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JAMA. 2009;302(19):2061.

Collaborative Care for Depression After CABG
Depressive symptoms are common after coronary artery bypass graft (CABG) surgery. In a randomized trial, Rollman and colleagues examined the effect of telephone-delivered collaborative care (provided by nurses supervised by a psychiatrist and primary care physician) vs usual physician care on post-CABG depression symptoms. The authors found that compared with usual care, telephone-delivered collaborative care resulted in greater improvements in mental health-related quality of life, physical functioning, and mood.

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Trends in Low-Density Lipoprotein Cholesterol
In an analysis of 1999-2006 data from the National Health and Nutrition Examination Survey, Kuklina and colleagues (SEE ARTICLE) found that among persons aged 20 years and older, the overall prevalence of high low-density lipoprotein cholesterol levels decreased from 31.5% in 1999-2000 to 21.2% in 2005-2006. In an editorial, Gaziano and Gaziano (SEE ARTICLE) discuss current treatment guidelines and recommend a simplified risk-based approach to dyslipidemia treatment.

Neurofibromatosis Type 1–Like Syndrome
In 2 cross-sectional studies, Messiaen and colleagues (SEE ARTICLE) assessed the frequency, mutational spectrum, and phenotype of a neurofibromatosis type 1 (NF1)–like syndrome (Legius syndrome). Among the authors' findings was a high SPRED1 mutation detection rate among NF1 mutation–negative families who have an autosomal dominant phenotype of café au lait macules with or without freckling and no other NF1 features. In an editorial, Stevenson and Viskochil (SEE ARTICLE) discuss the diagnostic challenge of overlapping pigmentary findings in NF1 and Legius syndrome.

Folic Acid, Vitamin B₁₂, and Incidence of Cancer
Many countries mandate folic acid fortification of flour and grain products to reduce the risk of neural tube defects. In an analysis of data from 2 clinical trials that tested the effects of treatment with folic acid and B vitamins on cardiovascular disease outcomes and that were conducted in Norway (where foods are not fortified with folic acid), Ebbing and colleagues (SEE ARTICLE) found that treatment with folic acid plus vitamin B₁₂ was associated with increased risks of cancer and all-cause mortality. In an editorial, Drake and Colditz (SEE ARTICLE) discuss the effects of intervention timing and dosage in cancer prevention studies.

Propagation of Human Spermatogonial Stem Cells
Young boys who are treated with high-dose chemotherapy are often infertile in adulthood. In a preliminary investigation, Sadri-Ardekani and colleagues report successful in vitro culture and propagation of human spermatogonial stem cells derived from testicular biopsy specimens—early steps toward a potential means of restoring fertility among men who have survived childhood cancer.

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CLINICIAN'S CORNER
Palpitations and Cardiac Arrhythmia
The Rational Clinical Examination
In a systematic review of the literature, Thavendiranathan and colleagues assessed the utility of clinical history, physical examination, and cardiac testing to differentiate benign from clinically significant cardiac arrhythmias in patients with palpitations. The authors conclude that no clinical examination features are sufficiently accurate to exclude clinically significant arrhythmias in most patients and that further testing with prolonged electrocardiographic monitoring is likely required to make a diagnosis.

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A Piece of My Mind
"The limited medical and psychological resources for this uninsured, immigrant woman and the life story underlying her symptoms only magnified my baseline sense of inadequacy." From "Going Home."

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Medical News & Perspectives
A growing cadre of nurses who have received doctoral-level training in clinical care are bringing a new perspective and set of skills to hospitals and practices across the country.

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Commentaries
Primary prevention of cardiovascular disease

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Digoxin in acute heart failure syndromes

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Author in the Room Teleconference
Join Laura Esserman, MD, MBA, Wednesday, December 16, from 2 to 3 PM eastern time to discuss the need to rethink screening for breast cancer and prostate cancer. To register, go to http://www.ihi.org/AuthorintheRoom.

Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Readers Respond
How would you advise a 37-year-old man who seeks a new physician affiliated with a high-quality hospital? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is November 29.

JAMA Patient Page
For your patients: Information about neurofibromatosis.

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