Table of Contents

February 18, 2003; 138 (4)

Articles

  • The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care

    • Elliott S. Fisher,
    • David E. Wennberg,
    • Thérèse A. Stukel,
    • Daniel J. Gottlieb,
    • F. L. Lucas,
    • and Étoile L. Pinder
    Ann Intern Med February 18, 2003 138:273-287

    The more inpatient-based and specialist-oriented pattern of practice observed in high-spending regions largely explains regional differences in Medicare spending. Neither quality of care nor access to care appear to be better for Medicare enrollees in higher-spending regions.

  • The Implications of Regional Variations in Medicare Spending. Part 2: Health Outcomes and Satisfaction with Care

    • Elliott S. Fisher,
    • David E. Wennberg,
    • Thérèse A. Stukel,
    • Daniel J. Gottlieb,
    • F. L. Lucas,
    • and É toile L. Pinder
    Ann Intern Med February 18, 2003 138:288-298

    Medicare enrollees in higher-spending regions receive more care than those in lower-spending regions but do not have better health outcomes or satisfaction with care.

  • Interferon Therapy after Tumor Ablation Improves Prognosis in Patients with Hepatocellular Carcinoma Associated with Hepatitis C Virus

    • Yasushi Shiratori,
    • Shuichiro Shiina,
    • Takuma Teratani,
    • Masatoshi Imamura,
    • Shun'taro Obi,
    • Shin'pei Sato,
    • Yukihiro Koike,
    • Haruhiko Yoshida,
    • and Masao Omata
    Ann Intern Med February 18, 2003 138:299-306

    After tumor ablation by ethanol injection, interferon therapy may enhance survival in selected patients with chronic hepatitis C and hepatocellular carcinoma.

  • Single-Detector Helical Computed Tomography as the Primary Diagnostic Test in Suspected Pulmonary Embolism: A Multicenter Clinical Management Study of 510 Patients

    • Marco J.L. van Strijen,
    • Wouter de Monyé,
    • Jan Schiereck,
    • Gerard J. Kieft,
    • Martin H. Prins,
    • Menno V. Huisman,
    • Peter M.T. Pattynama,
    • and for the Advances in New Technologies Evaluating the Localisation of Pulmonary Embolism (ANTELOPE) Study Group*
    Ann Intern Med February 18, 2003 138:307-314

    In patients with suspected pulmonary embolism, helical computed tomography can be used safely as the primary diagnostic test to rule out pulmonary embolism. Serial compression ultrasonography has limited additional value.

Brief Communications

  • Natural History of Benign Solid and Cystic Thyroid Nodules

    • Erik K. Alexander,
    • Shelley Hurwitz,
    • Jenny P. Heering,
    • Carol B. Benson,
    • Mary C. Frates,
    • Peter M. Doubilet,
    • Edmund S. Cibas,
    • P Reed Larsen,
    • and Ellen Marqusee
    Ann Intern Med February 18, 2003 138:315-318

    Thyroid nodules are common and most often benign, but the natural history of benign nodules is unclear. The authors found that most solid, benign thyroid nodules grow. Therefore, an increase in nodule volume alone is not a reliable predictor of malignancy.

Review

  • Managing the Patient with Venous Ulcers

    • Tami de Araujo,
    • Isabel Valencia,
    • Daniel G. Federman,
    • and Robert S. Kirsner
    Ann Intern Med February 18, 2003 138:326-334

    This case-based review discusses potential causes of leg ulcers, clinical characteristics suggesting that leg ulcers are due to venous disease, diagnostic procedures, therapy (including compression therapy, growth factors and other medical treatments, and surgery), and specialist referral.

Perspectives

  • Hospice Benefits and Phase I Cancer Trials

    • Ira Byock and
    • Steven H. Miles
    Ann Intern Med February 18, 2003 138:335-337

    Medicare denies hospice coverage to patients with terminal illnesses who enroll as participants in phase I studies, which assess the toxicity and dosing of potential treatments for incurable diseases. Such exclusions are not defensible on ethical or clinical grounds.

Clinical Guidelines

  • Fabry Disease, an Under-Recognized Multisystemic Disorder: Expert Recommendations for Diagnosis, Management, and Enzyme Replacement Therapy

    • Robert J. Desnick,
    • Roscoe Brady,
    • John Barranger,
    • Allan J. Collins,
    • Dominique P. Germain,
    • Martin Goldman,
    • Gregory Grabowski,
    • Seymour Packman,
    • and William R. Wilcox
    Ann Intern Med February 18, 2003 138:338-346

    Fabry disease is an X-linked recessive lysosomal storage disorder. Although the disease presents in childhood and culminates in cardiac, cerebrovascular, and end-stage renal disease, diagnosis is often delayed or missed. This paper reviews the key signs and symptoms of Fabry disease and provides expert recommendations for diagnosis, follow-up, medical management, and enzyme replacement therapy.

Editorials

  • Geographical Variations in Medicare Spending

    • Kenneth I. Shine
    Ann Intern Med February 18, 2003 138:347-348

    In this issue, Fisher and colleagues convincingly show that excellent outcomes for patients can be achieved in regions that do less, but do it right. The challenge is to convince the public that a lean style of practice is not about rationing but about better care.

  • What's Enough, What's Too Much?

    • Charles E. Phelps
    Ann Intern Med February 18, 2003 138:348-349

    The national scope, careful control of possibly confounding variables, and underlying design of Fisher and colleagues' study make this study possibly the most compelling yet showing that increased treatment intensity does not bring with it commensurate gains in health.

  • The Implications of Regional Variations in Medicare—What Does It Mean for Medicare?

    • Gail R. Wilensky
    Ann Intern Med February 18, 2003 138:350-351

    An increasing amount of attention has been given to the importance of improving quality and patient safety in Medicare. We need to find ways to encourage better practices, not discourage them by creating disincentives. We need more thought about how to reward physicians who practice high-quality conservative medicine.

  • Science, Public Health, and Public Awareness: Lessons from the Women's Health Initiative

    • Susan Dentzer
    Ann Intern Med February 18, 2003 138:352-353

    The firestorm that greeted the release of the Women's Health Initiative findings on hormone therapy has two main lessons: 1) Although crucial in disseminating health information, the media should not be relied on as the primary means of communicating a complicated health story to the public, and 2) the National Institutes of Health should supply an “instant context” for any given study by pulling together the extensive knowledge that already exists across the institutes.

On Being a Doctor

  • Valentine

    • Natalie A. Mariano
    Ann Intern Med February 18, 2003 138:354-355

    A heart writes mysterious stories, and we record them on cardiograms. Sharp, black lines etched across fine gray graph paper trace the electrical current that surges through heart muscle. Each little blip and spike narrates a detail of a story.

Letters

  • Screening for Colorectal Cancer

    • Donald M. Kirkpatrick
    Ann Intern Med February 18, 2003 138:356

  • Screening for Colorectal Cancer

    • Brian Budenholzer
    Ann Intern Med February 18, 2003 138:356

  • Screening for Colorectal Cancer

    • Robert S. Rosson and
    • Howard M. Spiro
    Ann Intern Med February 18, 2003 138:356-357

  • Screening for Colorectal Cancer

    • Michael Pignone
    Ann Intern Med February 18, 2003 138:357

  • Acute Hepatocellular-Cholestatic Liver Injury after Olanzapine Therapy

    • Khaled A. Jadallah,
    • David L. Limauro,
    • and Anthony M. Colatrella
    Ann Intern Med February 18, 2003 138:357-358

  • Furosemide Challenge in Patients with Heart Failure and Adverse Reactions to Sulfa-Containing Diuretics

    • Grace Earl,
    • James Davenport,
    • and Jagat Narula
    Ann Intern Med February 18, 2003 138:358-359

  • Antral Injections of Botulinum A Toxin for the Treatment of Obesity

    • Jens D. Rollnik,
    • Peter N. Meier,
    • Michael P. Manns,
    • and Michael Göke
    Ann Intern Med February 18, 2003 138:359-360

  • Food and Drug Administration Approval of Buprenorphine–Naloxone for Office Treatment of Addiction

    • Richard B. Resnick
    Ann Intern Med February 18, 2003 138:360

  • Correction: Postmenopausal Estrogen Replacement and Risk for Venous Thromboembolism

    Ann Intern Med February 18, 2003 138:360

Current Clinical Issues

  • Menopausal Hormone Therapy: Summary of a Scientific Workshop

    • Ruth Kirschstein
    Ann Intern Med February 18, 2003 138:361-364

Book Listings

Medical Notices

Summaries for Patients

  • The Implications of Regional Variations in Medicare Spending: The Content, Quality, and Accessibility of Care

    Ann Intern Med February 18, 2003 138:I-36

  • The Implications of Regional Variations in Medicare Spending: Health Outcomes and Satisfaction with Care

    Ann Intern Med February 18, 2003 138:I-49

  • Interferon Therapy Improves Survival in Patients with Liver Cancer and Hepatitis C Virus Infection

    Ann Intern Med February 18, 2003 138:I-52

  • Detecting Clots in the Lungs

    Ann Intern Med February 18, 2003 138:I-58

  • Are Thyroid Nodules that Grow Cancerous?

    Ann Intern Med February 18, 2003 138:I-60

Updates from the Annual Session

  • Update in Pulmonary Medicine

    • John H. Hansen-Flaschen
    Ann Intern Med February 18, 2003 138:319-325

    Pulmonary diseases, including chronic lung disease and pneumonia, are the third leading cause of death in the United States. This Update summarizes articles in six areas: chronic obstructive pulmonary disease, the acute respiratory distress syndrome, tuberculosis, thoracic imaging, sleep apnea, and end-of-life care.

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This Issue

February 18, 2003; 138 (4)
  1. Articles
  2. Brief Communications
  3. Review
  4. Perspectives
  5. Clinical Guidelines
  6. Editorials
  7. On Being a Doctor
  8. Letters
  9. Current Clinical Issues
  10. Book Listings
  11. Medical Notices
  12. Summaries for Patients
  13. Updates from the Annual Session

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