Annals of Internal Medicine tip sheet, Jan. 17, 2012

Chronic obstructive pulmonary disease (COPD) is one of the top 10 leading causes of morbidity and mortality in the United States. Vitamin D deficiency is present in 60 percent to 75 percent of patients with severe COPD. Researchers studied 182 patients with severe COPD to determine whether supplementation with high doses of vitamin D could reduce the incidence of COPD exacerbations. Patients were randomly assigned to receive either 100,000 IU of vitamin D or placebo every four weeks for one year. Researchers then measured time to exacerbation of COPD. The researchers found that vitamin D supplementation did not reduce the number of acute exacerbations of COPD nor improve lung function. According to the authors of an accompanying editorial, this study does not definitively refute the benefit of vitamin D supplements for reducing COPD exacerbations. The editorial notes that variability in the underlying disease and genetics is likely to modify the pulmonary response to vitamin D supplementation in people with COPD, and calls for larger studies with longer follow up and daily dosing.

Obstructive sleep apnea (OSA) affects up to 3 percent of middle-aged women. The condition is more prevalent in men, and is less often recognized in women. Studies have shown an association between OSA and risk for cardiovascular death, but studies have focused mostly or exclusively on men. Researchers studied 1,116 women who were referred for evaluation of OSA to two sleep medicine clinics between 1998 and 2007. All of the women had a sleep test to determine the level of their sleep apnea. Women with an apnea-hyponea index, or AHI (measurement of cessation of breathing for more than 10 seconds), of less than 10 were the control group. Women with an AHI of 30 or greater (severe OSA) were offered treatment with a continuous positive airway pressure (CPAP) device. Women with untreated, severe OSA had increased cardiovascular death. However, CPAP treatment decreased mortality to a rate that was similar to that among women without OSA.

Many screening and diagnostic tests often offer little benefit and sometimes cause harm

Common clinical scenarios can result in better health outcomes if physicians and patients discuss the benefits and harms of screening and diagnostics tests that are often unnecessary or might cause harm, according to an opinion article published by a group of physicians from the American College of Physicians (ACP). The authors identified 37 common clinical situations relevant to internal medicine in which screening and diagnostic tests are often used in ways that provide little or no benefit to patients. "We hope to promote thoughtful discussions among physicians, patients, and other stakeholders about common clinical scenarios in which there are opportunities to improve the quality of care for the benefit of patients," said co-author Steven Weinberger, MD, FACP, executive vice president and CEO of ACP. Physicians, other health care professionals, and members of the public can complete a brief web survey on www.annals.org to indicate whether they agree that each of the items represents low value care. Survey respondents can also indicate clinical situations that they would add to the list. In an editorial, Christine Laine, MD, FACP, editor of Annals of Internal Medicine, says that the time is right to discuss how to achieve health care savings and improve the quality of care through more thoughtful use of an ever increasing array of tests. "Physicians, whether they agree or disagree with the ACP workgroup's or other groups' lists of overused interventions, can improve the value of testing by asking themselves a few common sense questions before ordering any test," Dr. Laine writes.

In an Annals "Ideas and Opinions" piece, researchers summarize results of some of the most recent and promising HIV prevention studies. Evidence has been inconsistent that prophylactic use of antiretroviral medications could protect exposed, uninfected persons from acquiring HIV. However, the concept is promising. Effectiveness of any regimen depends on adherence. The failure of some studies to produce positive results could be, in part, due to lack of adherence. Many who suffer from HIV are still undertreated. With expanded HIV testing, treatment and care, selective use of prophylactic antiretroviral medications along with other evidence-based prevention approaches (male circumcision and harm reduction for high-risk individuals, such as men who have sex with men, needle drug users, and sex workers) could substantially reduce infections.