EMBARGOED FOR RELEASE UNTIL 5 P.M., EST, SUNDAY, DECEMBER 14, 1997
December 15, 1997, Tip Sheet
Annals of Internal Medicine is published by the American College of Physicians (ACP), 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.
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Isoniazid Recommended for Most Low-Risk Patients with Positive Skin Tests for Tuberculosis
Monitored isoniazid treatment for tuberculosis increased survival and reduced medical expenditures in all age groups of patients with positive skin tests but otherwise low risk for activation of the disease, a decision analysis found. (Article, p. 1051.) Current recommendations for use of isoniazid, developed before routine monitoring for isoniazid-caused liver disease, limit its use to people younger than 35 years or to older persons at increased risk for activating the tuberculosis.
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Many U.S. Women Physicians Use Postmenopausal Hormone Replacement Therapy
Women physicians use hormone replacement therapy (HRT) at a higher rate than women in general U.S. surveys, a random-sample survey of U.S. women physicians shows. (Brief Communication, p. 1093.) In other studies, use ranged from 8 percent in Massachusetts to more than 40 percent on the West coast and 24 percent nationally. Of physicians surveyed here, overall 47.4 percent currently use HRT, ranging from 59.8 percent of women between ages 40 to 49 to 36.4 percent of women between ages 60 to 70.
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Collaborative Management Among Patients, Families, Physicians and Health Care Systems Can Improve Care of Chronic Illness (Perspective, p. 1097.)
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ACP Issues Guidelines for Using Lab Tests to Diagnose Lyme Disease
Decisions on when to use blood tests to diagnose Lyme disease should be based on the patient's pretest probability of contracting Lyme disease and the characteristics of the test, says the American College of Physicians (ACP). (Position Papers, Part 1, p. 1106.) Laboratory tests are recommended only for patients whose pretest probability of Lyme disease is 0.20 to 0.80. In patients with clinical signs and when the probability of Lyme disease is 0.20 to 0.80, physicians should use either ELISA or an immunofluorescence assay, followed by a Western blotting of inconclusive specimens. ACP gives recommendations for patients with medium and high probabilities of Lyme disease and a variety of symptoms. For example, ACP does not recommend testing or antibiotic therapy for Lyme disease for patients with nonspecific symptoms of muscle pain. A related background paper discusses prevalence and incidence of the disease and the characteristics of the various tests. (Part 2, p.1109.)
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