Table of Contents

The prevalence of antibodies to hepatitis C virus (HCV) in the United States is 1.6%, equating to an estimated 4.1 million anti-HCV–positive persons nationwide, of whom an estimated 3.2 million have chronic HCV infection. The age at peak prevalence is increasing, the number of patients who use injection drugs is falling, and the number of new cases is falling. These facts suggest that the epidemic of chronic HCV liver disease is due largely to transmission within a cohort who used injection drugs in the 1960s and 1970s.

The authors measured the performance of the 3 Incontinence Questions (3IQ) questionnaire as a test to distinguish between urge urinary incontinence and stress incontinence in women. As measured against the gold standard of a final diagnosis based on an extensive urologic evaluation, the questionnaire had good, although not excellent, sensitivity and specificity and may be appropriate for use in primary care settings after further evaluation.

The authors assigned alternate patients with chronic Chagas disease to treatment with benznidazole or to no treatment and followed them for a mean of approximately 10 years. The patients had no evidence of cardiac disease at baseline. Compared with no treatment, benznidazole was associated with reduced progression to advanced stages of cardiac disease: 4.2% in the treated group versus 14.1% in the untreated group. On the basis of these findings, a randomized, controlled trial is warranted.

In this case series, 25 of 30 patients who received liver transplants for hepatitis C virus (HCV)–induced cirrhosis had immune-complex glomerulonephritis on intraoperative kidney biopsy. Of these, 10 had normal serum creatinine levels, urinalysis results, and proteinuria; 5 had only an increased serum creatinine level; and none had cryoglobulins in the blood or kidney. Infection with HCV may affect the kidney substantially more often than we have realized.

This review found that 4 benchmark institutions have done most of the published research on the effects of the electronic health record on medical care. The research shows that electronic health records can improve the quality and efficiency of health care. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear.

Within the past 2 years, an increasing body of literature has suggested that bisphosphonates, especially intravenous preparations, may be associated with osteonecrosis of the jaws. This paper reviews the action of bisphosphonates, outlines the clinical manifestations of bisphosphonate-associated osteonecrosis of the jaws, summarizes current treatment strategies, discusses possible mechanisms of etiopathogenesis, and suggests avenues of research.

The prevalence of chronic hepatitis C virus infection in prisons ranges from 12% to 31%, and best practices for identification, medical management, and treatment in this population remain uncertain. The authors report on a January 2003 meeting of experts in prison health, public health, hepatology, and infectious diseases. Their topic was the clinical care, prevention, and collaboration needed to manage hepatitis C infection in prisoners.

Two articles in this issue reiterate that the hepatitis C problem involves more than meets the eye. McGuire and colleagues describe the frequency of glomerulonephritis in patients with hepatitis C–associated cirrhosis who undergo liver transplantation, while Armstrong and colleagues present an updated analysis of the prevalence and acquisition of hepatitis C based on data from the National Health and Nutrition Examination Survey (NHANES). This editorial focuses on the latter article, which provides valuable perspectives on how our own behaviors contributed to the scourge that hepatitis C has become.

In this issue, Viotti and colleagues evaluated benznidazole in patients with chronic Chagas disease. The study was an advance over previous work because of the large number of patients, systematic assignment to study groups, and standardization of drug dose. Fewer treated patients had progression of cardiomyopathy, and more patients became serologically nonreactive. These results are new, positive evidence that specific treatment of chronic Chagas disease can ameliorate the most important effect of the infection: evolution to severe chronic cardiomyopathy.

In this issue, Chaudhry and colleagues note that 25% of the health information technology efficacy literature is from 4 institutions, each of which has developed its own electronic health record (EHR) system. Given this localized evidence base, what explains the national sense of urgency to implement EHRs, pay-for-performance incentives for e-prescribing, and quality imperatives?

As she entered the room, Joan saw a too-thin girl stretched out on the exam table with fuchsia hair peeking out from the hood of an oversized sweatshirt. A fleeting reflection passed through Joan's mind: “I used to be that girl.”

In August 2002, I left Boston for a cross-country trip. Destination: Stanford Medical School, where I would train to be a physician. Little did I know that I would also learn perhaps the most difficult lesson of all: how to be a patient.