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5 October 1999 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 physicians trained in internal medicine.

New Questionnaire Provides a Wakeup Call on Recognizing Sleep Apnea

A new questionnaire effectively screened primary care patients for sleep apnea (Article, p. 485). During routine office visits to five Cleveland doctors, 744 patients were given surveys about snoring, sleepiness, and obesity or hypertension. Based on their answers, 279 (37.5 percent) were considered at high risk for sleep apnea. Sleep studies then conducted at home confirmed sleep apnea in nearly half (46 percent) of the high-risk group. A related editorial says the prevalence of obstructive sleep apnea is probably higher than previously thought, and a simple questionnaire is an excellent way to identify patients at risk (Editorial, p. 535.)

Remission of Rheumatoid Arthritis Reported after Stem-Cell Transplant from Twin

A man with severe adult-onset rheumatoid arthritis received high-dose chemotherapy followed by stem-cell transplantation from his healthy identical twin (Brief Communications, p. 507). This is believed to be the first case of its kind. The patient remains free of symptoms two years later. Although this new approach is risky and still highly experimental, it is possible that some people with resistant autoimmune disease may ultimately benefit from this approach.

The Diagnosis of Suffering

Physicians may be diagnosing illness but may fail to diagnose the suffering, says a noted ethicist (Perspective, p. 531). The alleviation of suffering is crucial in all of medicine, especially in the care of the dying. Physicians can deal more effectively with suffering if they become more expert in diagnosing it. The author provides guidance on how this can be done.

Meta-analysis of Trials Shows That Warfarin, and to a Lesser Extent Aspirin, Unequivocally Reduce Stroke in Patients with Atrial Fibrillation (Article, p. 492; Editorial, p. 537)

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