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Following is an excerpt of this presentation by david boyko, the bristol-myers senior vice president of global medical affairs and lifecycle management.
In considering acupuncture for a patient, there are two main questions to be considered: Is there a valid physiologic justification for suggesting acupuncture to the client? Does evidence support use of acupuncture for this clinical condition? Being familiar with the types of physiologic changes acupuncture produces allows one to better assess whether it is suitable for a given problem in a particular patient. Studies involving functional brain imaging reveal changes in thalamic, cerebellar, and cortical function that may relate to endocrinologic, autonomic, cir.
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12-LEAD ELECTROCARDIOLOGY Describe the difference between monitoring and assessing a patient using an ECG machine. Demonstrate proper lead placement for a 12-Lead ECG. Using a simple chart and leads I, II, and III, determine the electrical axis and the presence of fascicular blocks hemiblocks ; . Using lead V1 MCL1 ; , determine bundle branch blocks. Describe the clinical significance of hemiblocks and bundle branch blocks in the cardiac patient. Describe the strategy for identifying V-Tach in wide complex tachycardia. On a 12-Lead or Multi-Lead ECG, identify ST and T-wave changes relative to myocardial ischemia, injury, and infarction. Describe a systematic "assessment" of a 12-Lead ECG. Describe possible complications of various infarct locations. HEMODYNAMIC MONITORING Identify hemodynamic monitor controls. Interpret hemodynamic readings. Identify alarm indications. Discuss alarm-troubleshooting procedures. Identify transport complications of hemodynamic monitors. Define: preload, afterload, contractility, systemic vascular resistance, cardiac output, cardiac index. List two purposes for invasive hemodynamic monitoring. Identify the function of each component of a PA catheter including: length markings, balloon inflation port, thermistor port, PA distal port, RA proximal port, auxiliary RA port. List normal hemodynamic pressures and identify normal pressure waveforms for the RA, RV, PA, PCWP, LA, and peripheral arterial sites. Interpret SVO2 monitoring data and discuss appropriate therapeutic modalities to treat abnormal values. Discuss indications of measuring cardiac output and cardiac index. Describe problems commonly encountered in measuring PA pressures and state appropriate interventions. List at least 5 potential complications associated with PA insertion. BLOOD ADMINISTRATION Differentiate between antigens, natural antibodies and acquired antibodies. Identify antibodies and antigens associated with specific blood types. Define Rh factor. Identify seven types of blood component therapy. Identify indications for blood administration. Describe the procedure for blood administration. Identify the signs and symptoms of transfusion reactions. Describe the management procedures for transfusion reactions. Describe the indications for administration of whole blood and packed red blood cells. Describe the indications for typing, screening and cross matching blood. Describe the ABO system for matching blood. Describe the characteristics of blood products. Describe the procedure for administration of whole blood or packed red blood cells. LABORATORY DATA INTERPRETATION Describe the relationship between laboratory medicine and the diagnosis and treatment of patients. Describe the common problems associated with specimen collection and ways to avoid these problems. Identify mean lab values and deviations for the complete blood count, the differential blood count, and platelet values. Interpret arterial blood gas data. Interpret chemistry studies. Interpret urinalysis. Describe the purpose of culture and sensitivity tests. Interpret miscellaneous lab studies and lotensin.
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Table 1. Frequency of numerical and structural chromosome aberrations in bone marrow cells of rats. N Numerical aberrations % ; Structural aberrations % ; Total aberrations % ; X SEM and lotrel.
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DOSAGE AND ADMINISTRATION HOW TO TAKE Loestrin 24 Fe IMPORTANT POINTS TO REMEMBER BEFORE YOU START TAKING YOUR PILLS: 1. BE SURE TO READ THESE DIRECTIONS: Before you start taking your pills Anytime you are not sure what to do 2. TAKE ONE PILL EVERY DAY AT THE SAME TIME. If you miss pills you could get pregnant. This includes starting the pack late. The more pills you miss, the more likely you are to get pregnant. 3. MANY WOMEN HAVE SPOTTING OR LIGHT BLEEDING, OR MAY FEEL SICK TO THEIR STOMACH WHILE TAKING THE FIRST 1 to 3 PACKS OF PILLS. If you have spotting or light bleeding or feel sick to your stomach, do not stop taking the pill. The problem will usually go away. If it doesn't go away, check with your healthcare provider. 4. MISSING PILLS CAN ALSO CAUSE SPOTTING OR LIGHT BLEEDING, even if you take these missed pills. On the days you take 2 pills to make up for missed pills, you could also feel a little sick to your stomach. 5. IF YOU HAVE VOMITING within 3 to 4 hours after you take your pill ; , you should follow the instructions for WHAT TO DO IF YOU MISS PILLS. IF YOU HAVE DIARRHEA or IF YOU TAKE CERTAIN MEDICINES, including some antibiotics, or the herbal supplement St. John's Wort, your pills may not work as well. Use a back-up method of birth control such as condoms or spermicide ; until you check with your healthcare provider. 6. IF YOU HAVE TROUBLE REMEMBERING TO TAKE THE PILL, talk to your healthcare provider about how to make pill-taking easier or about using another method of birth control. 7. IF YOU HAVE ANY QUESTIONS OR ARE UNSURE ABOUT THE INFORMATION IN THIS LEAFLET, call your healthcare provider. BEFORE YOU START TAKING YOUR PILLS 1. DECIDE WHAT TIME OF DAY YOU WANT TO TAKE YOUR PILL. It is important to take it at about the same time every day. 2. LOOK AT YOUR PILL PACK: Loestrin 24 Fe contains 24 "active" WHITE PILLS with hormones ; for WEEKS 1, 2, 3 and the first part of WEEK 4, and 4 "reminder" BROWN PILLS without hormones ; for the last part of WEEK 4 and macrobid.
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Expanding Proprietary Oral Contraceptive Franchise The successful launch of SEASONALE, while a highlight of the year, represented only one facet of our activities in proprietary oral contraceptive development.We have a strong portfolio of traditional regimen and extended-cycle oral contraceptives currently under development, and are complementing our internal development activities through select product acquisitions. During fiscal 2004, we acquired Women's Capital Corporation and its FDAapproved Plan B emergency contraceptive.We continue to market Plan B as a prescriptiononly product, while working with FDA to remove the prescription-only barrier, thus affording more timely access to this important therapy. Further expanding our proprietary oral contraceptive line, we acquired the U.S. and Canadian rights to Galen's Loestrin and the Loestrin Fe oral contraceptives. In addition to product acquisitions, we expanded internal development activities. As part of the commitment to build a portfolio of extended-cycle oral contraceptives, work progressed on our SEASONALE Lo oral contraceptive, a lower dosage form of SEASONALE that is in Phase IIIB clinical trials with a supplemental NDA sNDA ; submission targeted for the second half of fiscal 2005.We also expect to file a New Drug Application NDA ; in the first half of fiscal 2005 for DP-3, a 91-day extended-cycle oral contraceptive regimen that includes seven days of unopposed estrogen. Clinical trials to support the filing of a NDA for DP-3 were completed during the fiscal year.We are also developing a 28-day and medroxyprogesterone.
The human body responds to infection and injury through a cascade of events that produce inflammation. Clinically, inflammation is manifested as the redness, swelling, loss of function and increased temperature associated with tissue injury. Biologically, inflammation involves numerous agents and protein-protein interactions within the body that ultimately cause tissue infiltration and loss of function. The inflammation cascade is specifically mediated by white blood cells, chemokines, cytokines and adhesion factors. Although numerous organs are affected by inflammation, these components play specific and unique roles in this complex inflammatory cascade. Although well characterized by decades of research, inflammation has yet to be fully understood with further pathways and biological components yet to be elucidated. While inflammation is primarily responsible for protecting the body, several human disorders are caused by inappropriate triggering of the inflammatory cascade. Such disorders include autoimmune diseases including multiple sclerosis, rheumatoid arthritis, type I diabetes, lupus Erythematous ; cardiovascular disorders including angioplasty re-stenosis, by-pass graft occlusion, transplant vasculopathy ; and other disorders including Fibromyalgia, asthma, inflammatory bowel disease, transplant rejection ; . These disorders result in deleterious effects upon the human body that prevent normal organ function and lead to extensive healthcare costs.
Over the years, because of safety reasons, the amount of estrogen in oral contraceptives has decreased. Most of the newer ones have 20 micrograms of estrogen, which is considered low dose. These included Alesse, Mircette, Loestrin, Estrostep, Ortho Tri-Cyclen Lo and Yaz. Also, third-generation progestins have less cross-reactivity with the androgen receptor and are more "estrogenic" with higher levels of HDL and sex hormone-binding globulin. Oral contraceptives with third-generation progestins include Desogen, Ortho-Cept, Mircette, Ortho-Cyclen, Ortho TriCyclen and Ortho Tri-Cyclen Lo. There's a relatively new progestin called drospirenone. It is an analog of spironolactone, so there may be reason to think that this progestin has some of the benefits on acne that spironolactone has. There are two products that contain it -- Yasmin and Yaz. Yaz is a new oral contraceptive that was approved as a contraceptive in April 2006 and FDA approved for use in acne in early 2007. One advantage of Yaz is that patients have only 4 days of a menstrual period. As far as the oral contraceptives that have been studied in acne, we're all familiar with Ortho Tri-Cyclen. It was the one that was first approved for treatment of acne. Others have now been studied as well, and overall, all the trials were done as a single-agent trial, so the amount of lesion reduction was typically 30% to 40%, which again is why I think that oral contraceptives are effective as adjuvant agents, not as single agents and mescaline.
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ANTI-THYROIDS Propylthiouracil * Tapazole * CONTRACEPTIVES Ortho-Novum 1 35, Desogen 1 50, 7 Jenest-28 Ortho Tri-Cyclen Alesse Tri-Levlen Brevicon Demulen Norinyl 1 35, 1 Loestrin Fe Levlen Micronor Tri-Norinyl Modicon Estrostep Fe Ovcon Loestrin Ovrette Lo Ovral Triphasil Nordette Depo Provera Nor-Q.D. Injection Ortho-Cept Ovral Ortho-Cyclen CORTICOSTEROIDS - ORAL Cortef 20mg * Prelone 5mg 5ml Prelone 15mg 5ml * Deltasone * Prednisolone conc. Cortef 5mg, 10mg 5mg solution Cortisone * Decadron * Florinef Aristocort Medrol * Pediapred ESTROGENS Gynodiol Prempro Ogen * , Ortho-Est * Climara Alora Ortho-Dienestrol Estratab, Menest Vivelle Premarin Estraderm Premphase.
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6-D. Contraceptives QL for all contraceptives ; ESTROSTEP FE M ; Levora, Portia. * LEVLEN M ; Aviane, Lessina, Lutera. * LEVLITE M ; June1, Microgestin. * LOESTRIN M ; Junel FE, Microgestin FE. * LOESTRIN FE M ; Nortrel, Necon. * MODICON M ; ORTHO EVRA M!
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Medroxyprogesterone inj, 150 mg mL Depo-Provera ; desogestrel ethinyl estradiol Apri, Solia Ortho-Cept ; desogestrel ethinyl estradiol Kariva Mircette ; ethynodiol ethinyl estradiol Zovia Demulen ; levonorgestrel ethinyl estradiol Aviane, Lutera Alesse ; levonorgestrel ethinyl estradiol, triphasic Enpresse, Trivora Triphasil ; levonorgestrel ethinyl estradiol Lessina Levlite ; levonorgestrel ethinyl estradiol, 0.15 30 Levora, Portia Nordette ; norethindrone Camila, Nora-Be Nor-QD ; norethindrone Errin, Jolivette Ortho Micronor ; norethindrone acetate ethinyl estradiol Junel, Microgestin Loestrin ; norethindrone acetate ethinyl estradiol Fe Junel Fe, Microgestin Fe Loestrin Fe ; norethindrone ethinyl estradiol Necon, Nortrel Modicon ; norethindrone ethinyl estradiol Necon, Nortrel Ortho-Novum 1 35 ; norethindrone ethinyl estradiol, biphasic Necon OrthoNovum 10 11 ; norethindrone ethinyl estradiol, triphasic Necon, Nortrel Ortho-Novum 7 ; norethindrone mestranol Necon Ortho-Novum 1 50 ; norgestimate ethinyl estradiol, triphasic Trinessa, Tri-Previfem, Tri-Sprintec Ortho Tri-Cyclen ; norgestrel ethinyl estradiol Cryselle, Low-Ogestrel Lo Ovral ; norgestrel ethinyl estradiol Mononessa, Previfem, Sprintec Ortho-Cyclen ; norgestrel ethinyl estradiol Ogestrel Ovral.
Telephone: 09 ; 638 6040 or 09 ; 638 6041 E-mail: admin amac .nz Fax: 09 ; 631 0451 After hours or weekends: Contact your referring doctor. S he will have an emergency number to call if they are outside normal working hours. Urgent medical attention: Your local Hospital. Telephone numbers are listed in the phone book take your copy of the letter given to you at discharge by AMAC ; . Any 24 hours Emergency Accident and Medical Clinic. Telephone numbers are listed in the phone book take your copy of the letter given to you at discharge by AMAC ; . Postoperative check up Telephone your referring doctor or contact AMAC for an appointment with our doctor. Tel: 09 ; 638 6040 or 638 6041 and lorazepam.
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Normally undetectable in the serum but levels remain elevated for up to 16 hours following anaphylaxis. N-methyl-histamine, the major URINARY metabolite histamine may also be detectable for prolonged periods.Type 1 hypersensitivity reactions involve IgE 50% of thiopentone reactions ; Classical complement mediated activation involves IgG or IgMAlternative complement activation does not involve antibodies Reference: McKinnon & Wildsmith. Histaminoid reactions in Anaesthesia. British Journal of Anaesthesia 1995; 74: 217. Update in Anaesthesia No 12.
Ask if patient answers "called for a refill" to previous question ; If you need a medicine refill, how easy is it to reach your provider, a clinic nurse, or the pharmacy for a refill? choose one ; Very Easy 2 Somewhat Easy 3 Neither Easy Difficult 4 Somewhat Difficult 5 Very Difficult.
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Seattle medical associates; lewis and john dare center at the virginia mason medical center, another seattlebased practice; personal physicians health care pc and llc, a boston-based practice; personal physician group, llp in houston, texas; miami medical consultants, pa in coral gables, florida; and health access based in fort lauderdale.
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