Table of Contents

March 2, 2010; 152 (5)

Articles

  • Cardiovascular Screening in College Athletes With and Without Electrocardiography: A Cross-sectional Study

    • Aaron L. Baggish,
    • Adolph M. Hutter, Jr.,
    • Francis Wang,
    • Kibar Yared,
    • Rory B. Weiner,
    • Eli Kupperman,
    • Michael H. Picard,
    • and Malissa J. Wood
    Ann Intern Med March 2, 2010 152:269-275; doi:10.1059/0003-4819-152-5-201003020-00004

    Some experts recommend cardiovascular screening before participating in sports, but screening may not include electrocardiography (ECG). In this study, 11 of 510 college athletes had potentially risky cardiac abnormalities detected with echocardiography. Adding ECG to history and physical examination increased identification of athletes with these abnormalities from 5 to 10 but also increased the false-positive result rate from 5.5% to 16.9%. The decision to include ECG in screening must balance improved sensitivity with increased false-positive results that might lead to further testing or unnecessary exclusion of healthy persons from athletic participation.

  • Cost-Effectiveness of Preparticipation Screening for Prevention of Sudden Cardiac Death in Young Athletes

    • Matthew T. Wheeler,
    • Paul A. Heidenreich,
    • Victor F. Froelicher,
    • Mark A. Hlatky,
    • and Euan A. Ashley
    Ann Intern Med March 2, 2010 152:276-286; doi:10.1059/0003-4819-152-5-201003020-00005

    Inclusion of ECG in the screening of young athletes is controversial because of concerns about cost-effectiveness. This analysis estimated that, compared with screening with history and physical examination alone, adding ECG to the routine screening of high school and college competitive athletes saves 2.06 life-years per 1000 athletes screened at a cost of $42 000 per life-year saved. The addition of ECG seemed to remain cost-effective in a range of sensitivity analyses.

  • Association of Leg-Length Inequality With Knee Osteoarthritis: A Cohort Study

    • William F. Harvey,
    • Mei Yang,
    • Theodore D.V. Cooke,
    • Neil A. Segal,
    • Nancy Lane,
    • Cora E. Lewis,
    • and David T. Felson
    Ann Intern Med March 2, 2010 152:287-295; doi:10.1059/0003-4819-152-5-201003020-00006

    Unequal leg length is common and may play a role in a variety of musculoskeletal conditions, including knee osteoarthritis. This prospective study used radiography to evaluate leg length in 3026 adults aged 50 to 79 years with or at high risk for knee osteoarthritis. Leg-length inequality of 1 cm or more was associated with prevalent, incident, symptomatic, and progressive knee osteoarthritis that was strongest in the shorter leg. Future studies should evaluate whether leg-length inequality is a modifiable risk factor for knee osteoarthritis.

  • Brief Communication: Management of Implantable Cardioverter-Defibrillators in Hospice: A Nationwide Survey

    • Nathan Goldstein,
    • Melissa Carlson,
    • Elayne Livote,
    • and Jean S. Kutner
    Ann Intern Med March 2, 2010 152:296-299; doi:10.1059/0003-4819-152-5-201003020-00007

    Patients with implantable cardioverter-defibrillators (ICDs) are being admitted to hospice care, but little is known about how these patients are managed. Findings from this large nationwide survey of hospices were that 97% admitted patients with ICDs and 58% reported that at least 1 patient had been shocked in the past year. Only 10% had a policy that addressed deactivation. Among patients with ICDs, 42% had the shocking function deactivated.

Reviews

  • Narrative Review: Thrombocytosis, Polycythemia Vera, and JAK2 Mutations: The Phenotypic Mimicry of Chronic Myeloproliferation

    • Jerry L. Spivak
    Ann Intern Med March 2, 2010 152:300-306; doi:10.1059/0003-4819-152-5-201003020-00008

    Polycythemia vera, essential thrombocytosis, and primary myelofibrosis are hematopoietic stem-cell disorders characterized by clonal dominance and unregulated increase in circulating erythrocytes, leukocytes, or platelets alone or in combination. An activating mutation (V617F) in the gene for JAK2 (Janus kinase 2) may explain the shared clinical features of these 3 disorders. Polycythemia vera is the potential ultimate clinical phenotype of the JAK2 V617F mutation and, as a corollary, is the most common of the 3 disorders.

  • Systematic Review: Vitamin D and Cardiometabolic Outcomes

    • Anastassios G. Pittas,
    • Mei Chung,
    • Thomas Trikalinos,
    • Joanna Mitri,
    • Michael Brendel,
    • Kamal Patel,
    • Alice H. Lichtenstein,
    • Joseph Lau,
    • and Ethan M. Balk
    Ann Intern Med March 2, 2010 152:307-314; doi:10.1059/0003-4819-152-5-201003020-00009

    Vitamin D may modify risk for such cardiometabolic outcomes as type 2 diabetes, hypertension, or cardiovascular disease (CVD). This review found cohort studies in healthy adults that reported that lower vitamin D status was associated with increased risk for hypertension and possibly CVD. Data regarding associations with diabetes were unclear. Trials thus far show no consistent, statistically significant effect of vitamin D supplementation on blood pressure or glycemic or cardiovascular outcomes.

  • Systematic Review: Vitamin D and Calcium Supplementation in Prevention of Cardiovascular Events

    • Lu Wang,
    • JoAnn E. Manson,
    • Yiqing Song,
    • and Howard D. Sesso
    Ann Intern Med March 2, 2010 152:315-323; doi:10.1059/0003-4819-152-5-201003020-00010

    Vitamin D and calcium may affect the cardiovascular system independently and interactively. This review reports that some prospective studies and randomized, controlled trials suggest reductions in CVD risk among adults who receive vitamin D supplements, but studies show little to no difference in risk between recipients and nonrecipients of calcium supplements or between recipients of combined supplementation (vitamin D plus calcium) and placebo.

Editorials

  • National Electrocardiography Screening for Competitive Athletes: Feasible in the United States?

    • Barry J. Maron
    Ann Intern Med March 2, 2010 152:324-326; doi:10.1059/0003-4819-152-5-201003020-00012

    Two articles in this issue offer much-needed data on presport screening with ECG. In a study of 510 college student–athletes, Baggish and colleagues report that screening with ECG enhanced sensitivity and negative predictive accuracy (compared with history and physical examination alone) for detection of cardiovascular abnormalities but had a high rate of false-positive results. In a detailed economic analysis, Wheeler and coworkers present a construct supporting the cost-efficacy of ECG in screening athletes for CVD. However, the feasibility of routine ECG screening in the United States remains uncertain.

  • Vitamin D Supplementation in the Age of Lost Innocence

    • Eliseo Guallar,
    • Edgar R. Miller III,
    • Jose M. Ordovas,
    • and Saverio Stranges
    Ann Intern Med March 2, 2010 152:327-329; doi:10.1059/0003-4819-152-5-201003020-00013

    Two systematic reviews in this issue summarize the role of vitamin D in CVD and provide insight into the type of evidence that is needed to fully understand the effects of vitamin D. Pittas and colleagues reviewed the prospective observational studies on the association between vitamin D status and incident cardiometabolic outcomes. Wang and colleagues identified consistent inverse associations between vitamin D supplementation and CVD mortality in 6 prospective cohorts.

On Being a Doctor

  • In Transition

    • Albert K. Luo
    Ann Intern Med March 2, 2010 152:330-331; doi:10.1059/0003-4819-152-5-201003020-00014

    Somehow, it's fitting. She's the first cancer patient whom I worked up from scratch. She's also my last patient as a medical student. She presented like a textbook, which is what all students secretly hope for. But I'm hoping that she doesn't go like the textbooks say.

Letters

  • Justifying Different Levels of Palliative Sedation

    • Victor Cellarius and
    • Blair Henry
    Ann Intern Med March 2, 2010 152:332; doi:10.1059/0003-4819-152-5-201003020-00015

  • Justifying Different Levels of Palliative Sedation

    • Daniel P. Sulmasy,
    • Farr Curlin,
    • Gerard S. Brungardt,
    • and Thomas Cavanaugh
    Ann Intern Med March 2, 2010 152:332-333; doi:10.1059/0003-4819-152-5-201003020-00016

  • Justifying Different Levels of Palliative Sedation

    • Timothy E. Quill,
    • Daniel Brock,
    • Bernard Lo,
    • and Alan Meisel
    Ann Intern Med March 2, 2010 152:333; doi:10.1059/0003-4819-152-5-201003020-00017

  • Cost-Effectiveness of Biologics in Early Rheumatoid Arthritis

    • Axel Finckh,
    • Nick Bansback,
    • and Matthew H. Liang
    Ann Intern Med March 2, 2010 152:333-334; doi:10.1059/0003-4819-152-5-201003020-00018

  • Cost-Effectiveness of Biologics in Early Rheumatoid Arthritis

    • Maarten Boers
    Ann Intern Med March 2, 2010 152:334; doi:10.1059/0003-4819-152-5-201003020-00019

  • Long-Term Effects of Low-Carbohydrate Versus Low-Fat Diets in Obese Persons

    • Marion L. Vetter,
    • Nayyar Iqbal,
    • Cornelia Dalton-Bakes,
    • Sheri Volger,
    • and Thomas A. Wadden
    Ann Intern Med March 2, 2010 152:334-335; doi:10.1059/0003-4819-152-5-201003020-00020

  • Varenicline and Pheochromocytoma

    • Janne Hukkanen,
    • Olavi Ukkola,
    • and Neal L. Benowitz
    Ann Intern Med March 2, 2010 152:335-336; doi:10.1059/0003-4819-152-5-201003020-00021

Ad Libitum

  • November Rain

    • George N. Braman
    Ann Intern Med March 2, 2010 152:323; doi:10.1059/0003-4819-152-5-201003020-00011

Medical Notices

  • Medical Notices

    Ann Intern Med March 2, 2010 152:0; doi:10.1059/0003-4819-152-5-

Summaries for Patients

  • Adding Electrocardiography to Medical History and Physical Examination for Evaluation Before Sports Participation in College Athletes

    Ann Intern Med March 2, 2010 152:I-13; doi:10.1059/0003-4819-152-5-201003020-00001

  • Cost-Effectiveness of Different Types of Evaluations Before Sports Participation in Young Athletes

    Ann Intern Med March 2, 2010 152:I-40; doi:10.1059/0003-4819-152-5-201003020-00002

  • Unequal Leg Length and Knee Osteoarthritis

    Ann Intern Med March 2, 2010 152:I-46; doi:10.1059/0003-4819-152-5-201003020-00003

In the Clinic

  • Type 2 Diabetes

    • Sandeep Vijan
    Ann Intern Med March 2, 2010 152:ITC3-1; doi:10.1059/0003-4819-152-5-201003020-01003
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This Issue

March 2, 2010; 152 (5)
  1. Articles
  2. Reviews
  3. Editorials
  4. On Being a Doctor
  5. Letters
  6. Ad Libitum
  7. Medical Notices
  8. Summaries for Patients
  9. In the Clinic

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