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From the March ACP Observer, copyright © 2007 by the American College of Physicians.

Physicians' values affect treatment

Many physicians do not feel obligated to tell patients about or offer referrals for some legal but morally controversial medical procedures, a new study found. Researchers surveyed physicians on three issues: terminal sedation of dying patients, abortion for failed contraception and birth control for adolescents without parental approval.

Surveying a cross-sectional random sample of 2,000 physicians of all specialties, the researchers found that 8% of physicians felt they had no obligation to present all possible options to patients and 6% were undecided. Asked if they have to refer patients for medical procedures to which they object on moral grounds, 18% said no. Physicians who were male or religious were most likely to believe in telling patients about their objections and least likely to feel the need to present all options or offer a referral.

Of the total survey respondents, 17% objected to terminal sedation, 42% objected to birth control for teens without parental consent and 52% objected to abortion for failed contraception. The study was published in the Feb. 8 New England Journal of Medicine.

The findings suggest that patients who want information about and access to controversial procedures may need to be proactive to determine whether their physicians will accommodate such requests, said the study's authors.

Mammogram results misunderstood

Nearly twice as many African-American women as white women did not receive or understand their mammography results, a study concluded.

The study, published online Jan. 31 in the American Journal of Public Health, compared mammography results of 411 African-American and 743 white women in Connecticut. The women were asked, in phone interviews within six months of the mammogram, whether they received their results and what the results said.

Overall, 14.5% of the women in the study either misunderstood their results or said the results weren't adequately communicated. Most, 86% said they hadn't received results, while 14% had received the report but their understanding of it differed from their medical record. Receiving results from a screening facility rather than a primary care provider was more likely to result in inadequate communication, the study found.

Almost 21% of African-American women either reported not receiving results or misunderstood them, compared to 11% of white women. As well, 31% of African-American women who didn't receive or misunderstood results had an abnormal mammogram result compared to 6.5% of white women. Results were adjusted for age, income, education, occupational status, marital status and screening history, among other things.

Though most of the inadequate communication is attributable to results not being received, "It is worrisome that of the 23 women who reported incorrect results, most (78.3%) believed that their mammograms were normal, despite the fact that their records indicated otherwise," the authors said. The findings suggest abnormal or inconclusive results may be less effectively communicated than normal results, they said.

MRI beats CT for stroke

MRI scans are a better tool for diagnosing acute stroke than CT scans, a recent study found. The more sensitive diagnosis provided by MRIs showed superior results in detecting acute ischemic stroke, the most common form of stroke.

Researchers followed 356 patients with suspected stroke who arrived consecutively at the NIH Stroke Center. Stroke specialists conducted emergency clinical assessments with all patients before initiating both CT and MRI scans. When the scans were reviewed by four experts, MRIs revealed acute ischemic stroke in 164 of 356 patients, compared with 35 out of the 356 revealed by CT scans.

The results show that immediate non-contrast MRI is about five times more sensitive and twice as accurate as immediate non-contrast CT for diagnosing ischemic stroke, but the scans are equally effective in the diagnosis of acute intracranial hemorrhage, according to the NIH, which conducted the study. The study was published in the Jan. 27 issue of The Lancet.

Based on the study's findings, MRI should become the preferred imaging technique for diagnosing patients with acute stroke, although further research is needed to determine whether advanced contrast enhanced CT techniques can produce the same level of clinical information more quickly and with less expense, study authors said.

Pollution raises risk

Long-term exposure to fine particulate air pollution increases the risk of heart disease and death in older, post-menopausal women, a new study found.

The study, published in the Feb. 1 New England Journal of Medicine, examined 65,893 postmenopausal women age 50-79 who were enrolled in the Women's Health Initiative from 1994-1998. The authors assessed each woman's exposure to air pollutants using the monitor nearest her residence, and hazard ratios were estimated for the first cardiovascular event.

A total of 1,826 women had one or more fatal or nonfatal cardiovascular events as of August 2003. Each increase of 10 millionths of a gram per cubic meter of air was associated with a 76% increase in the risk of death from cardiovascular disease, and a 24% increase in the risk of a cardiovascular event. Results were adjusted for demographic factors like income as well as health factors, such as smoking status and diabetes.

Results suggest that the EPA's average annual limit of fine particulates, which is 15 millionths of a gram for every cubic meter of air, should be lower, said a pollution specialist interviewed by the New York Times.

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