 |
 |
|
|
Articles 
Gérald Simonneau, Lewis J. Rubin, Nazzareno Galiè, Robyn J. Barst, Thomas R. Fleming, Adaani E. Frost, Peter J. Engel, Mordechai R. Kramer, Gary Burgess, Lorraine Collings, Nandini Cossons, Olivier Sitbon, and David B. Badesch, for the PACES Study Group In a short-term multicenter trial, Simonneau and colleagues randomly assigned 267 patients with pulmonary arterial hypertension who had been receiving intravenous epoprostenol for at least 3 months to receive either oral sildenafil or placebo for 16 weeks. Compared with placebo, sildenafil improved exercise capacity and hemodynamic measurements, lengthened time to clinical worsening, and caused more headaches and dyspepsia. Patients with better baseline exercise capacity improved the most.
Katherine Esposito, Miryam Ciotola, Maria Ida Maiorino, Roberto Gualdiero, Bruno Schisano, Antonio Ceriello, Flora Beneduce, Giovanni Feola, and Dario Giugliano Many patients with type 2 diabetes that is poorly controlled with oral agents take bedtime insulin. In 2 previous trials, neutral protamine lispro (NPL) insulin achieved better glycemic control than neutral protamine Hagedorn insulin. Esposito and associates randomly assigned patients with poor control of type 2 diabetes taking oral medications to receive either bedtime insulin glargine or NPL insulin. Over 36 weeks, the 2 groups had similar glycemic control and rates of hypoglycemic events.
Paul L. Hebert, Jane E. Sisk, Jason J. Wang, Leah Tuzzio, Jodi M. Casabianca, Mark R. Chassin, Carol Horowitz, and Mary Ann McLaughlin Although nurse-led case management improves clinical outcomes for patients with heart failure, the cost- effectiveness of these programs is not clearly established. Using data on costs from a randomized trial of 12 months of case management versus usual care for socioeconomically disadvantaged patients with heart failure, Hebert and coworkers estimated the cost-effectiveness of case management to be less than $20 000 per quality-adjusted life-year. This program was a reasonably cost-effective way to reduce the burden of heart failure in this setting.
Reviews
Rehan Qayyum, Shari Bolen, Nisa Maruthur, Leonard Feldman, Lisa M. Wilson, Spyridon S. Marinopoulos, Padmini Ranasinghe, Muhammed Amer, and Eric B. Bass Premixed insulin analogues are a mixture of short-acting and intermediate-acting insulin analogues. Their effectiveness relative to other antidiabetic agents is not clearly established. This systematic review of comparative trials in adults with type 2 diabetes found that premixed insulin analogues and premixed human insulin provided similar glycemic control. Premixed insulin analogues provided tighter glycemic control and caused more hypoglycemia than did long-acting insulin analogues and noninsulin antidiabetic agents. Evidence for effects on clinical outcomes of diabetes, however, was scant and inconclusive.
Clinical Guidelines
U.S. Preventive Services Task Force The U.S. Preventive Services Task Force (USPSTF) updates its 2003 recommendation statement on counseling to promote breastfeeding. The Task Force evaluated the results of a systematic review of literature published between January 2001 and January 2007 on activities to promote and support breastfeeding that were initiated, conducted, or referable by primary care clinicians. The USPSTF recommends interventions during pregnancy and after birth to promote and support breastfeeding (grade B recommendation).
Mei Chung, Gowri Raman, Thomas Trikalinos, Joseph Lau, and Stanley Ip To support the USPSTF recommendation in this issue, Chung and colleagues systematically reviewed evidence that primary care–initiated interventions to promote breastfeeding improve breastfeeding rates and child and maternal health outcomes. Evidence suggests that breastfeeding interventions are more effective than usual care in increasing short- and long-term breastfeeding rates. Combining pre- and postnatal interventions and including lay support may be beneficial.
Editorials
Darren B. Taichman Combination therapy for pulmonary arterial hypertension (PAH) is in widespread use. In this issue, Simonneau and colleagues found that patients who were already receiving intravenous epoprostenol had improvements in 6-minute walk distance, hemodynamic measurements, health-related quality of life, and time to clinical worsening when oral sildenafil was added to their treatment. The trial is an important step forward in PAH research and reminds us that adequately powered studies of combination therapy in PAH can be accomplished and should continue.
Sachin Majumdar and Eugene Barrett In this issue, Esposito and colleagues and Qayyum and coworkers evaluate the potential roles of newer insulin analogues for treating type 2 diabetes. In making the transition from oral therapies to insulin, neutral protamine Hagedorn (NPH) insulin remains reasonable and cost-effective; a long-acting insulin analogue can be used if nocturnal hypoglycemia is a problem. For meal-related hyperglycemia, a mixed regimen, such as regular/NPH insulin or NPL, may be an alternative to a basal bolus regimen. Choosing and modifying the insulin regimen is easy—the hard part is getting patients to accept diabetes self-management and to do it competently over a lifetime.
On Being a Doctor
Joseph Zarconi I knew after the first few sentences of our conversation that I would need to schedule her follow-up appointments for longer time slots than the usual 15 minutes. She was going to disrupt the efficiency of my office on this day and probably for a long time to come. Her problem wasn't simple.
Vikram Padmanabhan The books state that in medicine, there are 2 options: curative versus palliative—black and white in a world full of grays. What does "palliative" mean to a 36-year-old mother dying of cancer?
Letters Truthfulness and Personal Disclosure in the Physician–Patient Relationship
Does Lower Diabetes-Related Numeracy Lead to Increased Risk for Hypoglycemic Events?
Disseminated Histoplasmosis Associated with the Treatment of Rheumatoid Arthritis with Anticytokine Therapy
Clomipramine-Induced Diabetes
Correction: Sjögren-Type Syndrome after Allogeneic Bone-Marrow Transplantation
Correction: In the Clinic: Allergic Rhinitis
Correction: Reported Methodologic Quality and Discrepancies between Large and Small Randomized Trials in Meta-analyses
Jennifer Fisher Wilson
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||
In this Issue
Articles
Previous Issue
