Health System

A 58-year-old man, G.C., is hospitalized with an acute myocardialinfarction (MI). His physician has prescribed metoprolol, ramipril,warfarin, and atorvastatin (Lipitor, Pfizer), but is debatingwhether to continue G.C.'s bedtime chlorpromazine 400 mg, whichhe's taken for 20 years for schizophrenia, or switch to a newermedication. G.C. is showing signs of tardive dyskinesia (TD). Hisrecent records show normal fasting blood glucose levels. His BMI is22. He is a smoker. His physician asks your opinion aboutantipsychotic therapy. What do you recommend?

Small signs of resistance to imatinib (Gleevec, Novartis) emerged soon after the drug's approval in 2001 as the first oral tyrosine kinase inhibitor for chronic myeloid leukemia (CML). But second-generation drugs with similar mechanisms of action were already in the pipeline, according to studies presented at the recent 2005 ASH annual meeting, held in Atlanta. Generally about 20% of CML chronic-phase patients relapse after three years of imatinib therapy, researchers pointed out.

New software and hardware

Pharmacists can and should prove that their treatments provide a significant return on investment (ROI), said Fred Pane, R.Ph., senior director of pharmacy affairs at Premier Inc., the San Diego group purchasing organization. "Pharmacists can move from a compartmentalized budget and expense analysis model to an overall cost-of-care model," he said. "The data exist to establish that the work they do generates the best patient outcomes, with a positive effect on overall costs and reimbursements."

Not only do 11% of serious medication errors involve insulin misadministration, but the same errors seen today have been documented at least as far back as 1975. These were but two of the points Matthew Grissinger, R.Ph., used to emphasize the importance of health-system insulin safety during February's ISMP teleconference, "Preventing Errors with Insulin: A Multidisciplinary Approach."

Oncology care faces two cliffs, said Lee Schwartzberg, M.D., board member of the Community Oncology Alliance (COA): a planned $400 million to $500 million in Medicare cuts and severe payment cuts announced by private insurers. An access-to-treatment crisis was averted primarily by the addition of $400 million in funding through the implementation of a Centers for Medicare & Medicaid Services oncology demonstration project at the end of 2004. Schwartzberg, also a medical oncologist in private practice at The West Clinic in Memphis, addressed a plenary session on the Medicare Modernization Act (MMA) at the First Annual Oncology World Congress, held recently in New York City.

Reducing excessive or inappropriate antibiotic use is the best way to slow down the spread of antimicrobial resistance in bacterial infections. A report examining dozens of studies of quality-improvement (QI) interventions found that actively engaging the clinician in workshops or educational outreach on antibiotic treatment appears to be more effective than simply posting signs about correct/incorrect antibiotic use. However, most QI interventions are generally effective at reducing both inappropriate antibiotic selection and treatment.

Dissatisfied with the attention hospitals have been giving to medication reconciliation, the Joint Commission on Accreditation of Healthcare Organizations has issued a sentinel event alert, signaling the high priority it's placing on this issue.

Over the past few years, more than 2,200 U.S. soldiers have died in the wars in Iraq and Afghanistan. In addition, more than 16,000 soldiers and Marines have been wounded but have survived. Ironically, this is due largely to new, high-tech ceramic body armor and new field medical and evacuation systems.

The Food & Drug Administration has been counting on radio frequency identification (RFID) technology to be ready for widespread adoption next year, allowing drug product packages to be tagged with tiny chips containing an electronic product code or unique electronic serial number. Now the agency thinks that may not happen and is in a bit of a quandary.

Believe it or not, one in four hospitalized patients has diabetes and the annual cost of treating inpatient diabetes in the United States has reached $40 billion. These stunning statistics represent only two of the reasons why the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) joined forces in late January to develop a position statement outlining strategies for improving inpatient glycemic control.

Not long ago, facing up to the reality that more than 50 million Americans live with persistent pain, Congress declared the period from 2001 through 2010 "The Decade of Pain Control and Research."

The list of major hospital killers is due for a shake-up. Proposed performance measures from the National Quality Forum (NQF) and the Joint Commission on Accreditation of Healthcare Organizations could drop venous thromboembolism (VTE) from the No. 1 cause of hospital-related mortality to well down the list.

There is more to choosing drugs for the intensive care unit than cost. How effective a particular agent is may be even more important than how much it costs.

Want to reduce errors in the pediatric critical care unit and other patient care areas? Slow down!

The results of a new study indicated that a previously uncommon strain of Clostridium difficile has become more resistant to fluoroquinolones.

A 76-year-old woman, D.N., is hospitalized with a severe E. coliurinary tract infection (UTI). She has taken ciprofloxacin 500 mgevery 12 hours and is responding to it. Prior to admission, becauseshe is allergic to sulfamethoxazole, D.N. was taking amoxicillinwhich has been discontinued. D.N. takes digoxin 0.125 mg andpravastatin (Pravachol, Bristol-Myers Squibb) 20 mg daily. Over thepast 24 hours, she developed severe diarrhea and a 101?Ftemperature. Her stool specimen is positive for C. difficile. D.N.is receiving replacement fluids and electrolytes, but her physicianis considering how to resolve the C. difficile infection. What doyou recommend?

Cardinal Health has released a new software version for its Alaris System intravenous pumps, adding safety features and expanding the range of situations in which the pumps can be used.

Drug Mart, Tallman, N.Y., has filed a suit against Becton, Dickinson (BD), accusing the firm of "anti-competitive and illegal" behavior.

Patient advocate Betsy McCaughey gives hospitals and government a failing grade on infection control. As founder and chairman of the Committee to Reduce Infection Deaths, or RID, she calls infection control in most American hospitals "shoddy."

Delmarva, Medicare's Quality Improvement Organization for Maryland and the District of Columbia, has announced the winners of its Medicare Quality Excellence Awards. The hospital award recognizes the top 10% of institutions that improve the most in the composite of a set of 10 performance measures: five acute myocardial infarction (AMI), two congestive heart failure (CHF), and three pneumonia measures.

Radiological services encompass a broad array of diagnostic and treatment modalities used in patient care and performed by various healthcare practitioners. The number of radiological procedures performed in the United States per year has been estimated at 300 million, of which 20% involve a radiological pharmaceutical.

Missed laboratory tests recommended for safety monitoring is a serious problem, according to recently published studies supported by the Agency for Healthcare Research & Quality. One study showed that 47%, 45%, and 44% of patients did not receive one or more recommended lab tests over three years. Another showed that 49.6% of all prescriptions that should have been accompanied by a lab test at the time the drug was prescribed were not.

Research reported at the 47th Annual Meeting and Exposition of the American Society of Hematology, held recently in Atlanta, featured upbeat findings for a new multiple myeloma agent for leukemia patients and found evidence supporting much wider prophylaxis against venous thromboembolism.

To commemorate its 50th anniversary, the Avon Foundation recently sponsored a global research symposium in New York City titled "Breast Cancer 2005: From Discovery to Delivery." There were a number of significant takeaways from the meeting.

The Coalition for Pulmonary Fibrosis (CPF) has issued the first-ever treatment guidelines for idiopathic pulmonary fibrosis (IPF) based on medical evidence. The guidelines, developed with Cerner Health Insights, were published in the October 2005 issue of the Journal of Sarcoidosis, Vasculitis, & Diffuse Lung Diseases.

The pharmaceutical management of hypertensive patients during oral surgery requires controlling patient stress and anxiety and knowing the uses and adverse interactions of antihypertensive drugs, according to recently released guidelines by the American Association of Oral and Maxillofacial Surgeons (AAOMS).

New antimicrobials, the increased pathogenicity and emergence of hyper-toxin-producing strains of Clostridium difficile, and new ways to treat recurrent genital herpes were some of the issues addressed at the recent 45th annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), held recently in Washington, D.C.

New antimicrobials, the increased pathogenicity and emergence of hyper-toxin-producing strains of Clostridium difficile, and new ways to treat recurrent genital herpes were some of the issues addressed at the recent 45th annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), held recently in Washington, D.C.

If your hospital is not using a closed-loop medication management system, it soon will be. That's the prediction from the Fourth Annual Summit on Patient Safety & Information Technology held in San Francisco last month. Bar-coding, radio frequency identification (RFID), computerized physician order entry (CPOE), and other elements of a closed-loop medication system are moving at different speeds in similar directions.