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Articles 
David A. Ahlquist, Daniel J. Sargent, Charles L. Loprinzi, Theodore R. Levin, Douglas K. Rex, Dennis J. Ahnen, Kandice Knigge, M. Peter Lance, Lawrence J. Burgart, Stanley R. Hamilton, James E. Allison, Michael J. Lawson, Mary E. Devens, Jonathan J. Harrington, and Shauna L. Hillman Ahlquist and colleagues compared 2 stool DNA tests with fecal blood testing for detection of screen-relevant neoplasia in 4482 average-risk adults, using colonoscopy as the criterion standard. Stool DNA test 1 (SDT-1) provided no improvement over HemoccultSensa for detection of screen-relevant neoplasms, whereas SDT-2 detects significantly more neoplasms than does Hemoccult or HemoccultSensa but with more positive results in colonoscopically normal patients.
Robert E. Eckart, Michael E. Field, Tomasz W. Hruczkowski, Daniel E. Forman, Sharmila Dorbala, Marcelo F. Di Carli, Christine E. Albert, William H. Maisel, Laurence M. Epstein, and William G. Stevenson The prognostic value of exercise-induced ventricular arrhythmia (EIVA) is uncertain, and outcomes may depend on QRS morphology. Among 585 patients with and 2340 patients without EIVA who were matched by age, sex, and risk factor and underwent exercise testing, 5.3% and 1.8%, respectively, died over 24 months. However, only patients with right bundle-branch block morphology had a higher risk for death than those without EIVA.
Andrew W. Roddam, Naomi E. Allen, Paul Appleby, Timothy J. Key, Luigi Ferrucci, H. Ballentine Carter, E. Jeffrey Metter, Chu Chen, Noel S. Weiss, Annette Fitzpatrick, Ann W. Hsing, James V. Lacey, Jr, Kathy Helzlsouer, Sabina Rinaldi, Elio Riboli, Rudolf Kaaks, Joop A.M.J.L. Janssen, Mark F. Wildhagen, Fritz H. Schröder, Elizabeth A. Platz, Michael Pollak, Edward Giovannucci, Catherine Schaefer, Charles P. Quesenberry, Jr., Joseph H. Vogelman, Gianluca Severi, Dallas R. English, Graham G. Giles, Pär Stattin, Göran Hallmans, Mattias Johansson, June M. Chan, Peter Gann, Steven E. Oliver, Jeff M. Holly, Jenny Donovan, François Meyer, Isabelle Bairati, and Pilar Galan Insulin-like growth factors (IGFs) and IGF binding proteins may be associated with some types of cancer. In this patient-level reanalysis of 12 studies including 3700 men with prostate cancer and 5200 control participants, the association found between IGFs and IGF binding proteins and prostate cancer suggests that higher levels of serum IGF-I are associated with higher risk for prostate cancer.
Improving Patient Care
Stephen B. Kritchevsky, Barbara I. Braun, Andrew J. Bush, Michele R. Bozikis, Linda Kusek, John P. Burke, Edward S. Wong, John Jernigan, Cralen C. Davis, Bryan Simmons for the TRAPE Study Group Kritchevsky and coworkers assessed the effect of a quality improvement collaborative versus receipt of only a feedback report to improve prophylaxis of surgery-related infection. The 44 U.S. acute care hospitals that participated each randomly sampled approximately 100 selected surgical cases to evaluate whether and when patients received prophylaxis. The groups did not differ in the change in proportion of patients who received a properly timed antimicrobial prophylaxis dose or in individual measures of antibiotic duration.
Reviews
Madeleine Verhovsek, James D. Douketis, Qilong Yi, Sanjay Shrivastava, R. Campbell Tait, Trevor Baglin, Daniela Poli, and Wendy Lim A test to identify persons at low risk for recurrent venous thromboembolism (VTE) could help with the decision to continue or stop anticoagulant treatment. This systematic review identified 7 studies that measured D-dimer 3 to 6 weeks after stopping treatment for a first unprovoked VTE. Recurrence rates within approximately 2 years were 8.9% and 3.5% in patients with a positive and negative D-dimer test result, respectively.
Clinical Guidelines
U.S. Preventive Services Task Force The U.S. Preventive Services Task Force (USPSTF) has issued a new statement on recommendations about behavioral counseling of adolescents and adults to prevent sexuallytransmitted infections (STIs). They recommend high-intensity behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs (B recommendation). Current evidence is insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non–sexually active adolescents and in adults not at increased risk for STIs (I statement).
Jennifer S. Lin, Evelyn Whitlock, Elizabeth O'Connor, and Vance Bauer To support the USPSTF recommendation in this issue, Lin and colleagues found good-quality evidence from 17 studies suggesting that behavioral counseling interventions with multiple sessions conducted in STI clinics and primary care effectively reduce STI incidence in at-risk adult and adolescent populations. Additional trial evidence is needed for lower-intensity behavioral counseling interventions and lower-risk patient populations.
Editorials
Daniel C. Chung A noninvasive test that preselects individuals who are likely to have advanced adenomas or cancer for subsequent colonoscopy is a worthy goal. Ahlquist and colleagues' study in this issue provides exciting evidence that such an approach may be possible. In time, a few strands of DNA may be all it takes to deliver an ounce of prevention.
On Being a Doctor
Ariel Frank Green
Letters Will Recommendations against Spirometry Make Chronic Obstructive Pulmonary Disease Harder to Treat?
Did Prescription Bias Affect Outcomes in a Study of the Relative Effectiveness of Osteoporosis Drugs?
The Effects of Race, Ethnicity, and Underlying Medical Diseases on Osteoporosis Are Still Unguided Territory for Internists
Symptomatic Hepatitis Associated with the Use of Herbal Red Yeast Rice
Right-Sided Native Valve Endocarditis Revealing Adult-Onset Still Disease
Alain Saraux, Aymeric Binard, Valérie Devauchelle-Pensec, Yannick Jobic, and Sandrine Jousse-Joulin Correction: Using Standarized Serum Creatinine Values in the Modification of Diet in Renal Disease Study Equation for Estimating Glomerular Filtration Rate
Correction: Is There Enough Evidence to Support Use of N-Acetylcysteine in Contrast-Induced Nephropathy?
Correction: Trial by Fire: In Memoriam
Michael K. Gusmano
Wayne B. Jonas
C. Scott Williams
George N. Braman
This issue provides a clinical overview of obesity, focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. | |||||||||||||||||||||||||||||||||||||||||||||
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