Annals of Internal Medicine tip sheet for Aug. 2, 2011

The American College of Physicians (ACP) and three other physician organizations released a joint clinical practice guideline on diagnosing and treating stable chronic obstructive pulmonary disease (COPD). ACP convened the four organizations, which represent more than 170,000 physicians from around the world, to develop the joint guideline. According to the authors, the goal of the guideline is to help clinicians diagnose and manage stable COPD, prevent and treat exacerbations, reduce hospitalizations and mortality, and improve the quality of life of patients with COPD. According to the lead author, "Since COPD occurs predominantly in cigarette smokers and continued smoking worsens COPD, it is important for patients with COPD to stop smoking and for physicians to help their patients to quit smoking."

When patients undergo computed tomography (CT) of the chest, pulmonary nodules are sometimes detected. Pulmonary nodules are usually benign, but some prove to be cancerous. In each case, the physician must decide whether to perform an invasive and potentially risky procedure called a transthoracic needle biopsy. Researchers reviewed health records for 15,865 adults who had transthoracic needle biopsy of a pulmonary nodule to estimate the risk for complications after the procedure. They calculated the percentage of biopsies complicated by hemorrhage, any pneumothorax, or pneumothorax requiring a chest tube. Hemorrhage was rare, but the risk for any pneumothorax was 15 percent and 6.6 percent, respectively. The authors conclude that for many patients, including those with a low risk for cancer, those who are too frail to undergo cancer treatment, or those with a high risk for cancer who should proceed directly to surgery, this procedure may be too risky. Physicians should inform their patients about the risks.

Hospitalists are physicians that care for patients full-time in the hospital setting. Studies have shown that compared to patients cared for by primary care physicians (PCP), those treated by hospitalists have shorter hospital stays. However, once patients leave the hospital, some worry that the discontinuity that results when a hospitalist rather than a patient's primary physician provides hospital care may lead to greater costs and utilization of health care resources after hospital discharge. Researchers examined a five percent national sample of Medicare patients who were cared for by their own physician or a hospitalist during hospitalization between 2001 and 2006. The researchers documented length of stay, hospital charges, discharge location and physician visits, emergency department visits, rehospitalization, and Medicare spending within 30 days after discharge. They found that patients cared for by hospitalists had shorter hospital stays and lower hospital costs, but after discharge, they had more visits to the emergency department, more readmissions to the hospital, and higher total expenses. Health care utilization after discharge may counter balance the savings during hospitalization that are associated with hospitalist care.

Since 2001, rates of primary and secondary syphilis in the United States have steadily increased. In no racial, ethnic, or social group has the increase been more apparent than among black and Hispanic young men who have sex with men (MSM). Researchers studied U.S. census records from 27 states with same sex partner data for 70 percent or more of male cases of primary or secondary syphilis for each year from 2005 and 2008. The data showed that primary and secondary syphilis is disproportionately affecting younger (aged 15 to 29) black and Hispanic MSM compared to white MSM. According to the researchers, black and Hispanic MSM are also at greater risk of co-infection with syphilis and HIV. The researchers cite previous reports that these men are engaging in risk behaviors that encourage transmission of both diseases, making it imperative for care providers to assess STD-related risk among black and Hispanic male patients, including asking about the sex of their partner, and to provide counseling about safer sexual practices.