Methods: An analysis was performed of the National Health and Nutrition Examination Survey II Mortality Cohort.

Results: Controlling for age, gender, race, alcohol use, smoking status, diabetes, hypertension, and body mass index, patients with positive allergy skin testing had a hazard ratio for stroke mortality of 1.56 (95% CI, 1.01–2.40) versus those without positive allergy testing. Patients with both positive allergy testing and an atopic respiratory condition had a hazard ratio for stroke mortality of 2.31 (95% CI, 1.13–4.73).

Conclusions: Individuals with both positive allergy skin testing and an atopic respiratory condition have more than a 2-fold increased risk of fatal stroke. This novel risk factor has substantial implications for a large segment of the population not previously considered at risk.

Methods: We performed an independent assessment of AVC, CAC, and calcium supplementation among patients enrolled in the Epidemiology of Coronary Artery Calcification study who were >60 years of age and had baseline and 4-year follow-up AVC data. In this population-based study of Olmsted County (Minnesota) residents, AVC and CAC scores were determined prospectively by electron beam computed tomography. We evaluated baseline demographic data and analyzed whether those patients using calcium supplementation had a higher rate of progression of both AVC and CAC.

Results: We identified 257 patients (mean age, 67.8 ± 5.2 years), 144 of whom were women. Twenty-five patients (all women) reported using calcium supplements. Analysis of the 144 women (25 taking calcium supplementation) showed there was no difference in the progression of AVC (mean difference in baseline and follow-up AVC score; no supplement versus supplement, 30 ± 9 vs 39 ± 28; P = .73) or CAC (mean difference in baseline and follow-up CAC score; no supplement vs supplement, 47 ± 15 vs 112 ± 22; P = .154). There were no significant differences between the 2 groups with regard to baseline AVC, serum calcium, renal function, diabetes, hypertension, cholesterol, or body mass index.

Conclusion: In this community-based observational study with a 4-year follow-up, no significant increased progression of AVC or CAC was found in women taking oral calcium supplementation. Larger prospective, randomized studies are needed to confirm these findings.

Methods: This pilot randomized controlled trial was conducted in 2 urban family practice clinics and enrolled 46 premenopausal, nonpregnant women with acute vaginal symptoms. In the control arm, women were managed based on a speculum examination and wet mount. In the intervention arm, women were managed based on symptoms. Women were tested for gonorrhea, chlamydia, and trichomoniasis and called 2 weeks later to assess symptom resolution, adverse medication effects, need for revisit, and satisfaction with care.

Results: Forty-one of 44 women (93%) felt better 2 weeks after the visit; 28 (64%) had complete resolution of symptoms. The intervention arm had slightly better resolution of symptoms (P = .046); there were other no differences between the 2 arms. Three women were diagnosed with sexually transmitted diseases (trichomoniasis, chlamydia, and gonorrhea).

Conclusions: Our pilot study suggests that in selected women it may be reasonable to initially manage vaginal complaints based on symptoms. These results should be confirmed in other larger trials. Testing for sexually transmitted diseases is important in our population.

Methods: Baseline data and data after intervention were collected through record review of 899 randomly selected patient visits across 3 outpatient clinics.

Results: From before to after intervention, identification of smokers increased 18% (from 71% to 84%; P < .001), and assessment for a plan to quit increased 100% (from 25.5% to 51%; P < .005). Among all smokers, cessation counseling increased 26% (from 23.6% to 29.8%; P = .41). Significantly more smokers who received the assessment for a plan to quit received cessation counseling (46% vs. 14%, P < .001). Regression analysis showed that patients receiving an assessment for plan to quit were 80% more likely to receive cessation counseling (OR 0.209; 95% CI, 0.095–0.456).

Conclusions: Physician-documented counseling rates are significantly higher when patients are asked about smoking and assessed for a plan to quit. Two questions that ask about smoking status and assess plans to quit may provide prompts to increase the likelihood that patients who smoke receive cessation counseling.

Methods: Adult, English-speaking patients who presented to a primary care office with a chief complaint of headache were matched to adult patients of the same age and sex who presented with problems other than headache. All participants completed the PRIME-MD 9-item Patient Health Questionnaire as a screen for depression.

Results: A total of 200 participants entered the study. The mean age of the participants was 43.8 years (range, 18–87 years). Women constituted 84% of the participants. Of those patients who presented with headache, 32% had a likelihood of possible major depressive disorder compared with 12% in the patients presenting without headache.

Conclusions: Almost one-third of adult patients who present to a primary care office with a complaint of headache report moderate symptoms of depression when screened compared with approximately 10% of patients presenting with a complaint other than headache. Given such a high prevalence of these symptoms, primary care physicians should screen all adult patients who present with headache for depression.

Methods: The Primary Care Multiethnic Network conducted a web- and paper-based survey of primary care clinicians who largely practice in low-income, medically underserved communities in 3 regions across the country.

Results: A total of 494 clinicians participated, for a response rate of 61%. Most (68%) clinicians view HCV as an important problem; more than half (59%) consider screening for HCV to be important when compared with other conditions they screen for in practice. With regard to reported screening habits for risk factors, 54% of clinicians routinely ask new patients whether they have used intravenous drugs and 28% inquire about blood transfusions before 1992. Sixty-one percent order an alanine aminotransferase test when patients present with other risk factors for HCV. The majority of clinicians (54%) refer 75% or fewer of their patients with HCV for treatment; nearly one-fifth (18%) provide antiviral treatment themselves. Key factors influencing clinician HCV decision making are patient comorbidities (74% reported this as a factor), access to treatment (55% reported this as a factor), and tolerance (44% reported this as a factor) of treatment.

Conclusions: In the face of conflicting national guideline recommendations about screening people at high risk for HCV, clinicians have varied views and practice habits influenced by multiple patient, access, and treatment issues.

Methods: A clinical syndrome was assigned to each inpatient and outpatient at the University of Chicago Medical Center with an MRSA infection in 2004 to 2005. Antimicrobial susceptibilities and molecular characteristics of MRSA isolates were assessed. Patients were stratified by lesion characteristics.

Results: Of MRSA isolates from 262 patients with purulent skin and soft tissue infections (SSTIs), 231 (88%) were susceptible to clindamycin, 253 (97%) contained staphylococcal chromosomal cassette mec (SCCmec) IV, and 245 (94%) contained Panton-Valentine leukocidin (pvl) genes, characteristics associated with community-associated MRSA strains. The presence of a purulent SSTI had a positive predictive value of 88% for a clindamycin-susceptible MRSA isolate. Among 87 isolates from a nonpurulent SSTI, 44% were susceptible to clindamycin and 34% contained pvl genes. In 179 invasive MRSA disease isolates, 33% were clindamycin-susceptible and 26% carried pvl genes.

Conclusions: A purulent MRSA SSTI strongly predicted the presence of a clindamycin-susceptible MRSA isolate. Presence of the pvl genes was almost universal among MRSA isolates causing purulent SSTIs; this was less common in nonpurulent SSTIs and other clinical syndromes.

Methods: We completed a retrospective chart audit to assess our adherence to Physician Quality Reporting Initiative guidelines. Women aged 65 to 75 with an office visit between June 1 to November 30, 2007, were divided into 3 subgroups: those who had a recent preventive general medical examination (GME), those who received one in the last 10 years, and those who had not. We determined osteoporosis screening rates for all 3 groups. The first group then underwent electronic medical record review to obtain patient demographics, determine bone mineral density results, and review if those with osteoporosis were receiving prescription treatment.

Results: Ninety-six percent of 305 female patients seen for a GME during the study period had completed bone mineral density testing. This was a screening rate significantly greater than that for patients with an earlier GME and those who never had one in our offices (70% and 50%, respectively). Seventy-seven percent of recent GME patients had abnormal T scores. Low weight and body mass index were significantly associated with osteoporotic T scores. Seventy-four percent of patients whose latest T scores were less than –2.5 were receiving prescription therapy.

Conclusions: Female patients who completed a recent GME had extraordinarily high rates of screening for osteoporosis. We believe this demonstrates the importance of a dedicated preventive health examination as well as the increased significance that physicians and patients currently place on this behavior.

Method: This was a 3-group retrospective case-control study (N = 915; mean age, 26 years). Cases included all patients with non-GAS identified on culture (n = 180). The control group 1 consisted of all patients with GAS infection identified by a rapid strep test or culture (n = 145); control group 2 included all patients with a negative rapid strep test and culture (presumed viral pharyngitis; n = 584). Multivariate analysis was used to compare the prevalence of 5 clinical features among the groups.

Results: The presence of headache and fever was significantly associated with streptococcal infection, with no difference between GAS and non-GAS infection. Exudates and lymphadenopathy were also significantly associated with both GAS and non-GAS infection compared with viral infection. When 2 criteria were present, the risk of any streptococcal infection rose to 55% (27% for non-GAS or GAS); when 3 or more criteria were present, the rate of any streptococcal infection rose to 81% (non-GAS infection, 34%; GAS infection, 47%).

Conclusion: In this predominantly young, adult population with acute pharyngitis, non-GAS infection was as common as GAS infection and was associated with the same clinical features typically associated with GAS. Although the benefits of treating non-GAS pharyngitis in terms of either symptomatic relief or prevention of sequelae are unproven, clinicians may want to consider treating patients with proven or presumptive non-GAS pharyngitis who fail to respond to symptomatic therapy or who are at increased risk for sequelae of group B or group C streptococcal infections, such as those patients who are or have close contact with pregnant women, neonates, and elderly or immunocompromised persons. Further study is needed to determine whether patients with non-GAS pharyngitis benefit from targeted antibiotic treatment.

Methods: Patients aged 18 years or older (n = 728) who were scheduled to see their primary care physician at 5 clinics were offered the opportunity to participate in an anonymous survey during their clinic visit. Their primary care physicians were also invited to participate in a separate online survey. Questions on both surveys included the current method of laboratory test results notification and satisfaction with the method.

Results: The majority of patients reported satisfaction with the current method of notification of normal results—the US mail—which was also the preferred method for notification of normal test results by both patients and physicians. Direct phone contact by the physician was the preferred method for notification of abnormal results by both patients (64%) and physicians (41%). Patients’ preferred method of notification of normal results significantly agreed with the current method (P < .0001), whereas that of abnormal results did not (P = .52).

Conclusions: Our findings indicate that patients and physicians both prefer the US mail for notification of normal laboratory test results and a direct phone call by the physician for notification of abnormal results.

Methods: A foldable, wallet-sized medication list card was distributed to a convenience sample of 104 patients ≥40 years of age at an outpatient residency site. They were also given a survey of demographic variables and the Patient Medication Scale, which measures their perceptions of patient responsibility, physician responsibility, and patients’ knowledge of their medical care. They were contacted by phone 4 to 11 months later to ascertain if they were using the medication card and the Patient Medication Scale was readministered.

Results: Forty-two of 66 patients contacted after the intervention consented to a full interview. Thirty-eight percent (25 of 66) reported using the card. The patients using the card showed increased scores in perceived patient knowledge and patient responsibility, with no change in their perceptions of physician responsibility. Among the 41 respondents not using the card, approximately half indicated interest in using the card in the future or were using a card of their own.

Conclusions: A significant percentage of patients were willing to use the medication list card. Use of the card also seemed to increase their sense of responsibility and perceived knowledge of their medical care.

Methods: An objective review of the clinical trial evidence.

Results: Clinical trials in hypertensive patients comparing ACEI and ARB with other drugs generally showed no difference in the primary cardiovascular outcome (United Kingdom Prospective Diabetes Study Group, Captopril Prevention Project, Swedish Trial in Old Patients with Hypertension 2, Japan Multicenter Investigation for Cardiovascular Diseases-B Randomized Trial, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, Second Australian National Blood Pressure Study Group, Valsartan Antihypertensive Long-Term Use Evaluation). Where the primary, or major secondary, cardiovascular end-point favors one of the treatment arms, it was always the arm with the lower achieved blood pressure that saw the better clinical result as in Losartan Intervention For Endpoint Reduction in Hypertension Study, Captopril Prevention Project, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, and Valsartan Antihypertensive Long-Term Use Evaluation. Trials comparing ACEI or ARB against placebo in patients at high risk of cardiovascular events have not showed a consistent result; cardiovascular outcomes were reduced in Heart Outcomes Prevention Evaluation, European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease, and the Jikei Heart Study, but were not significantly reduced in Perindopril Protection Against Recurrent Stroke Study, Comparison of Arnlodipine vs Enalapril to Limit Occurrences of Thrombosis Trial, Prevention of Events with ACEIs Trial, Telmisartan Randomized Assessment Study in ACE-Intolerant Subjects with Cardiovascular Disease Trial, and Prevention Regimen for Effectively Avoiding Second Strokes Trial. In the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial, combining ACEIs with ARBs in high-risk patients did not reduce cardiovascular or renal outcomes compared with ACEI monotherapy alone. This absence of a reduction in cardiovascular outcome from the ACEI and ARB combination arm is further evidence suggesting that these drugs do not have any special cardiovascular protective effect. This objective review thus shows that the rennin-angiotensin antagonists do not have special cardiovascular protective properties.

Conclusion: The key to reducing cardiovascular outcome is to appropriately control blood pressure as well as to treat all other coronary risk factors.