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October 2016 - January 1908

Decade

Year

Issue

January 24, 2011, Vol 171, No. 2, Pages 104-182

Editorial

Choice of Dialysis Modality in the United States

Abstract Full Text
Arch Intern Med. 2011;171(2):107-109. doi:10.1001/archinternmed.2010.370
Original Investigation

Similar Outcomes With Hemodialysis and Peritoneal Dialysis in Patients With End-Stage Renal Disease

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Arch Intern Med. 2011;171(2):110-118. doi:10.1001/archinternmed.2010.352
BackgroundThe annual payer costs for patients treated with peritoneal dialysis (PD) are lower than with hemodialysis (HD), but in 2007, only 7% of dialysis patients in the United States were treated with PD. Since 1996, there has been no change in the first-year mortality of HD patients, but both short- and long-term outcomes of PD patients have improved.MethodsData from the US Renal Data System were examined for secular trends in survival among patients treated with HD and PD on day 90 of end-stage renal disease (HD, 620 020 patients; PD, 64 406 patients) in three 3-year cohorts (1996-1998, 1999-2001, and 2002-2004) for up to 5 years of follow-up using a nonproportional hazards marginal structural model with inverse probability of treatment and censoring weighting.ResultsThere was a progressive attenuation in the higher risk for death seen in patients treated with PD in earlier cohorts; for the 2002-2004 cohort, there was no significant difference in the risk of death for HD and PD patients through 5 years of follow-up. The median life expectancy of HD and PD patients was 38.4 and 36.6 months, respectively. Analyses in 8 subgroups based on age (<65 and ≥65 years), diabetic status, and baseline comorbidity (none and ≥1) showed greater improvement in survival among patients treated with PD relative to HD at all follow-up periods.ConclusionIn the most recent cohorts, patients who began treatment with HD or PD have similar outcomes.

Patient Awareness and Initiation of Peritoneal Dialysis

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Arch Intern Med. 2011;171(2):119-124. doi:10.1001/archinternmed.2010.361
BackgroundFew US patients with kidney failure start treatment on peritoneal dialysis (PD) despite its potential survival, quality of life, and cost-saving benefits. We investigated patient awareness of PD and variables associated with PD selection, including dialysis unit ownership and geographic area.MethodsIn a cohort study, incident dialysis patients identified by the Centers for Medicare and Medicaid Services (CMS) and included in the United States Renal Data System (USRDS) were surveyed from 2005 to 2007 for the USRDS Comprehensive Dialysis Study. Participants reported whether PD had been discussed with them before they started regular treatment for kidney failure, and initial dialysis modality was verified in the USRDS patient registry.ResultsThe proportion of patients in our study cohort who reported that PD had been discussed with them (61%) was higher than in previous surveys, but only 10.9% of informed patients initiated PD. With patient demographic and clinical characteristics controlled for, the proportion of informed patients who started PD differed substantially across large dialysis organizations. Substantial variation in selection of PD was also evident among patients starting dialysis in the 18 end-stage renal disease Network areas.ConclusionsDespite patients' early awareness of PD as a treatment option, PD selection was low in this national cohort. Factors associated with PD selection merit continued study as CMS seeks to improve quality and cost-effectiveness of kidney patient care.

Cigarette Smoking and the Incidence of Breast Cancer

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Arch Intern Med. 2011;171(2):125-133. doi:10.1001/archinternmed.2010.503

Randomized Controlled Trial of Cognitive Behavioral Therapy vs Standard Treatment to Prevent Recurrent Cardiovascular Events in Patients With Coronary Heart DiseaseSecondary Prevention in Uppsala Primary Health Care Project (SUPRIM)

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Arch Intern Med. 2011;171(2):134-140. doi:10.1001/archinternmed.2010.510

Albuminuria and Decline in Cognitive FunctionThe ONTARGET/TRANSCEND Studies

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Arch Intern Med. 2011;171(2):142-150. doi:10.1001/archinternmed.2010.502

Risk of Influenza-Like Illness in an Acute Health Care Setting During Community Influenza Epidemics in 2004-2005, 2005-2006, and 2006-2007A Prospective Study

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Arch Intern Med. 2011;171(2):151-157. doi:10.1001/archinternmed.2010.500

Immunization Disparities by Hispanic Ethnicity and Language Preference

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Arch Intern Med. 2011;171(2):158-165. doi:10.1001/archinternmed.2010.499

Current and Potential Usefulness of Pneumococcal Urinary Antigen Detection in Hospitalized Patients With Community-Acquired Pneumonia to Guide Antimicrobial Therapy

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Arch Intern Med. 2011;171(2):166-172. doi:10.1001/archinternmed.2010.347
BackgroundThe role of pneumococcal urinary antigen detection in the treatment of adults with community-acquired pneumonia (CAP) is not well defined. We assessed the usefulness of pneumococcal urinary antigen detection in the diagnosis and antimicrobial guidance in patients hospitalized with CAP.MethodsA prospective study of all adults hospitalized with CAP was performed from February 2007 through January 2008. To evaluate the accuracy of the test, we calculated its sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. The gold standard used for diagnosis of pneumococcal pneumonia was isolation in blood or pleural fluid (definite diagnosis) and isolation in sputum (probable diagnosis). Antibiotic modifications, complications, and mortality were analyzed.ResultsA total of 474 episodes of CAP were included. Streptococcus pneumoniae was the causative pathogen in 171 cases (36.1%). It was detected exclusively by urinary antigen test in 75 cases (43.8%). Sixty-nine patients had CAP caused by a pathogen other than S pneumoniae. Specificity was 96%, positive predictive value ranged from 88.8% to 96.5%, and the positive likelihood ratio ranged from 14.6 to 19.9. The results of the test led the clinicians to reduce the spectrum of antibiotics in 41 patients. Pneumonia was cured in all of them. Potentially, this optimization would be possible in the 75 patients diagnosed exclusively by the test.ConclusionWhen its findings are positive, the pneumococcal urinary antigen test is a useful tool in the treatment of hospitalized adult patients with CAP because it may allow the clinician to optimize antimicrobial therapy with good clinical outcomes.
Images From Our Readers

Big Sur, California

Abstract Full Text
Arch Intern Med. 2011;171(2):133-133. doi:10.1001/archinternmed.2010.516
In This Issue of Archives of Internal Medicine

In This Issue of Archives of Internal Medicine

Abstract Full Text
Arch Intern Med. 2011;171(2):106-106. doi:10.1001/archinternmed.2010.497
Article

Error in Wording in: Suboptimal Potassium Intake and Potential Impact on Population Blood Pressure

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Arch Intern Med. 2011;171(2):165-165. doi:10.1001/archinternmed.2010.471
Commentary

Maintenance of Certification in Internal MedicineFacts and Misconceptions

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Arch Intern Med. 2011;171(2):174-176. doi:10.1001/archinternmed.2010.477
Research Letters

Surrogate Consent for Percutaneous Endoscopic Gastrostomy

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Arch Intern Med. 2011;171(2):178-182. doi:10.1001/archinternmed.2010.494
Editor's Correspondence

Analytical Issues Regarding Rosiglitazone Meta-analysis

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Arch Intern Med. 2011;171(2):179-180. doi:10.1001/archinternmed.2010.508

Analytical Issues Regarding Rosiglitazone Meta-analysis—Reply

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Arch Intern Med. 2011;171(2):179-180. doi:10.1001/archinternmed.2010.509

Where Do Diagnostic Adverse Events Come From?

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Arch Intern Med. 2011;171(2):180-181. doi:10.1001/archinternmed.2010.504

Where Do Diagnostic Adverse Events Come From?—Reply

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Arch Intern Med. 2011;171(2):180-181. doi:10.1001/archinternmed.2010.505

Lack of Evaluation of the Effects of Single Preventive Measures for Falling

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Arch Intern Med. 2011;171(2):181-182. doi:10.1001/archinternmed.2010.506

Lack of Evaluation of the Effects of Single Preventive Measures for Falling—Reply

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Arch Intern Med. 2011;171(2):181-182. doi:10.1001/archinternmed.2010.507
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