Table of Contents

Hormone replacement therapy (HRT) allegedly worsens disease activity in women with systemic lupus erythematosus (SLE). This randomized, controlled trial evaluated the effect of HRT on disease activity in postmenopausal women with SLE. Adding a short course of HRT causes a small increase in flares of lupus. Most flares are mild to moderate.

This study examined the clinical course of 168 patients with mild to moderate idiopathic pulmonary fibrosis. Physiologic variables changed minimally, but 21% of patients died. Acute clinical deterioration preceded death in 47% of decedents. Acute deterioration in mild to moderate disease is an ominous sign of the need for referral for lung transplantation.

Cardiac resynchronization devices use a bipolar electrode to depolarize the right and left ventricles synchronously. Loss of left ventricular capture may cause worsening heart failure and can be difficult to diagnose without special equipment. An algorithm that analyzes the R–S ratio on leads V1 and I of the surface electrocardiogram accurately diagnoses failure to capture the left ventricle.

The authors examined 95 randomized, controlled trials of antibiotic prophylaxis in afebrile neutropenic patients. Antibiotic prophylaxis for neutropenic patients undergoing cytotoxic therapy reduced mortality, especially with fluoroquinolones. Physicians should consider giving antibiotic prophylaxis, preferably with a fluoroquinolone, to neutropenic patients.

Employers often ask physicians to examine employees or review their diagnostic test results. These services are commonly called independent medical examinations. Given the current medical malpractice climate, physicians must understand their potential liability when doing independent medical examinations. This article summarizes the law and offers suggestions for limiting liability.

The market power of physicians and health systems is one commonly held explanation for high and rising health care costs in the United States. This third article of a 4-part series examines how the prices and the quantity of health care services interact to influence health care expenditures. The article also reviews cost-containment strategies to reduce prices and quantities of services.

Women and their health care providers need to know the safest and most effective medical and nonmedical treatments for menopausal symptoms. To address this need, the National Institute on Aging and the Office of Medical Applications of Research of the National Institutes of Health sponsored a State-of-the-Science Conference on Management of Menopause-Related Symptoms on 21–23 March 2005, in Bethesda, Maryland. This state-of-the-science statement answers the 5 key questions posed at the conference.

Patients with lupus have menopause-related symptoms, and some need hormone replacement therapy to gain relief. This randomized trial compared the rate of serious flares of lupus during 12 months of estrogen and progesterone therapy or placebo. Hormone replacement increases the rate of flares by a small amount that some women may find acceptable in order to gain relief from their menopausal symptoms.

July marks the first issue of a new volume of Annals. The transition from volume 142 to 143 seems an appropriate time to reflect on the journal's health, review new features begun in the past several months, discuss developments on the horizon, and share our wish list of different types of articles that we would like to see coming over the transom.

Annals places a high priority on publishing up-to-date summative articles because we believe that they should shape standards for clinical practice. This editorial offers advice to authors of reviews. In an accompanying supplement (part 2 of this issue), authors from the North American Evidence-based Practice Centers offer detailed advice on doing systematic reviews, compiling evidence reports, and handling the methodologic challenges of systematic reviews.

A few years ago, the Centers for Disease Control and Prevention reported that one out of every three black men who have sex with men are HIV positive. Since I am a physician who happens to be both black and homosexual, I belong to this risk group. For me, getting an HIV test is a yearly ritual—it's something many black men who have sex with men do because of the fear embedded in our psyches for simply being who we are.