Annals
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16 March 2010 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 www.annals.org. Past highlights are accessible as well.

1. Excess Risk for Death Following Hip Fracture Persists Over Time, Especially for Men

While almost all studies report an increased risk for death in the first three to six months following hip fracture, it is unclear whether this risk continues over the longer-term. Researchers identified and reviewed studies that followed people after hip fracture and compared their survival to that of age- and sex-matched control groups. The researchers found 22 studies that included 578,436 women and 17 studies that included 154,276 men with hip fracture. Their analysis found a five- to eight-fold increased risk for death during the first three months after hip fracture. While this excess mortality decreases significantly during the first two years, it does not return to the mortality rate seen in the control participants even after 10 years of follow-up. At any given age, excess mortality after hip fracture is higher in men than in women.

2. Empirical Study Explores Concerns About The Ethics of Payment to Live Kidney Donors

People who need kidney transplants outnumber available kidneys and many patients become sicker or die before a kidney is available. Paying donors might increase the number of available kidneys, but payment could result in the following ethical problems: 1) payment could dull a person’s sensitivity to the risks of donation; 2) poor or disadvantaged persons may be more enticed to donate than more economically advantaged people; and 3) payment could dissuade donation for altruistic reasons. Researchers surveyed 409 persons riding the regional rail and urban trolley lines in Philadelphia to determine whether payment for kidney donation might lead to these problems. Responses suggested that payment would not create undue or unjust incentives for donation or alter a person’s willingness to donate altruistically. However, the authors of a related editorial argue that empirical research should be examined with caution. For example, even though the study authors found no association between change of price and change of willingness to donate across income level, at any given price, lower income respondents were almost twice as likely to give in to the inducements. “We must scrutinize conclusions for their soundness, and we must be vigilant that we do not inadvertently use empirical findings to justify practices that are morally objectionable,” the editorialist writes.

3. Salsalate May Help Type 2 Diabetics Control Blood Glucose Levels

In small studies, salsalate has been shown to reduce blood glucose concentration. Researchers conducted a study to compare the efficacy and safety of salsalate at different doses in patients with type 2 diabetes. Participants aged 18 to 75 were randomly assigned to receive placebo or salsalate in dosages of 3.0, 3.5, or 4.0 g/d (27 patients each) in addition to their regular therapy. After 14 weeks, patients receiving all doses of salsalate had lower HbA1c levels and improvements in other markers of glycemic control. However, due to the small study size and short duration, researchers conclude that additional research is needed to determine if salsalate may provide a new avenue for treatment for patients with type 2 diabetes.

4. Pay for Performance Compatible with Medical Professionalism, Finds ACP

Some experts have proposed a Pay for Performance (P4P) approach to improving the quality of health care in the United States. However, some argue that this method is at odds with medical professionalism. The American College of Physicians (ACP) convened an expert panel in clinical medicine, law, management, and health policy at six in-person meetings to discuss the relationship between medical professionalism and P4P incentive programs. The advisory board used the Medical Professionalism Charter as the framework for the analysis. The panel systematically considered the interaction between P4P and the following Charter themes – application of scientific evidence, ethical interaction, achieving equity, and commitment to professionalism. They concluded that properly designed P4P models can strengthen the relationship between the physician and the patient and increase the likelihood that all physicians will deliver the best possible care to every patient.