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Phillip P Brown, HCA CCMN, Nashville, TN; Aaron D Kugelmass, Henry Ford Hosp, Detroit, MI; Frank Houser, Lynn G Tarkington, HCA CCMN, Nashville, TN; April W Simon, Cardiac Data Solutions, Inc., Atlanta, GA; Steven D Culler; Emory Univ Rollins Sch of Public Health, Atlanta, GA Objective: This study describes a voluntary, continuous quality improvement CQI ; program with the objective of increasing the use of evidence based medicine EBM ; structures and processes for cardiovascular care in HCA facilities. Methods: HCA's Cardiovascular Centers of Excellence COE ; program was developed to encourage CQI in HCA hospitals. Initially, 158 hospitals participated. Each hospital completed a web based survey of 1600 questions designed to evaluate CV care currently in place. Prior to and following the enrollment period, for example, tetracyclene. Several studies show that Black women are twice as likely to douche as White women, stats buoyed by the plethora of personal hygiene products peddled to us. But douching actually does much more harm than good. Most products wash away lactobacillus, some 10 normal bacteria and organisms that help keep our female organs healthy. Douching can cause pelvic inflammatory disease, which can lead to infertility, and other vaginal infections and irritation, as well as spread sexually transmitted diseases into the uterus, ovaries and fallopian tubes, causing even greater health risks. So how do you clean yourself without douching? "By bathing and albendazole. 7. Yates BJ, Miller AD, Lucot JB: Physiological basis and pharmacology of motion sickness: an update. Brain Research Bulletin, 1998; 47: 395406 Drummond PD: Motion sickness and migraine: optokinetic stimulation increases scalp tenderness, pain sensitivity in the fingers and photophobia. Cephalalgia, 2002; 22: 11724 Furman JM, Marcus DA, Balaban C: Migrainous vertigo: development of a pathogenetic model and structural diagnostic interview. Curr Opin Neurol, 2003; 16: 513 von Brevern M, Zeise D, Neuhauser H et al: Acute migrainous vertigo: clinical and oculographic findings. Brain, 2005; 128: 36574 Nishiike S, Takeda N, Kubo T, Nakamura S: Noradrenergic pathways involved in the development of vertigo and dizziness a review. Acta Otolaryngol Suppl, 2001; 545: 6164 Takeda N, Morita M, Horii A et al: Neural mechanisms of motion sickness. J Med Invest, 2001; 48: 4459 Halberstadt AL, Balaban CD: Organization of projections from the raphe nuclei to the vestibular nuclei in rats. Neuroscience, 2003; 120: 57394 Jeong HS, Lim YC, Kim TS et al: Excitatory effects of 5-hydroxytryptamine on the medial vestibular nuclear neuron via the 5-HT2 receptor. Neuroreport, 2003; 14: 20014 Javid FA, Naylor RJ: The effect of serotonin and serotonin receptor antagonists on motion sickness in Suncus murinus. Pharmacol Biochem Behav, 2002; 73: 97989 Burstein R, Collins B, Bajwa Z, Jakubowski M: Triptan therapy can abort migraine attacks if given before the establishment or in the absence of cutaneous allodynia and central sensitization: clinical and preclinical evidence. Headache, 2002; 42: 39091 Neuhauser H, Radtke A, von Brevern M, Lempert T: Zolmitriptan for treatment of migrainous vertigo: a pilot randomized placebo-controlled trial. Neurology, 2003; 60: 88283 Yates BJ, Miller AD, Lucot JB: Physiological basis and pharmacology of motion sickness: an update. Brain Research Bulletin, 1998; 47: 395406 Marcus DA, Kapelewski C, Jacob RG et al: Validation of a brief nurseadministered migraine assessment tool. Headache, 2004; 44: 32832 Headache Classification Subcommittee of the International Headache Society: The international classification of headache disorders. 2nd edition. Cephalalgia, 2004; 24 Suppl.1 ; : 1160 21. Marcus DA, Kapelewski C, Rudy TE et al: Diagnosis of migrainous vertigo: validity of a structured interview. Med Sci Monit, 2004; 10 5 ; : CR197CR201 22. Furman JM, Wuyts F: Clinical Application of Vestibular Laboratory Testing. In: Luxon LM, Martini A, Furman JM, Stephens D, editors. Textbook of audiological medicine. London: Martin Dunitz, 2003: 73546 23. Wilkins A, Nimmo-Smith I, Tait A et al: Neurological basis for visual discomfort. Brain, 1984; 107: 9891017 Marcus DA, Soso MJ: Migraine and stripe-induced visual discomfort. Arch Neurol, 1989; 46: 112932 Furman JM, Schor R, Schumann T: Off-Vertical Axis Rotation: A Test of the Otolith-Ocular-Reflex. Ann Otol Rhinol Laryngol, 1992; 101: 64350 Kennedy RS, Lane NE, Berbaum KS, Lilienthal MG: Simulator sickness questionnaire: an enhanced method for quantifying simulator sickness. Int J Aviat Psychol, 1993; 3: 20320 Wolpe J: The practice of behavior therapy. New York, Pergamon Press, 1982 28. Furman JM, Marcus DA, Balaban CD: Migrainous vertigo: development of a pathogenetic model and structured diagnostic interview. Curr Opin Neurol, 2003; 16: 513 Halberstadt AL, Balaban CD: Organization of projections from the raphe nuclei to the vestibular nuclei in rats. Neuroscience, 2003; 120: 57394! The risk that comes along with newer medications is that some physicians and patients have started to believe there is a drug to treat any type of ailment without considering that these new drugs are very powerful and potentially very dangerous if used for the wrong indications and spironolactone. Ministry of health nutrition programmes are found in other poor and food deficit districts in zimbabwe.
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