Table of Contents

November 17, 2009; 151 (10)

Articles

  • A Computerized Handheld Decision-Support System to Improve Pulmonary Embolism Diagnosis: A Randomized Trial

    • Pierre-Marie Roy,
    • Pierre Durieux,
    • Florence Gillaizeau,
    • Catherine Legall,
    • Aurore Armand-Perroux,
    • Ludovic Martino,
    • Mohamed Hachelaf,
    • Alain-Eric Dubart,
    • Jeannot Schmidt,
    • Mirko Cristiano,
    • Jean-Marie Chretien,
    • Arnaud Perrier,
    • and Guy Meyer
    Ann Intern Med November 17, 2009 151:677-686; doi:10.1059/0003-4819-151-10-200911170-00003

    Roy and colleagues developed a program to guide diagnosis of pulmonary embolism for use on a mobile, handheld device. The investigators randomly assigned 20 emergency departments in France to activation of either the decision-support system on the devices or posters and pocket cards that showed diagnostic strategies. The device-based program improved appropriate testing of patients with suspected pulmonary embolism more than paper guidelines alone.

  • Two Self-management Interventions to Improve Hypertension Control: A Randomized Trial

    • Hayden B. Bosworth,
    • Maren K. Olsen,
    • Janet M. Grubber,
    • Alice M. Neary,
    • Melinda M. Orr,
    • Benjamin J. Powers,
    • Martha B. Adams,
    • Laura P. Svetkey,
    • Shelby D. Reed,
    • Yanhong Li,
    • Rowena J. Dolor,
    • and Eugene Z. Oddone
    Ann Intern Med November 17, 2009 151:687-695; doi:10.1059/0003-4819-151-10-200911170-00148

    In this trial, 636 patients with hypertension were randomly assigned to receive usual care; a telephone-delivered, nurse-administered behavioral self-management intervention; home blood pressure self-monitoring; or both of the latter 2 interventions. Compared with usual care, the adjusted improvement in the proportion of patients with blood pressure control at 24 months was 4.3% for the behavioral intervention group, 7.6% for the blood pressure monitoring group, and 11.0% for the combined intervention group. The combined intervention improved blood pressure control and systolic and diastolic blood pressures more than usual care.

  • Effects of a Short Course of Eszopiclone on Continuous Positive Airway Pressure Adherence: A Randomized Trial

    • Christopher J. Lettieri,
    • Anita A. Shah,
    • Aaron B. Holley,
    • William F. Kelly,
    • Audrey S. Chang,
    • Stuart A. Roop,
    • and for the CPAP ASAP (CPAP Promotion and Prognosis—The Army Sleep Apnea Program) Trial
    Ann Intern Med November 17, 2009 151:696-702; doi:10.1059/0003-4819-151-10-200911170-00006

    Lettieri and coworkers assessed whether a short course of eszopiclone therapy improves long-term adherence to continuous positive airway pressure (CPAP). They randomly assigned 160 adults with severe obstructive sleep apnea to eszopiclone or placebo for the first 14 nights of CPAP, and measured patients' adherence to CPAP weekly for 24 weeks. Patients receiving eszopiclone were less likely to discontinue CPAP and also used CPAP more nights and longer per night than did patients receiving placebo.

Review

  • Systematic Review: Comparative Effectiveness of Medications to Reduce Risk for Primary Breast Cancer

    • Heidi D. Nelson,
    • Rongwei Fu,
    • Jessica C. Griffin,
    • Peggy Nygren,
    • M. E. Beth Smith,
    • and Linda Humphrey
    Ann Intern Med November 17, 2009 151:703-715; doi:10.1059/0003-4819-151-10-200911170-00147

    Nelson and colleagues reviewed trials and observational studies to summarize the benefits and harms of tamoxifen citrate, raloxifene, and tibolone in reducing the risk for primary breast cancer in women. Tamoxifen, raloxifene, and tibolone each reduced risk for invasive breast cancer more than placebo. Tamoxifen and raloxifene reduced risk for estrogen receptor–positive but not estrogen receptor–negative breast cancer or death. All drugs reduced fracture risks but increased risk for thromboembolic events (tamoxifen and raloxifene), endometrial cancer (tamoxifen), or strokes (tibolone).

Clinical Guidelines

  • Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement

    • U.S. Preventive Services Task Force
    Ann Intern Med November 17, 2009 151:716-726; doi:10.1059/0003-4819-151-10-200911170-00008

    This U.S. Preventive Services Task Force (USPSTF) update recommends biennial screening mammography for women aged 50 to 74 years (grade B recommendation). The USPSTF recommends against routine screening mammography in women aged 40 to 49 years (grade C recommendation) and against clinicians teaching women how to perform breast self-examination (grade D recommendation). Finally, the USPSTF found that evidence is insufficient to assess screening mammography in women aged 75 years or older, clinical breast examination beyond screening mammography in women aged 40 years or older, and either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities (I statements).

  • Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force

    • Heidi D. Nelson,
    • Kari Tyne,
    • Arpana Naik,
    • Christina Bougatsos,
    • Benjamin K. Chan,
    • and Linda Humphrey
    Ann Intern Med November 17, 2009 151:727-737; doi:10.1059/0003-4819-151-10-200911170-00009

    To inform the USPSTF recommendations about breast cancer screening, Nelson and coworkers reviewed evidence on the effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women, the effectiveness of clinical breast examination and breast self-examination, and the harms of screening. They found that mammography screening reduced breast cancer mortality for women aged 39 to 69 years, but data for older women were insufficient. They also found that false-positive results and additional imaging tests were common, particularly among younger women. No benefit has been shown for clinical breast examination or breast self-examination.

  • Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms

    • Jeanne S. Mandelblatt,
    • Kathleen A. Cronin,
    • Stephanie Bailey,
    • Donald A. Berry,
    • Harry J. de Koning,
    • Gerrit Draisma,
    • Hui Huang,
    • Sandra J. Lee,
    • Mark Munsell,
    • Sylvia K. Plevritis,
    • Peter Ravdin,
    • Clyde B. Schechter,
    • Bronislava Sigal,
    • Michael A. Stoto,
    • Natasha K. Stout,
    • Nicolien T. van Ravesteyn,
    • John Venier,
    • Marvin Zelen,
    • Eric J. Feuer,
    • and for the Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network (CISNET)
    Ann Intern Med November 17, 2009 151:738-747; doi:10.1059/0003-4819-151-10-200911170-00010

    To inform the USPSTF recommendations about breast cancer screening, Mandelblatt and colleagues developed 6 models of breast cancer incidence and mortality in the United States and estimated benefits and harms across 20 mammography screening strategies. The models showed that biennial screening achieves most of the benefit of annual screening with less harm. Decisions about the best screening strategy depend on program and individual objectives and the weight placed on benefits, harms, and resource considerations.

Editorials

  • Handy Point-of-Care Decision Support

    • Jeffrey M. Rothschild
    Ann Intern Med November 17, 2009 151:748-749; doi:10.1059/0003-4819-151-10-200911170-00011

    In this issue, Roy and colleagues studied the use of a handheld clinical decision-support system to improve the diagnosis of pulmonary embolism in 20 French emergency departments. Handheld computers could provide a key resource that improves access to decision-support tools and leads to better management decisions. Roy and colleagues' work represents a promising start toward this essential goal.

  • Evidence-Based Breast Cancer Prevention: The Importance of Individual Risk

    • Karla Kerlikowske
    Ann Intern Med November 17, 2009 151:750-752; doi:10.1059/0003-4819-151-10-200911170-00012

    Widespread use of screening mammography has been the mainstay of breast cancer prevention in the United States for the past 25 years. In this issue, the USPSTF has made major changes to its recommendations on breast cancer screening. Three accompanying articles summarize benefits and harms of screening, model different screening strategies, and review medications that reduce risk for breast cancer. The recommendations and new information should compel clinicians to examine whether current prevention practices in the United States are consistent with the best available evidence.

Letters

  • Similarities and Differences Between REPEAT and EPIC3

    • Thierry Poynard and
    • Eugene Shiff
    Ann Intern Med November 17, 2009 151:754; doi:10.1059/0003-4819-151-10-200911170-00014

  • Similarities and Differences Between REPEAT and EPIC3

    • Donald M. Jensen and
    • Patrick Marcellin
    Ann Intern Med November 17, 2009 151:754-755; doi:10.1059/0003-4819-151-10-200911170-00015

  • Hypomagnesemia Induced by Several Proton-Pump Inhibitors

    • Maarten A.C. Broeren,
    • Engelien A.M. Geerdink,
    • Huib L. Vader,
    • and A. Warmold L. van den Wall Bake
    Ann Intern Med November 17, 2009 151:755-756; doi:10.1059/0003-4819-151-10-200911170-00016

Ad Libitum

  • Nothing Is Sacred

    • Jack Coulehan
    Ann Intern Med November 17, 2009 151:686; doi:10.1059/0003-4819-151-10-200911170-00004

  • The Teardrop Approach

    • Lawrence J. Hergott
    Ann Intern Med November 17, 2009 151:753; doi:10.1059/0003-4819-151-10-200911170-00013

Medical Notices

  • Medical Notices

    Ann Intern Med November 17, 2009 151:0; doi:10.1059/0003-4819-151-10-200911170-00017

Summaries for Patients

  • Improving Use of Continuous Positive Airway Pressure for Obstructive Sleep Apnea

    Ann Intern Med November 17, 2009 151:I-38; doi:10.1059/0003-4819-151-10-200911170-00001

  • Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendations

    Ann Intern Med November 17, 2009 151:I-44; doi:10.1059/0003-4819-151-10-200911170-00002

ACP Journal Club

  • Editorial: The tough math of evidence-based health care: E × KT2 = ROI

    Ann Intern Med November 17, 2009 151:JC5-2; doi:10.1059/0003-4819-151-10-200911170-02002

  • Early transfer for angiography after fibrinolysis reduced ischemic events in patients with STEMI

    Ann Intern Med November 17, 2009 151:JC5-4; doi:10.1059/0003-4819-151-10-200911170-02004

  • Review: Evidence for the effectiveness of vitamin D and calcium for reducing CV outcomes, cancer, and death is limited

    Ann Intern Med November 17, 2009 151:JC5-5; doi:10.1059/0003-4819-151-10-200911170-02005

  • Review: Low BP targets do not reduce mortality or CV events in hypertension

    Ann Intern Med November 17, 2009 151:JC5-6; doi:10.1059/0003-4819-151-10-200911170-02006

  • Tight BP control reduced left ventricular hypertrophy in nondiabetic patients with hypertension

    Ann Intern Med November 17, 2009 151:JC5-7; doi:10.1059/0003-4819-151-10-200911170-02007

  • Preoperative staging using PET-CT reduced futile thoracotomies more than conventional staging in non–small-cell lung cancer

    Ann Intern Med November 17, 2009 151:JC5-8; doi:10.1059/0003-4819-151-10-200911170-02008

  • Disclosure of genetic risk for Alzheimer disease did not increase anxiety or depression in asymptomatic adults

    Ann Intern Med November 17, 2009 151:JC5-9; doi:10.1059/0003-4819-151-10-200911170-02009

  • Percutaneous closure of the left atrial appendage was noninferior to warfarin in atrial fibrillation

    Ann Intern Med November 17, 2009 151:JC5-10; doi:10.1059/0003-4819-151-10-200911170-02010

  • Capsule endoscopy had low sensitivity for detecting colonic lesions and high specificity for large lesions

    Ann Intern Med November 17, 2009 151:JC5-11; doi:10.1059/0003-4819-151-10-200911170-02011

  • Use of antipsychotic drugs was associated with increased risk for hyperglycemia in older patients with diabetes

    Ann Intern Med November 17, 2009 151:JC5-12; doi:10.1059/0003-4819-151-10-200911170-02012

  • Prolonged PR intervals were associated with increased risk for atrial fibrillation, pacemaker implantation, and mortality

    Ann Intern Med November 17, 2009 151:JC5-13; doi:10.1059/0003-4819-151-10-200911170-02013

  • Review: PPI use in pregnancy was not associated with increased congenital malformations, spontaneous abortion, or preterm delivery

    Ann Intern Med November 17, 2009 151:JC5-14; doi:10.1059/0003-4819-151-10-200911170-02014

  • Screening for abdominal aortic aneurysm (AAA) in men 65 to 74 years of age was cost-effective for AAA mortality at 10 years

    Ann Intern Med November 17, 2009 151:JC5-15; doi:10.1059/0003-4819-151-10-200911170-02015

  • Glossary

    Ann Intern Med November 17, 2009 151:JC5-16; doi:10.1059/0003-4819-151-10-200911170-02016
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This Issue

November 17, 2009; 151 (10)
  1. Articles
  2. Review
  3. Clinical Guidelines
  4. Editorials
  5. Letters
  6. Ad Libitum
  7. Medical Notices
  8. Summaries for Patients
  9. ACP Journal Club

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