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. 2012;172(11):833. doi:10.1001/archinternmed.2011.952.
Text Size: A A A
Published online

LARGE-SCALE VALIDATION OF THE CENTOR AND MCISAAC SCORES TO PREDICT GROUP A STREPTOCOCCAL PHARYNGITIS

n this study, Fine et al performed national-scale validations of the Centor and McIsaac scores for predicting group A streptococcal pharyngitis. Leveraging retail health data from more than 200 000 patients with sore throat, the study provides more precise estimates of a patient's risk of group A streptococcal infection based on a geographically diverse population, thus aiding clinical decision making.

See Article

SMOKING AND ALL-CAUSE MORTALITY IN OLDER PEOPLE

This systematic review with meta-analysis by Gellert et al aimed to provide an overview on the empirical evidence of the association of smoking with all-cause mortality in people 60 years and older. Seventeen studies from 7 countries were identified after a systematic literature search. Current smoking was associated with increased all-cause mortality in all studies; relative mortality (RM) of current smokers compared with never smokers was 1.83 (95% CI, 1.65-2.03) in meta-analysis. A moderate decrease of RM with increasing age was observed, but mortality remained increased up to the highest ages. Furthermore, a dose-response relationship of the amount of smoked cigarettes and premature death was found. Former smokers also showed increased mortality (meta-analysis: RM, 1.34; 95% CI, 1.28-1.40), but excess mortality compared with never smokers clearly decreased with duration of cessation. Smoking remains a strong risk factor for premature mortality also at older age.

See Article

OUTCOMES OF PATIENTS ADMITTED FOR OBSERVATION OF CHEST PAIN

Low-risk chest pain is a common cause for hospital admission, but there are no guidelines regarding the appropriate use of stress testing for such patients. This study examined the rates of stress testing and 30-day outcomes in adult patients admitted to a tertiary center with low-risk chest pain over a 2-year period. Among 2107 patients admitted with low-risk chest pain, 70% underwent stress tests, but only 13% of test results were abnormal. Pretest probability was strongly associated with an abnormal test result but played a minor role in determining who underwent a stress test. Within 30 days, only 4.7% of patients with abnormal test results underwent revascularization and only 2 (1.1%) were readmitted for myocardial infarction.

See Article

EXERCISE TESTING IN ASYMPTOMATIC PATIENTS AFTER REVASCULARIZATION

Given the controversy regarding the appropriateness of stress imaging in asymptomatic patients after revascularization, Harb et al evaluated whether predictors of increased risk by exercise echocardiography could lead to interventions that change outcome. Even though mortality was associated with ischemia on exercise echocardiography (hazard ratio, 2.10; 95% CI, 1.05-4.19; =  .04), many patients did not undergo repeated revascularization. Outcomes were similar in all groups. The main predictors of outcome were clinical and stress testing findings rather than echocardiographic features. The authors suggest that careful consideration is warranted before the screening of asymptomatic patients is considered appropriate at any stage after revascularization.

See Article

A RANDOMIZED, PLACEBO-CONTROLLED TRIAL OF ACUPUNCTURE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Dyspnea on exertion is a major symptom of COPD, which is predicted to be the third leading cause of death worldwide by 2020. Suzuki et al conducted a randomized, placebo-controlled trial of acupuncture on COPD. Results of the study clearly demonstrated that a 12-week intervention of acupuncture markedly reduced dyspnea during the 6-minute walking test (mean [SD] Borg scale score was reduced from 5.5 [2.8] to 1.9 [1.5]), which was accompanied by improvement in the reduction in SpO2 (oxygen saturation as measured by pulse oximetry) and extended walking distance during 6 minutes, while those in the placebo-acupuncture group showed no significant improvement. Pulmonary functions and the nutritional status was also improved in the acupuncture group. These results indicate that acupuncture could be a useful adjunct to standard care for COPD.

Place holder to copy figure label and caption

Graphic Jump LocationImage not available.

Acupuncture points used.

See Article

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption

Graphic Jump LocationImage not available.

Acupuncture points used.

Tables

References

Correspondence

CME
Also 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.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
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.