Showing papers in "Annals of Internal Medicine in 1995"
TL;DR: The relations between change in adult weight and the risk for noninsulin-dependent diabetes mellitus among women during 14 years of follow-up were quantified.
Abstract: Objective: To examine the relation between adult weight change and the risk for clinical diabetes mellitus among middle-aged women. Design: Prospective cohort study with follow-up from 1976 to 1990...
2,049 citations
TL;DR: The MDRD Study compared the rates of decline in glomerular filtration rate in 840 patients with a diverse array of renal diseases who were randomly assigned to either a usual or a low blood pressure goal and evaluated the effect of blood pressure on changes in proteinuria.
Abstract: Objective: To examine the relations among proteinuria, prescribed and achieved blood pressure, and decline in glomerular filtration rate in the Modification of Diet in Renal Disease Study. Design: ...
1,248 citations
TL;DR: In this paper, the authors investigated whether concurrent administration of misoprostol reduces the occurrence of serious upper gastrointestinal complications, such as perforation, gastric outlet obstruction, or bleeding, in patients with rheumatoid arthritis who are receiving nonsteroidal anti-inflammatory drugs (NSAIDs).
Abstract: . Objective : To investigate whether concurrent administration of misoprostol reduces the occurrence of serious upper gastrointestinal complications, such as perforation, gastric outlet obstruction, or bleeding, in patients with rheumatoid arthritis who are receiving nonsteroidal anti-inflammatory drugs (NSAIDs). . Design : 6-month randomized, double-blind, placebo-controlled trial. . Setting : 664 clinical practices of family medicine, internal medicine, or rheumatology in the United States and Canada. . Patients : 8843 men and women (mean age, 68 years) receiving continuous therapy with any of 10 specified NSAIDs for control of symptoms of rheumatoid arthritis. Patients were enrolled between July 1991 and August 1993. . Intervention : Patients were randomly assigned to receive 200 μg of misoprostol or placebo four times a day. . Measurements : Development of serious upper gastrointestinal complications detected by clinical symptoms or findings (not by scheduled endoscopy). . Results : Serious upper gastrointestinal complications were reduced by 40% (odds ratio, 0.598 [95% Cl, 0.364 to 0.982 ; P = 0.0491) among patients receiving misoprostol (25 of 4404 patients) compared with those receiving placebo (42 of 4439 patients). During the first month, more patients receiving misoprostol (20%) than placebo (15%) withdrew from the study, primarily because of diarrhea and related problems (P I 0.001). Risk factors for serious upper gastrointestinal complications were increasing age, history of peptic ulcer or bleeding, and cardiovascular disease. Patients with all four risk factors would have a 9% risk for a major complication in 6 months. . Conclusions : In older patients with rheumatoid arthritis, misoprostol reduced serious NSAID-induced upper gastrointestinal complications by 40% compared with placebo.
1,066 citations
TL;DR: In a meta-analysis of 20 cohort studies, the pooled estimates of vaccine efficacy (1-odds ratio) were 56% (95% CI, 39% to 68%) for preventing respiratory illness, 53% (CI, 35% to 66%), for preventing pneumonia, 50%(CI, 28% to 65%), and 68% (i.e., 56% to 76%).
Abstract: . Objective : To quantify the protective efficacy of influenza vaccine in elderly persons. . Data Sources : A MEDLINE search was done using the index terms influenza vaccine, vaccine efficacy, elderly, mortality, hospitalized, and pneumonia. Appropriate references in the initially selected articles were also reviewed. . Study Selection : Only cohort observational studies with mortality assessment were included in the meta-analysis. In addition, 3 recent case-control studies, 2 cost-effectiveness studies, and 1 randomized, double-blind, placebo-controlled trial were reviewed. . Data Extraction : Vaccine and epidemic virus strains, age and sex of patients, severity of illness, patient status, and study design were recorded. Upper respiratory illness, hospitalization, pneumonia, and mortality were used as outcome measures. . Data Synthesis : In a meta-analysis of 20 cohort studies, the pooled estimates of vaccine efficacy (1-odds ratio) were 56% (95% CI, 39% to 68%) for preventing respiratory illness, 53% (CI, 35% to 66%) for preventing pneumonia, 50% (CI, 28% to 65%) for preventing hospitalization, and 68% (CI, 56% to 76%) for preventing death. Vaccine efficacy in the case-control studies ranged from 32% to 45% for preventing hospitalization for pneumonia, from 31% to 65% for preventing hospital deaths from pneumonia and influenza, from 43% to 50% for preventing hospital deaths from all respiratory conditions, and from 27% to 30% for preventing deaths from all causes. The randomized, double-blind, placebo-controlled trial showed a 50% or greater reduction in influenza-related illness. Recent cost-effectiveness studies confirm the efficacy of influenza vaccine in reducing influenza-related morbidity and mortality and show that vaccine provides important cost savings per year per vaccinated person. . Conclusion : Despite the paucity of randomized trials, many studies confirm that influenza vaccine reduces the risks for pneumonia, hospitalization, and death in elderly persons during an influenza epidemic if the vaccine strain is identical or similar to the epidemic strain. Influenza immunization is an indispensable part of the care of persons 65 years of age and older. Annual vaccine administration requires the attention of all physicians and public health organizations.
1,048 citations
Journal Article•
TL;DR: The meta-analysis confirms the findings of several recent studies on the effectiveness of influenza vaccination in elderly persons and should heighten physician awareness and encourage the universal annual use of influenza vaccine in elderly Persons.
Abstract: Objective: To quantify the protective efficacy of influenza vaccine in elderly persons. Data Sources: A MEDLINE search was done using the index terms influenza vaccine, vaccine efficacy, elderly, m...
1,028 citations
TL;DR: The hypotheses that physical inactivity, obesity, and height increase the risk for colon cancer and adenoma independently of each other and of diet are addressed, and that the abdominal pattern of obesity is an additional independent risk factor are addressed.
Abstract: Objective: To determine whether physical inactivity and obesity increase risk for colon cancer and adenomas, which are precursors of cancer, and whether the abdominal distribution of obesity is an ...
1,024 citations
TL;DR: The objective was to compare plasma HIV-1 RNA with determinations of serum p24 antigen, neopterin, and 2-microglobulin levels and CD4+ T-cell counts as predictors of outcome in a cohort of homosexual men with documented HIV- 1 seroconversion.
Abstract: Objective: To investigate the relation between the quantity of human immunodeficiency virus type 1 (HIV-1) RNA in plasma and the risk for the acquired immunodeficiency syndrome (AIDS) or a decline ...
969 citations
TL;DR: Azathioprine and 6-mercaptopurine are effective in treating active Crohn disease and in maintaining remission of quiescent disease as mentioned in this paper, however, adverse effects were more common among patients receiving therapy.
Abstract: . Purpose : To assess the effectiveness of azathioprine and 6-mercaptopurine in inducing remission of active Crohn disease and the effectiveness of azathioprine in maintaining remission of quiescent disease. . Data Sources : Pertinent studies were selected from the MEDLINE database (1966 to May 1994), abstracts from major gastrointestinal meetings, and references from published articles and reviews. . Study Selection : Nine randomized, placebo-controlled trials of azathioprine or 6-mercaptopurine therapy were identified : Four addressed active disease, two addressed quiescent disease, and three had multiple therapeutic arms. . Data Extraction : Data were extracted by three independent observers on the basis of the intention-to-treat principle and were analyzed with logistic regression. Each study was given a quality score on the basis of predetermined criteria. . Data Synthesis : Compared with placebo, azathioprine or 6-mercaptopurine therapy had an odds ratio of response of 3.09 (95% CI, 2.45 to 3.91) in patients with active Crohn disease. When the single trial that used 6-mercaptopurine in active disease was excluded from the analysis, the odds ratio of response was 1.45 (Cl, 1.12 to 1.87). No trials of quiescent disease used 6-mercaptopurine ; the odds ratio of response in these trials of quiescent disease was 2.27 (Cl, 1.76 to 2.93). For active disease, continuation of therapy for at least 17 weeks improved response (P = 0.03). For quiescent disease, a higher dose improved response (P = 0.008). Increased cumulative dose improved response in both groups (P < 0.001 for active disease and P = 0.01 for quiescent disease). A steroid-sparing effect was seen in active disease (odds ratio, 3.69 (Cl, 2.12 to 6.42) and in quiescent disease (odds ratio, 4.64 [Cl, 1.00 to 21.54]). Fistulae improved with therapy (odds ratio, 4.44 [Cl, 1.50 to 13.20]). Adverse events requiring withdrawal from a trial, primarily allergy, leukopenia, pancreatitis, and nausea, were increased with therapy (odds ratio, 5.26 [Cl, 2.20 to 12.60]). . Conclusions : Azathioprine and 6-mercaptopurine are effective in treating active Crohn disease and in maintaining remission. Cumulative dose was an important factor in predicting response. Adverse effects were more common among patients receiving therapy.
897 citations
TL;DR: This is a mature study with all patients able to be followed for more than 5 years, and the evidence for therapeutic benefit was strong, but it was possible that the authors were only prolonging the interval to cancer recurrence and death rather than actually improving cure rates.
Abstract: Objective: To determine the effectiveness of two adjuvant therapy regimens in improving surgical cure rates in stage III (Dukes stage C) colon cancer. Design: Randomized, concurrently controlled cl...
865 citations
TL;DR: The effects of comprehensive pulmonary rehabilitation on both physiologic and psychosocial outcomes with the effects of education alone were compared with long-term, 6-year follow-up.
Abstract: Objective: To compare the effects of comprehensive pulmonary rehabilitation with those of education alone on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary dis...
856 citations
TL;DR: This study examined the association between estrogen use and bone mass in elderly women and found the protective effects of estrogen on fracture were greater in younger women and weaker in older women, as well as the relation between unopposed estrogen and fractures.
Abstract: Objective: To determine the relation between estrogen replacement therapy and fractures Design: Prospective cohort study Setting: Four clinical centers in Baltimore County, Maryland; Minneapolis,
TL;DR: The prevalence of domestic violence among female patients presenting to four community-based, primary care, adult medicine practices that serve patients of diverse socioeconomic background was determined and demographic and clinical differences between currently abused patients and patients not currently being abused were identified.
Abstract: Objectives: To determine the prevalence of domestic violence among female patients and to identify clinical characteristics that are associated with current domestic violence. Design: Cross-section...
TL;DR: The effect of biological age at which unilateral loading was started (that is, the starting age of training relative to the age at menarche) on the difference in bone mass in playing and nonplaying arms of female racket-sport players was determined.
Abstract: Objective: To determine in female tennis and squash players the effect of biological age (that is, the starting age of playing relative to the age at menarche) at which tennis or squash playing was...
TL;DR: Important aspects of IGFs in normal cell growth and their role in certain malignancies are highlighted and IGFs may enhance in vivo tumor cell formation, growth, and even metastasis.
Abstract: The insulin-like growth factor (IGF) family of peptides, binding proteins, and receptors are important for normal human growth and development and are involved in the specialized functions of most physiologic systems. Most members of the IGF system are expressed by different cancer cells and may play an important role in the propagation of these malignancies. New therapies aimed at modulating various components of the IGF system could affect the progression and metastasis of cancer.
TL;DR: The study compared the frequency with which flexible endoscopies were done during the period preceding the first diagnosis of cancer among patients with colorectal cancer and among controls without cancer to show that these procedures actually do reduce the risk for cancer in the large intestine.
Abstract: Objective: To determine whether patients with colorectal cancer are less likely than unaffected controls to have had one or more endoscopic procedures (flexible sigmoidoscopy, colonoscopy, or polyp...
Journal Article•
TL;DR: To critically appraise and synthesize the current evidence on endoscopic ligation for esophageal variceal bleeding, a meta-analysis of the results of randomized clinical trials that compared endoscope ligation with sclerotherapy is done.
Abstract: Purpose: To compare the effect of endoscopic ligation with that of sclerotherapy in the treatment of patients with bleeding esophageal varices. Data Sources: Strategies to identify published and un...
TL;DR: In this paper, the effect of endoscopic ligation compared with sclerotherapy in the treatment of patients with bleeding esophageal varices was compared in seven randomized trials.
Abstract: Purpose To compare the effect of endoscopic ligation with that of sclerotherapy in the treatment of patients with bleeding esophageal varices. Data sources Strategies to identify published and unpublished research included searches of computerized bibliographic and scientific citations, review of citations in relevant primary articles, searches of services providing information on unpublished studies, contact with primary investigators and the ligation equipment manufacturer, and review of proceedings from pertinent scientific meetings. Study selection From 158 potentially relevant articles, duplicate independent review identified 7 relevant randomized trials that compared endoscopic ligation with sclerotherapy for the treatment of patients with bleeding esophageal varices. Data abstraction Independent, duplicate data abstraction of the population, intervention, outcome, and methodologic quality of the trials was done. Data synthesis Ligation therapy compared with sclerotherapy reduced the rebleeding rate (odds ratio, 0.52 [95% CI, 0.37 to 0.74]), the mortality rate (odds ratio, 0.67 [CI, 0.46 to 0.98]), and the rate of death due to bleeding (odds ratio, 0.49 [CI, 0.24 to 0.996]). Four patients would need to be treated with ligation instead of sclerotherapy to avert one rebleeding episode, and 10 would need to be treated with ligation instead of sclerotherapy to prevent one death. Esophageal strictures occurred less frequently with ligation (odds ratio, 0.10 [CI, 0.03 to 0.29]), but no significant differences were seen between treatments for pulmonary infections or bacterial peritonitis. Additionally, the number of endoscopic treatment sessions required to achieve variceal obliteration was lower with ligation than with sclerotherapy. Conclusions On the basis of lower rates of rebleeding, mortality, and complications and the need for fewer endoscopic treatments, ligation should be considered the endoscopic treatment of choice for patients with esophageal variceal bleeding.
TL;DR: The development, performance, and validation of the SUPPORT prognostic model are described, and the model is compared both with previous efforts and with the simultaneous subjective prognostic estimates of the physicians who cared for the study patients.
Abstract: Objective: To develop and validate a prognostic model that estimates survival over a 180-day period for seriously ill hospitalized adults (phase I of SUPPORT [Study to Understand Prognoses and Pref...
TL;DR: Compared longitudinal changes in resting metabolic rate, body composition, and physical activity in a cohort of healthy premenopausal women who experienced menopause with changes in these variables in a cohorts of women who remained pre menopausal.
Abstract: Objective: To describe the effects of menopause on resting metabolic rate, body composition, fat distribution, physical activity during leisure time, and fasting insulin levels. Design: A longitudi...
TL;DR: A population-based, retrospective cohort study to determine whether the incidence of aortic aneurysm is increased in patients with previously diagnosed giant cell arteritis, and to identify clinical features of giantcell arteritis that could be associated with an increased risk for aneurYSm formation.
Abstract: Objective: To determine the frequency of aneurysm and dissection of the aorta in patients with giant cell arteritis and to assess the effects of these events on these patients. Design: Population-b...
TL;DR: In recent years, intense pressures to reduce the costs of health care have led many health care organizations to seek strategies that reduce resource utilization while maintaining the quality of care, among the most popular of the methods intended to meet this challenge are critical pathways.
Abstract: In an era of increasing competition in medical care, critical pathway guidelines have emerged as one of the most popular new initiatives intended to reduce costs while maintaining or even improving the quality of care. Developed primarily for high-volume hospital diagnoses, critical pathways display goals for patients and provide the corresponding ideal sequence and timing of staff actions for achieving those goals with optimal efficiency. Despite the rapid dissemination of critical pathway programs in hospitals throughout the United States, many uncertainties remain about their development, implementation, and evaluation. In addition, serious concerns have been raised about their effect on patient outcomes and satisfaction with care, physician autonomy, malpractice risks, and the teaching and research missions of many hospitals. Underlying these concerns is the absence of data from controlled trials to evaluate the effects of critical pathways. Physicians should understand the potential benefits and problems associated with critical pathways because physicians are increasingly being asked to provide leadership for pathway programs. Physicians and other health service investigators should also develop methods to study pathways in evolving health care settings. Although the promise of reduced costs and improved quality is enticing, the gaps in our knowledge about critical pathways are extensive; therefore, like any new health care technology, pathway programs should be fully evaluated in order to understand the conditions under which that promise may be fulfilled.
TL;DR: The prevalence of cognitive impairment was determined by screening a group of urban, elderly, primary care patients using the Short Portable Mental Status Questionnaire (SPMQ) and the clinical utility of routine diagnostic investigations are still being debated.
Abstract: Objective: To describe the prevalence of cognitive impairment among elderly primary care patients and to compare diagnostic evaluations and use of health services among patients with and those with...
TL;DR: The usefulness of continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in a medicalsurgical intensive care unit is evaluated.
Abstract: Objective: To determine whether continuous subglottic aspiration prevents nosocomial pneumonia in mechanically ventilated patients. Design: A randomized, controlled, blinded study. Setting: Medical...
TL;DR: The intent of this study was to study a large group of patients to elucidate the following points: whether the pattern of distribution of HCV genotypes has been changing over time; whether severity of illness (chronic hepatitis, cirrhosis, and hepatocellular carcinoma) and response to interferon- therapy differs with theHCV genotype; and whether the level ofHCV viremia varies with severity of liver disease.
Abstract: Objective: To analyze the distribution of hepatitis C virus (HCV) genotypes among patients positive for antibody to HCV (anti-HCV) according to age, severity of liver disease, and duration of infec...
TL;DR: The appearance of these highly resistant strains prompted a series of studies to assess the extent of colonization and infection with vancomycin-resistant enterococci in the patient population, to define risk factors for acquisition, and to evaluate the effect of interventions on rates of Colonization and infection.
Abstract: Objectives: To determine the distribution of and risk factors for colonization and infection with vancomycin-resistant enterococci; to evaluate the molecular epidemiology of these strains; and to a...
TL;DR: The feasibility and operating characteristics of several case-finding instruments that have been used to detect depressive disorders in primary care settings are assessed to familiarize providers with the advantages and disadvantages of these instruments so that they can make informed decisions about incorporating them into practice.
Abstract: Objective: To evaluate the usefulness of case-finding instruments for identifying patients with major depression in primary care settings. Data Sources: A MEDLINE search of the English-language med...
TL;DR: The natural history of polycythemia vera is reassessed and reliable estimates of both incidence of thrombosis and survival for use in defining the sample size for therapeutic treatment are obtained.
Abstract: Objective: To reassess the natural history of polycythemia vera and to obtain reliable estimates of both incidence of thrombosis and survival for use in defining the sample size for therapeutic cli...
TL;DR: The logistic and psychometric properties of a variation on the traditional CEX format, called the mini-CEX, are explored, designed around both the skills that residents most often need in actual patient encounters and the educational interactions that attending physicians routinely have with residents during teaching rounds.
Abstract: Objective: To gather preliminary data on the mini-CEX (clinical evaluation exercise), a device for assessing the clinical skills of residents. Design: Evaluation of residents by faculty members usi...
TL;DR: The high prevalence of coexisting essential mixed cryoglobulinemia and hepatocellular abnormalities, it was postulated that hepatotrophic viruses may be involved in the pathogenesis of this disease.
Abstract: Purpose: To review the available data on the association between hepatitis C virus (HCV) infection and conditions reportedly related to infection with the virus and to assess the clinical implicati...
TL;DR: Famciclovir, a new antiviral agent, was approved for marketing by the Food and Drug Administration in June 1994 for the management of acute herpes zoster and its effect on postherpetic neuralgia remains controversial.
Abstract: Objective: To document the effects of treatment with famciclovir on the acute signs and symptoms of herpes zoster and postherpetic neuralgia. Design: A randomized, double-blind, placebo-controlled,...