An 89-year-old woman is seen because of a white area on the tongue. She has been hospitalized on a behavioral health unit for 2 weeks; 1 day ago, enoxaparin was begun for a new left leg deep venous thrombosis. Recent antibiotic therapy for a urinary tract infection; candidal vulvitis followed and was treated with topical clotrimazole. Has penicillin allergy.
Hypertension affects approximately 73.6 million persons in the United States or one-third of the adult population. This is an increase from 72 million persons in 2007, 65 million persons in 2002, and 50 million US adults in 1994 (or one-third, 29%, and 25% of the adult population, respectively).
Despite clear evidence of its benefits, widespread adoption of electronic prescribing (ePrescribing) has been slow. The vast majority of prescriptions are still written by hand, a process plagued with errors and inefficiencies. The Southeast Michigan ePrescribing Initiative (SEMI), a collaborative effort of employers, health plans, physician groups, and others, was launched in 2005 to speed the adoption of ePrescribing. SEMI has accomplished much in 4 years, enrolling more than 3000 physicians who have transmitted nearly 9.5 million electronic prescriptions while improving patient safety and winning over physicians. (Drug Benefit Trends. 2009;21:23-26)
Influenza develops in about 20% of the global population each year. In the United States, annual influenza epidemics typically occur between late December and early March. While influenza may affect persons of any age, infection rates are highest among children.
Former Senate Majority Leader Thomas A. Daschle (D, SD) will become the nation’s health care policy czar with enormous influence on health care policy and reform. In addition to being named secretary of the vast 65,000-employee Department of Health & Human Services (HHS)-home of the FDA, the Centers for Medicare & Medicaid Services (CMS), and the NIH-
Most US adults still rely on word-of-mouth and physician recommendations when selecting health care providers despite an increase in health care price and quality transparency initiatives, according to findings of a study by the Center for Studying Health System Change (HSC) released on December 4. HSC interviewed 13,500 adults for its nationally representative 2007 Health Tracking Household Survey. The study was funded by the California HealthCare Foundation.
Generic drug utilization has reached its highest levels to date-60.4% for retail prescriptions and 49.3% for mail-service prescriptions (Cover Figure), while pharmacy reimbursement continues its downward trend.
One year after the Academy of Managed Care Pharmacy (AMCP) was founded in 1988, the first issue of Drug Benefit Trends was published. The past 20 years have seen the evolution of managed care from infancy to, well, young adulthood-established but still changing. By showcasing innovative research and ideas on drug benefit design and delivery, DBT has long supported the mission of AMCP: “AMCP’s mission is to empower its members to serve society by using sound medication management principles and strategies to improve health care for all.”
What are the most effective ways to reduce the incidence of acute exacerbations of chronic obstructive pulmonary disease (COPD)?
p>Drug-induced lung disease (DILD) can be caused by a variety of agents, including chemotherapeutic drugs, antiarrhythmic agents, antibiotics, and NSAIDs. The clinical syndromes associated with DILD include alveolar hypoventilation, acute bronchospasm, organizing pneumonia, and hypersensitivity reactions. Amiodarone lung toxicity often manifests as a chronic fibrosing alveolitis, characterized by an insidious onset of cough, dyspnea, and weight loss. Important components of the workup include chest radiography, pulmonary function testing, and bronchoscopy with bronchoalveolar lavage (BAL). BAL is particularly helpful in identifying eosinophilic pneumonia and diffuse alveolar hemorrhage and in ruling out infectious causes. Management includes drug withdrawal and, in some cases, corticosteroid therapy. Before starting corticosteroids, it is important to rule out infectious causes of lung disease, particularly in patients receiving chemotherapy. (J Respir Dis. 2009;30(1))
The population of elderly nursing home residents who have dementia has been steadily increasing. It is not unusual to be called early in these patients’ course, day or night, and be asked to prescribe something for agitation-triggered by strange new surroundings and people. Nearly 1 in 5 new nursing home residents receives an antipsychotic drug within 100 days of arrival.1 Does this “typical” practice have a downside?
Although gout has been recognized since ancient times, its management remains challenging. In a previous article (CONSULTANT, December 2008, page 1010), I focused on diagnosis; here I discuss how the treatment approaches for an acute flare and for chronic gout differ, and I compare the safety and efficacy of available therapies.
These firm papules, a classic sign of sarcoidosis, are seen around the eyes of a 27-year-old woman (A) and the external ear of a 33-year-old woman (B).
For several months, a 59-year-old woman has had numerous asymptomatic lesions on her arms and legs. During this period, she has not been exposed to the sun and has taken no new medications.
Premenstrual disorders affect many women in the United States. These disorders range in severity from the mild, bothersome symptoms that occur in more than 75% of women with regular menstrual cycles, to premenstrual syndrome (PMS) and, finally, to the most severe and disabling, premenstrual dysphoric disorder (PMDD). Nearly 5 million American women have PMDD.
Debate over the optimal time to initiate antiretroviral therapy for HIV infection is as old as the availability of effective anti-HIV treatment.1 As I've noted in several past editorials, there were cogent arguments on both sides,
Although the common cold is usually benign, it can lead to exacerbations of asthma and chronic obstructive pulmonary disease, and it is a leading cause of missed school and work. Strategies for prevention have been directed at interruption of viral transmission between persons, as with the use of virucidal agents or disinfectants, and prevention of infection after acquisition of the pathogen. Hand washing continues to be recommended, but there is no proof that hand sanitizers or virucidal tissues are effective in preventing colds. Prophylactic therapies that have been considered include vitamin C, vitamin E, zinc, Echinacea, ginseng, and probiotics. Although some evidence may suggest possible benefits with zinc and probiotics, for example, overall, the data are insufficient to recommend any of these as prophylaxis for the common cold. (J Respir Dis. 2009;30)
I sometimes get depressed myself (just a little!) when I see the latest offerings from pharmaceutical manufacturers. There are many new medications, but almost all are re-workings of familiar molecules-typically launched just before patent life is about to expire on the original formulation.
A 47-year-old man with HIV infection presented with progressive dyspnea and worsening productive cough for the past 3 weeks. He also reported increasingly purulent sputum production. The patient reported being adherent to his antiretroviral regimen, and he had an admission CD4+ cell count of 550/μL. He did not have any previous opportunistic infections, and he denied any drug or tobacco use, recent travel, and ill contacts.
A 44-year-old man with known HIV infection for more than 20 years presented with fatigue, nausea, and vomiting with a recent weight loss of 40 lb. His most recent CD4+ cell count was 206/µL, and his HIV RNA level was below 50 copies/mL.
