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Daily oral form of ibandronate. The availability of intravenous ibandronate and zoledronic acid will provide benefit for the three circumstances listed above, and the once-yearly dosing interval with zoledronic acid is especially appealing. All drugs have side effects. The patients who received intravenous zoledronic acid did not experience upper GI side effects. However, a moderate number of patients did experience a flulike illness that lasted for a few days after they received their intravenous treatment. These symptoms of muscle and joint aches, fever and headache were generally mild to moderate, lasted for only a few days, and were helped by taking medicines such as acetaminophen Tylenol ; . The symptoms most often occurred after the first dose, and did not occur after the second or third doses. Similar symptoms have occurred with intravenous Boniva and, less commonly, with the high-dose once monthly Boniva treatment. The results of the major fracture prevention study with zoledronic acid will be submitted to the FDA for their review and for them to decide about approving this treatment regimen for women with postmenopausal osteoporosis. It takes several months after the filing of this information before the FDA arrives at that decision. Zoledronic acid is already approved by the FDA for the treatment of patients with cancer who have high levels of blood calcium or have tumor that has spread to the bone tissue. Those patients receive very high doses of zoledronic acid Zometa ; , receiving IV treatments every 3-4 weeks. This treatment has been shown to slow the growth of tumor in the bone and to slow the progression of the bone complications of cancer. Zometa treatment has been associated with the development of a dental problem called osteonecrosis of the jaw. In some patients who are receiving the high doses of Zometa, the jaw bone does not heal after teeth are removed or after other dental procedures. A smaller number of patients have been seen with these jaw lesions who have taken oral bisphosphonates like Fosamax or Actonel for the treatment of osteoporosis, although the risk of developing jaw problems with bisphosphonate tablets appears to be very low. It is not known whether the dose of intravenous zoledronic acid that will be used for the treatment of osteoporosis will be associated with this complication and zanaflex. 118 HOT TOPICS IN UROLOGY terms of reducing the incidence of positive surgical margins. Although there is no absolute means of identifying those individuals with pre-existing microscopic invasion of extraprostatic tissue, methods are now available to establish those at highest risk. The most useful of these are the three components incorporated in the tables devised, and subsequently updated, by Partin et al, 19, 20 namely the clinical stage, the PSA and the Gleason score from the preoperative prostate biopsy. High clinical stage, high preoperative PSA, high Gleason grade as well as large tumor volume and multiple positive biopsies all increase the risk of positive surgical margins.3, 21, 22 While clinical staging using digital rectal examination DRE ; is inaccurate at assessing pathologic stage it is a useful predictor of positive margins. In a recent review positive surgical margin rates were: 5% for T1a, 22% for T1b, 23% for T1c, 17% for T2a, 36% for T2b, 27% for T2c and 40% for T3a clinical stage.1 Depending on the tumor site, clinical stage indirectly reflects tumor volume. Gomez et al23 showed patients with negative margins had a mean tumor volume of 4.8 ml compared with 12.3 ml in those with positive margins. As tumor size is difficult to assess preoperatively, attempts have been made to compare tumor volume with the preoperative prostate biopsy findings. Ackerman and colleagues demonstrated the presence of two or more positive biopsy cores as the most significant risk factor for positive margin status.3 Hammerer et al24 showed that men in whom margins were positive had a mean 3.79 positive cores compared with 1.89 in those with negative margins. PSA is also a useful predictor of the risk of positive margins. As the PSA rises the risk increases; the mean PSA for a patient with positive margins is 16.829.0 ng ml, whereas for men with negative margins it is 9.2716.6 ng ml.3, 10 Watson et al5 compared Gleason sum at biopsy with margin status; they found that of men who had a Gleason score of 7 or greater, 43% had positive margins compared with 30% of men with a Gleason score of less than 7. Although a higher Gleason score increases the risk of positive margins, Ohori et al25 emphasized the need to combine the Gleason score with the PSA and DRE. This combination identified 60% of poorly differentiated tumors of which 81% were organ confined. Newer techniques are evolving in an attempt to augment or improve on the `classical three' preoperative predictors biopsy Gleason grade, clinical stage and preoperative PSA score ; . DNA ploidy has been reported as an independent predictor of outcome after radical prostatectomy, 11 although it has not been adequately assessed for use in predicting margin status. Race is an independent predictor of positive surgical margins and disease-free survival in patients with positive surgical margins.26 In patients matched for pathologic stage, Gleason grade and tumor volume, AfricanAmerican men were found to have a higher incidence of positive margins compared with white Americans 48% vs 33% respectively, p 0.001 ; . Furthermore, African American men had a higher incidence of positive margins at the bladder base; however in this study, the location of the positive margin did not have an effect on the disease-free survival.26.
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Copaxone ; , so it was not possible to evaluate the effect of treatment. It's tempting, when faced with a diagnosis of MS -- especially when attacks occur infrequently -- to believe that things will go well as long as one makes positive lifestyle changes like eating well, exercising and minimizing stress, but the reality is that no one can easily predict the disease course of individuals. There are many patterns in MS: some people can have just a few relapses in the beginning and then basically are stable, showing progressive disease about ten years later -- with or without relapses. Our study showed that a person with seemingly benign MS should not ignore their disease, but should return to an MS-specialized neurologist regularly for assessment -- at least once every one or two years. Sometimes a thorough neurological exam shows signs of MS that the person was unaware of, and if a magnetic resonance imaging MRI ; is done, it may reveal lesions indicating likely MS disease activity. Anyone with MS attacks or evidence of new MRI lesions pointing to active inflammation should consider treatment with DMTs and accupril.
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Medical coders are bound by strict guidelines in ICD-9 diagnosis coding. Certain terms, while descriptive and clear in their intent for communication between physicians and nurses in the progress notes, are not included in the coding Index. One such example would be "H H low, will transfuse". Most healthcare professionals reading this would "know" the patient had anemia. However, the coder is only allowed to code what is documented in the chart. "H H low" cannot be coded. Therefore, the physician must document the term "anemia" in order to assign a code for this condition that has required nursing medical attention, monitoring and care. The more specific the physician can be with the diagnosis of anemia, the better. The first step is to give the reason for the transfusion or treatment, and the next step is to tell whether the anemia is acute or chronic. If chronic, the coder needs to know if it is due to kidney disease, malignancy, iron-deficiency, dietary, or other chronic factors. If the anemia is due to blood loss, again, documentation of acute or chronic is required. If this is chronic blood loss anemia, the further specification is needed, i.e. gastrointestinal blood loss. If it is bleeding, documentation of both the cause and the site of the bleeding is warranted i.e. polyp in the colon or ulcer in the esophagus ; , as well as whether this is felt to be an acute bleed or a chronic bleed. If the anemia is related to a surgical condition acute blood loss ; , further delineation should be given, such as perioperative, intraoperative or postoperative, as well as whether this amount of blood loss was expected or if it was a complication of the procedure. If the blood loss is due to injury, such as fracture, laceration, or hematoma, this should be clearly stated. When coders encounter transfusions with no documentation of the word anemia, or if they encounter the term anemia, but no clarification as to the specific type, it is necessary to Query the physician to obtain the precise wording necessary to lead to proper coding and reimbursement for our patients. Many of our physicians are already doing a great job with these guidelines, and we look forward to our continued interactions with the physicians through our query process. Remember, good documentation always makes a coder's day go better. I can be reached at Janelle.Wissler leememorial for any further clarification on this topic, or any other topics physicians would like addressed from a coding reimbursement standpoint. These medications can be used to help relieve congestion and runny noses associated with colds and viral upper respiratory infections. Most preparations are recommended to be used three to four times per day. The use of antihistamines and decongestants is not recommended in children 6 months of age. The use of combination cold medications such as Tylenol Cold is discouraged. AGE 6 9 months 9 12 months 12 18 months 18 24 months 2 4 years 4 6 years 6 12 years Decongestants Sudafed 30 mg tsp ; pseudoephedrine ; tsp 1 3 tsp 1 3 tsp tsp 2 3 tsp 1 tsp Antihistamines Chlorpheniramine Benadryl Elixir 12.5 mg tsp ; 2 mg tsp ; diphenhydramine ; tsp tsp tsp tsp tsp 1 tsp tsp 1 tsp 1 tsp 1 tsp 1 tsp 1 tsp 2 tsp 2 tsp.
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Price: $ 00 array biopharma appoints john yates, mb chb, md, to chief medical officer 2007 may 28. Inhibitors for patients with CHF remain disappointingly low. Integration of -blockers into standard clinical practice may be even slower because these agents may precipitate CHF and cause several other adverse effects. It is only since the 1990s that heart failure survival rates have begun to improve. Data from the Scottish National Health Service database from 1986 through 1995 showed an increase in median survival from 1.23 to 1.64 years in heart failure patients.18 These benefits coincide with the incorporation of ACE inhibitor therapy into the standard heart failure regimen. Because of the apparent importance of neurohormonal modulation and the ability of -blockers to reduce hospitalization rates, morbidity, and mortality in a clinical syndrome with a dismal prognosis, cardiologists and noncardiologists alike must become comfortable with the use of these agents in patients with CHF. The purpose of this review is to provide practical guidelines to assist noncardiologists in the integration of -blockers into their approach to the patient with CHF. WHY DO -BLOCKERS BENEFIT PATIENTS WITH CHF? Multiple mechanisms contribute to the beneficial effects of -blockers in CHF. Simply, the reduction in heart rate serves to lower myocardial energy expenditure, prolongs diastolic filling, and hence lengthens coronary perfusion. -Blockers possess antihypertensive, anti-ischemic, and antiarrhythmic properties. This pharmacological class also works adjunctively with ACE inhibitors as 1-adrenergic stimulation activates the renin-angiotensin cascade.19 As.

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