Issues

Daniel C. Cherkin, PhD; Karen J. Sherman, PhD, MPH; Janet Kahn, PhD; Robert Wellman, MS; Andrea J. Cook, PhD; Eric Johnson, MS; Janet Erro, RN, MN; Kristin Delaney, MPH; Richard A. Deyo, MD, MPH

Few studies have evaluated the effectiveness of massage for back pain. In this randomized trial, patients with chronic low back pain who received 10 weekly sessions of structural or relaxation massage experienced clinically important improvements in Roland Disability Questionnaire and symptom bothersomeness scores compared with patients who received usual care. There was no apparent difference in effect between the 2 types of massage, and the effects seemed to persist over 26 weeks.

Ann Intern Med. 2011;155(1):1-9. doi:10.7326/0003-4819-155-1-201107050-00002

John T. Schousboe, MD, PhD; Karla Kerlikowske, MD, MS; Andrew Loh, BA; Steven R. Cummings, MD

The optimal timing and frequency of screening mammography are controversial. This analysis found that the cost-effectiveness of screening mammography depended on a woman's age, breast density, family history, and history of breast biopsy. Mammography every 2 years was cost-effective for women aged 40 to 49 years with relatively high breast density or additional risk factors for breast cancer. Mammography every 3 to 4 years was cost-effective for women aged 50 to 79 years with low breast density and no other risk factors. These findings support personalizing decisions about screening mammography on the basis of a woman's characteristics.

Ann Intern Med. 2011;155(1):10-20. doi:10.7326/0003-4819-155-1-201107050-00003

Eric J. Chow, MD, MPH; Beth A. Mueller, DrPH; K. Scott Baker, MD, MS; Kara L. Cushing-Haugen, MS; Mary E.D. Flowers, MD; Paul J. Martin, MD; Debra L. Friedman, MD, MS; Stephanie J. Lee, MD, MPH

Hematopoietic stem cell transplant (HSCT) recipients are at risk for cardiovascular disease, but this risk has not been well-described. This single-center study confirms that patients who live at least 2 years after HSCT are more likely than the general population to develop uncontrolled coronary risk factors and cardiovascular disease and to die. There was no clear association between outcomes and specific HSCT exposures, such as radiation therapy or stem cell donor source. Clinicians should be aware of this risk and screen and treat HSCT recipients appropriately.

Ann Intern Med. 2011;155(1):21-32. doi:10.7326/0003-4819-155-1-201107050-00004

Max J. Liebo, MD; Rachel L. Israel, MD; Elizabeth O. Lillie, PhD; Michael R. Smith, MD; David S. Rubenson, MD; Eric J. Topol, MD

This study evaluated a portable electrocardiography device. The device produced images that were accurate for assessing ejection fraction and some (but not all) cardiac structures compared with standard echocardiography. Physicians with less experience disagreed more often about what the mobile images showed than did physicians with more experience. These findings are promising but suggest that the device is not ready for general use by clinicians who are untrained in obtaining and interpreting its images.

Ann Intern Med. 2011;155(1):33-38. doi:10.7326/0003-4819-155-1-201107050-00005

Agnes Dechartres, MD; Isabelle Boutron, MD, PhD; Ludovic Trinquart, MSc; Pierre Charles, MD; Philippe Ravaud, MD, PhD

This study explored whether estimates of treatment effect differ between single-center and multicenter randomized, controlled trials (RCTs). The researchers examined 48 meta-analyses that included 223 single-center RCTs and 198 RCTs. Single-center RCTs showed a larger treatment effect than multicenter RCTs. Adjustment for sample size yielded consistent results, as did adjustment for risk of bias within RCTs. These results suggest that number of study sites should be considered when interpreting results of RCTs and the meta-analyses that include them.

Ann Intern Med. 2011;155(1):39-51. doi:10.7326/0003-4819-155-1-201107050-00006

Janet P. Pregler, MD; Carolyn J. Crandall, MD, MS

This Update summarizes studies published in 2010 that the authors consider highly relevant to the practice of women's health. Topics include osteoporosis, calcium and vitamin D, hormone therapy and nonpharmacologic therapy in menopause, hereditary breast and ovarian cancer, cervical cancer, and emergency contraception.

Ann Intern Med. 2011;155(1):52-57. doi:10.7326/0003-4819-155-1-201107050-00341

Jeanne S. Mandelblatt, MD, MPH; Natasha Stout, PhD; Amy Trentham-Dietz, PhD

In this issue, Schousboe and colleagues report on a cost-effectiveness model to estimate the outcomes of mammography screening in a hypothetical cohort of U.S. women with varying risk for breast cancer. The editorialists discuss the innovations in Schousboe and colleagues' approach and the obstacles that remain to using such factors as breast density to refine current screening guidelines.

Ann Intern Med. 2011;155(1):58-60. doi:10.7326/0003-4819-155-1-201107050-00008

Steven Goodman, MD, MHS, PhD; Kay Dickersin, MA, PhD

Metabias poses unique challenges for comparative effectiveness research and evidence-based healthcare. Dechartres and colleagues' study in this issue raises the specter of a new metabias that is particularly troubling: that associated with single-center studies. The editorialists explore the implications of these findings and the conundrum that they pose.

Ann Intern Med. 2011;155(1):61-62. doi:10.7326/0003-4819-155-1-201107050-00010

Kimberly D. Manning, MD

“You have no idea who lies in that hospital bed.” “How true,” I murmured softly as I looked at the picture of my patient's smiling face on the obituary card. Somehow that smile seemed reserved just for me, and I bet everyone who looked at it felt that way. He had a way of making everyone feel special.

Ann Intern Med. 2011;155(1):63-64. doi:10.7326/0003-4819-155-1-201107050-00011

Ann Intern Med. 2011;155(1):65. doi:10.7326/0003-4819-155-1-201107050-00013

Ann Intern Med. 2011;155(1):65-66. doi:10.7326/0003-4819-155-1-201107050-00014

Ann Intern Med. 2011;155(1):66-67. doi:10.7326/0003-4819-155-1-201107050-00015

Ann Intern Med. 2011;155(1):67-68. doi:10.7326/0003-4819-155-1-201107050-00016

Beatriz Rodriguez, MD

Ann Intern Med. 2011;155(1):60. doi:10.7326/0003-4819-155-1-201107050-00009

Ronald H. Lands, MD

Ann Intern Med. 2011;155(1):64. doi:10.7326/0003-4819-155-1-201107050-00012

E. Michael Lewiecki, MD

Ann Intern Med. 2011;155(1):ITC1-1. doi:10.7326/0003-4819-155-1-201107050-01001

Ann Intern Med. 2011;155(1):I-28. doi:10.7326/0003-4819-155-1-201107050-00001