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3 June 2003 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians, an organization of more than 115,000 internal medicine physicians and medical students. Note: ACP-ASIM changed its name to ACP on March 31. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.

Task Force: Not Enough Evidence to Recommend For or Against Dementia Screening

The United States Preventive Services Task Force concludes that current evidence is insufficient to recommend for or against routine screening of older adults for dementia (Clinical Guidelines, p. 925). The recommendations apply to routine screening of adults who have no signs of memory loss or confusion. The Task Force says that physicians should assess cognitive function if they suspect impairment or deterioration while talking with the patient. A background review of the evidence notes that no one has performed a randomized, controlled trial of screening for dementia and that there is no direct evidence that screening improves health outcomes (Guidelines, p. 927).

Back Pain: Pervasive, Intractable. Two Articles Look at Alternative Therapies

Spinal manipulation is better than sham therapies for lower back pain but is neither better nor worse than conventional treatments, a meta-analysis of 39 randomized, controlled trials found (Article, p. 898). Researchers compared spinal manipulative therapy with conventional therapies, such as pain-killing drugs, physical therapy or back exercises.

A review of the effectiveness, safety and cost of acupuncture, massage therapy and spinal manipulation for persistent back pain found that massage had some benefit; spinal manipulative therapy had small clinical benefits equivalent to those of pain-killing drugs, physical therapy or back exercises; and the effectiveness of acupuncture remains unclear (Academia/Clinic, p. 898).

Smokers Have Higher Levels of Substances that Increase Heart Risk

In a sample of 17,353 adults, cigarette smoking was associated with elevated levels of C-reactive protein, fibrinogen, and homocysteine, three recently identified risk factors for heart disease (Brief Communication, p. 891). Current smokers had higher levels of the three risk factors than former smokers, as did those who smoked more cigarettes daily. It is possible that these risk factors are partly responsible for the effect of smoking on the risk of heart disease.

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