Disease Management plus Recommended Care versus Recommended Care Alone for Ambulatory Patients with Chronic Obstructive Pulmonary Disease.

Rationale: The efficacy of disease management programs in the treatment of patients with chronic obstructive pulmonary disease (COPD) remains uncertain.Objectives: To study the effect of disease management (DM) added to recommended care (RC) in ambulatory patients with COPD.Measurements and Main Results: In this trial, 1,202 patients with COPD (age, ≥40 yr), with moderate to very severe airflow limitation were randomly assigned either to DM plus RC (study intervention) or to RC alone (control intervention). RC included follow-up by pulmonologists, inhaled long-acting bronchodilators and corticosteroids, smoking cessation intervention, nutritional advice and psychosocial support when indicated, and supervised physical activity sessions. DM, delivered by trained nurses during patients' visits to the designated COPD centers and by remote contacts with the patients between these visits, included patient self-care education, monitoring patients' symptoms and adherence to treatment, provision of advice in case of acute disease exacerbation, and coordination of care vis-à-vis other healthcare providers. The primary composite endpoint was first hospital admission for respiratory symptoms or death from any cause. During 3,537 patient-years, 284 patients (47.2%) in the control group and 264 (44.0%) in the study intervention group had a primary endpoint event. The median (range) time elapsed until a primary endpoint event was 1.0 (0-4.0) years among patients assigned to the study intervention and 1.1 (0-4.1) years among patients assigned to the control intervention; adjusted hazard ratio, 0.92 (95% confidence interval, 0.77-1.08).Conclusions: DM added to RC was not superior to RC alone in delaying first hospital admission or death among ambulatory patients with COPD.

[A case of Crohn's disease following an infection by Epstein-Barr virus].

Infection by the Epstein-Barr virus (EBV) has been linked to the development of autoimmune diseases and recent studies have investigated its specific influence on inflammatory bowel diseases. This is a case report of a 20 year old patient who was diagnosed with Crohn's disease following a prolonged manifestation of infectious mononucleosis. The current information regarding the association between EBV and the development of inflammatory bowel diseases is discussed.

Primary care physicians' awareness and implementation of screening guidelines for colorectal cancer.

OBJECTIVE: The objective was to determine primary care physicians' (PCPs) familiarity and implementation of screening guidelines for colorectal cancer (CRC) in central Israel. METHODS: Fifty PCPs were interviewed and 1000 charts of their asymptomatic patients ages 50-70 were examined. All CRC patients treated at the regional Oncology Institute in 1980-1984 and in 1993-1997 were then compared, with emphasis on the event leading to diagnosis and tumor stage. RESULTS: Almost all PCPs endorsed screening. Fecal occult blood testing (FOBT) was appropriately recommended by 40% (annually), and the use of flexible sigmoidoscopy (FS) was appropriately recommended by 12% of physicians (every 3-5 years). Only four (8%) were correct in the use of both techniques. Most PCPs estimated that >25% of their patients had been screened for CRC. In fact, 92/1,000 had FOBT (9.2%), 14/1,000 had screening FS (1.4%), and 3 patients only had both tests. Only 1.2% of CRC diagnoses in the 1980s (n = 175) and 2.6% in the 1990s (n = 343) were established as a result of screening (P > 0.25, NS). Tumor stage distribution at diagnosis was similar. CONCLUSIONS: PCPs studied endorse CRC screening but they are not familiar with accepted guidelines and do very little about implementing them, and this has not changed much over the past decade. CRC screening has a potential to markedly decrease mortality, yet the best screening strategy is worthless without physician education and compliance.