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. 2008;168(7):682. doi:10.1001/archinte.168.7.682.
Text Size: A A A
Published online

LOOP DIURETIC USE AND INCREASED RATES OF HIP BONE LOSS IN OLDER MEN

Older adults commonly use loop diuretics, which can increase urinary calcium excretion, leading to potential bone loss. In a cohort of older men (mean age, 72.7 years), Lim et al compared rates of bone loss at the hip in men not taking loop diuretics, men taking loop diuretics intermittently, and men taking loop diuretics continuously. After adjustment for multiple potential confounders, mean total hip bone mineral density decreased by 0.33% per year in men not taking loop diuretics compared with a decrease of 0.58% (95% confidence interval [CI], −0.69% to −0.47%) per year in those taking loop diuretics intermittently and 0.78% (95% CI, −0.96% to −0.60%) per year in those taking loop diuretics continuously.

See page 735

LENGTH OF HOSPITAL STAY AND POSTDISCHARGE MORTALITY IN PATIENTS WITH PULMONARY EMBOLISM

The optimal length of stay (LOS) for patients with pulmonary embolism is unknown. While reducing LOS is likely to save costs, the effects on patient safety are unclear. Using data from 15 531 patient discharges with pulmonary embolism from 186 hospitals in Pennsylvania, Aujesky et al sought to assess whether LOS was associated with postdischarge mortality. After adjustment for hospital and patient factors, the authors found that postdischarge mortality was significantly higher for patients with an LOS of 4 days or less (odds ratio, 1.55; 95%CI, 1.21-2.0) relative to those with an LOS of 5 to 6 days, suggesting that physicians may inappropriately select patients with pulmonary embolism for early discharge who are at increased risk of complications.

See page 706

COMPUTED TOMOGRAPHIC COLONOGRAPHY TO SCREEN FOR COLORECTAL CANCER, EXTRACOLONIC CANCER, AND AORTIC ANEURYSM

This study details a cost-effective analysis of computed tomographic colonography (CTC) screening vs optical colonoscopy screening in a simulated population of 100 000 US subjects, taking into account the potential costs and benefits related to extracolonic evaluation. The main finding of this study is that the detection of abdominal aortic aneurysms and, to a lesser extent, extracolonic cancers substantially improves the cost-effectiveness of CTC for colorectal cancer screening. In fact, CTC dominated over colonoscopy (with or without ultrasonography) by being both a more clinically effective and less costly screening strategy.

See page 696

ASSOCIATION BETWEEN CANCER RISK PERCEPTION AND SCREENING BEHAVIOR AMONG DIVERSE WOMEN

This study identified significant ethnic differences in the perception of risk for breast, cervical, and colon cancers by ethnicity. Asian women consistently had the lowest and Latina women had the highest perceived risk of cancer for each of the 3 sites. African American women did not perceive their risk for these cancers to be different from white women. Having a family or self-history of cancer and fair or poor self-reported health status were associated with higher cancer risk perception. Higher perceived risk was associated with having had a colonoscopy in the previous 10 years. These findings suggest that communication of cancer risk information may serve as an important tool to promote early detection. Evaluation of perceived cancer risk may be useful to clinicians who are recommending screening tests and incorporating an intervention to help diverse populations understand risk and interpret medical data.

See page 728

INCIDENTAL FINDINGS ON CARDIAC MULTIDETECTOR ROW COMPUTED TOMOGRAPHY AMONG HEALTHY OLDER ADULTS

This cross-sectional analysis describes incidental findings prospectively evaluated in healthy older subjects who underwent cardiac multidetector row computed tomography for detection and quantification of coronary artery calcification. Of the 459 participants, 190 (41%) had incidental findings, and 105 (23%) had at least 1 incidental finding recommended for clinical or radiological follow-up examination. The most common finding was single or multiple pulmonary nodules (18%). Burt et al conclude that incidental findings, especially pulmonary nodules, are common in this setting. The net risks and benefits of looking for noncardiac abnormalities during cardiac multidetector row computed tomography should be rigorously evaluated.

Place holder to copy figure label and caption

An axial multidetector row computed tomographic scan of the liver.

Graphic Jump Location

See page 756

Figures

Place holder to copy figure label and caption

An axial multidetector row computed tomographic scan of the liver.

Graphic Jump Location

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.