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June 27, 2011, Vol 171, No. 12, Pages 1051-1130

Perspectives

Pulmonary Artery Rupture From Invasive Hemodynamic Monitoring

Abstract Full Text
Arch Intern Med. 2011;171(12):1109-1109. doi:10.1001/archinternmed.2011.250
Editorial

Patient Experience of Overtreatment

Abstract Full Text
Arch Intern Med. 2011;171(12):1054-1054. doi:10.1001/archinternmed.2011.114
Original Investigation

Dietary Fiber Intake and Mortality in the NIH-AARP Diet and Health Study

Abstract Full Text
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Arch Intern Med. 2011;171(12):1061-1068. doi:10.1001/archinternmed.2011.18
BackgroundDietary fiber has been hypothesized to lower the risk of coronary heart disease, diabetes, and some cancers. However, little is known of the effect of dietary fiber intake on total death and cause-specific deaths.MethodsWe examined dietary fiber intake in relation to total mortality and death from specific causes in the NIH (National Institutes of Health)-AARP Diet and Health Study, a prospective cohort study. Diet was assessed using a food-frequency questionnaire at baseline. Cause of death was identified using the National Death Index Plus. Cox proportional hazard models were used to estimate relative risks and 2-sided 95% confidence intervals (CIs).ResultsDuring an average of 9 years of follow-up, we identified 20 126 deaths in men and 11 330 deaths in women. Dietary fiber intake was associated with a significantly lowered risk of total death in both men and women (multivariate relative risk comparing the highest with the lowest quintile, 0.78 [95% CI, 0.73-0.82; P for trend, <.001] in men and 0.78 [95% CI, 0.73-0.85; P for trend, <.001] in women). Dietary fiber intake also lowered the risk of death from cardiovascular, infectious, and respiratory diseases by 24% to 56% in men and by 34% to 59% in women. Inverse association between dietary fiber intake and cancer death was observed in men but not in women. Dietary fiber from grains, but not from other sources, was significantly inversely related to total and cause-specific death in both men and women.ConclusionsDietary fiber may reduce the risk of death from cardiovascular, infectious, and respiratory diseases. Making fiber-rich food choices more often may provide significant health benefits.

Decreased Antibiotic Utilization After Implementation of a Guideline for Inpatient Cellulitis and Cutaneous Abscess

Abstract Full Text
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Arch Intern Med. 2011;171(12):1072-1079. doi:10.1001/archinternmed.2011.29
BackgroundCellulitis and cutaneous abscess are among the most common infections leading to hospitalization, yet optimal management strategies have not been adequately studied. We hypothesized that implementation of an institutional guideline to standardize and streamline the evaluation and treatment of inpatient cellulitis and abscess would decrease antibiotic and health care resource utilization.MethodsA retrospective preintervention-postintervention study was performed to compare management before and after implementation of the guideline (January 1, 2007–December 31, 2007, and July 9, 2009–July 8, 2010).ResultsA total of 169 patients (66 with cellulitis, 103 with abscess) were included in the baseline cohort, and 175 (82 with cellulitis, 93 with abscess) were included in the intervention cohort. The intervention led to a significant decrease in use of microbiological cultures (80% vs 66%; P = .003) and fewer requests for inpatient consultations (46% vs 30%; P = .004). The median duration of antibiotic therapy decreased from 13 days (interquartile range [IQR], 10-15 days) to 10 days (IQR, 9-12 days) (P < .001). Fewer patients received antimicrobial agents with broad aerobic gram-negative activity (66% vs 36%; P < .001), antipseudomonal activity (28% vs 18%; P = .02), or broad anaerobic activity (76% vs 49%; P < .001). Clinical failure occurred in 7.7% and 7.4% of cases (P = .93), respectively.ConclusionImplementation of a guideline for the management of inpatient cellulitis and cutaneous abscess led to shorter durations of more targeted antibiotic therapy and decreased use of resources without adversely affecting clinical outcomes.

Mortality Rate in Patients With Diastolic Dysfunction and Normal Systolic Function

Abstract Full Text
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Arch Intern Med. 2011;171(12):1082-1087. doi:10.1001/archinternmed.2011.244

Prognostic Role of Ambulatory Blood Pressure Measurement in Patients With Nondialysis Chronic Kidney Disease

Abstract Full Text
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Arch Intern Med. 2011;171(12):1090-1098. doi:10.1001/archinternmed.2011.230

Study of Neurontin: Titrate to Effect, Profile of Safety (STEPS) TrialA Narrative Account of a Gabapentin Seeding Trial

Abstract Full Text
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Arch Intern Med. 2011;171(12):1100-1107. doi:10.1001/archinternmed.2011.241
Images From Our Readers

Images From Our Readers

Abstract Full Text
Arch Intern Med. 2011;171(12):1111-1111. doi:10.1001/archinternmed.2011.254

Crossing a quiet street in Port-au-Prince, Haiti, 4 months after the earthquake

Abstract Full Text
Arch Intern Med. 2011;171(12):1115-1115. doi:10.1001/archinternmed.2011.253
In This Issue of Archives of Internal Medicine

In This Issue of Archives of Internal Medicine

Abstract Full Text
Arch Intern Med. 2011;171(12):1053-1053. doi:10.1001/archinternmed.2011.270
Commentary

Pulmonary Artery Catheterization in the Intensive Care UnitJust Numbers Floating By?

Abstract Full Text
Arch Intern Med. 2011;171(12):1110-1111. doi:10.1001/archinternmed.2011.249
Special Article

Airport Full-Body ScreeningWhat Is the Risk?

Abstract Full Text
Arch Intern Med. 2011;171(12):1112-1115. doi:10.1001/archinternmed.2011.105

In the past year, the Transportation Security Administration has deployed full-body scanners in airports across the United States in response to heightened security needs. Several groups have opposed the scans, citing privacy concerns and fear of the radiation emitted by the backscatter x-ray scanners, 1 of the 2 types of machines in use. The radiation doses emitted by the scans are extremely small; the scans deliver an amount of radiation equivalent to 3 to 9 minutes of the radiation received through normal daily living. Furthermore, since flying itself increases exposure to ionizing radiation, the scan will contribute less than 1% of the dose a flyer will receive from exposure to cosmic rays at elevated altitudes. The estimation of cancer risks associated with these scans is difficult, but using the only available models, the risk would be extremely small, even among frequent flyers. We conclude that there is no significant threat of radiation from the scans.

Research Letters

On the Benefit of Intensive Care for Very Old Patients

Abstract Full Text
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Arch Intern Med. 2011;171(12):1116-1117. doi:10.1001/archinternmed.2011.102

Low Serum Cholesterol Level and Increased Ischemic Stroke Mortality

Abstract Full Text
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Arch Intern Med. 2011;171(12):1116-1130. doi:10.1001/archinternmed.2011.255

Declines in Physician Acceptance of Medicare and Private Coverage

Abstract Full Text
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Arch Intern Med. 2011;171(12):1117-1119. doi:10.1001/archinternmed.2011.251

Prediction of Risk of Falling, Physical Disability, and Frailty by Rate of Decline in Grip Strength: The Women's Health and Aging Study

Abstract Full Text
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Arch Intern Med. 2011;171(12):1119-1121. doi:10.1001/archinternmed.2011.252
Editor's Correspondence

Dietary Fiber Prevents Both Morbidity and Mortality From Respiratory Disease

Abstract Full Text
Arch Intern Med. 2011;171(12):1123-1123. doi:10.1001/archinternmed.2011.240

Number Needed to Treat: Implementation for Diets

Abstract Full Text
Arch Intern Med. 2011;171(12):1123a-1124. doi:10.1001/archinternmed.2011.237

More Health Care Is Not Necessarily Better Health Care

Abstract Full Text
Arch Intern Med. 2011;171(12):1124-1124. doi:10.1001/archinternmed.2011.268

More Health Care Is Not Necessarily Better Health Care—Reply

Abstract Full Text
Arch Intern Med. 2011;171(12):1124-1124. doi:10.1001/archinternmed.2011.269

Improving the Prediction of Incident Atrial Fibrillation

Abstract Full Text
Arch Intern Med. 2011;171(12):1125-1125. doi:10.1001/archinternmed.2011.266

Improving the Prediction of Incident Atrial Fibrillation—Reply

Abstract Full Text
Arch Intern Med. 2011;171(12):1125-1125. doi:10.1001/archinternmed.2011.267

Bleeding Associated With Antiplatelet Agents and Warfarin Therapy in the Emergency Department

Abstract Full Text
Arch Intern Med. 2011;171(12):1126-1126. doi:10.1001/archinternmed.2011.265

Safety of Opioids in Older Adults

Abstract Full Text
Arch Intern Med. 2011;171(12):1126a-1126. doi:10.1001/archinternmed.2011.264

A Painful Setback: Misinterpretation of Analgesic Safety in Older Adults May Inadvertently Worsen Pain Care

Abstract Full Text
Arch Intern Med. 2011;171(12):1127-1127. doi:10.1001/archinternmed.2011.262

A Painful Setback: Misinterpretation of Analgesic Safety in Older Adults May Inadvertently Worsen Pain Care—Reply

Abstract Full Text
Arch Intern Med. 2011;171(12):1127-1127. doi:10.1001/archinternmed.2011.263

Do Not Abandon Cultures

Abstract Full Text
Arch Intern Med. 2011;171(12):1128-1128. doi:10.1001/archinternmed.2011.260

Do Not Abandon Cultures—Reply

Abstract Full Text
Arch Intern Med. 2011;171(12):1128-1128. doi:10.1001/archinternmed.2011.261

Uncertainties in the Dose From Full-Body Airport Screening

Abstract Full Text
Arch Intern Med. 2011;171(12):1129-1130. doi:10.1001/archinternmed.2011.258

Uncertainties in the Dose From Full-Body Airport Screening—Reply

Abstract Full Text
Arch Intern Med. 2011;171(12):1129-1130. doi:10.1001/archinternmed.2011.259

Seeding Trials and the Subordination of ScienceComment on “Study of Neurontin: Titrate to Effect, Profile of Safety (STEPS) Trial”

Abstract Full Text
Arch Intern Med. 2011;171(12):1107-1108. doi:10.1001/archinternmed.2011.232

Bupropion for Smoking Cessation in Patients With Acute Coronary Syndrome

Abstract Full Text
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Arch Intern Med. 2011;171(12):1055-1060. doi:10.1001/archinternmed.2011.72

Do the Health Benefits of Dietary Fiber Extend Beyond Cardiovascular Disease?Comment on “Dietary Fiber Intake and Mortality in the NIH-AARP Diet and Health Study”

Abstract Full Text
Arch Intern Med. 2011;171(12):1069-1070. doi:10.1001/archinternmed.2011.19
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