0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2011;171(21):1878. doi:10.1001/archinternmed.2011.559.
Text Size: A A A
Published online

CHRONIC DISEASE MANAGEMENT FOR TOBACCO DEPENDENCE

Joseph et al conducted a randomized controlled trial to compare a telephone-based chronic disease management intervention (1 year) with usual care (8 weeks) among 443 smokers. Longitudinal care yielded a significant increase in short-term and prolonged (6 months) abstinence from smoking compared with usual care. Findings suggest that once a smoker starts participation in tobacco treatment, treatment should persist for a longer period than typical current practice.

See Article

NATIONAL PERFORMANCE ON DOOR-IN TO DOOR-OUT TIME AMONG PATIENTS TRANSFERRED FOR PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Prompt treatment with primary percutaneous coronary intervention (PCI) increases survival rates for patients with ST-segment elevation acute myocardial infarction. For patients who must be transferred from one hospital to another for treatment with PCI, the time spent in the first hospital may result in additional delay. Using data reported to the Centers for Medicare & Medicaid Services, this study examines the national rates of time to transfer and the associations of time to transfer with patient and hospital characteristics. Among 13 776 included patients from 1034 hospitals, only 9.7% (1343) had a time to transfer within 30 minutes, and time to transfer exceeded 90 minutes for 31.0% (4267) of patients.

See Article

HELICOBACTER PYLORI ERADICATION IN FUNCTIONAL DYSPEPSIA

Eradication of Helicobacter pylori in patients with functional dyspepsia continues to be a matter of debate. The HEROES (Helicobacter Eradication Relief Of dyspEptic Symptoms) trial randomized 404 patients with functional dyspepsia who were infected with H pylori to receive antibiotics or a matched placebo in a double-blind, placebo-controlled, monocentric clinical trial. Data from the HEROES showed a 50% basal symptomatic score reduction in 49% of the patients (94 of 192) in the antibiotics group and 36.5% of the patients (72 of 197) in the control group (P = .01; number needed to treat, 8). Beyond symptomatic improvement, HEROES is the first H pylori eradication trial in functional dyspepsia to show improvement in quality of life.

See Article

IMPROVING CARE AFTER MYOCARDIAL INFARCTION USING A 2-YEAR INTERNET-DELIVERED INTERVENTION

Levine et al tested whether a longitudinal, multicomponent, Internet-delivered intervention with educational cases, guidelines, monthly updates, and e-mail reminders could improve guideline adherence and reduce coronary heart disease risk factors among myocardial infarction survivors with multiple comorbidities treated in primary care settings. In the national cluster-randomized trial involving 168 community-based primary care clinics and 847 health care providers, a median of 50% of providers (95% CI, 33.3%-66.7%) participated. The longitudinal, Internet-delivered intervention improved 1 of 7 clinical indicators of cardiovascular management in ambulatory myocardial infarction survivors. Patients in intervention clinics had greater improvements (from 85.2% to 88.0%) in the percentage prescribed β-blockers than patients in control clinics (87% to 89.1%; adjusted improvement gain for intervention vs control, 2.6%; 95% CI, 0.1%-4.1%).

See Article

ASSOCIATION BETWEEN GLYCEMIC CONTROL AND ADVERSE OUTCOMES IN PEOPLE WITH DIABETES MELLITUS AND CHRONIC KIDNEY DISEASE

Shurraw et al followed up more than 23 000 outpatients with diabetes and chronic kidney disease over approximately 4 years. Higher hemoglobin A1c (HbA1c) level was independently associated with increased risk of death, cardiovascular events, progression of kidney failure (including onset of end-stage renal disease), and hospitalization. The association between HbA1c and mortality was U-shaped: both HbA1c levels lower than 6.5% and higher than 8.0% were associated with higher mortality. These findings suggest that control of HbA1c in people with diabetes and impaired glomerular filtration rate may be more important than previously realized, but also suggest that intensive control (HbA1c level <6.5%) may increase mortality risk.

Graphic Jump LocationImage not available.

Histogram of observed HbA1c values in people with stage 3 to 4 chronic kidney disease. HR indicates adjusted hazard ratio.

See Article

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.