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In This Issue of Archives of Internal Medicine
July 23, 2007

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2007;167(14):1450. doi:10.1001/archinte.167.14.1450
Reducing the Population Burden of Cardiovascular Disease by Reducing Sodium Intake

Across populations, the level of blood pressure, the incremental rise in blood pressure with age, and the prevalence of hypertension are directly related to sodium intake. The majority of sodium consumption in the United States derives from amounts added by food processors and restaurants, and average sodium intakes in Americans far exceed recommended limits. Lowering sodium intake would result in a smaller rise in systolic blood pressure as individuals age, a reduction that would save thousands of lives annually. In the continued absence of voluntary measures adopted by the food industry, new regulations will be required to achieve lower sodium concentrations in processed and prepared foods.

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Venous Thromboembolism in the Outpatient Setting

The purposes of this observational study were to describe the frequency of venous thromboembolism (VTE) events occurring in the outpatient setting, characterize the prevalence of previously identified risk factors for VTE, and identify prior use of VTE prophylaxis in the community setting. Spencer et al identified 1897 residents with a confirmed episode of VTE in 1999, 2001, and 2003. Approximately 74% of patients developed VTE in the outpatient setting, and a substantial proportion of these patients had undergone surgery (23%) or hospitalization (37%) in the preceding 3 months. More than 50% experienced VTE within 1 month of the preceding hospital encounter. Among patients with a recent hospitalization who subsequently developed VTE, fewer than 50% had received anticoagulant prophylaxis for VTE during that visit. Efforts to improve in-hospital use of VTE prophylaxis may help decrease the incidence of outpatient VTE.

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Visceral Adipose Tissue Accumulation, Cardiorespiratory Fitness, and Features of the Metabolic Syndrome

Cardiorespiratory fitness, body fat distribution, and metabolic profile were evaluated in 169 asymptomatic middle-aged men. Subjects with the lowest cardiorespiratory fitness (CRF) had an increased visceral adipose tissue accumulation and poorer metabolic risk profile, as reflected by their increased triglyceride, apolipoprotein B, and insulin responses and by their reduced high-density lipoprotein cholesterol levels. These subjects also had increased glucose and insulin responses during an oral glucose tolerance test. Independently of CRF, subjects with an elevated accumulation of visceral adipose tissue were more likely to be characterized by features of the metabolic syndrome than were subjects with low visceral adiposity. These results suggest that visceral obesity is a strong correlate of a poor metabolic risk profile, irrespective af CRF.

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Influence of a Performance-Improvement Initiative on Quality of Care for Patients Hospitalized With Heart Failure

The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) is the largest national hospital-based quality-of-HF-care improvement initiative undertaken to date and the only program designed to capture 60- to 90-day postdischarge outcomes in a prespecified cohort of patients. The aim of OPTIMIZE-HF was to increase adherence to evidence-based guideline recommendations and performance measures for hospitalized patients with HF. A total of 259 US hospitals participating in OPTIMIZE-HF submitted data on 48 612 patients with HF during 2003-2004. Admission, hospital, discharge care, and outcomes data were collected using a Web-based registry that provided real-time feedback of performance measures benchmarked to other hospitals. Process-of-care improvement tools were provided. Participation in OPTIMIZE-HF was associated with an increase in evidence-based HF therapy use, adherence to performance measures, and shorter length of stay in patients hospitalized with HF.

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Effect of Residency Duty-Hour Limits

To determine the impact of residency duty-hour limitations, it is important to consider the views of faculty who have the greatest contact with residents. Reed et al conducted a national survey of 154 key clinical faculty at 39 internal medicine residency programs affiliated with US medical schools. Faculty reported worsening in residents' continuity of care (87%), the resident physician–patient relationship (75%), and residents' education (66%) and professionalism, including accountability to patients (73%) and ability to place patient needs above self-interests (57%). Faculty reported spending more time providing patient care on inpatient services (47%) and decreased satisfaction with teaching (56%), ability to develop mentoring relationships with residents (40%), and overall career satisfaction (31%). These results indicate that faculty who have the greatest contact with residents believe that duty-hour limitations have adversely affected important aspects of residents' patient care, education, and professionalism, as well as the workload and satisfaction of faculty teachers.

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