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Update in General Internal Medicine
Evidence Published in 2011

Presented at 
Society of General Internal Medicine Annual Meeting
Orlando, FL May 2012

Adding Niacin to Intensive Statin Therapy Does Not Improve Cardiovascular Outcomes

AIM-HIGH Investigators, Boden WE, Probstfield JL, Anderson T, et al. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med. 2011;365:2255-67.[PMID: 22085343]

  • Thromboembolism Prophylaxis with Heparin in Hospitalized Non-surgical Adult Patients Does Not Reduce Mortality
    Lederle FA, Zylla D, MacDonald R, et al. Venous thromboembolism prophylaxis in hospitalized medical patients and those with stroke: a background review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2011;155:602-15.[PMID: 22041949]

  • Outpatient Treatment of Acute Pulmonary Embolism Is Safe for Low-Risk Patients
    Aujesky D, Roy PM, Verschuren F, et al. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Lancet. 2011;378:41-8.[PMID: 21703676]

  • Oral Factor Xa Inhibitors Are Not Inferior to Warfarin in Preventing Thromboembolism and Bleeding in Patients with Atrial Fibrillation
    Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883-91.[PMID: 21830957]

  • Screening for Lung Cancer with Low-Dose Computed Tomography Scans Reduces Mortality in High-Risk Patients but Has a High Rate of False-Positive Results
    National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395-409.[PMID: 21714641].

  • Screening for Ovarian Cancer with Transvaginal Ultrasound and Serum Cancer Antigen 125 Does Not Reduce Mortality
    Buys SS, Partridge E, Black A, et al. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA. 2011;305:2295-303.[PMID: 21642681]
  • Screening for Prostate Cancer with Prostate-Specific Antigen Measurements Carries Uncertain Benefits; Treatment of Early-Stage Prostate Cancer Reduces Mortality but Is Frequently Accompanied by Adverse Side Effects
    Chou R, Croswell JM, Dana T, et al. Screening for prostate cancer: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155:762-71.[PMID: 21984740]

  • Blood Pressure Measurements Taken in the Clinic and Home Are Inaccurate for Diagnosing Hypertension as Defined by Ambulatory Blood Pressure Monitoring
    Hodgkinson J, Mant J, Martin U, et al. Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review. BMJ. 2011;342:d3621.[PMID: 21705406]

  • The Number and Site of Blood Pressure Measurements Influence Decisions About Hypertension Diagnosis and Treatment
    Powers BJ, Olsen MK, Smith VA, et al. Measuring blood pressure for decision making and quality reporting: where and how many measures? Ann Intern Med. 2011;154:781-8.[PMID: 21690592]

  • Primary care physicians believe thaeir pateints receive too much care. Sirovich BE, Woloshin, S, Schwarz LM. Too Little? Too Much? Primary Care Physicians’ Views on US Health Care. Arch Intern Med 2011;171(17):1582-1585 [PMID: 21949171] 
  • Advanced directives affect end-of-life care and costs in regions characterized by higher levels of end-of-life spending. 
    Nicholas LH, Langa KM, Iwashyna TJ, et al. Regional variation in the association between advance directives and end-of-life Medicare expenditures. JAMA 2011; 306(13):1447-1453. [PMID: 21972306]
  • Hospitalist care results in a decreased length of in hospital stay but increases in the cost of care after hospitalization.
    Kuo YF, Goodwin JS. Association of hospitalist care with medical utilization after discharge: Evidence of cost shift from a cohort study. Ann Intern Med 2011; 155:152-159 [PMID: 2180708]
  • Short episodes of physical exertion have the potential to decrease mortality compared with inactivity.
    Wen CP, Wai JP, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. The Lancet 2011;378:1244-1253. [PMID: 21846575]
  • Calcium supplements with or without vitamin D modestly increased the risk of cardiovascular events, especially myocardial infarction.
    Bolland MJ, Grey A, Avenell A, et al. Calcium supplements with or without vitamin D and risk of cardiovascular events: Re-analysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ 2011; 342:D2040 [PMID: 21505219]

  • Aggressive medical management is superior to stenting for the treatment of intracranial arterial stenosis
    Chimowitz MD, Lynn MJ, Derdyn C, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. NEJM 2011 365:993-1003 [PMID: 21899409]

  • Tiotropium is superior to salmeterol in the time to exacerbation, severity of exacerbations, and rate of exacerbations in patients with moderate to severe COPD.
    Vogelmeier C, Hederer B, Glaab T, et al. Tiotropium versus Salmeterol for the Prevention of Exacerbations of COPD. N Engl J Med 2011; 364:1093-1103.

  • Continuous azithromycin decreases COPD exacerbations.
    Albert RK, Connett J, Bailey WC, Casaburi R, Cooper JA Jr, Criner GJ, et al. Azithromycin for Prevention of Exacerbations of COPD. N Engl J Med 2011;365:689-698.

  • Leukotriene antagonists are effective alternatives as first-line or add-on therapy for asthma.
    Price D, Musgrave SD, Shepstone L, et al. Leukotriene antagonists as first-line or add-on asthma-controller therapy. N Engl J Med 2011; 364: 1695-1707. [PMID: 21542741]

  • Long-term aspirin use reduces mortality from some types of cancer after five years.
    Rothwell PM, Fowkes FG, Belch JF, et al. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomized trials. Lancet 2011; 377:31-41. [PMID: 21144578]

  • Caudal epidural steroid injection show no advantage over saline epidural injections or injections in patients with chronic lumbar radiculopathy.
    Iversen T, Solberg TK, Romner B, Wilsgaard T, et al. Effect of Caudal Epidural Steroid or Saline Injection in Chronic Lumbar Radiculopathy: a Randomised Controlled Trial. BMJ 2011;343:d5278. [PMID: 21914755]