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.
The American College of Physicians (ACP) has released the sixth edition of its Ethics Manual. New topics in the updated manual address the patient-physician relationship during health catastrophes, providing culturally sensitive care, use of human biologic materials in research, social media and online professionalism, industry sponsored research, and the challenges of taking care of so-called very important persons. ACP’s Ethics Manual also revisits and expands on issues of previous editions, such as end-of-life care, complementary and alternative medicine, physician-assisted suicide, physician-industry relations, genetic testing, and research ethics. Developed by ACP’s Ethics, Professionalism, and Human Rights Committee, ACP’s Ethics Manual is being published as a supplement to the current issue of Annals of Internal Medicine and is available online at www.annals.org. In an accompanying editorial, Ezekiel Emanuel, MD, PhD, a medical ethicist at the University of Pennsylvania, praises the manual for having many clear and specific recommendations. Dr. Emanuel writes: ACP’s Ethics Manual “is an important guide for physicians. It goes well beyond the usual banalities to take brave stands on current issues. Yet this document is a worthy heir to the tradition of medical oaths and codes that stretches back millennia.”
Most people experience neck pain within their lifetime. While not serious, neck pain can interfere greatly with daily activities. Usual care for neck pain may include medication or chiropractic, yet there has been little published evidence about the efficacy of spinal manipulation therapy (SMT) for neck pain. Researchers conducted a randomized trial to test the hypothesis that SMT is more effective than medication or home exercise with advice for acute and subacute neck pain. Two-hundred-seventy-two patients aged 18 to 65 with nonspecific neck pain for two to 12 weeks were randomly assigned to receive SMT, medication, or home exercise with advice for 12 weeks. Up to one year after treatment, patients having 12 weeks of SMT reported greater pain relief than patients in the medication group. Patients in the home exercise with advice group reported just as much pain relief as those in the SMT group over the same period. However, patients having SMT reported that they were more satisfied with care than those in either of the other groups. The researchers conclude that SMT and home exercise are similarly effective to each other and both are more effective than medication for neck pain.
In-hospital mortality rates are often used to measure the quality of hospital care. Since length of hospital stay varies for each patient and hospital, this type of measurement can favor hospitals with early transfers or shorter lengths of stay. Researchers sought to determine if a standardized 30-day follow-up procedure might eliminate the bias and serve as a more objective measuring tool. Researchers compared risk standardized in-hospital and 30-day mortality rates for acute care nonfederal hospitals in the U.S with at least 30 admissions for acute myocardial infarction, heart failure, and pneumonia from 2004 to 2006. They found that changing the type of mortality assessment changed the quality ranking for 8 to 15 percent of hospitals.
Eleven classes of medications have been introduced to manage type 2 diabetes since 1995. Physicians often use clinical practice guidelines to guide treatment decisions for their diabetic patients, but not all guidelines are of the same quality. Researchers reviewed 11 published guidelines on oral medications for type 2 diabetes to see if they were consistent with a 2007 systematic review of the current evidence and whether consistency of the guidelines depends on the quality of guideline development. Guidelines were assessed using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument, which measures quality of a guideline based on seven crucial elements of systematic review and reporting. While all 11 of the guidelines were consistent with the evidence review, the overall quality of all of the guidelines was poor (based on AGREE criteria). The researchers suggest that quality of guidelines will improve when the new IOM definition of a guideline and guideline development standards are followed.