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MCOs back reforms to expand healthcare access and reduce costly uncompensated care.

Finicky travelers seek five-star hotels; avid movie-goers-two thumbs up. And now, healthcare consumers who once thought they'd never have a reliable rating system for hospitals and physicians will be pleased with the progress of the many organizations that now are providing user-friendly quality reports.

If there's one thing Regina Herzlinger understands, it's the relationship between risk and benefit. Her home in Belmont, Mass., sits high on a hill and offers a stunning view of the Boston skyline across the Charles River. But there was a price to pay for that unobstructed view, and after a very frightening near-accident involving her car and some black ice, it didn't take Regina and her husband George-with doctorates in business and physics, respectively-long to realize that the risks were too high.

The epidemic of Severe Acute Respiratory Syndrome has barely touched upon U.S. soil. This briefing by an expert in the public health and economic consequences of infectious diseases clearly outlines the facts and the possibilities.

Antibiotic therapy has undergone enormous changes since the discovery of penicillin by Sir Alexander Fleming in 1928. 1. Today, clinicians face increasing reports of antibiotic resistance. Optimizing antibiotic regimens can maximize effectiveness and minimize adverse effects while decreasing the likelihood of the development of resistance. The task of designing optimal antibiotic dosing regimens incorporates pharmacodynamics (PDs), pharmacokinetics (PKs), and microbiological principles. PKs consist of absorption, distribution, metabolism, and excretion, with these parameters reflecting drug exposure over time. The relationship between drug exposure and the physiologic effect of the drug encompasses the principles of PDs. With antibiotic therapy, PDs incorporate exposure to the antibiotic and antimicrobial effect. The intricate relationship between these principles enhances the understanding of the efficacy of antibiotic therapy.

FDA proposes bar codes and new error reporting standards as part of an initiative to reduce medication errors

Pharmacodynamics, the relationship between drug exposure and physiologic effect, helps to differentiate the killing activity of antibiotic classes through various markers of outcome. Antibiotics are characterized by time-dependent or concentration-dependent bacterial killing activity. With antibiotic therapy, pharmacodynamics consists of an intricate relationship between drug exposure, bacterial susceptibility, and the antimicrobial effect of the drug. Due to increasing reports of resistance, many investigators and healthcare institutions are focused on the optimal use of antibiotic therapy. Studies on antimicrobial pharmacodynamics have been increasing in the hope of defining and establishing break points that are associated with various outcome markers to optimize therapy, but the application of these studies in clinical practice is still limited. Incorporating pharmacodynamics into the study of antibiotic therapy can enhance the design of rational and optimal dosing regimens and improve the understanding of the emergence of resistance.

Adalimumab is the newest addition to a class of medications called tumor necrosis factor-alpha (TNF-a) inhibitors. Adalimumab (Humira, Abbott) is the first fully human monoclonal antibody approved to treat rheumatoid arthritis, distinguishing it from the other TNF inhibitors. FDA approval was received in December 2002, which was earlier than expected, based on clinical trial results that demonstrated a slowed progression of joint damage in addition to an improved quality of life in adalimumab-treated RA patients. Adalimumab has been found to be effective when used alone or in combination with methotrexate and/or other disease-modifying antirheumatic drugs. Existing TNF inhibitors for RA are associated with inconvenient or complicated dosing schedules. Adalimumab offers patients the convenience of an infrequent dosing schedule. In the absence of clinical trials directly comparing adalimumab with other biologic therapies, choice will largely depend on patient factors. Pricing information places adalimumab in line with its competitors.

Antibiotic therapy has undergone enormous changes since the discovery of penicillin by Sir Alexander Fleming in 1928. 1. Today, clinicians face increasing reports of antibiotic resistance. Optimizing antibiotic regimens can maximize effectiveness and minimize adverse effects while decreasing the likelihood of the development of resistance. The task of designing optimal antibiotic dosing regimens incorporates pharmacodynamics (PDs), pharmacokinetics (PKs), and microbiological principles. PKs consist of absorption, distribution, metabolism, and excretion, with these parameters reflecting drug exposure over time. The relationship between drug exposure and the physiologic effect of the drug encompasses the principles of PDs. With antibiotic therapy, PDs incorporate exposure to the antibiotic and antimicrobial effect. The intricate relationship between these principles enhances the understanding of the efficacy of antibiotic therapy.

HMO industry is currently in a state of flux or transition

Enrollment data as of January 2002

Mike Cascone has spent his entire career -- more than 35 years -- with the fortunate BCBS of Florida.

Partnerships between public health entities and private managed care systems have proven crucial for tracking public health trends. Now that the Centers for Disease Control and Prevention (CDC) is preparing to go live with its National Bioterror Syndromic Surveillance Demonstration Project, MCOs continue to shape the country's ability to recognize and respond to health threats, including ones posed by biological, chemical and radiological agents.

Michael Cascone Jr. must be a big fan of Charles Darwin. When asked to identify the single most important issue facing healthcare today, the CEO of Blue Cross Blue Shield of Florida (BCBSF) replied, "Keeping the government out of benefits definition, and allowing people to shape the marketplace according to the benefits they want."

Osteoporosis affects more than 10 million Americans and accounts for 1.5 million fractures annually. Several treatment options have been shown to prevent fractures and improve outcomes in patients with osteoporosis. Alendronate and risedronate clearly reduce fractures and are good initial choices in many patients. Raloxifene and calcitonin reduce the risk of vertebral fractures and may be appropriate in certain patients. Teriparatide was recently approved by FDA for the treatment of osteoporosis and may offer another treatment option. Combination therapy has been shown to increase bone mineral density; however, a reduction in the risk of fractures remains to be established. Zoledronic acid may offer an advantage of reduced frequency of administration.

Omalizumab appears effective in patients with poorly controlled allergic asthma.

New agent reduces PTH levels in hemodialysis patients with secondary hyperparathyroidism.

Congress to weigh Medicare reform plan and patient safety; FDA addresses product risk and quality

Recommendations for approval, approvable designations, Fast-track designations

Two options are available for patients requiring treatment for arthritis who are at risk for ulcer disease: nonsteroidal anti-inflammatory drugs (NSAIDs) that are selective for cyclooxygenase-2 (COX-2) or the combination of a non-selective NSAID with a proton-pump inhibitor. A recent study of representative members from these therapeutic classes has offered findings that the two alternatives are statistically similar in their efficacy with respect to the prevention of recurrent ulcer bleeding.Celecoxib, a COX-2-selective NSAID, was given to 144 patients through random assignment. Another group of patients (N=143) were randomly assigned to receive a combination of diclofenac (a nonselective NSAID) plus omeprazole (a proton-pump inhibitor) during the 6-month trial.

An ingredient in dozens of cough syrups, which the FDA says is not dangerous,never underwent the current drug approval process because it was introducedbefore FDA efficacy guidelines were in place. The drug, extended-releaseguaifenesin, is marketed as an expectorant by 66 companies in prescriptioncough syrups.

Corticosteroid therapy is an effective treatment for asthma sufferers, but the use of systemic corticosteroids is known to increase the risk of osteoporotic fractures. A recent study published in the Journal of Allergy and Clinical Immunology suggests that moderate doses of inhaled corticosteroids (ICs) carry less risk than traditional oral corticosteroid (OC) therapy with respect to reduction of bone mineral density (BMD) in postmenopausal women. This assertion is based on the premise that the lowest daily dose of IC sufficient to control the patient's asthma is used.

Enfuvirtide (Fuzeon, Roche/Trimeris) is the first member of a unique class of antiretrovirals known as the fusion inhibitors to gain FDA approval for the treatment of human immunodeficiency virus type-1 (HIV-1) infection. Enfuvirtide is indicated for use in combination with other antiretroviral agents in the treatment of HIV-1 infection in treatment-experienced patients with evidence of HIV-1 replication despite ongoing antiretroviral therapy. Phase 3 trials demonstrated that adding enfuvirtide 90 mg twice daily to an optimized background regimen chosen with genotypic and phenotypic resistance testing improved the surrogate end points of HIV ribonucleic acid (RNA) levels, CD4 cell counts, and the proportion of patients reaching clinically undetectable HIV RNA levels (<400 and <50 copies/mL) through 24 weeks. Enfuvirtide?s efficacy in treatment-experienced patients when added to an optimized background regimen makes it a promising choice for salvage therapy. Further studies will be required to support enfuvirtide?s use in treatment-naïve patients.

He first became interested in healthcare because of its growth and ever-changing dynamics. What has kept Bob Tremain interested for the last 30 years, however, is the industry's unique mission of improving public health through better outcomes.

With a forte for everything from anthropology to accounting to medicine, it's understandable if today's pharmacy directors feel like every piece of the managed care equation is in their hands at any given time.

When it comes to sheer inspiration, Rocky Balboa doesn't have anything on Dr. Edson Bueno. Boxers always have a "puncher's chance" to land a knockout blow, but what chance does a poor -- and poorly educated -- Brazilian boy have of becoming the leader of his nation's biggest health plan?

Information exchange can optimize the flow of data and help create a patient-friendly environment

With tips from countries that haveless to work with, the U.S. healthcare industry moves toward major reform

Fear of ever-growing health care costs leads the way in Kaiser&s latest Health Security Watch health poll report.

Fear of ever-growing health care costs leads the way in Kaiser&s latest Health Security Watch health poll report.