Tennessee medicine : journal of the Tennessee Medical Association 

About: Tennessee medicine : journal of the Tennessee Medical Association is an academic journal. The journal publishes majorly in the area(s): Health care & MEDLINE. It has an ISSN identifier of 1088-6222. Over the lifetime, 456 publications have been published receiving 2620 citations.

The Health Insurance Portability and Accountability Act.

Abstract: The Health Insurance Portability and Accountability Act, also known as HIPAA, was first delivered to congress in 1996 and consisted of just two Titles. It was designed to protect health insurance coverage for workers and their families while between jobs. It establishes standards for electronic health care transactions and addresses the issues of privacy and security when dealing with Protected Health Information (PHI). HIPAA is applicable only in the United States of America.

Special supplemental nutrition program for women, infants, and children (WIC).

Abstract: This report examines variability in WIC food transaction prices across store formats and four WIC State agencies in the Midwest, West, Southwest, and Mountain Plains using purchase-level data on 2014 Electronic Benefit Transfer (WIC EBT) transactions. While mass merchandisers and traditional grocers tended to have the lowest transaction prices in many product categories, prices vary greatly across States and store formats. Thus, the costliness of food baskets composed of various WIC food items varied significantly across the various store formats of WIC vendors, driven by prices in select product categories. State agencies may be able to reduce food costs in several key product categories, but potential savings may be outweighed by compromises to participant satisfaction or access to food benefits. Acknowledgments The authors would like to thank the following individuals for technical reviews: David E. Davis (South Dakota State University); Victor Oliveira (USDA, ERS), Tatiana Andreyeva (Rudd Center for Food Policy & Obesity, Yale University), and multiple reviewers from USDA, Food and Nutrition Service. Special thanks to Elizabeth Frazão (now retired from USDA, ERS) for previous work on this issue. Thanks also to ERS editor Dale Simms and designer Curtia Taylor.

The promise and the peril.

Abstract: The medicare population represents the most important group of covered lives to most providers. Medicare is now pushing seniors to join risk-based plans, and is encouraging providers to form PSOs to contract directly with Medicare for risk-based contracts. By eliminating the commercial HMOs as the middlemen, PSOs can not only control their own destiny as providers, they can retain the risk 'profit' in the community for enhanced services or higher payments to providers. To be successful, however, PSOs must have in place the key elements to manage the organization in a managed care environment. While the task of creating a PSO can appear daunting and the risk can be real and substantial, every provider organization should examine the potential of starting or joining a PSO. The greatest risk could be the risk of doing nothing, which could lead to loss of control of the Medicare population, decreased utilization, declining payment for services, the loss of patients being directed to other providers, and the loss of the risk premium from Medicare capitation.

Simvastatin-diltiazem drug interaction resulting in rhabdomyolysis and hepatitis.

Abstract: Simvastatin, a hydroxymethyl glutarate coenzyme A (HMG-CoA) reductase inhibitor, is a commonly used cholesterol lowering agent. The long-term safety profile of simvastatin, established over ten-years of clinical use, is excellent. Both rhabdomyolysis and hepatitis, however, are recognized toxic effects of this medication, and generally occur when the patients are taking more than 40 mg of simvastatin a day. Potent inhibitors of the cytochrome P450 3A4 (CYP3A4) enzyme increase the incidence of simvastatin toxicity. Calcium channel blockers are weak inhibitors of the CYP3A4 enzyme. Diltiazem is known to increase the serum concentration of simvastatin. Many patients who take both simvastatin and diltiazem require lower doses of simvastatin to achieve the recommended reduction in cholesterol. Since diltiazem is known to increase plasma levels of lovastatin, a similar phenomenon may occur with simvastatin. Our patient had been stable for three years on simvastatin therapy. His rhabdomyolysis and hepatitis coincided with the addition of diltiazem. This is the first report of the combined toxicities of rhabdomyolysis and hepatitis being induced by the addition of diltiazem to simvastatin therapy. This patient serves as a reminder to the clinician of the potential interaction of these two commonly used drugs.

Management of type 2 diabetes mellitus.

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