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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

Friendly Foley

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.

Allergic rhinitis is highly prevalent; about 20% of adults in the United States and 25% of children worldwide are affected. It is a major societal expense, with direct costs, attributable to physician visits and medications, of up to $5 billion per year, and indirect costs, mainly stemming from lost productivity, of up to $9.7 billion per year. In the United States, allergic rhinitis results in 3.5 million lost workdays and 2 million lost schooldays each year.

Careful monitoring of disease progression is vital to ensuring that patients with pulmonary arterial hypertension receive maximal therapy before the onset of overt right-sided heart failure. Routine follow-up includes the evaluation of symptoms, functional class, and exercise capacity and assessment of pulmonary pressures and right ventricular (RV) function. Transthoracic echocardiography (TTE) offers a noninvasive and fairly reliable technique for monitoring pulmonary artery pressure (PAP) and structural changes of the right side of the heart. However, TTE does not reliably assess cardiac output, right-sided filling pressures, or pulmonary venous pressure. Pulmonary artery catheterization may be particularly useful in patients who have inconsistent findings, such as a reduction in PAP measured by TTE in the presence of worsening symptoms or other signs of disease progression. An increase in RV end-diastolic pressure, usually above 10 mm Hg, is a concern and warrants consideration of additional therapy even if other hemodynamic and clinical parameters are unchanged. (J Respir Dis. 2009;30(1-2)

It is, of course, conflict and disagreement that make news. However, the coverage of protests at town hall meetings about health care reform legislation held by members of Congress in their home districts over summer recess and the differences between competing drafts of what such legislation should look like mask one core truth: there is a good bit of agreement on what should be in the final package.

The development of drug-resistant strains of Mycobacterium tuberculosis has increased morbidity and mortality associated with tuberculosis (TB) and has greatly increased the costs of care for patients with this disease.

Major depressive disorder (MDD) does not always respond to antidepressants. Whether we are using SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclics, monoamine oxidase inhibitors, or heterocyclics (trazodone, nefazodone, bupropion), the result often falls short of full remission of symptoms.

Requirement of higher copayments for prescription drugs can delay the start of treatment for patients with newly diagnosed chronic problems, such as hypertension, hypercholesterolemia, and diabetes. This finding is particularly salient in patients who have no prior experience with prescription drugs.

The Medicare Prescription Drug Benefit (Part D) was initiated to help protect beneficiaries from increasing drug costs and to reduce the cost-related underuse of medications. A recent study by Zhang and associates1 provides noteworthy information about how Part D has affected prescription drug and other medical expenditures.

The rapid spread of Klebsiella pneumoniae carbapenemases (KPCs) is limiting the effectiveness of carbapenems in the treatment of multidrug-resistant infections. The resistance genes found in KPCs have been identified in other organisms as well and have properties that have raised concerns regarding their transmissibility and epidemic potential.

Asthma is a prevalent disease that continues to be associated with significant health care costs. Kamble and Bharmal, for example, estimated that the annual direct medical expenditure attributable to asthma in the United States was about $37.2 billion in 2007. In their study, the estimated prevalence of asthma was 8.7% in children and 6.72% in adults.

In this new feature, you’ll findpaired photographs of two differentdermatological disorders, accompaniedby a checklist of clinical features.You are invited to go throughthe checklists and match the variouscharacteristics with one or both ofthe disorders illustrated.