EMBARGOED FOR RELEASE
UNTIL 5 P.M., EST,
TUESDAY, DECEMBER 31,
1996
January 1, 1997, Tip Sheet
Annals of Internal Medicine is published by the American College of
Physicians, 85,000 physicians trained in internal medicine. The
following highlights are not intended to substitute for articles as sources of
information. To obtain a copy of an article call
1-800-523-1546, ext. 2656 or 215-351-2656.
* * *
Coronary Artery Bypass Rates in New York State
and Ontario Differ, But Which Rate is Right?
A new study of 1993 data from cardiac surgery
registries found that the overall age-adjusted rate
of coronary artery bypass graft (CABG) surgery was
1.9 times greater in New York State than in
Ontario. (Article, p. 13.) New York had more
surgery among the elderly, women, and
people who recently had heart attacks, and 8.97
times more surgery in patients with limited
coronary disease. The authors suggest that
there is probably neither one right rate
nor a simple relation between service rates and
appropriateness of case selection.
* * *
Polycystic Ovaries Associated with More
Extensive Heart Disease, Metabolic Abnormalities
Women with more extensive coronary artery disease
were more likely to have polycystic ovaries (shown
by ultrasound) than those with less extensive
disease, a new study of 143 women who had
coronary angiography found. (Brief Communications, p. 32.)
Further, those with polycystic ovaries were
more likely to have metabolic and endocrine
abnormalities. The exact implications of these
findings for prevention and treatment need to be
determined.
* * *
Satiety Hormone Is Higher in Obese People; No
Genetic Factor Found
A study of 23 identical twins, in which one of
each pair was obese, found that levels of
plasma leptin were increased in the obese,
independent of genetic background. (Article, p.
26.) Previous studies of unrelated people found
that increased levels of leptin, a recently
discovered hormone, were associated with obesity,
but the role of genetic versus environmental
factors has not previously been clarified.
* * *
Three Conditions for Bedside Rationing
Bedside rationing occurs only if: the physician
must withhold or withdraw a medical service that is
in the patients best medical interest; must
act to promote the best interests of someone
other than the patient; and must have control
over the use of the beneficial service,
authors say. (Medicine and Public Issues, p.
74.) Once bedside rationing has been
defined, the authors say, persons who are opposed
to any form of it and those who consider it
inevitable or justifiable may find that what
appeared....irresolvable....rests on different
interpretations ....rather than on a deep
or abiding incompatibility of world views.
RSS