Table of Contents

May 6, 2003; 138 (9)

Articles

  • Duration of Antibiotic Therapy for Early Lyme Disease: A Randomized, Double-Blind, Placebo-Controlled Trial

    • Gary P. Wormser,
    • Roshan Ramanathan,
    • John Nowakowski,
    • Donna McKenna,
    • Diane Holmgren,
    • Paul Visintainer,
    • Rhea Dornbush,
    • Brij Singh,
    • and Robert B. Nadelman
    Ann Intern Med May 6, 2003 138:697-704

    A 10-day course of doxycycline was sufficient for patients with erythema migrans. Extending doxycycline treatment to 20 days or adding one ceftriaxone dose at the beginning of a 10-day course of doxycycline did not enhance therapeutic efficacy. Regardless of regimen, objective evidence of treatment failure was extremely rare.

  • Intravenous and Oral Itraconazole versus Intravenous and Oral Fluconazole for Long-Term Antifungal Prophylaxis in Allogeneic Hematopoietic Stem-Cell Transplant Recipients: A Multicenter, Randomized Trial

    • Drew J. Winston,
    • Richard T. Maziarz,
    • Pranatharthi H. Chandrasekar,
    • Hillard M. Lazarus,
    • Mitchell Goldman,
    • Jeffrey L. Blumer,
    • Gerhard J. Leitz,
    • and Mary C. Territo
    Ann Intern Med May 6, 2003 138:705-713

    Itraconazole is more effective than fluconazole for long-term prophylaxis against invasive fungal infections after allogeneic hematopoietic stem-cell transplantation. Except for gastrointestinal side effects, itraconazole is well tolerated.

  • Comparison of 10-mg and 5-mg Warfarin Initiation Nomograms Together with Low-Molecular-Weight Heparin for Outpatient Treatment of Acute Venous Thromboembolism: A Randomized, Double-Blind, Controlled Trial

    • Michael J. Kovacs,
    • Marc Rodger,
    • David R. Anderson,
    • Beverly Morrow,
    • Gertrude Kells,
    • Judy Kovacs,
    • Eleanor Boyle,
    • and Philip S. Wells
    Ann Intern Med May 6, 2003 138:714-719

    A dosing nomogram for starting warfarin anticoagulation achieves a therapeutic international normalized ratio more quickly if the first dose is 10 mg rather than 5 mg.

Brief Communications

  • Suboptimal Monitoring and Dosing of Unfractionated Heparin in Comparative Studies with Low-Molecular-Weight Heparin

    • Robert Raschke,
    • Jack Hirsh,
    • and James R. Guidry
    Ann Intern Med May 6, 2003 138:720-723

    Few published randomized, controlled trials comparing low-molecular-weight heparin with unfractionated heparin used validated therapeutic ranges for adjusted partial thromboplastin time or standardized protocols for adjusting unfractionated heparin dose. This departure from good clinical trials practice may have biased the results of previous trials in favor of low-molecular-weight heparin.

Academia and Clinic

  • Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules

    • Michael K. Gould,
    • Gillian D. Sanders,
    • Paul G. Barnett,
    • Chara E. Rydzak,
    • Courtney C. Maclean,
    • Mark B. McClellan,
    • and Douglas K. Owens
    Ann Intern Med May 6, 2003 138:724-735

    In patients with a solitary pulmonary nodule, positron emission tomography with 18-fluorodeoxyglucose is the preferred option when the pretest probability and computed tomography findings disagree or when the pretest probability of malignancy is intermediate and the patient is at high risk for surgical complications. In most other circumstances, computed tomography–based strategies result in similar quality-adjusted life-years and lower costs.

Review

  • Eponyms and the Diagnosis of Aortic Regurgitation: What Says the Evidence?

    • Ajit N. Babu,
    • Steven M. Kymes,
    • and Sharon M. Carpenter Fryer
    Ann Intern Med May 6, 2003 138:736-742

    For more than a century, eponymous signs of aortic regurgitation have occupied a prominent place in medical textbooks. The evidence that these signs are accurate indicators of aortic regurgitation is weak. To sustain the place of these signs in the traditions of clinical diagnosis, we need better evidence about their accuracy.

Perspectives

  • Resolution of Futility by Due Process: Early Experience with the Texas Advance Directives Act

    • Robert L. Fine and
    • Thomas Wm. Mayo
    Ann Intern Med May 6, 2003 138:743-746

    By enacting a law regulating end-of-life decisions, Texas became the first state to provide a mechanism for resolving medical futility disputes and other end-of-life ethical disagreements. Data collected at a large tertiary care teaching hospital strongly suggest that this law represents a first step toward practical resolution of this controversial area of modern health care.

Position Papers

  • Training and Competency Evaluation for Interpretation of 12-Lead Electrocardiograms: Recommendations from the American College of Physicians*

    • Stephen M. Salerno,
    • Patrick C. Alguire,
    • and Herbert S. Waxman
    Ann Intern Med May 6, 2003 138:747-750

    This paper presents the American College of Physicians' recommendations for initial assessment of competency in the interpretation of resting electrocardiograms. The article also contains recommendations about maintaining competency and using computer-assisted electrocardiogram interpretation.

  • Competency in Interpretation of 12-Lead Electrocardiograms: A Summary and Appraisal of Published Evidence

    • Stephen M. Salerno,
    • Patrick C. Alguire,
    • and Herbert S. Waxman
    Ann Intern Med May 6, 2003 138:751-760

    This systematic review provides detailed supporting evidence for the American College of Physicians' recommendations on competency in electrocardiogram interpretation. The authors found no evidence that attaining or maintaining competency requires a specific minimum number of electrocardiogram interpretations.

Editorial

  • Duration of Antibiotic Therapy for Lyme Disease

    • Allen C. Steere
    Ann Intern Med May 6, 2003 138:761-762

    Over the years, physicians have prescribed longer and longer courses of antibiotic therapy for erythema migrans (often 21 to 30 days), primarily to treat persistent subjective symptoms. Investigators have begun to question whether longer courses of therapy accomplish this goal. In this issue, Wormser and colleagues show that treating erythema migrans for longer than 10 days does not improve outcomes.

On Being a Doctor

  • Dark Rounds

    • Faith T. Fitzgerald
    Ann Intern Med May 6, 2003 138:763-764

    It is not with a recommendation that all follow suit that I write this piece, but rather to let those teaching physicians who are unhappy, frustrated, rushed, and harried in the modern academic environment know there is a quieter place, an older place, a more fulfilling place—the subdued hospital in the dark of night.

  • Stuck

    • Christine Seibert
    Ann Intern Med May 6, 2003 138:765-766

    I felt a brief prick on the pad of my right third finger. I did not say or do anything to alert the resident with whom I was working, but instead continued until the lumbar puncture on our patient with end-stage AIDS was finished.

Letters

  • Quality Grand Rounds

    • David Hirsch,
    • Peter Gliatto,
    • and Yasmin Meah
    Ann Intern Med May 6, 2003 138:W-50

  • Screening for Depression in Adults

    • James C. Coyne,
    • Steven C. Palmer,
    • and Patricia A. Sullivan
    Ann Intern Med May 6, 2003 138:767

  • Screening for Depression in Adults

    • Amar K. Das,
    • Raz Gross,
    • and Myrna M. Weissman
    Ann Intern Med May 6, 2003 138:767

  • Screening for Depression in Adults

    • Michael Pignone,
    • Bradley Gaynes,
    • Kathleen Lohr,
    • Jerry Rushton,
    • and Cynthia Mulrow
    Ann Intern Med May 6, 2003 138:767-768

  • Screening for Breast Cancer

    • John K. Whiteford and
    • John Ryan Whiteford
    Ann Intern Med May 6, 2003 138:768-769

  • Screening for Breast Cancer

    • Peter C. Gøtzsche
    Ann Intern Med May 6, 2003 138:769-770

  • Screening for Breast Cancer

    • Linda L. Humphrey,
    • Mark Helfand,
    • and Benjamin K.S. Chan
    Ann Intern Med May 6, 2003 138:770

  • The Mammography Dilemma

    • Alfred O. Berg,
    • Janet Allan,
    • and Steven Woolf
    Ann Intern Med May 6, 2003 138:770-771

  • The Mammography Dilemma

    • Donald E. Stanley
    Ann Intern Med May 6, 2003 138:771

  • The Mammography Dilemma

    • Steven N. Goodman
    Ann Intern Med May 6, 2003 138:771

  • Correction: Factors That Affect Accuracy of Screening Mammography

    Ann Intern Med May 6, 2003 138:771

Medical Writings

  • What Do Doctors Find Meaningful about Their Work?

    • Carol R. Horowitz,
    • Anthony L. Suchman,
    • William T. Branch, Jr.,
    • and Richard M. Frankel
    Ann Intern Med May 6, 2003 138:772-775

    The internists in the authors' study wrote about miracles and mistakes, sharing their own lives and their patients' lives, witnessing profound experiences, and receiving acknowledgment for a job well done. Through these experiences, they gained a deeper appreciation of what it means to be a human being and a doctor. They learned that their caring actions meant everything to their patients.

Medical Writings: Book Notes

Book Listings

Medical Notices

Summaries for Patients

  • Duration of Antibiotic Treatment for Early Lyme Disease

    Ann Intern Med May 6, 2003 138:I-27

  • Preventing Fungal Infections in Patients with Stem-Cell Transplants

    Ann Intern Med May 6, 2003 138:I-37

  • A Comparison of Two Methods of Starting the Anticoagulant Drug Warfarin

    Ann Intern Med May 6, 2003 138:I-50

  • What Is the Most Effective Blood Thinner for Treating Patients with Blood Clots in the Veins?

    Ann Intern Med May 6, 2003 138:I-63
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This Issue

May 6, 2003; 138 (9)
  1. Articles
  2. Brief Communications
  3. Academia and Clinic
  4. Review
  5. Perspectives
  6. Position Papers
  7. Editorial
  8. On Being a Doctor
  9. Letters
  10. Medical Writings
  11. Medical Writings: Book Notes
  12. Book Listings
  13. Medical Notices
  14. Summaries for Patients

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