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Annals of Internal Medicine tip sheet for Oct. 2

1. Organizations Issue Comprehensive Guidelines for Treating Low Back Pain -- Clinicians Shouldnt Routinely Order Imaging and Other Diagnostic Tests

(Clinical Guidelines, p. 487.) (NOTE: This article is the subject of a video news release. Call for coordinates. A separate news release will be issued.)

2. Trial of Two Drugs Finds One Better at Suppressing Hepatitis B Virus

A 52-week, randomized trial involving 135 people with chronic hepatitis B virus (HBV) compared an older drug adefovir dipivoxil and a newer drug, telbivudine. Researchers found that telbivudine was better at suppressing blood virus levels than adefovir. A group of patients who were switched at 24 weeks from adefovir to telbivudine also showed reduced levels of the virus at 52 weeks compared to the group who continued on adefovir for 52 weeks. Researchers say the study results support the concept that maximizing viral suppression early in the course of therapy is linked to improved efficacy responses and less resistance, suggesting that agents providing the greatest viral suppression may be preferable as initial therapy. (This study is being released early online and will be published in the Dec. 4, 2007, print edition of Annals of Internal Medicine.)

3. All Screening Models for Breast Cancer-Causing Gene Mutations Work, with Reservations

Researchers applied seven prediction models to 3,342 families to determine an individual family members probability of having a BRCA1/BRCA2 mutation and compared the results with actual genetic tests for the mutations (Article, p. 441). They found that the seven models were similarly good at discriminating between people with a BRCA1/BRCA2 mutation and people without such mutations, but the models did make mistakes. Researchers found that predictions varied widely when the seven models were applied to one person, so genetic counselors may want to consider using several predictive models before recommending genetic testing. The genetic mutation tests are expensive, so clinicians use screening tests to try to determine if a person is likely to have the mutation before proceeding with the testing. An editorial writer notes that all the prediction models require information from family medical history and urges families to keep track of family members medical history and clinicians to ask about it (Editorial, p. 515).


Contact: Steve Majewski
American College of Physicians

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