Computerized prescriber (also called “physician” or “provider”) order entry (CPOE) is currently a hot topic in the field of medicine. CPOE is offered as a cure for many of the ills in health care delivery organizations, offering not only increased patient safety but also improved efficiency and quality of care. If they haven’t already done so, P&T committees should become familiar with CPOE issues.

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The efforts of managed care organizations to control health care costs may have spread eastward from California, but innovation in controlling prescription drug spending today is flowing in the opposite direction. In 2000, the state of Maine enacted an aggressive plan, called “Maine Rx,” to force pharmaceutical companies to lower the prices of drugs for uninsured residents. The industry challenged it all the way to the Supreme Court, and on May 19, 2003, Maine won, at least in the first round. As a result, Maine’s plan may become a model for many other states; 28 states have already expressed interest.

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After passing different versions of the Medicare prescription drug bill months ago, the House and Senate seem to have become bogged down in their conference committee, with too many differences between the two bills and too many gaps to bridge. Although it appeared this past spring that Congress would pass a Medicare outpatient drug bill, it doesn’t seem as likely now. A Washington Post editorial in mid-September suggested that maybe Congress should, as one of HBO’s Sopranos might say, just fuhgedaboutit; this is because Republicans and Democrats seemed destined to produce—if they produce anything at all—an unwieldy, expensive Frankenstein’s monster.

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Conjugated equine estrogens and medroxyprogesterone have been the most commonly prescribed postmenopausal hormone therapy in the U.S. for women with a uterus and, until 2001-2002, had been used each day by more than six million women. It had been thought that the use of these agents would prevent cardiovascular disease, osteoporosis, and cancer in postmenopausal women during the aging process.

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In 1981, the National Commission, in describing the principles of equitable selection of subjects, stated that women could take part in all research studies. This decision coincided with a publication by Kinney et al. showing that young women served as subjects in premarketing drug trials less frequently than young men. The authors discussed the moral, legal, and medical implications of women’s underrepresentation and the increased risks to female patients because of the denial of medication. Furthermore, safety risks increased when women received certain new drugs only in the postmarketing phase.

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INTRODUCTION

Prior to the third quarter of the 20^thcentury, the Food and Drug Administration’s (FDA’s) guidelines for the inclusion of women in clinical studies for all types of illnesses were limited. The FDA barred women of childbearing age from all phase I trials (safety studies) and from all other studies until animal teratology and fetal toxicity studies could be completed and analyzed.

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Speaker: Benjamin Brenner, MD, Associate Professor of Hematology, The Bruce Rappaport Faculty of Medicine, Tech-nicon-Israel Institute of Technology, Haifa, Israel.

Enoxaparin (Lovenox®, Aventis), a well-known, low-molecular-weight heparin, has been shown to be safe and comparatively effective in preventing miscarriages in thrombophilic women with a history of recurrent pregnancy loss.

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