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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.
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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.

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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.

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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.

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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%).

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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.

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

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