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One really needs a clear, uncluttered mind to understand the ground rules for the use of patient information that pharmacy benefit managers (PBMs) will face, now that the Bush administration has published its final rule on medical data confidentiality. This rule has been brewing since 1996, when Congress passed the Health Insurance Portability and Accountability Act (HIPAA).
- In: Main
- Tags: Privacy Rule
Since the Institute of Medicine report on medical errors was released in November 1999, health care professionals and the media have given unprecedented coverage to computerized pre-scriber order entry (CPOE). Although few could argue with the clear evidence that well-designed CPOE systems hold enormous potential to reduce errors, this technology requires millions of dollars to implement and maintain. For example, in the mid-1990s, the CPOE system at Boston’s Brigham and Women’s Hospital cost about $1.4 million for in-house development and hardware and at least $500,000 per year for maintenance. Although this dollar outlay seems staggering at first glance, the cost savings that accompany CPOE are even more impressive—between $5 and $10 million per year at Brigham and Women’s Hospital.
- In: Main
- Tags: Strategic Plans
The Women’s Health Initiative (WHI) is a long-term, prospective, experimental study that addresses the use of HRT for the primary prevention of CHD among healthy, postmenopausal women. Data collection was recently suspended in the continuous combined HRT group (CEEs 0.625 mg/day with MPA 2.5 mg each day) after 5.2 years, and the results of this arm were published early; however, the estrogen monotherapy arm is still ongoing. Data were released early from the combined HRT arm because of evidence that the risks were outweighing the benefit for these subjects. This arm of the study included 16,608 postmenopausal women with an intact uterus who were between ages 50 and 79 (mean = 63.3 years). Subjects were randomly assigned to receive either continuous, combined HRT (CEEs 0.625 mg/day with MPA 2.5 mg/day) or placebo.
- In: Cancer
- Tags: cardiovascular disease, Hormone Replacement
The Postmenopausal Estrogen/Progestin Interventions (PEPI) trial was an experimental study primarily designed to evaluate the effect of HRT on cardiovascular disease. This randomized, double-blind, placebo-controlled trial compared estrogen monotherapy with continuous or cyclic estrogen-plus-pro-gestin combination therapy. Two forms of progestins were assessed, medroxyprogesterone acetate (MPA) and micronized progesterone (MP). This study confirmed that all HRT therapies increased HDL-cholesterol, with the greatest increase seen in the estrogen monotherapy treatment group. The addition of either progestin decreased this effect, but MP therapy was associated with less blunting. In addition to the effects on HDL-cholesterol, all active groups experienced a decrease in LDL-cholesterol and an increase in triglycerides. Among patients receiving HRT, treatment did not affect blood pressure or postchallenge insulin levels, and decreased fibrinogen levels were observed across all HRT groups.
- In: Cancer
- Tags: cardiovascular disease, Hormone Replacement
Postmenopausal Hormone Replacement Therapy and Cardiovascular Disease: HORMONE REPLACEMENT THERAPY
27 Jun2010
The administration of HRT has been shown to counteract many of these negative effects of menopause that increase the risk of CHD. However, the combination of hormones, dosage, and route of administration can affect the outcomes (Table 1).
- In: Cancer
- Tags: cardiovascular disease, Hormone Replacement
INTRODUCTION
Historically, heart disease has been viewed as a health problem of middle-aged men, and misperceptions concerning the prevalence of cardiovascular disease among women still exist. However, cardiovascular disease is a significant health problem among women. The incidence of cardiovascular disease in men and women equalizes after the age of 65, and the prevalence among women exceeds that of men after the age of 75. Overall, coronary heart disease (CHD) and stroke are the leading causes of death among American women, accounting for 44.6% of all deaths in women. This figure is higher than the next four causes of female deaths combined. Also, women are more likely to die within one year following a heart attack than are men. Despite these facts, it has been reported that women are expressing more concern about breast cancer than about cardiovascular disease. In reality, one of every two women will die from heart disease or stroke, whereas only one of 25 will die from breast cancer.
- In: Cancer
- Tags: cardiovascular disease, Hormone Replacement
Computer-Generated MAR Format
25 Jun2010
Problem: Nurses sometimes find the way in which drug orders are presented on pharmacy computer-generated medication administration records (MARs) to be confusing. With many pharmacy computer systems, the specifications for drug profiles first present the dosage strength available in stock and then present the number of tablets or volume of oral or injectable liquid needed for the prescribed dose. This sequence is transferred to the MAR, so that the drug name and available dosage strength, often in bold print, appear on the top lines, with the patient’s actual dose appearing in plain type below. This presentation also guides the dose selection for daily cart distribution.
- In: Main
- Tags: Computer-Generated