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In This Issue of Archives of Internal Medicine
June 27, 2011

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2011;171(12):1053. doi:10.1001/archinternmed.2011.270
Dietary Fiber Intake and Mortality in the NIH-AARP Diet and Health Study

Dietary fiber intake in relation to total and cause-specific mortality was examined in the National Institutes of Health (NIH)-AARP Diet and Health Study, a prospective cohort. The study found that dietary fiber intake was associated with significantly lowered risk of total death and death from cardiovascular, infectious, and respiratory diseases in both men and women. Dietary fiber from grains, but not from other sources, was significantly inversely related to total and cause-specific death. Making fiber-rich food choices more often may provide significant health benefits.

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Mortality Rate in Patients With Diastolic Dysfunction and Normal Systolic Function

Diastolic dysfunction is known to be associated with increased mortality in the presence of impaired systolic function. Prognostic data on the impact of diastolic dysfunction in patients with normal systolic function is lacking. A total of 36 261 patients with normal systolic function and various degrees of diastolic dysfunction were followed for a mean (SD) follow-up time of 6.2 (2.3) years. Diastolic dysfunction was present in 65% of the cohort with mild diastolic dysfunction being the most prevalent type. After propensity matching, only moderate and severe diastolic dysfunction were associated with an increased mortality risk (hazard ratios, 1.58 [95% confidence interval, 1.20-2.08] and 1.84 [95% confidence interval, 1.29-2.62], respectively, P < .001 for each).

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Decreased Antibiotic Utilization After Implementation of a Guideline for Inpatient Cellulitis and Cutaneous Abscess

Cellulitis and cutaneous abscess are among the most common infections leading to hospitalization, but optimal management strategies are not well defined. Jenkins et al implemented a clinical practice guideline for the management of inpatient cellulitis and abscess and studied the effects on antibiotic and health care resource utilization. The intervention decreased the use of microbiological cultures, advanced imaging studies, and inpatient consultations. In addition, the intervention led to considerable decreases in antimicrobial exposure through shorter durations of therapy and less frequent use of antibiotics with an unnecessarily broad spectrum of activity. Clinical outcomes were not compromised despite the more streamlined care.

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Study of Neurontin: Titrate to Effect, Profile of Safety (STEPS) Trial

Seeding trials, clinical studies conducted by pharmaceutical companies for marketing purposes, have rarely been described. Using documents produced during the gabapentin (Neurontin) marketing, sales practices, and product liability litigation, the investigators reviewed all documents related to the clinical trial Study of Neurontin: Titrate to Effect, Profile of Safety (STEPS) to determine the extent of marketing involvement in its planning and implementation. Documents demonstrated that STEPS was a seeding trial posing as a legitimate scientific study. The trial itself, not trial results, was part of a marketing strategy used to promote gabapentin and increase prescribing among investigators without informing trial patients or investigators. Marketing was extensively involved in its planning and implementation and rates and dosages of gabapentin prescribing among STEPS investigators were examined to determine the impact of investigator participation in the STEPS trial. These ethical breaches in clinical trial conduct and steps to prevent seeding trials from taking place in the future are discussed.

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Bupropion for Smoking Cessation in Patients With Acute Coronary Syndrome

Bupropion hydrochloride has a proven efficacy as a smoking-cessation aid, but data regarding its safety and efficacy in patients with acute coronary syndromes (ACS) is limited. Planer et al conducted a double-blind, randomized, placebo-controlled trial that evaluated the efficacy and safety of bupropion, as an adjunct to nurse-led intensive counseling, for smoking abstinence at 1 year. In addition, predictors for smoking cessation were analyzed. It was found that although there were no significant adverse events associated with bupropion use in patients with ACS, it had no added value over intensive continuous counseling in achieving abstinence from smoking at 1 year. Interestingly, any invasive procedure performed during the index hospitalization and lack of adverse effects attributable to study medication were independent predictors of smoking abstinence at 1 year.

Efficacy of bupropion hydrochloride compared with placebo. SR indicates slow release.

Efficacy of bupropion hydrochloride compared with placebo. SR indicates slow release.

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