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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2009;169(10):920. doi:10.1001/archinternmed.2009.99.
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Extensive literature documents personal distress among physicians and a decrease in their satisfaction with the practice of medicine over recent years. In this study, Shanafelt et al measured career fit (the extent to which individuals are able to focus their effort on the aspect of work they find most meaningful) and burnout among faculty physicians in the department of medicine at a large academic medical center. The amount of time spent working on most meaningful activity was strongly related to risk of burnout, with those spending less than 20% of their effort (approximately 1 d/wk) on the activity most meaningful to them having higher rates of burnout (53.8% vs 29.9%; P < .001). Time spent on most meaningful activity was the largest predictor of burnout in multivariate analysis (odds ratio, 3.26; P < .001). Efforts to optimize career fit may promote physician satisfaction and help to reduce attrition among academic faculty.

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Singh et al prospectively evaluated the nature and frequency of prescription errors related to inconsistent communication in a computerized provider order entry (CPOE) system. Errors of inconsistent information within the same prescription (ie, mismatch between the structured template and the associated free-text field of CPOE) were estimated to occur in approximately 1% of prescriptions, with drug dosage being the most common inconsistent element. Approximately 20% of errors could have resulted in moderate to severe harm. The authors conclude that despite standardization of data entry, inconsistent communication in CPOE poses a significant risk to safety.

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This meta-analysis estimated the effects of Internet- and computer-based smoking cessation programs from randomized controlled trials conducted on cigarette smokers. After searching 3 major databases including PubMed, EMBASE, and the Cochrane Review, Myung et al included a total of 22 randomized controlled trials in the final analysis. Overall, the results indicated that the interventions had a significant effect on smoking cessation (relative risk [RR], 1.44; 95% confidence interval [CI], 1.27-1.64). Similar findings were observed in 9 trials using an Internet-based intervention and in 13 trials using a computer-based intervention. Subgroup analyses revealed similar results for different levels of methodological rigor, stand-alone vs supplemental interventions, type of abstinence rates used, and follow-up period duration, but not for adolescent populations (RR, 1.08; 95% CI, 0.59-1.98). There is sufficient clinical evidence to support the use of Internet- and computer-based smoking cessation programs for adult smokers.

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Dysfunction of the inner ear balance (vestibular) system can be debilitating and can lead to catastrophic outcomes such as falls. Agrawal et al probed the population-based 2001-2004 National Health and Nutrition Examination Survey and found that vestibular dysfunction is surprisingly common among US adults: the impairment was present in 35% of Americans 40 years or older, corresponding to 69 million Americans. The authors observed that prevalence increases significantly with age and that individuals with less than a high school education as well as those with diabetes are at increased risk. The authors also found that individuals with vestibular dysfunction have a 12-fold increase in the risk of falling. These findings suggest the importance of diagnosing, treating, and potentially screening for vestibular deficits to reduce the burden of fall-related injuries and deaths in the United States.

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The extent to which retail clinics provide access to care for underserved populations remains largely unknown. By mapping the locations of retail clinics in the United States as of July 2008, Pollack and Armstrong found that retail clinics were significantly less likely to be located in medically underserved areas/populations compared with census tracts without retail clinics. Similarly, in an analysis of 6 counties, the authors found that retail clinics were significantly less likely to be located in underserved areas after accounting for the underlying distribution of chain stores. To the extent that location correlates with accessibility, this distribution may undermine their ability to promote access. If retail clinics are determined to be a valuable and effective source of care, focusing on the distribution of these clinics may be an important avenue for improving their potential societal benefit.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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