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https://www.readbyqxmd.com/read/29688040/commentary
#1
Victoria Mango, Yolanda Bryce, Elizabeth Anne Morris, Elisabetta Gianotti, Katja Pinker
Screening mammography reduces breast cancer mortality in average-risk women. However, adverse consequences include false-positive findings possibly leading to benign breast biopsies and patient anxiety. There is also potential for overdiagnosis and overtreatment. Differences in how to balance benefits and harms have led to varying recommendations by the U.S. Preventive Services Task Force, the American Cancer Society, the National Comprehensive Cancer Network and the American College of Radiology/Society of Breast Imaging...
April 24, 2018: British Journal of Radiology
https://www.readbyqxmd.com/read/29686450/using-shared-decision-making-to-address-possible-overtreatment-in-patients-at-high-risk-for-hypoglycemia-the-veterans-health-administration-s-choosing-wisely-hypoglycemia-safety-initiative
#2
Samantha M Wright, Sandra C Hedin, Mark McConnell, Brian V Burke, Sharon A Watts, Donna M Leslie, David C Aron, Leonard M Pogach
IN BRIEF Successful management of patients with diabetes requires individualizing A1C and treatment goals in conjunction with identifying and managing hypoglycemia risk. This article describes the Veterans Health Administration's Choosing Wisely Hypoglycemia Safety Initiative (CW-HSI), a voluntary program that aims to reduce the occurrence of hypoglycemia through shared decision-making about deintensifying diabetes treatment in a dynamic cohort of patients identified as being at high risk for hypoglycemia and potentially overtreated...
April 2018: Clinical Diabetes: a Publication of the American Diabetes Association
https://www.readbyqxmd.com/read/29685879/clinicopathological-risk-factors-for-an-invasive-breast-cancer-recurrence-after-ductal-carcinoma-in-situ-a-nested-case-control-study
#3
Lindy L Visser, Lotte E Elshof, Michael Schaapveld, Koen Van de Vijver, Emma J Groen, Mathilde M Almekinders, Carolien Bierman, Flora E Van Leeuwen, Emiel J T Rutgers, Marjanka K Schmidt, Esther H Lips, Jelle Wesseling
PURPOSE: Ductal carcinoma in situ (DCIS) is treated to prevent progression to invasive breast cancer. Yet, most lesions will never progress, implying that overtreatment exists. Therefore, we aimed to identify factors distinguishing harmless from potentially hazardous DCIS using a nested case-control study. EXPERIMENTAL DESIGN: We conducted a case-control study nested in a population-based cohort of DCIS patients treated with breast conserving surgery (BCS) alone (n=2,658) between 1989-2005...
April 23, 2018: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/29685542/normal-mri-findings-of-the-knee-in-patients-with-clinically-active-juvenile-idiopathic-arthritis
#4
E Charlotte van Gulik, Robert Hemke, Mendy M Welsink-Karssies, Dieneke Schonenberg-Meinema, Koert M Dolman, Anouk M Barendregt, Charlotte M Nusman, Mario Maas, Taco W Kuijpers, J Merlijn van den Berg
OBJECTIVE: In a number of patients with clinically active juvenile idiopathic arthritis (JIA), contrast-enhanced MRI shows no signs of synovitis. The objective of this study was to assess the frequency and the patient characteristics in clinically active JIA patients in which MRI showed no signs of synovitis. METHODS: From our cohort of 313 patients in which contrast-enhanced MRI of the knee had been performed, we selected 72 JIA patients with clinically active disease involving the target joint...
May 2018: European Journal of Radiology
https://www.readbyqxmd.com/read/29669162/development-and-validation-of-algorithms-to-differentiate-ductal-carcinoma-in-situ-from-invasive-breast-cancer-within-administrative-claims-data
#5
Jacqueline M Hirth, Sandra S Hatch, Yu-Li Lin, Sharon H Giordano, H Colleen Silva, Yong-Fang Kuo
BACKGROUND: Overtreatment is a common concern for patients with ductal carcinoma in situ (DCIS), but this entity is difficult to distinguish from invasive breast cancers in administrative claims data sets because DCIS often is coded as invasive breast cancer. Therefore, the authors developed and validated algorithms to select DCIS cases from administrative claims data to enable outcomes research in this type of data. METHODS: This retrospective cohort using invasive breast cancer and DCIS cases included women aged 66 to 70 years in the 2004 through 2011 Texas Cancer Registry (TCR) data linked to Medicare administrative claims data...
April 18, 2018: Cancer
https://www.readbyqxmd.com/read/29666020/geographic-variation-in-the-treatment-of-u-s-adult-heart-transplant-candidates
#6
William F Parker, Allen S Anderson, Donald Hedeker, Elbert S Huang, Edward R Garrity, Mark Siegler, Matthew M Churpek
BACKGROUND: The current U.S. priority ranking for heart candidates is based on treatment intensity, not objective markers of severity of illness. This system may encourage centers to overtreat candidates. OBJECTIVES: This study sought to describe national variation in the intensity of treatment of adult heart transplantation candidates and identify center-level predictors of potential overtreatment. METHODS: The registrations of all U.S. adult heart transplantation candidates from 2010 to 2015 were collected from the SRTR (Scientific Registry of Transplant Recipients)...
March 20, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29659930/automated-cervical-screening-and-triage-based-on-hpv-testing-and-computer-interpreted-cytology
#7
Kai Yu, Noorie Hyun, Barbara Fetterman, Thomas Lorey, Tina R Raine-Bennett, Han Zhang, Robin E Stamps, Nancy E Poitras, William Wheeler, Brian Befano, Julia C Gage, Philip E Castle, Nicolas Wentzensen, Mark Schiffman
Background: State-of-the-art cervical cancer prevention includes human papillomavirus (HPV) vaccination among adolescents and screening/treatment of cervical precancer (CIN3/AIS and, less strictly, CIN2) among adults. HPV testing provides sensitive detection of precancer but, to reduce overtreatment, secondary "triage" is needed to predict women at highest risk. Those with the highest-risk HPV types or abnormal cytology are commonly referred to colposcopy; however, expert cytology services are critically lacking in many regions...
April 11, 2018: Journal of the National Cancer Institute
https://www.readbyqxmd.com/read/29658199/the-added-value-of-the-lateral-chest-radiograph-for-diagnosing-community-acquired-pneumonia-in-the-pediatric-emergency-department
#8
Michalle Soudack, Semion Plotkin, Aviva Ben-Shlush, Lisa Raviv-Zilka, Jeffrey M Jacobson, Michael Benacon, Arie Augarten
BACKGROUND: Opinions differ as to the need of a lateral radiograph for diagnosing community acquired pneumonia in children referred to the emergency department. A lateral radiograph increases the ionizing radiation burden but at the same time may improve specificity and sensitivity in this population. OBJECTIVES: To determine the value of the frontal and lateral chest radiographs compared to frontal view stand-alone images for the management of children with suspected community acquired pneumonia seen in a pediatric emergency department...
January 2018: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/29653161/is-routine-use-of-renal-tumor-biopsy-associated-with-lower-rates-of-benign-histology-following-nephrectomy-for-small-renal-masses
#9
Patrick O Richard, Luke T Lavallée, Frederic Pouliot, Maria Komisarenko, Lisa Martin, Jean-Baptiste Latouff, Antonio Finelli
PURPOSE: Renal tumor biopsies (RTBs) have been proposed as a management alternative to avoid treatment of benign or low-risk small renal masses (SRMs). However, many urologists are reluctant to recommend RTB because they feel its result frequently will not impact management. Our primary objective was to evaluate if centers that routinely favor RTB (FRB) have lower rates of benign histology after surgery than centers that use a selective RTB approach (SRB). METHODS: This was a retrospective multicenter study of patients who underwent a partial or radical nephrectomy for a lesion suspicious for localised RCC and measuring ≤4cm (cT1a and pT1a or pT3a) between 2013 and 2015...
April 10, 2018: Journal of Urology
https://www.readbyqxmd.com/read/29626022/diagnosis-and-management-of-cellulitis
#10
Tadhg Sullivan, Eoghan de Barra
Cellulitis is a frequently encountered condition, but remains a challenging clinical entity. Under and overtreatment with antimicrobials frequently occurs and mimics cloud the diagnosis. Typical presentation, microbiology and management approaches are discussed.
March 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/29623863/-fibronectin-test-in-threatened-preterm-labour-cost-saving-but-not-yet-widely-implemented-in-the-netherlands
#11
T M S van Winden, M M C Bruijn, M A Oudijk, G J van Baaren, A H L C van Kaam, B W J Mol, M Kok
OBJECTIVE: Analysis of national implementation of the foetal fibronectin test in the diagnostics of threatened preterm labour in the Netherlands, and indication of the possible obstacles and consequences of implementation or no implementation. DESIGN: National questionnaire, retrospective cohort study and cost-effectiveness calculation. METHODS: We approached all hospitals in the Netherlands (n = 86) with a questionnaire on use of the fibronectin test...
2018: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/29623468/misses-and-near-misses-in-diagnosing-nodular-fasciitis-and-morphologically-related-reactive-myofibroblastic-proliferations-experience-of-a-referral-center-with-emphasis-on-frequency-of-usp6-gene-rearrangements
#12
Ramona Erber, Abbas Agaimy
Although harmless, reactive and benign neoplastic myo-/fibroblastic proliferations represent a diagnostic challenge in routine surgical pathology practice as reflected by their frequency among consultation cases. In addition to resembling each other, the prototypical nodular fasciitis (NF) and NF-like lesions can be mistaken for low-grade or aggressive sarcomas. USP6 translocation was reported recently as the molecular driver and potential diagnostic marker of NF. We reviewed 71 lesions with a diagnosis of NF (n = 48) or NF-like myofibroblastic proliferations (n = 23) and screened them for USP6 translocation by fluorescence in situ hybridization (FISH)...
April 5, 2018: Virchows Archiv: An International Journal of Pathology
https://www.readbyqxmd.com/read/29616221/incidence-trends-of-cervical-cancer-and-its-precancerous-lesions-in-women-of-central-switzerland-from-2000-until-2014
#13
Katrin Ochs, Gesine Meili, Joachim Diebold, Volker Arndt, Andreas Günthert
Objective: Cervical cancer (CC) screening by Pap smears has led to a decrease in the incidence of CC worldwide. Indeed, the incidence of CC in Switzerland is very low; however, there is a lack of data to evaluate the efficiency of the Pap smear as a screening tool. Until now, only Pap smears have been used and other methods such as the presence of an infection with HPV have not been integrated into the routine screening. The aim of this study is to evaluate trends in the incidence of CC and its precancerous lesions in Central Switzerland, which represents a rural region, with those in urban regions and the entire country of Switzerland...
2018: Frontiers in Medicine
https://www.readbyqxmd.com/read/29614977/diagnostic-behaviour-of-general-practitioners-when-suspecting-lyme-disease-a-database-study-from-2010-2015
#14
Esmée Botman, C Wim Ang, Johanna H K Joosten, Pauline Slottje, Johannes C van der Wouden, Otto R Maarsingh
BACKGROUND: Due to the raised public awareness of Lyme Borreliosis (LB), its increased incidence and the increased availability of serological tests, the demand for diagnostic testing on LB has increased. This may affect the diagnostic behaviour of general practitioners (GPs). Aim of our study was to describe GPs' diagnostic behaviour when suspecting LB. METHODS: In this descriptive study from January 2010 to June 2015, we used the anonymized electronic medical records of 56,996 patients registered in 12 general practices in Amsterdam, The Netherlands...
April 3, 2018: BMC Family Practice
https://www.readbyqxmd.com/read/29614508/diagnosis-and-management-of-asthma-the-swiss-guidelines
#15
Thomas Rothe, Paolo Spagnolo, Pierre-Olivier Bridevaux, Christian Clarenbach, Christine Eich-Wanger, Franca Meyer, David Miedinger, Alexander Möller, Laurent P Nicod, Geneviève Nicolet-Chatelain, Alain Sauty, Claudia Steurer-Stey, Joerg D Leuppi
The Global Initiative for Asthma (GINA) is a network of individuals, organizations, and public health officials that was established to disseminate information about the care of patients with asthma and to improve asthma care. The GINA ("Global Strategy for Asthma Management and Prevention") report has been updated annually since 2002. Due to new knowledge and therapeutic development in the field, the Swiss Respiratory Society felt the need to provide a new document that is based on both the available literature and the recommendations of the 2016 GINA report...
April 3, 2018: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/29610129/ultrasound-for-lower-extremity-deep-venous-thrombosis-multidisciplinary-recommendations-from-the-society-of-radiologists-in-ultrasound-consensus-conference
#16
REVIEW
Laurence Needleman, John J Cronan, Michael P Lilly, Geno J Merli, Srikar Adhikari, Barbara S Hertzberg, M Robert DeJong, Michael B Streiff, Mark H Meissner
Venous ultrasound is the standard imaging test for patients suspected of having acute deep venous thrombosis (DVT). There is variability and disagreement among authoritative groups regarding the necessary components of the test. Some protocols include scanning the entire lower extremity, whereas others recommend scans limited to the thigh and knee supplemented with serial testing. Some protocols use gray-scale ultrasound alone, whereas others include Doppler interrogation. Point-of-care ultrasound is recommended in some settings, and there is heterogeneity of these protocols as well...
April 3, 2018: Circulation
https://www.readbyqxmd.com/read/29608422/a-systematic-review-of-pericolic-extraluminal-air-in-left-sided-acute-colonic-diverticulitis
#17
Stefan T van Dijk, Sabrina A N Doelare, Anna A W van Geloven, Marja A Boermeester
BACKGROUND: Although approximately 15% of all patients with acute colonic diverticulitis have pericolic extraluminal air found on computed tomography (CT), studies on the natural course and treatment of these patients are scarce. It is not clear whether these patients behave as mild uncomplicated diverticulitis or as severe diverticulitis needing more aggressive treatment. Consequently, there is no consensus about the treatment, guidelines do not discuss this group of patients, and physicians treat these patients based on their own experiences and opinion...
April 2, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29605260/pediatric-phyllodes-tumors-a-review-of-the-national-cancer-data-base-and-adherence-to-nccn-guidelines-for-phyllodes-tumor-treatment
#18
Harold J Leraas, Laura H Rosenberger, Yi Ren, Brian Ezekian, Uttara P Nag, Christopher R Reed, Samantha M Thomas, Eun-Sil Shelley Hwang, Elisabeth T Tracy
BACKGROUND: Phyllodes tumors are fibroepithelial breast lesions that are uncommon in women and rare among children. Due to scarcity, few large pediatric phyllodes tumor series exist. Current guidelines do not differentiate treatment recommendations between children and adults. We examined national guideline adherence for children and adults. METHODS: We queried the NCDB (2004-2014) for female patients with phyllodes tumor histology, excluding patients with missing age or survival data...
March 7, 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29599329/additional-nodal-disease-prediction-in-breast-cancer-with-sentinel-lymph-node-metastasis-based-on-clinicopathological-features
#19
Paolo Orsaria, Emanuele Caredda, Federica Genova, Marco Materazzo, Ilaria Capuano, Gianluca Vanni, Alessandra Vittoria Granai, Adriano DE Majo, Ilaria Portarena, Pierpaolo Sileri, Giuseppe Petrella, Leonardo Palombi, Oreste Claudio Buonomo
AIM: The standard-of-care in breast cancer (BC) with positive sentinel lymph node (SLN) metastasis includes complete axillary lymph node dissection (ALND); however, almost half of such cases have no further tumor burden. This study aimed to assess the clinicopathological factors that predict non-SLN metastasis to define subgroups of SLN-positive patients in whom the axilla may be staged by SLN biopsy alone, while avoiding unnecessary overtreatment. PATIENTS AND METHODS: The records of 191 patients with histologically-proven primary BC who underwent a positive (SLN) biopsy between 2005 and 2017 were reviewed...
April 2018: Anticancer Research
https://www.readbyqxmd.com/read/29596224/cdc-syphilis-summit-diagnostics-and-laboratory-issues
#20
Allan Pillay
Syphilis, caused by the bacterium Treponema pallidum, is on the rise in the United States (US) particularly among men who have sex with men (MSM). The disease is complex with varied clinical manifestations and challenges remain in the laboratory diagnostic setting because T. pallidum is non-cultivable and no single test can accurately diagnose all stages of the disease. There are missed opportunities for the use of direct detection tests in primary and secondary (P&S) syphilis. The increasing use of different reverse sequence algorithms for serology testing without validation in populations with varying risks for syphilis makes the interpretation of test results difficult; this has led to concerns about diagnostic errors or overtreatment...
March 29, 2018: Sexually Transmitted Diseases
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