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An aerosol is a suspension of liquid or solid particles in air. Aerosols exist naturally in the earth's atmosphere. Some examples are dust, pollen solid particles ; and fog liquid particles ; . Other aerosols are man-made and are produced by industry. Some exampies are spray air-fresheners or cooling processes in manufacturing. Regardless of the origin of the aerosol, airborne particles are inhaled during the normal breathing cycle. Inhaled particles may deposit in the nasal cavity, throat or lungs or may not deposit at al1 and be exhaled back into the atrnosphere. A particles deposition site is affected by many factors including particle size, air flow rate and lung morphoIoa. WhiIe much of the deposited aerosol is rernoved by the body's naturaI defense system, having little effect, some particles may cause adverse effects such as pollen causing an allergic reaction. Deposition of aerosol particles can also have positive effects. By targeting the size of particles that the body is least capable of removing, medical science uses inhaied aerosols to deliver dmgs to the lung to treat pulmonary disorders such as asthma or cystic fibrosis. There are three common types of devices used to produce medical aerosols. The nebulizer produces aerosols from dmg solutions or suspensions using air-water spray atomization t e c ~Nebulizers are used most commonly by hospitals and young . children and require a source of compressed air or a portable compressor. Metered dose inhalers use a pressurized canister to produce a precisely measured volume of inhalable spray. The canister contains a formulation of solution or suspension of active drug in propellant, While inexpensive and convenient, metered dose inhalers can be completely ineffectual if not used properly. Dry powder inhalers contain finely milled drug powder that often require inhalation power to deaggregate the powder. Expense and convenience are similar to the metered dose inhale- but many dry powder inhalers produce varying doses depending upon the inhalation flow rate and therefore have inconsistent results. This. Phone. An unfamiliar voice calling itself Dr. Smith asks that a patient under the nurse's care receive an obviously excessive dose - on the bottle it says maximum daily dose 10 mg; the nurse is asked to give 20 of a fictional drug covertly placed in the drug cabinet on the floor. The drug's concocted name "Astrotech" is obviously not on the stock list and is therefore unauthorized, not cleared for use. Just the fact that the medication order is given only over the phone violates hospital policy. How many of the nurses, despite all this, would go to give the drug? The researchers explained the scenario to twelve nurses; ten said that if they were in the situation they would not have given the drug. They asked 21 nursing students; all 21 said they would have refused. When they actually did the experiment though, how many nurses had to be stopped at the door of the patient's room, dose in hand? Ninety-five percent - 21 out of 22 - obeyed. Only a single nurse dared to question authority. The others expressed to the caller essentially no resistance to the order and offered no delay after conclusion of the call. From the discussion at the end of the study: None of the investigators and but one of the highly experienced nurse consultants with whom the project had been discussed in advance predicted the outcome correctly. It has been long recognized that when there is friction between doctors and nurses, it is the patients who chiefly suffer. However, the present study underscores the danger to patients. of the nurse-doctor relationship even when there is little or no friction. There is considerable evidence that a considerable amount of self-deception goes on in the average staff nurse. This investigation tends to show that the view. that the nurse will habitually defend the well-being of her patients as she sees it and strive to maintain the standards of her profession. is an illusion, which. is widespread and enduring.[452] "A cute, fluffy puppy." I cringed to hear that there was a paper entitled "Obedience to Authority with an Authentic Victim." What if the victim was actually given graded shocks? As described in their protocol, two researchers took "A cute, fluffy puppy." Same as Milgram, but with a puppy and with real shocks. College students, 13 men and 13 women, were told to give the puppy 30 shocks. The shocks caused the puppy to run, howl, and yelp. The final level, researchers report, resulted in, "continuous barking and howling." The conclusion? "Females were not expected to be more willing than males to shock a cute puppy." But they were; all 13 women went all the way, delivering 30 shocks each.[453], for example, prednisone. Regarding repeatable private prescriptions to all community pharmacists. It will be recommended that if a year has elapsed since the patient last collected an instalment, they should revisit the prescriber as their condition may have changed or further monitoring may be required.

Scure correct diagnosis of depression. Bridges and Goldberg3 demonstrated that 95% of their study's patients with anxiety and depression were correctly diagnosed when psychological distress was the presenting complaint, whereas only 48% of the patients with psychiatric illness who presented with somatic complaints were correctly diagnosed.9 The other major considerations in diagnosing depression in the medically ill are the potential confounding effects of somatic symptoms caused by the patient's medical illness es ; . Many of the common somatic symptoms of depression, such as fatigue, anorexia, insomnia, decreased mental efficiency, weight loss, and pain, can be caused by physical illness. If a clinically significant physical illness is present, the somatic symptoms directly attributable to medical illness must be relatively discounted in the diagnostic assessment and careful attention must be directed to nonsomatic symptoms. These symptoms would include unremitting and pervasive anhedonia, hopelessness, crying, guilt, low self-esteem, worthlessness, and suicidal ideation. Historical data may also help, such as a family history of depression or a personal history of prior depressive episodes.10 Biological tests for depression, such as the dexamethasone suppression test, do not as yet have acceptable rates of sensitivity to warrant their routine use in clinical settings and are often confounded by the presence of medical illness. GENERAL PHARMACOKINETIC CONSIDERATIONS FOR THE USE OF ANTIDEPRESSANTS IN MEDICALLY ILL PATIENTS Cytochrome P450 Isoenzyme IID6 The cytochrome P450 CyP450 isoenzyme IID6 is important in the metabolism of many psychotropic agents, including the tricyclic antidepressants TCAs ; , and several neuroleptics, including haloperidol, perphenazine, and thioridazine. Cytochrome P450 IID6 drug interactions become clinically important in persons who lack this isoenzyme from 5% to 6% of Caucasians and mexitil.
2. Dinovo, E. C., Gottschallc, L k, Nandi, B.R., and Geddes, P., GLC analysis of thioridazine, mesoridazine and their metabolites. J.

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The study was supported by a grant from the Danish Medical Research Council grant no. 9701203 ; . The authors thank Dr. Niels Joergen Secher for valuable comments on previous versions of the manuscript. People Living With HIV AIDS ACT Provides support for HIV + people in the ACT through a Newsletter and links with other PLWHA organisations throughout Australia. We also provide individual support with advocacy and representation on health and other issues, and referral to other agencies. Phone 6257 4985 Positive Support Network HIV + people get together to offer support and share information. PSN is mostly a social occasion where people can share the experience of being HIV + over a free meal, without the formality of a structured meeting. Dinner on alternate Tuesdays. Ph 6257 4985. Positive Women's Group The Positive Women's Group meets for social activities throughout the year. For information on the group's gatherings contact Marcus, Nada or Stephanie on 6257 2855 or 6257 4985. Trevor Daley Fund The Fund provides assistance for people with HIV AIDS who are experiencing financial hardship, for the part payment of bills, a treatments allowance and some other costs. Applications can be made to the TDF Committee by any service provider. There is a monthly limit of $20 reimbursement for bus tickets. For more information call the TDF on 6257 2855. "Links" The Volunteer Service The AIDS Action Council has trained volunteers to help with transport, housework, home care or simply to provide friendly company. For any request you may have, call Marcus or Leonie at PLWHA or AAC on 6257 2855. Counselling Stephanie Buckle is the AIDS Action Council counsellor. Free consultation available to all HIV + people, their partners, carers or significant others. Phone 6257 2855 to make an appointment. Jane Keany is the counsellor for the ACT Division of General Practice HIV AIDS Program, and offers subsidised counselling services for people infected with or affected by HIV, their significant others and people at risk of HIV infection. Jane is available at the Canberra Sexual Health Centre and the Interchange General Practice. Phone 6161 1605 or 0402 222 408 to make an appointment. Vitamin Service The AAC operates a Vitamin and Health Supplements Service with items available at cost price. Certain items are kept in stock, others may be ordered as required. For further information or for orders, contact Marcus, Mark or Nada on 6257 2855. Massage Massages are available each Wednesday between 12.45pm and 4.15pm. Treatments are of hour duration. Appointments can be made by contacting the PLWHA ACT Office on 6257 4985. Nutrition Consultation with a dietician from The Canberra Hospital is available free at the Canberra Sexual Health Centre. Appointments necessary. Phone Canberra Sexual Health on 6244 2184. Canberra Sexual Health Centre Co-located with The Canberra Hospital. Free service available no Medicare card is required ; for testing and treatment of STIs, HIV clinic and counselling for issues such as safe sex, relationships and sexual functioning problems. Walk-in consultations available for urgent matters. Call on 6244 2184 to make an appointment and vermox. Pari, G. S. and Keown, W. A. 1997 ; . Experimental strategies in efficient transfection of mammalian cells Calcium phosphate and DEAE-dextran. Methods Mol. Biol. 62, 301-306. Salamero, J., Le Borgne, R., Saudrais, C., Goud, B. and Hoflack, B. 1996 ; . Expression of major histocompatibility complex class II molecules in HeLa cells promotes the recruitment of AP-1 Golgi-specific assembly proteins on Golgi membranes. J. Biol. Chem. 271, 30318-30321. Schulein, R., Lorenz, D., Oksche, A., Wiesner, B., Hermosilla, R., Ebert, J. and Rosenthal, W. 1998 ; . Polarized cell surface expression of the green fluorescent protein- tagged vasopressin V2 receptor in Madin Darby canine kidney cells. FEBS Lett. 441, 170-176. Sokoloff, P. and Schwartz, J. C. 1995 ; . Novel dopamine receptors half a decade later. Trends Pharmacol. Sci. 16, 270-275. Takizawa, P. A., Yucel, J. K., Veit, B., Faulkner, D. J., Deerinck, T., Soto, G., Ellisman, M. and Malhotra, V. 1993 ; . Complete vesiculation of Golgi membranes and inhibition of protein transport by a novel sea sponge metabolite, ilimaquinone. Cell 73, 1079-1090. Tarasova, N. I., Stauber, R. H., Choi, J. K., Hudson, E. A., Czerwinski, G., Miller, J. L., Pavlakis, G. N., Michejda, C. J. and Wank, S. A. 1997 ; . Visualization of G protein-coupled receptor trafficking with the aid of the green fluorescent protein. Endocytosis and recycling of cholecystokinin receptor type A. J. Biol. Chem. 272, 14817-14824. Valdenaire, O. and Vernier, P. 1997 ; . G protein coupled receptors as modules of interating proteins: A family meeting. Prog. Drug Res. 49, 458482. Vickery, R. G. and von Zastrow, M. 1999 ; . Distinct dynamin-dependent and -independent mechanisms target structurally homologous dopamine receptors to different endocytic membranes. J. Cell Biol. 144, 31-43. Von Zastrow, M., Link, R., Daunt, D., Barsh, G. and Kobilka, B. 1993 ; . Subtype-specific differences in the intracellular sorting of G protein-coupled receptors. J. Biol. Chem. 268, 763-766. White, J. H., Wise, A., Main, M. J., Green, A., Fraser, N. J., Disney, G. H., Barnes, A. A., Emson, P., Foord, S. M. and Marshall, F. H. 1998 ; . Heterodimerization is required for the functional GABAb receptor. Nature 396, 679-682. Yamamoto, S., Kawamura, K. and James, T. N. 1998 ; . Intracellular distribution of adenylate cyclase in human cardiocytes determined by electron microscopic cytochemistry. Microsc. Res. Tech. 40, 479-487. Yung, K. K., Bolam, J. P., Smith, A. D., Hersch, S. M., Ciliax, B. J. and Levey, A. I. 1995 ; . Immunocytochemical localization of D1 and D2 dopamine receptors in the basal ganglia of the rat: light and electron microscopy. Neuroscience 65, 709-730.

Servizio di Ematologia, Ospedale Maggiore, I.R.C.C.S. Istituto di Scienze Mediche, Universit di Milano, Italy.

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