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. 2005;165(18):2052. doi:10.1001/archinte.165.18.2052.
Text Size: A A A
Published online

LEFT VENTRICULAR ASSESSMENT IN MYOCARDIAL INFARCTION

Assessment of left ventricular (LV) function has been recommended as a quality metric of care in patients with a myocardial infarction, especially those complicated by heart failure. However, it is unknown how often LV function is assessed with either echocardiography or cardiac catheterization in this setting or how much international variation exists. Furthermore, the link between the process of LV assessment and other performance measures or other end points is also unknown. Therefore, Hernandez et al analyzed the frequency of LV assessment and its association with quality of care using an international registry of patients with an acute myocardial infarction that accompanied the Valsartan in Acute Myocardial Infarction (VALIANT) trial.

See Article

DISPARITIES DESPITE COVERAGE

Despite its effectiveness in reducing mortality, colorectal cancer (CRC) screening rates are low, especially among low-income and minority groups; however, physician recommendation can increase screening rates. Using the Medicare Current Beneficiary survey linked with claims, O’Malley and colleagues identified determinants of racial and socioeconomic disparities in CRC screening among beneficiaries with a usual physician. Racial differences in CRC screening receipt were eliminated after adjustment for socioeconomic status. Socioeconomic disparities decreased but remained significant after adjustment for personal and health system factors. Awareness of CRC (adjusted odds ratio, 2.76) and having a primary care generalist (vs another specialist) as one's usual physician (adjusted odds ratio, 1.31) were associated with higher odds of screening. The odds of screening were also higher among those whose usual physician was rated more highly on information-giving skills.

See Article

RACIAL DISPARITIES IN HYPERTENSION PREVALENCE, AWARENESS, AND MANAGEMENT

Improved control of risk factors, specifically hypertension, is an important method for eliminating racial disparities in cardiovascular health. In this report, Hertz et al analyzed data from the National Health and Nutrition Examination Surveys (NHANES) 1999-2002 and III (1988-1994). Using the most recent survey data, they confirmed higher prevalence (41.4% vs 28.1%), awareness (77.7% vs 70.4%), and treatment rates (68.2% vs 60.4%) in black patients, the latter 2 rates being driven by higher rates in black women. Although control rates among those pharmacologically treated have increased in both races since NHANES III (17.6% in blacks and 24.2% in whites), primarily as a result of increased control in black and white men, treated black patients are less likely than white patients to reach blood pressure goal. The disparity in control among those treated has increased over time, and currently 48.9% of blacks and 59.7% of whites reach treatment goal. The higher hypertension prevalence in blacks and the growing disparity in control among those treated are causes for concern.

See Article

REDUCED SCREENING MAMMOGRAPHY AMONG WOMEN WITH DIABETES

Chronic disease such as diabetes may pose a barrier to preventive care. Using population-based data from Ontario, Canada, Lipscombe and colleagues examined the effect of diabetes on screening mammogram rates among 731 687 women aged 50 to 67 years over a 2-year period. The authors found that despite a higher number of physician visits, diabetes was associated with an estimated 30% reduction in mammograms when compared with women without diabetes. This was not explained by age, income, or comorbidity status. These results suggest that the complexity involved in diabetes care may lead to neglect of routine primary care such as cancer screening.

See Article

CARDIORESPIRATORY FITNESS AND BMI AS PREDICTORS OF CVD MORTALITY AMONG MEN WITH DIABETES

Questions remain as to whether higher levels of cardiorespiratory fitness are associated with lower risk of cardiovascular disease (CVD) mortality in overweight and obese individuals with diabetes. In this prospective epidemiological study of 2316 men with diabetes, Church et al sought to quantify the independent and joint relations of cardiorespiratory fitness and body mass index with CVD mortality. They found that low cardiorespiratory fitness was associated with increased risk of CVD mortality within normal weight, overweight, and class 1 obese weight categories. These results further reinforce that health care providers should give increased attention to counseling for increasing activity and improving fitness in patients with diabetes for the intrinsic benefits associated with increased fitness and for the critical role regular physical activity plays in long-term weight loss and maintenance.

See Article

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.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
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.