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Update in General Internal Medicine
- John V.L. Sheffield, MD; and
- Eric B. Larson, MD, MPH
- 1997-98 Series John Roberts, MD, Editor. From Harborview Medical Center and the University of Washington Medical Center, Seattle, Washington. Requests for Reprints: Eric B. Larson, MD, University of Washington Medical Center, Room AA 316, Box 356330, Seattle, WA 98195-4021. Current Author Addresses: Dr. Sheffield: Harborview Medical Center, Box 359782, 325 Ninth Avenue, Seattle, WA 98104.
Advances in general internal medicine have come quickly and from a wide diversity of sources in the past year or two. Clearly, it is impossible for one or two general internists to reliably identify the most significant clinical advances. We therefore asked 13 general internists at the University of Washington to answer the question, “What were the five most important papers or most important advances you read about in the past year?” From among their responses, we selected those papers that focused on common and clinically relevant problems and circulated the relevant papers to the editors of ACP Journal Club for their feedback on the adequacy of the scientific evidence.
We discuss six themes that emerged for 1996: HIV-related disease, cardiovascular disease, anticoagulation for atrial fibrillation, efficacy of selective serotonin reuptake inhibitors, treatment of postmenopausal osteoporosis, and several topics in preventive medicine. Much of the material overlaps with that in other Updates in this series; when this overlap occurs, we summarize the results of studies and leave the detailed descriptions to the authors of other Updates.
HIV Disease
In 1996, the rate of death from HIV-related illness decreased dramatically in the United States. Most experts believe that this decrease reflects the success of changes in treatment. These advances will be discussed in more detail in the upcoming Update in Infectious Diseases.
Three clinical trials seem to have put to rest the use of zidovudine monotherapy [1-3]. The results of these studies indicate that multidrug therapy is now the standard of care. Four protease inhibitors are now available, and initial studies have shown that these drugs are associated with major improvements in laboratory outcomes [4].
The major problem now facing clinicians is the complexity of the newer drug combinations. Patients are taking several pills a day; some must be taken with …
