Giuseppe Camporese, MD; Enrico Bernardi, MD, PhD; Paolo Prandoni, MD, PhD; Franco Noventa, MD; Fabio Verlato, MD; Paolo Simioni, MD, PhD; Kadimashi Ntita, MD; Giovanna Salmistraro, MD; Christos Frangos, MD; Franco Rossi, MD; Rosamaria Cordova, MD; Francesca Franz, MD; Pietro Zucchetta, MD; Dimitrios Kontothanassis, MD; Giuseppe Maria Andreozzi, MD; for the KANT (Knee Arthroscopy Nadroparin Thromboprophylaxis) Study Group
In this trial, 1761 adults who had knee arthroscopy were randomly assigned to receive 7 or 14 days of low-molecular-weight heparin (LMWH) or to wear a full-length graduated compression stocking on the operated leg for 1 week. Fewer than 1% of the patients in any group had significant postsurgical bleeding complications. Fewer patients in the 7-day LMWH group experienced a composite outcome of deep venous thrombosis, pulmonary embolism, or death.
Ann Intern Med. 2008;149(2):73-82. doi:10.7326/0003-4819-149-2-200807150-00003
Mindy G. Schuster, MD; John E. Edwards Jr., MD; Jack D. Sobel, MD; Rabih O. Darouiche, MD; Adolf W. Karchmer, MD; Susan Hadley, MD; Gus Slotman, MD; Helene Panzer, PhD; Pinaki Biswas, PhD; John H. Rex, MD
This multicenter trial tested the effect of empirical antifungal treatment in febrile intensive care unit patients. Investigators randomly assigned 270 patients with fever despite taking broad-spectrum antibiotics to either fluconazole, 800 mg/d, or placebo for 2 weeks. About 40% of patients in each group achieved all 4 components of successful treatment: resolution of fever, no invasive fungal infection, no stopping therapy because of toxicity, and no need for a nonstudy systemic antifungal medication. Compared with placebo, empirical antifungal fluconazole therapy had no effect in high-risk intensive care unit patients.
Ann Intern Med. 2008;149(2):83-90. doi:10.7326/0003-4819-149-2-200807150-00004
Mark J. Pletcher, MD, MPH; Kirsten Bibbins-Domingo, PhD, MD; Cora E. Lewis, MD; Gina S. Wei, MD, MPH; Steve Sidney, MD, MPH; J. Jeffrey Carr, MD, MSCE; Eric Vittinghoff, PhD; Charles E. McCulloch, PhD; Stephen B. Hulley, MD, MPH
In their prospective cohort study, Pletcher and colleagues found that prehypertension before age 35 years, especially systolic prehypertension, showed a graded association with coronary calcium later in life. This association remained strong after adjustment for differences in blood pressure elevation after age 35 years and other coronary risk factors and participant characteristics.
Ann Intern Med. 2008;149(2):91-99. doi:10.7326/0003-4819-149-2-200807150-00005
Video
Joel S. Weissman, PhD; Eric C. Schneider, MD, MSc; Saul N. Weingart, MD, PhD; Arnold M. Epstein, MD, MA; JoAnn David-Kasdan, RN, MS; Sandra Feibelmann, MPH; Catherine L. Annas, JD; Nancy Ridley, MS; Leslie Kirle, MPH; Constantine Gatsonis, PhD
Little is known about whether patient interviews can reveal adverse events not detected by medical record review. Weissman and colleagues compared adverse event rates from postdischarge patient interviews with those from medical records. Among 998 study patients, 23% had at least 1 adverse event detected by interview, compared with 11% by record review. Record review identified 11 serious and preventable events. Interviews identified 21 serious and preventable events that were not documented in the medical record. Hospitals should consider adding questions about adverse events to postdischarge interviews.
Ann Intern Med. 2008;149(2):100-108. doi:10.7326/0003-4819-149-2-200807150-00006
Rosario Gonzalez, MD; Javier Zamora, MD, PhD; Judith Gomez-Camarero, MD; Luis-Miguel Molinero, PhD; Rafael Bañares, MD, PhD; Agustín Albillos, MD, PhD
Gonzalez and coworkers performed a meta-analysis of 23 trials that compared the combination of endoscopic and β-blocker therapy with either therapy alone for preventing recurrent esophageal bleeding. Combination therapy was more effective. Most trials, however, studied variceal sclerotherapy, which has largely been superseded by variceal banding as the standard of care. To prevent variceal bleeding, combined endoscopic and oral β-blocker therapy seems to be more effective than either approach alone.
Ann Intern Med. 2008;149(2):109-122. doi:10.7326/0003-4819-149-2-200807150-00007
CME
Woojin Lew, MD, MSc; Madhukar Pai, MD, PhD; Olivia Oxlade, MSc; Daniel Martin, BSc; Dick Menzies, MD, MSc
Optimizing tuberculosis treatment outcomes is increasingly difficult as drug-resistant tuberculosis becomes more common. Lew and colleagues reviewed 22 trials and 7 cohort studies that involved 14 333 new tuberculosis cases. Poor outcomes were associated with drug-resistant organisms at the outset of therapy and with treatment that did not reflect drug-susceptibility testing. Failure or relapse rates were 35% to 40% for patients who received rifampin for 2 months and 20% for patients who received rifampin for 6 months. Settings that do not do susceptibility testing before tuberculosis treatment can expect poor outcomes.
Ann Intern Med. 2008;149(2):123-134. doi:10.7326/0003-4819-149-2-200807150-00008
Charles M. Grossman, MD
The first dose of penicillin given in the United States was administered at Yale–New Haven Hospital on 12 March 1942 to a patient dying of septicemia. As a young Yale house officer, I found myself involved in what few of us then realized was a very profound sequence of events.
Ann Intern Med. 2008;149(2):135-136. doi:10.7326/0003-4819-149-2-200807150-00009
Russell D. Hull, MBBS, MSc
In this issue, Camporese and colleagues report the findings of a large randomized trial of LMWH prophylaxis in adults undergoing knee arthroscopy. The study adds substantive information on the efficacy and safety of LMWH prophylaxis for this indication, and the findings support using LMWH to prevent venous thromboembolism in knee arthroscopy patients undergoing meniscectomy.
Ann Intern Med. 2008;149(2):137-139. doi:10.7326/0003-4819-149-2-200807150-00010
Thomas Fekete, MD
In this issue, Schuster and colleagues show that empirical antifungal fluconazole therapy has no effect in high-risk intensive care unit patients with persistent fever despite taking conventional antibiotics. The time for empirical prophylactic studies of fluconazole in intensive care unit patients is over, and the authors encourage us to move on to other ways of improving patient outcomes.
Ann Intern Med. 2008;149(2):140-141. doi:10.7326/0003-4819-149-2-200807150-00011
Victor S. Sloan, MD
Deep down, all of us have prejudices, and physicians are not immune. Almost 45 years after Dr. Martin Luther King Jr. wished that his children—and ours—would be judged by the content of their character rather than by the color of their skin, we still have a long way to go.
Ann Intern Med. 2008;149(2):142-143. doi:10.7326/0003-4819-149-2-200807150-00012
Ann Intern Med. 2008;149(2):144. doi:10.7326/0003-4819-149-2-200807150-00014
Ann Intern Med. 2008;149(2):144. doi:10.7326/0003-4819-149-2-200807150-00015
Ann Intern Med. 2008;149(2):144-145. doi:10.7326/0003-4819-149-2-200807150-00016
Ann Intern Med. 2008;149(2):145. doi:10.7326/0003-4819-149-2-200807150-00017
Ann Intern Med. 2008;149(2):145-146. doi:10.7326/0003-4819-149-2-200807150-00018
Ann Intern Med. 2008;149(2):146. doi:10.7326/0003-4819-149-2-200807150-00019
Ann Intern Med. 2008;149(2):146-147. doi:10.7326/0003-4819-149-2-200807150-00020
Ann Intern Med. 2008;149(2):147. doi:10.7326/0003-4819-149-2-200807150-00021
Ann Intern Med. 2008;149(2):147. doi:10.7326/0003-4819-149-2-200807150-00022
Jennifer Fisher Wilson
Ann Intern Med. 2008;149(2):149-152. doi:10.7326/0003-4819-149-2-200807150-00025
George N. Braman, MD
Ann Intern Med. 2008;149(2):143. doi:10.7326/0003-4819-149-2-200807150-00013
Dirk Bassler, MD, MSc; Jason W. Busse, DC, MSc; Paul J. Karanicolas, MD; Gordon H. Guyatt, MD, MSc
Ann Intern Med. 2008;149(2):JC1-2. doi:10.7326/0003-4819-149-2-200807150-02002
Raj Padwal, MD
Ann Intern Med. 2008;149(2):JC1-3. doi:10.7326/0003-4819-149-2-200807150-02003
Lawrence J. Cheskin, MD
Ann Intern Med. 2008;149(2):JC1-4. doi:10.7326/0003-4819-149-2-200807150-02004
Ellie Grossman, MD, MPH; Scott Sherman, MD, MPH
Ann Intern Med. 2008;149(2):JC1-5. doi:10.7326/0003-4819-149-2-200807150-02005
Brigitta C. Brott, MD; William B. Hillegass, MD, MPH
Ann Intern Med. 2008;149(2):JC1-6. doi:10.7326/0003-4819-149-2-200807150-02006
Graeme J. Hankey, MD, FRACP, FRCP
Ann Intern Med. 2008;149(2):JC1-7. doi:10.7326/0003-4819-149-2-200807150-02007
Ken Uchino, MD
Ann Intern Med. 2008;149(2):JC1-8. doi:10.7326/0003-4819-149-2-200807150-02008
Matthew Hotopf, MD
Ann Intern Med. 2008;149(2):JC1-9. doi:10.7326/0003-4819-149-2-200807150-02009
John C. Marshall, MD
Ann Intern Med. 2008;149(2):JC1-10. doi:10.7326/0003-4819-149-2-200807150-02010
Michael K. Gould, MD, MS
Ann Intern Med. 2008;149(2):JC1-11. doi:10.7326/0003-4819-149-2-200807150-02011
Daniel I. Steinberg, MD
Ann Intern Med. 2008;149(2):JC1-12. doi:10.7326/0003-4819-149-2-200807150-02012
David W. Molloy, MD
Ann Intern Med. 2008;149(2):JC1-13. doi:10.7326/0003-4819-149-2-200807150-02013
Kavita Nanda, MD; Ward Cates, MD
Ann Intern Med. 2008;149(2):JC1-14. doi:10.7326/0003-4819-149-2-200807150-02014
Ann Intern Med. 2008;149(2):I-40. doi:10.7326/0003-4819-149-2-200807150-00001
Ann Intern Med. 2008;149(2):I-47. doi:10.7326/0003-4819-149-2-200807150-00002
Jose Emilio Esteban, DVM, MBA, PhD
Ann Intern Med. 2008;149(2):148. doi:10.7326/0003-4819-149-2-200807150-00023
Alfredo Morabia, MD, PhD
Ann Intern Med. 2008;149(2):148. doi:10.7326/0003-4819-149-2-200807150-00024