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JOURNAL ofMEDICINE �
The Green Journal August 2013 Volume 126/Number 8
Imaging for the Clinician
EDITORIALS657 “Can We All Get Along?” Cooperative Strategies
to Reduce Imaging OveruseRobert G. Stern
659 Tempus Fugit—Time Flies, Use It WiselyJoseph S. Alpert
661 The Future of Integrative MedicineVictor S. Sierpina and James E. Dalen
COMMENTARY663 Emerging Clinical Challenges in the Use of
StatinsCharles H. Hennekens, Nicolas R. Breuer,Ira J. Gelb, David J. Bjorkman, Jeffrey S. Borer,and Marc A. Pfeffer
REVIEWS665 Treatment Trials for Post-Lyme Disease
Symptoms RevisitedMark S. Klempner, Phillip J. Baker,Eugene D. Shapiro, Adriana Marques,Raymond J. Dattwyler, John J. Halperin, andGary P. Wormser
Treatment trials of patients with persistent,unexplained symptoms—despite previous anti-biotic treatment for Lyme disease—determinedthat retreatment provides little if any benefit andcarries significant risk.
670 Aortopathies: Etiologies, Genetics, DifferentialDiagnosis, Prognosis and ManagementTimothy E. Paterick, Julie A. Humphries,Khawaja Afzal Ammar, M. Fuad Jan,Rachel Loberg, Michelle Bush,Bijoy K. Khandheria, and A. Jamil Tajik
Ascending aortic aneurysm can be inheritedor sporadic, but different etiologies mayrepresent a disease spectrum rather thandiscrete entities.
DIAGNOSTIC DILEMMA679 Barking Up the Wrong Tree: Regional
Pericarditis Mimicking STEMIStephen Rechenmacher, Daniel Jurewitz,Jeffrey Southard, and Ezra Amsterdam
ECG IMAGE OF THE MONTH682 Signs of Stress: Deep Symmetric T-wave
InversionsPeter K. Moore, Lucas N. Marzec, andMori J. Krantz
IMAGES IN RADIOLOGY685 Major Crush: a Solitary Fibrous Pleural
TumorAmi Schattner, Nadia Sokolovski, Edward Altman,and Meital Adi
CLINICAL RESEARCH STUDIES687 Impact of Provider-led, Technology-enabled
Radiology Management Program on Imaging
Ivan K. Ip, Louise Schneider, Steven Seltzer,Allen Smith, Jessica Dudley, Andrew Menard, andRamin Khorasani
A provider-led radiology medical managementprogram enabled through health informationtechnology and accountability tools may pro-duce significant reduction in high-cost imagingutilization.
693 Adherence to Secondary Prevention Medicationsand Four-year Outcomes in Outpatients withAtherosclerosisDharam J. Kumbhani, Ph. Gabriel Steg,Christopher P. Cannon, Kim A. Eagle,Sidney C. Smith, Jr., Elaine Hoffman,Shinya Goto, E. Magnus Ohman, andDeepak L. Bhatt; on Behalf of the REductionof Atherothrombosis for Continued HealthRegistry Investigators
Nonadherence with evidence-based secondaryprevention therapies in patients with establishedatherothrombosis is associated with a signifi-cant increase in long-term adverse events,including mortality.
701 Digoxin Reduces 30-day All-cause HospitalAdmission in Older Patients with ChronicSystolic Heart FailureRobert C. Bourge, Jerome L. Fleg,Gregg C. Fonarow, John G. F. Cleland,John J. V. McMurray, Dirk J. van Veldhuisen,Mihai Gheorghiade, Kanan Patel,Inmaculada B. Aban, Richard M. Allman,Connie White-Williams, Michel White,Gerasimos S. Filippatos, Stefan D. Anker, andAli Ahmed
Digoxin reduces 30-day all-cause hospitaladmission in ambulatory older patients withchronic systolic heart failure.
709 Using High-sensitivity Troponin T: TheImportance of the Proper Gold StandardMiguel Santaló, Alfonso Martin, Joaquin Velilla,Juan Povar, Francisco Temboury, Jose Balaguer,Mar Muñoz, Pilar Calmarza, Carmen Ortiz,Arturo Carratalá, Ignacio Gich, Javier Mercé,Allan S. Jaffe, and Jordi Ordoñez-Llanos
When myocardial infarction is diagnosedusing hscTnT 99th percentile values with a 20%change, more are identified, diagnosis is delayedand the optimal value for use is reduced.
718 Half a Diagnosis: Gap in ConfirmingInfection among Hepatitis C Antibody-positivePatientsEmily McGibbon, Katherine Bornschlegel, andSharon Balter
One-third of HCV antibody-positive patientsdid not get the recommended RNA testingto determine HCV infection status. Oneapproach to this problem is for reflex HCVRNA testing for positive antibody tests tobecome routine, similar to the HIV testingprotocol.
723 Quantitative ST-depression in Acute CoronarySyndromes: the PLATO ElectrocardiographicSubstudyPaul W. Armstrong, Cynthia M. Westerhout,Yuling Fu, Robert A. Harrington,Robert F. Storey, Hugo Katus, Stefan James,and Lars Wallentin
The treatment effect of ticagrelor amongnon-ST-segment elevation acute coronarysyndrome patients was consistently expressedacross all baseline ST-segment depressionstrata. There was no indication of an anti-ischemic benefit of ticagrelor as reflected onthe discharge ECG.
Please note that articles with an “e” pagedesignation are available only in the onlineversion of the Journal at www.amjmed.com.
730.e1 Caffeine Reduces Myocardial Blood FlowDuring ExerciseJohn P. Higgins and Kavita M. Babu
Caffeine reduces myocardial blood flowduring exercise, at the very time whenincreased flow is required. Clinicallysignificant effects, including ischemia andarrhythmia, may occur when caffeine andexercise are combined.
CLINICAL RESEARCH STUDIES
730.e9 Cardiovascular Risk in RheumatoidArthritis: Comparing TNF-a Blockade withNonbiologic DMARDsDaniel H. Solomon, Jeffrey R. Curtis,Kenneth G. Saag, Joyce Lii, Lang Chen,Leslie R. Harrold, Lisa J. Herrinton,David J. Graham, Mary K. Kowal,Bindee Kuriya, Liyan Liu, Marie R. Griffin,James D. Lewis, and Jeremy A. Rassen
Elevated TNF-a likely contributes to theexcess cardiovascular risk observed inrheumatoid arthritis. The hazard ratio forcardiovascular events for rheumatoid ar-thritis patients using TNF-a blocking agentcompared with nbDMARD was reduced by20-29%, depending on the analysis.
730.e19 The IRAD Classification Systemfor Characterizing Survival after AorticDissection
Anna M. Booher, Eric M. Isselbacher,Christoph A. Nienaber, Santi Trimarchi,Arturo Evangelista, Daniel G. Montgomery,James B. Froehlich, Marek P. Ehrlich,Jae K. Oh, James L. Januzzi, Patrick O’Gara,Thoralf M. Sundt, Kevin M. Harris,Eduardo Bossone, Reed E. Pyeritz, andKim A. Eagle, IRAD Investigators
International Registry of Aortic Dissection(IRAD) Classification System can provideclinicians with a more robust method ofcharacterizing survival after aortic dissectionover time than previous methods. This systemwill be useful for treating patients, counselingpatients and families, and studying newdiagnostic and treatment methods.
CLINICAL COMMUNICATIONS TO THE EDITOR
e1 Unexplained Hypoxia in a Woman Presentingwith Acute on Chronic Abdominal PainWassim Shatila and Alicia Clark
e3 Eagle’s SyndromeChristoph Becker and Jens Pfeiffer
e5 Plasma Dabigatran Activity One Week AfterDiscontinuation Despite Normal Renal FunctionJecko Thachil, Gill Pike, Lynne Keighley-Jones, andMichael J. Nash
e7 Thyrotoxicosis and Neck Pain: Getting the RightTest at the Right TimeShahid Aziz and Ali Rizvi
e9 Tombstone ST Elevation Without MyocardialInfarction: A Variant of the “Spiked Helmet”Sign?Laszlo Littmann and Michael H. Monroe
e11 The ReplyFaisal Latif, Muhammad A. Chaudhry, andZainab Omar
e13 Chronic Lyme Disease: Liberation from LymeDenialismRaphael B. Stricker and Lorraine Johnson
e15 Alternative Considerations for “CommonMisconceptions About Lyme Disease”Alfred Miller
e17 The ReplyJohn J. Halperin, Phillip J. Baker, andGary P. Wormser
e19 D-Dimers and Computed Tomography forPulmonary Embolism: When and HowArie Markel
e21 Deep Venous Thrombosis Attributed toSleep ApneaNazia Naz S. Khan and M. Safwan Badr
e23 The ReplyKun-Ta Chou and Hsin-Bang Leu
BRIEF OBSERVATIONS732 A Brief, Low-cost Intervention Improves the
Quality of Ambulatory GastroenterologyConsultation Notes
Justin L. Sewell, Lukejohn W. Day,Delphine S. Tuot, Ricardo Alvarez, Albert Yu, andAlice Hm Chen
739 Capturing the Diagnosis: An Internal MedicineEducation Program to Improve DocumentationBrad Spellberg, Darrell Harrington, Susan Black,Darryl Sue, William Stringer, and Mallory Witt
AAIM PERSPECTIVES744 Yale-New Haven Hospital’s Planning
and Execution of a Complex HospitalAcquisitionRichard D’Aquila, William J. Aseltyne,Abe Lopman, Jillian Jweinat, Teresa Ciaccio, andMatthew J. Comerford
CLASSIFIED ADSB1 Positions available