Use of EMRs, WHI data on multivitamins and depression among medical students

In what surely coincides with my clinical impression, researchers from Dana Farber recently published their findings that clinicians frequently override most electronic medical record medication safety alerts (full text available here with log-in), suggesting that for optimal patient safety, that alert system will have to change. Not surprisingly, clinicians were most likely to override the alerts if the patient had previously received the medication without difficulty. The most common alerts were high-risk interactions among a combination of medications. I think this is one area where the promise of EMR does not live up to the practical application of EMR — at least not yet.

The Women's Health Initiative has published more data, showing more negative prevention findings. In this case, multivitamins were not useful in decreasing rates of breast, colorectal, endometrial, kidney, bladder, stomach, ovary or lung cancers among postmenopausal women. The authors caution that this cohort was well educated and had generally good health patterns, in addition to taking the multivitamin, and that perhaps there may still be a benefit for patients who have a less robust diet.

In another large cohort study (The Nurses' Health Study II), aspirin, acetaminophen and NSAIDs did not appear to reduce the rates of invasive premenopausal breast cancer.

And lest you think I only read the Archives of Internal Medicine, I also came across this interesting article (via KevinMD) about higher than average rates of depression among medical students. Based on Center for Epidemiological Studies Depression Scale and Primary Care Evaluation of Mental Disorders criteria, 12% of the students surveyed had major depression, and another 9% had mild or moderate depression. If you interact with or teach medical students as a part of your practice, this is definitely something to be more aware of.