Table of Contents

December 7, 1999; 131 (11)

Articles

  • Expression of guanylyl cyclase C messenger RNA in lymph nodes is associated with recurrence of colorectal cancer in patients with stage II disease. Analysis of this expression by reverse transcriptase polymerase chain reaction may be useful for colorectal cancer staging.

  • In patients with failure of antiretroviral therapy that contains protease inhibitors, HIV-1 genotype is predictive of virologic response to subsequent therapy. This predictive capacity adds to that of standard clinical evaluation.

  • A continuing medical education program geared toward developing clinicians' communication skills was not effective in improving general patient satisfaction. To improve global visit satisfaction, communication skills training programs may need to be longer and more intensive, teach a broader range of skills, and provide ongoing performance feedback.

  • The Internet may expand patient access to health-related services but at an overall increased cost. In addition, the quality of physician care over the Internet is uncertain, and potential for serious abuse exists.

Brief Communications

  • Skin preparation with alcoholic chlorhexidine is more efficacious than skin preparation with aqueous povidone-iodine in reducing contamination of blood cultures.

  • Cardiac amyloidosis can present as angina pectoris associated with coronary flow reserve abnormalities despite normal coronary angiograms. This finding may have major therapeutic and prognostic implications in patients with this disorder.

Updates

  • Despite extensive clinical study, no distinct consensus has emerged on the optimal management of fibromyalgia. This paper discusses the diagnosis, pathophysiology, and treatment of fibromyalgia.

Position Papers

  • This position paper describes guidelines physicians should carefully consider when deciding whether to sell products out of the office and, if so, which ones.

Editorials

  • In this issue, Brown and colleagues report that physicians who participated in a communications skills program believed that the program improved their skills, but patients did not. Methodologic considerations aside, the intervention may have been unsuccessful because behavior is hard to change.

  • The Internet can be an important tool for providing health-related products, services, and information. As pointed out by Bloom and Iannacone in this issue, however, consumers must use this tool wisely. Until appropriate safeguards have been implemented, patients and practitioners should be cautious.

MMWR Supplements

  • In August 1999, agencies of the U.S. Public Health Service, in collaboration with the Infectious Diseases Society of America, published guidelines for preventing opportunistic infections in HIV-infected persons. These guidelines are reproduced here in an effort to reach all internists who care for HIV-infected patients.

Letters

Medical Writings

  • Can a mere idea cause medical pathology? Some disease conceptions appear to induce illness in the absence of any classic pathogen. These psychosomatic memes induce biological, psychological, and social changes in their hosts, and they can be transmitted to others.

Medical Writings: Book Notes

Book Listings

Medical Notices

Summaries for Patients

Updates from the Annual Session

  • This Update contains information that is directly applicable to primary care practices, where internists see an ever-increasing number of older persons. The topics covered are dementia and Alzheimer disease, osteoporosis, cardiovascular risk, antidepressant therapy and falls, incontinence, and pain.