers, and decreased cancer-related worry. Potential benefits and harms of genetic counseling and testing varied according to the woman's underlying risk.
Ann Intern Med. 2014;160(4):255-266. doi:10.7326/M13-1684
John E. Cornell, PhD; Cynthia D. Mulrow, MD, MSc; Russell Localio, PhD; Catharine B. Stack, PhD, MS; Anne R. Meibohm, PhD; Eliseo Guallar, MD, DrPH; Steven N. Goodman, MD, PhD
A primary goal of meta-analysis is to improve the estimation of treatment effects by pooling results of similar studies. This article discusses the problems associated with using the DerSimonian–Laird estimator, a widely used method for pooling heterogeneous studies. The authors suggest using analyses based on a critical synthesis that recognizes the uncertainty in the evidence and describe several analyses that provide more accurate results than the DerSimonian–Laird method.
Ann Intern Med. 2014;160(4):267-270. doi:10.7326/M13-2886
Virginia A. Moyer, MD, MPH; on behalf of the U.S. Preventive Services Task Force
The U.S. Preventive Services Task Force (USPSTF) recommends that primary care providers screen women who have family members with breast, ovarian, tubal, or peritoneal cancer to identify a family history that may be associated with an increased risk for mutations in BRCA1 or BRCA2. The USPSTF recommends that women with positive screening results receive genetic counseling and, if indicated after counseling, BRCA testing. It recommends against routine genetic counseling or BRCA testing for women whose family history is not associated with an increased risk for mutations in the BRCA1 or BRCA2 genes.
Ann Intern Med. 2014;160(4):271-281. doi:10.7326/M13-2747
Camille Nelson Kotton, MD
In this issue, Hocevar and colleagues discuss their investigation into an illness cluster among 3 solid organ transplant recipients from a common donor, which they found to be due to infection with the microorganism E. cuniculi. The editorialist urges clinicians to be mindful of the potential for donor-derived infections and to notify the appropriate parties when such an infection is suspected.
Ann Intern Med. 2014;160(4):282-283. doi:10.7326/M13-2906
John B. Wong, MD
In this issue, Kazi and colleagues analyze the cost-effectiveness of 5 dual antiplatelet therapy strategies for acute coronary syndrome after percutaneous coronary intervention. The editorialist discusses the findings and commends the authors for conducting an analysis that included the potential benefits of new therapies and genetic testing.
Ann Intern Med. 2014;160(4):284-285. doi:10.7326/M14-0040
Cathy Liu, MD
My life changed in an instant. I was in my second week of internal medicine residency at University of California, Davis, School of Medicine. I don't remember the car that hit me.
Ann Intern Med. 2014;160(4):286-287. doi:10.7326/M13-1105
Jonathan Kole, MD, MBE
In the first 2 years of medical school, buried in biochemistry and living in lecture halls, we craved patient contact. Eager to serve and solve with science, we longed for opportunities to put our diagnostic skills to use.
Ann Intern Med. 2014;160(4):288. doi:10.7326/M13-0995
Ann Intern Med. 2014;160(4):289. doi:10.7326/L14-5004
Ann Intern Med. 2014;160(4):289. doi:10.7326/L14-5004-2
Ann Intern Med. 2014;160(4):289-290. doi:10.7326/L14-5004-3
Ann Intern Med. 2014;160(4):290-291. doi:10.7326/L14-5004-4
Ann Intern Med. 2014;160(4):291. doi:10.7326/L14-5004-5
Ann Intern Med. 2014;160(4):291-292. doi:10.7326/L14-5004-6
Nicky Quinlan, MB, BCh, BAO
Ann Intern Med. 2014;160(4):266. doi:10.7326/M13-0994
D. L. Longworth, MD
Ann Intern Med. 2014;160(4):292. doi:10.7326/M12-3042
Ann Intern Med. 2014;160(4):JC2. doi:10.7326/0003-4819-160-4-201402180-02002
Ann Intern Med. 2014;160(4):JC3. doi:10.7326/0003-4819-160-4-201402180-02003
Ann Intern Med. 2014;160(4):JC4. doi:10.7326/0003-4819-160-4-201402180-02004
Ann Intern Med. 2014;160(4):JC5. doi:10.7326/0003-4819-160-4-201402180-02005
Ann Intern Med. 2014;160(4):JC6. doi:10.7326/0003-4819-160-4-201402180-02006
Ann Intern Med. 2014;160(4):JC7. doi:10.7326/0003-4819-160-4-201402180-02007
Ann Intern Med. 2014;160(4):JC8. doi:10.7326/0003-4819-160-4-201402180-02008
Ann Intern Med. 2014;160(4):JC9. doi:10.7326/0003-4819-160-4-201402180-02009
Ann Intern Med. 2014;160(4):JC10. doi:10.7326/0003-4819-160-4-201402180-02010
Ann Intern Med. 2014;160(4):JC11. doi:10.7326/0003-4819-160-4-201402180-02011
Ann Intern Med. 2014;160(4):JC12. doi:10.7326/0003-4819-160-4-201402180-02012
Ann Intern Med. 2014;160(4):JC13. doi:10.7326/0003-4819-160-4-201402180-02013
Geno J. Merli, MD; Howard H. Weitz, MD
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.
Ann Intern Med. 2014;160(4):CG2. doi:10.7326/G14-3002
Ann Intern Med. 2014;160(4):I-11. doi:10.7326/P14-9005
Ann Intern Med. 2014;160(4):I-16. doi:10.7326/P14-9008
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