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In This Issue of Archives of Internal Medicine
September 27, 2010

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2010;170(17):1521. doi:10.1001/archinternmed.2010.315

Incidental Findings in Imaging Research

Little information exists concerning the frequency or clinical importance of incidental findings (IFs) in imaging research. The medical records of 1376 research subjects were reviewed following reports of IFs discovered during research imaging examinations, with findings presented to an expert panel to determine potential medical benefit or burden. While 40% of examinations generated an IF, this frequency varied widely by imaging modality and body region and increased with age, with only 2.5% of examinations generating subsequent clinical action. The expert panel concluded that most research IFs result in unclear medical benefit or burden but 1% resulted in clear medical benefit and 0.5% resulted in clear medical burden.

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No Beneficial Effects of Pine Bark Extract on Cardiovascular Disease Risk Factors

Pine bark extract, a dietary supplement source of antioxidant oligomeric proanthocynadin complexes, has multiple putative cardiovascular benefits. To study the effects of pine bark extract on cardiovascular disease risk factors, this trial randomly assigned 130 overweight and obese individuals with prehypertension or hypertension to take 200 mg of a pine bark extract or placebo daily for 12 weeks. The results showed that this pine bark extract at a dosage of 200 mg/d did not significantly affect blood pressure and other cardiovascular disease risk factors, even for subpopulations at increased risk.

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Long-term Outcomes of Exercise: Follow-up of a Randomized Trial in Older Women With Osteopenia

Long-term evidence from randomized trials for the effectiveness of exercise in preventing disability and fall-related fractures in elderly persons has been lacking. This extended follow-up period with a mean time under observation of 7.1 years was performed in 160 elderly women with osteopenia. Primary outcomes were femoral neck bone mineral density, postural sway, and leg strength. Secondary outcomes were hospital-treated fractures and functional ability measures. The mainly home-based exercises followed by voluntary home training had a long-term effect on balance and gait. It also seemed to protect high-risk elderly women from hip fractures.

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Racial Disparities in the Outcomes of Communication on Medical Care Received Near Death

This study evaluated the effects of end-of-life discussions on communication goals and end-of-life care outcomes among 261 white and 71 black patients with advanced cancer. Among whites, end-of-life discussions were associated with attainment of communication goals, such as recognition that the illness was terminal, the development of preferences for symptom-directed care, and the institution of do-not-resuscitate (DNR) orders. These communication goals were in turn associated with less life-prolonging care at the end of life. Among blacks, however, communication did not result in less life-prolonging end-of-life care. End-of-life discussions between black patients and their physicians resulted in preferences for symptom-directed care and placement of DNR orders. However, these communication goals were not consistently associated with the end-of-life care actually received. For example, black patients with DNR orders were no less likely than black patients without DNR orders to receive life-prolonging care.

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Pregabalin for the Treatment of Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Pregabalin has been proven to be effective for treating neuropathic pain. Increasing evidence suggests that the urogenital pain of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) may be neuropathic. A randomized, double-blind, placebo-controlled trial was conducted across 10 tertiary care centers in North America, comparing pregabalin with placebo in men with CP/CPPS. The primary outcome, a 6-point decrease in the National Institutes of Health Chronic Prostatitis Symptom Index (CPSI) total score at 6 weeks, was not significantly different between groups (P = .07). Secondary end points included a significantly higher Global Response Assessment response rate (P = .02). Our results suggest that pregabalin may be superior to placebo.

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