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Evidence-based medicine is the driving philosophy for pharmacy and therapeutics (P&T) committee decision-making. When the available evidence is incomplete or unclear, the decision-making process becomes complex. Evaluation of the published literature to make sound decisions regarding appropriate medication use can be a time-consuming process. The use of expert panels or subcommittees may facilitate decision-making; however, this process is often limited by the schedules and time constraints of busy clinicians. This article describes the creation and utilization of a "virtual" panel of experts utilizing anonymous electronic communications to assist the P&T committee at a university-based teaching hospital in making medication use policy. The article includes a detailed description of the P&T committee's experience in the selection of virtual panel members, methods used, advantages, potential pitfalls, and the outcomes of a virtual committee used to evaluate the appropriateness of the off-label use of nesiritide (Natrecor, Scios).

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Surfactant replacement therapy (Surfaxin, Discovery Laboratories) for the prevention of respiratory distress syndrome (RDS) in premature infants

Link to Learn

A new e-learning initiative succeeds more often when upper management supports it.

BREAST CANCER is the most common cancer found in women, and the second leading cause of cancer deaths in women. More than 200,000 new cases of invasive breast cancer are diagnosed in the United States each year, approximately 77% of them in women over 50 years of age.

Onward & Upward

You don't have to be in the healthcare industry for long before it becomes obvious that change is the only constant. Late in 2004, Christopher Koller conducted an interview with MANAGED HEALTHCARE EXECUTIVE and talked about his job as CEO of Providence-based Neighborhood Health Plan of Rhode Island (NHPRI), which was created in 1993 by the state's 14 Community Health Centers.

LAST FALL, THE CENTERS for Medicare and Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC), published a memorandum providing guidance to state regulators regarding the licensure and regulation of Medicare Advantage (MA) organizations.

EVERY SO OFTEN, something in healthcare really captures my imagination. I am frequently amazed by the innovation, intelligence and dedication of the people who work in this industry, but once in a while something special will happen and I'll think, "I'm going to remember this for the rest of my life."

If approved, cilansetron (Calmactin, Solvay Pharmaceuticals) would be the second selective 5-HT3 antagonist introduced for the treatment of irritable bowel syndrome (IBS). Based on 2 main clinical trials, cilansetron 2 mg orally 3 times daily appears to be effective in the relief of IBS-D symptoms (abdominal pain/discomfort) and abnormal bowel habits in both male and female patients. Adverse effects were minor, with constipation being the most commonly reported adverse effect. No information is currently available on cilansetron's potential for drug interactions, need for dose adjustments in renal or hepatic insufficiency, long-term safety, or cost. Cilansetron was granted priority review status by FDA on September 1, 2004, for the treatment of diarrhea-predominant IBS in men and women. Currently marketed agents for the treatment of IBS are only approved for use in female patients.

Benign prostatic hyperplasia (BPH) is a common chronic disease, with the incidence of BPH increasing with age. Histopathologic features are present in almost half of all men aged >60 years. The disease can have a profoundly negative impact on patients' quality of life, often causing them to limit or avoid basic activities of daily living. Many patients who develop BPH will seek treatment for bothersome lower urinary tract symptoms (LUTS).

At a minimum, healthcare organizations must show an ongoing effort to assess their level of compliance. And for many, compliance is uncharted territory where processes, costs and solutions are unknown.

Comfort Care

A possible hospice barrier is the requirement that patients forego further curative care.

"I'm losing my patience"

As George Bernard Shaw once said, "Nothing is ever done in this world until men are prepared to kill one another if it is not done." While accidental fatalities, even those caused by preventable mistakes and human errors, are a far cry from murder, Don Berwick, MD, has seen enough death. He's also heard enough rhetoric about ways to improve healthcare quality.