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.
The U.S. Preventive Services Task Force (USPSTF) recommends that all adults over 50 be screened for colorectal cancer. The Task Force identified two screening methods that have been shown to reduce death from colorectal cancer: the fecal occult blood test and flexible sigmoidoscopy. The Task Force also recommended colonoscopy but says the evidence that it reduces death from colorectal cancer is indirect. The Task Force did not recommend a specific screening test, saying instead that patients and their physicians should discuss the advantages and disadvantages of the tests and decide which test is best for them. The frequency of screening depends on the test. Adults with known risk factors for colorectal cancer, such as a family or personal history of colorectal cancer, need more intensive screening. (Recommendations and Rationale, p. 129; Summary of Evidence, p. 132; Cost-Effectiveness Analysis, p. 96)
Reminding emergency department physicians of the potential benefit of clot-busting drugs in patients with myocardial infarction appears to increase the use of this proven treatment in certain groups of patients, according to a newly published study (Article, p. 87). The drugs and angioplasty are underused in women and in some types of heart attacks. The prediction decision tool in the study used information from the ECG combined with patient information such as age, sex, health history and when the heart attack symptoms began.
The second article in the new Annals of Internal Medicine series on medical errors examines a case of unexpected hypoglycemia in a critically ill patient (Academia and Clinic, p. 110). The patient, who subsequently died, was not diabetic and was given insulin instead of heparin to clear an intravenous line. The article discusses how individual mistakes and weaknesses in the hospital's systems led to the error, and describes how the hospital responded.