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Articles 
Bart J. Veldt, E. Jenny Heathcote, Heiner Wedemeyer, Juerg Reichen, W. Peter Hofmann, Stefan Zeuzem, Michael P. Manns, Bettina E. Hansen, Solko W. Schalm, and Harry L.A. Janssen In their retrospective cohort study, Veldt and colleagues compared clinical outcomes in 479 patients with chronic hepatitis C and advanced fibrosis who did and did not have sustained virologic response to treatment. They found that sustained virologic response decreased the hazard of clinical events, largely because of a reduction in liver failure. It also seemed to be associated with a reduction in liver cancer and liver-related death, although the number of these events was small.
Pepijn D.D.M. Roelofs, Sita M.A. Bierma-Zeinstra, Mireille N.M. van Poppel, Petra Jellema, Sten P. Willemsen, Maurits W. van Tulder, Willem van Mechelen, and Bart W. Koes Lumbar supports are commonly used to prevent low back pain, but evidence on their effectiveness is lacking. Roelofs and coworkers randomly assigned 360 home care workers with a history of low back pain to a short course on healthy work habits, with or without worker-directed use of 1 of 4 types of lumbar support. Over 12 months, participants assigned to lumbar support had a similar number of sick days but had fewer days with low back pain than did participants assigned to the course only. Adding lumbar supports to instruction on healthy work habits may decrease low back pain recurrence, but not absenteeism, among workers with previous back pain.
Jeffrey Farber, Albert Siu, and Patricia Bloom Much primary care takes place outside of the office and is not reimbursed. Farber and associates collected information on clinical interactions outside of office visits in an academic geriatric medicine practice. They estimated that providers spent an additional 6.7 minutes outside of every 30-minute office visit providing care, which amounted to an extra 7.8 hours of clinical work per week for a full-time provider. The finding may not apply to full-time providers in community practices; similar data should be collected in broader settings to inform debates over reimbursement reform.
Improving Patient Care
Angela Raval, Gita Akhavan-Toyserkani, Allen Brinker, and Mark Avigan In October 2001, the U.S. Food and Drug Administration (FDA) modified infliximab labeling to include a boxed warning about infliximab-associated tuberculosis that included instructions to screen for tuberculosis, treat latent tuberculosis before treatment, and monitor for tuberculosis during infliximab therapy. The authors of this case series reviewed 130 cases of infliximab-associated tuberculosis reported to the FDA after the labeling change and found that many cases occurred in patients who had negative tuberculin skin test results but had risk factors for tuberculosis. Clinicians need to be vigilant in screening and monitoring for tuberculosis in patients receiving infliximab.
Updates
Thomas G. DeLoughery This Update in Hematology features 12 articles published in 2006. Topics include anticoagulation, antiplatelet therapy, duration of anticoagulation, gender and thrombosis, immune thrombocytopenia, anemia, and transfusion.
Reviews
Dena M. Bravata, Allison L. Gienger, Kathryn M. McDonald, Vandana Sundaram, Marco V. Perez, Robin Varghese, John R. Kapoor, Reza Ardehali, Douglas K. Owens, and Mark A. Hlatky The relative benefits and harms of coronary artery bypass graft surgery (CABG) versus percutaneous coronary intervention (PCI) are sometimes unclear. Bravata and colleagues systematically reviewed 23 randomized trials that found that survival at 10 years was similar for CABG and PCI, even among diabetic patients. Procedural strokes and angina relief were more common after CABG (risk difference, 0.6% and about 5% to 8%, respectively), whereas repeated revascularization procedures were more common after PCI (risk difference, 24% at 1 year).
Clinical Guidelines
Advisory Committee on Immunization Practices The Advisory Committee on Immunization Practices (ACIP) presents the Adult Immunization Schedule for October 2007–September 2008, which was approved in June 2007, and highlights the changes from the previous schedule. The ACIP annually reviews the recommended Adult Immunization Schedule to ensure that the schedule reflects current recommendations for the licensed vaccines. This schedule has also been approved by the American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and American College of Physicians.
Editorials
Thomas Bodenheimer Care coordination is the information exchange among care providers and also between providers and patients and families, and it is perhaps the most problem-ridden facet of primary care. In this issue, Farber and colleagues found that physicians spend a considerable amount of unpaid time providing care between office visits. If physicians are to improve their care coordination performance, they need time to do the work and must be paid for it.
Raymond J. Gibbons and Stephan D. Fihn In this issue, the meta-analysis by Bravata and colleagues found that early procedural mortality rates (1.15% vs. 1.8%) and 5-year survival rates (89.7% vs. 90.7%) are similar after percutaneous coronary intervention and coronary artery bypass grafting. This editorial discusses the most immediate implications of these findings for the practicing internist.
Gregory A. Poland and William Schaffner Vaccines are among the most effective public health and medical strategies for protecting and preserving health. Still, almost 50 000 Americans (99% of whom are adults) die of vaccine-preventable diseases each year, and hundreds of thousands more are hospitalized. This issue marks the first time that Annals has published the recommended Adult Immunization Schedule. The purpose of the schedule is to guide practitioners in the use of vaccines. Physicians should know the Adult Immunization Schedule and should develop policies and procedures to ensure that adult patients receive the appropriate vaccines.
On Being a Doctor
Jane deLima Thomas I stood quietly in the middle of the circle, with 4 or 5 friendly hands on my belly. Nothing in my career to that point had prepared me for this moment, but I found myself relaxing and enjoying the feeling of connection and support. I felt a deep appreciation that this group saw nothing inconsistent about praying for me and my unborn son in the midst of praying for their dying mother, grandmother, and friend.
Letters The Long-Term Effects of False-Positive Mammograms
Screening Mammography for Women Age 40 to 49 Years
Pegvisomant-Induced Lipohypertrophy: Report of a Case with Histopathology
Correction: "Doctor, How CERTain Are We That This Diabetes Medication Is Best for Me?"
Halcyon Skinner
Jeffrey S. Groeger
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