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In This Issue of Archives of Internal Medicine
January 26, 2009

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2009;169(2):104. doi:10.1001/archinternmed.2008.571
Clinical Information Technologies and Inpatient Outcomes

Amarasingham et al examined the relationship between a hospital's level of automation, as measured by the Clinical Information Technology Assessment Tool (CITAT), and mortality, complications, costs, and length of stay among 41 hospitals and 167 233 patients. The CITAT is a previously validated physician-based survey instrument that measures a hospital's level of automation by assessing the physicians' daily interactions with the hospital information system. They found that hospitals that automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality, and lower costs.

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Loop Diuretic Use and Fracture in Postmenopausal Women

Loop diuretics may cause orthostatic hypotension and increase calcium excretion and as such have the potential to be associated with increased risk for falls and osteoporotic fractures. In 133 855 postmenopausal women in the Women's Health Initiative, including 3411 loop diuretic users and 130 444 nonusers, there was no relationship found between loop diuretic use and risk of falls, bone mineral density changes, or fractures. These findings persisted after adjustment for potential confounding effects. In fact, in a small subset of these women with incident coronary heart failure, there was a small inverse association between loop diuretic use and fracture. In women who used loop diuretics for prolonged periods, a small positive association of loop diuretic use with fracture was seen. These findings may suggest that the association between loop diuretic use and fractures may be influenced by poorer overall health status.

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Effects of Exercise Modality on Insulin Resistance and Functional Limitation in Older Adults

The incremental effects of combined resistance and aerobic exercise compared with either modality alone on risk factors for chronic disease and disability in older adults is generally unknown. Davidson et al randomized 136 abdominally obese men and women to control, resistance exercise, aerobic exercise, and combined (aerobic and resistance) exercise. The principal finding was that 90 minutes of aerobic exercise combined with 60 minutes of resistance exercise performed over 3 days per week (eg, 150 minutes of combined exercise per week) was the optimal exercise strategy for simultaneous reduction in insulin resistance and functional limitation in previously sedentary abdominally obese, older adults.

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Increased Mortality and Cardiovascular Morbidity Associated With Use of Nonsteroidal Anti-inflammatory Drugs in Chronic Heart Failure

In this nationwide cohort study of patients with chronic heart failure in Denmark, Gislason et al identified comprehensive use of nonsteroidal anti-inflammatory drugs (NSAIDs) between 1995 and 2004 using pharmacy claim data. Risk of death, myocardial infarction, and readmission for heart failure associated with NSAID use was analyzed using multivariate time-dependent Cox regression models. Notably, 34% of the population claimed a prescription for NSAIDs during the period. The risk of death was disturbingly high, with hazard ratios of 1.70, 1.75, 1.31, 2.08, and 1.22 for rofecoxib, celecoxib, ibuprofen, diclofenac, and naproxen, respectively. There was a dose-dependent increase in risk of death and increased risk of myocardial infarction and readmission for heart failure. These results should raise awareness about NSAID use among physicians caring for patients with heart failure.

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Exclusive Staphylococcus aureus Throat Carriage

Staphylococcus aureus screening for methicillin-susceptible or methicillin-resistant S aureus (MRSA) is focused on the anterior nares in most institutions. However, approximately one-quarter of all S aureus carriers are exclusively colonized in the throat, where routine screening of the nares only fails to identify carriers. Absence of exposure to the health care system and young age was found to predict individuals with exclusive throat carriage, a population also at highest risk for community-onset MRSA. Even sophisticated microbiological methods will miss a quarter of S aureus carriers if screening does not involve a swab from the nares and throat. Failure to identify such MRSA carriers may contribute to the spread of community-onset MRSA and the limited success to control MRSA by admission screening.

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