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Presents information on nesiritide, a recombinant form of human B-type natriuretic peptide approved by the U.S. Food and Drug Administration for the treatment of acute decompensated chronic heart failure. Safety and efficacy of nesiritide; Economic factors that must be considered in taking the drug;

Until 1994, herbal products in the U.S. were regulated as food supplements or food additives. However, with the passage of the Dietary and Nutritional Supplement Health and Education Act, oversight of these products by the Food and Drug Administration (FDA) has been greatly diminished. A case in point is that of the herbal drug ephedra which is promoted to enhance athletic performance, weight loss and sexual drive. The ease with which ephedra can be obtained is alarming, since its use has been associated with adverse cardiovascular events. In response to concerns about this substance, FDA has proposed mandatory warning labels on the packaging of products containing ephedra. However, based on the poor risk-benefit ratio, the banning of ephedra is more appropriate than making labeling changes.

The article responds to the comments of Dr. Briscoe-Dwyer about ethics and professional obligation. It believes that every locality including rural areas has the right of seamless access to medication. A recent poll showed that only 16% of 1,000 test adults believe that pharmacists can refuse to give out drugs. It believes that pharmacists do not have the right to obstruct medical care.

Background: The Centers for Medicare & Medicaid Services Hospital-Acquired Conditions (CMS-HAC) links Medicare payments to health care quality. Experiencing a serious disability or death associated with a fall in a health care facility based on diagnosis codes has been identified as an opportunity for improvement. Multiple factors contribute to an inpatient fall, including medications that affect cognition in older adults. The primary aim of this study was to investigate the effect of the commonly prescribed classes of medications on the CMS-HAC falls and trauma definition in US hospitals in a large inpatient database from 2019 to 2021., Methods: The authors analyzed data from 835 hospitals in the Vizient Clinical Data Base between January 1, 2019, and December 31, 2021, on patients ≥ 65 years of age with CMS-HAC patient falls and trauma codes. Using logistic regression and stepwise Poisson regression analysis, the authors identified demographic, clinical, and hospital-related variables associated with falls meeting the CMS-HAC definition. The top 20 prescribed drug classes in these patients were also identified., Results: Among 11,064,024 patient encounters, 5,978 met the CMS-HAC definition of a serious fall. Patients who experienced a serious fall were significantly more likely to be > 79 years of age (p < 0.001, odds ratio [OR] 1.30, 95% confidence interval [CI] 1.23-1.37), have a history of prior falls (p < 0.001, OR 2.30, 95% CI 2.11-2.50), have a code for dementia (p < 0.001, OR 1.50, 95% CI 1.40-1.60), and have higher anticholinergic cognitive burden (ACB) scores (p < 0.001, OR 1.14, 95% CI 1.13-1.14). Specific medication classes associated with CMS-HAC falls were first-generation antihistamines (p < 0.00, OR 1.21, 95% CI 1.09-1.35), second-generation antihistamines (p ≤ 0.001, OR 1.15, 95% CI 1.13-1.19), and atypical antipsychotics (p < 0.001, OR 1.18, CI 1.13-1.29)., Conclusion: Patients who experience a fall meeting the CMS-HAC fall definition are significantly more likely to have a prior history of falling, dementia, and a higher ACB score. Results from this study may inform future quality improvement work aimed at reducing injurious falls., (Copyright © 2023 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

Purpose: The epidemiology, virology, and transmission of West Nile virus (WNV) are reviewed, and the clinical features, diagnosis, and treatment of WNV infection are examined., Summary: WNV infection is caused by a flavivirus transmitted from birds to humans through the bite of culicine mosquitoes. WNV was discovered in the blood of a febrile woman from Uganda's West Nile province in 1937. The first case of domestically acquired WNV infection was reported in the United States in 1999 in New York. Since then, WNV infection has spread rapidly across the United States, with 9306 confirmed cases and 210 deaths reported from 45 states in 2003. It is still not clear how WNV was introduced into North America. WNV is a small, single-stranded RNA virus and a member of the Japanese encephalitis virus antigenic complex. While most humans infected with WNV are asymptomatic, some may develop an influenza-like illness. Disease surveillance remains the cornerstone for the early recognition and control of WNV. We describe one case of WNV infection with an update on the disease. Strategies for the prevention and control of this infection are reviewed., Conclusion: There is no established treatment for WNV infection. Currently, prevention and control are the only measures that help decrease the morbidity and mortality associated with WNV infection. As the number of cases escalates and the geographic distribution of WNV infection widens, the epidemic will continue to pose a major challenge to clinicians in the coming years. There is an urgent need for more research on the pathogenesis and treatment of WNV infection.