Annals of Internal Medicine tip sheet for Aug. 15, 2006, issue

Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information.

Kidney Function Blood Test Also Identifies Risk for Heart Disease and Stroke

A blood test for cystatin C level, a measure of kidney function, identified a group of elderly people with "preclinical kidney disease" who were also at higher risk for cardiovascular disease, stroke, and death than those with normal cystatin C levels, a new study finds (Article, p. 237).

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Review of Court Documents Finds that Drug Company Systematically Used Medical Education and Research to Promote Off-Label Use

A pharmaceutical company promoted its anti-seizure drug with a comprehensive marketing strategy that included continuing medical education and research, authors say (Review, p. 284).

The authors reviewed documents that became available during the trial in which the parent pharmaceutical company admitted that it violated federal regulations by promoting the drug for unapproved uses such as pain, psychiatric conditions, and migraine.

Although some of the company activities have been described elsewhere, the authors say that this report is one of the first to describe the overall structure and extent of the off-label promotional activities.

Nurse Managers Help Ethnic Minority Patients with Heart Failure

Nurse management can improve heart failure outcomes, a new study finds (Improving Patient Care, p. 273).

A group of 406 mostly African American and Hispanic people with heart failure received either counseling by nurse managers about heart failure, or a patient information handout. After 12 months, the patients in the nurse-manager group functioned better and had modestly fewer hospitalizations (148 vs. 180) than the other group, but the differences did not continue after 12 months, when the counseling stopped.

Does Pay-for-Performance Improve the Quality of Health Care? Jury's Still Out

Despite "increasing enthusiasm" for the idea of linking payment to performance in heath care, this review of published studies of financial incentives on quality of care identified few studies to inform this enthusiasm (Improving Patient Care, p. 265).

The review found some positive effects and some unintended negative effects of financial incentives.

The authors propose a 13-point research agenda for studying explicit financial incentives in health care.

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