Table of Contents

September 1, 2009; 151 (5)

Articles

  • The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation

    • Daniel E. Singer,
    • Yuchiao Chang,
    • Margaret C. Fang,
    • Leila H. Borowsky,
    • Niela K. Pomernacki,
    • Natalia Udaltsova,
    • and Alan S. Go
    Ann Intern Med September 1, 2009 151:297-305; doi:10.1059/0003-4819-151-5-200909010-00003

    Guidelines for prescribing anticoagulants in atrial fibrillation should balance treatment benefits and harms. Singer and colleagues calculated 6-year ischemic stroke rates (benefit) and intracranial hemorrhage rates (harm) in 13 359 adults receiving and not receiving warfarin. Net treatment benefit was highest in patients with previous stroke, age older than 84 years, and others with high stroke risk. Risk assessment that incorporates risk for both thromboembolism and intracranial hemorrhage can advance decision making about antithrombotic therapy in patients with atrial fibrillation.

  • Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes: A Randomized Trial

    • Katherine Esposito,
    • Maria Ida Maiorino,
    • Miryam Ciotola,
    • Carmen Di Palo,
    • Paola Scognamiglio,
    • Maurizio Gicchino,
    • Michela Petrizzo,
    • Franco Saccomanno,
    • Flora Beneduce,
    • Antonio Ceriello,
    • and Dario Giugliano
    Ann Intern Med September 1, 2009 151:306-314; doi:10.1059/0003-4819-151-5-200909010-00004

    Esposito and associates compared the effects of low-carbohydrate, Mediterranean-style and low-fat, calorie-restricted diets on the need for antihyperglycemic drug therapy in 215 overweight patients with newly diagnosed type 2 diabetes. After 4 years, 44% of the Mediterranean-style diet group and 70% of the low-fat diet group required treatment of diabetes, and the Mediterranean-style diet group lost more weight and experienced greater improvements in some glycemic control and coronary risk measures.

  • The Geographic Distribution, Ownership, Prices, and Scope of Practice at Retail Clinics

    • Rena Rudavsky,
    • Craig Evan Pollack,
    • and Ateev Mehrotra
    Ann Intern Med September 1, 2009 151:315-320; doi:10.1059/0003-4819-151-5-200909010-00005

    Rudavsky and coworkers characterize medical clinics located in retail outlets. Almost half of the 982 clinics in retail outlets in the United States were located in 5 states. All offered sore throat treatment, and more than 95% offered treatment of skin conditions, immunizations, pregnancy testing, and lipid or diabetes screening. Almost all accepted private insurance and Medicare fee-for-service.

Improving Patient Care

  • Comparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses

    • Ateev Mehrotra,
    • Hangsheng Liu,
    • John L. Adams,
    • Margaret C. Wang,
    • Judith R. Lave,
    • N. Marcus Thygeson,
    • Leif I. Solberg,
    • and Elizabeth A. McGlynn
    Ann Intern Med September 1, 2009 151:321-328; doi:10.1059/0003-4819-151-5-200909010-00006

    Mehrotra and colleagues found that for otitis media, pharyngitis, and urinary tract infection, overall costs of care were substantially lower at retail clinics than at physician offices, urgent care centers, and emergency departments. Prescription costs, quality scores, and receipt of preventive care were similar in retail clinics, physician offices, and urgent care centers.

Academia and Clinic

  • An Electronic Practice-Based Network for Observational Comparative Effectiveness Research

    • Wilson D. Pace,
    • Maribel Cifuentes,
    • Robert J. Valuck,
    • Elizabeth W. Staton,
    • Elias C. Brandt,
    • and David R. West
    Ann Intern Med September 1, 2009 151:338-340; doi:10.1059/0003-4819-151-5-200909010-00140

    The Distributed Ambulatory Research in Therapeutics Network is a federated network of electronic health data from 8 organizations representing more than 500 clinicians and more than 400 000 patients. Pace and colleagues describe how this large information source provides insight about the comparative effectiveness of oral diabetes medications.

  • Design of a National Distributed Health Data Network

    • Judith C. Maro,
    • Richard Platt,
    • John H. Holmes,
    • Brian L. Strom,
    • Sean Hennessy,
    • Ross Lazarus,
    • and Jeffrey S. Brown
    Ann Intern Med September 1, 2009 151:341-344; doi:10.1059/0003-4819-151-5-200909010-00139

    This companion article to Pace and colleagues' discussion further describes the design and potential uses and advantages of distributed health data networks: They may allow studies of comparative clinical effectiveness, best practices, diffusion of medical technologies, and quality of care and support assessment of medical product safety.

Review

  • Systematic Review: Diagnostic Procedures to Differentiate Unilateral From Bilateral Adrenal Abnormality in Primary Aldosteronism

    • Marlies J.E. Kempers,
    • Jacques W.M. Lenders,
    • Lieke van Outheusden,
    • Gert Jan van der Wilt,
    • Leo J. Schultze Kool,
    • Ad R.M.M. Hermus,
    • and Jaap Deinum
    Ann Intern Med September 1, 2009 151:329-337; doi:10.1059/0003-4819-151-5-200909010-00007

    Computed tomography (CT), magnetic resonance imaging (MRI), and adrenal vein sampling (AVS) are used to distinguish unilateral from bilateral aldosterone secretion so that primary aldosteronism can be treated appropriately. Kempers and associates found that CT or MRI results did not agree with AVS results in 38% of 950 patients in 38 studies. If CT or MRI alone had been used to determine lateralization, 15% of patients would have had inappropriate adrenalectomy, 19% would have been inappropriately excluded from adrenalectomy, and 4% would have had adrenalectomy on the wrong side.

Perspectives

  • Discussing Treatment Preferences With Patients Who Want “Everything”

    • Timothy E. Quill,
    • Robert Arnold,
    • and Anthony L. Back
    Ann Intern Med September 1, 2009 151:345-349; doi:10.1059/0003-4819-151-5-200909010-00010

    When asked about setting limits on medical treatment in the face of severe illness, patients and their families often respond that they want “everything.” Clinicians should not take this request at face value, but should instead use it as the basis for a broader discussion about what “doing everything” means to the patient. Quill and colleagues describe an approach by which patients, families, and clinicians can develop a treatment plan that best respects patient and family values in light of what is medically achievable.

History of Medicine

  • Endocrine and Autoimmune Aspects of the Health History of John F. Kennedy

    • Lee R. Mandel
    Ann Intern Med September 1, 2009 151:350-354; doi:10.1059/0003-4819-151-5-200909010-00011

    Throughout his campaign and presidency, John F. Kennedy was portrayed as the epitome of youth and vigor, yet he had the most complex medical history of any U.S. president. Recent review of Kennedy's White House medical records, coupled with other sources, suggests that his health history can be explained in the context of a unifying autoimmune endocrine disorder.

Editorials

  • Do Current Guidelines Result in Overuse of Warfarin Anticoagulation in Patients With Atrial Fibrillation?

    • Robert G. Hart and
    • Jonathan L. Halperin
    Ann Intern Med September 1, 2009 151:355-356; doi:10.1059/0003-4819-151-5-200909010-00012

    In this issue, Singer and colleagues question the net clinical benefit of adjusted-dose warfarin for at least half of patients with atrial fibrillation, including the one third deemed to have moderate stroke risk. If their findings are confirmed in other large cohorts, recommendations should be modified to ensure that patients with atrial fibrillation for whom anticoagulation is advocated are likely to accrue net clinical benefit when the small risk for catastrophic cerebral hemorrhage is taken into account.

  • Primary Aldosteronism—One Picture Is Not Worth a Thousand Words

    • William F. Young, Jr.
    Ann Intern Med September 1, 2009 151:357-358; doi:10.1059/0003-4819-151-5-200909010-00013

    In this issue, Kempers and colleagues report that adrenal morphologic characteristics on CT or MRI do not accurately identify the source of aldosterone excess as unilateral or bilateral in patients with primary aldosteronism. The editorialist describes the keys to a successful AVS program and offers a more practical approach to use of AVS.

  • Toward Reuse of Clinical Data for Research and Quality Improvement: The End of the Beginning?

    • Mark G. Weiner and
    • Peter J. Embi
    Ann Intern Med September 1, 2009 151:359-360; doi:10.1059/0003-4819-151-5-200909010-00141

    Using Pace and colleagues' and Maro and associates' articles in this issue as a touchstone, the editorialists discuss the challenges and benefits of capturing and disseminating vast amounts of data in distributed health data networks.

On Being a Doctor

  • Is There a Doctor in the Home?

    • Roy C. Ziegelstein and
    • Ronald Zaczek
    Ann Intern Med September 1, 2009 151:361-362; doi:10.1059/0003-4819-151-5-200909010-00015

Letters

  • Comparing the USPSTF and GRADE Approaches to Recommendations

    • Gordon H. Guyatt,
    • Mark Helfand,
    • and Regina Kunz
    Ann Intern Med September 1, 2009 151:363; doi:10.1059/0003-4819-151-5-200909010-00016

  • Comparing the USPSTF and GRADE Approaches to Recommendations

    • Diana B. Petitti,
    • Steven M. Teutsch,
    • Mary B. Barton,
    • George F. Sawaya,
    • Judith K. Ockene,
    • and Thomas DeWitt
    Ann Intern Med September 1, 2009 151:363-364; doi:10.1059/0003-4819-151-5-200909010-00017

  • Inadequacies of Statutory Drug Compendia Also Affect the Mental Health Field

    • Richard P. Paczynski and
    • Stefan P. Kruszewski
    Ann Intern Med September 1, 2009 151:364-365; doi:10.1059/0003-4819-151-5-200909010-00018

  • Would Health Care Reform Be Easier With a Single-Payer System?

    • Aaron M. Roland
    Ann Intern Med September 1, 2009 151:365; doi:10.1059/0003-4819-151-5-200909010-00019

  • Would Health Care Reform Be Easier With a Single-Payer System?

    • Jonathan Oberlander,
    • Theodore Marmor,
    • and Joseph White
    Ann Intern Med September 1, 2009 151:365-366; doi:10.1059/0003-4819-151-5-200909010-00020

  • Toward a 21st-Century Health Care System: The Devil Is in the Details

    • Lester Mayers
    Ann Intern Med September 1, 2009 151:366; doi:10.1059/0003-4819-151-5-200909010-00021

  • Toward a 21st-Century Health Care System: The Devil Is in the Details

    • Robert M. Hansen
    Ann Intern Med September 1, 2009 151:366; doi:10.1059/0003-4819-151-5-200909010-00022

  • Toward a 21st-Century Health Care System: The Devil Is in the Details

    • Umesh Gidwani
    Ann Intern Med September 1, 2009 151:366; doi:10.1059/0003-4819-151-5-200909010-00023

  • Toward a 21st-Century Health Care System: The Devil Is in the Details

    • Philip Cohen
    Ann Intern Med September 1, 2009 151:366-367; doi:10.1059/0003-4819-151-5-200909010-00024

Medical Writings: Book Notes

  • The ACP Evidence-Based Guide to Complementary & Alternative Medicine

    • Stephen M. Sagar
    Ann Intern Med September 1, 2009 151:368; doi:10.1059/0003-4819-151-5-200909010-00025

  • Integrative Oncology

    • Marvin J. Stone and
    • Z. H. Lieberman
    Ann Intern Med September 1, 2009 151:368; doi:10.1059/0003-4819-151-5-200909010-00026

Summaries for Patients

  • Net Benefit of Warfarin in Atrial Fibrillation

    Ann Intern Med September 1, 2009 151:I-36; doi:10.1059/0003-4819-151-5-200909010-00001

  • The Effects of a Mediterranean Diet on the Need for Type 2 Diabetes Treatment

    Ann Intern Med September 1, 2009 151:I-42; doi:10.1059/0003-4819-151-5-200909010-00002

In the Clinic

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This Issue

September 1, 2009; 151 (5)
  1. Articles
  2. Improving Patient Care
  3. Academia and Clinic
  4. Review
  5. Perspectives
  6. History of Medicine
  7. Editorials
  8. On Being a Doctor
  9. Letters
  10. Medical Writings: Book Notes
  11. Summaries for Patients
  12. In the Clinic

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