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Many jurisdictions would allow them to seek compensation. To its supporters, the medical criteria approach has the benefit of making arguably minimal changes in the tort liability system, leaving questions of how to deal with all those claims that meet the medical criteria and remain within the litigation system to state tort doctrine and procedural rules. Because it would prevent many asbestos-exposed workers who are currently eligible for compensation from claiming compensation in the future unless and until they met the specified criteria, this reform strategy has been opposed by those who represent these workers, including many asbestos plaintiff attorneys and labor union leaders. Some defendant corporations and insurers also are reluctant to support the medical criteria proposal because they fear that the costs of compensating mesothelioma claimants and other seriously injured claimants might be so high in the future as to offset any economic benefits to them that might accrue from eliminating unimpaired claims from the liability system. Trust Fund. With the success of the medical criteria proposal in doubt, many defendant corporations and insurers began to pursue an alternative strategy that would eliminate tort liability for asbestos claimants entirely and substitute an administrative compensation program, funded by defendant corporations and insurers i.e., a trust fund ; . Unlike the medical criteria approach, which would leave each defendant to respond to the suits that remain within the tort system as the defendant sees fit, the administrative compensation program strategy requires that defendant corporations and insurers agree on a funding formula. To achieve consensus, defendant corporations and insurers have had to grapple with the same questions that have challenged designers of asbestos personal injury trusts in Chapter 11 proceedings and those who have sought to negotiate long-term settlements of asbestos litigation outside of bankruptcy: How many claimants will appear in the future? How much should each defendant and potential defendant pay? With the federal government unwilling to act as guarantor of the compensation program, payors' and claimants' representatives need to consider what might happen if the amount originally negotiated proves to be inadequate. Some defendants also worried that eligibility was too broadly defined. Unlike previous trust fund proposals, the one debated in the 108th Congress did not limit compensation to cancer victims and those with a severe respiratory impairment. As negotiations continued, the price tag for the proposed fund mounted to a level that some were unwilling to support, and the parties were not able to reach agreement on a formula before the time for congressional action expired. Now the 109th Congress has taken up the trust fund proposal again, for example, glucophage xr.
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Introduction The goal of treating type II diabetes is above all to prevent complication. When there is sulphanylurea inadequacy, despite maximal sulphonylurea therapy and when near normal FPG levels cannot be achieved with a combination of sulphonelurea and metformin, improved glycemic control can often be achieved by along acting insulin preparation such as ultralente Aim: In patient with type 2 diabetes, the aim of the intensive approach for glucose controle with metformen sulphonyurea of Insulin theraples in addition to a dietary advice was to obtain near normal fasting plasma glucose ie 7mmol L 126 mg dl ; Patient were kept on allocated mono therapy alone until marked hyperglycemia developed then a combination therapy could be started, so that the clinical effect of each therapy could be assessed Methods: Of 2663 patient consult our center Al Waffa diabetic center ; for the last year 2385 were type II diabetes. Main age 59 year had raised fasting plasma glucose with or with out hyperglycemic symptoms, after followed up for 3 months on diet alone or with mono therapy, then started our Intensive approach for plasma glucose control with a combination therapy by Metformin with sulphonylurea or with insulin or with both if needed, or we combined sulphonylurea with insulin, so we can survey which method of therapy was the best in reaching near normal plasma glucose level. Analysis and results We divided the patient in a 2 groups Group 1 : On monotherapy. The result after intensive therapy 47, 1% had FPG below 126ml dl were on diet alone, 34, 8% had FPG below 126 ml dl, were Insulin, 27% were on Glucopage and 20, 1% on Sulphonylurea Group 2 : On combination therapy: 28, 6% had FPG below 126ml dl were on with Insulin 18, 4% were Sulphomylurea with Insulin at the bed time. 12, 5% were on sulphonylurea. Glucoophage and Insulin. 15, 6% were on sulphonyurea with Glycophage Conclusion: By the comparison of the validity of combination therapy for type II diabetes we obtain the best glycemic control in the group receiving Insulin at the bed time with Glucophage. On the other hand the group treated by diet alone show the best glycemic control.
The Department believes that the cost containment initiatives in the Medicaid Prescription Drug Program have been innovative, yet rational in approach, and have produced much needed savings. These initiatives promote quality care through an evidence based process. Overall expenditures in the Medicaid Prescription Drug Program continue to grow as a result of increased enrollment and increasing expenditures for medications. The cost containment initiatives provide a comprehensive approach and the necessary tools to effectively manage this program. It is imperative that we continue down this path in order to be good stewards of the public funds we are entrusted to administer for care of Wyoming's most vulnerable residents. In this regard, the Department plans to move forward with the following initiatives: Current activities: Maintenance and further implementation of the Preferred Drug List PDL ; , enforced by prior authorization PA ; . Maintenance and further implementation of PA alone for "problem" medications which are not appropriate for the PDL. Maintenance of the tiered co-pay structure. Continued educational campaigns for issues not appropriate for PDL or PA. Continued efforts of the Lock-In Program. Continued fraud and abuse efforts. Maintenance of the State Maximum Allowable Cost SMAC ; Program. New activities: Implementation of the Generic Mandatory Program. Implementation of the Pharmacy Case Management model through the Wyoming Health Information Network WHIN ; Polypharmacy project. Implementation of Supplemental Rebate Program. Implementation of SMART PA. Continued monitoring and research of: Reimbursement and pricing issues. Potential effectiveness of provider incentives, including differential dispensing fees for brand and generic medications. Formulary issues, including coverage of over the counter OTC ; and durable medical equipment DME ; . The Department recommends continued support of prescription drug cost containment initiatives and would appreciate feedback regarding its initiatives to date and glucotrol.
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The target level for hemoglobin A1c is 7.0 percent in many of the current guidelines. The guideline of the American Association of Clinical Endocrinologists sets the appropriate level at 6.5 percent. The level of 7.0 percent was established after analyses indicated that achieving this level would result in a substantial reduction in microvascular complications. Regression analysis shows that there will be a continuous decline in microvascular complications as the hemoglobin A1c declines below 7.0 percent and even 6.5 percent. Thus, aggressive glycemic control benefits the patient by reduction in long-term complications. Although changes in the hemoglobin A1c value may be significant in as short a period as four weeks, it takes up to three months to see the overall effect of a change in treatment. The target for fasting plasma glucose in diabetic patients is 90-130 mg dl. If this is achieved along with postprandial control of blood sugar, hemoglobin A1c levels of less than 7.0 percent will be easily achieved. The target for 2-hour postprandial blood sugars is 180 mg dl. Since individuals without diabetes closely maintain blood sugars within a range of about 40 mg dl, it is likely that postprandial levels of even less than 180 mg dl are important for truly tight control of blood sugar. Clearly, after six months, Mr. Cooper needs pharmacologic intervention for the treatment of his diabetes. Since he still has only a mild elevation of his hemoglobin A1c, it is possible that he will be controlled with a single agent. Of the choices given, metformin generic, Flucophage ; would be the most logical. Its advantages include lack of weight gain, no associated hypoglycemia, and generally good tolerance, although some patients are unable to tolerate the gastrointestinal side effects. It may delay the progression of diabetes. Glipizide generic, Glucotrol ; would be considered an alternative. It is cost effective but does have the disadvantage of associated weight gain and rare but occasionally serious hypoglycemia. There is some question of whether the long acting secretagogues may have an adverse effect on the beta cells over a prolonged period of time. No evidence suggests that secretagogues play any role in preventing the progression of diabetes. The patient has still not achieved the goal for treatment of his lipids and the statin [in this case, atorvastatin Lipitor ; , although others may be used] should be increased with a plan to increase it to the maximum dose 80 mg daily ; to reach the target level. If necessary, an adjunctive agent such as Ezetimibe Zetia ; can be used, although with caution because of the increased risk of liver dysfunction with this combination. At the September visit, Mr. Cooper's HDL cholesterol is.
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1997 SCM Championship: Bob thanked Ed Gendreau for making a NE SCM championship a reality. Ed is responsible for several meet innovations including: workout competition, peel-off results available at the meet and an attractive meet certificate of participation. We can expect to see many new NE Top Ten times, a few NE records and perhaps a new world record or two. 1998 SCY Championship: Bob recommended that we hold our championship at Wheaton College. Additionally, he suggested that we contract out the job of handling entries, running the meet software, and producing results. Our SCY Championship meet at Wheaton has grown to the point where Bella Marlow and John Benedick cannot be expected to handle the expanding work of running both the front back ends of the meet at the same time. Fall Winter Schedule: Matt Connery reported that the Fall schedule is set and that he will now work on creating the Winter Schedule. Meet venues mentioned for the Winter include Harvard, MIT, BU, Simmons, NE, Brown, Exeter, Portsmouth, PC, Sudbury, Andover. Our objective will be to have three meets a month, including a central Boston venue, during the period January-March. Meet Director's Handbook: Tom circulated a very substantial piece of work that he developed that will become the meet director's bible. Meet Sanctions Timers: USMS rules require two watches on each lane for sanctioned swims. Our Club has not always done a very good job of adhering to the rule. That means that some swims at sanctioned meets have not been recognized due to this regrettable situation. There were several suggestions to address this problem. After some discussion we agreed that: It is the responsibility of the VP of Meets job to inform each meet director of the two- watch requirement. The Officials Chair should remind each official starter to check that sanctioned meets event in fact have two watches on each swimmer. We need to encourage meet directors to recruit non-swimmer timers. Ed came up with numerous examples of how to get non-swimmers to assume timing responsibility. His suggestions will be incorporated in the meet management book and some of Ed's ideas will be tested at upcoming meets. Top Ten: Esther reported that everything seems to be on track assuming that she receives Matt's results from the Brown meet later this week. Next Meeting: Early December; time and place to be determined. Return to list of club news items. Return to list of articles at top of page and isosorbide.
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