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In This Issue of Archives of Internal Medicine
May 11, 2009

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2009;169(9):827. doi:10.1001/archinternmed.2009.73
A Comprehensive Pharmacist Intervention to Reduce Morbidity in Patients 80 Years or Older

Drug-related problems are common reasons for hospital visits, especially among elderly patients. In this prospective, randomized controlled trial of patients 80 years and older, Gillespie et al found that interventions performed by ward-based pharmacists reduced the total number of visits to a hospital by 16%, drug-related admissions by 80%, and costs by $267 per patient compared with standard care. They conclude that adding pharmacists to health care teams should lead to major reductions in drug-related morbidity and health care costs.

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Effect of Exposure to Small Pharmaceutical Promotional Items on Treatment Preferences

Previous social science research suggests that small promotional items of minimal value influence attitudes and decisions toward marketed products. However, physicians generally do not believe they are influenced by such pharmaceutical promotional items, which is reflected in US medical ethics guidelines. In this randomized experimental study of medical students at 2 US schools, Grande et al found that brief exposures to pharmaceutical promotional items favorably influence implicit (ie, unconscious) attitudes for the marketed product. However, in the setting of restrictive policies limiting pharmaceutical marketing activities and negative attitudes toward marketing, the effect is reversed.

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Consistency With the DASH Diet and Incidence of Heart Failure

The Dietary Approaches to Stop Hypertension (DASH) diet, which is characterized by high intake of fruits, vegetables, low-fat dairy products, and whole grains, has been shown to reduce blood pressure in trials. Because of the effect on blood pressure and other potential cardiovascular benefits, this eating pattern may reduce the incidence of heart failure. Diet was measured using food frequency questionnaires in 36 019 women aged 48 to 83 years, who were classified by consistency with the DASH diet. The women were followed up for heart failure hospitalization or mortality from 1998 through 2004. Compared with the lowest 25%, women who were in the top 25% based on ranking components of the DASH diet had a 37% lower rate of heart failure (95% confidence interval, 19%-52%). The pattern of the association with heart failure was similar for scores using other strategies to measure consistency with the DASH diet.

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A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain

This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain. A total of 638 adults with chronic mechanical low back pain were randomized to individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. At 8 weeks, after up to 10 treatments, participants receiving real or simulated acupuncture fared equally well but were more likely than those receiving usual care to experience clinically meaningful improvements. Some of the treatment benefits persisted for 1 year. Although acupuncture was found to be effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appears to be unimportant in eliciting therapeutic benefits.

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Syncope and Its Consequences in Patients With Dementia Receiving Cholinesterase Inhibitors

Cholinesterase inhibitors are commonly used to treat dementia, but these drugs can provoke bradycardia and syncope. These underrecognized adverse drug effects may then contribute to permanent pacemaker insertion and fall-related injuries such as hip fracture. In a population-based cohort study, Gill et al report that cholinesterase inhibitor use increased the risk of syncope-related outcomes including pacemaker insertion and hip fracture. Clinicians should carefully consider these findings when weighing the potential benefits and risks of cholinesterase inhibitor treatment for their patients with dementia.

Conceptualizing syncope-related outcomes.

Conceptualizing syncope-related outcomes.

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