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.
The use of HIV susceptibility testing (GPT) can help guide the selection of antiretroviral therapy for HIV-positive patients. Susceptibility testing looks for the presence of HIV mutations that are associated with how well the virus responds to various drugs. Researchers observed 2,699 HIV-positive patients eligible for susceptibility testing to evaluate the relationship between testing and survival. They found that patients who underwent suseceptibility testing were less likely to die than those who did not have testing. The study authors concluded that more research is needed to determine whether increased survival is due to better treatment selection or because patients who had susceptibility testing also had other types of care that improve survival.
Asthma is a chronic lung disease that causes episodes of difficult breathing for 22 million Americans. A very serious illness, asthma attacks cause 4,000 deaths a year. Attacks can be prevented if patients avoid triggers and take their medication as instructed by a physician. However, despite the availability of monitoring tools and effective drug therapies, many people do not have adequate asthma control. Researchers sought to determine if the Internet could help. They randomly assigned 200 adult asthma patients to either usual care by their doctor or an Internet-based asthma program in addition to usual care. The Internet-based self-management program included weekly asthma control monitoring and treatment advice, online group education, and remote Web communication. At 12 months, patients in the Internet group reported improvements in asthma control and lung function compared with patients in the usual care group. However, the improvements in quality of life were small and the number of asthma attacks did not improve. According to the study authors, the challenge is finding a way to incorporate Internet-based self-management into routine asthma care on a wider scale.
Physicians commonly perform surveillance colonoscopies on persons who have had a past colon adenoma (polyp). Practice guidelines have been established for clinicians to determine the appropriate interval for surveillance colonoscopies. High-risk patients should have a follow-up screening at three years, while low-risk patients can wait five to 10 years. However, the criteria for choosing between five- and 10-year follow-up is not clear. To help establish an appropriate screening interval, researchers studied 564 patients who had two surveillance colonoscopies after a baseline colonoscopy that showed adenoma. They used the results from the first and second colonoscopies to determine the probability of high-risk findings on a third colonoscopy. Researchers found that patients with advanced or multiple adenomas on both the first and second colonoscopy had a relatively high likelihood (18.2%) of high-risk findings at the third examination. Very few participants (0.5%) that had low-risk findings on their first two examinations had high-risk results on their third colonoscopy. This result suggests that a longer follow-up interval may be appropriate for lower risk patients, as determined by their adenoma history.
Although blood cholesterol levels in the United States have decreased slightly since the 1980s, people continue to consume too much artificial trans fat – a recognized contributor to coronary heart disease. While health care providers often focus on educating their patients about the relationship between cholesterol and dietary habits, only about a quarter of those with high cholesterol levels are able to gain adequate control. Because trans fat is widespread in our food supply, it is virtually impossible for consumers to avoid. New York City’s Health Department sought to help consumers make better food choices when it restricted artificial trans fat in restaurants. Preliminary analyses from that restriction suggest that replacement of artificial trans fat has resulted in restaurant food with healthier fatty acid profiles. This paper describes implementation of the New York City Health Department program.