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Amounts to blaming the patient for his or her own disease. Even when the evidence points in the opposite direction, doctors frequently come up with psychological diagnoses in the absence of clear answers. Children may be the most vulnerable of all to such treatment. It's hard for them to fight for their rights, or make the case for their own sanity. Pediatricians, when flummoxed by their small patients' complaints, tend to cast a suspicious eye at the child's home environment: If the parents are in distress, pediatricians are provided with a convenient explanation for mysterious symptoms in the child. As a pediatrician, I recognize the legitimacy of including the status of a child's home life in my differential diagnosis - the decision tree I work from as I search for the correct diagnosis. But I do not automatically exclude the possibility of medical illness in a child because his parents are on the verge of a divorce, or if a grandmother died. Just as it is possible to have child with diabetes living.
1. 2. 3. ACC AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult. J Coll Cardiol. 2005 Sep 20; 46 6 ; : e1-82. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003 Dec; 42 6 ; : 1206-52. Epub 2003 Dec 1. ACC AHA guidelines for the management of patients with ST-elevation myocardial infarction. A report of the American College of Cardiology American Heart Association Task Force on Practice Guidelines. American College of Cardiology American Heart Association. 1996 Nov 1 revised 2004 Jul ; . Circulation. 2004 Aug 3; 110 5 ; : 588-636. Standards of Medical Care in Diabetes. American Diabetes Association. Diabetes Care. 2005 Jan; 28 Suppl 1: S4-S36. Atacand [package insert]. Wilmington, DE: AstraZeneca LP, May 2005. Teveten [package insert]. Bridgewater, NJ: Biovail Pharmaceuticals, Inc, Jan. 2004. Avapro [package insert]. New York, NY: Bristol-Myers Squibb Sanofi-Synthelabo Partnership, Oct 1005. Cozaar [package insert]. Whitehouse Station, NJ: Merck & Co., Inc., Apr 2005. Benicar [package insert]. Parsippany, NJ: Sankyo Pharma, Inc., Jul 2005. Micardis [package insert]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc., Aug 2005. Diovan [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corp., Aug 2005. Kastrup EK, Ed. Drug Facts and Comparisons. Facts and Comparisons. St. Louis. 2005. MICROMEDEX Healthcare Series: MICROMEDEX, Englewood, CO Edition expires 2006 ; Tatro DS, ed. Drug Interaction Facts. St. Louis, MO: Wolters Kluwer Health, Inc.; 2005. Dahlof B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study LIFE ; : a randomized trial against atenolol. Lancet. 2002 Mar 23; 359 9311 ; : 995-1003. Julius S, Alderman MH, Beevers G, et al. Cardiovascular risk reduction in hypertensive black patients with left ventricular hypertrophy: the LIFE study. J Coll Cardiol. 2004 Mar 17; 43 6 ; : 1047-55. Lindholm LH, Ibsen H, Dahlf B, et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention for Endpoint reduction in hypertension study LIFE ; : a randomized trial against atenolol. Lancet. 2002; 359: 1004-10. Kjeldson G, Dahlof B, Devereux RB, et al. Effects of losartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy. A LIFE substudy. JAMA. 2002; 288: 1491-8. Lithell H, Hansson L, Skoog I, et al. The study on cognition and prognosis in the elderly SCOPE ; : principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21: 875-86. Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomized trial. Lancet.2004; 363: 2022-31. Conlin PR, Spence JD, Williams B et al. PREVAIL meta-analysis Angiotensin II Antagonists. Are there differences in efficacy. Amer J Htn. 2000; 13: 418-26. Oparil S, Williams D, Chrysant SG et al. Comparative efficacy of olmesartan, losartan, valsartan, and irbesartan in the control of essential hypertension. J Clin Hypertens. 2001; 3: 283-291, Cohn JN, Tognoni G, et al. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med. 2001; 345: 1667-75. Pfeffer MA, Swedberg K, Granger CB, et al. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall Programme. Lancet. 2003 Sep 6; 362 9386 ; : 759-66. McMurray JJ, Ostergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet. 2003 Sep 6; 362 9386 ; : 767-71. Granger, CB, McMurray JJ, Yusuf S, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet. 2003 Sep 6; 362 9386 ; : 772-6 and telmisartan.
PROCEDURE There are certain circumstances when communication with medical control is not possible due to failure of the normal communication methods. In these unusual circumstances, the paramedic or RN may continue protocols requiring medical control contact in the best interest of patient care. When utilizing the Communication Failure Procedure, the crew-member providing patient care must complete a Communication Failure Report immediately after completing the call and must turn the form in to Clinical Services, along with a copy of the PCR, at the end of shift. Report will be reviewed by Clinical Services and or the Medical Director.
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| 60. GLOBAL REPORTING INITIATIVE, supra note 54, at 2231. 61. Id. at 10. 62. Id. at 4456. 63. Id. at 30. 64. Id. at 26. 65. Id. at 25. 66. Id. at 27. 67. Such a context might include nationally or internationally recognized goals or targets which are beyond the boundaries of the reporting company. 68. Id. at 24. 69. As of October 2005, twenty-six "health care products" companies worldwide report using the GRI framework, including seven U.S.-based firms: Abbot Laboratories, Allergan, Baxter International, Bristol-Myers Squibb, Genecor International, Lilly, and Wyeth. The remaining are companies based in the U.K., France, Germany, Japan, Ireland, Switzerland, Denmark, Sweden, and India. Organisations Using the GRI Guidelines, : globalreporting guidelines reports search last visited Mar. 31, 2006 ; select Health Care Products from Activity Sector drop-down menu; click Search.
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5.1 LEUKOCYTE, PLATELET AND ENDOTHELIAL CELL INTERACTIONS IN INTESTINAL INFLAMMATION D. Neil Granger Molecular & Cellular Physiology, LSU Health Sciences Center, 1501 Kings Highway, Shreveport, Louisiana, 71130-3932 The microcirculation plays an important role in the recruitment of different circulating blood cells into the inflamed intestine. This role is achieved through phenotypic changes in vascular endothelium that lead to a more pro-adhesive surface and which allows for blood cell attachment and extravasation. A variety of endothelial cell adhesion molecules, including P- and E-selectins, ICAM-1, VCAM-1 and MAdCAM-1 are upregulated on the surface of endothelial cells in the gut microcircualtion and these glycoproteins can mediate the recruitment of diverse cell populations, including neutrophils, T-lymphocytes, and platelets. A consequence of these responses is that vascular endothelial cells assume both an inflammatory and thrombogenic phenotype. In human and experimental IBD, platelets circulate in an activated state and more readily form aggregates with leukocytes. Platelets represent an important source of inflammatory mediators and can modulate the activation state of inflammatory cells as well as endothelial cells. Experimental evidence indicates that the increased thrombogenic potential in IBD is related to disease severity and is linked to the adhesion and activation of leukocytes in the gut microcirculation. REFERENCES 1. Shigematsu T, Specian RD, Wolf RE, Grisham MB, Granger DN. MAdCAM mediates lymphocyteendothelial cell adhesion in a murine model of chronic and minocycline.
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NON-INVASIVE ASSESSMENTS FOR OSTEOPOROTIC FRACTURE RISK B-K Tan1, RI Price2, R Day3, SS Dhaliwal4 & KP Singer5 1 Centre for Musculoskeletal Studies, School of Surgery and Pathology, The University of Western Australia; School of Physiotherapy, Curtin University of Technology, Perth, WA 2 Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, WA 3 Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, WA 4 School of Public Health, Curtin University of Technology, Perth, WA 5 Centre for Musculoskeletal Studies, School of Surgery and Pathology, The University of Western Australia, Perth, WA Aim: Bone loss and the propensity to fall increase the risk of fragility fractures and this risk increases with aging. The aim of the study was to investigate if calcaneal quantitative ultrasonometry and falls risk assessments can identify a group of osteoporotic elderly women from a non-osteoporotic group. Methods: 104 community-dwelling women mean age 71.3 5.8 ; , recruited prospectively, underwent DXA BMD and calcaneal QUS measurements; rasterstereographic thoracic curvature examination and performance-based assessment of strength, mobility and balance. The women were classified into a `High Risk' or a `Low Risk' of osteoporotic fracture based on the WHO recommended BMD T-score of -2.5 and or a history of fragility fracture. Results.
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While reimbursement reform, curricular change, and changes in physician supply policies are all necessary to correct our health care system gone awry, they are not sufficient. They must be accompanied by new thinking about the nature of health and illness and specifically about a union between science and general medicine. We need more, not less, science in the trenches; and we need to consider other ways of knowing, if we are to provide excellent care to our patients in a constantly changing health care environment. It is this unmet need to understand and improve general medical practice that has inspired the creation of practice-based research and the establishment of the NJFPRN. The NJFPRN is meant to be a resource to the physicians and patients of New Jersey: A laboratory to generate new knowledge and translate existing knowledge into practice, and to support financially the practices that are the laboratory. Founded by Robert Pallay, MD in 2001, the NJFPRN is a subsidiary of the New Jersey Academy of Family Physicians Foundation, and consists of 150 Family Physician members, practicing out of 50 offices that care for over 300, 000 patients. Currently, the Network is expanding and will eventually include approximately 80 family practices. The Network is governed by a seven-member Board of Directors, the majority of whom are practicing Family Physicians. Research expertise will be available from a Board of Advisors and the research team from the UMDNJ-RWJMS Department of Family Medicine. A three-member Patient and Community Advisory Board will provide input into the Network's research agenda. Two principal activities of the Network will be: 1 ; to conduct pharmaceutical industry sponsored clinical trials these will generate practice revenue, as well as provide training in data collection and 2 ; to participate in clinician and researcher initiated practice-based research projects. Current pharmaceutical studies generating revenue to the participating practices and the Foundation include hypertension, seasonal allergic rhinitis, and GERD. A .4 million National Heart, Lung, and Blood Institutefunded practice improvement project to work with practices to improve care for management of asthma, diabetes, and hypertension is an example of a researcher initiated project. More pharmaceutical and other studies are in and mefenamic and micardis.
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Cardiology micardis powerful push secures success A product of blockbuster potential, micardis in 2002 showed the first results of marketing efforts, improving its position from being our ninth best-selling product to No. 5. After the micardis branding campaign was announced in December 2001, it was implemented in most countries by the second quarter of 2002. The large-scale ontarget trial programme, encompassing the main trial ontarget ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial ; , with approximately 23, 400 patients, and the parallel trial transcend Telmisartan Randomized AssessmeNt Study in aCE-I iNtolerant subjects, with cardiovascular Disease ; with up to 5, 000 patients, started in November 2001. The trial programme has run extremely well, with nearly 800 sites in 40 countries. To date, recruitment has been far faster than forecast and is expected to finish in mid-2003, or six months earlier than expected. This major accomplishment was possible due to a strong academic-industrial partnership and a Medico-Marketing Communications strategy. It is the largest cardiovascular trial ever performed with an angiotensin II receptor blocker and has gained micardis prestige among cardiovascular opinion leaders all over the world. Central Nervous System mirapex sifrol promise for early Parkinson's patients Parkinson's disease affects approximately 1 % of people over 60, causing tremor, muscle rigidity, slowed motion, shuffling gait and a loss.
Telmisartan Micardis Boehringer Ingelheim ; Pritor Glaxo Wellcome ; 40 mg and 80 mg tablets Approved indication: hypertension Australian Medicines Handbook Section 6.4.5 Telmisartan adds to the choice of angiotensin receptor antagonists1 available in Australia. It is suitable for patients with mild to moderate hypertension who cannot tolerate other treatments. Patients take telmisartan once a day. There is extensive first-pass metabolism so the bioavailability of a 40 mg dose is 40%. Less than 1% of the dose is excreted unchanged in the urine. The half-life is approximately 20 hours. Blockade of the AT1 receptor reduces vascular resistance. This lowers the blood pressure, but it does not increase the pulse. The effect on blood pressure is slow and the full effect is not reached for 4-8 weeks. Orthostatic hypotension is uncommon. Telmisartan has been compared with other antihypertensive drugs and placebo. In a comparison with enalapril, 278 elderly patients were treated for 26 weeks. Both drugs provided effective 24-hour control of blood pressure. The mean reductions in blood pressures were 22 12 for telmisartan and 20 11 for enalapril.2 An unpublished trial compared telmisartan and losartan. Although the treatment period was only six weeks, telmisartan had a greater effect on blood pressure. The mean reductions were 11 7 for telmisartan and 6 4 for losartan. Telmisartan is generally well tolerated. In clinical trials the incidence of cough was approximately 1%. Diarrhoea and dyspepsia occur more frequently than with placebo.
1. US Renal Data System: USRDS 2001 Annual Data Report, Atlas of End Stage Renal Disesase in the United States, Bethesda, MD, National Institutes of Health, National Institute of Diabetes, Digestive, and Kidney Diseases, 2001 2. Committee for the Study of the Medicare ESRD Program Division of Health Care Services: Kidney failure and the federal government, edited by Rettig RA, Levinsky NG, Nat Acad Press 91: 116 117, Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure: The sixth report of the Joint National Committee on Prevention, Detection, Evaluation.
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