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20 July 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 HIV Therapy Works Better in Clinical Trials Than in the Real World

Highly active antiretroviral therapy (HAART) successfully suppresses the HIV-1 virus by reducing plasma HIV-1 RNA levels in many patients in clinical trials. But a retrospective study of unselected patients receiving HAART therapy in a large urban clinic found it much less successful (Article, p. 81). The most important risk factor for failure of the therapy was missing clinic visits. Authors say research is needed to determine whether targeting high-risk groups with intensive patient education "can maximize the success of HAART in real-world practice."

A Gastric Cancer Sometimes Responds to Antibiotics Prescribed for H. pylori

Fourteen of 28 H. pylori positive patients with gastric tumors of mucosa-associated lymphoid tissue (MALT) achieved complete remission after antibiotic treatment for H. pylori (Article, p. 88). In this prospective, uncontrolled trial, an additional 8 H. pylori positive patients achieved partial remission, although treatment eventually failed in 4 of the 8; and 10 did not respond to treatment. Six H. pylori-negative patients in the study did not respond to antibiotic treatment.

New Problem Statements Reduce Medical Jargon into Controlled Vocabulary

A team reviewed 891,770 problem statements in patient records in one hospital and condensed them into 15,534 "canonical" (definitive) clinical problem statements (Academia and Clinic, p. 117). The new system performed well when compared with another major system that was independently developed to rationalize medical language, and with the physicians' intended meanings. An editorial praises the work: "Fewer words, applied more accurately, would benefit education, evaluation, and feedback, as well as patient care."

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