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Current Opinion in Internal Medicine - Current Table Of Contents
Breastfeeding and allergies: time for a change in paradigm?.
Page: 539DOI: 10.1097/MCI.0b013e32831dae43Authors: Duncan, Joanne M; Sears, Malcolm R
New aspects in allergic contact dermatitis.
Page: 547DOI: 10.1097/MCI.0b013e32831dae50Authors: Mortz, Charlotte Gotthard; Andersen, Klaus Ejner
Contemporary approaches to the identification of athletes at risk for sudden cardiac death.
Page: 552DOI: 10.1097/MCI.0b013e32831daee4Authors: Drezner, Jonathan A
pubmed: 0003-4819
Hypomagnesemia Induced by Several Proton-Pump Inhibitors.
Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW Hypomagnesemia Induced by Several Proton-Pump Inhibitors. Ann Intern Med. 2009 Nov 17;151(10):755-756 Authors: Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW PMID: 19920278 [PubMed - as supplied by publisher]
Similarities and Differences Between REPEAT and EPIC3.
Poynard T, Shiff E Similarities and Differences Between REPEAT and EPIC3. Ann Intern Med. 2009 Nov 17;151(10):754 Authors: Poynard T, Shiff E PMID: 19920277 [PubMed - as supplied by publisher]
Evidence-Based Breast Cancer Prevention: The Importance of Individual Risk.
Kerlikowske K Evidence-Based Breast Cancer Prevention: The Importance of Individual Risk. Ann Intern Med. 2009 Nov 17;151(10):750-752 Authors: Kerlikowske K PMID: 19920276 [PubMed - as supplied by publisher]
Handy Point-of-Care Decision Support.
Rothschild JM Handy Point-of-Care Decision Support. Ann Intern Med. 2009 Nov 17;151(10):748-749 Authors: Rothschild JM PMID: 19920275 [PubMed - as supplied by publisher]
Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms.
Mandelblatt JS, Cronin KA, Bailey S, Berry DA, de Koning HJ, Draisma G, Huang H, Lee SJ, Munsell M, Plevritis SK, Ravdin P, Schechter CB, Sigal B, Stoto MA, Stout NK, van Ravesteyn NT, Venier J, Zelen M, Feuer EJ, Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms. Ann Intern Med. 2009 Nov 17;151(10):738-747 Authors: Mandelblatt JS, Cronin KA, Bailey S, Berry DA, de Koning HJ, Draisma G, Huang H, Lee SJ, Munsell M, Plevritis SK, Ravdin P, Schechter CB, Sigal B, Stoto MA, Stout NK, van Ravesteyn NT, Venier J, Zelen M, Feuer EJ, Background: Despite trials of mammography and widespread use, optimal screening policy is controversial. Objective: To evaluate U.S. breast cancer screening strategies. Design: 6 models using common data elements. Data Sources: National data on age-specific incidence, competing mortality, mammography characteristics, and treatment effects. Target Population: A contemporary population cohort. Time Horizon: Lifetime. Perspective: Societal. Interventions: 20 screening strategies with varying initiation and cessation ages applied annually or biennially. Outcome Measures: Number of mammograms, reduction in deaths from breast cancer or life-years gained (vs. no screening), false-positive results, unnecessary biopsies, and overdiagnosis. Results of Base-Case Analysis: The 6 models produced consistent rankings of screening strategies. Screening biennially maintained an average of 81% (range across strategies and models, 67% to 99%) of the benefit of annual screening with almost half the number of false-positive results. Screening biennially from ages 50 to 69 years achieved a median 16.5% (range, 15% to 23%) reduction in breast cancer deaths versus no screening. Initiating biennial screening at age 40 years (vs. 50 years) reduced mortality by an additional 3% (range, 1% to 6%), consumed more resources, and yielded more false-positive results. Biennial screening after age 69 years yielded some additional mortality reduction in all models, but overdiagnosis increased most substantially at older ages. Results of Sensitivity Analysis: Varying test sensitivity or treatment patterns did not change conclusions. Limitation: Results do not include morbidity from false-positive results, patient knowledge of earlier diagnosis, or unnecessary treatment. Conclusion: Biennial screening achieves most of the benefit of annual screening with less harm. Decisions about the best strategy depend on program and individual objectives and the weight placed on benefits, harms, and resource considerations. Primary Funding Source: National Cancer Institute. PMID: 19920274 [PubMed - as supplied by publisher]
Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force.
Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009 Nov 17;151(10):727-737 Authors: Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L Background: This systematic review is an update of evidence since the 2002 U.S. Preventive Services Task Force recommendation on breast cancer screening. Purpose: To determine the effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women aged 40 to 49 years and 70 years or older, the effectiveness of clinical breast examination and breast self-examination, and the harms of screening. Data Sources: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2008), MEDLINE (January 2001 to December 2008), reference lists, and Web of Science searches for published studies and Breast Cancer Surveillance Consortium for screening mammography data. Study Selection: Randomized, controlled trials with breast cancer mortality outcomes for screening effectiveness, and studies of various designs and multiple data sources for harms. Data Extraction: Relevant data were abstracted, and study quality was rated by using established criteria. Data Synthesis: Mammography screening reduces breast cancer mortality by 15% for women aged 39 to 49 years (relative risk, 0.85 [95% credible interval, 0.75 to 0.96]; 8 trials). Data are lacking for women aged 70 years or older. Radiation exposure from mammography is low. Patient adverse experiences are common and transient and do not affect screening practices. Estimates of overdiagnosis vary from 1% to 10%. Younger women have more false-positive mammography results and additional imaging but fewer biopsies than older women. Trials of clinical breast examination are ongoing; trials for breast self-examination showed no reductions in mortality but increases in benign biopsy results. Limitation: Studies of older women, digital mammography, and magnetic resonance imaging are lacking. Conclusion: Mammography screening reduces breast cancer mortality for women aged 39 to 69 years; data are insufficient for older women. False-positive mammography results and additional imaging are common. No benefit has been shown for clinical breast examination or breast self-examination. Primary Funding Source: Agency for Healthcare Research and Quality. PMID: 19920273 [PubMed - as supplied by publisher]
Archives of Internal Medicine current issue
Is It Time to Eliminate Consultation Codes?: An Analysis of Impact and Rationale [Special Article]
Shalowitz, J. I.Background As issues of health care cost escalation and parity of payment between primary care and other physicians have become more important, one proposal has been to eliminate consultation codes. Little is known about the current payment accuracy or financial impact of such a change.Methods To assess the impact of consultation code elimination, 2 assessments were conducted. First, from June 1, 2008, to July 1, 2009, 500 consecutive referrals from primary care physicians to other specialists were reviewed and matched with claims for accuracy of coding and billing. Second, to evaluate the financial impact of this change, year 2007 data on outpatient consultations from the Centers for Medicare and Medicaid Services were reviewed.Results Of the 500 claims reviewed, 466 were appropriate for analysis. Overall, the coding error rate was 32.4%. When the requesting physician ordered a consultation, the error rate was 5.5%; however, with lower paid referral requests, the error rate was 78.0%. Changing ambulatory consultation codes to those for new patient visits would save Medicare $534.5 million per year.Conclusions Consultation codes are being billed erroneously at a high rate. Furthermore, the differential cost to Medicare of these codes over those for new patient evaluation and management codes is over half a billion dollars per year. With the growing needs for cost savings as well as encouraging payment parity for cognitive services for primary care physicians, it is time these codes are reevaluated.Published online November 9, 2009 (doi:10.1001/archinternmed.2009.446).
About This Journal [About This Journal]
In This Issue of Archives of Internal Medicine [In This Issue of Archives of Internal Medicine]
Orienting Health Care Reform Around Universal Access [Commentary]
Cerise, F. P., Chokshi, D. A.
Controlling Health Care Costs in Massachusetts After Health Care Reform: There Is No Silver Bullet [Editorial]
Bigby, J.
Emergency Care: The Increasing Weight of Increasing Waits [Editorial]
Hsia, R. Y., Tabas, J. A.
Treatment of Polymyalgia Rheumatica: A Systematic Review [Review Article]
Hernandez-Rodriguez, J., Cid, M. C., Lopez-Soto, A., Espigol-Frigole, G., Bosch, X. Background Polymyalgia rheumatica (PMR) treatment is based on low-dose glucocorticoids. Glucocorticoid-sparing agents have also been tested. Our objective was to systematically examine the peer-reviewed literature on PMR therapy, particularly the optimal glucocorticoid type, starting doses, and subsequent reduction regimens as well as glucocorticoid-sparing medications. Methods We searched Cochrane Databases and MEDLINE (1957 through December 2008) for English-language articles on PMR treatment (randomized trials, prospective cohorts, case-control trials, and case series) that included 20 or more patients. All data on study design, PMR definition criteria, medical therapy, and disease outcomes were collected using a standardized protocol. Results Thirty studies (13 randomized trials and 17 observational studies) were analyzed. No meta-analyses or systematic reviews were found. The PMR definition criteria, treatment protocols, and outcome measures differed widely among the trials. Starting prednisone doses higher than 10 mg/d were associated with fewer relapses and shorter therapy than were lower doses; starting prednisone doses of 15 mg/d or lower were associated with lower cumulative glucocorticoid doses than were higher starting prednisone doses; and starting p
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Breastfeeding and allergies: time for a change in paradigm?.
Page: 539DOI: 10.1097/MCI.0b013e32831dae43Authors: Duncan, Joanne M; Sears, Malcolm R
New aspects in allergic contact dermatitis.
Page: 547DOI: 10.1097/MCI.0b013e32831dae50Authors: Mortz, Charlotte Gotthard; Andersen, Klaus Ejner
Contemporary approaches to the identification of athletes at risk for sudden cardiac death.
Page: 552DOI: 10.1097/MCI.0b013e32831daee4Authors: Drezner, Jonathan A
pubmed: 0003-4819
Hypomagnesemia Induced by Several Proton-Pump Inhibitors.
Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW Hypomagnesemia Induced by Several Proton-Pump Inhibitors. Ann Intern Med. 2009 Nov 17;151(10):755-756 Authors: Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW PMID: 19920278 [PubMed - as supplied by publisher]
Similarities and Differences Between REPEAT and EPIC3.
Poynard T, Shiff E Similarities and Differences Between REPEAT and EPIC3. Ann Intern Med. 2009 Nov 17;151(10):754 Authors: Poynard T, Shiff E PMID: 19920277 [PubMed - as supplied by publisher]
Evidence-Based Breast Cancer Prevention: The Importance of Individual Risk.
Kerlikowske K Evidence-Based Breast Cancer Prevention: The Importance of Individual Risk. Ann Intern Med. 2009 Nov 17;151(10):750-752 Authors: Kerlikowske K PMID: 19920276 [PubMed - as supplied by publisher]
Handy Point-of-Care Decision Support.
Rothschild JM Handy Point-of-Care Decision Support. Ann Intern Med. 2009 Nov 17;151(10):748-749 Authors: Rothschild JM PMID: 19920275 [PubMed - as supplied by publisher]
Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms.
Mandelblatt JS, Cronin KA, Bailey S, Berry DA, de Koning HJ, Draisma G, Huang H, Lee SJ, Munsell M, Plevritis SK, Ravdin P, Schechter CB, Sigal B, Stoto MA, Stout NK, van Ravesteyn NT, Venier J, Zelen M, Feuer EJ, Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms. Ann Intern Med. 2009 Nov 17;151(10):738-747 Authors: Mandelblatt JS, Cronin KA, Bailey S, Berry DA, de Koning HJ, Draisma G, Huang H, Lee SJ, Munsell M, Plevritis SK, Ravdin P, Schechter CB, Sigal B, Stoto MA, Stout NK, van Ravesteyn NT, Venier J, Zelen M, Feuer EJ, Background: Despite trials of mammography and widespread use, optimal screening policy is controversial. Objective: To evaluate U.S. breast cancer screening strategies. Design: 6 models using common data elements. Data Sources: National data on age-specific incidence, competing mortality, mammography characteristics, and treatment effects. Target Population: A contemporary population cohort. Time Horizon: Lifetime. Perspective: Societal. Interventions: 20 screening strategies with varying initiation and cessation ages applied annually or biennially. Outcome Measures: Number of mammograms, reduction in deaths from breast cancer or life-years gained (vs. no screening), false-positive results, unnecessary biopsies, and overdiagnosis. Results of Base-Case Analysis: The 6 models produced consistent rankings of screening strategies. Screening biennially maintained an average of 81% (range across strategies and models, 67% to 99%) of the benefit of annual screening with almost half the number of false-positive results. Screening biennially from ages 50 to 69 years achieved a median 16.5% (range, 15% to 23%) reduction in breast cancer deaths versus no screening. Initiating biennial screening at age 40 years (vs. 50 years) reduced mortality by an additional 3% (range, 1% to 6%), consumed more resources, and yielded more false-positive results. Biennial screening after age 69 years yielded some additional mortality reduction in all models, but overdiagnosis increased most substantially at older ages. Results of Sensitivity Analysis: Varying test sensitivity or treatment patterns did not change conclusions. Limitation: Results do not include morbidity from false-positive results, patient knowledge of earlier diagnosis, or unnecessary treatment. Conclusion: Biennial screening achieves most of the benefit of annual screening with less harm. Decisions about the best strategy depend on program and individual objectives and the weight placed on benefits, harms, and resource considerations. Primary Funding Source: National Cancer Institute. PMID: 19920274 [PubMed - as supplied by publisher]
Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force.
Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009 Nov 17;151(10):727-737 Authors: Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L Background: This systematic review is an update of evidence since the 2002 U.S. Preventive Services Task Force recommendation on breast cancer screening. Purpose: To determine the effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women aged 40 to 49 years and 70 years or older, the effectiveness of clinical breast examination and breast self-examination, and the harms of screening. Data Sources: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2008), MEDLINE (January 2001 to December 2008), reference lists, and Web of Science searches for published studies and Breast Cancer Surveillance Consortium for screening mammography data. Study Selection: Randomized, controlled trials with breast cancer mortality outcomes for screening effectiveness, and studies of various designs and multiple data sources for harms. Data Extraction: Relevant data were abstracted, and study quality was rated by using established criteria. Data Synthesis: Mammography screening reduces breast cancer mortality by 15% for women aged 39 to 49 years (relative risk, 0.85 [95% credible interval, 0.75 to 0.96]; 8 trials). Data are lacking for women aged 70 years or older. Radiation exposure from mammography is low. Patient adverse experiences are common and transient and do not affect screening practices. Estimates of overdiagnosis vary from 1% to 10%. Younger women have more false-positive mammography results and additional imaging but fewer biopsies than older women. Trials of clinical breast examination are ongoing; trials for breast self-examination showed no reductions in mortality but increases in benign biopsy results. Limitation: Studies of older women, digital mammography, and magnetic resonance imaging are lacking. Conclusion: Mammography screening reduces breast cancer mortality for women aged 39 to 69 years; data are insufficient for older women. False-positive mammography results and additional imaging are common. No benefit has been shown for clinical breast examination or breast self-examination. Primary Funding Source: Agency for Healthcare Research and Quality. PMID: 19920273 [PubMed - as supplied by publisher]
Archives of Internal Medicine current issue
Is It Time to Eliminate Consultation Codes?: An Analysis of Impact and Rationale [Special Article]
Shalowitz, J. I.Background As issues of health care cost escalation and parity of payment between primary care and other physicians have become more important, one proposal has been to eliminate consultation codes. Little is known about the current payment accuracy or financial impact of such a change.Methods To assess the impact of consultation code elimination, 2 assessments were conducted. First, from June 1, 2008, to July 1, 2009, 500 consecutive referrals from primary care physicians to other specialists were reviewed and matched with claims for accuracy of coding and billing. Second, to evaluate the financial impact of this change, year 2007 data on outpatient consultations from the Centers for Medicare and Medicaid Services were reviewed.Results Of the 500 claims reviewed, 466 were appropriate for analysis. Overall, the coding error rate was 32.4%. When the requesting physician ordered a consultation, the error rate was 5.5%; however, with lower paid referral requests, the error rate was 78.0%. Changing ambulatory consultation codes to those for new patient visits would save Medicare $534.5 million per year.Conclusions Consultation codes are being billed erroneously at a high rate. Furthermore, the differential cost to Medicare of these codes over those for new patient evaluation and management codes is over half a billion dollars per year. With the growing needs for cost savings as well as encouraging payment parity for cognitive services for primary care physicians, it is time these codes are reevaluated.Published online November 9, 2009 (doi:10.1001/archinternmed.2009.446).
About This Journal [About This Journal]
In This Issue of Archives of Internal Medicine [In This Issue of Archives of Internal Medicine]
Orienting Health Care Reform Around Universal Access [Commentary]
Cerise, F. P., Chokshi, D. A.
Controlling Health Care Costs in Massachusetts After Health Care Reform: There Is No Silver Bullet [Editorial]
Bigby, J.
Emergency Care: The Increasing Weight of Increasing Waits [Editorial]
Hsia, R. Y., Tabas, J. A.
Treatment of Polymyalgia Rheumatica: A Systematic Review [Review Article]
Hernandez-Rodriguez, J., Cid, M. C., Lopez-Soto, A., Espigol-Frigole, G., Bosch, X. Background Polymyalgia rheumatica (PMR) treatment is based on low-dose glucocorticoids. Glucocorticoid-sparing agents have also been tested. Our objective was to systematically examine the peer-reviewed literature on PMR therapy, particularly the optimal glucocorticoid type, starting doses, and subsequent reduction regimens as well as glucocorticoid-sparing medications. Methods We searched Cochrane Databases and MEDLINE (1957 through December 2008) for English-language articles on PMR treatment (randomized trials, prospective cohorts, case-control trials, and case series) that included 20 or more patients. All data on study design, PMR definition criteria, medical therapy, and disease outcomes were collected using a standardized protocol. Results Thirty studies (13 randomized trials and 17 observational studies) were analyzed. No meta-analyses or systematic reviews were found. The PMR definition criteria, treatment protocols, and outcome measures differed widely among the trials. Starting prednisone doses higher than 10 mg/d were associated with fewer relapses and shorter therapy than were lower doses; starting prednisone doses of 15 mg/d or lower were associated with lower cumulative glucocorticoid doses than were higher starting prednisone doses; and starting p
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Annals of Internal Medicine: Information relevant to internal medicine and related fields. [Registration required for full text.] Includes past issues.Archives of Internal Medicine: Archives of Internal Medicine is a bi-monthly professional medical journal published by the American Medical Association. Archives of Internal Medicine publishes original, peer-reviewed manuscripts on a full spectrum of internal medicine topics including cardiovascular disease, geriatrics, infec...
British Medical Journal: The aims of the electronic version of the BMJ are to publish rigorous accessible information that will help doctors improve their practice and will influence the international debate on health.
Cerrahpasa Journal of Medicine: (ISSN 1300-5227), the official journal of the Cerrahpasa Medical Faculty, is published quarterly in Turkish with abstracts in English.
Iranian Journal of Medical Sciences: A quarterly journal published by Shiraz University of Medical Sciences.
Journal of the American Medical Association: JAMA, the Journal of the American Medical Association, is a highly cited weekly medical journal that publishes peer-reviewed new medical research findings and editorial opinions on a wide variety of topics important to clinical practice and biomedical science. JAMA has the largest circulation of ...
MedBioWorld: Links to Internal Medicine, Gastroenterology & Pulmonology Journals
Medical Journal of Australia: Australia's leading peer reviewed journal of medical practice and clinical research.
Medicine: Bimonthly journal covering the latest results in clinical investigation relevant to hospital and office practice.
Rangel Medical Library: Links to informative sites arranged by internal medicine specialty.
Southern Medical Journal: Southern Medical Association's monthly publication devoted to continuing medical education.
The New England Journal of Medicine: The New England Journal of Medicine (NEJM) is a weekly general medical journal that publishes new medical research findings, review articles, and editorial opinion on a wide variety of topics of importance to biomedical science and clinical practice.
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