Table of Contents

August 16, 2005; 143 (4)

Articles

  • Warfarin plus Aspirin after Myocardial Infarction or the Acute Coronary Syndrome: Meta-Analysis with Estimates of Risk and Benefit

    • Michael B. Rothberg,
    • Carmel Celestin,
    • Louis D. Fiore,
    • Elizabeth Lawler,
    • and James R. Cook
    Ann Intern Med August 16, 2005 143:241-250

    After acute coronary syndromes, warfarin plus aspirin was associated with fewer myocardial infarctions, ischemic strokes, and revascularization procedures. Warfarin was associated with an increase in major bleeding, but mortality did not differ. For patients who are at low or intermediate risk for bleeding, the cardiovascular benefits of warfarin outweigh the bleeding risks.

  • Clinical Outcomes and Cost-Effectiveness of Strategies for Managing People at High Risk for Diabetes

    • David M. Eddy,
    • Leonard Schlessinger,
    • and Richard Kahn
    Ann Intern Med August 16, 2005 143:251-264

    The authors used a novel decision model to estimate the long-term outcomes and costs of care when patients with impaired glucose tolerance use metformin or enroll in a lifestyle modification program. Although the program used in the Diabetes Prevention Program prevented diabetes in some patients and delayed it in others, the authors found that it was not cost-effective for health plans to implement.

  • A Prognostic Index for Systemic AIDS-Related Non-Hodgkin Lymphoma Treated in the Era of Highly Active Antiretroviral Therapy

    • Mark Bower,
    • Brian Gazzard,
    • Sundhiya Mandalia,
    • Tom Newsom-Davis,
    • Christina Thirlwell,
    • Tony Dhillon,
    • Anne Marie Young,
    • Tom Powles,
    • Andrew Gaya,
    • Mark Nelson,
    • and Justin Stebbing
    Ann Intern Med August 16, 2005 143:265-273

    The International Prognostic Index predicts death in non-Hodgkin lymphoma, including AIDS-related lymphoma before highly active antiretroviral therapy (HAART). Since the advent of HAART, the prognosis has improved for AIDS-related non-Hodgkin lymphoma. A combination of the International Prognostic Index and the CD4 cell count defines 4 strata of risk for death in AIDS-related lymphoma in the HAART era.

Improving Patient Care

  • Quality of Care Is Associated with Survival in Vulnerable Older Patients

    • Takahiro Higashi,
    • Paul G. Shekelle,
    • John L. Adams,
    • Caren J. Kamberg,
    • Carol P. Roth,
    • David H. Solomon,
    • David B. Reuben,
    • Lillian Chiang,
    • Catherine H. MacLean,
    • John T. Chang,
    • Roy T. Young,
    • Debra M. Saliba,
    • and Neil S. Wenger
    Ann Intern Med August 16, 2005 143:274-281

    The authors studied the effect of the quality of care received by 372 community-dwelling vulnerable older patients on their survival over the next 3 years. Three-year survival improved steadily as the quality score improved. Better performance on process quality measures is strongly associated with better survival in vulnerable older adults.

Review

  • Evaluation and Management of the Patient with Pulmonary Arterial Hypertension

    • Lewis J. Rubin and
    • David B. Badesch
    Ann Intern Med August 16, 2005 143:282-292

    Pulmonary arterial hypertension raises several diagnostic possibilities: idiopathic or familial cause, systemic diseases (connective tissue disease, HIV infection, or chronic liver disease), or drugs (fenfluramine anorexigens, amphetamines, or cocaine). In this review, the authors present approaches to the diagnosis and management of pulmonary arterial hypertension, using a typical case to highlight the key management points.

Perspectives

  • Promoting Informed Choice: Transforming Health Care To Dispense Knowledge for Decision Making

    • Steven H. Woolf,
    • Evelyn C.Y. Chan,
    • Russell Harris,
    • Stacey L. Sheridan,
    • Clarence H. Braddock III,
    • Robert M. Kaplan,
    • Alex Krist,
    • Annette M. O'Connor,
    • and Sean Tunis
    Ann Intern Med August 16, 2005 143:293-300

    This article is about providing patients with the information they need to participate in difficult decisions about their health care. The authors look to health systems to meet these information needs. Their proposed solutions include expanding information resources for decision support and linking the information to decision counseling.

Editorials

  • Trying To Predict the Future for People with Diabetes: A Tough but Important Task

    • Michael M. Engelgau
    Ann Intern Med August 16, 2005 143:301-302

    The article by Eddy and colleagues describes a novel approach to modeling the costs and outcomes of health interventions. As applied to programs to alter lifestyle to prevent diabetes in patients with impaired glucose tolerance, the model's predictions are similar in most respects to previous work but differ about cost-effectiveness. This difference leads the authors to diametrically opposed conclusions about whether health plans should offer programs to modify lifestyle.

  • Modeling Complex Medical Decision Problems with the Archimedes Model

    • Margaret L. Brandeau
    Ann Intern Med August 16, 2005 143:303-304

    In an ideal world, low-cost, powerful, and ethical clinical trials would decide which treatments work best. In the real world, clinical trials are often too time-consuming, too expensive, unethical, or even impossible to perform. How, then, can we obtain answers to inform patient care? We need a structured framework that uses the best evidence and captures relevant complexities. Decision analysis meets these requirements but raises a new question: “How do we decide if we can trust the predictions of a decision model?”

  • Improving Patient Care Can Set Your Brain on Fire

    • Sankey V. Williams
    Ann Intern Med August 16, 2005 143:305-306

    In this issue, Higashi and colleagues conclude that “better performance on process quality measures is strongly associated with better survival among community-dwelling vulnerable older adults.” This conclusion, if true, is important because it appears to validate a fundamental assumption underlying most quality improvement efforts: A better process of care will lead to better patient outcomes.

On Being a Doctor

  • Lessons from a Patient

    • William Rifkin
    Ann Intern Med August 16, 2005 143:307-308

    Whenever a patient shares with me her tale of misery, I experience the following, perhaps common to most doctors: first, horror at how cruel and harsh the world can be, then appreciation of the relatively insignificant hurts I have experienced in comparison, followed by compassion and a compunction to “make it all better.” Finally, once reality sets in, I realize that what I have to offer is very unlikely to help in the end. I often feel that I am simply not giving enough.

Letters

  • Screening for Abdominal Aortic Aneurysms

    • Jack L. Cronenwett
    Ann Intern Med August 16, 2005 143:309

  • Screening for Abdominal Aortic Aneurysms

    • Ned Calonge and
    • Diana Petitti
    Ann Intern Med August 16, 2005 143:309-310

  • Target Blood Pressure and Kidney Disease

    • Chester B. Good
    Ann Intern Med August 16, 2005 143:310

  • Target Blood Pressure and Kidney Disease

    • Yujiro Kida
    Ann Intern Med August 16, 2005 143:310-311

  • Target Blood Pressure and Kidney Disease

    • Mark J. Sarnak,
    • Andrew S. Levey,
    • and Tom Greene
    Ann Intern Med August 16, 2005 143:311

  • High-Output Heart Failure Associated with Anagrelide Therapy for Essential Thrombocytosis

    • Peter J. Engel,
    • Heide Johnson,
    • Robert P. Baughman,
    • and Arthur I. Richards
    Ann Intern Med August 16, 2005 143:311-313

  • Subungual Splinter Hemorrhages: A Clinical Window to Inhibition of Vascular Endothelial Growth Factor Receptors?

    • Caroline Robert,
    • Sandrine Faivre,
    • Eric Raymond,
    • Jean-Pierre Armand,
    • and Bernard Escudier
    Ann Intern Med August 16, 2005 143:313-314

  • Disseminated Aspergillosis Mimicking Hepatic Veno-Occlusive Disease

    • George L. Daikos,
    • Vassiliki Syriopoulou,
    • George Aperis,
    • Christos Toubanakis,
    • George Petrikkos,
    • and Maria Demonakos
    Ann Intern Med August 16, 2005 143:315-316

  • Correction: Recommendations for the Diagnosis and Treatment of the Acute Porphyrias

    Ann Intern Med August 16, 2005 143:316

Medical Notices

  • Medical Notices

    Ann Intern Med August 16, 2005 143:0

Summaries for Patients

  • Benefits and Harms of Warfarin plus Aspirin after Acute Coronary Events

    Ann Intern Med August 16, 2005 143:I-14

  • The Outcomes and Costs of Diabetes Prevention with a Diet and Exercise Program or Metformin: A Computer Model

    Ann Intern Med August 16, 2005 143:I-22

  • Estimating Outcome in Patients with HIV-Related Lymphoma

    Ann Intern Med August 16, 2005 143:I-28

  • Association of Quality of Care with Survival of Elderly Managed Care Patients

    Ann Intern Med August 16, 2005 143:I-33
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This Issue

August 16, 2005; 143 (4)
  1. Articles
  2. Improving Patient Care
  3. Review
  4. Perspectives
  5. Editorials
  6. On Being a Doctor
  7. Letters
  8. Medical Notices
  9. Summaries for Patients

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