Table of Contents

May 15, 2012; 156 (10)

Original Research

  • A Comprehensive Care Management Program to Prevent Chronic Obstructive Pulmonary Disease Hospitalizations: A Randomized, Controlled Trial

    • Vincent S. Fan,
    • J. Michael Gaziano,
    • Robert Lew,
    • Jean Bourbeau,
    • Sandra G. Adams,
    • Sarah Leatherman,
    • Soe Soe Thwin,
    • Grant D. Huang,
    • Richard Robbins,
    • Peruvemba S. Sriram,
    • Amir Sharafkhaneh,
    • M. Jeffery Mador,
    • George Sarosi,
    • Ralph J. Panos,
    • Padmashri Rastogi,
    • Todd H. Wagner,
    • Steven A. Mazzuca,
    • Colleen Shannon,
    • Cindy Colling,
    • Matthew H. Liang,
    • James K. Stoller,
    • Louis Fiore,
    • and Dennis E. Niewoehner
    Ann Intern Med May 15, 2012 156:673-683; doi:10.1059/0003-4819-156-10-201205150-00003

    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.

  • A Multidimensional Index and Staging System for Idiopathic Pulmonary Fibrosis

    • Brett Ley,
    • Christopher J. Ryerson,
    • Eric Vittinghoff,
    • Jay H. Ryu,
    • Sara Tomassetti,
    • Joyce S. Lee,
    • Venerino Poletti,
    • Matteo Buccioli,
    • Brett M. Elicker,
    • Kirk D. Jones,
    • Talmadge E. King Jr.,
    • and Harold R. Collard
    Ann Intern Med May 15, 2012 156:684-691; doi:10.1059/0003-4819-156-10-201205150-00004

    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.

  • Diagnostic Accuracy of Laxative-Free Computed Tomographic Colonography for Detection of Adenomatous Polyps in Asymptomatic Adults: A Prospective Evaluation

    • Michael E. Zalis,
    • Michael A. Blake,
    • Wenli Cai,
    • Peter F. Hahn,
    • Elkan F. Halpern,
    • Imrana G. Kazam,
    • Myles Keroack,
    • Cordula Magee,
    • Janne J. Näppi,
    • Rocio Perez-Johnston,
    • John R. Saltzman,
    • Abhinav Vij,
    • Judy Yee,
    • and Hiroyuki Yoshida
    Ann Intern Med May 15, 2012 156:692-702; doi:10.1059/0003-4819-156-10-201205150-00005

    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.

Updates

  • Update in Pulmonary and Critical Care Medicine: Evidence Published in 2011

    • C. Gregory Elliott and
    • Polly E. Parsons
    Ann Intern Med May 15, 2012 156:736-742; published ahead of print April 18, 2012, doi:10.1059/0003-4819-156-10-201205150-00414

    This Update summarizes studies published in 2011 that the authors consider highly relevant to the practice of pulmonary and critical care medicine.

Reviews

  • Risk for Colorectal Cancer in Persons With a Family History of Adenomatous Polyps: A Systematic Review

    • Thomas F. Imperiale and
    • David F. Ransohoff
    Ann Intern Med May 15, 2012 156:703-709; doi:10.1059/0003-4819-156-10-201205150-00006

    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.

  • Oral Direct Factor Xa Inhibitors Versus Low-Molecular-Weight Heparin to Prevent Venous Thromboembolism in Patients Undergoing Total Hip or Knee Replacement: A Systematic Review and Meta-analysis

    • Ignacio Neumann,
    • Gabriel Rada,
    • Juan Carlos Claro,
    • Alonso Carrasco-Labra,
    • Kristian Thorlund,
    • Elie A. Akl,
    • Shannon M. Bates,
    • and Gordon H. Guyatt
    Ann Intern Med May 15, 2012 156:710-719; published ahead of print March 12, 2012, doi:10.1059/0003-4819-156-10-201205150-00421

    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.

  • Prolonged Versus Standard-Duration Venous Thromboprophylaxis in Major Orthopedic Surgery: A Systematic Review

    • Diana M. Sobieraj,
    • Soyon Lee,
    • Craig I. Coleman,
    • Vanita Tongbram,
    • Wendy Chen,
    • Jennifer Colby,
    • Jeffrey Kluger,
    • Sagar Makanji,
    • Ajibade O. Ashaye,
    • and C. Michael White
    Ann Intern Med May 15, 2012 156:720-727; published ahead of print March 12, 2012, doi:10.1059/0003-4819-156-10-201205150-00423

    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.

Research and Reporting Methods

  • How Variability in the Institutional Review Board Review Process Affects Minimal-Risk Multisite Health Services Research

    • Laura A. Petersen,
    • Kate Simpson,
    • Richard SoRelle,
    • Tracy Urech,
    • and Supicha Sookanan Chitwood
    Ann Intern Med May 15, 2012 156:728-735; doi:10.1059/0003-4819-156-10-201205150-00011

    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.

Ideas and Opinions

  • Reactivation of Hepatitis B During Immunosuppressive Therapy: Potentially Fatal Yet Preventable

    • Anna S.F. Lok,
    • John W. Ward,
    • Robert P. Perrillo,
    • Brian J. McMahon,
    • and T. Jake Liang
    Ann Intern Med May 15, 2012 156:743-745; doi:10.1059/0003-4819-156-10-201205150-00013

    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.

Editorials

  • Ethical Dilemmas and Malfunctions in Clinical Trials Research

    • Stuart J. Pocock
    Ann Intern Med May 15, 2012 156:746-747; doi:10.1059/0003-4819-156-10-201205150-00015

    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.

  • Assessing the Utility of Venous Thrombosis Prophylaxis in Orthopedic Surgery Patients

    • Marc Carrier and
    • Mary Cushman
    Ann Intern Med May 15, 2012 156:748-749; published ahead of print March 12, 2012, doi:10.1059/0003-4819-156-10-201205150-00422

    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.

On Being a Doctor

Letters

  • Evaluation of Guidelines on Diabetes Medication

    • Keith Brown,
    • Robin Harbour,
    • and John Petrie
    Ann Intern Med May 15, 2012 156:752; doi:10.1059/0003-4819-156-10-201205150-00019

  • Evaluation of Guidelines on Diabetes Medication

    • Andrea Giaccari,
    • Carlo B. Giorda,
    • Gabriele Riccardi,
    • Alberto De Micheli,
    • Graziella Bruno,
    • Luca Monge,
    • and Simona Frontoni
    Ann Intern Med May 15, 2012 156:752-753; doi:10.1059/0003-4819-156-10-201205150-00020

  • Evaluation of Guidelines on Diabetes Medication

    • Wendy L. Bennett,
    • Olaide A. Odelola,
    • and Lisa M. Wilson
    Ann Intern Med May 15, 2012 156:753-754; doi:10.1059/0003-4819-156-10-201205150-00021

  • Exposing Unethical Human Research

    • Howard M. Spiro
    Ann Intern Med May 15, 2012 156:754; doi:10.1059/0003-4819-156-10-201205150-00022

  • Successful Treatment of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis With Eicosapentaenoic Acid

    • Junichi Hirahashi,
    • Airi Jo,
    • Kohei Ueda,
    • Akihiro Tojo,
    • and Toshiro Fujita
    Ann Intern Med May 15, 2012 156:755-756; doi:10.1059/0003-4819-156-10-201205150-00023

  • Correction: Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus

    Ann Intern Med May 15, 2012 156:756; doi:10.1059/0003-4819-156-10-201205150-00024

Ad Libitum

Summaries for Patients

  • A Comprehensive Care Management Program to Prevent Chronic Obstructive Pulmonary Disease Hospitalizations

    Ann Intern Med May 15, 2012 156:I-30; doi:10.1059/0003-4819-156-10-201205150-00001

  • Screening for Colon Cancer by Using a Computed Tomographic Scan Without a Laxative

    Ann Intern Med May 15, 2012 156:I-36; doi:10.1059/0003-4819-156-10-201205150-00002

ACP Journal Club

  • Review: Enoxaparin during PCI is better than unfractionated heparin for reducing mortality in coronary heart disease

    Ann Intern Med May 15, 2012 156:JC5-02; doi:10.1059/0003-4819-156-10-201205150-02002

  • Low-dose rivaroxaban reduced mortality in patients with a recent acute coronary syndrome

    Ann Intern Med May 15, 2012 156:JC5-03; doi:10.1059/0003-4819-156-10-201205150-02003

  • Enoxaparin plus idrabiotaparinux was noninferior to enoxaparin plus warfarin for recurrent VTE in acute PE

    Ann Intern Med May 15, 2012 156:JC5-04; doi:10.1059/0003-4819-156-10-201205150-02004

  • Adding N-acetylcysteine to prednisolone reduced early mortality in severe alcoholic hepatitis

    Ann Intern Med May 15, 2012 156:JC5-05; doi:10.1059/0003-4819-156-10-201205150-02005

  • IV salbutamol increased mortality in patients with the acute respiratory distress syndrome

    Ann Intern Med May 15, 2012 156:JC5-06; doi:10.1059/0003-4819-156-10-201205150-02006

  • 2-cm and 4-cm surgical excision margins did not differ for survival in cutaneous melanoma > 2 mm thick

    Ann Intern Med May 15, 2012 156:JC5-07; doi:10.1059/0003-4819-156-10-201205150-02007

  • Review: Vitamin D supplementation improves some balance measures but not muscle strength in older adults

    Ann Intern Med May 15, 2012 156:JC5-08; doi:10.1059/0003-4819-156-10-201205150-02008

  • Review: Biologic agents increase short-term risk for some adverse events in conditions other than HIV or AIDS

    Ann Intern Med May 15, 2012 156:JC5-09; doi:10.1059/0003-4819-156-10-201205150-02009

  • Review: Limited evidence suggests that clobetasol or mometasone is effective in genital lichen sclerosus

    Ann Intern Med May 15, 2012 156:JC5-10; doi:10.1059/0003-4819-156-10-201205150-02010

  • SSRI use in late pregnancy was associated with increased persistent pulmonary hypertension in newborns

    Ann Intern Med May 15, 2012 156:JC5-11; doi:10.1059/0003-4819-156-10-201205150-02011

  • Educational messages on laboratory results improved diastolic BP but not systolic BP, HbA1c, or cholesterol in diabetes

    Ann Intern Med May 15, 2012 156:JC5-12; doi:10.1059/0003-4819-156-10-201205150-02012

  • A 5-item calculator predicted risk for postoperative respiratory failure

    Ann Intern Med May 15, 2012 156:JC5-13; doi:10.1059/0003-4819-156-10-201205150-02013

  • Glossary

    Ann Intern Med May 15, 2012 156:JC5-14; doi:10.1059/0003-4819-156-10-201205150-02014

This Issue

May 15, 2012; 156 (10)
  1. Original Research
  2. Updates
  3. Reviews
  4. Research and Reporting Methods
  5. Ideas and Opinions
  6. Editorials
  7. On Being a Doctor
  8. Letters
  9. Ad Libitum
  10. Summaries for Patients
  11. ACP Journal Club

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