Table of Contents

In this study of 100 311 women younger than 65 years of age with stage I to stage IIIA breast cancer, women with disabilities had lower rates of breast-conserving surgery and higher all-cause and breast cancer–specific mortality rates than other women. Among those who had breast-conserving surgery, women with disabilities were less likely to receive radiotherapy and axillary lymph node dissection.

At some point, a person won't live long enough to benefit from cancer screening. The authors used the Surveillance, Epidemiology, and End Results (SEER) data set and Medicare files to calculate life expectancy of patients with colorectal cancer at a given age and with specific chronic diseases. With 3 or more chronic diseases, patients between 76 and 81 years of age with stage I colorectal cancer have life expectancies of 5 years or less, too little time to experience longer survival because of screening.

The authors surveyed a random sample of internists and family physicians about their usual practice in obtaining surveillance colonoscopy after a diagnosis of a colonic polyp. Respondents chose a surveillance colonoscopy interval for vignettes depicting a man who had a polypectomy. Most respondents chose shorter surveillance intervals than recommended by professional society guidelines.

The authors prospectively monitored thyroid function in a series of imatinib-resistant patients treated with sunitinib for gastrointestinal stromal tumors. Thirty-six percent developed hypothyroidism during the course of treatment. The incidence of hypothyroidism increased progressively with duration of treatment.

This Update in Hospital Medicine discusses articles published in 2005 that provided good-quality evidence of importance to hospital administrators and physicians who care for hospitalized patients. Some articles are likely to affect clinical practice. Others focus on patient safety and quality improvement.

This systematic review of 16 randomized trials in adult patients with type 1 or type 2 diabetes found that inhaled insulin reduced hemoglobin A1c levels slightly less than subcutaneous insulin and more than fixed doses of oral agents. Patients preferred inhaled insulin over subcutaneous insulin. Severe hypoglycemia was more likely with inhaled insulin than with oral agents. Mild to moderate nonprogressive dry cough and mild decreases in pulmonary function were more common in patients taking inhaled insulin.

This review describes the discovery of the ubiquitin proteasome system and the mechanisms of its action and regulation; aberrations in the ubiquitin system that result in disease; and the development of drugs that target the biological mechanisms of the system.

In a recent meta-analysis, Salpeter and colleagues documented a significant increase in life-threatening asthma exacerbations and severe exacerbations requiring hospital admission in patients treated with long-acting β-agonists. The authors of this Perspective raise concerns about Salpeter and colleagues' results and their applicability to current practice.

Value-based purchasing, or pay-for-performance, is a major emerging theme in U.S. health care. Employers, government payers, and health plans are establishing a wide variety of pay-for-performance programs. This article reviews the critical design features of such efforts, describes the current types of programs on offer, and comments on the implications of this emerging movement for the future of health care in the United States.

In this issue, Gross and colleagues show that life expectancy after a diagnosis of colorectal cancer depends on the patient's age and comorbid diseases at the time of diagnosis, providing a way to make individualized predictions of survival and assist in patient-specific screening decisions. McCarthy and colleagues' study also illustrates the challenges, and importance, of communication and shared decision making. Physicians must talk to their patients about their preferences for treatment and their knowledge of the options.

Imatinib, sunitinib, and sorafenib have been promoted as targeted drugs lacking the usual toxicities of chemotherapy. During the past year, however, the list of unexpected toxicities of targeted therapies has grown. The study by Desai and colleagues in this issue adds primary hypothyroidism induced by sunitinib to the list.

“He says, ‘Thanks for saving me,’” explains the interpreter as we approach the bedside of patient 4914. His name, which we usually remember to use, is Sabir. Sabir, the Iraqi policeman who has been with us longer than any other patient in the short history of our facility, is the last patient to be seen on ICU rounds in the Air Force Theater Hospital at Balad Airbase, Iraq.