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In This Issue of Archives of Internal Medicine
July 28, 2003

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2003;163(14):1634. doi:10.1001/archinte.163.14.1634
Sex Differences in Risk for Coronary Heart Disease Mortality Associated With Diabetes and Established Coronary Heart Disease

Current national guidelines recommend treating individuals with diabetes as aggressively as individuals with prior coronary heart disease (CHD) because recent data indicate that individuals with diabetes have as high a risk for CHD mortality as those with prior CHD. Natarajan et al evaluated whether the risk for CHD mortality in individuals with diabetes varied by sex and quantitated this effect by comparison with individuals with prevalent CHD. Their results indicate that, in men, established CHD signifies a higher risk for CHD mortality than diabetes. This is reversed in women, with diabetes being associated with greater risk for CHD mortality. Current treatment recommendations for individuals with diabetes may need to be further refined to match CHD mortality risk.

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Neuroprotection in Parkinson Disease

Recent discoveries of the etiopathogenesis of Parkinson disease, as well as new diagnostic modalities, are changing the therapeutic strategies of this disease. Therapeutic interventions designed to slow disease progression are being studied, with emphasis placed on early diagnosis. For neuroprotection to become a therapeutic possibility, collaboration between primary care physicians and clinical researchers must occur.

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Pulmonary Embolism Mortality in the United States, 1979-1998: An Analysis Using Multiple-Cause Mortality Data

Pulmonary thromboembolism–reported mortality in the United States has substantially decreased over a 20-year period. The mortality decrease is likely multifactorial, but improved detection and treatment of pulmonary thromboembolism and its risk factors is likely to play a major role. Black men continue to have the highest pulmonary thromboembolism mortality rates, but the gap is narrowing.

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Direct Observation of Requests for Clinical Services in Office Practice: What Do Patients Want and Do They Get It?

Practicing physicians know that patients frequently ask for a variety of clinical services that may or may not be clinically indicated. However, the nature and prevalence of such requests has not been ascertained by direct observation. In this study, Kravitz and colleagues audiotaped 559 visits to 45 internists, cardiologists, and family physicians. About one fourth of patients requested at least 1 diagnostic test, specialty referral, or new prescription medication. Such requests were more common among patients experiencing greater health-related distress (P<.05) and much more common among patients of internists and family physicians than among patients of cardiologists (P<.01). Compared with patients making no requests, patients making requests for referrals and prescription drugs were much more likely to receive them. The authors conclude that patients' requests for clinical services are both pervasive and influential.

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A Pilot Randomized Double-blind Comparison of a Low-Molecular-Weight Heparin, a Nonsteroidal Anti-inflammatory Agent, and Placebo in the Treatment of Superficial Vein Thrombosis

In a double-blind trial, 427 patients with documented acute symptomatic superficial vein thrombosis of the legs were randomly assigned to receive, once daily for 8 to 12 days, one of the following: subcutaneous enoxaparin sodium, 40 mg; subcutaneous enoxaparin, 1.5 mg/kg; oral tenoxicam; or placebo. Treatment with low-molecular-weight heparin or with an oral nonsteroidal anti-inflammatory agent tended to reduce the incidence of deep venous thromboembolic complications and was effective and safe in reducing the incidence of recurrence or extension of superficial venous thrombosis. Further investigations in larger patient populations are warranted to confirm these results and to examine whether a longer antithrombotic treatment would reduce the incidence of deep venous thromboembolism.

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