Major depression is twice as likely to develop in post-stroke patients (approximately 20%) than in nonstroke patients of the same age.1 Other psychiatric symptoms that are also more common in post-stroke patients include minor depression, anxiety, anger, and inappropriate or excessive laughing or crying (emotional incontinence).2
Cumulative research with animal, normative, and clinical populations over several decades shows that the mechanisms underlying anxiety disorders differ from those of the normal emotion of anxiety. In persons with anxiety disorders, fear and tension are disproportionate to the actual threat and may be present when no real threat exists, thereby generating an expectation of danger and distorted perceptions related to danger and various types of threats. The most common anxiety disorders are social anxiety disorder (SAD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). Persons with SAD can experience a wide range of social fears as well as severe functional consequences, whereas persons with GAD tend to experience emotional, interpersonal, and somatic symptoms of high levels of chronic anxiety. Persons with PTSD have vivid memories of and thoughts about a terrifying event or ordeal that lead to the development of anxiety, depression, and functional impairment. Effective treatment options-pharmacotherapy; psychotherapy, particularly cognitive-behavioral therapy; or a combination-can be discussed openly with the patient to make a collaborative, informed decision. A variety of medications can be used to successfully manage anxiety disorders, of which SSRIs and serotonin-norepinephrine reuptake inhibitors are the most effective. When properly used, medications can enhance a patient's own efforts to master anxiety; overcome fearful avoidance; and address troubling behaviors, patterns, or memories. (Drug Benefit Trends. 2008;20:101-113)
More US adults are taking more prescription medications, fueling $12 billion in additional spending during 2006 alone, according to the Geographic Variation in Prescription Utilization study released on February 13 by Express Scripts. The number of US adults with at least 1 prescription increased from 67% in 2000 to 74% in 2006, and the number of prescriptions per capita rose from 10.8 to 14.3 in the same period-a 32% jump.
American consumers want more from the health care system than they are currently getting. They want to have online access to their primary care physicians (PCPs) and medical records. They also want greater access to wellness programs and alternative treatments.
Many traditional PBMs have revenue streams that are not disclosed or shared with plan sponsors. These revenue streams include pharmaceutical manufacturer rebates, pharmacy network discounts and spread, and data sales. Such arrangements can result in a misalignment of incentives, making it difficult for plan sponsors to achieve the lowest costs possible. Partially transparent or "translucent" PBMs may disclose some but not all rebate revenues. Fully transparent PBMs identify and share all revenue streams with their plan sponsors. (Drug Benefit Trends. 2008;20:98-100)
A 22-year-old man presentedwith a 3-week history ofcough and hemoptysis withright-sided chest pain and decreasedoral intake associated with a 4.5-kg(10-lb) weight loss. Ten days beforehospital admission, he was involvedin a fistfight, which resulted in his arrest.He was taken to jail and placedin a holding cell for 3 hours. Shortlybefore his pulmonary symptoms developed,he was seen by his primarycare physician because he had a sorethroat and exudative tonsillitis, forwhich amoxicillin/clavulanate wasprescribed. He stopped taking theantibiotic after 3 days.
Nonhuman primate bites in the United States are rare. Mostphysicians have no experience managing them. The lesionsare initially treated in much the same way as human bites,although consultation with an infectious diseases specialist,surgeon, and veterinarian are recommended, especially formicrobial infection control and management. Of particularconcern is animal-to-human transmission of herpes B virus,which can be fatal. We report a case of polymicrobial simianbite wound infection with associated nerve injury in a12-year-old boy. [Infect Med. 2008;25:120-122]
Last month I reviewed key findings in HIV that were published within a 2-month interval near the end of 2007. I have extended that review here, reporting highlights of research announced in the last few weeks of 2007.
Public health experts once held high hopes that the female condom would give women worldwide the ability to protect themselves from sexually transmitted diseases.
A 52-year-old woman presented with a 2-year history of progressive bilateral lower extremity edema and increasing pain. The patient complained of shortness of breath, productive cough, and rash on the upper extremities and torso for the past year.
Legionella species are among the leading causes of community-acquired pneumonia (CAP) in the general population, and although rare in patients with HIV infection, Legionella pneumonia is associated with significant morbidity and mortality
The words HIV or AIDS do not appear in the title of this book, and at first glance, this book appears to be about something else. On the contrary, it is about HIV and much more.
The prevalence of Kaposi sarcoma (KS) in HIV-infected persons in the pre-HAART era has been reported to be as high as 20%. Although AIDS-associated KS has declined by more than 80% since the introduction of highly active antiretroviral regimens, KS remains an important malignancy in the HIV-infected population
A program that is gaining interest and momentum in some health care circles is so-called academic detailin
Nemaline rod myopathy is a rare human neuromuscular disorder defined by the presence of rod-shaped structures infiltrating muscle fibers.
An 84-year-old woman with progressive stenosis of the cervical spinal canal, type 2 diabetes mellitus, hyperlipidemia, gastroesophageal reflux disease, hypertension, and stable angina presents to her primary care physician after an appointment with the orthopedist who is monitoring her chronic degenerative joint disease.
Rather than relying on a gag or a wide-mouthed cry after otoscopy to examine a very young child's posterior pharynx, consider a happier alternative.
NSAIDs help control the pain and inflammation of rheumatoid arthritis (RA) but do not affect disease progression; they are recommended for patients with newly diagnosed RA only as an adjunct to disease-modifying antirheumatic drug (DMARD) therapy.
Patients want and need information about diet. I recommend that they "shop the perimeter."
A 63-year-old African American man presented with severe epigastric pain of 1 day's duration. The pain was sharp and continuous and radiated toward the left flank. There were no aggravating or relieving factors or previous similar episodes.
