Marion Smits, MD; Diederik W.J. Dippel, MD, PhD; Ewout W. Steyerberg, MD, PhD; Gijs G. de Haan, MD; Helena M. Dekker, MD; Pieter E. Vos, MD, PhD; Digna R. Kool, MD; Paul J. Nederkoorn, MD, PhD; Paul A.M. Hofman, MD, PhD; Albert Twijnstra, MD, PhD; Hervé L.J. Tanghe, MD; M.G. Myriam Hunink, MD, PhD
Existing prediction rules to guide selective use of computed tomography (CT) after minor head injury were developed in patients whose injury caused loss of consciousness. In the CT in Head Injury Patients (CHIP) study, the investigators prospectively evaluated 3181 adults with minor head injury regardless of whether it was associated with loss of consciousness. A prediction rule based on such factors as age; Glasgow Coma Scale score; skull fracture; and posttraumatic vomiting, amnesia, or seizure successfully identified patients who had intracranial findings on CT or who required neurosurgical intervention.
Ann Intern Med. 2007;146(6):397-405. doi:10.7326/0003-4819-146-6-200703200-00004
Yvonne P.M. Goekoop-Ruiterman, MD; Jeska K. de Vries-Bouwstra, MD; Cornelia F. Allaart, MD; Derkjen van Zeben, MD; Pit J.S.M. Kerstens, MD; J. Mieke W. Hazes, MD; Aelko H. Zwinderman, PhD; André J. Peeters, MD; Johanna M. de Jonge-Bok, MD; Constant Mallée, MD; Wim M. de Beus, MD; Peter B.J. de Sonnaville, MD; Jacques A.P.M. Ewals, MD; Ferdinand C. Breedveld, MD; Ben A.C. Dijkmans, MD
First-year results of the BeSt study showed that starting therapy for rheumatoid arthritis with several combinations of drugs produced more rapid clinical improvement and less progression of joint damage than starting with monotherapy. Treating clinicians were free to adjust medication on the basis of disease activity score and reassessed clinical and radiologic outcomes. After 2 years, patients originally assigned to combination therapy groups or to monotherapy had similar disease activity, although treating physicians often converted the patients to combination therapy from monotherapy during follow-up.
Ann Intern Med. 2007;146(6):406-415. doi:10.7326/0003-4819-146-6-200703200-00005
Susan L. Greenspan, MD; Joel B. Nelson, MD; Donald L. Trump, MD; Neil M. Resnick, MD
Androgen deprivation therapy (ADT) for prostate cancer increases risk for bone loss and fractures. The researchers randomly assigned patients with prostate cancer receiving ADT to alendronate or placebo. At baseline, 39% of men had osteoporosis and 52% had low bone mass. During the first year, alendronate increased bone mineral density by 3.7% at the spine and 1.6% at the femoral neck and increased bone turnover. The groups had the same rates of adverse events.
Ann Intern Med. 2007;146(6):416-424. doi:10.7326/0003-4819-146-6-200703200-00006
Joe T.R. Clarke, MD, PhD
Fabry disease is an X-linked, hereditary, lysosomal storage disease caused by deficiency of the enzyme α-galactosidase A. It results in accumulation of globotriaosylceramide (Gb3), a neutral glycosphingolipid, in small blood vessels, nerves, dorsal root ganglia, renal glomerular and tubular epithelial cells, and cardiomyocytes. Enzyme replacement therapy (ERT), given as intravenous infusions of recombinant human α-galactosidase A, consistently decreases Gb3 levels in plasma. The effects of ERT on Gb3 deposits in other tissues are less certain.
Ann Intern Med. 2007;146(6):425-433. doi:10.7326/0003-4819-146-6-200703200-00007
Amir Qaseem, MD, PhD, MHA; Vincenza Snow, MD, MS; 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 Academy of Family Physicians/American College of Physicians Panel on Deep Venous Thrombosis/Pulmonary Embolism†
This guideline, a companion to the recommendation statement and systematic review on management of venous thromboembolism (VTE) that were published in the 6 February 2007 issue of Annals, summarizes current approaches to diagnosis of VTE. Its purpose is to present recommendations based on current evidence to aid clinicians in diagnosis of deep venous thrombosis and pulmonary embolism.
Ann Intern Med. 2007;146(6):454-458. doi:10.7326/0003-4819-146-6-200703200-00013
David J. Casarett, MD, MA; Timothy E. Quill, MD
Growing evidence indicates that hospice can provide high-quality care for patients near the end of life and can help their families. However, many patients do not enroll in hospice, and those who enroll generally do so very late in their illness. This article describes a strategy that can make conversations about hospice referral more compassionate, more effective, and—it is hoped—more timely.
Ann Intern Med. 2007;146(6):443-449. doi:10.7326/0003-4819-146-6-200703200-00011
Christine Laine, MD, MPH, Senior Deputy Editor; Steven N. Goodman, MD, PhD, MHS, Associate Editor; Michael E. Griswold, PhD, Associate Editor; Harold C. Sox, MD, Editor
Scientists arrive at the truth by independently verifying new observations. Journals aid this process by winnowing out research that is unlikely to stand up to independent verification and trying to ensure transparent, objective descriptions of the research. In this article, the editors of Annals describe their evaluative processes and announce a new policy to help the scientific community evaluate, and build on, the research findings published in Annals.
Ann Intern Med. 2007;146(6):450-453. doi:10.7326/0003-4819-146-6-200703200-00154
Shervin Eshaghian, MD; Sanjay Kaul, MD; Sameer Amin, MD; Prediman K. Shah, MD; George A. Diamond, MD
The available evidence from randomized trials indicates that dual therapy with clopidogrel and aspirin is modestly but significantly more effective than aspirin alone in preventing serious vascular events. It is also associated with a favorable benefit–risk profile in patients at high risk, but the bleeding risk exceeds potential cardiovascular benefit in low-risk patients.
Ann Intern Med. 2007;146(6):434-441. doi:10.7326/0003-4819-146-6-200703200-00008
James R. O'Dell, MD
Over the past few years, the outlook for patients recently diagnosed with rheumatoid arthritis (RA) has improved dramatically because of several key advances. Regardless, important questions remain about early treatment of RA. In this issue, Goekoop-Ruiterman and colleagues focus on 2 of these questions: Should patients with early RA receive combinations of disease-modifying, antirheumatic drugs as initial therapy? Is it helpful for clinicians to set clear treatment goals?
Ann Intern Med. 2007;146(6):459-460. doi:10.7326/0003-4819-146-6-200703200-00014
David M. Nathan, MD; Michael Berkwits, MSCE, Deputy Editor
Despite the growing number of options for treating type 2 diabetes, clinicians wanting to prevent the disease in high-risk patients have few good choices. Two large trials in 2002 showed that metformin and acarbose effectively prevent diabetes in participants with impaired glucose tolerance, but neither drug has been approved by the U.S. Food and Drug Administration for prevention, and their use has not become part of routine practice.
Ann Intern Med. 2007;146(6):461-463. doi:10.7326/0003-4819-146-6-200703200-00015
Frank Brennan, MBBS
Ann Intern Med. 2007;146(6):464. doi:10.7326/0003-4819-146-6-200703200-00016
Jon C. Tilburt, MD, MPH
Ann Intern Med. 2007;146(6):465-466. doi:10.7326/0003-4819-146-6-200703200-00017
Ranjana Srivastava, MBBS
Ann Intern Med. 2007;146(6):467-468. doi:10.7326/0003-4819-146-6-200703200-00018
Ann Intern Med. 2007;146(6):469. doi:10.7326/0003-4819-146-6-200703200-00019
Ann Intern Med. 2007;146(6):469. doi:10.7326/0003-4819-146-6-200703200-00020
Ann Intern Med. 2007;146(6):469. doi:10.7326/0003-4819-146-6-200703200-00021
Ann Intern Med. 2007;146(6):470. doi:10.7326/0003-4819-146-6-200703200-00022
Ann Intern Med. 2007;146(6):470-471. doi:10.7326/0003-4819-146-6-200703200-00023
Ann Intern Med. 2007;146(6):471. doi:10.7326/0003-4819-146-6-200703200-00024
Jennifer Fisher Wilson
Ann Intern Med. 2007;146(6):473-476. doi:10.7326/0003-4819-146-6-200703200-00027
George N. Braman, MD
Ann Intern Med. 2007;146(6):442. doi:10.7326/0003-4819-146-6-200703200-00009
Ann Intern Med. 2007;146(6):442. doi:10.7326/0003-4819-146-6-200703200-00010
Ann Intern Med. 2007;146(6):I-72. doi:10.7326/0003-4819-146-6-200703200-00001
Ann Intern Med. 2007;146(6):I-63. doi:10.7326/0003-4819-146-6-200703200-00002
Ann Intern Med. 2007;146(6):I-55. doi:10.7326/0003-4819-146-6-200703200-00003
Helen Hoenig, MD
Ann Intern Med. 2007;146(6):472. doi:10.7326/0003-4819-146-6-200703200-00025
Eyad Almasri, MD; Lewis R. Kline, MD
Ann Intern Med. 2007;146(6):472. doi:10.7326/0003-4819-146-6-200703200-00026
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