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(7):661-663. doi:10.1001/jama.2013.5260.
Text Size: A A A
Published online


A System-Level Approach to Blood Pressure Control

Hypertension control remains a major clinical challenge. Jaffe and colleagues describe implementation of a multifaceted hypertension quality improvement program, which in 2001-2009 involved between 349 937 and 652 763 adult members of an integrated health system, and they compare annual health system–level hypertension control rates with statewide and national estimates. The authors found that compared with state and national hypertension control rates implementation of the hypertension quality improvement program was associated with a significant increase in hypertension control rates in the integrated health system. In an Editorial, Goyal and Bornstein discuss effective system-level approaches to improve blood pressure control.

Related Editorial

Urinary Albumin Excretion and Coronary Heart Disease

Excess urinary albumin excretion (an albumin to creatinine ratio [ACR] >30 mg/g) is more common in black than white individuals and is associated with increased risk of incident stroke. To assess whether a similar association extends to coronary heart disease, Gutiérrez and colleagues analyzed data from a prospective cohort of 28 207 adults of both races aged 45 years and older. The authors found that higher urinary ACR was associated with increased risk of incident but not recurrent coronary heart disease in black compared with white individuals. In an Editorial, Weiner and Winkelmayer discuss the interaction of race with kidney disease and cardiovascular risk.

Related Editorial

Gene Variants, APOA1, and Risk of Infantile Pyloric Stenosis

Infantile hypertrophic pyloric stenosis (IHPS) shows strong familial aggregation and heritability, but knowledge of specific genetic variants associated with IHPS is limited. Feenstra and colleagues report results of a study to identify gene variants associated with IHPS. Among the authors’ findings was the identification of a new genome-wide significant locus on chromosome 11q23.3—in a region harboring the apolipoprotein A-1 (APOA1) gene cluster—suggesting the possibility of an inverse relationship between cholesterol levels in neonates and IPHS risk.

Lateral Wedge Insoles and Medial Knee Osteoarthritis Pain

To assess the efficacy of lateral wedge insoles as a conservative treatment for medial knee osteoarthritis pain, Parkes and colleagues performed a systematic literature review and identified 12 randomized trials (885 participants) that compared lateral wedge treatments with neutral or flat insole (control) conditions. The authors report that meta-analysis of the data from the 12 studies showed a favorable effect of lateral wedge insoles on knee pain; however, analysis of 7 trials in which lateral wedges were compared with neutral insoles found no effect—suggesting lateral wedge insoles are not efficacious for the treatment of medial knee osteoarthritis pain.


Clinical Diagnosis of Obstructive Sleep Apnea

Obstructive sleep apnea may be a diagnostic consideration when patients present with a symptom of excessive daytime fatigue. In this article in The Rational Clinical Examination Series, Myers and colleagues report results of a systematic review of 42 studies that examined the accuracy of the clinical examination for predicting obstructive sleep apnea in patients referred to a sleep laboratory. Among the authors’ findings was that obstructive sleep apnea is most likely diagnosed in patients who snore, who have body mass index greater than 30, and who have the composite findings of hypertension, increased neck circumference, and nocturnal gasping or choking.

Cost-effectiveness of Bariatric Surgery

Economic analyses—including one published in JAMASurgery in February 2013—suggest that during extended patient follow-up, bariatric surgery is cost-effective but not cost-saving compared with usual medical care or intensive life-style interventions. In this From the JAMA Network article, Maciejewski and Arterburn discuss the need to identify patient or procedural factors that may be associated with a potential for health improvement and cost savings to inform insurance coverage decisions for bariatric procedures.



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.