Table of Contents

January 20, 2004; 140 (2)

Articles

  • Although low back pain is frequently associated with disability and absence from work, few studies have evaluated strategies targeted to an early return to work. The authors found that graded exercises were more effective than usual care in reducing the number of days of absence from work because of low back pain.

  • In this large case series of patients with AL amyloidosis, hematologic remission, improved 5-year survival, and reversal of amyloid-related disease occurred in a substantial proportion of selected patients after treatment with high-dose melphalan and stem-cell transplantation.

  • High plasma homocysteine level has been associated with increased risk for coronary heart disease (CHD) events in nondiabetic individuals, especially in those with previously diagnosed CHD. In this large cohort of patients with type 2 diabetes, plasma homocysteine level was a strong and independent risk factor for CHD events.

Brief Communications

  • Left atrial thrombus is a contraindication to percutaneous transvenous mitral commissurotomy (PTMC). The authors found that after 6 months of oral anticoagulation, left atrial thrombus disappeared in about a quarter of candidates for PTMC, allowing them to undergo the procedure safely.

Reviews

  • This review found little good-quality evidence about treatments for patients with idiopathic thrombocytopenic purpura who have persistent severe thrombocytopenia after splenectomy.

  • A negative result on an Ottawa knee rule test accurately excludes knee fractures after acute knee injury, in part because the rule is calibrated toward 100% sensitivity and in part because fracture prevalence is low.

Clinical Guidelines

  • The U.S. Preventive Services Task Force concludes that the evidence is insufficient to recommend for or against routine screening for thyroid disease in adults.

  • This systematic review provides the evidence to support the U.S. Preventive Services Task Force's position on screening adults for thyroid disease.

Editorial

  • In this issue, Staal and colleagues report on an intervention aimed at changing the way disabled workers perceive and cope with back pain. Patient-centered efforts that promote return to work and address known psychosocial factors through graded activities hold promise for improving disability outcomes. As the authors state, pain relief is not a prerequisite for return to work.

On Being a Doctor

  • When teaching my students about what goes into a good doctor–patient interaction, I tell them about the studies that show how quickly doctors interrupt their patients. How long do I wait, I wondered? I decided to try an experiment. I would let my next patient talk as long as he or she needed to explain his or her reason for seeing me. I would watch the clock and see how long a patient might naturally take to explain the presenting complaint. I would hold my tongue.

Letters

Medical Writings: Book Notes

Current Clinical Issues

Book Listings

Medical Notices

Summaries for Patients

Updates from the Annual Session

  • This Update focuses on 3 topics of interest: hypertension, proteinuria, and renal replacement therapy. The author also reviews a study of nephrolithiasis and a study of glomerulonephritis associated with lupus-related nephropathy.