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One of the primary goals in today?s medical environment is to find treatments that provide positive clinical outcomes but also satisfy pressures on healthcare professionals and hospitals to deliver care as cost effectively as possible. To attain this goal, a hospital must have a pharmacy and therapeutics committee that is both scientifically and economically sound. Based on the experience of over 25 years each of the former chairman of the pharmacy and therapeutics committee (R. Quintiliani) and the director of Drug Information Services (R. Quercia) at Hartford Hospital, a large tertiary hospital in Connecticut, this article addresses ways to accomplish this goal, with particular attention given to anti-infective agents.

No matter what happens outside the industry, we provide a vital service that will endure whatever else society must contend with. In this respect at least, some might argue that healthcare is recession-proof.

The following is the second in a two-part series designed to help executives determine their leadership style.

Expert analysis of the October DTR chart information

Compiled from company proxy statements by Managed Care Week, Atlantic Information Services and wwwAISHealth.com.

Policies governing controversial or experimental modalities need to be in tune with best practices

Premiums climb almost 14% prompting hefty deductibles, tiered drug plans

Every state will be forced to implement Medicaid cost-containment strategies in 2004.

The competition in healthcare has never been fiercer than it is today. Even in the best of economies (which the current one certainly isn't, even though Wall Street seems to be gaining steam), health plans usually operate on a profit margin of 2% or less.

Users of statins were 20% less likely to have cancer (adjusted odds ratio, 0.80; 95% CI, 0.66­0.96) in a case-control study from the Academic Medical Centre, University of Amsterdam, Netherlands, that was presented at the 39th Annual Meeting of the American Society of Clinical Oncology

Finasteride (Propecia, Merck), an inhibitor of 5a-reductase, prevents or delays the appearance of prostate cancer by 24.8% (P<.001), according to researchers from the University of Texas Health Science Center, San Antonio, Texas.

Three different drugs at half the standard dose are estimated to reduce the risk of stroke by 63% and ischemic heart disease (IHD) events by 46% for those aged 60 to 69 years, according to a study in BMJ. Another study published in the same issue recommends that those with known occlusive vascular disease and everyone aged 55 years or older take a "polypill," including the combination of blood pressure-lowering drugs, a statin, folic acid, and aspirin.

5-HT3 receptor antagonist indicated to prevent delayed CINV

First combination therapy for treating hepatitis C in children

Approved as monotherapy for pediatric epilepsy

FDA actions

FDA pipeline

New statin approved for the treatmentof various lipid disorders

In these tight economic times, hospitals and managed care organizations are looking to eliminate unnecessary costs.

Asthma is a chronic inflammatory disease of the airways affecting 5%–7% of the US and European populations. It accounts for nearly 400,000 hospitalizations and 5,000 deaths per year. Acute asthma comprises those asthmatics with severe symptoms, despite attempts at appropriate control. Typically these patients will present to a local emergency department for evaluation and treatment. This review examines the pharmaceutical treatment options made available to these patients in emergency settings, including their risks, benefits, side effects and overall effectiveness. (Formulary 2003;38:537–543.)

Lumiracoxib (Prexige, Novartis) appears to be the next COX-2 specific inhibitor that will be marketed in the United States. Currently, lumiracoxib is being studied for the treatment of osteoarthritis, rheumatoid arthritis, and acute pain. Lumiracoxib has been shown in vitro to be more selective for the COX-2 isoenzyme compared to rofecoxib and celecoxib, but clinical head-to-head studies between these agents are lacking. Small controlled trials, presented in abstract form, have shown lumiracoxib to have comparable efficacy to diclofenac and celecoxib in osteoarthritis. It has an adverse effect profile similar to other COX-2 inhibitors and superior to traditional NSAIDs concerning gastrointestinal safety, but cardiovascular and renal safety data are still not available. While existing clinical data on lumiracoxib are minimal and only published in abstract form, research is ongoing, including comparing lumiracoxib to ibuprofen and naproxen in the largest arthritis trial undertaken to date. When the results of this study are published, lumiracoxib?s efficacy and safety profile will be better understood. (Formulary 2003;38:528?536.)

Coleman-Stephens v. Commissioner of Internal Revenue tax court okays depression exemption; insurance scams; 2003 Hay Benefits Report tracking the health care cost shift

As prescription drug spending grows, employers ? who pay a large part of the bill ? want to know if they are getting their money's worth. A critical review of scientific literature on some common diseases provides the answer.

Part 5 of a 7-part series: Subtly influencing coworkers, employees with borderline personality traits can prove a real challenge for management.

Strategies must prepare MCOs for the changing face of the American population

Diagnostic Imaging is often the portal of entry for a patient into an integrated delivery system

Physicians connected to health plans deliver better care, enjoy faster reimbursements, and have a lighter administrative load

Slew of recent lawsuits impact states' awareness of unfair practice allegations

Consumers and providers need to work together to improve overall healthcare

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