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20 May 2003 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.

Heart Stents Have Only Modest Benefits Over Balloon Angioplasty

Analyzing data from 19 medical trials on 9,918 people with heart disease, researchers found that using coronary stents routinely on lesions treated with percutaneous transluminal coronary angioplasty (PTCA) did not improve survival or prevent more heart attacks than using stents only for complications of standard PTCA (Article, p. 777). Routine use of stents was more effective in avoiding repeated procedures because of re-closing of treated arteries. In an accompanying editorial, a writer notes that stenting is more expensive than standard PTCA, that the trials studied did not include many of the heart lesions being treated today and that the study did not evaluate the new stents that are coated with drugs to prevent re-closure (Editorial, p. 842).

Unwanted Treatment Is a Medical "Error." Physicians Must Plan Ahead for Care During a Patient's Fatal Chronic Illness, Experts Say

(Academia and Clinic, p. 812.)

Internal Medicine Professionalism Charter Initiative Enters Phase 2

The Medical Professionalism Charter, published in November 1999, has redefined standards of professional conduct in the health professions. More than 90 professional associations have endorsed the Charter. After initial publication in Annals of Internal Medicine and Lancet in February 2002, many medical journals have reprinted the Charter, and it now appears in six languages with four more translations underway. Phase II of the project, a joint program of the American Board of Internal Medicine Foundation and the American College of Physicians Foundation, will further explore the mutual obligations of patients, physicians and society (Perspective, p. 839). An accompanying editorial points out that the Charter poses unrealistic expectations for physicians to alter attitudes and behaviors of institutions over which they have little power to effect change (Editorial, p. 844). The editorialists advocate collaboration between health professionals, health care institutions, and patients and their advocacy groups to achieve quality patient care and population health.

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