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April 11, 2011, Vol 171, No. 7, Pages 612-710

Editorial

Diagnostic Tests: Another Frontier for Less Is MoreOr Why Talking to Your Patient Is a Safe and Effective Method of Reassurance

Abstract Full Text
Arch Intern Med. 2011;171(7):619-619. doi:10.1001/archinternmed.2010.465
Original Investigation

Physicians Recommend Different Treatments for Patients Than They Would Choose for Themselves

Abstract Full Text
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Arch Intern Med. 2011;171(7):630-634. doi:10.1001/archinternmed.2011.91

Electronic Patient Messages to Promote Colorectal Cancer ScreeningA Randomized Controlled Trial

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Arch Intern Med. 2011;171(7):636-641. doi:10.1001/archinternmed.2010.467
BackgroundColorectal cancer is a leading cause of cancer mortality, yet effective screening tests are often underused. Electronic patient messages and personalized risk assessments delivered via an electronic personal health record could increase screening rates.MethodsWe conducted a randomized controlled trial in 14 ambulatory health centers involving 1103 patients ranging in age from 50 to 75 years with an active electronic personal health record who were overdue for colorectal cancer screening. Patients were randomly assigned to receive a single electronic message highlighting overdue screening status with a link to a Web-based tool to assess their personal risk of colorectal cancer. The outcomes included colorectal cancer screening rates at 1 and 4 months.ResultsScreening rates were higher at 1 month for patients who received electronic messages than for those who did not (8.3% vs 0.2%, P < .001), but this difference was no longer significant at 4 months (15.8% vs 13.1%, P = .18). Of 552 patients randomized to receive the intervention, 296 (54%) viewed the message, and 47 (9%) used the Web-based risk assessment tool. Among 296 intervention patients who viewed the electronic message, risk tool users were more likely than nonusers to request screening examinations (17% vs 4%, P = .04) and to be screened (30% vs 15%, P = .06). One-fifth of patients (19%) using the risk assessment tool were estimated to have an above-average risk for colorectal cancer.ConclusionElectronic messages to patients produce an initial increase in colorectal cancer screening rates, but this effect is not sustained over time.Trial Registrationclinicaltrials.gov Identifier: NCT01032746

Patient Outreach to Promote Colorectal Cancer Screening Among Patients With an Expired Order for ColonoscopyA Randomized Controlled Trial

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Arch Intern Med. 2011;171(7):642-646. doi:10.1001/archinternmed.2010.468
BackgroundTargeted interventions to promote colorectal cancer screening among specific populations could increase screening rates. Patients with an expired order for screening colonoscopy might be persuaded to follow through with screening by such an intervention.MethodsWe conducted a randomized controlled trial of a combined reminder/outreach intervention among patients in a large general internal medicine practice. Participants included 628 patients aged 50 to 79 years with an expired order for screening colonoscopy. Patients were stratified based on receipt of any previous colorectal cancer screening and randomly assigned either to (1) an intervention group that received a mailing containing a reminder letter from their primary care physician, a brochure and digital video disc about colorectal cancer and colorectal cancer screening, and a follow-up telephone call or (2) a usual care control group. The primary outcome was receipt of fecal occult blood testing, sigmoidoscopy, or colonoscopy within 3 months of randomization. Screening outcomes were observed for an additional 3 months (6 months from randomization).ResultsScreening rates at 3 months were 9.9% (31 of 314 patients) in the intervention group and 3.2% (10 of 314 patients) in the control group (rate ratio, 3.1; 95% confidence interval, 1.5-6.2; P = .001). At 6 months, rates were 18.2% (57 of 314 patients) and 12.1% (38 of 314 patients), respectively (rate ratio, 1.5; 95% confidence interval, 1.03-2.2; P = .03).ConclusionPatient outreach to individuals with an expired order for colonoscopy may be an effective tool to modestly increase short-term completion of colorectal cancer screening.Trial Registrationclinicaltrials.gov Identifier: NCT00793455

The Optimal Delivery of Palliative CareA National Comparison of the Outcomes of Consultation Teams vs Inpatient Units

Abstract Full Text
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Arch Intern Med. 2011;171(7):649-655. doi:10.1001/archinternmed.2011.87

Cost-effectiveness of Adding Magnetic Resonance Imaging to Rheumatoid Arthritis Management

Abstract Full Text
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Arch Intern Med. 2011;171(7):657-667. doi:10.1001/archinternmed.2011.115

Blood Urea Nitrogen in the Early Assessment of Acute PancreatitisAn International Validation Study

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Arch Intern Med. 2011;171(7):669-676. doi:10.1001/archinternmed.2011.126

Structured Interdisciplinary Rounds in a Medical Teaching UnitImproving Patient Safety

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Arch Intern Med. 2011;171(7):678-684. doi:10.1001/archinternmed.2011.128

Opioid Dose and Drug-Related Mortality in Patients With Nonmalignant Pain

Abstract Full Text
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Arch Intern Med. 2011;171(7):686-691. doi:10.1001/archinternmed.2011.117
Invited Commentary

Reconciling Physician Bias and RecommendationsComment on “Physicians Recommend Different Treatments for Patients Than They Would Choose for Themselves”

Abstract Full Text
Arch Intern Med. 2011;171(7):634-635. doi:10.1001/archinternmed.2011.98

Improving Colorectal Cancer Screening in 2011Comment on “Patient Outreach to Promote Colorectal Cancer Screening Among Patients With an Expired Order for Colonoscopy”

Abstract Full Text
Arch Intern Med. 2011;171(7):647-648. doi:10.1001/archinternmed.2011.104

Identifying the Effective Components of Palliative CareComment on “The Optimal Delivery of Palliative Care”

Abstract Full Text
Arch Intern Med. 2011;171(7):655-656. doi:10.1001/archinternmed.2011.62

What We Can Learn From a Decision ModelComment on “Cost-effectiveness of Adding Magnetic Resonance Imaging to Rheumatoid Arthritis Management"

Abstract Full Text
Arch Intern Med. 2011;171(7):667-668. doi:10.1001/archinternmed.2011.67

BUN Level as a Marker of Severity in Acute Pancreatitis: Simple, Universal, and AccurateComment on “Blood Urea Nitrogen in the Early Assessment of Acute Pancreatitis”

Abstract Full Text
Arch Intern Med. 2011;171(7):676-677. doi:10.1001/archinternmed.2011.125

Communication Failures and a Call for New Systems to Promote Patient SafetyComment on “Structured Interdisciplinary Rounds in a Medical Teaching Unit”

Abstract Full Text
Arch Intern Med. 2011;171(7):684-685. doi:10.1001/archinternmed.2011.129

Limiting the Potential Harms of High-Dose Opioid TherapyComment on “Opioid Dose and Drug-Related Mortality in Patients With Nonmalignant Pain”

Abstract Full Text
Arch Intern Med. 2011;171(7):691-693. doi:10.1001/archinternmed.2011.101
Review Article

The Efficacy of Proton Pump Inhibitors for the Treatment of Asthma in AdultsA Meta-analysis

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Arch Intern Med. 2011;171(7):620-629. doi:10.1001/archinternmed.2011.116
Challenges in Clinical Electrocardiography

The Serial Electrocardiogram—Discussion

Abstract Full Text
Arch Intern Med. 2011;171(7):616-618. doi:10.1001/archinternmed.2011.100

The Serial ElectrocardiogramAn Important Tool in the Assessment of Chest Pain

Abstract Full Text
Arch Intern Med. 2011;171(7):616-618. doi:10.1001/archinternmed.2011.99
Images From Our Readers

Pike's Peak from Crystal Reservoir, Colorado Springs, Colorado (2010)

Abstract Full Text
Arch Intern Med. 2011;171(7):656-656. doi:10.1001/archinternmed.2011.123
In This Issue of Archives of Internal Medicine

In This Issue of Archives of Internal Medicine

Abstract Full Text
Arch Intern Med. 2011;171(7):614-614. doi:10.1001/archinternmed.2011.118
Special Article

Crush Syndrome: Saving More Lives in DisastersLessons Learned From the Early-Response Phase in Haiti

Abstract Full Text
Arch Intern Med. 2011;171(7):694-696. doi:10.1001/archinternmed.2011.122
Clinical Observation

Left Main Trunk Coronary Artery Dissection as a Consequence of Inaccurate Coronary Computed Tomographic Angiography

Abstract Full Text
Arch Intern Med. 2011;171(7):698-701. doi:10.1001/archinternmed.2010.464

A 52-year-old woman presented to a community hospital with atypical chest pain. Her low-density lipoprotein cholesterol and high-sensitivity C-reactive protein levels were not elevated. She underwent cardiac computed tomography angiography, which showed both calcified and noncalcified coronary plaques in several locations. Her physicians subsequently performed coronary angiography, which was complicated by dissection of the left main coronary artery, requiring emergency coronary artery bypass graft surgery. Her subsequent clinical course was complicated, but eventually she required orthotopic heart transplantation for refractory heart failure. This case illustrates the hazards of the inappropriate use of cardiac computed tomography angiography in low-risk patients and emphasizes the need for restraint in applying this new technology to the evaluation of patients with atypical chest pain.

Research Letters

Orlistat and Acute Kidney Injury: An Analysis of 953 Patients

Abstract Full Text
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Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.103

Unexpectedly High PTT Values After Low-Dose Heparin Prophylaxis

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Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.106
Editor's Correspondence

Gastroesophageal Reflux Disease Stimulation of NSAID-Associated Atrial Fibrillation

Abstract Full Text
Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.107

Gastroesophageal Reflux Disease Stimulation of NSAID-Associated Atrial Fibrillation—Reply

Abstract Full Text
Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.108

Hard-Stops for Drug Interactions

Abstract Full Text
Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.109

Hard-Stops for Drug Interactions—Reply

Abstract Full Text
Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.110

Bayesian Thinking: A Safer Tool for Reassurance

Abstract Full Text
Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.111

Consequence of Overuse of Invasive Coronary Angiography

Abstract Full Text
Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.112

Consequence of Overuse of Invasive Coronary Angiography—Reply

Abstract Full Text
Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.113

Another Point of View

Abstract Full Text
Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.119

Another Point of View—Reply

Abstract Full Text
Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.120
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