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Arch Intern Med. 2004;164:2194.

Hormone Therapy and the Impact of Estrogen Intake on the Risk of Ovarian Cancer
To examine the effect of the cumulative oral estrogen intake from hormone therapy (HT) and the risk of ovarian cancer, a Danish population-based case-control study was carried out. The risk of ovarian cancer in relation to oral HT use increased with the total intake of the estrogen component of HT, such that each additional gram of estrogen was associated with the same relative increase. The results indicate that the increased ovarian cancer risk associated with oral HT may be diminished substantially by minimizing the daily dose of estrogen from oral HT.

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"I Wish I Had Seen This Test Result Earlier!"
Failure to review and follow up on outpatient test results in a timely manner represents a patient safety and malpractice concern. In a survey of physicians working in 15 internal medicine practices affiliated with 2 large urban teaching hospitals, 83% of respondents reported at least 1 delay in reviewing test results during the previous 2 months. Despite reporting spending 74 minutes a day managing test results, only 41% of physicians reported being satisfied with how they managed test results. Physicians believe that systems to help generate result letters to patients, prioritize workflow, and track test orders to completion would be very helpful for a test result management system. This study suggests that delays in test result review are common, and physicians in office practice need systems to improve test result management and improve workflow efficiency.

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Recurrence Risk of Oculorespiratory Syndrome After Influenza Vaccination
In Canada in 2000, a previously unrecognized adverse event, called oculorespiratory syndrome (ORS), was identified in association with the influenza vaccine. Oculorespiratory syndrome was characterized by bilateral red eyes, and/or respiratory symptoms, and/or facial edema, occurring within a few hours of influenza immunization and generally resolving within 48 hours. During that year, ORS was associated mostly with one manufacturer’s vaccine, but the following year, ORS was reported to occur with both manufacturers’ vaccines marketed in Canada. In this randomized placebo-controlled crossover trial, De Serres and colleagues assessed the safety of revaccination in patients affected by ORS in 2000 or 2001 and found that patients who sustained ORS in 2000 and were not revaccinated had a high risk of recurrence when given the 2002-2003 formulation of the vaccine initially associated with ORS. For the second vaccine and for patients who had ORS in 2000 who had been revaccinated the year before or those who had ORS in 2001, the risk of recurrence was much lower. Most recurrences were mild: 86% of patients rated severity as mild (bothersome but did not interfere with daily activities) and nearly all (94%) said they would be revaccinated the following year. Vaccine providers should reassure patients affected by ORS that this experience is not a contraindication to revaccination.

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A Randomized Trial of Nortriptyline Combined With Transdermal Nicotine for Smoking Cessation
Many smokers fail to quit smoking with standard drug therapy. Nortriptyline hydrochloride as a single agent has been shown in several trials to be effective. In this study, Prochazka et al tested the combination of nortriptyline with transdermal nicotine against transdermal nicotine alone in a placebo-controlled trial. At 6 months, 23% of those receiving nortriptyline with transdermal nicotine had quit compared with 10% of those receiving transdermal nicotine alone. However, there was an increased rate of drug discontinuation and adverse effects in the nortriptyline group. Nortriptyline combined with transdermal nicotine may be an alternative approach for those smokers who have not succeeded with standard cessation therapy.

Validated 6-month continuous cessation rates.

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