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17 June 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. Hearing Impairment is Common Among Adults With Diabetes

Hearing impairment is common in adults with diabetes, and diabetes seems to be an independent risk factor for the condition. Using the National Health and Nutrition Examination Survey, collected by the National Center for Health Statistics from 1999 to 2004, researchers analyzed data from 5,140 adults aged 20 to 69 who completed an audiometric examination and a diabetes questionnaire. Hearing impairment was more prevalent among adults with diabetes. Age-adjusted prevalence of low- or mid-frequency hearing impairment of mild or greater severity assessed in the worse ear was 21.3 percent among 399 adults with diabetes compared to 9.4 percent among 4,741 adults without diabetes. These differences in hearing between people with and without diabetes were present in both sexes; all groups of race or ethnicity, education, and income; and all age groups but the oldest. See separate news release and video news release for more information.

Note: This article will be posted online at along with the June 17, 2008, issue of Annals of Internal Medicine. It will appear in the July 1, 2008, print edition of the journal.

2. Coffee Drinkers Have Slightly Lower Death Rates Than People Who Do Not Drink Coffee

Regular coffee drinking (up to 6 cups per day) is not associated with increased deaths in either men or women. In fact, both caffeinated and decaffeinated coffee consumption is associated with a somewhat smaller rate of death from heart disease. Women consuming two to three cups of caffeinated coffee per day had a 25 percent lower risk of death from heart disease during the follow-up period (which lasted from 1980 to 2004 and involved 84,214 women) as compared with non-consumers, and an 18 percent lower risk of death caused by something other than cancer or heart disease as compared with non-consumers during follow-up. For men, this level of consumption was associated with neither a higher nor a lower risk of death during the follow-up period (which lasted from 1986 to 2004 and involved 41,736 men). See separate news release and video news release for more information.

3. Screening HIV in Patients Older Than 55 Years of Age is Cost-Effective

A new study examined the cost-effectiveness of HIV screening in patients from age 55 to 75. Recently revised screening guidelines issued by the CDC recommend that all patients aged 13 to 64 be tested. The study looked at economic effects of voluntary HIV screening in patients aged 55 to 75: 8,672 inpatients and outpatients at six Department of Veterans Affairs Health Care Systems, whose HIV status was unknown, were included. The authors concluded that if the tested population has an HIV prevalence of 0.1 percent or greater, HIV screening in persons from age 55 to 75 is cost-effective according to conventional definitions of cost-effectiveness. The authors also suggest that to be cost-effective, screening decisions in patients older than 64 should consider whether the patient is at increased risk, has a partner at risk for contracting HIV, or has other life-threatening conditions. Advanced age alone should not preclude screening for HIV.

4. Open-access Scheduling has Mixed Results

The goal of open-access scheduling of office appointments is to guarantee patients that they can see a physician on the same day that they seek an appointment. The authors assessed the impact of open-access scheduling on patient appointment availability, no-show rates, and patient and staff satisfaction in six primary care practices from 2003 to 2006. The authors found that within four months of implementation, practices were able to significantly reduce their mean wait for appointment availability. However, none of the practices attained the goal of same-day access, although most practices felt their efforts were beneficial, since implementing open-access scheduling forced a re-evaluation of office systems and staffing. The findings contrast with the more optimistic results of several previous studies, which suggests the need for large-scale research of the effects of open-access scheduling.

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