Showing papers in "Annals of Internal Medicine in 1994"
TL;DR: A conceptual framework and a set of research guidelines for use in studies of the chronic fatigue syndrome are developed that cover the clinical and laboratory evaluation of persons with unexplained fatigue; the identification of underlying conditions that may explain the presence of chronic fatigue; revised criteria for defining cases of the Chronic fatigue syndrome; and a strategy for dividing the chronic Fatigue syndrome and other unexplained cases of Chronic fatigue into subgroups.
Abstract: The complexities of the chronic fatigue syndrome and the methodologic problems associated with its study indicate the need for a comprehensive, systematic, and integrated approach to the evaluation, classification, and study of persons with this condition and other fatiguing illnesses. We propose a conceptual framework and a set of guidelines that provide such an approach. Our guidelines include recommendations for the clinical evaluation of fatigued persons, a revised case definition of the chronic fatigue syndrome, and a strategy for subgrouping fatigued persons in formal investigations.
4,621 citations
TL;DR: A noxious, unstable gas, nitric oxide, a byproduct of automobile exhaust, electric power stations, and lightning, was discovered in the body, where it participates in various functions, including suppression of pathogens, vasodilation, and neurotransmission, focusing on its clinical relevance.
Abstract: Purpose: To review the physiologic role of nitric oxide, an unusual messenger molecule that mediates blood vessel relaxation, neurotransmission, and pathogen suppression. Data Sources: A MEDLINE se...
947 citations
TL;DR: A casecontrol study focused exclusively on intracranial hemorrhage occurring among outpatients taking warfarin, drawing on an 11-year experience of one general hospital to provide case-patients and using the same hospital's large anticoagulant therapy unit to provide contemporaneous controls who were also takingwarfarin.
Abstract: Objective: To explore the rational use of anticoagulants, especially among the elderly, balancing antithrombotic efficacy and risk for hemorrhage. Previous prospective studies have not provided pow...
918 citations
TL;DR: The problem of falls in the nursing home is reviewed, focusing on identifiable causes, risk factors, and preventive approaches, and the major reported immediate causes of falls and their relative frequencies are presented.
Abstract: Objective: To review the epidemiology and causes of falls and fall-related injuries in nursing homes and to provide clinicians with a structured framework to evaluate and treat nursing home residen...
833 citations
TL;DR: These guidelines are used to review 11 journal articles published from January 1990 through December 1991 whose primary purpose was to assess the accuracy of a diagnostic test against a concurrent reference standard using meta-analysis, and the guidelines are based on current concepts of how to assess diagnostic tests and conduct meta-analyses.
Abstract: Objectives: To introduce guidelines for the conduct, reporting, and critical appraisal of meta-analyses evaluating diagnostic tests and to apply these guidelines to recently published meta-analyses...
772 citations
TL;DR: The relation between aspirin and other NSAID use and the risk for colorectal adenoma and cancer incidence and mortality in a large U.S. cohort of male health professionals is examined.
Abstract: Objective: To determine whether regular use of aspirin decreases the risk for colorectal cancer. Design: Prospective cohort study. Setting: Male health professionals throughout the United States. P...
765 citations
TL;DR: It is hypothesized that long-term estrogen administration would improve vasomotor function in postmenopausal women and was conducted in a double-blind, randomized, crossover, placebo-controlled trial.
Abstract: Objective: To assess the effect of estrogen replacement therapy on endothelium-dependent vasodilation in postmenopausal women. Design: Double-blind, placebo-controlled, cross-over trial. Setting: U...
729 citations
TL;DR: This randomized, controlled trial compared the effectiveness of a physician-directed, nurse-managed, home-based case-management system for coronary risk factor modification with that of usual medical care.
Abstract: Objective: To evaluate the efficacy of a physician-directed, nurse-managed, home-based case-management system for coronary risk factor modification. Design: Randomized clinical trial in which patie...
725 citations
TL;DR: This overview focuses on studies of the final and most clinically important stages of evaluation and examines controlled trials designed to measure the effects of CDSSs on clinician performance and patient outcomes.
Abstract: Objective: To review the evidence from controlled trials of the effects of computer-based clinical decision support systems (CDSSs) on clinician performance and patient outcomes. Data Sources: The ...
716 citations
TL;DR: This study examined the functional and psychosocial status of women after the diagnosis and treatment of breast cancer in the Detroit metropolitan area through the Metropolitan Detroit Cancer Surveillance System (MDCSS), a population-based cancer surveillance system that monitors the 4 million residents of the region.
Abstract: Objective: To determine the effect of comorbidity and stage of disease on 3-year survival in women with primary breast cancer. Design: Longitudinal, observational study. Setting: Metropolitan Detro...
695 citations
TL;DR: The possible beneficial influence of cotrimoxazole in Wegener granulomatosis, patients receiving prolonged continuous treatment with antibiotics, is examined, with special emphasis on current or recent use of antibiotics.
Abstract: Objective: To examine possible risk factors for relapse, including chronic nasal carriage of Staphylococcus aureus and serial antineutrophil cytoplasmic antibody (ANCA) determinations in patients w...
TL;DR: The relation between housestaff coverage and potentially preventable adverse events in hospitalized patients using previously tested self-report methods was studied.
Abstract: Objective: To study the relation between housestaff coverage schedules and the occurrence of preventable adverse events. Design: Case-control study. Setting: Urban teaching hospital. Patients: All ...
TL;DR: In this paper, the effects of a comprehensive discharge planning protocol, designed specifically for the elderly and implemented by nurse specialists, on patient and caregiver outcomes and cost of care were studied.
Abstract: Objective To study the effects of a comprehensive discharge planning protocol, designed specifically for the elderly and implemented by nurse specialists, on patient and caregiver outcomes and cost of care. Design Randomized clinical trial. Setting Hospital of the University of Pennsylvania. Patients 276 patients and 125 caregivers. Patients were 70 years and older and were placed in selected medical and surgical cardiac diagnostic-related groups. Measurements Group differences in patient outcomes (length of initial hospital stay, length of time between initial hospital discharge and readmission, and rehospitalization rates) and charges for care (charges for initial hospitalization, rehospitalizations, health services after discharge, and nurse specialist services) were measured 2, 6, and 12 weeks after discharge. Results From the initial hospital discharge to 6 weeks after discharge, patients in the medical intervention group had fewer readmissions, fewer total days rehospitalized, lower readmission charges, and lower charges for health care services after discharge. No differences in these outcomes were found between the surgical intervention and control groups during this period. Conclusions Study findings support the need for comprehensive discharge planning designed for the elderly and implemented by nurse specialists to improve their outcomes after hospital discharge and to achieve cost savings. The findings also suggest that this intervention had its greatest effect in delaying or preventing rehospitalization of patients in the medical intervention group during the first 6 weeks after discharge.
TL;DR: A stable estimate of the overall effect of various NSAIDs on blood pressure is produced to evaluate possible mechanisms by which NSAID therapy may alter blood pressure and to determine potential predisposing factors for this interaction.
Abstract: Purpose: A meta-analysis of randomized trials studying the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on blood pressure. Data Sources and Study Selection: Eight databases were searched...
TL;DR: The problems with the framework of statistical power are elucidated in the course of explaining why post hoc estimates of power are of little help in interpreting results and why the focus of attention should be exclusively on confidence intervals.
Abstract: Although there is a growing understanding of the importance of statistical power considerations when designing studies and of the value of confidence intervals when interpreting data, confusion exists about the reverse arrangement: the role of confidence intervals in study design and of power in interpretation. Confidence intervals should play an important role when setting sample size, and power should play no role once the data have been collected, but exactly the opposite procedure is widely practiced. In this commentary, we present the reasons why the calculation of power after a study is over is inappropriate and how confidence intervals can be used during both study design and study interpretation.
TL;DR: The primary purpose of this review of selected peer-reviewed articles on the biosynthesis, biochemistry, and biological actions of the leukotrienes is to help readers understand the therapeutic potential of these inhibitors.
Abstract: Objective: To review the biochemistry and biological activities of leukotrienes, focusing on their role in the mediation of inflammatory diseases. Data Sources: MEDLINE (1966-1994), EMBASE (Excerpt...
TL;DR: How ambulatory blood pressure measurements obtained during an entire 24-hour period, while awake and asleep, differed among people with and without sleep-disordered breathing in the general population is determined.
Abstract: Objective: To measure the independent association of sleep-disordered breathing (sleep apnea and habitual snoring) and hypertension in a healthy adult population. Design: A cross-sectional study of...
TL;DR: Magnetic resonance imaging (MRI) at 1.5 tesla, combined with the use of the paramagnetic contrast agent, gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA), enhances the capacity to visualize the pituitary gland and to screen patients forpituitary adenomas and evaluated the pituitsary gland before and after administration of Gd- DTPA in 100 volunteers.
Abstract: Objective: To determine the prevalence of focal lesions of the pituitary gland that suggest the presence of a pituitary adenoma in asymptomatic persons. Design: 100 normal volunteers (70 women, 30 ...
TL;DR: The quality of reports about drug and food interactions with warfarin was evaluated to address the fine points of therapy such as drug interactions, and it was essential to evaluate the quality of these studies.
Abstract: • Purpose: To evaluate the quality of studies about drugs and food interactions with warfarin and their clinical relevance. • Data Sources: MEDLINE and TOXLINE databases from 1966 to October 1993 using the Medical Subject Headings warfarin, drug interactions, and English only. • Study Selection: All articles reporting original data on drug and food interactions with warfarin. • Data Extraction: Each report, rated independently by at least two investigators (using causality assessment), received a summary score indicating the level of assur ance (level 1 = highly probable, level 2 = probable, level 3 = possible, and level 4 = doubtful) that a clini cally important interaction had or had not occurred. Inter-rater agreement was assessed using a weighted kappa statistic. • Results: Of 793 retrieved citations, 120 contained original reports on 186 interactions. The weighted kappa statistic was 0.67, representing substantial agreement. Of 86 different drugs and foods appraised, 43 had level 1 evidence. Of these, 26 drugs and foods did interact with warfarin. Warfarin's anticoagulant ef fect was potentiated by 6 antibiotics (cotrimoxazole, erythromycin, fluconazole, isoniazid, metronidazole, and miconazole); 5 cardiac drugs (amiodarone, clofibrate, propafenone, propranolol, and sulfinpyrazone); phenylbutazone; piroxicam; alcohol (only with concom itant liver disease); cimetidine; and omeprazole. Three patients had a hemorrhage at the time of a potentiating interaction (caused by alcohol, isoniazid, and phenyl butazone). Warfarin's anticoagulant effect was inhibited by 3 antibiotics (griseofulvin, rifampin, and nafcillin); 3 drugs active on the central nervous system (barbitu
TL;DR: To better understand the value of the total cholesterol/HDL ratio as a summary measure of risk for coronary heart disease, the ability of this ratio to predict persons who will and will not develop coronaryHeart disease was examined, using statistical tests to compare this ratio with other cholesterol measures.
Abstract: Objective: Comparison of four measures of cholesterol for predicting men and women who will develop coronary heart disease within 8 to 10 years. Design: Cohort study. Patients: 1898 men who receive...
TL;DR: The objective of this study was to evaluate the effects of long-term intravenous infusion of prostacyclin on exercise capacity, hemodynamics, and survival in patients with primary pulmonary hypertension.
Abstract: Objective: To evaluate the effects of long-term intravenous infusion of prostacyclin on exercise capacity, hemodynamics, and survival in patients with primary pulmonary hypertension. Design: Open, ...
TL;DR: The discussants in this conference review several of these new therapies that are directed at different elements of the inflammatory cascade, including a bacterial toxin (endotoxin), host proteins that mediate the inflammatory response (TNF and IL-1), an inflammatory cell (the neutrophil), and a low-molecular-weight messenger (nitric oxide) that causes hypotension.
Abstract: Purpose: To review selected new therapies for septic shock designed to inhibit bacterial toxins or endogenous mediators of inflammation. Data Sources: Scientific journals, scientific meeting procee...
TL;DR: A national survey of a random sample of American College of Physicians (ACP) members to assess ACP members' familiarity with, confidence in, and attitudes about guidelines issued by ACP and other organizations and members' perceptions of the effect of ACp and other guidelines on their practices.
Abstract: Objective: To assess internists' familiarity with, confidence in, and attitudes about practice guidelines issued by various organizations. Design: Cross-sectional, self-administered survey. Partici...
TL;DR: A large, simple trial design to test the use of septic shock as an indication for HA-1A treatment and the effectiveness of 100 mg of HA- 1A and placebo in reducing the 14-day all-cause mortality rate in patients with sepsis who had gram-negative bacteremia was tested.
Abstract: Objective To compare the effectiveness of 100 mg of HA-1A and placebo in reducing the 14-day all-cause mortality rate in patients with septic shock and gram-negative bacteremia in the Centocor: HA-1A Efficacy in Septic Shock (CHESS) trial, and to assess the safety of 100 mg of HA-1A given to patients with septic shock who did not have gram-negative bacteremia. Design Large, simple, group-sequential, randomized, double-blind, multicenter, placebo-controlled trial. Setting 603 investigators at 513 community and university-affiliated hospitals in the United States. Patients Within 6 hours before enrollment, the patients had been in shock with a systolic blood pressure of less than 90 mm Hg after adequate fluid challenge or had received vasopressors to maintain blood pressure. These episodes of shock began within 24 hours of enrollment. A presumptive clinical diagnosis of gram-negative infection as the cause of the shock episode and a commitment from the patients' physicians to provide full supportive care were required. Measurements Blood cultures were obtained within 48 hours of enrollment, and death at day 14 after treatment was recorded. Adverse events occurring within 14 days after enrollment were also tabulated. Results 2199 patients were enrolled; 621 (28.2%) met all enrollment criteria, received HA-1A or placebo, and had confirmed gram-negative bacteremia. Mortality rates in this group were as follows: placebo, 32% (95 and HA-1A, 33% (109 of 328) (P = 0.864, Fisher exact test, two-tailed; 95% CI for the difference, -6.2% to 8.6%). Mortality rates in the patients without gram-negative bacteremia were as follows: placebo, 37% (292 of 793) and HA-1A, 41% (318 of 785) (P = 0.073, Fisher exact test, one-tailed; CI, -0.8% to 8.8%). Conclusions In this trial, HA-1A was not effective in reducing the 14-day mortality rate in patients with gram-negative bacteremia and septic shock. These data do not support using septic shock as an indication for HA-1A treatment. If HA-1A is effective in reducing the mortality rate in patients dying from endotoxemia, these patients must be identified using other treatment criteria.
TL;DR: The primary advantage of proton pump inhibitors over all other antireflux therapies is their specific efficacy in patients with severe, refractory reflux disease, nonhealing Barrett ulcers, or peptic strictures.
Abstract: Objective: To evaluate the long-term efficacy and safety of omeprazole in patients with gastroesophageal reflux disease resistant to treatment with histamine-2 (H2)-receptor antagonists. Design: Co...
TL;DR: The purpose of this study was to evaluate the long-term efficacy of acarbose in improving the metabolic control of patients with noninsulin-dependent diabetes mellitus that was not well controlled by diet alone, diet or metformin, diet and sulfonylurea, or diet and insulin.
Abstract: Objective: To evaluate the long-term efficacy of acarbose, an α-glucosidase inhibitor, in improving glycemic control in patients with non–insulin-dependent diabetes mellitus. Design: A 1-year, mult...
TL;DR: This review lists the medicinal agents currently available for chemical pleurodesis but defer discussion of less considered and unavailable agents such as CalmetteGurin bacillus cell-wall skeleton, nitrogen mustard, quinacrine, and thiotepa.
Abstract: Purpose: To provide information about available agents for chemical pleurodesis. Data Sources: A MEDLINE search (1966 to October 1992) was conducted using the terms malignant pleural effusion and p...
TL;DR: The natural history of symptomatic recurrences in the complete population and in the subset of untreated patients is summarized.
Abstract: Objective: To evaluate the frequency of reactivation of genital herpes infection and to identify predictors for recurrence. Design: Prospective, observational cohort study. Setting: Research clinic...
TL;DR: The proarrhythmic potential of amiodarone is examined, with particular reference to its ability to provoke polymorphic ventricular tachycardia of the torsade de pointes type.
Abstract: Purpose: To assess the incidence of amiodarone-mediated aggravation of ventricular tachyarrhythmias or the development of new arrhythmias, such as torsade de pointes, in patients with cardiac disea...
TL;DR: Whether simplified questionnaires and joint counts, which can be obtained in 10 to 15 minutes in a physician's office, provide effective data to identify increased probability of mortality over the subsequent 15 years in individual patients is extended to analyze.
Abstract: Objective: To describe mortality over 15 years in a cohort of patients with rheumatoid arthritis, according to a simple questionnaire and joint count. Design: A cohort study with 15 years of follow...