Cost-benefit issues in the practice of internal medicine

Article Abstract:

The rapidly rising cost of medical care makes it incumbent upon physicians to consider cost issues in choosing therapies and tests. Some examples of cost-saving measures are outlined to suggest ways that individual physicians might help to reduce the tremendous cost of medical care. Antibiotic choices are often made without regard to cost. For simple upper respiratory infections, typical antibiotics prescribed include amoxicillin, erythromycin, cefaclor, and amoxicillin-clavulanate. The latter two cost three times more than the others, and so should be reserved for cases in which they are clearly indicated. Intravenous antibiotics also vary widely in price. Certain particularly ill patients require the use of antibiotics known as aminoglycosides, which include gentamicin, tobramycin, and amikacin. Gentamicin costs far less than the other two, and should be used except when there is known resistance to gentamicin by the bacteria infecting the patient. In those patients who are candidates for it, home intravenous therapy can offer substantial savings over hospital administration. Blood pressure medications also vary widely in their costs. Some, like the older diuretics ("water pills"), can cost many times less than the newer blood pressure drugs. Judicious use of generic drugs can offer savings. Laboratory tests are another source of rising medical costs. Often, physicians order full panels of test offered by laboratories. If several of the tests in the panel are needed, the whole panel can be a savings, but if only one or two of the tests are likely to be of use, then the whole panel might be costlier than the individual tests. Ordering the newer magnetic resonance imaging studies might provide somewhat greater accuracy in their results, but if a CT (computerized tomography) scan can give the desired information, it should be chosen, as it costs half as much as MRI. Thus, when no clear cut benefit can be seen from the use of a more expensive therapy, the less costly choice might provide considerable savings for the patient and the health care system. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Drugs, Economic aspects, Finance, Medical care, Cost of, Health care costs, Dosage and administration, Drug administration and dosage, Internal medicine, Diagnosis, Laboratory, Laboratory diagnosis

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Daily stress and recurrence of genital herpes simplex

Article Abstract:

Genital herpes simplex is the infection of the genital and anal skin and mucosa with the herpes simplex virus. The virus is usually transmitted by sexual contact and is classified as a sexually transmitted disease. It is characterized by the development of thin-walled vesicles or blisters that recur on the same areas of the skin, most often at the site where the mucous membrane joins the skin. Emotional stress is thought to trigger recurrences of oral and genital herpes simplex infection. The relationship between daily stress and recurrence of genital herpes simplex was assessed daily in 64 subjects for one to three months. Most of the subjects were women, and the average age was 28 years. All of the subjects experienced at least one recurrence of genital herpes simplex type 2 before or during the study. The subjects were required to complete a questionnaire concerning psychological and emotional stress in six areas of their lives. The categories were physical health, relations with friends, relations with family, relations with sex partner(s), financial state, and vocation or education. Stress reported on each of the six days before the recurrence was compared with that on days during or after a recurrence and during a period unrelated to recurrence of herpes. The results showed that there was no increase in psychological and emotional stress in the period preceding a recurrence of genital herpes simplex infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Health aspects, Measurement, Risk factors, Stress (Psychology), Herpes genitalis, Genital herpes

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