What's New in General Internal Medicine?

The latest Update in General Internal Medicine is published in the Annals of Internal Medicine (PDFs free after 6 months). While the whole text is spread over 11 pages, I would like to summarize just a few things I found useful. Recommendations are divided in 3 groups: "start", "consider" and "stop."


Start

Start prescribing a high-dose statin (Lipitor 80 mg po qd) for patients with CAD.
I am not so sure about prescribing the high dose if you can achieve a significant LDL and CRP reduction with a lower statin dose.

Start U/S screening for AAA in male smokers aged 65 to 73.
It took us such a long time to realize that U/S screening saves lives in AAA patients...

Start considering seriously MRSA in skin/soft tissue infections, and consider Vancomycin treatment according to local guidelines.


Consider

Consider referring eligible patients with CHF for AICD.

Consider once-daily Spiriva (tiotropium) in COPD patients.


Stop

Stop prescribing high-dose vitamin E. In a large study of 130,000 patients, vitamin E use was associated with increased mortality.

Stop prescribing cholinesterase inhibitors (Aricept) routinely in dementia. These drug are at best marginally effective and can cause significant adverse effects. Memantine (Namenda) is still considered helpful, at least until newer studies show that it may not be...

Stop prescribing beta-blockers for:
- low-risk patients in the perioperative period. Patients with RCRI > 3, may still benefit from a beta-blocker.
- first-line HTN treatment. Beta-blockers increase the risk for development of DM2 and offer less protection against stroke than CCB and ACEi.


Up-To-Date also publishes regular updates in different medical specailties in the section "What's New" (paid subscription required).


References:
Update in General Internal Medicine. Christopher L. Knight, MD, and Stephan D. Fihn, MD, MPH. Annals of Internal Medicine, 7/2006. Paid subscription required (PDFs free after 6 months).

Perioperative beta blockers may not benefit patients with diabetes (if not used properly)

Norvasc plus ACEi much better than Atenolol plus HCTZ

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