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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

Recommended Adult Immunization Schedule: United States, 2012.
Recommended Adult Immunization Schedule: United States, 2012. Ann Intern Med. 2012 Jan 31; Authors: PMID: 22298576 [PubMed - as supplied by publisher]
Adult Immunization 2012: Politics, Process, and Progress.
Fryhofer SA Adult Immunization 2012: Politics, Process, and Progress. Ann Intern Med. 2012 Jan 31; Authors: Fryhofer SA PMID: 22298575 [PubMed - as supplied by publisher]

Archives of Internal Medicine current issue

On Motivating Patients: A Picture, Even If Worth a Thousand Words, Is Not Enough [Editorial]
O'Malley, P. G. Mon, 23 Jan 2012 12:41:30 -0800

Positive Affect and Self-affirmation Are Beneficial, but Do They Facilitate Maintenance of Health-Behavior Change?: Comment on "A Randomized Controlled Trial of Positive-Affect Intervention and Medication Adherence in Hypertensive African Americans" [Invited Commentary]
Williams, G. C., Niemiec, C. P. Mon, 23 Jan 2012 12:41:20 -0800

Impact of Carotid Plaque Screening on Smoking Cessation and Other Cardiovascular Risk Factors: A Randomized Controlled Trial [Original Investigation]
Rodondi, N., Collet, T.-H., Nanchen, D., Locatelli, I., Depairon, M., Aujesky, D., Bovet, P., Cornuz, J. Mon, 23 Jan 2012 12:41:11 -0800
Background  Screening of peripheral atherosclerosis is increasingly used, but few trials have examined its clinical impact. We aimed to assess whether carotid plaque screening helps smokers to improve their health behaviors and cardiovascular risk factors. Methods  We randomly assigned 536 smokers aged 40 to 70 years to carotid plaque ultrasonographic screening (US group) vs no screening (control group) in addition to individual counseling and nicotine replacement therapy for all participants. Smokers with at least 1 plaque received pictures of their plaques with a 7-minute structured explanation. The outcomes included biochemically validated smoking cessation at 12 months (primary outcome) and changes in cardiovascular risk factor levels and Framingham risk score. Results  At baseline, participants (mean age, 51.1 years; 45.0% women) smoked an average of 20 cigarettes per day with a median duration of 32 years. The US group had a high prevalence of carotid plaques (57.9%). At 12 months, smoking cessation rates were high, but did not differ between the US and control groups (24.9% vs 22.1%; P = .45). In the US group, cessation rates did not differ according to the presence or absence of plaques. Control of cardiovascular risk factors (ie, blood pressure and low-density lipoprotein cholesterol and hemoglobin A1c levels in diabetic patients) and mean absolute risk change in Framingham risk score did not differ between the groups. The mean absolute risk change in Framingham risk score was +0.6 in the US group vs +0.3 in the control group (P = .56). Conclusion  In smokers, carotid plaque screening performed in addition to thorough smoking cessation counseling is not associated with increased rates of smoking cessation or control of cardiovascular risk factors. Trial Registration  clinicaltrials.gov Identifier: NCT00548665
Increasing Physical Activity in Patients With Asthma Through Positive Affect and Self-affirmation: A Randomized Trial [Original Investigation]
Mancuso, C. A., Choi, T. N., Westermann, H., Wenderoth, S., Hollenberg, J. P., Wells, M. T., Isen, A. M., Jobe, J. B., Allegrante, J. P., Charlson, M. E. Mon, 23 Jan 2012 12:40:59 -0800
Background  Patients with asthma engage in less physical activity than peers without asthma. Protocols are needed to prudently increase physical activity in asthma patients. We evaluated whether an educational intervention enhanced with positive affect induction and self-affirmation was more effective than the educational protocol alone in increasing physical activity in asthma patients. Methods  We conducted a randomized trial in New York City from September 28, 2004, through July 5, 2007; of 258 asthma patients, 252 completed the trial. At enrollment, control subjects completed a survey measuring energy expenditure, made a contract to increase physical activity, received a pedometer and an asthma workbook, and then underwent bimonthly follow-up telephone calls. Intervention patients received this protocol plus small gifts and instructions in fostering positive affect and self-affirmation. The main outcome was the within-patient change in energy expenditure in kilocalories per week from enrollment to 12 months with an intent-to-treat analysis. Results  Mean (SD) energy expenditure at enrollment was 1767 (1686) kcal/wk among controls and 1860 (1633) kcal/wk among intervention patients (P = .65) and increased by 415 (95% CI, 76-754; P = .02) and 398 (95% CI, 145-652; P = .002) kcal/wk, respectively, with no difference between groups (P = .94). For both groups, energy expenditure was sustained through 12 months. No adverse events were attributed to the trial. In multivariate analysis, increased energy expenditure was associated with less social support, decreased depressive symptoms, more follow-up calls, use of the pedometer, fulfillment of the contract, and the intervention among patients who required urgent asthma care (all P < .10, 2-sided test). Conclusions  A multiple-component protocol was effective in increasing physical activity in asthma patients, but an intervention to increase positive affect and self-affirmation was not effective within this protocol. The intervention may have had some benefit, however, in the subgroup of patients who required urgent asthma care during the trial. Trial Registration  clinicaltrials.gov Identifier: NCT00195117
Randomized Controlled Trial of Positive Affect Induction to Promote Physical Activity After Percutaneous Coronary Intervention [Original Investigation]
Peterson, J. C., Charlson, M. E., Hoffman, Z., Wells, M. T., Wong, S.-C., Hollenberg, J. P., Jobe, J. B., Boschert, K. A., Isen, A. M., Allegrante, J. P. Mon, 23 Jan 2012 12:40:50 -0800
Background  Within 1 year after percutaneous coronary intervention, more than 20% of patients experience new adverse events. Physical activity confers a 25% reduction in mortality; however, physical activity is widely underused. Thus, there is a need for more powerful behavioral interventions to promote physical activity. Our objective was to motivate patients to achieve an increase in expenditure of 336 kcal/wk or more at 12 months as assessed by the Paffenbarger Physical Activity and Exercise Index. Methods  Two hundred forty-two patients were recruited immediately after percutaneous coronary intervention between October 2004 and October 2006. Patients were randomized to 1 of 2 groups. The patient education (PE) control group (n = 118) (1) received an educational workbook, (2) received a pedometer, and (3) set a behavioral contract for a physical activity goal. The positive affect/self-affirmation (PA) intervention group (n = 124) received the 3 PE control components plus (1) a PA workbook chapter, (2) bimonthly induction of PA by telephone, and (3) small mailed gifts. All patients were contacted with standardized bimonthly telephone follow-up for 12 months. Results  Attrition was 4.5%, and 2.1% of patients died. Significantly more patients in the PA intervention group increased expenditure by 336 kcal/wk or more at 12 months, our main outcome, compared with the PE control group (54.9% vs 37.4%, P = .007). The PA intervention patients were 1.7 times more likely to reach the goal of a 336-kcal/wk or more increase by 12 months, controlling for demographic and psychosocial measures. In multivariate analysis, the PA intervention patients had nearly double the improvement in kilocalories per week at 12 months compared with the PE control patients (602 vs 328, P = .03). Conclusion  Patients who receive PA intervention after percutaneous coronary intervention are able to achieve a sustained and clinically significant increase in physical activity by 12 months. Trial Registration  clinicaltrials.gov Identifier: NCT00248846
A Randomized Controlled Trial of Positive-Affect Intervention and Medication Adherence in Hypertensive African Americans [Original Investigation]
Ogedegbe, G. O., Boutin-Foster, C., Wells, M. T., Allegrante, J. P., Isen, A. M., Jobe, J. B., Charlson, M. E. Mon, 23 Jan 2012 12:40:34 -0800
Background  Poor adherence explains poor blood pressure (BP) control; however African Americans suffer worse hypertension-related outcomes. Methods  This randomized controlled trial evaluated whether a patient education intervention enhanced with positive-affect induction and self-affirmation (PA) was more effective than patient education (PE) alone in improving medication adherence and BP reduction among 256 hypertensive African Americans followed up in 2 primary care practices. Patients in both groups received a culturally tailored hypertension self-management workbook, a behavioral contract, and bimonthly telephone calls designed to help them overcome barriers to medication adherence. Also, patients in the PA group received small gifts and bimonthly telephone calls to help them incorporate positive thoughts into their daily routine and foster self-affirmation. The main outcome measures were medication adherence (assessed with electronic pill monitors) and within-patient change in BP from baseline to 12 months. Results  The baseline characteristics were similar in both groups: the mean BP was 137/82 mm Hg; 36% of the patients had diabetes; 11% had stroke; and 3% had chronic kidney disease. Based on the intention-to-treat principle, medication adherence at 12 months was higher in the PA group than in the PE group (42% vs 36%, respectively; P  = .049). The within-group reduction in systolic BP (2.14 mm Hg vs 2.18 mm Hg; P  = .98) and diastolic BP (–1.59 mm Hg vs –0.78 mm Hg; P = .45) for the PA group and PE group, respectively, was not significant. Conclusions  A PE intervention enhanced with PA led to significantly higher medication adherence compared with PE alone in hypertensive African Americans. Future studies should assess the cost-effectiveness of integrating such interventions into primary care. Trial Registration  clinicaltrials.gov Identifier: NCT00227175
Effect of Aspirin on Vascular and Nonvascular Outcomes: Meta-analysis of Randomized Controlled Trials [Review Article]
Seshasai, S. R. K., Wijesuriya, S., Sivakumaran, R., Nethercott, S., Erqou, S., Sattar, N., Ray, K. K. Mon, 09 Jan 2012 12:41:49 -0800
Background  The net benefit of aspirin in prevention of CVD and nonvascular events remains unclear. Our objective was to assess the impact (and safety) of aspirin on vascular and nonvascular outcomes in primary prevention. Data Sources  MEDLINE, Cochrane Library of Clinical Trials (up to June 2011) and unpublished trial data from investigators. Study Selection  Nine randomized placebo-controlled trials with at least 1000 participants each, reporting on cardiovascular disease (CVD), nonvascular outcomes, or death were included. Data Extraction  Three authors abstracted data. Study-specific odds ratios (ORs) were combined using random-effects meta-analysis. Risks vs benefits were evaluated by comparing CVD risk reductions with increases in bleeding. Results  During a mean (SD) follow-up of 6.0 (2.1) years involving over 100 000 participants, aspirin treatment reduced total CVD events by 10% (OR, 0.90; 95% CI, 0.85-0.96; number needed to treat, 120), driven primarily by reduction in nonfatal MI (OR, 0.80; 95% CI, 0.67-0.96; number needed to treat, 162). There was no significant reduction in CVD death (OR, 0.99; 95% CI, 0.85-1.15) or cancer mortality (OR, 0.93; 95% CI, 0.84-1.03), and there was increased risk of nontrivial bleeding events (OR, 1.31; 95% CI, 1.14-1.50; number needed to harm, 73). Significant heterogeneity was observed for coronary heart disease and bleeding outcomes, which could not be accounted for by major demographic or participant characteristics. Conclusions  Despite important reductions in nonfatal MI, aspirin prophylaxis in people without prior CVD does not lead to reductions in either cardiovascular death or cancer mortality. Because the benefits are further offset by clinically important bleeding events, routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case-by-case basis.
Reducing Inappropriate Urinary Catheter Use: A Statewide Effort [Original Investigation]
Fakih, M. G., Watson, S. R., Greene, M. T., Kennedy, E. H., Olmsted, R. N., Krein, S. L., Saint, S. Mon, 09 Jan 2012 12:41:40 -0800
Background  Indwelling urinary catheters may lead to both infectious and noninfectious complications and are often used in the hospital setting without an appropriate indication. The objective of this study was to evaluate the results of a statewide quality improvement effort to reduce inappropriate urinary catheter use. Methods  Retrospective analysis of data collected between 2007 and 2010 as part of a statewide collaborative initiative before, during, and after an educational intervention promoting adherence to appropriate urinary catheter indications. The data were collected from 163 inpatient units in 71 participating Michigan hospitals. The intervention consisted of educating clinicians about the appropriate indications for urinary catheter use and promoting the daily assessment of urinary catheter necessity during daily nursing rounds. The main outcome measures were change in prevalence of urinary catheter use and adherence to appropriate indications. We used flexible generalized estimating equation (GEE) and multilevel methods to estimate rates over time while accounting for the clustering of patients within hospital units. Results  The urinary catheter use rate decreased from 18.1% (95% CI, 16.8%-19.6%) at baseline to 13.8% (95% CI, 12.9%-14.8%) at end of year 2 (P < .001). The proportion of catheterized patients with appropriate indications increased from 44.3% (95% CI, 40.3%-48.4%) to 57.6% (95% CI, 51.7%-63.4%) by the end of year 2 (P = .005). Conclusions  A statewide effort to reduce inappropriate urinary catheter use was associated with a significant reduction in catheter use and improved compliance with appropriate use. The effect of the intervention was sustained for at least 2 years.
Aspirin Therapy in Primary Prevention: To Use or Not to Use?: Comment on "Effect of Aspirin on Vascular and Nonvascular Outcomes" [Invited Co Subscribe to Publications RSS feed