Table of Contents

November 3, 2009; 151 (9)

Articles

  • Community-Based Interventions to Promote Blood Pressure Control in a Developing Country: A Cluster Randomized Trial

    • Tazeen H. Jafar,
    • Juanita Hatcher,
    • Neil Poulter,
    • Muhammad Islam,
    • Shiraz Hashmi,
    • Zeeshan Qadri,
    • Rasool Bux,
    • Ayesha Khan,
    • Fahim H. Jafary,
    • Aamir Hameed,
    • Ata Khan,
    • Salma H. Badruddin,
    • Nish Chaturvedi,
    • and for the Hypertension Research Group
    Ann Intern Med November 3, 2009 151:593-601; doi:10.1059/0003-4819-151-9-200911030-00004

    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).

  • Specialty Differences in Primary Care Physician Reports of Papanicolaou Test Screening Practices: A National Survey, 2006 to 2007

    • K. Robin Yabroff,
    • Mona Saraiya,
    • Helen I. Meissner,
    • David A. Haggstrom,
    • Louise Wideroff,
    • Gigi Yuan,
    • Zahava Berkowitz,
    • William W. Davis,
    • Vicki B. Benard,
    • and Steven S. Coughlin
    Ann Intern Med November 3, 2009 151:602-611; doi:10.1059/0003-4819-151-9-200911030-00005

    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.

  • Treatment of Very Early Rheumatoid Arthritis With Symptomatic Therapy, Disease-Modifying Antirheumatic Drugs, or Biologic Agents: A Cost-Effectiveness Analysis

    • Axel Finckh,
    • Nick Bansback,
    • Carlo A. Marra,
    • Aslam H. Anis,
    • Kaleb Michaud,
    • Stanley Lubin,
    • Marc White,
    • Sonia Sizto,
    • and Matthew H. Liang
    Ann Intern Med November 3, 2009 151:612-621; doi:10.1059/0003-4819-151-9-200911030-00006

    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.

Academia and Clinic

  • Much Cheaper, Almost as Good: Decrementally Cost-Effective Medical Innovation

    • Aaron L. Nelson,
    • Joshua T. Cohen,
    • Dan Greenberg,
    • and David M. Kent
    Ann Intern Med November 3, 2009 151:662-667; doi:10.1059/0003-4819-151-9-200911030-00011

    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.

Reviews

  • Systematic Review: Comparative Effectiveness and Harms of Combination Therapy and Monotherapy for Dyslipidemia

    • Mukul Sharma,
    • Mohammed T. Ansari,
    • Ahmed M. Abou-Setta,
    • Karla Soares-Weiser,
    • Teik Chye Ooi,
    • Margaret Sears,
    • Fatemeh Yazdi,
    • Alexander Tsertsvadze,
    • and David Moher
    Ann Intern Med November 3, 2009 151:622-630; doi:10.1059/0003-4819-151-9-200911030-00144

    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.

  • Systematic Review: Sodium Bicarbonate Treatment Regimens for the Prevention of Contrast-Induced Nephropathy

    • Sophia Zoungas,
    • Toshiharu Ninomiya,
    • Rachel Huxley,
    • Alan Cass,
    • Meg Jardine,
    • Martin Gallagher,
    • Anushka Patel,
    • Ali Vasheghani-Farahani,
    • Gelareh Sadigh,
    • and Vlado Perkovic
    Ann Intern Med November 3, 2009 151:631-638; doi:10.1059/0003-4819-151-9-200911030-00008

    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.

Clinical Guidelines

  • Hormonal Testing and Pharmacologic Treatment of Erectile Dysfunction: A Clinical Practice Guideline From the American College of Physicians

    • Amir Qaseem,
    • Vincenza Snow,
    • Thomas D. Denberg,
    • Donald E. Casey, Jr.,
    • Mary Ann Forciea,
    • Douglas K. Owens,
    • Paul Shekelle,
    • and for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians
    Ann Intern Med November 3, 2009 151:639-649; doi:10.1059/0003-4819-151-9-200911030-00151

    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.

  • Oral Phosphodiesterase-5 Inhibitors and Hormonal Treatments for Erectile Dysfunction: A Systematic Review and Meta-analysis

    • Alexander Tsertsvadze,
    • Howard A. Fink,
    • Fatemeh Yazdi,
    • Roderick MacDonald,
    • Anthony J. Bella,
    • Mohammed T. Ansari,
    • Chantelle Garritty,
    • Karla Soares-Weiser,
    • Raymond Daniel,
    • Margaret Sampson,
    • Steven Fox,
    • David Moher,
    • and Timothy J. Wilt
    Ann Intern Med November 3, 2009 151:650-661; doi:10.1059/0003-4819-151-9-200911030-00150

    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.

Editorial

  • Cost-Effectiveness of Biologics as First-Line Treatment of Rheumatoid Arthritis: Case Closed?

    • Maarten Boers
    Ann Intern Med November 3, 2009 151:668-669; doi:10.1059/0003-4819-151-9-200911030-00013

    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.

Letters

  • Management of Hyperlipidemia in Patients With Abdominal Aortic Aneurysm

    • Ankur Sethi
    Ann Intern Med November 3, 2009 151:670; doi:10.1059/0003-4819-151-9-200911030-00014

  • Management of Hyperlipidemia in Patients With Abdominal Aortic Aneurysm

    • Frank A. Lederle
    Ann Intern Med November 3, 2009 151:670; doi:10.1059/0003-4819-151-9-200911030-00015

  • Comments and Critiques on the EMBRACE Health Care Reform Plan

    • Quentin D. Young
    Ann Intern Med November 3, 2009 151:670-671; doi:10.1059/0003-4819-151-9-200911030-00016

  • Comments and Critiques on the EMBRACE Health Care Reform Plan

    • Richard L. O'Brien and
    • Donald Frey
    Ann Intern Med November 3, 2009 151:671; doi:10.1059/0003-4819-151-9-200911030-00017

  • Comments and Critiques on the EMBRACE Health Care Reform Plan

    • Christopher K. Johnson
    Ann Intern Med November 3, 2009 151:671-672; doi:10.1059/0003-4819-151-9-200911030-00018

  • Comments and Critiques on the EMBRACE Health Care Reform Plan

    • Gary R. Gibson
    Ann Intern Med November 3, 2009 151:672; doi:10.1059/0003-4819-151-9-200911030-00019

  • Comments and Critiques on the EMBRACE Health Care Reform Plan

    • Gilead I. Lancaster,
    • Ryan O'Connell,
    • and David L. Katz
    Ann Intern Med November 3, 2009 151:672-673; doi:10.1059/0003-4819-151-9-200911030-00020

  • Fulminant Hepatic Failure After Use of the Herbal Weight-Loss Supplement Exilis

    • W. Michael McDonnell,
    • Renuka Bhattacharya,
    • and Jeffrey B. Halldorson
    Ann Intern Med November 3, 2009 151:673-674; doi:10.1059/0003-4819-151-9-200911030-00021

  • Correction: Evidence for Improving Palliative Care at the End of Life

    Ann Intern Med November 3, 2009 151:674; doi:10.1059/0003-4819-151-9-200911030-00022

Medical Writings: Book Notes

  • Practical Gynecology: A Guide for the Primary Care Physician

    • Sara L. Jackson and
    • Joann G. Elmore
    Ann Intern Med November 3, 2009 151:675; doi:10.1059/0003-4819-151-9-200911030-00023

  • The Cambridge World History of Medical Ethics

    • Wendy Terese Grace
    Ann Intern Med November 3, 2009 151:675; doi:10.1059/0003-4819-151-9-200911030-00024

  • Mastering Communication with Seriously Ill Patients: Balancing Honesty with Empathy and Hope

    • Neil Abramson
    Ann Intern Med November 3, 2009 151:676; doi:10.1059/0003-4819-151-9-200911030-00025

  • New Knowledge for New Results: A Comprehensive Strategy for Reducing Skyrocketing Medical Costs

    • Ann Hendricks
    Ann Intern Med November 3, 2009 151:676; doi:10.1059/0003-4819-151-9-200911030-00026

Ad Libitum

  • I Wish I Could Remember His Name

    • Andrew Zweifler
    Ann Intern Med November 3, 2009 151:667; doi:10.1059/0003-4819-151-9-200911030-00012

Medical Notices

  • Medical Notices

    Ann Intern Med November 3, 2009 151:0; doi:10.1059/0003-4819-151-9-200911030-00027

Summaries for Patients

  • Home Health Education and Physician Training to Improve Care for Patients With High Blood Pressure in a Developing Country

    Ann Intern Med November 3, 2009 151:I-24; doi:10.1059/0003-4819-151-9-200911030-00001

  • A National Survey of Doctors About Screening for Cervical Cancer

    Ann Intern Med November 3, 2009 151:I-38; doi:10.1059/0003-4819-151-9-200911030-00002

  • Hormonal Testing and Pharmacologic Treatment of Erectile Dysfunction

    Ann Intern Med November 3, 2009 151:I-44; doi:10.1059/0003-4819-151-9-200911030-00159

In the Clinic

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This Issue

November 3, 2009; 151 (9)
  1. Articles
  2. Academia and Clinic
  3. Reviews
  4. Clinical Guidelines
  5. Editorial
  6. Letters
  7. Medical Writings: Book Notes
  8. Ad Libitum
  9. Medical Notices
  10. Summaries for Patients
  11. In the Clinic

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