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Research Letter 
Nathalie Moise, MD; Karina W. Davidson, PhD; William Chaplin, PhD; Steven Shea, MD, MS; Ian Kronish, MD, MPH
Depression is a known risk factor for poor prognosis among patients with cardiovascular disease.1 Numerous biological and behavioral mechanisms have been proposed.2 However, few studies have investigated the association between depression and “clinical inertia,” or lack of treatment intensification in individuals not at evidence-based goals for care.3 To address this ...
Viewpoint 
Scott A. Flanders, MD; Sanjay Saint, MD, MPH
Original Investigation 
Jane A. Gwira Baumblatt, MD; Caleb Wiedeman, MPH; John R. Dunn, DVM, PhD; William Schaffner, MD; Leonard J. Paulozzi, MD, MPH; Timothy F. Jones, MD

Importance  From January 1, 2003, through December 31, 2010, drug overdose deaths in Tennessee increased from 422 to 1059 per year. More of these deaths involved prescription opioids than heroin and cocaine combined.

Objective  To assess the contribution of certain opioid-prescribing patterns to the risk of ...

Original Investigation 
Wolfgang C. Winkelmayer, MD, ScD; Aya A. Mitani, MPH; Benjamin A. Goldstein, PhD; M. Alan Brookhart, PhD; Glenn M. Chertow, MD, MPH
Includes: Supplemental Content

Importance  Anemia is common in patients with advanced chronic kidney disease. Whereas the treatment of anemia in patients with end-stage renal disease (ESRD) has attracted considerable attention, relatively little is known about patterns and trends in the anemia care received by patients before they start maintenance dialysis ...

Research Letter 
Christopher M. Jones, PharmD, MPH; Leonard J. Paulozzi, MD, MPH; Karin A. Mack, PhD
The health consequences of nonmedical use of prescription opioid pain relievers, such as oxycodone and hydrocodone, are significant.1 The commonly cited statistic that most nonmedical users obtain these medications from friends or family for free2 often serves as the basis for interventions focused on patients. This statistic, however, reflects sources ...
Topics: pain opioids
Research Letter 
Donal J. Sexton, MB; Scott Reule, MD; Craig Solid, PhD; Allan J. Collins, MD; Robert N. Foley, MB
Before the advent of effective antiviral therapy, AIDS was associated with extremely high mortality.1 Human immunodeficiency virus (HIV)–associated nephropathy (HIVAN) emerged as a common cause of progressive kidney disease in inadequately treated patients predominantly of African descent, characterized by an increasingly evident genetic predisposition.2,3
Invited Commentary 
Daniel W. Coyne, MD
Epoetin alfa, the first erythropoiesis-stimulating agent (ESA), was approved in 1989 for the treatment of anemia in patients with chronic kidney disease (CKD). By 1991, in dialysis, there were no longer patients requiring regular transfusions for severe anemia (eg, hemoglobin concentration, <7 g/dL [to convert to grams per liter, multiply ...
Challenges in Clinical Electrocardiography 
David F. Katz, MD; Paul D. Varosy, MD; Frederick A. Masoudi, MD, MSPH
A 60-year-old man was evaluated for recurrent syncope. He had a history of hepatitis C and hypothyroidism treated with levothyroxine. He was treated with methadone for opiate dependency. He had no history of cardiovascular disease. For 6 months he noted increasing urinary frequency and difficulty initiating urination. Over 1 month ...
Challenges in Clinical Electrocardiography 
Topics: syncope
Challenges in Clinical Electrocardiography 
Apurva O. Badheka, MD; Peeyush M. Grover, MD; Tanyanan Tanawuttiwat, MD; Amit Badiye, MD; George R. Marzouka, MD; Nileshkumar J. Patel, MD; Sandra V. Chaparro, MD; Raul D. Mitrani, MD
A 74-year-old man with a history of heart transplant presented with altered mental status. On admission, his blood pressure was 96/63 mm Hg and his heart rate was 72/min. On examination, he was in no immediate distress and had clear lung fields. There were no gallops on examination, and he ...
Challenges in Clinical Electrocardiography 
Original Investigation  FREE
Martin J. O’Donnell, MB, PhD; Jiming Fang, MSc, PhD; Cami D’Uva, MSc; Gustavo Saposnik, MD; Linda Gould; Emer McGrath, MB; Moira K. Kapral, MD, MSc; for the Investigators of the Registry of the Canadian Stroke Network

Background We sought to develop and validate a simple clinical prediction rule for death and severe disability after acute ischemic stroke that can be used by general clinicians at the time of hospital admission.

Methods We analyzed data from a registry of 9847 patients (4943 in the derivation ...

Original Investigation  FREE
Sengwee Toh, ScD; Marsha E. Reichman, PhD; Monika Houstoun, PharmD; Mary Ross Southworth, PharmD; Xiao Ding, PhD; Adrian F. Hernandez, MD; Mark Levenson, PhD; Lingling Li, PhD; Carolyn McCloskey, MD, MPH; Azadeh Shoaibi, MS, MHS; Eileen Wu, PharmD; Gwen Zornberg, MD, MS, ScD; Sean Hennessy, PharmD, PhD
Includes: Supplemental Content

Background Although certain drugs that target the renin-angiotensin-aldosterone system are linked to an increased risk for angioedema, data on their absolute and comparative risks are limited to the use of most drugs that target the system. We assessed the risk for angioedema associated with the use of angiotensin-converting ...

Original Investigation  FREE
Kishore M. Gadde, MD; Mariko F. Kopping, MS, RD; H. Ryan Wagner, PhD; Gretchen M. Yonish, MPH, RD; David B. Allison, PhD; George A. Bray, MD
Includes: Supplemental Content

Background Obese individuals who have failed to achieve adequate weight loss with lifestyle changes have limited nonsurgical therapeutic options. We evaluated the efficacy and tolerability of zonisamide, an antiepileptic drug, for enhancing weight loss in obese patients receiving diet and lifestyle guidance.

Methods This was a 1-year, randomized, ...

Challenges in Clinical Electrocardiography 
Mary Fredrickson, MD; Yader Sandoval, MD; Woubeshet Ayenew, MD
A 60-year-old man with no known medical history was admitted to our emergency department following an episode of syncope. The patient was at work when he suddenly developed tunnel vision and lightheadedness followed by loss of consciousness for 10 seconds. There was no chest pain, shortness of breath, or palpitations. ...
Challenges in Clinical Electrocardiography 
Challenges in Clinical Electrocardiography 
This ECG shows ST-segment elevations in leads aVR, V1, V2, and aVL (where the ST-segment elevation appears to be of a lesser degree given the low voltage of the QRS complexes in that lead). There are scooped ST depressions in leads II, III, aVF, and V4-V6. PR-segment depression and a ...
Editor's Note 
Deborah Grady, MD, MPH
I was attending in our general medical practice last week when one of our usually bright, cheerful, energetic residents dragged himself into the attending office looking as if he had lost his last friend. When I asked him what was wrong, he said, “Oh nothing, I just have an upper ...

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