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THE AMERICAN
JOURNAL of
MEDICINE �www.amjmed.comCONTENTS
The Green Journal August 2013 Volume 126/Number 8
Imaging for the Clinician
EDITORIALS657 “Can We All Get Along?” Cooperative Strategies
to Reduce Imaging Overuse
Robert G. Stern659 Tempus Fugit—Time Flies, Use It Wisely
Joseph S. Alpert661 The Future of Integrative Medicine
Victor S. Sierpina and James E. DalenCOMMENTARY663 Emerging Clinical Challenges in the Use of
Statins
Charles H. Hennekens, Nicolas R. Breuer,Ira J. Gelb, David J. Bjorkman, Jeffrey S. Borer,and Marc A. PfefferREVIEWS665 Treatment Trials for Post-Lyme Disease
Symptoms Revisited
Mark S. Klempner, Phillip J. Baker,Eugene D. Shapiro, Adriana Marques,Raymond J. Dattwyler, John J. Halperin, andGary P. WormserTreatment 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 Management
Timothy E. Paterick, Julie A. Humphries,Khawaja Afzal Ammar, M. Fuad Jan,Rachel Loberg, Michelle Bush,Bijoy K. Khandheria, and A. Jamil TajikAscending 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 STEMI
Stephen Rechenmacher, Daniel Jurewitz,Jeffrey Southard, and Ezra AmsterdamECG IMAGE OF THE MONTH682 Signs of Stress: Deep Symmetric T-wave
Inversions
Peter K. Moore, Lucas N. Marzec, andMori J. KrantzIMAGES IN RADIOLOGY685 Major Crush: a Solitary Fibrous Pleural
Tumor
Ami Schattner, Nadia Sokolovski, Edward Altman,and Meital AdiA11
CLINICAL RESEARCH STUDIES687 Impact of Provider-led, Technology-enabled
Radiology Management Program on Imaging
A12
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 withAtherosclerosis
Dharam 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 InvestigatorsNonadherence 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 Failure
Robert 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 AhmedDigoxin 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 Standard
Miguel 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-LlanosWhen 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-positivePatients
Emily McGibbon, Katherine Bornschlegel, andSharon BalterOne-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 ElectrocardiographicSubstudy
Paul W. Armstrong, Cynthia M. Westerhout,Yuling Fu, Robert A. Harrington,Robert F. Storey, Hugo Katus, Stefan James,and Lars WallentinThe 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.
AJM ONLINE
Please note that articles with an “e” pagedesignation are available only in the onlineversion of the Journal at www.amjmed.com.
REVIEW
730.e1 Caffeine Reduces Myocardial Blood FlowDuring Exercise
John P. Higgins and Kavita M. BabuCaffeine 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 DMARDs
Daniel 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. RassenElevated 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 Pain
Wassim Shatila and Alicia Clarke3 Eagle’s Syndrome
Christoph Becker and Jens Pfeiffere5 Plasma Dabigatran Activity One Week AfterDiscontinuation Despite Normal Renal Function
Jecko Thachil, Gill Pike, Lynne Keighley-Jones, andMichael J. Nashe7 Thyrotoxicosis and Neck Pain: Getting the RightTest at the Right Time
Shahid Aziz and Ali RizviLETTERS
e9 Tombstone ST Elevation Without MyocardialInfarction: A Variant of the “Spiked Helmet”Sign?
Laszlo Littmann and Michael H. Monroee11 The Reply
Faisal Latif, Muhammad A. Chaudhry, andZainab Omare13 Chronic Lyme Disease: Liberation from LymeDenialism
Raphael B. Stricker and Lorraine Johnsone15 Alternative Considerations for “CommonMisconceptions About Lyme Disease”
Alfred Millere17 The Reply
John J. Halperin, Phillip J. Baker, andGary P. Wormsere19 D-Dimers and Computed Tomography forPulmonary Embolism: When and How
Arie Markele21 Deep Venous Thrombosis Attributed toSleep Apnea
Nazia Naz S. Khan and M. Safwan Badre23 The Reply
Kun-Ta Chou and Hsin-Bang LeuA13
BRIEF OBSERVATIONS732 A Brief, Low-cost Intervention Improves the
Quality of Ambulatory GastroenterologyConsultation Notes
A14
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 Documentation
Brad Spellberg, Darrell Harrington, Susan Black,Darryl Sue, William Stringer, and Mallory WittAAIM PERSPECTIVES744 Yale-New Haven Hospital’s Planning
and Execution of a Complex HospitalAcquisition
Richard D’Aquila, William J. Aseltyne,Abe Lopman, Jillian Jweinat, Teresa Ciaccio, andMatthew J. ComerfordCLASSIFIED ADSB1 Positions available
