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In This Issue of Archives of Internal Medicine
Feb 13, 2012

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2012;172(3):207. doi:10.1001/archinternmed.2011.1019

Indwelling urinary catheters may lead to both infectious and noninfectious complications and are often used in the hospital setting without an appropriate indication. Fakih et al evaluated the impact of the Michigan Hospital Association Keystone Initiative, a statewide quality improvement effort implemented in Michigan hospitals to reduce inappropriate urinary catheter use. They observed an overall 28% reduction in the odds of catheter use and a simultaneous 71% increase in the odds of appropriate placement among those with urinary catheters at 2 years following baseline. The authors suggest that broad-scale intervention programs may assist hospitals in reducing inappropriate urinary catheter use, thereby contributing to potential decreases in catheter-associated urinary tract infection rates.

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In medical emergencies, such as acute coronary syndrome, cardiopulmonary resuscitation, stroke, and exacerbations of obstructive pulmonary disease, supplemental oxygen is often routinely administered. Most physicians believe that this intervention is potentially lifesaving, and many guidelines support the routine use of high-dose supplemental oxygen. Over the decades, however, potential detrimental effects of supplemental oxygen appear to have been ignored. Many clinicians are unaware of the variety of preclinical studies that suggest that hyperoxia causes both coronary and systemic vasoconstriction, resulting in deterioration of several important (hemodynamic) parameters. In this Research Letter, Cornet et al draw attention to the collective clinical evidence that argues against the routine use of high-dose oxygen, which probably creates excess morbidity and mortality.

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Weuve et al compared rates of cognitive decline by level of exposure to coarse and fine particulate matter (PM) air pollution in more than 19 000 older women living throughout the contiguous United States. Higher long-term exposures to both coarse and fine PM were associated with significantly faster cognitive decline. The difference in rates of cognitive decline in 10-μg/m3 increments in long-term exposure to either PM was equivalent to the difference in rates of decline between women in the study who were approximately 2 years apart in age. These results suggest that interventions that lessen PM exposure may reduce the population burden of age-related cognitive decline.

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Given controversies surrounding the net benefit of aspirin for primary prevention of cardiovascular disease (CVD) and recent evidence of its protective role against cancer, Seshasai et al present the largest literature-based meta-analysis to date on the wider effects of aspirin in this population. Using information from up to 9 relevant randomized controlled trials involving over 100 000 participants, the authors demonstrate that aspirin, given for a mean period of approximately 6 years, significantly reduced the risk of all CVD events (by 10%, with a number needed to treat of 120), although this was largely driven by reductions in risk of nonfatal myocardial infarction (20%; number needed to treat, 162). However, these benefits were importantly offset by an excess risk (30%) of clinically nontrivial bleeding events (number needed to harm, 73). Furthermore, there was no significant reduction in CVD death or all-cause mortality and, contrary to recent suggestions, there was no significant benefit of aspirin prophylaxis on cancer mortality. The authors conclude that routine use of aspirin for primary prevention of CVD is not warranted in contemporary practice, and any indications for its use are best considered on a case-by-case basis.

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Whether ambient fine particulate matter (PM2.5) at levels below current US regulatory standards increases the risk of ischemic stroke remains uncertain. Wellenius et al conducted a case-crossover study of PM2.5 and ischemic stroke onset among 1705 Boston-area patients hospitalized with neurologist-confirmed ischemic stroke. The relative risk of ischemic stroke onset was 1.34 (95% CI, 1.13-1.58) (P <.001) following a 24-hour period, during which the air quality was “moderate” compared with a period during which it was “good,” as classified by the US Environmental Protection Agency's Air Quality Index. The increase in risk was greatest within 12 to 14 hours of exposure to PM2.5. These results suggest that further reductions in PM2.5 levels may prevent a substantial number of ischemic strokes in the United States.

Odds ratio of ischemic stroke onset for categories of mean PM2.5 levels in the 24 hours preceding stroke onset.

Odds ratio of ischemic stroke onset for categories of mean PM2.5 levels in the 24 hours preceding stroke onset.

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