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In This Issue of Archives of Internal Medicine
February 13, 2006

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2006;166(3):268. doi:10.1001/archinte.166.3.268

Effects of Low-Carbohydrate vs Low-Fat Diets on Weight Loss and Cardiovascular Risk Factors

Nordmann and colleagues conducted a meta-analysis of randomized controlled trials to assess the effects of calorie-unrestricted, low-carbohydrate vs calorie-restricted, low-fat diets on weight loss and cardiovascular risk factors. Low-carbohydrate diets appeared to be at least as effective as low-fat diets in inducing weight loss for a duration of up to 1 year. However, potential favorable changes in triglyceride and high-density lipoprotein cholesterol values should be weighed against potential unfavorable changes in low-density lipoprotein cholesterol values when considering low-carbohydrate diets to induce weight loss.

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The Implications of Choice

Most Americans are enrolled in 3-tier pharmacy benefit plans, plans that offer physicians and patients substantial choice in the prescribing process. Shrank et al evaluated how the choice to initiate patients on generic, preferred, or nonpreferred formulary options affects patient adherence to long-term medication use. The authors found that patients are most adherent when started on therapy with generic medications, averaging a 12.6% greater proportion of days covered compared with patients who were started on therapy with nonpreferred medications. Adherence was 8.8% greater for patients started on therapy with preferred vs nonpreferred brand-name medications. These findings suggest that physicians and patients who aim to improve adherence to long-term medication use ought to be aware of the generic and formulary options within a drug class when initiating therapy.

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Screening for Hemochromatosis in Asymptomatic Subjects With or Without a Family History

This study assessed screening for hereditary hemochromatosis in 672 asymptomatic subjects identified by family screening or by health checks. Hepatic iron overload and fibrosis were comparable between the 2 groups. Significant hepatic iron overload was present in 56% of men and 34.5% of women, hepatic fibrosis was present in 18.4% of men and 5.4% of women, and cirrhosis was present in 5.6% of men and 1.9% of women. All cirrhotic subjects were asymptomatic. Hepatic fibrosis and cirrhosis correlated significantly with the hepatic iron concentration and, except for cirrhosis, fibrosis was reversed by iron removal.

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Adherence to Black Box Warnings for Prescription Medications in Outpatients

Lasser and colleagues examined the frequency with which clinicians prescribe drugs in violation of black box warnings for drug-drug, drug-laboratory, and drug-disease interactions and the harm associated with such prescribing. In this observational study of approximately 325 000 outpatients, approximately 7 in 1000 patients received a prescription violating a black box warning. After adjustment for confounders, receipt of medication in violation of a black box warning was more likely when patients were older than 75 years or female. The number of medications taken, number of medical problems, and site of care were also associated with violations. Fewer than 1% of patients who received a drug in violation of a black box warning had an adverse drug event as a result.

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Chlorhexidine Gluconate to Cleanse Patients in a Medical Intensive Care Unit

Historically, interrupting transmission of antimicrobial-resistant bacteria has focused on improving health care workers' adherence to infection-control practices. Vernon and colleagues evaluated an adjunctive approach, “source control,” by decontaminating patients' skin. A prospective sequential group clinical trial in a medical intensive care unit evaluated vancomycin-resistant enterococci (VRE) contamination of environmental surfaces and health care workers' hands and patient acquisition of VRE colonization. Soap and water baths were compared with chlorhexidine cloth cleansing and cloth cleansing without chlorhexidine. Cleansing with chlorhexidine cloths resulted in less VRE on patients' skin, health care workers' hands, and environmental surfaces. Vancomycin-resistant enterococci acquisition decreased from 26 per 1000 patient-days to 9 per 1000 patient-days. Cleansing with nonmedicated cloths was similar to soap and water baths. The authors concluded that cleansing patients with chlorhexidine cloths is an effective strategy to reduce the bioburden of VRE in a medical intensive care unit.

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