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. 2004;164(13):1361. doi:10.1001/archinte.164.13.1361.
Text Size: A A A
Published online

Obesity is more strongly related to morbidity and disability than to mortality. Following a representative cohort of 19 518 Finnish adults for 15 years, Visscher and colleagues showed that obesity has a lifetime impact on disability and morbidity. Obese men and women had an increased number of unhealthy life-years owing to work disability, coronary heart disease, and premature need for long-term medication compared with normal-weight counterparts. A further increase in obesity will lead to an increase in unhealthy life-years and in direct and indirect health care costs.

See page 1413

An evidence-based practice guideline produced by the American Society of Addiction Medicine found that sedative hypnotic medications were more effective than neuroleptics in reducing duration of delirium and mortality in alcohol withdrawal delirium. There were no deaths reported in 217 patients from randomized trials using benzodiazepines or barbiturates, with no differences found among various agents in these classes. Key recommendations are that treatment should focus on rapid control of agitation using parenteral rapid-acting hypnotics that are cross-tolerant with alcohol, followed up with adequate dosages to maintain light somnolence for duration of the delirium. Coupled with comprehensive supportive care, this approach is highly effective in preventing morbidity and mortality.

see page 1405

Weight loss is a key facet of clinical care for persons with diabetes mellitus, but is difficult to achieve and maintain in the long term. Norris et al present a systematic review of randomized controlled trials of pharmacotherapy for weight loss in adults with type 2 diabetes mellitus. Sufficient data for a meta-analysis were available for fluoxetine, orlistat, and sibutramine, and these drugs can achieve modest but statistically significant weight loss over 26 to 52 weeks (2.6-5.8 kg; 2%-3% of initial body weight). However, longer-term benefits and safety remain unclear.

see page 1395

Renal transplantation is the treatment of choice for most patients with end-stage renal disease, the incidence and prevalence of which is increasing in many developed countries. Despite a large increase in kidney donation by living donors over the last 10 years, a shortage of transplantable organs remains a major problem. Fortunately, over the same period, rates of acute rejection have fallen, and transplanted kidneys are surviving longer. In this article, Magee and Pascual discuss strategies to reduce the organ shortage and review the advances in immunosuppression, which have contributed to better kidney transplant survival. As early posttransplant outcomes are now so good, there is more emphasis on the prevention and treatment of long-term complications of transplantation such as cardiovascular disease, neoplasia, and bone disease. A multidisciplinary approach is thus needed to optimize long-term outcomes in renal transplant recipients.

see page 1373

Moderate doses of statins decrease mortality, coronary heart disease (CHD) or cerebrovascular events, and cardiovascular procedures in adults with CHD by 16% to 24%. The benefits occur within 2 years of initiation of statins, at pretreatment low-density lipoprotein cholesterol (LDL-C) levels less than 100 mg/dL (<2.59 mmol/L), in women and the elderly, and are independent of concomitant CHD medications. The preferred dose of statins is not known, though most trials used moderate fixed doses. There is no conclusive evidence that lowering LDL-C level to less than 100 mg/dL (<2.59 mmol/L) with statin therapy is superior to lowering to between 100 and 130 mg/dL (2.59-3.36 mmol/L). However, the results from 2 other meta-analyses suggest that risk reduction is related to the reduction in cholesterol levels.

see page 1427




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.