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VOLUME 66 • NUMBER 8 • I S S N 0891-1150

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T A B L E OF C O N T E N T S M E D I C A L G R A N D ROUNDS

Palliative care: Clinical approach 459 to chronic pain and intestinal obstruction Oral medications should control pain in up to 80% of patients with terminal cancer. Yet, many patients receive inadequate pain treatment.

G. HANKS

M E D I C A L G R A N D ROUNDS

Evidence-based medicine in everyday practice 461 A step-by-step guide to using evidence to answer specific questions, with the answers guided hy the patient's wishes and values.

G. GUVATT

1 -MINUTE CONSULT

Should one routinely screen for lipoprotein(a)?

465

The evidence does not yet justify screening everyone, hut you may want to obtain an Lp(a)

level if the LDL level remains high despite statin therapy.

J.P. FROLKIS

IM BOARD REVIEW

A 74-year-old woman with abdominal pain and fever What is the likely cause of this patient's symptoms?

469

A self-test on a clinical case.

P. M A Z Z O N E AND C. NIELSEN

REVIEW

Shortcomings of coronary angiography 479 and their implications in clinical practice Angiography is the gold standard for detecting coronary artery disease, but its results must be interpreted with caution. An accompanying illustration shows why.

S.E. NISSEN

CONTINUED ON PAGE 452

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D E D I C A T E D TO L I F E L O N G L E A R N I N G

AND JNIC

J Ö U R N A I P F M E D I C I N E

n

JOHN D. CLOUGH, MD Editor-in-Chief

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C A R I N G FOR OLDER PATIENTS

Hypertension in older persons: 487 Treatment reduces mortality, but is underused Despite compelling evidence that treatment reduces mortality, hypertension is undertreated, and especially so in older patients. A step-by-step approach, based on the latest recommendations from the NIH.

w . s . A R O N O W

REVIEW

'Telephone treatment' 495 of uncomplicated acute cystitis Most women with uncomplicated acute cystitis can be treated over the telephone, saving time and money.

J. C A M P B E L L , M . FELVER, AND S. K A M A R E I

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FOR THE 5TH CONSECUTIVE Y E A R

INFECTIOUS D I S E A S E A L E R T

Clostridium difficile diarrhea and colitis: A clinical overview In hospitalized patients who have received antibiotics, toxin-producing strains of C difficile can play havoc.

A.J. TAEGE AND K .A . ADAL

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