Reviews

This article originally appeared in BMJ USA

This section calls attention to new studies and systematic reviews, selected by the Editor from journals published just as this issue went into production (approximately 2 months before publication). The Journals hand-searched for the Journal Rack are: American Journal of Medicine, American Journal of Preventive Medicine, Annals of Internal Medicine, Circulation, JAMA, Journal of Family Practice, Journal of General Internal Medicine, Journal of the American Board of Family Practice, JNCI, Lancet, New England Journal of Medicine, and Pediatrics. Studies are noted that might directly influence clinical practice decisions in primary care and have been classified by type of problem addressed.

CardiovascularA randomized trial involving 9193 patients with essential hypertension and left ventricular hypertrophy compared the effects of losartan, a selective angiotensin-II receptor antagonist, and atenolol over 4 years. Although both groups experienced similar blood pressure reductions, the losartan group had a lower risk of cardiovascular events and death. Losartan appeared to achieve benefits beyond blood pressure reduction (Dahlöf et al. Lancet March 23 2002;359:995-1003).

CardiovascularAn analysis of 388,964 admissions to New York hospitals for heart failure, myocardial infarction, or stroke in 1993-1995 found that standardized in-hospital mortality rates were lower in major teaching hospitals than in non-teaching hospitals (Polanczyk et al. Am J Med March 2002;112:255-261).

EndocrineGlucose tolerance testing of 167 obese children and adolescents in Connecticut determined that 22% had impaired glucose tolerance and 2% (all adolescents) had type 2 diabetes (Sinha et al. N Engl J Med March 14 2002;346:802-810).

GeriatricA randomized trial involving 1388 frail hospitalized patients age 65 and older found that those cared for in specialized inpatient geriatric units followed by outpatient geriatric clinics had no better survival, although some aspects of functional status were improved (Cohen et al. N Engl J Med March 21 2002;346:905-912).

Infectious diseasesA randomized trial involving 1251 women in Cameroon at increased risk of sexually transmitted diseases found that nonoxynol-9 gel was no more effective than condoms in preventing gonococcal or chlamydial infections (Roddy et al. JAMA March 6 2002;287:1117-1122).

Mental healthNational Ambulatory Medical Care Survey data indicate that the number of office visits with a recorded anxiety disorder diagnosis increased from 9.5 million in 1985 to 12.3 million per year in 1997-1998, and 48% of these visits were to primary care physicians (Harman et al. J Gen Intern Med March 2002;17:165-172).

NeurologicA blinded analysis of drawings made by 226 children referred to a pediatric neurology clinic found that what was drawn accurately differentiated migraine from non-migraine headaches, with a sensitivity, specificity, and positive predictive value of 93%, 83%, and 87%, respectively (Stafstrom et al. Pediatrics March 2002;109:460-472.).

OncologicAn update of five Swedish trials of mammography screening confirmed a 21% reduction in mortality from breast cancer over a median of 16 years of follow-up. Benefits by age group were statistically significant for women age 55-69 at entry. The authors also rebutted recent criticisms of the five Swedish trials (Nyström et al. Lancet March 16 2002;359:909-919).

OncologicWhen a mammography interpretation test for British radiologists was administered to 60 California radiologists, sensitivity was 76% for high-volume radiologists (> 300 mammograms read per month) but 65% for low-volume radiologists ( 100 mammograms read per month) (Esserman et al. J Natl Cancer Inst March 6 2002;94:369-375).

OncologicData from two cohort studies involving 135 342 adults suggest that those with a calcium intake of > 1250 mg/day had a significantly lower risk of distal colon cancer than those who took < 500 mg/day (Wu et al. J Natl Cancer Inst March 20 2002;94:437-446).

Primary care practiceOf the 512 primary care patients in Providence, Rhode Island who returned a postal survey about Internet use, 60% felt that the information was "the same as" or "better than" information from their doctors. Of those using the Internet for health information, 59% did not discuss this information with their doctors (Diaz et al. J Gen Intern Med March 2002;17:180-185).

Primary care practiceA study of 34 519 office visits and 2534 referrals over 15 days at 87 family practices found that 5% of office visits led to referrals, but 18% of referrals were made during encounters other than office visits (eg, by telephone). Help with diagnosis or management was sought in 52% of referrals, whereas 26% were for direct medical management (Forrest et al. J Fam Pract March 2002;51:215-222).

RheumatologicA longitudinal study found that, among 641 women with hypertension and no congestive heart failure, those who regularly used angiotensin-converting enzyme inhibitors had a slower rate of decline in muscle strength than those taking other or no antihypertensive drugs (Onder et al. Lancet March 16 2002;359:926-930).

Substance abuseA Swiss randomized trial demonstrated that internal medicine residents trained to provide counseling that matched smokers' motivation to quit and who practiced these skills with standardized patients achieved higher 1-year smoking abstinence rates than did a control group (which received training in dyslipidemia) (Cornuz et al. Ann Intern Med March 19 2002;136:429-437).

Substance abuseA retrospective study showed that 102 near-daily cannabis users had poorer memory and attention on psychological testing than did short-term users or controls. The effects endured beyond the period of intoxication and worsened with increasing years of regular use (Solowij et al. JAMA March 6 2002;287:1123-1131).

TraumaA review of 128 cases of commotio cordis (sudden death caused by a blunt nonpenetrating chest blow) found that 62% occurred during organized sporting events such as baseball, but 38% occurred with other activities, such as playful "shadow" boxing or parental discipline (Maron et al. JAMA March 6 2002;287:1142-1146).

TraumaAn analysis of motor vehicle accidents involving 11 335 child occupants found that children in compact extended-cab pickup trucks were three times as likely to be injured as were children in other vehicles, especially if they sat in the back seat (Winston et al. JAMA March 6 2002;287:1147-1152).