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Any screening for coronary artery calcification (CAC) for primary prevention of cardiovascular disease (CVD) is still an unproven strategy to improve health outcomes. A brief summary of the evidence to date would conclude that CAC, measured with fast computed tomography (CT) protocols, is a valid marker of underlying atherosclerosis, correlates with the burden of coronary atherosclerosis, confers independent added prognostic value to conventional risk prediction, and may be valuable in refining risk prediction in such a way as to alter decision making about medical therapies (although, to my knowledge, there is no randomized trial evidence to prove this). However, there is ample reason to be wary of screening for CAC. First, we do not know whether it results in improved outcomes. One randomized trial that tested its motivational effect did not show any improvement on cardiovascular risk factors.
Archives of Internal Medicine (Medicina interna) - Gio, 17 Dicembre 2009
http://archinte.ama-assn.org/
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Accurate information on harms of medical interventions is essential for evidence-based practice. Most newly introduced treatments usually have small, incremental benefits, if any, against already available interventions, and differences in the profile of harms should play a key role on treatment choice. Randomized trials offer an excellent opportunity to evaluate harms of interventions using the most robust experimental design available in clinical research. However, several empirical evaluations (Table) have shown that many trials do not report harms or report them in a fragmented or suboptimal way. In this issue, an excellent study by Pitrou et al1 adds more evidence on this issue.
Archives of Internal Medicine (Medicina interna) - Ven, 30 Ottobre 2009
http://archinte.ama-assn.org/
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There has been a dramatic increase in the incidence of type 2 diabetes mellitus in developed countries during the last 50 years. In the United States, the prevalence of diabetes has increased from 0.9% in 1958 to 4.4% in 2000 and is projected to reach 7.2% by 2050.2 Diabetes causes substantial morbidity, disability, and mortality and is a major contributor to increased health care costs. In 2007, medical expenses related to diabetes totaled an astronomical $116 billion in the United States. We are therefore in great need of interventions to reduce the incidence of this disease
Archives of Internal Medicine (Medicina interna) - Ven, 16 Ottobre 2009
http://archinte.ama-assn.org/
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The concept of patient-centered care—that medical care providers should respect patients' preferences, wants, and needs; solicit patients' input into decisions; and customize treatment recommendations—is not new.
Archives of Internal Medicine (Medicina interna) - Lun, 5 Ottobre 2009
http://archinte.ama-assn.org/
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In this issue, in an article examining the association between hospitalists and performance on hospital-level quality indicators, López and colleagues1 found that hospitals with hospitalists have higher "quality of care" scores than those without hospitalists and attribute these improvements to the hospitalists' presence. This article provides interesting data, which unfortunately are not persuasive enough to support that conclusion.
Archives of Internal Medicine (Medicina interna) - Ven, 28 Agosto 2009
http://archinte.ama-assn.org/
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The critical appraisal of any medical test or strategy requires careful assessment of its potential risks, benefits, and costs. Accurate definition of the risks, benefits, and costs of the use of coronary artery calcium (CAC) scanning with computed tomography (CT) in asymptomatic individuals remains an elusive goal.
Archives of Internal Medicine (Medicina interna) - Lun, 20 Luglio 2009
http://archinte.ama-assn.org/
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The repercussion of alcohol abuse on pharmacological therapies in general has not been deeply studied yet, so a retrospective trial has been performed using the data of the large Veterans Affairs database, taking clinical information of about 20,000 patients treated with statins, anti-hypertensive drugs and oral glucose-lowering drugs.
MedNews (Medicina interna) - Ven, 29 Maggio 2009
http://mn.medsurfnews.com/
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New Policies Needed Now on Interactions Between Pharmaceutical Companies and Physicians.
Archives of Internal Medicine (Medicina interna) - Ven, 15 Maggio 2009
http://archinte.ama-assn.org/
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It has been almost a decade since the publication of To Err Is Human: Building a Safer Health System in 2000 and Crossing the Quality Chasm: A New Health System for the 21st Century in 2001. In the interim, it has become routine to decry the high cost and numerous deficiencies in the quality of health care delivery in the United States, so routine that the Archives of Internal Medicine editorial office has given lower priority to manuscripts that simply describe quality deficiencies.
Archives of Internal Medicine (Medicina interna) - Gio, 30 Aprile 2009
http://archinte.ama-assn.org/
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Physical activity promotion is a priority, but contribution of physicians' interventions is unclear. The effectiveness of the PEPAF ("Experimental Program for Physical Activity Promotion"), which was implemented exclusively by physicians in routine primary care from October 2003 to December 2004, was assessed.
Archives of Internal Medicine (Medicina interna) - Ven, 24 Aprile 2009
http://archinte.ama-assn.org/