The SMART Study Group
A previously published randomized, controlled trial showed that episodic use of antiretroviral therapy guided by CD4+ cell counts is inferior to continuous antiretroviral therapy. In a continuation of this trial, the SMART Study Group measured the effect of reinitiating continuous antiretroviral therapy on the excess risk for opportunistic disease or death due to episodic treatment. Resumption of continuous therapy rapidly suppressed HIV RNA and reduced—but did not eliminate—the excess risk for opportunistic disease or death.
Ann Intern Med. 2008;149(5):289-299. doi:10.7326/0003-4819-149-5-200809020-00003
Peter V. Chin-Hong, MD; J. Michael Berry, MD; Su-Chun Cheng, DSc, MS; Joseph A. Catania, PhD; Maria Da Costa, MS; Teresa M. Darragh, MD; Fred Fishman, BS; Naomi Jay, NP, PhD; Lance M. Pollack, PhD; Joel M. Palefsky, MD
Self-collected samples may increase adherence to anal cancer screening guidelines. This study compared the sensitivity and specificity of patient-collected and physician-collected cytology samples, using high-resolution anoscopy as the reference standard, in 126 men who have sex with men. Patient-collected specimens were feasible but unsatisfactory because many patients with anal intraepithelial neoplasia (AIN) had a negative cytology result after self-collection. Even with a physician-collected sample, anal cytology misses too many cases of AIN. Anoscopy is a better screening test, especially for high-risk patients.
Ann Intern Med. 2008;149(5):300-306. doi:10.7326/0003-4819-149-5-200809020-00004
Christin Heidemann, DrPH, MSc; Qi Sun, MD, ScD; Rob M. van Dam, PhD; James B. Meigs, MD, MPH; Cuilin Zhang, MD, PhD; Shelley S. Tworoger, PhD; Christos S. Mantzoros, MD, DSc; Frank B. Hu, MD, PhD
As biologically active molecules secreted by adipose tissue, adipokines might be the link between obesity and diabetes. The authors measured 2 adipokines (adiponectin and resistin) in 1038 initially healthy women of the Nurses' Health Study who later developed type 2 diabetes and 1136 matched control participants who did not develop diabetes. Adiponectin, but not resistin, was strongly associated with increased risk for diabetes, independent of body mass index.
Ann Intern Med. 2008;149(5):307-316. doi:10.7326/0003-4819-149-5-200809020-00005
Philip D. Sloane, MD, MPH; Lauren W. Cohen, MA; Thomas R. Konrad, PhD; Christianna S. Williams, PhD; John G. Schumacher, PhD; Sheryl Zimmerman, PhD
Many “baby boomer” physicians are reaching retirement age, which is contributing to concerns about a physician shortage in the United States. If retired physicians volunteered to see patients, it would offset some of the effects of large-scale retirement. The authors surveyed 910 physicians 55 years of age or older living in North Carolina. At least one third expressed strong interest in volunteer teaching and working in free medical clinics during retirement. Programs that make it easy for retired physicians to be involved in patient care are needed.
Ann Intern Med. 2008;149(5):317-322. doi:10.7326/0003-4819-149-5-200809020-00006
Marc Carrier, MD; Grégoire Le Gal, MD, PhD; Philip S. Wells, MD, MSc; Dean Fergusson, PhD; Tim Ramsay, PhD; Marc A. Rodger, MD, MSc
In a systematic review, Carrier and colleagues summarized 36 studies of the prevalence of previously undiagnosed cancer at diagnosis and various time points after unprovoked venous thromboembolism (VTE). They also measured the number of cases detected by limited and extensive occult cancer screening at the time of VTE diagnosis. The prevalence of occult cancer was 6.1% at VTE diagnosis and increased to 10.0% 12 months after VTE diagnosis. Extensive screening increased the proportion of cases that were detected at baseline (from 49.4% to 69.7% with limited screening) but still missed many cases.
Ann Intern Med. 2008;149(5):323-333. doi:10.7326/0003-4819-149-5-200809020-00007
Liselotte N. Dyrbye, MD; Matthew R. Thomas, MD; F. Stanford Massie, MD; David V Power, MD; Anne Eacker, MD; William Harper, MD; Steven Durning, MD; Christine Moutier, MD; Daniel W. Szydlo, BA; Paul J. Novotny, MS; Jeff A. Sloan, PhD; Tait D. Shanafelt, MD
The stresses of medical school can lead to suicidal ideation or burnout. The prevalence of these conditions in medical students is not known. In a survey of 4287 medical students at 7 U.S. medical schools, 49.6% of students reported burnout and 11.2% reported suicidal ideation in the past year. Ninety-nine of the 370 students who met criteria for burnout subsequently recovered; recovery was associated with much lower rates of suicidal ideation.
Ann Intern Med. 2008;149(5):334-341. doi:10.7326/0003-4819-149-5-200809020-00008
Aaron S. Kesselheim, MD, JD, MPH; David M. Studdert, LLB, ScD
The Department of Justice has increased its efforts to prosecute health care fraud litigation. Whistleblowers play a major role in calling attention to health care fraud and receive 15% to 25% of the money recovered from defendants. Among 370 cases of federal health care fraud litigation from 1996 to 2005, the government recovered $9.3 billion from defendants, of which whistleblowers received more than $1.0 billion. Whistleblowers were often executives or physicians, and 75% were employees of defendant organizations.
Ann Intern Med. 2008;149(5):342-349. doi:10.7326/0003-4819-149-5-200809020-00009
Deborah L. Ornstein, MD
In this issue, Carrier and colleagues report the period prevalence of cancer in patients with VTE at 3 time points and confirm that unprovoked VTE is more commonly associated with cancer than provoked VTE, and that extensive screening finds more cases of cancer at baseline than usual care. These findings demonstrate that if we look hard enough, we can find hidden cancer in a sizeable proportion of patients with idiopathic VTE. However, the search for cancer is expensive, and we do not know whether finding it changes survival.
Ann Intern Med. 2008;149(5):350-352. doi:10.7326/0003-4819-149-5-200809020-00010
Elisabeth D. Riviello, MD
Ann Intern Med. 2008;149(5):353-354. doi:10.7326/0003-4819-149-5-200809020-00011
Jeanne Macrae, MD
Ann Intern Med. 2008;149(5):355-356. doi:10.7326/0003-4819-149-5-200809020-00012
Ann Intern Med. 2008;149(5):357. doi:10.7326/0003-4819-149-5-200809020-00014
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Ann Intern Med. 2008;149(5):359-360. doi:10.7326/0003-4819-149-5-200809020-00017
Ann Intern Med. 2008;149(5):360. doi:10.7326/0003-4819-149-5-200809020-00018
Ann Intern Med. 2008;149(5):360-361. doi:10.7326/0003-4819-149-5-200809020-00019
Ann Intern Med. 2008;149(5):361. doi:10.7326/0003-4819-149-5-200809020-00020
Ann Intern Med. 2008;149(5):361. doi:10.7326/0003-4819-149-5-200809020-00021
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Ann Intern Med. 2008;149(5):362. doi:10.7326/0003-4819-149-5-200809020-00023
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Ann Intern Med. 2008;149(5):363-364. doi:10.7326/0003-4819-149-5-200809020-00025
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Ann Intern Med. 2008;149(5):364-365. doi:10.7326/0003-4819-149-5-200809020-00027
Ann Intern Med. 2008;149(5):365-367. doi:10.7326/0003-4819-149-5-200809020-00028
Amy Lee Lipan, MD
Ann Intern Med. 2008;149(5):356. doi:10.7326/0003-4819-149-5-200809020-00013
Bhuvana Chandra, MD
Ann Intern Med. 2008;149(5):367. doi:10.7326/0003-4819-149-5-200809020-00029
Steve Goodacre, MB, ChB, MSc, PhD
Ann Intern Med. 2008;149(5):ITC3-1. doi:10.7326/0003-4819-149-5-200809020-01003
Ann Intern Med. 2008;149(5):I-30. doi:10.7326/0003-4819-149-5-200809020-00001
Ann Intern Med. 2008;149(5):I-38. doi:10.7326/0003-4819-149-5-200809020-00002
Michael A. Horberg, MD, MAS
Ann Intern Med. 2008;149(5):368. doi:10.7326/0003-4819-149-5-200809020-00030
Robert L. Barbieri, MD
Ann Intern Med. 2008;149(5):368. doi:10.7326/0003-4819-149-5-200809020-00031
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