Psychological distress and death
Psychological distress is associated with an increased risk of death from cerebrovascular disease. This study obtained data from a population-based cohort in the UK. Psychological distress was measured using the 12-item General Health Questionnaire. These results show that the cardiovascular effects of psychological distress are not limited to coronary artery disease and may be useful for screening and preventive care, say the authors. See Research, page 1461
Although the cardiovascular benefits of treating psychological stress remain unproven, clinicians should be mindful of traditional cardiovascular risk factors in people who are stressed and refer them for support and treatment, suggest Pan and Rexrode. See Commentary, page 1453
Bicarbonate and risk of diabetes
We still do not know why insulin receptors become less receptive as type 2 diabetes develops. In this cohort study of American Nurses, chronically low plasma bicarbonate was shown to be associated with risk of diabetes; if confirmed, this finding could improve our understanding of the pathogenesis of type 2 diabetes. See Research, page E719
Shared decisions reduced prescribing
A shared decision-making tool led to fewer patients deciding to use antibiotics for acute respiratory infections. As well as use, outcomes such as quality of life, decisional conflict, repeat consultation and adverse effects were compared in 359 patients in this cluster randomized controlled trial carried out in 9 family practice units. Future studies should assess shared decision-making in other clinical areas in which overuse is an issue, say the authors. See Research, page E726
Adverse events among children in hospital
About 1 in 9 children admitted to Canadian hospitals experience an adverse event. Some of these are not preventable, but the authors of this study emphasize that there are many opportunities to reduce harm, particularly related to surgery, intensive care and diagnostic error. See Research, page E709
Management of colonic diverticulitis
New insights into the pathogenesis of colonic diverticular disease are changing the management of acute and recurrent diverticulitis, says Tursi. Areas of particular interest include the use of mesalazine and probiotics in preventing recurrence. See Review, page 1470
Use of electronic health records
Electronic health records afford numerous potential benefits, but some clinicians are concerned that processing electronic information will reduce their productivity and increase their workload. Sittig and Singh tackle these concerns and others by presenting 10 “rights” and corresponding responsibilities to ensure that the quality of health care continues to be improved. See Analysis, page 1479
Herpes zoster
A 69-year-old man has a vesicular rash that is diagnosed as herpes zoster. Should he receive an oral antiviral agent? If postherpetic neuralgia develops, will anything decrease the pain? What about the herpes zoster vaccine? MacFadden and Gold address these and other common questions about herpes zoster. See Practice, page 1489
Acetaminophen overdose in children
Acetaminophen overdose in children is a major cause of acute liver failure in children. This case reviews developmental differences in drug metabolism between infants and older children, and highlights controversies in the treatment of acute acetaminophen overdose. Ogilvie and coauthors emphasize that the widespread use and availability of acetaminophen make the potential for overdose a population health concern. See Practice, page 1492
Acne
Topical treatments for acne can be continued for years, whereas oral antibiotics can be gradually discontinued if the condition remains under control for 2 months, say Freiman and Barankin. See Practice, page 1497