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In This Issue of Archives of Internal Medicine
January 12, 2009

In This Issue of Archives of Internal Medicine

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Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Intern Med. 2009;169(1):8. doi:10.1001/archinternmed.2008.538
Joint Effects of Sodium and Potassium Intake on Subsequent Cardiovascular Disease

While reduced sodium and higher potassium intake appear to lead to lower blood pressure, their dose-response relation with cardiovascular disease (CVD) itself has not been fully determined. Most previous studies have relied on suboptimal measures of intake, which may attenuate the relationship. Cook et al followed participants in the 2 Trials of Hypertension Prevention to determine the association of a mean of 3 to 7 excretion measures with subsequent CVD 10 to 15 years after the trial. The sodium to potassium ratio exhibited a strong, direct relation with CVD, with a 24% increased risk per unit of the ratio (rate ratio, 1.24; 95% confidence interval, 1.05-1.46). These data suggest that population strategies to decrease sodium consumption and increase consumption of potassium-rich foods may reduce the incidence of CVD.

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Vasopressin, Epinephrine, and Corticosteroids for In-Hospital Cardiac Arrest

This prospective, randomized, double-blind, controlled trial showed an improved survival to hospital discharge in patients with refractory cardiac arrest treated with combined vasopressin, epinephrine, and methylprednisolone during cardiopulmonary resuscitation and with stress-dose hydrocortisone in case of the development of postresuscitation shock. This main result is supported and explained by a more frequent successful resuscitation, increased postarrest mean arterial pressure and central venous oxygen saturation, and attenuated postarrest systemic inflammatory response and organ dysfunction in the combination therapy (ie, the study) group relative to the control group.

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Motivating Factors for Physician Ordering of Factor V Leiden Genetic Tests

The factor V Leiden (FVL) genetic test is used by many physicians despite its uncertain clinical utility. Hindorff et al investigated whether self-reported motivations and behaviors concerning FVL genetic testing differed between 2 groups of primary care physicians defined by frequency of prior FVL test use. Generally, both groups of physicians reported similar motivating factors for ordering FVL genetic tests, and reported behaviors were consistent with existing guidelines. More striking differences were observed for measures such as barriers to and confidence in using genetic tests. Additional research is necessary to evaluate the impact of these observations on issues relevant to the translation of genetic knowledge to clinical practice.

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Osteoporosis Case Manager for Patients With Hip Fractures

Elderly patients who survive a hip fracture are at high risk of future fractures, but less than 20% are ever treated for osteoporosis. Majumdar et al previously demonstrated in a Canadian randomized trial that a case manager could substantially improve quality of osteoporosis care compared with usual care. They now report a formal cost-effectiveness analysis of their intervention. Their main findings were that for every 100 case-managed patients, 6 fractures (4 hip fractures) would be prevented, 4 quality-adjusted life-years would be gained, and that a third-party health care payer would expect to save money within 2 to 3 years. They conclude that their case-manager intervention dominated usual hip fracture care and that implementation in most jurisdictions should quickly lead to better quality of care and cost savings.

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Sleep Habits and Susceptibility to the Common Cold

This study found that fewer hours of sleep and poorer sleep efficiency (percentage of time in bed actually asleep) during the weeks preceding exposure to a rhinovirus were both associated with an increased likelihood of developing a cold. For 14 consecutive days, 153 healthy volunteers reported the number of hours they slept and their sleep efficiency during the previous night. Subsequently, the participants were administered nasal drops containing a rhinovirus, quarantined, and monitored for 5 days for the development of a clinical cold (infection in the presence of objective signs of illness). Those who averaged less than 7 hours sleep were nearly 3 times more likely to develop a cold than those with 8 hours or more. Those with less than 92% efficiency were more than 5 times more likely to develop a cold than those with efficiencies of 98% or greater. These relations could not be explained by differences in prechallenge virus-specific antibody, demographics, season of the year, body mass, socioeconomic status, psychological variables, or health practices.

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Sleep efficiency (percentage of time in bed asleep) averaged over a 14-day period before virus exposure is associated with the percentage of persons who subsequently develop a cold.

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