Showing papers in "Annals of Internal Medicine in 2008"

Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration.

Abstract: Adequate reporting of randomized, controlled trials (RCTs) is necessary to allow accurate critical appraisal of the validity and applicability of the results. The CONSORT (Consolidated Standards of Reporting Trials) Statement, a 22-item checklist and flow diagram, is intended to address this problem by improving the reporting of RCTs. However, some specific issues that apply to trials of nonpharmacologic treatments (for example, surgery, technical interventions, devices, rehabilitation, psychotherapy, and behavioral intervention) are not specifically addressed in the CONSORT Statement. Furthermore, considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement. Therefore, the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments. A consensus meeting of 33 experts was organized in Paris, France, in February 2006, to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments. The participants extended 11 items from the CONSORT Statement, added 1 item, and developed a modified flow diagram. To allow adequate understanding and implementation of the CONSORT extension, the CONSORT group developed this elaboration and explanation document from a review of the literature to provide examples of adequate reporting. This extension, in conjunction with the main CONSORT Statement and other CONSORT extensions, should help to improve the reporting of RCTs performed in this field.

Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses (Annals of Internal Medicine (2008) 149, (219))

Abstract: Discrepancies may occur between the results of large randomized trials and the pooled results of several small trials in meta-analyses (14). Previous studies have suggested that discrepancies may be due to publication bias, that is, the fact that small trials are more likely to be published if they show a statistically significant intervention effect (58). Previous empirical studies of the association between methodologic quality and intervention effects have had inconsistent conclusions (912). In theory, adequate randomization requires adequate generation of the allocation sequence and adequate allocation concealment. The assumption is partly supported by studies from Schulz and colleagues (10) and Moher and associates (11, 12), who found that trials with inadequate allocation concealment exaggerate intervention effects significantly compared with trials reporting adequate allocation concealment. However, Emerson and coworkers (9) found no association between reported allocation concealment and intervention effects. Furthermore, none of the studies (912) found a significant association between generation of allocation sequence and intervention effects, although Schulz and colleagues found a nonsignificant trend (10). Schulz and colleagues (10), who analyzed trials in pregnancy and childbirth, found that trials without double blinding exaggerate intervention effects significantly compared with double-blind trials. However, Emerson and coworkers (9) and Moher and associates (11), who included trials from several therapeutic areas, found no association between double blinding and intervention effects. Methodologic quality can be assessed by using separate components, as in the studies discussed above, or by using one of several quality scales (13). One popular scale, developed by Jadad and colleagues in 1996 (14), has thus far received 233 registered citations (Institute for Scientific Information, Philadelphia, Pennsylvania). The scale includes assessment of the reported generation of allocation sequence, double blinding, and follow-up. Moher and associates (11, 12) found that trials with a low score on this scale exaggerate intervention effects significantly compared with trials that have high quality scores. However, the use of this and other quality scales has been disputed by Jni and coworkers (15), who showed that several quality scales produce inconsistent conclusions. We studied the potential association between reported methodologic quality and intervention effects to assess whether methodologic quality may explain discrepancies between the results of large and small randomized trials in meta-analyses. Methods Identification and Selection of Meta-Analyses and Trials According to suggestions in other studies (24), we arbitrarily defined trials with 1000 or more participants as large. We searched the Cochrane Library, MEDLINE on PubMed (using meta-analysis, review, randomi*ed, and controlled clinical trial as free text search words), and reference lists of relevant articles to identify potentially eligible meta-analyses that included at least one large trial. We identified 23 eligible meta-analyses. Nine were excluded because they included trials that were also included in larger eligible meta-analyses (n = 5), lacked references to the primary trials (n = 3), or excluded low-quality trials (n = 1). Accordingly, 14 meta-analyses (1626) were included. Three of the included Cochrane Reviews included two meta-analyses each (22, 25, 26). The meta-analyses included 248 trials, of which 58 were excluded because they were unpublished (n = 33), were quasi-randomized (n = 15), or were published as abstracts (n = 8). We were unable to translate 2 Spanish-language articles. The remaining 190 trials, published as English-language (n = 188) or German-language (n = 2) full-length articles, were included. Our analyses included 23 large and 167 small randomized trials and a total of 136 164 participants. On the basis of the study by Schulz and colleagues (10), who analyzed 250 controlled trials with 62 091 participants, we estimated that our sample size would be large enough to show significant differences between intervention benefits in high-quality and low-quality trials. Assessment of Methodologic Quality Methodologic quality was defined as the confidence that the trial's design, conduct, analysis, and presentation minimized or avoided biases in the trial's intervention comparisons (12). The reported methodologic quality was assessed in an unmasked manner by using four separate components and a composite quality scale. The four components were generation of the allocation sequence (adequate [computer-generated random numbers or similar] or inadequate [not described]), allocation concealment (adequate [central independent unit, sealed envelopes, or similar] or inadequate [not described or open table of random numbers or similar]), double blinding (adequate [identical placebo tablets or similar] or inadequate [not performed or tablets versus injections or similar]), and follow-up (adequate [number and reasons for dropouts and withdrawals described] or inadequate [number or reasons for dropouts and withdrawals not described]). The five-point quality scale included generation of the allocation sequence (2 points, computer-generated random numbers or similar; 1 point, not described; 0 points, quasi-randomized trial [which we excluded]), double blinding (2 points, identical placebo tablets or similar; 1 point, not described; 0 points, no blinding or inadequate method, such as tablets versus injections or similar), and follow-up (1 point, number and reasons for dropouts and withdrawals described; 0 points, number or reasons for dropouts and withdrawals not described). The quality score was ranked as low ( 2 points) or high ( 3 points), as suggested elsewhere (11). Two reviewers assessed the effect of masking and the interobserver reliability of the quality assessments. The reported methodologic quality of 30 trials was assessed with and without masking the names of the authors and journal, the year of publication, acknowledgments, institutional affiliations, and funding. The unmasked assessments were performed first. The masked assessments were performed 3 months later, ensuring that the assessors did not remember the trials. The difference between masked and unmasked quality assessments was not significant (mean [SE] quality score, 3.70 0.19 vs. 3.63 0.21; P > 0.2). Interobserver reliability was assessed by using 30 randomized trials randomly selected from the Cochrane Hepato-Biliary Group Controlled Trials Register and was found to be high (intraclass correlation coefficient, 0.96 [95% CI, 0.92 to 0.98]) (27). After assessing the quality of 100 trials, we reassessed the methodologic quality of the trials from the Cochrane Hepato-Biliary Group Controlled Trials Register and found that the testretest reliability was high (0.98 [CI, 0.97 to 0.99]) (27). Data Extraction Data were extracted independently by two reviewers. First, the primary binary outcome measure described by the largest number of trials in each meta-analysis was identified. We then extracted the number of events in the intervention and control groups and the number of participants randomly assigned to the intervention and control groups. All disagreements were due to inaccurate data extraction and were resolved through further consulting of the original articles and meta-analyses. Consensus was achieved before analyses were done in all cases. Statistical Analysis Analyses were performed by using SAS for Windows, version 6.12 (SAS Institute, Inc., Cary, North Carolina) or SPSS for Windows, version 10.0 (SPSS, Inc., Chicago, Illinois). Differences between the masked and unmasked quality assessments were estimated by using the KruskalWallis test. The number of participants and the year of publication in trials with adequate versus inadequate generation of allocation sequence, allocation concealment, double blinding, and follow-up and high versus low quality scores were compared by using the Pearson chi-square test. To estimate evidence of publication bias and other biases, we used linear regression to analyze funnel-plot asymmetry (7). The standard normal deviate, defined as the log odds ratio divided by its standard error, was regressed against the precision (the inverse of the standard error). If funnel-plot asymmetry is present, the regression line will not run through the origin, and the intercept will provide a measure of asymmetry. Intervention effects were estimated by using the number of events and participants in the treatment group and the number of events and participants in the control group (Appendix). Accordingly, two observations were needed per trial, one for the intervention group and one for the control group. When necessary, positive outcomes were re-expressed as unwanted end points, for example, mortality instead of survival. Discrepancies between intervention effects in large and small trials were estimated by the ratio of odds ratios (10), which is the summary odds ratio of large trials divided by the summary odds ratio of small trials. In this modeling convention, a ratio of odds ratios less than 1.0 indicates that a group of trials (for example, small trials with inadequate allocation concealment) exaggerates the intervention effect compared with the referent group (for example, large trials). Variance and confidence intervals were increased to adjust for overdispersion (Appendix). The Pearson chi-square test was used to estimate the potential overlap between quality components. Results Characteristics of Included Trials We were able to locate and retrieve all 190 included trials and to reproduce the results reported in the meta-analyses (1626) (Table 1). Of the 190 trials, 81 (43%) reported adequate generation of the allocation sequence, 68 (36%) reported adequate allocation concealment, 103 (54%) reported adequate double blinding, and 1

Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement

Abstract: DESCRIPTION Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for colorectal cancer. METHODS To update its recommendation, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review on 4 selected questions relating to test characteristics and benefits and harms of screening technologies, and 2) a decision analytic modeling analysis using population modeling techniques to compare the expected health outcomes and resource requirements of available screening modalities when used in a programmatic way over time. RECOMMENDATIONS The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary. (A recommendation). The USPSTF recommends against routine screening for colorectal cancer in adults 76 to 85 years of age. There may be considerations that support colorectal cancer screening in an individual patient. (C recommendation). The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years. (D recommendation). The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer. (I statement).

Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update.

Abstract: The tuberculin skin test (TST) was formerly the only test for detecting latent tuberculosis infection; however, interferon-γ–release assays (IGRAs) have emerged as attractive alternatives Two IGRAs, QuantiFERON-TB Gold (Cellestis, Carnegie, Australia) and T-SPOTTB (Oxford Immunotec, Oxford, United Kingdom), are now commercially available, and their use is expanding Although IGRAs are intended for diagnosing latent tuberculosis infection, active tuberculosis is used as a surrogate standard to estimate accuracy in the absence of a gold standard for latent tuberculosis infection In a recent meta-analysis (1), Menzies and colleagues showed that IGRAs have high specificity, especially in populations who have received bacille Calmette-Guerin (BCG) vaccination However, the sensitivity of both TST and IGRAs was suboptimal, and none of these tests could distinguish between latent tuberculosis and active disease Since the publication of this meta-analysis, the evidence base for IGRAs has rapidly grown with publication of several guidelines and statements (2–6) We present an updated meta-analysis that will provide helpful information for clinicians and for agencies developing updated guidelines

Burnout and suicidal ideation among U.S. medical students.

Abstract: The stresses of medical school can lead to suicidal ideation or burnout. The prevalence of these conditions in medical students is not known. In a survey of 4287 medical students at 7 U.S. medical ...

Systematic Reviews of Diagnostic Test Accuracy

Abstract: More and more systematic reviews of diagnostic test accuracy studies are being published, but they can be methodologically challenging. In this paper, the authors present some of the recent developments in the methodology for conducting systematic reviews of diagnostic test accuracy studies. Restrictive electronic search filters are discouraged, as is the use of summary quality scores. Methods for meta-analysis should take into account the paired nature of the estimates and their dependence on threshold. Authors of these reviews are advised to use the hierarchical summary receiver-operating characteristic or the bivariate model for the data analysis. Challenges that remain are the poor reporting of original diagnostic test accuracy studies and difficulties with the interpretation of the results of diagnostic test accuracy research.

Incidence of Types of Cancer among HIV-Infected Persons Compared with the General Population in the United States, 1992–2003

Abstract: Antiretroviral therapy has dramatically improved survival of HIV-infected individuals and reduced the incidence of AIDS-defining cancer but may have—directly or indirectly—increased cases of non–AI...

Systematic review: the evidence that publishing patient care performance data improves quality of care.

Abstract: Public reporting of health care system performance might cause patients to migrate to high-performing systems, creating a business case for quality improvement programs. The authors synthesized the...

Screening for Colorectal Cancer : A Targeted, Updated Systematic Review for the U.S. Preventive Services Task Force

Abstract: To support the USPSTF recommendation in this issue, Whitlock and colleagues sought evidence on knowledge gaps from the 2002 recommendation and considered community performance of screening endoscop...

Prevalence of cognitive impairment without dementia in the United States.

Abstract: Results: In 2002, an estimated 5.4 million people (22.2%) in the United States age 71 years or older had cognitive impairment without dementia. Prominent subtypes included prodromal Alzheimer disease (8.2%) and cerebrovascular disease (5.7%). Among participants who completed follow-up assessments, 11.7% with cognitive impairment without dementia progressed to dementia annually, whereas those with subtypes of prodromal Alzheimer disease and stroke progressed at annual rates of 17% to 20%. The annual death rate was 8% among those with cognitive impairment without dementia and almost 15% among those with cognitive impairment due to medical conditions. Limitations: Only 56% of the nondeceased target sample completed the initial assessment. Population sampling weights were derived to adjust for at least some of the potential bias due to nonresponse and attrition. Conclusion: Cognitive impairment without dementia is more prevalent in the United States than dementia, and its subtypes vary in prevalence and outcomes.

Determinants and Time Course of the Postthrombotic Syndrome after Acute Deep Venous Thrombosis

Abstract: Chronic leg symptoms after deep venous thrombosis (DVT) (the postthrombotic syndrome) are common but difficult to predict. By using a standardized scale, Kahn and coworkers evaluated leg symptoms i...

Effectiveness of Cholinesterase Inhibitors and Memantine for Treating Dementia: Evidence Review for a Clinical Practice Guideline

Abstract: Raina and associates reviewed the evidence for the effectiveness of cholinesterase inhibitors and memantine in achieving clinically relevant improvements in patients with dementia Consistent diffe

Sensitivity and Specificity of a Single Emergency Department Measurement of Urinary Neutrophil Gelatinase–Associated Lipocalin for Diagnosing Acute Kidney Injury

Abstract: The authors measured urinary neutrophil gelatinase–associated lipocalin (NGAL) in 635 patients being admitted to the hospital from the emergency department. Blinded to the urinary NGAL results, the...

Meta-analysis: Effect of Monotherapy and Combination Therapy with Inhibitors of the Renin–Angiotensin System on Proteinuria in Renal Disease

Abstract: BACKGROUND: Reduction of proteinuria is associated with delayed progression of chronic kidney disease. Reports suggest that angiotensin-receptor blockers (ARBs) reduce proteinuria, but results are variable. The relative effect of ARBs and angiotensin-converting enzyme (ACE) inhibitors, and their combined administration, remains uncertain. PURPOSE: To establish the effect of ARBs versus placebo and alternative treatments, and the effect of combined treatment with ARBs and ACE inhibitors, on proteinuria. DATA SOURCES: English-language studies in MEDLINE and the Cochrane Library Central Register of Controlled Trials (January 1990 to September 2006), reference lists, and expert contacts. STUDY SELECTION: Randomized trials of ARBs versus placebo, ACE inhibitors, calcium-channel blockers, or the combination of ARBs and ACE inhibitors in patients with or without diabetes and with microalbuminuria or proteinuria for whom data were available on urinary protein excretion at baseline and at 1 to 12 months. DATA EXTRACTION: Two investigators independently searched and abstracted studies. DATA SYNTHESIS: Forty-nine studies involving 6181 participants reported results of 72 comparisons with 1 to 4 months of follow-up and 38 comparisons with 5 to 12 months of follow-up. The ARBs reduced proteinuria compared with placebo or calcium-channel blockers over 1 to 4 months (ratio of means, 0.57 [95% CI, 0.47 to 0.68] and 0.69 [CI, 0.62 to 0.77], respectively) and 5 to 12 months (ratio of means, 0.66 [CI, 0.63 to 0.69] and 0.62 [CI, 0.55 to 0.70], respectively). The ARBs and ACE inhibitors reduced proteinuria to a similar degree. The combination of ARBs and ACE inhibitors further reduced proteinuria more than either agent alone: The ratio of means for combination therapy versus ARBs was 0.76 (CI, 0.68 to 0.85) over 1 to 4 months and 0.75 (CI, 0.61 to 0.92) over 5 to 12 months; for combination therapy versus ACE inhibitors, the ratio of means was 0.78 (CI, 0.72 to 0.84) over 1 to 4 months and 0.82 (CI, 0.67 to 1.01) over 5 to 12 months. The antiproteinuric effect was consistent across subgroups. LIMITATIONS: Most studies were small, varied in quality, and did not provide reliable data on adverse drug reactions. Proteinuria reduction is only a surrogate for important progression of renal failure. CONCLUSION: The ARBs reduce proteinuria, independent of the degree of proteinuria and of underlying disease. The magnitude of effect is similar regardless of whether the comparator is placebo or calcium-channel blocker. Reduction in proteinuria from ARBs and ACE inhibitors is similar, but their combination is more effective than either drug alone. Uncertainty concerning adverse effects and outcomes that are important to patients limits applicability of findings to clinical practice.

Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer.

Abstract: Understanding the benefits and harms of treatment strategies for clinically localized prostate cancer is difficult because of shortcomings in the evidence and the treatments themselves. This system...

Evaluating Test Strategies for Colorectal Cancer Screening: A Decision Analysis for the U.S. Preventive Services Task Force

Abstract: Despite recent declines in both incidence and mortality (1), colorectal cancer remains the second most common cause of cancer death in the United States (2). Screening for colorectal cancer reduces mortality by allowing physicians to detect cancer at earlier, more treatable stages, as well as to identify and remove adenomatous polyps (asymptomatic benign precursor lesions that may lead to colorectal cancer). Many tests are available for screening, such as fecal occult blood tests (FOBTs), flexible sigmoidoscopy, and colonoscopy. Screening with FOBT (Hemoccult II, Beckman Coulter, Fullerton, California) has been shown to reduce colorectal cancer mortality by 15% to 33% in randomized, controlled trials (3--5), and screening with more sensitive FOBTs, flexible sigmoidoscopy, colonoscopy, or combinations of these tests may reduce the burden of colorectal cancer even more (6, 7). In the absence of adequate clinical trial data on several recommended screening strategies, microsimulation modeling can provide guidance on the risks, benefits, and testing resources required for different screening strategies to reduce the burden of colorectal cancer. In July 2002, the U.S. Preventive Services Task Force (USPSTF) concluded that there was sufficient evidence to recommend strongly that all average-risk adults 50 years of age and older should be offered colorectal cancer screening (8). However, the logistics of screening, such as the type of screening test, screening interval, and age at which to stop screening, were not evaluated in terms of the balance of benefits and potential harms. The USPSTF has again addressed recommendations for colorectal cancer screening with a systematic review of the evidence (9) on screening tests. For this assessment, the USPSTF requested a decision analysis to project expected outcomes of various strategies for colorectal cancer screening. Two independent microsimulation modeling groups from the Cancer Intervention and Surveillance Modeling Network (CISNET), funded by the National Cancer Institute, used a comparative modeling approach to compare life-years gained relative to resource use of different strategies for colorectal cancer screening.

Evidence for Improving Palliative Care at the End of Life: A Systematic Review

Abstract: This systematic evidence review supports the American College of Physicians guideline on palliative care at the end of life. Strong to moderate evidence supports use of various treatments for cance...

Addition of Sildenafil to Long-Term Intravenous Epoprostenol Therapy in Patients with Pulmonary Arterial Hypertension: A Randomized Trial

Abstract: Background Oral sildenafil and intravenous epoprostenol have independently been shown to be effective in patients with pulmonary arterial hypertension. Objective To investigate the effect of adding oral sildenafil to long-term intravenous epoprostenol in patients with pulmonary arterial hypertension. Design A 16-week, double-blind, placebo-controlled, parallel-group study. Setting Multinational study at 41 centers in 11 countries from 3 July 2003 to 27 January 2006. Patients 267 patients with pulmonary arterial hypertension (idiopathic, associated anorexigen use or connective tissue disease, or corrected congenital heart disease) who were receiving long-term intravenous epoprostenol therapy. Intervention Patients were randomly assigned to receive placebo or sildenafil, 20 mg three times daily, titrated to 40 mg and 80 mg three times daily, as tolerated, at 4-week intervals. Of 265 patients who received treatment, 256 (97%) patients (123 in the placebo group and 133 in the sildenafil group) completed the study. Measurements Change from baseline in exercise capacity measured by 6-minute walk distance (primary end point) and hemodynamic measurements, time to clinical worsening, and Borg dyspnea score (secondary end points). Results A placebo-adjusted increase of 28.8 meters (95% CI, 13.9 to 43.8 meters) in the 6-minute walk distance occurred in patients in the sildenafil group; these improvements were most prominent among patients with baseline distances of 325 meters or more. Relative to epoprostenol monotherapy, addition of sildenafil resulted in a greater change in mean pulmonary arterial pressure by -3.8 mm Hg (CI, -5.6 to -2.1 mm Hg); cardiac output by 0.9 L/min (CI, 0.5 to 1.2 L/min); and longer time to clinical worsening, with a smaller proportion of patients experiencing a worsening event in the sildenafil group (0.062) than in the placebo group (0.195) by week 16 (P = 0.002). Health-related quality of life also improved in patients who received combined therapy compared with those who received epoprostenol monotherapy. There was no effect on the Borg dyspnea score. Of the side effects generally associated with sildenafil treatment, the most commonly reported in the placebo and sildenafil groups, respectively, were headache (34% and 57%; difference, 23 percentage points [CI, 12 to 35 percentage points]), dyspepsia (2% and 16%; difference, 13 percentage points [CI, 7 to 20 percentage points]), pain in extremity (18% and 25%; difference, 8 percentage points [CI, -2 to 18 percentage points]), and nausea (18% and 25%; difference, 8 percentage points [CI, -2 to 18 percentage points]). Limitations The study excluded patients with pulmonary arterial hypertension associated with other causes. There was an imbalance in missing data between groups, with 8 placebo recipients having no postbaseline walk assessment compared with 1 sildenafil recipient. These patients were excluded from the analysis. Conclusion In some patients with pulmonary arterial hypertension, the addition of sildenafil to long-term intravenous epoprostenol therapy improves exercise capacity, hemodynamic measurements, time to clinical worsening, and quality of life, but not Borg dyspnea score. Increased rates of headache and dyspepsia occurred with the addition of sildenafil.

Daily Assessment of Pain in Adults with Sickle Cell Disease

Abstract: Although outpatient, emergency department, and hospital visits have been used as indicators of sickle cell disease severity, the relationship between painful episodes and subsequent use of health c...

Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer.

Abstract: Women at high risk for breast cancer need a highly sensitive screening test. This review summarizes data from 11 prospective studies that screened very high-risk women with mammography plus magneti...

Using clinical factors and mammographic breast density to estimate breast cancer risk: development and validation of a new predictive model.

Abstract: Existing breast cancer prediction tools do not account for breast density, a strong risk factor for breast cancer. Tice and associates developed a breast cancer risk prediction model that incorpora...

Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis

Abstract: This systematic review of 76 randomized trials and 24 meta-analyses found good evidence that several agents, including alendronate, zoledronic acid, and estrogen, reduced the risk for vertebral and...

Methods and Processes of the CONSORT Group: Example of an Extension for Trials Assessing Nonpharmacologic Treatments

Abstract: This article supports the extension of CONSORT Statement in this issue. It is available online only.

Meta-analysis: Subclinical Thyroid Dysfunction and the Risk for Coronary Heart Disease and Mortality

Abstract: The authors systematically reviewed 12 prospective cohort studies to determine whether subclinical thyroid dysfunction increases risk for coronary heart disease and death. Both subclinical hypothyr...

Systematic review: the effect of preventive lamivudine on hepatitis B reactivation during chemotherapy.

Abstract: Background Lamivudine is increasingly being used to prevent hepatitis B reactivation in patients with cancer who test positive for hepatitis B surface antigen (HBsAg) and are undergoing chemotherapy.

Meta-analysis: Effectiveness of Drugs for Preventing Contrast-Induced Nephropathy

Abstract: Contrast-induced nephropathy is a common cause of acute renal failure in hospitalized patients. Clinicians use many drugs to reduce the risk for the condition, including N-acetylcysteine, theophyll...

Emergence of Multidrug-Resistant, Community-Associated, Methicillin-Resistant Staphylococcus aureus Clone USA300 in Men Who Have Sex with Men

Abstract: Researchers have recently identified USA300, a clone of community-acquired, methicillin-resistant Staphylococcus aureus (MRSA) that is resistant to multiple antibiotics. Diep and colleagues demonst...

Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals.

Abstract: Previous efforts to reduce the frequency of methicillin-resistant Staphylococcus aureus (MRSA) infections have failed. After a baseline year, Robicsek and colleagues screened all intensive care uni...

Association of numeracy and diabetes control

Abstract: We do not understand the influence of a patient's skill with numbers (also called numeracy) on their management of diabetes. Cavanaugh and colleagues tested the ability of 398 adult patients with t...