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Dr. Mark W. Banks is well aware that physicians nationwide sometimes get frustrated with managed care. The CEO of Blue Cross and Blue Shield of Minnesota, a former practicing physician himself, saw the changes coming in the mid-1980s.

Building IT for tomorrow

The Journal of the American Hospital Assn. voted it one of the most wired hospitals in the United States for the third consecutive year, but it's not backing off its investment in information technology. Northwestern Memorial Hospital has been operating in its new, $258 million facility since 1999.

He's president of Evergreen Re, a managed-care consulting firm and reinsurance broker. Evergreen&s annual survey of the finances of managed care prompted a wide-ranging conversation from capitation to IT investments to inappropriate transplants.

Microbial resistance is a concern in treating urinary tract infection (UTI) and bacteremia. But analysis of data from more than 200 US hospitals in the Surveillance Network Database-USA from 1999 to 2001 demonstrated bloodstream and urinary tract isolates with the potential to cause urosepsis to be very susceptible in vitro to broad-spectrum b-lactams and aminoglycosides. The study results were reported at the 42nd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in San Diego, CA.

Studies presented at the Third European Stanley Foundation Conference on Bipolar Disorder in September in Freiburg, Germany, show two newer antipsychotics are each more effective than standard therapy for preventing mania relapse or reducing symptoms.

A phase III study presented at the 14th annual meeting of the Migraine Trust International Research Symposium (MTIRS) in September in London showed that topiramate (Topamax) significantly reduced migraine frequency at doses as low as 100 mg/d. The onset of efficacy was observed as early as the first month of treatment. Topiramate is already approved in the United States and worldwide as an

Aripiprazole is an investigational atypical antipsychotic that received an approvable status from FDA in September 2002 for the treatment of schizophrenia. The decision on approval could be made as early as the end of this year. Aripiprazole offers a unique mechanism of action as a dopamine system stabilizer. Aripiprazole has been found to be effective in both short-term (4?6 wk) and long-term (26?52 wk) treatment trials. It appears to produce less hyperprolactinemia, weight gain, and extrapyramidal symptoms than other antipsychotics.

Although the commonly used HMG CoA reductase inhibitors (statins) are well tolerated and relatively safe, muscle toxicity and rhabdomyolysis can occur with administration and can be severe. This risk is higher with more bioavailable and lipophilic statins. This article summarizes what is known about the etiology of statin-associated muscle toxicity, the risks for each statin, and the current recommendations for monitoring and management.

After months of speculation, in late September the White House finally nominated its lead health policy advisor, Mark B. McClellan, MD, PhD, as the next commissioner of the FDA.

Sign Up Sign On

In its most basic form, the Internet is about access. At any time of the day, from anywhere on the planet, people who have a computer and a phone line have a world of information at their fingertips.

Lamentable litigation

Sixteenth century author Thomas Deloney likened lawsuits to "the winter nights: long and wearisome." Wearisome legal battles in healthcare can be exhausted with motions as costs increase proportionately. Ultimately, the chill is felt in the premiums of millions of Americans.

The Power of Purchasers

The U.S. health care system is at a crossroads. Purchasers must think what lies around the bend before they abandon proven tactics in a flurry of short-term cost sharing.

News & Trends

Uninformed consumers study from Cigna Healthcare, obesity in America, new JCAHO accreditation plan

Orlistat (Xenical) in combination with diet and lifestyle changes significantly prevents obese patients from developing type 2 diabetes, say researchers involved in this 4-year study presented at the 9th International Congress on Obesity, Sao Paulo, Brazil. They add that this is the first time a weight loss drug has been shown to prevent or delay the onset of type 2 diabetes in an at-risk population.

Eplerenone is a selective aldosterone receptor antagonist under FDA review for treatment of hypertension. With a high trough-to-peak ratio, it is suitable for once-daily dosing. It significantly reduces blood pressure in patients with mild to severe hypertension and can be used alone or in combination with other antihypertensives. Although chemically related to spironolactone, eplerenone has a lower binding affinity for androgenic and progestogenic receptors than spironolactone, which may translate into a lower incidence of endocrine-related adverse effects. In addition, eplerenone lowers blood pressure particularly well in patients with low-renin, salt-sensitive hypertension, such as African Americans.

Sometimes regarded with suspicion, evidence-based medicine is not just a ploy to reduce costs. Rather, it is the best approach to decision-making in modern medical practice. This internationally recognized authority on evidence-based medicine explains what it is, how to use it to make the best clinical decisions, and how to implement it in practice. Sometimes regarded with suspicion, evidence-based medicine is not just a ploy to reduce costs. Rather, it is the best approach to decision-making in modern medical practice. This internationally recognized authority on evidence-based medicine explains what it is, how to use it to make the best clinical decisions, and how to implement it in practice.