Internal_Medicine RSS : Gourt

An Intimate Hospital in a Growing Community Seeks an IM Physician for South Carolina :: South Carolina :: CompHealth Inc

Job 3112624 Very family-oriented community with tremendous growth Traditional setting with 1:6 established call Supported by one of the country's best community hospital corporations Located within

IM Physicians to Practice and Grow Quickly on the Beautiful SW Florida Coast :: Florida :: CompHealth Inc

Job 3112751 Internal Medicine physicians needed in Southwest Florida just minutes to the Gulf Coast Be busy quickly with a waitiing patient base from the growing community demand Community has strong

Charming, Friendly Community Central to Indianapolis, Cincinnati and Dayton :: Indiana :: CompHealth Inc

Job 6510574 Hospital-based employed practice Both Inpatient and outpatient components Call 1:4 Compensation: $160,000 + DOE plus incentive Full benefits (health, life, retirement, CME allowance, generous

East Georgia Seeks Internist Offers Ideal Growth and Earnings Potential :: Georgia :: CompHealth Inc

Job 3113319 *Internist needed to join another in a traditional practice setting *Be busy quickly with patients from growing community demand for more IM physicians *Competitive Salary and incentives *Benefits

Charming South Carolina Community Seeks and Internal Medicine Physician :: South Carolina :: CompHealth Inc

Job 3112959 BC/BE Internal Medicine Physician will be highly welcome for this SC community Will have an option to join another or be in their own solo practice Traditional practice setting doing Inpatient/Outpatient

High Income Potential with your Own Practice in Central Florida :: Florida :: CompHealth Inc

Job 3113004 Internal Medicine physician for this growing community in Central Florida Hospital will assist and market in setting up your own Solo practice Traditional practice setting being busy from

Family Practice Physician Needed in Beautiful Washington State :: Washington :: CompHealth Inc

Job 3112776 Traditional setting with 1:5 call rotation Growing community need will have new physician busy from the start Family community that offers very affordable housing and low cost of living

Outstanding Internal Medicine Opportunity in Central Maine :: Maine :: CompHealth Inc

Job 6510891 Hospital employed practice seeks additional Internist Outpatient practice only, no hospital work Salary starts in the $135,000 range plus all benefits Phone call for practice is 1:9 Enjoy

IM Role in Beautiful Southwest Florida on the Gulf Coast :: Florida :: CompHealth Inc

Job 3113051 Premier group in the region is seeking an Internal medicine doctor to add to their medical staff They are always looking to facilitate an adequate number of specialists to insure the growing

100% Outpatient Minutes from the Beaches of Miami :: Florida :: CompHealth Inc

Job 6510971 100% outpatient Shared phone call only Strong compensation plus productivity bonus Employed practice with a predictable schedule Must be fluent in Spanish All insurances covered with ample

Internal Medicine on the Beautiful Kansas Plains :: Kansas :: CompHealth Inc

Job 6510560 Join established traditional practice or solo start up with shared call Generous income guarantee, potential $250k Loan forgiveness program, relocation assistance Practice establishment

Strong Internal Medicine need in Central Florida :: Florida :: CompHealth Inc

Job 917784 Successful Florida group looking to bring on another in a fabulous location Incredible location Partnership available Great Central Florida Location Easy access to all amenities Stable schedule

Busy Practice Seeks Internist Outside Dallas :: Texas :: CompHealth Inc

Job 3112979 Join another busy practice or establish an independent practice Clinic affiliated with the hospital BC/BE Internist will be busy quickly due to community demand No personal income tax

Internists...Come to North Carolina !!! :: North Carolina :: CompHealth Inc

Job 6510668 Less than 45 minutes to Winston-Salem Well established practice with waiting patient base Affordable cost of living Low taxes Fabulous benefits with unlimited earning potential Malpractice

The Golden State Seeks an Internist :: California :: CompHealth Inc

Job 911342 Join a solo physician Waiting patient base Ready for physician to start now Metropolitan community Easy access to the Bay Area Location, location, location! Competitive income guarantee

Missouri IM Position at it's Best! :: Missouri :: CompHealth Inc

Job 3112817 Solo practice with 1:4 call Coverage Very strong salary guarantee and incentives Up to 10K relocation and 20K sign on bonus Will qualify for rural health reimbursement Excellent Family Community,

IM Role in the Florida Keys :: Florida :: CompHealth Inc

Job 3112881 Internal Medicine physicians needed for a traditional practice setting Established call coverage 1:5 Be busy from the start with a waiting patient base from community demand for more primary

Wyoming FP & IM Outpatient :: Wyoming :: CompHealth Inc

Job 918271 The Doctor has a few options, 1) Start their own practice with the help of the hospital 2) Work in the hospital clinic 3) Work with another practice within the community with the backing

Wyoming FP & IM Outpatient :: Wyoming :: CompHealth Inc

Job 918284 The Doctor has a few options, 1) Start their own practice with the help of the hospital 2) Work in the hospital clinic 3) Work with another practice within the community with the backing

Hawaii Internal Medicine :: Hawaii :: CompHealth Inc

Job 918834 Traditional Internal Medicine Multi-Specialty Group Possible partnership after two years Earning potential over 200K Sign on bonus; Negotiable Two excellent private schools Full family health

Breastfeeding and allergies: time for a change in paradigm?.

Page: 539DOI: 10.1097/MCI.0b013e32831dae43Authors: Duncan, Joanne M; Sears, Malcolm R

New aspects in allergic contact dermatitis.

Page: 547DOI: 10.1097/MCI.0b013e32831dae50Authors: Mortz, Charlotte Gotthard; Andersen, Klaus Ejner

Contemporary approaches to the identification of athletes at risk for sudden cardiac death.

Page: 552DOI: 10.1097/MCI.0b013e32831daee4Authors: Drezner, Jonathan A

How to break the vicious circle of antibiotic resistances?.

Page: 560DOI: 10.1097/MCI.0b013e32831dabd1Authors: Leone, Marc; Martin, Claude

Benefits of high-protein weight loss diets: enough evidence for practice?.

Page: 566DOI: 10.1097/MCI.0b013e32831daebdAuthors: Brehm, Bonnie J a; D'Alessio, David A b

Chronic pancreatitis.

Page: 572DOI: 10.1097/MCI.0b013e32831daddaAuthors: Conwell, Darwin L; Banks, Peter A

Heparin-induced thrombocytopenia: some working hypotheses on pathogenesis, diagnostic strategies and treatment.

Page: 577DOI: 10.1097/MCI.0b013e32831dae94Authors: Alberio, Lorenzo

Long-term prognosis after deep venous thrombosis.

Page: 586DOI: 10.1097/MCI.0b013e32831daea9Authors: Shbaklo, Hadia a; Kahn, Susan R a,b

New advances in Clostridium difficile infection: changing epidemiology, diagnosis, treatment and control.

Page: 591DOI: 10.1097/MCI.0b013e32831daed2Authors: DuPont, Herbert L a,b,c; Garey, Kevin b,c,d; Caeiro, Juan-Pablo b,c; Jiang, Zhi-Dong a

Elevations in serum creatinine with RAAS blockade: why isn't it a sign of kidney injury?.

Page: 599DOI: 10.1097/MCI.0b013e32831daeffAuthors: Ryan, Michael J a; Tuttle, Katherine R a,b

Renin inhibition: should it supplant ACE inhibitors and ARBS in high risk patients?.

Page: 606DOI: 10.1097/MCI.0b013e32831daf11Authors: Gaddam, Krishna K; Oparil, Suzanne

Diabetic polyneuropathy: an update.

Page: 613DOI: 10.1097/MCI.0b013e32831dae0bAuthors: Zochodne, Douglas W

Drug-induced myopathies.

Page: 620DOI: 10.1097/MCI.0b013e32831dae1cAuthors: Klopstock, Thomas

Evolving epidemiology of malignancies in HIV.

Page: 626DOI: 10.1097/MCI.0b013e32831dae71Authors: Bonnet, Fabrice a,b,c; Chene, Genevieve a,b

Vaccines against cervical cancer.

Page: 633DOI: 10.1097/MCI.0b013e32831dae88Authors: Rogers, Linda J; Eva, Lois J; Luesley, David Michael

Effectiveness and cost effectiveness of thrombolysis in patients with acute pulmonary embolism.

Page: 638DOI: 10.1097/MCI.0b013e32831dad76Authors: Zamanian, Roham T a,b; Gould, Michael K a,c

Update on biologics in juvenile idiopathic arthritis.

Page: 643DOI: 10.1097/MCI.0b013e32831dae32Authors: Ilowite, Norman T

Retraction of article from ACP Journal Club. Retraction.

Retraction of article from ACP Journal Club. Retraction. Ann Intern Med. 2009 Nov 17;151(10):JC5-3 Authors: Haynes RB PMID: 19938333 [PubMed - in process]

Is It Time to Eliminate Consultation Codes?: An Analysis of Impact and Rationale [Special Article]

Background As issues of health care cost escalation and parity of payment between primary care and other physicians have become more important, one proposal has been to eliminate consultation codes. Little is known about the current payment accuracy or financial impact of such a change.Methods To assess the impact of consultation code elimination, 2 assessments were conducted. First, from June 1, 2008, to July 1, 2009, 500 consecutive referrals from primary care physicians to other specialists were reviewed and matched with claims for accuracy of coding and billing. Second, to evaluate the financial impact of this change, year 2007 data on outpatient consultations from the Centers for Medicare and Medicaid Services were reviewed.Results Of the 500 claims reviewed, 466 were appropriate for analysis. Overall, the coding error rate was 32.4%. When the requesting physician ordered a consultation, the error rate was 5.5%; however, with lower paid referral requests, the error rate was 78.0%. Changing ambulatory consultation codes to those for new patient visits would save Medicare $534.5 million per year.Conclusions Consultation codes are being billed erroneously at a high rate. Furthermore, the differential cost to Medicare of these codes over those for new patient evaluation and management codes is over half a billion dollars per year. With the growing needs for cost savings as well as encouraging payment parity for cognitive services for primary care physicians, it is time these codes are reevaluated.Published online November 9, 2009 (doi:10.1001/archinternmed.2009.446).

About This Journal [About This Journal]

In This Issue of Archives of Internal Medicine [In This Issue of Archives of Internal Medicine]

Home Is Where the Health Is: Advancing Team-Based Care in Chronic Disease Management [Editorial]

Thyrotropin Blood Levels, Subclinical Hypothyroidism, and the Elderly Patient [Editorial]

Meta-analysis of the Impact of 9 Medication Classes on Falls in Elderly Persons [Review Article]

Background There is increasing recognition that the use of certain medications contributes to falls in seniors. Our objective was to update a previously completed meta-analysis looking at the association of medication use and falling to include relevant drug classes and new studies that have been completed since a previous meta-analysis. Methods Studies were identified through a systematic search of English-language articles published from 1996 to 2007. We identified studies that were completed on patients older than 60 years, looking at the association between medication use and falling. Bayesian methods allowed us to combine the results of a previous meta-analysis with new information to estimate updated Bayesian odds ratios (ORs) and 95% credible intervals (95% CrIs) Results Of 11 118 identified articles, 22 met our inclusion criteria. Meta-analyses were completed on 9 unique drug classes, including 79 081 participants, with the following Bayesian unadjusted OR estimates: antihypertensive agents, OR, 1.24 (95% CrI, 1.01-1.50); diuretics, OR, 1.07 (95% CrI, 1.01-1.14); β-blockers, OR, 1.01 (95% CrI, 0.86-1.17); sedatives and hypnotics, OR, 1.47 (95% CrI, 1.35-1.62); neuroleptics and antipsychotics, OR, 1.59 (95% CrI, 1.37-1.83); antidepressants, OR, 1.68 (95% CrI, 1.47-1.91); benzodiazepines, OR, 1.57 (95% CrI, 1.43-1.72); narcotics, OR, 0.96 (95% CrI, 0.78-1.18); and nonsteroidal anti-inflammatory drugs, OR, 1.21 (95% CrI, 1.01-1.44). The updated Bayesian adjusted OR estimates for diuretics, neuroleptics and antipsychotics, antidepressants, and benzodiazepines were 0.99 (95% CrI, 0.78-1.25), 1.39 (95% CrI, 0.94-2.00), 1.36 (95% CrI, 1.13-1.76), and 1.41 (95% CrI, 1.20-1.71), respectively. Stratification of studies had little effect on Bayesian OR estimates, with only small differences in the stratified ORs observed across population (for β-blockers and neuroleptics and antipsychotics) and study type (for sedatives and hypnotics, benzodiazepines, and narcotics). An increased likelihood of falling was estimated for the use of sedatives and hypnotics, neuroleptics and antipsychotics, antidepressants, benzodiazepines, and nonsteroidal anti-inflammatory drugs in studies considered to have "good" medication and falls ascertainment. Conclusion The use of sedatives and hypnotics, antidepressants, and benzodiazepines demonstrated a significant association with falls in elderly individuals.

The Prevalence of Clinically Relevant Incidental Findings on Chest Computed Tomographic Angiograms Ordered to Diagnose Pulmonary Embolism [Original Investigation]

Background Chest computed tomographic angiograms (CTAs) are frequently ordered for evaluation of suspected pulmonary embolism (PE) in the emergency department, but non-PE findings are often noted. Our objective was to determine the prevalence and management implications of incidental findings on chest CTAs ordered to assess for PE. Methods In a cross-sectional study, we reviewed 589 pulmonary CTAs that were ordered in the emergency department of a tertiary care hospital. We measured the prevalence of PE and placed other findings into the following 3 categories: (1) findings that provided potential alternative explanations for acute symptoms, (2) incidental findings that required clinical or radiologic follow-up, and (3) other findings that required less urgent or no follow-up. We reviewed all newly diagnosed pulmonary nodules and significant thoracic adenopathy and determined standard recommended clinical follow-up. Results Pulmonary embolism was found in 55 of 589 CTAs (9%). A total of 195 CTAs (33%) had findings that supported alternative diagnoses. A total of 141 patients (24%) had a new incidental finding that required diagnostic follow-up, including 73 patients (13%) with a new pulmonary nodule and 51 patients (9%) with new adenopathy. Using current clinical guidelines, follow-up computed tomography or another procedure would be recommended for 96% of patients with new incidental pulmonary nodules. Conclusions The CTAs that are ordered in the emergency department are more than twice as likely to find an incidental pulmonary nodule or adenopathy than a PE. Systematic approaches should be developed to help primary care physicians contend with a growing number of clinically relevant incidental radiologic findings.

Computed Tomographic Pulmonary Angiography to Diagnose Acute Pulmonary Embolism: The Good, the Bad, and the Ugly: Comment on "The Prevalence of Clinically Relevant Incidental Findings on Chest Computed Tomographic Angiograms Ordered to Diagnose Pulmonary Embolism" [Invited Commentary]

Error in Abstract in: Risk of Hyperkalemia in Nondiabetic Patients With Chronic Kidney Disease Receiving Antihypertensive Therapy [Correction]

Costs and Consequences of Direct-to-Consumer Advertising for Clopidogrel in Medicaid [Original Investigation]

Background Direct-to-consumer advertising (DTCA) is assumed to be a major driver of rising pharmaceutical costs. Yet, research on how it affects costs is limited. Therefore, we studied clopidogrel, a commonly used and heavily marketed antiplatelet agent, which was first sold in 1998 and first direct-to-consumer advertised in 2001. Methods We examined pharmacy data from 27 Medicaid programs from 1999 through 2005. We used interrupted time series analysis to analyze changes in the number of units dispensed, cost per unit dispensed, and total pharmacy expenditures after DTCA initiation. Results In 1999 and 2000, there was no DTCA for clopidogrel; from 2001 through 2005, DTCA spending exceeded $350 million. Direct-to-consumer advertising did not change the preexisting trend in the number of clopidogrel units dispensed per 1000 enrollees (P = .10). However, there was a sudden and sustained increase in cost per unit of $0.40 after DTCA initiation (95% confidence interval, $0.31-$0.49; P < .001), leading to an additional $40.58 of pharmacy costs per 1000 enrollees per quarter thereafter (95% confidence interval, $22.61-$58.56; P < .001). Overall, this change resulted in an additional $207 million in total pharmacy expenditures. Conclusions Direct-to-consumer advertising was not associated with an increase in clopidogrel use over and above preexisting trends. However, Medicaid pharmacy expenditures increased substantially after the initiation of DTCA because of a concomitant increase in the cost per unit. If drug price increases after DTCA initiation are common, there are important implications for payers and for policy makers in the United States and elsewhere.

Pooled Analysis of Rofecoxib Placebo-Controlled Clinical Trial Data: Lessons for Postmarket Pharmaceutical Safety Surveillance [Original Investigation]

Background In September 2004, rofecoxib was voluntarily withdrawn from the worldwide market. Our objective was to determine whether and when analysis of published and unpublished placebo-controlled trials could have revealed cardiovascular risk associated with rofecoxib before its withdrawal as an example to inform future postmarket pharmaceutical safety surveillance efforts. Methods We conducted a cumulative subject-level pooled analysis of data from all randomized, placebo-controlled trials of rofecoxib conducted by the manufacturer before September 2004. Our main outcome measurement was incidence of any investigator-reported death from any cause or cardiovascular thromboembolic (CVT) adverse event. Results We identified 30 randomized, placebo-controlled trials of rofecoxib that enrolled a combined 20 152 subjects. Trial duration ranged from 4 weeks to 4 years; enrollment ranged from 17 to 2586 subjects prescribed either rofecoxib or placebo; and rofecoxib dose ranged from 12.5 mg to 50 mg. As of December 2000, 21 of these trials had been completed (70%), and the risk of a CVT adverse event or death was greater among subjects assigned to the rofecoxib group (rate ratio [RR], 2.18; 95% confidence interval [CI], 0.93-5.81) (P = .07), raising concerns from a safety standpoint. Subsequently collected data through June 2001 showed that rofecoxib was associated with a 35% increased risk of a CVT adverse event or death (RR, 1.35; 95% CI, 1.00-1.96) (P = .05). Analyzing data available as of April 2002, we found a 39% increased risk (RR, 1.39; 95% CI, 1.07-1.80) (P = .02), and using data available as of September 2004, we found a 43% increased risk (RR,1.43; 95% CI, 1.16-1.76) (P < .001). Conclusion Cumulative pooled analysis of all randomized, placebo-controlled trials demonstrates a trend toward increased cardiovascular risk associated with rofecoxib compared with placebo as early as December 2000, the comparison reaching a P value of .05 by June 2001, nearly 31/2 years before the manufacturer's voluntary market withdrawal.

Bringing the FDA's Information to Market [Invited Commentary]

Case Management to Reduce Risk of Cardiovascular Disease in a County Health Care System [Original Investigation]

Background Case management (CM) is a systematic approach to supplement physician-centered efforts to prevent cardiovascular disease (CVD). Research is limited on its implementation and efficacy in low-income, ethnic minority populations. Methods We conducted a randomized clinical trial to evaluate a nurse- and dietitian-led CM program for reducing major CVD risk factors in low-income, primarily ethnic minority patients in a county health care system, 63.0% of whom had type 2 diabetes mellitus. The primary outcome was the Framingham risk score (FRS). Results A total of 419 patients at elevated risk of CVD events were randomized and followed up for a mean of 16 months (81.4% retention). The mean FRS was significantly lower for the CM vs usual care group at follow-up (7.80 [95% confidence interval, 7.21-8.38] vs 8.93 [8.36-9.49]; P = .001) after adjusting for baseline FRS. This is equivalent to 5 fewer heart disease events per 1000 individuals per year attributable to the intervention or to 200 individuals receiving the intervention to prevent 1 event per year. The pattern of group differences in the FRS was similar in subgroups defined a priori by sex and ethnicity. The main driver of these differences was lowering the mean (SD) systolic (–4.2 [18.5] vs 2.6 [22.7] mm Hg; P = .003) and diastolic (–6.0 [11.6] vs –3.0 [11.7] mm Hg; P = .02) blood pressures for the CM vs usual care group. Conclusion Nurse and dietitian CM targeting multifactor risk reduction can lead to modest improvements in CVD risk factors among high-risk patients in low-income, ethnic minority populations receiving care in county health clinics. Trial Registration clinicaltrials.gov Identifier: NCT00128687

Physician and Pharmacist Collaboration to Improve Blood Pressure Control [Original Investigation]

Background Studies have demonstrated that blood pressure (BP) control can be improved when clinical pharmacists assist with patient management. The objective of this study was to evaluate if a physician and pharmacist collaborative model in community-based medical offices could improve BP control. Methods This was a prospective, cluster randomized, controlled clinical trial with clinics randomized to a control group (n = 3) or to an intervention group (n = 3). The study enrolled 402 patients (mean age, 58.3 years) with uncontrolled hypertension. Clinical pharmacists made drug therapy recommendations to physicians based on national guidelines. Research nurses performed BP measurements and 24-hour BP monitoring. Results The mean (SD) guideline adherence scores increased from 49.4 (19.3) at baseline to 53.4 (18.1) at 6 months (8.1% increase) in the control group and from 40.4 (22.6) at baseline to 62.8 (13.5) at 6 months (55.4% increase) in the intervention group (P = .09 for adjusted between-group comparison). The mean BP decreased 6.8/4.5 mm Hg in the control group and 20.7/9.7 mm Hg in the intervention group (P < .05 for between-group systolic BP comparison). The adjusted difference in systolic BP was –12.0 (95% confidence interval [CI], –24.0 to 0.0) mm Hg, while the adjusted difference in diastolic BP was –1.8 (95% CI, –11.9 to 8.3) mm Hg. The 24-hour BP levels showed similar effect sizes. Blood pressure was controlled in 29.9% of patients in the control group and in 63.9% of patients in the intervention group (adjusted odds ratio, 3.2; 95% CI, 2.0-5.1; P < .001). Conclusions A physician and pharmacist collaborative intervention achieved significantly better mean BP and overall BP control rates compared with a control group. Additional research should be conducted to evaluate efficient strategies to implement team-based chronic disease management. Trial Registration clinicaltrials.gov Identifier: NCT00201019

Impact of a Pharmacist-Facilitated Hospital Discharge Program: A Quasi-Experimental Study [Original Investigation]

Background Medication discrepancies are common at hospital discharge and can result in adverse events, hospital readmissions, and emergency department visits. Our objectives were to characterize medication discrepancies at hospital discharge and test the effects of a pharmacist intervention on health care utilization following discharge. Methods We used a prospective, alternating month quasi-experimental design to compare outcomes of patients receiving the intervention (n = 358) with controls (n = 366). All patients were discharged to home and were at high risk for medication-related problems following discharge because of the number or types of medications they were prescribed, multiple medication changes during hospitalization, or problems managing medications. The intervention consisted of medication therapy assessment, medication reconciliation, screening for adherence concerns, patient counseling and education, and postdischarge telephone follow-up. The primary outcomes were 14-day and 30-day readmission rates and emergency department visits within 72 hours of discharge. Medication discrepancies occurring at discharge were also characterized. Results Medication discrepancies at discharge were identified in 33.5% of intervention patients and 59.6% of control patients (P < .001). Although all discrepancies were resolved in the intervention group prior to discharge, readmission rates did not differ significantly between groups at 14 days (12.6% vs 11.5%; P = .65) and 30 days (22.1% vs 18%; P = .17), nor did emergency department visits (2.8% vs 2.2%, respectively; P = .60). Conclusion While our intervention improved the quality of patient discharge by identifying and reconciling medication discrepancies at discharge, there was no effect on postdischarge health care resource utilization.

Subclinical Hypothyroidism and Functional Mobility in Older Adults [Original Investigation]

Background Health risks associated with subclinical hypothyroidism in older adults are unclear. Our objective was to compare the functional mobility of people aged 70 to 79 years by thyroid function categorized by thyrotropin (TSH) level as euthyroid (≥0.4 to <4.5 mIU/L), mild subclinical hypothyroid (≥4.5 to <7.0 mIU/L), or moderate subclinical hypothyroid (≥7.0 to ≤20.0 mIU/L with a normal free thyroxine level) cross-sectionally and over 2 years. Methods A total of 2290 community-dwelling residents participating in the year 2 clinic visit (July 1998–June 1999) of the Health, Aging, and Body Composition (Health ABC) Study, who had measured TSH level, had the capacity to walk 20 m unaided, and were not taking thyroid medication or had TSH levels consistent with hyperthyroidism or hypothyroidism. Main outcome measures included self-reported and performance-based measures of mobility (usual and rapid gait speed and endurance walking ability) assessed at study baseline (year 2) and 2 years later. Results In age- and sex-adjusted analyses, the mild subclinical hypothyroid group (vs the euthyroid group) demonstrated better mobility (faster mean usual and rapid gait speed [1.20 vs 1.15 m/s and 1.65 vs 1.56 m/s, respectively; P < .001] and had a higher percentage of those with good cardiorespiratory fitness and reported walking ease [39.2% vs 28.0% and 44.7% vs 36.5%, respectively; P < .001]). After 2 years, persons with mild subclinical hypothyroidism experienced a similar decline as the euthyroid group but maintained their mobility advantage. Persons with moderate subclinical hypothyroidism had similar mobility and mobility decline as the euthyroid group. Conclusion Generally, well-functioning 70- to 79-year-old individuals with subclinical hypothyroidism do not demonstrate increased risk of mobility problems, and those with mild elevations in TSH level show a slight functional advantage.

Yield of Bone Marrow Examination in Diagnosing the Source of Fever of Unknown Origin [Original Investigation]

Background Fever of unknown origin (FUO) still remains a diagnostic challenge, while diagnosis may remain obscure for several weeks or months. The role of tissue biopsy is crucial in the diagnostic approach. We report a series of 130 consecutive patients with FUO who had undergone a bone marrow biopsy (BMB). Methods Among 280 consecutive nonimmunocompromised patients hospitalized between 1995 and 2005 for a febrile illness of uncertain cause, lasting at least 3 weeks, with no diagnosis after an appropriate minimal diagnostic workup, 130 underwent BMB. Results Overall, a specific diagnosis was achieved by BMB and histological examination in 31 cases (diagnostic yield, 23.7%). Three types of diseases were found: hematological malignant diseases in 25 cases, including 19 patients with malignant lymphoma, 4 with acute leukemia, 1 with hairy cell leukemia, and 1 with multiple myeloma; infectious diseases in 3 cases; systemic mastocytosis in 2 cases; and disseminated granulomatosis in 1 case. Thrombocytopenia (odds ratio, 4.9; 95% confidence interval, 1.04-9.30) and anemia (odds ratio, 3.24; 95% CI, 1.13-9.34) were the most reliable predictive factors regarding the usefulness of BMB. Bone marrow cultures had very limited value in our cohort. Finally, corticosteroid use did not seem to affect the yield of BMB. Conclusions Bone marrow biopsy is a useful technique for the diagnosis of prolonged fever in immunocompetent patients. Thrombocytopenia and anemia seem to be correlated with the value of this test.

Direct-to-Consumer Offers for Free and Discounted Medications on the Internet: A Content Analysis of "e-Samples" [Comments, Opinions, and Brief Case Reports]

A Question of the Clinical Relevance of Determining Thrombomodulin Level While Receiving Anticoagulant Therapy [Editor's Correspondence]

A Question of the Clinical Relevance of Determining Thrombomodulin Level While Receiving Anticoagulant Therapy--Reply [Editor's Correspondence]

The International Normalized Ratio Range of 2.0 to 3.0 Remains Appropriate for Atrial Fibrillation [Editor's Correspondence]

Optimal Anticoagulation Therapy in Patients With Valvular Heart Disease or Atrial Fibrillation [Editor's Correspondence]

Optimal Anticoagulation Therapy in Patients With Valvular Heart Disease or Atrial Fibrillation--Reply [Editor's Correspondence]