Alan T. Mulgrew, MB; Nurit Fox, MSc, CCRP; Najib T. Ayas, MD, MPH; C. Frank Ryan, MB
The authors sought alternatives to polysomnography for making a diagnosis of obstructive sleep apnea (OSA). They created a clinical algorithm that used clinical methods and overnight home oximetry to calculate the probability of OSA. Sixty-eight patients with a probability of OSA of 90% or greater were randomly assigned to usual care (polysomnography before starting continuous positive airway pressure [CPAP]) or ambulatory management (start CPAP without doing polysomnography). After 3 months, the 2 groups had the same results on overnight polysomnography.
Ann Intern Med. 2007;146(3):157-166. doi:10.7326/0003-4819-146-3-200702060-00004
Richard Saitz, MD, MPH; Tibor P. Palfai, PhD; Debbie M. Cheng, ScD; Nicholas J. Horton, ScD; Naomi Freedner, MPH; Kim Dukes, PhD; Kevin L. Kraemer, MD, MSc; Mark S. Roberts, MD, MPP; Rosanne T. Guerriero, MPH; Jeffrey H. Samet, MD, MA, MPH
The authors screened all adult medical inpatients at an inner-city teaching hospital and randomly assigned 341 risky drinkers to a 30-minute motivational counseling intervention followed by treatment planning or to usual care. By 3 months, the same proportion of patients from both groups had received alcohol assistance. At 12 months, both groups had reduced their drinking to the same degree. A 30-minute intervention was insufficient to change behavior in these risky drinkers, 76% of whom were alcohol-dependent.
Ann Intern Med. 2007;146(3):167-176. doi:10.7326/0003-4819-146-3-200702060-00005
Manjula Kurella, MD, MPH; Kenneth E. Covinsky, MD, MPH; Alan J. Collins, MD; Glenn M. Chertow, MD, MPH
Data from a national registry of end-stage renal disease patients showed that the number of octogenarians and nonagenarians starting dialysis has nearly doubled from 1996 to 2003. Patients starting dialysis in 2003 had higher glomerular filtration rates and less morbidity related to chronic kidney disease than those starting dialysis in 1996. Although people starting dialysis in 2003 had less advanced kidney disease, the 1-year mortality rate on dialysis was approximately 50% in 1996 and 2003.
Ann Intern Med. 2007;146(3):177-183. doi:10.7326/0003-4819-146-3-200702060-00006
Martin J. O'Donnell, MB; Clive Kearon, MB, PhD; Judy Johnson, RN; Marlene Robinson, RN, BScN; Michelle Zondag, RN; Irene Turpie, MB, MSc; Alexander G. Turpie, MB
When patients on long-term warfarin therapy require surgery, low-molecular-weight heparins are often used as bridging therapy between full anticoagulation with warfarin and no anticoagulation during surgery. Because of safety concerns, the authors measured heparin activity after an evening dose of low-molecular-weight heparin. They found that two thirds of 94 patients—who received their last dose of enoxaparin 14 hours before surgery—had elevated heparin levels when surgery was scheduled to begin. They suggest a longer interval between the last dose of heparin and the time of surgery.
Ann Intern Med. 2007;146(3):184-187. doi:10.7326/0003-4819-146-3-200702060-00007
Kristofer L. Smith, MD, MPP; Theresa A. Soriano, MD, MPH; Jeremy Boal, MD
Home-based primary care for homebound elderly patients is complex, practice constraints are unique, and no quality-of-care standards exist. An expert panel reviewed established standards for geriatric care and modified some to make them more applicable to home-based care. A separate panel used a modified Delphi process to rate the validity of the indicators and found that the quality indicator set provides a comprehensive framework for evaluating home-based primary care.
Ann Intern Med. 2007;146(3):188-192. doi:10.7326/0003-4819-146-3-200702060-00008
Alexis F. Turgeon, MD, MSc; Brian Hutton, MSc; Dean A. Fergusson, MHA, PhD; Lauralyn McIntyre, MD, MSc; Alan A. Tinmouth, MD, MSc; D. William Cameron, MD; Paul C. Hébert, MD, MSc
Intravenous immunoglobulin (IVIG) therapy is a proposed adjuvant treatment for sepsis, although the benefits remain unclear and it is not currently recommended. This meta- analysis identified 20 randomized trials that studied a total of 2621 critically ill adults with sepsis. Polyclonal IVIG decreased mortality more than placebo or no intervention. The largest survival benefits occurred with higher doses and prolonged administration and in more severely ill patients.
Ann Intern Med. 2007;146(3):193-203. doi:10.7326/0003-4819-146-3-200702060-00009
Vincenza Snow, MD; Amir Qaseem, MD, PhD, MHA; Patricia Barry, MD, MPH; E. Rodney Hornbake, MD; Jonathan E. Rodnick, MD; Timothy Tobolic, MD; Belinda Ireland, MD, MS; Jodi B. Segal, MD; Eric B. Bass, MD, MPH; Kevin B. Weiss, MD, MPH; Lee Green, MD, MPH; Douglas K. Owens, MD, MS; and the Joint American College of Physicians/American Academy of Family Physicians Panel on Deep Venous Thrombosis/Pulmonary Embolism*
Venous thromboembolism is a common condition affecting 7.1 community residents per 10 000 person-years. Incidence rates are higher for men and African Americans and increase substantially with age. The target audience for the guidelines in this issue is all clinicians who care for patients with deep venous thromboembolism or pulmonary embolism.
Ann Intern Med. 2007;146(3):204-210. doi:10.7326/0003-4819-146-3-200702060-00149
Jodi B. Segal, MD, MPH; Michael B. Streiff, MD; Lawrence V. Hofmann, MD; Katherine Thornton, MD; Eric B. Bass, MD, MPH
New treatments are available for venous thromboembolism. This background paper to the guidelines on treatment of venous thromboembolism from the American College of Physicians and the American Academy of Family Physicians in this issue reviews the evidence on the efficacy of interventions for treatment of deep venous thrombosis and pulmonary embolism.
Ann Intern Med. 2007;146(3):211-222. doi:10.7326/0003-4819-146-3-200702060-00150
Patrick G. O'Connor, MD, MPH
In this issue, Saitz and colleagues studied the effects of a brief intervention in hospitalized problem drinkers. The result is disappointing: The intervention had no effect on any of the 2 primary outcomes or the 9 secondary outcomes. The study, which was of extremely high scientific quality, may have had more success with interventions that were targeted at specific subpopulations.
Ann Intern Med. 2007;146(3):223-225. doi:10.7326/0003-4819-146-3-200702060-00012
David C. Dale, MD
In this issue, the On Being a Doctor story of Squatter Sam is well worth reading and sharing. It is a physician's story—a story about the kind of patient we all remember well. With a few words, this vignette goes deeply into the physician–patient experience and speaks to critical professional qualities of caring, bonding, doing what's right, and reflecting on what we have done.
Ann Intern Med. 2007;146(3):226. doi:10.7326/0003-4819-146-3-200702060-00013
David S. Grauman, MD
It was a cold winter afternoon in Fairbanks, Alaska. There was a slight air of expectation in our 2-doctor internal medicine office. After a 5-year hiatus, Sam had finally made an appointment. I first met Sam some 15 years ago, and even in a place famous for colorful characters, he was a standout.
Ann Intern Med. 2007;146(3):227-228. doi:10.7326/0003-4819-146-3-200702060-00014
Ann Intern Med. 2007;146(3):229. doi:10.7326/0003-4819-146-3-200702060-00015
Ann Intern Med. 2007;146(3):229. doi:10.7326/0003-4819-146-3-200702060-00016
Ann Intern Med. 2007;146(3):229-230. doi:10.7326/0003-4819-146-3-200702060-00017
Ann Intern Med. 2007;146(3):230. doi:10.7326/0003-4819-146-3-200702060-00018
Ann Intern Med. 2007;146(3):230-232. doi:10.7326/0003-4819-146-3-200702060-00146
Ann Intern Med. 2007;146(3):232. doi:10.7326/0003-4819-146-3-200702060-00020
Jennifer F. Wilson
Ann Intern Med. 2007;146(3):ITC2-1. doi:10.7326/0003-4819-146-3-200702060-01002
Ann Intern Med. 2007;146(3):I-22. doi:10.7326/0003-4819-146-3-200702060-00001
Ann Intern Med. 2007;146(3):I-35. doi:10.7326/0003-4819-146-3-200702060-00002
Ann Intern Med. 2007;146(3):I-43. doi:10.7326/0003-4819-146-3-200702060-00151
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