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I have been a user of the HMR process over the last 2 years. Generally I have found them very useful especially getting the feedback regarding possible interactions. Often it is something that we have been doing informally with our patients but now gives us an opportunity to formalize the process for both patient and doctor. The remuneration is a welcome surprise. I think the paperwork can be simplified especially as most pharmacists present the information in a user friendly manner. I think our division has done this process very well and I congratulate everyone involved. I would like to see the pharmacists try and follow the same Performa and presentation to make this an excellent service. Dr Dave Bramley.

ORIGIN OF NAET: Dr. Devi Nambudripad in southern California was highly allergic to many foods. Her diet was limited to broccoli and rice. She discovered NAET in the early 1980's to eliminate her own allergies. The new method involves the use of energy medicine and Eastern medicine not yet taught in most US medical schools. It involves no medications or surgery. It alters reaction of the body so it no longer considers an allergen eg Cat ; to be an enemy of the body and cause an allergic reaction. DIAGNOSIS OF ALLERGIES traditionally involves skin tests with skin injections, scratch tests or patch tests. NAET uses a more efficient non-needle method called Neuromuscular Sensitivity Testing NST ; . It takes advantage of a phenomenon of weak muscles when the allergic substance allergen ; is held in the fingers. The finger pads contain the sensitive receptor nerves. Any group of muscles can be used to elicit weakness. Usually the arm muscles are used. An arm is extended at a right angle to and in front of the body with the thumb pointed downward toward the feet. The suspected allergen substance is held in the fingers of the other hand. A second person applies steady downward pressure on the forearm. A weakness of the arm muscles indicates an allergy to the substance. NST POSITIVE INDICATES A MUSCLE WEAKNESS AND THAT THE PERSON IS ALLERGIC TO THE SUBSTANCE BEING TESTED. NST NEGATIVE MEANS NO MUSCLE WEAKNESS AND THAT THE PERSON IS NOT ALLERGIC TO THAT SUBSTANCE. ANAPHYLAXIS is a rapid onset allergic reaction that may be life threatening. It can occur from foods, inhaled substances, medications taken by mouth or injected and substances that contact or are injected into the skin such as insect stings. Symptoms of anaphylaxis may include weakness, perspiration, hives, intense itching, angioedema rapid swelling of tissues ; , sneezing, nose running, closing of the throat and cardizem. In 2003, acquisitions of intangible assets comprised purchases of software 24 million euros ; and purchases of pharmaceutical products 9 million euros ; . In 2002, acquisitions of intangible assets mainly comprised the purchase of the rights to Ambien in the United States resulting from the acquisition of Pharmacia-Searle's 51% interest in Lorex Pharmaceuticals see note C.2 ; , and payment of the balance for the rights to Avapro in the United States. In 2001, they included the payment made in connection with the increase in the Group's share in profits arising from the marketing of Avapro in the United States. Acquisitions of property, plant and equipment relate mainly to industrial facilities chemicals and drugs manufacturing ; and to research sites. The accelerated level of investment in property, plant and equipment in 2002 was related to increases in production capacity for new products. D.5. Investments in advances to equity investees Investments in and advances to equity investees as of December 31, 2003, 2002 and 2001 comprise. With any diet containing poultry fat or with a wheat carbohydrate base, add a spoonful of vegetable oil to the feed twice a week to help prevent skin problems crisco or mazola corn oil; do not use store-labeled brands as they are frequently stale and cardura.
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Tierney's operation to repair her diaphragmatic hernia was performed by Dr. Croitoro on February 5, 1992. The surgery went well and Tierney recuperated in the PICU. She looked so relaxed and I can remember her sucking her tongue in her sleep. Tierney needed very little medication and was sent home earlier than expected on February 9, 1992. The 1 st 6 months of Tierney's life were pretty uneventful. I breast fed her and she thrived very well. She did have a tendency to vomit on occasion but I thought it was from overindulging herself with milk. When Tierney wa s 6 months old she started to have bouts of severe vomiting and abdominal pain. After several visits to our pediatrician and finally a visit to the hospital for dehydration, we were told she had reflux and she was put on two different medications. We were relieved to hear a diagnosis and to have a solution to the problem. Our relief was gone shortly as she started vomiting again and her pain seemed to intensify. We spent many nights walking with Tierney as she only seemed comfortable when you held her upright and she did not like us to sit down. I even took her for late night drives in the car because my back would ache from carrying her. We had monthly visits with the Pediatric Gastroenterologist PG ; that diagnosed her with reflux and he assured us that Tierney would eventually grow out of having reflux. Many times I discussed her CDH with him but he said there was no correlation between her CDH and her current problems. Tierney's weight gain was very slow and she became a very picky eater. We would go for a week or two with no problems when suddenly she would vomit for a few days in a row and would be extremely uncomfortable. On Tierney's "bad days" she would sometimes hold a cookie that she would normally love to eat ; in her hand for hours on end! She knew she would like to eat it but she couldn't because she felt so lousy! We continued to see our PG and Tierney had X-rays, ultrasounds. Upper GI's, Lower GI's etc. but nothing was ever seen to be abnormal. Tierney was put on IV liquids a few times for dehydration and was even hospitalized for a few days right after her 2nd birthday but the diagnosis was the same REFLUX. In September of 1994 Tierney experienced a severe bout of vomiting and pain. She couldn't even brush her teeth without vomiting. Her pain seemed to come and go and was so severe she would tighten up her legs and be straight as a board and then when she had a little relief her eyes would roll back. Perry and I decided we needed to get her to the hospital. Tierney was admitted but they had to rule out appendicitis and other things so they couldn't give her pain medication. She was in such pain and no one seemed to know what to do so finally called Dr. Croitoro's office and they sent Dr. Donald Nuss to see her. He reviewed a recent upper GI and determined that she may have blockage caused by adhesions and she needed immediate surgery. Dr. Nuss operated on Tierney the very same night he examined her. After the operation Dr. Nuss told us Tierney was a very sick little girl and that her threshold for pain must be extremely high because she had a volvulus. Apparently her intestines never adhered to the stomach wall after her CDH repair and they were twisting and turning until they finally tied into a complete knot that could not untwist. Dr. Nuss told us that Tierney would have died if he did not perform the operation. Tierney was closely monitored in the PICU and after 24 hours Dr. Nuss operated again to perform a resection on her intestines. Tierney spent a few days in the P ICU with a tube through her nose to drain the "gunk" in her stomach and was later moved to a regular room. After 2 weeks Tierney was well enough to go home. Tierney sometimes complains of stomach pain but for the most part she is a happy, healthy, well-adjusted child. We had one bad scare a few months after her surgery with severe abdominal pain but we found she had eaten a large amount of peanuts and she suffered blockage from the peanuts that she could not digest properly. We don't allow her to eat peanuts but other than that she eats a normal diet. Tierney is now eight and is in second grade. She is on a swim team, participates in Brownies, Soccer and Basketball. In addition to Tierney's older sister, she has two younger sisters and one younger brother. After reading several other stories we realize we are very lucky but we hope the potential for intestinal problems is not overlooked by doctors of CDH survivors in the future. We know Tierney could have been spared a lot of pain if a connection could have been recognized earlier in her life. Theresa Hohman mom of Tierney Elizabeth Hohman, 2 3 92, Bay Point Dr., Virginia Beach, VA 23454, 757-496-2115, thohman rscre and ceftin and avapro. 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To manage asthma, patients need to be educated about avoidance of triggers, altering home environment, monitoring symptoms and correct use of drugs. Studies have shown that the incorporation of patient education as part of asthma management increases overall asthma control in patients as opposed to those who do not receive it. Education should be directed towards improving patient knowledge, attitudes and perhaps self-management to improve asthma outcomes. However one of the key issues is whether the kind and level of information provided should be the same in all parts of the world and whether what has been successful in western countries will also have the same impact in India. A patient's own cultural interpretation about health and illness can affect the likelihood of accepting or rejecting education messages of asthma. There are several differences between various cultures and ethnic groups regarding beliefs about a particular disease and patient education needs development of `cultural competency.' This is the ability to work effectively when the language, customs, religion or beliefs of the health care provider are different from those of the patients. What is urgently required is therefore research in patient education to address questions such as how many patients accept asthma as a diagnosis, what are their beliefs about asthma as a disease, why are patients reluctant to use inhalers, what is their concern about the use of inhaled steroids, and how much of an issue is affordability. What concerns parents have when their child is diagnosed with asthma should also be investigated. Research into these areas will provide some answers to the development of patient education strategies in India and in the long term alter beliefs and attitudes regarding the disease. It also may be worthwhile to study which tools are a good medium to promote education among patients - is it posters, booklets, films etc. How much of a role can nurses and paramedical staff play in this area and how will physicians accept the concept of a health team for asthma is another area which needs answers. All these are the research challenges in India that should play a major role in improving asthma outcomes in the general population.
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Avapro may be the one bp medicine that doesn't seem to affect and azmacort. Other therapies Although psychological factors have not been shown to cause IBS, there is a clear correlation between psychological wellbeing and IBS. Psychotherapy includes a wide range of treatments, and relaxation techniques are the most common form. Nurses can teach simple relaxation techniques to patients either in hospital or in the community Smith 2003 ; , and measures such as regular exercise should be encouraged. Some patients benefit from yoga, meditation, aromatherapy or reflexology. Biofeedback may be used as a relaxation techNobaek S et al 2000 ; Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. American Journal of Gastroenterology. 95, 5, 1231-1238. Nunn P 2003 ; What nurses think of IBS patients: then and now. Gastrointestinal Nursing. 1, 17-18. Parker D 2004 ; One woman's fight against an entire syndrome. Gastrointestinal Nursing. 2, 4, 10-12. Silk D 2003 ; Management of irritable bowel syndrome: start of a new era? European Journal of Gastroenterology and Hepatology.

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