Persons with chronic pain who participated in a collaborative care program with primary care physicians and psychologists showed improvement in depression, pain severity, and pain-related disability compared with those who received treatment by primary care physicians only, according to a study published in the March 25 issue of the Journal of the American Medical Association.

The media is full of alarming stories about veterans who return from the conflicts in Iraq and Afghanistan with various behavioral health issues, notably posttraumatic stress disorder (PTSD), major depression, traumatic brain injury (TBI), and alcohol abuse. Let’s review the professional literature data on the prevalence of these conditions in war veterans.

A total of 50 health care professionals, including 25 health plan medical directors, 20 health plan pharmacy directors, and 5 pharmacy directors for pharmacy benefit management companies were surveyed regarding their perceptions of the value of 3 novel cancer therapies. The physicians and pharmacists were asked to estimate the monthly average wholesale price of each therapy, overall survival benefit of bevacizumab for treatment of persons with advanced colorectal cancer and erlotinib for treatment of persons with non–small-cell lung cancer, and progression-free survival benefit of sunitinib malate for treating persons with advanced renal cell carcinoma. Most respondents overestimated drug costs and underestimated survival benefit associated with these treatments. Mean incremental cost-effectiveness ratio for all drugs studied was approximately $170,000/quality-adjusted life-year (QALY). Cost-effectiveness ratios were lower than the $300,000/QALY cited by oncologists in another study but significantly higher than those for many other costly interventions. Our study findings reflect the need for a better understanding of the value of the clinical benefits of novel cancer therapies in an environment of product innovation but with resource constraints. (Drug Benefit Trends. 2009;21:120-130)

The number of physicians using health care information technology in their practices has increased dramatically in the past 5 years, as have their frustrations with the available software. Results of the second Health Care Technology Survey conducted by the American College of Physician Executives (ACPE) found that 64.5% of physicians use electronic medical records (EMRs), up from 33.1% in 2004. The 2009 survey was open from November 15 to December 20, and 950 ACPE members participated.

A retrospective review of administrative claims data was conducted to identify health plan members with asthma who were persistent with their controller medications and those who were not persistent. Utilization of health care services and associated costs were measured for both groups. Non-persistent use of controller medications resulted in more asthma-related emergency department visits and home health services whereas persistent controller use was associated with more physician office and outpatient visits. Mean asthma-related medical costs per member were greater in the non-persistent cohort ($577.62) than in the persistent cohort ($323.03). These findings support the need for targeted interventions to address non-persistence in a managed Medicaid population.(Drug Benefit Trends. 2009;21:112-118)

Medicare Advantage (MA) plans will feel a major effect next year from the switchover from the Bush administration to the Obama administration. One of the first actions taken by President Barack Obama-just 2 days after his inauguration-was to revoke the 2010 draft Call Letter that the Centers for Medicare & Medicaid Services (CMS) had issued for MA plans. The new draft Call Letter suggests harsher rules and more oversight in a number of specific areas.

Many persons with chronic conditions are not getting the care and support they seek from the health care system, according to findings of a survey of 1109 persons aged 44 years and older with at least 1 chronic condition, stratified as baby boomers (aged 44 to 63) and seniors (aged 65 and older). Among their biggest complaints, persons with chronic health conditions say their physicians do not spend enough time with them. They also report having had to put off care because of cost.

Recently, I accompanied my mother to the hospital for cataract surgery and, the next day, to the eye surgeon’s for a follow-up visit. Both the hospital and the doctor’s office still use paper records exclusively. Multicolored folders filled floor-to-ceiling file cabinets that took up most of the doctor’s outer office while the hospital keeps its mostly handwritten patient records in 3-ring binders. The surgery took just 15 minutes and resulted in crystal-clear 20/20 vision in the affected eye. Impressive, especially considering that my mother is 81 years old.

Jonathan Test Article Description

Immunosuppression that is associated with human T-cell lymphotropic virus 1 (HTLV-1) infection predisposes to hyperinfective strongyloidiasis.1,2

A 53-year-old woman with metastatic ovarian cancer presented with excessive tearing of the left eye that was associated with redness and swelling.

Histoplasmosis is caused by the dimorphic fungus Histoplasma capsulatum, which is endemic to the Ohio and Mississippi river valleys. It is associated with a variety of manifestations, and its severity ranges from asymptomatic infection to severe disseminated illness.

It is estimated that approximately 33.2 million persons worldwide were living with HIV infection in 2007.1 With the development of effective antiretroviral treatment strategies, HIV infection has now become a manageable chronic disease.2 Despite advances in treatment, drug resistance, long-term adverse effects, and high adherence requirements represent ongoing challenges to durable viral suppression.

Making headlines recently was the revelation that HIV infection can be transmitted from men to women through the healthy squamous epithelium of the vaginal tract.

The 16th Conference on Retroviruses and Opportunistic Infections (CROI) was held in Montreal from February 8 to 11, 2009. This conference provided significant new insights into HIV therapeutics. Here we summarize new findings presented on the effect of antiretroviral therapy on cardiovascular disease (CVD) risk; new pharmacokinetic data, notably, the progress in developing pharmacokinetic boosters as alternatives to low-dose ritonavir; and the lack of clinical benefit with interleukin (IL)-2.

The manifestations of HIV infection are known to involve every organ system and aspect of pathophysiology. The bone marrow is particularly susceptible to the ravages of HIV infection; in addition to non-Hodgkin lymphoma, myelodysplasia and acute leukemia have been associated with HIV infection, although they are not considered to be AIDS-defining illnesses.1-5 Here we report the case of a 58-year-old man who presented with myelodysplasia as a primary manifestation of his HIV infection.

Herpes simplex virus type 1 (HSV-1) is the most common cause of sporadic encephalitis worldwide. In the California Encephalitis Project, 24% of the cases of viral encephalitis were caused by HSV-1 and 3% were caused by HSV-2.1

The death rate for HIV-infected patients who miss scheduled clinic appointments during their first year of treatment is more than double that for patients with perfect attendance, according to a recent study (Douglas D. Reuters Health. February 11, 2009).

In 2005, members of the Group of Eight (G8)-an international forum for the governments of Canada, France, Germany, Italy, Japan, Russia, the United Kingdom, the United States, and the European Union-along with the African Union and the heads of state attending the 2005 United Nations World Summit, joined with the UNAIDS Secretariat in committing themselves to providing universal access to HIV care, prevention, and treatment for all those in need by 2010.

Although children can usually inhale very well during lung auscultation, typically they do not exhale sufficiently. I ask them to “breathe in real big and then let all the air out without being noisy.” I place one hand on their chest and the other on their back; I let them inhale, and when they start to exhale, I gently compress the chest to accentuate the breath sounds and to obtain a full exhalation. Children tolerate this very well.