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Perhaps nothing is as professionally frustrating to today's health-system pharmacists as the gap between the promise and reality of computerized physician order entry (CPOE). Concern may have risen to a new level in March with publication of a report in the Journal of the American Medical Association that said CPOE could cause as many medication errors as it prevents. Add that to a growing awareness among R.Ph.s that many physicians hate the systems and the fact that most hospitals can't afford them, and CPOE's promise of improved patient safety seems a dream.

The Centers for Disease Control & Prevention recently released detailed recommendations to state health departments that are considering mandatory public reporting of healthcare-associated infections (HAIs). "HAIs are a major public health problem in the United States," said Patrick Brennan, M.D., chairman of the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC), which wrote the document.

How do you increase the dispensing rate of generic prescription drugs in a state that's in the backyard of some of the largest name-brand pharmaceutical companies? That was the dilemma facing Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare Services Inc., New Jersey's largest health insurer.

As mandatory mail-order pharmacy continues to grow and encroach on the market share of traditional pharmacies, the National Association of Chain Drug Stores met in Philadelphia last month and discussed ways to respond to this competition. Potential solutions included: retail pharmacies' contracting with their own pharmacy benefit managers to service mail-order plans, mounting a public relations campaign to attack the accepted belief that mandatory mail plans save money, and offering alternative 90-day retail programs that provide mail-order savings but retain contact between patient and pharmacist.

Uncle Sam has given up to 145 clinical pharmacists the job of reviewing the formularies of drug plan sponsors seeking to be part of the Medicare prescription drug benefit that is set to begin on New Year's Day, 2006.

According to the Home Safety Council (HSC), falls at home cause an average of more than 4,700 deaths and 1.1 million medical visits each year among adults aged 65 and older. In 2002, approximately 38% of all unintentional injury deaths among older adults were caused by falls, and many were associated with medication use.

In light of the continuing confusion over what women should do to alleviate their symptoms of menopause, the National Institutes of Health held a state-of-the-science conference on this subject recently. But the conference may have raised more questions than it answered. The NIH-sponsored panel confirmed that there is still much to be learned about this condition. And the same is true of most medications used to treat menopausal symptoms.

According to a recent study, invasive candidiasis kills approximately 10% to 40% of infected immunocompromised patients. Fortunately, there's a new treatment available. The Food & Drug Administration recently approved micafungin (Mycamine, Astellas Pharma US) for injection for the treatment of patients with esophageal candidiasis and the prophylaxis of Candida infections in those undergoing hematopoietic stem cell transplantation (HSCT).

The Food & Drug Administration approved pramlintide (Symlin, Amylin Pharmaceuticals) injection recently as an adjunct treatment in patients with Type 1 or Type 2 diabetes who use mealtime insulin and have failed to achieve desired glucose control despite optimal insulin therapy.

Drug counterfeiting has swelled into one of the world's largest black market industries, its rapid growth spurred by lucrative promises, minimal risk, and aggressive consumer demand. In a recent study, the World Health Organization determined that up to 10% of medicines worldwide are counterfeited, a deadly hazard that costs the pharmaceutical industry about $46 billion a year.

The FDA has approved ondansetron (Zofran, GlaxoSmithKline) injection for the prevention of postoperative nausea and vomiting (PONV) in children as young as one month of age and chemotherapy-induced nausea and vomiting (CINV) in children as young as six months.

Lung cancer is the leading cause of cancer death among both men and women in the United States. According to the American Cancer Society, an estimated 163,510 deaths (90,490 in men and 73,020 in women) will be attributed to the disease in 2005. The five-year survival rate for lung cancer patients is approximately 14%. Late diagnosis is a significant obstacle to improving lung cancer outcomes.

The best treatment for young patients with bipolar disorder (BPD) has been elusive. Confounding factors include few large-scale studies, differences between adult and childhood BPD, and a lack of useful treatment guidelines.

The Centers for Medicare & Medicaid Services says it's doing all it can to move the six million people who are eligible for both Medicare and Medicaid into the Medicare drug benefit program, which starts Jan. 1, 2006. But states and provider groups say CMS' work may not be enough.

Wyeth Pharmaceuticals announced that ethionamide (Trecator-SC) sugarcoated tablets have been reformulated to film-coated tablets and renamed Trecator.

Obese and diabetic patients may benefit from participating in a medically supervised weight loss program that provides access to a weight loss counselor. With additional counseling from a pharmacist, patients may derive even greater health benefits.

The Food & Drug Administration would like to alert healthcare providers to errors involving the inadvertent oral administration of Foradil Aerolizer and Spiriva HandiHaler capsules for inhalation. In total, the FDA has received 30 cases concerning the inadvertent oral administration of the Foradil Aerolizer product and two concerning the Spiriva HandiHaler product.

The guy on the telephone sounded panicky. And he sounded like he didn't have his false teeth in. I told him to slow down and tell me his concern. He had used the word mistake in his opening sentence, and that got my attention right away.

Connetics' investigational acne drug Velac—a once-a-day mixture of topical clindamycin and tretinoin in hydrogel—may be more convenient and at least as safe as either workhorse acne agent alone, say new studies. The findings could be hopeful news for the estimated 17 million or more Americans with acne. These results were reported at the American Academy of Dermatology annual meeting in New Orleans last month.

The Centers for Medicare & Medicaid Services is proposing additional changes to Medicare outpatient drug programs. Earlier this month, CMS requested proposals for a system to calculate the true out-of-pocket (TrOOP) cost for patients buying drugs under the Part D benefit that begins in 2006.

Recognizing a need for healthcare systems to be able to evaluate employee attitudes about patient safety and quality improvements, the Medical Errors Workgroup of the Quality Interagency Coordination Task Force (QuIC) sponsored the development of a survey tool. The tool will help hospitals, and their departments, evaluate employees' support-or nonsupport-of safety and quality issues.

Most hospitals are not complying with standard guidelines for antibiotic (ABX) prophylaxis before surgery. Barely more than half of patients in a recent study received antibiotics within one hour of the initial incision. Less than half of patients were taken off ABX prophylaxis within 24 hours following surgery. The result is an unknown number of surgical site infections that could have been prevented with more appropriate treatment.

An e-prescribing initiative announced recently by the Big Three automakers might help business, said Hassane Fadlallah, R.Ph. "If this is a move that could bring more prescriptions to us, that would be great,' said the owner of Dix Drugstore in Dearborn, Mich., adding that nearly two-thirds of his business comes from automaker employees and their families." It's got to be a better step for us than some of their other moves, like mandatory mail order."

Long-term care pharmacists can expect to see more scrutiny of how they manage residents' pressure ulcers and weight control in the coming months. CMS, the Centers for Medicare & Medicaid Services, will add quality measures on weight loss and pressure sores to evaluations of nursing home quality.