The Institute of Medicine report To Err Is Human: Building a Safer Health System recommends pharmacist participation in patient rounds as an immediate approach to reducing medical errors. In the same report and in prior publications, cardiovascular drugs have been commonly associated with severe adverse drug events. Through a systematic review of the experience of a clinical pharmacist on the cardiology wards between 1995 and 2000, Allen LaPointe and Jollis classified medication errors according to the type of error, the medication(s) involved, the personnel involved, the stage(s) of drug administration involved, and the time of year most frequently associated with errors. The transition from outpatient to inpatient was identified as the most common point in the system for the occurrence of medication errors. In addition, higher numbers of errors were identified during the transition periods of house staff. The development of better systems to communicate and maintain medication information between ambulatory and hospital settings appears critical in reducing medication errors during hospitalization. Improved education and support of new interns during their initial months of training also appears to be important in reducing medication errors. Clinical pharmacists are uniquely qualified to provide support in both of these areas to reduce medication errors.
Few studies have examined the long-term impact of physical activity among people with type 2 diabetes mellitus. In a nationally representative sample of persons with type 2 diabetes, Gregg et al examined the association of walking and other physical activities on 8-year all-cause and cardiovascular mortality. Persons who reported walking at least 2 hours per week had a 39% lower mortality rate than sedentary persons (when controlled for sex, age, race, body mass index, smoking, and health status). The mortality rate was lowest (56% less) for persons who walked 3 to 4 hours per week and for those who reported that their walking involved moderate increases in heart rate and breathing. The protective association was observed for persons with diverse demographic characteristics, diabetes duration, and comorbid conditions. These findings suggest that increasing walking should be a major part of programs to reduce the burden of type 2 diabetes.
Chronic renal failure is characterized by a persistently abnormal glomerular filtration rate. The rate of progression varies substantially. Several morphologic features are prominent: fibrosis, loss of native renal cells, and infiltration by monocytes and/or macrophages. Mediators of the process include abnormal glomerular hemodynamics, hypoxia, proteinuria, hypertension, and several vasoactive substances (ie, cytokines and growth factors). Several predisposing host factors may also contribute to the process. Treatments to delay progression are aimed at treating the primary disease and at strictly controlling the systemic blood pressure and proteinuria. In this article, Yu discusses the processes that affect progression after the initial renal insult has occurred and the role of antihypertensive agents, statins, and use of other maneuvers such as protein restriction and novel approaches.
Maron et al studied the impact of a theaflavin-enriched green tea extract on the lipid and lipoprotein levels of subjects with mild to moderate hypercholesterolemia in a double-blind, randomized, placebo-controlled, parallel-group trial in China. A total of 240 men and women 18 years or older on a low-fat diet with mild to moderate hypercholesterolemia were randomly assigned to receive a daily capsule containing theaflavin-enriched green tea extract (375 mg) or placebo for 12 weeks. Main outcome measures were mean percentage changes in total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels compared with baseline. The results are shown in Figure 1. The authors conclude that the theaflavin-enriched green tea extract used in their study is an effective adjunct to a low-saturated-fat diet to lower low-density lipoprotein cholesterol levels in adults with hypercholesterolemia and is well tolerated.
Asterisk indicates P<.01 compared with baseline; dagger, P<.001 compared with baseline.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2003;163(12):1389. doi:10.1001/archinte.163.12.1389