In April 2003, guidelines for internal compliance programs at pharmaceutical companies were issued.
According to these guidelines, which one of the following is likely to be considered appropriate?
Correct Answer E:
In 2003, guidelines for internal compliance programs at pharmaceutical companies were issued, providing information about practices likely to provoke government prosecution under current law. With regard to sponsorship of continuing medical education (CME) activities, the OIG recommends disclosure of industry sponsorship and potential conflicts of interest. Unacceptable industry practices include compensating physicians for attending CME activities, as well as influencing the choice of speakers and content of CME activities. The OIG recommends separating CME functions and the awarding of grants from the sales and marketing divisions of a company.
An 85-year-old female with hypertension is receiving hospice care for oral cancer.
Which one of the following services typically would not be covered under hospice?
Correct Answer D:
Hospice covers a wide array of services, including dietary counseling; short-term hospital and respite care; medicine and supplies to treat symptoms of terminal illness; physical, occupational, and speech therapies; and many other benefits as deemed appropriate by the hospice team. However, medicine used to cure the illness that led to hospice care, as well as medicines that treat other comorbid illnesses, are not covered under the hospice benefit. Therefore, it is important for patients to maintain other coinsurance.
Under current guidelines, hospice programs are most likely to serve patients dying from:
The general requirement for enrolling an individual in hospice is that they have a terminal illness and an estimated life expectancy of 6 months or less. Given these criteria, it is not surprising that over 40% of hospice patients have a cancer diagnosis. Cancer usually has a short period of obvious decline at the end and is predictable to a degree. Diseases such as COPD, end-stage liver disease, and heart failure result in long-term disability with periodic exacerbations, any one of which could result in death, but far less predictably. Those with severe dementia or frailty often experience a dwindling course that is also difficult to predict.
Which one of the following statements is true regarding malpractice cases?
Correct Answer A:
The vast majority of medically injured patients do not sue. The usual time to resolution of malpractice cases is 5 years, although many take 6 years or more to resolve. Obstetrician-gynecologists are the most frequently sued doctors. Malpractice claims typically involve severe injuries or death. Plaintiffs win only one-fifth of cases brought to court.
An 18-year-old white female who works at a day-care center sees you because of a cough. Three weeks ago she developed cold symptoms that have progressed to paroxysms of coughing with post-tussive emesis. She reports that there are children at the day-care center who have coughs and colds, but none have been diagnosed with pertussis. She has always been healthy, has no known drug allergies, and had all of the routine childhood immunizations. A polymerase chain reaction (PCR) is negative for pertussis and a chest film appears normal.
Which one of the following would be most appropriate at this point?
This person works in an environment where pertussis may be contracted from unvaccinated or incompletely vaccinated individuals. According to the Centers for Disease Control and Prevention (CDC) this patient has “clinical” pertussis, defined as an acute cough for 14 days with no other apparent cause, plus one of the following: paroxysmal cough, post-tussive emesis, or inspiratory “whooping.” A negative PCR does not exclude clinical pertussis.
The CDC recommends treating clinical cases with erythromycin, azithromycin, or clarithromycin. Because pertussis is highly contagious, antibiotics are recommended to control outbreaks.
The effectiveness of symptom-reducing treatments (e.g., antihistamines, corticosteroids, ß-agonists, or immunoglobulins) is unclear. A systematic review showed little evidence to justify their use for pertussis. The CDC’s Advisory Committee on Immunization Practices no longer recommends the Td booster, and Td would not boost her immunity to pertussis. Because of the waning of pertussis immunity after routine childhood immunizations, the newer tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine is recommended for adolescents. Although it is unclear whether this patient needs Tdap because of boosted immunity resulting from clinical pertussis, immunization would not be the first treatment in this case.
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