In the Literature

Clinical Shorts

DRONEDARONE USE IN ATRIAL FIBRILLATION REDUCES CARDIOVASCULAR EVENTS

In the ATHENA trial, dronedarone decreased rates of first hospitalization due to cardiovascular events and death (31.9% vs. 39.4%) in atrial fibrillation without increasing pulmonary or thyroid toxicity.

Citation: Hohnloser SH, Crijns HJ, van Eickels M, et al. Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med. 2009;360(7):668-678.

CENTRAL-LINE-RELATED MRSA BLOODSTREAM INFECTIONS (BSI) DECREASING IN U.S.

CDC analysis from 1997-2007 reveals a 49.6% decrease in the actual incidence of MRSA central-line-associated BSI but a 25.8% increase in the proportion of MRSA in comparison with MSSA.

Citation: Burton DC, Edwards JR, Horan TC, Jernigan JA, Fridkin SK. Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997-2007. JAMA. 2009;301(7):727-736.

MULTIVITAMIN USE IN POSTMENOPAUSAL WOMEN SHOWS NO MEANINGFUL BENEFIT

Large cohort study fails to explain the rationale for widespread multivitamin use, because long-term use did not significantly impact risk for common cancers, cardiovascular disease, or mortality.

Citation: Neuhouser ML, Wassertheil-Smoller S, Thomson C, et al. Multivitamin use and risk of cancer and cardiovascular disease in the Women’s Health Initiative cohorts. Arch Intern Med. 2009;169(3):294-304.

PREVIOUS FLUCONAZOLE EXPOSURE LINKED TO RESISTANT CANDIDA GLABRATA BSI

In this case-control study, fluconazole and linezolid were coined as independent risk factors for subsequent fluconazole-resistant Candida glabrata BSI, while cefepime and metronidazole increased the risk for susceptible glabrata BSI.

Citation: Lee I, Fishman NO, Zaoutis TE, et al. Risk factors for fluconazole-resistant Candida glabrata bloodstream infections. Arch Intern Med. 2009;169(4):379-383.

PHYSICIANS’ RISK STRATIFICATION CORRELATED POORLY WITH VALIDATED CARDIAC RISK SCORES IN PATIENTS WITH NSTEMI

Multicenter study reveals that clinical risk stratification in non-ST elevation myocardial infarction (NSTEMI) conflicted with objective cardiac risk scores, was uninfluenced by prognosticators like heart failure and creatinine, and perpetuated under-recognition of risk.

Citation: Yan AT, Yan RT, Huynh T, et al. Understanding physicians’ risk stratification of acute coronary syndromes: insights from the Canadian ACS 2 Registry. Arch Intern Med. 2009;169(4):372-378.

HANDHELD ULTRASOUND CAN SUPPLEMENT HOSPITALISTS’ CARDIAC EXAMINATION

In a blinded interventional study, hospitalists’ training in basic echocardiography improved assessment of lower ventricular dysfunction (46% to 59%), cardiomegaly, and pericardial effusions, but not valvular lesions.

Citation: Martin LD, Howell EE, Ziegelstein RC, et al. Hand-carried ultrasound performed by hospitalists: does it improve the cardiac physical examination? Am J Med. 2009;122(1):35-41.

REDUCED-CALORIE DIETS, IRRESPECTIVE OF RELATIVE CARBOHYDRATE, FAT, OR PROTEIN PROPORTIONS, ARE EFFECTIVE IN WEIGHT LOSS

Randomized controlled trial of 811 patients showed that reduced-calorie diets with different macronutrient compositions promoted clinically significant and similar weight loss. Weight loss was strongly predicted by group-

session attendance.

Citation: Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360(9):859-873.

PATIENTS’ ABILITY TO CORRECTLY IDENTIFY THEIR INPATIENT PHYSICIAN DEPENDS ON DISSATISFACTION OF CARE

In a prospective survey, patient (age, race, education) and system level (teaching service) factors influenced correct physician identification; those who could not were more likely to be unsatisfied with their care.

Citation: Arora V, Gangireddy S, Mehrotra A, Ginde R, Tormey M, Meltzer D. Ability of hospitalized patients to identify their in-hospital physicians. Arch Intern Med. 2009;169(2):199-201.