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In a field study in the emergency departments of 3 cities in southwest France, Blazejewski et al found that in more than 600 persons admitted to hospital for more than 24 hours because of a traffic accident, sleepiness had almost as much effect as alcohol, doubling the risk of being responsible for the accident.
An initiative of the National Physicians Alliance, the “Good Stewardship in Clinical Practice” project developed a list of the “Top 5” activities in primary care for which changes in practice could lead to higher-quality care and better use of finite clinical resources. One recommendation was to avoid routine imaging for low back pain (LBP). Srinivas et al examine the prevalence of routine imaging in LBP, describe physician and patient attitudes toward imaging, and summarize recent systematic reviews or meta-analyses concerning its benefits. They found only 1 meta-analysis focusing on clinical outcomes, which found no clinical benefit to routine imaging. The authors conclude that unneeded advanced imaging for LBP has not been justified by the literature, estimating that approximately $300 million could be saved annually by eliminating it.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2012;172(13):980. doi:10.1001/archinternmed.2011.962
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