Faculty Bibliography

Leading cardiologists compared the differences in care for [Dick Cheney] with that of that another national figure, President Dwight Eisenhower, after his serious heart attack in 1955 at age 64. Cheney, 60, returned to work soon after two brief hospitalizations since November. [Christopher Cannon] showed that in November, Cheney's score was high, 5 out of 7, for developing fatal and nonfatal heart problems in the future. When Cheney came back to the hospital with chest pains in March, his score improved a notch, to 4 out of 7, because in that instance blood- enzyme tests did not show evidence of a heart attack, Cannon said. Also, Cheney would have heard evidence that challenges a long- held belief about heart attacks. The belief has been that most heart attacks occur when a blood clot forms on a coronary artery that has become nearly completely closed by fatty deposits known as plaques. The clot stops blood flow, leading to the death of heart muscle cells. Not much emphasis was given to cellular activity within the plaque

Today, Swedish researchers are reporting the first evidence from a rigorously controlled study that a beta blocker drug can slow progression of plaques in the carotid arteries. The study found that metoprolol slowed the rate of progression by 40 percent in healthy people who had plaque buildup in the carotid without overt symptoms. In the study, metoprolol and fluvastatin exerted their benefits on different regions of the carotid artery. Fluvastatin slowed plaque formation in the main segment of the artery while metoprolol acted where the artery divides into branches. Plaque formation at such junctions is often more dangerous than at other sites. Because such stress can affect platelets, which help blood clot, Dr. [Goran Berglund] said his team was also conducting studies to determine what role platelets play in sticking to the branching site and producing plaques. Dr. Berglund said his team planned to test larger doses of metoprolol to determine whether they would produce more protection against plaque formation. But the larger doses may induce more side effects

Coronary artery disease (CAD) is the leading cause of death in Americans, accounting for about 500,000 deaths every year. The annual incidence of myocardial infarction (MI) is about 1.5 million. As many as 2 million middle-aged men may have silent myocardial ischemia. (1)

OBJECTIVE: The researchers evaluated the Alcohol Use Disorders Identification Test (AUDIT), the first 3 questions of the AUDIT (AUDIT-C), the third AUDIT question (AUDIT-3), and quantity-frequency questions for identifying hazardous drinkers in a large primary care sample. STUDY DESIGN: Cross-sectional survey. POPULATION: Patients waiting for care at 12 primary care sites in western Pennsylvania from October 1995 to December 1997. OUTCOMES MEASURED: Sensitivity, specificity, likelihood ratios, and predictive values for the AUDIT, AUDIT-C, and AUDIT-3. RESULTS: A total of 13,438 patients were surveyed. Compared with a quantity-frequency definition of hazardous drinking (> or =16 drinks/week for men and > or =12 drinks/week for women), the AUDIT, AUDIT-C, and AUDIT-3 had areas under the receiver-operating characteristic curves (AUROC) of 0.940, 0.949, and 0.871, respectively. The AUROCs of the AUDIT and AUDIT-C were significantly different (P=.004). The AUROCs of the AUDIT-C (P<.001) and AUDIT (P <.001) were significantly larger than the AUDIT-3. When compared with a positive AUDIT score of 8 or higher, the AUDIT-C (score > or =3) and the AUDIT-3 (score > or =1) were 94.9% and 99.6% sensitive and 68.8% and 51.1% specific in detecting individuals as hazardous drinkers. CONCLUSIONS: In a large primary care sample, a 3-question version of the AUDIT identified hazardous drinkers as well as the full AUDIT when such drinkers were defined by quantity-frequency criterion. This version of the AUDIT may be useful as an initial screen for assessing hazardous drinking behavior.

Lamm and Couzens discuss what stomach discomfort means and whether a visit to a doctor is necessary. People suffering from consistent stomach discomfort should make it a point to provide the precise location and duration of the problem, its relationship to the time they eat, whether the discomfort occurs only at night, or if they experience a loss of appetite

"Roots of Disorder: Race and Criminal Justice in the American South, 1817-80" by Christopher Waldrep is reviewed

Anthologized in Best American Essays, Fourth College Edition Atwan R (ed.), New York : Houghton Mifflin, 2004 and Best American Essays, 2002 Gould SJ, Atwan R (eds.), New York : Houghton Mifflin, 2002