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 JAMA |

Highlights FREE

JAMA. 2013;310(2):117-119. doi:10.1001/jama.2013.5196.
Text Size: A A A
Published online


To examine how different financial incentives between Medicare Advantage and Medicare fee-for-service (FFS) reimbursement structures might influence cardiovascular procedure use, Matlock and colleagues analyzed data from 878 339 Medicare Advantage patients and 5 013 650 Medicare FFS patients across 32 hospital referral regions in 12 states. The authors found that patients enrolled in Medicare Advantage programs had lower rates of angiography and percutaneous coronary intervention procedures than those enrolled in Medicare FFS. Substantial and similar geographic variation in procedure rates was observed among patients in both Medicare Advantage and Medicare FFS programs. In an Editorial, Krumholz discusses steps to ensure high-quality, patient-centered decision making.

Related Editorial

To examine whether differences in the per capita rates of cardiac catheterization in New York State and Ontario, Canada, are due to a difference in the burden of coronary artery disease (CAD) or a difference in patient selection for the procedure, Ko and colleagues analyzed registry data from 18 114 New York patients and 54 933 Ontario patients who underwent elective cardiac catheterization. The authors found that patients in Ontario were significantly more likely to have obstructive CAD than patients in New York and that a higher percentage of New York patients with a low predicted probability of CAD underwent catheterization.

Related Editorial

Observational data suggest there is an inverse association between soy consumption and prostate cancer risk. In a randomized, placebo-controlled trial that enrolled 177 men at high risk of prostate cancer recurrence after radical prostatectomy, Bosland and colleagues found that daily consumption of a soy protein–based supplement for 2 years after radical prostatectomy did not reduce or delay the rate of biochemical recurrence.

Low serum levels of 25-hydroxyvitamin D have been associated with increased risk of coronary heart disease (CHD) in white populations. Robinson-Cohen and colleagues analyzed data from 6436 participants in the Multi-Ethnic Study of Atherosclerosis who were free of known cardiovascular disease at baseline and found that lower serum vitamin D concentration was associated with an increased risk of incident CHD events among study participants who were white or Chinese but who were not black or Hispanic during a median 8.5 years’ follow-up. In an Editorial, Norris and Williams discuss the study findings and questions to explore in future research of the relationship between race, ethnicity, vitamin D and CHD.

Related Editorial


Percutaneous coronary intervention (PCI) with stent placement is the most commonly performed coronary revascularization procedure. Brilakis and colleagues reviewed the contemporary literature on optimal medical therapy after PCI and found that dual antiplatelet therapy with aspirin and a P2Y12 inhibitor reduces the risk of stent thrombosis and subsequent cardiovascular events after PCI (number needed to treat 33-53) and is the current standard of care. Aspirin should be administered indefinitely, whereas the P2Y12 inhibitor is usually administered for 12 months. Adjustments in therapy are appropriate for patients at high risk of bleeding, such as patients who need warfarin. Routine platelet function or genetic testing is not recommended.

A 43-year-old Asian man reports a 6-month history of generalized nonpuritic, nonpainful papules and nodules. Microscopy of a biopsied lesion reveals foamy histiocytes with emperipolesis (engulfed lymphocytes) in the dermis. What would you do next?



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.