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In This Issue of Archives of Internal Medicine
May 27, 2002

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2002;162(10):1089. doi:10.1001/archinte.162.10.1089
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.

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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.

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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.

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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).

Relative risk of AMI.

Relative risk of AMI.

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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.

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