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The practice of academic detailing is gaining interest and momentum in some health care circles. The primary aim of academic detailing is to prevent the overuse and misuse of certain medications. This is done by educating prescribers on the therapies that are clinically appropriate as well as the costs of therapeutically similar choices. It is less an issue of switching to generics than it is of favoring step therapy or moving toward cost-effective therapeutically equivalent options. A well-designed program should maintain prescriber autonomy and quality of care while helping manage drug costs for both health plans and patients.

A report from the Government Accountability Office (GAO) has led to new questions about the way health care for seniors covered under Medicare Advantage (MA) plans is paid for-and has prompted Centers for Medicare & Medicaid Services (CMS) acting administrator Kerry N. Weems to promise to collect more data from plans.

The highest rate of nonspecific serious psychological distress (SPD) (14.4%) among persons aged 18 and older in 2005 and 2006 was found in Utah, but overall, national SPD rates declined slightly. The rates of major depressive episodes (MDEs) among youths aged 12 to 17 years in Utah decreased significantly, from 10.1% in 2004 to 2005 to 8.2% from 2005 to 2006, according to a report released on March 6 by the Substance Abuse and Mental Health Services Administration (SAMHSA). MDE and SPD rates across all age groups were highest in the Midwest (7.8% and 11.8%, respectively) and lowest in the Northeast (7% and 10.8%, respectively). The study is based on data from 136,110 respondents collected for the 2005-2006 National Survey on Drug Use and Health.

Last month I wrote about how patients-or rather consumers-were taking on greater responsibility for decisions affecting their own health, largely because of the Internet and the ability to research and form opinions about individual treatments. That was only scratching the surface of how the Internet is revolutionizing health care.

Once a person reaches age 65 years, his or her prescription drug costs typically increase dramatically, according to results of a meta-analysis published in the March issue of the British Journal of Clinical Pharmacology. Researchers from the faculty of pharmacy at the University of Barcelona, Spain, led by Eduardo L. Marino, PharmD, PhD, examined the computerized pharmacy dispensing records of 5.47 million patients in Catalonia from January 1, 2002, to December 31, 2002. The team established 20 age-sex categories and analyzed the participants' use of 15 therapeutic classes of prescription drugs.

A new FDA policy requires pharmaceutical manufacturers to examine whether study participants become suicidal during clinical trials of new medications.1 The policy derives from the belated recognition that antidepressants seem to slightly increase suicidality in children, adolescents, and young adults early in the course of treatment. This is not the only news about medications linked to possible increases in suicidal ideation or behavior.

As dermatologists' use of biologic drugs for psoriasis grows, MCOs must take an increasingly active role in managing the near-term utilization of these high-cost agents while also taking into account that some of the "payback" for these drugs comes in the form of long-term costs avoided. Meanwhile, physicians, insurers, and employers continue to wrestle with issues such as step-down dosing; step therapy; patient-administration versus physician-administration; and whether biologic drugs should be covered under a plan's pharmacy benefit, medical benefit, or some combination. (Drug Benefit Trends. 2008;20:143-147).

With the increasing managed care restrictions on health care coverage, a look into the efficacy of some of these procedures is needed. This study examines the cost burden of implementing prior authorization (PA) for prescription drugs. Seventy-five prescriptions dispensed by 2 Philadelphia pharmacies requiring PA were tracked and the savings analyzed. Requiring PA proved to be financially beneficial to MCOs but resulted in an increase in uncompensated time for physicians and pharmacies. Two classes of drugs, antihistamines and proton pump inhibitors, accounted for 48% of the medications requiring PA. By educating plan members in advance concerning coverage limits for these medications, MCOs could decrease the use of PA and reduce the amount of time spent by physicians, pharmacists, and patients in dealing with this procedure. (Drug Benefit Trends. 2008;20:136-139)

Prescription drug sales in the United States grew at a modest 3.8% rate in 2007 (Cover Figure), to total $286.5 billion, according to an annual IMS Health report, US Pharmaceutical Market Performance Review, based on findings of the IMS National Sales Perspectives and the IMS National Prescription Audit. This compares with a growth rate of 8.3% for 2006. Slower sales growth was attributed by IMS Health to brand-name patent expirations, fewer new products approved, and drug safety issues.

CARRIAGE OF A STRAIN of methicillin-resistant Staphylococcus aureus(MRSA) was shown to be prevalentin men who have sex with men. Thefinding was based on epidemiologicalstudies conducted in San Franciscoand Boston. In addition to beingresistant to methicillin, the S aureusstrain isolated from the study populationalso appears to be resistant toclindamycin, tetracycline, and mupirocin.The research appears in theJanuary 14 and February 19 issues ofAnnals of Internal Medicine.

The biomechanical complexities of the foot and the circumstances that cause infections can make foot infections difficult to manage.1 When an otherwise healthy patient presents with a foot infection, a traumatic process usually is involved and treatment is relatively straightforward. Sometimes a more serious condition is the cause. The more common presentation, however, is a patient who is immunosuppressed or who has a metabolic or peripheral vascular defect that complicates treatment of the infection.

Filamentous fungi (molds) can be divided into 2 broad morphologically distinct groups: those that produce aseptate hyphae and those that produce aseptate (or rarely septated) hyphae. Identification of aseptate hyphae in tissue is virtually pathognomonic of zygomycosis (mucormycosis)-disease caused by fungi of the class Zygomycetes (order Mucorales). The discovery of septate hyphae in tissue is less diagnostic; septate hyphae may be caused by fungi that typically grow as yeasts (eg, Candida and Trichosporon) or a vast number of species of molds. The septate molds are often divided into those with darkly pigmented hyphae (phaeohyphomycetes) and those with pale or colorless (hyaline) hyphae (hyalohyphomycetes).

The laryngeal mask airway (LMA) has become a popularalternative to endotracheal intubation. Many cliniciansconsider it a safe procedure, but complications do occur.Although uncommon, retropharyngeal perforation withmediastinal abscess can become a life-threatening event. Wereport a case of mediastinal abscess in an 84-year-old womanwho received LMA ventilation during a surgical procedurefor total knee replacement. [Infect Med. 2008;25:180-185]

The number of Americans with arthritis or another rheumatological disorder is expected to climb to 67 million-a 44% increase-by the year 2030, according to a new study released by the CDC for the National Arthritis Data Workgroup (NADW).

I work for the Child Protection Team at a local university. Recently, I saw a 9-year-old girl who had been taken to the local emergency department (ED) with sudden left-sided abdominal pain.

The CDC and other public health organizations have identified numerous disparities in the incidence and outcomes of HIV disease among different population groups

A 37-year-old man with a 9-year history of HIV infection presented to the emergency department after 5 days of fever, chills, malaise, and a pruritic rash initially on his forehead and arms that spread to his scalp, neck, and legs.

Dermatological disorders may occur in more than 90% of persons infected with HIV. In this setting, skin disorders tend to be more frequent as immunodeficiency progresses. The spectrum of cutaneous diseases includes inflammatory dermatoses, drug reactions, infections, and neoplasms. Johnson and colleagues1 present an unusual case of Sweet syndrome in a 37-year-old HIV-positive man coinfected with Treponema pallidum. Sweet syndrome was originally described by the late English dermatologist Dr Rob