We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
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(20):1533. doi:10.1001/archinternmed.2011.997.
Text Size: A A A
Published online

In this study, Toh et al used data from the Mini-Sentinel program to assess the risk of angioedema associated with angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and the direct renin inhibitor aliskiren. Compared with the use of β-blockers, the angioedema risk was approximately 3-fold higher for ACEIs and aliskiren and was 16% higher for ARBs.

See Article

In a preliminary investigation, zonisamide, an antiepileptic drug, administered at up to 600 mg/d, led to 6% weight loss (vs 1% for placebo) over 16 weeks in obese adults. This randomized controlled trial examined the weight loss efficacy of 2 doses of zonisamide (200 mg and 400 mg) vs placebo in 225 obese adults over 1 year. Change in body weight was −4.0 kg (95% CI, −5.8 kg to −2.3 kg) for placebo; −4.4 kg (95% CI, −6.1 to −2.6) for zonisamide, 200 mg; and −7.3 kg (95% CI, −9.0 to −5.6) for zonisamide, 400 mg. A weight loss of 10% or greater was achieved in 8% of patients assigned to placebo; 22% of patients assigned to zonisamide, 200 mg; and 32% of patients assigned to zonisamide, 400 mg. Gastrointestinal, nervous system, and psychiatric adverse events occurred at a higher incidence with zonisamide than with placebo. The authors conclude that zonisamide, 400 mg, moderately enhanced weight loss achieved with diet and lifestyle counseling but had a high incidence of adverse events.

See Article

In a meta-analysis of 7 randomized controlled trials, Komócsi et al evaluated the safety and efficacy of new-generation oral anticoagulants compared with placebo in 31 286 patients receiving antiplatelet therapy after an acute coronary syndrome. The use of oral activated factor X antagonists or direct thrombin inhibitors was associated with a 3-fold increase in bleeding events (odds ratio, 3.03; 95% CI, 2.20-4.16; P < .001). Significant but moderate reductions in the risk for stent thrombosis or composite ischemic events were observed, without a significant effect on overall mortality. Regarding net clinical benefit, oral anticoagulant treatment provided no advantage over placebo (odds ratio, 0.98; 95% CI, 0.90-1.06; P = .57).

See Article

Tobias et al evaluated the association between adherence to 3 healthful dietary patterns and risk of progression to type 2 diabetes mellitus (T2DM) among 4413 female participants in the Nurses' Health Study with a history of gestational diabetes mellitus. Food frequency questionnaires measured usual diet, from which authors assessed adherence to the Alternate Mediterranean Diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and Alternate Healthy Eating Index (aHEI) dietary patterns. After 16 years of follow-up, women with greater adherence to these dietary patterns were significantly less likely to develop T2DM. For a 1–standard deviation increase in score, the aMED, DASH, and aHEI patterns were associated with 23%, 18%, and 30% lower risk of T2DM, respectively.

See Article

Aragon et al examined patterns of Medicare skilled nursing facility (SNF) benefit use in the last 6 months of life among 5163 decedents from the Health and Retirement Study (HRS). They found that 30.5% of HRS decedents used the SNF benefit in the last 6 months of life and 9.2% had died while enrolled in the SNF benefit. The use of the SNF benefit was greater among patients who were 85 years or older, had at least a high school education, did not have cancer, resided in a nursing home, used home health services, and were expected to die soon. These findings suggest that palliative care should be a focus in SNFs alongside the goal of functional improvement.

See Article

First Page Preview

View Large
First page PDF preview




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.


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

0 Citations

Related Content

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