Table of Contents

October 21, 2008; 149 (8)

Articles

  • Addition of Sildenafil to Long-Term Intravenous Epoprostenol Therapy in Patients with Pulmonary Arterial Hypertension: A Randomized Trial

    • Gérald Simonneau,
    • Lewis J. Rubin,
    • Nazzareno Galiè,
    • Robyn J. Barst,
    • Thomas R. Fleming,
    • Adaani E. Frost,
    • Peter J. Engel,
    • Mordechai R. Kramer,
    • Gary Burgess,
    • Lorraine Collings,
    • Nandini Cossons,
    • Olivier Sitbon,
    • David B. Badesch,
    • and for the PACES Study Group
    Ann Intern Med October 21, 2008 149:521-530; doi:10.1059/0003-4819-149-8-200810210-00004

    In a short-term multicenter trial, Simonneau and colleagues randomly assigned 267 patients with pulmonary arterial hypertension who had been receiving intravenous epoprostenol for at least 3 months to receive either oral sildenafil or placebo for 16 weeks. Compared with placebo, sildenafil improved exercise capacity and hemodynamic measurements, lengthened time to clinical worsening, and caused more headaches and dyspepsia. Patients with better baseline exercise capacity improved the most.

  • Addition of Neutral Protamine Lispro Insulin or Insulin Glargine to Oral Type 2 Diabetes Regimens for Patients with Suboptimal Glycemic Control: A Randomized Trial

    • Katherine Esposito,
    • Miryam Ciotola,
    • Maria Ida Maiorino,
    • Roberto Gualdiero,
    • Bruno Schisano,
    • Antonio Ceriello,
    • Flora Beneduce,
    • Giovanni Feola,
    • and Dario Giugliano
    Ann Intern Med October 21, 2008 149:531-539; doi:10.1059/0003-4819-149-8-200810210-00005

    Many patients with type 2 diabetes that is poorly controlled with oral agents take bedtime insulin. In 2 previous trials, neutral protamine lispro (NPL) insulin achieved better glycemic control than neutral protamine Hagedorn insulin. Esposito and associates randomly assigned patients with poor control of type 2 diabetes taking oral medications to receive either bedtime insulin glargine or NPL insulin. Over 36 weeks, the 2 groups had similar glycemic control and rates of hypoglycemic events.

  • Cost-Effectiveness of Nurse-Led Disease Management for Heart Failure in an Ethnically Diverse Urban Community

    • Paul L. Hebert,
    • Jane E. Sisk,
    • Jason J. Wang,
    • Leah Tuzzio,
    • Jodi M. Casabianca,
    • Mark R. Chassin,
    • Carol Horowitz,
    • and Mary Ann McLaughlin
    Ann Intern Med October 21, 2008 149:540-548; doi:10.1059/0003-4819-149-8-200810210-00006

    Although nurse-led case management improves clinical outcomes for patients with heart failure, the cost- effectiveness of these programs is not clearly established. Using data on costs from a randomized trial of 12 months of case management versus usual care for socioeconomically disadvantaged patients with heart failure, Hebert and coworkers estimated the cost-effectiveness of case management to be less than $20 000 per quality-adjusted life-year. This program was a reasonably cost-effective way to reduce the burden of heart failure in this setting.

Review

  • Systematic Review: Comparative Effectiveness and Safety of Premixed Insulin Analogues in Type 2 Diabetes

    • Rehan Qayyum,
    • Shari Bolen,
    • Nisa Maruthur,
    • Leonard Feldman,
    • Lisa M. Wilson,
    • Spyridon S. Marinopoulos,
    • Padmini Ranasinghe,
    • Muhammed Amer,
    • and Eric B. Bass
    Ann Intern Med October 21, 2008 149:549-559; doi:10.1059/0003-4819-149-8-200810210-00242

    Premixed insulin analogues are a mixture of short-acting and intermediate-acting insulin analogues. Their effectiveness relative to other antidiabetic agents is not clearly established. This systematic review of comparative trials in adults with type 2 diabetes found that premixed insulin analogues and premixed human insulin provided similar glycemic control. Premixed insulin analogues provided tighter glycemic control and caused more hypoglycemia than did long-acting insulin analogues and noninsulin antidiabetic agents. Evidence for effects on clinical outcomes of diabetes, however, was scant and inconclusive.

Clinical Guidelines

  • Primary Care Interventions to Promote Breastfeeding: U.S. Preventive Services Task Force Recommendation Statement

    • U.S. Preventive Services Task Force
    Ann Intern Med October 21, 2008 149:560-564; doi:10.1059/0003-4819-149-8-200810210-00008

    The U.S. Preventive Services Task Force (USPSTF) updates its 2003 recommendation statement on counseling to promote breastfeeding. The Task Force evaluated the results of a systematic review of literature published between January 2001 and January 2007 on activities to promote and support breastfeeding that were initiated, conducted, or referable by primary care clinicians. The USPSTF recommends interventions during pregnancy and after birth to promote and support breastfeeding (grade B recommendation).

  • Interventions in Primary Care to Promote Breastfeeding: An Evidence Review for the U.S. Preventive Services Task Force

    • Mei Chung,
    • Gowri Raman,
    • Thomas Trikalinos,
    • Joseph Lau,
    • and Stanley Ip
    Ann Intern Med October 21, 2008 149:565-582; doi:10.1059/0003-4819-149-8-200810210-00009

    To support the USPSTF recommendation in this issue, Chung and colleagues systematically reviewed evidence that primary care–initiated interventions to promote breastfeeding improve breastfeeding rates and child and maternal health outcomes. Evidence suggests that breastfeeding interventions are more effective than usual care in increasing short- and long-term breastfeeding rates. Combining pre- and postnatal interventions and including lay support may be beneficial.

Editorials

  • Therapy for Pulmonary Arterial Hypertension: The More, the Merrier?

    • Darren B. Taichman
    Ann Intern Med October 21, 2008 149:583-585; doi:10.1059/0003-4819-149-8-200810210-00010

    Combination therapy for pulmonary arterial hypertension (PAH) is in widespread use. In this issue, Simonneau and colleagues found that patients who were already receiving intravenous epoprostenol had improvements in 6-minute walk distance, hemodynamic measurements, health-related quality of life, and time to clinical worsening when oral sildenafil was added to their treatment. The trial is an important step forward in PAH research and reminds us that adequately powered studies of combination therapy in PAH can be accomplished and should continue.

  • Newer Insulins in Search of a Niche

    • Sachin Majumdar and
    • Eugene Barrett
    Ann Intern Med October 21, 2008 149:586-588; doi:10.1059/0003-4819-149-8-200810210-00011

    In this issue, Esposito and colleagues and Qayyum and coworkers evaluate the potential roles of newer insulin analogues for treating type 2 diabetes. In making the transition from oral therapies to insulin, neutral protamine Hagedorn (NPH) insulin remains reasonable and cost-effective; a long-acting insulin analogue can be used if nocturnal hypoglycemia is a problem. For meal-related hyperglycemia, a mixed regimen, such as regular/NPH insulin or NPL, may be an alternative to a basal bolus regimen. Choosing and modifying the insulin regimen is easy—the hard part is getting patients to accept diabetes self-management and to do it competently over a lifetime.

On Being a Doctor

  • Legal Advice

    • Joseph Zarconi
    Ann Intern Med October 21, 2008 149:589-590; doi:10.1059/0003-4819-149-8-200810210-00012

    I knew after the first few sentences of our conversation that I would need to schedule her follow-up appointments for longer time slots than the usual 15 minutes. She was going to disrupt the efficiency of my office on this day and probably for a long time to come. Her problem wasn't simple.

  • My Condolences

    • Vikram Padmanabhan
    Ann Intern Med October 21, 2008 149:591-592; doi:10.1059/0003-4819-149-8-200810210-00013

    The books state that in medicine, there are 2 options: curative versus palliative—black and white in a world full of grays. What does “palliative” mean to a 36-year-old mother dying of cancer?

Letters

  • Truthfulness and Personal Disclosure in the Physician–Patient Relationship

    • David Lewis
    Ann Intern Med October 21, 2008 149:593; doi:10.1059/0003-4819-149-8-200810210-00014

  • Truthfulness and Personal Disclosure in the Physician–Patient Relationship

    • Dean Blakeley
    Ann Intern Med October 21, 2008 149:593; doi:10.1059/0003-4819-149-8-200810210-00015

  • Truthfulness and Personal Disclosure in the Physician–Patient Relationship

    • David R. Fulp
    Ann Intern Med October 21, 2008 149:593; doi:10.1059/0003-4819-149-8-200810210-00016

  • Truthfulness and Personal Disclosure in the Physician–Patient Relationship

    • Abha Agrawal
    Ann Intern Med October 21, 2008 149:593-594; doi:10.1059/0003-4819-149-8-200810210-00017

  • Does Lower Diabetes-Related Numeracy Lead to Increased Risk for Hypoglycemic Events?

    • Urmimala Sarkar and
    • Dean Schillinger
    Ann Intern Med October 21, 2008 149:594; doi:10.1059/0003-4819-149-8-200810210-00018

  • Does Lower Diabetes-Related Numeracy Lead to Increased Risk for Hypoglycemic Events?

    • Kerri Cavanaugh and
    • Russell L. Rothman
    Ann Intern Med October 21, 2008 149:594; doi:10.1059/0003-4819-149-8-200810210-00019

  • Disseminated Histoplasmosis Associated with the Treatment of Rheumatoid Arthritis with Anticytokine Therapy

    • Nina Saksena Asrani
    Ann Intern Med October 21, 2008 149:594-595; doi:10.1059/0003-4819-149-8-200810210-00020

  • Clomipramine-Induced Diabetes

    • Nicola Mumoli and
    • Marco Cei
    Ann Intern Med October 21, 2008 149:595-596; doi:10.1059/0003-4819-149-8-200810210-00021

  • Correction: Sjögren-Type Syndrome after Allogeneic Bone-Marrow Transplantation

    Ann Intern Med October 21, 2008 149:596; doi:10.1059/0003-4819-149-8-200810210-00022

  • Correction: In the Clinic: Allergic Rhinitis

    Ann Intern Med October 21, 2008 149:596; doi:10.1059/0003-4819-149-8-200810210-00023

  • Correction: Reported Methodologic Quality and Discrepancies between Large and Small Randomized Trials in Meta-analyses

    Ann Intern Med October 21, 2008 149:596; doi:10.1059/0003-4819-149-8-200810210-00024

Current Clinical Issues

  • Primary Care Delivery Changes as Nonphysician Clinicians Gain Independence

    • Jennifer Fisher Wilson
    Ann Intern Med October 21, 2008 149:597-600; doi:10.1059/0003-4819-149-8-200810210-00025

Summaries for Patients

  • A Combination Treatment for Pulmonary Hypertension

    Ann Intern Med October 21, 2008 149:I-38; doi:10.1059/0003-4819-149-8-200810210-00001

  • Comparison of Two Types of Insulin Added to Diabetes Pills in Poorly Controlled Type 2 Diabetes

    Ann Intern Med October 21, 2008 149:I-46; doi:10.1059/0003-4819-149-8-200810210-00002

  • Health Care Strategies to Promote Breastfeeding: U.S. Preventive Services Task Force Recommendations

    Ann Intern Med October 21, 2008 149:I-52; doi:10.1059/0003-4819-149-8-200810210-00003

ACP Journal Club

  • Editorial: Spectrum bias: why generalists and specialists don't connect

    Ann Intern Med October 21, 2008 149:JC4-2; doi:10.1059/0003-4819-149-8-200810210-02002

  • Glycemic control was not affected by self-monitoring of blood glucose in type 2 diabetes

    Ann Intern Med October 21, 2008 149:JC4-4; doi:10.1059/0003-4819-149-8-200810210-02004

  • Self-monitoring of blood glucose was not cost-effective in non–insulin-treated type 2 diabetes

    Ann Intern Med October 21, 2008 149:JC4-5; doi:10.1059/0003-4819-149-8-200810210-02005

  • Thromboprophylaxis with rivaroxaban or enoxaparin did not differ for major bleeding or other safety outcomes in hip arthroplasty

    Ann Intern Med October 21, 2008 149:JC4-6; doi:10.1059/0003-4819-149-8-200810210-02006

  • Thromboprophylaxis with rivaroxaban or enoxaparin did not differ for major bleeding in knee arthroplasty

    Ann Intern Med October 21, 2008 149:JC4-7; doi:10.1059/0003-4819-149-8-200810210-02007

  • Rhythm control and rate control did not differ for CV mortality in atrial fibrillation and congestive heart failure

    Ann Intern Med October 21, 2008 149:JC4-8; doi:10.1059/0003-4819-149-8-200810210-02008

  • Review: Mifepristone is more effective for emergency contraception than levonorgestrel

    Ann Intern Med October 21, 2008 149:JC4-9; doi:10.1059/0003-4819-149-8-200810210-02009

  • Review: Nonergot dopamine agonists reduce symptoms in the restless legs syndrome but may be discontinued due to adverse events

    Ann Intern Med October 21, 2008 149:JC4-10; doi:10.1059/0003-4819-149-8-200810210-02010

  • An intervention involving pharmacist care via the Web improved blood pressure control in uncontrolled hypertension

    Ann Intern Med October 21, 2008 149:JC4-11; doi:10.1059/0003-4819-149-8-200810210-02011

  • Adding single-point acupuncture to physiotherapy for painful shoulder improved function and reduced pain

    Ann Intern Med October 21, 2008 149:JC4-12; doi:10.1059/0003-4819-149-8-200810210-02012

  • Review: 64-slice computed tomography coronary angiography accurately diagnoses coronary artery disease

    Ann Intern Med October 21, 2008 149:JC4-13; doi:10.1059/0003-4819-149-8-200810210-02013

  • Review: Spot protein–creatinine ratio has moderate diagnostic performance for proteinuria in pregnant women with hypertension

    Ann Intern Med October 21, 2008 149:JC4-14; doi:10.1059/0003-4819-149-8-200810210-02014

  • A model was sensitive but not specific for screening for tuberculosis in contact patients

    Ann Intern Med October 21, 2008 149:JC4-15; doi:10.1059/0003-4819-149-8-200810210-02015

  • Glossary

    Ann Intern Med October 21, 2008 149:JC4-16; doi:10.1059/0003-4819-149-8-200810210-02016
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This Issue

October 21, 2008; 149 (8)
  1. Articles
  2. Review
  3. Clinical Guidelines
  4. Editorials
  5. On Being a Doctor
  6. Letters
  7. Current Clinical Issues
  8. Summaries for Patients
  9. ACP Journal Club

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