Authors
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Medication Nonadherence and the Risks of Hospitalization, Emergency Department Visits, and Death Among Medicare Part D Enrollees With DiabetesThe authors are affiliated with the University of Mississippi School of Pharmacy, in University, Miss. Dr Yang is assistant professor in the department of pharmacy administration.
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Economic Evaluation of a Prior Authorization Program for Biologic Response ModifiersSpecialty medications constitute the fastest-growing segment of drug spending under the pharmacy benefit. This study evaluated the impact of a specialty pharmacy prior authorization (PA) program on prescription drug costs for biologic response modifiers (BRMs) used in the treatment of persons with rheumatoid arthritis, juvenile rheumatoid arthritis, Crohn disease, ankylosing spondylitis, psoriatic arthritis, psoriasis, and other spondyloarthropathies. A retrospective, case-control, one-to-one matching approach based on patient age, sex, and client characteristics was used. Case clients were enrolled in the specialty pharmacy PA program from January 1 through December 31, 2005. The control group consisted of clients who were not enrolled in the program during this time. The average costs per eligible member per month (PMPM), for the total, plan, and member were $1.32, $1.29, and $0.03, respectively, in the case group, and $1.44, $1.41, and $0.03, respectively, in the control group. Clients who implemented the specialty pharmacy PA program for BRMs saved an estimated total cost of $0.12 PMPM. Implementing a specialty pharmacy PA program reduced BRM costs. (Drug Benefit Trends. 2008;20:26-31)
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Acute Suppurative Thyroiditis in a Patient With Aplastic AnemiaAcute suppurative thyroiditis (AST) is a rare inflammatorycomplication in patients with hematological malignancy.Infection spreads to the thyroid from a distant site throughthe bloodstream or the lymphatics. Defects such as persistentthyroglossal duct and pyriform sinus fistula are associatedwith the development of AST. Ultrasonography, bariumswallow testing, CT, and fine-needle aspiration are usedfor diagnosis. Treatment includes the administration ofparenteral antibiotics, drainage, and excision. We describea patient with aplastic anemia and bacteremic AST.[Infect Med. 2008;25:339-342]
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Nasal HemangiomaA 21-year-old woman had suffered recurrent nosebleeds and pain in her nose for the previous 2 months. Physical examination revealed an extremely vascular, slowly enlarging intranasal growth on the anterior surface of the septum.
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Case In Point: Acute eosinophilic pneumonia in a 19-year-old manThe authors describe a case of acute eosinophilic pneumonia (AEP) that occurred in a previously healthy young man. The presentation was similar to that of acute respiratory distress syndrome (ARDS), and the diagnosis was established by bronchoalveolar lavage (BAL). The authors note that it is important to recognize the subset of patients with AEP who present with an ARDS-like picture, especially since corticosteroids are very effective in this setting.
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Emphysematous Pyelonephritis Caused by Pasteurella multocidaEmphysematous pyelonephritis (EPN) is a rare but life-threatening infection characterized by widespread necrosis and production of gas within the kidney.
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Bilateral Leg Ulcers in a Cachectic ManA 51-year-old man is admitted to the hospital with painful ulcers on both lower extremities, severe anemia, and a 45-kg (100-lb) weight loss over the past year. Pain from the ulcers prevents him from walking. The ulcers developed about 5 years earlier, as a result of his wearing high boots for work; they began as small sores and grew over time.
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Crusty Scalp LesionAn 89-year-old woman is seen for an erosion on the frontal area of the scalp. History is positive for actinic keratosis. What's your Dx?
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Bacterial ArthritidesGonococcal infection is the leading cause of bacterial arthritis in adults.
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Arterial and Venous Thrombosis From a Patent Foramen Ovale (With Video)A 59-year-old man presented with painful paraparesis of acute onset, severe low back pain, and shortness of breath. On initial examination, he had 0/5 strength and numbness in his lower extremities. The skin from below his umbilicus to his lower legs was pale.
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New Orleans Now -- Few Doctors in the HouseA Multimedia Special ReportThis special report from Zach Wise, a MedPageToday contributing photographer, presents the sights and sounds of New Orleans medicine a year after Hurricane Katrina.
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Case In Point: Peripheral nerve sheath tumor mimicking pulmonary embolismWe describe a case in which a patient received thrombolytic therapy after he presented with a clinical picture consistent with submassive pulmonary embolism (PE). Two months later, a malignant peripheral nerve sheath tumor was diagnosed, and the patient died with metastatic disease. The filling defect in the left main pulmonary artery originally interpreted as PE was in fact a tumor. This case describes an unusual presentation of a rare disease (malignant peripheral nerve sheath tumor) mimicking a submassive PE.
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Wellens SyndromeA 72-year-old obese man with chronic atrial fibrillation, hypertension, hyperlipidemia, and a history of tobacco use presented for a routine office visit. A year earlier, he began to experience recurrent chest pain, but an ECG had shown normal T waves.
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Pretibial MyxedemaThe persistent effects of Graves disease were evident in a 48-year-old woman who had recently emigrated from Haiti to the United States. Thyrotoxicosis had developed several years before she sought treatment in her native country. The patient's obstructive goiter was removed and treatment with thyroxine was begun.
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Abnormal Liver Function Tests:ABSTRACT: Serum levels of aspartate aminotransferase and alanine aminotransferase that exceed 1000 IU/L indicate acute viral hepatitis (A, B and, rarely, C), acute drug toxicity (eg, acetaminophen overdose or isoniazid hepatotoxicity), or ischemic liver injury. In chronic hepatitis (ie, hepatitis B or C or autoimmune), values range from mildly elevated to usually less than 400 IU/L. Elevated levels of alkaline phosphatase and gamma;-glutamyltransferase (GGT) are consistent with cholestatic disease: primary biliary cirrhosis, primary sclerosing cholangitis, idiosyncratic drug reactions, or mechanical biliary obstruction (eg, biliary stones or tumor). Elevation in the GGT level can also be induced by alcohol consumption or medications (eg, phenytoin). Isolated unconjugated hyperbilirubinemia suggests Gilbert syndrome or a hematologic disorder; conjugated hyperbilirubinemia reflects impaired hepatic excretion. Serum bilirubin and albumin and INR have prognostic significance in chronic liver disease; bilirubin and INR are more useful in acute liver failure because albumin has a long half-life.
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Hip Pain, Irregular Skin Lesions in a 12-year-old GirlA symptom and a sign from a triad that is pathognomonic for this patient's condition. What's your Dx?
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Hip Pain, Irregular Skin Lesions in a 12-year-old GirlA symptom and a sign from a triad that is pathognomonic for this patient's condition. What's your Dx?
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Hip Pain, Irregular Skin Lesions in a 12-year-old GirlA symptom and a sign from a triad that is pathognomonic for this patient's condition. What's your Dx?
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Hip Pain, Irregular Skin Lesions in a 12-year-old GirlA symptom and a sign from a triad that is pathognomonic for this patient's condition. What's your Dx?
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Pediatric and Adolescent Migraine: Update on Treatment OptionsIf the goal of headache therapy for adolescent migraineurs is a pain-free adult life, here's a road map.
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Treatment of Diabetes in Older Adults: Guideline HighlightsThe Numbers: >90% of US adults aged ≥65 yrs have diabetes; 33% of those have T2DM; ~50% of older adults have prediabetes. We highlight new Endocrine Society treatment guidance.
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Pruritic Papulovesicular Rash on Lower Legs: Your Dx?Here are key clues: an intensely pruritic rash on the lower legs that developed within hours after the patient walked through a grassy field near a lake.
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Pruritic Papulovesicular Rash on Lower Legs: Your Dx?Here are key clues: an intensely pruritic rash on the lower legs that developed within hours after the patient walked through a grassy field near a lake.
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Elinzanetant Demonstrates Clinically Meaningful Reductions in Menopausal Vasomotor Symptoms, Meta-analysis ShowsElinzanetant reduced VMS frequency and intensity, and improved sleep and quality of life, according to the meta-analysis to be presented at the ACOG 2025 meeting.
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Expanding Leg Ulcer in a Young WomanSelf-treatment has done nothing to slow the progress of this lesion which the patient thought might be an insect bite at first. Your Dx?
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Top 3 Atrial Fibrillation Studies in 2018Andexxa, CABANA, and new AF score. Cardiologist and Patient Care author Payal Kohli, MD, highlights 3 pivotal developments from 2018.
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Vaping-related Hospitalization, Mortality: A Quiz on New CDC GuidanceTry your hand at these 8 questions based on the latest CDC guidance on rehospitalization and mortality in patients with vaping-related lung injury.
