PrimeCuts: This Week in the Journals

March 16, 2009

picture-032.jpgCommentary by Ami Jhaveri MD, PGY-1

Faculty Peer Reviewed

Spring is approaching, but the buzz in the journals is about this winter’s drug-resistant influenza virus. Oseltamivir, used for treatment and prophylaxis of influenza A, had until recently low rates of resistance (<1%) against the virus. Now, surveillance data from 2008-2009 estimates resistance to be >90%. A retrospective study in JAMA compared risk factors, underlying medical illnesses, and clinical outcomes of patients infected with oseltamivir-resistant influenza A during the 2007-2008 influenza season to patients infected with oseltamivir-susceptible virus and found that there were no significant differences between the two groups. This study found that using oseltamivir did not increase chances for infection with oseltamivir resistant viruses.

Also to watch out for as we’re gearing up for spring is a recent Neurology article finding that headaches are more common in warmer weather. This case-crossover study of 7054 patients who left the ED with a primary diagnosis of headache found that for each 5 degree increase in temperature, there was a 7.5% higher risk for headache. Researchers in this study were not able to find a clear association between air pollution and headache.

With the bounty of fresh fruits and vegetables coming soon, this is an opportune time to include them in our daily repertoire. This would help attain a low sodium diet and, according to this week’s Lancet, help with blood pressure control. The Lancet highlights a research study from China that performed a dietary intervention in 1906 people with a low sodium diet for 7 days followed by a high sodium diet for 7 days. The study divided the study population into two groups, one with metabolic syndrome and the other without, and compared the response of blood pressure in each group to the level of salt load. This study showed that the blood pressure changes associated with the degree of dietary salt were more pronounced in the group with metabolic syndrome. The more risk factors of metabolic syndrome a study participant had, the more responsive the participant’s blood pressure was to salt load. This study identifies a potential target population in which a low sodium diet may help prevent hypertension.

Although it is well-known that patients with hypertension should follow a low sodium diet, a topic of debate is the role of glucose control in heart disease. Researchers attempted to elucidate glucose control on admission in patients with acute myocardial infarction in a cohort study in the Archives of Internal Medicine. 7820 patients with acute MI found to have glucose levels > 140 on admission were divided into 2 groups: those who did receive insulin therapy after admission and those who did not. Glucose normalization, whether on its own or after insulin treatment, was associated with better survival.

A special article in the NEJM acknowledged the substantial growth of hospitalist medicine over the past 20 years. Researchers used national Medicare data to calculate the percentage of patient care in hospitals provided by hospitalists. The proportion of physicians in internal medicine who are hospitalists increased three times between 1995 to 2006 from 5.9% to 19.0%. Correlating with this substantial growth, the percentage of services in hospitals provided by hospitalists increased four-fold between 1995 and 2006 from 9.1% to 37.1%. This study also commented that as the role of hospitalists have become a mainstay in our system, the career stability of those in this field have also increased. Two-thirds of hospitalists in 2004 continued this career path in 2006, whereas 10 years ago in 1995, only one-third of hospitalists did so. The study demonstrates the vast changes in the health care system that have occurred just in the past 10 years.

The advent of a new technology such as electronic medical records allow better communication between primary care physicians and hospitalists in maintaining continuity of patient care. Even Wal-Mart has picked up on this trend and is going to market an EMR system to physicians, teaming Dell computers with the EClinicalWorks EMR software, as reported in the NY Times. Wal-Mart’s goal is to bring this system into small-physicians’ offices. Wal-Mart’s EMR package will be arriving this Spring at Sam’s clubs and will cost $25,000 for the first physician in a practice and an additional $10,000 for each additional physician in the practice.

References:

 

1. Dharan,N,  Gubareva L, Meyer J, et al. Infections with Oseltamivir-Resistant Influenza A (H1N1 Virus) in the United States. JAMA. 2009 March 11; 301(10):1034-1041.

2. Mukamal K, Wellenius G, Suh H, et al.  Weather and Air Pollution as Triggers of Severe Headaches. Neurology. 2009 March 10; 72(10); 922-927.

3. Chen J, Gu D, Huag J, et al. Metabolic Syndrome and Salt Sensitivity of Blood Pressure in Non-diabetic People in China: a dietary intervention study. The Lancet. 2009 March 7; 373(9666): 829-835.

4. Kosiborod M, Inzucchi S, Krumholz H, et al. Glucose Normalization and Outcomes in Patients with Acute Myocardial Infarction. Archives of Internal Medicine. 2009 March 9; 169(5): 438-446.

5. Kuo Y, Sharma G, Freeman J, et al. Growth in the Care of Older Patients by Hospitalists in the United States. 2009 March 12; 360(11):1102-1112.

6. Lohr S. Wal-Mart Plans to Market Digital Health Records System. NY Times. 09 March 10.

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