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In This Issue of Archives of Internal Medicine
August 10, 2009

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2009;169(15):1350. doi:10.1001/archinternmed.2009.213

Lactation and Incidence of Premenopausal Breast Cancer

The association between lactation and the risk of premenopausal breast cancer has remained speculative, but data from large, prospective cohort studies are lacking. Stuebe et al analyzed the association between lactation and premenopausal breast cancer in the Nurses' Health Study II. Among women whose mother or sister had breast cancer, having ever breastfed was associated with a 59% reduction in incidence of premenopausal breast cancer (hazard ratio, 0.41; 95% confidence interval, 0.22-0.75). Lactation was not related to incident premenopausal breast cancer among women without a family history of breast cancer.

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Hospitalists and the Quality of Care in Hospitals

Hospitalists are an evolving specialty of physicians whose primary professional focus is the general medical care of hospitalized patients and whose activities include patient care, teaching, research, and leadership-related inpatient care. Less is known about the association between the use of hospitalists and the national standards of the Hospital Quality Alliance benchmark quality measures for acute myocardial infarction, congestive heart failure, and pneumonia. In this study of 3619 hospitals, López et al found that hospitals with hospitalists were associated with better performance on quality indicators for acute myocardial infarction and pneumonia and in the composite domains of disease treatment and diagnosis as well as counseling and prevention, controlling for hospital characteristics such as size, location, ownership type, and staffing availability.

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Healthy Living Is the Best Revenge

In this study of 23 153 German participants aged 35 to 65 years of the European Prospective Investigation Into Cancer and Nutrition–Potsdam Study, the impact of 4 healthy lifestyle factors—never smoking, having a body mass index lower than 30 (calculated as weight in kilograms divided by height in meters squared), performing 3.5 h/wk or more of physical activity, and adhering to healthy dietary principles (high intake of fruits, vegetables, and whole-grain bread and low meat consumption)—on the incidence of chronic disease (diabetes, myocardial infarction, stroke, and cancer) was examined. At baseline, approximately 4% of participants had zero healthy factors, most had 1 to 3 healthy factors, and approximately 9% had 4 factors. During a mean follow-up of 7.8 years, 2006 participants developed a chronic disease. Compared with participants with no healthy factor, reductions in chronic disease among participants with 1, 2, 3, and 4 healthy factors were 49% (95% confidence interval [CI], 40%-57%), 63% (95% CI, 57%-69%), 72% (95% CI, 67%-76%), and 78% (95% CI, 72%-83%), respectively. Adhering to 4 simple healthy lifestyle principles can have a strong impact on the prevention of chronic diseases.

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Use of Simulation-Based Education to Reduce Catheter-Related Bloodstream Infections

Central venous catheters (CVCs) and associated catheter-related bloodstream infections (CRBSIs) are a major source of preventable adverse events in hospitals. Prior research shows that lack of experience correlates with complications when inserting CVCs. However, simulation-based education has been linked to improved procedural skills and reduced complications during CVC insertion. In this study, Barsuk et al evaluated the effect of a simulation-based mastery learning intervention on the rate of CRBSIs in a medical intensive care unit (MICU). In an observational cohort study design, CRBSI rates were measured before and after the simulation-based intervention. After the intervention, there were fewer CRBSIs in the MICU (0.50 infections per 1000 catheter-days) compared with the same unit prior to the intervention (3.20 per 1000 catheter-days; P = .001) and with a comparison surgical intensive care unit in the same hospital throughout the study period, (5.03 per 1000 catheter-days; P = .001). The authors conclude that an educational intervention in CVC insertion significantly improved patient outcomes and improved the quality of care for patients in the MICU.

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Thiazolidinediones and Fractures in Men and Women

The association between thiazolidinediones (TZDs) and fractures in men and women is not adequately understood. Dormuth et al evaluated this association in patients exposed to the TZDs rosiglitazone and pioglitazone compared with control patients exposed to sulfonylureas in a large and stable population of 4.3 million people in British Columbia, Canada. The results showed that both men and women who received TZDs were at an increased risk of fractures and that pioglitazone may be more strongly associated with fractures than is rosiglitazone.

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