Annals
Established in 1927 by the American College of Physicians

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1 December 2009 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656, or visit www.annals.org. Past highlights are accessible as well.

1. New Self-assessment Score Could Better Predict Diabetes Risk

Diabetes and its complications are a major cause of mortality and morbidity worldwide, making it important to identify who is at risk. However, large-scale screening is expensive, and there are no consistent guidelines on who should be screened. In an effort to create a screening score that could be used in a wide variety of community settings and clinical encounters, researchers developed a six-question screening test that patients can score themselves. Simple questions about the patient's age, gender, health history, and lifestyle were assigned a point value. With a high score of 10, no complex math is involved. This new score proved easy to use and seems to be better at predicting risk than existing methods. Researchers suggest future studies to evaluate the score in diverse populations in real-world settings.

2. Rare but Serious Complications Cause Physicians to Consider Expanding Treatment Approach for Sore Throat

Pharyngitis, or sore throat, is a common illness among adolescents and young adults. Current guidelines suggest that clinicians consider group A strep as a cause when diagnosing and managing patients with sore throats. While strep is a common cause of pharyngitis in adolescents and young adults, recent research indicates that another bacteria, Fusobacterium necrophorum, is nearly as likely to cause sore throat. F. necrophorum is particularly worrisome because it is associated with a rare but life-threatening complication called Lemierre syndrome. In Lemierre syndrome, patients develop a deep infection in the neck. While group A strep is also associated with a serious complication--rheumatic fever--the incidence rate of Lemierre syndrome following F. necrophorum is higher and associated with greater morbidity and mortality. The author suggests expanding the diagnostic paradigm for adolescents and young adults with sore throat to consider F. necrophorum. He proposes aggressive antibiotic treatment for F. necrophorum infection in adolescents and young adults who develop bacteremic symptoms. He also suggests that physicians learn the red flags for pharyngitis in this group, such as worsening of symptoms and neck swelling.

3. Some Gender Bias Evident in Academic Medicine

While women are entering the medical profession at higher rates than ever, their representation in the senior echelons of academic medicine remains low. Researchers sought to determine the subsequent academic success of recipients of the National Institutes of Health (NIH) career development awards. They reviewed NIH records for 2,784 recipients of K08 and K23 awards for whom sex could be determined. They found that 31 percent of the 1,919 K08 awardees and 43.7 percent of the 865 K23 awardees were female. Women were less likely than men to receive an R01 award at five years (18.8 percent vs. 24.8 percent). At 10 years, gender continued to be an independent significant predictor of R01 award attainment.

4. For Some Patients, The Mortality Benefits of Low-dose Aspirin May Outweigh the Bleeding Risks

Physicians often prescribe low dose aspirin to prevent heart disease, yet aspirin significantly increases the risk of stomach (peptic) ulcer bleeding. Yet, there is uncertainty about whether patients who have had an episode of ulcer bleeding are better off if they stop or if they continue aspirin after the bleeding is controlled. In a randomized, double-blind, placebo-controlled non-inferiority trial, researchers assigned 78 patients to receive 80 mg aspirin daily and 78 patients to receive placebo immediately after endoscopic treatment of ulcer bleeding. After eight weeks, researchers concluded that continuing aspirin after an episode of ulcer bleeding is controlled may increase the risk of recurrent bleeding but potentially reduces mortality, most likely through its heart benefits. They caution that larger trials are needed to confirm these findings.