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In This Issue of Archives of Internal Medicine
September 27, 2004

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2004;164(17):1827. doi:10.1001/archinte.164.17.1827
Diabetic Ketoacidosis in Type 1 and Type 2 Diabetes Mellitus

Diabetic ketoacidosis (DKA) is no longer a unique feature of type 1 diabetes mellitus. This retrospective study of 178 admissions for moderate to severe DKA by 138 patients compares the clinical and biochemical characteristics of the 30 patients with type 2 diabetes with those with type 1 diabetes. With regard to precipitants of DKA, 29% of the patients with type 2 diabetes were found to only have noncompliance with medical therapy as a possible precipitant. Type 2 diabetes was also associated with less severe acidosis and more normal serum potassium levels compared with type 1 diabetes. Although patients with type 2 diabetes required more time from presentation to achieve a negative urine ketone status, this difference disappeared when using the time following initiation of the intravenous insulin infusion protocol.

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Postservice Mortality in Vietnam Veterans

Afollow-up investigation was undertaken on the Vietnam Experience Study cohort of 18  313 male US Army veterans to further assess the health impact of the Vietnam experience on cause-specific mortality by comparing mortality between Vietnam veterans and veterans who did not serve in Vietnam. Vital status and underlying cause of death data were retrospectively ascertained from the end of the original study through 2000 and analyzed using Cox proportional hazards regression. All-cause mortality was slightly higher among Vietnam veterans than non-Vietnam veterans over the entire follow-up period. Death rates from disease-related chronic conditions did not differ between Vietnam veterans and their peers. Vietnam veterans continued to experience higher mortality than non-Vietnam veterans from unintentional poisonings and drug-related causes.

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Effects of Hospitalist Attending Physicians on Trainee Satisfaction With Teaching and With Internal Medicine Rotations

Hospitalists now serve as attending physicians at many academic medical centers and teaching hospitals. The aim of this study designed by Hauer et al was to compare house staff and student teaching evaluations when their internal medicine ward rotations were supervised by hospitalists with traditional nonhospitalist attending physicians. The analysis demonstrated that hospitalists were rated more favorably for teaching effectiveness, inpatient knowledge, teaching of pathophysiology, emphasis on cost-effectiveness, and provision of feedback. When supervised by hospitalists, trainees rated the overall educational value of the rotation and the feedback higher than when supervised by traditional attending physicians. These findings suggest that hospitalists either have or develop a specific skill set that leads to an improved educational experience for trainees.

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Breast Cancer Risk in Primary Care

Some women at increased risk of breast cancer may benefit from taking tamoxifen citrate for breast cancer prevention if the potential benefits outweigh the potential risks of adverse events. Lewis and colleagues found that among women in general internal medicine practices in North Carolina, the proportion at increased risk for breast cancer ranged in white women from 9% for those in their 40s to 53% for those in their 60s. For black women, the percentage ranged from 3% to 12%. When adverse events were considered, 10% or less of white women in all age groups were eligible for discussions about chemoprevention. The maximum proportion of breast cancers prevented in eligible women was 6% to 8%. New chemopreventive strategies may improve the balance between the risks and benefits and increase the numbers of breast cancers prevented in women from primary care practices.

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Effect of Helicobacter pylori Eradication on Platelet Recovery in Patients With Chronic Idiopathic Thrombocytopenic Purpura

The prevalence of Helicobacter pylori infection in Japanese patients with chronic idiopathic thrombocytopenic purpura (ITP) and the effect of its eradication on platelet count was determined. Of 53 patients with chronic ITP, 39 (74%) were H pylori positive. Of 32 infected patients who received treatment, H pylori was successfully eradicated in 27 (84%). A significant increase in platelet count was demonstrated in patients in whom H pylori was successfully eradicated but not in patients who were unsuccessfully treated or in untreated patients. Current corticosteroid therapy was reported more often in nonresponders than in responders. Eradication of H pylori may prove effective in increasing platelet count in H pylori–positive patients with chronic ITP.

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