Depression is common in patients with heart failure. In a multicenter, randomized trial that involved 2322 patients with heart failure, Blumenthal and colleagues assessed the effect of aerobic exercise training—consisting of 3 months of supervised exercise followed by home exercise—on depressive symptoms and a composite outcome of death or hospitalization. The authors report that compared with guideline-based usual care, exercise training was associated with a moderate reduction in depressive symptoms and better clinical outcomes.
Article AND AUTHOR AUDIO INTERVIEW
The safety and durability of endoscopic vein graft harvesting (EVH)—an alternative to incision-based open-vein graft harvesting—in coronary artery bypass graft (CABG) surgery has been called into question. Williams and colleagues compared long-term outcomes following the 2 procedures in 235 394 Medicare patients who underwent CABG surgery between 2003 and 2008. In analyses that adjusted for clinical characteristics, the authors found no difference in mortality or a composite outcome of death, myocardial infarction, and revascularization among patients having EVH or open-vein harvesting. In an editorial, Dacey discusses the safety of EVH in contemporary CABG surgery.
Multiple colorectal adenomas may arise in individuals with mutations in the APC and MTUYH genes. In a cross-sectional study of 8676 unrelated individuals with multiple colorectal adenomas who had undergone genetic testing, Grover and colleagues found that APC and MUTYH mutation prevalence varied by adenoma count. APC mutations predominated among individuals with classic polyposis (≥100 adenomas), whereas the prevalence of APC and MUTYH mutations was similar among those with attenuated polyposis (20-99 adenomas). In an editorial, Roy and Khandekar discuss gene mutation analysis in familial adenomatous polyposis.
Visual impairment is a known risk factor for fractures. To examine the association of cataract surgery with subsequent fracture risk, Tseng and colleagues assessed 1-year fracture incidence in a 5% random sample (1.1 million) of Medicare beneficiaries with cataracts who did or did not undergo cataract surgery between 2002 and 2009. The authors report that compared with patients who did not undergo cataract surgery, those who did had a lower risk of hip fracture in the year after surgery.
Coburn and colleagues assessed the accuracy of clinical variables to predict bacteremia in immunocompetent adult patients in a systematic review and analysis of data from 35 studies (representing 4566 episodes of bacteremia and 25 946 negative blood culture episodes). Among the authors' findings was that neither isolated fever nor leukocytosis served as a useful predictor of bacteremia. Both the systemic inflammatory response syndrome and a multivariable decision rule that includes major and minor criteria were sensitive but not specific predictors of bacteremia.
Androgen-inhibiting therapies and other interventions may provide new options for treating men with prostate cancer.
Curbing the opioid epidemic
Potential consequences of competitive bidding in Medicare
Integrating public health and primary care
“Note time span is a new phenomenon in the EMR era. It manipulates time and transforms the traditional linear timeline of medical storytelling into a nonlinear one.” From “John Lennon's Elbow.”
Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
How would you manage a patient with probable nonalcoholic fatty liver disease? Read the case at www.jama.com and submit your response by August 5 for possible online posting.
Join Melanie A. Thompson, MD, and Paul A. Volberding, MD, Wednesday, August 15, from 2 to 3 PM eastern time to discuss updated recommendations for treatment of HIV infection. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about viral gastroenteritis.
This Week in JAMA. JAMA. 2012;308(5):427. doi:10.1001/jama.2012.3123