Abstract:
OBJECTIVE:To determine whether self-assessment of purified protein derivative of tuberculin (PPD) skin test reactions, done using a simple two-choice approach, is an effective screening method for tuberculosis. DESIGN:Double-blind comparison between self-assessments and trained professional readings of PPD skin test reactions, done 72 hours after test administration. SETTING:The New York City Fire Department's Bureau of Health Services. PARTICIPANTS:2011 New York City firefighters and fire officers were given PPD skin tests during a mandatory retraining course. Thirty-seven persons were excluded because of a history of a positive PPD skin test result or a bacille Calmette-Guérin vaccination. All others agreed to participate in testing and self-assessment done using simple written instructions. Self-assessment results were submitted just before trained professional readings were done. MEASUREMENTS:Self-assessments and trained professional readings of PPD skin test reactions. RESULTS:1833 participants (91%) interpreted their test reactions as flat. Of these interpretations, 1824 (99.5%) matched the professional reading and 9 (0.5%) did not. One hundred seventy-eight participants (9%) interpreted their test reactions as not flat; 136 of these interpretations (76.4%) matched the professional reading and 42 (23.6%) did not (kappa = 0.828; lower 95% confidence limit = 0.790). The predictive value of a negative self-assessment reading was 99.5%, and the specificity was 97.7%. CONCLUSION:In this occupational health care setting, we follow (and recommend to others with similar populations) a tuberculin screening program based on self-assessment. Repeated tests with follow-up are required for all persons who do not report their results. All persons with self-assessments of "not flat" should return for readings by trained professionals, counseling, and treatment.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Prezant DJ,Kelly KJ,Karwa ML,Kavanagh Kdoi
10.7326/0003-4819-125-4-199608150-00004subject
Has Abstractpub_date
1996-08-15 00:00:00pages
280-3issue
4eissn
0003-4819issn
1539-3704journal_volume
125pub_type
杂志文章abstract::Conventional interpretation of clinical trials relies heavily on the classic p value. The p value, however, represents only a false-positive rate, and does not tell the probability that the investigator's hypothesis is correct, given his observations. This more relevant posterior probability can be quantified by an ex...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-98-3-385
更新日期:1983-03-01 00:00:00
abstract::We discuss here some of the last decade's diagnostic and therapeutic advances in the treatment of lung cancer, as well as current and future research objectives. Roentgenographs from selected patients illustrate the natural history of lung cancer. We present perspectives concerning selection from the growing diagnosti...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-83-1-93
更新日期:1975-07-01 00:00:00
abstract:BACKGROUND:New tests, such as magnetic resonance imaging (MRI) and electron-beam computed tomography (CT), are being developed for the diagnosis of coronary artery disease. OBJECTIVE:To determine the conditions that a new test must meet to be a cost-effective alternative to established imaging tests. DESIGN:Decision ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-131-9-199911020-00008
更新日期:1999-11-02 00:00:00
abstract::Cataract disrupts the crystalline lens, a transparent, elastic, avascular, biconvex structure composed of a capsule, lens epithelium, and lens fiber cells. Many factors contribute to the progression of lens opacity, but aging is most frequently associated with cataract. As aging-related cataract develops, many biochem...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-102-1-82
更新日期:1985-01-01 00:00:00
abstract::For years patients hospitalized with viral hepatitis have been placed in two categories of isolation--enteric precautions and blood precautions. This strategy was based on the inability to differentiate between hepatitis A and B and on the assumption that feces and blood from patients with either type might be infecti...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-91-6-872
更新日期:1979-12-01 00:00:00
abstract::Much of what is formally taught in medicine is about the knowledge, skills, and behaviors required of a physician, including how to express compassion and respect for patients at the bedside. What is learned, however, includes not only admirable qualities but also behaviors and qualities that are inconsistent with eth...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M17-2058
更新日期:2018-04-03 00:00:00
abstract::Internal medicine residencies risk becoming obsolete if they are not adjusted to changing patterns of medical practice. Declining length of hospital stay, increased intensity of hospital care, movement of critical management decisions to outpatient settings, increased proportions of admissions for specific diagnostic ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-104-4-554
更新日期:1986-04-01 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::The autoimmune lymphoproliferative syndrome (ALPS) affords novel insights into the mechanisms that regulate lymphocyte homeostasis and underlie the development of autoimmunity. This syndrome arises early in childhood in persons who inherit mutations in genes that mediate apoptosis, or programmed cell death. The timely...
journal_title:Annals of internal medicine
pub_type: 共识发展会议,杂志文章,评审
doi:10.7326/0003-4819-130-7-199904060-00020
更新日期:1999-04-06 00:00:00
abstract::The causes, therapy for, and consequences of hypernatremia in elderly patients are not well understood. We found that in 15,187 consecutive hospital admissions, 162 (1.1%) patients who were at least 60 years of age had serum sodium levels that measured greater than 148 meq/L. Of that 162, 57% had become hypernatremic ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-107-2-309
更新日期:1987-09-01 00:00:00
abstract:BACKGROUND:Electrical cardioversion in patients with atrial fibrillation is associated with an increased risk for embolic stroke. Screening for atrial thrombi with transesophageal echocardiography (TEE) before cardioversion should, in many patients, safely permit cardioversion to be done earlier than would be possible ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-126-3-199702010-00004
更新日期:1997-02-01 00:00:00
abstract:BACKGROUND:Severe aplastic anemia is a life-threatening bone marrow failure disorder. High-dose cyclophosphamide therapy followed by allogeneic bone marrow transplantation cures the disease. However, it requires a suitable donor and carries the risk for graft-versus-host disease. A small pilot study demonstrated that h...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.7326/0003-4819-135-7-200110020-00006
更新日期:2001-10-02 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::The 1986 False Claims Act Amendments authorize private citizens to sue on behalf of the U.S. government to recover federal funds from fraudulent recipients. The "relator" receives a share of any proceeds from a successful lawsuit. Originally enacted because of defense procurement scandals, this statute also applies to...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-114-12-1050
更新日期:1991-06-15 00:00:00
abstract::Patients with variant angina refractory to medical therapy pose a difficult management problem. We report two patients with variant angina who had focal spasm in coronary arteries with fixed obstructions of less than 20% of the luminal diameter. Ischemic episodes were accompanied by malignant ventricular arrhythmias a...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-94-6-771
更新日期:1981-06-01 00:00:00
abstract:BACKGROUND:3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy has proven efficacy in reducing the rate of coronary and cerebrovascular events in patients 75 years of age or younger with a history of myocardial infarction. However, in patients older than 75 years of age, the efficacy and potentia...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-132-10-200005160-00003
更新日期:2000-05-16 00:00:00
abstract:Background:Frailty assessment may inform surgical risk and prognosis not captured by conventional surgical risk scores. Purpose:To evaluate the evidence for various frailty instruments used to predict mortality, functional status, or major adverse cardiovascular and cerebrovascular events (MACCEs) in older adults unde...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/M16-0652
更新日期:2016-11-01 00:00:00
abstract::In 1993, the Clinical Efficacy Assessment Subcommittee began evaluation of new topics and reevaluation of previous guidelines on common screening tests, which were published in Annals of Internal Medicine between 1988 and 1990 and republished as a collection in 1991 (Eddy DM, ed. Common Screening Tests. Philadelphia: ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-122-12-199506150-00008
更新日期:1995-06-15 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::Behavior modification applied to the treatment of obesity has evolved from the environmental control of eating behavior to a broader approach characterized by systematic manipulation of all factors associated with eating and exercise patterns. This approach has shown success in helping obese persons lose modest amount...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-119-7_part_2-199310011-00014
更新日期:1993-10-01 00:00:00
abstract::In alternative medicine, the main question regarding placebo has been whether a given therapy has more than a placebo effect. Just as mainstream medicine ignores the clinical significance of its own placebo effect, the placebo effect of unconventional medicine is disregarded except for polemics. This essay looks at th...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-136-11-200206040-00011
更新日期:2002-06-04 00:00:00
abstract:BACKGROUND:Left bundle-branch block (BBB) is considered an important predictor of poor outcome in patients with acute myocardial infarction, but the consequences of right BBB are not well understood. OBJECTIVES:To 1) estimate the prevalence of left and right BBB in patients with myocardial infarction; 2) compare the c...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-129-9-199811010-00003
更新日期:1998-11-01 00:00:00
abstract:BACKGROUND:Many states have laws requiring mammography facilities to tell women with dense breasts and negative results on screening mammography to discuss supplemental screening tests with their providers. The most readily available supplemental screening method is ultrasonography, but little is known about its effect...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M14-0692
更新日期:2015-02-03 00:00:00
abstract::Prospective data at Framingham and elsewhere have shown conclusively that risk of coronary heart disease in persons younger than age 50 is strikingly related to the serum total cholesterol level. Within so-called normal limits risk has been found to mount over a five-fold range. The impact has been found to be augment...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-90-1-85
更新日期:1979-01-01 00:00:00
abstract::The question of whether initial treatment is necessary in relatively asymptomatic patients with stage III and IV non-Hodgkin's lymphomas of favorable histologic types was studied by retrospective analysis. Two groups of patients were studied: [1] 44 nonprotocol patients, followed since 1963, in whom initial treatment ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-90-1-10
更新日期:1979-01-01 00:00:00
abstract::We provide a new perspective with which to understand what for a half century has been known as the "placebo effect." We argue that, as currently used, the concept includes much that has nothing to do with placebos, confusing the most interesting and important aspects of the phenomenon. We propose a new way to underst...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-136-6-200203190-00011
更新日期:2002-03-19 00:00:00
abstract::We report the case of a 23-year-old woman who developed severe myalgias in association with mild hepatitis B surface antigen-positive hepatitis. Muscle biopsy showed myriads of microvacuoles filled with neutral lipid. Prednisone therapy was associated with complete clearing of all clinical and laboratory abnormalities...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-87-4-417
更新日期:1977-10-01 00:00:00
abstract:DESCRIPTION:Updated U.S. Preventive Services Task Force (USPSTF) recommendation about screening for type 2 diabetes mellitus in adults. METHODS:To estimate the balance of benefits and harms of screening, the USPSTF updated its 2003 evidence review, adding evidence from new trials as well as updates on earlier studies....
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引
doi:10.7326/0003-4819-148-11-200806030-00007
更新日期:2008-06-03 00:00:00
abstract::Twenty-one juvenile-onset diabetic patients with azotemic nephropathy underwent coronary angiography and left ventriculography before renal transplantation or chronic hemodialysis. Two-year survival of 12 patients with no coronary artery disease (group A) was 88% compared to 22% for nine patients with coronary artery ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-88-3-346
更新日期:1978-03-01 00:00:00
abstract:BACKGROUND:The fecal immunochemical test (FIT) is a common method for colorectal cancer (CRC) screening, yet its acceptability and performance over several rounds of annual testing are largely unknown. OBJECTIVE:To assess FIT performance characteristics over 4 rounds of annual screening. DESIGN:Retrospective cohort s...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M15-0983
更新日期:2016-04-05 00:00:00