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17 August 2004 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians, an organization of more than 115,000 internal medicine physicians and medical students. These 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.

Elderly Benefit from Early, Aggressive Management of C.A.D.

In a study of 2,220 patients admitted to hospitals with symptoms of acute coronary artery disease, patients were randomly assigned to receive either conservative or early and invasive treatment (Article, p. 186). Conservative treatment involved medication, unless instability suggested the need for more invasive care. Early, invasive treatment involved cardiac catheterization within 4 to 48 hours of presentation, with subsequent revascularization procedure (angioplasty, stent, or surgery) when possible. For prevention of heart attack or death, early invasive treatment showed a benefit, and the benefit was greater in patients older than 65 compared to younger patients.

Female Physicians in Academic Medicine Earn Less Than Male Counterparts

A survey of 1,814 full-time U.S. medical school faculty in 1995-1996 found that female faculty earned less than men, even after adjustment for hours worked, job responsibilities, and productivity (Academia and Clinic, p. 205). Editorial writers say that census data show "no other profession in the United States exhibits greater salary disparities by sex" (Editorial, p. 238). Since "the strongest evidence of inequity comes from academic medicine," they say, academic medicine is the place to implement solutions. They suggest more transparency in promotion and compensation practices and institutional commitment to remedy disparities.

Netherlands Study Examines Practice of Terminal Sedation in the Care of Dying Patients

A survey of 482 physicians in the Netherlands found that 52 percent had used terminal sedation with cessation of food and water in the care of terminally ill patients (Article, p. 178). In 211 of the most recent cases, hastening death was the physicians' explicit intent for 47 percent of the patients. Hastening death was partly the physicians' intent in 27 percent of the patients. Physicians reported that symptom relief was the main intent in many cases. An editorial writer says that the medical profession as a whole should control use of terminal sedation by developing and implementing practice guidelines (Editorial, p. 236). He notes that model guidelines exist.

ACP Cites 8 Principles to Heal Ethnic Disparities in Health Care

The American College of Physicians, the nation's largest medical specialty society, says it is dedicated to eliminating all ethnic disparities in U.S. health care (Position Paper, p. 226). The organization identifies eight principles on which to focus action. Four commentaries, commissioned by Annals of Internal Medicine, applaud the ACP paper and, in general, agree with the eight principles, but the commentators point out some devils in the details of implementation.

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