Issues

Andrea Trombetti, MD; Mélany Hars, PhD; Fang-Chi Hsu, PhD; Kieran F. Reid, PhD; Timothy S. Church, MD, PhD; Thomas M. Gill, MD; Abby C. King, PhD; Christine K. Liu, MD; Todd M. Manini, PhD; Mary M. McDermott, MD; Anne B. Newman, MD; W. Jack Rejeski, PhD; Jack M. Guralnik, MD, PhD; Marco Pahor, MD; Roger A. Fielding, PhD; for the LIFE Study Investigators

Studies suggest that exercise-based interventions may improve physical functioning and prevent disability among frail older adults. This secondary analysis of a large multicenter randomized controlled trial involving sedentary older adults compared the effects of a structured physical activity program with those of health education on the risk for frailty. The authors also examined whether the participants' baseline frailty status modified the positive effects of the physical activity intervention on reducing major mobility disability.

Ann Intern Med. 2018;168(5):309-316. doi:10.7326/M16-2011

Malin Hultcrantz, MD, PhD; Magnus Björkholm, MD, PhD; Paul W. Dickman, MSc, PhD; Ola Landgren, MD, PhD; Åsa R. Derolf, MD, PhD; Sigurdur Y. Kristinsson, MD, PhD; Therese M.L. Andersson, MSc, PhD

Patients with myeloproliferative neoplasms (MPNs) have been reported to be at increased risk for thrombotic events, but no population-based study has estimated this excess risk compared with matched control participants. In this cohort study, the authors analyzed data on patients reported to the Swedish Cancer Register between 1987 and 2009 to assess risk for arterial and venous thrombosis among those with MPNs compared with matched control participants.

Ann Intern Med. 2018;168(5):317-325. doi:10.7326/M17-0028

Per E. Lønning, MD, PhD; Elisabet O. Berge, PhD; Merete Bjørnslett, PhD; Laura Minsaas, PhD; Ranjan Chrisanthar, PhD; Hildegunn Høberg-Vetti, MD; Cécile Dulary, MSc; Florence Busato, MSc; Silje Bjørneklett, MSc; Christine Eriksen, MSc; Reidun Kopperud, PhD; Ulrika Axcrona, MD; Ben Davidson, MD, PhD; Line Bjørge, MD, PhD; Gareth Evans, MD, PhD; Anthony Howell, MD, PhD; Helga B. Salvesen, MD, PhD; Imre Janszky, MD, PhD; Kristian Hveem, MD, PhD; Pål R. Romundstad, PhD; Lars J. Vatten, MD, PhD; Jörg Tost, PhD; Anne Dørum, MD, PhD; Stian Knappskog, PhD

Women who carry germline BRCA1 mutations have an increased risk for ovarian cancer, particularly the high-grade serous type. The authors conducted 2 large case–control studies to examine the association between normal tissue BRCA1 methylation and the risk for ovarian cancer overall as well as for high-grade serous ovarian cancer, low-grade serous ovarian cancer, and nonserous ovarian cancer.

Ann Intern Med. 2018;168(5):326-334. doi:10.7326/M17-0101

Rahman Shah, MD; Mannu Nayyar, MD; Ion S. Jovin, MD, ScD; Abdul Rashid, MD; Beatrix R. Bondy, MD; Tai-Hwang M. Fan, MD, PhD; Michael P. Flaherty, MD, PhD; Sunil V. Rao, MD

This meta-analysis of recent landmark trials examines the benefits and harms of percutaneous closure of patent foramen ovale compared with medical therapy alone in patients with cryptogenic stroke.

Ann Intern Med. 2018;168(5):335-342. doi:10.7326/M17-2679

Salvatore De Rosa, MD, PhD; Horst Sievert, MD; Jolanda Sabatino, MD; Alberto Polimeni, MD; Sabato Sorrentino, MD, PhD; Ciro Indolfi, MD

This meta-analysis of recent landmark trials examined the benefits and harms of percutaneous closure of patent foramen ovale compared with medical therapy alone in patients with cryptogenic stroke.

Ann Intern Med. 2018;168(5):343-350. doi:10.7326/M17-3033

Robert M. Carey, MD; Paul K. Whelton, MB, MD, MSc; for the 2017 ACC/AHA Hypertension Guideline Writing Committee

In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released the guideline for the prevention, detection, evaluation, and treatment of high blood pressure in adults. This synopsis summarizes the major recommendations from the guideline.

Ann Intern Med. 2018;168(5):351-358. doi:10.7326/M17-3203

Robert M. Carey, MD; Paul K. Whelton, MB, MD, MSc

The 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults is the first comprehensive clinical practice guideline for hypertension since the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) in 2003. This commentary discusses the 4 ACC/AHA recommendations that differ substantially from those in JNC 7.

Ann Intern Med. 2018;168(5):359-360. doi:10.7326/M18-0025

Rebecca T. Brown, MD, MPH; Kenneth E. Covinsky, MD, MPH

Trombetti and colleagues' secondary analysis of a large multicenter randomized controlled trial compared the effects of a structured physical activity program versus health education on the risk for frailty among sedentary older adults. The editorialists discuss the study's findings and implications.

Ann Intern Med. 2018;168(5):361-362. doi:10.7326/M17-3048

Alison R. Moliterno, MD; Elizabeth V. Ratchford, MD

Hultcrantz and colleagues' study examined thrombosis patterns in Swedish patients with MPNs diagnosed between 1987 and 2009 compared with matched control participants. The editorialists discuss the implications of the study's findings and highlight the keys to a personalized, precision medicine approach to primary and secondary thrombosis prevention for patients with MPNs.

Ann Intern Med. 2018;168(5):363-364. doi:10.7326/M17-3153

Alexander Dobrovic, PhD

Lønning and colleagues reported substantially increased BRCA1 promoter region methylation in patients with ovarian cancer relative to a control population in 2 independent case–control studies. The editorialist believes that this and previous studies make it clear that BRCA1 constitutional methylation is strongly associated with the same tumor types as BRCA1 mutation. Thus, it may be seen as an alternate mechanism of BRCA1 inactivation, leading to an increased risk for breast or ovarian cancer in which tumors are methylated for BRCA1.

Ann Intern Med. 2018;168(5):365-366. doi:10.7326/M17-3340

William G. Kussmaul III, MD

Two meta-analyses in this issue make a case that the totality of available data favors patent foramen ovale closure to prevent recurrent stroke in patients who, after work-up, are found to have patent foramen ovale and no other apparent cause of stroke. The editorialist discusses the findings and how they should be incorporated into clinical practice.

Ann Intern Med. 2018;168(5):367-368. doi:10.7326/M18-0024

Timothy J. Wilt, MD, MPH; Devan Kansagara, MD, MCR; Amir Qaseem, MD, PhD; for the Clinical Guidelines Committee of the American College of Physicians

The recent hypertension guideline from the ACC/AHA raises important questions about hypertension diagnosis and treatment but differs substantially from guidelines issued by other organizations. The editorialists discuss the ways in which the guideline falls short in weighing the potential benefits against potential harms, costs, and anticipated variation in individual patient preferences, specifically for adults older than 60 years.

Ann Intern Med. 2018;168(5):369-370. doi:10.7326/M17-3293

Theresa E. Vettese, MD

After spending so much time with people at the end of their lives, many of us grow to feel that there are worse things to fear than death itself—mainly suffering through the dying process.

Ann Intern Med. 2018;168(5):371-372. doi:10.7326/M17-1662

Ann Intern Med. 2018;168(5):375-376. doi:10.7326/M17-1758

Ann Intern Med. 2018;168(5):376-379. doi:10.7326/M17-2485

Ann Intern Med. 2018;168(5):379-380. doi:10.7326/L17-0687

Ann Intern Med. 2018;168(5):380. doi:10.7326/L17-0688

Ann Intern Med. 2018;168(5):380-381. doi:10.7326/L17-0689

Ann Intern Med. 2018;168(5):381-382. doi:10.7326/L17-0624

Ann Intern Med. 2018;168(5):381-382. doi:10.7326/L17-0626

Ann Intern Med. 2018;168(5):382. doi:10.7326/L17-0625

Ann Intern Med. 2018;168(5):382-383. doi:10.7326/L17-0699

Ann Intern Med. 2018;168(5):383-384. doi:10.7326/L17-0700

Ann Intern Med. 2018;168(5):384. doi:10.7326/L18-0061

C. Scott Williams, MD

Ann Intern Med. 2018;168(5):373-374. doi:10.7326/M17-1915

Meredith L. Clements, PhD

Ann Intern Med. 2018;168(5):373-374. doi:10.7326/M17-2270

Keith M. Swetz, MD, MA; Arif H. Kamal, MD, MBA, MHS

Ann Intern Med. 2018;168(5):ITC33-ITC48. doi:10.7326/AITC201803060

Darren B. Taichman, MD, PhD

Ann Intern Med. 2018;168(5):ED5. doi:10.7326/AFED201803060

William J. Doan, BA, MFA, PhD

The author/artist imagines what depression looks like inside himself and wonders, "Is this the black dog of depression I've read about?"

Ann Intern Med. 2018;168(5):W9-W17. doi:10.7326/G17-0016

Ann Intern Med. 2018;168(5):I-22. doi:10.7326/P17-9052