EMBARGOED FOR RELEASE UNTIL 5 P.M., EDT, THURSDAY, JULY 31, 1997
August 1, 1997, Tip Sheet
Annals of Internal Medicine is published by the American College of Physicians (ACP), more than 100,000 physicians trained in internal medicine. The following 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. The full text of selected articles can be accessed on the Internet at http://www.acponline.org/journals/annals/annaltoc.htm
* * * Dialysis and Aggressive Care not Cost-effective for Hospitalized Patients With Kidney Failure
The costs of initiating dialysis and continuing aggressive care in seriously ill hospitalized patients with renal failure are not consistent with many experts' estimates for what is acceptable as cost-effective medical care, a study shows. (Article, p. 195.) A study of 490 hospitalized patients with kidney failure found that, with the exception of a subgroup of patients with the best prognoses, dialysis and continued aggressive care are at the high end of the cost-effectiveness scale.
* * * High Levels of Vitamin D From Over-the-counter Dietary Supplements Can Result in Low Bone Mineral Density
Intake of dietary supplements that contain unadvertised high levels of vitamin D can be associated with vitamin D intoxication and thinning of bones, a new study finds. (Brief Communications, p. 203.) Patients who discontinued use of these large amounts of nonprescription dietary supplements regained bone mineral as measured by increase in bone density. An associated editorial comments on the need to recommend vitamin D supplementation with care, and for physicians and patients to recognize the possibility of "hidden" vitamin toxicity. (Editorial, p. 231.)
* * * Strategies for Improving End-of-Life Care
Hospitals and physicians are not equipped to handle the medical and psychosocial problems of dying patients, new data suggests. (Perspective, p. 225.) A paper reviews barriers to achieving a peaceful death, including inadequate education about palliative care, uncertainty about the difference between forgoing life-sustaining treatment and active euthanasia, the difficulty of recognizing when a patient is dying and the sense that a patient's death is a professional failure. The authors propose strategies to improve the delivery of palliative care at the end of life.
* * * New Guidelines for Diagnosing and Treating Diabetes
An editorial reports on new guidelines from the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus on the diagnosis of diabetes and the classification of populations as normal and abnormal with respect to blood sugar levels. (Editorial, p. 235.) # # #
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