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CLINICAL PHARMACY TECHNICIAN: A NEW PATIENT CARE MODEL Michelle L. Stec * , Karen Kelly, Stan Kent Evanston Northwestern Healthcare, 2650 Ridge Avenue, Evanston, Il, 60201 mstec enh Currently, an established and ongoing nursing shortage is affecting hospitals nation wide. Recent reports predict that more than one million new and replacement nurses will be needed by the year 2010. This drastic shortage is due to multiple factors such as decreased job satisfaction caused by mandatory overtime and increasing workloads, and a reduction in nursing program enrollment. To compensate for the projected nursing shortage the government, college institutions, and health care facilities are taking a variety of approaches to resolve the issue. At Evanston Northwestern Healthcare, a new patient-care model was developed to address the nursing shortage problem. The design is intended to allow the nurses to focus more on clinical responsibilities. The model distributes some of the nurse's activities to patient care technicians and clinical pharmacy technicians. The clinical pharmacy technician is assigned to a nursing unit and is responsible for various medication-related activities that a nurse would encounter on a daily basis. Some of the daily activities include pulling patient medications from unit-based cabinets UBC ; , finding missing medications, and resolving discrepancies. Candidates for the clinical pharmacy technician position underwent an interview process and took part in a training program designed to focus on the clinical aspects of their job responsibilities. All clinical pharmacy technicians were required to pass a comprehensive exam after each area of training. The new patient care model is currently in a three-month trial period on pre-selected nursing units at Evanston, Glenbrook, and Highland Park hospitals. During this pilot, data is being collected in the following areas: number of phone calls to central pharmacy, pages to unit pharmacist, and reported missing medications. Following the pilot, the patient care model will be modified and expanded to the remaining nursing units. Learning Objectives: Describe the clinical pharmacy technician role in the new patient care. Model Discuss the need for a new patient care model. Self Assessment Questions: Increased workloads, wages, and mandatory overtime are all factors contributing to the nursing shortage. T F The clinical pharmacy technician's responsibilities include locating missing medications, solving discrepancies, and answering all medication-related questions on their assigned nursing unit. T F.
BIGUANIDES Patient Scenario Joshua is on glipizide 10 mg 2x day and metformin 1000 mg 2X day. He follows his meal plan correctly. He had a hypoglycemic reaction early this morning. The physician changed the metformin dose and the patient continues to have hypoglycemic reactions. Can you figure out the problem after you read more about managing Type 2 Diabetes? Class Biguanides Generic Name metformin Available as generic? yes Brand Names Glucophage.
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Substitutions, L75R, H219Q, V390D A, R409K, L449F, and E468K in the present study Table 1 ; . When HIV-1 was passaged under APV pressure, L75R and H219Q mutations in the Gag protein emerged prior to the emergence of protease mutations, and we found that such Gag mutations were indispensable for the efficient replication of APV resistant HIV-1 HIV-1AR ; . We thought that Gag polyprotein containing L75R or H219Q would be more sensitive to the cleavage by mutant protease since such a protease has impaired enzymatic activity due to the accumulation of amino acid substitutions within itself. Indeed, HIV-1AR whose mutant gag gene was substituted with a wild type gag gene but with the mutant protease being intact ; HIV-1ARL75 H219 V390 ; failed to replicate Figure 2 and sirolimus.
Eugene Giles, PhD * , Department of Anthropology, University of Illinois, 607 South Mathews Avenue, Urbana, IL 61801 The goal of this presentation is to review the early extension of quantitative statistical methods in forensic anthropology that provided the impetus for the development of FORDISC for use in research and casework. This presentation will impact the forensic community and or humanity by providing help to forensic anthropologists and other forensic scientists in understanding the origins of the multivariate statistical techniques used in their field. A statistical approach to skeletal identification and description developed in the nineteenth century with the use of indices to quantify observational characteristics of features such as skull shape, nose shape, relative long bone lengths, and the like. An index so used had the advantage of ostensibly removing size from consideration, and allowed its adherents to claim a quantitative group characterization of shape. The French anthropologist Paul Topinard wrote in 1894 that a cephalic index 100 X head breadth - head length ; of 75 and under was "universally adopted" but there were exceptions ; as defining long-headedness or dolichocephaly. Topinard also combined several sets of skeletal measurements to form a database for determining stature by average long bone stature ratios. For example, he found stature to be seven times maximum radius length, so stature cm ; 7 radius length [cm] ; plus 3.5 cm a constant he employed only to move from skeletal to living stature ; . Topinard's ratio approach seriously misrepresented both ends of the stature range. His remedy was to divide the sample into tall, short and medium sized people. A more adequate solution, which underpins today's FORDISC, was first used by the British biometrician Karl Pearson at the turn of the century. Pearson applied regression, said to be the most used and least understood type of statistical methodology, in its most elementary form, linear regression, to the calculation of stature. As Pearson 1899 ; put it, "The theory of regression shows that the most probable value of B [for example, stature] is expressible, so long as the correlation is normal, as a linear function of A [for example, femur length]." A step of significance in the application of statistics to forensic anthropology came in the middle 1930s. Sometimes called the Fisherian stage of discriminatory analysis after its principal originator, R.A. Fisher, the linear discriminant function was initially applied by colleagues of Fisher's to problems familiar to forensic anthropologists. E.S. Martin in 1935 used Fisher's linear discriminant function to sex a collection of Egyptian.
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The continued access to Renagel under the Medicare Part D program in the United States and market expansion in Brazil and throughout the Americas. NEXT-GENERATION PROGRESS Genzyme has made excellent progress on Renvela sevelamer carbonate ; , a next-generation version of Renagel designed to benefit both the current Renagel patient population and those with earlier-stage chronic kidney disease CKD ; who are not on dialysis. Having successfully completed a pivotal trial comparing Renvela to Renagel in later-stage patients, we filed for approval in late 2006 and expect to launch the new product in early 2008. CHRONIC KIDNEY DISEASE Following the launch of Renvela for patients on dialysis, we plan to seek approval for this product candidate to treat those with CKD who are not on dialysis. Our clinical trial of a powder formulation of Renvela is now fully enrolled. Renvela powder is designed to be used once a day, an option aimed at improving convenience for patients and therefore overall compliance. We are also working to expand Hectorol, a Vitamin D2 analog used in the growing CKD market, to countries around the world. This product, our entry into the CKD market, experienced 20 percent growth in 2006. We are further investing in Hectorol by bringing manufacturing in-house and skelaxin.
With antimalarial drug resistance a global challenge, patients in malaria-endemic countries need inexpensive, efficacious, field-adapted drugs. Preserving the life span of antimalarial drugs through highly effective combination treatments is a key part of the strategy to roll back malaria. Safe and rapidly acting, the combination of artesunate AS ; and amodiaquine AQ ; is one of the antimalarial drug combinations recommended by the World Health Organization WHO ; for Africa.1 Fixed-dose formulations, which are easier to use and ensure drugs are taken together and in correct proportions, are needed but are often not available for children.2 For the approximately 3, 000 African children dying every day due to malaria, 3 such an innovation could make a major difference. This fixed-dose combination of AS and AQ was developed by the FACT partners managed by the non-profit product development organization, DNDi, and with the involvement since 2004 of the world's fourthlargest pharmaceutical company, sanofi-aventis. ASAQ will simplify treatment: 1 tablet a day for children, the population most at risk, over 3 days to treat uncomplicated malaria. Available under the name Artesunate-Amodiaquine Winthrop ASAQ ; for public market and the brand name Coarsucam for private market, ASAQ has four key features.
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Occasional weakly positive cells. Fig. 2 ; . Immunologic marker studies revealed that over 95% blasts expressed surface Ia-like antigens. All cells were negative for the common ALL antigen, human Tlymphoid antigens, and SmIg. In smears, the smaller.
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Abstract Background. The purpose of the present study was to evaluate the impact of cinacalcet administration on the attainment of Kidney Disease Outcomes Quality Initiative of the National Kidney Foundation NFK-K DOQI ; targets, in a group of dialysis patients with secondary hyperparathyroidism that were not controlled with vitamin D metabolites due to inadequate elevations in serum calcium and or phosphorus. Methods. Twenty-eight patients undergoing haemodialysis that presented secondary hyperparathyroidism PTH 300 pg ml ; with difficulty to use vitamin D either because of hypercalcaemia 10.2 mg dl ; and or hyperphosphoraemia 5.5 mg dl ; were included in this study. The follow-up period was 9 months before and after the introduction of cinacalcet. We started by adding 30 mg of cinacalcet orally once daily to their previous vitamin D metabolite treatment. The following variables were calculated and recorded: the mean of all measurements of serum Ca, P and parathyroid hormones PTH ; , and Ca P in each patient; calcium in dialysate mEq l doses of vitamin D administered; doses of cinacalcet used, and the average prescription of calciumbased phosphate binders, sevelamer hydrochloride and aluminum binders, corresponding to two periods according to the introduction of cinacalcet. The proportions of patients with different serum Ca levels as well as serum P levels; serum PTH levels and CaxP at the beginning and at the end of the nine month period of treatment with cinacalcet were calculated. Results. Serum PTH 826.9 325 vs 248.1 77.3, P 0.001 ; , serum calcium 9.9 0.6 vs 8.6 0.4 and somatropin.
The group of chemicals called corticosteroids, as mentioned earlier, are secreted by various tissues in the body, but their presence can also stem from an extrinsic source when used therapeutically. Corticosteroids are used in a wide variety of differing systemic diseases, especially in inflammatory and autoimmune diseases Table 1 ; . The antiinflammatory actions of steroids are partly due to inhibition of the effect of lymphokines and retardation of lymphocyte and monocyte macrophage migration to the relevant site. This anti-inflammatory effect suppresses the manifestations of the disease process, but the process itself may continue undetected as diagnosis is made difficult, so corticosteroids should be used with great care, both systemically and in the eye. Side effects are rare during short-term.
08 10 2005--Announced it has completed the treatment phase of the Company's clinical trial involving 72 patients at 14 sites designed to test the safety and effectiveness of its AutoloGelTM System for diabetic foot ulcers. 07 15 2005--Announced the promotion of Andrew Maslan to the position of CFO and the resignation of William Allender, the previous CFO. 06 27 2005--Announced that Perfusion Partners and Associates Inc. PPAI ; , based in Fort Myers, Florida, and its affiliate organization, Transcorporeal Inc., have settled a patent dispute with Cytomedix for its platelet-derived therapies for treating wounds and other damaged tissue. Cytomedix had filed a suit against PPAI in the United States District Court for the Northern District of Illinois, which included claims for infringement of its "Knighton" patent related to the use of platelet releasates for the healing of tissue. 06 21 2005--Announced that Dr. Kshitij Mohan, CEO, will assume the additional position of chairman of the board effective July 1, 2005, succeeding Robert Burkett who has elected to retire from the board. 06 16 2005--Announced the appointment of Andrew Maslan to the new position of corporate controller, effective, July 1, 2005. 05 the approval of its listing application for the American Stock Exchange AMEX ; . The company's stock will be trading under the new ticker symbol GTF. 05 24 2005--Announced that the Company and Harvest Technologies Inc., of Plymouth, Massachusetts, have resolved a patent dispute related to the litigation between them to the mutual satisfaction of both companies. The two companies have agreed to dismiss the lawsuit, and a license has been granted to Harvest as part of the settlement. 05 09 2005--Announced that it has completed the planned enrollment of 72 patients in the Company's ongoing FDA-approved, prospective, randomized, blinded and controlled clinical trial to test the safety and effectiveness for the AutoloGelTM System for the treatment of diabetic foot ulcers. 04 26 2005--Announced that Medtronic agreed to settle a patent dispute and has been granted a license for its key Knighton patent U.S. Patent No. 5, 165, 938 and corresponding patents in other countries ; for all applications of its autologous platelet releasate therapy. 04 2005--Announced that Ronald R. Baker has joined the management team as vice president of sales and marketing, a newly created position reporting to the Company's CEO. 03 14 2005--Announced that it has signed a sales agreement with KOL Bio-Medical Instruments, Inc. to represent the company in select east coast territories of the United States for an initial six-month period under a commission fee structure, subject to renewal based upon mutual agreement. 03 08 2005--Announced that it has entered into a second licensing agreement with DePuy Spine, Inc., a Johnson and Johnson company. The additional license of Cytomedix's Knighton patent U.S. Patent No. 5, 165, 938 ; is for all applications of its autologous platelet releasate therapy, excluding treatment of chronic wounds, such as pressure ulcers, venous stasis, or diabetic foot ulcers. 02 16 2005--Received proceeds in excess of .4 million through the exercise of approximately 1.1 million warrants and options for the period between October 1, 2004 and February 15, 2005. Also during this period, certain shareholders converted about 1.7 million shares of the company's series A, B and C convertible preferred stock into approximately 670, 000 shares of common stock. These preferred stock conversions represent a decrease in dividend expense of approximately 0, 000 on an annual basis and sorafenib.
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Aside from the most significant OCDs that will produce clinical signs, most will improve or resolve with time .They are a juvenile condition of a young horse's bones as it is growing, and as it matures, the condition will be resolved in most cases . From research conducted by Drs . McIlwraith, Bramlage, and others, the evidence suggests that most OCDs do not have an adverse affect on a Thoroughbred's racing potential . Buyers should try to gain as much information as possible about the animal and should not let the radiographs have the final call, except in a few very severe situations: for instance, when a horse has large cyst-like lesions, erosive lesions in the joints, or crushed hocks . Typically, small chips will resolve or can be removed, most holes or openings ; in peripheral areas will fill in, and stifle OC lesions will be OK if monitored and given appropriate time . To understand these things and their subtle differences in particular cases, a buyer needs to have a good working relationship with a veterinarian so that the buyer knows how to interpret the findings and still can take a swing on a horse that he really likes . -- RobeRt J. hunt, DVm, ms Diplomate, acVs suRGeon Hagyard Equine Medical Institute.
PLACING THE TMJ FOSSAEMINENCE PROSTHESIS COMPONENT OF THE TMJ METALON-METAL TOTAL JOINT REPLACEMENT SYSTEM 1. Place the patient in the planned occlusion bilaterally posteriorly and anteriorly. Care must be taken not to contaminate the surgical sites during this procedure. If an IMF is placed, it is recommended that the individual applying the IMF change their gown and gloves before returning to the sterile field. Care must also be taken that none of the instruments used intraorally find their way back to the sterile field. Having a separate Mayo stand with dedicated IMF instrumentation and suction precludes such problems. 2. Perform any pre-operatively planned mandibular contouring. Remove bone conservatively with repeated trial placement of components to prevent unnecessary bone removal. 3. Insert the fossa component and place into proper position using the fossa-seating tool. 4. Again, confirm the fit of the fossa component. It is strongly recommended that at least four 4 ; Fossa-Eminence screws be used where practical to achieve firm fixation of the TMJ Fossa-Eminence prosthesis. Be sure to use the screws provided to insure compatibility of the metals. Caution should be used so as not to force the screw in place with too much pressure as the screw head could fracture. Always drill the hole slightly deeper than the length of the screw. 5. When the implant has been secured in place, check again for proper occlusion. Be sure to use the drill bits provided for preparing screw holes. Be diligent in this surgery to avoid injury to important adjacent structures i.e. middle cranial fossa, ear structures, facial nerve, and middle meningeal artery. Copiously irrigate to remove any bone or metal residuals that might occur in securing the metal components. 6. The TMJ Fossa-Eminence prosthesis must be secured only through the use of the drills and screws supplied by TMJ Implants, Inc. The screws and drills used with the TMJ Fossa-Eminence prosthesis have been specifically selected by size to ensure correct fixation of each prosthesis when used as directed. Any use of substitute drill bits or screws not supplied by TMJ Implants, Inc. in the TMJ Fossa and soriatane.
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The creation of an international community of spinal muscular atrophy researchers. We would like especially to thank Audrey Lewis, founder of Families of Spinal Muscular Atrophy. This work was presented in part at the Neurobiology of Disease in Children: Symposium on Spinal Muscular Atrophy, in conjunction with the 35th Annual Meeting of the Child Neurology Society, Pittsburgh, Pennsylvania, October 18-21, 2006. Supported by grants from Families of Spinal Muscular Atrophy, the Muscular Dystrophy Association USA, the American Academy of Neurology Foundation, and the Spinal Muscular Atrophy Foundation and sevelamer.
Scott Stransky, soon to be a sophomore at MIT and majoring in Mathematics and Computer Science. Scott returns to the MMRF this summer to assist with the office's information technology systems. He will be working with a database design expert to help create a customized informational database that will improve the way the MMRF is able to communicate with physicians and patients. Scott began working as a volunteer with the MMRF two years ago, and was recognized for his computer skills and willingness to take on several tasks. His previous work included the creation of new databases, web site consulting, donation processing, event organization and information technology system maintenance and sparfloxacin.
Used in prior work, and the constituents of the medium as used are presented in table 1. The assays were conducted on a semi-micro scale in which the final volume of medium per tube was 2 ml. In all cases the standard curves were based on at least 5 tubes at each of 6 different levels. The standard solutions were prepared to contain 18 Mgof DL-threonine, 8 ng of L-methionine, 2 and 2o jag of L-lysine added as the monohydrochloride ; . Samples were!
Rather ineffective in many cases. Cost and managed care coverage regulations restriction use. The efficacy to lower Hgb A1c values is not as potent as other single oral agents. It's hard to justify the cost of day. Not that powerful in lowering A1c, and not that much weight loss. It is expensive if out of pocket ; and is not covered by most insurances requiring preauthorizations which are time consuming and irritating ; . It is costly and has not dropped pt weight nor has it decreased A1C similar to Byetta. I wish it had weight loss also. Also, insurance coverage lacks The limited experience and knowledge of side effects. The cost and insurance coverage is the biggest problem. Januvia seems to have a relatively modest effect in persons with longstanding Type 2 diabetes mellitus. I wish it hadn't turned out to be weight neutral. I was hoping for a more robust appetite-attenuating effect. I believe it is expensive medication, and the change in A1c with its use is less than 1% in combination therapy with other oral medications. It just is too weak and renal function is a factor in dose. Lack of insurance reimbursement, lack of clinical experience, and long-term outcome studies. Januvia cannot be given with insulin. It is not covered by a lot of insurance companies. It is expensive. Side effects of headache and nausea. No impact on weight. Lack of weight loss. I have no problems so far with Januvia. Very expensive and not as much coverage yet. Cost, not tier two on most formularies, also A1c lowering not as good as some oral agents Lack of efficacy in some cases. Expensive limiting ability of patients to obtain it. Formulary coverage cost, but that should improve with time. Formulary coverage continues to be a big issue. Although I have written many scripts, I have gotten many call backs. The fact that it can only be given by subcutaneous injection. I was hoping that Januvia would have a greater efficacy in terms of A1C HB reduction. Formulary coverage, cost of medication, efficacy occasionally not as optimal as anticipated. None. But it is not cover by ins. It is not potent as other meds. Don't know enough patient responses to respond to that as yet. Most patients do well on it. Need to monitor renal function. Interaction with some medications. It is expensive and some insurances don't cover for it, also more literature and patient education is needed. Still has to do prior authorization with many insurance companies which make prescribing the drug less attractive as our office doesn't have the time to do prior authorization each time I consider using the drug. Drug gets approved anyway, but the inconvenience of doing and spectinomycin.
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Plant Proposed Near Elementary School Empire Synfuels, LLC, has submitted an application to the Town of DeWitt for a coal gasification plant at the former Alpha Cement plant in Jamesville, N.Y. Coal gasification is an old process, but this plant will use a new version of the technology. With no model for comparison it is not easy to predict hazards. This is what we know about the site: Former Alpha Cement plant and quarry in Jamesville -- 126 acres Abuts Jamesville elementary school Abuts Clark Reservation with endangered plant and animal species and a NY State protected wetland. Only 2 miles from hospitals , colleges, city and town centers Many residences to the north and south This is what we know about the process: 10, 000 tons of coal per day will arrive from Pennsylvania and West Virginia on 110-car trains, six days per week, traversing the city. Trains will idle their diesel engines for four hours or more while unloading. The process will require 4 million gallons per day for cooling from the Dewitt water supply. The 4 million gallows of waste water will be sent to metro water treatment facility. 80 vehicular trips per hour are expected to and from the site. A Westinghouse Plasma Gasifier develops 5000F heat for this process. The process generates synthetic natural gas, called synfuel. The developers plan to sell this as a natural gas substitute. Atlantic Chapter -- Iroquois Group and sirolimus.
23, 26, 27 ; . We examined which splice variant s ; corresponded to the secreted form of PD-1 produced at a high level in sera and the SF of RA patients. As shown in Fig. 5A, among three alternative splice variants that have unaffected open reading frame, the PD1 ex3 was preferentially expressed in peripheral blood and synovial T cells derived from RA compared with the controls, whereas the other variants were not detected in any of the groups. The PD-1 ex3 variant lacks the membrane-spanning domain of the PD-1 molecule but has an untouched extracellular domain of PD-1, suggesting that the putative translational product is soluble PD-1. We further addressed whether the PD-1 ex3 variant was associated characteristically with RA or whether its increased expression in SF and sera merely reflected the activation state of T cells in RA. For this purpose, we analyzed the expression levels of this alternative splice variant in T cells that were obtained from RA or controls and activated in vitro with anti-CD3 CD28 Abs. The results showed that the activation state did not significantly alter the expression of the PD-1 ex3 variant in T cells as evidenced by the and spiriva.
Has become the preferred method of treating cancer rather than vitamin A--although both are well-documented cancer fighters. The fact that beta-carotene has no known toxicity should not be overlooked. In contrast, daily high doses of vitamin A can damage the liver. The only side effect of beta-carotene called carotenosis ; is a yellowish-orange appearance to the skin. But this is totally harmless. Here is the dosage of beta-carotene: The dosage of an anti-cancer substance, which is given to a cancer patient, is always far higher than a preventive dose taken to maintain health and prevent cancer. But, in the case of beta-carotene, they can be the same! Beta-carotene is always perfectly safe. A typical dosage of between 75, 000 IU to 150, 000 IU of beta-carotene is prescribed for cancer patients at clinics, using nutritional approaches. This is equivalent to 1 or capsules 25, 000 IU each ; at each of three meals. But those who are not ill can take the same amount, if they wish: 75, 000 IU a day, or 150, 000 IU a day. Many do, including leading health experts who know the research findings on the subject.
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