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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2007;167(19):2024.
Adverse Effects of Inhaled Corticosteroids in Funded and Nonfunded Studies
Nieto et al assessed the relationship between funding and the finding and interpretation of adverse effects of inhaled corticosteroids in 504 original studies. There was a negative association between pharmaceutical funding and the finding of adverse effects: a multivariate analysis found that this was due mainly to different design features of funded and nonfunded studies. For the same level of statistical significance, the clinical interpretation of such adverse effects was more benevolent in funded studies: these results might be applicable to other medical treatments. A more explicit and available disclosure of sponsorship would help readers make a more balanced judgment of the interpretations of results by authors of the studies.
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Impact of Electronic Alerts on Isolation Precautions for Patients With Multidrug- Resistant Bacteria
Healthcare workers' compliance with isolation precautions for patients colonized or infected with multidrug-resistant bacteria (MRB) is low. In a 750-bed university hospital, Kac et al evaluated over a 4-year period the impact of electronic alerts linked to the hospital information system on healthcare workers' compliance with isolation precautions. Alerts were generated for all new patients with MRB, for all transfers between wards, and all readmissions of patients with MRB. When these alerts were dispatched to the infection control team who directly ordered the implementation of isolation precautions in electronic nursing charts, a statistically significant and sustained increase of both the nurse's awareness of the patients' MRB status (24%-93%) and the proportion of correctly isolated patients (15%-90%) was observed.
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Adiposity, Adult Weight Change, and Postmenopausal Breast Cancer Risk
In this study by Ahn et al, the relations of adiposity and adult weight change with breast cancer risk were examined in the large, prospective National Institutes of Health–AARP cohort. Current body mass index (BMI) and BMI at ages 50 and 35 years were each associated with increased breast cancer risk, particularly among women not using menopausal hormone therapy (MHT). In addition, weight gained between age 18 years and age at study baseline, between ages 18 and 35 years, between ages 35 and 50 years, and between age 50 years and age at study baseline was consistently associated with increased breast cancer risk among MHT nonusers. Specifically, women who gained more than 50 kg between age 18 years and age at study baseline showed a 2.15-times increase in risk of breast cancer compared with women with no weight change. Risk associated with adult weight change was stronger among women with later vs earlier age at menarche. These findings indicate that weight gain throughout adulthood is associated with increased postmenopausal breast cancer risk among MHT nonusers.
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Breakfast Cereals and Risk of Heart Failure in the Physicians' Health Study I
Consumption of grain products and dietary fiber has been shown to reduce the risk of hypertension and myocardial infarction. However, it is not known whether a higher consumption of breakfast cereals is associated with the risk of heart failure (HF). Djoussé and Gaziano studied prospectively 21 376 men from the Physicians' Health Study to examine the relationship between intake of breakfast cereals and HF. During a mean follow-up of 19.6 years, 1018 new cases of HF occurred. Consumption of whole grain but not refined breakfast cereals was associated with a lower risk of HF in a graded manner. Compared with people who did not consume whole grain cereal, intake of 1 or fewer, 2 to 6, and 7 or more servings per week was associated with 14%, 22%, and 28% lower risk of HF, respectively, adjusting for potential confounders (P for trend, <.001).
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Use of a Case Manager to Improve Osteoporosis Treatment After Hip Fracture
Elderly patients who survive a hip fracture are at high-risk of repeated fractures, but only 10% to 20% are ever treated for osteoporosis. Majumdar et al used an osteoporosis case manager to educate patients, arrange bone mineral density tests, and provide prescription treatments. They compared their case manager intervention with usual care in a randomized trial. The intervention more than doubled rates of treatment and led to 67% of patients receiving appropriate, guideline-indicated osteoporosis care within 6 months, compared with 26% of controls. The authors conclude that a case manager can substantially improve osteoporosis care for vulnerable elderly patients after hip fracture.
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