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Literature reviews and special ar tides. Generally they are solicited by the editor and are 4, 000 to 7, 000 words excluding references. Persons interested in submitting such material should consult the editor. Reviews should focus on the literature of the last two to three years and should include an abstract. Brief reports. The maximum length is 1, 200 words, plus no more than ten references and one table or figure. Reports of unusual cases. Such re ports, describing highly unusual or dif ficult patients and their management, should not exceed 1, 200 words and ten references. They should consist of a brief literature review, an account of the case and its treatment, and a dis cussion. Open Forum, letters. The Open Fo rum section contains letters to the editor plus other short comment and opinion. Letters published at the dis cretion of the editor ; can be no more than 500 words plus a maximum of five references, and must be double and plendil.
PLAVIX indication expanded to include patients with any acute coronary syndromes ACS ; PARIS, France, and PRINCETON, New Jersey - September 7, 2006 Sanofi-aventis EURONEXT: SAN and NYSE: SNY ; and Bristol-Myers Squibb Company NYSE: BMY ; announced today that the European Commission has granted a new indication for the antiplatelet agent PLAVIX clopidogrel bisulfate ; to include patients with ST-segment Elevation acute Myocardial Infarction STEMI ; who are eligible for thrombolytic therapy. STEMI is a severe heart attack in which an artery supplying the heart with blood is generally blocked completely.1 These blockages are caused by clot formation in the coronary arteries, which is associated with an underlying disease known as atherothrombosis.2 PLAVIX is a prescription antiplatelet medicine taken once a day that helps keep platelets in the blood from sticking together and forming clots. PLAVIX is approved for early and long term risk reduction in patients at risk for atherothrombotic events. The new indication is based on the findings of two clinical trials that treated patients who had STEMI with PLAVIX administered on a background of standard therapy, including ASA. "PLAVIX taken with ASA has previously been shown to reduce the risk of death, recurrent heart attacks or stroke in patients with unstable angina or less severe heart attacks, " said Keith A.A. Fox, Professor of Cardiology, University of Edinburgh, Scotland. "Now, based on the results of two clinical trials, CLARITY-TIMI 28 and COMMIT CCS-2, clopidogrel has been approved by the European Commission as showing benefit, together with ASA acetyl salicylic acid ; , in patients with the most severe types of heart attacks. With this new guidance from the European Commission, clopidogrel shows benefit in patients across the spectrum of acute coronary syndrome." There are approximately 10 million heart attacks per year worldwide; 3 and 3 million are STEMI events.4 In 2005, for the United Kingdom, France, Germany, Italy and Spain, there were more than 1 million acute coronary syndrome events, of which 25% were STEMI.13 Patients who have experienced STEMI are also at high risk of another heart attack, stroke or death.5.
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Workshop themes contents presentations ; Generally there was a similar good satisfaction with all the presentations and the identified subthemes. The health issues in schools were particularly well received and commented upon as an area where a lot of effort should be placed, based on the KEDAHR generated knowledge. Many of the other themes were also observed as bringing lots of useful information to the participants, with a few critics of some being too brief on the subject. Group work The central aim of the workshop was the interaction between researchers and users of health knowledge, enabling action-oriented research to be identified and health policy recommendations to evolve. In order to succeed in this, high commitment from all the participants to involve themselves in the group process was needed. This was unfortunately not accomplished to a fully satisfactory level. The tendency of some group members to not join the groups resulted in variation of group competency and resulted in a need to merge two groups in order to secure competency in discussions. Although the group process did not succeed exactly as intended, important linkages between KEDAHR competences and the Ministry of Health and the Ministry of Education were established in connection with the health education focus. The group works' contribution to the final discussion and conclusion was both comprehensive and targeted. Among the participants the group work was rated as acceptable as ranking was influenced by the observations on lack of commitment from other group members, but also acknowledged the inspiration occurring when researchers and users meet. Overall relevance and quality of the workshop process and results The participants were very satisfied with the workshop, finding it extremely relevant and of high quality. The intention of bringing users and researchers together, in order to learn from and supplement each other, was found to be an important experience needed for future health achievements. Identified workshop weaknesses were mostly of practical character, for instance concerning poor time keeping. The relatively little time spent on the health systems theme was also identified as a workshop shortcoming. Among strengths of the workshop, the ability to identify research gaps, and the need to involve stakeholders in the research process was pointed out.
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Reproductive Biology Section Three singleton deliveries with healthy children from one couple after Cryo-TESE and ICSI A.G. Schmutzler, M. Glander, B. Acar, O. Chanysheva, S. Buck, F.J. Martinez Portillo, L. Mettler - Campus Kiel, GERMANY.
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After two years, the rate of heart attack or death among patients with bare-metal stents was more than five per 100 worse than the coated stent patients who stayed on plavix but better than those with coated stents who stopped the drugs.
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| Rationale: The prostaglandin analogues are similarly safe and efficacious in reducing intraocular pressure in the treatment of open angle glaucoma and elevated intraocular pressure. Lumigan and Xalatan are the preferred formulary ophthalmic prostaglandin inhibitors. PDE-5 Inhibitors Preferred Non-Preferred Cialis tadalafil ; Tier 2 ; Levitra vardenafil ; Viagra sildenafil ; Tier 2 ; Rationale: While the PDE-5 inhibitors differ in pharmacokinetic profiles, with Cialis having an increased duration of action, these agents are efficacious and exhibit a similar side effect profile. Nitrates are contraindicated in patients taking PDE-5 Inhibitors Concomitant alpha blockers increase the risk of hypotension. Cialis and Viagra should be used cautiously with concomitant CYP 3A4 Inhibitors. Platelet Aggregation Inhibitors Preferred Non-Preferred clopidogrel 0lavix ; Tier 2 ; ticlopidine Ticlid ; aspirin dipyridamole Aggrenox ; Tier 3 ; Rationale: Ticlopidine displays similar efficacy to aspirin. It is non-formulary due to the risk of anemia.
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Subjective Chief complaint: pain at any location, nausea, vomiting, amnesia, or loss of sensation. Mechanism of injury: estimated force involved, ground level fall, use of a helmet or seat belt, ejection, damage to the vehicle, ambulatory on scene or moved after the accident. Medical problems that may have preceded the incident such as a change in medication, an MI, seizure, hypoglycemia, CVA, etc. Objective Mental status: presence of agitation, anxiety, altered mentation Vital Signs: pulse and blood pressure must be evaluated in the context of pre-existing history of hypertension, medications such as beta blockers, calcium channel blockers, and ACE inhibitors. See Special Considerations ; . Respirations: diaphragmatic breathing suggests spinal cord damage. Signs of trauma: deformity, contusions, abrasions, swelling. Presence of any distracting injury: Fractured long bone, pelvic fracture, etc. Obtain medical history and medications, especially presence of anticoagulants. Interview caregiver Treatment Procedure FR OEC EMT B Airway, O2 Strongly consider spinal immobilization Keep patient warm Control bleeding with direct pressure. IV IO: Consider 1-2: large bore with fluid therapy If hypoglycemia present, administer D50 Monitor cardiac rhythm. Special Considerations Medical history of anticoagulants, such as coumadin, aspirin, Ticlid or Plavix, is highly suspicious for slow internal or intracranial bleeding. Fractured hips are common results of falls. Pain management is appropriate and encouraged. Trauma may be precipitated by a medical condition. It is important to determine the cause of the trauma. Spinal immobilization with scoop and abundant padding is preferred. Ground level falls have high incidence of cervical fractures. Alternative cervical immobilization includes pediatric cervical collars and towel rolls. Elderly patients are more prone to hypothermia. In elderly patients found down for an unknown period of time are particularly susceptible to hypothermia, dehydration, pneumonia, sepsis and other medical complications. X X X EMTB IV EMT I EMT P and prilosec.
These remarks were later amplified: `In the Adverse Reactions Subcommittee, I and others were perpetually arguing for adequate computer facilities, always to be fobbed off with temporary expedients. In the mid-1970s, we thought we had begun to progress, and we had prepared a formal case for the Department to provide a suitable computer to be dedicated to CSM work. Almost at my last meeting, I ventured to ask about the progress of this proposal. A civil servant who attended as a representative of officialdom answered firmly that members of the subcommittee had no power to ask questions about this matter.' David Finney to Mrs L A Reynolds, 9 January 1997. Dr Kuenssberg also remarked on the paucity of computer support in a later letter: `I would also like to comment on the expressions of the "good working" of the Safety of Drugs Committee. I remember that there was considerable unhappiness among the Committee members, the reason being that the Committee was certain that it required computing facilities to do its job properly. During my membership, however, we seemed to be prevented from obtaining this essential resource. I think it was during my last two years of membership that I certainly considered resignation because we as a Committee were making no progress with the computer question.' Ekkehard V Kuennsberg to Dr Tilli Tansey, 27 November 1996. 54 Halbach H. 1964 ; Development of a WHO programme for drug safety. Pharmakotherapia 2 1 ; : 239243.
Seat belt injuries have high incidence of sternal fractures, aortic injuries, cardiac contusions and abdominal injuries. A large amount of blood can be lost in soft tissues and internally without external signs. Keep this in mind if altered mental status and hypoperfusion persist despite fluid resuscitation. Pre-existing cardiac problems, hypertension and presence of antihypertensive medications will interfere with the body's own compensatory mechanisms. Administer fluids carefully, adjust according to lung sounds. Reassess vital signs frequently. Mental status is a better gauge of adequate perfusion than a systolic pressure Many elderly are on anticoagulants such as aspirin, clopidogrel Plaix ; , ticlopidine Ticlid ; , warfarin Coumadin ; or low molecular weight heparin Lovenox ; . Therefore closed head injuries are always suspect for slow subdural bleeding as well as blunt trauma for slow internal bleeding. Syncopal events or dizziness when changing position warrants questions about recent trauma. Common examples of alpha blockers include: clonidine Catapres ; , doxazosin Cardura ; , methyldopa Aldomet ; , prazosin Minipres ; , and terazosin Hytrin ; . Common examples of beta blockers include: labatalol Trandate or Normodyne ; , carvedilol Coreg ; , metoprolol Lopressor ; , atenolol Tenormin ; , propranolol Inderal ; , blocadren Timolol ; Common examples of calcium channel blockers include: amlodiprine Narvasc ; , verapamil Calan ; , diltiazem Cardizem ; , felodipine Plendil ; , nicardipine Cardene ; , and nifedipine Adalat, Procardia ; . Common examples of ACE inhibitors include: benazepril Lotensin ; , captopril Capoten ; , enalapril Vasotec ; , lisinopril Prinivil ; , quinapril Accupril ; , and ramipril Altace ; . Consider other medications that may alter mental status and prinivil and plavix.
Drug Name ANTICOAGULANTS Generics jantoven warfarin sodium Brands * COUMADIN warfarin sodium ; ANTIPLATELET DRUGS Generics cilostazol dipyridamole ticlopidine HCl Brands AGGRENOX * PERSANTINE dipyridamole ; PLAVIX * PLETAL cilostazol ; * TICLID ticlopidine HCl ; HEMOSTATICS Generics aminocaproic acid Brands * AMICAR aminocaproic acid ; HEPARIN Generics hep-lock hep-lock u p hep-pak cvc hep-pak lkfl heparin flush heparin iv flush heparin lock heparin lock flush heparin sodium heparin sodium in 5% dextrose Brands LOVENOX Req. Limits.
A University of Wisconsin School of Pharmacy project to improve teaching of pharmaceutical care for ambulatory patients is described. A detailed account is given of the design and development of patient and prescription order databases and software which together provide a computerized database management system that is used to create course materials needed for constructing simulated patient care exercises for pharmacy students. The database system is described, and an example is given illustrating how it is employed to create prescription orders and patient medication profile sets which are used to provide students with structured experiences in drug utilization review and patient consultation. In creating the patient simulation exercises, activities of pharmaceutical care, as it relates to outpatient pharmacy services, were first analyzed, types of practice situations presenting drug-related problems were defined, therapeutic classes of drugs were selected, and model patient medication consults were written. Methods used to validate the clinical accuracy of these course materials and to evaluate the success of the teaching strategy are presented. A list of planned future improvements of the databases and database system are outlined and procardia.
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CLINICAL TRIALS Study demographics and trial design The safety and efficacy of PLAVIX in preventing atherothrombotic events has been evaluated in two large double-blind trials: the CAPRIE study, a comparison of PLAVIX to ASA, and the CURE study, a comparison of PLAVIX to placebo in addition to background therapy that included ASA. CAPRIE: The CAPRIE trial was a 19, 185 patient, 304 centre, international, randomized, double-blind, parallel-group study comparing PLAVIX 75 mg daily ; to ASA 325 mg daily ; . Patients ranged in age from 21 to 94 years mean 62 years ; . The study was composed of 72.4% men and 27.6% women and included patients with established atherosclerosis or history of atherothrombosis as manifested by myocardial infarction, ischemic stroke or peripheral arterial disease. Patients received randomized treatment for up to 3 years mean treatment period 1.6 years ; and were followed to 3 years or study termination, irrespective of whether study drug had been discontinued mean follow-up 1.9 years.
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There has been increasing public concern about the risks of high dose antipsychotic treatment which has partly been due to the association of high dose treatment and death in a small number of patients, although this has as yet been unproven. Hirsch and Barnes, 1994; Brown and Kocsis, 1984; Simpson, et al., 1987 ; . In patients with learning disabilities, antipsychotic medication is used not only for defined psychiatric illness but also for the control of aggressive and disturbed behaviour, hyperactivity and stereotypical behaviour in the absence of.
Acute coronary syndrome acs ; for patients with acs unstable angina non-q-wave mi ; , including patients who are to be managed medically and those who are to be managed with percutaneous coronary intervention with or without stent ; or coronary artery bypass graft surgery cabg ; , plaavix has been shown to decrease the rate of a combined end point of cardiovascular death, mi, or stroke as well as the rate of a combined end point of cardiovascular death, mi, stroke, or refractory ischemia.
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Gingival bleeding is an uncommon adverse effect, but some drugs may directly or indirectly cause bleeding gums. The gums may bleed spontaneously or following oral hygiene procedures or eating. Bleeding may result from anticoagulants and drug interactions which increase the bleeding time. Adverse effects such as gingival enlargement, oral ulceration, xerostomia and immune suppression are known to increase the likelihood of bleeding gums.
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