BRIGHTEN Heart: Design and baseline characteristics of a randomized controlled trial for minority older adults with depression and cardiometabolic syndrome.

OBJECTIVES: African American and Hispanic elderly are at elevated risk of both depression and cardiovascular disease, relative to non-Hispanic whites. Effective interventions are therefore needed to address depressive symptoms and to reduce these disparities. BRIGHTEN Heart was a behavioral randomized controlled trial to test the efficacy of a virtual team intervention in reducing depressive symptoms in minority elderly as measured by the 9-item Patient Health Questionnaire (PHQ9). STUDY DESIGN: 250 African American and Hispanic adults, age ≥60 years, with comorbid depression and overweight/obesity were randomized. Participants randomized to the Intervention condition received a social work evaluation, team-based electronic consultation, case management, and psychotherapy over a 12 month period. Control participants were enrolled in a membership program that provided health classes and other services to support chronic disease self-management. Blinded research assistants completed assessments at baseline, and 6 and 12 months postrandomization. RESULTS: The study population was characterized by low socioeconomic status, with 81.4% having a household income of less than $20,000. Although median depression scores were in the mild range, 25% of participants had scores showing moderate to severe depression at baseline. 75% of participants had four or more chronic conditions. Significant demographic and clinical differences were observed between the African American and Hispanic populations. CONCLUSIONS: BRIGHTEN Heart was designed to rigorously test the efficacy of a multi-level intervention to reduce comorbid depressive symptoms and cardiovascular risk in minority elderly. Investigators successfully recruited a cohort well suited to testing the study hypothesis.

William Osler at 150: an overview of a life.

Sir William Osler is one of the most admired and honored physicians in the history of medicine. He influenced the development of medicine in Canada, the United States, and Great Britain, where he held professorships at McGill University, the University of Pennsylvania, Johns Hopkins University, and Oxford University. Through his textbook, The Principles and Practice of Medicine, and other clinical and philosophical writings, he exercised a truly global influence. In this sesquicentennial of his birth, William Osler continues to serve as a model of excellence for the medical profession. This examination of the reasons for his enduring impact reveals a legacy of clinical, scientific, literary, educational, and intraprofessional accomplishments linked to a remarkable personality, and bound together by an extraordinary humanism.

Recurrent giant hypogastric artery aneurysms--a case report.

Aneurysms of the hypogastric artery are rare occurrences that are frequently asymptomatic until the time of rupture. When signs and symptoms are present, a pulsatile pelvic mass, frequently detected by rectal or vaginal examination, may produce compression symptoms with urologic, gastrointestinal, and neurologic manifestations. In addition to classical invasive methods of detection such as angiography, newer noninvasive imaging techniques, including ultrasonography, computerized tomography, and magnetic resonance imaging, may be employed to establish the diagnosis. Proximal ligation of the hypogastric artery is the usual method of treatment. A case of bilateral, giant hypogastric artery aneurysms with successful surgical management is reported.

Sir William Osler and the anatomical tubercle.

Tuberculosis of the skin resulting from direct inoculation of a tuberculin-sensitive individual (tuberculosis verrucosa cutis) is a rare disease first described by Laennec. Various terms, including prosector's wart and the anatomical tubercle, have been used to describe these lesions, which were often acquired in the autopsy room. The disease usually remains local in those patients with acquired immunity from previous infection with tuberculosis. Sir William Osler possessed an abiding interest in pathology throughout his career and performed nearly 1,000 postmortem examinations. He describes the acquisition of numerous prosector's warts and their evolution and treatment. It is postulated that Osler was a tuberculin-sensitive individual at the time he acquired his anatomical tubercles. His contributions to dermatology are discussed.