Changes in Congress and FDA shape healthcare policy
February 1st 2003The recent selection of Sen Bill Frist (R-Tenn), MD, to lead Senate Republicans has moved healthcare policy up the priority list in the Senate. As a physician, Dr Frist has played a lead role in assessing federal health programs and policies.
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Atomoxetine, a norepinephrine reuptake inhibitor, is the first nonstimulant agent approved for the treatment of ADHD (Strattera, Lilly). It has been approved for use in pediatric and adult patients. Atomoxetine improves ADHD symptom severity versus placebo, as evaluated by the ADHD Rating Scale (ADHD RS), and its efficacy appears comparable to immediate-release methylphenidate. Atomoxetine requires dosage titration and may be administered once or twice daily. Common side effects seen in both pediatric and adult patients include nausea, decreased appetite, and dizziness. Dosage adjustments are necessary for patients receiving atomoxetine and cytochrome P450 2D6 inhibitors. Based on average wholesale price (AWP), atomoxetine is more costly than existing ADHD therapies. Atomoxetine provides an alternative ADHD therapy for patients who may fail or cannot tolerate conventional treatments.
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An overview of the pathophysiology and treatment of secondary peritonitis
February 1st 2003Intraabdominal infection was first thoroughly described by Hippocrates. Centuries later, despite advances in surgical and supportive therapies, this disease state continues to be associated with significant morbidity and mortality. This article reviews the literature on intraabdominal infections. It describes the pathophysiology, classification, and etiology of intraabdominal infections, focusing primarily on secondary peritonitis. The bacteriology of the gastrointestinal tract in both the normal and infected host is reviewed. Treatment options, including newly approved antimicrobial agents and agents under clinical investigation, are reviewed.
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ASHP, AMA ask for federal assistance to resolve drug shortage problem
February 1st 2003Washington, DC-Representatives from the American Society of Health-SystemPharmacists and the American Medical Association met with the Health andHuman Services assistant secretary for health Eve Slater, MD, and FDA'sdeputy commissioner Lester Crawford, DVM, PhD, in late January to discussdrug shortages and ask for federal assistance in resolving the problem.
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An overview of the pathophysiologyand treatment of secondary peritonitis
February 1st 2003Intraabdominal infection was first thoroughly described by Hippocrates. Centuries later, despite advances in surgical and supportive therapies, this disease state continues to be associated with significant morbidity and mortality. This article reviews the literature on intraabdominal infections. It describes the pathophysiology, classification, and etiology of intraabdominal infections, focusing primarily on secondary peritonitis. The bacteriology of the gastrointestinal tract in both the normal and infected host is reviewed. Treatment options, including newly approved antimicrobial agents and agents under clinical investigation, are reviewed.
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Supreme court to rule on AWP laws
February 1st 2003Washington, D.C. - The high court heard arguments last month in a case(Kentucky Association of Health Plans vs. Miller) charging that a Kentuckystate any-willing-provider (AWP) law violates the Employee Retirement IncomeSecurity Act (ERISA).
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Delnor-Community Hospital in Geneva, Ill., wanted to become a national leader in patient satisfaction, as well as the first choice in its primary market. In achieving its goal, Delnor was challenged by the same issues many healthcare organizations are experiencing today, including staff retention and patient/customer satisfaction.
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Supreme court to rule on AWP laws
February 1st 2003Washington, D.C. - The high court heard arguments last month in a case(Kentucky Association of Health Plans vs. Miller) charging that a Kentuckystate any-willing-provider (AWP) law violates the Employee Retirement IncomeSecurity Act (ERISA). Kentucky insurers urged the Supreme Court to overturna lower court decision that the state law regulates insurance and thus isnot subject to the ERISA preemption. The managed care community maintainsthat the proliferation of AWP laws is undermining their ability to controlcosts and hopes that the U.S. Supreme Court will issue a strong ruling thisspring to curb this trend.
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Incorporating an ethical template into pharmacy benefit decision-making (PDF)
January 1st 2003J Russell Teagarden, MA, RPh, vice president of clinical practices and therapeutics at Medco Health Solutions in Franklin Lakes, NJ, explains how using an ?ethical template? for pharmacy benefit decisions can make those decisions consistent and fair, reducing patient displeasure, conflict, and litigation.
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A comparison of the newer treatment options for ADHD (PDF)
January 1st 2003Psychostimulant drugs have consistently demonstrated efficacy in the treatment of attention-deficit/hyperactivity disorder (ADHD). Innovative technology has fueled the development of novel release mechanisms and isolation of active enantiomer components with the hopes of enhancing the duration of action and improving the safety and effectiveness. As a result, several new stimulant agents have recently been added to the arsenal of ADHD treatment options. Formulary selection is complicated by the high costs and small but distinct differences among these agents. The five newest FDA-approved stimulant agents for the treatment of ADHD are detailed, and a brief summary of future treatment options, including a recently approved nonstimulant agent, is provided.
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Incorporating an ethical template into pharmacy benefit decision-making
January 1st 2003If asked, could you present the underlying rationale for your pharmacy benefit coverage decisions? When considered from the consumer or employee perspective, why should they consider the payors or providers of their drug benefit legitimate decision-makers in limiting their healthcare policies?
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Duloxetine: An antidepressant that inhibits both norepinephrine and serotonin uptake
January 1st 2003Duloxetine is a reuptake inhibitor at serotonergic and noradrenergic neurons and appears to have low affinity for other neurotransmitter systems. In three published clinical trials in patients with MDD, duloxetine was well tolerated and more effective than placebo. Further study is needed to compare its efficacy with that of other antidepressants, to prospectively assess time to onset of antidepressant effect, and to clarify effects on somatic symptoms and potential adverse cardiovascular and sexual effects. Duloxetine is also under investigation for the treatment of stress urinary incontinence in women (trade name to be determined, comarketed by Lilly and Boehringer Ingelheim). Preliminary information suggests that duloxetine therapy reduces the number of incontinence episodes. Duloxetine has been deemed ?approvable? for the treatment of MDD and will be comarketed under the trade name Cymbalta by Eli Lilly and Company and Quintiles.
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As a former college athlete, Daniel J.Hilferty, president and chief executive officer of AmeriHealth Mercy/Keystone Mercy in Philadelphia, knows how critical teamwork is. Teammates are especially helpful when dealing with complicated healthcare issues, such as serving the Medicaid population.
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Migraine therapy: balancing efficacy and safety with quality of life and cost (PDF)
December 1st 2002Successful management of migraine attacks and their symptoms leads to economic benefits such as decreased reliance on healthcare resources, decreased employee absenteeism, and increased productivity. Appropriate treatment includes prophylaxis with lifestyle changes and drug therapy, and acute therapy with drugs. Over-the-counter analgesics can be effective acute therapy for mild migraine; for moderate to severe attacks, the 5HT1B/1D agonists, or triptans, offer significant efficacy and cost-effectiveness.
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Ezetimibe: a novel cholesterol absorption inhibitor (PDF)
December 1st 2002Ezetimibe (Zetia), approved in late October, represents the first new class of cholesterol-lowering drugs in 15 years. Ezetimibe, an intestinal cholesterol absorption inhibitor, has a unique mechanism of action, distinct from those of statins and bile acid sequestrants. When used as monotherapy, ezetimibe lowers low-density lipoprotein cholesterol (LDL-C) levels up to 18.5%. Coadministration of ezetimibe with statin therapy reduces LDL-C levels up to an additional 22%. The article reviews ezetimibe?s chemistry, pharmacology, pharmacokinetics, and clinical trial results.
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