Commentary by Michael Poles MD, Associate Editor, Clinical Correlations
It’s time again for this week’s shortcuts, and I have got some interesting things to discuss. Anyone who has spent time in our hospitals these days has been inundated with pleads to be careful with sound-alike or look-alike medications, such as MSO4 and MgSO4. A recent U.S. Pharmacopeia review of more than 26,000 patient records supports that effort. The investigators found that there are 3,170 pairs of drug names that look or sound alike and can result in medication errors. Apparently, that represents a near doubling since 2004, when there were 1,750 similarly named drug pairs. These drug pairs resulted in more than 30,000 drug-name mix-ups in the January 2008 review, which harmed patients 1.4% of the time, and included 7 deaths. To prevent these errors, experts suggested writing the indication for the medication chosen on the prescription so the pharmacist has a better opportunity to avoid distributing the incorrect medication.
Now on to some notable journal articles. Let’s start with the New England Journal of Medicine. An interesting study by the ON-TARGET investigators, sought to examine the effect of ACE inhibitors, angiotensin-receptor blockers (ARBs), or their combination in patients with vascular disease or high-risk diabetes without heart failure. In this large study, 8576 subjects were assigned to receive 10 mg of ramipril daily, 8542 to receive 80 mg of telmisartan daily, and 8502 assigned to a combination of both drugs. While they showed that mean blood pressure was lower in both the telmisartan and the combination-therapy groups, compared to the ramapril group, there were no differences in the primary composite outcomes of death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. Combination therapy was, on the other hand, associated with more adverse events.
In that same issue of NEJM, Dr Gurm, et al. writing for the SAPPHIRE investigators completed a 3-year study comparing carotid stenting with emboli-protection to carotid endarterectomy for the treatment of carotid artery disease. The authors had previously shown that at 30 days and at 1 year, there was no difference in the risk of death, stroke, or myocardial infarction. They now extend these findings to the 3-year timepoint, showing no difference in the risk of death or ipsilateral stroke in these patients.
An interesting article also appeared in last week’s Neurology journal that showed that there is a disparity in survival rates among patients diagnosed with Alzheimer’s disease (AD), based on race. We have seen many articles, examining many disease states, which have come to similar conclusions. What makes this one different is that they found that ethnic minorities with AD survive longer than their Caucasian counterparts. In all, they studied 30,916 AD patients, who were followed for 2.4 ± 2.9 years. The median survival of the group was 4.8 years, but African American and Latino AD patients had a lower adjusted hazard for mortality compared with white AD patients despite similar neuropathologic characteristics and similar clinical severity.
Lastly, making news last week was an article in the Archives of Pediatric and Adolescent Medicine that suggested that daily sleep duration of less than 12 hours during infancy may be a risk factor for overweight and adiposity in preschool-aged children. Judging from my decreasing sleep and expanding waistline, the same appears to be true for adults (N=1).
Image: A young mountain goat in the Alpine Lakes WIlderness, Washington, Courtesy of Wikimedia Commons