Ana I. Sánchez-Fructuoso, MD, PhD; Maria Marques, MD, PhD; Dolores Prats, MD; José Conesa, MD; Natividad Calvo, MD; M. Jesús Pérez-Contín, MD; Jesús Blazquez, MD; Cristina Fernández, MD, PhD; Ervigio Corral, MD; Francisco Del Río, MD; Jose R. Núñez, MD, PhD; Alberto Barrientos, MD, PhD
Spanish law allows physicians to maintain circulation in people brought to the hospital after cardiac arrest until it is possible to contact relatives for permission to harvest organs for donation. In this case series from Madrid, Spain, graft survival at 1 and 5 years in 320 recipients of kidneys from such “non–heart-beating” donors was similar to that in 458 recipients of cadaver kidneys from heart-beating donors age 60 years or younger.
Ann Intern Med. 2006;145(3):157-164. doi:10.7326/0003-4819-145-3-200608010-00003
Christianne L. Roumie, MD, MPH; Tom A. Elasy, MD, MPH; Robert Greevy, PhD; Marie R. Griffin, MD, MPH; Xulei Liu, MD, MS; William J. Stone, MD; Kenneth A. Wallston, PhD; Robert S. Dittus, MD, MPH; Vincent Alvarez, MD; Janice Cobb, RN; Theodore Speroff, PhD
The authors randomly assigned providers caring for hypertensive patients to 1 of 3 interventions: 1) a Web link to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; 2) the Web link and a computer reminder of the patient's blood pressure; or 3) the Web link, the computer alert, and a letter to their patients about ways to control their blood pressure. Patients of providers assigned to the third group had better blood pressure control.
Ann Intern Med. 2006;145(3):165-175. doi:10.7326/0003-4819-145-3-200608010-00004
Johan Ärnlöv, MD, PhD; Michael J. Pencina, PhD; Shreyasee Amin, MD; Byung-Ho Nam, PhD; Emelia J. Benjamin, MD, ScM; Joanne M. Murabito, MD, ScM; Thomas J. Wang, MD; Philip E. Knapp, MD; Ralph B. D'Agostino Sr., PhD; Shalendar Bhasin, MD; Ramachandran S. Vasan, MD
A total of 2084 men from 2 Framingham Heart Study cohorts had 1 measurement of total serum estrogen, testosterone, and dehydroepiandrosterone sulfate (DHEA-S), followed by 10 years of monitoring for cardiovascular disease (CVD) outcomes. Testosterone and DHEA-S levels were not associated with CVD risk, but high estrogen levels were associated with low risk. The risk for CVD in men whose estrogen levels were in the highest quartile was 0.68 times (95% CI, 0.50 to 0.92 times) that in the lowest quartile.
Ann Intern Med. 2006;145(3):176-184. doi:10.7326/0003-4819-145-3-200608010-00005
Neil Boudville, MD; G. V. Ramesh Prasad, MD; Greg Knoll, MD, MSc; Norman Muirhead, MD; Heather Thiessen-Philbrook, MMath; Robert C. Yang, MD; M. Patricia Rosas-Arellano, MD, PhD; Abdulrahman Housawi, MD; Amit X. Garg, MD, PhD; for the Donor Nephrectomy Outcomes Research (DONOR) Network*
This review found 10 studies that compared the blood pressure of kidney donors and healthy adults of similar age, sex, and ethnicity. Within 5 to 10 years of donation, the average blood pressure of kidney donors was 5 mm Hg higher than that anticipated with normal aging.
Ann Intern Med. 2006;145(3):185-196. doi:10.7326/0003-4819-145-3-200608010-00006
U.S. Preventive Services Task Force*
The U.S. Preventive Services Task Force recommends against routine genetic screening for hereditary hemochromatosis in the asymptomatic general population.
Ann Intern Med. 2006;145(3):204-208. doi:10.7326/0003-4819-145-3-200608010-00008
Evelyn P. Whitlock, MD, MPH; Betsy A. Garlitz, MD; Emily L. Harris, PhD, MPH; Tracy L. Beil, MS; Paula R. Smith, RN, BSN
This review supports the U.S. Preventive Services Task Force recommendation on routine genetic screening for hereditary hemochromatosis.
Ann Intern Med. 2006;145(3):209-223. doi:10.7326/0003-4819-145-3-200608010-00009
David Steinberg, MD
According to an important principle of fairness, objective criteria, such as medical need, determine priority of access to a transplantable organ. Many people are willing to donate an organ to a stranger, and patients seek out these altruistic donors. Transactions between these parties threaten the principle of equity according to objective medical need. Altruistic donors should allocate their donated organs through a system that ensures access according to medical need rather than to the donor's emotional response to a particular patient's plight, identity, or circumstances. No such system exists at present.
Ann Intern Med. 2006;145(3):197-203. doi:10.7326/0003-4819-145-3-200608010-00007
James F. Childress, PhD
There are many “opportunities for action” to increase the supply of transplantable organs. The media tend to focus on the most controversial proposals, such as buying and selling organs, rather than the less dramatic but potentially very effective proposals, such as donation after circulatory determination of death. Furthermore, although living donation will be an important continuing source of organs—mainly kidneys—it clearly needs much more attention and oversight because of incomplete information about risks to donors and other ethical concerns.
Ann Intern Med. 2006;145(3):224-225. doi:10.7326/0003-4819-145-3-200608010-00010
Irwin H. Rosenberg, MD; Cynthia D. Mulrow, MD, MSc, Deputy Editor
Several large trials have examined the reduction of total homocysteine levels as secondary stroke prevention in patients with vascular disease. In the Vitamin Intervention for Stroke Prevention (VISP) trial, a moderate reduction of total homocysteine levels had no statistically significant effect on vascular outcomes. Two larger, double-blind, placebo-controlled trials with longer follow-up were subsequently done: the Heart Outcomes Prevention Evaluation (HOPE) 2 and the Norwegian Vitamin (NORVIT) trial. What did these landmark trials show, and how will their findings affect clinical practice?
Ann Intern Med. 2006;145(3):226-227. doi:10.7326/0003-4819-145-3-200608010-00011
Sylvia R. Cruess, MD; Richard L. Cruess, MD
Dr. Neubauer highlights some of the more disturbing aspects of the Health Information Portability and Accountability Act of 1996, which can prevent health care professionals from meeting patients' legitimate needs. How should physicians respond when faced with legally enforceable rules and regulations that contravene their professional obligations?
Ann Intern Med. 2006;145(3):229-230. doi:10.7326/0003-4819-145-3-200608010-00013
Richard L. Neubauer, MD
In 2002, diagnosed with peripheral neuropathy from primary amyloidosis at age 52, I became a patient. I decided to share my experiences with those impacted by my illness, thinking that this would possibly benefit them. But I was not prepared for the intricate set of privacy rules currently implemented as part of the Health Insurance Portability and Accountability Act (HIPAA). I fear that unless modified, this brave new world may do more harm than good.
Ann Intern Med. 2006;145(3):228-229. doi:10.7326/0003-4819-145-3-200608010-00012
Ann Intern Med. 2006;145(3):231. doi:10.7326/0003-4819-145-3-200608010-00014
Ann Intern Med. 2006;145(3):231. doi:10.7326/0003-4819-145-3-200608010-00015
Ann Intern Med. 2006;145(3):231-232. doi:10.7326/0003-4819-145-3-200608010-00016
Ann Intern Med. 2006;145(3):232. doi:10.7326/0003-4819-145-3-200608010-00017
Ann Intern Med. 2006;145(3):232-233. doi:10.7326/0003-4819-145-3-200608010-00018
Ann Intern Med. 2006;145(3):233. doi:10.7326/0003-4819-145-3-200608010-00019
Ann Intern Med. 2006;145(3):233-234. doi:10.7326/0003-4819-145-3-200608010-00020
Ann Intern Med. 2006;145(3):234-235. doi:10.7326/0003-4819-145-3-200608010-00021
Ann Intern Med. 2006;145(3):235. doi:10.7326/0003-4819-145-3-200608010-00022
Ann Intern Med. 2006;145(3):235. doi:10.7326/0003-4819-145-3-200608010-00023
Clayton J. Baker, MD
Ann Intern Med. 2006;145(3):236. doi:10.7326/0003-4819-145-3-200608010-00024
Ann Intern Med. 2006;145(3):I-12. doi:10.7326/0003-4819-145-3-200608010-00001
Ann Intern Med. 2006;145(3):I-18. doi:10.7326/0003-4819-145-3-200608010-00002
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