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15 July 2008 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656, or visit Past highlights are accessible as well.

1. Young Adults With Prehypertension Are More Likely to Have Coronary Artery Calcium and Atherosclerosis Later in Life

High blood pressure in middle-aged and older adults is a strong risk factor for cardiovascular disease. Less is known about the risks of high blood pressure in young adults. Researchers analyzed blood pressure measurements of 3,560 adults 18 to 30 years of age from seven examinations over the course of 20 years. Nearly one fifth (635) of the study participants developed prehypertension (systolic blood pressure 120-139 mmHG or diastolic blood pressure 80-89 mmHg) before the age of 35. Although these blood pressure levels are below the cutoff for hypertension, young adults with prehypertension were more likely than those with lower blood pressure to have calcium in their coronary arteries, a condition that is linked to future heart attacks and strokes. Prehypertension was most common in patients who were male, overweight, black, and of low socioeconomic status.

2. Low-Molecular-Weight Heparin May Prevent Some Blood Clots After Knee Arthroscopy

Knee arthroscopy, the most common orthopedic operation in the United States and Europe, is a relatively minor surgery. Blood thinners are not routinely used to prevent blood clots in the leg after the procedure, but a new study may challenge this practice. Researchers studied 1,761 patients undergoing knee arthroscopy, randomly assigning them to three groups: One wore a graduated compression stocking for seven days, another received injections of low-molecular-weight heparin (LMWH) for seven days, and the third group received LMWH injections for 14 days. Although blood clots were uncommon in all groups, fewer patients receiving LMWH developed blood clots compared to those wearing compression stockings (0.9 percent vs. 3.2 percent). Patients receiving LMWH for 14 days did not have fewer clots than those receiving LMWH for seven days. Blood thinners made the biggest difference in people having arthroscopic surgery on the cartilage of the knees (meniscectomy).

3. Disconnect Found Between Patient-Reported Hospital Errors and Medical Record Review

Researchers found that among 998 patients who completed a questionnaire about their hospitalization experience, poor agreement about the occurrence of adverse hospital events exists between patient interviews and medical records. The study suggests that patients report serious and preventable events that are not documented in medical records. It also suggests that hospitals should consider monitoring patient safety by adding questions about adverse events to post-discharge interviews.

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