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While avoidance measures are a key component of the treatment of allergic rhinitis, pharmacological therapies are often needed to adequately control symptoms. Intranasal corticosteroids are highly effective and are particularly useful in patients with moderate to severe disease.

While the facts support the claim from the Centers for Medicare & Medicaid Services (CMS) that beneficiaries have “robust” choices in the sign-up period for 2010 Part D drug coverage plans that begins in November, the number of options available have continued to decline. At the peak in 2007, 1875 stand-alone Medicare drug plans were offered; this year, the number had shrunk to 1659, and the total for next year will be 1510.

We assessed the association between pharmacy cost-containment policy actions by states’ Medicaid programs and access to prescription drug and medical care, controlling for nonpharmacy cost-containment policy actions and socio-environmental differences among states.

A 60-year-old woman with a 3-month history of progressively worsening epigastric pain was referred for elective cholecystectomy after ultrasonography showed findings consistent with chronic cholecystitis (A and B). The patient reported having postprandial abdominal discomfort since 4 years of age. She also had occasional nausea and vomiting but denied jaundice, change in bowel habits, or urinary symptoms.

Match the following characteristics with the clinical disorders pictured in the photographs of Cases 1 and 2. Then read the brief descriptions that follow to see how well you did.

A 78-year-old man examined on rehabilitation unit, where he has beenreceiving intensive physical therapy after uneventful total knee arthroplasty.

Astrict definition of “dehydration” is a relative absence of water as manifested by hypernatremia. However, patients who are dehydrated are usually also volume-contracted; I prefer the latter term for a patient who has experienced vomiting, diarrhea, or decreased intake. Volume contraction denotes the need for replacement with saline equivalents, whereas dehydration indicates the need for water-and only possibly saline as well.

The medications currently approved for the treatment of insomnia include 9 benzodiazepine receptor agonist (BZRA) hypnotics and the selective melatonin receptor agonist ramelteon.

A novel H1N1 influenza virus has emerged from swine and is causing a worldwide pandemic. Children and young adults have been most affected, in terms of both numbers of cases and severity of disease. Perhaps the most striking feature of the pandemic so far is that fewer than half of those hospitalized or killed by this virus have had identifiable prior medical conditions or risk factors.

Despite the recent development of several new therapies, pulmonary arterial hypertension (PAH) remains an incurable disease. Careful monitoring of disease progression is vital to ensuring that patients receive maximal medical therapy before the onset of overt right-sided heart failure. In part 1 of this article, I reviewed the role of the history and physical examination, chest radiography, electrocardiography, echocardiography, and pulmonary artery catheterization. In part 2, I focus on MRI, cardiopulmonary exercise testing (CPET), the 6-minute walk test, and biomarkers.

In a recent editorial in The AIDS Reader, the “burden of responsibility for routine HIV testing” was accurately described as now falling on all clinicians, including those in emergency departments (EDs). Routine HIV testing in the ED seems logical because patients who seek health care in the ED are often underinsured and have low incomes, the very populations with a higher prevalence of undiagnosed HIV.

Estimates for the costs of treating breast cancer vary considerably, depending on patient population, time horizon, methodology, and other variables. According to a recent review by Campbell and Ramsey1 from the Fred Hutchinson Cancer Research Center in Seattle, estimates of lifetime per patient costs associated with breast cancer ranged from $20,000 to $100,000. As a result of the relatively long survival of patients with breast cancer, the costs of continuing care account for the largest proportion of lifetime costs.

Many psychotherapists adhere to psychotherapy protocols such as cognitive-behavioral therapy, interpersonal therapy, dialectic behavioral therapy, or psychoanalytically oriented psychotherapy. Nonetheless, what actually goes on between therapist and patient is often variable and sometimes unique.

The opioid antagonist naltrexone is approved for the treatment of alcohol dependence at an oral dosage of 50 mg daily.

Under new FDA rules going into effect this month, more patients will be able to access experimental drugs without taking part in clinical trials. The new rules are meant to clarify a formal process in place since 1987

When patients experience discomfort with Foley catheterization, fill a 2-mL syringe with lidocaine jelly and inject this (without using the needle!) through the urethral meatus and into the urethra. Wait several minutes, then insert the catheter.

THE CASE: A 77-year-old woman who has had shortness of breath and intermittent left flank pain for the past 2 to 3 days is brought by her family for evaluation. The dyspnea worsens when she lies down. She denies chest pain, back pain, and syncope. She has also had mild nonbloody diarrhea of 2 days’ duration but no vomiting or oral intake intolerance.

A healthy 33-year-old woman is seen in the office of her primary careclinician.