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Gastrointestinal hemorrhage is the most frequent complication of peptic ulcer disease and is associated with substantial morbidity, mortality, and health care cost. However, the correct approach for the long-term prevention of ulcer and bleeding recurrence is still debatable. In this study, during 5 years of follow-up observation, recurrent peptic ulcers and reappearance of Helicobacter pylori infection were also completely prevented in patients with bleeding peptic ulcers after successful H pylori eradication therapy and ulcer healing, with or without receiving further antiulcer maintenance treatment. Findings from this study show that antiulcer maintenance treatment is not necessary in the long-term management of patients with bleeding peptic ulcers if H pylori has been successfully eradicated and the ulcer had healed.
The Institute of Medicine report To Err Is Human proposes that systems, not people, should be blamed for errors. Systems solutions involve getting the right resources at the appropriate place in the process of care. This article proposes that by adding a pharmacist to the rounding process in the hospital, the incidence of preventable adverse drug events would be significantly reduced. A previously published article demonstrated a 72% reduction in preventable adverse drug events when a pharmacist was added to the rounding process in the intensive care unit. Kucukarslan et al propose that pharmacists may significantly reduce the incidence of adverse drug events in general practice units as well.
Obesity and depression are two of the most common illnesses of modern society, yet relatively little is known regarding the relationship between them. A high prevalence of symptoms of depression preoperatively is found in this study of patients seeking surgical treatment for obesity. Symptoms of depression were commonly found in subjects who were younger and female and in those with poor self-evaluation of appearance, rather than in those with metabolic abnormalities. Weight loss is associated with a sustained major reduction in the symptoms of depression, with groups at greater risk obtaining greater benefit. Study findings support the hypothesis that depression is a comorbidity of obesity.
Helical computed tomography (CT) has rapidly gained acceptance as a diagnostic tool for evaluation of pulmonary embolism, without clear evidence of its efficacy. Donato and colleagues reviewed outcomes of 433 consecutive helical CT scans for the evaluation of pulmonary embolism. They identified 239 patients with negative CT scans who were not receiving anticoagulation and found 4 adverse outcomes (1.7%; 2 pulmonary emboli and 2 deep venous thromboses), with 1 fatality in that cohort. The authors compare their data with other outcomes data for helical CT in the literature, as well as with outcomes data for other testing modalities for pulmonary embolism.
In 1988, the Physicians' Health Study (PHS) demonstrated a conclusive 44% reduction in risk of a first myocardial infarction, while the much smaller British Doctors' Trial showed no significant effect. Since this time, 3 subsequent trials of aspirin in primary prevention of vascular diseases have been published. A meta-analysis of these 5 trials showed that among 55 580 randomized participants (11 466 women), there was a statistically significant reduction in risk of a first nonfatal myocardial infarction of 32% due to aspirin use (relative risk, 0.68; 95% confidence interval, 0.59-0.79). The evidence provides strong support for the initial findings from the landmark PHS that aspirin use reduces risk of a first myocardial infarction in apparently healthy individuals. For individuals in whom the risk of a first vascular event is 10% or more over 10 years, the benefits of aspirin use are likely to outweigh the risks.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2003;163(17):1993. doi:10.1001/archinte.163.17.1993