Bias in reporting study outcomes, so as to favor statistically significant results, is a relatively recently documented phenomenon, which conflates hypothesis testing with hypothesis generation. The biased publication of significant results is enhanced by the preference for authors to submit publications with statistically “positive” results, and journal editors to publish them. Citation bias has been shown to occur throughout the scientific process, from grant writing to final manuscripts. Peer review, from grant submission to manuscripts, is also subject to bias, favoring the status of the authors. All of this contributes to the “winners curse,” the propensity for the first studies declaring an association to be wrong.

1. Transfusion-associated cardiovascular overload (TACO) is most common in critically ill patients receiving a large amount or rapid infusion of blood products who have a history of cardiac or renal dysfunction.

2. TACO will present with signs of fluid overload, including tachypnea, hypoxia, jugular venous distention (JVD), and/or rales on exam.

3. Bedside ultrasound and chest x-ray can be useful in the diagnosis of TACO.

4. Treatment of TACO consists of oxygenation and ventilation as needed, diuretics, and pausing transfusion until the patient’s fluid status is optimized.

5. To reduce risk of TACO in high risk patients, blood given should be limited to what is necessary, rates should be reduced, and diuresis during/after should be considered.

People with serious mental illness (SMI) are over-represented throughout the US criminaljustice system. To address this issue, forensic assertive community treatment has recently emerged as a best-practice intervention. Also known as forensic ACT, ForACT, or most commonly as “FACT,” forensic assertive community treatment is an adaptation of the assertive community treatment (ACT) model. Unlike ACT, however, FACT is purposefully designed to prevent arrest and incarceration among people with SMI who have histories of involvement with the criminal justice system (i.e., “justice-involved” individuals). Although FACT was recognized as a best practice by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2019, FACT teams vary widely in their structure and daily operations. This lack of a standard FACT model continues to impede FACT program implementation and outcomes research. This article begins with a review of FACT origins, followed by a discussion of what we know (and do not know) about FACT operation and effectiveness. Based on the authors’ experience, the article then discusses key components of FACT and concludes with a discussion of current challenges and research recommendations for FACT model development.

1. CIPN is not a single entity, and presentation varies based on the causative drug and cumulative dose.

2. While sensory symptoms are most common, CIPN may also present as motor and autonomic findings.

3. Duloxetine is the only medication with proven benefit for pain from CIPN.

4. CIPN places patients at risk for other injuries. Consider PT/OT for gait instability and weakness. Instruct patients to avoid extreme temperatures, pressure points like tight shoes, foot care, and inspection for unfelt injuries.

5. Cold sensitivity from oxaliplatin can be very distressing, particularly if laryngospasm occurs from cold air or a cold beverage. Patients with signs of oxaliplatin induced CIPN should be advised to take precautions to protect themselves from cold exposure.

The origins and treatment-target related mechanisms of schizophrenia remain to be more fully understood. Pharmacological and non-pharmacological treatments require expansion and improvements to meet more peoples’ needs and goals. Nevertheless, antipsychotics are a cornerstone when managing schizophrenia, being essential for reducing symptom severity, preventing relapse, improving long-term functional outcomes and reducing premature mortality risk. This narrative review synthesizes key evidence on the efficacy and risks associated with antipsychotic medications. The concept of effect sizes is introduced allowing to compare antipsychotics across trials with different ratings instruments and across different conditions. The available evidence in schizophrenia and comparison with medications used for medical conditions counters the sometimes voiced criticism that antipsychotics “do not work”. Instead, for a substantial group of people with schizophrenia, positive psychotic symptoms and global psychopathology improve with a medium effect size of about 0.4 vs. placebo. These results are comparable to median effect sizes across commonly used medications for somatic disorders. When patients with initial response are continued on antipsychotics, the effect size increases to 0.9 for relapse prevention, translating into a number-needed-to-treat of about three to prevent on more relapse versus no treatment. This number-needed-to-treat is 10-20 times higher than for the prevention of poor outcomes in some common medical conditions. Nevertheless, further development is needed regarding preventive interventions, the development of medications with mechanisms other than postsynaptic dopamine receptor blockade, with broader efficacy for positive, negative, cognitive, suicidality and/or reward dysregulation symptomatology, and the identification of illness mechanism/biomarker-targeting treatments to enhance treatment personalization.

Tuskegee, the early twentieth-century eugenics movement, and Roma studies, are examples of major research efforts that were biased and misdirected. More recent examples from the study of electro-magnetic field exposure and childhood cancer, as influenced by interviewer bias, are provided.

Here, we discuss more formal approaches for identifying the influence of possible bias on a study design, or in the conduct of a study, what is called quantitative bias assessment. Then we consider the even more difficult problem of managing systemic bias in researchers themselves, and in research teams. Investigators find it particularly difficult to recognize cognitive and psychological bias in themselves and suggestions for facilitating this are made. The importance of creating a “bias calculation” in grant proposals is emphasized. A hierarchical structure to research bias is recognized.

Schizophrenia is a highly heterogenous disorder with substantial interindividual variationin how the illness is experienced and how it presents clinically. The disorder is composed of primary symptom clusters—positive symptoms, negative symptoms, disorganization, neurocognitive deficits, and social cognitive impairments. These, along with duration, severity, and excluding other possible etiologies, comprise the diagnostic criteria for the disorder outlined in the two commonly used diagnostic classification systems—the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition, Text Revision and the International Classification of Diseases, 11th Revision. These primary symptoms as well as accessory symptoms (mood disturbances, anxiety, violence) and comorbidities (substance use, suicidality) bear upon each other to varying degrees and impact functionaloutcomes. The following review presents two patient cases illustrating the clinical heterogeneity of schizophrenia, the natural history of the illness and diagnosis, followed by the current understanding of the primary symptom clusters, accessory symptoms, and comorbidities. In addition to noting symptom prevalence, onset, and change over time, attention is paid to the impact of symptoms on functional outcome.

1. Management for massive pulmonary embolism (PE) requires hemodynamic stabilization and consider consulting interventional radiology or surgical specialists for intermediate-high risk cases.

2. Initiation of anticoagulation for incidental PE in patients with cancer is generally recommended if no contraindications exists, especially when the PE is proximal or if the patient has other risk factors such as decreased mobility.

3. Confirm the patient’s code status and/or goals of care prior to initiating aggressive interventions that may not align with the patient’s wishes

4. .Utilization of the Pulmonary Embolism Severity Index (PESI) score helps to risk stratify patients based on risk of 30-day mortality.

5. Patients who are low-intermediate risk without contraindications on the American Heart Association/European Society of Cardiology Guidelines for PE Risk Stratification can be discharged with close follow-up and initiation of either low molecular weight heparin (LMWH) or a direct oral anticoagulant (DOAC).

Here we sail into an analysis of what is random error (chance) and what is systemic error (bias), the focus of this present work. Bias produces research whose results are the most destructive; the result appears to be precise (chance does not exert a large effect), but it is wrong. Early descriptions of bias list 35 types but later catalogues describe well over 200. Documenting an association between risk factor and disease is the sine qua non in a causal analysis, and this is where bias most fully operates.

1. Hyperleukocytosis may be the first presentation of acute myeloid leukemias and prognosticates high morbidity and mortality making immediate therapy imperative.

2. Neurologic deficits, respiratory failure with pulmonary infiltrates, fever and visual changes are frequent presentations of hyperleukocytosis due to leukocyte infiltrates or vessel occlusion. Antibiotics are warranted although the etiology may not be infectious.

3. Hyperleukocytosis can result in other oncologic emergencies such as leukostasis, tumor lysis syndrome, and/or disseminated intravascular coagulation involving multiple organ systems. Evaluation and work up should be directed by symptoms; consider evaluation for intracranial hemorrhage.

4. Differentiate between the true hyperkalemia of tumor lysis syndrome and pseudohyperkalemia of hyperleukocytosis with ECG and a heparinized plasma sample before treating.

5. Urgent cytoreduction with Hydroxyurea (Hydrea) and/or leukapheresis may need to be initiated in parallel to induction chemotherapy. If necessary, transfer to an institution that is able to provide these services immediately.

Control and comparison groups are essential for most biomedical research, but who is employed fundamentally influences risk estimation. Historical and hospital control groups are especially susceptible to bias. Natural experiments can prove useful if conducted carefully. Pharmaco-epidemiology has to manage the, not quite, intractable problem of indication bias: Are treatment effects a result of the drug or the disease being treated? Some control groups may be appropriate for detecting and ameliorating bias: respectively, negative and sibling controls.

1. Broad-spectrum antibiotics should be ordered and administered within 60 minutes of patient arrival to the ED.

2. If possible, obtain blood cultures prior to starting antibiotics. However, the administration of antibiotics should not be delayed for the collection of blood cultures.

3. If a patient is known to have a history of multidrug resistant organisms, antibiotic choice will need to be adjusted according to history, if known, or consider consulting Infectious Disease for assistance.

4. Patients with neutropenic fever can deteriorate into sepsis rapidly and therefore, need to be monitored closely.

5. For patients with elevated lactic acid/lactate, it is important to repeat this lab value following a fluid bolus to monitor for clinical deterioration and the development of sepsis.

Schizophrenia is a severe and disabling psychiatric illness that profoundly affects a person’s ability to think clearly, perceive reality, manage emotions, and engage in daily activities. While antipsychotic medications have long been the cornerstone of treatment, debates persist around their long-term use and potential impact on brain structure and function. In our review, we examine whether antipsychotic medications improve or worsen long-term outcomes in schizophrenia, particularly when treatment is refused or discontinued. Drawing from randomized controlled trials, large-scale observational studies, forensic outcome data, international guidelines, and neuroimaging research, the findings demonstrate that sustained antipsychotic treatment significantly reduces relapse, improves functional outcomes, and may protect against neurobiological deterioration. In contrast, untreated or inconsistently treated psychosis is associated with higher relapse rates, treatment resistance, cognitive decline, and progressive brain changes. While treatment must be personalized and compassionate, the cumulative evidence supports the critical role of early and continuous antipsychotic use in preserving health, autonomy, and long-term recovery for individuals living with schizophrenia