A 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.

An 83-year-old man examined on admission for end-of-life care due to profound dementia. His wife states that his penis has not changed in appearance, but knows that he always had concerns about it. To her knowledge he never had trouble voiding. Patient too impaired to discuss any topic coherently. Wife considers it unlikely he would have disclosed any symptom of this type to her.

Painful cracks in the fingertips are a common problem, especially during cold weather. A simple but effective remedy is to have the patient apply petroleum jelly to the crack, cover it with an adhesive bandage put on with a bit of tension, and then place a second adhesive bandage over the first at right angles for reinforcement. Instruct the patient to leave the bandages on overnight and to reapply 1 or 2 more nights if needed. If a patient’s daytime activities permit it, the bandages can also be worn during the day.

During a review of systems, I find it helpful and timesaving to ask the patient if he or she experiences symptoms that are out of the ordinary for the typical person. For example, instead of asking “Do you have fevers, chills, or night sweats?” I ask “Do you have fevers, chills, or night sweats more than the average person?” I find this approach yields more useful responses: they indicate whether the patient perceives the symptom as significant.

A 7-year-old girl was brought to the emergency department because of moderate pain on swallowing and mild upper abdominal discomfort. A few hours earlier, she had been given a piggy bank in order to save money for a family trip planned for the next day. On shaking the piggy bank upside down above her head, a few coins fell out. The child admitted to swallowing a coin. Physical examination findings were unremarkable. A plain abdominal radiograph showed what appeared to be 1 coin in the stomach (A)

This is the second part of a 2-part article on trends in HIV care.

Herpes simplex virus (HSV) is an enveloped double-stranded DNA virus that is a common pathogen in humans. There are 2 subtypes, HSV-1 and HSV-2,

One of the most highly discussed and publicized HIV-related presentations at the recent Interscience Conference on Antimicrobial Agents and Chemotherapy/Infectious Diseases Society of America (ICAAC/IDSA)

A 19-year-old woman presented with shortness of breath, dry cough, and pleuritic chest pain of unknown duration. Her medical history included endometriosis, a benign ovarian cyst,

A 74-year-old woman with a history of breast cancer and cutaneous sarcoidosis was admitted after a fall from bed that resulted in a left hip fracture.

An estimated 62 million noninstitutionalized US adults 18 years and older, or approximately 30% of the adult population, have a disability that affects daily activity (Figure 1). About two-thirds (67%) of persons with basic actions difficulty (defined as difficulty with basic movement or sensory, cognitive, or emotional difficulties) are younger than 65 years, according to the National Center for Health Statistics (NCHS), a CDC division.

When medical professionals think of the health consequences of obesity, we usually think of increased prevalence of coronary artery disease, stroke, some cancers, diabetes, and hypertension. If we think a bit more, osteoarthritis, gallstones, asthma, and sleep disorders come to mind.1 How many of us are aware of the connection between obesity and the increased risk of various mental illnesses and conditions?

Opioid analgesics provide effective treatment for noncancer pain, but many physicians have concerns about adverse effects, tolerance, and addiction. Misuse of these drugs is prominent in patients with chronic pain. Recognition and early prevention of misuse helps physicians identify the causes and proceed with patient care. Most persons with chronic pain have a significant medical comorbidity (eg, asthma) that affects treatment decisions.

In response to recommendations from the Government Accountability Office (GAO), the Centers for Medicare & Medicaid Services (CMS) says it is cracking down on insurers that offer private fee-for-service (PFFS) plans under the Medicare Advantage (MA) program.

Supermarket pharmacy retailers, including Giant Food, Stop & Shop, Publix, and Wegman’s Food Markets, are offering frequently prescribed antibiotics, such as amoxicillin, bacitracin, and penicillin, at no charge. While the programs are intended to provide customers economic relief during the cold and influenza season, the Infectious Diseases Society of America (IDSA) is urging retailers to offer free influenza vaccinations instead. Because of a significant increase in anti-biotic-resistant infections, the IDSA considers the antibiotic giveaway counterproductive. Most concerning to the IDSA are promotions such as Wegman’s that link antibiotics to the cold and influenza season even though the drugs will have no effect on these viral illnesses and carry risks of adverse effects.

Asthma affects approximately 22 million adults and children in the United States and poses a significant economic burden on the health care system and on employers. According to the National Heart, Lung, and Blood Institute, direct and indirect costs for all forms of asthma totaled $19.7 billion in 2007. Prescription drugs represented the largest single direct cost at $6.2 billion.

Genetic testing to guide initial dosing of warfarin is useful but unlikely to be cost-effective for persons with nonvalvular atrial fibrillation, according to a study published in the January 20 issue of the Annals of Internal Medicine. Principal investigator Mark H. Eckman, MD, MS, professor of medicine at the University of Cincinnati, noted that in 2007, the FDA changed the labeling for warfarin, suggesting that clinicians consider genetic testing before initiating therapy. Eckman led a team of researchers to determine whether genetic testing-also known as pharmacogenetic-guided dosing and genotype-guided dosing-is worth the cost. The team combined the results of the only 3 published clinical studies to analyze the extent to which pharmacogenetic-guided dosing decreases the risk of hemorrhage compared with standard induction of warfarin therapy.

A 45-year-old Hispanic man who acquired HIV infection in April 2003 presented with a 24-hour history of worsening right lower quadrant pain accompanied by fever, decreased appetite, nausea, and vomiting.

Employers gave their PBMs the highest marks ever for overall service and performance. Satisfaction ratings for 2008 averaged 8 on a 10-point scale, up from 7.9 in 2007 and 7.8 in 2006. PBMs that provided the greatest degree of financial transparency and the most aggressive intervention received the highest satisfaction ratings by employers. More than two-thirds (71.4%) of employers say they are very likely to renew their PBM contract, up from 63% in 2007.

There is a lot of talk in health care these days about transparency and the need for business practices to be transparent. According to my well-worn Webster’s, the definition of transparent includes: “sheer enough to be seen through; free from pretense or deceit; readily understood; obvious.” We need more transparency in health care, especially as we consider changes in how health care is delivered and paid for. PBMs and pharmaceutical companies are already moving toward greater transparency.