 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
|
Articles 
Ramy A. Mahmoud, Gahan J. Pandina, Ibrahim Turkoz, Colette Kosik-Gonzalez, Carla M. Canuso, Mary J. Kujawa, and Georges M. Gharabawi-Garibaldi When patients with major depression do not respond to first-line monotherapy, physicians often add a second agent despite scant evidence that augmentation therapy is effective. Mahmoud and colleagues added a 6-week course of risperidone or placebo to the treatment of 274 adults with major depression who had not responded adequately to antidepressant monotherapy. Mean depression scale scores improved more in the risperidone group than the placebo group, and more risperidone recipients had response to therapy or remission. Somnolence and dry mouth were more common in risperidone recipients.
Wolfgang Stremmel, Robert Ehehalt, Frank Autschbach, and Max Karner In patients with chronic active ulcerative colitis, clinicians have few options when immunosuppressant drugs fail or cause intolerable side effects. Stremmel and associates randomly assigned 60 adults who had steroid-refractory chronic ulcerative colitis with continued symptoms or intolerable side effects during immunosuppressant drug therapy to receive phosphatidylcholine or placebo for 12 weeks. More phosphatidylcholine recipients than placebo recipients improved and could stop receiving corticosteroids. Bloating was more common with phosphatidylcholine than placebo.
Javier D. Finkielman, Peter A. Merkel, Darrell Schroeder, Gary S. Hoffman, Robert Spiera, E. William St. Clair, John C. Davis, Jr., W. Joseph McCune, Andrea K. Lears, Steven R. Ytterberg, Amber M. Hummel, Margaret A. Viss, Tobias Peikert, John H. Stone, Ulrich Specks for the WGET Research Group Serum antibodies that react with the neutral serine protease proteinase 3 in the cytoplasm of neutrophils (PR3-ANCA) are useful diagnostically because they are detectable in most patients with Wegener granulomatosis. The authors compared antibodies against the immature form of PR3 and the mature form as a measure of disease activity. In 156 patients with active disease, neither type of antibody was superior as a measure of disease activity. Moreover, decreases in PR3-ANCA levels were not associated with shorter time to remission, and increases in PR3-ANCA levels were not associated with relapse. Despite their diagnostic value, PR3-ANCA levels are not a useful guide to immunosuppressive therapy.
Improving Patient Care
Karin V. Rhodes, Richard M. Frankel, Naomi Levinthal, Elizabeth Prenoveau, Jeannine Bailey, and Wendy Levinson Victims of domestic abuse often seek care in emergency departments. Rhodes and associates analyzed audiotapes of 293 emergency department visits during which providers screened adult women for abuse. Providers' queries were often perfunctory and lacked follow-up probing or open-ended opportunities to talk. Of the 77 women who disclosed abuse, providers documented only 24 of the disclosures and referred only 19 women for counseling. Examples of interviews highlight common communication pitfalls and good practices.
Updates
Alpesh N. Amin and Michael J. Pistoria This Update in Hospital Medicine features 9 articles published in 2006. Topics include quality processes of inpatient care, transitions of care, perioperative consultation, venous thromboembolism, pay-for-performance, and education.
Position Papers
Wally R. Smith, Joseph R. Betancourt, Matthew K. Wynia, Jada Bussey-Jones, Valerie E. Stone, Christopher O. Phillips, Alicia Fernandez, Elizabeth Jacobs, and Jacqueline Bowles The Society of General Internal Medicine Health Disparities Task Force has developed curricular recommendations for health disparities. The broad goal is for learners to develop a commitment to eliminating inequities in health care quality. Specific goals include understanding the attitudes of practitioners and patients; finding ways to eliminate health disparities; and developing the skills to effectively communicate across cultures, languages, and literacy levels.
Clinical Guidelines
Amir Qaseem, Vincenza Snow, Paul Shekelle, Katherine Sherif, Timothy J. Wilt, Steven Weinberger, Douglas K. Owens for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians* In the United States, chronic obstructive pulmonary disease (COPD) affects more than 5% of the adult population and is the 4th leading cause of death and the 12th leading cause of morbidity. This guideline presents the available evidence on the diagnosis and management of COPD. The target audience is all physicians, and the target patient population is all adults with COPD.
Timothy J. Wilt, Dennis Niewoehner, Roderick MacDonald, and Robert L. Kane This systematic review evaluated the effectiveness of COPD management strategies. Long-acting inhaled therapies, supplemental oxygen, and pulmonary rehabilitation are beneficial in adults with bothersome respiratory symptoms and FEV1 less than 60%. Supplemental oxygen reduced mortality rates among symptomatic patients with resting hypoxia. Neither disease management programs nor ambulatory oxygen improved measured outcomes. The evidence on using spirometry to guide therapy is not strong enough to support a recommendation.
Editorials
Elaine J. Alpert The article by Rhodes and colleagues in this issue reminds us that the ability of most health professionals to effectively identify, assess, and respond to domestic violence has lagged far behind societal awareness and community responses. The candid and often unsettling examples of discussions with patients underscore the importance of sensitive inquiry about domestic violence, and their findings should awaken the medical community to its responsibility to improve education, training, and response to domestic violence.
George F. Sawaya and Harold C. Sox Among more than 45 000 women randomly assigned to conventional or liquid-based cervical cytology, the frequency of false-negative results was the same for both methods, but liquid-based cytology had a higher false-positive rate. Users of liquid-based cytology should reconsider their decision to adopt this technology.
On Being a Doctor
David W. Hines When Guillermo told me that he was thinking of ways to end it all, I wondered how I was going to deal with this. What he needed was a break from the realities of his terminal disease. What the doctor ordered was a home-cooked turkey dinner.
Letters Bridging Low-Molecular-Weight Heparin for Temporary Interruption of Warfarin
Elevated Creatinine Levels and Quality of Care in Heart Failure
New Tests for the Diagnosis of Latent Tuberculosis Infection
Aspirin and Nonsteroidal Anti-inflammatory Drugs for the Primary Prevention of Colorectal Cancer: Weighing the Evidence
Reversible Hepatic Decompensation in Primary Biliary Cirrhosis Due to Hypercoagulability
Correction: Benzodiazepines and Hip Fractures
Correction: Serum and Biliary Insulin-like Growth Factor I and Vascular Endothelial Growth Factor in Determing the Cause of Obstructive Cholestasis
Lisa June
Daniel B. Mendlovic
This issue provides a clinical overview of migraine, focusing on prevention and screening, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. | |||||||||||||||||||||||||||||||||||||||||||||
In this Issue
Articles
Previous Issue
