At the time of diagnosis, 20% of patients with newly diagnosed non-small cell lung cancer NSCLC ; exhibit stage IIIA disease with clinical mediastinal lymph node involvement cN2 ; 1 ; . The majority of patients with locally advanced stage IIIA NSCLC, particularly those with cN2, eventually develop distant metastases within several months of local treatment. Although the complete resection is technically feasible for patients at stage IIIA cN2, their 5-year survival is only 10%, mainly because of the development of distant metastases 2 ; . This poor outcome has prompted investigations of additional chemotherapy given before or after resection. Regarding neoadjuvant chemotherapy, several phase II trials involving combinations of cisplatin and older drugs have shown that neoadjuvant chemotherapy is feasible in patients with stage IIIA disease 35 ; . However, the results of randomized.
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Identify the various social risk factors responsible for poor growth. 2 List and interpret critical clinical and laboratory findings which were key in the processes of exclusion, differentiation, and diagnosis: Interpret growth parameters to diagnose poor growth. Investigate with minimum but appropriate evaluations the commonly associated problems associated with a child who is failing to thrive. 2 Conduct an effective initial plan of management for a patient who fails to thrive: Conduct a counseling and education program for caregivers of children with poor growth. Conduct an ongoing program to monitor the progress of such children. Appropriately utilize hospitalization, consultation with other health professionals and community resources. Explain the social and psychological impact of failure to thrive on the family and child.
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Howard E. Greenberg, MD, Chair Patricia W. Slattum, PharmD, PhD, Vice Chair, CPE Julio Licinio, MD, Vice Chair, CME Lisa R. Bomgaars, MD, Vice Chair, Medical Education Laurence J. Egan, MD Jean-Michel Gries, PharmD, PhD Carol Hope, PharmD, MS Roger W. Jelliffe, MD Nancy A. Lass, MD Barbara A. Levey, MD, FACP James McLeod, MD Gary A. Thompson, PhD.
References: 1. MRC Working party. BMJ. 1992; 304: 405-412. SHEP Cooperative Research Group. JAMA. 1991; 265: 3255-3264. Collins R, Peto R, MacMahon S, et al. Lancet. 1990; 335: 827-838. Arch Intern Med. 1997; 157: 2413-2446. Ambrosioni E, Safar M, Degaute JP, et al. J Hypertens. 1998; 16: 1677-1684. Raggi U, Palumbo P, Moro B, Bevilacqua M, Norbiato G. Hypertension. 1985; 6: 157-160. Gosse P, Dubourg O, Guret P, et al. J Coll Cardiol. 1999; 33 suppl A ; : 246. 8. Mallion JM, Asmar R, Boutelant S, et al. J Cardiovasc Pharmacol. 1998; 32: 673-678. Guez D, Mallion JM, Degaute JP, et al. Arch Mal Coeur Vaiss. 1996; 89: 17-26. Bulpitt CJ. J Hypertens. 1997; 15: S130-S142. 11. Thurston H, Desch P. J Cardiovasc Pharmacol. 1991; 18 suppl 7 ; : S45-S49. 12. Morgan T, Anderson A. Clin Exp Pharmacol Physiol Suppl. 1992; 19: 61-65. Myers MG. Can J Cardiol. 1996; 12: 1191-1196. MacFadyen RJ, Lees KR, Reid JL. Br Heart J. 1991-66: 206-211. 15. MacFadyen RJ, Squire IB, Reid JL, Devlin A, Lees KR. J Cardiovasc Pharmacol. 1996; 27-657-666.
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Glucosamine--an alternative treatment for arthritis in dogs Drs. C. Runyon and M. Vijarnsorn Osteoarthritis is a relatively common joint problem in dogs.There is deterioration of the cartilage and inflammation of the joint capsule, causing pain and varying degrees of lameness which generally worsen over time.Various drugs are used to reduce the pain and improve the dog's quality of life, but all of these have some undesirable side effects when used over the long term. Recently, attention has shifted to alternative methods of managing arthritis that focus on slowing the process of cartilage deterioration, and at the same time promote production of new cartilage. Glucosamine is one such nutritional supplement that has been used successfully in humans to relieve some of the symptoms of arthritis. Although it is also being used to some extent in dogs, its effectiveness has not been studied. This project will look at the use of glucosamine as a treatment for osteoarthritis in dogs. Affected dogs will be thoroughly assessed before and after commencing treatment with glucosamine; assessment will include x-rays, blood tests, and detailed analysis of the gait. If the study demonstrates that glucosamine does provide relief and improve joint function in dogs, veterinarians will have another alternative for the treatment of osteoarthritis and for the improvement of quality of life in dogs with this disorder. Benazepril in dogs with chronic kidney failure Drs. D. Shaw, P. Foley, and A. Cribb Chronic renal failure CRF ; is a serious disease of dogs and cats in which there is progressive loss of kidney function, ultimately causing death. A study was funded last year by the Animal Welfare Centre to determine if TGF-beta, a small protein with many effects, is a factor in the scarring and associated loss of function that occurs in the kidneys of animals with CRF.The study showed that TGF-beta levels are significantly higher in dogs with CRF. Studies in laboratory animals and people have shown that TGFbeta production is increased by a peptide hormone called angiotensin II, and that drugs which block production of this hormone result in a decrease in levels of TGF-beta in the blood, and slow the progression of chronic kidney disease.This project is a clinical trial of benazepril an angiotensin II blocker ; in dogs with chronic kidney disease, to see the effect on the levels of TGF-beta, and on kidney function. If a link can be established between treatment with angiotensin II blocking drugs and decreased TGFbeta concentrations in the blood, this may be a significant breakthrough in the management of this debilitating and ultimately fatal disease.
The mean sd ; relative bioavailabilities, as represented by auc 0− ∞ , of amlodipine and benazeprilat for tablets versus capsules were 060 170 ; versus 949 197 ; , respectively and betamethasone.
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Observed with this agent 2, 3 ; are not ultimately harmful to patients with type 2 diabetes because they are offset by potentially beneficial changes in lipoprotein composiPediatricians and diabetologists tion and susceptibility to oxidation. This conclusion must be interpreted with cauhould it be methodologically correct tion for several reasons. to compare French and Belgian First, although several observational patients and doctors? We thank Dr. studies have shown an association Paris and colleagues 1 ; for reassuring us between small, dense LDL and coronary collectively, as pediatricians taking care of heart disease CHD ; in patients with diayoung patients with diabetes. As a young betes 4, 5 ; , the effects of changing LDL resident in endocrinology 20 years ago, I size have never been directly evaluated in was trained in the intangible idea that the any patient population. In contrast, ISABELLE PARIS, MD results of adult diabetologists' efforts were increases in LDL cholesterol concentraMICHEL HERMANS, MD indisputably more efficacious in terms of tions have been shown to be a strong and MARTIN BUYSSCHAERT, MD glycemic control than those of pediatri- consistent risk factor for coronary artery cians. Was it true in those times? Remem- disease in both cross-sectional and longiFrom the Unit de Diabtologie et Nutrition, Service ber that in many countries, including tudinal analyses of individuals with or d'Endocrinologie et Nutrition, Cliniques Universi- France, pediatricians were advocating free without diabetes. Furthermore, lowering taires Saint Luc, Brussels, Belgium. diet freedom meaning a lot of sugar ; and LDL cholesterol concentration has been Address correspondence to M. Buysschaert, proven to decrease the incidence of carCliniques Universitaires Saint Luc, Service d'En- one insulin shot daily and discouraging docrinologie et Nutrition, Unit de Diabtologie et the use of capillary blood in favor of the diovascular events in several intervenNutrition 54.74, B-1200 Brussels, Belgium. good old urinary measurements. tional studies 6, 7 ; . Those times are gone, fortunately for Neither the American Diabetes Associour patients, and we can now enjoy ation nor the National Cholesterol EducaReferences 1. Rosilio M, Cotton J-B, Wieliczko M-C, Gen- shameless comparisons of results with our tion Program has treatment recommendadrault B, Carel J-C, Couvaras O, Ser N, colleagues. As an echo to Dr. Paris's letter, tions suggesting that increases in LDL conGillet P, Soskin S, Garandeau P Stuckens C, let us regret that besides well-known inter- centration are ameliorated by changes in , Le luyer B, Jos J, Bony-Trifunovic H, vention studies of intensive therapy in LDL size. Thus, increases in LDL size Bertrand A-M, Leturcq F Lafuma A, the highly selected centers and patients, there should not be construed to negate the , French Pediatric Diabetes Group, are too few reports of actual glycemic known risk of increases in total LDL choBougnres P-F: Factors associated with results in large cohorts mostly adult ; of lesterol concentrations. glycemic control: a cross-sectional nation- patients with type 1 diabetes. Second, the data from Tack et al. 1 ; wide study in 2, 579 French children with showed decreased susceptibility to oxidatype 1 diabetes. Diabetes Care 21: 1146 PIERRE BOUGNRES, MD tion in the LDL after troglitazone therapy. 1153, 1998 This is consistent with the change in size 2. Hermans MP, Maes M, Vandeleene B, Pirard F Buysschaert M: The Belgian From the Hpital Saint Vincent de Paul, Paris, because small, dense LDL are known to be , France. more susceptible to oxidation in vitro 8 ; . Health Service HBGM scheme: cost-effecAddress correspondence to Pierre Bougnres, tiveness in a cross-sectional survey of an MD, Hpital Saint Vincent de Paul, Inserm U342, 82 Although there are a large number of in insulin-treated population registry Avenue Denfert Rochereau, Paris, France F-75014. vitro studies pointing to the importance of Abstract ; . In Proceedings of the 10th Inter LDL oxidation in the atherosclerotic national Congress of Endocrinology, San process, there are no clinical trials showing Francisco, CA, 1996 335 p References that changes in LDL oxidation can alter 3. Buysschaert M, Maes M, Hermans MP: 1. Paris I, Hermans M, Buysschaert M: CHD risk. Manipulations that decrease Traitement et contrle glycmique de Glycemic control in type 1 diabetes: a oxidization ability might be of potential 1200 diabtiques inscrits dans la Convencross-sectional study in 1, 200 Belgian benefit; until clinical trial data are available, tion INAMI "diabte" in French ; . Acta patients Letter ; . Diabetes Care however, such manipulations associated Clin Belg57: 211218, 1997 21: with increasing LDL cholesterol concentra4. The Diabetes Control and Complications Trial Research Group: The effects of intentions cannot be assumed to be beneficial. sive treatment of diabetes on the developFinally, the study reported by Tack et al. ment and progression of long-term com- LDL Cholesterol and 1 ; was not conducted in patients with diaplications in insulin-dependent diabetes Troglitazone Therapy betes. Individuals with diabetes are known mellitus. N Engl J Med 329: 977986, to have increases in several CHD risk factors 1993 and to be at significantly increased risk for 5. Krolewski A, Laffel L, Krolewski M, Quinn he recent study by Tack et al. 1 ; cardiovascular disease CVD ; . Thus, any M, Warram J: Glycosylated hemoglobin reported larger average LDL size in therapeutic regimen that results in increased and the risk of microalbuminuria in individuals on troglitazone therapy LDL cholesterol concentrations in patients patients with insulin-dependent diabetes mellitus. N Engl J Med332: 12511255, and appears to suggest that the increases with diabetes must be viewed as increasing 1995 in LDL cholesterol concentration typically the risk of atherosclerosis in affected indi.
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References 1. Spranger J. The mucopolysaccharidoses. In: Emery AEH, Rimom DL, eds. Principles and practice of medical genetics. New York: Churchill Livingstone, 1983: 1339-47. 2. McKusick VA, Neufeld EF. The mucopolysaccharidosis storage diseases.n: Stanbury JB, Wyngaarden JB, Fredrickson DS, GoldI and urecholine.
Agitated and socially inflexible." After a few dry clinical sessions, we met for lunch with several other "patients" one day, ostensibly to evaluate her social skill deficits so that she could learn to be "appropriate." A picture of an airplane hung on the restaurant and she began to talk about her earlier work as a Pan flight attendant. For the first time her eyes sparkled and her voice radiated as she talked about her international travels. People paid little attention until she mentioned a London to New York flight in early February 1964 that contained four unknown musicians on their way for an appearance on the Ed Sullivan show. Nobody at the table ever disregarded her again because of her brain injury. On that specific flight, she had brought the Beatles to America. My friend rarely had problems relating to others again. It was not because of the Beatles, but because she and others acknowledged her life of which brain injury was only one part. From this initial base other wonderful facets also appeared. She could still be as cantankerous and unyielding as anybody, but this was only part of her and there was so much more that she had to give and receive from others. And she no longer introduced herself as "My name is Sally and I'm brain injured." From then on, simply "Sally" was sufficient.
The Papua New Guinea Paediatric Surveillance Unit was established in 1996. It is a combined project between the Paediatric Society of Papua New Guinea, responsible for determining the conditions under surveillance, and for the follow up of reported cases, and HOPE Worldwide PNG ; , responsible for the administration of the Unit. The aim of the unit is to obtain information relating to conditions occurring in Papua New Guinean children which, though not among the leading causes of death and morbidity, are nevertheless of importance. All paediatricians, and a number of other doctors and health workers throughout the country actively participate in the Unit's programme. Each month the Unit sends out a card listing the diseases under surveillance to the participants, who return the card indicating if they have seen any children affected during the previous month. The paediatrician responsible for a particular condition then communicates with the reporter in order to obtain further information about the cases seen. This allows a central database on that condition to be built up. There are currently about 40 participants reporting to the Unit. Initially the diseases under surveillance were: 1. Insulin dependent diabetes mellitus 2. Paediatric HIV infection and AIDS 3. Congenital hypothyroidism 4. Thalassaemia 5. Renal tubular acidosis 6. Neurologic endemic cretinism 7. Paediatric malignancies. A number of other conditions have been added, and, as adequate information has been obtained, some of the conditions have been deleted. Acute flaccid paralysis was one of the conditions added, and the Surveillance Unit worked closely with the Health Department Surveillance Unit in the successful programme to document the eradication of polio. The Unit has provided important information on a number of conditions since its inception. Of particular note perhaps has been the information on paediatric malignancy, HIV AIDS, subacute sclerosing panencephalitis and renal tubular acidosis. The latest condition to be added is pigbel. It is anticipated that surveillance of this condition will help to provide a rational basis for decisions relating to pigbel vaccination. Diseases currently under surveillance are: 1. Insulin dependent diabetes mellitus 2. Congenital hypothyroidism 3. Renal tubular acidosis 4. Neurologic endemic cretinism 5. Subacute sclerosing panencephalitis 6. Acute flaccid paralysis 7. Pigbel and bicalutamide.
AZILECT AZMACORT AZULFIDINE AZULFIDINE ENTABS BARACLUDE BARACLUDE ORAL SOLUTION BECONASE AQ BENAZEPRIL HCL BENICAR BENICAR HCT BETASERON BONIVA 150MG BUTALBITAL APAP CAFFEINE BUTORPHANOL NASAL SPRAY CADUET CANASA 1000MG CANASA 500MG CARDIZEM LA CARDURA XL CARTIA XT CARERJECT * CELEBREX CELEXA 10 MG CELEXA 20 MG CELEXA 40 MG CHANTIX CIALIS * CIPRO XR 1000MG CIPRO XR 500MG CLARINEX CLARINEX-D 12 HR CLARINEX-D 24 HR CLIMARA CLIMARA PRO CLOZARIL 100MG CLOZARIL 25MG COLAZAL COMBIPATCH COMBIVENT CONCERTA 36 MG CONCERTA ALL OTHER STRENGTHS ; COPAXONE COPEGUS COVERA-HS COZAAR CRESTOR 30 tabs 30 days 2 inhalers 30 days 360 tabs 30 days 360 tabs 30 days 30 tabs 30 days 600 ml 30 days 3 nasal sprays 30 days 30 tabs 30 days 30 tabs 30 days 30 tabs 30 days 15 vials 30 days 1 tabs 30 days 360 caps-tabs 30 days 2 bottles 30 days 30 tabs 30 days 60 suppositories 30 days 90 suppositories 30 days 30 tabs 30 days 30 tabs 30 days 30 caps 30 days 6 inj 30 days 60 caps 30 days 30 tabs 30 days 90 tabs 30 days 45 tabs 30 days 56 tabs 30 days 6 tabs 30 days 14 tabs per script 3 tabs per script 30 tabs 30 days 60 tabs 30 days 30 tabs 30 days 4 patches 30 days 4 patches 30 days 270 tabs 30 days 90 tabs 30 days 270 tabs 30 days 8 patches 30 days 2 inhalers 30 days 60 tabs 30 days 30 tabs 30 days 1 kit 30 days 168 tabs 30 days 30 tabs 30 days 60 tabs 30 days 30 tabs 30 days CYMBALTA 20 MG, 30 MG CYMBALTA 60 MG DALMANE DARVOCET-N 100 DAYTRANA DEPO-PROVERA150 MG ML VIAL SYRINGE DESOXYN DEXEDRINE DIABETIC BLOOD GLUCOSE TEST STRIPS DIFLUCAN 150 MG DILTIA XT DIOVAN DIOVAN HCT DURABAC FORTE DURADRIN DURAGESIC DURAXIN EDEX * EFFEXOR XR 37.5 MG, 150 MG EFFEXOR XR 75 MG ELIGARD 22.5 MG, 30 MG, 7.5 MG EMEND 125 MG 80 MG EMEND 80 MG, 125 MG EMSAM ENBREL 25 MG EPIPEN ENBREL 50 MG ML EPOGEN 10, 000 UNITS ML EPOGEN 2, 000 UNITS ML EPOGEN 20, 000 UNITS ML EPOGEN 3, 000 UNITS ML EPOGEN 4, 000 UNITS ML EPOGEN 40, 000 UNITS ML ESCLIM ESTRADERM ESTRASORB ESTRING ESTROGEL EXELON 1.5, 3MG EXELON ALL OTHER STRENGTHS ; EXELON 2MG ML ORAL SOLUTION EXUBERA COMBINATION PACK 180 60 caps 30 days 30 caps 30 days 30 caps 30 days 180 tabs 30 days 30 patches 30 days 1 vial syringe 90 days 120 tabs 30 days 120 caps-tabs 30 days 300 strips 30 days 2 tabs 30 days 30 caps 30 days 60 tabs 30 days 30 tabs 30 days 240 tabs 30 days 360 caps 30 days 20 patches 30 days 360 caps 30 days 6 inj 30 days 30 caps 30 days 90 caps 30 days 1 syringe 30 days 6 caps 30 days 10 caps 30 days 30 patches 30 days 8 vials 30 days 1 pen copayment 4 syringes 30 days 12 vials 30 days 12 vials 30 days 12 vials 30 days 12 vials 30 days 12 vials 30 days 4 vials 30 days 8 patches 30 days 8 patches 30 days 56 packets 30 days 1 ring 90 days 1 gel pump 60 days 90 caps 30 days 60 caps 30 days 240 ml 30 days 1 pack per script.
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Commas should not be used in dates; in sentences they should be used only where the break is a natural one where to take breath, if reading aloud ; . COMPANIES On first mention use full title for companies but use contraction for Ltd, Co and plc, eg Gordon Bennett Holdings Ltd. Thereafter you can use Gordon Bennett, or Bennett Holdings. If writing for a supplies supplement, however, full titles should be given in a footnote address. Some companies can be abbreviated subsequently, notably private medical companies such as American Medical International AMI ; . BUPA can be abbreviated first time. DISCRIMINATORY LANGUAGE Avoid all language which is sexist, racist, ageist - and any other -ist. All doctors and managers are not male, nor all nurses and secretaries female. Some solutions to commonly used sexist language are: chairman: use only if you know it to be male unless the female incumbent prefers this form of address ; chairwoman: use if you know it to be female chair chairperson in the chair chairing the meeting or other variations with 7 and casodex.
The University of Utah College of Pharmacy began operating the Drug Regimen Review Center DRRC ; in May 2002 to fulfill the terms of a contract with Utah Medicaid. The contract supports the Utah Medicaid prescription drug program and its drug utilization review department. The emphasis of the program is to improve drug use in Medicaid patients, to reduce the number of prescriptions and drug cost in high utilizers of the Medicaid drug program, and to educate prescribers for top utilizers of the Utah Medicaid prescription drug program. Each month, the top drug utilizers are reviewed by a team of clinically trained pharmacists. These reviews result in recommendations that are made to prescribers. These recommendations are described later in this report. Recommendations are transmitted in writing, are sent to all prescribers, and include a list of drugs dispensed during the month of review. The DRRC also provides information and consultation by telephone with prescribers and pharmacists.
NovaCardia Inc., San Diego, Calif. Product: KW-3902 IV Business: Cardiovascular Molecular target: Adenosine A1 receptor Description: Adenosine A1 receptor antagonist Indication: Treat fluid overload in congestive heart failure CHF ; patients undergoing diuresis Endpoint: Change in hourly urine volume from baseline over the first 12 hours after dosing Status: Additional Phase II data Milestone: NA Additional data from the double-blind, dose-escalation, U.S. Phase II trial CKI-202 ; in 34 CHF patients refractory to high-dose diuretics showed that all 3 doses of KW-3902 increased hourly urine volume over a 9-hour period vs. placebo. Kidney function was relatively preserved. Patients received either 10, 30 or 60 mg KW-3902. Data were presented at the European Society of Cardiology-Heart Failure meeting in Helsinki. PDL BioPharma Inc. PDLI ; , Fremont, Calif. Product: Cardene nicardipine IV ; Business: Neurology Molecular target: Ca channel Description: Intravenous calcium channel blocker and potent vasodilator nicardipine Indication: Lower blood pressure following stroke Endpoint: NA Status: NA Milestone: NA Data from a study showed that Cardene administered within 24 hours of sustaining an intracerebral hemorrhage appeared to safely reduce blood pressure BP ; . Specifically, 25 of 29 86% ; patients treated with IV Cardene were able to achieve and maintain mean arterial BP readings of 130 mm Hg. Additionally, rates of neurological deterioration found in 4 of patients ; and hematoma enlargement in 5 of patients ; , considered primary causes of poor outcomes, were lower than expected. Data were published in Critical Care Medicine. Based on these data, additional Phase II trials have been initiated to assess this approach within 6 hours of stroke symptom onset. Savient Pharmaceuticals Inc. SVNT ; , East Brunswick, N.J. Product: Puricase pegylated urate oxidase Business: Metabolic Molecular target: Not available Description: Pegylated urate oxidase uricase ; Indication: Treat severe refractory gout Endpoint: Change in baseline uric acid levels in area under curve over 12 weeks of dosing Status: Additional Phase II data Milestone: NA Additional data from an open-label, U.S. Phase II trial in 41 patients showed that 12 weeks of treatment with IV Puricase led to sustained reduction in plasma urate levels. The greatest reduction was seen in patients receiving 8 mg every 2 weeks of Puricase. Specifically, mean plasma urate after 12 weeks of treatment with 8 mg every 2 weeks of Puricase was 1.42 mg dL vs. 9.09 mg dL before treatment. Patients received 4 mg every 2 weeks, 8 mg every 2 weeks, 8 mg every 4 weeks and 12 mg every 4 weeks of Puricase treatment for 12 weeks. Puricase is in Phase III testing. Data were presented at the European League Against Rheumatism meeting in Amsterdam and bisoprolol.
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The entry-level midwife assumes responsibility for practicing in accord with the principles outlined in this document. The midwife uses a foundation of knowledge and or skill which includes the following: A. B. C. MANA's documents concerning the art and practice of Midwifery. The purpose and goal of MANA and local state or provincial ; midwifery associations. The principles of data collection as relevant to midwifery practice. Laws governing the practice of midwifery in her local jurisdiction. Various sites, styles, and modes of practice within the larger midwifery community. A basic understanding of maternal child health care delivery systems in her local jurisdiction. Awareness of the need for midwives to share their knowledge and experience and zebeta!
Intermediaries deny cases falling within these categories under existing procedures. Also, if the beneficiary receives care in a totally nonparticipating institution, denial on the grounds that he was not in a participating hospital is still appropriate. 29l.3 Determining Liability For Services Furnished in a Non-Certified or Inappropriately Certified Hospital Bed-A. Beneficiary Liability.--If it is determined that the beneficiary did not consent to placement in the non-certified bed within your participating facility see 29l.2C. ; , and that no other basis for denial of the claim exists see 29l.3D ; , the beneficiary is found not liable under l879. B. Hospital Liability.--If the beneficiary is found not liable under l879, liability may rest with you, or with the program. Liability rests with the Medicare program, unless any of the following conditions exist, making you liable for the services. o You did not give timely written notice to the beneficiary of the implications of receiving care in a non-certified or inappropriately certified bed as discussed in 291.2B. o You failed to attempt to obtain a valid consent statement from the beneficiary. See 29l.2C.
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TABLE 1. Clinical characteristics and AR expression MOD.
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When a seizure recurs, the major issues to consider include: 1 ; whether this is a manifestation of progressive pathology, such as a tumor or a neurodegenerative disorder; 2 ; whether there was a precipitant which could be avoided in the future; 3 ; if the patient was receiving an AED, a ; whether compliance or some other pharmacokinetic factor i.e. absorption, metabolism ; is at issue, or b ; whether the dose or the medication should be altered; and 4 ; if the patient was not taking medication, whether this recurrent seizure is an indication to institute treatment. Slide 32 ; In general, patients with partial seizures with or without secondary generalization ; who experience a change in seizure pattern, especially a change in the initial manifestation, should be evaluated for a progressive lesion with a neurologic exam, and possibly a repeat MRI and EEG.
2304 Angus Road Charlottesville, Virginia 22901 434 ; 295-9861 800 ; 728-4405 Email: pma8n adelphia FROM THE PRESIDENT Joe Powers Driving up from the quiet of our farm near Charlottesville to the hustle and bustle of Washington is always a challenge. Along the way I thought about the challenges we face as patients and as advocates for medical research. What is it I wondered, beyond selfinterest in survival that would motivate patients and other MGFA Chapter members to become truly strong advocates committed to finding better therapies if not "a cure"? Although the drive lasted 3 hours, I didn't really find a good answer until I got to the meeting. Convened by the National Coalition of Autoimmune Patient Groups NCAPG ; , the meeting was intended to evaluate the status of the NIH Autoimmune Research Plan. See attached minutes at the end of this newsletter ; . Among the representatives from several National patient groups was a young lady, Abby Bernstein, who had earlier written her story of dealing with Autoimmune Hepatitis for inclusion in the NIH Plan and appears on the inside cover of this newsletter with her niece, Erynn's, story. At the end of the meeting, as our paths crossed, I complimented Abby on the article that I found so valid in describing the challenge of dealing with an autoimmune disease. There was a long moment of silence before she replied. Carefully considering her words and looking very directly at me, Abby said, "That was from the heart". The emotional sincerity and simplicity of the statement surprised me. It isn't often that someone will reveal or share their feelings so openly. At first I didn't quite know how to respond except to ask how she was doing her health. As for many of us.
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