Table of Contents

The authors used a decision model to estimate the cost-effectiveness of same-day rapid-test HIV screening. They accounted for outcomes experienced by the infected person and his or her sexual contacts. One-time screening was cost-effective when the prevalence of HIV was as low as 0.20%, which is similar to the prevalence of HIV in random testing of healthy people. This evidence supports the new Centers for Disease Control and Prevention recommendation for health care settings to screen everyone between 13 and 64 years of age.

The authors studied first-degree relatives of persons with protein S, protein C, or antithrombin deficiency who had had venous thromboembolism (VTE). They assessed each relative for environmental exposures and additional thrombophilic defects. Risk for VTE in first-degree relatives increased with the number of defects and with exposure to environmental risk factors.

The authors randomly assigned 100 patients with chronic obstructive pulmonary disease in a 3-week respiratory rehabilitation program to receive either high-intensity continuous exercise or high-intensity exercise alternating with low-intensity exercise (interval exercise). After 5 weeks, both groups had marked improvement in quality of life and similar respiratory symptoms in daily activities and 6-minute walking distance. The interval exercise group adhered better to the exercise protocol.

The authors used data from a California health maintenance organization quality report card to compare the quality of care delivered by integrated medical groups or practices in individual practice associations. Integrated medical groups did better on 4 of 6 standard measures of quality: screening for cervical cancer, breast cancer, chlamydia infection, and diabetic retinopathy. Integrated groups had more quality improvement activities and use of electronic medical records, but these did not account for the differences in quality.

This year's Update in Rheumatology includes discussions of advances related to rheumatoid arthritis, systemic lupus erythematosus, Wegener granulomatosis, antineutrophil cytoplasmic antibody–associated vasculitis, and gout.

Tobacco use remains a very serious health problem. Prevention, especially among youth, and cessation are the cornerstones of strategies to reduce tobacco use. Tobacco use is a critical and chronic problem that requires close attention from health care providers, health care organizations, and research support organizations. This article answers key questions about helping smokers to quit.

Although self-help strategies alone marginally affect quit rates, individual and combined pharmacotherapies and counseling either alone or in combination can significantly increase cessation. Using effective smoking treatments is strongly encouraged for all populations, especially those with high rates of smoking, such as psychiatric and substance abuse populations.

Few diagnostic tests or screening procedures have engendered as much controversy as the HIV test. From its inception, unique social issues have complicated deliberations about HIV testing. In this issue, Paltiel and colleagues examine the cost-effectiveness of HIV screening with rapid tests, using a sophisticated cost-utility analysis that expresses benefits as gains in quality-adjusted life-years. They conclude that routine, one-time rapid HIV testing for all adult patients is cost-effective even when the prevalence of undiagnosed HIV infection is as low as 0.2%.

The quality of medical care depends on individual physicians and on the organization in which they work. In this issue, Mehrotra and colleagues compare medical groups, independent practice associations (IPAs), and “hybrids.” The study lends limited and somewhat inconsistent support for the hypothesis that large medical groups deliver better care than do smaller groups and IPAs.

A visit with her grandmother shortly before her grandmother's death was the pivotal event that convinced this internist to focus on geriatrics. But had all of her training prepared her to deal with the shadow of a person she found before her?