Table of Contents

February 17, 2009; 150 (4)

Articles

  • Safely Ruling Out Deep Venous Thrombosis in Primary Care

    • Harry R. Büller,
    • Arina J. ten Cate-Hoek,
    • Arno W. Hoes,
    • Manuela A. Joore,
    • Karel G.M. Moons,
    • Ruud Oudega,
    • Martin H. Prins,
    • Henri E.J.H. Stoffers,
    • Diane B. Toll,
    • Eit F. van der Velde,
    • Henk C.P.M. van Weert,
    • and for the AMUSE (Amsterdam Maastricht Utrecht Study on thromboEmbolism) Investigators
    Ann Intern Med February 17, 2009 150:229-235; doi:10.1059/0003-4819-150-4-200902170-00003

    Office-based methods to rule out suspected deep venous thrombosis (DVT) are needed to reduce the number of avoidable referrals for ultrasonography. Büller and colleagues conducted a management trial of a prediction rule that uses clinical findings and a point-of-care d-dimer test to identify patients at very low risk for suspected DVT. Among 1028 patients from approximately 300 primary care practices, nearly half (49%) were at low enough risk to withhold imaging tests and anticoagulation treatment. In 3 months, 1.4% had venous thromboembolism.

  • Primary Care Physicians' Links to Other Physicians Through Medicare Patients: The Scope of Care Coordination

    • Hoangmai H. Pham,
    • Ann S. O'Malley,
    • Peter B. Bach,
    • Cynthia Saiontz-Martinez,
    • and Deborah Schrag
    Ann Intern Med February 17, 2009 150:236-242; doi:10.1059/0003-4819-150-4-200902170-00004

    An essential task of primary care physicians is to coordinate care that their patients receive from other physicians. This role is central to models of care, such as the patient-centered medical home. This analysis used survey data from 2284 primary care physicians and claims for the Medicare beneficiaries they cared for in 2005. They found that the typical primary care physician must interact with 211 different physicians in 117 different practices.

  • Comparing Impact and Cost-Effectiveness of Primary Prevention Strategies for Lipid-Lowering

    • Mark J. Pletcher,
    • Lawrence Lazar,
    • Kirsten Bibbins-Domingo,
    • Andrew Moran,
    • Nicolas Rodondi,
    • Pamela Coxson,
    • James Lightwood,
    • Lawrence Williams,
    • and Lee Goldman
    Ann Intern Med February 17, 2009 150:243-254; doi:10.1059/0003-4819-150-4-200902170-00005

    Lipid-lowering therapy is costly but effective at reducing coronary heart disease (CHD) risk. The authors used a probabilistic model to show that the Adult Treatment Panel III guidelines, which recommend treatment based on cholesterol level and estimated CHD risk, are reasonably cost-effective if statins cost about $1.50 to $2.20 per pill. At costs lower than $0.10 per pill, treating everyone with low-density lipoprotein cholesterol levels greater than 3.4 mmol/L (>130 mg/dL), regardless of other CHD risk factors, could be a better strategy.

Improving Patient Care

  • Comparison of Methods for Delivering a Lifestyle Modification Program for Obese Patients: A Randomized Trial

    • Andres G. Digenio,
    • James P. Mancuso,
    • Robert A. Gerber,
    • and Roman V. Dvorak
    Ann Intern Med February 17, 2009 150:255-262; doi:10.1059/0003-4819-150-4-200902170-00006

    Obese people have difficulty changing their lifestyle to eat less. In their randomized trial, Digenio and coworkers compared 5 ways of providing support for lifestyle modification in obese patients who were taking sibutramine, an antiobesity drug. They found that high-frequency telephone contact with a dietitian led to the same weight loss as in-person contact and more weight loss than low-frequency contact, e-mail contact, or no contact. Telephone contacts with dietitians may be a more efficient way to help obese patients lose weight.

Medicine and Public Issues

  • Consistency of State Statutes With the Centers for Disease Control and Prevention HIV Testing Recommendations for Health Care Settings

    • Anish P. Mahajan,
    • Lara Stemple,
    • Martin F. Shapiro,
    • Jan B. King,
    • and William E. Cunningham
    Ann Intern Med February 17, 2009 150:263-269; doi:10.1059/0003-4819-150-4-200902170-00007

    The Centers for Disease Control and Prevention now recommend offering opt-out HIV screening to all patients in all health care settings without separate written consent and prevention counseling. State law on HIV testing may be a barrier to implementing these recommendations. To offer policymakers and providers a comprehensive analysis, Mahajan and colleagues did a state-by-state review of all statutes pertaining to HIV testing and systematically assessed the compatibility of these laws with the new recommendations.

Editorials

  • Much Ado About (Doing) Nothing

    • Brendan M. Reilly and
    • Arthur T. Evans
    Ann Intern Med February 17, 2009 150:270-271; doi:10.1059/0003-4819-150-4-200902170-00008

    In this issue, Büller and colleagues present the results of a study designed to reduce unnecessary diagnostic testing (ultrasonography) for primary care patients with suspected DVT. We are cautiously optimistic that the use of the AMUSE rule can improve clinicians' decisions by reducing unnecessary care.

  • Primary Care: Too Important to Fail

    • David S. Meyers and
    • Carolyn M. Clancy
    Ann Intern Med February 17, 2009 150:272-273; doi:10.1059/0003-4819-150-4-200902170-00009

    The principal goals of health care reform are to improve quality, increase access, and contain costs. In this issue, Pham and colleagues calculated that a typical primary care clinician must coordinate the care for their Medicare patients with 229 other physicians in 117 different practices, suggesting that a primary care infrastructure investment must address the substantial challenges of care coordination. We cannot build a reformed health care system on an endangered primary care enterprise. We must invest now. Primary care is too important to fail.

  • Health Policy and Cost-Effectiveness Analysis: Yes We Can. Yes We Must.

    • John B. Wong,
    • Cynthia Mulrow,
    • and Harold C. Sox
    Ann Intern Med February 17, 2009 150:274-275; doi:10.1059/0003-4819-150-4-200902170-00010

    Pletcher and colleagues' cost-effectiveness analysis in this issue found that some statin strategies had acceptable economic value in preventing CHD. Wong and associates provide a brief introduction to cost-effectiveness analyses and discuss whether the U.S. federal government should use them to inform its policy decisions about health care.

On Being a Doctor

  • You Are a Blessing

    • Laura Carbone
    Ann Intern Med February 17, 2009 150:276; doi:10.1059/0003-4819-150-4-200902170-00011

    It's been 3 years since we knew its name—“non–small-cell lung cancer with mets to the bone and pleura.” But nothing at all had changed during this time.… After all, you were still at every clinic every day, for your patients needed you.…

  • Honor, Home, Heritage, and HIV

    • Kartik K. Venkatesh
    Ann Intern Med February 17, 2009 150:277-278; doi:10.1059/0003-4819-150-4-200902170-00012

    The experience of conducting research in my family's ancestral home had proven to be contradictory—the changes sweeping a new globalizing India were a world apart from my parents' memories of an unchanging India recovering from its colonial past.

  • The Birthday Gift

    • Abigail A.D. Ford
    Ann Intern Med February 17, 2009 150:279-280; doi:10.1059/0003-4819-150-4-200902170-00013

    I spent the evening of my 27th birthday working overnight on the labor floor. I had been an intern for just over a month and had begun to feel the slight, constant tug of fatigue and stress on my spirit.

Letters

  • Where Is the Evidence That the Resurgence of Nomograms Is Harmful?

    • Samuel H. Zwillich
    Ann Intern Med February 17, 2009 150:282; doi:10.1059/0003-4819-150-4-200902170-00016

  • Where Is the Evidence That the Resurgence of Nomograms Is Harmful?

    • David A. Grimes
    Ann Intern Med February 17, 2009 150:282; doi:10.1059/0003-4819-150-4-200902170-00017

  • Can the SMART Study Data Be Used to Assess Risk Factors for Renal Disease?

    • Samir K. Gupta
    Ann Intern Med February 17, 2009 150:282; doi:10.1059/0003-4819-150-4-200902170-00018

  • Can the SMART Study Data Be Used to Assess Risk Factors for Renal Disease?

    • James D. Neaton and
    • for the INSIGHT SMART Study Group
    Ann Intern Med February 17, 2009 150:282-283; doi:10.1059/0003-4819-150-4-200902170-00019

  • Is There a Proven Link Between Anal Cancer Screening and Reduced Morbidity or Mortality?

    • Kenneth A. Katz,
    • Christina A. Clarke,
    • Kyle T. Bernstein,
    • Mitchell H. Katz,
    • and Jeffrey D. Klausner
    Ann Intern Med February 17, 2009 150:283-284; doi:10.1059/0003-4819-150-4-200902170-00020

  • Is There a Proven Link Between Anal Cancer Screening and Reduced Morbidity or Mortality?

    • Peter V. Chin-Hong,
    • Nancy A. Hessol,
    • and Joel M. Palefsky
    Ann Intern Med February 17, 2009 150:284-285; doi:10.1059/0003-4819-150-4-200902170-00021

  • Is There a Connection Between High Educational Debt and Suicidal Ideation Among Medical Students?

    • John D. Yoon and
    • Vineet M. Arora
    Ann Intern Med February 17, 2009 150:285; doi:10.1059/0003-4819-150-4-200902170-00022

  • Is There a Connection Between High Educational Debt and Suicidal Ideation Among Medical Students?

    • Liselotte N. Dyrbye,
    • Jeff A. Sloan,
    • and Tait D. Shanafelt
    Ann Intern Med February 17, 2009 150:285; doi:10.1059/0003-4819-150-4-200902170-00023

  • Is Too Much Intervention Recommended in the ACP Osteoporosis Treatment Guidelines?

    • Pablo Alonso-Coello,
    • Alberto López,
    • Laurie J. Pencille,
    • and Victor M. Montori
    Ann Intern Med February 17, 2009 150:285-286; doi:10.1059/0003-4819-150-4-200902170-00024

  • Is Too Much Intervention Recommended in the ACP Osteoporosis Treatment Guidelines?

    • Amir Qaseem,
    • Paul Shekelle,
    • and Douglas K. Owens
    Ann Intern Med February 17, 2009 150:286-287; doi:10.1059/0003-4819-150-4-200902170-00025

  • Agranulocytosis After Consumption of Cocaine Adulterated With Levamisole

    • Nancy Y. Zhu,
    • Donald F. LeGatt,
    • and A. Robert Turner
    Ann Intern Med February 17, 2009 150:287-289; doi:10.1059/0003-4819-150-4-200902170-00102

  • Recurrent Spontaneous Pneumothorax as the Presenting Sign of the Birt–Hogg–Dubé Syndrome

    • Joshua M. Diamond and
    • Robert M. Kotloff
    Ann Intern Med February 17, 2009 150:289-290; doi:10.1059/0003-4819-150-4-200902170-00027

  • The Joy of Cooking Too Much: 70 Years of Calorie Increases in Classic Recipes

    • Brian Wansink and
    • Collin R. Payne
    Ann Intern Med February 17, 2009 150:291-292; doi:10.1059/0003-4819-150-4-200902170-00028

  • Correction: What Do You Do When Your Loved One Is Ill?

    Ann Intern Med February 17, 2009 150:291-292; doi:10.1059/0003-4819-150-4-200902170-00029

  • Correction: Radiographic Contrast Infusion and Catecholamine Release in Patients With Pheochromocytoma

    Ann Intern Med February 17, 2009 150:292; doi:10.1059/0003-4819-150-4-200902170-00030

Ad Libitum

  • My Second Wind

    • Clayton J. Baker
    Ann Intern Med February 17, 2009 150:281; doi:10.1059/0003-4819-150-4-200902170-00014

  • She's Drawn to Trailers

    • Clayton J. Baker
    Ann Intern Med February 17, 2009 150:281; doi:10.1059/0003-4819-150-4-200902170-00015

Medical Notices

  • Medical Notices

    Ann Intern Med February 17, 2009 150:0; doi:10.1059/0003-4819-150-4-200902170-00031

Summaries for Patients

  • Safely Ruling Out Deep Venous Thrombosis in Primary Care

    Ann Intern Med February 17, 2009 150:I-36; doi:10.1059/0003-4819-150-4-200902170-00001

  • How Many Other Doctors Do Primary Care Doctors Need to Coordinate Patient Care With?

    Ann Intern Med February 17, 2009 150:I-44; doi:10.1059/0003-4819-150-4-200902170-00002

ACP Journal Club

  • Editorial: Interpreting meta-analysis in systematic reviews

    Ann Intern Med February 17, 2009 150:JC2-2; doi:10.1059/0003-4819-150-4-200902170-02002

  • Review: Low-molecular-weight heparin reduces risk for venous thromboembolism in adults with leg immobilization

    Ann Intern Med February 17, 2009 150:JC2-4; doi:10.1059/0003-4819-150-4-200902170-02004

  • Influenza immunization during pregnancy reduced influenza in infants and respiratory illness in mothers

    Ann Intern Med February 17, 2009 150:JC2-5; doi:10.1059/0003-4819-150-4-200902170-02005

  • Telmisartan did not reduce a composite of CV death, MI, HF, or stroke in high-risk patients intolerant to ACE inhibitors

    Ann Intern Med February 17, 2009 150:JC2-6; doi:10.1059/0003-4819-150-4-200902170-02006

  • High-dose vitamin B supplements did not slow cognitive decline in mild-to-moderate Alzheimer disease

    Ann Intern Med February 17, 2009 150:JC2-7; doi:10.1059/0003-4819-150-4-200902170-02007

  • Aspirin plus extended-release dipyridamole and clopidogrel were similarly effective for preventing recurrent stroke

    Ann Intern Med February 17, 2009 150:JC2-8; doi:10.1059/0003-4819-150-4-200902170-02008

  • Telmisartan did not prevent recurrent stroke or major cardiovascular events

    Ann Intern Med February 17, 2009 150:JC2-9; doi:10.1059/0003-4819-150-4-200902170-02009

  • Carotid artery stenting increased risk for stroke more than carotid endarterectomy in severe symptomatic stenosis

    Ann Intern Med February 17, 2009 150:JC2-10; doi:10.1059/0003-4819-150-4-200902170-02010

  • Carotid artery stenting and carotid endarterectomy were similarly effective in severe symptomatic stenosis

    Ann Intern Med February 17, 2009 150:JC2-11; doi:10.1059/0003-4819-150-4-200902170-02011

  • Intensive insulin therapy reduced long-term risk for incident hypertension in type 1 diabetes

    Ann Intern Med February 17, 2009 150:JC2-12; doi:10.1059/0003-4819-150-4-200902170-02012

  • CT colonography had 90% sensitivity and 86% specificity for diagnosing large adenomas and cancer in asymptomatic adults

    Ann Intern Med February 17, 2009 150:JC2-13; doi:10.1059/0003-4819-150-4-200902170-02013

  • Review: d-dimer levels predict risk for recurrent VTE after anticoagulant therapy is stopped

    Ann Intern Med February 17, 2009 150:JC2-14; doi:10.1059/0003-4819-150-4-200902170-02014

  • Review: Sgarbossa scores ≥ 3 have low sensitivity and high specificity for predicting MI in left bundle branch block

    Ann Intern Med February 17, 2009 150:JC2-15; doi:10.1059/0003-4819-150-4-200902170-02015

  • Glossary

    Ann Intern Med February 17, 2009 150:JC2-16; doi:10.1059/0003-4819-150-4-200902170-02016
« Previous | Next Issue »

This Issue

February 17, 2009; 150 (4)
  1. Articles
  2. Improving Patient Care
  3. Medicine and Public Issues
  4. Editorials
  5. On Being a Doctor
  6. Letters
  7. Ad Libitum
  8. Medical Notices
  9. Summaries for Patients
  10. ACP Journal Club

Search in this issue:

Current Issue

  1. November 17, 2009, 151 (10)
  1. Alert me to current issues