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October 2016 - January 1908

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March 14, 2011, Vol 171, No. 5, Pages 365-478

Editorial

Time to Rethink the Timing of Dialysis Initiation

Abstract Full Text
Arch Intern Med. 2011;171(5):382-383. doi:10.1001/archinternmed.2010.413
Original Investigation

Early Start of Hemodialysis May Be Harmful

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Arch Intern Med. 2011;171(5):396-403. doi:10.1001/archinternmed.2010.415
BackgroundA dramatic increase in the “early start” of dialysis with an estimated glomerular filtration rate (eGFR) at least 10 mL/min/1.73 m2 has occurred in the United States since at least 1996. Several recent studies have reported a comorbidity-adjusted survival disadvantage of early start of dialysis. The current study examines a relatively “healthy” dialysis cohort to minimize confounding issues and determine whether early initiation of hemodialysis is associated with a survival benefit or harm.MethodsWe examined demographics, year of dialysis initiation, primary etiology of renal failure, and body mass index, hemoglobin, and serum albumin levels in 81 176 nondiabetic, 20- to 64-year-old, in-center incident hemodialysis patients with no reported comorbidity besides hypertension. We compared survival, using a piecewise proportional hazards model to estimate covariate-adjusted mortality hazard ratios (HRs) for eGFR at the time of initiation of dialysis. We also performed time-dependent adjusted analysis stratified by initial serum albumin levels lower than 2.5 g/dL, 2.5 to 3.49 g/dL, and 3.5 g/dL or higher (the “healthiest” group [HG]).ResultsUnadjusted 1-year mortality by eGFR ranged from 6.8% in the reference group (eGFR <5.0 mL/min/1.73 m2) to 20.1% in the highest eGFR group (≥15.0 mL/min/1.73 m2). Compared with the reference group, the HR for the HG was 1.27 (eGFR, 5.0-9.9 mL/min/1.73 m2), 1.53 (eGFR, 10.0-14.9 mL/min/1.73 m2), and 2.18 (eGFR ≥15.0 mL/min/1.73 m2) and ranged from 1.50 to 3.53 mL/min/1.73 m2 in the first year of dialysis for the early-start group.ConclusionThe increased HR during hemodialysis associated with early start in the healthiest group of patients undergoing dialysis indicates that early start of dialysis may be harmful.

Impact of Diabetes on Cardiovascular Disease Risk and All-Cause Mortality in Older MenInfluence of Age at Onset, Diabetes Duration, and Established and Novel Risk Factors

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Arch Intern Med. 2011;171(5):404-410. doi:10.1001/archinternmed.2011.2

Long-term Renal Outcomes of Patients With Type 1 Diabetes Mellitus and MicroalbuminuriaAn Analysis of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Cohort

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Arch Intern Med. 2011;171(5):412-420. doi:10.1001/archinternmed.2011.16

Collaborative Care of Opioid-Addicted Patients in Primary Care Using BuprenorphineFive-Year Experience

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Arch Intern Med. 2011;171(5):425-431. doi:10.1001/archinternmed.2010.541

Development and Validation of a Brief Cognitive Assessment ToolThe Sweet 16

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Arch Intern Med. 2011;171(5):432-437. doi:10.1001/archinternmed.2010.423
BackgroundCognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16.MethodsThe Sweet 16 was developed in a cohort from a large post–acute hospitalization study (n = 774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n = 709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).ResultsThe Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P < .001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P = .06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80% and a specificity of 70%, whereas an MMSE score of less than 24 showed a sensitivity of 64% and a specificity of 86% against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99% and a specificity of 72% in contrast to an MMSE score with a sensitivity of 87% and a specificity of 89%. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P = .03).ConclusionsThe Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.

Potentially Inappropriate Treatment of Urinary Tract Infections in Two Rhode Island Nursing Homes

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Arch Intern Med. 2011;171(5):438-443. doi:10.1001/archinternmed.2011.13

Association of Alcohol Intake With Pancreatic Cancer Mortality in Never Smokers

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Arch Intern Med. 2011;171(5):444-451. doi:10.1001/archinternmed.2010.536

Comparative Effectiveness of Goal Setting in Diabetes Mellitus Group ClinicsRandomized Clinical Trial

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Arch Intern Med. 2011;171(5):453-459. doi:10.1001/archinternmed.2011.70

The Effect of Guided Care Teams on the Use of Health ServicesResults From a Cluster-Randomized Controlled Trial

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Arch Intern Med. 2011;171(5):460-466. doi:10.1001/archinternmed.2010.540
Review Article

Antihypertensive Treatment and Development of Heart Failure in HypertensionA Bayesian Network Meta-analysis of Studies in Patients With Hypertension and High Cardiovascular Risk

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Arch Intern Med. 2011;171(5):384-394. doi:10.1001/archinternmed.2010.427
BackgroundIt is still debated whether there are differences among the various antihypertensive strategies in heart failure prevention. We performed a network meta-analysis of recent trials in hypertension aimed at investigating this issue.MethodsRandomized, controlled trials published from 1997 through 2009 in peer-reviewed journals indexed in the PubMed and EMBASE databases were selected. Selected trials included patients with hypertension or a high-risk population with a predominance of patients with hypertension.ResultsA total of 223 313 patients were enrolled in the selected studies. Network meta-analysis showed that diuretics (odds ratio [OR], 0.59; 95% credibility interval [CrI], 0.47-0.73), angiotensin-converting enzyme (ACE) inhibitors (OR, 0.71; 95% CrI, 0.59-0.85) and angiotensin II receptor blockers (ARBs) (OR, 0.76; 95% CrI, 0.62-0.90) represented the most efficient classes of drugs to reduce the heart failure onset compared with placebo. On the one hand, a diuretic-based therapy represented the best treatment because it was significantly more efficient than that based on ACE inhibitors (OR, 0.83; 95% CrI, 0.69-0.99) and ARBs (OR, 0.78; 95% CrI, 0.63-0.97). On the other hand, diuretics (OR, 0.71; 95% CrI, 0.60-0.86), ARBs (OR, 0.91; 95% CrI, 0.78-1.07), and ACE inhibitors (OR, 0.86; 95% CrI, 0.75-1.00) were superior to calcium channel blockers, which were among the least effective first-line agents in heart failure prevention, together with β-blockers and α-blockers.ConclusionsDiuretics represented the most effective class of drugs in preventing heart failure, followed by renin-angiotensin system inhibitors. Thus, our findings support the use of these agents as first-line antihypertensive strategy to prevent heart failure in patients with hypertension at risk to develop heart failure. Calcium channel blockers and β-blockers were found to be less effective in heart failure prevention.
Challenges in Clinical Electrocardiography

Tachycardia in a Patient With a Dual-Chamber Pacemaker

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Arch Intern Med. 2011;171(5):379-379. doi:10.1001/archinternmed.2011.59

Tachycardia in a Patient With a Dual-Chamber Pacemaker—Discussion

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Arch Intern Med. 2011;171(5):380-381. doi:10.1001/archinternmed.2011.60
Images From Our Readers

Swiss Alps at the base of the Eiger

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Arch Intern Med. 2011;171(5):451-451. doi:10.1001/archinternmed.2011.68
In This Issue of Archives of Internal Medicine

In This Issue of Archives of Internal Medicine

Abstract Full Text
Arch Intern Med. 2011;171(5):378-378. doi:10.1001/archinternmed.2011.42
Article

Errors in Figure in: A Randomized Trial of Internet and Telephone Treatment for Smoking Cessation

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Arch Intern Med. 2011;171(5):395-395. doi:10.1001/archinternmed.2011.65

Error in Figure in: The Comparative Safety of Analgesics in Older Adults With Arthritis

Abstract Full Text
Arch Intern Med. 2011;171(5):403-403. doi:10.1001/archinternmed.2011.28
Research Letters

Potential Savings From Greater Use of $4 Generic Drugs

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Arch Intern Med. 2011;171(5):468-469. doi:10.1001/archinternmed.2011.46

The Impact of Medical School Oaths and Other Professional Codes of Ethics: Results of a National Physician Survey

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Arch Intern Med. 2011;171(5):469-471. doi:10.1001/archinternmed.2011.47
Editor's Correspondence

Considering Selection Bias When Developing a Search Strategy

Abstract Full Text
Arch Intern Med. 2011;171(5):471-472. doi:10.1001/archinternmed.2011.45

Network Meta-analysis of Heart Failure Prevention by Antihypertensive Drugs

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Arch Intern Med. 2011;171(5):472-473. doi:10.1001/archinternmed.2011.44

Network Meta-analysis of Heart Failure Prevention by Antihypertensive Drugs—Reply

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Arch Intern Med. 2011;171(5):472-473. doi:10.1001/archinternmed.2011.58

Time to Change the Paradigm—From “Potentially Inappropriate” to Real Patient Harms

Abstract Full Text
Arch Intern Med. 2011;171(5):473-474. doi:10.1001/archinternmed.2011.48

Time to Change the Paradigm—From “Potentially Inappropriate” to Real Patient Harms—Reply

Abstract Full Text
Arch Intern Med. 2011;171(5):473-474. doi:10.1001/archinternmed.2011.49

Patient-Centered Care Means Better Health Care

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Arch Intern Med. 2011;171(5):474-475. doi:10.1001/archinternmed.2011.50

Mediators of Patient-Physician Communication Discrepancies

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Arch Intern Med. 2011;171(5):475-476. doi:10.1001/archinternmed.2011.51

Mediators of Patient-Physician Communication Discrepancies—Reply

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Arch Intern Med. 2011;171(5):475-476. doi:10.1001/archinternmed.2011.52

Dietary Supplements: Safety Issues and Quality Control

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Arch Intern Med. 2011;171(5):476-477. doi:10.1001/archinternmed.2011.53

Dietary Supplements: Safety Issues and Quality Control—Reply

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Arch Intern Med. 2011;171(5):476-477. doi:10.1001/archinternmed.2011.54

Survivor Bias in Early- vs Late-Start Hemodialysis Studies

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Arch Intern Med. 2011;171(5):477-478. doi:10.1001/archinternmed.2011.55

Survivor Bias in Early- vs Late-Start Hemodialysis Studies—Reply

Abstract Full Text
Arch Intern Med. 2011;171(5):477-478. doi:10.1001/archinternmed.2011.66
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