Julio Rosenstock, MD; Bernard Zinman, MD; Liam J. Murphy, MD; Stephen C. Clement, MD; Paul Moore, MD; C. Keith Bowering, MD; Rosa Hendler, MD; Shu-Ping Lan, MPH; William T. Cefalu, MD
The authors measured glycemic control with inhaled insulin alone or added to dual oral therapy in 309 patients who had no clinically significant respiratory disease. Combination therapy with inhaled insulin was more effective than monotherapy, but both therapies significantly reduced hemoglobin A1c levels. Hypoglycemia, mild weight gain, and mild cough were more frequent with inhaled insulin than with oral agents alone.
Ann Intern Med. 2005;143(8):549-558. doi:10.7326/0003-4819-143-8-200510180-00005
Robert J. Heine, MD, PhD; Luc F. Van Gaal, MD; Don Johns, PhD; Michael J. Mihm, PhD; Mario H. Widel, MS; Robert G. Brodows, MD; for the GWAA Study Group*
Exenatide mimics a polypeptide hormone that coordinates insulin release with ingestion of food. The authors compared glycemic control with exenatide or insulin glargine. After 26 weeks, both exenatide and insulin glargine had reduced hemoglobin A1c level by 1.11%, showing that the two are comparable. Exenatide principally affected postprandial glucose, while insulin glargine affected fasting glucose. Nausea and vomiting were more common with exenatide.
Ann Intern Med. 2005;143(8):559-569. doi:10.7326/0003-4819-143-8-200510180-00006
Mark E. Rupp, MD; Steven J. Lisco, MD; Pamela A. Lipsett, MD; Trish M. Perl, MD, MSc; Kevin Keating, MD; Joseph M. Civetta, MD; Leonard A. Mermel, DO, ScM; David Lee, MD; E. Patchen Dellinger, MD; Michael Donahoe, MD; David Giles, MD; Michael A. Pfaller, MD; Dennis G. Maki, MD; Robert Sherertz, MD
This trial compared second-generation antiseptic-coated venous catheters with uncoated catheters in 384 and 393 patients, respectively. Antiseptic coating significantly reduced the frequency of bacterial colonization of the catheter (13.3 vs. 24.1 colonized catheters per 1000 catheter-days). Rates of bloodstream infection with antiseptic-coated catheters and conventional catheters were 0.42 per 1000 catheter-days and 1.24 per 1000 catheter-days, respectively. This difference was not statistically significant.
Ann Intern Med. 2005;143(8):570-580. doi:10.7326/0003-4819-143-8-200510180-00007
William C. Holmes, MD, MSCE; Mary D. Sammel, ScD
The authors interviewed a random sample of 197 men living in inner-city neighborhoods. One hundred participants (51%) reported a history of childhood physical abuse, which was severe in half of the cases. A parent was the abuser in 73% of cases. Symptoms of depression and post-traumatic stress disorder were more common in men with a history of childhood physical abuse, even after adjustment for differences between them and men who were not abused.
Ann Intern Med. 2005;143(8):581-586. doi:10.7326/0003-4819-143-8-200510180-00008
Julie R. Brahmer, MD
This Update in Oncology focuses on new treatments for 4 common tumors in patients: prostate cancer, non–small-cell lung cancer, breast cancer, and colorectal cancer. The hot topics in 2004 were docetaxel for prostate cancer and pemetrexed and epidermal growth factor receptor mutations for non–small-cell lung cancer. The major advance for breast cancer was the use of aromatase inhibitors for adjuvant treatment. For colorectal cancer, the major development was the outcome of the trials studying bevacizumab and cetuximab.
Ann Intern Med. 2005;143(8):587-592. doi:10.7326/0003-4819-143-8-200510180-00009
Combination Pharmacotherapy and Public Health Research Working Group*
Rather than screening for risk factors for cardiovascular disease (CVD), Wald and Law proposed that everyone take a “polypill” containing a statin, a diuretic, a β-blocker, an angiotensin-converting enzyme inhibitor, aspirin, and folic acid. This type of combination pharmacotherapy may prove to be efficacious, but may also have harms that outweigh the benefits in a population in which relatively few persons are destined to develop CVD.
Ann Intern Med. 2005;143(8):593-599. doi:10.7326/0003-4819-143-8-200510180-00010
Dawn E. Havrda, PharmD, BCPS; Beth A. Omundsen, MD; William Bender, MD; Mary Ann Kirkpatrick, PhD
The authors measured the impact of the Medicare Modernization Act of 2003 on medication expenditures by low-income Medicare recipients who qualify for pharmaceutical company assistance for obtaining medications. Medicare drug discount cards resulted in less savings than pharmaceutical company assistance programs.
Ann Intern Med. 2005;143(8):600-608. doi:10.7326/0003-4819-143-8-200510180-00011
Richard J. Comi, MD
When an obese diabetic patient does not maintain glucose control, clinicians must decide if better control of glycemia is worth 10 pounds of weight gain. Why are we in this therapeutic dilemma? First, we have an incomplete mechanistic understanding of the pathophysiology of diabetes at the molecular level. Second, poor lifestyle choices continue to undo the benefits of treatment. In this issue, 2 articles describe potentially valuable new treatments that address these difficulties.
Ann Intern Med. 2005;143(8):609-610. doi:10.7326/0003-4819-143-8-200510180-00012
Christine Laine, MD, MPH, Senior Deputy Editor; Cynthia D. Mulrow, MD, MSc, Deputy Editor
Ghosts and guests haunt medical journals. We don't usually notice them, but they occasionally rattle their chains to make us aware of their presence. A recent experience reminded us that authorship is not always what it seems, and so we reflect on practices that cast dark shadows across scientific publications: guest authoring and ghostwriting.
Ann Intern Med. 2005;143(8):611-612. doi:10.7326/0003-4819-143-8-200510180-00013
Jules Hirsch, MD
A colleague once showed me a letter from the new financial manager of a distinguished academic hospital, warning all alumni that giving special assistance to fellow physicians or their families, sometimes called “professional courtesy,” could be too costly in these times of health care penury. I always considered the injunction of the Hippocratic Oath “to consider dear to me as my parents him who taught me this art” a good lesson in kindness to be shown to other physicians and their families. I shared my colleague's indignation and, as I considered the matter, remembered my first brush with professional courtesy.
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