Table of Contents

February 4, 2003; 138 (3)

Articles

  • Among patients discharged home from a general medical service, adverse events occurred frequently in the peridischarge period. Many of these events might have been prevented or ameliorated with simple strategies.

  • Mammographic breast density and age are important predictors of the accuracy of screening mammography. Although use of hormone replacement therapy is not an independent predictor of accuracy, it probably affects accuracy by increasing breast density.

  • Screening 50-year-old men with symptoms of gastroesophageal reflux disease to detect adenocarcinoma associated with Barrett esophagus is probably cost-effective. However, subsequent surveillance of patients with Barrett esophagus but no dysplasia, even at 5-year intervals, is expensive.

Brief Communications

  • The incarcerated population can be effectively treated for hepatitis C virus infection with interferon and ribavirin. The correctional setting may provide an opportunity to safely treat patients with these two challenging comorbid conditions.

Academia and Clinic

  • This article examines how to incorporate complementary and alternative medical therapies as an integral part of the medical curriculum. It offers practical suggestions for finding time in an already packed curriculum, getting started, including faculty and students in the process, and sustaining the initiative with the necessary administrative and institutional support.

Review

  • The authors discuss the management of hepatitis C in HIV-infected persons by using the available literature to provide recommendations and, when necessary, highlight controversial areas.

Perspectives

  • Position statements opposing legalization of physician-assisted suicide generally understate the limitations of palliative care to alleviate some end-of-life suffering, and they do not provide adequate guidance about how physicians should approach patients with intractable suffering when they wish to die. The authors argue in favor of medical organizations' taking a position of studied neutrality on this contentious issue.

Clinical Guidelines

  • The U.S. Preventive Services Task Force concludes that the evidence is insufficient to recommend for or against routinely screening asymptomatic adults for type 2 diabetes, impaired glucose tolerance, or impaired fasting glucose. The Task Force recommends screening for type 2 diabetes in adults with hypertension or hyperlipidemia.

  • This systematic review supports the U.S. Preventive Services Task Force's position on screening adults for type 2 diabetes.

Editorials

  • Primary care leaders and practitioners are concerned about the future of their specialty. In a supplement to this issue, they explain their concerns and offer suggestions based on discussions at a conference on the Future of Primary Care held in October 2001. This editorial underscores some of the reasons for concern, highlights key elements of the mission of primary care, and identifies points of leverage for renewal of the field.

  • This editorial discusses the recent history of payment for primary care services, the outlook for maintaining equity in relation to procedural services, and how payment structure could support the directions for primary care outlined in the primary care supplement.

  • In this issue, Allen and colleagues demonstrate that a comprehensive approach to hepatitis C virus (HCV) in correctional facilities can be safely and effectively implemented. The failure of most correctional systems to implement systematic HCV programs means that they are missing an important opportunity to help reduce HCV transmission and thereby improve the health of the communities to which their inmates will return.

Letters

Medical Writings: Book Notes

Book Listings

Medical Notices

Supplement: The Future of Primary Care

Summaries for Patients