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16 December 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. Colonoscopy Significantly Reduces Death from Left-sided Colon Cancer but Not from Right-sided Colon Cancer

Physicians Should Advise Patients of Test Limitations

A new study finds that colonoscopy is strongly associated with fewer deaths from colorectal cancer. However, the risk reduction appears to be entirely due to a reduction in deaths from left-sided cancers. According to the study, colonoscopy shows almost no mortality prevention benefit for cancer that develops in the right side of the colon. Colorectal cancer is the second-leading cause of cancer death in North America. The study appears on the Annals of Internal Medicine Web site and will be printed in the January 6, 2009, issue. "While colonoscopy remains the gold standard for evaluation of the colon, our study sheds light on some of the real-world limitations of this practice for screening and prevention," said Nancy Baxter, MD, PhD, Colorectal Surgeon and a Researcher at St. Michael's Hospital, who is lead author on the study.

Note: This study also is the subject of a separate news release and video news story.

2. Interruptions in Medicaid Coverage Increase Unnecessary Hospitalizations

Many low-income U.S. citizens experience interruptions in health insurance coverage. A study of more than 4.7 million California adults with Medicaid found an association between interruptions in coverage and a higher rate of hospitalization for ambulatory care-sensitive conditions. Ambulatory conditions are those that are typically treated on an out-patient basis, such as diabetes and chronic obstructive pulmonary disease (COPD). Hospital admissions for these types of conditions indicate a decline in the quality of health care that lower-income people receive outside the hospital. Authors suggest that policies that reduce the frequency of interruptions in Medicaid coverage might prevent some of these hospitalizations and reduce health care costs.

3. Family Members Want Straight Talk from Physicians Regarding Poor Patient Prognosis

When a patient is incapacitated by serious illness, family members become surrogate decision makers. However, physicians may feel reluctant to discuss a particularly poor prognosis with surrogates for fear that it could extinguish all sense of hope. Researchers conducted face-to-face interviews with 179 family members of seriously ill patients to determine their opinions about balancing hope and telling the truth about a poor prognosis. Nearly all of the surrogates said that withholding bad news was not acceptable. They felt that knowing the truth was important because it gave them an opportunity to prepare emotionally and practically for a loved one's death.

4. Home Rehabilitation is a Safe, Viable Option for COPD Patients

COPD is a progressive disease that causes debilitating shortness of breath. Exercise training can reduce shortness of breath, even in severe COPD. While hospitals have programs that provide closely supervised exercise training, access to these programs is limited. Researchers conducted a study of 252 COPD patients to find out if a home-based, largely unsupervised exercise program could be as effective as a hospital-based program. All patients had four weeks of education about living with COPD before being randomly assigned to either hospital or home rehabilitation. In both programs, patients were instructed to perform three exercise sessions per week for eight weeks. During the eight weeks, trainers called home exercisers weekly to provide encouragement. After eight weeks, trainers called once every two months. At one year, patients in both groups reaped equal benefits, with both reporting less shortness of breath than before. Researchers conclude that tailoring pulmonary rehabilitation to meet individual needs could improve accessibility to this effective intervention.

Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information. Annals of Internal Medicine attribution is required in stories and articles.

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