Faculty Bibliography

[Kofi Annan] and Dr. Peter Piot, executive director of the AIDS program, spoke as the General Assembly began a three-day meeting aimed at renewing the political commitment urged in 2001 and setting new goals for expenditures and for measuring progress in the battle against AIDS. The General Assembly also heard from Khensani Mavasa of South Africa, who became the first person known to be infected with HIV to address a plenary session about AIDS. Mavasa urged that the new declaration not be 'a document of empty promises,' but 'a platform for targets based on action.' Mavasa said that she had been raped and abused, and recommended setting a goal of ending violence against women. Describing her life as one 'under the power of men and the institutions they run,' she called for making condoms available to everyone and creating a culture that encourages their regular use

Outside of those countries which include Haiti, Cambodia, Kenya and Zimbabwe the number of new AIDS infections continues to rise or hover at its current pace. Meanwhile, public health efforts are reaching only a small proportion of people at risk, Dr. Peter Piot, the executive director of Unaids, said Tuesday. 'It's a very complex epidemic,' he said. 'We can no longer talk about AIDS' as a single epidemic but as many diverse ones. The progress against AIDS in some regions represents dividends from a surge in financing since 2001, when the United Nations pledged its commitment to stem the epidemic by 2010. That declaration called for countries to report regularly on their responses to AIDS. The report, the most comprehensive survey ever compiled from country data, pointed to the 2001 UN meeting as a turning point for AIDS financing. In 2005, the United States and the rest of the world spent $8.3 billion on AIDS, compared with $1.6 billion in 2001

Mr. [Kofi Annan] and Dr. Peter Piot, executive director of the AIDS program, spoke as the General Assembly began a three-day meeting aimed at renewing the political commitment urged in 2001 and setting new goals for expenditures and for measuring progress in the battle against AIDS. The General Assembly also heard from Khensani Mavasa of South Africa, who became the first person known to be infected with H.I.V. to address a plenary session about AIDS. Such sessions are normally reserved for United Nations officials and delegates from member countries. Khensani Mavasa of South Africa, addressing the United Nations yesterday, called for making condoms available to all to fight AIDS. (Photo by Stuart Ramson/Associated Press)

BACKGROUND:Coronary artery calcium (CAC) scanning is being increasingly used for cardiac risk assessment in asymptomatic patients, particularly in those with a Framingham 10-year risk of 10% to 20%. Physician awareness of this technology and its appropriate uses and limitations is crucial to appropriate use. METHODS:With the goal of establishing clinical paradigms, this document integrates the results of key published articles, Framingham Risk Score, National Cholesterol Education Program Adult Treatment Plan III guidelines, American College of Cardiology/American Heart Association exercise testing and angiographic guidelines, and the authors' extensive clinical experience. RESULTS:Coronary artery calcium scanning is best used in the asymptomatic population with a 10% to 20% risk of cardiac events over 10 years, with selected application in higher and lower risk categories. In the 10%-20% risk patient, coronary artery calcium scores >100 or >75th percentile for age and sex transform the moderately high-risk patient to higher risk status with the attendant recommendation for more aggressive therapy; scores from 11 to 100 and <75th percentile are consistent with the 10%-20% 10-year risk status and scores from 0 to 10 and <75th percentile convert the patient to lesser risk categories. If stress testing is planned in the asymptomatic patient, it should be preceded by coronary artery calcium scanning and performed only for scores >400; it should always precede coronary angiography in these patients. CONCLUSIONS:Coronary artery calcium scanning is an important risk assessment tool with direct clinical applications; it is of particular utility in the Framingham 10%-20% 10-year risk population.

Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties including residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources.

OBJECTIVES: We performed a meta-analysis of prognostic studies of patients with a Brugada ECG to assess predictors of events. BACKGROUND: The Brugada syndrome is an increasingly recognized cause of idiopathic ventricular fibrillation; however, there is wide variation in the prognosis of patients with the Brugada ECG. METHODS AND RESULTS: We retrieved 30 prospective studies of patients with the Brugada ECG, accumulating data on 1,545 patients. Summary estimates of the relative risk (RR) of events (sudden cardiac death [SCD], syncope, or internal defibrillator shock) for a variety of potential predictors were made using a random-effects model. The overall event rate at an average of 32 months follow-up was 10.0% (95% CI 8.5%, 11.5%). The RR of an event was increased (P < 0.001) among patients with a history of syncope or SCD (RR 3.24 [95% CI 2.13, 4.93]), men compared with women (RR 3.47 [95% CI 1.58, 7.63]), and patients with a spontaneous compared with sodium-channel blocker induced Type I Brugada ECG (RR 4.65 [95% CI 2.25, 9.58]). The RR of events was not significantly increased in patients with a family history of SCD (P = 0.97) or a mutation of the SCN5A gene (P = 0.18). The RR of events was also not significantly increased in patients inducible compared with noninducible by electrophysiologic study (EPS) (RR 1.88 [95% CI 0.62, 5.73], P = 0.27); however, there was significant heterogeneity of the studies included. CONCLUSIONS: Our findings suggest that a history of syncope or SCD, the presence of a spontaneous Type I Brugada ECG, and male gender predict a more malignant natural history. Our findings do not support the use of a family history of SCD, the presence of an SCN5A gene mutation, or EPS to guide the management of patients with a Brugada ECG

PURPOSE/OBJECTIVE:Ways to predict the risk of cardiovascular (CV) events or all-cause mortality have largely been derived from populations in which old and very old subjects were underrepresented. We set out to estimate the incremental prognostic utility of inflammation and atherosclerosis markers in the prediction of all-cause and CV mortality in elderly men. METHODS:In a prospective population-based cohort study, conventional CV risk factors were documented in 403 independently living elderly men. C-reactive protein (CRP) and interleukin (IL)-6 levels were measured. Carotid plaques were assessed by ultrasound. Analyses were performed with proportional hazards analyses, and bootstrapping was used for internal validation. Main outcome was CV and all-cause mortality occurring during 4 years of follow-up. RESULTS:Increasing tertiles of CRP, IL-6, and number of plaques were independently associated with all-cause and CV mortality. With information on age, carotid plaques, IL-6, and CRP yielded good discriminatory power for all-cause and CV mortality: area under the receiver operating characteristic curve (95% confidence interval), 0.76 (0.70-0.82) and 0.74 (0.68-0.80), respectively. Combined use of only IL-6 and plaque burden allowed identification of subjects with low and high mortality risk. The Framingham PROCAM and a Dutch Risk Function poorly predicted mortality risk, similar or worse than a model using age alone. CONCLUSION/CONCLUSIONS:In the old and very old, IL-6 and number of carotid plaques are powerful predictors of mortality risk in the years to come. Conventional risk scores seem to perform unsatisfactorily.

Many doctors like to criticize drug salespeople for over-promoting their products. But most of the drug reps the author knows are polite, well-meaning professionals who bring his attention to medications he might otherwise not consider. Many times drug reps have shown him information about their products that have helped him decide what to prescribe. Drug salespeople are a strong part of the chain that brings the latest technology to doctors and thereby to patients