Currently, the American Board of Internal Medicine requires recertifying internists to complete at least 1 practice improvement module (PIM). Simpkins et al undertook a cluster-randomized trial to determine whether completing an asthma-specific PIM improved care processes and/or disease outcomes. Participating physicians were randomized by practice to 1 of 2 study arms (completing an asthma-specific PIM or continued usual care). Following the intervention, there was no improvement in the primary outcome measure, inhaled corticosteroid fills; however, the authors observed lower self-reported asthma severity among patients seen by intervention group physicians. These findings provide the first evidence that practice improvement modules may improve disease outcomes.
Odden et al measured kidney function in the Fat Redistribution and Metabolic Change in HIV (human immunodeficiency virus) Infection (FRAM) study, a US population–based sample of HIV-infected individuals and HIV-negative controls. Kidney function was assessed by both creatinine and cystatin C measurements. Cystatin C is an alternative serum biomarker of kidney function that is more sensitive in detecting mild to moderate kidney disease compared with traditional creatinine-based measures. When measured by cystatin C, kidney function was substantially worse in HIV-infected persons. In contrast, creatinine levels were similar in the 2 groups. Cystatin C could be a useful clinical tool for detection of early kidney disease in HIV-infected persons.
Oxidative stress contributes to brain aging. Use of antioxidant vitamins, especially over the long term, might confer cognitive benefits. Grodstein et al added cognitive testing to the Physicians' Health Study II (PHSII), a randomized trial of beta carotene supplements (50 mg, every other day). The PHSII included participants continuing their original beta carotene assignment from the PHS (n = 4052; ages ≥65 years), begun in 1982, and newer recruits randomized as of 1998 (n = 1904; ages ≥65 years). Near the close of the beta carotene arm, the authors assessed general cognition, verbal memory, and category fluency. The authors found no effect of short-term treatment, but among continuing participants from the PHS (mean 18 years of treatment), significantly better overall cognition and verbal memory was found for the beta carotene group compared with the placebo group.
This randomized study examines and compares the effects of programs of walking and flexibility with and without strength training exercises, an education curriculum, and combining exercise and education on functional status, symptoms, and self-efficacy in 207 women with fibromyalgia. The 2 exercise groups and the combination group demonstrated improvements in physical, emotional and social function, pain, fatigue, depression, anxiety, and self-efficacy at completion of the 16-week interventions. The education-only group showed no changes. Overall, improvements were greatest in the exercise and education group. The exercise groups that included strength training with and without education maintained improvements in physical function for 6 months after completion of the group intervention. These findings suggest that an appropriate exercise program combined with patient education be included in the treatment of fibromyalgia.
This prospective monocentric observational study of 83 patients admitted for classic heat stroke, with a 2-year follow-up period, was conducted during the French heat wave (August 1-20, 2003) in Lyon, France. The 28-day and 2-year mortality were 58% and 71%, respectively. Mortality was influenced as early as admission by the level of fever and the number of organ dysfunctions. Multivariate analysis revealed an independent contribution to mortality if patients came from an institution, used long-term antihypertensive medication, or presented at admission with anuria, coma, or cardiovascular failure. Most surviving patients exhibited a dramatic alteration of their functional status at 1 and 2 years. Thus, heat stroke is associated with poor outcomes in temperate urban areas.
The greater the number of organ dysfunctions at the onset of heatstroke, the more survival decreased.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2007;167(20):2163. doi:10.1001/archinte.167.20.2163