Hossein A. Ghofrani, MD; Frank Reichenberger, MD; Markus G. Kohstall, MD; Eike H. Mrosek, MD; Timon Seeger, MD; Horst Olschewski, MD; Werner Seeger, MD; Friedrich Grimminger, PhD, MD
Fourteen mountain climbers received sildenafil and placebo in random order at low altitude while breathing hypoxic gas and again at an elevation of 5400 m. Sildenafil reduced hypoxic pulmonary hypertension at rest and with exercise and increased maximum exercise capacity and cardiac output.
Ann Intern Med. 2004;141(3):169-177. doi:10.7326/0003-4819-141-3-200408030-00005
Judith A.C. Rietjens, MSc; Agnes van der Heide, MD, PhD; Astrid M. Vrakking, MSc; Bregje D. Onwuteaka-Philipsen, PhD; Paul J. van der Maas, MD, PhD; Gerrit van der Wal, MD, PhD
Terminal sedation precedes a substantial number of deaths in the Netherlands. In about two thirds of most recent cases, physicians indicated that in addition to alleviating symptoms, they intended to hasten death.
Ann Intern Med. 2004;141(3):178-185. doi:10.7326/0003-4819-141-3-200408030-00006
Richard G. Bach, MD; Christopher P. Cannon, MD; William S. Weintraub, MD; Peter M. DiBattiste, MD; Laura A. Demopoulos, MD; H. Vernon Anderson, MD; Paul T. DeLucca, PhD; Elizabeth M. Mahoney, ScD; Sabina A. Murphy, MPH; Eugene Braunwald, MD
After acute coronary syndromes, older people have a larger risk for poor ischemic outcomes than younger people. Despite this increased risk, a routine early invasive strategy can significantly improve ischemic outcomes in elderly patients with unstable angina and non–ST-segment elevation myocardial infarction.
Ann Intern Med. 2004;141(3):186-195. doi:10.7326/0003-4819-141-3-200408030-00007
Eric G. Neilson, MD; Kevin B. Johnson, MD; S. Trent Rosenbloom, MD, MPH; William D. Dupont, PhD; Doug Talbert, PhD; Dario A. Giuse, Dr Ing; Allen Kaiser, MD; Randolph A. Miller, MD; and the Resource Utilization Committee*
The authors studied the effect of a computer-based medical order entry system on unnecessary test ordering. Two strategies reduced test orders: computer prompts that questioned repetitive orders for routine tests and unbundling the tests in a metabolic panel. The system did not affect patient readmission rates, length of stay, transfer to intensive care units, or mortality rates.
Ann Intern Med. 2004;141(3):196-204. doi:10.7326/0003-4819-141-3-200408030-00008
Kurt Kroenke, MD; Lia Logio, MD
This year's Update in General Internal Medicine incorporates articles on thromboembolic disease, imaging, hypertension, combination therapy versus single-drug therapy, preventive medicine, pain, and physician satisfaction.
Ann Intern Med. 2004;141(3):213-220. doi:10.7326/0003-4819-141-3-200408030-00010
American College of Physicians*
This position paper provides ample evidence that compared to nonminorities, minorities do not always receive the same quality of health care, do not have the same access to health care, are less represented in the health professions, and have poorer overall health status. This statement sets forth specific actions for reducing these disparities.
Ann Intern Med. 2004;141(3):226-232. doi:10.7326/0003-4819-141-3-200408030-00015
Arlene S. Ash, PhD; Phyllis L. Carr, MD; Richard Goldstein, PhD; Robert H. Friedman, MD*
Female medical school faculty do not advance as rapidly and are not as well compensated as similar male colleagues. Deficits for female physicians are greater than those for nonphysician female faculty. Compared to men, deficits are greater for female faculty with more seniority.
Ann Intern Med. 2004;141(3):205-212. doi:10.7326/0003-4819-141-3-200408030-00009
Risa Lavizzo-Mourey, MD, MBA; John R. Lumpkin, MD
The American College of Physicians' position statement on racial and ethnic disparities is comprehensive and can be a model for other specialties and disciplines. The emphasis on enhancing cultural competency is important because such competency can improve outcomes.
Ann Intern Med. 2004;141(3):221. doi:10.7326/0003-4819-141-3-200408030-00011
Sherrie H. Kaplan, PhD, MPH; Sheldon Greenfield, MD
We must not let the call for action to reduce disparities in health get lost in niggling debates over the details of implementation. Yet the details are precisely where the difficulties lie. The leadership of U.S. medicine must question whether some of the proposed solutions will actually produce better health care for minorities.
Ann Intern Med. 2004;141(3):222-223. doi:10.7326/0003-4819-141-3-200408030-00012
Neil R. Powe, MD, MPH, MBA; Lisa A. Cooper, MD, MPH
The direct evidence that increasing the diversity of the physician workforce improves health status is not ironclad, but, on balance, the American College of Physicians is right to support action to diversify the health professional workforce.
Ann Intern Med. 2004;141(3):223-224. doi:10.7326/0003-4819-141-3-200408030-00013
Theodore Pincus, MD
The American College of Physicians' position paper presents a largely “physician-centric” perspective on how to improve health of minorities. This “biomedical model” is spectacularly successful in high-intensity, acute medical care but plays a much smaller role in the outcomes of general health and chronic diseases.
Ann Intern Med. 2004;141(3):224-225. doi:10.7326/0003-4819-141-3-200408030-00014
Lewis J. Rubin, MD; Robert Naeije, MD
In this issue, Ghofrani and colleagues report on a study that is a technical and logistic tour de force. We must nevertheless ask the following questions: How do their results fit into the current understanding of how hypoxia limits exercise capacity? Are there plausible alternative explanations for their findings?
Ann Intern Med. 2004;141(3):233-235. doi:10.7326/0003-4819-141-3-200408030-00016
Muriel R. Gillick, MD
Rietjens and colleagues' description of physician behavior near the end of their patients' lives can help us decide whether the ethical concerns raised by terminal sedation are merely theoretical or whether they lead to harm. The data are not reassuring.
Ann Intern Med. 2004;141(3):236-237. doi:10.7326/0003-4819-141-3-200408030-00018
Christine Laine, MD, MPH, Senior Deputy Editor; Barbara J. Turner, MD, MSEd
An article in this issue provides the most recent evidence that, despite near-equal representation of women and men in medicine, equal compensation eludes us. Physicians should be mortified that no other profession in the United States exhibits greater salary disparities by sex.
Ann Intern Med. 2004;141(3):238-240. doi:10.7326/0003-4819-141-3-200408030-00019
John H. Stone, MD, MPH
The news came via e-mail: “Well, the day has come. I am now profoundly deaf. … I'm O.K. with that—as much as one can be.” With that Internet message, Stacey informed us that our efforts to preserve her hearing had failed. Feeling utterly powerless in the wake of her e-mail, I realized then that my admiration for her had only begun.
Ann Intern Med. 2004;141(3):241-242. doi:10.7326/0003-4819-141-3-200408030-00020
Ann Intern Med. 2004;141(3):243. doi:10.7326/0003-4819-141-3-200408030-00021
Ann Intern Med. 2004;141(3):243-244. doi:10.7326/0003-4819-141-3-200408030-00022
Ann Intern Med. 2004;141(3):244. doi:10.7326/0003-4819-141-3-200408030-00023
Ann Intern Med. 2004;141(3):244-245. doi:10.7326/0003-4819-141-3-200408030-00024
Ann Intern Med. 2004;141(3):245. doi:10.7326/0003-4819-141-3-200408030-00025
Ann Intern Med. 2004;141(3):245-246. doi:10.7326/0003-4819-141-3-200408030-00026
Ann Intern Med. 2004;141(3):246. doi:10.7326/0003-4819-141-3-200408030-00027
Ann Intern Med. 2004;141(3):246-247. doi:10.7326/0003-4819-141-3-200408030-00028
Ann Intern Med. 2004;141(3):W-51. doi:10.7326/0003-4819-141-3-200408030-00028-w1
Anthony J. Chiaramida, MD
Ann Intern Med. 2004;141(3):235. doi:10.7326/0003-4819-141-3-200408030-00017
Ann Intern Med. 2004;141(3):I-12. doi:10.7326/0003-4819-141-3-200408030-00001
Ann Intern Med. 2004;141(3):I-22. doi:10.7326/0003-4819-141-3-200408030-00002
Ann Intern Med. 2004;141(3):I-56. doi:10.7326/0003-4819-141-3-200408030-00003
Ann Intern Med. 2004;141(3):I-57. doi:10.7326/0003-4819-141-3-200408030-00004
Mark J. Brown, MD
Ann Intern Med. 2004;141(3):248. doi:10.7326/0003-4819-141-3-200408030-00030
Christian Guilleminault, MD
Ann Intern Med. 2004;141(3):248. doi:10.7326/0003-4819-141-3-200408030-00031
Ann Intern Med. 2004;141(3):No Pagination Specified. doi:10.7326/0003-4819-141-3-200408030-00033
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