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In This Issue of Archives of Internal Medicine
April 14, 2008

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2008;168(7):682. doi:10.1001/archinte.168.7.682
Loop Diuretic Use and Increased Rates of Hip Bone Loss in Older Men

Older adults commonly use loop diuretics, which can increase urinary calcium excretion, leading to potential bone loss. In a cohort of older men (mean age, 72.7 years), Lim et al compared rates of bone loss at the hip in men not taking loop diuretics, men taking loop diuretics intermittently, and men taking loop diuretics continuously. After adjustment for multiple potential confounders, mean total hip bone mineral density decreased by 0.33% per year in men not taking loop diuretics compared with a decrease of 0.58% (95% confidence interval [CI], −0.69% to −0.47%) per year in those taking loop diuretics intermittently and 0.78% (95% CI, −0.96% to −0.60%) per year in those taking loop diuretics continuously.

See page 735

Length of Hospital Stay and Postdischarge Mortality in Patients With Pulmonary Embolism

The optimal length of stay (LOS) for patients with pulmonary embolism is unknown. While reducing LOS is likely to save costs, the effects on patient safety are unclear. Using data from 15 531 patient discharges with pulmonary embolism from 186 hospitals in Pennsylvania, Aujesky et al sought to assess whether LOS was associated with postdischarge mortality. After adjustment for hospital and patient factors, the authors found that postdischarge mortality was significantly higher for patients with an LOS of 4 days or less (odds ratio, 1.55; 95%CI, 1.21-2.0) relative to those with an LOS of 5 to 6 days, suggesting that physicians may inappropriately select patients with pulmonary embolism for early discharge who are at increased risk of complications.

See page 706

Computed Tomographic Colonography to Screen for Colorectal Cancer, Extracolonic Cancer, and Aortic Aneurysm

This study details a cost-effective analysis of computed tomographic colonography (CTC) screening vs optical colonoscopy screening in a simulated population of 100 000 US subjects, taking into account the potential costs and benefits related to extracolonic evaluation. The main finding of this study is that the detection of abdominal aortic aneurysms and, to a lesser extent, extracolonic cancers substantially improves the cost-effectiveness of CTC for colorectal cancer screening. In fact, CTC dominated over colonoscopy (with or without ultrasonography) by being both a more clinically effective and less costly screening strategy.

See page 696

Association Between Cancer Risk Perception and Screening Behavior Among Diverse Women

This study identified significant ethnic differences in the perception of risk for breast, cervical, and colon cancers by ethnicity. Asian women consistently had the lowest and Latina women had the highest perceived risk of cancer for each of the 3 sites. African American women did not perceive their risk for these cancers to be different from white women. Having a family or self-history of cancer and fair or poor self-reported health status were associated with higher cancer risk perception. Higher perceived risk was associated with having had a colonoscopy in the previous 10 years. These findings suggest that communication of cancer risk information may serve as an important tool to promote early detection. Evaluation of perceived cancer risk may be useful to clinicians who are recommending screening tests and incorporating an intervention to help diverse populations understand risk and interpret medical data.

See page 728

Incidental Findings on Cardiac Multidetector Row Computed Tomography Among Healthy Older Adults

This cross-sectional analysis describes incidental findings prospectively evaluated in healthy older subjects who underwent cardiac multidetector row computed tomography for detection and quantification of coronary artery calcification. Of the 459 participants, 190 (41%) had incidental findings, and 105 (23%) had at least 1 incidental finding recommended for clinical or radiological follow-up examination. The most common finding was single or multiple pulmonary nodules (18%). Burt et al conclude that incidental findings, especially pulmonary nodules, are common in this setting. The net risks and benefits of looking for noncardiac abnormalities during cardiac multidetector row computed tomography should be rigorously evaluated.

An axial multidetector row computed tomographic scan of the liver.

An axial multidetector row computed tomographic scan of the liver.

See page 756