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In This Issue of Archives of Internal Medicine
December 8/22, 2008

In This Issue of Archives of Internal Medicine

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Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Intern Med. 2008;168(22):2400. doi:10.1001/archinternmed.2008.508
Half- vs Full-Dose Trivalent Inactivated Influenza Vaccine (2004-2005)

Half-dose trivalent inactivated influenza vaccination may be an effective strategy for healthy adults younger than 50 years in the setting of supply shortages, especially in women. Antibody responses were compared before and after (≥21 days) vaccination in this single-blinded, prospective randomized controlled trial of persons aged 18 to 64 years, stratified by age and sex. Antibody responses to the half dose were not substantially inferior in healthy, previously immunized adults. The frequencies of medical visits and hospitalizations during the 2004-2005 influenza season appeared to be similar in the half- and full-dose groups, regardless of age group. Among the 3 factors, dose, sex, and age, sex was the most important determinant of immune response.

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A Simple Algorithm to Predict Incident Kidney Disease

Kshirsagar et al developed an algorithm to predict incident kidney disease (KD). They combined demographic and simple noninvasive medical characteristics from 2 complementary general population cohort studies, the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study. Advanced age, female sex, and history of hypertension, diabetes mellitus, cardiovascular disease (including peripheral vascular disease, heart failure, or coronary artery disease), and anemia were associated with developing a glomerular filtration rate of less than 60 mL/min/1.73 m2. After assigning points for each risk factor, a numeric score of 3 or higher using the simplified algorithm captured approximately 70% of incident cases (sensitivity) and accurately predicted a 17% risk of developing KD (positive predictive value). The algorithm may be a useful tool for clinicians to engage in discussion with patients about long-term risk of KD.

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Effect of Electronic Prescribing With Formulary Decision Support on Medication Use and Cost

Fischer et al studied the impact of an electronic prescribing (e-prescribing) system provided to community-based practices in Massachusetts in 2004-2005. The e-prescribing system had decision support that identified preferred lower-cost medications by color coding. After controlling for baseline difference between prescribers and for trends in use of generic medications over time, the study found that e-prescribing corresponded to a 3.3% increase (95% confidence interval, 2.7%-4.0%) in prescribing of low-cost generic medications, with corresponding decreases in higher-cost agents. The potential cost implications of these changes are significant. Even at the low rates of e-prescribing seen in these early adopters, the potential savings on prescriptions were more than $8 per patient per year, and with increased use of e-prescribing, the potential savings could increase several fold.

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Poor Glycemic Control in Diabetes and the Risk of Incident Chronic Kidney Disease Even in the Absence of Albuminuria and Retinopathy

Diabetic nephropathy is the leading cause of kidney failure in the United States. The extent to which elevated glycated hemoglobin (HbA1c) is associated with increased risk of chronic kidney disease (CKD) among individuals with diabetes in the absence of albuminuria and retinopathy, the hallmarks of diabetic nephropathy, is uncertain. In 1871 adults with diabetes who were followed up for 11 years in the Atherosclerosis Risk in Communities Study, HbA1c was measured. Higher HbA1c level was observed to be strongly and positively associated with risk of incident CKD. This association, which was graded and independent of traditional risk factors, was present even in the absence of albuminuria and retinopathy. Hyperglycemia is an important indicator of CKD risk among individuals with diabetes, whether or not albuminuria or retinopathy is present.

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Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status

Epidemiological studies suggest that the Mediterranean diet (MedDiet) may reduce the risk of the metabolic syndrome (MetS). This multicenter, randomized, controlled, parallel trial compared the effect of 2 types of traditional Mediterranean diets, one supplemented with virgin olive oil (VOO) and the other with mixed nuts, with that of a low-fat diet (control diet) on MetS status. One-year MetS prevalence was reduced by 6.7%, 13.7%, and 2.0% in the MedDiet + VOO, MedDiet + nuts, and control diet groups, respectively (P < .05, MedDiet + nuts vs control diet). Incident MetS rates were not significantly different among groups (22.9%, 17.9%, and 23.4%, respectively). After adjustment for sex, age, baseline obesity status, and weight changes, the odds ratios (95% confidence intervals) for reversion of MetS were 1.3 (0.8-2.1) for the MedDiet + VOO and 1.7 (1.1-2.6) for the MedDiet + nuts compared with the control diet. The authors concluded that a traditional MedDiet enriched with nuts could be a useful tool in the management of MetS.

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One-year reversion among participants who had MetS at baseline (top) and incidence among participants who did not have MetS at baseline (bottom).

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