Annals of Internal Medicine tip sheet for Oct. 16, 2007

1. Two Heart Interventions -- CABG and PCI -- Compared for Effectiveness

A new systematic review of trials of the comparative effectiveness of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) in patients in whom both procedures are feasible found that survival to 10 years was similar.

CABG was more effective in relieving angina and led to fewer repeated revascularizations but had a higher risk for procedural stroke. PCI led to more repeated revascularization procedures.

Researchers reviewed 23 randomized trials but did not look at literature that involved drug-eluting stents or patients with extensive coronary disease.

Note: This article is released early online at the Web site of Annals of Internal Medicine www.annals.org. It will appear in the Nov. 20, 2007, print edition of the journal.

2. E-Quality: Electronic Health Record Test in a Small Practice Finds Quality Improved, But with Effort and a Price

Eighteen months after implementing a full-featured electronic health record (EHR) in their practice, four internists used the system to measure and improve their mammography rate (Improving Patient Care, p. 549).

They ultimately achieved a 10 percent absolute improvement in rates at a modest, but unreimbursed, cost.

The author describes challenges such as acquiring structured data in an environment shaped by paper-chart thinking. The experience highlighted critical elements for EHR adopters who use it for quality improvement projects in their practice, including the need for standardized reports from other health care providers and redesign of practice work flows.

3. Knee Buckling Can Be Downfall for Older Adults

A study of 2,351 men and women 36 to 94 years old who did not have arthritis or knee replacement found that 12 percent had experienced knee buckling at least once in the past 3 months (Article, p. 534).

Of those whose knees gave way, 13 percent fell as a result. The frequency of buckling was similar both among men and women and among middle-aged and older persons.

Most people were walking or climbing stairs when their knees buckled.

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