Table of Contents

December 16, 2008; 149 (12)

Articles

  • Surgical Treatment of Spinal Stenosis with and without Degenerative Spondylolisthesis: Cost-Effectiveness after 2 Years

    • Anna N.A. Tosteson,
    • Jon D. Lurie,
    • Tor D. Tosteson,
    • Jonathan S. Skinner,
    • Harry Herkowitz,
    • Todd Albert,
    • Scott D. Boden,
    • Keith Bridwell,
    • Michael Longley,
    • Gunnar B. Andersson,
    • Emily A. Blood,
    • Margaret R. Grove,
    • James N. Weinstein,
    • and for the SPORT Investigators
    Ann Intern Med December 16, 2008 149:845-853; doi:10.1059/0003-4819-149-12-200812160-00003

    Tosteson and colleagues used data from SPORT (Spine Patient Outcomes Research Trial)—which found that patients who had surgery for spinal stenosis or degenerative spondylolisthesis had better outcomes over 2 years than patients who did not have surgery—to estimate the cost-effectiveness of surgery. Surgery for spinal stenosis costs about $77 000 per quality-adjusted life-year gained, and surgery for degenerative spondylolisthesis costs about $115 000 per quality-adjusted life-year gained. However, the cost-effectiveness could change if patients are followed over a longer period.

  • Interruptions in Medicaid Coverage and Risk for Hospitalization for Ambulatory Care–Sensitive Conditions

    • Andrew B. Bindman,
    • Arpita Chattopadhyay,
    • and Glenna M. Auerback
    Ann Intern Med December 16, 2008 149:854-860; doi:10.1059/0003-4819-149-12-200812160-00004

    Many persons in the United States experience interruptions in their health insurance coverage. Bindman and coworkers found an association between interruptions in coverage and a higher rate of hospitalization for ambulatory care–sensitive conditions, such as heart failure, diabetes, and chronic obstructive pulmonary disease, among hospitalized California adults with Medicaid. Policies that reduce interruptions in coverage might prevent some of these hospitalizations.

  • Hope, Truth, and Preparing for Death: Perspectives of Surrogate Decision Makers

    • Latifat Apatira,
    • Elizabeth A. Boyd,
    • Grace Malvar,
    • Leah R. Evans,
    • John M. Luce,
    • Bernard Lo,
    • and Douglas B. White
    Ann Intern Med December 16, 2008 149:861-868; doi:10.1059/0003-4819-149-12-200812160-00005

    Physicians caring for critically ill patients are often reluctant to discuss poor prognoses with family members. In interviews about discussing prognosis of patients in intensive care units, 95% of surrogate decision makers felt that avoiding discussions about prognosis was an unacceptable way to maintain hope. A theme that emerged from the interviews was that timely discussion of prognosis is essential to prepare emotionally and logistically for a loved one's death.

  • Effects of Home-Based Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Trial

    • François Maltais,
    • Jean Bourbeau,
    • Stan Shapiro,
    • Yves Lacasse,
    • Hélène Perrault,
    • Marc Baltzan,
    • Paul Hernandez,
    • Michel Rouleau,
    • Marcel Julien,
    • Simon Parenteau,
    • Bruno Paradis,
    • Robert D. Levy,
    • Pat Camp,
    • Richard Lecours,
    • Richard Audet,
    • Brian Hutton,
    • John R. Penrod,
    • Danielle Picard,
    • Sarah Bernard,
    • and for the Chronic Obstructive Pulmonary Disease Axis of the Respiratory Health Network, Fonds de la recherche en santé du Québec
    Ann Intern Med December 16, 2008 149:869-878; doi:10.1059/0003-4819-149-12-200812160-00006

    Pulmonary rehabilitation programs improve outcomes, but access to outpatient, hospital-based programs is very limited. In a 10-center, Canadian noninferiority trial, Maltais and coworkers randomly assigned 252 patients to home-based or outpatient, hospital-based exercise training for 8 weeks. At 1 year, both interventions had reduced dyspnea by the same amount, as measured on the dyspnea subscale of the Chronic Respiratory Questionnaire. Home-based pulmonary rehabilitation may be a reasonable alternative to hospital-based programs.

Academia and Clinic

  • Systematic Reviews of Diagnostic Test Accuracy

    • Mariska M.G. Leeflang,
    • Jonathan J. Deeks,
    • Constantine Gatsonis,
    • Patrick M.M. Bossuyt,
    • and on behalf of the Cochrane Diagnostic Test Accuracy Working Group
    Ann Intern Med December 16, 2008 149:889-897; doi:10.1059/0003-4819-149-12-200812160-00008

    Lefflang and colleagues present some recent developments in how to conduct systematic reviews of diagnostic test accuracy studies. Investigators conducting such reviews should avoid restrictive electronic search filters and summary quality scores, use methods for meta-analysis that account for the paired nature of the estimates and their dependence on threshold, and use the hierarchical summary receiver-operating characteristic or the bivariate model for analysis of the data. Challenges in diagnostic test accuracy research include poor reporting of and difficulties in interpreting the results of systematic reviews.

Review

  • Meta-analysis: Are 3 Questions Enough to Detect Unhealthy Alcohol Use?

    • Levente Kriston,
    • Lars Hölzel,
    • Ann-Kristin Weiser,
    • Michael M. Berner,
    • and Martin Härter
    Ann Intern Med December 16, 2008 149:879-888; doi:10.1059/0003-4819-149-12-200812160-00007

    Kriston and colleagues examined whether a 3- or 10-item questionnaire (Alcohol Use Disorders Identification Test– Consumption [AUDIT-C] or AUDIT) better identifies unhealthy alcohol use in adults. They found 14 studies that directly compared the accuracy of the 2 questionnaires. These studies, conducted mainly in primary care settings, used different reference standards and had heterogeneous findings. Some pooled analyses suggested that primary care patients with a positive result on AUDIT were more likely than those with a positive result on AUDIT-C to be engaging in risky drinking. The evidence suggests, but does not prove, that AUDIT may be better in some settings for identifying unhealthy alcohol use in adults.

Abroad

  • A New Approach to Very-High-Altitude Land Travel: The Train to Lhasa, Tibet

    • John B. West
    Ann Intern Med December 16, 2008 149:898-900; doi:10.1059/0003-4819-149-12-200812160-00009

    West discusses the Qinghai–Tibet Railway—which travels for more than 14 hours at an average altitude of 4500 m, the highest point being 5072 m (16 600 ft)—and the engineering feat in oxygenating the whole train. The medical challenges during construction of the track and in protecting the passengers against hypoxia are impressive, and the completion of the railway was one of the most ambitious high-altitude engineering projects to date.

Editorials

  • Cost-Effectiveness of Spine Surgery: The Jury Is Out

    • Jeffrey N. Katz and
    • Elena Losina
    Ann Intern Med December 16, 2008 149:901-903; doi:10.1059/0003-4819-149-12-200812160-00010

    The 2-year analyses by Tosteson and colleagues in this issue suggest that decompressive surgery without fusion for spinal stenosis offers good value and that fusion surgery for spondylolisthesis offers less value for its cost than other interventions. This work is critically important in the context of limited resources and seemingly unlimited costly therapies for chronic disease. However, the jury is still out about whether the benefits of spine surgery justify the investment.

  • Diagnostic Test Accuracy and Clinical Decision Making

    • John Cornell,
    • Cynthia D. Mulrow,
    • and A. Russell Localio
    Ann Intern Med December 16, 2008 149:904-906; doi:10.1059/0003-4819-149-12-200812160-00011

    In this issue, Leeflang and colleagues sort through the issues associated with systematic reviews of diagnostic test accuracy studies and conclude that test accuracy depends on its immediate clinical context. Also in this issue, Kriston and associates—who compared the diagnostic accuracy of AUDIT and AUDIT-C—illustrate that comparing the performance of diagnostic tests within the context of their use in practice gives clinicians a better idea of how a test may perform in practice. Herein lies the Holy Grail: Link evidence on diagnostic test accuracy to clinical practice.

On Being a Doctor

  • Family Doctor

    • Elizabeth Toman
    Ann Intern Med December 16, 2008 149:907-908; doi:10.1059/0003-4819-149-12-200812160-00012

    I always wanted to be the family doctor. That is not to say that I regret my decision to be an internist. But my vision of being a doctor always included an image of my mother, otoscope in hand, examining a cousin or neighbor at our dining room table. She was our family's doctor.

Letters

  • Evaluating Open Access: Problems with the Program or the Studies?

    • Mark F. Murray
    Ann Intern Med December 16, 2008 149:909; doi:10.1059/0003-4819-149-12-200812160-00013

  • Evaluating Open Access: Problems with the Program or the Studies?

    • Daren R. Anderson
    Ann Intern Med December 16, 2008 149:909-910; doi:10.1059/0003-4819-149-12-200812160-00014

  • Evaluating Open Access: Problems with the Program or the Studies?

    • Chris Salisbury
    Ann Intern Med December 16, 2008 149:910; doi:10.1059/0003-4819-149-12-200812160-00015

  • Evaluating Open Access: Problems with the Program or the Studies?

    • Arthur L. Kellermann
    Ann Intern Med December 16, 2008 149:910-911; doi:10.1059/0003-4819-149-12-200812160-00016

  • Evaluating Open Access: Problems with the Program or the Studies?

    • Ateev Mehrotra,
    • Lori Keehl-Markowitz,
    • and John Z. Ayanian
    Ann Intern Med December 16, 2008 149:911; doi:10.1059/0003-4819-149-12-200812160-00017

  • Remission of Hepatitis B Virus–Related Cryoglobulinemic Vasculitis with Entecavir

    • Tamihiro Kawakami,
    • Shiho Ooka,
    • Masako Mizoguchi,
    • Yoshinao Soma,
    • and Masahide Yamazaki
    Ann Intern Med December 16, 2008 149:911-912; doi:10.1059/0003-4819-149-12-200812160-00018

  • Entecavir to Treat Hepatitis B–Associated Cryoglobulinemic Vasculitis

    • Masaru Enomoto,
    • Takeshi Nakanishi,
    • Masamitsu Ishii,
    • Akihiro Tamori,
    • and Norifumi Kawada
    Ann Intern Med December 16, 2008 149:912-913; doi:10.1059/0003-4819-149-12-200812160-00019

Thanks to Reviewers

  • Thanks to Reviewers—2008

    Ann Intern Med December 16, 2008 149:914-920; doi:10.1059/0003-4819-149-12-200812160-00020

Medical Notices

  • Medical Notices

    Ann Intern Med December 16, 2008 149:0; doi:10.1059/0003-4819-149-12-200812160-00021

Summaries for Patients

  • Family Members' Opinions about Sharing Bad News

    Ann Intern Med December 16, 2008 149:I-48; doi:10.1059/0003-4819-149-12-200812160-00001

  • Effects of Home-Based Pulmonary Rehabilitation in Patients with Chronic Obstructive Lung Disease

    Ann Intern Med December 16, 2008 149:I-56; doi:10.1059/0003-4819-149-12-200812160-00002

ACP Journal Club

  • Editorial: GRADE: assessing the quality of evidence for diagnostic recommendations

    Ann Intern Med December 16, 2008 149:JC6-2; doi:10.1059/0003-4819-149-12-200812160-02002

  • Benefits of early intensive glucose control to prevent diabetes complications were sustained for up to 10 years

    Ann Intern Med December 16, 2008 149:JC6-4; doi:10.1059/0003-4819-149-12-200812160-02004

  • Benefits of tight blood pressure control to prevent diabetes complications were not sustained

    Ann Intern Med December 16, 2008 149:JC6-5; doi:10.1059/0003-4819-149-12-200812160-02005

  • Review: Enteral or parenteral nutrition reduces risk for mortality in acute pancreatitis

    Ann Intern Med December 16, 2008 149:JC6-6; doi:10.1059/0003-4819-149-12-200812160-02006

  • A combination of telmisartan and ramipril increased renal outcomes in vascular disease or diabetes

    Ann Intern Med December 16, 2008 149:JC6-7; doi:10.1059/0003-4819-149-12-200812160-02007

  • Annual zoledronic acid did not increase renal abnormalities at 2 years in postmenopausal women with osteoporosis

    Ann Intern Med December 16, 2008 149:JC6-8; doi:10.1059/0003-4819-149-12-200812160-02008

  • Noninvasive ventilation improved dyspnea but did not reduce short-term mortality in acute cardiogenic pulmonary edema

    Ann Intern Med December 16, 2008 149:JC6-9; doi:10.1059/0003-4819-149-12-200812160-02009

  • Low-molecular-weight heparin for 7 days was more effective than compression stockings for preventing DVT in knee arthroscopy

    Ann Intern Med December 16, 2008 149:JC6-10; doi:10.1059/0003-4819-149-12-200812160-02010

  • Review: Perioperative LMW heparin does not reduce mortality after surgery more than unfractionated heparin in patients with cancer

    Ann Intern Med December 16, 2008 149:JC6-11; doi:10.1059/0003-4819-149-12-200812160-02011

  • Review: Custom-made foot orthoses are effective for some types of foot pain

    Ann Intern Med December 16, 2008 149:JC6-12; doi:10.1059/0003-4819-149-12-200812160-02012

  • A single measure of urinary neutrophil gelatinase–associated lipocalin was accurate for diagnosing acute kidney injury

    Ann Intern Med December 16, 2008 149:JC6-13; doi:10.1059/0003-4819-149-12-200812160-02013

  • Review: Persons with epilepsy have higher risk for death by drowning than does the general population

    Ann Intern Med December 16, 2008 149:JC6-14; doi:10.1059/0003-4819-149-12-200812160-02014

  • Review: Vasomotor symptoms peak at 1 year after final menstrual period and may persist for many years

    Ann Intern Med December 16, 2008 149:JC6-15; doi:10.1059/0003-4819-149-12-200812160-02015

  • Glossary

    Ann Intern Med December 16, 2008 149:JC6-16; doi:10.1059/0003-4819-149-12-200812160-02016
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This Issue

December 16, 2008; 149 (12)
  1. Articles
  2. Academia and Clinic
  3. Review
  4. Abroad
  5. Editorials
  6. On Being a Doctor
  7. Letters
  8. Thanks to Reviewers
  9. Medical Notices
  10. Summaries for Patients
  11. ACP Journal Club

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