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Rates of screening mammography and Papanicolaou smears are high among older women in California. Although screening rates decline with advancing age, women of a similar age have similar screening rates whether they say that they are in good health or poor health. Physicians should target their screening efforts at healthy older women, in whom the benefits of screening are likely to outweigh potential harms.
Diabetes screening targeted to people with hypertension is more cost-effective than universal screening. The most cost-effective strategy is to screen people at age 55 to 75 years because hypertension is more common and cardiovascular death rates are higher in older people.
Insulin-resistant patients experience a smaller increase in coronary blood flow by endothelium-dependent mechanisms than do insulin-sensitive patients. Thiazolidinedione therapy, which increases insulin sensitivity, normalized the abnormalities in insulin-resistant individuals. Insulin resistance may be associated with abnormalities in coronary vasomotor function.
An enzyme-linked immunospot assay detects T cells that are specific for Mycobacterium tuberculosis–specific antigens. A positive result on this test helped diagnose subclinical active tuberculosis in an immunosuppressed patient with a false-negative tuberculin skin test result.
In older patients, failures to prescribe indicated medications, monitor medications appropriately, document necessary information, educate patients, and maintain continuity are more common prescribing problems than is use of inappropriate drugs.
Most patient education materials on early-stage prostate cancer treatment do not contain comprehensive information about the risks and benefits of each treatment alternative. To help patients and physicians choose among prostate cancer treatment options, we need a new generation of patient education materials.
In principle, stem cells could rapidly regenerate contracting myocardium and improve immediate and long-term prognosis after acute myocardial infarction. This article describes the formidable obstacles to achieving this goal.
The U.S. Preventive Services Task Force concludes that the evidence is insufficient to recommend for or against screening asymptomatic persons for lung cancer with low-dose computed tomography, chest x-ray, sputum cytology, or a combination of these tests.
Current data do not show that screening for lung cancer is effective with any method. The evidence, however, is not strong enough to conclude that screening is ineffective, particularly in women. Two ongoing randomized trials of screening with chest radiography or low-dose computed tomography should help clinicians to decide whether lung cancer screening is worthwhile.
Readers can be confident that a substantial proportion of elderly women should undergo regular cervical and breast cancer screening. Now the tougher question: Are we screening these women for the right reason?
Hoerger and colleagues have used decision modeling to advance our understanding of the benefit of screening for diabetes in people with and without hypertension. However, without optimized management of hypertension and hyperglycemia after the diagnosis of diabetes, no screening program can be effective or cost-effective.
As an expert witness for the defense, I reviewed the case of a 90-year-old woman with Alzheimer disease who died of complications from a urinary tract infection in a nursing home. The case seemed like a typical clinical situation I had been involved with many times as a geriatrician, but in this case, the doctor was being sued for wrongful death.
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