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3 December 2002 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.

Hospitalists Reduce Costs, Length of Hospital Stay and Short-Term Mortality

Two studies found lower costs, shorter hospital stays, and fewer deaths following hospitalization for patients under the care of hospitalists compared to those under the care of physicians who did not specialize in hospital care (Articles, p. 859 and p. 866). The benefits of hospitalists became evident only in the second year of both studies, indicating that hospitalist experience is important. An editorial says that these studies provide the best current evidence about hospitalist outcomes but do not show how hospitalists achieved favorable outcomes and do not prove that optimum hospital care requires hospitalists (Editorial, p. 930).

USPSTF Does Not Recommend For or Against Screening for Prostate Cancer

The United States Preventive Services Task Force (USPSTF), after reviewing published research on the benefits and harms of screening for prostate cancer, concluded that the evidence is insufficient to recommend for or against routine screening for prostate cancer using either digital rectal examination or prostate-specific antigen (PSA) tests (Clinical Guidelines, p. 915 and p. 917). The Task Force found good evidence that PSA screening detects early-stage prostate cancer but inconclusive evidence that early detection improves health outcomes or saves lives.

Study Examines Bone Density When Estrogen and Alendronate are Stopped

Researchers followed 244 postmenopausal women with low bone mass who took various combinations of bone-loss prevention drugs for two years, then stopped (Article, p. 875). At the end of three years, women who switched from alendronate or a combination of alendronate and estrogen to a placebo, or dummy pill, maintained bone density. Women who switched from estrogen alone to a placebo lost bone mass at greater rates than women who had never been on a drug to prevent bone loss. Women who continued taking the combination of alendronate and estrogen had spinal bone mineral density 11.2 percent higher than those in the three-year placebo group. All women in the study had had hysterectomies.

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