Obese patients are frequently initiated on anticoagulation therapy for treatment or prevention of venous thromboembolism, prevention of stroke, and systemic embolism in atrial fibrillation, and the treatment of acute coronary syndromes. Unfortunately, due to the low number of obese patients enrolled in clinical trials, data on both efficacy and safety of traditional anticoagulant dosing in obese patients is lacking. The current literature for unfractionated heparin, low-molecular weight heparin, warfarin, dabigatran, rivaroxaban, and apixaban was reviewed to evaluate appropriate dosing in obese patients. Due to the lack of consensus and limited obese patients studied, dosing should be based on both patient- and drug-specific factors.
New regulations in the Patient Protection and Affordable Care Act have led to the birth of essential health benefits. The Centers for Medicare and Medicaid Services' (CMS) new division, the Center for Consumer Information and Insurance Oversight (CCIIO), is responsible for the oversight of the insurance offerings on the new health insurance exchanges, which have 10 required essential health benefit categories. One of these essential categories is prescription drugs. Prospective qualified health plans, pharmacy benefit managers, and consultant agencies have struggled through the legislation and guidance from CCIIO in an attempt to build benefits that meet the requirements. With elements of typical commercial offerings as well as those of Medicare Part D, there are many nuances that one must consider when building an exchange formulary and creating the surrounding benefit.
Estimates of the cost of fraud in the Medicare system range broadly from $17 billion to $90 billion. However, there are no estimates of—or methods to detect—how much of the wasted money is attributable to old-fashioned human error rather than blatant crime.
For patients with sexual disorders, there's been very little help, but a review of the pipeline indicates that help might soon be on the way.
On February 1, 2013, the Centers for Medicare & Medicaid Services (CMS) released new regulations about the reporting of fees, meals, travel expenses, and other transfers of value for the implementation of the Physician Payment Sunshine Act (PPSA). These new regulations require that data on the payments and gifts that drug and medical device companies make to physicians will become available publicly in a searchable database beginning in September 2014.1
Self-management has small effects on pain and disability in people with low back pain, according to a study published online in Arthritis Care & Research.
Incidence of human immunodeficiency virus (HIV) has decreased dramatically since its emergence in the early 1980s, but it remains a worldwide epidemic. There is a reduction in newly diagnosed patients, but prevalence is increasing due to a longer life expectancy, which is attributed in part to highly effective antiretroviral therapies. Newly approved and investigational antiretroviral therapies provide additional options for the healthcare team to prevent progression of disease as well as transmission of HIV. Early detection and prevention of HIV is still paramount with the use of in-home HIV testing as well as antiretrovirals for pre-exposure prophylaxis. While many advances in HIV diagnosis and treatment have been made, the importance of education and risk avoidance cannot be underestimated.
