With the increasing managed care restrictions on health care coverage, a look into the efficacy of some of these procedures is needed. This study examines the cost burden of implementing prior authorization (PA) for prescription drugs. Seventy-five prescriptions dispensed by 2 Philadelphia pharmacies requiring PA were tracked and the savings analyzed. Requiring PA proved to be financially beneficial to MCOs but resulted in an increase in uncompensated time for physicians and pharmacies. Two classes of drugs, antihistamines and proton pump inhibitors, accounted for 48% of the medications requiring PA. By educating plan members in advance concerning coverage limits for these medications, MCOs could decrease the use of PA and reduce the amount of time spent by physicians, pharmacists, and patients in dealing with this procedure. (Drug Benefit Trends. 2008;20:136-139)

Prescription drug sales in the United States grew at a modest 3.8% rate in 2007 (Cover Figure), to total $286.5 billion, according to an annual IMS Health report, US Pharmaceutical Market Performance Review, based on findings of the IMS National Sales Perspectives and the IMS National Prescription Audit. This compares with a growth rate of 8.3% for 2006. Slower sales growth was attributed by IMS Health to brand-name patent expirations, fewer new products approved, and drug safety issues.

Complete insurance coverage of cardiovascular medications may lower health care costs as well as increase adherence and improve patient outcomes. Researchers led by Niteesh K. Choudhry, MD, PhD, assistant professor at Harvard University and in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital, Boston, analyzed the cost-effectiveness of providing full prescription drug coverage for post–myocardial infarction (MI) Medicare beneficiaries 65 years and older enrolled in the Part D program. Study results were published in the March 11 issue of Circulation.

CARRIAGE OF A STRAIN of methicillin-resistant Staphylococcus aureus(MRSA) was shown to be prevalentin men who have sex with men. Thefinding was based on epidemiologicalstudies conducted in San Franciscoand Boston. In addition to beingresistant to methicillin, the S aureusstrain isolated from the study populationalso appears to be resistant toclindamycin, tetracycline, and mupirocin.The research appears in theJanuary 14 and February 19 issues ofAnnals of Internal Medicine.

The biomechanical complexities of the foot and the circumstances that cause infections can make foot infections difficult to manage.1 When an otherwise healthy patient presents with a foot infection, a traumatic process usually is involved and treatment is relatively straightforward. Sometimes a more serious condition is the cause. The more common presentation, however, is a patient who is immunosuppressed or who has a metabolic or peripheral vascular defect that complicates treatment of the infection.

Filamentous fungi (molds) can be divided into 2 broad morphologically distinct groups: those that produce aseptate hyphae and those that produce aseptate (or rarely septated) hyphae. Identification of aseptate hyphae in tissue is virtually pathognomonic of zygomycosis (mucormycosis)-disease caused by fungi of the class Zygomycetes (order Mucorales). The discovery of septate hyphae in tissue is less diagnostic; septate hyphae may be caused by fungi that typically grow as yeasts (eg, Candida and Trichosporon) or a vast number of species of molds. The septate molds are often divided into those with darkly pigmented hyphae (phaeohyphomycetes) and those with pale or colorless (hyaline) hyphae (hyalohyphomycetes).

The laryngeal mask airway (LMA) has become a popularalternative to endotracheal intubation. Many cliniciansconsider it a safe procedure, but complications do occur.Although uncommon, retropharyngeal perforation withmediastinal abscess can become a life-threatening event. Wereport a case of mediastinal abscess in an 84-year-old womanwho received LMA ventilation during a surgical procedurefor total knee replacement. [Infect Med. 2008;25:180-185]

I work for the Child Protection Team at a local university. Recently, I saw a 9-year-old girl who had been taken to the local emergency department (ED) with sudden left-sided abdominal pain.

The CDC and other public health organizations have identified numerous disparities in the incidence and outcomes of HIV disease among different population groups

A 37-year-old man with a 9-year history of HIV infection presented to the emergency department after 5 days of fever, chills, malaise, and a pruritic rash initially on his forehead and arms that spread to his scalp, neck, and legs.

Dermatological disorders may occur in more than 90% of persons infected with HIV. In this setting, skin disorders tend to be more frequent as immunodeficiency progresses. The spectrum of cutaneous diseases includes inflammatory dermatoses, drug reactions, infections, and neoplasms. Johnson and colleagues1 present an unusual case of Sweet syndrome in a 37-year-old HIV-positive man coinfected with Treponema pallidum. Sweet syndrome was originally described by the late English dermatologist Dr Rob

Self-Test Your Diagnostic Acumen

Patients with HIV infection demonstrate an unexpectedly high incidence of bone-related disorders, most notably osteonecrosis

Osteonecrosis, also known as avascular necrosis or aseptic necrosis, refers to ischemic death of the cellular constituents of bone and marrow when it occurs in the epiphyseal or subarticular region. The incidence of osteonecrosis may be increased by as much as 100-fold in HIV-infected persons relative to the general population,1

Leadership: the ability to move others in a desired direction. Perhaps that is not the definition you will find in Merriam-Webster’s Collegiate Dictionary, but it will do for this discussion.

One time-honored way of acknowledging that a research finding has become mainstream is to see it listed as a clue in the New York Times crossword puzzle.

Yunnan Province opened 7 mobile methadone treatment clinics last year in rural areas along the drug-producing Golden Triangle (Xinhua News Agency. January 5, 2008).

Patients who have been prescribed an alternating dosage of warfarin--for example, 2 mg one day and 3 mg the next-may have trouble determining how much to take because they cannot remember how much they took the day before.

It can be difficult for children to learn to swallow pills with water. Suggest to parents that miniature versions of candy-coated chocolates (eg, M&M's Minis) are a harmless substitute with which to practice.

For 2 months, a 68-year-old man had had progressive weakness, arthralgia, myalgia, and a rash on the arms and legs. Closer examination of the rash showed petechial lesions and follicular hyperkeratosis with perifollicular hemorrhage and corkscrew hairs. The patient also had poor dentition and swollen, purple, spongy gingivae.