In high-risk outpatients with COVID-19, neither colchicine nor aspirin reduced disease progression or death at 45 d.

Eikelboom JW, Jolly SS, Belley-Cote EP, et al. Lancet Respir Med. 2022;10:1160-8.

In non-low back musculoskeletal injuries, NSAIDs and acetaminophen reduce acute pain.

Busse JW, Sadeghirad B, Oparin Y, et al. Ann Intern Med. 2020;173:730-8.

A single baseline ultrasound assessment of fibroid presence and size is strongly predictive of future uterine procedure: 8-year follow-up of randomly sampled premenopausal women aged 35-49 years.

Study Question: How well can a single baseline ultrasound assessment of fibroid burden (presence or absence of fibroids and size of largest, if present) predict future probability of having a major uterine procedure?

Summary Answer: During an 8-year follow-up period, the risk of having a major uterine procedure was 2% for those without fibroids and increased with fibroid size for those with fibroids, reaching 47% for those with fibroids ≥ 4 cm in diameter at baseline.

What Is Known Already: Uterine fibroids are a leading indication for hysterectomy. However, when fibroids are found, there are few available data to help clinicians advise patients about disease progression.

Vitamin d and the risk of uterine fibroids.

Background: Uterine leiomyomata (also known as fibroids) are benign tumors of uterine smooth muscle that are characterized by overproduction of extracellular matrix. Fibroids are the leading indication for hysterectomy in the United States. The active metabolite of vitamin D has been shown to inhibit cell proliferation and extracellular matrix production in fibroid tissue culture and to reduce fibroid volume in the Eker rat.

The association of health literacy and socio-demographic factors with medication knowledge.

Objective: To compare patient demographics and Rapid Estimate of Adult Literacy in Medicine (REALM) scores with respect to their ability to predict medication comprehension.

Methods: A survey was conducted of 100 patients presenting for follow-up at an academic primary care clinic serving a low socio-economic status population. The Medication Knowledge Score (MKS) consisted of knowledge of drug name, dose, indication, and a potential side effect for each of their medications and then averaged.

Uterine leiomyomata in relation to insulin-like growth factor-I, insulin, and diabetes.

Background: Insulin-like growth factor-I (IGF-I) and insulin stimulate cell proliferation in uterine leiomyoma (fibroid) tissue. We hypothesized that circulating levels of these proteins would be associated with increased prevalence and size of uterine fibroids.

Methods: Participants were 35-49-year-old, randomly selected members of an urban health plan who were enrolled in the study in 1996-1999.

Changing conversations: teaching safety and quality in residency training.

Improving patient safety and quality in health care is one of medicine's most pressing challenges. Residency training programs have a unique opportunity to meet this challenge by training physicians in the science and methods of patient safety and quality improvement (QI).With support from the Health Resources and Services Administration, the authors developed an innovative, longitudinal, experiential curriculum in patient safety and QI for internal medicine residents at the University of Virginia.

Appointment adherence and disparities in outcomes among patients with diabetes.

Background: Successful control of diabetes mellitus requires lifelong adherence to multiple self-management activities in close collaboration with health professionals. We examined the association of such control with appointment keeping behavior in a rural health system.

Methods: Among 4,253 predominantly lower socioeconomic status patients with diabetes, the association of metabolic control (most recent A1c <7% or >9% in two models of respectively 'good' and 'poor' control) with 'missed appointment rate' over a 3-year period was examined using multiple logistic regression.

Association of physical activity with development of uterine leiomyoma.

The relation between physical activity and uterine leiomyomata (fibroids) has received little study, but exercise is protective for breast cancer, another hormonally mediated tumor. Participants in this study were randomly selected members of a health plan based in Washington, DC, aged 35-49 years (734 African Americans, 455 Whites) enrolled between 1996 and 1999. Fibroid status was based on ultrasound screening.

Physician perception of hospital safety and barriers to incident reporting.

Background: Despite increased attention to patient safety in recent years, physician involvement in hospital safety activities appears to have remained limited.

Methods: An anonymous survey of internal medicine housestaff and faculty physicians at an academic medical center assessed safety reporting behavior and witnessed adverse events or near misses.

Results: Although 65% of the 120 physicians responding (56% response rate) had not made any adverse event or near miss reports in the prior year, 60% had witnessed at least three adverse events or near misses.

Ultrasound guidance during central venous catheterization: a survey of use by house staff physicians.

Purpose: The objective of this study is to explore the attitudes, knowledge, and behavior of house staff physicians regarding the use of ultrasound guidance (UG) during central venous catheter placement (CP).

Materials And Methods: A questionnaire-based study was used to survey house staff in multiple training programs at an academic tertiary care center.

Results: Fifteen percent of the respondents reported using UG on at least 60% of CP attempts.

Determinants of physician use of an ambulatory prescription expert system.

Purpose: To determine whether physician experience with and attitude towards computers is associated with adoption of a voluntary ambulatory prescription writing expert system.

Methods: A prescription expert system was implemented in an academic internal medicine residency training clinic and physician utilization was tracked electronically. A physician attitude and behavior survey (response rate=89%) was conducted six months after implementation.

The Clinical Health Economics System Simulation (CHESS): a teaching tool for systems- and practice-based learning.

Academic medical centers face barriers to training physicians in systems- and practice-based learning competencies needed to function in the changing health care environment. To address these problems, at the University of Virginia School of Medicine the authors developed the Clinical Health Economics System Simulation (CHESS), a computerized team-based quasi-competitive simulator to teach the principles and practical application of health economics. CHESS simulates treatment costs to patients and society as well as physician reimbursement.

The effect of physician feedback and an action checklist on diabetes care measures.

The objective was to evaluate whether physician feedback accompanied by an action checklist improved diabetes care process measures. Eighty-three physicians in an academic general medicine clinic were provided a single feedback report on the most recent date and result of diabetes care measures (glycosylated hemoglobin [A1c], urine microalbumin, serum creatinine, lipid levels, retinal examination) as well as recent diabetes medication refills with calculated dosing and adherence on 789 patients. An educational session regarding the feedback and adherence information was provided.

Repeated-measures modeling improved comparison of diagnostic tests in meta-analysis of dependent studies.

Objective: Current methods for meta-analysis of diagnostic tests do not allow utilizing all the information from papers in which several tests have been studied on the same patient sample. We demonstrate how to combine several studies of diagnostic tests, where each study reports on more than one test and some tests (but not necessarily all of them) are shared with other papers selected for the meta-analysis. We adopt statistical methodology for repeated measurements for the purpose of meta-analysis of diagnostic tests.

Patient safety in the ambulatory setting. A clinician-based approach.

Background: Voluntary reporting of near misses/adverse events is an important but underutilized source of information on errors in medicine. To date, there is very little information on errors in the ambulatory setting and physicians have not traditionally participated actively in their reporting or analysis.

Objectives: To determine the feasibility and effectiveness of clinician-based near miss/adverse event voluntary reporting coupled with systems analysis and redesign as a model for continuous quality improvement in the ambulatory setting.

D-dimer testing for deep venous thrombosis: a metaanalysis.

Background: The use of D-dimer assays as a rule-out test for deep venous thrombosis (DVT) is controversial. To clarify this issue we performed a systematic review of the relevant literature.

Methods: We identified eligible studies, using MEDLINE entries from February 1995 through October 2003, supplemented by a review of bibliographies of relevant articles.

Can prescription refill feedback to physicians improve patient adherence?

Background: Although adherence to long-term drug therapy is an important issue, the means to facilitate its assessment and improvement in clinical practice remain a challenge.

Objective: To evaluate the impact of prescription refill feedback and adherence education provided to primary care physicians.

Methods: We provided 83 resident and attending physicians at a university-based general internal medicine practice with refill adherence reports on each of 340 diabetic patients.