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The U.S. Preventive Services Task Force recommends a one-time ultrasound examination to screen for abdominal aortic aneurysm for men between the ages of 65 and 75 who are or have been smokers (Clinical Guidelines, p. 198 and 203). This is the first time the Task Force has recommended screening for abdominal aortic aneurysm. Estimates indicate that between 59 percent and 83 percent of patients with ruptured abdominal aortic aneurysms die before reaching the hospital and having surgery. New evidence has shown that screening and surgery to repair large abdominal aortic aneurysms reduces the number of deaths from ruptured aneurysm in men.
A study of health records of 113,927 elderly people who had never had a heart attack examined the relationship of use of nonsteroidal anti-inflammatory drugs (NSAIDs) and risk for heart attack.* Researchers found that people who used rofecoxib had an increased risk for myocardial infarction. The risk was greater at higher doses. They found that aspirin use offset the heart risk associated with low-dose but not high-dose rofecoxib. There was no evidence of increased heart risk with other NSAIDs. The researchers studied aspirin, naproxen, and meloxicam and the COX-2 inhibitors rofecoxib and celecoxib. This study adds to the growing and consistent evidence that rofecoxib increases the risk of heart disease. It also contributes to the as yet inconsistent body of evidence about the heart risks of celecoxib: Some studies have shown increased risk and others have shown no increased risk.
*(This article is released online, along with the Feb. 1, 2005, issue of Annals of Internal Medicine. It will be published in the April 5, 2005, print edition.)
Pneumonia is one of the most important causes of death. A study of 203 patients with community-acquired pneumonia and low risk for dying found that about 80 percent of both those treated at home and those treated in the hospital improved without side effects, complications, or the need to change antibiotics (Article, p. 165). Patients treated at home were more satisfied with their overall care. The patients at low risk for complications were identified using a commonly used scoring system, the Pneumonia Severity Index. An editorial writer says that the decision to treat a patient with community-acquired pneumonia at home or in the hospital is very important (Editorial, p. 215). Inpatient care is expensive, and outpatient care has some advantages in encouraging recovery. The writer says that the study findings, if confirmed, should stimulate emergency departments to systematize their approach to management of community-acquired pneumonia.
(Improving Patient Care, p. 182; Editorial, p. 220.)