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In This Issue of Archives of Internal Medicine
September 26, 2005

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2005;165(17):1935. doi:10.1001/archinte.165.17.1935
Ability of Physicians to Diagnose and Manage Illness Due to Category A Bioterrorism Agents

The Centers for Disease Control and Prevention has identified infectious agents likely to be used by terrorists in an attack on the United States. Many of these agents have significant clinical overlap with other, more common illnesses. The ability of physicians to recognize, diagnose, and manage patients presenting after a bioterror attack is unknown. This study shows that physician ability to diagnose and manage such patients is poor and can be improved by an online training module.

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Empirical Atypical Coverage for Inpatients With Community-Acquired Pneumonia

Pneumonia is a potentially lethal disease. The causative agents are traditionally divided into “typical” and “atypical,” each dictating a distinct antibiotic treatment. Because the causative agent at presentation is usually unknown, initial treatment is empirical, customarily covering both groups. No sufficient evidence exists to support the necessity of such coverage, while limiting it may reduce toxic effects, resistance, and expense. Shefet et al conducted a systematic review and meta-analysis of randomized-controlled trials comparing treatment regimens with and without coverage of atypical pathogens in adults hospitalized with community-acquired pneumonia. For the regimens tested, no advantage in clinical efficacy or mortality was found for coverage of atypical pathogens. Studies specifically assessing the addition of atypical coverage to a β-lactam are lacking.

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Acupuncture for Subacute Stroke Rehabilitation

This study of 116 patients with subacute stroke from a United Kingdom–based district general hospital, who received 12 sessions of either real or sham acupuncture over 2 weeks, found that the improvements in the Barthel activities of daily living scores in the real and sham acupuncture groups were not significantly different. Interestingly, post hoc analysis in the severely disabled subgroup with a baseline Barthel score less than the median showed greater improvement with acupuncture in leg function compared with the less severely disabled group. Park and colleagues conclude that acupuncture is not superior to sham acupuncture for recovery in activities of daily living and health-related quality of life after stroke, although there may be a limited effect on leg function in more severely affected patients.

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Description of a New Hepatitis C Risk Assessment Tool

Chronic hepatitis C virus (HCV) infection is a growing public health challenge. Earlier detection and treatment of infection may result in better clinical outcomes. This cross-sectional study describes the derivation process and preliminary performance characteristics of a self-administered HCV risk assessment tool. Participants with and without HCV completed a 72-item, self-administered questionnaire. After analysis, 7 factors were associated with HCV infection: sex with a prostitute or an intravenous drug user, exposure to blood products, refused as a blood donor or as a life insurance applicant, witnessing illicit drug use, and self-reported hepatitis B virus infection. The likelihood of HCV infection could be quantified based on the number of positive factors reported.

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Colchicine as First-Choice Therapy for Recurrent Pericarditis

To verify the safety and efficacy of colchicine as an adjunct to conventional therapy for the first episode of recurrent pericarditis and to verify if the natural history of the disease may change because of the early use of colchicine, Imazio et al conducted a prospective, randomized, open-label study. Eighty-four consecutive patients with a first episode of recurrent pericarditis were randomly assigned to conventional treatment (aspirin or prednisone) or conventional treatment combined with colchicine, 1.0 to 2.0 mg for the first day and then 0.5 to 1.0 mg/d for 6 months. During 1682 patient-months (mean follow-up, 20 months), treatment with colchicine vs conventional treatment significantly decreased the recurrence rate (actuarial rates at 18 months were 24.0% vs 50.6%; number needed to treat = 4.0) and symptoms persistence at 72 hours (9.5% vs 31.0%). In multivariate analysis, previous corticosteroid use was an independent risk factor for further recurrences.

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