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Ative study of blood-pressure-lowering drugs ever completed, 4 and The Second Australian National Blood Pressure Study ANBP2 ; , a smaller head-to-head comparison of diuretics and ACE inhibitors, carried out entirely within general practice in Australia.5 Here, we review, primarily, the results of ALLHAT and ANBP2 in the context of the accumulated evidence about the newer classes of blood-pressure-lowering drugs reported since JNC VI and WHO-ISH 1999 were published.1, 2 Our review is made more timely by the release of JNC VII in May this year, 6 with recommendations based predominantly on the outcomes of ALLHAT4 and the recent European Guidelines, released in June 2003 by the European Society for Hypertension jointly with the European Society of Cardiology.7 The importance of the effective treatment of hypertension has been reinforced in a most powerful way by the recent World Health Organization report WHO Report 2002 ; , 8 as highlighted in two shorter articles in the Lancet.9, 10 These reports confirm that, in developed countries, blood pressure is the single most important contributor to global mortality.
Professionals need to be aware of the potential for alcoholrelated problems in this population and to offer the support needed for successful interventions. Health care providers and administrators should plan for an expected increase in the number of older people with alcohol-related medical and social problems in the future, for instance, package insert.
RX FLUOCINOLONE ACETONIDE 0.01% IN OIL Fluocinolone acetonide 10 mg Vegetable oil qs 100 mL Incorporate the fluocinolone acetonide into a vegetable oil, such as sesame oil, almond oil, etc. and mix well. Package and label. Formulations for Hair Loss.
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The effectiveness, risks, and estimated costs for 10 drugs: acarbose sold as precose ; , glimepiride amaryl ; , glipizide glucotrol ; , glyburide micronase, diabeta, glynase prestab.
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Devereaux PJ, Goldman L, Cook DJ, Gilbert K, Leslie K, Guyatt GH. Perioperative cardiac risk and risk assessment in patients undergoing cardiac surgery. CMAJ 2005; in press ; . Ellis SG, Hertzer NR, Young JR, Brener S. Angiographic correlates of cardiac death and myocardial infarction complicating major nonthoracic vascular surgery. J Cardiol 1996; 77: 1126-28. Eagle KA, Coley CM, Newell JB, et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med 1989; 110: 859-66. Vanzetto G, Machecourt J, Blendea D, et al. Additive value of thallium single-photon emission computed tomography myocardial imaging for prediction of perioperative events in clinically selected high cardiac risk patients having abdominal aortic surgery. J Cardiol 1996; 77: 143-48. Gilbert K, Larocque BJ, Patrick LT. Prospective evaluation of cardiac risk indices for patients undergoing noncardiac surgery. Ann Intern Med 2000; 133: 356-9. Gordon AJ, Macpherson DS. Guideline chaos: conflicting recommendations for preoperative cardiac assessment. J Cardiol 2003; 91: 1299-1303. Almanaseer Y, Mukherjee D, Kline-Rogers EM, et al. Implementation of the ACC AHA Guidelines for preoperative cardiac risk assessment in a general medicine preoperative clinic: Improving efficiency and preserving outcomes. Cardiology 2005; 103: 24-29. Taher T, McAlister FA, Khan N, Devereaux PJ, Fisher BW, Ghali WA. Assessment and reporting of perioperative cardiac risk by Canadian general internists. J Gen Intern Med 2002; 17: 933-6. Steen PA, Tinker JH, Tarhan S. Myocardial reinfarction after anaesthesia and surgery. JAMA 1978; 239: 2566-70. Allen JR, Helling TS, Hartzler GO. Operative procedures not involving the heart after percutaneous transluminal coronary angioplasty. Surg Gynecol Obstet 1991; 173: 285-8. Huber KC, Evans MS, Breshanan JF, Gibbons RJ, Holmes DR Jr. Outcome of noncardiac operations in patients with severe coronary artery disease successfully treated preoperatively with coronary angioplasty. Mayo Clin Proc 1992; 67: 15-21. Gottlieb A, Banoub M, Sprung J, et al. Perioperative cardiovascular morbidity in patients with coronary artery disease undergoing vascular surgery after percutaneous transluminal coronary angioplasty. J Cardiothorac Vasc Anest 1998; 12: 501-6.
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SULFONYLUREA How it works These drugs cause the pancreas to make more insulin. The drugs listed are the more common sulfonylureas prescribed. ; Examples Generic name Brand name glimepiride Amaryl glipizide Glucotrol glipizide Glucotrol XL glyburide DiaBeta glyburide Glynase PreTab glyburide Micronqse Side effects Low blood glucose, weight gain, rash, nausea MEGLITINIDE D-PHENYLALANINE How it works These drugs cause the pancreas to make more insulin and act more quickly. Examples Generic name Brand name repaglinide Prandin nateglinide Starlix Side effects Low blood glucose rare and loperamide.
Synopsis Drug misuse treatment is now part of the star ratings for PCTs. The National Treatment Agency is coordinating a mini-census of information held about numbers in treatment in 2003 04. Treatment agencies are being sent information for checking updating in April. For further information, please visit nta.nhs programme national.
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| Micronase 5Refer to the list of long-acting benzodiazepines attached at the end of this document. Short-acting benzodiazepines and other anti-anxiety and sedative medications should not be used, unless: ! ! ! There is documented evidence that other possible causes of the resident's distress have been considered and ruled out; Its use results in maintenance or improvement in the resident's functional status as reflected on the MDS Daily use is less than four continuous months unless an attempt at a gradual dose reduction is unsuccessful; Its use is less than, or equal to, the listed total daily doses refer to the list of short-acting benzodiazepines at the end of this document ; , unless higher doses as evidenced by the resident's response and or the resident's clinical record ; are necessary to maintain or improve the resident's function; Its use is for one of the following indications, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition DSM-IV ; : o Generalized anxiety disorder; o Panic disorder; o Symptomatic anxiety that occurs in residents with another diagnosed psychiatric disorder e.g., depression, adjustment disorder o Dementia, delirium, amnestic, and other cognitive disorders as specified by the DSM-IV ; with associated behaviors indicating distress, which are quantitatively and objectively documented See Note discussing documentation at the end of the section for and indomethacin.
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Seldom an explicit issue in our more open, better educated and tolerant society, and pharmacists harbouring explicit prejudices are, in addition to acting illegally, acting unethically. Subconsciously, however, we may be more guarded, less sympathetic and perhaps less helpful to individuals we dislike or who differ from ourselves. Differences in social class may also present a barrier. It is not easy to be tolerant and sympathetic to someone who is smelly, unkempt or downright rude. To overcome such a barrier is to be truly professional. Remember that such individuals, in their rudeness and aggression, are perhaps only exhibiting the symptoms of people who have not been listened to properly. A research study in the early 1990s considered the ability of pharmacists to respond to symptoms and in particular, their ability to use questions, although for various reasons this study was never published. The study involved covert visits to pharmacies in Northern Ireland during which actors were used to create two scenarios: l Scenario 1: A man in his late 60s suffering from an impacted bowel asked to speak to the pharmacist and reported his symptom as constipation. On questioning he divulged additional information which, if the pharmacist was astute enough, would warrant referral to the GP Scenario 2: A 35-year old woman suffering from headache asked to speak to the pharmacist and reported her symptoms as "severe" headache. She had been trained to give additional information that confirmed migraine if questioned Venting our emotions usually means that we calm down, become more rational, see the bigger picture and perhaps, see why we are being naive or narrow-minded. Failure to allow this process to occur presents a huge barrier to good communication. Empathy Empathy is seeking to understand where other people are coming from -- what their wants and needs are. This allows for more productive and constructive dialogue. Empathy is a state of harmony that exists between two people. It is a positive state that encourages better communication and better outcomes. Lack of empathy does just the opposite. I referred a patient to a GP with a note that her blood glucose should be further investigated. I quoted a random blood glucose of 17.9 mmol L measured in the pharmacy ; , which gave me cause for concern. Rather than being delighted at the idea of teamwork between GPs and pharmacists, the doctor was incensed. He questioned what right I had to interfere with his patients and indeed frighten them unnecessarily with false diagnoses which I had no right to be making. Although I could simply have said that the GP was being gratuitous, I needed to understand why I received this rebuke. The GP felt he was being admonished for not spotting poor diabetic control in his patient and to his shame, his negligence was being picked up by others. He saw my actions as a personal slight and not wishing to lose face he fought back. The remedy was to ensure that the GP was made aware of the service I was providing and the extent of my involvement ie, I was not diagnosing diabetes but was merely identifying patients for him to investigate further ; . Communication of my intentions for better patient care, complementing and respecting his role, would have greatly reduced the likelihood of this unnecessary conflict, for example, lactic acidosis.
Hoya Lens Australia has released a new 1.67-index lens material Eynoa. The material is thin, lightweight and strong. It comes with Visual Perfection scratch-resistant and smudge free multicoat as standard in stock lenses and with Super Final Touch smudge-free multicoat coating, which is as scratchresistant as glass, for grind jobs ex-Japan. Eynoa 1.67 material is suitable for young presbyopes with a dynamic lifestyle, as well as for older ones. Three multifocal designs Eynoa is available in three multifocal designs, each with its own characteristics: Hoyalux iD Integrated Double Surface Progressive Design ; , the first ever double-surface multifocal design. Hoyalux Summit Pro is intended for consumers who value premium quality, but also want to keep within a certain budget. It ensures that the wearer has natural vision at higher addition values. Hoyalux Summit CD, the optimal design for fashion-conscious presbyopes, especially the younger generation. Summit CD is ideal for small, trendy frames, and offers complete freedom in terms of style combined with maximum visual comfort. In addition to these multifocals, Eynoa 1.67 is also available in two single vision designs: Nulux Eynoa 1.67 and Hilux Eynoa 1.67. Visual Perfection coatings offer a number of benefits: ease of cleaning; water and grease resistance; and they attract less dust and grime. Super Final Touch coatings offer: scratch resistance like glass; ease of cleaning; water and grease resistance; and they attract less dust and grime and ismo!
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The Ottawa ankle rules" Stiell et al., 1993 ; developed in 1992 at the Ottawa Civic Hospital, provide a nice example. These rules provide a simple but very effective set of observational techniques for determining, without X-ray, whether an injured ankle is fractured. Sprained ankles are one of the commonest problems presented in the emergency room, and are typically X-rayed; on average only about 15% are found to be fractured. ; Yet ten years later this diagnostic procedure is still being debated, and its application resisted. Heyworth 2003 ; in an editorial in the British Medical Journal writes: "In this issue, Bachmann et al p. 417 ; report a systematic review of 27 studies evaluating the implementation of the Ottawa ankle rules. A sensitivity of almost 100% was confirmed, with a possible overall reduction in the number of radiographs performed of 30-40%. Despite these impressive figures, the use of the Ottawa ankle rules remains variable, with far more common use reported by clinicians in Canada and the United Kingdom compared with the United States, France, and Spain.7 Critics of the decision rule concept cite loss of clinical autonomy and reluctance to practise within rigid guidance. However, such resistance is difficult to support given the large amount of evidence in favour of the Ottawa ankle rules." For cases of suppression of research by threatened interests, see Deyo et al. 1997 and sorbitrate and micronase, for example, amaryl.
Impaired oral function also has a number of troubling consequences: difficulty eating, impaired nutritional intake, poor communication and interpersonal contacts, and ultimately a breakdown in the host's defense mechanisms. Saliva is important to the maintenance of the health of the oral cavity because it provides a broad defense against numerous oral problems. The lack of saliva can cause dental caries and predispose a person to periodontal problems, mucosal and taste disorders, difficulties swallowing, and a variety of serious diseases. Salivary hypofunction is common in the elderly due to numerous medical problems and their treatments e.g., medications, chemotherapy.
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All studies 15 ; cite trials reported by Raskind et al., Wilcock et al., and Tariot et al., to establish effectiveness Getsios et al. present summary findings from the trials, but all other studies failed to present findings from the clinical trials cited.
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Grade 3 or 4 adverse events compared with the mitoxantrone group p 0.001 ; . Fifty-four 16% ; patients in the docetaxel group and 32 10% ; of patients in the mitoxantrone group discontinued treatment due to adverse events. Eight patients 2% ; in the docetaxel group and four patients 1% ; in the mitoxantrone group died as a result of treatment-related adverse events. Table 7 shows the proportion of patients experiencing grade 3 or 4 adverse events. Summary Summary results are given in Table 8.
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Inappropriate in others. The fact that a health assistant used to dispense drugs in the absence of the qualified pharmacist in some pharmacies makes the rationale for restriction of pharmacy license to pharmacists meaningless. A considerable percentage 40% ; of drug dispensers said that they dispense even a partial dose of prescription-only-medication which is inappropriate professional practice. These drug dispensers said that they usually advise the patients to collect the remaining dose s ; in some other time. Because some patients stop taking even medications at their hands when they feel a sort of improvement from the ailments 11 ; , dispensing partial dose means inviting the patients for noncompliance to clinical prescriptions with all consequences of non-compliance. Up-to-date drug information is not accessible to the majority of drug-dispensers 80% ; and most of them particularly health assistants use inserted package leaflets as a main source of drug information. Inserted package leaflets may contain manipulated information about a particular drug as they are prepared by drug companies and thus are subject to bias. Although a workshop on rational drug use in Ethiopia proposed strategies to provide objective and unbiased information to prescribers, dispensers and the community some ten years ago 6 ; , no change has yet been seen. Periodical upgrading of the pharmaceutical knowledge of the professionals is important for proper selection, procurement, storage, and dispensing of drugs as well as instructing the patients and the community about the proper use of drugs. The average prices of locally produced drugs are relatively lower than those of imported ones with the same dosage form and strength. The complaint of some local drug manufacturers not to cope up with market competition of imported pharmaceuticals because they are cheaper personal communication with a representative.
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Discontinued ; glez diabeta , glibenclamide , glyburide , glynase , micronase ; used to treat type 2 noninsulin-dependent ; diabetes formerly adult-onset ; , particularly in people whose diabetes cannot be controlled by diet alone.
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HSC's 12th Annual Wall Street Comes to Washington Conference: Hospital, Physician and Pharmaceutical Trends and Closing Remarks 6 14 07 PAUL GINSBURG, PH.D.: JEFF SCHAUB: Yes, Jeff?.
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Notice is hereby given that sealed bids addressed to the Purchasing Department of Jefferson County, 1149 Pearl Street, Beaumont, Texas 77701, will be received until 11: 00 am, May 5, 2003, at which time said bids will be publicly opened and read for Bid Number 03-046 DG, Pharmaceuticals and Pharmaceutical Supplies for Jefferson County. Bids shall be submitted for unit pricing. Payment shall be from current funds. Envelopes containing bids must be so marked or they will not be considered. Copies of specifications may be obtained from the Purchasing Department, 1149 Pearl Street, First Floor, Beaumont, Texas, or from Jefferson County's Internet site at: : co.jefferson.tx purchasing main htm All interested firms are invited to submit a bid in accordance with the terms and conditions stated in this bid. RESPONDENTS ARE STRONGLY ENCOURAGED TO CAREFULLY READ THE ENTIRE INVITATION.
Ost dentists are very knowledgeable about the contraindications, interactions and adverse effects of the medications that compose their own therapeutic arsenals. However, with the myriad of drugs available over the counter and by prescription, it is extremely difficult for dental prescribers to be aware of every medication's pharmacological profile. When prescribing, practitioners often risk overlooking some detail that may result in suboptimal treatment. At best, these prescribing errors may be an inconvenience to the patient. At worst, poor prescriber judgment may result in significant patient morbidity, or even mortality, and can damage the doctor-patient relationship, possibly to the point of litigation. Health care providers are now charged by third-party payers, legislators and the public with the responsibility of maximizing positive patient outcomes. At a conference on pharmaceutical care, Gerbino noted that, in today's litigious society, "thou shalt do no harm" has been replaced by "thou shalt be complete."' An important aspect of this enhanced standard of care is the drive to improve the overall quality of medication use. Practitioners now are expected to use medical history, concomitant disease states and other patientspecific factors when making pharmacotherapeutic decisions. This article is intended to provide clinicians with a relatively simple, systematic approach to establishing treatment regimens that will allow for detection and avoidance of prescribing errors.
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