Driving-impaired patients leaving the emergency department
A study was performed to determine how many patients admitted to the hospital emergency department who were presumably impaired by alcohol had their blood alcohol level tested. The management of these situations by physicians was also investigated. Blood alcohol levels were measured in 80 percent of the university medical center patients and 68 percent of Veterans Affairs Medical Center (VAMC) patients. Driving skills are known to deteriorate at blood alcohol levels of 11 millimoles per liter of blood or higher, yet 63 percent of university hospital and 88 percent of VAMC patients were discharged with blood alcohol levels at or above this concentration. The way in which these cases were managed by physicians was as follows. Only 4 percent of university hospital and 9 percent of VAMC alcohol-impaired patients were advised not to drive. Thirty-one percent of university and 20 percent of VAMC patients were accompanied by a responsible person. The prevalence of prior driving-while-impaired convictions was 34 percent among university hospital and 58 percent among VAMC patients. These results show that most alcohol-impaired patients seen at emergency departments are tested for blood alcohol levels, but few are advised not to drive or are offered safe transportation home. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Noninvasive carotid artery testing
Carotid doppler ultrasonography, carotid duplex ultrasonography, and magnetic resonance angiography are three noninvasive tests that may be equally successful in determining narrowing and occlusion of the carotid artery. A meta-analysis of 568 published studies on carotid artery narrowing and occlusion in humans found that, compared to the invasive test of carotid angiography, the three noninvasive tests had similar sensitivities and specificities in measuring narrowing of 70% or greater of carotid diameter. Occlusion of the carotid artery that remains untreated may lead to stroke. Noninvasive tests may enable angiography to be used more effectively in patients with moderate stenoses. Noninvasive tests may not provide enough information about occlusion to allow treatment decisions to be made. Noninvasive testing may not be a good substitute for angiography for patients who will have carotid endarterectomies, removal of the occluded part of the artery either by surgery or by high pressure gas. Supraorbital Doppler ultrasonography may also provide useful information about carotid narrowing.
Publication Name: Annals of Internal Medicine
General internal medicine
Major issues in the practice of general medicine include the dearth of medical students choosing to specialize in the field, the use of low-technology means to make diagnoses and how gender affects the practice of medicine from both the clinicians' and patients' views. The lack of generalists in medicine in the US has been an often-discussed issue especially in relation to efforts to control the costs of health care. Current moves toward providing accessible and affordable health care bode well for the practice of internal medicine and the recruitment of more general practitioners. Generalists are being encouraged to rely more on clinical observation instead of automatically referring patients for expensive tests before offering a diagnosis. Gender differences play a significant role in how patients and doctors interact. Female physicians spend more time talking with their patients than their male colleagues. Male physicians are also more likely to be defendants in malpractice claims.
Publication Name: JAMA, The Journal of the American Medical Association
- Abstracts: Physicians' attitudes about the care of patients in the persistent vegetative state: a national survey. Doctrs' willingness to participate in the death penalty
- Abstracts: Anticardiolipin antibodies in patients with recurrent pregnancy wastage: treatment and uterine blood flow. Betamethasone and the human fetal ductus arteriosus
- Abstracts: Intraoperative evaluation of depth of myometrial invasion in stage I endometrial adenocarcinoma. Treatment failure in endometrial carcinoma
- Abstracts: Diabetic retinopathy in pregnancy: a review. Quality of prenatal care; selected social, behavioral, and biomedical factors; and birth weight
- Abstracts: Screening for colorectal cancer: need for controlled trials. Hemoccult screening in detecting colorectal neoplasm: sensitivity, specificity, and predictive value