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Annals of Internal Medicine tip sheet for Jan. 1, 2008, issue

1. Targeted Digital Mammography May Be Cost-Effective Method of Screening for Breast Cancer, but Digital Mammography for All Women Is Not

A cost-effectiveness study of the value of digital mammography breast cancer screening has found that digital mammography screening does not result in sufficient health gains to warrant its increased cost unless its use is limited to younger women or to women with dense breasts (Article, p. 1).

The study was conducted as part of the Digital Mammography Imaging Screening Trial (DMIST) and involved more than 42,000 women in the United States and Canada through the American College of Radiology Imaging Network (ACRIN).

Researchers found a nonsignificant tendency toward better breast cancer detection with conventional film mammography in older women with nondense breasts, and because of this finding, digital mammography screening for all age groups was not cost-effective.

(NOTE: To reach first author, Dr. Anna Tosteson, contact Deb Kimbell 802-236-6934;

2. Way a Drug Concentration is Expressed Affects Dosing Errors

Epinephrine (adrenaline) is a drug that can be used to treat life-threatening allergies. The drug is stored in salt water and can be expressed as both a dose or mass concentration level (e.g. 1 mg per 1 mL of salt water) and a ratio (1 part drug for every 1000 parts of salt water).

A randomized, blinded, controlled study, designed to see whether labeling the drug as a dose or a ratio affected accuracy or speed in giving the drug, divided 28 doctors into two groups to handle a simulated severe allergic reaction.

The study found that all but two of the doctors in the group that used adrenaline in ampules with ratio labels gave more adrenaline (i.e. overdosed) and took longer to do so than the doctors in the group using ampules with dose labels (Article, p. 11).

NOTE: To reach author Dr. Daniel W. Wheeler, e-mail

3. Annals Begins Podcast in Chinese

With this issue, Annals of Internal Medicine begins providing audio summaries of Annals content in Chinese. The summaries will feature an article in the issue important to a Chinese audience and will more briefly describe the rest of the journal issue's content.

The summaries will be read by Yu-Xiao Yang, MD, MSCE, an Associate Editor at Annals. The summaries are available online free of charge, or listeners can subscribe to the summaries as a podcast by visiting at or at iTunes.


Contact: Susan Anderson
American College of Physicians

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