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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2009;169(16):1459. doi:10.1001/archinternmed.2009.239.
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GUIDELINE-CONCORDANT THERAPY AND REDUCED MORTALITY AND LENGTH OF STAY IN ADULTS WITH COMMUNITY-ACQUIRED PNEUMONIA

Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Clinical practice guidelines for empirical CAP treatment remain controversial and inconsistently applied. The association between clinical outcomes and receipt of guideline-concordant therapy was evaluated in a large quality-improvement database that included both community and teaching hospitals. Receipt of guideline-concordant therapy was associated with improved health outcomes, including decreased in-hospital mortality and decreased length-of-stay in adults hospitalized with CAP.

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RANDOMIZED CONTROLLED TRIAL OF PROACTIVE WEB-BASED ALCOHOL SCREENING AND BRIEF INTERVENTION FOR UNIVERSITY STUDENTS

This study tested the efficacy of a proactive Web-based alcohol screening and brief intervention program targeting university students whose drinking is unhealthy. Web-based screening was conducted with 7237 undergraduates at an Australian university, and 2435 who screened positive for unhealthy alcohol use were randomized to 10 minutes of Web-based motivational assessment and personalized feedback or screening alone. Six months later the intervention group was drinking significantly less often and less alcohol overall. Acceptability of the intervention was high and it could be widely implemented.

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THE PREVALENCE OF WEEKLY ANGINA AMONG PATIENTS WITH CHRONIC STABLE ANGINA IN PRIMARY CARE PRACTICES

Stable angina is the most frequent manifestation of coronary artery disease and is amenable to an expanding range of therapies. Despite its routine assessment being considered a performance measure of quality, the prevalence of symptomatic angina in primary care clinics and its variation across practices is unknown. This cluster-stratified cross-sectional survey of 2031 patients with stable angina from 207 Australian primary care clinics used the Seattle Angina Questionnaire in consecutive patients with coronary artery disease to document angina symptoms and their association with quality of life. Almost 1 in 3 patients experienced angina at least once a week, and weekly angina was strongly associated with impaired function and quality of life. Importantly, the proportion of each practitioner's patients with weekly angina varied considerably, suggesting that differences in practice may account for some of the control of patients' angina. The investigators conclude that reporting and comparing angina control may support systematic efforts to improve patients' outcomes and quality of life.

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EFFECTIVENESS OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS FOR THE PRIMARY PREVENTION OF SUDDEN CARDIAC DEATH IN WOMEN WITH ADVANCED HEART FAILURE

The role of implantable cardioverter-defibrillators in women with advanced heart failure for the prevention of sudden cardiac death has not been well established. We conducted a meta-analysis of 5 prospective randomized controlled trials of implantable cardioverter-defibrillators for the primary prevention of sudden cardiac death that reported all-cause mortality as an outcome for the female sex. These data suggest that there is no statistically significant decrease in all-cause mortality in women with heart failure who receive implantable cardioverter-defibrillators. Further focused studies are needed to confirm and investigate the reasons for this observation and define the female population who may benefit most from implantable cardioverter-defibrillator therapy.

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POPULATION-BASED INTERVENTION TO REDUCE PREHOSPITAL DELAYS IN PATIENTS WITH CEREBROVASCULAR EVENTS

To reduce prehospital delays in patients with cerebrovascular events, we performed a population-based, cluster-randomized trial. Cluster units were 48 zip code areas in the catchment area of 3 inner-city hospitals in Berlin, Germany. The intervention consisted of information material and reminders focusing on the importance of calling the emergency medical services in case of an acute event. A total of 741 patients were admitted from the control areas and 647 from the intervention areas. The intervention significantly reduced time to hospital by 27% in women, whereas no effect was found in men. Future research needs to focus on transferability, sustainability, and sex-specific aspects of the intervention.

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Prehospital time in intervention and control group in men (A) and women (B).

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Prehospital time in intervention and control group in men (A) and women (B).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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