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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2002;162:1089.
Adrenal Function in the Human Immunodeficiency Virus–Infected
Patient
Subclinical manifestations of adrenal dysfunction are common in human
immunodeficiency virus–infected patients. The most commonly observed
finding is asymptomatic hypercortisolemia, but other alterations of the hypothalamic-pituitary-adrenal
axis have also been described. Although patients with hypocortisolemia should
receive appropriate therapy regardless of the existence of symptoms, no significant
benefit is expected from specific therapy or further studies in those with
asymptomatic hypercortisolemia.
(SEE ARTICLE)
Symptom-Triggered vs Fixed-Schedule Doses of Benzodiazepine for Alcohol
Withdrawal
Benzodiazepines are the pharmacologic first line of choice in the treatment
of alcohol withdrawal. Yet, they are usually prescribed on a fixed-schedule
basis, resulting often in oversedation and in delays to initiate the treatment
of the underlying disorder, alcoholism. In a sample of 117 alcohol-dependent
patients admitted to an inpatient treatment program, this randomized study
compared a personalized symptom-triggered medication prescription with a 3-day
fixed-schedule regimen. Results indicate that the symptom-triggered prescription
method allowed clinicians to avoid any benzodiazepine prescriptions in 60%
of the patients and was associated, on average, with a 6-fold reduction in
the quantity of medication prescribed and a 3-fold reduction in treatment
duration, without group differences in treatment safety and in comfort. These
data support the recommendation of individualized benzodiazepine prescriptions
for alcohol withdrawal treatment, when close monitoring of withdrawal symptoms
is possible.
(SEE ARTICLE)
Intimate Partner Violence and Physical Health Consequences
This study investigated the physical health consequences of intimate
partner violence (IPV) in a sample (201 cases and 240 controls) of middle-class
female health maintenance organization enrollees whose IPV history was known.
Women who reported any abuse between 1989 and 1998 were more likely to report
poor health, as well as a number of gynecological, central nervous system,
and stress-related symptoms and illnesses. Women who reported sexual abuse
with or without physical abuse reported more gynecological symptoms and illnesses
and were also more likely to have at least 1 chronic stress-related or central
nervous system symptom or illness than women who reported physical abuse only.
The pattern of symptoms and illnesses in this sample is comparable with that
found in samples of lower-income women, indicating that IPV affects women
regardless of social and economic status. The results suggest that routine
IPV screening is important, not just for women's safety, but also because
it provides physicians with important information about the causes of presenting
symptoms. In the absence of screening, physicians whose patients present with
multiple gynecological, central nervous system, or chronic stress symptoms
or illnesses should sensitively probe for IPV in the health history.
(SEE ARTICLE)
Nonsteroidal Anti-inflammatory Drug Use and Acute Myocardial Infarction
While aspirin has been shown to protect patients from acute myocardial
infarction (AMI), it is not clear whether nonaspirin nonsteroidal anti-inflammatory
drugs (NSAIDs) have a similar effect or whether NSAIDs differ in their effect
on the risk of AMI. A case-control study was performed among 22 125 persons.
After adjusting for known or potential risk factors for AMI overall, NSAID
users had the same risk of AMI as nonusers, whether such use was measured
on the index date (adjusted odds ratio, 1.04; P =
.55) or at any time in the prior 6 months (adjusted odds ratio, 1.00; P = .92).
However, use of naproxen was associated with a significant reduction in the risk of AMI (adjusted odds ratio, 0.84;
P = .03).
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Relative risk of AMI.
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(SEE ARTICLE)
The "Hassle Factor": What Motivates Physicians to Manipulate Reimbursement
Rules?
Physicians are willing to misrepresent clinical information to insurance
companies in some circumstances. This study surveyed 1617 physicians to assess
whether the difficulty of the appeals process influences the likelihood that
they will sanction such deception. A sizable minority of physicians responded
that they would misrepresent their patient's condition to get insurance approval
for a test or procedure. Physicians were more likely to sanction deception
if the appeals process was longer, the likelihood of a successful appeal was
lower, and the health condition was more severe.
(SEE ARTICLE)
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