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Frances A. Vincent, BSN, RN, Associate Editor and Nurse Consultant Mervyn Rimai, MD, Medical Consultant Elaine Labrecque, Technical Review Neena Singh, MD, Medical Review Mary E. Stewart , Compliance Review Published monthly except July and August ; by Quest Diagnostics. All inquiries, suggestions and comments should be addressed to William F. Vincent, Ph.D., Quest Diagnostics, P.O. Box 420, East Granby, CT 06026. Tel: . 800-982-6810 Ext. 7158 Fax: 860-653-3276 Email: william.f.vincent questdiagnostics Quest, Quest Diagnostics, the associated logo and all associated Quest Diagnostics marks are the trademarks of Quest Diagnostics 2004. Quest Diagnostics All rights. reserved questdiagnostics All other marks ' and TM' - are the property of their respective owners, for example, flomax alcohol.
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| ACKNOWLEDGEMENTS This work was supported by the Ente Cassa di Risparmio di Firenze PROMELAB project ; , the Ministero dell'Istruzione, dell'Universit e della Ricerca M.I.U.R. ; , and by the U.S.A. National Institutes of Health RO1 HL69830 and flovent, for example, buy flomax.
1. CDSC. Methicillin resistance in Staphylococcus aureus isolated from blood in England and Wales: 1994 to 1998. Commun Dis Rep CDR Weekly 1999; 9: 65, Working party report. Revised guidelines for the control of epidemic methicillin-resistant Staphylococcus aureus infections in hospitals. J Hosp Infect 1998; 39: 253290. Davies S, Zadik PM. Comparison of methods for the isolation of methicillin resistant Staphylococcus aureus. J Clin Pathol 1997: 50: 257258. Lally RT, Ederer MN, Woolfrey BF. Evaluation of mannitol salt agar with oxacillin as a screening medium for methicillinresistant Staphylococcus aureus. J Clin Microbiol 1985; 22: 501504. Ludlam GB. A selective medium for the isolation of Staph. aureus from heavily contaminated material. Monthly Bull Min Health 1949; 8: 1520. Lindsay JA, Riley TV Susceptibility to desferrioxamine: a new . test for the identication of Staphylococcus epidermidis. J Med Microbiol 1991; 35: 4548. Gunn BA, Dunkelberg WE, Creitz JR. Clinical evaluation of 2LSM medium for primary isolation and identication of.
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Lead remains a significant problem in many U.S. communities. Without proper screening, children face many consequences, including death. Children, being unable to protect themselves from their environment or from the lack of compliance of their parents, have little to no defense. The burden of protecting children from lead contamination rests largely on physicians, but pressure on state and federal public health policy must be maintained, if not strengthened. Only they can institute office practices that create a largely foolproof regimen for screening children for lead. While problems may lie with parental compliance, solutions lie with proactive physicians. Tammy Eisentrout, DO, graduated from Philadelphia College of Osteopathic Medicine in 2000. She completed her Family Practice Residency in Sandusky Ohio at Firelands Regional Medical Center in 2003. Dr. Eisentrout is board certified in Family Practice. She is currently the Chairman of the Department of Family Practice at Doctors Hospital in Massillon, Ohio and gemfibrozil.
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Key areas of member dissatisfaction were identified through analysis of information gathered from all data sources. Primary areas of dissatisfaction appeared consistently in more than one information source, whether the data was taken from member satisfaction surveys, complaints, provider change requests, and or appeal information. The primary areas of PCO member dissatisfaction concerns were: Referrals MSTS, CAHPS, complaints, and appeals ; , refer to pages 102-104 Telephone access MSTS, CAHPS , telephone response results ; , refer to pages 95-99 Pharmacy MSTS, complaints, appeals ; , refer to pages 110-111 Claims complaints, CAHPS ; , refer to pages 90-95 PCP access availability MSTS, CAHPS ; , refer to pages 31-34 and glyburide.
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References 1. Taylor WJ, Diers Caviness MH, MT ASCP ; , MA, A Textbook for the Clinical Application of Therapeutic Drug Monitoring, Abbott Laboratories, 1986. 2. Henry JB, MD, Clinical Diagnostic & Management by Laboratory Methods, 18th Edit., 1991. 3. Baselt RC, Cravey RH, Disposition of Toxic Drugs and Chemicals in Man, 4th Edit., 1996. * These precision, linearity and correlation studies were obtained in limited evaluations and are not intended to represent performance specifications for this reagent. * TDx is a trademark of Abbott Laboratories.
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Reptile husbandry, F. Frye ed. ; . Krieger Publishing, Melbourne, Florida, pp. 101160. GLAZEBROOK, J. S., AND R. S. F. CAMPBELL. 1990a. A survey of the diseases of marine turtles in northern Australia. I. Farmed turtles. Diseases of Aquatic Organisms 9: 8395. , AND . 1990b. A survey of the diseases of marine turtles in northern Australia. II. Oceanarium-reared and wild turtles. Diseases of Aquatic Organisms 9: 97104. HARMS, C. A., G. A. LEWBART, AND J. BEASLEY. 2002. Medical management of mixed nocardial and unidentified fungal osteomyelitis in a Kemp's ridley sea turtle, Lepidochelys kempii. Journal of Herpetological Medicine and Surgery 12: 2126. HINES, M. E., J. M. KREEGER, AND A. J. HERRON. 1995. Mycobacterial infections of animals: Pathology and pathogenesis. Laboratory Animal Sciences 45: 334351. JONGEVOS, S. F., E. P. PRENS, AND J. M. WERNERHABETS. 1999. Successful triple-antibiotic therapy for cutaneous infection due to Mycobacterium chelonae. Clinical Infectious Diseases 28: 145146. KEYMER, I. F. 1978a. Diseases of chelonians: 1 ; Necropsy survey of tortoises. The Veterinary Record 103: 548552 1978b. Diseases of chelonians: 2 ; Necropsy survey of terrapins and turtles. The Veterinary Record 103: 577582. LEONG, J. K., D. L. SMITH, D. B. REVERA, LT. J. C. CLARY, D. H. LEWIS, J. L. SCOTT, AND A. R. DINUZZO. 1989. Health care and diseases of captive-reared loggerhead and Kemp's ridley sea turtles. In Proceedings of the 1st international symposium on Kemp's ridley sea turtle biology, C. W. Caillouet and A. M. Landry eds. ; . National Marine Fisheries Service, Texas A & M University, Galveston, Texas, pp. 178 201. MARCUS, L. C. 1981. Specific diseases of herpetofauna. In Veterinary biology and medicine of captive amphibians and reptiles, L. C. Marcus ed. ; . Lea and Febiger, Philadelphia, Pennsylvania, pp. 83221. MILLER, A. C., C. A. COMMENS, R. JAROWORSKI, AND D. PACKHAM. 1990. The turtle's revenge: A case of soft tissue Mycobacterium chelonae infection. The Medical Journal of Australia 153: 493495. OGDEN, N. A., A. G. J. RHODIN, G. J. CONLOGUE, AND T. R. LIGHT. 1981. Pathobiology of septic arthritis and contiguous osteomyelitis in a leatherback turtle Dermochelys coriacea ; . Journal of Wildlife Diseases 17: 277287. RHODIN, A. G. J., AND M. R. ANVER. 1977. Mycobacteriosis in turtles: Cutaneous and hepatosplenic involvement in a Phrynops hilari. Journal of Wildlife Diseases 13: 180183.
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The Board of Directors of the American Board of Managed Care Medicine ABMCM ; announced that Dr. Kirk A. Calhoun UTMB HealthCare Systems ; has completed a rigorous education and testing procedure to help benefit patients who are members of area health plans. Calhoun has completed all the requirements for board certification in managed care medicine and was elected to diplomat status in the ABMCM. Dr. Michele A. Carter Institute for the Medical Humanities ; has been asked to help develop the National Cancer Institute's new Cancer Genetics Network as a member of its steering committee. The network will be a major national resource to support collaborative investigations into the genetic basis of cancer susceptibility, explore mechanisms to integrate this new knowledge into medical practice, and identify means of addressing the associated psychosocial, ethical, legal, and public health issues. Dr. Kleanthe Caruso UTMBTDCJ System Nursing Services ; is chair-elect of the National Commission on Correctional Health Care. Caruso will become the chair of the NCCHC after the November 1999 board of directors meeting. In his congratulations to Caruso, NCCHC President Edward A. Harrison said, "Your election speaks to the confidence your fellow board members have in your knowledge of correctional health care issues and your abilities to lead this organization into the new millennium." Dr. David Haber School of Allied Health Sciences ; has received the 1999 Molly Mettler Award for Leadership in Health Promotion. Haber will be honored with a reception to be held in San Diego. The Molly Mettler Award, named for the first Health Promotion Institute chairperson, was established in 1994. It is given annually to an individual who has provided outstanding leadership in the field of health promotion and aging. Dr. Grace K. Jameson Psychiatry and Behavioral Sciences ; received the Texas Society of Psychiatric Physicians' Distinguished Service Award at the recent annual Business and Awards Luncheon in Houston. The Distinguished Service Award was established in 1976 to recognize individuals for sustained contributions in psychiatry. Dr. Jon Nilsestuen School of Allied Health Sciences ; was inducted into the inaugural class of fellows in the American Association for Respiratory Care. Nilsestuen was recognized for his "profound and lasting contribution to the profession of respiratory care." One of Nilsestuen's principal contributions to this relatively young field was helping to develop standards and guidelines for delivery of oxygen and other aerosol therapy. Dr. Cam Patterson Internal Medicine ; was selected as a finalist for the 1999 Young Investigators Awards Competition of the American College of Cardiology. The purpose of the awards is to find and encourage the young investigators of promise on whom the future of cardiology depends. The American College of Critical Care Medicine has honored Dr. Donald S. Prough Anesthesiology ; with the Distinguished Investigator Award for outstanding scientific contributions to the field of critical care medicine. The award, presented at the Society of Critical Care Medicine's 1999 Educational and Scientific Symposium in San Francisco, was based on Prough's contributions to critical care research, in peer-reviewed publications, the presentation of original data, and lectures on the findings. Dr. Ben Raimer Primary Care Outpatient Clinics ; received the 1998 Ray E. Helfer, M.D., Award for his contributions to prevent child abuse and neglect. Sponsored by the National Alliance of Children's Trust and Prevention Funds and the American Academy of Pediatrics' Section on Child Abuse, the award honors Helfer, who was dedicated to ensuring that the nation's children grow up safe and free from harm. Dr. Giuseppe Sant'Ambrogio Physiology and Biophysics ; has been chosen to receive a Recognition for Scientific Accomplishments Award from the American Thoracic Society at the 1999 American Lung Association American Thoracic Society International Conference. Dr. Aubrey Thompson Human Biological Chemistry and Genetics ; has been awarded the inaugural Edna Seinsheimer Levin Endowed Professorship in Cancer Studies for the School of Medicine. As a tribute to the late Edna Seinsheimer Levin for her many contributions to UTMB and the community, Dr. William C. Levin, UTMB president emeritus, and his daughters, Gerry Lee Hornstein and Carol Lynn Cantini, established this professorship to assist in cancer research and study. This professorship will rotate every three years among the four schools, beginning in the SOM. Dr. Robert Ullrich Radiation Oncology ; was recently invited to become a member of the International Commission on Radiological Protection Committee. The Scientific Advisory Committee of the Charles E. Culpepper Foundation has named Joseph M. Vinetz WHO Collaborating Center for Tropical Diseases ; as one of its four Medical Science Scholars for 1999. Candidates were nominated by 36 medical schools across the country. The goal of Vinetz's research is to prevent the transmission of malaria parasites from mosquitoes to humans. Dr. Barbara W.K. Yee School of Allied Health Sciences ; was elected to serve as a Fellow in the Gerontological Society of America, in "recognition of her outstanding achievement and exemplary contributions to the field of gerontology through research, practice, and education in aging and flonase.
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OF RISK STATUS IN ELDERLY AND YOUNG WrrH ACUTh CORONARY SYNDROMES Mthot . ; Bradley C. Banks, MDI, Carl J. Lavie, MD, Richard V. Milani, MD, Section on Cardiology, Ochsner Medical Institutions, New Odeans, Louisiana Cardiac rehabilitation and exercise training dramatically improve short and long-lena prognoses and quality of life after acute coronaiy events. We analyzed 154 consecutive patients with acute coronary syndromes to assess risk factor status, including assessment ofstress via the validated General Health Questionnaire GHQ ; , and referral bias in 54 elderly patients 65 years; 735 years; 61% male ; versus 100 younger patients 538 years; 72% male ; , who were candidates forcardiac rehabilitation. Risk factors as swnmaiized: Elderly Young P-value n 54i n lO0 LDL-C, mg dl 13730 15258 0.3 HDL-C, mg dl 4314 378 0.03 BMI, kg rn2 28.05.5 28.95.4 NS Smoking, % 9% 35% 0.002 Hypertension, % 69% 52% NS Diabetes, % 46% 25% 0.02 GHQ, units 2.23.2 3.84.5 0.03.
The current Prostate Clinical Studies Group has completed its 3 years term and the members of the team are to be congratulated on taking the group forward, overseeing the continuation of the study portfolio, completing several important studies and developing other new ones. Membership Membership rotation will take place in summer 2006. There have been a large number of applications to join the Group, many of whom are new to the NCRI CSG. The current chairman was reappointed for a further 3 years in July 2006. Portfolio and accrual A number of trials have been completed successfully and others have begun or are in development. An overall resume of the trial portfolio is shown below. Completed Trials These comprise a mix of NCRI funded and locally adopted studies. Of the former, the MAPS, PR07, Process, Prostate HDR High Dose Brachytherapy ; , RIB Radiotherapy vs Ibandronate ; , RT01, TAPS, Prostate Cardiovascular and Intercontinental Studies were completed successfully. There were a number of noteworthy successes, particularly the collaborations with the NCIC of Canada in the PR07 and Intercontinental studies, where UK participation boosted recruitment numbers significantly. Amongst the locally adopted studies, the Flomax, High Dose Rhenium study, Prostate Cancer Symptom and Cognition and Intermittent ADT studies recruited well and the HIPRO data and methodology was incorporated in aspects of the CHHIP study, which is currently ongoing. Ongoing Trials There are a number of NCRI funded and adopted studies which are either recruiting actively or in advanced stages of development. The Familial prostate cancer, MAPS and Protect studies have been supplemented with new studies including the Stampede Multi Arm Therapy in high risk hormone nave patients ; , CHHIP IMRT and hypofractionation in localised CaP ; , Patch Oestrogen Patches for hormone manipulation ; and Sabre Decision aids in brachytherapy ; studies. The Radicals study radiotherapy short and long term hormones post radical surgery ; has been funded by CTAAC and is in an advanced stage of preparation and the START study active surveillance vs treatment in low risk CaP ; is being developed in an international collaboration. Ongoing locally nationally adopted studies include intermittent and combination hormonal studies DA vs DAS, Intermittent Hormone Therapy, EORTC 30985 ; and studies of symptoms PCSS ; . These are recruiting actively. Accrual was 9.3% of incidence cases. New Study Developments It was recognised by the Group at their last meeting that new trials were needed in certain areas, particularly in the hormone refractory setting and in the phase 2 and developmental therapies area. It was also recognised that there were too few imaging and marker based studies. With this in mind the Group have proposed to initiate a series of new trials development meetings to scope the area and develop new protocols. A working group will be constituted to take this forward and will meet once the new group membership is finalised.
IDSA ATS Guidelines. Measure Information Measures: PN-6b Pneumonia Flowchart Algorithm ; Measures: PN-6b Changed to reflect the recommendations in the 2007 IDSA ATS Guidelines. Add "Regimen7 False" to the `Initialize Variables' process box Add Additional Branch logic for new regimen to check for Antibiotic Name on Table 2.7 and 2.17 after Regimen6 as follows: Remove the page connector PN-6b M connecting from the arrow for Regimen 5. Reflow the arrow to the newly added branch for Regimen7. Add decision points and associated logic for data elements Antibiotic Name, Antibiotic Administration Route, Pseudomonas Risk, Antibiotic Allergy to process for the new regimen Regimen7, following Regimen6. Add process box to set the new variable Regimen7 True to process outcomes flowing down from the above decision points for the respective scenarios. Add page connector PN-6b M to the arrow flowing down for the logic outcomes if the case did not meet the criteria to pass any of the antibiotic regimens. Add page connector PN-6b N to Regimen7 True. Add Note box for the newly added regimen Regimen7. Add decision point and associated logic for new regimen Regimen7 after decision point Regimen6. Add off page connector PN-6b E for measure PN-6, 6ab-28 PN-6, 6ab-32 10-01-2007 Discharges, for example, flomax pumps.
This approach implies that a large spleen has already been detected clinically or radiologically. The sensitivity of clinical methods of detecting splenomegaly varies from as low as 46% with percussion being the most sensitive clinical method in various studies , however the most accurate technique if there is doubt is by ultrasound or isotope scan. It is important to bear in mind that up to 3% of healthy young individuals may have a palpable spleen and that on the other hand not all abnormal spleens are palpable.
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TABLE 3. Average Refraction, Weight, and Axial Length Differences between Form-Deprived Eyes Treated with Muscarinic Antagonists, and their Fellow Control Eyes Refraction Differences D ; Scopolamine 100 mM ; n Saline n 6 Tropicamide 100 mM ; n Saline n 6 Propantheline 10 mM ; n Saline n 6 Scopolamine 200 mM ; n Saline n 6 Dexetimide 10 mM ; n Saline n 6 Benztropine 10 mM ; n Saline n 6 4-DAMP 10 mM ; n Saline n 6 HHSiD 10 mM ; n Saline n 6 pf-HHSiD 10 mM ; n Saline n 6 AF-DX-116 11.5 mM ; n Saline n 6 QNB 7.4 mM ; n Vehicle n 6 P 0.001 4.20 0.56 P 0.001 2.2 0.31 P 0.001 3.7 0.57 P 0.01 4.40 1.34 P 0.01 6.00 1.00 P 0.0001 1.67 0.82 P 0.01 3.17 0.98 P 0.01 3.00 0 8.50 1.22 P 0.01 4.38 2.34 P 0.0010 3.00 1.10 P 0.0001 Weight Differences mg ; 49.83 9.85 92.50 P 0.001 46.00 7.69 P 0.001 19.00 7.72 P 0.001 50.00 15.65 P NS 43.00 22.10 78.67 P 0.05 58.17 21.30 P 0.4209 15.50 15.36 P 0.01 56.67 20.49 P NS 38.17 18.08 57.17 P NS 48.17 12.29 60.50 P 0.0774 31.17 15.28 P 0.0002 Axial Length Difference mm ; 0.25 0.08 0.67 P 0.001 0.27 0.05 P 0.001 0.15 0.03 P 0.001 0.44 0.26 P NS 0.35 0.18 0.74 P 0.05 0.48 0.20 P 0.0077 0.17 0.11 P 0.01 0.37 0.13 P NS 0.45 0.13 0.49 P NS 0.45 0.16 0.82 P 0.0009 0.25 0.18 P 0.0001 A-scan Axial Length Difference mm ; 0.17 0.24 0.35 P NS 0.23 0.21 0.35 P NS 0.11 0.13 0.39 P 0.001 Choroid Thickness Difference mm ; 0.06 0.11 0.07 P NS 0.05 0.08 0.07 P NS 0.07 0.04 0.03 P NS.
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