Abstract:
BACKGROUND:The appropriate roles for several diagnostic tests for coronary disease are uncertain. OBJECTIVE:To evaluate the cost-effectiveness of alternative approaches to diagnosis of coronary disease. DESIGN:Meta-analysis of the accuracy of alternative diagnostic tests plus decision analysis to assess the health outcomes and costs of alternative diagnostic strategies for patients at intermediate pretest risk for coronary disease. DATA SOURCES:Studies of test accuracy that met inclusion criteria; published information on treatment effectiveness and disease prevalence. TARGET POPULATION:Men and women 45, 55, and 65 years of age with a 25% to 75% pretest risk for coronary disease. TIME HORIZON:30 years. PERSPECTIVE:Societal. INTERVENTIONS:Diagnostic strategies were initial angiography and initial testing with one of five noninvasive tests--exercise treadmill testing, planar thallium imaging, single-photon emission computed tomography (SPECT), stress echocardiography, and positron emission tomography (PET)--followed by coronary angiography if noninvasive test results were positive. Testing was followed by observation, medical treatment, or revascularization. OUTCOME MEASURES:Life-years, quality-adjusted life-years (QALYs), costs, and costs per QALY. RESULTS OF BASE-CASE ANALYSIS:Life expectancy varied little with the initial diagnostic test; for a 55-year-old man, the best-performing test increased life expectancy by 7 more days than the worst-performing test. More sensitive tests increased QALYs more. Echocardiography improved health outcomes and reduced costs relative to stress testing and planar thallium imaging. The incremental cost-effectiveness ratio was $75,000/QALY for SPECT relative to echocardiography and was greater than $640,000 for PET relative to SPECT. Compared with SPECT, immediate angiography had an incremental cost-effectiveness ratio of $94,000/QALY. RESULTS OF SENSITIVITY ANALYSIS:Qualitative findings varied little with age, sex, pretest probability of disease, or the test indeterminancy rate. Results varied most with sensitivity to severe coronary disease. CONCLUSIONS:Echocardiography, SPECT, and immediate angiography are cost-effective alternatives to PET and other diagnostic approaches. Test selection should reflect local variation in test accuracy.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Garber AM,Solomon NAdoi
10.7326/0003-4819-130-9-199905040-00003subject
Has Abstractpub_date
1999-05-04 00:00:00pages
719-28issue
9eissn
0003-4819issn
1539-3704pii
199905040-00003journal_volume
130pub_type
杂志文章,meta分析abstract::HemoQuant, an assay based on heme-derived porphyrin, quantifies both total fecal hemoglobin ant that fraction already converted to porphyrin by gut flora (the intestinal converted fraction). Recovery by HemoQuant of blood added to stools exceeded 99% and was not affected by ascorbic acid, iron, or other additives. Hem...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-101-3-297
更新日期:1984-09-01 00:00:00
abstract:STUDY OBJECTIVE:To define the clinical and hematologic effects of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on patients with chronic severe neutropenia. DESIGN:Open-label, phase II study of rhGM-CSF. SETTING:Inpatient hematology and surgery clinic at a university medical center. P...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-111-11-887
更新日期:1989-12-01 00:00:00
abstract::All practicing physicians should be prepared to respond to requests from patients for advice about participating in clinical trials research. Even physicians who choose not to conduct clinical trials but rather devote their practice to clinical care may have patients who consider volunteering for research. In advising...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-138-8-200304150-00015
更新日期:2003-04-15 00:00:00
abstract::We ascertained the incidence of hypercalcemia in 79 consecutive patients with active pulmonary tuberculosis and a control group of 79 patients with chronic obstructive pulmonary disease. Twenty-two patients developed hypercalcemia (serum calcium greater than 10.5 mg/dl) within 4 to 16 weeks after initiation of chemoth...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-90-3-324
更新日期:1979-03-01 00:00:00
abstract:BACKGROUND:Injection insulin therapy is not readily accepted by patients and many health care providers; therefore, less invasive options for insulin therapy are desirable. PURPOSE:To examine the efficacy, safety, and patient acceptability of inhaled insulin therapy in nonpregnant adults with diabetes mellitus. DATA ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-145-9-200611070-00009
更新日期:2006-11-07 00:00:00
abstract:BACKGROUND:Little evidence exists to support the theory that small-bore nasogastric tubes prevent gastroesophageal reflux and microaspiration in intubated patients. OBJECTIVE:To determine whether gastroesophageal reflux and microaspiration in intubated patients can be reduced by the use of a small-bore nasogastric tub...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-130-12-199906150-00007
更新日期:1999-06-15 00:00:00
abstract::Meta-analysis is the process of combining study results that can be used to draw conclusions about therapeutic effectiveness or to plan new studies. We review important design and statistical issues of this process. The design issues include protocol development, objectives, literature search, publication bias, measur...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-107-2-224
更新日期:1987-08-01 00:00:00
abstract::Population screening for hemochromatosis done by using the transferrin saturation test has been advocated by experts to permit the initiation of therapeutic phlebotomy before the onset of clinical disease. The discovery of a gene associated with hemochromatosis has made DNA testing another option for screening and dia...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-129-11_part_2-199812011-00008
更新日期:1998-12-01 00:00:00
abstract:BACKGROUND:Many nonpharmacologic therapies are available for treatment of low back pain. PURPOSE:To assess benefits and harms of acupuncture, back schools, psychological therapies, exercise therapy, functional restoration, interdisciplinary therapy, massage, physical therapies (interferential therapy, low-level laser ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析,评审
doi:10.7326/0003-4819-147-7-200710020-00007
更新日期:2007-10-02 00:00:00
abstract::The mechanisms of flushing reactions are pharmacologically and physiologically heterogeneous. Flushing may result from agents acting directly on the vascular smooth muscle or may be mediated by vasomotor nerves. Vasomotor nerves may lead to flushing as a result of events at both peripheral and central sites. In suscep...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-95-4-468
更新日期:1981-10-01 00:00:00
abstract::Infection with human immunodeficiency virus (HIV) may cause viral antigenemia, detected primarily as p24 viral core protein. Among 16 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex studied serially, 12 had or developed antigenemia ranging from 16 to 3006 pg/mL in plasma. The level ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-108-2-175
更新日期:1988-02-01 00:00:00
abstract::Hypophosphatemic osteomalacia that remits after resection of a coexisting tumor has been described in 35 patients. Because the associated neoplasms have been of mesenchymal origin, it has been inferred that this tumor-induced osteomalacia syndrome is uniquely related to tumours of this derivation. However, in the pres...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-93-2-275
更新日期:1980-08-01 00:00:00
abstract:BACKGROUND:Exercise rehabilitation programs increase treadmill walking performance in patients with peripheral arterial disease (PAD) and intermittent claudication. However, it is unknown whether patients with PAD who walk for exercise regularly have less functional decline than those with less walking activity. OBJEC...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-144-1-200601030-00005
更新日期:2006-01-03 00:00:00
abstract::A patient with bladder carcinoma metastatic to lung and brain died of pneumonia. Autopsy examination showed a confluent bronchopneumonia with several small abscesses and acute pyelonephritis with abscess formation. Legionella pneumophila, serogroup 4, was isolated in pure culture from lung tissue postmortem and was al...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-93-6-835
更新日期:1980-12-01 00:00:00
abstract:OBJECTIVE:To determine the effect of a resistance-training program on walking endurance in a healthy, community-dwelling elderly population. DESIGN:12- week randomized, controlled trial comparing a resistance- training group with a nonexercising control group. SETTING:Hospital-affiliated outpatient exercise facility....
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-124-6-199603150-00005
更新日期:1996-03-15 00:00:00
abstract::A controlled clinical trial compared three-drug and four-drug combination chemotherapy in 109 patients with advanced small-cell anaplastic carcinoma of the lung. The combination of vincristine, 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU), cyclophosphamide, and methotrexate was significantly superior to the com...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-89-2-177
更新日期:1978-08-01 00:00:00
abstract::Recent reviews have suggested a higher frequency of the lupus anticoagulant or related antiphospholipid antibodies in patients with systemic lupus erythematosus (21% to 65%) than was found in earlier studies (6% to 18%). In our study of 60 consecutive patients, we found the frequency of the lupus anticoagulant by Russ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-106-4-524
更新日期:1987-04-01 00:00:00
abstract::After decades of silence, the German Society for Internal Medicine (DGIM) has made considerable efforts to come to terms with its role and actions during the Nazi era (1933 to 1945). This is particularly important because, with more than 27 000 members, the DGIM is the largest medical society in present-day Germany. S...
journal_title:Annals of internal medicine
pub_type: 历史文章,杂志文章
doi:10.7326/M20-0064
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:Lack of confidence in postpolypectomy surveillance guidelines may be a factor in the observed low adherence rates among providers. OBJECTIVE:To assess the 2006 postpolypectomy colonoscopy surveillance guidelines, which recommend 3-year follow-up colonoscopy for individuals with high-risk adenomas (defined a...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-148-6-200803180-00004
更新日期:2008-03-18 00:00:00
abstract::Subjects (109) with symptomatic Paget's disease of bone were treated with 5, 10, or 20 mg of sodium etidronate (EHDP)/kg body weight - day for 6 to 24 months. Significant decreases in serum alkaline phosphatase and urinary hydroxyproline were noted after 6 months of therapy; no significant further improvement resulted...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-87-6-656
更新日期:1977-12-01 00:00:00
abstract:BACKGROUND:Although few retrospective studies of high altitude have reported that obesity might be associated with the development of acute mountain sickness (AMS), this association has not been studied prospectively. OBJECTIVE:To determine whether obesity is associated with the development of AMS. DESIGN:Obese and n...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-139-4-200308190-00007
更新日期:2003-08-19 00:00:00
abstract::Forceful new demands for accountability in medicine are arising from many interested parties. To maintain professional standards, physicians need to establish which demands are desirable and which are not. We adopt a model of stratified accountability that includes three major components: the accountable parties, the ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-124-2-199601150-00008
更新日期:1996-01-15 00:00:00
abstract:BACKGROUND:HIV-infected patients with sustained immunologic improvement from antiretroviral therapy may be able to discontinue chemoprophylaxis against Pneumocystis carinii pneumonia (PCP). OBJECTIVE:To compare PCP incidence in HIV-infected patients who had sustained CD4+ lymphocyte counts greater than 200 cells/mm3 a...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-132-3-200002010-00005
更新日期:2000-02-01 00:00:00
abstract:OBJECTIVE:To determine the number and distribution of internists in subspecialty training and compare with data collected since 1976; to determine the distribution of activity of subspecialty fellows; and to focus on hematology and oncology. DESIGN:Repeated mail survey with telephone follow-up. PARTICIPANTS:All direc...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-114-1-36
更新日期:1991-01-01 00:00:00
abstract:PURPOSE:To evaluate the use of thyroid function tests to monitor therapy in patients taking levothyroxine. DATA IDENTIFICATION:Studies published between 1966 and January 1990 were identified through computer searches and references of identified studies. STUDY SELECTION:Studies that included a careful description of ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-113-6-450
更新日期:1990-09-15 00:00:00
abstract:SOURCE CITATION:Mahady SE, Margolis KL, Chan A, et al. Major GI bleeding in older persons using aspirin: incidence and risk factors in the ASPREE randomised controlled trial. Gut. 2020. [Epub ahead of print.] 32747412. ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/ACPJ202101190-004
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Poor patient attendance to scheduled flexible sigmoidoscopy or colonoscopy may contribute to deficient colorectal cancer screening. OBJECTIVE:To examine the association of physician appointment-keeping behavior with attendance to scheduled endoscopic studies of the colon. DESIGN:Retrospective cohort. SETT...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-140-7-200404060-00013
更新日期:2004-04-06 00:00:00
abstract:DESCRIPTION:The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives, developed a recommendation on screening for anxiety in adolescent and adult women to improve detection; achieve earlier diagnosis and treatment; and improve healt...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引
doi:10.7326/M20-0580
更新日期:2020-07-07 00:00:00
abstract:BACKGROUND:Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding procedure that can cause substantial complications. Competence in performing ERCP and the learning curve for achieving competence are poorly understood. OBJECTIVE:To evaluate the number of supervised ERCPs that physicians must ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-125-12-199612150-00009
更新日期:1996-12-15 00:00:00
abstract::Molecular analysis of normal and abnormal human globin genes and their gene products has recently provided information on the precise genetic events that result in hemoglobinopathies. In the case of structurally abnormal hemoglobins, the following mechanisms can be invoked: single nucleotide base substitutions leading...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-91-4-605
更新日期:1979-10-01 00:00:00