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. 2009;169(12):1094. doi:10.1001/archinternmed.2009.142.
Text Size: A A A
Published online

Casalino et al found that physicians frequently fail to inform patients of important abnormal test results. They reviewed outpatient medical records of 5434 patients in 23 medical practices and found apparent failures to inform for 7.1% of important abnormal results; the failure rate ranged from 0% in 3 practices to 26% in 1 practice. Practices that used 5 simple processes to manage test results, such as having the physician sign off on all results, had significantly lower failure-to-inform rates.

See page 1123

As life expectancy of persons infected with human immunodeficiency virus (HIV) has increased, cancers have become an important cause of morbidity in this population. Crum-Cianflone et al studied the incidence rates and factors associated with cutaneous malignancies among 4490 HIV-infected persons. Six percent (n = 254) of patients with HIV developed a cutaneous malignancy during a mean of 7.5 years of follow-up. Since the advent of highly active antiretroviral therapy (HAART), non–AIDS-defining cancers, basal cell carcinoma in particular, are now the most common cutaneous malignancies among HIV-infected persons, surpassing AIDS-defining cancers such as Kaposi sarcoma. In the authors' multivariate analyses, the development of cutaneous non–AIDS-defining cancers among HIV-infected persons was associated with the traditional risk factors of aging and skin color but was not related to immune function or HAART use.

See page 1130

Loss of motor function is a common consequence of aging, but little is known about factors that predict idiopathic motor decline. To test the hypothesis that late-life social activity is related to the rate of change in motor function in old age, Buchman et al followed 906 community-dwelling elders who rated the frequency of their participation in common social activities at baseline. Motor performance measures were tested annually for up to 11 years. Analyses showed that less frequent participation in social activities was associated with a more rapid rate of motor function decline. Furthermore, the annual rate of motor function decline related to less frequent participation in social activities was associated with a 40% increased risk of death and 65% increased risk of disability.

See page 1139

This study systematically reviews the randomized controlled trial (RCT) data on health-related quality of life for patients treated according to “low/intermediate” (9-12 g/dL) and “high” (>12 g/dL) hemoglobin target levels. A comprehensive search to identify all RCTs of erythropoietin-stimulating agent therapy with anemia associated with chronic kidney disease was completed. Eleven eligible studies were identified, with 9 using the 36-Item Short-Form Health Survey (SF-36). The reporting of these data was generally incomplete. Data from each domain of the SF-36 were summarized. Statistically significant changes were noted in 4 of the 8 domains: physical function (weighted mean difference, 2.9; 95% confidence interval [CI], 1.3-4.5), general health (2.9; 95% CI, 1.3-4.5), social function (2.7; 95% CI, 1.3-4.2), and mental health (0.4; 95% CI, 0.1-0.8). Targeting hemoglobin levels in excess of 12 g/dL led to small and not clinically meaningful improvements in health-related quality of life. This, in addition to significant safety concerns, suggests that targeting treatment to hemoglobin levels that are in the range of 9 to 12 g/dL is preferred.

See page 1104

Hyperkalemia is a potential threat to patient safety in chronic kidney disease (CKD). Einhorn et al examined a large sample of veterans who had at least 1 hospitalization at the Veterans Health Administration in 2004-2005 to determine the incidence of hyperkalemia in the presence or absence of CKD and whether this metabolic disturbance was associated with excess mortality. The authors found that hyperkalemia was more common in patients with CKD vs no CKD, and the highest incidence was in those with CKD but no recent treatment with a renin-angiotensin aldosterone system blocker. The odds of death within 1 day of a hyperkalemic event were increased relative to normokalemia; however, this risk was somewhat attenuated in the presence of CKD. These findings underscore the importance of this metabolic disturbance as a threat to patient safety, especially in the presence of CKD where it is common.

Place holder to copy figure label and caption

The odds ratio of death within 1 day of a moderate (potassium, ≥ 5.5 and < 6.0 mEq/L) and severe (potassium, ≥ 6.0 mEq/L) hyperkalemic event.

Graphic Jump Location

See page 1156


Place holder to copy figure label and caption

The odds ratio of death within 1 day of a moderate (potassium, ≥ 5.5 and < 6.0 mEq/L) and severe (potassium, ≥ 6.0 mEq/L) hyperkalemic event.

Graphic Jump Location




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.