Cardioversion alone should be the initial management strategy for persistent nonvalvular atrial fibrillation. On relapse of arrhythmia, repeated cardioversion plus low-dose amiodarone is cost-effective for patients at moderate to high risk for ischemic stroke.

The prevalence of abdominal aortic aneurysm was found to be significantly increased among brothers of patients with surgically treated aneurysms. Aging brothers have the highest risk for developing the disease.

The factor V Leiden mutation and resistance to activated protein C are important, independent risk factors for venous thromboembolism. Phenotypic evaluation of resistance to activated protein C should be encouraged in patients with venous thromboembolism.

Breast symptoms in women 40 to 70 years of age were common in a large primary care practice. Evaluation beyond initial examination was common, and cancer was diagnosed in more than 4% of breast symptom episodes. These findings indicate that follow-up of breast symptoms is important in primary care practices.

Hydrochlorothiazide treatment in men with hypercalciuria and osteoporosis was associated with a rapid rebound increase in bone mineral density at the spine and hip.

Since leptin was discovered 4 years ago, understanding of the mechanisms underlying neuroendocrine function, body weight, and energy homeostasis has greatly broadened. Elucidation of these mechanisms is expected to result in the development of novel therapeutic approaches for obesity and eating disorders.

In response to a proposal suggesting that researcher contributions to published papers be specified, The Lancet began disclosing these contributions at the end of original articles. This study of the contribution lists in The Lancet found that publication of such lists is feasible and seems to impart important information.

Use and availability of beds in acute care hospitals have been confirmed to be the principal determining factors in location of death. Within that constraint, however, the availability of other resources and services both facilitates the process of arranging for patients to die outside the hospital and improves satisfaction with the quality of terminal care.

Cost-cutting tactics used by managed care plans have spawned movements that demand rights for patients and providers; shoring up those rights, however, will increase the number of uninsured persons. The problems created by this untenable sequence of events will not be resolved until some form of universal health insurance is implemented.

Over the past decade, the management of patients with nonvalvular atrial fibrillation has been the subject of more papers than any clinician has time to digest. In this issue, Catherwood and colleagues extend their previous model to offer a new cost-effectiveness analysis of therapies for nonvalvular fibrillation.

The health care system in the United States is an embarrassing, world-class mess. At times, it seems that nothing short of a constitutional amendment will prevent us from continuing to turn our backs on the health care problem.

The issues of how best to diagnose the presence of Helicobacter pylori and how best to eliminate this organism must follow from the larger question: In whom is elimination of H. pylori beneficial?

Does Stella really mean “no” when she says that she does not want to be put on a respirator?