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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2005;165(22):2555. doi:10.1001/archinte.165.22.2555.
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The environment in which patients consume medical information is in flux as health information becomes more common online and patients adopt a more proactive approach to medical decision making. Hesse et al used baseline data from the Health Information National Trends Survey (a nationally representative telephone survey sponsored by the National Institutes of Health) to analyze trust and use patterns across different communication channels in the new environment. Indicators of trust were shown to be highest for physicians as a valued source of information, but indicators of use showed a predilection toward using the Internet as the information source of first resort.

See page 2628

Evidence from laboratory studies indicates that green and black tea preparations may protect against various cancers. The possible protective role of tea consumption against the development of ovarian cancer in humans is unclear. This study prospectively examined tea consumption in relation to the risk of ovarian cancer in a population-based cohort of 61 057 women. The authors ascertained 301 incident cases of invasive epithelial ovarian cancer during an average follow-up of 15.1 years. After controlling for relevant risk factors, compared with women who never or seldom consumed tea, those who consumed 2 or more cups of tea per day had a 46% lower risk of ovarian cancer (rate ratio, 0.54). These findings suggest that tea consumption may lower the risk of ovarian cancer.

See page 2683

O’Hare et al evaluated the association of cystatin C, a novel marker of renal function, with risk for developing complications related to peripheral arterial disease (PAD) among participants in the Cardiovascular Health Study. These authors found that among participants without PAD at baseline, a cystatin C level in the highest quintile was associated with an increased risk for requiring a lower extremity amputation or revascularization procedure during follow-up (hazard ratio, 2.5 for the highest compared with the lowest quintile of cystatin C). They concluded that an elevated cystatin C level is an independent predictor of incident PAD events among community-dwelling elderly patients.

See page 2666

Internal medicine residents are at particular risk for burnout. In July 2003, the Accreditation Council for Graduate Medical Education mandated that residents work no more than 24 consecutive hours with an additional 6 hours for educational and administrative activities and no more than 80 h/wk averaged over 4 weeks. Gopal et al studied the effect of these new work-hour restrictions and the resulting change in work schedule on internal medicine resident burnout and self-reported quality of care and education. Fewer residents experienced high emotional exhaustion after the work hours were restricted. There was also a trend toward fewer residents with high depersonalization. Personal accomplishment did not change. The assessment of self-reported quality of care did not significantly change from 2003 to 2004. Residents reported attending fewer educational conferences per month. Reducing hours may be the first step to reduce burnout, but the resulting change in work schedule may also impact education and quality of care.

See page 2595

This report describes the investigation of a large outbreak of central venous catheter-associated Klebsiella oxytoca and Enterobacter cloacae bloodstream infections among outpatients at an oncology chemotherapy clinic. Twenty-seven patients had blood cultures that grew K oxytoca, E cloacae, or both, and all had central venous catheters that were flushed with saline at the clinic during the period between February 17 and March 3, 2004. Klebsiella oxytoca and E cloacae isolates were matched by pulsed-field gel electrophoresis to K oxytoca and E cloacae isolates obtained from multiple predrawn syringes and from the intravenous fluid and administration set in use in the clinic at the time of its closing. This report discusses strategies for prevention of bloodstream infections in the outpatient setting.

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Pulsed-field gel electrophoresis patterns after Xba1 digestion of isolates of Klebsiella oxytoca.

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Pulsed-field gel electrophoresis patterns after Xba1 digestion of isolates of Klebsiella oxytoca.

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