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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2001;161:800.
Physicians vs Physicians
In today's tumultuous health care environment, conflict between physicians
has become increasingly common, according to this article by Manian, which
covers 4 areas of conflict: (1) attending or consulting physicians vs health
maintenance organization medical directors; (2) attending or consulting physicians
vs similar physicians; (3) hospitalists vs consulting physicians; and (4)
attending or consulting physicians vs laboratory medical directors.
(SEE ARTICLE)
Electron-Beam Computed Tomography in the Diagnosis of Coronary Artery
Disease
Electron-beam computed tomography (EBCT) is a new, noninvasive method
of detecting coronary calcification and is increasingly advocated as a diagnostic
test for coronary artery disease. Before clinical use of EBCT can be justified,
its overall diagnostic accuracy (which, according to the literature, varies
widely) must be established. In this study, Nallamothu et al used weighted,
pooled analysis and summary receiver operating curve analysis to combine sensitivity
and specificity rates from 9 studies that included 1662 subjects. Based on
their results, EBCT appears to be reasonably accurate for detecting obstructive
coronary artery disease.
(SEE ARTICLE)
Early Switch From Intravenous to Oral Antibiotics in Patients
With Streptococcus pneumoniae Pneumonia
In this article, Ramirez and Bordon report that hospitalized patients
with community-acquired pneumonia can be switched from intravenous to oral
antibiotics as soon as they reach clinical stability, even if they were bacteremic
with Streptococcus pneumoniae at the time of diagnosis.
(SEE ARTICLE)
Characteristics and Work Experiences of Hospitalists in the United
States
Little is known about the personal characteristics, work-related attitudes,
and professional experiences of hospitalists. These issues are important for
physicians (primarily internists) in considering hospital medicine as a viable
career choice. This study by Hoff and colleagues draws on responses from a
mail survey of 820 hospitalists who are members of the National Association
of Inpatient Physicians and who spend 50% or more of their time doing clinical
work, teaching, or performing research related to hospital medicine. Their
analysis is based on 393 responses. The results show a group of younger, mostly
male individuals at the early stages of their careers who have high levels
of job satisfaction and autonomy, low levels of burnout, and a long-term commitment
to remain in the hospitalist role. Hospital medicine is currently a source
of positive social and professional work experiences based on interaction
with physician peers, patients and their families, and nonphysician coworkers
in the hospital environment. Key components of hospitalists' jobs, practices,
and workload appear to be coalescing. However, certain developments, such
as changing patterns of compensation and an increase in general internists
and women becoming hospitalists, merit further examination. This study complements
research on hospitalists' performance-related outcomes and helps to better
understand and assess the long-term potential of a new career path in medicine.
(SEE ARTICLE)
Cardiovascular Fitness as a Predictor of Mortality in Men
This study by Laukkanen et al was designed to examine the association
of cardiovascular fitness, as measured by maximal oxygen uptake, with overall
cardiovascular and noncardiovascular disease mortality. The sample was 1294
randomly selected men in eastern Finland who had no cardiovascular disease,
pulmonary disease, or cancer at the initiation of the study. During an average
follow-up of 10.7 years, there were 124 overall deaths (42 from cardiovascular
disease, 82 from noncardiovascular disease). The relative risk results did
not change even when taking into account smoking habits, alcohol consumption,
serum lipid profile, blood pressure, plasma fibrinogen, diabetes, and fasting
serum insulin. Furthermore, the risk of cardiovascular and noncardiovascular
disease-related death was the same as the risk of overall death. Low maximal
oxygen uptake was as strong a risk factor as conventional risk factors for
death, including elevated systolic blood pressure, smoking, obesity, and diabetes.
This finding emphasizes the importance of low cardiovascular fitness as a
risk factor for death. In this study, low cardiovascular fitness represents
one of the strongest predictors of mortality.
(SEE ARTICLE)
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