Showing papers in "Annals of Internal Medicine in 2002"
University of Texas Southwestern Medical Center1, University of Michigan2, University of Washington3, University of California, San Francisco4, University of California, Los Angeles5, University of Nebraska Omaha6, University of Pittsburgh7, Mayo Clinic8, Baylor University Medical Center9, Northwestern University10, Washington University in St. Louis11, Icahn School of Medicine at Mount Sinai12, Oregon Health & Science University13, University of Miami14, Yale University15, University of Alabama at Birmingham16, Harvard University17
TL;DR: The primary aim was to compare presenting clinical features and liver transplantation in patients with acute liver failure related to acetaminophen hepatotoxicity, other drugs, indeterminate factors, and other causes.
Abstract: Acetaminophen overdose and idiosyncratic drug reactions have replaced viral hepatitis as the most frequent causes of acute liver failure. The cause of liver failure and coma grade at admission were...
1,988 citations
TL;DR: The prevalence of burn out among internal medicine residents in a single university-based program is evaluated and the relationship of burnout to self-reported patient care practices is evaluated.
Abstract: In this study, burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices.
1,958 citations
TL;DR: A meta-analysis of 54 trials showed that previously sed-entary adults could decrease systolic blood pressure with aerobic exercise and showed smaller reduc-tions in blood pressure in trials lasting longer than 6 months, perhaps because of difficulties in sustaining regular exercise.
Abstract: Purpose Physical activity has been associated with reduced blood pressure in observational epidemiologic studies and individual clinical trials. This meta-analysis of randomized, controlled trials was conducted to determine the effect of aerobic exercise on blood pressure. Data sources English-language articles published before September 2001. Study selection 54 randomized, controlled trials (2419 participants) whose intervention and control groups differed only in aerobic exercise. Data extraction Using a standardized protocol and data extraction form, three of the investigators independently abstracted data on study design, sample size, participant characteristics, type of intervention, follow-up duration, and treatment outcomes. Data synthesis In a random-effects model, data from each trial were pooled and weighted by the inverse of the total variance. Aerobic exercise was associated with a significant reduction in mean systolic and diastolic blood pressure (-3.84 mm Hg [95% CI, -4.97 to -2.72 mm Hg] and -2.58 mm Hg [CI, -3.35 to -1.81 mm Hg], respectively). A reduction in blood pressure was associated with aerobic exercise in hypertensive participants and normotensive participants and in overweight participants and normal-weight participants. Conclusions Aerobic exercise reduces blood pressure in both hypertensive and normotensive persons. An increase in aerobic physical activity should be considered an important component of lifestyle modification for prevention and treatment of high blood pressure.
1,684 citations
TL;DR: A systematic review of the research evidence linking volume and outcome in health care is conducted, to summarize and describe the methodologic rigor of the existing literature, and to highlight the research and policy implications of these findings.
Abstract: High volume is associated with better outcomes across a wide range of procedures and conditions, but the magnitude of the association varies greatly. The clinical and policy significance of these f...
1,675 citations
TL;DR: A new classification scheme for bloodstream infections is sought that distinguishes among and compares patients with community-acquired, health careassociated, and nosocomial infections.
Abstract: The authors define health care–associated bloodstream infections as those that are associated with intensive, out-of-hospital care of serious illness. These bloodstream infections are similar to no...
1,444 citations
Journal Article•
TL;DR: In this article, an increase in aerobic physical activity should be considered an important component of lifestyle modification for pre-menopausal and postmenopausal individuals. But, it is not recommended for individuals with high blood pressure.
Abstract: Exercise reduces blood pressure in both hypertensive and normotensive persons. An increase in aerobic physical activity should be considered an important component of lifestyle modification for pre...
1,371 citations
TL;DR: This study redefined ALT limits in blood donors at low risk for NAFLD and without hepatitis B or C and tested the sensitivity and specificity of the ranges obtained from these participants in the clinical evaluation of anti-HCVpositive persons with and without chronic liver damage.
Abstract: Serum alanine aminotransferase (ALT) activity, the variable most commonly measured to assess hepatic disease, fails to identify many patients with hepatic injury. Current standards for “normal” ALT...
1,354 citations
1,186 citations
TL;DR: The goal was to critically appraise and synthesize evidence about the overall effectiveness of breast cancer screening, as well as its effectiveness among women younger than 50 years of age, and to evaluate previous meta-analyses of these trials and of screening test characteristics and studies evaluating the harms associated with false-positive test results.
Abstract: Study Selection: Eight randomized, controlled trials of mammography and 2 trials evaluating breast self-examination were included. One hundred fifty-four publications of the results of these trials, as well as selected articles about the test characteristics and harms associated with screening, were examined. Data Extraction: Predefined criteria were used to assess the quality of each study. Meta-analyses using a Bayesian randomeffects model were conducted to provide summary relative risk estimates and credible intervals (CrIs) for the effectiveness of screening with mammography in reducing death from breast cancer. Data Synthesis: For studies of fair quality or better, the summary relative risk was 0.84 (95% CrI, 0.77 to 0.91) and the number needed to screen to prevent one death from breast cancer after approximately 14 years of observation was 1224 (CrI, 665 to 2564). Among women younger than 50 years of age, the summary relative risk associated with mammography was 0.85 (CrI, 0.73 to 0.99) and the number needed to screen to prevent one death from breast cancer after 14 years of observation was 1792 (CrI, 764 to 10 540). For clinical breast examination and breast self-examination, evidence from randomized trials is inconclusive. Conclusions: In the randomized, controlled trials, mammography reduced breast cancer mortality rates among women 40 to 74 years of age. Greater absolute risk reduction was seen among older women. Because these results incorporate several rounds of screening, the actual number of mammograms needed to prevent one death from breast cancer is higher. In addition, each screening has associated risks and costs.
1,117 citations
TL;DR: An updated systematic review for the U.S. Preventive Services Task Force found that several short, accurate, and easy-to-use instruments for detecting depression are available and appear to perform as well as longer instruments.
Abstract: for suicide in primary care reduces morbidity and mortality. The remainder of the review focused on the questions of reliable screening tests for suicide risk and the effectiveness of interventions to decrease depression, suicidal ideation, and suicide attempts or completion. One screening study provided limited evidence for the accuracy of suicide screening in a primary care setting. Intervention studies provided fair and mixed evidence that treating those at risk for suicide reduces the number of suicide attempts or completions. The evidence suggests mild to moderate improvement for interventions addressing intermediate outcomes such as suicidal ideation, decreased depressive severity, decreased hopelessness, or improved level of function. Conclusion: Because of the complexity of studying the risk for suicide and the paucity of well-designed research studies, only limited evidence guides the primary care clinician’s assessment and management of suicide risk.
1,102 citations
TL;DR: Treatment with an insulin-sensitizing agent, such as metformin, in patients with type 2 diabetes mellitus may correct several of the primary pathophysiological abnormalities of the metabolic syndrome.
Abstract: Metformin is an insulin-sensitizing agent with potent antihyperglycemic properties. Its efficacy in reducing hyperglycemia in type 2 diabetes mellitus is similar to that of sulfonylureas, thiazolidinediones, and insulin. Metformin-based combination therapy is often superior to therapy with a single hypoglycemic agent. The antihyperglycemic properties of metformin are mainly attributed to suppressed hepatic glucose production, especially hepatic gluconeogenesis, and increased peripheral tissue insulin sensitivity. Although the precise mechanism of hypoglycemic action of metformin remains unclear, it probably interrupts mitochondrial oxidative processes in the liver and corrects abnormalities of intracellular calcium metabolism in insulin-sensitive tissues (liver, skeletal muscle, and adipocytes) and cardiovascular tissue.
TL;DR: The historical and theoretical framework of acupuncture, the scientific evidence for its claims to effectiveness, and its safety profile are reviewed, and the provision of acupuncture therapy is discussed.
Abstract: Traditionally, acupuncture is embedded in naturalistic theories that are compatible with Confucianism and Taoism. Such ideas as yin-yang, qi, dampness, and wind represent East Asian conceptual frameworks that emphasize the reliability of ordinary, human sensory awareness. Many physicians who practice acupuncture reject such prescientific notions. Numerous randomized, controlled trials and more than 25 systematic reviews and meta-analyses have evaluated the clinical efficacy of acupuncture. Evidence from these trials indicates that acupuncture is effective for emesis developing after surgery or chemotherapy in adults and for nausea associated with pregnancy. Good evidence exists that acupuncture is also effective for relieving dental pain. For such conditions as chronic pain, back pain, and headache, the data are equivocal or contradictory. Clinical research on acupuncture poses unique methodologic challenges. Properly performed acupuncture seems to be a safe procedure. Basic-science research provides evidence that begins to offer plausible mechanisms for the presumed physiologic effects of acupuncture. Multiple research approaches have shown that acupuncture activates endogenous opioid mechanisms. Recent data, obtained by using functional magnetic resonance imaging, suggest that acupuncture has regionally specific, quantifiable effects on relevant brain structures. Acupuncture may stimulate gene expression of neuropeptides. The training and provision of acupuncture care in the United States are rapidly expanding.
TL;DR: The association between major dietary patterns and risk for type 2 diabetes in a large prospective study of U.S. professional men with extensive, repeatedly obtained information on diet and other lifestyle factors is examined.
Abstract: A western dietary pattern (characterized by higher consumption of red and processed meat, high-fat dairy products, and sweets) is associated with a substantially increased risk for type 2 diabetes ...
TL;DR: An updated systematic review was performed to help the USPSTF evaluate new evidence on the effectiveness of different colorectal cancer screening tests as it updated its previous recommendation.
Abstract: This systematic review supports the U.S. Preventive Services Task Force's position on screening for colorectal cancer.
TL;DR: The concept of the placebo effect has been expanded much more broadly to include just about every conceivable sort of beneficial biological, social, or human interaction that doesn't involve some drug well-known to the pharmacopoeia.
Abstract: We provide a new perspective with which to understand what for a half century has been known as the "placebo effect." We argue that, as currently used, the concept includes much that has nothing to do with placebos, confusing the most interesting and important aspects of the phenomenon. We propose a new way to understand those aspects of medical care, plus a broad range of additional human experiences, by focusing on the idea of "meaning," to which people, when they are sick, often respond. We review several of the many areas in medicine in which meaning affects illness or healing and introduce the idea of the "meaning response." We suggest that use of this formulation, rather than the fixation on inert placebos, will probably lead to far greater insight into how treatment works and perhaps to real improvements in human well-being.
TL;DR: Taking a history is more useful than physical examination in screening for underlying malignancy, at least in the early stages (Table 2) (7, 10).
Abstract: The authors review evidence on the diagnostic accuracy of clinical information and imaging for patients with low back pain in primary care settings.
TL;DR: In this long-term, prospective population-based study, apoE, elevated total cholesterol level, and elevated systolic hypertension increased the risk for Alzheimer disease in an independent and additive manner.
Abstract: The association between the apolipoprotein E (apoE) e4 allele and Alzheimer disease does not seem to be mediated by vascular factors. The apoE e4 allele, elevated midlife total cholesterol level, a...
TL;DR: There is a substantial gap between the recommended and actual care of diabetes in the United States between 1988 and 1995, and U.S. national data is used to provide a reference and benchmark of the quality of diabetes care as measured by the DQIP indicators.
Abstract: Results: 18.0% of participants (95% CI, 15.7% to 22.3%) had poor glycemic control (hemoglobin A 1c level > 9.5%), and 65.7% (CI, 62.0% to 69.4%) had blood pressure less than 140/90 mm Hg. Cholesterol was monitored biannually in 85.3% (CI, 83.1% to 88.6%) of participants, but only 42.0% (CI, 34.9% to 49.1%) had LDL cholesterol levels less than 3.4 mmol/L (<130 mg/dL). During the previous year, 63.3% (CI, 59.6% to 67.0%) had a dilated eye examination and 54.8% (CI, 51.3% to 58.3%) had a foot examination. When researchers controlled for age, sex, ethnicity, education, health insurance, insulin use, and duration of diabetes, insured persons were more likely than uninsured persons to have a dilated eye examination (66.5% [CI, 62.6% to 70.4%]) vs. 43.2% [CI, 29.5% to 56.9%]) and were less likely to have a hemoglobin A1c level greater than or equal to 9.5%. Persons taking insulin were more likely than those who were not to have annual dilated eye examination (72.2% [CI, 66.3% to 78.1%] vs. 57.6% [CI, 53.7% to 61.5%]) and foot examination (67.3% [CI, 61.4% to 73.2%] vs. 47.1% [CI, 43.2% to 51.0%]) but were also more likely to have poor glycemic control (24.2% [CI, 18.3% to 30.1%] vs. 15.5% [CI, 11.6% to 19.4%]). Conclusions: According to U.S. data collected during 1988– 1995, a gap exists between recommended diabetes care and the care patients actually receive. These data offer a benchmark for monitoring changes in diabetes care.
TL;DR: It is concluded that the most important risk factors for colonization or infection with the various multiresistant microorganisms are common and universal.
Abstract: Recent years have witnessed a rapidly growing crisis in antimicrobial resistance, especially among microorganisms that cause nosocomial infection To better understand common risk factors among multiresistant organisms, this review explores risk factors for nosocomial infection with methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, Clostridium difficile, extended-spectrum beta-lactamase-producing gram-negative bacilli, and Candida This review comprises data from 74 published studies; 53 (71%) were retrospective studies and addressed few risk factors or did not quantify risk The analysis shows impressive commonality of risk factors across these diverse multiresistant organisms: advanced age; underlying diseases and severity of illness; inter-institutional transfer of the patient, especially from a nursing home; prolonged hospitalization; gastrointestinal surgery or transplantation; exposure to invasive devices of all types, especially central venous catheters; and exposure to antimicrobial drugs, especially cephalosporins More restricted use of antibiotics, especially cephalosporins, and strategies to prevent medical device-related infection and cross-infection in the hospital would yield benefit with all types of resistant organisms Preemptive isolation of all patients with risk factors for infection by resistant organisms would very likely reduce secondary spread within the hospital Conversely, programs that focus on only one organism or one antimicrobial drug are unlikely to succeed Prospective studies of sufficient size that address all potential risk factors, especially individual anti-infective agents, and that use matched controls who are shown by surveillance cultures to be free of colonization by resistant organisms would enhance understanding of the epidemiology of antimicrobial resistance in institutions and guide efforts to develop more effective strategies for prevention
TL;DR: This review examined studies examining aspirin's ability to prevent cardiovascular events and its likelihood of causing adverse effects and used the best estimates of the beneficial and harmful effects to model its impact on populations of patients with different levels of risk for coronary heart disease.
Abstract: Data Synthesis: Meta-analysis was performed, and the quantitative results of the review were then used to model the consequences of treating patients with different levels of baseline risk for coronary heart disease. Five trials examined the effect of aspirin on cardiovascular events in patients with no previous cardiovascular disease. For patients similar to those enrolled in the trials, aspirin reduces the risk for the combined end point of nonfatal myocardial infarction and fatal coronary heart disease (summary odds ratio, 0.72 [95% CI, 0.60 to 0.87]). Aspirin increased the risk for hemorrhagic strokes (summary odds ratio, 1.4 [CI, 0.9 to 2.0]) and major gastrointestinal bleeding (summary odds ratio, 1.7 [CI, 1.4 to 2.1]). All-cause mortality (summary odds ratio, 0.93 [CI, 0.84 to 1.02]) was not significantly affected. For 1000 patients with a 5% risk for coronary heart disease events over 5 years, aspirin would prevent 6 to 20 myocardial infarctions but would cause 0 to 2 hemorrhagic strokes and 2 to 4 major gastrointestinal bleeding events. For patients with a risk of 1% over 5 years, aspirin would prevent 1 to 4 myocardial infarctions but would cause 0 to 2 hemorrhagic strokes and 2 to 4 major gastrointestinal bleeding events. Conclusions: The net benefit of aspirin increases with increasing cardiovascular risk. In the decision to use aspirin chemoprevention, the patient’s cardiovascular risk and relative utility for the different clinical outcomes prevented or caused by aspirin use must be considered.
TL;DR: The virus's rapid geographic expansion and subsequent persistence in newly established enzootic areas in North America indicate that West Nile virus has become a permanent fixture of the U.S. medical landscape.
Abstract: This paper provides the clinician with an understanding of the epidemiologic and biological characteristics of West Nile virus in North America, as well as useful information on the diagnosis, repo...
TL;DR: In this paper, the authors quantitatively assessed the relative effectiveness of previously studied approaches for improving adherence to adult immunization and cancer screening guidelines, including reminder, feedback, education, financial incentive, legislative action, organizational change, or mass media campaign.
Abstract: Purpose: The relative effectiveness of the diverse approaches used to promote preventive care activities, such as cancer screening and adult immunization, is unknown. Despite many high-quality published studies, practices and policymakers attempting to improve preventive care have little definitive information on which to base decisions. Thus, we quantitatively assessed the relative effectiveness of previously studied approaches for improving adherence to adult immunization and cancer screening guidelines. Data Sources: MEDLINE, the Cochrane Effective Practice and Organization of Care Review Group register, previous systematic reviews, and the Medicare Health Care Quality Improvement Project database. Study Selection: Controlled clinical trials that assessed interventions to increase use of immunizations for influenza and pneumococcal pneumonia and screening for colon, breast, and cervical cancer in adults. Data Extraction: Two reviewers independently extracted data on characteristics and outcomes from unmasked articles. Intervention components to increase use of services were classified as reminder, feedback, education, financial incentive, legislative action, organizational change, or mass media campaign. Data Synthesis: Of 552 abstracts and articles, 108 met the inclusion criteria. To assess the effect of intervention components, meta-regression models were developed for immunizations and each cancer screening service by using 81 studies with a usual care or control group. The most potent intervention types involved organizational change (the adjusted odds ratios for increased use of services from organizational change ranged from 2.47 to 17.6). Organizational change interventions included the use of separate clinics devoted to prevention, use of a planned care visit for prevention, or designation of nonphysician staff to do specific prevention activities. The next most effective intervention components were patient financial incentives (adjusted odds ratios, 1.82 to 3.42) and patient reminders (adjusted odds ratios, 1.74 to 2.75); the adjusted odds ratios ranged from 1.29 to 1.53 for patient education and from 1.10 to 1.76 for feedback. Conclusions: Rates of adult immunization and cancer screening are most likely to improve when a health care organization supports performance of these activities through organizational changes in staffing and clinical procedures. Involving patients in self-management through patient financial incentives and reminders is also likely to positively affect performance.
TL;DR: The neglected clinical significance of the placebo effect in alternative medicine is examined and the possibility that some types of unconventional medicine may produce placebo outcomes that are dramatic and, from the patient's perspective, especially compelling is raised.
Abstract: In alternative medicine, the main question regarding placebo has been whether a given therapy has more than a placebo effect. Just as mainstream medicine ignores the clinical significance of its own placebo effect, the placebo effect of unconventional medicine is disregarded except for polemics. This essay looks at the placebo effect of alternative medicine as a distinct entity. This is done by reviewing current knowledge about the placebo effect and how it may pertain to alternative medicine. The term placebo effect is taken to mean not only the narrow effect of a dummy intervention but also the broad array of nonspecific effects in the patient-physician relationship, including attention; compassionate care; and the modulation of expectations, anxiety, and self-awareness. Five components of the placebo effect--patient, practitioner, patient-practitioner interaction, nature of the illness, and treatment and setting--are examined. Therapeutic patterns that heighten placebo effects are especially prominent in unconventional healing, and it seems possible that the unique drama of this realm may have "enhanced" placebo effects in particular conditions. Ultimately, only prospective trials directly comparing the placebo effects of unconventional and mainstream medicine can provide reliable evidence to support such claims. Nonetheless, the possibility of enhanced placebo effects raises complex conundrums. Can an alternative ritual with only nonspecific psychosocial effects have more positive health outcomes than a proven, specific conventional treatment? What makes therapy legitimate, positive clinical outcomes or culturally acceptable methods of attainment? Who decides?
TL;DR: Outcomes in patients with acute MI and any degree of renal failure, including end-stage renal disease, were compared to determine whether treatment of these patients differs from that of patients with normal renal function and to determine the extent to which treatment factors explain differences in prognosis.
Abstract: Patients with renal failure are at increased risk for death after acute myocardial infarction and receive less aggressive treatment compared with patients who have normal renal function.
TL;DR: This large cohort study of Medicare beneficiaries hospitalized between April 1994 and July 1995 revealed the following: 1-year postmyocardial infarction mortality for no, mild, and moderate renal insufficiency was 24%, 46%, and 66%, respectively.
Abstract: Renal insufficiency was an independent risk factor for death in elderly patients after myocardial infarction. Targeted interventions may be needed to improve treatment for this high-risk population.
TL;DR: This fourth edition of the guidelines for preventing opportunistic infections (OIs) among persons infected with human immunodeficiency virus (HIV) is intended for clinicians and other health-care providers who care for HIV-infected persons.
Abstract: In 1995, the U.S. Public Health Service (USPHS) and the Infectious Diseases Society of America (IDSA) developed guidelines for preventing opportunistic infections (OIs) among persons infected with human immunodeficiency virus (HIV); these guidelines were updated in 1997 and 1999. This fourth edition of the guidelines, made available on the Internet in 2001, is intended for clinicians and other health-care providers who care for HIV-infected persons. The goal of these guidelines is to provide evidence-based guidelines for preventing OIs among HIV-infected adults and adolescents, including pregnant women, and HIV-exposed or infected children. Nineteen OIs, or groups of OIs, are addressed, and recommendations are included for preventing exposure to opportunistic pathogens, preventing first episodes of disease by chemoprophylaxis or vaccination (primary prophylaxis), and preventing disease recurrence (secondary prophylaxis). Major changes since the last edition of the guidelines include 1) updated recommendations for discontinuing primary and secondary OI prophylaxis among persons whose CD4+ T lymphocyte counts have increased in response to antiretroviral therapy; 2) emphasis on screening all HIV-infected persons for infection with hepatitis C virus; 3) new information regarding transmission of human herpesvirus 8 infection; 4) new information regarding drug interactions, chiefly related to rifamycins and antiretroviral drugs; and 5) revised recommendations for immunizing HIV-infected adults and adolescents and HIV-exposed or infected children.
TL;DR: This statement summarizes the current U.S. Preventive Services Task Force recommendations for screening for depression and the supporting scientific evidence and updates the 1996 USPSTF recommendations on this topic.
Abstract: This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendations for screening for depression and the supporting scientific evidence and updates the 1996 USPSTF recommendations on this topic. At that time, the USPSTF concluded that there was insufficient evidence to recommend for or against routine use of standardized questionnaires to screen for depression in primary care patients. The complete information on which the current statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the systematic evidence review on this topic, which can be obtained through the USPSTF Web site (http://www.ahrq.gov/clinic/uspstfix.htm) and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (800-358-9295).
TL;DR: A meta-analysis of all available published and unpublished studies comparing chlor hexidine gluconate with povidone-iodine solution for vascular catheter-site care found that chlorhexidine glUconate is more effective than povodoneiodine for intravascular catheter -site care and it is also more expensive.
Abstract: Bloodstream infections are significantly reduced in patients with central vascular lines who receive chlorhexidine gluconate versus povidone-iodine for skin site disinfection. Use of chlorhexidine ...
TL;DR: The neurobiological correlates of the stressors and the diathesis for suicidal behavior are described and the factors that determined inclusion in this review were superiority of research design, quality of psychometrics, and adequate representation of major points of view.
Abstract: Suicide and suicide attempts are a major cause of death and morbidity worldwide. Suicide is generally a complication of a psychiatric disorder, but it requires additional risk factors because most psychiatric patients never attempt suicide. This review includes a hypothesized stress-diathesis model, which has implications for detection of high-risk patients and treatment interventions, and discusses promising treatment approaches that have been recently identified.