Michael S. Lauer, MD; Claire E. Pothier, MPH; David J. Magid, MD, MPH; S. Scott Smith, MD; Michael W. Kattan, PhD
In a large prospective cohort study, Lauer and colleagues developed a post–treadmill test prediction rule to determine mortality in adults with normal electrocardiograms and suspected coronary artery disease. Their model used clinical and treadmill variables coupled with a nomogram to predict all-cause mortality. The nomogram better discriminated between those who die and those who survive than did the standard Duke treadmill score, which uses only treadmill test variables to predict outcome. It gave good results when used to predict all-cause mortality in an independent population of patients from a large HMO.
Ann Intern Med. 2007;147(12):821-828. doi:10.7326/0003-4819-147-12-200712180-00001
Susan Morpeth, MBChB; David Murdoch, MD; Christopher H. Cabell, MD, MHS; Adolf W. Karchmer, MD; Paul Pappas, MS; Donald Levine, MD; Francisco Nacinovich, MD; Pierre Tattevin, MD; Núria Fernández-Hidalgo, MD; Stuart Dickerman, MD; Emilio Bouza, MD, PhD; Ana del Río, MD; Tatjana Lejko-Zupanc, MD, PhD; Auristela de Oliveira Ramos, MD; Diana Iarussi, MD; John Klein, MD; Catherine Chirouze, MD; Roger Bedimo, MD, MS; G. Ralph Corey, MD; Vance G. Fowler Jr., MD, MHS; and the International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) Investigators*
Endocarditis caused by non-HACEK organisms (species other than Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) has long been thought to be associated with injection drug use. Morpeth and coworkers described the clinical characteristics and outcomes of 2761 cases of patients with infective endocarditis from 61 hospitals. Non-HACEK organisms accounted for fewer than 2% of cases. Most non-HACEK endocarditis infections were associated with health care: 59% of patients had implanted endovascular devices or prosthetic valves and only 4% were injection drug users. More than half of the patients with non-HACEK infections had cardiac surgery; 24% died.
Ann Intern Med. 2007;147(12):829-835. doi:10.7326/0003-4819-147-12-200712180-00002
Mark Bower, PhD; Tom Powles, MD; Sarah Williams, MB; Tom Newsom Davis, PhD; Mark Atkins, PhD; Silvia Montoto, MD; Chloe Orkin, MD; Andy Webb, PhD; Martin Fisher, BSc; Mark Nelson, MA; Brian Gazzard, MD; Justin Stebbing, PhD; Peter Kelleher, PhD
Rituximab has shown some therapeutic promise in patients with Castleman disease previously treated with chemotherapy, but we lack data on initial therapy with rituximab. This uncontrolled case series suggests that initial treatment with rituximab can achieve better overall and disease-free survival than that anticipated in untreated patients (overall and disease-free survival rates at 2 years were 95% and 79%, respectively). Laboratory measures of disease activity also improved with therapy. Because the study lacked a concurrent control group, we must wait for definitive assessment of the efficacy or safety of this therapy.
Ann Intern Med. 2007;147(12):836-839. doi:10.7326/0003-4819-147-12-200712180-00003
Suetonia C. Palmer, MBChB; David O. McGregor, PhD; Petra Macaskill, PhD; Jonathan C. Craig, PhD; Grahame J. Elder, PhD; Giovanni F.M. Strippoli, MD, MPH(Hons), MM
Most patients with advanced kidney disease take vitamin D compounds to prevent secondary hyperparathyroidism. Palmer and colleagues' meta-analysis of 76 randomized trials found no good evidence that vitamin D compounds reduced risk for death, bone pain, vascular calcification, or need for parathyroidectomy in patients with chronic kidney disease (CKD). Compared with placebo, older vitamin D sterols increased the risk for hypercalcemia and hyperphosphatemia, whereas newer vitamin D analogues increased the risk for hypercalcemia but not hyperphosphatemia. Direct comparisons between newer analogues and established agents found no advantage to newer drugs. Vitamin D compounds do not reduce adverse outcomes in CKD and might increase them.
Ann Intern Med. 2007;147(12):840-853. doi:10.7326/0003-4819-147-12-200712180-00004
U.S. Preventive Services Task Force
In this update to a previous recommendation, the U.S. Preventive Services Task Force recommends that clinicians not screen for asymptomatic carotid artery stenosis in the general adult population. This recommendation applies to adults without neurologic signs or symptoms or a history of transient ischemic attacks or stroke.
Ann Intern Med. 2007;147(12):854-859. doi:10.7326/0003-4819-147-12-200712180-00005
Tracy Wolff, MD, MPH; Janelle Guirguis-Blake, MD; Therese Miller, DrPH; Michael Gillespie, MD, MPH; Russell Harris, MD, MPH
This evidence update supports the U.S. Preventive Services Task Force recommendations on screening for carotid artery stenosis.
Ann Intern Med. 2007;147(12):860-870. doi:10.7326/0003-4819-147-12-200712180-00006
George F. Sawaya, MD; Janelle Guirguis-Blake, MD, MPH; Michael LeFevre, MD, MSPH; Russell Harris, MD, MPH; Diana Petitti, MD, MPH; for the U.S. Preventive Services Task Force
The major goal of the U.S. Preventive Services Task Force is to provide reliable and accurate evidence-based recommendations on a wide range of preventive services. In this article, the Task Force describes its current, updated process for evaluating evidence, determining the certainty and magnitude of net benefit, and assigning a final letter grade to recommendations.
Ann Intern Med. 2007;147(12):871-875. doi:10.7326/0003-4819-147-12-200712180-00007
Michael A. DeVita, MD; Arthur L. Caplan, PhD
The National Conference on Uniform State Laws modified the Uniform Anatomical Gift Act (2006) to prevent care at the end of life from precluding organ donation. The new language has the unintended consequence of giving higher priority to care of the potential donor organs than the dying person. The act has been revised, but many states have enacted the original version into law. DeVita and Caplan discuss the reason for updating the act; the ethical concerns involved; and the lessons to be learned from the failure to recognize an important and long-standing ethical boundary: the protected status of a physician's orders and a patient's wishes.
Ann Intern Med. 2007;147(12):876-879. doi:10.7326/0003-4819-147-12-200712180-00008
Marcello Tonelli, MD, SM
Palmer and colleagues' meta-analysis in this issue synthesizes data from 76 trials evaluating the clinical benefits of vitamin D supplementation in 3776 patients with CKD. The results will surprise many physicians who care for patients with CKD: The evidence does not support the current widespread use of vitamin D in CKD.
Ann Intern Med. 2007;147(12):880-881. doi:10.7326/0003-4819-147-12-200712180-00009
Ann Intern Med. 2007;147(12):882. doi:10.7326/0003-4819-147-12-200712180-00010
Ann Intern Med. 2007;147(12):882. doi:10.7326/0003-4819-147-12-200712180-00011
Ann Intern Med. 2007;147(12):882-883. doi:10.7326/0003-4819-147-12-200712180-00012
Ann Intern Med. 2007;147(12):883. doi:10.7326/0003-4819-147-12-200712180-00013
Ann Intern Med. 2007;147(12):883-884. doi:10.7326/0003-4819-147-12-200712180-00014
Ann Intern Med. 2007;147(12):884. doi:10.7326/0003-4819-147-12-200712180-00015
Ann Intern Med. 2007;147(12):884-885. doi:10.7326/0003-4819-147-12-200712180-00016
Ann Intern Med. 2007;147(12):885-887. doi:10.7326/0003-4819-147-12-200712180-00017
Ann Intern Med. 2007;147(12):887. doi:10.7326/0003-4819-147-12-200712180-00018
Jennifer Best, MD
Ann Intern Med. 2007;147(12):888. doi:10.7326/0003-4819-147-12-200712180-00019
Lawrence J. Hergott, MD
Ann Intern Med. 2007;147(12):896. doi:10.7326/0003-4819-147-12-200712180-00021
Ann Intern Med. 2007;147(12):889-895. doi:10.7326/0003-4819-147-12-200712180-00020
Ann Intern Med. 2007;147(12):I-36. doi:10.7326/0003-4819-147-12-200712180-00022
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