Review

Journal rack: new evidence for primary care

From BMJ USA 2003;April:229

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). Studies are noted that might directly influence clinical practice decisions in primary care. 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 General Internal Medicine, Journal of the American Board of Family Practice, JNCI, Lancet, New England Journal of Medicine, Obstetrics and Gynecology, Pediatrics

Cardiovascular — A randomized trial involving 6083 older adults (age 65 to 84) with hypertension found that those who received angiotensin-converting enzyme inhibitors had an 11% lower 4-year risk of cardiovascular events and death than did those treated with diuretics. (Wing et al. N Engl J Med Feb 13, 2003;348:583-592.)

Cardiovascular — A study of 5-year outcomes among 29 244 patients who underwent exercise stress testing revealed that ventricular ectopy after exercise was a stronger predictor of death than was ventricular ectopy during exercise (11% versus 9%, respectively). (Frolkis et al. N Engl J Med Feb 27, 2003;348:781-790.)

Endocrinologic — A systematic review performed for the US Preventive Services Task Force concluded that early screening and intervention for diabetes was more likely to be beneficial through cardiovascular risk reduction than through tight glycemic control. (Harris et al. Ann Intern Med Feb 4, 2003;138:215-229.)

Endocrinologic — A chart audit of 465 medical records at a community health center revealed that 83 contained a provider diagnosis of obesity, but an additional 74 revealed evidence of obesity based on body mass index but no diagnosis by the provider. (Lemay et al. J Am Board Fam Pract Jan-Feb 2003;16:14-21.)

Gastroenterologic — A cost-effectiveness analysis estimated that screening 50-year-old white men with symptoms of gastroesophageal reflux, followed by surveillance of patients with Barrett's esophagus with dysplasia, would cost $10 440 per quality-adjusted life-year gained. (Inadomi et al. Ann Intern Med Feb 4, 2003;138:176-186.)

Geriatric — An analysis of end-of-life spending among Medicare beneficiaries found that patients in regions of the United States with higher spending had similar baseline health status, quality of care, and outcomes, but they received 60% more care and were more likely to visit physicians, be referred to specialists, and undergo testing, minor procedures, and hospitalization. (Fisher et al. Ann Intern Med Feb 18, 2003;138:273-287; Fisher et al. Ann Intern Med Feb 18, 2003;138:288-298.)

Infectious diseases — A retrospective study of 36 766 Veterans Affairs patients who received care for HIV infection found no evidence to support the concern that such patients are at increased risk of cardiovascular and cerebrovascular disease. (Bozzette et al. N Engl J Med Feb 20, 2003;348:702-710.)

Mental health — Prospective data on 333 patients with dysthymia or minor depression revealed that response to paroxetine was 3 times greater among those who did not view their disease as a biological illness. (Sullivan et al. J Am Board Fam Pract Jan-Feb 2003;16:22-31.)

Mental health — A systematic review of 31 randomized trials of continuing antidepressant treatment in patients who have responded to acute treatment found that continuation reduced the risk of relapse by 70% compared with discontinuation, with the treatment effect persisting for up to 36 months. (Geddes et al. Lancet Feb 22, 2003;361:653-661.)

Mental health — A survey of 1024 family practice patients revealed that 10% of women and 11% of men reported violent victimization by partners, friends, family, or strangers within the previous year. (Porcerelli et al. J Am Board Fam Pract Jan-Feb 2003;16:32-39.)

Neurologic — A systematic review of 7 trials reported that the use of interferon for multiple sclerosis reduced by 27% the number of patients who experienced exacerbations in the first year, but its benefit at 2 years could not be interpreted. (Filippini et al. Lancet Feb 15, 2003;361:545-552.)

Oncologic — Data from 35 298 sigmoidoscopy examinations and 39 286 colonoscopy examinations of Medicare beneficiaries indicate that the rates of perforation were 0.88/1000 and 1.96/1000, respectively. (Gatto et al. J Natl Cancer Inst Feb 5, 2003;95:230-236.)

Oncologic — A prospective study of 329 495 women who underwent screening mammography found that sensitivity and specificity ranged from 63% and 89%, respectively, in women with extremely dense breasts to 87% and 97%, respectively, in women with fattier breasts. Sensitivity and specificity also increased with age, from 69% and 91%, respectively, in women age 40 to 44 to 83% and 94%, respectively, in women age 80 to 89. (The age-related increase in specificity occurred only in nonusers of hormone replacement therapy. Specificity remained about 92% for HRT users of all ages.) (Carney et al. Ann Intern Med Feb 4, 2003;138:168-175.)

Oncologic — A study of 110 radiologists interpreting screening mammograms found that accuracy was not significantly related to the volume of films read but was associated with recent training and with characteristics of the facility (number of examinations and biopsies performed, being a comprehensive or freestanding breast center, use of double reading). (Beam et al. J Natl Cancer Inst Feb 19, 2003;95:282-290.)

Pulmonary — An international randomized trial involving 1465 patients with chronic obstructive pulmonary disease found that the combination of salmeterol and fluticasone achieved significantly larger forced expiratory volume in 1 second than did either agent alone. (Calverley et al. Lancet Feb 8, 2003;361:449-456.)

Pulmonary — A Dutch study of 510 patients with suspected pulmonary embolism found that using helical computed tomography as the primary diagnostic test identified pulmonary embolism in 24% of patients and was safe (4% mortality in patients with normal scans). (van Strijen et al. Ann Intern Med Feb 18, 2003;138:307-314.)

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