Reviews

From BMJ USA 2002;August:471-472

This section calls attention to new studies and systematic reviews, selected by the Editor from journals published just as this issue went into production (approximately 2 months before publication). The Journals hand-searched for the Journal Rack are: American Journal of Medicine, American Journal of Preventive Medicine, Annals of Internal Medicine, Circulation, JAMA, Journal of Family Practice, Journal of General Internal Medicine, Journal of the American Board of Family Practice, JNCI, Lancet, New England Journal of Medicine, and Pediatrics. Studies are noted that might directly influence clinical practice decisions in primary care and have been classified by type of problem addressed.

CardiovascularSurvey data indicate that Mexican Americans are less likely than non-Hispanic whites to undergo blood pressure or cholesterol screening, a disparity associated with lack of health insurance and a usual source of care (Stewart and Silverstein. J Gen Intern Med June 2002;17:405-411).

CardiovascularA Swedish study of 181 patients who were hospitalized for acute myocardial infarction and lacked a prior diagnosis of diabetes found that 35% and 31%, respectively, had impaired glucose tolerance or diabetes at discharge (Norhammar et al. Lancet June 22, 2002;359:2140-2144).

CardiovascularA Dutch study involving 126 patients with suspected deep venous thrombosis of the upper extremities found that duplex ultrasound had a sensitivity and specificity of 82% when compared with contrast venography. The authors concluded that duplex ultrasound should be the initial diagnostic test (Baarslag et al. Ann Intern Med June 18, 2002;136:865-872).

CardiovascularAnother Dutch study involving 704 patients with suspected deep venous thrombosis found that the semiquantitative D-dimer test had a sensitivity of 99% and a negative predictive value of 98% in detecting sonographically confirmed thrombosis (Schutgens et al. Am J Med June 1, 2002;112:617-621).

CardiovascularA cross-sectional study involving 740 patients with peripheral arterial disease demonstrated that lower extremity dysfunction was more accurately predicted by the ankle brachial index than by a history of intermittent claudication (McDermott et al. Ann Intern Med June 18, 2002;136:873-883).

EndocrineLongitudinal surveys of young adults demonstrate that obesity develops 2.1 times faster among black women and 1.5 times faster among Hispanic women than among white women (McTigue et al. Ann Intern Med June 18, 2002;136:857-864).

EndocrineA nine-country randomized trial involving 1429 patients with impaired glucose tolerance found that those treated with 100 mg acarbose three times daily were 25% less likely to develop diabetes over 3 years than those treated with placebo (Chiasson et al. Lancet June 15, 2002;359:2072-2077).

EndocrineA review of the care of 601 patients with type 2 diabetes found that patients were less likely to have cholesterol testing than measurement of glycohemoglobin levels or blood pressure. Drug therapy was more likely for elevated glycohemoglobin levels than for elevated blood pressure or LDL cholesterol. The latter, however, are considered more likely to reduce mortality (Grant et al. Am J Med June 1, 2002;112:603-609).

GastrointestinalA Chinese randomized trial involving 123 patients found that lansoprazole achieved a ten-fold reduction in ulcer recurrence over one year in patients who were taking low-dose aspirin, had experienced previous ulcer complications on low-dose aspirin, and had Helicobacter pylori infections that had been eradicated (Lai et al. N Engl J Med June 27, 2002;346:2033-2038).

GynecologicA case-control study involving 9257 women found that past or current use of oral contraceptives was not associated with an increased risk of breast cancer (Marchbanks et al. N Engl J Med June 27, 2002;346:2025-2032).

GynecologicA retrospective study of 268 women who underwent colposcopy examinations found that those who received cryotherapy were 19 times more likely to have inadequate follow-up colposcopic examinations than those who had no procedure (Sparks et al. J Fam Pract June 2002;51:526-529).

Infectious DiseasesA meta-analysis of four randomized trials found that chlorhexidine skin disinfection was twice as effective as povidone-iodine in preventing catheter-related bloodstream infection (Chaiyakunapruk et al. Ann Intern Med June 4, 2002;136:792-801).

NeurologicA Canadian meta-analysis of 27 studies reported that angiotensin II receptor antagonists reduce the risk of headaches by one third, although the mechanism is unclear (Etminan et al. Am J Med June 1, 2002;112:642-646).

OncologicColonoscopy screening examinations performed on 906 employees age 40-49 found advanced neoplasms in only 3.5% of the subjects, and none had cancer. Over half the lesions were potentially within reach of a sigmoidoscope (Imperiale et al. N Engl J Med June 6, 2002;346:1781-1785).

PediatricA Canadian randomized trial involving 290 children with suspected viral upper respiratory tract infection found that intranasal sodium cromoglycate and saline spray were equally effective in resolving symptoms after one week {Butler et al. Lancet June 22, 2002;359:2153-2158).

PediatricA survey of 10 079 children age 12-18 found that 34% used sunscreen, 36% reported having had at least three sunburns the previous summer, and 10% used a tanning bed (Geller et al. Pediatrics June 2002;109:1009-1014).

PediatricA telephone survey of 1192 youths also found that 10% used indoor tanning sunlamps. The survey noted that 8% of primary caregivers also used indoor sunlamps, and the prevalence of sunlamp use by the children they cared for was 30% (Cokkinides et al. Pediatrics June 2002;109:1124-1130).

PediatricA survey of 477 adolescents found that tattoos and body piercings were significantly associated with disordered eating behavior, gateway or hard drug use, sexual behavior, and suicidal ideation (Carroll et al. Pediatrics June 2002;109:1021-1027).

PreventionA British randomized trial involving 690 adults found that a brief negotiation method resulted in increased fruit and vegetable intake after 6 months and a lowering of systolic and diastolic blood pressure (by an average of 4.0 mm Hg and 1.5 mm Hg, respectively) (John et al. Lancet June 8, 2002;359:1969-1974).

PreventionA Danish population-based trial involving 2000 patients age 30-50 found that those randomized to two health screenings had lower cardiovascular risk scores, body mass index, and serum cholesterol levels after 5 years than those who received no health screenings (Engberg et al. J Fam Pract June 2002;51:546-552).

Primary care practiceA randomized trial involving 134 patients found that the presence of a medical student during office visits did not significantly alter patients' satisfaction with their visit or their physician, but 40% of patients seen by a student indicated that the student's involvement did not improve their care and 30% did not want to see a student at subsequent office visits (Gress et al. J Gen Intern Med June 2002;17:420-427).

RheumatologicA randomized trial involving 1019 patients with osteoarthritis of the knee found that valdecoxib and naproxen were equally effective in improving symptoms but that the naproxen group had a significantly higher incidence of ulcers (Kivitz et al. J Fam Pract June 2002;51:530-537).