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A-PSRS has received a number of reports of a complication during delivery that may be prevented or substantially reduced: fetal lacerations associated with Cesarean section C-section ; . While approximately half of the reports of this type of occurrence are reported under Event Type F.5.d. neonatal complication, birth injury or trauma ; , the remainder are classified under other Event Types. Incidence in Reporting While most of the lacerations reported to date have been superficial, some have required suturing and or plastic surgery intervention. This occurrence has been reported by at least 20 facilities, ranging from university medical centers to small community hospitals. Consistent with the clinical literature, approximately 70% of the lacerations occurred on the face, head, and ear. Approximately 20% of the lacerations occurred below the waist buttocks, leg, ankle ; , while 10% were on the back. Emergency Csections were documented in 20% of the reports. Background A range of incidence rates for this complication exists in the clinical literature. In studies involving a review of nearly 900 C-sections, the rate of fetal laceration injury ranged from 1.5% to 1.9%.1, 2 However, in one larger study involving over 2, 000 Csections, the incidence of fetal laceration was 0.74%.3 One study indicated that a non-vertex presentation was associated with a 6% fetal laceration rate.1 However, this factor was not found to be statistically significant in other studies.2-4 Risk factors associated with increased risk for neonatal laceration identified in the literature include: 3-5 Ruptured membranes prior to C-section Low transverse uterine incision Active labor Emergent urgent C-section Inexperience of the surgeon or resident. Naprelan 375 mg cr tabletMs. Kelly Hawsey of Life Reach at Providence Hospital reported to the committee that Providence Hospital is requesting approval for participation in the Life Reach Cricothyrotomy Pilot Project. Ms. Hawsey distributed a handout to the Committee that described the service, the need for the program, equipment and functions; cost effectiveness, the procedure etc. Dr. Norcross asked if it were true that one half of the service's transports are trauma; even with Palmetto Richland's helicopter service. Ms. Hawsey answered "yes." Dr. Norcross stated that at Meducare only 2 cricothyrotomies have been done in the past 10 years and he cautioned that it is difficult to keep skills up in this situation. The question was asked if RSI were available. Ms. Hawsey said that the policy is that surgical cricothyrotomies would be used as a last ditch effort after other means have been exhausted. The question was asked about how cricothyrotomies would be taught? Ms. Hawsey answered, by didactic and manikins. Dr. Norcross stated that he does not want to see cricothyrotomies performed statewide at the EMS level until RSI is approved statewide. Mr. Smith stated that the total statewide scope of practice needs to be reviewed and changes made. Dr. Sorrell stated that he felt that cricothyrotomies should be made a local option for medical control, and, short of that, a motion should be made to approve this pilot project. Dr. Norcross made a motion to allow Life Reach to participate in this pilot project, using the training and guidelines set from Meducare. Meducare and the Medical Control Committee will address the issue of RSI and cricothyrotomies for a statewide optional skill at the next meeting. Dr. Rogers seconded the motion. All were in favor. The motion passed. 12-LEAD EKG FOR EMT-B Dr. Staggs, Aiken County's Medical Control Director, informed the Committee that Aiken County EMS has been utilizing 12-lead capability for approximately three years. He stated that the problem that exists is that a paramedic must be present to conduct the 12-lead. Aiken County is requesting that EMT-B's and EMT-I's be trained in the use of 12-lead EKGs for transmission to the ED physician. He explained that training would consist of a four hour course covering: the review of anatomy and physiology of the cardiovascular system, equipment familiarization, practice acquiring the 12-lead and practice transmitting EKG. Dr. Norcross asked if use of the 12-lead would be restricted to Aiken? Dr. Staggs stated that this would be for statewide use. Mr. Smith felt that this would be a change in the scope of practice. He recommended reconsidering the use of the 12-lead. He stated that this may cause confusion in the EMT and noroxin. Implementing a community drug awareness program need not involve large sums of money. The important thing to remember is that there are organizations willing and able to help young people make a difference in fighting drugs. Potential sources of support may include service or civic clubs, neighborhood watch groups, local corporations, etc. The Elks are one service group which has selected drug abuse prevention as a major project. In addition, groups can earn money by holding events such as dances, bowling, car washes, bake sales, etc. The Brown list is a list of all drugs which have been considered by the Oxfordshire Area prescribing committee as not recommended for prescribing across Oxfordshire. This will be because there is no good cost-effectiveness data, their use has been replaced by other medicines or for other reasons as detailed below. It is recognised that whilst the prescribing of some of those listed below will be zero there may be a few patient specific indications for prescribing them. The prescribing team have identified 7 medicines which they believe are not suitable for prescribing. We currently spend over 800k year on these 7 preparations and it is suggested that this resource could be better spent elsewhere. Below is a list of these medicines and possible alternatives and norfloxacin. 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There is some evidence that nonsteroidal anti-inflammatory drugs NSAIDs ; offer some protection against prostate cancer. NSAIDs suppress chemical in the body called COX-2, a protein that may cause prostate cancer cells to spread. Standard NSAIDs include aspirin, ibuprofen Advil ; , and naproxen Aleve, Naprosyn, Naprelan, Anaprox ; . Many other NSAIDs, such as sulindac Clinoril ; , are available only by prescription and are being studied for protection. Newer agents, such as celecoxib Celebrex ; , rofecoxib Vioxx ; , valdecoxib Bextra ; , and meloxicam Mobic ; may warrant specific investigation. A 2002 study reported a 50% reduction in the risk for prostate cancer in men over 60 who took a daily NSAID, although conclusive evidence is still needed and nicotine. Public Citizen, "Rx R&D Myths: The Case Against the Drug Industry's R&D `Scare Card', " 2001. 18 Id. 19 Id. 20 Id. 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Osteoporosis medication is page about osteoporosis medication. In epidemiological studies, the consumption of saturated fat is more strongly correlated with mortality than stress or even cigarette smoking. 25 Belgium epidemiologist H. Kesteloot, who presided over two international nutrition and health symposiums, writes "A decrease in the dietary intake of saturated fat . should get the highest priority as a means to improve public health."26 What is the greatest source of saturated fat? Dairy products supply about one-third of the saturated fat in the typical American diet. Red meat supplies another third, and poultry and fish contribute the next highest amounts. The vegan diet tends to contain very little saturated fat, and the proportion of saturated fat to total fat tends to be low as well. The only concentrated sources of saturated fat in the plant kingdom are tropical oils and artificially hydrogenated oils like margarine. 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Source: Ohio Medicaid Statistical Information System, 1999 and CMS, HCFA-64 Report, FY 2000. * 2000 data on recipients and expenditures by maintenance assistance status and basis of eligibility are unavailable. You can use a list to let your doctor and pharmacist know about everything you are taking, and about any drug allergies you may have. Remember to include prescriptions, over-the-counter medicines and complementary medicines such as vitamins and herbs ; on your list. Accessed: May 1, 2007 Evangelista, R. P500m in fake drugs seized. Manila Standard Today. June 23, 2007. Available from: : manilastandardtoday ?page poli ce june23 2007 Accessed: June 26, 2007 Asian countries on the road to tackle counterfeits. SCRIP World Pharmaceutical News Feb 20, 2004. Issue 2928; west Sussex, UK. PJB Publications Ltd: 18. Nonsteroidal Anti-inflammatory Drugs NSAIDs ; . Over-the-counter nonsteroidal anti-inflammatory drugs NSAIDs ; may be sufficient for about 75% of women with endometrial pain. NSAIDs block prostaglandins the substances that increase uterine contractions ; . They are effective painkillers and also have other properties that act against inflammatory factors. Aspirin is the most common NSAID, but there are dozens of others available over the counter or by prescription. Among the most effective NSAIDs for menstrual disorders are ibuprofen Advil, Motrin, Midol PMS ; , naproxen Aleve, Naprosyn, Naprelan, Anaprox ; , and mefenamic acid Ponstel ; . For maximum benefit, they should be taken seven to 10 days before a period is expected. It should be noted, however, that long-term use of any NSAID, can increase the risk for gastrointestinal bleeding and ulcers. In fact, one 2001 study of women with iron deficiency anemia reported that overuse of NSAIDs for menstrual disorders contributed to the anemia. COX-2 Inhibitors. Celecoxib Celebrex ; , rofecoxib Vioxx ; , and valdecoxib Bextra ; are known as cyclooxygenase-2 COX-2 ; inhibitors, . Meloxicam Mobicox ; is a related drug known as a COX-2 preferential. These agents are effective painkillers and are being used with some success for menstrual cramps. They have actions that are similar to those of NSAIDs, but theoretically COX-2 inhibitors should be less harmful to the GI tract than standard NSAIDs. Studies to date are somewhat mixed, with most reporting few problems. Still experts urge that studies are needed that are not sponsored by drug manufacturers in order to get a clear picture or their risks and benefits. 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