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In This Issue of Archives of Internal Medicine

In This Issue of Archives of Internal Medicine Guideline-Concordant Therapy and Reduced Mortality and Length of Stay in Adults With Community-Acquired Pneumonia Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Clinical practice guidelines for empirical CAP treatment remain controversial and inconsistently applied. The association between clinical outcomes and receipt of guideline-concordant therapy was evaluated in a large quality-improvement database that included both community and teaching hospitals. Receipt of guideline-concordant therapy was associated with improved health outcomes, including decreased in-hospital mortality and decreased length-of-stay in adults hospitalized with CAP. See Article Randomized Controlled Trial of Proactive Web-Based Alcohol Screening and Brief Intervention for University Students This study tested the efficacy of a proactive Web-based alcohol screening and brief intervention program targeting university students whose drinking is unhealthy. Web-based screening was conducted with 7237 undergraduates at an Australian university, and 2435 who screened positive for unhealthy alcohol use were randomized to 10 minutes of Web-based motivational assessment and personalized feedback or screening alone. Six months later the intervention group was drinking significantly less often and less alcohol overall. Acceptability of the intervention was high and it could be widely implemented. See Article The Prevalence of Weekly Angina Among Patients With Chronic Stable Angina in Primary Care Practices Stable angina is the most frequent manifestation of coronary artery disease and is amenable to an expanding range of therapies. Despite its routine assessment being considered a performance measure of quality, the prevalence of symptomatic angina in primary care clinics and its variation across practices is unknown. This cluster-stratified cross-sectional survey of 2031 patients with stable angina from 207 Australian primary care clinics used the Seattle Angina Questionnaire in consecutive patients with coronary artery disease to document angina symptoms and their association with quality of life. Almost 1 in 3 patients experienced angina at least once a week, and weekly angina was strongly associated with impaired function and quality of life. Importantly, the proportion of each practitioner's patients with weekly angina varied considerably, suggesting that differences in practice may account for some of the control of patients' angina. The investigators conclude that reporting and comparing angina control may support systematic efforts to improve patients' outcomes and quality of life. See Article Effectiveness of Implantable Cardioverter-Defibrillators for the Primary Prevention of Sudden Cardiac Death in Women With Advanced Heart Failure The role of implantable cardioverter-defibrillators in women with advanced heart failure for the prevention of sudden cardiac death has not been well established. We conducted a meta-analysis of 5 prospective randomized controlled trials of implantable cardioverter-defibrillators for the primary prevention of sudden cardiac death that reported all-cause mortality as an outcome for the female sex. These data suggest that there is no statistically significant decrease in all-cause mortality in women with heart failure who receive implantable cardioverter-defibrillators. Further focused studies are needed to confirm and investigate the reasons for this observation and define the female population who may benefit most from implantable cardioverter-defibrillator therapy. See Article Population-Based Intervention to Reduce Prehospital Delays in Patients With Cerebrovascular Events To reduce prehospital delays in patients with cerebrovascular events, we performed a population-based, cluster-randomized trial. Cluster units were 48 zip code areas in the catchment area of 3 inner-city hospitals in Berlin, Germany. The intervention consisted of information material and reminders focusing on the importance of calling the emergency medical services in case of an acute event. A total of 741 patients were admitted from the control areas and 647 from the intervention areas. The intervention significantly reduced time to hospital by 27% in women, whereas no effect was found in men. Future research needs to focus on transferability, sustainability, and sex-specific aspects of the intervention. View LargeDownload Prehospital time in intervention and control group in men (A) and women (B). See Article http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

In This Issue of Archives of Internal Medicine

Archives of Internal Medicine , Volume 169 (16) – Sep 12, 2009
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In This Issue of Archives of Internal Medicine

Abstract

Guideline-Concordant Therapy and Reduced Mortality and Length of Stay in Adults With Community-Acquired Pneumonia Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Clinical practice guidelines for empirical CAP treatment remain controversial and inconsistently applied. The association between clinical outcomes and receipt of guideline-concordant therapy was evaluated in a large quality-improvement database that included both community and teaching...
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Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinternmed.2009.239
Publisher site
See Article on Publisher Site

Abstract

Guideline-Concordant Therapy and Reduced Mortality and Length of Stay in Adults With Community-Acquired Pneumonia Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Clinical practice guidelines for empirical CAP treatment remain controversial and inconsistently applied. The association between clinical outcomes and receipt of guideline-concordant therapy was evaluated in a large quality-improvement database that included both community and teaching hospitals. Receipt of guideline-concordant therapy was associated with improved health outcomes, including decreased in-hospital mortality and decreased length-of-stay in adults hospitalized with CAP. See Article Randomized Controlled Trial of Proactive Web-Based Alcohol Screening and Brief Intervention for University Students This study tested the efficacy of a proactive Web-based alcohol screening and brief intervention program targeting university students whose drinking is unhealthy. Web-based screening was conducted with 7237 undergraduates at an Australian university, and 2435 who screened positive for unhealthy alcohol use were randomized to 10 minutes of Web-based motivational assessment and personalized feedback or screening alone. Six months later the intervention group was drinking significantly less often and less alcohol overall. Acceptability of the intervention was high and it could be widely implemented. See Article The Prevalence of Weekly Angina Among Patients With Chronic Stable Angina in Primary Care Practices Stable angina is the most frequent manifestation of coronary artery disease and is amenable to an expanding range of therapies. Despite its routine assessment being considered a performance measure of quality, the prevalence of symptomatic angina in primary care clinics and its variation across practices is unknown. This cluster-stratified cross-sectional survey of 2031 patients with stable angina from 207 Australian primary care clinics used the Seattle Angina Questionnaire in consecutive patients with coronary artery disease to document angina symptoms and their association with quality of life. Almost 1 in 3 patients experienced angina at least once a week, and weekly angina was strongly associated with impaired function and quality of life. Importantly, the proportion of each practitioner's patients with weekly angina varied considerably, suggesting that differences in practice may account for some of the control of patients' angina. The investigators conclude that reporting and comparing angina control may support systematic efforts to improve patients' outcomes and quality of life. See Article Effectiveness of Implantable Cardioverter-Defibrillators for the Primary Prevention of Sudden Cardiac Death in Women With Advanced Heart Failure The role of implantable cardioverter-defibrillators in women with advanced heart failure for the prevention of sudden cardiac death has not been well established. We conducted a meta-analysis of 5 prospective randomized controlled trials of implantable cardioverter-defibrillators for the primary prevention of sudden cardiac death that reported all-cause mortality as an outcome for the female sex. These data suggest that there is no statistically significant decrease in all-cause mortality in women with heart failure who receive implantable cardioverter-defibrillators. Further focused studies are needed to confirm and investigate the reasons for this observation and define the female population who may benefit most from implantable cardioverter-defibrillator therapy. See Article Population-Based Intervention to Reduce Prehospital Delays in Patients With Cerebrovascular Events To reduce prehospital delays in patients with cerebrovascular events, we performed a population-based, cluster-randomized trial. Cluster units were 48 zip code areas in the catchment area of 3 inner-city hospitals in Berlin, Germany. The intervention consisted of information material and reminders focusing on the importance of calling the emergency medical services in case of an acute event. A total of 741 patients were admitted from the control areas and 647 from the intervention areas. The intervention significantly reduced time to hospital by 27% in women, whereas no effect was found in men. Future research needs to focus on transferability, sustainability, and sex-specific aspects of the intervention. View LargeDownload Prehospital time in intervention and control group in men (A) and women (B). See Article

Journal

Archives of Internal Medicine – American Medical Association

Published: Sep 12, 2009

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