EMBARGOED FOR RELEASE UNTIL 5 P.M., EST, WEDNESDAY, DECEMBER 31, 1997
January 1, 1998, Tip Sheet
Annals of Internal Medicine is published by the American College of Physicians (ACP), an organization of more than 100,000 physicians trained in internal medicine. The following highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656. The full text of selected articles can be accessed on the Internet at http://www.acponline.org/journals/annals on Jan. 1, 1998. * * *
ACP Guidelines for Testing Patients Suspected of Having Lyme Disease are Cost-Effective
Test-treatment strategies to diagnose Lyme disease (published by the American College of Physicians in the Dec. 15, 1997, Annals of Internal Medicine), are cost-effective, according to an analysis of four strategies applied to three common patient scenarios. (Academia and Clinic, p. 37.) Neither testing nor antibiotic treatment is cost-effective if the pretest probability of Lyme disease is low, authors say. Antibiotic therapy is recommended if the pretest probability is high, and two-step testing is recommended if the pretest probability is intermediate. * * *
Practice Guidelines for Individuals Do Not Necessarily Benefit Overall Population
A cost-effectiveness analysis found that the clusters of management decisions taken from six clinical guidelines that yielded maximum benefit for the whole population differed from the management decisions favored for the individual guidelines 57 percent of the time. (Medicine and Public Issues, p. 56.) Authors say that in order to allocate resources efficiently, decision makers should consider other sources of information in addition to the recommendations of clinical practice guidelines. Authors advocate "robust" guidelines that simultaneously address both individual and societal health needs. * * *
Three New Studies Shed Light on Diagnosis and Prevention of Deep Vein Blood Clots
A prospective cohort study finds that patients suspected of having a first deep venous thrombosis do not need anticoagulation therapy if they have two normal compression ultrasonographies in sequence. (Article, p. 1.) This approach separates those who do not benefit from further testing and anticoagulation therapy and those, with abnormal sonography results, who do.
A retrospective study of an extended family found that protein S deficiency, a regulatory protein in coagulation, is a strong independent risk factor for venous blood clots. (Article, p. 8.) Identifying people with the deficiency can limit treatment to people in high-risk situations such as pregnancy and surgery.
Relatives of persons carrying the factor V Leiden mutation, a genetic defect associated with venous blood clots, have low annual risk for the clots, according to a retrospective blinded study. Authors find no major benefit from screening relatives of patients with blood clots and this mutation. (Article, p. 15.)
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