EMBARGOED: 5 P.M., EST, TUESDAY, JANUARY 14, 1997
January 15, 1997, Tip Sheet Annals of Internal Medicine is published by the American College of Physicians, 89,000 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.
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Providing Quality Care for Dying Patients; Practical Issues for Physician-Assisted Suicide
Three articles in this issue explore end-of-life care. A prospective
cohort study of family members and other surrogate decision makers
of dying patients found that most elderly and seriously ill patients
died in acute care hospitals with severe pain, fatigue and other
symptoms. (Article, p. 97.) The study also found that although many
patients preferred comfort care, life-sustaining treatments
were often used inappropriately.
An editorial suggests establishing separate hospital units, extended-care facilities, nursing homes and hospices for dying patients in order to improve end-of-life care. (Editorials, p. 164.) The author calls for changing our cultural attitude to accept death as a natural phenomenon, and for health care institutions to commit more resources to improving end-of-life care.
Practical issues involved in physician-assisted suicide should be
included in the ongoing debate about its legalization, an article
states. (Perspectives, p. 146.) In order to resolve the difficulties
associated with the practical application of physician-assisted
suicide, future legislation, professional societies, individual
physicians, professional educators and key researchers must work
together, the author states.
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Tuberculosis in HIV-Infected Individuals More Common in Eastern United States
A study of HIV-infected patients found a higher incidence of tuberculosis in the Eastern United States, in patients with positive reactions to purified protein derivative tuberculin, and in patients with CD4 cell counts of less than 200 cells/mm3. (Article, p. 123.) The study also found that nonreactivity to mumps antigen independently indicated an increased risk for tuberculosis.
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Medical Decision Rules Should Not Be Based On Medical Necessity, Cost-Effectiveness
Data on medical necessity and cost-effectiveness should not be used as a substitute for medical decision rules, a study suggests. (Article, p. 152.) The study uses an analytical framework to show the tradeoff between sensitivity and specificity that occurs when using medical
necessity and cost-effectiveness as decision rules. The authors
recommend that medical necessity and cost-effectiveness should be
used instead as tools to help patients, providers and payers make better-informed decisions about patient care.
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