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A 37-Year-Old Man Trying to Choose a High-Quality Hospital [Clinical Crossroads]
Reynolds, E.
Uniform Format for Disclosure of Competing Interests in ICMJE Journals [Editorial]
Drazen, J. M., Van Der Weyden, M. B., Sahni, P., Rosenberg, J., Marusic, A., Laine, C., Kotzin, S., Horton, R., Hebert, P. C., Haug, C., Godlee, F., Frizelle, F. A., de Leeuw, P. W., DeAngelis, C. D.
A 66-Year-Old Man With an Abdominal Aortic Aneurysm [Clinical Crossroads]
Burns, R.
This Week in JAMA [This Week in JAMA]

Surgical Mask vs N95 Respirator for Preventing Influenza Among Health Care Workers: A Randomized Trial [Original Contribution]
Loeb, M., Dafoe, N., Mahony, J., John, M., Sarabia, A., Glavin, V., Webby, R., Smieja, M., Earn, D. J. D., Chong, S., Webb, A., Walter, S. D. Context  Data about the effectiveness of the surgical mask compared with the N95 respirator for protecting health care workers against influenza are sparse. Given the likelihood that N95 respirators will be in short supply during a pandemic and not available in many countries, knowing the effectiveness of the surgical mask is of public health importance. Objective  To compare the surgical mask with the N95 respirator in protecting health care workers against influenza. Design, Setting, and Participants  Noninferiority randomized controlled trial of 446 nurses in emergency departments, medical units, and pediatric units in 8 tertiary care Ontario hospitals. Intervention  Assignment to either a fit-tested N95 respirator or a surgical mask when providing care to patients with febrile respiratory illness during the 2008-2009 influenza season. Main Outcome Measures  The primary outcome was laboratory-confirmed influenza measured by polymerase chain reaction or a 4-fold rise in hemagglutinin titers. Effectiveness of the surgical mask was assessed as noninferiority of the surgical mask compared with the N95 respirator. The criterion for noninferiority was met if the lower limit of the 95% confidence interval (CI) for the reduction in incidence (N95 respirator minus surgical group) was greater than –9%. Results  Between September 23, 2008, and December 8, 2008, 478 nurses were assessed for eligibility and 446 nurses were enrolled and randomly assigned the intervention; 225 were allocated to receive surgical masks and 221 to N95 respirators. Influenza infection occurred in 50 nurses (23.6%) in the surgical mask group and in 48 (22.9%) in the N95 respirator group (absolute risk difference, –0.73%; 95% CI, –8.8% to 7.3%; P = .86), the lower confidence limit being inside the noninferiority limit of –9%. Conclusion  Among nurses in Ontario tertiary care hospitals, use of a surgical mask compared with an N95 respirator resulted in noninferior rates of laboratory-confirmed influenza. Trial Registration  clinicaltrials.gov Identifier: NCT00756574 Published online October 1, 2009 (doi:10.1001/jama.2009.1466).
Factors Associated With Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California [Original Contribution]
Louie, J. K., Acosta, M., Winter, K., Jean, C., Gavali, S., Schechter, R., Vugia, D., Harriman, K., Matyas, B., Glaser, C. A., Samuel, M. C., Rosenberg, J., Talarico, J., Hatch, D., for the California Pandemic (H1N1) Working Group Context  Pandemic influenza A(H1N1) emerged rapidly in California in April 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A(H1N1) disproportionately affects younger ages and causes generally mild disease. Objective  To describe the clinical and epidemiologic features of pandemic 2009 influenza A(H1N1) cases that led to hospitalization or death. Design, Setting, and Participants  Statewide enhanced public health surveillance of California residents who were hospitalized or died with laboratory evidence of pandemic 2009 influenza A(H1N1) infection reported to the California Department of Public Health between April 23 and August 11, 2009. Main Outcome Measure  Characteristics of hospitalized and fatal cases. Results  During the study period there were 1088 cases of hospitalization or death due to pandemic 2009 influenza A(H1N1) infection reported in California. The median age was 27 years (range, <1-92 years) and 68% (741/1088) had risk factors for seasonal influenza complications. Sixty-six percent (547/833) of those with chest radiographs performed had infiltrates and 31% (340/1088) required intensive care. Rapid antigen tests were falsely negative in 34% (208/618) of cases evaluated. Secondary bacterial infection was identified in 4% (46/1088). Twenty-one percent (183/884) received no antiviral treatment. Overall fatality was 11% (118/1088) and was highest (18%-20%) in persons aged 50 years or older. The most common causes of death were viral pneumonia and acute respiratory distress syndrome. Conclusions  In the first 16 weeks of the current pandemic, the median age of hospitalized infected cases was younger than is common with seasonal influenza. Infants had the highest hospitalization rates and persons aged 50 years or older had the highest mortality rates once hospitalized. Most cases had established risk factors for complications of seasonal influenza.

 
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National Association of Retired Physicians - An association established to promote the use of retired physicians more easily in volunteer medicine.

American Board of Internal Medicine - Establishes certification requirements and sets standards for internal medicine.
Meta Description: [ American Board of Internal Medicine, Philadelphia PA 19106. A resource for residents and fellows in training, diplomates, and training program directors for Board Certification and Maintenance of Cetification in Internal Medicine and its subspecialties. Including information for health organizat... ]

American Board of Medical Specialties - Umbrella organization for the 24 approved medical specialty boards in the United States.

American Society of Internal Medicine - Largest medical specialty society in the US.
Meta Description: [ Web site of the American College of Physicians, the leading professional organization for internal medicine. Publisher of Annals of Internal Medicine and MKSAP (Medical Knowledge Self-Assessment Program). ]

Doctors For Adults - Information about internal medicine physicians.
Meta Description: [ Information about internists / doctors of internal medicine and common illnesses they diagnose and treat. Internists are primary care physicians and specialists that focus on adult health care. ]

Internal Medicine on the Web - Various online associations devoted to the improvement of medical education in the US, Canada, and Puerto Rico.

Society of General Internal Medicine - Seeking to improve patient care, education, and research in primary care and general internal medicine.

Southern Medical Association - Offering education, networking, and collegiality to physicians practicing in the South.
Meta Description: [ The Southern Medical Association enables physicians to practice the highest standards of medicine by fostering professional development and economic stability through education, services, collegiality, and leadership across multiple specialties. ]

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