Michael B. Rothberg, MD, MPH; Carmel Celestin, MD; Louis D. Fiore, MD, MPH; Elizabeth Lawler, MPH; James R. Cook, MD, MPH
After acute coronary syndromes, warfarin plus aspirin was associated with fewer myocardial infarctions, ischemic strokes, and revascularization procedures. Warfarin was associated with an increase in major bleeding, but mortality did not differ. For patients who are at low or intermediate risk for bleeding, the cardiovascular benefits of warfarin outweigh the bleeding risks.
Ann Intern Med. 2005;143(4):241-250. doi:10.7326/0003-4819-143-4-200508160-00005
David M. Eddy, MD, PhD; Leonard Schlessinger, PhD; Richard Kahn, PhD
The authors used a novel decision model to estimate the long-term outcomes and costs of care when patients with impaired glucose tolerance use metformin or enroll in a lifestyle modification program. Although the program used in the Diabetes Prevention Program prevented diabetes in some patients and delayed it in others, the authors found that it was not cost-effective for health plans to implement.
Ann Intern Med. 2005;143(4):251-264. doi:10.7326/0003-4819-143-4-200508160-00006
Mark Bower, MA, PhD; Brian Gazzard, MD; Sundhiya Mandalia, PhD; Tom Newsom-Davis, MB BS; Christina Thirlwell, MB BS; Tony Dhillon, MB BS; Anne Marie Young, MB BS; Tom Powles, MD; Andrew Gaya, MB BS; Mark Nelson, MD; Justin Stebbing, MA, PhD
The International Prognostic Index predicts death in non-Hodgkin lymphoma, including AIDS-related lymphoma before highly active antiretroviral therapy (HAART). Since the advent of HAART, the prognosis has improved for AIDS-related non-Hodgkin lymphoma. A combination of the International Prognostic Index and the CD4 cell count defines 4 strata of risk for death in AIDS-related lymphoma in the HAART era.
Ann Intern Med. 2005;143(4):265-273. doi:10.7326/0003-4819-143-4-200508160-00007
Takahiro Higashi, MD, PhD; Paul G. Shekelle, MD, PhD; John L. Adams, PhD; Caren J. Kamberg, MSPH; Carol P. Roth, RN, MPH; David H. Solomon, MD; David B. Reuben, MD; Lillian Chiang, MD; Catherine H. MacLean, MD, PhD; John T. Chang, MD, MPH; Roy T. Young, MD; Debra M. Saliba, MD, MPH; Neil S. Wenger, MD, MPH
The authors studied the effect of the quality of care received by 372 community-dwelling vulnerable older patients on their survival over the next 3 years. Three-year survival improved steadily as the quality score improved. Better performance on process quality measures is strongly associated with better survival in vulnerable older adults.
Ann Intern Med. 2005;143(4):274-281. doi:10.7326/0003-4819-143-4-200508160-00008
Lewis J. Rubin, MD; David B. Badesch, MD
Pulmonary arterial hypertension raises several diagnostic possibilities: idiopathic or familial cause, systemic diseases (connective tissue disease, HIV infection, or chronic liver disease), or drugs (fenfluramine anorexigens, amphetamines, or cocaine). In this review, the authors present approaches to the diagnosis and management of pulmonary arterial hypertension, using a typical case to highlight the key management points.
Ann Intern Med. 2005;143(4):282-292. doi:10.7326/0003-4819-143-4-200508160-00009
Steven H. Woolf, MD, MPH; Evelyn C.Y. Chan, MD, MS; Russell Harris, MD, MPH; Stacey L. Sheridan, MD, MPH; Clarence H. Braddock, III, MD, MPH; Robert M. Kaplan, PhD; Alex Krist, MD; Annette M. O'Connor, RN, MScN, PhD; Sean Tunis, MD, MSc
This article is about providing patients with the information they need to participate in difficult decisions about their health care. The authors look to health systems to meet these information needs. Their proposed solutions include expanding information resources for decision support and linking the information to decision counseling.
Ann Intern Med. 2005;143(4):293-300. doi:10.7326/0003-4819-143-4-200508160-00010
Michael M. Engelgau, MD, MS
The article by Eddy and colleagues describes a novel approach to modeling the costs and outcomes of health interventions. As applied to programs to alter lifestyle to prevent diabetes in patients with impaired glucose tolerance, the model's predictions are similar in most respects to previous work but differ about cost-effectiveness. This difference leads the authors to diametrically opposed conclusions about whether health plans should offer programs to modify lifestyle.
Ann Intern Med. 2005;143(4):301-302. doi:10.7326/0003-4819-143-4-200508160-00011
Margaret L. Brandeau, PhD
In an ideal world, low-cost, powerful, and ethical clinical trials would decide which treatments work best. In the real world, clinical trials are often too time-consuming, too expensive, unethical, or even impossible to perform. How, then, can we obtain answers to inform patient care? We need a structured framework that uses the best evidence and captures relevant complexities. Decision analysis meets these requirements but raises a new question: “How do we decide if we can trust the predictions of a decision model?”
Ann Intern Med. 2005;143(4):303-304. doi:10.7326/0003-4819-143-4-200508160-00012
Sankey V. Williams, MD
In this issue, Higashi and colleagues conclude that “better performance on process quality measures is strongly associated with better survival among community-dwelling vulnerable older adults.” This conclusion, if true, is important because it appears to validate a fundamental assumption underlying most quality improvement efforts: A better process of care will lead to better patient outcomes.
Ann Intern Med. 2005;143(4):305-306. doi:10.7326/0003-4819-143-4-200508160-00013
William Rifkin, MD
Whenever a patient shares with me her tale of misery, I experience the following, perhaps common to most doctors: first, horror at how cruel and harsh the world can be, then appreciation of the relatively insignificant hurts I have experienced in comparison, followed by compassion and a compunction to “make it all better.” Finally, once reality sets in, I realize that what I have to offer is very unlikely to help in the end. I often feel that I am simply not giving enough.
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