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Articles 
Anthony B. Miller, Teresa To, Cornelia J. Baines, and Claus Wall After 11 to 16 years of follow-up, four or five annual screenings with mammography, breast physical examination, and breast self-examination had not reduced breast cancer mortality compared with usual community care after a single breast physical examination and instruction on breast self-examination. The study data show that true effects of 20% or greater are unlikely.
Barry R. Davis, Jeffrey A. Cutler, Curt D. Furberg, Jackson T. Wright, Jr., Michael A. Farber, James V. Felicetta, John D. Stokes for the ALLHAT Collaborative Research Group* In high-risk patients with hypertension, the higher risk for heart failure while taking doxazosin compared with chlorthalidone is attenuated but not eliminated by adding other antihypertensive drugs. The small observed difference in systolic blood pressure does not explain this increased risk.
Joaquim Fernández-Solà, Josep María Nicolás, Josep Oriola, Emilio Sacanella, Ramón Estruch, Emanuel Rubin, and Alvaro Urbano-Márquez Vulnerability to cardiomyopathy among chronic alcohol abusers is partially genetic and is related to presence of the angiotensin-converting enzyme DD genotype. This finding demonstrates genetic susceptibility to alcohol-induced myocardial damage.
Academia and Clinic
Timothy P. Hofer and Rodney A. Hayward This article analyzes the case of a 40-year-old woman with a history of chronic aortic dissection and pericardial effusion who was admitted with unilateral swelling of her left breast and arm accompanied by dyspnea. During hospitalization, the patient developed complications from the diagnostic and therapeutic procedures. This case illustrates some limitations of routinely undertaking time-consuming and costly reviews, or "root-cause analyses," as a patient safety strategy when they are unlikely to reveal remediable "errors" or to suggest better systems of care that will prevent errors.
Perspectives
Jennifer E. Potter The author presents vignettes from her personal experiences as a lesbian patient and doctor to illustrate the importance of creating an environment in which sexual orientation can be disclosed and to portray the challenges and rewards of coming out as a gay physician.
Clinical Guidelines
U.S. Preventive Services Task Force* The U.S. Preventive Services Task Force recommends screening mammography, with or without clinical breast examination, every 1 to 2 years for women aged 40 and older.
Linda L. Humphrey, Mark Helfand, Benjamin K.S. Chan, and Steven H. Woolf This systematic review supports the U.S. Preventive Services Task Force's position on breast cancer screening.
Editorials
Harold Sox This issue of Annals adds fuel to the breast cancer screening debate. It contains the U.S. Preventive Services Task Force recommendations on breast cancer screening, a summary of the supporting evidence, an editorial about dealing responsibly with conflicting evidence, and a report from the Canadian National Breast Screening Study. It's a debate worth following closely, because women are deciding about breast cancer screening, and it's our role to keep them informed as best we can.
Steven N. Goodman The newest contretemps over mammography is yet the latest eruption from a debate that has been simmering for decades. But a closer look at this controversy, which is officially joined here by publication of the rationale for the recommendations of the U.S. Preventive Services Task Force, shows that its focus has shifted in a way that continues to pose a dilemma not only for women and their doctors but for evidence-based medicine itself.
On Being a Doctor
David S. Pisetsky In August of each year, I take a 2-week vacation with my family, wanting to get as far away as possible from the hospital where I'm the rheumatology division chief. This year, however, my plans for rest went awry when, on the Monday of my second week on vacation, I decided to take a walk on the beach.
Letters Rapidly Progressive Glomerulonephritis
Prognostic Disclosure
Continuous Positive Airway Pressure in Patients without Daytime Sleepiness
Colloid Use in the Critically Ill
Clinical Assessment and D-Dimer Testing in Deep Venous Thrombosis
Clinical Assessment and D-dimer Testing in Deep Venous Thrombosis
Physicians and Patient Spirituality
Sprout-Associated Outbreaks
Newspaper Reporting of Screening Mammography
Clozapine-Associated Neuroleptic Malignant Syndrome
Superior Sagittal Sinus Thrombosis and HIV
Alejandro C. Arroliga, Sara Newman, David L. Longworth, and James K. Stoller The authors describe the frequency with which pulmonary and critical care physicians use metaphors in explaining diagnosis or treatment to their patients. Through this study, they have begun to assemble a "catalog" of metaphors for a variety of pulmonary issues that may be useful to colleagues seeking new communicative strategies.
Helen K. Delichatsios
Charles Moldow
Bonnie Salomon
Jason David Eubanks
Catherine Reinis Lucey and Carmella A. Cole This Update addresses new lessons learned about secondary prevention in cardiovascular disease, the management of systolic dysfunction, the specific choice of antihypertensive agents for special populations, the significance of Helicobacter pylori infection, the management of thromboembolic disease, and the use of estrogen replacement therapy. | |||||||||||||||||||||||||||
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