ARTICLE TITLE: Real-time three-dimensional echocardiography for
measurement of left ventricular volumes.
ARTICLE SOURCE: Am J Cardiol (United States), Dec 15 1999, 84(12)
p1434-9
AUTHOR(S): Schmidt MA; Ohazama CJ; Agyeman KO; Freidlin RZ; Jones M;
Laurienzo JM; Brenneman CL; Arai AE; von Ramm OT; Panza JA
AUTHOR'S ADDRESS: Cardiology Branch, the Laboratory of Cardiac
Energetics, and the Laboratory of Animal Medicine and Surgery,
National Heart, Lung, and Blood Institute, the Center for Information
Technology, Bethesda, Maryland, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Left ventricular (LV) volumes are important prognostic
indexes in patients with heart disease. Although several methods can
evaluate LV volumes, most have important intrinsic limitations.
Real-time 3-dimensional echocardiography (RT3D echo) is a novel
technique capable of instantaneous acquisition of volumetric images.
The purpose of this study was to validate LV volume calculations with
RT3D echo and to determine their usefulness in cardiac patients. To
this end, 4 normal subjects and 21 cardiac patients underwent
magnetic resonance imaging (MRI) and RT3D echo on the same day. A
strong correlation was found between LV volumes calculated with MRI
and with RT3D echo (r = 0.91; y = 20.1 + 0.71x; SEE 28 ml). LV
volumes obtained with MRI were greater than those obtained with RT3D
echo (126 +/- 83 vs 110 +/- 65 ml; p = 0.002), probably due to the
fact that heart rate during MRI acquisition was lower than that
during RT3D echo examination (62 +/- 11 vs 79 +/- 16 beats/min; p =
0.0001). Analysis of intra- and interobserver variability showed
strong indexes of agreement in the measurement of LV volumes with
RT3D echo. Thus, LV volume measurements with RT3D echo are accurate
and reproducible. This technique expands the use of ultrasound for
the noninvasive evaluation of cardiac patients and provides a new
tool for the investigational study of cardiovascular disease.
MB. I wonder if 3 dimensional echos which even I could read will
interfere with a new source of income.
ARTICLE TITLE: Lack of effect of increased inspired oxygen
concentrations on maximal exercise capacity or ventilation in stable
heart failure.
ARTICLE SOURCE: Am J Cardiol (United States), Dec 15 1999, 84(12)
p1412-6
AUTHOR(S): Russell SD; Koshkarian GM; Medinger AE; Carson PE;
Higginbotham MB
AUTHOR'S ADDRESS: Department of Medicine, Duke University Medical
Center, Durham, North Carolina 27710, USA. russe016@mc.duke.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
This study failed to demonstrate any physiologic or functional
benefit from the administration of increased oxygen concentrations to
patients with stable heart failure.
ARTICLE TITLE: Hemodynamic and functional consequences of radial
artery removal for coronary artery bypass grafting.
ARTICLE SOURCE: Am J Cardiol (United States), Dec 1 1999, 84(11)
p1353-6, A8
AUTHOR(S): Serricchio M; Gaudino M; Tondi P; Gasbarrini A; Gerardino
L; Santoliquido A; Pola P; Possati G
AUTHOR'S ADDRESS: Department of Angiology, Catholic University, Rome,
Italy.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Five years after surgery the echo-Doppler characteristics
of the forearm circulation and the transcutaneous oxygen and carbon
dioxide pressures of the operated and control arm were determined at
rest and under conditions of hand exercise in 34 patients who
received a radial artery graft for myocardial revascularization.
Doppler measurements showed the ulnar compensation to radial artery
removal, and transcutaneous measurements demonstrated a moderate
degree of exercise-induced hand ischemia on the operated site.
ARTICLE TITLE: Beta-adrenergic blocker mortality trials in
congestive heart failure.
ARTICLE SOURCE: Am J Cardiol (United States), Nov 4 1999, 84(9A)
p94R-102R
AUTHOR(S): Teerlink JR; Massie BM
AUTHOR'S ADDRESS: Section of Cardiology, San Francisco Veterans
Affairs Medical Center, Cardiovascular Research Institute, University
of California San Francisco, 94121-1545, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (42 references); REVIEW,
TUTORIAL
ABSTRACT: Many of the current discussions of beta-adrenergic blocker
therapy in patients with congestive heart failure have used fairy
tales to describe the evolution of this treatment from
contraindication to standard of care. This article reviews the early
studies that initiated this revolution in heart failure therapy and
discusses the major mortality trials that have demonstrated that
these agents improve survival and limit the progression of congestive
heart failure. These major trials have used 1 of 4 beta blockers
(metoprolol, bisoprolol, carvedilol, or bucindolol) in varying study
designs with different patient populations. Each trial had different
objectives and limitations, and these are described in the context of
their impact on proving a survival benefit. In addition, the specific
effect of beta-blocker therapy on sudden death in patients with heart
failure is briefly discussed. The weight of these trials suggests
that beta-adrenergic blocker therapy can save 1 life of every 35
patients treated in patients with mild-to-moderate heart failure. The
data are compelling and the techniques for "starting low and going
slow" with titrations have been well documented.
ARTICLE TITLE: Meta-analysis of antiarrhythmic drug trials.
ARTICLE SOURCE: Am J Cardiol (United States), Nov 4 1999, 84(9A)
p90R-93R
AUTHOR(S): Connolly SJ
AUTHOR'S ADDRESS: Faculty of Health Sciences, McMaster University,
Ontario, Canada.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
ABSTRACT: During the past 15 years, the efficacy of antiarrhythmic
drugs has been investigated for reducing premature death in patients
at high risk of arrhythmia. Whereas the benefits of beta-blocker
therapy are well established, a reduction in mortality with other
antiarrhythmic drugs remains unproved and in some cases, there is
evidence of increased mortality with class I and some class III
agents. A limitation of individual clinical trials is inadequate
sample size to detect significant differences between interventions.
Meta-analysis, by combining results from multiple clinical trials,
provides a technique to overcome sample size limitations and assess
the benefits and limitations of an intervention. Thirteen randomized
clinical trials evaluated the role of prophylactic amiodarone in
patients at risk of death from cardiac arrhythmias. Whereas 3 of
these studies reported a reduction in mortality, several others
revealed no benefits of amiodarone. Because neither trial was
designed to detect reductions in total mortality, it remained unclear
whether the beneficial effect of amiodarone on arrhythmic death and
resuscitated ventricular fibrillation translated into a beneficial
effect on total mortality. To address this, a meta-analysis was
performed from the 13 trials of amiodarone in patients after an acute
myocardial infarction or with congestive heart failure. The results
showed a significant reduction in mortality and in arrhythmic death
with amiodarone.
ARTICLE TITLE: Overview of trends in the control of cardiac
arrhythmia: past and future.
ARTICLE SOURCE: Am J Cardiol (United States), Nov 4 1999, 84(9A)
p3R-10R
AUTHOR(S): Singh BN
AUTHOR'S ADDRESS: Division of Cardiology, Veterans Administration
Medical Center of West Los Angeles and University of California at
Los Angeles, 90073, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (53 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Alcohol consumption, coronary calcium, and coronary
heart disease events.
ARTICLE SOURCE: Am J Cardiol (United States), Oct 1 1999, 84(7)
p802-6
AUTHOR(S): Yang T; Doherty TM; Wong ND; Detrano RC
AUTHOR'S ADDRESS: Department of Medicine, Harbor-UCLA Medical Center,
Torrance, California 90502-2064, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: This study was performed to determine if alcohol intake was
associated with reduced coronary risk in a high-risk asymptomatic
population, and whether this effect was independent of coronary risk
factors and coronary calcium. In 1,196 asymptomatic subjects with
coronary risk factors, we assessed alcohol consumption history,
performed risk factor measurements, and quantified coronary calcium
with electron beam computed tomography. These subjects were then
followed for a mean of 41 months, and coronary events (myocardial
infarction or coronary death) were noted. Significant inverse
predictors of coronary events included alcohol use and serum
high-density lipoprotein cholesterol level. Direct predictors of
events were history of systemic hypertension, smoking, diabetes
mellitus, serum cholesterol, and coronary calcium score. Subjects
with coronary calcium were 3.1 times more likely to suffer a coronary
event than those without calcium (95% confidence interval
[CI] limits 1.3 to 7.2). Subjects who drank alcohol had a
relative risk of 0.3 (95% CI limits 0.2 to 0.6) for developing
coronary events. After controlling for age, gender, and other risk
factors with logistic regression, these differences in relative risk
persisted (relative risk 0.58; 95% CI limits 0.41 to 0.82). Alcohol
consumption is a significant inverse predictor of coronary events,
comparable in magnitude to standard risk factors and to
radiographically measured coronary calcium. This effect is
independent of coronary risk factors and coronary calcium.
ARTICLE TITLE: Sexual activity and the cardiovascular patient:
guidelines.
ARTICLE SOURCE: Am J Cardiol (United States), Sep 9 1999, 84(5B)
p6N-10N
AUTHOR(S): Taylor HA Jr
AUTHOR'S ADDRESS: Department of Medicine, University of Mississippi
Medical Center, Jackson 39213, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (19 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Trends in coronary revascularization 1989 to 1997:
the Bypass Angioplasty Revascularization Investigation (BARI) survey
of procedures.
ARTICLE SOURCE: Am J Cardiol (United States), Jul 15 1999, 84(2)
p157-61
AUTHOR(S): Holubkov R; Detre KM; Sopko G; Sutton-Tyrrell K; Kelsey
SF; Frye RL
AUTHOR'S ADDRESS: Department of Epidemiology, Graduate School of
Public Health, University of Pittsburgh, Pennsylvania 15261, USA.
holubkov@edc.gsph.pitt.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; MULTICENTER STUDY
ABSTRACT: Use of catheter-based and surgical coronary
revascularization has steadily increased in North America.
Introduction of catheter-based "new devices," including intracoronary
stents, has expanded the range of patients who can be treated with
percutaneous approaches. We sought to address trends in the practice
of catheter-based and surgical coronary revascularization during 1989
to 1997. The 17 North American institutions participating in the
NHLBI Bypass Angioplasty Revascularization Investigation (BARI)
periodically completed a 5-working day survey of all surgical and
catheter-based coronary revascularizations. Data collected included
patient demographics, vessel disease, prior interventions, and use of
new devices or minimally invasive surgical techniques. The proportion
of all procedures that were catheter based (vs surgical) increased
from 52.1% in 1989/1990 to 62.0% in 1997 (p <0.001). Among
surgically treated patients, prevalence of prior bypass surgery
decreased from 13.4% in 1989/1990 to 7.5% in 1997 (p <0.001). In
1997, 3% of surgical procedures used minimal incisions or were
performed without cardiopulmonary bypass. Among patients undergoing
catheter-based intervention, prevalence of left main disease
increased from 2.2% to 5.7% (p <0.001), myocardial infarction
within 24 hours increased from 2.4% to 9.7% (p <0.001), and prior
bypass surgery increased from 16.2% to 20.8% (p = 0.056). Use of new
devices increased from 11.6% of catheter-based procedures in 1990 to
67.0% in 1997 (p <0.001). Compared with the early 1990s,
catheter-based revascularization is currently more commonly used for
patients with acute myocardial infarction, prior bypass surgery, or
severe left main narrowing. These trends are likely due to the
proliferation of new devices, especially intracoronary stents, since
the mid 1990s.
ARTICLE TITLE: Cardiopulmonary resuscitation during severe
hypothermia in pigs: does epinephrine or vasopressin increase
coronary perfusion pressure?
ARTICLE SOURCE: Anesth Analg (United States), Jan 2000, 90(1)
p69-73
AUTHOR(S): Krismer AC; Lindner KH; Kornberger R; Wenzel V; Mueller G;
Hund W; Oroszy S; Lurie KG; Mair P
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care
Medicine, Leopold-Franzens-University of Innsbruck, Austria.
anette.krismer@uibk.ac.at.
MAJOR SUBJECT HEADING(S): Blood Pressure [drug effects];
Cardiopulmonary Resuscitation; Coronary Circulation [drug
effects]; Epinephrine [therapeutic use]; Hypothermia
[therapy]; Vasoconstrictor Agents [therapeutic use];
Vasopressins [therapeutic use]
MINOR SUBJECT HEADING(S): Body Temperature [drug effects]
[physiology]; Heart Arrest [pathology]; Swine
INDEXING CHECK TAG(S): Animal; Female; Male; Support, Non-U.S.
Gov't
PUBLICATION TYPE: JOURNAL ARTICLE
IMPLICATIONS: Our study was designed to assess the effects of
vasopressin and epinephrine in a porcine model simulating cardiac
arrest during severe hypothermia. This study demonstrates that the
administration of both emergency drugs results in an increased
perfusion pressure in the heart.
ARTICLE TITLE: Recovery of cognitive function after
remifentanil-propofol anesthesia: a comparison with desflurane and
sevoflurane anesthesia.
ARTICLE SOURCE: Anesth Analg (United States), Jan 2000, 90(1)
p168-74
AUTHOR(S): Larsen B; Seitz A; Larsen R
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care
Medicine, University of Saarland, Homburg/Saar, Germany.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
IMPLICATIONS: We compared awakening and intermediate recovery times
after remifentanil-propofol anesthesia to desflurane-N2O and
sevoflurane-N2O anesthesia. Emergence and return of cognitive
function was significantly faster after remifentanil-propofol
compared with desflurane and sevoflurane up to 60 min after
anesthesia administration.
ARTICLE TITLE: Prolonged coma and quadriplegia after accidental
subarachnoid injection of a local anesthetic with an opiate.
ARTICLE SOURCE: Anesth Analg (United States), Jan 2000, 90(1)
p116-8
AUTHOR(S): Evron S; Krumholtz S; Wiener Y; Brohorov T; Bahar M
AUTHOR'S ADDRESS: Department of Anesthesiology, Assaf Harofeh Medical
Center, Tel Aviv University, Israel.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: The pain visual analog scale: is it linear or
nonlinear?
ARTICLE SOURCE: Anesth Analg (United States), Dec 1999, 89(6)
p1517-20
AUTHOR(S): Myles PS; Troedel S; Boquest M; Reeves M
AUTHOR'S ADDRESS: Department of Anaesthesia and Pain Management,
Alfred Hospital, Prahan, Victoria, Australia.
p.myles@alfred.org.au.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
ABSTRACT: The visual analog scale (VAS) is a tool widely used to
measure pain, yet controversy surrounds whether the VAS score is
ratio or ordinal data. We studied 52 postoperative patients and
measured their pain intensity using the VAS. We then asked them to
consider different amounts of pain (conceptually twice as much and
then half as much) and asked them to repeat their VAS rating after
each consideration (VAS2 and VAS3, respectively). Patients with
unrelieved pain had their pain treated with IV fentanyl and were then
asked to rate their pain intensity when they considered they had half
as much pain. We compared the baseline VAS (VAS1) with VAS2 and VAS3.
The mean (95% confidence interval) for VAS2:1 was 2.12 (1.81-2.43)
and VAS3:1 was 0.45 (0.38-0.52). We conclude that the VAS is linear
for mild-to-moderate pain, and the VAS score can be treated as ratio
data. IMPLICATIONS: A change in the visual analog scale score
represents a relative change in the magnitude of pain sensation. Use
of the VAS in comparative analgesic trials can now meaningfully
quantify differences in potency and efficacy.
ARTICLE TITLE: Renin angiotensin system antagonists and
anesthesia.
ARTICLE SOURCE: Anesth Analg (United States), Nov 1999, 89(5)
p1143-55
AUTHOR(S): Colson P; Ryckwaert F; Coriat P
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care,
Montpellier University Hospital, Montpellier, France.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (161 references); REVIEW,
ACADEMIC
ARTICLE TITLE: Percutaneous versus surgical tracheostomy: a
double-blind randomized trial.
ARTICLE SOURCE: Ann Surg (United States), Nov 1999, 230(5)
p708-14
AUTHOR(S): Gysin C; Dulguerov P; Guyot JP; Perneger TV; Abajo B;
Chevrolet JC
AUTHOR'S ADDRESS: Department of Otolaryngology-Head and Neck Surgey,
Geneva University Hospital, Switzerland.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: OBJECTIVE: To compare surgical (SgT) and percutaneous (PcT)
tracheostomies. BACKGROUND: Percutaneous tracheostomy has been said
to provide numerous advantages over classical SgT. METHODS: A
prospective randomized trial with a double-blind evaluation was used
to compare SgT and PcT. SgT and PcT were performed according to
established techniques (n = 70). The procedure was performed at the
bedside in the intensive care unit in 21 cases (30%). The outcome
measures were divided into procedure-related variables, perioperative
complications, and postoperative complications. The procedure-related
variables (location, duration, and difficulty) were evaluated by the
surgeon. The perioperative and postoperative complications were
divided into serious, intermediate, and minor. Perioperative and
early postoperative (14 days) complications were evaluated daily by
an intensive care unit nurse blinded to the technique used. Long-term
postoperative complications were evaluated 3 months after
decannulation by a surgeon blinded to the surgical technique.
RESULTS: There were no major complications in either group. Most
variables studied were not statistically different between the PcT
and SgT groups. The only variables to reach statistical significance
were the size of the incision (smaller with PcT, p < 0.0001),
minor perioperative complications (greater with PcT, p = 0.02), and
difficult cannula changes (greater with PcT; p < 0.05). Among
nonsignificant differences, difficult procedures and false passages
were more frequent with PcT, whereas long-term unesthetic scars were
more frequent with SgT. CONCLUSIONS: Both techniques are associated
with a low rate of serious or intermediate complications when
performed by experienced surgeons. There were more minor
perioperative complications with PcT and more minor long term
complications with SgT.
MB. Another study was not agree with this. Percutaneous dilatational
tracheostomy: still a surgical procedure.
ARTICLE SOURCE: Am Surg (United States), Oct 1999, 65(10) p982-6
Based on the experience to date, Cedars-Sinai Medical Center (Los
Angeles, CA) continues to require a surgeon privileged to perform OT
to participate in all PDT procedures.
ARTICLE TITLE: Epidural anesthesia in infants
[editorial]
ARTICLE SOURCE: Can J Anaesth (Canada), Dec 1999, 46(12) p1105-9
AUTHOR(S): Desparmet JF
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Thoracic epidural analgesia via the caudal approach
using nerve stimulation in an infant with CATCH22.
ARTICLE SOURCE: Can J Anaesth (Canada), Dec 1999, 46(12) p1138-42
AUTHOR(S): Tsui BC; Seal R; Entwistle L
AUTHOR'S ADDRESS: Department of Anesthesiology and Pain Medicine,
University of Alberta Hospitals, Walter Mackenzie Health Sciences
Centre, Edmonton, Canada. btsui@pop.srv.ualberta.ca.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Epidural stimulation may help placement of the epidural
catheter at the appropriate dermatome for effective anesthesia and
analgesia.
ARTICLE TITLE: Improved efficiency of hypervolemic therapy with
inhibition of natriuresis by fludrocortisone in patients with
aneurysmal subarachnoid hemorrhage.
ARTICLE SOURCE: J Neurosurg (United States), Dec 1999, 91(6)
p947-52
AUTHOR(S): Mori T; Katayama Y; Kawamata T; Hirayama T
AUTHOR'S ADDRESS: Department of Neurological Surgery, Nihon
University School of Medicine, Tokyo, Japan.
ARTICLE TITLE: Secondary abdominal compartment syndrome: an
underappreciated manifestation of severe hemorrhagic shock.
ARTICLE SOURCE: J Trauma (United States), Dec 1999, 47(6) p995-9
AUTHOR(S): Maxwell RA; Fabian TC; Croce MA; Davis KA
AUTHOR'S ADDRESS: Department of Surgery, Presley Regional Trauma
Center, Memphis, Tennessee, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
.On the basis of these observations, we recommend that bladder
pressures should be routinely checked and acted on appropriately when
resuscitation volumes approach 10 liters of crystalloid or 10 units
of packed red cells.
ARTICLE TITLE: Effect of increased renal venous pressure on renal
function.
ARTICLE SOURCE: J Trauma (United States), Dec 1999, 47(6) p1000-3
AUTHOR(S): Doty JM; Saggi BH; Sugerman HJ; Blocher CR; Pin R; Fakhry
I; Gehr TW; Sica DA
AUTHOR'S ADDRESS: Department of Surgery, Medical College of Virginia
of Virginia Commonwealth University, Richmond, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Elevated renal vein pressure (RVP) alone leads to
decreased renal artery blood flow and glomerular filtration rate and
increased plasma renin activity, serum aldosterone, and urinary
protein leak. These changes are consistent with the renal
pathophysiology seen in acute abdominal compartment syndrome (AACS),
morbid obesity, and preeclampsia. The changes are partially or
completely reversed by decreasing renal venous pressure as occurs
with abdominal decompression for AACS.
ARTICLE TITLE: Bedside carbon dioxide (CO2) preinsertion cavagram
for inferior vena cava filter placement: case report.
ARTICLE SOURCE: J Trauma (United States), Dec 1999, 47(6) p1140-1
AUTHOR(S): Sing RF; Stackhouse DJ; Cicci CK; Le Quire MH
AUTHOR'S ADDRESS: Department of Surgery, Carolinas Medical Center,
Charlotte, North Carolina, USA. rsing@carolinas.org.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Bedside insertion of inferior vena cava filters in
the intensive care unit.
ARTICLE SOURCE: J Trauma (United States), Dec 1999, 47(6) p1104-7
AUTHOR(S): Sing RF; Cicci CK; Smith CH; Messick WJ
AUTHOR'S ADDRESS: Department of Surgery, Carolinas Medical Center,
Charlotte, North Carolina 28203, USA. rsing@carolinas.org.
MAJOR SUBJECT HEADING(S): Catheterization, Central Venous
[methods]; Fluoroscopy [methods]; Intensive Care
Units; Multiple Trauma [complications]; Point-of-Care
Systems; Radiography, Interventional [methods];
Thromboembolism [etiology] [prevention &
control]; Vena Cava, Inferior [radiography]
MINOR SUBJECT HEADING(S): Adolescence; Adult; Aged; Algorithms;
Catheterization, Central Venous [adverse effects]
[instrumentation]; Decision Trees; Fluoroscopy [adverse
effects] [instrumentation]; Middle Age; Patient
Selection; Practice Guidelines; Prospective Studies; Radiography,
Interventional [adverse effects] [instrumentation];
Risk Factors; Treatment Outcome
INDEXING CHECK TAG(S): Female; Human; Male
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Bedside inferior vena cava filter (IVCF) insertion with a
preinsertion cavagram is a percutaneous procedure that can be safely
performed in the ICU. Bedside insertion of IVCF avoids the potential
complications of transporting critically ill patients and may reduce
costs.
ARTICLE TITLE: Screening for prostate cancer. The challenge of
promoting informed decision making in the absence of definitive
evidence of effectiveness.
ARTICLE SOURCE: Med Clin North Am (United States), Nov 1999, 83(6)
p1423-42, vi
AUTHOR(S): Burack RC; Wood DP Jr
AUTHOR'S ADDRESS: Department of Internal Medicine, Wayne State
University School of Medicine, Detroit, Michigan, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (57 references); REVIEW,
TUTORIAL
ABSTRACT: Evidence demonstrating the burden of prostate cancer upon
men in the United States is incontrovertible; less compelling,
however, is proof of benefit from early detection efforts.
Nevertheless, the absence of definitive evidence does not lessen the
interest of men in prostate testing or the obligation of physicians
to help interested men make well-informed decisions, which integrate
personal circumstance and preference with the best available data.
This article provides the counseling physician with the information
required to frame the current prostate testing debate and an approach
to support informed decision making by men who can benefit from their
assistance.
ARTICLE TITLE: Colorectal cancer screening.
ARTICLE SOURCE: Med Clin North Am (United States), Nov 1999, 83(6)
p1403-22, vi
AUTHOR(S): Helm JF; Sandler RS
AUTHOR'S ADDRESS: Department of Medicine, University of South
Florida, Tampa, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (86 references); REVIEW,
TUTORIAL
ABSTRACT: Colorectal cancer is an important problem in the United
States, with over 130,000 new cases and 55,000 deaths each year.
There is now strong evidence that screening for colorectal cancer
with fecal occult blood testing can decrease mortality, and
additional evidence that removing benign adenomas can decrease cancer
incidence. Evidence-based screening guidelines depend on colorectal
cancer risk. Individuals at higher risk because of a personal or
family history deserve more intensive screening than asymptomatic
individuals over age 50.
ARTICLE TITLE: Principles of screening.
ARTICLE SOURCE: Med Clin North Am (United States), Nov 1999, 83(6)
p1323-37, v
AUTHOR(S): Nielsen C; Lang RS
AUTHOR'S ADDRESS: Department of General Internal Medicine, Cleveland
Clinic Foundation, Ohio, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (31 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Rethinking the role of tube feeding in patients
with advanced dementia.
ARTICLE SOURCE: N Engl J Med (United States), Jan 20 2000, 342(3)
p206-10
AUTHOR(S): Gillick MR
AUTHOR'S ADDRESS: Hebrew Rehabilitation Center for Aged, Boston, MA
02131, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: ACE inhibition in cardiovascular disease
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 2000 Jan 20; 342(3):145-53
ARTICLE SOURCE: N Engl J Med (United States), Jan 20 2000, 342(3)
p201-2
AUTHOR(S): Francis GS
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: More preoperative assessment by physicians and less
by laboratory tests [editorial; comment]
COMMENTS: Comment on: N Engl J Med 2000 Jan 20; 342(3):168-75
ARTICLE SOURCE: N Engl J Med (United States), Jan 20 2000, 342(3)
p204-5
AUTHOR(S): Roizen MF
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Supplemental perioperative oxygen to reduce the
incidence of surgical-wound infection. Outcomes Research Group
[see comments]
COMMENTS: Comment in: N Engl J Med 2000 Jan 20; 342(3):202-4
ARTICLE SOURCE: N Engl J Med (United States), Jan 20 2000, 342(3)
p161-7
AUTHOR(S): Greif R; Akca O; Horn EP; Kurz A; Sessler DI
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care
Medicine, Donauspital, Vienna, Austria.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Destruction by oxidation, or oxidative killing,
is the most important defense against surgical pathogens and depends
on the partial pressure of oxygen in contaminated tissue. An easy
method of improving oxygen tension in adequately perfused tissue is
to increase the concentration of inspired oxygen. We therefore tested
the hypothesis that the supplemental administration of oxygen during
the perioperative period decreases the incidence of wound infection.
METHODS: We randomly assigned 500 patients undergoing colorectal
resection to receive 30 percent or 80 percent inspired oxygen during
the operation and for two hours afterward. Anesthetic treatment was
standardized, and all patients received prophylactic antibiotic
therapy. With use of a double-blind protocol, wounds were evaluated
daily until the patient was discharged and then at a clinic visit two
weeks after surgery. We considered wounds with culture-positive pus
to be infected. The timing of suture removal and the date of
discharge were determined by the surgeon, who did not know the
patient's treatment-group assignment. RESULTS: Arterial oxygen
saturation was normal in both groups; however, the arterial and
subcutaneous partial pressure of oxygen was significantly higher in
the patients given 80 percent oxygen than in those given 30 percent
oxygen. Among the 250 patients who received 80 percent oxygen, 13
(5.2 percent; 95 percent confidence interval, 2.4 to 8.0 percent) had
surgical-wound infections, as compared with 28 of the 250 patients
given 30 percent oxygen (11.2 percent; 95 percent confidence
interval, 7.3 to 15.1 percent; P=0.01). The absolute difference
between groups was 6.0 percent (95 percent confidence interval, 1.2
to 10.8 percent). The duration of hospitalization was similar in the
two groups. CONCLUSIONS: The perioperative administration of
supplemental oxygen is a practical method of reducing the incidence
of surgical-wound infections.
ARTICLE TITLE: Prevention of surgical-wound infections
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 2000 Jan 20; 342(3):161-7
ARTICLE SOURCE: N Engl J Med (United States), Jan 20 2000, 342(3)
p202-4
AUTHOR(S): Gottrup F
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Effects of an angiotensin-converting-enzyme
inhibitor, ramipril, on cardiovascular events in high-risk patients.
The Heart Outcomes Prevention Evaluation Study Investigators [see
comments]
COMMENTS: Comment in: N Engl J Med 2000 Jan 20; 342(3):201-2
ARTICLE SOURCE: N Engl J Med (United States), Jan 20 2000, 342(3)
p145-53
AUTHOR(S): Yusuf S; Sleight P; Pogue J; Bosch J; Davies R; Dagenais
G
AUTHOR'S ADDRESS: Canadian Cardiovascular Collaboration Project
Office, Hamilton General Hospital, McMaster University, ON.
hope@ccc.mcmaster.ca.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Ramipril significantly reduces the rates of death,
myocardial infarction, and stroke in a broad range of high-risk
patients who are not known to have a low ejection fraction or heart
failure.
ARTICLE TITLE: ACE inhibition in cardiovascular disease
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 2000 Jan 20; 342(3):145-53
ARTICLE SOURCE: N Engl J Med (United States), Jan 20 2000, 342(3)
p201-2
AUTHOR(S): Francis GS
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: The effect of the volume of procedures at
transplantation centers on mortality after liver transplantation.
ARTICLE SOURCE: N Engl J Med (United States), Dec 30 1999, 341(27)
p2049-53
AUTHOR(S): Edwards EB; Roberts JP; McBride MA; Schulak JA; Hunsicker
LG
AUTHOR'S ADDRESS: United Network for Organ Sharing, Richmond, VA,
USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND AND METHODS: For many complex surgical
procedures there is an association between a low volume of procedures
and an increased risk of death for the patients who undergo the
procedures. We examined the effect of the volume of procedures at
transplantation centers on the risk of death after liver
transplantation. We analyzed all liver transplantations performed in
the United States between October 1, 1987, and April 30, 1994.
Because the results for 1987 to 1991 were largely similar to those
from 1992 to 1994, we focused on the more recent period. RESULTS:
Between January 1, 1992, and April 30, 1994, 47 centers performed 20
or fewer liver transplantations each per year (total, 837
transplantations) and were designated low-volume centers, and 52
centers performed more than 20 transplantations each per year (total,
6526) and were designated high-volume centers. The one-year mortality
rate for the low-volume centers was 25.9 percent, as compared with
20.0 percent for the high-volume centers. Thirteen centers, all of
which had low volumes, had one-year mortality rates of more than 40
percent. Low-volume centers that were affiliated with high-volume
centers, such as pediatric transplantation programs, had results
similar to those of the high-volume centers. The one-year mortality
rate at unaffiliated low-volume centers was 28.3 percent, as compared
with a rate of 20.1 percent for the group of all high-volume centers
plus affiliated low-volume centers (P<0.001). CONCLUSIONS: As a
group, liver-transplantation centers in the United States that
perform 20 or fewer transplantations per year have mortality rates
that are significantly higher than those at centers that perform more
than 20 transplantations per year. Information regarding the outcome
of liver transplantation at transplantation centers should be made
widely available to the public in a timely manner.
MB We are about twice that.
ARTICLE TITLE: Improved clinical outcome after widespread use of
coronary-artery stenting in Canada [see comments]
COMMENTS: Comment in: N Engl J Med 1999 Dec 23; 341(26):2005-6
ARTICLE SOURCE: N Engl J Med (United States), Dec 23 1999, 341(26)
p1957-65
AUTHOR(S): Rankin JM; Spinelli JJ; Carere RG; Ricci DR; Penn IM;
Hilton JD; Henderson MA; Hayden RI; Buller CE
AUTHOR'S ADDRESS: Vancouver General Hospital, British Columbia,
Canada.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: The need for target-vessel revascularization during one
year of follow-up decreased after percutaneous coronary intervention
during the mid-1990s. The reduction was coincident with the
introduction and subsequent widespread use of coronary stenting.
ARTICLE TITLE: Coronary angioplasty with or without stent
implantation for acute myocardial infarction. Stent Primary
Angioplasty in Myocardial Infarction Study Group [see
comments]
COMMENTS: Comment in: N Engl J Med 1999 Dec 23; 341(26):2005-6
ARTICLE SOURCE: N Engl J Med (United States), Dec 23 1999, 341(26)
p1949-56
AUTHOR(S): Grines CL; Cox DA; Stone GW; Garcia E; Mattos LA;
Giambartolomei A; Brodie BR; Madonna O; Eijgelshoven M; Lansky AJ;
O'Neill WW; Morice MC
AUTHOR'S ADDRESS: Division of Cardiology, William Beaumont Hospital,
Royal Oak, Mich 48073-6769, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: In patients with acute myocardial infarction, routine
implantation of a stent has clinical benefits beyond those of primary
coronary angioplasty alone.
ARTICLE TITLE: Coronary stents--have they fulfilled their promise?
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Dec 23; 341(26):1949-56;
Comment on: N Engl J Med 1999 Dec 23; 341(26):1957-65
ARTICLE SOURCE: N Engl J Med (United States), Dec 23 1999, 341(26)
p2005-6
AUTHOR(S): Jacobs AK
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: A randomized study of the prevention of sudden
death in patients with coronary artery disease. Multicenter
Unsustained Tachycardia Trial Investigators.
ARTICLE SOURCE: N Engl J Med (United States), Dec 16 1999, 341(25)
p1882-90
AUTHOR(S): Buxton AE; Lee KL; Fisher JD; Josephson ME; Prystowsky EN;
Hafley G
AUTHOR'S ADDRESS: Department of Medicine, Brown University School of
Medicine and Rhode Island Hospital, Providence 02905, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Electrophysiologically guided antiarrhythmic therapy
with implantable defibrillators, but not with antiarrhythmic drugs,
reduces the risk of sudden death in high-risk patients with coronary
disease.
ARTICLE TITLE: Reducing cardiac risk in noncardiac surgery
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Dec 9; 341(24):1789-94
ARTICLE SOURCE: N Engl J Med (United States), Dec 9 1999, 341(24)
p1838-40
AUTHOR(S): Lee TH
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: The effect of bisoprolol on perioperative mortality
and myocardial infarction in high-risk patients undergoing vascular
surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying
Stress Echocardiography Study Group [see comments]
COMMENTS: Comment in: N Engl J Med 1999 Dec 9; 341(24):1838-40
ARTICLE SOURCE: N Engl J Med (United States), Dec 9 1999, 341(24)
p1789-94
AUTHOR(S): Poldermans D; Boersma E; Bax JJ; Thomson IR; van de Ven
LL; Blankensteijn JD; Baars HF; Yo TI; Trocino G; Vigna C; Roelandt
JR; van Urk H
AUTHOR'S ADDRESS: Erasmus Medical Center, Rotterdam, The
Netherlands.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Cardiovascular complications are the most
important causes of perioperative morbidity and mortality among
patients undergoing major vascular surgery. METHODS: We performed a
randomized, multicenter trial to assess the effect of perioperative
blockade of beta-adrenergic receptors on the incidence of death from
cardiac causes and nonfatal myocardial infarction within 30 days
after major vascular surgery in patients at high risk for these
events. High-risk patients were identified by the presence of both
clinical risk factors and positive results on dobutamine
echocardiography. Eligible patients were randomly assigned to receive
standard perioperative care or standard care plus perioperative
beta-blockade with bisoprolol. RESULTS: A total of 1351 patients were
screened, and 846 were found to have one or more cardiac risk
factors. Of these 846 patients, 173 had positive results on
dobutamine echocardiography. Fifty-nine patients were randomly
assigned to receive bisoprolol, and 53 to receive standard care.
Fifty-three patients were excluded from randomization because they
were already taking a beta-blocker, and eight were excluded because
they had extensive wall-motion abnormalities either at rest or during
stress testing. Two patients in the bisoprolol group died of cardiac
causes (3.4 percent), as compared with nine patients in the
standard-care group (17 percent, P=0.02). Nonfatal myocardial
infarction occurred in nine patients given standard care only (17
percent) and in none of those given standard care plus bisoprolol
(P<0.001). Thus, the primary study end point of death from cardiac
causes or nonfatal myocardial infarction occurred in 2 patients in
the bisoprolol group (3.4 percent) and 18 patients in the
standard-care group (34 percent, P<0.001). CONCLUSIONS: Bisoprolol
reduces the perioperative incidence of death from cardiac causes and
nonfatal myocardial infarction in high-risk patients who are
undergoing major vascular surgery.
ARTICLE TITLE: Comparison of mortality in all patients on
dialysis, patients on dialysis awaiting transplantation, and
recipients of a first cadaveric transplant [see comments]
COMMENTS: Comment in: N Engl J Med 1999 Dec 2; 341(23):1762-3
ARTICLE SOURCE: N Engl J Med (United States), Dec 2 1999, 341(23)
p1725-30
AUTHOR(S): Wolfe RA; Ashby VB; Milford EL; Ojo AO; Ettenger RE;
Agodoa LY; Held PJ; Port FK
AUTHOR'S ADDRESS: U.S. Renal Data System Coordinating Center,
Department of Biostatistics, University of Michigan, Ann Arbor 48103,
USA. bobwolfe@umich.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Among patients with end-stage renal disease, healthier
patients are placed on the waiting list for transplantation, and
long-term survival is better among those on the waiting list who
eventually undergo transplantation.
ARTICLE TITLE: A survival advantage for renal transplantation
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Dec 2; 341(23):1725-30
ARTICLE SOURCE: N Engl J Med (United States), Dec 2 1999, 341(23)
p1762-3
AUTHOR(S): Hunsicker LG
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Quality and equity in dialysis and renal
transplantation [editorial]
ARTICLE SOURCE: N Engl J Med (United States), Nov 25 1999, 341(22)
p1691-3
AUTHOR(S): Levinsky NG
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Pathogenesis of inherited forms of dilated
cardiomyopathy [editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Dec 2; 341(23):1715-24
ARTICLE SOURCE: N Engl J Med (United States), Dec 2 1999, 341(23)
p1759-62
AUTHOR(S): Graham RM; Owens WA
ARTICLE TITLE: A comparison of virtual and conventional
colonoscopy for the detection of colorectal polyps [see
comments]
COMMENTS: Comment in: N Engl J Med 1999 Nov 11; 341(20):1540-2
ARTICLE SOURCE: N Engl J Med (United States), Nov 11 1999, 341(20)
p1496-503
AUTHOR(S): Fenlon HM; Nunes DP; Schroy PC 3rd; Barish MA; Clarke PD;
Ferrucci JT
AUTHOR'S ADDRESS: Department of Radiology, Boston University School
of Medicine, Boston Medical Center, MA 02118, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
CONCLUSIONS: In a group of patients at high risk for colorectal
neoplasia, virtual and conventional colonoscopy had similar efficacy
for the detection of polyps that were 6 mm or more in diameter.
ARTICLE TITLE: Virtual colonoscopy--promising, but not ready for
widespread use [editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Nov 11; 341(20):1496-03
ARTICLE SOURCE: N Engl J Med (United States), Nov 11 1999, 341(20)
p1540-2
AUTHOR(S): Bond JH
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Calcium-antagonist drugs.
ARTICLE SOURCE: N Engl J Med (United States), Nov 4 1999, 341(19)
p1447-57
AUTHOR(S): Abernethy DR; Schwartz JB
AUTHOR'S ADDRESS: Division of Clinical Pharmacolgy, Georgetown
University Medical Center, Washington, DC, USA.
abernethyd@grc.nia.nih.gov.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (102 references); REVIEW,
TUTORIAL
ARTICLE TITLE: The economic implications of HLA matching in
cadaveric renal transplantation [see comments]
COMMENTS: Comment in: N Engl J Med 1999 Nov 4; 341(19):1468-9
ARTICLE SOURCE: N Engl J Med (United States), Nov 4 1999, 341(19)
p1440-6
AUTHOR(S): Schnitzler MA; Hollenbeak CS; Cohen DS; Woodward RS;
Lowell JA; Singer GG; Tesi RJ; Howard TK; Mohanakumar T; Brennan
DC
AUTHOR'S ADDRESS: Pharmaco-economic Transplant Research, Health
Administration Program, Washington University School of Medicine, St.
Louis, MO 63110, USA. schnitz@wueconc.wustl.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Transplantation of better-matched cadaveric kidneys
could have substantial economic advantages. In our simulations,
HLA-based allocation of kidneys at the local level produced the
largest estimated cost savings, when the duration of cold ischemia
was taken into account. No additional savings were estimated to
result from a national allocation program, because the additional
costs of longer cold ischemia time were greater than the advantages
of optimizing HLA matching.
ARTICLE TITLE: Long-term benefit of primary angioplasty as
compared with thrombolytic therapy for acute myocardial infarction
[see comments]
COMMENTS: Comment in: N Engl J Med 1999 Nov 4; 341(19):1464-5
ARTICLE SOURCE: N Engl J Med (United States), Nov 4 1999, 341(19)
p1413-9
AUTHOR(S): Zijlstra F; Hoorntje JC; de Boer MJ; Reiffers S; Miedema
K; Ottervanger JP; van'THof AW; Suryapranata H
AUTHOR'S ADDRESS: Department of Cardiology, Hospital De Weezenlanden,
Zwolle, The Netherlands. v.derks@diagram-zwolle.nl.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: During five years of follow-up, primary coronary
angioplasty for acute myocardial infarction was associated with lower
rates of early and late death and nonfatal reinfarction, fewer
hospital readmissions for ischemia or heart failure, and lower total
medical charges than treatment with intravenous streptokinase.
ARTICLE TITLE: A comparison of osteopathic spinal manipulation
with standard care for patients with low back pain [see
comments]
COMMENTS: Comment in: N Engl J Med 1999 Nov 4; 341(19):1465-8
ARTICLE SOURCE: N Engl J Med (United States), Nov 4 1999, 341(19)
p1426-31
AUTHOR(S): Andersson GB; Lucente T; Davis AM; Kappler RE; Lipton JA;
Leurgans S
AUTHOR'S ADDRESS: Department of Orthopedic Surgery,
Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
ganderss@rush.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Osteopathic manual care and standard medical care had
similar clinical results in patients with subacute low back pain.
However, the use of medication was greater with standard care.
ARTICLE TITLE: New options for the prevention of influenza
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Oct 28; 341(18):1336-43
ARTICLE SOURCE: N Engl J Med (United States), Oct 28 1999, 341(18)
p1387-8
AUTHOR(S): Cox NJ; Hughes JM
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Presidential address: toward physician
competency.
ARTICLE SOURCE: Surgery (United States), Oct 1999, 126(4) p589-93
AUTHOR(S): Nahrwold DL
AUTHOR'S ADDRESS: Department of Surgery, Northwestern University
Medical School, Chicago, Ill, USA.
PUBLICATION TYPE: ADDRESSES
ARTICLE TITLE: Managed care and the ethics of regulation.
ARTICLE SOURCE: J Med Philos (Netherlands), Oct 1999, 24(5)
p492-517
AUTHOR(S): De Ville KA
AUTHOR'S ADDRESS: Department of Medical Humanities, School of
Medicine, East Carolina University, Greenville, North Carolina
27858-4354, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: The dramatic appearance of managed care organizations
(MCOs) on the U.S. health scene has generated tremendous anxiety
among health care providers and patients. These fears are based on
the belief that managed care techniques pose greater risks of under
treatment than do fee-for-service modes of payment. In addition, many
physicians and patients resent the limits placed on clinical autonomy
by the MCO model and the stresses that it places on the traditional
physician-patient relationship. These misgivings have been
exacerbated by the mostly negative response to MCOs in the media and
academia. Legislatures have responded to these claims and public
fears with a wave of regulatory initiatives. Some of these
regulations are attempts to protect patients. Others, however, are
motivated primarily by antipathy toward the concept of managed care
itself. This essay is an attempt to develop a social ethic of
regulation and argues that the sole reason that private enterprise
may be justifiably limited is when it presents a risk of harm to
others or society. While some regulation and proposed regulation of
MCOs meet this standard, much legislation represents an unjustified
attempt to limit or handicap otherwise legal behavior merely because
a segment of the population and medical profession find it
aesthetically unpleasing and oppose its approach to the delivery of
health services.
ARTICLE TITLE: Hume, bioethics, and philosophy of medicine.
ARTICLE SOURCE: J Med Philos (Netherlands), Aug 1999, 24(4)
p315-21
AUTHOR(S): Kopelman LM; McCullough LB
AUTHOR'S ADDRESS: Department of Medical Humanities, East Carolina
University School of Medicine, Greenville, NC 27858, USA.
PUBLICATION TYPE: BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE