Vincent S. Fan, MD, MPH; J. Michael Gaziano, MD, MPH; Robert Lew, PhD; Jean Bourbeau, MD, MSc; Sandra G. Adams, MD, MS; Sarah Leatherman, MS; Soe Soe Thwin, PhD, MS; Grant D. Huang, PhD, MPH; Richard Robbins, MD; Peruvemba S. Sriram, MD; Amir Sharafkhaneh, MD; M. Jeffery Mador, MD; George Sarosi, MD; Ralph J. Panos, MD; Padmashri Rastogi, MD; Todd H. Wagner, PhD; Steven A. Mazzuca, PhD; Colleen Shannon, MPH; Cindy Colling, RPH, MS; Matthew H. Liang, MD, MPH; James K. Stoller, MD, MS; Louis Fiore, MD, MPH; Dennis E. Niewoehner, MD
This trial comparing usual care with a care management program (patient education, action plans for exacerbations, and scheduled telephone calls with case managers) was stopped early when the data safety monitoring board noted more deaths in the intervention group. The study illustrates the importance of data safety monitoring in behavioral intervention studies.
Ann Intern Med. 2012;156(10):673-683. doi:10.7326/0003-4819-156-10-201205150-00003
Brett Ley, MD; Christopher J. Ryerson, MD, MAS; Eric Vittinghoff, PhD; Jay H. Ryu, MD; Sara Tomassetti, MD; Joyce S. Lee, MD, MAS; Venerino Poletti, MD; Matteo Buccioli, BS; Brett M. Elicker, MD; Kirk D. Jones, MD; Talmadge E. King, MD; Harold R. Collard, MD
The clinical course of patients with idiopathic pulmonary fibrosis varies, making predicting survival difficult. This study developed and validated 2 models to predict mortality by using variables readily available in clinical encounters (sex, age, FVC, and diffusion capacity). One model used continuous predictors and the other a simple point-scoring system. Each performed well in predicting survival. The models may be useful in identifying patients at heightened risk for death and in guiding care and clinical research.
Ann Intern Med. 2012;156(10):684-691. doi:10.7326/0003-4819-156-10-201205150-00004
Michael E. Zalis, MD; Michael A. Blake, MB BCh; Wenli Cai, PhD; Peter F. Hahn, MD, PhD; Elkan F. Halpern, PhD; Imrana G. Kazam, PhD; Myles Keroack, MD; Cordula Magee, PhD; Janne J. Näppi, PhD; Rocio Perez-Johnston, MD; John R. Saltzman, MD; Abhinav Vij, MD; Judy Yee, MD; Hiroyuki Yoshida, PhD
Computed tomographic colonography (CTC) and optical colonoscopy require a laxative bowel preparation, which remains a barrier to colorectal cancer screening. A third screening method, laxative-free CTC, combines the use of low-fiber diet, oral contrast, and postprocessing software to electronically cleanse images. This study compared laxative-free CTC with optical colonoscopy in the same patients and found that laxative-free CTC performed well at detecting adenomas larger than 10 mm but not for smaller lesions.
Ann Intern Med. 2012;156(10):692-702. doi:10.7326/0003-4819-156-10-201205150-00005
Thomas F. Imperiale, MD; David F. Ransohoff, MD
People may be at greater risk for colorectal cancer if they have a first-degree relative who has an adenomatous polyp, but that risk is not well-understood. This systematic review found 2 studies that report an increased risk; however, study design problems affect the validity and generalizability of their results. It also found 10 studies that have been cited incorrectly as reporting an increased risk. Further research is needed to inform recommendations about screening for colorectal cancer in patients with a family history of adenomatous polyps.
Ann Intern Med. 2012;156(10):703-709. doi:10.7326/0003-4819-156-10-201205150-00006
Ignacio Neumann, MD; Gabriel Rada, MD; Juan Carlos Claro, MD; Alonso Carrasco-Labra, DDS; Kristian Thorlund, PhD; Elie A. Akl, MD, MPH, PhD; Shannon M. Bates, MD, MSc; Gordon H. Guyatt, MD, MSc
Several strategies to prevent venous thromboembolism are available for patients undergoing major orthopedic surgery. This systematic review examined 22 trials that compared oral factor Xa inhibitors with low-molecular-weight heparin (LMWH) in adults undergoing hip or knee replacement. Reviewers found no important differences in mortality or pulmonary embolism between the 2 drugs. However, compared with LMWH, factor Xa inhibitors decreased the risk for symptomatic deep venous thrombosis (DVT). High, but not lower, doses of factor Xa inhibitors increased bleeding; lower doses reduced risk for symptomatic DVT without increasing bleeding.
Ann Intern Med. 2012;156(10):710-719. doi:10.7326/0003-4819-156-10-201205150-00421
Diana M. Sobieraj, PharmD; Soyon Lee, PharmD; Craig I. Coleman, PharmD; Vanita Tongbram, MBBS, MPH; Wendy Chen, PharmD; Jennifer Colby, PharmD; Jeffrey Kluger, MD; Sagar Makanji, PharmD; Ajibade O. Ashaye, MD, MPH; C. Michael White, PharmD
The optimal duration of thromboprophylaxis after major orthopedic surgery is unclear. This systematic review identified 8 randomized trials that compared prolonged (≥21 days) with standard-duration (7 to 10 days) thromboprophylaxis after major orthopedic surgery in adults. Prolonged prophylaxis decreased the risk for venous thromboembolism, pulmonary embolism, and DVT but increased the risk for minor bleeding. Most data were for hip replacement surgery; applicability of these findings to knee replacement and hip fracture surgery is unclear.
Ann Intern Med. 2012;156(10):720-727. doi:10.7326/0003-4819-156-10-201205150-00423
Laura A. Petersen, MD, MPH; Kate Simpson, MPH; Richard SoRelle, BS; Tracy Urech, MPH; Supicha Sookanan Chitwood, MPH
Randomized, controlled trials are relatively rare in health services research, and institutional review boards (IRBs) may lack experience in reviewing them. The authors compared the outcomes of review of the same proposal for a multisite, minimal-risk trial. They assessed the variability in IRB reviews and the effect of review determinations on site participation, budget, and timeline and found that complying with IRB requirements required substantial resources and threatened the study's internal and external validity.
Ann Intern Med. 2012;156(10):728-735. doi:10.7326/0003-4819-156-10-201205150-00011
C. Gregory Elliott, MD; Polly E. Parsons, MD
This Update summarizes studies published in 2011 that the authors consider highly relevant to the practice of pulmonary and critical care medicine.
Ann Intern Med. 2012;156(10):736-742. doi:10.7326/0003-4819-156-10-201205150-00414
Anna S.F. Lok, MD; John W. Ward, MD; Robert P. Perrillo, MD; Brian J. McMahon, MD; T. Jake Liang, MD
Prophylactic antiviral therapy can prevent hepatitis B virus (HBV) reactivation; however, HBV testing before immunosuppressive therapy is recommended but often not done because of lack of awareness, uncertainty regarding who should be screened, and cost. This commentary advocates collaboration between multidisciplinary medical specialists and public health experts to promote recommendations for prevention.
Ann Intern Med. 2012;156(10):743-745. doi:10.7326/0003-4819-156-10-201205150-00013
Stuart J. Pocock, PhD
Two articles in this issue raise ethical concerns about the conduct and monitoring of clinical trials. Fan and colleagues report a trial of a behavioral intervention strategy for patients with chronic obstructive pulmonary disease that was stopped early because of excess deaths in the intervention group. Petersen and colleagues illustrate how IRB requirements can be time-consuming and can adversely affect a trial's internal and external validity. The editorialist discusses these studies and the importance of ethical safeguards in clinical trials.
Ann Intern Med. 2012;156(10):746-747. doi:10.7326/0003-4819-156-10-201205150-00015
Marc Carrier, MD, MSc; Mary Cushman, MD, MSc
In this issue, 2 reviews assess the effect of type and duration of thromboprophylaxis in patients undergoing major orthopedic surgery. Neumann and colleagues compared the efficacy and safety of thromboprophylaxis using oral direct factor Xa inhibitors or LMWH. Sobieraj and colleagues compared outcomes of prolonged versus standard-duration thromboprophylaxis after major orthopedic surgery. The editorialists discuss the findings and identify the remaining questions that future studies should address.
Ann Intern Med. 2012;156(10):748-749. doi:10.7326/0003-4819-156-10-201205150-00422
Shilpa Bhardwaj, MD, MPH
Ann Intern Med. 2012;156(10):750-751. doi:10.7326/0003-4819-156-10-201205150-00017
Ann Intern Med. 2012;156(10):752. doi:10.7326/0003-4819-156-10-201205150-00019
Ann Intern Med. 2012;156(10):752-753. doi:10.7326/0003-4819-156-10-201205150-00020
Ann Intern Med. 2012;156(10):753-754. doi:10.7326/0003-4819-156-10-201205150-00021
Ann Intern Med. 2012;156(10):754. doi:10.7326/0003-4819-156-10-201205150-00022
Ann Intern Med. 2012;156(10):755-756. doi:10.7326/0003-4819-156-10-201205150-00023
Ann Intern Med. 2012;156(10):756. doi:10.7326/0003-4819-156-10-201205150-00024
Luming Li, BA
Ann Intern Med. 2012;156(10):719. doi:10.7326/0003-4819-156-10-201205150-00008
Peter Glusker, MD
Ann Intern Med. 2012;156(10):745. doi:10.7326/0003-4819-156-10-201205150-00014
Kalyan Banda, MBBS
Ann Intern Med. 2012;156(10):751. doi:10.7326/0003-4819-156-10-201205150-00018
Debabrata Mukherjee, MD, MS
Ann Intern Med. 2012;156(10):JC5-2. doi:10.7326/0003-4819-156-10-201205150-02002
Richard G. Bach, MD
Ann Intern Med. 2012;156(10):JC5-3. doi:10.7326/0003-4819-156-10-201205150-02003
Francesco Dentali, MD
Ann Intern Med. 2012;156(10):JC5-4. doi:10.7326/0003-4819-156-10-201205150-02004
Asma Siddique, MD; Kris V. Kowdley, MD, FACP
Ann Intern Med. 2012;156(10):JC5-5. doi:10.7326/0003-4819-156-10-201205150-02005
Clarence Chant, PharmD, BCPS, FCSHP, FCCP; Karen E.A. Burns, MD, FRCPC, MSc (Epid)
Ann Intern Med. 2012;156(10):JC5-6. doi:10.7326/0003-4819-156-10-201205150-02006
Carlos Garcia, MD
Ann Intern Med. 2012;156(10):JC5-7. doi:10.7326/0003-4819-156-10-201205150-02007
KoKo Aung, MD, MPH, FACP
Ann Intern Med. 2012;156(10):JC5-8. doi:10.7326/0003-4819-156-10-201205150-02008
Ami Schattner, MD
Ann Intern Med. 2012;156(10):JC5-9. doi:10.7326/0003-4819-156-10-201205150-02009
Daniel J. Hogan, MD
Ann Intern Med. 2012;156(10):JC5-10. doi:10.7326/0003-4819-156-10-201205150-02010
George Saade, MD
Ann Intern Med. 2012;156(10):JC5-11. doi:10.7326/0003-4819-156-10-201205150-02011
Steven A. Smith, MD
Ann Intern Med. 2012;156(10):JC5-12. doi:10.7326/0003-4819-156-10-201205150-02012
Francis Whalen, MD
Ann Intern Med. 2012;156(10):JC5-13. doi:10.7326/0003-4819-156-10-201205150-02013
Ann Intern Med. 2012;156(10):I-30. doi:10.7326/0003-4819-156-10-201205150-00001
Ann Intern Med. 2012;156(10):I-36. doi:10.7326/0003-4819-156-10-201205150-00002
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