Abstract:
Background:Delirium is common in hospitalized patients and is associated with worse outcomes. Antipsychotics are commonly used; however, the associated benefits and harms are unclear. Purpose:To conduct a systematic review evaluating the benefits and harms of antipsychotics to treat delirium in adults. Data Sources:PubMed, Embase, CENTRAL, CINAHL, and PsycINFO from inception to July 2019 without language restrictions. Study Selection:Randomized controlled trials (RCTs) of antipsychotic versus placebo or another antipsychotic, and prospective observational studies reporting harms. Data Extraction:One reviewer extracted data and assessed strength of evidence (SOE) for critical outcomes, with confirmation by another reviewer. Risk of bias was assessed independently by 2 reviewers. Data Synthesis:Across 16 RCTs and 10 observational studies of hospitalized adults, there was no difference in sedation status (low and moderate SOE), delirium duration, hospital length of stay (moderate SOE), or mortality between haloperidol and second-generation antipsychotics versus placebo. There was no difference in delirium severity (moderate SOE) and cognitive functioning (low SOE) for haloperidol versus second-generation antipsychotics, with insufficient or no evidence for antipsychotics versus placebo. For direct comparisons of different second-generation antipsychotics, there was no difference in mortality and insufficient or no evidence for multiple other outcomes. There was little evidence demonstrating neurologic harms associated with short-term use of antipsychotics for treating delirium in adult inpatients, but potentially harmful cardiac effects tended to occur more frequently. Limitations:Heterogeneity was present in terms of dose and administration route of antipsychotics, outcomes, and measurement instruments. There was insufficient or no evidence regarding multiple clinically important outcomes. Conclusion:Current evidence does not support routine use of haloperidol or second-generation antipsychotics to treat delirium in adult inpatients. Primary Funding Source:Agency for Healthcare Research and Quality. (PROSPERO: CRD42018109552).
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Nikooie R,Neufeld KJ,Oh ES,Wilson LM,Zhang A,Robinson KA,Needham DMdoi
10.7326/M19-1860subject
Has Abstractpub_date
2019-10-01 00:00:00pages
485-495issue
7eissn
0003-4819issn
1539-3704pii
2749495journal_volume
171pub_type
杂志文章abstract:PURPOSE:To review epidemiologic studies on the association between homocyst(e)ine level and risk for cardiovascular disease and the potential benefits of homocysteine-decreasing therapies. DATA SOURCES:Computerized and manual searches of the literature on total homocysteine levels and cardiovascular disease. STUDY SE...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-131-5-199909070-00008
更新日期:1999-09-07 00:00:00
abstract:BACKGROUND:The Department of Health and Human Services recently called for public comment on human subjects research protections. OBJECTIVE:To assess variability in reviews across institutional review boards (IRBs) for a multisite, minimal-risk trial of financial incentives for evidence-based hypertension care and to ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/0003-4819-156-10-201205150-00011
更新日期:2012-05-15 00:00:00
abstract::Smoking remains the leading cause of preventable death in the United States, yet it is still regarded by many as merely a bad habit. Most smokers want to quit but find it difficult. Behavioral counseling and pharmacotherapies are available, safe, and effective in the treatment of tobacco dependence. Nicotine replaceme...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-148-7-200804010-00012
更新日期:2008-04-01 00:00:00
abstract:BACKGROUND:Variants in genes involved in warfarin metabolism and sensitivity affect individual warfarin requirements and the risk for bleeding. Testing for these variant alleles might allow more personalized dosing of warfarin during the induction phase. In 2007, the U.S. Food and Drug Administration changed the labeli...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-150-2-200901200-00005
更新日期:2009-01-20 00:00:00
abstract:BACKGROUND:Hospitals are implementing discharge support programs to reduce readmissions, and these programs have had mixed success. OBJECTIVE:To examine whether a peridischarge, nurse-led intervention decreased emergency department (ED) visits or readmissions among ethnically and linguistically diverse older patients ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.7326/M14-0094
更新日期:2014-10-07 00:00:00
abstract:BACKGROUND:When deep venous thrombosis is suspected, objective testing is required to confirm or refute the diagnosis. OBJECTIVE:To determine whether the combination of a low clinical suspicion and a normal D -dimer result rules out deep venous thrombosis. DESIGN:Prospective cohort study. SETTING:Three tertiary care...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-135-2-200107170-00011
更新日期:2001-07-17 00:00:00
abstract::Platelets may have a role in the development of animal tumor metastases. Ultrastructural studies in vivo have shown arrested tumor emboli surrounded by platelets. Several tumor cell lines induce thrombocytopenia in vivo. Certain tumor cells aggregate platelets in vitro. Correlations exist between the ability of some t...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-95-5-636
更新日期:1981-11-01 00:00:00
abstract:BACKGROUND:Opioid detoxification in a primary care setting followed by ongoing substance abuse treatment may be appropriate for selected opioid-dependent patients. OBJECTIVE:To compare three pharmacologic protocols for opioid detoxification in a primary care setting. DESIGN:Randomized, double-blind clinical trial wit...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-127-7-199710010-00004
更新日期:1997-10-01 00:00:00
abstract::Two hundred forty previously healthy military personnel with nonstreptococcal upper respiratory infections were prospectively studied to define the incidence and clinicopathologic characteristics of possible virus-associated glomerulonephritis. Nine patients without preceding streptococcal infection had erythrocyte ca...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-91-5-697
更新日期:1979-11-01 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:BACKGROUND:Bed alarm systems intended to prevent hospital falls have not been formally evaluated. OBJECTIVE:To investigate whether an intervention aimed at increasing bed alarm use decreases hospital falls and related events. DESIGN:Pair-matched, cluster randomized trial over 18 months. Nursing units were allocated b...
journal_title:Annals of internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.7326/0003-4819-157-10-201211200-00005
更新日期:2012-11-20 00:00:00
abstract:Background:The 2013 pooled cohort equations (PCEs) are central in prevention guidelines for cardiovascular disease (CVD) but can misestimate CVD risk. Objective:To improve the clinical accuracy of CVD risk prediction by revising the 2013 PCEs using newer data and statistical methods. Design:Derivation and validation ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M17-3011
更新日期:2018-07-03 00:00:00
abstract::HLA-B27 is a transplantation antigen found in a high proportion of patients with ankylosing spondylitis. Recently, an association has been shown to exist between HLA-B27 and acute uveitis, even in the absence of ankylosing spondylitis. We have examined the HLA antigen profile of 45 patients with acute nongranulomatous...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-85-5-606
更新日期:1976-11-01 00:00:00
abstract:BACKGROUND:Treatment of chronic hepatitis C virus (HCV) infection with direct-acting antivirals (DAAs) for 6 weeks achieves sustained virologic response (SVR) rates of 95% in some patients. If effective, shorter therapeutic courses could improve adherence and treatment costs. OBJECTIVE:To determine factors predictive ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/M15-0642
更新日期:2015-12-15 00:00:00
abstract:OBJECTIVE:To determine risk factors for community-acquired and nosocomial group B streptococcal disease in adults. DESIGN:Case-control study. SETTING:3 metropolitan areas in the United States with an aggregate population of 6.6 million persons. PATIENTS:219 nonpregnant adults with invasive group B streptococcal infe...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-123-6-199509150-00003
更新日期:1995-09-15 00:00:00
abstract:PURPOSE:To examine the cost-effectiveness of test-treatment strategies for patients suspected of having Lyme disease. DATA SOURCES:The medical literature was searched for information on outcomes and costs. Expert opinion was sought for information on utilities. STUDY SELECTION:Articles that described patient populati...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-128-1-199801010-00007
更新日期:1998-01-01 00:00:00
abstract:BACKGROUND:Early prenatal care is vital for improving maternal health outcomes and health behaviors, but medically vulnerable and underserved populations are less likely to begin prenatal care in the first trimester. In 2017, the Health Center Program provided safety-net care to more than 27 million persons, including ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M19-3248
更新日期:2020-12-01 00:00:00
abstract::Clinical features of 99 patients with staphylococcal infection were reviewed, and sera were tested by solid-phase radioimmunoassay and gel diffusion for staphylococcal antibodies to ascertain whether these variables predict the extent of infection and the need for prolonged therapy. Clinical features, including the pr...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-89-4-467
更新日期:1978-10-01 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:OBJECTIVE:To assess the accuracy of Histoplasma capsulatum variety capsulatum polysaccharide antigen testing for the identification of histoplasmosis relapse in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN:A retrospective study using stored specimens. SETTING:A referral center and several priva...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-115-12-936
更新日期:1991-12-15 00:00:00
abstract:OBJECTIVE:To determine whether the quality of care for common ambulatory conditions is adversely affected when physicians are provided with incentives to limit the use of health services. DESIGN:Retrospective cohort study over a 2-year period. SETTING:Four group practices that cared for both fee-for-service patients ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-115-5-394
更新日期:1991-09-01 00:00:00
abstract:SOURCE CITATION:Cao B, Wang Y, Wen D, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med. 2020;382:1787-99. 32187464. ...
journal_title:Annals of internal medicine
pub_type: 评论,杂志文章
doi:10.7326/ACPJ202006160-063
更新日期:2020-06-16 00:00:00
abstract:PURPOSE:To review the radiofrequency ablation method, describe the technique, and discuss the indications, results, and limitations of its use in patients with cardiac tachyarrhythmias. DATA SOURCES:Peer-reviewed reports in the literature by clinical investigators who use radiofrequency catheter ablation as identified...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-121-6-199409150-00010
更新日期:1994-09-15 00:00:00
abstract:BACKGROUND:Medicare's value-based purchasing (VBP) and the Hospital Readmissions Reduction Program (HRRP) could disproportionately affect safety-net hospitals. OBJECTIVE:To determine whether safety-net hospitals incur larger financial penalties than other hospitals under VBP and HRRP. DESIGN:Cross-sectional analysis....
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M14-2813
更新日期:2015-09-15 00:00:00
abstract:Background:More than half of enrollees in the U.S. Department of Veterans Affairs (VA) are also covered by Medicare and can choose to receive their prescriptions from VA or from Medicare-participating providers. Such dual-system care may lead to unsafe opioid use if providers in these 2 systems do not coordinate care o...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M18-2574
更新日期:2019-04-02 00:00:00
abstract:BACKGROUND:Vertebral fractures are a hallmark of postmenopausal osteoporosis and an important end point in trials of osteoporosis treatment, but the clinical significance of these fractures remains uncertain. OBJECTIVE:To determine the association of new vertebral fractures with back pain and back-related functional l...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-128-10-199805150-00001
更新日期:1998-05-15 00:00:00
abstract::Active-control noninferiority trials are being performed with increasing frequency when standard placebo-controlled trials are considered unethical. Three attributes are optimally required to establish noninferiority: 1) The treatment under consideration exhibits therapeutic noninferiority to the active control; 2) th...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-145-1-200607040-00011
更新日期:2006-07-04 00:00:00
abstract::The Advisory Committee on Immunization Practices (ACIP) consists of 15 experts in immunization and related fields, selected by the Secretary of the U.S. Department of Health and Human Services, to provide advice and guidance on control of vaccine-preventable diseases. In its role as a federal advisory committee, the A...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-150-1-200901060-00009
更新日期:2009-01-06 00:00:00
abstract::Individual differences in metabolism of the sulfonamides may predispose patients to idiosyncratic reactions. Sulfonamides are metabolized by N-acetylation (mediated by a genetically polymorphic enzyme) and oxidation to potentially toxic metabolites. We examined 6 patients who had severe reactions to sulfonamides and c...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-105-2-179
更新日期:1986-08-01 00:00:00
abstract:BACKGROUND:Increased prevalence of adolescent obesity requires effective treatment options beyond behavior therapy. OBJECTIVE:To see whether sibutramine reduced weight more than placebo in obese adolescents who were receiving a behavior therapy program. DESIGN:12-month, 3:1 randomized, double-blind trial conducted fr...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-145-2-200607180-00005
更新日期:2006-07-18 00:00:00