Singh et al assessed whether use of electronic medical records to facilitate the transmission and availability of diagnostic imaging results eliminates the problem of missed findings. In a study of 1196 abnormal imaging result notifications, they found 92 (7.7%) without timely follow-up at 4 weeks. Nearly all abnormal results lacking timely follow-up were eventually found to have measurable clinical impact in terms of requiring further diagnostic testing or treatment. The authors suggest several multidisciplinary strategies to improve abnormal imaging result follow-up in electronic medical record systems.
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This modeling study used data from the recently reported trials of prostate-specific antigen (PSA) screening to estimate the absolute benefits and harms of annual PSA screening for men at varying ages (40, 50, 60, and 70 years) and level of risk based on family history (low, moderate, and high risk). For example, men aged 50 years (low risk) can reduce their chances of dying from prostate cancer over the next 10 years from approximately 0.6 per 1000 to 0.5 per 1000 by participating in screening over this time. Doing so increases their chances of having prostate cancer detected (and treated) from approximately 4 per 1000 to 19 per 1000. These data can be used in patient decision aids to inform men about the benefits and risks of PSA screening and can also be used by clinicians in clinical consultations with men considering screening.
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Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) often necessitate hospitalization and are associated with significant morbidity and mortality. A simple severity of illness score (BAP-65) was developed and validated based on a review of nearly 100 000 admissions for AECOPD. Patients receive points for elevated blood (B) urea nitrogen level, altered (A) mental status, increased pulse (P), and age older than 65 years. Patients with no risk points face a very low risk for both death or need for mechanical ventilation. The presence of all risk factors is associated with a more than 22% chance for death or need for mechanical ventilation. The use of this tool may facilitate medical decision making through making triage decision easier and may also be applied as an adjunct to clinical trials in the field of AECOPD management.
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Mullan et al conducted a pilot, cluster randomized trial of Diabetes Medication Choice, a decision aid that describes 5 antihyperglycemic drugs and their effect on weight change, hypoglycemia risk, other adverse effects, route and frequency of the medication, glucose self-monitoring demands, and impact on hemoglobin A1c (HbA1c). It is designed to be used in the clinical encounter by clinicians and their patients considering the addition of an antihyperglycemic medication. Twenty-one clinicians were randomized to use the decision aid during the clinical encounter and 19 to usual care and an educational pamphlet. Eighty-five patients participated in the trial: 48 in the decision aid arm and 37 in the usual care arm. Patients receiving the decision aid found the tool more helpful, had improved knowledge, and had more involvement in making decisions about diabetes medications. At 6 months, both groups had near-perfect medication use, with better adherence and persistence in the usual care group and no significant impact on HbA1c.
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This multicenter study assessed the effects of weight loss on obstructive sleep apnea (OSA) among 264 participants with obesity, type 2 diabetes, and OSA. Participants were randomized to Intensive Lifestyle Intervention (ILI) or Diabetes Support and Education (DSE). The ILI participants lost more weight at 1 year than did the DSE participants (11.1 kg vs 0.5 kg; P < .001). Relative to the DSE group, the ILI intervention was associated with a mean (SD) decrease in apnea-hypopnea index (AHI) of 9.7 (2.0) events per hour (P < .001). At 1 year, more than 3 times as many participants in the ILI than in the DSE group had total remission of their OSA, and the prevalence of severe OSA among ILI participants was half that of the DSE group. Initial AHI and weight loss were the strongest predictors of changes in AHI at 1 year (P < .01). Those with weight losses of 10 kg or more had the greatest reductions in AHI.
See page 1619
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2009;169(17):1550. doi:10.1001/archinternmed.2009.288