This article reviews how pharmacy benefit managers (PBMs) play a role in the delivery of modern healthcare services. A discussion regarding the lack of transparency regarding PBM services, consolidation of the market and vertical integration, as well as a typical flow of payments related to medications is provided. Authors review what higher drug costs are doing to patients, and provide an overview of what is happening to fight these trends.
Sarcoidosis is a disease hallmarked by granulomatous inflammation of nearly all organ systems. Though it has been widely recognized for over 100 years, much remains unknown about the etiology and pathophysiology of the disease. Due in part to this is ambiguity, diagnosis and treatment, algorithms have been difficult to create and even harder to develop a strong evidence base for. In this article, we attempt to consolidate the guidelines, recommendations, and algorithms provided by multiple societies across the US and abroad. We have assembled these into a concise quick-reference format article for those looking for a cohesive approach to the diagnosis and management of sarcoidosis, including when it doesn't respond to initial therapy. We also delve into a new and promising treatment that is in the investigation pipeline, but not yet ready for implementation.
[This corrects the article on p. 424 in vol. 119, PMID: 36338001.].
Metabolic bone diseases are a heterogenous group of conditions that all result in aberrant bone mineral homeostasis with resulting skeletal disease. The underlying causes are variable, ranging from nutritional deficiencies to pathogenic variants in skeletal genes. To properly diagnose and treat these conditions, a clinician needs to understand bone metabolism as well as recognize the signs of disease in a patient. This review will focus on three relatively common metabolic bone diseases (osteogenesis imperfecta, hypophosphatasia, and X-linked hypophosphatemic rickets) that are caused by genetic variants, not by nutritional deficiency. As molecular DNA sequencing has improved, the scientific community has been able to better understand the genetic basis of these conditions and create sophisticated medical treatments based on the genetic deficiency.
Joint hypermobility is very common in the general population as is arthralgia. Increased awareness of hypermobility and hypermobile Ehlers Danlos Syndrome (hEDS) among patients and providers has led to a surge in demand for evaluation. Many patients with hypermobility meet clinical criteria for a diagnosis of hypermobile spectrum disorder (HSD) or hEDS, but monogenic connective tissue diseases (CTD) are rare. Genetic testing is not recommended for patients with HSD/hEDS unless another underlying CTD is suspected. Given the high prevalence of HSD/hEDS in the general population, primary care providers should be familiar with HSD/hEDS evaluation, management, and indication for referral to a CTD specialist.
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