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State Medicaid budgets are being squeezed between soaring costs and plummeting revenues, making it difficult to cope with growing enrollment while maintaining expanded services. As budget shortfalls widen, state officials are seeking ways to curb outlays, which could mean payment cuts for providers and plans.

It might have been a fluke the first time, some healthcare insiders thought in 1996. That was the year that both Newsweek and U.S. News & World Report did their stories on the best HMOs in America, and the top-rated company was Fallon Community Health Plan, a regional mixed-model HMO with 193,000 members.

Enoxaparin (Lovenox) is typically used during hospitalization after orthopedic or abdominal surgery. Recent studies of its use after orthopedic surgery have shown that extending administration of the low-molecular-weight heparin after hospital discharge significantly reduces the frequency of deep-vein thrombosis (DVT). A new study confirms this is also the case for abdominal surgery for cancer, which carries a high risk of this complication.

LIPS: Statin reduces cardiac event risk by 22% in first PCI procedureAzithromax ineffective for reducing recurrent CV events

Therapy starting with the angiotensin receptor blocker (ARB) losartansignificantly reduced the risk of cardiovascular outcomes and new-onsetdiabetes compared with a beta blocker in older high-risk hypertensive patients,said Björn Dahlöf, MD. The improved outcomes with losartan occurredeven after adjusting for small differences in blood pressure reduction betweenthe two study drugs.

Lercanidipine is currently under FDA review for the management of hypertension. In comparative clinical trials, lercanidipine has shown antihypertensive efficacy comparable to that of slow-release nifedipine, amlodipine, nitrendipine, verapamil, captopril, and atenolol. Its side effect profile is similar or superior to these agents. This Focus article reviews those trials as well as lercanidipine?s pharmacologic properties and addresses the agent?s potential role in patients with comorbid conditions.

Although selective serotonin reuptake inhibitors (SSRIs) are prescribed most often for depression disorders, they are increasingly being used to treat a variety of other conditions. In this article, the authors assess the evidence on anxiety disorders—generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, and social phobia. For each condition, they present the rationale for SSRI use, the degree of supportive clinical trial evidence, indication-specific dosing and safety considerations, and their recommendations for the preferred and alternative SSRIs.

Last month the FDA's Nonprescription Drugs Advisory Committee unanimously supported loratadine's (Claritin, Schering-Plough) switch from prescription to over-the-counter status for treatment of chronic idiopathic urticaria, moving the drug one step closer to full OTC status (see significant event timeline in sidebar).

The enemy within

Bioterror forces new contingency plans to better coordinate resources and information to contain and minimize an outbreak

Fits like a glove

In today's world, it's easy to assume that the more sophisticated and complex a solution is, the better it is. After all, we live in a world where cutting-edge technologies make us safer, better connected and more efficient.