Hisamichi Yuda Department of Respiratory Medicine, Mie Prefectural General Medical Care Center, Japan ; Fung J. Lin Respiratory Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan ; T.K. Lim Department of Medicine, National University Hospital, Singapore.
The goal of pharmaceutical companies is to maximise their profit and the return for their shareholders. The commercial imperative underlying their activities is driven by this ethos. "Regardless of what a company is selling, they are in the business of making money and satisfying their fiduciary duties. Pharmaceutical companies are no different. They are in the business of making money by selling pharmaceuticals. For them to operate the management must generate the highest level of profitability possible to fulfill its fiduciary duty of maximising shareholder value." 8 There is a clear and well-recognised link between DTCA and growth in prescription drug spending and utilisation9 . Expenditure on DTCA is growing world-wide at an exponential rate Spending on DTCA has grown exponentially over recent years Figure 1 ; . In 1995 in the United States $US375 million was spent on DTCA. This rose dramatically to $US791 million in 1996, then rose to 1.3, 2.5 and over 2.7 billion dollars in 1996, 1998, 2000 and 2001 respectively, for instance, autism bricanyl firm law.
Dr. C.R. Kumana, BSc, MB, FRCP Reader in Medicine Clinical Pharmacologist University of Hong Kong The choice of antihypertensive therapy in diabetes mellitus constitutes a very large topic which cannot be covered comprehensively in the space of this article. Under the circumstances, there will be a focus on certain aspects of antihypertensive drug therapy with particular reference to a ; the treatment of mild to moderate hypertension not severe hypertension or emergency treatment ; , b ; issues which are clinically relevant to general practitioners and c ; popular first and second line agents viz; - adrenergic antagonists, thiazide diuretics, and vasodilators ; , as are commonly used in the stepped care approach to antihypertensive treatment!
Consider alternate sources or causes for these FMS symptoms so that the patient is not subjected to unnecessary and sometimes potentially harmful investigations and treatments. Headache: vascular migraine, space-occupying intracranial lesions, temporal arteritis Ocular disturbance pain: glaucoma, iritis Auricular disturbance pain: otitis interna media externa, posterior fossa tumor Sinonasal pain stuffiness: infective or vasomotor rhinitis sinusitis Temporomandibular pain: temporal arteritis Neck spasm swelling: lymphadenopathy Dysphagia: obstructive lesion, pharyngitis Dysphonia: laryngitis Dyspnea: pulmonary disease, airway obstruction Chest pain: pleurisy, pulmonary embolism, angina pectoris, myocardial infarction, pericarditis, gastroesophageal reflux, costochondritis Abdominal pain: intraabdominal pathology, renal colic Irritable bowel: bowel infection infestation inflammation, villous adenoma, diverticulitis Irritable bladder: bladder infection, renal colic Pelvic pain: pelvic organ pathology Dizziness imbalance: vestibular neuronitis, cardiac arrhythmia, cerebellar dysfunction Swelling vasomotor instability of extremities: arthritis, impaired circulation Cognitive impairment: Alzheimer's, depression Paresthesia weakness: multiple sclerosis, peripheral neuropathy Claudication: vascular insufficiency, because budesonide.
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Prescribing of emergency hormonal contraception is falling as more women realise that there are simpler ways of obtaining it than seeing their GPs. The latest statistics on contraception services in England show that the number of EHC prescriptions fell by 2 per cent between 200203 and 200304. This repeats a 2 per cent fall from the previous year. However, national survey data show that the percentage of women obtaining EHC from pharmacies has fallen from 33 per cent in 200203 to 27 per cent in 200304. Conversely, the percentage obtaining EHC from walk-in centres or minor injuries units over the same two years rose from nil to 11 per cent. EHC guidance The Royal Pharmaceutical Society has updated its guidance to pharmacists on selling EHC as a pharmacy medicine. The new guidance reflects the recent change to the dosage used from two 750g levonorgestrel tablets taken 12 hours apart to a single dose of 1.5mg levonorgestrel taken within 72 hours of unprotected sexual intercourse and terbutaline.
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Patients. TEE has been touted as a useful intraoperative monitor for assessing wall motion, left-ventricular contractility, and the need for infusion of IV fluid. For these reasons, we performed our examination 4-6 ; . The effectiveness of TEE as a monitor, and whether its use improves patient outcome, remains unclear. At issue is the quality of data interpretation when TEE is performed by anesthesiologists. In this case, the TEE study quickly ruled out ventricular failure, volume overload, and acute valve dysfunction as causes of the high alveolar-to-arterial oxygen gradient, and confirmed the need for additional fluid administration. Additionally, TEE identified the patient's left-atria1 myxoma. Placement of a pulmonary artery catheter may have helped in the hemodynamic management of the patient, but could not have provided a diagnosis of left atria1 myxoma or detailed direct information regarding cardiac function. Clearly, TEE is not needed for routine monitoring of patients undergoing general anesthesia; however, this case illustrates how TEE can be helpful in diagnosing and managing patients who have an unstable cardiovascular status. It is important to remember TEE's diagnostic power, as well as its usefulness as a monitor, particularly when it is not possible to perform a thorough preoperative cardiovascular evaluation, for example, pulmacort.
A significant outcome of our integrated approach, has been the development of Recombinant Human Insulin on a commercial scale. The success of this technology has been endorsed by a long-term supply agreement with Bristol-Myers Squibb and a Drug Master File submitted to US FDA. In the very near future, we will also be launching our finished formulation `Insugen', and are confident that it will compete effectively in the Indian market. Simultaneously, we are exploring global opportunities for generic Insulin in semi and non-regulated markets in the short term and regulated markets in the medium term. We believe Insulin to be a key growth driver for us in the future and betamethasone.
Prevention of venous thromboembolic events abdominal surgery ; 289 06 Rotigotine patch NeuPro ; Parkinson's disease 288 06 Paricalcitol injection Zemplar ; Secondary hyperparathyroidism 290 06 Pegaptanib intravitreal injection Macugen ; Age-related macular degeneration 291 06 Ertapenem paediatric infusion Invanz ; Intra-abdominal infections 292 06 Salmeterol inhaler Serevent Evohaler ; Regular symptomatic treatment of reversible airways obstruction 294 06 Travoprost timolol eye drops Duotrav ; Open angle glaucoma 296 06 Losartan hydrochlorothiazide Cozaar-comp ; Essential hypertension 308 06 Testosterone injection Nebido ; Testosterone deficiency 309 06 Carbetocin injection Pabal ; Uterine atony and excessive bleeding following Caesarean section 310 06 Rivastigmine Exelon ; Dementia in patients with Parkinson's disease 177 05 Beclometasone inhaler Clenil Modulite ; Asthma The following changes and additions have been made to the Lanarkshire formulary since the publication of the previous prescribing supplement in March 2006 Dorzolamide 2% preservative free unit dose eye drops added to section 11.6 Desmopressin 120 microgram oral lyophilisate DesmoMelt ; added to section 7.4.2 Testosterone 50mg 5g gel Testim ; added to section 6.4.2 Blood glucose monitoring strips added to section 6.1.6 Terbutaline Brixanyl ; MDI discontinued section 3.1.1 Clobetasol propionate Dermovate NN ; ointment discontinued section 13.4 Apomorphine Uprima ; tablets discontinued section 7.4.5 Cardioplen XL replaces felodipine m r tablets section 2.6.2 Levonelle-2 changed name to Levonelle 1500 section 7.3.1 Roc Total Sunblock changed name to ROC Sante Soleil section 13.8.1 Gliclazide m r 30mg tablets should be reserved for patients with demonstrable compliance problems Clobetasol propionate cutaneous foam comment added to section 13.4.
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Workshop Chair: Prameet Singh, MD, Beth Israel Medical Center, New York, NY Workshop Presenters: Richard Rosenthal, MD, St. Luke's Roosevelt Hospital Center, Columbia University, New York, NY; Martin Kron, MD, Beth Israel Medical Center, New York, NY Date: Friday, December 10 Time: 2: 00-3: 30 p.m. Location: Gardenia 1 Addicted patients frequently present with psychiatric symptoms at the gateway into treatment. Often it is the psychiatric symptoms themselves that are the impetus for seeking help. Consequently, the treatment sought is psychopharmacological in nature. However many of these syndromes would subside once the person achieved a period of sobriety, and do not in fact warrant medication treatment. To treat with psychiatric medications in fact may be harmful, as it detracts from addictions treatment by reinforcing the and urecholine.
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Petavy, A.-F., Deblock, S. & Gilot, B. 1984 ; Mise en evidence de la larve du Taenia multiloculaire chez 2 campagnols Microtus arvalis et Clethrionomys glareolus ; dans le foyer d'echinococcose alveolaire du Massif Central France ; . Comptes Rendus de l'Academie des Sciences Paris ; , serie III 299, 735 737. Petavy, A.-F., Deblock, S. & Walbaum, S. 1990 ; The house mouse: a potential intermediate host for Echinococcus multilocularis in France. Transactions of the Royal Society of Tropical Medicine and Hygiene 84, 571 572. Rey, M., Morin, B., Petavy, A.-F., Cambon, M. & Baril, A. ` 1977 ; Premieres observations auvergnates d'echino coccose alveolaire. Nouvelle Presse Medicale 17, 4070 4071. Viel, J.-F., Giraudoux, P., Abrial, V. & Bresson-Hadni, S. 1999 ; Water vole Arvicola terrestris scherman ; density as risk factor for human alveolar echinococcosis. American Journal of Tropical Medicine and Hygiene 61, 559 565.
WHOLE-BODY BAROMETRIC PLETYSMOGRAPHY IN HEALTHY DOGS: REPEATABILITY AND MEASUREMENT OF AIRWAY RESPONSIVENESS. J. Talavera1, F. Billen1, P. Gustin2, N. Kirschvink2, C. Clercx1. 1Department for clinical sciences B44, 2 Department for functional sciences B41, Faculty of veterinary medicine, University of Lige, Lige, Belgium. Barometric whole-body pletysmography BWBP ; is a non-invasive technique able to monitor airway responses to induced bronchoconstriction, as shown in rodents and cats. So far this technique has not yet been used in dogs. The aims of this study were to assess the validity of BWBP in healthy dogs and to standardize a simple bronchoconstriction test to investigate airway responsiveness in healthy dogs using BWBP. Six healthy beagle dogs 14 to 18 kg; 6 to 8 years ; were used. The chamber of BWBP Model PLY 3220, Buxco Electronics Incorporated, Sharon, CT, USA ; included a test chamber inner volume of 299, 5 L ; and a reference chamber, a differential pressure transducer attached to both chambers, a preamplifier and a computing system for recording, digitalizing and calculating box pressure derived parameters. Continuous bias flow 8 L min ; was introduced by controlled suction Bias Flow Regulator PLY 1050, Buxco Electronics Inc, Sharon, Conn ; . Values calculated from the box signal included frequency, tidal volume, inspiratory and expiratory times, peak inspiratory and expiratory flows, pause and enhanced pause Penh ; . Penh was used as an index of bronchoconstriction. In order to evaluate the repeatability of the BWBP measurements and the influence of the time passed into the chamber, respiratory variables were collected during two morning and two evening sessions of 10.5 minutes each. Data from each 10.5 minutes session were then divided in three 3.5 minutes periods. For the bronchoprovocative challenge, the respiratory variables were recorded during 5-minutes period before and after 3-minute of aerosol administration jet nebulizer, AIGLON, Impec ; of saline solution and each increasing concentrations of histamine 0.1, 0.2, 0.4, and 1.4% ; directly into the chamber. When mean value for Penh of 10 consecutive breaths exceeded 300% baseline, additional aerosol administration was not performed. A two-way ANOVA was used to test for differences between sessions and periods, the influence of histamine concentration on respiratory parameters as well as to test for the repeatability of bronchoconstrictive challenge p 0.05 ; . Basal values of Penh were 0.74 0.19 0.45-1.02 ; . There were no significant effects of the session or periods in the measurements, but there was a significant dog effect. Bronchoprovocative challenge with histamine was safe, highly reproducible and induced a significant increase in Penh. In conclusion: 1 ; BWBP is a safe, non-invasive and valid method for monitoring respiratory function in dogs, 2 ; Penh is a sensitive index for bronchoconstriction and 3 ; challenge with increasing concentrations of histamine is a reproducible and safe method of investigation of bronchoreactivity in dogs and casodex.
13. 1. McKenna RJ 1994 ; Clinical aspects of cancer in the elderly. Cancer 74: 210721 17 Bergam L, Dekker G, Van Leeuven F, Huisman SJ, Van Dam FS, Van Dongen JA 1991 ; The effect of age on treatment choice and survival in elderly breast cancer patients. Cancer 67: 22272234 3. Fentiman LS 1991 ; Treatment of cancer in the elderly. Br J Cancer 64: 993994 4. Donato V, Montagna A, Musio D, Cellini N 1999 ; Radiotherapy in the symptomatic treatment of the oncological patients. Anticancer Res 19: 33753382 5. Cassel CK 1998 ; Money, medicine and Methuselah. M Sinai J Med 65: 237245 6. Hulshof MC, Koot RW, Shimmel EC, Dekker F, Bosch DA, Gonzalez Gonzalez D 2001 ; Prognostic factors in glioblastoma multiforme. Ten years' experience of a single institution. Strahlenther Onkol 177: 283290 7 . Hercbergs AA, Tadmor R, Findler G, Sahar A, Brenner H 1989 ; Hypofractionated radiation therapy and concurrent cisplatin in malignant cerebral gliomas. Rapid palliation in low performance status patients. Cancer 64: 816820 8. Hulshof MC, Schimmel EC, Andries Bosch D, Gonzales Gonzales D 2000 ; Hypofractionation in glioblastoma multiforme. Radiother Oncol 54: 143148 9. DeAngelis LM 2000 ; Radiotherapy of the brain in elderly patients. Arb Eur J Cancer 36: 451452 10. Bartelink H, Horiot JH, Poortmamns PM, et al 2001 ; Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med 345: 13781387 21.
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Finally, a study by IMS Health found that, in the one year after an advertising campaign began for an osteoporosis drug, physician visits by women concerned about this disease doubled. So clearly, it is raising awareness, it is creating a dialogue between patients and doctors, which we believe is very important to the overall healthcare system. There's also considerable evidence that consumers appreciate DTC advertising. You saw some of the numbers and the difference between those who viewed the ads and those who were not viewing the ads in this test sample. But in a survey, or I should say, and in a survey conducted by the FDA in 1999, 62 percent of those surveys said the ads helped them have better discussions with their physicians about their health. And another study by Prevention Magazine found that 72 percent of respondents felt the ads "educate people about the risks and benefits of prescription medicines." There's also a growing acceptance among doctors of DTC advertising and we're gonna obviously hear from Dr. Levine but, in the past, some physicians have expressed concerns about DTC advertising. However, a study conducted last year by Harris Interactive and the Harvard School of Public Health found that 64 percent of doctors believe DTC advertising of prescription drugs had helped "educate and inform their patients." And 40 percent believed the ads increased patient compliance. So again, very good benefits from direct-to-consumer advertising. And a 1999 survey by the FDA suggests that patients are seeking additional information, this all goes back to the empowerment question and the consumer movement, as a result of DTC promotions and that "this could represent a significant and positive health benefit, particularly if these patients are talking about an undiagnosed heart disease, or other serious disorders." As I started off, the pharmaceutical industry's in the business of discovering, developing and marketing treatments and cures. And our hope is that more and more healthcare leaders will be supportive of patients and against those who are advocating, or asking for, a don't ask--I'm sorry, let me get this right. A don't tell, don't ask policy. That is, don't tell patients about the treatments and hope they don't ask for them. Instead, we hope there's continuing support for a patient's right to know about treatments and cures that are available to them, seeking information from a variety of sources, and discussing that with their doctors because, ultimately, we believe that the physician is the one who is responsible for, capable of, and ultimately the expert in prescribing the right treatment or cure. Just one other comment today. A note from this summer, you'll recall maybe that the National Institutes of Health told us over the summer that as many as 23 million more Americans should be taking drugs to prevent strokes, heart attacks and other calamities brought on by high cholesterol. And DTC advertising is the most efficient way to reach those people clearly. And fortunately, cholesterols are among the most advertised drugs, so people will be getting that information.
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DataStar Documents Alcohol and alcoholism Oxford Oxfordshire ; Jul- Aug 2006 epub: 25 Apr 2006 ; , vol. 41, no. 4, p. 412-20, ISSN: 0735-0414. Author s ; Dom-Geert, De-Wilde-Bieke, Hulstijn-Wouter, van-den-Brink-Wim, Sabbe- Bernard. Author affiliation Psychiatric Centre Alexian Brothers, Provinciesteenweg 408, Boechout, 2530, Belgium. geert.dom skynet.be. Abstract AIMS: Studies have shown that alcoholics with a cluster-B personality disorder cluster-B PD ; are characterized by high levels of impulsivity. However, impulsivity has mainly been studied as a broad concept without its different aspects being considered. The present study compared abstinent alcoholic inpatients without any personality disorder PD ; and abstinent alcoholics with cluster-B PD on different aspects of impulsivity, i.e. self-reported impulsivity and neuropsychological indicators such as behavioural control and delay of gratification. METHODS: Forty alcohol-dependent inpatients without PD and 22 alcohol-dependent inpatients with a cluster-B PD were compared on two self-report impulsivity questionnaires Barratt impulsiveness scale; sensation-seeking scales ; and three behavioural impulsivity tasks Go No-Go task; delay discounting task DDT Stroop colour word test ; . Tests were administered after stable abstinence of at least 3 weeks. RESULTS: Self-report measures of impulsivity were higher in cluster-B alcoholics than in alcoholics without PD. Behavioural tasks revealed a more differentiated pattern of impairments. On the Go No-Go task, cluster-B alcoholics were impaired in inhibitory control but not in reaction time compared with alcoholics without PD. In contrast, no significant differences on the DDT and the Stroop were observed. CONCLUSION: Alcohol-dependent patients with and without a cluster-B PD differ in terms of behavioural inhibition but not in terms of activation or the ability to delay gratification. This finding may partly account for their impulsive and self- ; destructive behaviours. Treatment planning should pay specific attention to these impairments in behavioural control. Language English. Publication year 2006.
Funding agent: kaiser permanente community benefit programs this pilot project, also called "bienestar pre-escolar, " will compare a group well-child visit in spanish with routine toddler care by spanish-speaking pediatricians for effectiveness in increasing healthy toddler feeding and activity practices.
Can medical practice be evidence based? Recent audits have been encouraging; a general medicine service at a district general hospital affiliated with a university found that 53% of patients admitted to the service received primary treatments that had been validated in randomised controlled trials or systematic reviews of randomised controlled trials; an additional 29% of patients received care based on convincing nonexperimental evidence.13 Three quarters of all of the evidence had been immediately available in the form of critically appraised topic summaries, and the remaining quarter was identified and applied by asking answerable questions at the time of admission, rapidly finding good evidence, quickly determining its validity and usefulness, swiftly integrating it with clinical expertise and each patient's unique features, and offering it to the patients. Similar results have been found in a study performed at a psychiatric hospital, 14 general practitioners' office, 15 and a paediatric surgery department.16 Practising evidence based medicine is one way for clinicians to keep up to date with the exponential growth in medical literature, not just by more efficient browsing but by improving our skills in asking questions, finding the best evidence, critically appraising it, integrating it with our clinical expertise and our patients' unique features, and applying the results to clinical practice. When added to conscientiously practised clinical skills and constantly developing clini.
Classes - and it also has a link on our home page to an excellent source for all sorts of medical information at Medline Plus medlineplus.gov. ; Medline Plus is available to the general public and contains a gold mine of health information from the world's largest medical library, the National Library of Medicine. It is authoritative and up to date and, because it is run by the government, does not contain all of the advertisements found on many other search engines. Medline Plus Dawn O'Bar, Health Resource Center Coordinator includes a medical dictionary, encyclopedia, directory of doctors, dentists and hospitals, and over 700 health topics and surgical videos. You can find information on everything from Arthritis to West Nile Virus and the most important part is this website is maintained and updated daily by health professionals. And it's easy to find either through our website or by going directly to medlineplus.gov. Another search engine we use to help locate answers to health questions comes from "Teoma" teoma ; . The word "teoma" means expert in Gaelic. This search engine employs four "R" techniques. "Refine" gives suggestions to narrow the search results. "Results" are based on subject- specific popularity. Teoma is able to find expert "Resources" about a particular subject and finally, Teoma features an enhanced ability to filter span to allow more "Relevant" results. Next time you are surfing the net and want to find reliable health information, take a minute to look at the above and see what information they have. Or better yet, contact the Health Resource Center staff at 805-681-7672 and we will be happy to guide you through the search process. BOOK REVIEW: Our Bodies, Ourselves, a new edition for a new era. 2005 If this title rings a familiar bell, its original version was first printed in 1970. This is a classic book about women's health and sexuality written by women, for women. This text has over 800 pages including chapters of information on nutrition and exercise, relationships and sexuality, complementary medicine, environmental and occupational health, childbearing, growing older, and medical problems and procedures. There is even a section on how to get the most out of your health care visits and guidelines on choosing a health care provider. And, true to the earlier edition, there is even a section titled, "The Politics of Women's Health." Our Bodies, Ourselves is authored by the Boston Women's Health Book Collective over 400 contributors ; with a grant from Brigham and Women's Hospital and the Boston University School of Public Health. The Journal of American Medical Association JAMA ; says this volume is , "A mother lode of information and resources for the client consumer and the physician." In addition to the text contained within this volume there are also 16 pages of other resources for women's health as well as a companion website located at ourbodiesourselves . Stop by the Health Resource Center located on the first floor of Foundation Clinic at 215 Pesetas Lane to check out a book, get help in your internet search, or just to say hello.
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Indicator Proposed by Staff 11. First-line pharmacotherapy for diabetics should include an ACE inhibitor, a calcium channel blocker, or a thiazide diuretic. Follow-up 12. Hypertensive patients should visit the provider at least once each year. 13. Hypertensive patients with consistent average SBP 160 or DBP 90 over 6 months should have one of the following interventions recorded in the medical record: Change in dose or regimen of antihypertensives; or Repeated education regarding lifestyle modifications.
Hospital, Great Western Road, Gloucester GL1 3NN; 2University of St Andrews School of Geography & Geosciences, Irvine Building, North Street, St Andrews KY16 9AL; 3Health Protection Agency Statistics Unit, Centre for Infections, 61 Colindale Avenue, London NW9 5HT; Southwold, York Rd, Southwold IP18 6AN; 4University of Dundee Health Informatics Centre, Kirsty Semple Way, Dundee DD2 4BF Background and objectives The public have a key role in the emergence and spread of bacterial resistance to antibiotics. In 2000 the World Health Organization WHO ; Report Overcoming Antimicrobial Resistance identified three key issues for public involvement: improving access to medical services, reducing unnecessary use of antimicrobial drugs and not sharing medication with other people or keeping part of the course for another occasion. It is also essential, however, to gather reliable information about patient's attitudes to antibiotic use, and their use of these drugs. The objective of this study is to assess the public's knowledge and attitudes to antibiotics, their reported antibiotic use, and the relationship between them. Patients and methodsA questionnaire was included within the face-to-face British Office for National Statistics Omnibus Household Survey in 2003. Of 10, 981 randomly selected adults from England, Scotland and Wales, 7, 120 65% ; completed the questionnaire. Results Although 79% of respondents were aware that `antibiotic resistance is a problem in British hospitals', 38% of respondents thought that `antibiotics work against most coughs or colds', and 43% did not know that `antibiotics can kill the bacteria that normally live on the skin or in the gut'. Respondents without formal qualifications were least knowledgeable about antibiotics. In a multivariable analysis better knowledge of antibiotics was not associated with being less likely to be prescribed any in the last year, but was independently associated with being more likely to finish a course of antibiotic as prescribed. Knowledge was also independently associated with being more likely to take antibiotics without being told to do so. In women better knowledge was associated with being more likely to give an antibiotic to someone for whom it not prescribed. Conclusion We have shown that there is not a simple relationship between increased knowledge and antibiotic use. Future national antibiotic campaigns should have a defined audience and aims, in order to facilitate prudent antibiotic use by clinicians and the public.
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