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Articles 
Carísi A. Polanczyk, Karen M. Kuntz, David B. Sacks, Paula A. Johnson, and Thomas H. Lee Measurement of creatine kinase–MB mass plus early exercise testing is a cost-effective initial strategy for younger patients and those with a low to moderate probability of myocardial infarction. Troponin I measurement can be a cost-effective second test in higher-risk patients if the creatine kinase–MB level is normal and early exercise testing is not an option.
Nancy A. Shadick, Charlotte B. Phillips, Oliver Sangha, Eric L. Logigian, Richard F. Kaplan, Elizabeth A. Wright, Anne H. Fossel, Karin Fossel, Victor Berardi, Robert A. Lew, and Matthew H. Liang Because persons in this study with previous Lyme disease had no sequelae on physical examination and neurocognitive tests a mean of 6 years after infection, musculoskeletal and neurocognitive outcomes seem favorable. However, the data suggest that long-term impairment of functional status can occur.
Alan S. Go, Elaine M. Hylek, Leila H. Borowsky, Kathleen A. Phillips, Joe V. Selby, and Daniel E. Singer In a large cohort of ambulatory patients with atrial fibrillation who received care in a health maintenance organization, warfarin use was considerably higher than that reported in other studies.
Pernille Ravn, Marianne Bidstrup, Richard D. Wasnich, James W. Davis, Michael R. McClung, Ana Balske, Carol Coupland, Opinder Sahota, Amarjot Kaur, Marianne Daley, Giovanni Cizza for the Early Postmenopausal Intervention Cohort Study Group* Four years of alendronate or estrogen–progestin therapy prevented postmenopausal bone loss. A residual effect was seen 2 years after alendronate therapy was stopped; however, continuous alendronate treatment was more effective in preventing postmenopausal bone loss than 2 years of alendronate therapy followed by 2 years of placebo.
Brief Communications
Christoph Schramm, Peter Schirmacher, Ilka Helmreich-Becker, Guido Gerken, Karl Heinz Meyer zum Büschenfelde, and Ansgar W. Lohse Combined immunosuppressive therapy may alter the progression of primary sclerosing cholangitis. Adding immunosuppressive drugs to ursodeoxycholic acid therapy may be beneficial.
Finlay A. McAlister, Heather D. Clark, Carl van Walraven, Sharon E. Straus, Fiona M.E. Lawson, David Moher, and Cynthia D. Mulrow According to this critical appraisal of all reviews of clinical topics published in six general medical journals in 1996, the methodologic quality of clinical review articles varies widely, and many of these articles do not specify systematic methods.
Updates
Kenneth A. Woeber This Update reviews recent studies on screening for thyroid disease, thyroid eye disease and treatment with iodine-131, antithyroid drug treatment, therapy for hypothyroidism, and management of thyroid nodules.
Medicine and Public Issues
Steve S. Kraman and Ginny Hamm Since 1987, one Veterans Affairs medical center has used humanistic risk management that includes early injury review, steadfast maintenance of the relationship between the hospital and the patient, proactive full disclosure to patients who have been injured because of accidents or medical negligence, and fair compensation for injuries. Although the financial consequences of such a policy are unknown, this Veterans Affairs medical center has had encouragingly moderate liability payments.
Editorials
Arthur C. Fox and Richard I. Levin In this issue, Polanczyk and colleagues used relatively new markers of myocardial necrosis—creatine kinase–MB and troponin I—to formulate triage strategies for acute chest pain in the emergency department. Do the results of their cost-effectiveness analysis challenge the prevailing algorithm for diagnosis?
Albert W. Wu The risk management model discussed by Kraman and Hamm in this issue seems to be designed to maximize malpractice lawsuits, but instead it appears to have maximized only the number of patients who are justly compensated.
On Being a Doctor
Eric Michael David The act of human dissection may very well be the one event that distinguishes physicians from nonphysicians in a very real way. It is not simply the solution to the great mystery of what lies behind the bellybutton but also an act so taboo that it is criminalized outside the medical context.
On Being a Patient
H.J. Van Peenen After moving to a small town, a retired physician tries to become a patient—a "consumer"—instead of a physician-colleague.
Letters Cost-Effectiveness of Therapy in Nonatrial Fibrillation
Tests for Coronary Artery Disease
Saquinavir-Induced Hypoglycemia in Type 2 Diabetes
Michael Mayo-Smith
Reed E. Pyeritz
Bennett Lorber
Paul T. Kefalides
Pamela Charney, Judith Walsh, and Ann B. Nattinger Of the many important articles on women's health topics published in 1998, the following were chosen for this Update because of their implications for clinical practice: gynecology, risk factors for coronary artery disease, risk factors for and prevention of breast cancer, and osteoporosis. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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