Annals of internal medicine tip sheet, July 20, 2004

July 19, 2004

1. Guidelines show how heart patients can travel safely by air

After reviewing literature on heart patients traveling by airplane, authors discuss effects of air travel and security devices on pacemakers and implantable automatic defibrillators; preflight screening; and in-flight venous thrombosis. They make recommendations on safe air travel after heart attacks and prevention of in-flight deep venous thrombosis.

Authors also present a nine-item pretravel checklist for patients with cardiovascular disease.

2. Long-term antibiotic doesn't ease gulf war illnesses

A 12-month course of the broad-spectrum antibiotic doxycycline did not improve symptoms of Gulf War veterans' illnesses (GWVI), a new study found (Article, p. 85). The researchers did the study because of speculation that infection with Mycoplasma (a form of bacteria) caused Gulf War illness.

Researchers randomized 491 deployed Gulf War veterans with GWVI and antibodies indicating current or past infection with Mycoplasma to take doxycycline or a placebo (dummy pill). The group taking doxycycline did no better than the group taking the placebo in physical or mental function, or in pain or fatigue, at 12- and 18-month checkups.

An editorial writer says that it "was never very likely that Mycoplasma infection accounted for the Gulf War health effect," but "increasing numbers of U.S. veterans were beginning long-term, potentially hazardous antibiotic treatment" (Editorial, p. 155). This study, the writer says, shows unequivocally that doxycycline "has no effect on the health of symptomatic Gulf War veterans."

3. Does a living will affect chance of not dying in a hospital?

A study of data on 539 elderly people who died in the United States between 1993 and 1995 found that 40 percent had living wills (Article, p. 113). People with living wills were more likely to die at home or in a nursing home than in a hospital.

An editorial writer says that "an association between having a living will and site of death does not imply causality" and called for public policy to address the problems of care for frail and older people dying from chronic, progressive illnesses (Editorial, p. 159).

4. ACP, insurers, patients, develop code of ethics for managed care
Annals of Internal Medicine is published by the American College of Physicians, an organization of more than 115,000 internal medicine physicians and medical students. These highlights are not intended to substitute for articles as sources of information.

For an embargoed copy of an article, call 800-523-1546, ext. 2653, or 215-351-2653. Leave fax or e-mail and article topics. PDFs are available on Wednesday, July 14.

American College of Physicians

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