Who is to decide: functional disability screening as an example

Article Abstract:

Two points of view have been voiced regarding a study by Rubenstein et al. that appeared in the November 11, 1989 Annals of Internal Medicine. This study assessed the effectiveness of questionnaires in monitoring the functional progress of patients with disabilities with the objective of enhancing health care. According to the Rubenstein study, this method of evaluation is ineffective. Another point of view is that this practice, which has been recommended by the American College of Physicians and Society of General Internal Medicine, is useful, regardless of the conclusions drawn by Rubenstein et al. Thus, a debate on the validity of this practice continues without a practical resolution. However, a resolution is required because the practice of medicine is ongoing and not just the subject of a theoretical debate. In these types of medical policy issues, a social consensus based on economic grounds eventually develops. The separation of numerous types of approaches in dealing with this and similar problems is artificial. The clinical practitioners, the academic professionals, patient representatives, and insurance providers all have a specific and, therefore, limited point of view. A synthesis of a cluster of ideas will eventually provide a satisfactory outcome to this debate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Management, Evaluation, Disability evaluation, Function tests (Medicine), Aldosterone assay, Health education, column

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Screening for vitamin B12 deficiency: caveat emptor

Article Abstract:

Tests for vitamin B12 deficiency should be used conservatively, primarily on patients who are at high risk of developing the deficiency. Tests that measure blood levels of vitamin B12 or its metabolic products, methylmalonic acid and homocysteine, may not accurately detect deficiencies. A 1996 study found suggested that vitamin B12 deficiency is more common among people who have had stomach surgery than previously thought and these people should regularly be tested for the deficiency. However, the questionable accuracy of the vitamin B12 tests may have introduced errors into their results. In general, people at risk of the deficiency, such as the elderly and people who have had stomach surgery, should have the test for vitamin B12. The more expensive tests for metabolic products should be used when there is a discrepancy between symptoms and the results of the vitamin B12 test. In some cases, B12 therapy may be more cost-effective than administering the test for metabolic products.

Editorial, Vitamin B12 deficiency

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Is colonoscopy indicated for small adenomas found be screening flexible sigmoidoscopy?

Article Abstract:

Patients with small polyps found by flexible sigmoidoscopy probably do not require further examination with colonoscopy. Both techniques use an endoscope to examine the inside of the colon but only colonoscopy examines the entire colon. Researchers did flexible sigmoidoscopy on 4,490 patients and found a cancerous polyp in 401 (9%). A full colonoscopy was done in 301 of these patients. No patients with a single polyp 5 millimeters or less had polyps further back in the colon, whereas 5% of those with multiple polyps or bigger polyps did and 8% of those with malignant polyps did.

Medical examination, Colonoscopy, Intestinal polyps, Colon (Anatomy), Colon

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