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Background: Antibiotic misuse is common and costly and may promote antibiotic resistance. We tested the efficacy of a targeted one-on-one educational program ("academic detailing") designed to improve the appropriateness of broad-spectrum antibiotic use., Methods: A randomized controlled trial was conducted in a large US teaching hospital. During an 18-week study period, 17 general medical, oncology, and cardiology services either received academic detailing or did not. The intervention was prompted by an order for either levofloxacin or ceftazidime that led to a computer-based review of data for that patient. Orders for the 2 target antibiotics deemed unnecessary by a priori criteria were included in the study. The primary outcome examined was the number of days that unnecessary levofloxacin or ceftazidime was administered in intervention and control groups., Results: Before the trial, intervention and control services had similar prescribing patterns for the target antibiotics; the drugs were used for similar indications throughout the study period. During the intervention, there was a reduction of 37% in days of unnecessary levofloxacin or ceftazidime use per 2-week interval on services randomized to the educational intervention vs control services (P< .001). In multivariable analyses controlling for baseline prescribing and study interval, the rate of unnecessary use of the 2 target antibiotics was reduced by 41% on the intervention services compared with controls (95% confidence interval, 44%-78%; P< .001). Length of stay, intensive care unit transfers, readmission rates, and in-hospital death rates were similar in both groups (P> or =.10 for all)., Conclusion: Targeted one-on-one education is a practical, effective, and safe method for reducing excessive broad-spectrum antibiotic use.

Previous cross-sectional studies have shown age trends in electrocardiographic wave patterns, including leftward shift in frontal plane axis and decreases in R, S, and T wave amplitudes with age. The effects of smoking on electrocardiographic measurements have also been examined. Findings of several studies vary and include possible smoking-induced changes in T wave amplitude and frontal plane axis measurements. To examine both cross-sectionally and longitudinally the effects of cigarette smoking on electrocardiographic measurements, serial recordings obtained 5 yr apart were taken from 702 healthy male participants of the Normative Aging Study, who were 23-74 yr of age at their first examination. These men were classified as current smokers (at both baseline and follow-up examinations, N = 291), former smokers (men who stopped smoking prior to the baseline examination, N = 203), or never smokers (at any time, N = 208). At baseline, P-R interval duration was shorter in current smokers than in former or never smokers. Longitudinal results indicated that R, S, and T wave amplitudes decreased at greater rates in smokers than in nonsmokers. These findings suggest that changes in the electrocardiogram attributed to aging may be modified by smoking.

This prospective study compared pre- to post-retirement changes in physical health among male retirees with changes among age peers who continued to work. The 229 retirees and 409 workers aged 55-73 at follow-up were all participants in the Veterans Administration Normative Aging Study. Physical health at baseline and follow-up (three to four years apart) was rated on a four-point scale according to the findings of medical examinations. Although physical health declined generally over time, regression analyses showed no significant difference between eventual retirees and continuing workers on health change, after controlling for age and excluding men who retired due to illness or disability. Among retirees alone, pre- to post-retirement health change was also not significantly associated with several circumstances which purportedly make the retirement transition more stressful, such as mandatory retirement or retirement to a reduced standard of living. The results of this study of physical health, which corroborate those of other studies based on self-reported health measures and mortality data, support the conclusion that the event of retirement does not influence the risk of health deterioration.

The relationship between the baseline electrocardiogram and 10-year incidence of myocardial infarction was examined in a cohort of 1013 men. The men were participants in the Normative Aging Study, a longitudinal study of aging initiated in 1963 at the Veterans Administration Outpatient Clinic in Boston, Massachusetts. Absence of the U wave among these men yielded a relative risk estimate of myocardial infarction of 2.7 as compared to men with a U wave present (95% confidence interval, 1.4-5.2). This association persisted when standard coronary risk factors (cholesterol, blood pressure, and cigarette smoking) were taken into consideration in a multivariate analysis. The results support the conclusion that an abnormality in the electrocardiogram considered to be of little importance indicates an increased risk of myocardial infarction independent of known coronary risk factors.