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In This Issue of Archives of Internal Medicine
July 9, 2012

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2012;172(13):980. doi:10.1001/archinternmed.2011.962

In a field study in the emergency departments of 3 cities in southwest France, Blazejewski et al found that in more than 600 persons admitted to hospital for more than 24 hours because of a traffic accident, sleepiness had almost as much effect as alcohol, doubling the risk of being responsible for the accident.

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An initiative of the National Physicians Alliance, the “Good Stewardship in Clinical Practice” project developed a list of the “Top 5” activities in primary care for which changes in practice could lead to higher-quality care and better use of finite clinical resources. One recommendation was to avoid routine imaging for low back pain (LBP). Srinivas et al examine the prevalence of routine imaging in LBP, describe physician and patient attitudes toward imaging, and summarize recent systematic reviews or meta-analyses concerning its benefits. They found only 1 meta-analysis focusing on clinical outcomes, which found no clinical benefit to routine imaging. The authors conclude that unneeded advanced imaging for LBP has not been justified by the literature, estimating that approximately $300 million could be saved annually by eliminating it.

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This cross-sectional survey of health care providers examined their current practices and attitudes toward discussing the risks of medical imaging procedures with their patients at the time of ordering imaging. Health care providers reported having little training about the risks of medical imaging, felt uncomfortable discussing risks, and did not frequently discuss these risks with their patients when ordering imaging.

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The amphetamine derivative 1,3-dimethylamylamine (DMAA) was withdrawn over 40 years ago as an approved pharmaceutical. Surprisingly, DMAA has resurged as an ingredient in hundreds of dietary supplements sold at major franchises throughout the United States. Manufacturers contend that DMAA is found in geranium oil, but a review of the evidence reveals that this claim is unsubstantiated. Furthermore, DMAA has been implicated as potentially contributing to multiple serious adverse events including panic attacks, strokes, seizures, stress-induced cardiomyopathy, and deaths. All supplements containing DMAA should be recalled immediately.

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In a retrospective cohort study of 103 368 patients with type 2 diabetes mellitus, the incidence of diabetic macular edema (DME) was higher among users compared with nonusers of thiazolidinediones (odds ratio, 3.3 [95% CI, 2.2-5.0], and hazard ratio [HR], 2.3 [95% CI, 1.7-3.0], at 1 year and 10 years, respectively). This result was seen after adjustment for important factors that may influence the risk of DME, multiple imputation analysis to adjust for missing values, and propensity score analysis to exclude any selection bias. Combination therapy with insulin plus a thiazolidinedione was associated with a higher risk of DME after propensity score adjustment (HR, 3.0 [95% CI, 1.5-5.9]); meanwhile, aspirin use (HR, 0.6 [95% CI, 0.4-0.9]) and angiotensin-converting enzyme inhibitor use (HR, 0.4 [95% CI, 0.2-0.7]) were associated with a reduced risk of DME. Clinicians should be vigilant in the clinical screening for DME among those patients taking thiazolidinediones.

Kaplan-Meier time to DME curves according to thiazolidinedione (TZD) use with or without insulin.

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