Frank J. Palella Jr., MD; Carl Armon, MSPH; Kate Buchacz, PhD, MPH; Stephen R. Cole, PhD; Joan S. Chmiel, PhD; Richard M. Novak, MD; Kathleen Wood, BSN; Anne C. Moorman, BSN; John T. Brooks, MD; for the HOPS (HIV Outpatient Study) Investigators
Drug susceptibility testing guides the choice of antiretroviral drugs. Genotypic susceptibility testing identifies HIV-1 mutations that confer antiretroviral drug resistance. Phenotypic susceptibility testing measures viral replication in the presence of the drugs. The effect of testing on survival is unknown. In an observational study, Palella and colleagues found that patients who had HIV-1 susceptibility testing were less likely to die than were patients who did not have testing. Whether this association is due to better treatment selection in tested patients or to confounding is unknown.
Ann Intern Med. 2009;151(2):73-84. doi:10.7326/0003-4819-151-2-200907210-00003
Wee-Shian Chan, MD, MSc; Agnes Lee, MD, MSc; Frederick A. Spencer, MD; Mark Crowther, MD, MSc; Marc Rodger, MD, MSc; Tim Ramsay, MSc, PhD; Jeffrey S. Ginsberg, MD
The clinical predictors of deep venous thrombosis (DVT) are well known in the general population but not in pregnant women. Over 7 years, clinical thrombosis experts enrolled 194 pregnant women with suspected DVT in 5 Canadian centers, evaluated them, and did leg vein compression ultrasonography. Seventeen (8.8%) women had DVT. All had at least 1 of the following clinical predictors: left leg symptoms, difference in calf circumference of 2 cm or more, and presentation during the first trimester of pregnancy. These 3 variables may improve the accuracy of DVT diagnosis in pregnancy.
Ann Intern Med. 2009;151(2):85-92. doi:10.7326/0003-4819-151-2-200907210-00004
Farah Ahmad, MBBS, MPH, PhD; Sheilah Hogg-Johnson, PhD; Donna E. Stewart, MD; Harvey A. Skinner, PhD, CPsych; Richard H. Glazier, MD, MPH; Wendy Levinson, MD
Intimate partner violence and control (IPVC) often goes unnoticed by health care systems, and screening is often difficult to implement. Ahmad and colleagues randomly assigned adult women at a single Canadian family practice clinic to a computer survey of questions about IPVC or to usual care. When a computer-generated report detailing patients' responses to the survey was attached to medical charts, family practitioners were more likely to ask about and detect IPVC. Computer-assisted screening for IPVC led to improved detection in a busy ambulatory care setting.
Ann Intern Med. 2009;151(2):93-102. doi:10.7326/0003-4819-151-2-200907210-00124
Douglas J. Robertson, MD, MPH; Carol A. Burke, MD; H. Gilbert Welch, MD, MPH; Robert W. Haile, DrPh; Robert S. Sandler, MD, MPH; E. Robert Greenberg, MD; Dennis J. Ahnen, MD; Robert S. Bresalier, MD; Richard I. Rothstein, MD; Bernard Cole, PhD; Leila A. Mott, MS; John A. Baron, MD
Robertson and coworkers studied 564 patients who had 2 surveillance colonoscopies after a baseline colonoscopy that showed an adenoma. They used the results of the first (baseline) and second studies to predict a high-risk adenoma on the third one. When the second examination showed no adenomas, the prevalence of high-risk adenoma on the third examination was 4.9% if the baseline examination showed low-risk adenomas and 12.3% if it showed high-risk adenomas. When deciding on the interval between surveillance colonoscopies, clinicians should consider the baseline colonoscopy results.
Ann Intern Med. 2009;151(2):103-109. doi:10.7326/0003-4819-151-2-200907210-00007
Victor van der Meer, MD; Moira J. Bakker, RN; Wilbert B. van den Hout, PhD; Klaus F. Rabe, MD, PhD; Peter J. Sterk, MD, PhD; Job Kievit, MD, PhD; Willem J.J. Assendelft, MD, PhD; Jacob K. Sont, PhD; for the SMASHING (Self-Management in Asthma Supported by Hospitals, ICT, Nurses and General Practitioners) Study Group
This randomized trial compared Internet-based asthma self-management with usual care in 200 adults with asthma. van der Meer and colleagues found modest improvements in asthma control and lung function with the Internet intervention but no reduction in exacerbations and changes in asthma-related quality of life that were less than clinically significant at 12 months. Although Internet-based self-management improved some asthma outcome measures, the improvements were small, and the program did not affect the number of exacerbations.
Ann Intern Med. 2009;151(2):110-120. doi:10.7326/0003-4819-151-2-200907210-00008
Lorenzo Fuccio, MD; Rocco Maurizio Zagari, MD; Leonardo Henry Eusebi, MD; Liboria Laterza, MD; Vincenzo Cennamo, MD; Liza Ceroni, MD; Diego Grilli, PhD; Franco Bazzoli, MD
Helicobacter pylori infection is associated with an increased risk for gastric cancer. Fuccio and coworkers reviewed 7 randomized trials that compared eradication treatment withno treatment in H. pylori–positive patients and assessed subsequent gastric cancer or progression of preneoplastic lesions. Overall, 37 of 3388 (1.1%) treated patients developed gastric cancer compared with 56 of 3307 (1.7%) untreated control participants. In a pooled analysis of 6 studies, the relative risk for gastric cancer was 0.65 (95% CI, 0.43 to 0.98). Helicobacter pylori eradication seems to reduce gastric cancer risk.
Ann Intern Med. 2009;151(2):121-128. doi:10.7326/0003-4819-151-2-200907210-00009
Sonia Y. Angell, MD, MPH; Lynn Dee Silver, MD, MPH; Gail P. Goldstein, MPH; Christine M. Johnson, MBA; Deborah R. Deitcher, MPH; Thomas R. Frieden, MD, MPH; Mary T. Bassett, MD, MPH
Cholesterol control efforts have focused on consumer education and medical treatment. An approach is to change the makeup of food—a route the New York City Department of Health and Mental Hygiene took when it restricted artificial trans fat in restaurants. Preliminary analyses suggest that replacement of artificial trans fat has resulted in products with more healthful fatty acid profiles. Angell and colleagues describe the rationale and process that led to this ruling and the Department's experience in implementing it.
Ann Intern Med. 2009;151(2):129-134. doi:10.7326/0003-4819-151-2-200907210-00010
Paul Volberding, MD
In this issue, Palella and colleagues investigated the utility of HIV drug resistance testing by analyzing patient survival as a function of whether a physician had ordered either a genotype or a phenotype resistance test. Their report is instructive and highlights the advantages and limitations of observational research versus randomized clinical trials. Their results are encouraging and reinforce current guidelines for drug resistance testing in HIV care.
Ann Intern Med. 2009;151(2):135-136. doi:10.7326/0003-4819-151-2-200907210-00011
Julie Louise Gerberding, MD, MPH
In this issue, Angell and colleagues describe the New York City Department of Health and Mental Hygiene's trans fat restriction program. The successful intervention raises a key policy question: Is it time to institute broader federal government efforts to assure that people in all communities experience the potential health benefits of safer dietary fats? To answer this question, we must assess the evidence of health benefits, the feasibility of national elimination, and the need for federal government intervention.
Ann Intern Med. 2009;151(2):137-138. doi:10.7326/0003-4819-151-2-200907210-00012
David H. Balaban, MD
The appointment looked innocent enough: “10:30 a.m. Weinstein, Estelle. Follow-up.” I was the new doctor, just out of residency and filling in for a recently departed internist as a locum tenens physician. Usually that meant seeing urgent-care patients with little chance of establishing a lasting relationship.
Ann Intern Med. 2009;151(2):139-140. doi:10.7326/0003-4819-151-2-200907070-00013
Ann Intern Med. 2009;151(2):141. doi:10.7326/0003-4819-151-2-200907210-00014
Ann Intern Med. 2009;151(2):141-142. doi:10.7326/0003-4819-151-2-200907210-00015
Ann Intern Med. 2009;151(2):142. doi:10.7326/0003-4819-151-2-200907210-00016
Ann Intern Med. 2009;151(2):142. doi:10.7326/0003-4819-151-2-200907210-00017
Ann Intern Med. 2009;151(2):143. doi:10.7326/0003-4819-151-2-200907210-00018
Ann Intern Med. 2009;151(2):143-144. doi:10.7326/0003-4819-151-2-200907210-00019
Ann Intern Med. 2009;151(2):144. doi:10.7326/0003-4819-151-2-200907210-00020
Jennifer Fisher Wilson
Ann Intern Med. 2009;151(2):145-148. doi:10.7326/0003-4819-151-2-200907210-00021
Philip W. Smith, MD
Ann Intern Med. 2009;151(2):102. doi:10.7326/0003-4819-151-2-200906020-00006
Ann Intern Med. 2009;151(2):JC1-2. doi:10.7326/0003-4819-151-2-200907210-02002
Ann Intern Med. 2009;151(2):JC1-4. doi:10.7326/0003-4819-151-2-200907210-02004
Ann Intern Med. 2009;151(2):JC1-5. doi:10.7326/0003-4819-151-2-200907210-02005
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Ann Intern Med. 2009;151(2):JC1-10. doi:10.7326/0003-4819-151-2-200907210-02010
Ann Intern Med. 2009;151(2):JC1-11. doi:10.7326/0003-4819-151-2-200907210-02011
Ann Intern Med. 2009;151(2):JC1-12. doi:10.7326/0003-4819-151-2-200907210-02012
Ann Intern Med. 2009;151(2):JC1-13. doi:10.7326/0003-4819-151-2-200907210-02013
Ann Intern Med. 2009;151(2):JC1-14. doi:10.7326/0003-4819-151-2-200907210-02014
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Ann Intern Med. 2009;151(2):I-42. doi:10.7326/0003-4819-151-2-200907210-00001
Ann Intern Med. 2009;151(2):I-36. doi:10.7326/0003-4819-151-2-200907210-00002
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