Tazeen H. Jafar, MD, MPH; Juanita Hatcher, PhD; Neil Poulter, MD; Muhammad Islam, MSc; Shiraz Hashmi, MD; Zeeshan Qadri, MSc; Rasool Bux, MSc; Ayesha Khan, MSc; Fahim H. Jafary, MD; Aamir Hameed, MD; Ata Khan, MD; Salma H. Badruddin, PhD; Nish Chaturvedi, MD; for the Hypertension Research Group
Jafar and colleagues assessed the effectiveness of community-based interventions on blood pressure in 1341 hypertensive adults in Karachi, Pakistan. Participants received home health education (HHE) every 3 months from lay health workers, with or without care from general practitioners (GPs) specially trained in hypertension management, or no intervention. Patients who received HHE plus GP care had greater decreases in systolic blood pressure (10.8 mm Hg vs. 5.8 mm Hg in the other 3 groups).
Ann Intern Med. 2009;151(9):593-601. doi:10.7326/0003-4819-151-9-200911030-00004
K. Robin Yabroff, PhD; Mona Saraiya, MD; Helen I. Meissner, PhD; David A. Haggstrom, MD, MAS; Louise Wideroff, PhD; Gigi Yuan, MS; Zahava Berkowitz, MSc, MSPH; William W. Davis, PhD; Vicki B. Benard, PhD; Steven S. Coughlin, PhD
In a cross-sectional survey that involved 4 clinical vignettes, 91% of 1212 physicians reported providing Papanicolaou tests to eligible patients. However, the number of tests ordered or performed, use of patient reminder systems, and cytology method varied by specialty, and few physicians applied guideline-consistent recommendations for starting and stopping testing across multiple vignettes.
Ann Intern Med. 2009;151(9):602-611. doi:10.7326/0003-4819-151-9-200911030-00005
Axel Finckh, MD, MS; Nick Bansback, MS; Carlo A. Marra, PharmD, PhD; Aslam H. Anis, PhD; Kaleb Michaud, PhD; Stanley Lubin, MD; Marc White, PhD; Sonia Sizto, BA; Matthew H. Liang, MD, MPH
Finckh and associates assessed the cost-effectiveness of 3 strategies (2 early interventions with disease-modifying antirheumatic drugs [DMARDs] or biologics, and a pyramid strategy) to treat very early rheumatoid arthritis (RA) in U.S. adults. Very early intervention increased quality-adjusted life more than the pyramid strategy and saved long-term costs. The cost-effectiveness of very early intervention with biologics remains uncertain.
Ann Intern Med. 2009;151(9):612-621. doi:10.7326/0003-4819-151-9-200911030-00006
Mukul Sharma, MD, MSc; Mohammed T. Ansari, MBBS, MMedSc, MPhil; Ahmed M. Abou-Setta, MD, PhD; Karla Soares-Weiser, MD, PhD; Teik Chye Ooi, MBBS; Margaret Sears, PhD; Fatemeh Yazdi, MSc; Alexander Tsertsvadze, MD, MSc; David Moher, PhD
This systematic review of 102 studies compared the benefits and harms of high-dose statin monotherapy with those of combination therapy in adults at high risk for coronary disease. Limited evidence suggested that combinations of lipid-lowering agents did not improve clinical outcomes more than high-dose statin monotherapy.
Ann Intern Med. 2009;151(9):622-630. doi:10.7326/0003-4819-151-9-200911030-00144
Sophia Zoungas, MD, PhD; Toshiharu Ninomiya, MD, PhD; Rachel Huxley, DPhil; Alan Cass, MD, PhD; Meg Jardine, MD, PhD; Martin Gallagher, MD; Anushka Patel, MD, PhD; Ali Vasheghani-Farahani, MD; Gelareh Sadigh, MD; Vlado Perkovic, MD, PhD
In this review of 23 trials on whether sodium bicarbonate reduced risk for contrast-induced nephropathy (CIN) more than saline, the pooled relative risk for CIN was 0.62 (95% CI, 0.45 to 0.86). However, studies were often of poor quality and showed no clear effects of sodium bicarbonate on the risk for dialysis, heart failure, and total mortality. The effectiveness of sodium bicarbonate treatment to prevent CIN in high-risk patients remains uncertain.
Ann Intern Med. 2009;151(9):631-638. doi:10.7326/0003-4819-151-9-200911030-00008
Amir Qaseem, MD, PhD, MHA; Vincenza Snow, MD; Thomas D. Denberg, MD, PhD; Donald E. Casey, Jr., MD, MPH, MBA; Mary Ann Forciea, MD; Douglas K. Owens, MD, MS; Paul Shekelle, MD, PhD; for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians
This American College of Physicians (ACP) guideline addresses management of erectile dysfunction (ED). The ACP recommends that clinicians initiate therapy with a phosphodiesterase-5 (PDE-5) inhibitor in men who seek treatment for ED and do not have a contraindication to PDE-5 inhibitor use (strong recommendation) and that clinicians base the choice of a specific PDE-5 inhibitor on the individual preferences of men with ED (weak recommendation). It does not recommend for or against routine use of hormonal blood tests or hormonal treatment in the management of ED.
Ann Intern Med. 2009;151(9):639-649. doi:10.7326/0003-4819-151-9-200911030-00151
Alexander Tsertsvadze, MD, MSc; Howard A. Fink, MD, MPH; Fatemeh Yazdi, MSc; Roderick MacDonald, MSc; Anthony J. Bella, MD; Mohammed T. Ansari, MBBS, MMedSc, MPhil; Chantelle Garritty, MSc; Karla Soares-Weiser, MD, PhD; Raymond Daniel, BA; Margaret Sampson, MLIS; Steven Fox, MD, MPH; David Moher, PhD; Timothy J. Wilt, MD, MPH
This review assesses the efficacy and harms of oral PDE-5 inhibitors and hormonal treatments for ED and the effect of measuring serum hormone levels on treatment outcomes for ED. Data, primarily from short-term trials, indicate that PDE-5 inhibitors are more effective than placebo in improving sexual intercourse success but are associated with increased risk for adverse events. Results of 15 trials on hormonal treatment of ED were inconsistent on whether treatment improved outcomes.
Ann Intern Med. 2009;151(9):650-661. doi:10.7326/0003-4819-151-9-200911030-00150
Aaron L. Nelson, MD, PhD; Joshua T. Cohen, PhD; Dan Greenberg, PhD; David M. Kent, MD, MS
Under conditions of constrained resources, cost-saving innovations may improve overall outcomes, even when they are slightly less effective than available options. The authors systematically reviewed cost–utility analyses to identify medical innovations that might offer favorable “decrementally” cost-effective tradeoffs. Their findings demonstrate the rarity of such innovations in the literature: Of 2128 cost-effectiveness ratios from 887 publications, 9 comparisons described 8 decrementally cost-effective innovations.
Ann Intern Med. 2009;151(9):662-667. doi:10.7326/0003-4819-151-9-200911030-00011
Maarten Boers, MSc, MD, PhD
The editorialist discusses several points of Finckh and colleagues' findings on the cost-effectiveness of DMARDs and biologics in early RA. He suggests that we reconsider what we are willing to pay when strategies are developed that are truly remittive.
Ann Intern Med. 2009;151(9):668-669. doi:10.7326/0003-4819-151-9-200911030-00013
Ann Intern Med. 2009;151(9):670. doi:10.7326/0003-4819-151-9-200911030-00014
Ann Intern Med. 2009;151(9):670. doi:10.7326/0003-4819-151-9-200911030-00015
Ann Intern Med. 2009;151(9):670-671. doi:10.7326/0003-4819-151-9-200911030-00016
Ann Intern Med. 2009;151(9):671. doi:10.7326/0003-4819-151-9-200911030-00017
Ann Intern Med. 2009;151(9):671-672. doi:10.7326/0003-4819-151-9-200911030-00018
Ann Intern Med. 2009;151(9):672. doi:10.7326/0003-4819-151-9-200911030-00019
Ann Intern Med. 2009;151(9):672-673. doi:10.7326/0003-4819-151-9-200911030-00020
Ann Intern Med. 2009;151(9):673-674. doi:10.7326/0003-4819-151-9-200911030-00021
Ann Intern Med. 2009;151(9):674. doi:10.7326/0003-4819-151-9-200911030-00022
Andrew Zweifler, MD
Ann Intern Med. 2009;151(9):667. doi:10.7326/0003-4819-151-9-200911030-00012
Margaret Trexler Hessen, MD
Ann Intern Med. 2009;151(9):ITC5-1. doi:10.7326/0003-4819-151-9-200911030-01005
Ann Intern Med. 2009;151(9):I-44. doi:10.7326/0000605-200911030-00159
Ann Intern Med. 2009;151(9):I-24. doi:10.7326/0003-4819-151-9-200911030-00001
Ann Intern Med. 2009;151(9):I-38. doi:10.7326/0003-4819-151-9-200911030-00002
Sara L. Jackson, MD, MPH; Joann G. Elmore, MD, MPH
Ann Intern Med. 2009;151(9):675. doi:10.7326/0003-4819-151-9-200911030-00023
Wendy Terese Grace, MS
Ann Intern Med. 2009;151(9):675. doi:10.7326/0003-4819-151-9-200911030-00024
Neil Abramson, MD
Ann Intern Med. 2009;151(9):676. doi:10.7326/0003-4819-151-9-200911030-00025
Ann Hendricks, PhD
Ann Intern Med. 2009;151(9):676. doi:10.7326/0003-4819-151-9-200911030-00026
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