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Giuseppe Camporese, Enrico Bernardi, Paolo Prandoni, Franco Noventa, Fabio Verlato, Paolo Simioni, Kadimashi Ntita, Giovanna Salmistraro, Christos Frangos, Franco Rossi, Rosamaria Cordova, Francesca Franz, Pietro Zucchetta, Dimitrios Kontothanassis, Giuseppe Maria Andreozzi for the KANT (Knee Arthroscopy Nadroparin Thromboprophylaxis) Study Group

In this trial, 1761 adults who had knee arthroscopy were randomly assigned to receive 7 or 14 days of low-molecular-weight heparin (LMWH) or to wear a full-length graduated compression stocking on the operated leg for 1 week. Fewer than 1% of the patients in any group had significant postsurgical bleeding complications. Fewer patients in the 7-day LMWH group experienced a composite outcome of deep venous thrombosis, pulmonary embolism, or death.

Empirical Fluconazole versus Placebo for Intensive Care Unit Patients: A Randomized Trial

Mindy G. Schuster, John E. Edwards, Jr., Jack D. Sobel, Rabih O. Darouiche, Adolf W. Karchmer, Susan Hadley, Gus Slotman, Helene Panzer, Pinaki Biswas, and John H. Rex

This multicenter trial tested the effect of empirical antifungal treatment in febrile intensive care unit patients. Investigators randomly assigned 270 patients with fever despite taking broad-spectrum antibiotics to either fluconazole, 800 mg/d, or placebo for 2 weeks. About 40% of patients in each group achieved all 4 components of successful treatment: resolution of fever, no invasive fungal infection, no stopping therapy because of toxicity, and no need for a nonstudy systemic antifungal medication. Compared with placebo, empirical antifungal fluconazole therapy had no effect in high-risk intensive care unit patients.

Prehypertension during Young Adulthood and Coronary Calcium Later in Life

Mark J. Pletcher, Kirsten Bibbins-Domingo, Cora E. Lewis, Gina S. Wei, Steve Sidney, J. Jeffrey Carr, Eric Vittinghoff, Charles E. McCulloch, and Stephen B. Hulley

In their prospective cohort study, Pletcher and colleagues found that prehypertension before age 35 years, especially systolic prehypertension, showed a graded association with coronary calcium later in life. This association remained strong after adjustment for differences in blood pressure elevation after age 35 years and other coronary risk factors and participant characteristics.

Improving Patient Care Back

Comparing Patient-Reported Hospital Adverse Events with Medical Record Review: Do Patients Know Something That Hospitals Do Not?

Joel S. Weissman, Eric C. Schneider, Saul N. Weingart, Arnold M. Epstein, JoAnn David-Kasdan, Sandra Feibelmann, Catherine L. Annas, Nancy Ridley, Leslie Kirle, and Constantine Gatsonis

Little is known about whether patient interviews can reveal adverse events not detected by medical record review. Weissman and colleagues compared adverse event rates from postdischarge patient interviews with those from medical records. Among 998 study patients, 23% had at least 1 adverse event detected by interview, compared with 11% by record review. Record review identified 11 serious and preventable events. Interviews identified 21 serious and preventable events that were not documented in the medical record. Hospitals should consider adding questions about adverse events to postdischarge interviews.

Early-Release Article: 1 July 2008

Systematic Review: T-Cell–Based Assays for the Diagnosis of Latent Tuberculosis Infection: An Update

Pai, Zwerling, and Menzies

Print Issue: 1 July 2008

ARTICLES

Diabetes and Hearing Impairment in the United States: Audiometric Evidence from the National Health and Nutrition Examination Survey, 1999 to 2004

Bainbridge, Hoffman, and Cowie

The Effect of Comorbid Illness and Functional Status on the Expected Benefits of Intensive Glucose Control in Older Patients with Type 2 Diabetes: A Decision Analysis

Huang, Zhang, Gandra, Chin, and Meltzer

Relationship of Specific Vaginal Bacteria and Bacterial Vaginosis Treatment Failure in Women Who Have Sex with Women

Marrazzo, Thomas, Fiedler, Ringwood, and Fredricks

IMPROVING PATIENT CARE

Public Reporting of Antibiotic Timing in Patients with Pneumonia: Lessons from a Flawed Performance Measure

Wachter, Flanders, Fee, and Pronovost

REVIEW

Meta-analysis: Effects of Adding Salmeterol to Inhaled Corticosteroids on Serious Asthma-Related Events

Bateman, Nelson, Bousquet, Kral, Sutton, Ortega, and Yancey

Click here for this article's CME course.

PERSPECTIVE

Surrogate Decision Making: Reconciling Ethical Theory and Clinical Practice

Berger, DeRenzo, and Schwartz

CLINICAL GUIDELINES

Screening for Asymptomatic Bacteriuria in Adults: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement

U.S. Preventive Services Task Force

Screening for Asymptomatic Bacteriuria in Adults: Evidence for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement

Lin and Fajardo

EDITORIALS

Hearing Loss and Diabetes: You Might Not Know What You're Missing

Hirose

Drug Safety and Salmeterol: The Controversy Continues

Datta, Koutsky, Ratelle, Unger, Shlay, McClain, Weaver, Kerndt, and others

Differences in Kidney Function and Incident Hypertension: The Multi-Ethnic Study of Atherosclerosis

Kestenbaum, Rudser, de Boer, Peralta, Fried, Shlipak, Palmas, and others

Comparison of 2 Interventions for Liquid Aspiration on Pneumonia Incidence: A Randomized Trial

Robbins, Gensler, Hind, Logemann, Lindblad, Brandt, Baum, Lilienfeld, and others

ACADEMIA AND CLINIC

Exploring the Geometry of Treatment Networks

Salanti, Kavvoura, and Ioannidis

REVIEW

Systematic Review: The Effect of Preventive Lamivudine on Hepatitis B Reactivation during Chemotherapy

Loomba, Rowley, Wesley, Liang, Hoofnagle, Pucino, and Csako

PERSPECTIVE

The Case for Treating Tobacco Dependence as a Chronic Disease

Steinberg, Schmelzer, Richardson, and Foulds

Author interview:

CLINICAL GUIDELINES

Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: U.S. Preventive Services Task Force Recommendation Statement

U.S. Preventive Services Task Force

Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force

Lin, Watkins, Johnson, Rodriguez, and Barton

EDITORIAL

Adding Human Papillomavirus Testing to Cytology for Primary Cervical Cancer Screening: Shooting First and Asking Questions Later

Sawaya

IN THE CLINIC

Dementia

Davinder P.S. Dosanjh, Timothy S.C. Hinks, John A. Innes, Jonathan J. Deeks, Geoffrey Pasvol, Sarah Hackforth, Hansa Varia, Kerry A. Millington, Rubamalar Gunatheesan, Valerie Guyot-Revol, and Ajit Lalvani

Dosanjh and colleagues investigated the ability of 2 T-cell–based blood tests (ELISpot and ELISpotPLUS) to rule out active tuberculosis. In 389 adults with moderate to high suspicion of active tuberculosis, the sensitivity of ELISpotPLUS was higher than that of 15-mm threshold tuberculin skin testing (TST) (89% vs. 79%) and similar to that of 10-mm threshold TST (83%) in unvaccinated patients for identifying culture-confirmed and highly probable tuberculosis. Patients with negative results on both ELISpotPLUS and TST had a very low likelihood ratio for tuberculosis. The ELISpotPLUS assay, particularly when used in combination with TST, can help to rule out active tuberculosis.

Using Clinical Factors and Mammographic Breast Density to Estimate Breast Cancer Risk: Development and Validation of a New Predictive Model

Jeffrey A. Tice, Steven R. Cummings, Rebecca Smith-Bindman, Laura Ichikawa, William E. Barlow, and Karla Kerlikowske

Existing breast cancer prediction tools do not account for breast density, a strong risk factor for breast cancer. Tice and associates developed a breast cancer risk prediction model that incorporates a measure of breast density that radiologists routinely report with mammography. Its predictions were accurate, but it had only modest ability to distinguish women who did not develop cancer from those who did. Before it is used in patient care, the model requires validation in additional populations to more fully characterize its accuracy.

Brief Communication: Clinical Implications of Short-Term Variability in Liver Function Test Results

Mariana Lazo, Elizabeth Selvin, and Jeanne M. Clark

The authors analyzed the results of performing repeated liver function tests about 17 days apart. The population was 1864 men and women in the Third National Health and Nutrition Examination Survey. More than 95% of the initially normal results remained normal, whereas 12% to 38% of abnormal results had reverted to normal at the second examination. Because of this high intraindividual variability, the authors suggest that practice guidelines should recommend repeating liver tests in asymptomatic persons with abnormal results.

Improving Patient Care Back

Performance Measurement in the Small Office Practice: Challenges and Potential Solutions

Bruce E. Landon and Sharon-Lise T. Normand

A majority of U.S. internists work in practices with 4 or fewer physicians. This article reviews the practice landscape in the United States; describes performance measurement challenges in small practices, including financial and staffing implications; discusses statistical issues that affect assessment of practice quality; and describes potential solutions.

Reviews Back

Systematic Review: Gene Expression Profiling Assays in Early-Stage Breast Cancer

Luigi Marchionni, Renee F. Wilson, Antonio C. Wolff, Spyridon Marinopoulos, Giovanni Parmigiani, Eric B. Bass, and Steven N. Goodman

Three gene expression–based breast cancer prognostication tests have been licensed for use: Oncotype DX, MammaPrint, and H/I. The authors summarize the evidence on the validity and utility of these tests. Overall, the body of evidence showed that this new generation of tests may improve prognostication and prediction of response to specific therapies. The tests offer clinically important improvement in risk stratification compared with standard outcome predictors.

Clinical Guidelines Back

Current Pharmacologic Treatment of Dementia: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians

Amir Qaseem, Vincenza Snow, J. Thomas Cross, Jr., Mary Ann Forciea, Robert Hopkins, Jr., Paul Shekelle, Alan Adelman, David Mehr, Kenneth Schellhase, Doug Campos-Outcalt, Pasqualina Santaguida, Douglas K. Owens the Joint American College of Physicians/American Academy of Family Physicians Panel on Dementia

The American College of Physicians and American Academy of Family Physicians offer recommendations on current pharmacologic treatment of dementia. Clinicians should base the decision to initiate a trial of therapy with a cholinesterase inhibitor or memantine on individualized assessment (weak recommendation, moderate-quality evidence). In addition, they should base the choice of agent on tolerability, adverse effect profile, ease of use, and cost. The evidence is insufficient to compare the effectiveness of different agents for the treatment of dementia (weak recommendation, low-quality evidence).

Effectiveness of Cholinesterase Inhibitors and Memantine for Treating Dementia: Evidence Review for a Clinical Practice Guideline

Parminder Raina, Pasqualina Santaguida, Afisi Ismaila, Christopher Patterson, David Cowan, Mitchell Levine, Lynda Booker, and Mark Oremus

Raina and associates reviewed the evidence for the effectiveness of cholinesterase inhibitors and memantine in achieving clinically relevant improvements in patients with dementia. Consistent differences between cholinesterase inhibitors and memantine were found for cognition and global assessment, but effect sizes were small. Behavioral and quality-of-life outcomes showed less consistent effects. Drug treatment of dementia results in cognitive improvement that is statistically significant but not consistently clinically important.

Editorials Back

Using Tests for Latent Tuberculous Infection to Diagnose Active Tuberculosis: Can We Eat Our Cake and Have It Too?

Dick Menzies

In this issue, Dosanjh and colleagues present results from using a combination of tuberculin skin testing (TST) and an interferon-{gamma} release assay (ELISpotPLUS) to diagnose active tuberculosis. Sensitivity was 99% in patients with positive TST or ELISpotPLUS results. However, several studies and a systematic review and meta-analysis are required before we can be confident that the sensitivity is truly this high. In the meantime, physicians who strongly suspect tuberculosis despite negative results on both TST and ELISpotPLUS should follow the patient closely before ruling out active tuberculosis.

Trials That Matter: The Effect of a Fixed-Dose Combination of an Angiotensin-Converting Enzyme Inhibitor and a Diuretic on the Complications of Type 2 Diabetes

George L. Bakris and Michael Berkwits

The ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicon-MR Controlled Evaluation) trial tested whether perindopril, 2 mg/d, and indapamide, 0.625 mg/d, plus standard antihypertensive treatment reduced both the microvascular and macrovascular complications of diabetes. Compared with placebo, participants taking the drug combination had a statistically significant mean reduction in systolic and diastolic blood pressure and a borderline statistically significant reduction in major macrovascular and microvascular events. Because the mean blood pressure of participants was lower than that of participants in previous trials, the ADVANCE trial provides new evidence that starting antihypertensives at a prehypertensive stage in patients with type 2 diabetes is beneficial.

Binh An Diep, Henry F. Chambers, Christopher J. Graber, John D. Szumowski, Loren G. Miller, Linda L. Han, Jason H. Chen, Felice Lin, Jessica Lin, Tiffany HaiVan Phan, Heather A. Carleton, Linda K. McDougal, Fred C. Tenover, Daniel E. Cohen, Kenneth H. Mayer, George F. Sensabaugh, and Françoise Perdreau-Remington

Researchers have recently identified USA300, a clone of community-acquired, methicillin-resistant Staphylococcus aureus (MRSA) that is resistant to multiple antibiotics. Diep and colleagues demonstrate that the incidence of multidrug-resistant USA300 MRSA is highest in the areas of San Francisco where more male same-sex couples reside. The infection frequently manifests as an abscess or cellulitis in the buttocks, genitals, or perineum. Although multidrug-resistant USA300 MRSA infection might be sexually transmitted in this population, direct evidence on the mode of transmission is lacking.

A 10-Year Experience with Universal Health Insurance in Taiwan: Measuring Changes in Health and Health Disparity

Chi Pang Wen, Shan Pou Tsai, and Wen-Shen Isabella Chung

In 1995, Taiwan implemented national health insurance. Wen and associates assessed its role in improving life expectancy and reducing health disparities in Taiwan. Differences in life expectancy between the healthiest and least healthy regions, defined as health disparities, were increasing before national health insurance and decreased afterward. However, disparities remained large. Whereas expenditures on health care increased, the percentage of gross domestic product spent on health care remained at 5% to 6%. Universal national health insurance alone may reduce health disparities, but only by a small amount in the absence of health system reform, which did not occur in Taiwan.

Effect of Glucosamine Sulfate on Hip Osteoarthritis: A Randomized Trial

Rianne M. Rozendaal, Bart W. Koes, Gerjo J.V.M. van Osch, Elian J. Uitterlinden, Eric H. Garling, Sten P. Willemsen, Abida Z. Ginai, Jan A.N. Verhaar, Harrie Weinans, and Sita M.A. Bierma-Zeinstra

Although many patients use glucosamine to treat osteoarthritis, available studies have reported inconsistent effects of glucosamine on symptoms and joint changes. In the first trial focusing on hip osteoarthritis, Rozendaal and colleagues randomly assigned 222 patients to glucosamine, 1500 mg/d, or placebo. After 2 years of treatment, they found no clinically significant effect on pain, function, or joint space narrowing. Whatever its effects on osteoarthritis in other joints, glucosamine sulfate was no better than placebo in reducing symptoms and progression of hip osteoarthritis.

Academia and Clinic Back

Methods and Processes of the CONSORT Group: Example of an Extension for Trials Assessing Nonpharmacologic TreatmentsWeb-only lightning bold

Isabelle Boutron, David Moher, Douglas G. Altman, Kenneth F. Schulz, Philippe Ravaud for the CONSORT Group

This article supports the extension of CONSORT Statement in this issue. It is available online only.

Extending the CONSORT Statement to Randomized Trials of Nonpharmacologic Treatment: Explanation and Elaboration

Isabelle Boutron, David Moher, Douglas G. Altman, Kenneth F. Schulz, Philippe Ravaud for the CONSORT Group

The conduct of randomized, controlled trials of nonpharmacologic treatments—such as surgery or behavioral interventions—presents specific challenges that clinical trial reports often do not address adequately, leaving readers unsure whether to believe the evidence. In order to strengthen the reporting of randomized trials of nonpharmacologic treatments, clinical epidemiologists and experts in this type of research developed additional reporting requirements to add to the CONSORT (Consolidated Standards of Reporting Trials) Statement. This article describes these additional standards.

Reviews Back

Narrative Review: The Enigma of Pulmonary Arterial Hypertension: New Insights from Genetic Studies

John H. Newman, John A. Phillips, III, and James E. Loyd

When pulmonary arterial hypertension (PAH) is not caused by other illnesses, its etiology is a mystery that is now beginning to be solved. Inherited susceptibility to PAH occurs in families, and researchers report a strong association between PAH and mutations in a receptor in the gene for a transforming growth factor that regulates cell growth (transforming growth factor-β [TGF-β]). Newman and colleagues describe the research that led to this discovery and treatment opportunities. The evidence increasingly suggests that idiopathic PAH is caused by an imbalance of TGF-β receptor signals that promote or retard vascular intimal proliferation.

Meta-analysis: Effectiveness of Drugs for Preventing Contrast-Induced Nephropathy

Aine M. Kelly, Ben Dwamena, Paul Cronin, Steven J. Bernstein, and Ruth C. Carlos

Contrast-induced nephropathy is a common cause of acute renal failure in hospitalized patients. Clinicians use many drugs to reduce the risk for the condition, including N-acetylcysteine, theophylline, fenoldopam, dopamine, furosemide, mannitol, and bicarbonate. In their meta-analysis of 33 trials involving 3622 patients, Kelly and colleagues found the strongest evidence for N-acetylcysteine, mannitol, and theophylline when compared with periprocedural hydration alone. However, available studies examined laboratory measures of renal function rather than clinical end points.

Editorials Back

More Challenges in the Prevention and Management of Community-Associated, Methicillin-Resistant Staphylococcus aureus Skin Disease

Rachel Gorwitz, Scott K. Fridkin, and Kimberly A. Workowski

In this issue, Diep and colleagues explore the epidemiology of methicillin-resistant Staphylococcus aureus USA300 isolates that contain the conjugative plasmid pUSA03. They suggest that men who have sex with men may be at increased risk for this infection. However, although evidence suggests that the infection is sexually transmitted, it is not strong enough to prove this hypothesis.

Learning from Taiwan: Experience with Universal Health Insurance

Karen Davis and Andrew T. Huang

In this issue, Wen and colleagues analyze trends in life expectancy in Taiwan before and after the introduction of national health insurance. Their results suggest a substantial payoff for investing in health insurance for all but also indicate the importance of a broad, systemic approach targeting the root causes of disease, such as smoking and obesity.

http://www.annals.org/content/vol148/issue4/images/data/DC1/annals_20080219.mp3

Glucosamine Sulfate in Osteoarthritis: The Jury Is Still Out

Johannes W.J. Bijlsma and Floris P.J.G. Lafeber

In this issue, Rozendaal and colleagues report what is apparently the first randomized trial on the effect of glucosamine sulfate on hip osteoarthritis. They concluded that glucosamine sulfate was no better than placebo in reducing symptoms and progression. However, osteoarthritis is a heterogeneous disease, and glucosamine may ameliorate symptoms in the joints. Still, the bottom line is that glucosamine is unproven therapy for osteoarthritis.

On Being a Doctor Back

I Can't Be Bothered

Faith Fitzgerald

I tell my patients, residents, and students that they should call me if they need me. They are not an interruption to my work; they are my work. In this sense, I can't be "bothered" by them. But a system and a culture designed to protect doctors from their patients assume I am bothered, and so gives that same impression to those trying to reach me. This really bothers me.

Wesley Yin, Anirban Basu, James X. Zhang, Atonu Rabbani, David O. Meltzer, and G. Caleb Alexander

The authors analyzed prescriptions from a random sample of pharmacy customers to estimate changes in utilization and out-of-pocket expenditures due to the Medicare Part D prescription benefit program. During the enrollment period, average monthly drug utilization by all Part D–eligible beneficiaries—regardless of whether they enrolled in Part D—increased by 1.1% and out-of-pocket expenditures decreased by 8.8%. After enrollment stabilized, average monthly drug utilization increased by 5.9% and expenditures decreased by 13.1%. Overall, the drug benefit saved people about $9 a month and provided an extra 14 days of pills.

Influence of Alternative Thresholds for Initiating HIV Treatment on Quality-Adjusted Life Expectancy: A Decision Model

R. Scott Braithwaite, Mark S. Roberts, Chung Chou H. Chang, Matthew Bidwell Goetz, Cynthia L. Gibert, Maria C. Rodriguez-Barradas, Steven Shechter, Andrew Schaefer, Kimberly Nucifora, Robert Koppenhaver, and Amy C. Justice

Controversy continues about the optimal CD4 cell count or viral load at which to start HIV treatment. The authors used a validated computer simulation to weigh harms and benefits of starting antiretroviral therapy at a relatively high CD4 cell count in a mostly male cohort with newly diagnosed chronic HIV infection. Although the simulation tended to underestimate benefits of treating early in the natural history of the disease, earlier treatment increased life expectancy and quality-adjusted life-years at age 30 years regardless of viral load and at age 40 years if viral loads were at least 30 000 copies/mL.

Systematic Review: Comparing Routine and Selective Invasive Strategies for the Acute Coronary Syndrome

Rehan Qayyum, M. Rizwan Khalid, Jurga Adomaityte, Stylianos P. Papadakos, and Frank C. Messineo

Qayyum and associates performed a systematic review of 10 randomized trials to compare the effects of managing all patients with non–ST-segment elevation acute coronary syndrome invasively or selectively. Of 10 648 patients, 15.9% of those assigned to a routine invasive strategy died or had nonfatal myocardial infarction, compared with 17.5% of those assigned to a selective invasive strategy. The trial evidence does not establish the superiority of routine invasive management over a selective approach.

Reviews Back

Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis

Catherine MacLean, Sydne Newberry, Margaret Maglione, Maureen McMahon, Veena Ranganath, Marika Suttorp, Walter Mojica, Martha Timmer, Alicia Alexander, Melissa McNamara, Sheetal B. Desai, Annie Zhou, Susan Chen, Jason Carter, Carlo Tringale, Di Valentine, Breanne Johnsen, and Jennifer Grossman

This systematic review of 76 randomized trials and 24 meta-analyses found good evidence that several agents, including alendronate, zoledronic acid, and estrogen, reduced the risk for vertebral and hip fractures more than placebo. Harms included increased risk for thromboembolic events with raloxifene and estrogen and esophageal symptoms with bisphosphonates. No large trials directly compared 2 or more agents. The available evidence on the relative benefits and harms of various therapies for osteoporosis is inadequate.

Perspectives Back

Balancing Efficacy and Safety of Drug-Eluting Stents in Patients Undergoing Percutaneous Coronary Intervention

Allen Jeremias and Ajay Kirtane

Some cardiologists have questioned the safety of drug-eluting stents because of an apparent increase in late stent thrombosis. However, the current evidence seems to say that the net clinical benefit of drug-eluting stents may outweigh their risks. Patients who are candidates for drug-eluting stents should be screened for their ability to tolerate uninterrupted antiplatelet therapy for longer than is necessary with bare-metal stents, and all patients should take antiplatelet and other optimal medical therapies. Full assessment of the net clinical effects of drug-eluting stents compared with bare-metal stents will require randomized trials that are larger than past studies.

Clinical Guidelines Back

Screening for Bacterial Vaginosis in Pregnancy to Prevent Preterm Delivery: U.S. Preventive Services Task Force Recommendation Statement

U.S. Preventive Services Task Force

In this update of a 2001 recommendation, the U.S. Preventive Services Task Force explains why it recommends against screening for bacterial vaginosis in pregnant women at low risk for preterm delivery. Even in pregnant women at high risk for preterm delivery, current evidence is insufficient to assess the balance of benefits and harms of screening.

Evidence on the Benefits and Harms of Screening and Treating Pregnant Women Who Are Asymptomatic for Bacterial Vaginosis: An Update Review for the U.S. Preventive Services Task Force

Peggy Nygren, Rongwei Fu, Michele Freeman, Christina Bougatsos, Mark Klebanoff, and Jeanne-Marie Guise

To support the updated U.S. Preventive Services Task Force recommendation in this issue, Nygren and colleagues performed a systematic review and meta-analysis of information from 7 new randomized, controlled treatment trials and 2001 report data. They found no benefit of treating women with low- or average-risk pregnancies for asymptomatic bacterial vaginosis. More research is needed to better understand the conditions under which treatment can be harmful or helpful.

Biomarkers of Inflammation and Thrombosis as Predictors of Near-Term Mortality in Patients with Peripheral Arterial Disease: A Cohort Study

Himabindu Vidula, Lu Tian, Kiang Liu, Michael H. Criqui, Luigi Ferrucci, William H. Pearce, Philip Greenland, David Green, Jin Tan, Daniel B. Garside, Jack Guralnik, Paul M Ridker, Nader Rifai, and Mary M. McDermott

Changes in thrombogenic and inflammatory biomarkers might predict near-term cardiovascular disease events. The authors measured D-dimer, amyloid A protein, and C-reactive protein annually for 3.4 years in 377 patients with peripheral arterial disease. Elevated levels were associated with all-cause and cardiovascular disease–related deaths occurring 1 to 2 years after their measurement but not with deaths occurring after 2 years. A similar pattern occurred a