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4 March 2008 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656. Past highlights are accessible as well.

1. ACP-AAFP Guideline for Treating Dementia Recommends Individual Assessment Followed by Treatment Based on Drug Profile. Currently, Evidence is Insufficient to Compare Dementia Drugs

A separate news release on the guideline has been released (Clinical Guidelines, p. 370).

2. New Blood Tests and Standard Test to Diagnose TB Evaluated

New T-cell blood tests, with fast turn-around time, are recommended for diagnosis of latent tuberculosis (Article, p. 325). A study involving 389 adults with moderate to high clinical suspicion of active tuberculosis evaluated two T- cell assays and tuberculin skin testing individually and in combination with each other. Researchers found the ELISpot(plus) more sensitive than the ELISpot and tuberculin skin testing. Almost all patients with active tuberculosis had positive results on either tuberculin skin testing or ELISpot(plus). If both tests are negative, active tuberculosis is very unlikely to be the diagnosis. An editorial writer discusses the issues of specificity and sensitivity raised by the combination tests and says “the search for a rapid, accurate test must go on” (Editorial, p. 398).

3. New Model for Predicting Breast Cancer Risk Includes Breast Density

Researchers developed a new risk-prediction model that uses breast density in addition to other, better known predictors of breast cancer risk (Article, p. 337). Breast density seemed to be a useful addition to the model, and low breast density was associated with a low breast cancer risk regardless of family history of breast cancer and other factors. However, like older models, the new risk-prediction model had only modest ability to discriminate between women who will develop breast cancer and those who will not. Although the model is easy to use, its accuracy needs further study before it can be recommended for routine clinical practice.

4. New Recommendation from the USPSTF: Do Not Screen Adults for COPD Using Spirometry

The U.S. Preventive Services Task Force (USPSTF) issues a new recommendation on screening for chronic obstructive pulmonary disease (COPD): do not screen healthy adults for COPD using spirometry. After weighing the benefits and harms of such screening identified in a systematic review of the evidence, the task force found that there is at least moderate certainty that screening for COPD using spirometry has no net benefit. This recommendation applies to healthy adults who do not recognize or report respiratory symptoms. COPD is a pulmonary disease caused by cigarette smoking. It is characterized by airflow limitation that is not fully reversible. It is the fourth leading cause of death in the United States and affects more than 5 percent of the adult U.S. population. Spirometry is a lung function test that measures the amount of air breathed in and out over a period of time.

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