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In This Issue of Archives of Internal Medicine
September 10, 2007

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2007;167(16):1705. doi:10.1001/archinte.167.16.1705

The Variability and Quality of Medication Container Labels

Poor medication labeling is cited as one potential cause of medication errors. Shrank et al evaluated labels from identically written prescriptions for 4 commonly used medications filled in various pharmacies in 4 cities. Characteristics of the format and content of both the main container label and auxiliary stickers were evaluated. The format of most container labels emphasized pharmacy characteristics and items frequently used by pharmacists rather than use instructions or medication warnings. The content of warning and instruction stickers was highly variable depending on the pharmacy. The authors discuss policy implications regarding the improvement of prescription drug labeling.

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Improving Sleep Hygiene of Medical Interns

The Accreditation Council for Graduate Medical Education (ACGME) duty-hour restrictions are aimed to improve sleep deprivation in medical trainees. However, the current ACGME duty-hour limits, particularly in the absence of effective interventions to improve the sleep hygiene of medical trainees, may be inadequate to achieve this goal. This study demonstrates that medical interns, in compliance with ACGME duty-hour restrictions, are still experiencing acute sleep deprivation and not obtaining adequate recovery sleep when off duty. Despite required educational programs for house staff, such as the SAFER (Sleep Alertness and Fatigue Education for Residents) program developed by the American Academy of Sleep Medicine, education alone is ineffective in improving the sleep hygiene of medical trainees. To prevent the negative consequences of sleep deprivation in residents, the adoption of proven countermeasures to fatigue and the promotion of a culture that facilitates healthy sleep habits is warranted.

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Association of Overweight With Increased Risk of Coronary Heart Disease Partly Independent of Blood Pressure and Cholesterol Levels

Moderate overweight (body mass index [BMI] [calculated as weight in kilograms divided by height in meters squared], 25.0-29.9) and obesity (BMI ≥30.0) are risk factors for coronary heart disease independent of their effects via blood pressure and cholesterol levels. This meta-analysis of 21 prospective cohort studies of healthy, mainly white persons (N = 302 296) indicates that adverse effects of excess weight on blood pressure and cholesterol levels account for about 45% of the increased risk of coronary heart disease. The relative risks that remained statistically significant after adjustment for blood pressure and cholesterol levels were 1.17 (95% confidence interval, 1.11-1.23) for moderate overweight and 1.49 (95% confidence interval, 1.32-1.67) for obesity. Hence, overweight may deserve to be incorporated as a risk factor in risk classification schemes for coronary heart disease.

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Increasing Use of Single and Combination Medical Therapy in Patients Hospitalized for Acute Myocardial Infarction in the 21st Century

Using data from a large coronary disease registry of patients hospitalized with acute myocardial infarction, Goldberg et al observed steady increases in the use of angiotensin-converting enzyme inhibitors, β-blockers, and lipid-lowering therapy between 2000 and 2005, while the use of aspirin (approximately 95%) remained high during all periods examined. The proportion of hospital survivors treated with all 4 of these effective cardiac medications increased from 23% in 2000 to 58% during 2005. Older age, female sex, history of heart failure, and occurrence of atrial fibrillation during hospitalization were associated with the underuse of combination medical therapy.

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A Double-blind, Placebo-Controlled, Randomized Trial of Bupropion for Smoking Cessation in Primary Care

Studies undertaken in academic and specialized settings have shown that bupropion hydrochloride, an antidepressant with dopaminergic and noradrenergic activity, can double the odds of stopping smoking compared with placebo. To assess whether these results apply in primary care, Fossati et al performed a randomized trial to be conducted by general practitioners. Seventy-one Italian general practitioners randomized 593 healthy smokers to receive 300 mg/d of sustained-release bupropion hydrochloride or placebo for 7 weeks. Of the bupropion group, 41% were continuously abstinent from weeks 4 to 7 compared with 22% of the placebo group (multivariate odds ratio, 2.37; 95% confidence interval, 1.60-3.53). The continuous abstinence rates from week 4 to 12 months were 25% in the bupropion group and 14% in the placebo group (odds ratio, 2.11; 95% confidence interval, 1.32-3.39).

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