Table of Contents

The authors assigned 772 participants to a low-fat diet or to 1 of 2 Mediterranean diets that emphasized consumption of either olive oil or nuts. They then measured changes in body weight, blood pressure, lipid profile, glucose levels, and inflammatory molecules. Compared with the low-fat diet, the 2 Mediterranean diets had a beneficial effect on most of these outcomes at 3 months.

The authors randomly assigned patients with knee osteoarthritis to physiotherapy and as-needed anti-inflammatory drugs, traditional Chinese acupuncture, or sham acupuncture. The 2 acupuncture interventions led to greater improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 26 weeks but did not differ from each other. The observed differences could be due to placebo effects, differences in intensity of provider contact, or a physiologic effect of needling.

Adding high-sensitivity C-reactive protein (hsCRP) to a global risk prediction model improves cardiovascular risk classification, mostly for women at intermediate risk. However, since most of this apparently healthy population of women had a low cardiovascular disease risk, adding hsCRP reclassified relatively few women.

The authors documented clinical outcomes of subsequent pregnancy in 15 Haitian women with peripartum cardiomyopathy. Half of the 15 women experienced worsening heart failure and long-term systolic dysfunction, while the other half experienced no deterioration and eventually regained normal left ventricular systolic function.

Active-control noninferiority trials test the hypothesis that one intervention is no worse than another. They help to make clinical, insurance coverage, and regulatory decisions about new interventions. Formal analysis of such trials requires several assumptions that are difficult to validate explicitly. The authors evaluate 8 recently published noninferiority trials and conclude that only 4 of the 8 established noninferiority. Reports of noninferiority trials must make explicit the assumptions underlying the interpretation of the results.

In 2005, several important studies challenged the general internist's definition of routine care for many conditions. This Update discusses research on coronary artery disease, vitamin E, women's health, perioperative consultation, abdominal aortic aneurysm, HIV screening, colon cancer, peptic ulcer disease, dementia, methicillin-resistant Staphylococcus aureus, shingles, and hypertension.

In this review, the authors describe what is known about the gain in ability to predict the incidence of cardiovascular disease (CVD) by adding C-reactive protein (CRP) to prediction models that use traditional CVD risk factors. They did not find definitive evidence that CRP improves prediction in most individuals. They define several research questions that must be answered before deciding whether to incorporate CRP into risk prediction algorithms and whether to recommend universal screening with CRP.

The authors examined 11 randomized trials assessing the effect of cysticidal drugs on neuroimaging and clinical outcomes of patients with neurocysticercosis. Cysticidal drug therapy resulted in better resolution of cystic and enhancing lesions on neuroimaging tests and lower rates of seizures.

In this issue, 2 articles express widely divergent views regarding the role of C-reactive protein (CRP) in cardiovascular disease risk stratification. The place of CRP in the cardiovascular disease prevention pantheon remains uncertain. Reasons for skepticism include the following: CRP may not be causally related to coronary heart disease; testing for CRP is more expensive than asking patients about their health, lifestyles, and socioeconomic background; and CRP adds only modest additional predictive ability after conventional risk factors are considered.

“My psychiatrist says I need all my meds, but he doesn't know how I'm goin' to get them,” Maggie said. That was true. Eleven years after one of the most progressive managed care Medicaid programs in the country had been introduced in Tennessee, political and financial pressures had led the state to disenroll more than 300 000 patients.

My mother, Ida, died a few years ago. By itself, her death could hardly be seen as a remarkable event. But the way she died was another matter altogether. In the week before her death she was quite convinced she was already dead.