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Annals of Internal Medicine Tip Sheet
April 11, 2017


Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.


1. Benefits and harms of osteoporosis medications unclear for patients with CKD

Abstract: http://annals.org/aim/article/doi/10.7326/M16-2752

More research is needed to determine the benefits and harms of osteoporosis medications on bone mineral density (BMD), fracture risk, and safety among patients with chronic kidney disease (CKD). This is important because complications of CKD include weak bones and increased fracture risk. The results of a systematic review and meta-analysis are published in Annals of Internal Medicine.

Researchers at Johns Hopkins University Bloomberg School of Public Health in Baltimore, MD, reviewed published research to ascertain the benefits and harms of osteoporosis medications (bisphosphonates, teriparatide, raloxifene, and denosumab) compared with placebo, usual care, or active control in terms of bone mineral density (BMD), fractures, and safety in patients with CKD. Evidence showed that bisphosphonates may slow loss of BMD among transplant recipients, but their effects on fractures and safety in transplant recipients and others with CKD were not clear. Raloxifene may prevent vertebral fractures but may not improve BMD. Effects of teriparatide and denosumab on BMD and fractures were unclear and these medications may increase risk for some safety outcomes.

The authors concluded that more research is needed to determine the best options for patients across the spectrum of CKD to improve BMD and prevent fractures with minimal risk for diverse outcomes.

2. Short, emergency department screening tool may help to identify youths at high risk for future firearm violence

The SaFETy score could be used to influence development of prevention and intervention efforts

Article: http://annals.org/aim/article/doi/10.7326/M16-1927

A short, in-office screening tool could be used as part of routine clinical care in urban settings to identify youths at high risk for future firearm violence. The results could be used to determine where to focus firearm violence prevention and intervention efforts. The study is published in Annals of Internal Medicine.

Interpersonal firearm violence among youth is a substantial public health problem, and emergency department (ED) physicians require a way to identify those at high risk. Researchers at the University of Michigan Injury Center in Ann Arbor, MI, used machine learning methods and data collected as part of the Flint Youth Injury Study to identify factors predictive of future firearm violence that could be incorporated into a brief clinical screening tool. A total of 599 substance-using youths, age 14 to 24 years, seeking ED care for an assault-related injury and a proportionately sampled group of non-assault-injured youth were followed over two years. The four domains that were most predictive of firearm violence were violence victimization, community exposure, peer influences, and fighting. The 10-point SaFETy (Serious fighting, Friend weapon carrying, community Environment, and firearm Threats) score was derived by selecting one item from each of the four domains. The researchers found that the SaFETy screening tool could be administered in 1 to 2 minutes and accurately defined a gradient of future firearm violence risk that could be adapted to a variety of settings. The info could also be used to inform prevention efforts.

3. Wrist-worn activity trackers offer inconsistent heart rate data

Abstract: http://annals.org/aim/article/doi/10.7326/L16-0353

Wrist-worn activity trackers that measure heart rate with a light-emitting diode offer inconsistent heart rate data. While current trackers may help to motivate people to engage in healthy behaviors, more research is needed before clinicians can use the data to advise patients about health issues or conduct clinical trials that require a high level of accuracy and reliability for heart rate measurement. The clinical observation is published in Annals of Internal Medicine.

Researchers at the University of Wisconsin in Madison, WI, studied 4 commercial, wrist-worn activity trackers to determine the accuracy of their heart rate monitoring. Study participants were 40 healthy consenting adults aged 30 to 65 without cardiovascular conditions. Each participant wore 2 trackers on each wrist in random order. Seated participants were then connected to an electrocardiograph to measure resting heart rate at one minute intervals for 10 minutes using the electrocardiograph and each of the 4 trackers. The measures were repeated while participants walked on the treadmill. Of the four commercial trackers tested, all performed better at rest than during moderately active exercise when compared with measures taken by electrocardiograph, and some of the activity trackers were more consistent than others.

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