Susan Davis, MD, PhD; Mary-Anne Papalia, MD; Robert J. Norman, MD; Sheila O'Neill, MD; Margaret Redelman, MD; Margaret Williamson, MD; Bronwyn G.A. Stuckey, MD; John Wlodarczyk, PhD; Karen Gard'ner, MSc; Andrew Humberstone, PhD
Davis and colleagues evaluated the effects of 3 doses of exogenous testosterone and placebo, all administered with a metered-dose transdermal spray, on sexual function. They randomly assigned 261 premenopausal women who reported a decrease in satisfying sexual activity and had a morning serum free testosterone level less than 3.8 pmol/L (<1.1 pg/mL). After 16 weeks, the daily 90-µL dose of transdermal testosterone improved self-reported sexual satisfaction by a mean of 0.8 satisfactory sexual event per month. The rate with higher and lower testosterone doses did not differ from the rate with placebo.
Ann Intern Med. 2008;148(8):569-577. doi:10.7326/0003-4819-148-8-200804150-00001
Barbara J. Turner, MD, MSEd; Christopher S. Hollenbeak, PhD; Mark Weiner, MD; Thomas Ten Have, PhD; Simon S.K. Tang, MPH
Little is known about the quality of care received by patients with multiple unrelated comorbid conditions. The authors examined the electronic medical records of 15 459 patients with uncontrolled hypertension at 6 primary care practices. Most patients had 2 or more comorbid conditions unrelated to hypertension, such as arthritis, gastroesophageal reflux, or thyroid disease. At office visits, clinicians were less likely to intensify treatment for uncontrolled hypertension in patients with multiple unrelated conditions.
Ann Intern Med. 2008;148(8):578-586. doi:10.7326/0003-4819-148-8-200804150-00002
Robert A. Brodsky, MD
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematopoietic stem-cell disorder caused by a mutation that leads to increased susceptibility to complement-induced hemolysis. An expensive but highly effective drug markedly reduces the activity of PNH. This narrative review describes the history of the condition, its molecular biology and clinical manifestations, diagnostic testing, and therapeutic options.
Ann Intern Med. 2008;148(8):587-595. doi:10.7326/0003-4819-148-8-200804150-00003
Matthew T. James, MD; Joslyn Conley, MSc, MD; Marcello Tonelli, MD, SM; Braden J. Manns, MD, MSc; Jennifer MacRae, MD, MSc; Brenda R. Hemmelgarn, PhD, MD; for the Alberta Kidney Disease Network
Catheter-related infections are a major cause of illness among patients receiving long-term hemodialysis with a central venous catheter. This systematic review found 16 randomized trials that assessed the potential benefits of applying antibiotics topically to the catheter exit site or instilling them intraluminally into the catheter. Compared with no antibiotic therapy, prophylaxis with either topical or intraluminal antibiotics reduced bloodstream infections and the need to remove the catheter because of infection.
Ann Intern Med. 2008;148(8):596-605. doi:10.7326/0003-4819-148-8-200804150-00004
Kimberly A. Workowski, MD; Stuart M. Berman, MD, ScM; John M. Douglas Jr., MD
Prevention and control of gonorrhea is an important public health concern. Over the past 60 years, the increasing prevalence of multiple antibiotic-resistant strains of Neisseria gonorrhoeae has begun to limit therapeutic options. Workowski and colleagues describe comprehensive strategies for sustaining the effectiveness of antimicrobials and maintaining control over endemic gonorrhea.
Ann Intern Med. 2008;148(8):606-613. doi:10.7326/0003-4819-148-8-200804150-00005
Aaron S. Kesselheim, MD, JD; Niteesh K. Choudhry, MD, PhD
In response to increasing prescription drug costs, more U.S. patients and policymakers are importing less-expensive pharmaceuticals from other countries. Federal legislators continue to debate whether to legalize importation. Three factors affect whether U.S. patients and policymakers can rely on other countries as sources of imported prescription drugs: the feasibility of strategies to ensure the safety of the product, how the import price compares with domestic prices, and how importation might affect the exporting country's pharmaceutical market.
Ann Intern Med. 2008;148(8):614-619. doi:10.7326/0003-4819-148-8-200804150-00006
Rosemary Basson, MD
Sexual dissatisfaction is highly prevalent among women, ranging from 17% to 25%. We know enough about its causes to formulate a logical approach to treating sexual dissatisfaction in women. In this issue, the article by Davis and colleagues suggests that transdermal testosterone might be used to manage sexual dissatisfaction in premenopausal women. Their study showed only very modest benefit of testosterone treatment, and the authors caution against the widespread adoption of testosterone therapy in sexually dissatisfied premenopausal women.
Ann Intern Med. 2008;148(8):620-621. doi:10.7326/0003-4819-148-8-200804150-00007
Katherine Chang Chretien, MD
Long before my daughter was born, I acquired a top-of-the-line breast pump. My maternity leave was over when Jolie was 11 weeks old, and it was time to bring my pumping to work. I had to plunge right into patients, housestaff, actual medicine, while I contended with pumping and separation anxiety. My days, which had always been busy, were now nonstop action—I saw time in an entirely different light: the vanishing minutes of a working mother.
Ann Intern Med. 2008;148(8):622-623. doi:10.7326/0003-4819-148-8-200804150-00008
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Ann Intern Med. 2008;148(8):635. doi:10.7326/0003-4819-148-8-200804150-00027
Woodruff J. English, MD
Ann Intern Med. 2008;148(8):636. doi:10.7326/0003-4819-148-8-200804150-00028
Krista M. Johnson, MD; Holly J. Humphrey, MD
Ann Intern Med. 2008;148(8):636. doi:10.7326/0003-4819-148-8-200804150-00029
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