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Each visit, the subject will be given a set of new medications. A supply will be given sufficient for the time to the next visit to allow for small variations in the visit time. Timelines The CLIC trial will initiate enrollment of patients in January 2002. It is anticipated that the last patient visits will occur in February 2003. References 1. National Asthma Education and Prevention Program Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health, National Heart, Lung, and Blood Institute, Publ. No. 97-4051, 1997. Dunhill MS. The pathology of asthma with special reference to changes in the bronchial mucosa. J Clin Pathol 1960; 13: 27-33. Laitinen LA, Heino M, Laitinen A, Kava T, Haahtela T. Damage of the airway epithelium and bronchial reactivity in patients with asthma. Rev Respir Dis 1985; 131: 599-606. Robinson DS, Hamid Q, Ying S, Tsicopoulos A, Barkans J, Bentley AM, Corrigan C, Durham SR, Kay AB. Predominant TH2-like bronchoalveolar T-lymphocyte population in atopic asthma. N Engl J Med 1992; 326: 298-304. Bousquet J, Chanez P, Lacoste JY, Barneon G, Ghavanian N, Enander I, Venge P, Ahlstedt S, Simony-Lafontaine J, Godard P, Michel F-B. Eosinophilic inflammation in asthma . N Engl J Med 1990; 323: 1033-9. Schwartz HJ, Lowell FC, Melby JC. Steroid resistance in bronchial asthma. Ann Intern Med 1968; 69: 493-9. Lee TH, Brattsand R, Leung DYMe. Corticosteroid action and resistance in asthma. J Respir Cell Mol Biol Suppl ; 1996; 93: S1-S79. Sher ER, Leung DYM, Surs W, Kam JC, Zieg G, Kamada AK, Szefler SJ. Steroid-resistant asthma. Cellular mechanisms contributing to inadequate response to glucocorticoid therapy. J Clin Invest 1994; 93: 33-9. Hill MR, Szefler SJ, Ball BD, Bartoszek M, Brenner AM. Monitoring glucocorticoid therapy: a pharmacokinetic approach. Clin Pharmacol Ther 1990; 48: 390-8. Kamada AK, Spahn JD, Surs W, Brown E, Leung DYM, Szefler SJ. Coexistence of glucocorticoid receptor and pharmacokinetic abnormalities: factors that contribute to a poor response to treatment with glucocorticoids in children with asthma. J Pediatr 1994; 124: 984-6 and diovan. STRATEGY Programs BCMA Council on Health Promotion Childhood Obesity Initiative: developing a public campaign aimed at speaking to parents about making healthy lifestyle changes for their families around balanced eating habits and increased physical activity. This is the Council's special project for 2005. Be Real: Counselling program offered on North Shore for "at risk" 11-19 year olds who show tendencies towards eating disorders. Physicians Promoting Healthy Living: Program providing physicians with resources to promote healthy living among patients. Note: does not seem to be very active at present. ; Shape Down: Ten-week counselling program offered to overweight teens and their parents by community-based nutritionists. Programs BC Baby Friendly Initiative: Network of health professionals promote and support breast-feeding through newsletter and website and via public health nurses. Health Canada, RNABC, provincial health authorities ; Healthy Start for Life: Dietitians of Canada and partner organizations promote development of healthy eating and activity patterns for preschool kids. Web-based resources and online courses. Heart Smart Fun Kits for Families: Resource kits distributed by teaches of Kindergarten through Grade 6 kids to help families become more active. Heart & Stroke Foundation of BC Yukon ; Programs Action Schools! BC program & policy ; : Encourages physical activity at school and fosters healthy weight interventions beyond the school setting, e.g. extracurricular and family community activity. Ministry of Health Services Ministry of Education ; Beauty from the Inside Out: Provincial program rotating to different schools each year, involves health professionals presenting on healthy lifestyles. Better Choices: Provincial program involving teachers talking to kids about healthy living. BC Cancer Agency Rotary Club ; Children Teaching Children: Pilot program at two Sunshine Coast schools. Involves children in Grades 4 through 6 being trained in healthy lifestyle approaches, then teaming up as "buddies" with kids in Kindergarten through Grade 3. BC Children's Hospital, for example, 10mg cyclobenzaprine pack. 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How many times have you as a patient with a central line or Portacath wished you could go for a blood test or transfusion without having to change into a patient gown? Often the temperature in the treatment room is chilly making it even more uncomfortable wearing a patient gown. Mary Pat Grieshaber solved this problem by designing a medical access shirt. The Mary Pat Portshirt provides medical personnel easy access to a central line or implanted port for blood draws, transfusions, chemotherapy without having to remove the patient's shirt or expose the entire chest. Mary Pat dealt with aplastic anemia for ten years had an implanted portacath for six years. Her nurses often asked her, "where did you buy your shirt?" "It makes it so easy for us, and adds to your comfort as well." The Mary Pat Portshirt is now available to all patients who would also like to streamline their port access. It is available in black or white, adult sizes: S, M, L & XL for $35, plus shipping. The Earl J. Goldberg Aplastic Anemia Foundation, an affiliate of AA&MDSIF is handling the sale of this item. All profits from the sale of The Mary Pat Portshirt will be donated toward bone marrow failure research. For information e-mail Portshirt aol or phone EJGAAF at 1-847-559-0688 and elocon. 1. Ostuni, P, Botsios, C, Sfriso, P, et al. Fibromyalgia in Italian patients with primary Sjgren's syndrome. Joint Bone Spine 2002; 69: 51. Giles, I, Isenberg, D. Fatigue in primary Sjgren's syndrome: is there a link with the fibromyalgia syndrome? Ann Rheum Dis 2000; 59: 875. Vitali, C, Tavoni, A, Neri, R, et al. Fibromyalgia features in patients with primary Sjgren's syndrome. Evidence of a relationship with psychological depression. Scand J Rheumatol 1989; 18: 21. Tishler, M, Barak, Y, Paran, D, Yaron, M. Sleep disturbances, fibromyalgia and primary Sjgren's syndrome. Clin Exp Rheumatol 1997; 15: 71. Wolfe, F, Smythe, HA, Yunus, MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33: 160. Valim, V, Oliveira, L, Suda, A, et al. Aerobic fitness effects in fibromyalgia. J Rheumatol 2003; 30: 1060. Carette, S, McCain, GA, Bell, DA, Fam, AG. Evaluation of amitriptyline in primary fibrositis. A double-blind, placebocontrolled study. Arthritis Rheum 1986; 29: 655. Carette, S, Bell, MJ, Reynolds, WJ, et al. Comparison of amitriptyline, cyclobenzaprine, and placebo in the treatment of fibromyalgia. A randomized, double-blind clinical trial. Arthritis Rheum 1994; 37: 32. Lawson, K. Tricyclic antidepressants and fibromyalgia: what is the mechanism of action? Expert Opin Investig Drugs 2002; 11: 1437. Russell, IJ, Fletcher, EM, Michalek, JE, et al. Treatment of primary fibrositis fibromyalgia syndrome with ibuprofen and alprazolam. A double-blind, placebo-controlled study. Arthritis Rheum 1991; 34: 552. Arnold LM, Lu Y, Crofford LJ, et al. A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum 2004; 50: 2974. The present study represents the first effort to analyze the mechanisms underlying the potential neuroprotective action of several AEDs by using a combined approach including the analysis of Na and Ca2 currents as well as the measurement of glutamate-mediated synaptic potentials. Accordingly, the modulation of these electrophysiological events seems to play a role also in the mechanisms underlying the antiepileptic action of tested drugs.8 This electrophysiological analysis was performed in the striatum, a brain area selectively vulnerable to ischemia.2, 3, 6 Moreover, the selected neuronal subtype was the striatal GABAergic projecting spiny neuron. This cell, in fact, represents the large majority of striatal neurons 95% ; and shows the highest sensitivity to energy deprivation among the various striatal neuronal subtypes.2, 3, 6, 13 In the present study we found that CBZ, VPA, and TPM exert neuroprotective effects, allowing a partial recovery of the field potential recorded from striatal slices toward control and evista and cyclobenzaprine, for instance, cyclob4nzaprine breastfeeding.
When it comes to symptom management, clinicians agree that they treat sleep first. That's not only because 70-95% of CFS patients experience sleep dysfunction, but because sleep problems exacerbate other CFS symptoms. See article beginning on page 32. ; "I start with sleep, " says Klimas, "because if you don't manage the sleep right, you don't get far. It's difficult to untangle the threads of the illness until sleep dysfunction is addressed." Sleep is hard to address effectively because many patients respond poorly to conventional treatments or develop side effects from drug interventions. "More often than not, I refer them to a sleep specialist who usually orders an overnight sleep study, " says Levine. Klimas also prescribes sleep studies because she finds sleep management problematic with CFS patients. "However, " she cautions, "I recommend that patients see a neurologist rather than a pulmonologist for a sleep study because pulmonologists are usually only looking for sleep apnea, and study results don't show the kind of sleep dysfunction CFS patients have. Neurologists come from a more global perspective." When treating sleep problems, our panelists start with recommendations for good sleep hygiene, encouraging patients to establish a regular bedtime routine; avoid napping during the day; control noise, light and temperature in the bedroom; and avoid caffeine, alcohol and tobacco. Gentle exercise and stretching earlier in the day, not close to bedtime, can also improve sleep. Relaxation techniques like deep breathing and massage closer to bedtime may also be of benefit. Although our panelists were open to the use of herbal remedies like melatonin and over-thecounter drugs like Benadryl and Tylenol PM, these usually don't provide enough relief. Pocinki says, "Many patients need a combination of meds--one for sleep initiation most often Ambien or Ambien CR ; , one for sleep maintenance most often amitriptyline or trazodone ; and one for pain most often a muscle relaxant like Flexeril or a NSAID ; ." Lapp says the most successful combination he has found is clonazepam to fall asleep and trazodone to maintain sleep. Tricyclic drugs such as amitriptyline, doxepin or desipramine ; or tetracyclics such as mirtazapine ; can also be of benefit. "We also consider sleep-inducing hypnotic drugs such as Sonata, Lunesta or Ambien, " Lapp says. "We try to avoid benzodiazepine sedative-hypnotics such as lorazepam and diazepam because they tend to disrupt normal sleep patterns and have a potential for habituation. The exception would be Klonopin, which is long-acting and also treats restless legs and myoclonic jerking." Levine, who often starts with low doses of liquid Sinequan, will also prescribe Klonopin in low doses if the patient is still having difficulty falling asleep. Next she "might try low-dose trazodone, amitriptyline or norpramin. Occasionally, I'll use Neurontin or cyclobenzapine for sleep. And for patients who are deficient in growth hormone, replacing this hormone can improve sleep patterns. Such information does not alter the intended use of any pharmanex products and flomax. Cyclobenzaprine ; , narcotic pain relievers e, g.
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