Dick Menzies, MD, MSc; Richard Long, MD; Anete Trajman, MD, PhD; Marie-Jose Dion, MSc; Jae Yang, MD; Hamdan Al Jahdali, MD; Ziad Memish, MD; Kamran Khan, MD, MPH; Michael Gardam, MD; Vernon Hoeppner, MD; Andrea Benedetti, PhD; Kevin Schwartzman, MD, MPH
Nine-month isoniazid treatment of latent tuberculosis infection is hepatotoxic and is complicated by poor patient adherence. Menzies and colleagues compared the frequency of adverse events and treatment completion between 4-month rifampin therapy and 9-month isoniazid therapy among 847 patients randomly assigned to either treatment. Patients who took rifampin had fewer adverse events and were more likely to complete treatment. The investigators did not compare efficacy of the 2 treatments, so their data justify a larger trial to compare the efficacy of these 2 treatments for latent tuberculosis infection.
Ann Intern Med. 2008;149(10):689-697. doi:10.7326/0003-4819-149-10-200811180-00003
Susan R. Kahn, MD, MSc; Ian Shrier, MD, PhD; Jim A. Julian, MMath; Thierry Ducruet, MSc; Louise Arsenault, BA; Marie-Jos Miron, MD; Andre Roussin, MD; Sylvie Desmarais, MD; France Joyal, MD; Jeannine Kassis, MD; Susan Solymoss, MD; Louis Desjardins, MD; Donna L. Lamping, PhD; Mira Johri, PhD; Jeffrey S. Ginsberg, MD
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 in 387 patients for 2 years after DVT. Mild, moderate, and severe postthrombotic syndrome occurred in 30%, 10%, and 3% of patients, respectively, at all study intervals, but severity fluctuated over time in many patients. Age, previous DVT, and severity at 1 month were the best predictors of long-term severity.
Ann Intern Med. 2008;149(10):698-707. doi:10.7326/0003-4819-149-10-200811180-00004
Khalida Ismail, BM BCh, PhD; Stephen M. Thomas, MB BS; Esther Maissi, MSc; Trudie Chalder, PhD; Ulrike Schmidt, MD, PhD; Jonathan Bartlett, MSc; Anita Patel, PhD; Christopher M. Dickens, MB BS, PhD; Francis Creed, MB, BChir, MD; Janet Treasure, MB BS, PhD
Psychological issues can interfere with management of type 1 diabetes. Ismail and colleagues examined whether psychological therapy might improve diabetes control. They compared motivational enhancement therapy with and without cognitive behavior therapy with usual care in 344 adults with type 1 diabetes (average baseline hemoglobin A1c level, 9.4%). Motivational enhancement therapy plus cognitive behavior therapy achieved a greater decrease in hemoglobin A1c over 12 months than did usual care (difference between groups, 0.46%). No other improvements were observed.
Ann Intern Med. 2008;149(10):708-719. doi:10.7326/0003-4819-149-10-200811180-00005
Larry R. Churchill, PhD; David Schenck, PhD
Physicians' relationships with their patients can have healing effects, but the skills required are understudied. Churchill and Schenck interviewed 50 allopathic and alternative medicine practitioners identified by peers. Eight skills emerged as pivotal: do the little things; take time; be open and listen; find something to like, to love; remove barriers; let the patient explain; share authority; and be committed.
Ann Intern Med. 2008;149(10):720-724. doi:10.7326/0003-4819-149-10-200811180-00006
Amir Qaseem, MD, PhD, MHA; Vincenza Snow, MD; Thomas D. Denberg, MD, PhD; Mary Ann Forciea, MD; Douglas K. Owens, MD, MS; for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians
This guideline presents current evidence on second-generation antidepressant treatment during the acute, continuation, and maintenance phases of major depressive disorder, dysthymia, subsyndromal depression, and accompanying symptoms. The American College of Physicians recommends that clinicians select second-generation antidepressants on the basis of adverse effect profiles, cost, and patient preferences. Clinicians should assess patient status, therapeutic response, and adverse effects of therapy on a regular basis beginning within 1 to 2 weeks of therapy initiation and should modify treatment if no adequate response to therapy is observed within 6 to 8 weeks of the therapy initiation. Treatment should continue for 4 to 9 months after a satisfactory response in patients with a first episode or for even longer in patients who have had 2 or more episodes.
Ann Intern Med. 2008;149(10):725-733. doi:10.7326/0003-4819-149-10-200811180-00007
Gerald Gartlehner, MD, MPH; Bradley N. Gaynes, MD, MPH; Richard A. Hansen, PhD, RPh; Patricia Thieda, MA; Angela DeVeaugh-Geiss, MS; Erin E. Krebs, MD, MPH; Charity G. Moore, PhD, MSPH; Laura Morgan, MA; Kathleen N. Lohr, PhD
The authors reviewed the evidence of the benefits and harms of second-generation antidepressants for the treatment of depressive disorders in adults. They found that second-generation antidepressants did not substantially differ in efficacy or effectiveness (on the basis of 203 studies), but the incidence of specific adverse events and the onset of action did differ. The evidence is insufficient to draw conclusions about the comparative efficacy, effectiveness, or harms of these agents for the treatment of dysthymia and subsyndromal depression.
Ann Intern Med. 2008;149(10):734-750. doi:10.7326/0003-4819-149-10-200811180-00008
Holly Janes, PhD; Margaret S. Pepe, PhD; Wen Gu, MS
Risk stratification tables evaluate the benefit of adding a new risk marker to a risk prediction model that includes an established set of markers. Janes and colleagues show how to use the tables to compare models with and without the new marker for 3 important measures of model performance. They discuss how the tables are an improvement over commonly reported measures of risk prediction model performance.
Ann Intern Med. 2008;149(10):751-760. doi:10.7326/0003-4819-149-10-200811180-00009
Henry M. Blumberg, MD
Poor acceptance and adherence to treatment regimens for latent tuberculosis infection (LTBI) are common. In this issue, Menzies and colleagues found that grade 3 to 4 hepatotoxicity was significantly less common among patients randomly assigned to 4 months of rifampin therapy than among those randomly assigned to 9 months of isoniazid therapy. Patients in the rifampin group were also more likely to complete treatment. The authors rightly conclude that a large-scale trial is indicated to assess the efficacy of rifampin monotherapy for the treatment of LTBI.
Ann Intern Med. 2008;149(10):761-763. doi:10.7326/0003-4819-149-10-200811180-00011
David B. Seder, MD
Sitting down, looking strangers in the eye, and talking about death is part of the poetry of critical care. At first I thought that I had a talent for these discussionsthat they were something others avoided that I could do. But that isn't quite right. In fact, these are opportunities for performance, and I seek them out like strong coffee or difficult procedures.
Ann Intern Med. 2008;149(10):764-765. doi:10.7326/0003-4819-149-10-200811180-00012
Andrea A. Peterson, MD
When I sit down on the side of the bed, I know. He has pale blue eyes and a careworn face, and I know that I will not make it home for dinner. I speak slowly and say, On the CT scan, there are multiple abnormal spots in your liver. A pause, then: It looks like the cancer has spread.
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Ann Intern Med. 2008;149(10):775-776. doi:10.7326/0003-4819-149-10-200811180-00029
Clayton J. Baker, MD
Ann Intern Med. 2008;149(10):760. doi:10.7326/0003-4819-149-10-200811180-00010
R. Brian Haynes, MD; Lawrence E. Hart, MB, BCh
Ann Intern Med. 2008;149(10):JC5-2. doi:10.7326/0003-4819-149-10-200811180-02002
Lillian S. Kao, MD; Alexander Gallus, MD
Ann Intern Med. 2008;149(10):JC5-4. doi:10.7326/0003-4819-149-10-200811180-02004
Anne Holbrook, MD, PharmD
Ann Intern Med. 2008;149(10):JC5-5. doi:10.7326/0003-4819-149-10-200811180-02005
Robert L. Danner, MD
Ann Intern Med. 2008;149(10):JC5-6. doi:10.7326/0003-4819-149-10-200811180-02006
Christopher B. Granger, MD
Ann Intern Med. 2008;149(10):JC5-7. doi:10.7326/0003-4819-149-10-200811180-02007
Robert P. Kauffman, MD
Ann Intern Med. 2008;149(10):JC5-8. doi:10.7326/0003-4819-149-10-200811180-02008
Chris Del Mar, MD
Ann Intern Med. 2008;149(10):JC5-9. doi:10.7326/0003-4819-149-10-200811180-02009
Jacob Korula, MD
Ann Intern Med. 2008;149(10):JC5-10. doi:10.7326/0003-4819-149-10-200811180-02010
Joe Alcorn, MD
Ann Intern Med. 2008;149(10):JC5-11. doi:10.7326/0003-4819-149-10-200811180-02011
Vincent Wai-Sun Wong, MD; Francis Ka-Leung Chan, MD
Ann Intern Med. 2008;149(10):JC5-12. doi:10.7326/0003-4819-149-10-200811180-02012
Wieslaw Oczkowski, MD
Ann Intern Med. 2008;149(10):JC5-13. doi:10.7326/0003-4819-149-10-200811180-02013
Ami Schattner, MD
Ann Intern Med. 2008;149(10):JC5-14. doi:10.7326/0003-4819-149-10-200811180-02014
Richard D. Moore, MD, MHS
Ann Intern Med. 2008;149(10):JC5-15. doi:10.7326/0003-4819-149-10-200811180-02015
Ann Intern Med. 2008;149(10):I-48. doi:10.7326/0003-4819-149-10-200811180-00001
Ann Intern Med. 2008;149(10):I-56. doi:10.7326/0003-4819-149-10-200811180-00002
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