In Reply.\p=m-\Wefully agree with Dr Belmin that the lag time between clinical research and the generalized application to medical practice is common to all age groups. Belmin also observed that the percentage of patients receiving \g=b\-blockers relative to all patients with myocardial infarction without contraindications did not change with age. Still, the absolute number of elderly patients older than 65 years who might benefit from \g=b\-blockade (those without
contraindications)
actually higher
was
than that of patients younger than 65 years. Moreover, in light of the high morbidity and mortality associated with myocardial infarction in the elderly,1 the addition of \g=b\-blockertherapy may be
especially important.
Daniel Forman, MD Jeanne Y. Wei, MD Harvard Medical School Boston, Mass 1. Wei JY, Gersh BJ. Heart disease in the elderly. In: O'Rourke BA, Crawford MH, eds. Current Prob Cardiol. Chicago, Ill: Year Book Medical Publishers; 1987:7-65.
'Beeper Obliterans': Clinical Staging and Natural History To the Editor.\p=m-\In this report, we describe a common but previously uncharacterized clinical entity affecting hospital staff physicians: "beeper obliternas." The essential element of this syndrome is the periodic emission of high-pitched electronic tones secondary to an everincreasing abdominal girth that impinges on the test button located on the superior aspect of the wearer's pager-beeper. Using a modified version of the Disease Staging1 methodology, we (two staff pediatricians with 25 years of combined experience) have described this condition's inexorable march (see Table). Advancement to stage 4 is directly correlated to a body mass index of 35 kg/m2 or greater, clinical service of 10 or more years, and knowledge of the code for the patient pantry-door lock. Of interest is the notable "silent phase" Clinical
Staging
Stage
and Natural
seen man
are
at the level of departmental chair-
(when beeper is shed and all calls taken by the secretary, program
director, or safely ignored). Further research on the natural history and treat¬ ment of this ponderous problem is suggested. Neil Izenberg, MD Steven A. Dowshen, MD Albert Einstein Medical Center
Philadelphia, Pa JF, ed. Disease Staging. 3rd ed. New York, NY: SysteMetrics McGraw Hill; 1986. 1. Gonnella
The Relationship Between 'Job Strain,' Workplace Diastolic Blood Pressure, and Left Ventricular Mass Index: A Correction
To the Editor. \p=m-\Wewould like to clarify certain aspects of our protocol and make a correction to our article "The Relationship Between 'Job Strain,' Workplace Diastolic Blood Pressure, and Left Ventricular Mass Index" that appeared in an issue of JAMA.1 Our case-control studysample differed in certain respects from our published description, and some
echocardiographic data were mismerged larger database. We put our protocol into operation in a slightly different manner than was stated in our article. Our protocol should have stated that subjects were eligible for the study if they could read and speak English and not that they had to have to the
been educated in the United States. The article stated that subjects had to have been in their current job for at least 3 years prior to screening and, if applicable, prior to learning that they had high blood pressure. In fact, subjects were required to have been employed at their current work site, not necessarily in the same job, for this duration. In practice, the upper limit for body mass index (BMI) was 32.5 kg/m2 instead of 30 kg/m2, as published. However, due to inconsistency in the implementation of this criterion, some potential subjects with screening BMIs between 30.0 and
History of Beeper Obliterane
Status and Description Condition-Free. Beeper functions as designed. Physician alert and ready. Reaches phone within 15 s 100% of time. Body mass index (BMI) 22 BMI wt/ht2(kg/m2)._ Pager Paunch. Truncal flexion by wearer sets off beeper test button. Physician frequently confused. Answers 125% of pages answered (paradoxical irritability).
beeps 31
kg/m2._
Beeper Obliterans. Beeper completely enveloped by adipose tissue. Associated with In¬ creased risk of coronary artery and gallbladder diseases, as well as non-insulindependent diabetes;
contraindications)
actually higher
was
than that of patients younger than 65 years. Moreover, in light of the high morbidity and mortality associated with myocardial infarction in the elderly,1 the addition of \g=b\-blockertherapy may be
especially important.
Daniel Forman, MD Jeanne Y. Wei, MD Harvard Medical School Boston, Mass 1. Wei JY, Gersh BJ. Heart disease in the elderly. In: O'Rourke BA, Crawford MH, eds. Current Prob Cardiol. Chicago, Ill: Year Book Medical Publishers; 1987:7-65.
'Beeper Obliterans': Clinical Staging and Natural History To the Editor.\p=m-\In this report, we describe a common but previously uncharacterized clinical entity affecting hospital staff physicians: "beeper obliternas." The essential element of this syndrome is the periodic emission of high-pitched electronic tones secondary to an everincreasing abdominal girth that impinges on the test button located on the superior aspect of the wearer's pager-beeper. Using a modified version of the Disease Staging1 methodology, we (two staff pediatricians with 25 years of combined experience) have described this condition's inexorable march (see Table). Advancement to stage 4 is directly correlated to a body mass index of 35 kg/m2 or greater, clinical service of 10 or more years, and knowledge of the code for the patient pantry-door lock. Of interest is the notable "silent phase" Clinical
Staging
Stage
and Natural
seen man
are
at the level of departmental chair-
(when beeper is shed and all calls taken by the secretary, program
director, or safely ignored). Further research on the natural history and treat¬ ment of this ponderous problem is suggested. Neil Izenberg, MD Steven A. Dowshen, MD Albert Einstein Medical Center
Philadelphia, Pa JF, ed. Disease Staging. 3rd ed. New York, NY: SysteMetrics McGraw Hill; 1986. 1. Gonnella
The Relationship Between 'Job Strain,' Workplace Diastolic Blood Pressure, and Left Ventricular Mass Index: A Correction
To the Editor. \p=m-\Wewould like to clarify certain aspects of our protocol and make a correction to our article "The Relationship Between 'Job Strain,' Workplace Diastolic Blood Pressure, and Left Ventricular Mass Index" that appeared in an issue of JAMA.1 Our case-control studysample differed in certain respects from our published description, and some
echocardiographic data were mismerged larger database. We put our protocol into operation in a slightly different manner than was stated in our article. Our protocol should have stated that subjects were eligible for the study if they could read and speak English and not that they had to have to the
been educated in the United States. The article stated that subjects had to have been in their current job for at least 3 years prior to screening and, if applicable, prior to learning that they had high blood pressure. In fact, subjects were required to have been employed at their current work site, not necessarily in the same job, for this duration. In practice, the upper limit for body mass index (BMI) was 32.5 kg/m2 instead of 30 kg/m2, as published. However, due to inconsistency in the implementation of this criterion, some potential subjects with screening BMIs between 30.0 and
History of Beeper Obliterane
Status and Description Condition-Free. Beeper functions as designed. Physician alert and ready. Reaches phone within 15 s 100% of time. Body mass index (BMI) 22 BMI wt/ht2(kg/m2)._ Pager Paunch. Truncal flexion by wearer sets off beeper test button. Physician frequently confused. Answers 125% of pages answered (paradoxical irritability).
beeps 31
kg/m2._
Beeper Obliterans. Beeper completely enveloped by adipose tissue. Associated with In¬ creased risk of coronary artery and gallbladder diseases, as well as non-insulindependent diabetes;
