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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2004;164(18):1949. doi:10.1001/archinte.164.18.1949.
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INSULIN THERAPY FOR CRITICALLY ILL HOSPITALIZED PATIENTS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Hyperglycemia is common among hospitalized patients, and it is associated with increased morbidity and mortality. Pittas and colleagues performed a systematic review of randomized trials of insulin therapy in critically ill hospitalized adult patients. A meta-analysis of 35 trials that met the inclusion criteria showed that insulin therapy decreased short-term mortality in the surgical intensive care unit, when the aim of therapy was glucose control, and in patients with diabetes. This analysis provides further support to the increasing appreciation of the need for improved management of in-hospital hyperglycemia.

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ALCOHOL AND RISK OF ATRIAL FIBRILLATION OR FLUTTER: A COHORT STUDY

The evidence for an association between alcohol consumption and risk of atrial fibrillation is conflicting. Frost and Vestergaard prospectively examined the association between alcohol consumption and risk of atrial fibrillation or flutter among 47 949 participants (mean age, 56 years) in the Danish Diet, Cancer, and Health Study. During follow-up (mean, 5.7 years), atrial fibrillation or flutter developed in 374 men and 182 women. Consumption of alcohol was associated with increased risk of atrial fibrillation or flutter in men. In women, moderate consumption of alcohol did not seem to be associated with risk of atrial fibrillation or flutter.

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COMPREHENSIVE STRATEGY TO PREVENT NOSOCOMIAL SPREAD OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN A HIGHLY ENDEMIC SETTING

The effectiveness and feasibility of a comprehensive strategy to reduce nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in a highly endemic setting has not yet been proven. The results of this study by Tomic and colleagues show that implementing a comprehensive infection control program can reduce nosocomial transmission of MRSA in a highly endemic area. With good hand hygiene using alcohol hand rub, early detection, isolation, and decolonization strategy, containment of MRSA was achievable despite a high rate of transferred patients with MRSA.

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SYMPTOMS AND TREATMENT BURDEN OF GASTROESOPHAGEAL REFLUX DISEASE: VALIDATING THE GERD ASSESSMENT SCALES

Gastroesophageal reflux disease (GERD) is a common chronic problem that can be treated with medication, surgery, or endoscopic techniques. To compare treatment options for GERD, researchers need a valid, reliable, and comprehensive assessment method to aid in clinical decision making, especially with the advent of new technology and medications. Existing assessment methods focus primarily on symptom assessment and do not account for the burden of treatment needed to control symptoms. In this study, Liu and colleagues developed and evaluated an instrument for measuring the impact of GERD, creating 3 separate scales: overall GERD burden, the burden of GERD-related symptoms, and the burden of GERD treatments. They found that the burden of treatment is distinct from that of symptoms and conclude that their scales are reliable, valid, and responsive measures for use in patients with GERD. In addition, their analyses highlight the importance of assessing both GERD symptom and treatment burden.

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SAFETY OF ANTICOAGULATION THERAPY IN WELL-INFORMED OLDER PATIENTS

In a combined retrospective and prospective cohort study, 323 patients 80 years or older, discharged from the hospital with the recommendation of oral anticoagulation therapy, were followed up for a mean ± SD of 28.8 ± 36.3 months. The rate of major bleedings was 2.4 events per 1000 patient-months. Socioeconomic and cognitive parameters, or functional impairments, were not associated with increased rate of bleeding. In multivariate analysis, insufficient education regarding oral anticoagulation therapy as perceived by the patient or caregiver, polypharmacy, and international normalized ratio values above the therapeutic range were the only significant predictive factors for bleeding complications. These findings indicate a relatively low rate of major bleeding complications in elderly patients, even those with cognitive and functional impairments. Insufficient education regarding oral anticoagulation therapy was the major factor that predicted bleeding.

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