Archives of Internal Medicine

Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity.A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use.A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale.The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

Robert L. Spitzer

Kurt Kroenke

Janet B. W. Williams

Bernd Löwe

Arch Intern Med

A Brief Measure for Assessing Generalized Anxiety Disorder

评估广泛性焦虑障碍的简要量表

Previous studies of 3-tier formularies are rare, although the evidence suggests that their cost-sharing structure reduces overall drug spending. However, it is unclear how incentive-based formularies affect the selection of medications with safety advantages, or restrict the access that high-risk populations have to recommended therapies in the higher tiers. This study was designed to determine whether 3-tier formularies influence the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in a population of patients with arthritis.This retrospective study used the 2000 MarketScan Research Database, which contains person-level claims data for employer-sponsored health plans. The sample for this study consisted of 20 868 individuals treated for osteoarthritis or rheumatoid arthritis and using NSAIDs while enrolled in tiered drug plans (n = 32). The likelihood of any use of cyclo-oxygenase (COX-2)-selective inhibitors was determined as a function of tiered drug plan coverage, adjusting for other person-level and plan-level covariates.Use of COX-2-selective inhibitors decreased (63.0% vs 53.6% vs 41.6%, respectively) and use of generic NSAIDs increased (37.7% vs 40.7% vs 55.7%, respectively) as formularies incorporated 1, 2, and 3 tiers. Enrollees in 3-tier plans with arthritis and serious gastrointestinal comorbidities (odds ratio, 0.51; 95% confidence interval, 0.40-0.66) were significantly less likely to use COX-2-selective inhibitors compared with patients in 1-tier plans.Three-tier formularies appear to reduce the use of COX-2-selective inhibitors among all patients with arthritis, even those at risk of experiencing gastrointestinal complications from using nonselective NSAIDs. These findings are among the first to suggest that tiered-copayment drug plans may be influencing the selection of medications beyond generic and branded products.

Becky Briesacher

Sachin Kamal-Bahl

Marc Hochberg

Denise Orwig

Kristijan H Kahler

Three-Tiered–Copayment Drug Coverage and Use of Nonsteroidal Anti-inflammatory Drugs

三层共付药品覆盖与非甾体抗炎药的使用

Extraintestinal lesions that are associated with ulcerative colitis and regional enteritis (Crohn disease) are recognized widely.<sup>1</sup>The frequency and temporal relation of these complications have led to a general acceptance of the likelihood that these intestinal disorders are, in fact, systemic disorders.<sup>2</sup>The six patients we report in this communication developed unexplained severe pulmonary disease after the diagnosis of nonspecific inflammatory bowel disease. The cases are reported in detail as potential evidence for a relationship between the disorders. The pertinent clinical findings in each case are listed in Table 1, results of pulmonary function tests in Table 2, and other laboratory data in Table 3. <h3>PATIENT SUMMARIES</h3><h3>Patient 1.—</h3> A 53-year-old man had developed mild ulcerative colitis that involved the rectosigmoid colon in 1935 at the age of 17. A sister had ulcerative colitis also. The disease had remained inactive until 1947, when a severe exacerbation occurred and

Sumner C. Kraft

Unexplained Bronchopulmonary Disease With Inflammatory Bowel Disease

未解释的支气管肺疾病与炎症性肠病

Acute intermittent porphyria is a genetic disease in which endogenous hormones affect clinical expression. Premenstrual exacerbations can occur, sometimes often, in women with this disease. Gonadotropin releasing hormone analogues can prevent ovulation by reducing secretion of luteinizing hormone and follicle-stimulating hormone. In six patients with well-documented acute intermittent porphyria and frequent cyclical exacerbations, daily administration of an agonistic gonadotropin releasing hormone analogue, ([ImBzl]-D-His6,Pro9-NET)gonadotropin releasing hormone, intranasally or subcutaneously for as long as 26 months reduced or eliminated premenstrual attacks and caused only minor side effects. Adjustments in dosage or route of administration were sometimes needed. We conclude that endocrine manipulation by treatment with a gonadotropin releasing hormone agonist will prevent neurovisceral attacks of acute intermittent porphyria due to cyclical changes in endogenous hormones and is a safe alternative to exogenous steroids, which may induce attacks of this disease.

K E Anderson

I M Spitz

C W Bardin

A Kappas

A Gonadotropin Releasing Hormone Analogue Prevents Cyclical Attacks of Porphyria

一种促性腺激素释放激素类似物可预防卟啉病的周期性发作

A clinical prediction model to identify malignant nodules based on clinical data and radiological characteristics of lung nodules was derived using logistic regression from a random sample of patients (n = 419) and tested on data from a separate group of patients (n = 210).To use multivariate logistic regression to estimate the probability of malignancy in radiologically indeterminate solitary pulmonary nodules (SPNs) in a clinically relevant subset of patients with SPNs that measured between 4 and 30 mm in diameter.A retrospective cohort study at a multispecialty group practice included 629 patients (320 men, 309 women) with newly discovered (between January 1, 1984, and May 1, 1986) 4- to 30-mm radiologically indeterminate SPNs on chest radiography. Patients with a diagnosis of cancer within 5 years prior to the discovery of the nodule were excluded. Clinical data included age, sex, cigarette-smoking status, and history of extrathoracic malignant neoplasm, asbestos exposure, and chronic interstitial or obstructive lung disease; chest radiological data included the diameter, location, edge characteristics (eg, lobulation, spiculation, and shagginess), and other characteristics (eg, cavitation) of the SPNs. Predictors were identified in a random sample of two thirds of the patients and tested in the remaining one third.Sixty-five percent of the nodules were benign, 23% were malignant, and 12% were indeterminate. Three clinical characteristics (age, cigarette-smoking status, and history of cancer [diagnosis, > or = 5 years ago]) and 3 radiological characteristics (diameter, spiculation, and upper lobe location of the SPNs) were independent predictors of malignancy. The area (+/-SE) under the evaluated receiver operating characteristic curve was 0.8328 +/- 0.0226.Three clinical and 3 radiographic characteristics predicted the malignancy in radiologically indeterminate SPNs.

Stephen J. Swensen

The Probability of Malignancy in Solitary Pulmonary Nodules

孤立性肺结节恶性概率

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal

Masao Suzuki

Naoto Ishizaki

Acupuncture for Dyspnea on Exertion in Chronic Obstructive Pulmonary Disease: No Blindness—Reply

针灸治疗慢性阻塞性肺疾病劳累性呼吸困难：无盲法——回复

Fiona Hawke

Joshua Burns

New Evidence for Stretching for Preventing Nocturnal Cramps

预防夜间抽筋的新证据

Leeat Granek

Grief in Health Care Professionals: When Screening for Major Depression Is Needed—Reply

医护人员中的悲伤情绪：何时需要筛查重度抑郁症——回复

Emmanuelle Corruble

Ronald Pies

Sidney Zisook

Grief in Health Care Professionals: When Screening for Major Depression Is Needed

医护人员中的悲伤情绪：何时需要筛查重度抑郁症

William H. Carter

The Burden of Hospitalization for Atrial Fibrillation

心房颤动住院负担

涉及主题	医学内科学生物病理心理学外科化学遗传学内分泌学生物化学精神科
出版信息	出版商: American Medical Association，出版周期: Semimonthly，期刊类型: journal，开源期刊: 否
基本数据	创刊年份: 1960，原创研究文献占比: 0.00%，自引率:N.A.， Gold OA占比: 0.00%
平均录用比例	网友分享经验：容易

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