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Articles 
Thomas F. Imperiale, David R. Wagner, Ching Y. Lin, Gregory N. Larkin, James D. Rogge, and David F. Ransohoff A clinical prediction rule incorporating age, sex, and endoscopic findings within reach of a flexible sigmoidoscope identified a subgroup at very low risk for advanced neoplasia in the proximal colon. If the prediction rule consistently identifies a group at similarly low risk in other cohorts of patients, it could be the basis for selecting patients for endoscopic screening for colorectal cancer.
Leslie K. Dennis, Laura E. Beane Freeman, and Marta J. VanBeek Despite earlier reports that sunscreen use was associated with melanoma, the authors found no evidence in the published literature for this association. Previous studies that showed an association between sunscreen use and melanoma risk may have failed to control for factors that influence both sunscreen use and the risk for melanoma.
Charles A. Henrikson, Eric E. Howell, David E. Bush, J. Shawn Miles, Glenn R. Meininger, Tracy Friedlander, Andrew C. Bushnell, and Nisha Chandra-Strobos Contrary to common belief, relief of chest pain with nitroglycerin did not predict active coronary artery disease in patients admitted for acute chest pain.
Improving Patient Care
Lee Goldman and Ajay J. Kirtane The basis of this article is a patient who was sent home from the emergency department after presenting with chest pain. Later events proved that the patient had a myocardial infarction. The authors discuss the diagnosis and triage of patients presenting with acute chest pain or with symptoms consistent with possible cardiac ischemia.
Reviews
C. Daniel Meyers, Molly C. Carr, Sang Park, and John D. Brunzell No-flush niacin preparations that do not require a prescription for purchase do not contain any free nicotinic acid and are without value for treating dyslipidemia. Sustained-release niacin available without prescription does contain free nicotinic acid, but some brands are hepatotoxic. Immediate-release niacin contains free nicotinic acid and is the least expensive form of over-the-counter niacin.
Clinical Guidelines
Vincenza Snow, Kevin B. Weiss, Michael LeFevre, Robert McNamara, Eric Bass, Lee A. Green, Keith Michl, Douglas K. Owens, Jeffrey Susman, Deborah I. Allen, Christel Mottur-Pilson the Joint AAFP/ACP Panel on Atrial Fibrillation This paper summarizes the recommendations of the Joint Panel of the American Academy of Family Physicians and the American College of Physicians for managing a first episode of atrial fibrillation in adults.
Robert L. McNamara, Leonardo J. Tamariz, Jodi B. Segal, and Eric B. Bass This review, which supports the recommendations of the American Academy of Family Physicians and the American College of Physicians, summarizes the available evidence about the efficacy of medications used for ventricular rate control, stroke prevention, acute rhythm conversion, and maintenance of sinus rhythm. The review also discusses the efficacy of electrical cardioversion and the use of echocardiography in patients with atrial fibrillation.
Editorials
Sidney J. Winawer In this issue, Imperiale and colleagues take a systematic approach to examining clinical and flexible sigmoidoscopy findings that identify patients who have the lowest risk for advanced adenomas in the proximal colon. Their findings suggest a screening colonoscopy strategy that makes the best use of the test's high diagnostic accuracy and avoids exposure to its expense, inconvenience, and risk when the predicted yield is low. Whether this strategy will conserve resources remains to be determined.
Raymond J. Gibbons The study by Henrikson and colleagues in this issue is an important addition to the evidence on the diagnostic value of chest pain relief by nitroglycerin. The response to sublingual nitroglycerin had no diagnostic value in patients who developed chest pain (presumably at rest) under medical supervision after admission. Do these findings mean that we should stop using the response to nitroglycerin to help diagnose patients with chronic chest pain?
Christine Laine, Cynthia Mulrow for the Editors In this issue, Annals salutes the individuals who reviewed manuscripts over the past year. This editorial reflects on the value, quality, and future of peer review.
On Being a Doctor
Ted Louie In my second year of private practice, as the junior partner, I expected to be on call on Christmas. That was only fair, it seemed. But it didn't seem all that fair when Christmas Day actually came around. There I was, in the hospital, doing consultations and seemingly endless rounds, as the rest of the world enjoyed the day in the company of family and friends.
Louis D. Boshes It was early on Christmas Eve, 24 December 1943, and I was far away from home on duty at a U.S. Navy medical facility. I had always requested duty on holidays to cover for my medical buddies who were not of my own faith, and they did the same for me. My patients were a large group of 17-, 18-, and 19-year-old Marines fresh off Guadalcanal, where they had aged so rapidly in combat with enemies and tropical illnesses. They were truly ill, both physically and emotionally.
Letters Defibrillators and Sudden Death
Subacute Painful Quadriplegia and Purpura
A. M. Huisman, M. F. van der Meulen, T. W.M. Raaymakers, M. R. Canninga-van Dijk, J. W.J. Bijlsma, and A. Coremans Postmenopausal Hormones and Glycemic Effects
Acute Liver Failure in the United States
Culture of Tropheryma whippelii from the Vitreous Fluid of a Patient Presenting with Unilateral Uveitis
Michel Drancourt, Didier Raoult, Hubert Lépidi, Florence Fénollar, Marie-Laure Birg, Bahram Bodaghi, Phuc Le Hoang, and Jean-Daniel Lelièvre
Helen Chen
Paul E. Epstein
Rosanne M. Leipzig This Update focuses on a variety of topics in the field: disease prevention and health promotion, cognitive training, physical exercise, glaucoma prevention, cardiovascular disease, and late-life depression. | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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