| Purpose: Medication errors ME ; in the Intensive Care Unit ICU ; are frequent and lead to attributable patient morbidity and mortality, increased length of ICU stay and substantial extra costs. We investigated if the introduction of a computerized ICU system Deio Clinisoft, General Electric ; reduces the incidence and severity of ME. Methods: A one-month March 2004 ; prospective trial was conducted comparing ME in a computerized unit CU ; versus a paper-based unit PBU ; in a university hospital. Every medication entry was registered and evaluated for ME, Medication Prescription Errors MPE ; and Rule Violations RV ; by an experienced and unit-independent clinical pharmacist. An independent panel evaluated the severity class of every ME according the NCC MERP guidelines. Results: 160 patient-days resulting in 2662 medication prescriptions were evaluated. There were no differences in the CU-patients compared with the PBU-patients regarding age, admission reason, severity of illness APACHE, SAPS, SOFA score ; , renal failure and number of administered medications. The incidence of ME, MPE, RV was significantly lower in the CU compared with the PBU 5, 1% vs. 24, 7%, 0, 9% vs. 15, 0% and 0, 17% vs. 7, 90%, respectively; all P 0.001 ; . The most significant reduction were seen in dosing errors 1, 6% vs. 7, 4% ; , dose errors in renal failure 0, 4% vs. 4, 5% ; and wrong name errors 0, 42% vs. 8, 87% ; all P 0.001 ; . The most frequent drug classes involved were cardiovascular medication and antibiotics in both groups, but more errors in sedative, analgesic and gastro-intestinal medication prescription were seen in the PBU. The severity of ME was mainly class A 36% vs. 52% ; and C 54% vs. 44% ; according to the NCC MERP classification, but in the PBU more class D errors occurred 1, 4% vs. 2, 5%, P 0.025 ; . No fatal errors were seen. Allergy status was recorded in 69% of CU patients vs. only 2% in PBU. Patient weight was recorded in 60% of CU patients vs. 18% of PBU patients. Conclusions: The ICU computerization, including the medication order entry, resulted in a significant decrease in the occurrence and severity of medication errors in the ICU. The main reasons are the more adequate recording of allergy status and patient weight and the drug dose recommendation by the ICU computerized system.
To minimise the risk of harm to the fetus or child, drugs should be prescribed cautiously for women who are planning a pregnancy, pregnant or breastfeeding. As a result the thresholds for non-drug treatments, particularly psychological treatments, are likely to be lower than those set in NICE clinical guidelines on specific mental disorders, and prompt and timely access to treatments should be ensured if they are to be of benefit. 1.4.1.1 Women requiring psychological treatment should be seen for treatment normally within 1 month of initial assessment, and no longer than 3 months afterwards. This is because of the lower threshold for access to psychological therapies during pregnancy and the postnatal period arising from the changing riskbenefit ratio for psychotropic medication at this time. 1.4.1.2 Discussions about treatment options with a woman with a mental disorder who is planning a pregnancy, pregnant or breastfeeding should cover: the risk of relapse or deterioration in symptoms and the woman's ability to cope with untreated or subthreshold symptoms severity of previous episodes, response to treatment and the woman's preference the possibility that stopping a drug with known teratogenic risk after pregnancy is confirmed may not remove the risk of malformations the risks from stopping medication abruptly the need for prompt treatment because of the potential impact of an untreated mental disorder on the fetus or infant the increased risk of harm associated with drug treatments during pregnancy and the postnatal period, including the risk in overdose, because atacand 16mg.
100 + 20, 100 42, cpm ; in the response to HGG was 5700 cpm 42, 200 36, epm ; . Since this difference 5, 700 cpm ; was less than the agentinduced variation in the response to HGG 7, 400 epm ; , the effect these agents had on HGG-responding cells was considered additive. When the effect is additive, it shows that these agents inactivated different cells that respond to HGG. This approach has been extensively used to analyze selective cytostatie cytotoxie effects of drugs on.
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Mildred Audrey Rudd, Lakeita Beck, Leola Henderson, Waldo Rogers, North Carolina Central University, Durham, NC; Teresa McGhee, Black Nurses Association, Durham, NC; LaVerne Reid, Theodore Parrish, North Carolina Central University, Durham, NC In an effort to reduce the health disparity of cardiovascular disease within African American communities we have initiated an outreach education program that targets churches and civic organizations in the Triangle region of North Carolina. We propose that education on the detrimental effects of risk factors for cardiovascular disease will effect behavioral changes that will ultimately lead to a reduction in cardiovascular disease rates. The first phase of the education program involves making initial contacts and visiting selected sites. Each visitation is made by a team consisting of a nurse to perform blood pressure screening, a speaker who will give a slide presentation, a cardiovascular disease expert to answer questions, and survey assistants who administer surveys to assess knowledge gain and intent to modify behavior. This report focuses on the observed prevalence of hypertension among the various sites within the Triangle area of North Carolina. The average systolic and diastolic blood pressures of those screened at the twenty sites visited were 136.1 1.6 and 82.3 0.9 mmHg, respectively. Of the 117 persons screened, 47.8% had systolic and or diastolic blood pressures above the recommended 140 and 90, respectively. Interestingly, when we compared the blood pressures from sites that had existing health education programs to those without on site health education programs in place, we found that blood pressures were significantly lower in the on site health education venues systolic: 130.5 2.4 vs. 140.8 2.0 mmHg, p 0.02; diastolic: 77.4 1.4 vs. 86.2 1.1 mmHg, p 0.001 ; . Additionally, the percentage of screened individuals that had either systolic or diastolic hypertension was significantly less within the group with on site health education 35% vs. 59%; p 0.02 ; . These data show that the prevalence of hypertension within the African American population in the surrounding Triangle region of North Carolina is greater than the national rate of 36.6% and that ongoing health education is associated with a reduction in hypertension rates. We conclude from these data that continuous health education may be an effective strategy in reducing the health disparity that exists within African American communities and ciloxan, for example, atacand blood pressure medicine.
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The annual Red Ribbon campaign will be celebrated October 23-31 throughout the nation. The purpose of this event is to bring attention to the problems relating to drug usage. In 1985, federal agent Enrique Camarena was killed at the hands of drug dealers. This sparked the campaign to recognize the problem in hopes of alleviating the demand for drugs. State employees should receive red ribbons with their paychecks and are encouraged to wear them during this special week to show support for this cause and serophene.
Continuation rate of OC and reasons for discontinuation Continuation and discontinuation rates are difficult to assess reliably and good data are few, since data from clinical trials are generally short-term and thus not representative. The limited data that do exist suggest that the most common reason for stopping the OC is to become pregnant. In general, in any one year 1015% of women will stop using OC. Fear of risks and the presence of side-effects whether real or perceived ; and, especially, weight gain account for many discontinuations. Although the absolute risks of serious side-effects are extremely small, nevertheless some women do not even start the pill because of fears concerning safety Oddens et al., 1994a; Larsson et al., 1997 ; . Fear of the more serious risks will also lead to cessation of pill use. In the Swedish study Larsson et al., 1997 ; more than 30% of 29 year old women gave `fear' as the main reason for stopping the pill. The media, tending to report only negative news about contraception and to sensationalize that news, are quite effective in this respect. The `pill scare' of 1995 was said to have resulted in 25 000 women in Norway stopping the OC in November and December of 1995 Skjeldestad, 1997 ; . The continuation rate in women taking OC in a survey of 29 studies has been compared to the compliance with other medical treatments and, surprisingly, the rates of compliance 1868.
ACCURETIC [G] ATACAND HCT atenolol w chlorthalidone AVALIDE benazepril hcl-hctz BENICAR HCT bisoprolol fumarate hctz CAPOZIDE [G] captopril hydrochlorothiazide CLORPRES CORLOPAM [INJ] CORZIDE DIOVAN HCT enalapril maleate-hctz fosinopril-hydrochlorothiazide hydra-zide HYPERSTAT I.V. [INJ] HYZAAR INDERIDE-40 25 [G] INVERSINE LEXXEL lisinopril-hctz LOPRESSOR HCT [G] LOTENSIN HCT [G] LOTREL * methyldopa hydrochlorothiazide [CARE] metoprolol-hydrochlorothiazide MICARDIS HCT MONOPRIL HCT [G] PRINZIDE [G] propranolol hcl w hctz quinapril-hydrochlorothiazide quinaretic reserpine TARKA TENORETIC 100, 50 [G] TEVETEN HCT UNIRETIC and clomiphene.
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SUSTAINED HYPOXIA DECREASES SENSORY PROCESSING TO BRIEF PULSES OF NEGATIVE UPPER AIRWAY PRESSURE DURING NREM SLEEP Eckert DJ, 1, 2 Catcheside PG, 1, 2 George K, 1 Thompson K, 1 Webster KE, 4 McEvoy R1, 2, 3 1 ; Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, SA, Australia, 2 ; School of Molecular and Biomedical Science, Discipline of Physiology, The University of Adelaide, Adelaide, SA, Australia, 3 ; Department of Medicine, Flinders University, Bedford Park, SA, Australia, 4 ; Musculoskeletal Research Centre, La Trobe University, Bundoora, VIC, Australia Introduction : Hypoxia is common in several respiratory disorders including sleep apnea and sleep hypoventilation syndrome. Sustained hypoxia has been shown to have depressant effects on ventilation, respiratory load sensation and cough and therefore may have deleterious effects in hypoxic respiratory disorders. Using respiratory related evoked potentials RREP ; s hypoxia has recently been shown to depress sensory processing to brief respiratory resistive loads during wakefulness. We hypothesized that sustained hypoxia would similarly depress respiratory sensory processing during sleep. Methods : On two separate occasions, 9 healthy males slept overnight in the sleep laboratory instrumented with scalp EEG electrodes C3, Cz, C4, Fz and Pz ; and standard EOG and EMG recordings for sleep staging and arousal scoring. In random order, subjects breathed normoxia medical air ; or isocapnic hypoxia SaO285% ; via a nasal mask and pneumotachograph throughout each visit. Upper airway negative pressure pulses 12 cmH2O mask pressure, 250 msec ; were delivered during early inspiration via a computer-controlled rapid actuating solenoid valve system during stable NREM sleep and the following morning during wakefulness to elicit RREPs. Approximately 75 pulses per subject were identified that were not associated with ASDA arousal or movement artifact. The EEG responses to these pulses were ensemble averaged across NREM sleep stages to generate RREP waveform components in each condition. Similarly, approximately 55 pulses under each gas condition were averaged to generate RREP components during wakefulness. Results : Stimulus magnitude was well matched between hypoxia and normoxia during sleep minimum mask pressure 12.0 1.5 vs. 13.6 and clozaril.
General Definition NOTE: Red, bold italic type indicates new or edited definitions, GPRA measures in yellow ; Contraindications to ASA other anti-platelet defined as any of the following occurring ever unless otherwise noted: A ; Patients with a 180-day course of treatment for Warfarin Coumadin during the Report Period, using site-populated BGP CMS WARFARIN MEDS taxonomy; B ; Hemorrhage diagnosis POV 459.0 C ; NMI not medically indicated ; refusal for any aspirin at least once during the Report Period; or D ; CPT G8008 Clinician documented that AMI patient was not an eligible candidate to receive aspirin at arrival ; at least once during the Report Period. Adverse drug reaction documented ASA other anti-platelet allergy defined as any of the following occurring anytime ever: A ; POV 995.0-995.3 AND E935.3; B ; "aspirin" entry in ART Patient Allergies File or C ; "ASA" or "aspirin" contained within Problem List or in Provider Narrative field for any POV 995.0-995.3 or V14.8. ACEI ARB Numerator Logic: Ace Inhibitor ACEI ; medication codes defined with medication taxonomy BGP HEDIS ACEI MEDS. ACEI medications: Benazepril Lotensin ; , Captopril Capoten ; , Enalapril Vasotec ; , Fosinopril Monopril ; , Lisinopril Prinivil Zestril ; , Moexipril Univasc ; , Perindopril Aceon ; , Quinapril Accupril ; , Ramipril Altace ; , Trandolopril Mavik ; . ACEI-Combination Products: Benazepril + HCTZ Lotensin HCT ; , Captopril + HCTZ Capozide, Hydrochlorothiazide + Capropril ; , Enalapril + HCTZ Vaseretic ; , Fosinopril + HCTZ Monopril HCT ; , Lisinopril + HCTZ Prinzide, Zestoreti, Hydrochlorothiazide + Lisinopril ; , Moexipril + HCTZ Uniretic ; , Quinapril + HCTZ Accuretic ; . Refusal of ACEI: REF refusal of any ACE Inhibitor medication in site-populated medication taxonomy BGP HEDIS ACEI MEDS at least during the Report Period. Contraindications to ACEI defined as any of the following: 1 ; Diagnosis ever for moderate or severe aortic stenosis POV 395.0, 395.2, 396.0, or 747.22 ; or 2 ; NMI not medically indicated ; refusal for any ACEI at least once during the Report Period. Adverse drug reaction documented ACEI allergy defined as any of the following occurring anytime through the end of the Report Period: 1 ; POV 995.0-995.3 AND E942.6; 2 ; "ace inhibitor" or "ACEI" entry in ART Patient Allergies File or 3 ; "ace i * " or "ACEI" contained within Problem List or in Provider Narrative field for any POV 995.0-995.3 or V14.8. ARB Angiotensin Receptor Blocker ; medication codes defined with medication taxonomy BGP HEDIS ARB MEDS. ARB medications: Candesartan Atacanr ; , Eprosartan Teveten ; , Irbesartan Avapro ; , Losartan Cozaar ; , Olmesartan Benicar ; , Telmisartan Micardis ; , Valsartan Diovan ; . ARB Combination Products: Candesartan Ataccand HCT ; , Irbesartan Avalide ; , Losartan Hyzaar ; , Telmisartan Micardis HCT ; , Valsartan Diovan HCT ; . Refusal of ARB: REF refusal of any ARB medication in site-populated medication taxonomy BGP HEDIS ARB MEDS at least once during the Report Period. Contraindications to ARB defined as any of the following: Diagnosis ever for moderate or severe aortic stenosis POV 395.0, 395.2, 396.0, ; or 2 ; NMI not medically indicated ; refusal for any ARB at least once during the Report Period. Adverse drug reaction documented ARB allergy defined as any of the following occurring anytime through the end of the Report Period: 1 ; POV 995.0-995.3 AND E942.6; 2 ; "Angiotensin Receptor Blocker" or "ARB" entry in ART Patient Allergies File or 3 ; "Angiotensin Receptor Blocker" or "ARB" contained within Problem List or in Provider Narrative field for any POV 995.0-995.3 or V14.8. Statins Numerator Logic: Statin medication codes defined with medication taxonomy BGP HEDIS STATIN MEDS. Statin medications: Atorvostatin Lipitor ; , Fluvastatin Lescol ; , Lovastatin Altocor ; , Mevacor, Pravastatin Pravachol ; , Simvastatin Zocor ; , Rosuvastatin Crestor ; . Statin Combination Products: Caduet, PraviGard Pac, Vytorin. Refusal of Statin: REF refusal of any statin medication in site-populated medication taxonomy BGP HEDIS STATIN MEDS at least once during the Report Period.
MEDICATION ARICEPT 10MG TABLET ARICEPT 5MG TABLET ARIMIDEX 1MG TABLET ARISTOCORT 0.1% OINTMENT ARISTOCORT A 0.1% CREAM ARIXTRA 2.5MG 0.5ML SYRINGE ARMOUR THYROID 120MG TABLET ARMOUR THYROID 15MG TABLET ARMOUR THYROID 180MG TABLET ARMOUR THYROID 240MG TABLET ARMOUR THYROID 300MG TABLET ARMOUR THYROID 30MG TABLET ARMOUR THYROID 60MG TABLET ARMOUR THYROID 90MG TABLET AROMASIN 25MG TABLET ARTANE 5MG TABLET ARTHROTEC 50 TABLET EC ARTHROTEC 75 TABLET EC ASACOL 400MG TABLET EC ASPIRIN CODEINE 325 30 TAB ASTELIN 137MCG NASAL SPRAY ATACAND 16MG TABLET ATACAND 32MG TABLET ATACAND 4MG TABLET ATACAND 8MG TABLET ATACAND HCT 16-12.5MG TABLET ATACAND HCT 32-12.5MG TABLET ATARAX 10MG 5ML SYRUP ATARAX 25MG TABLET ATENOLOL 100MG TABLET ATENOLOL 25MG TABLET ATENOLOL 50MG TABLET ATENOLOL CHLORTHAL 100 25 ATENOLOL CHLORTHAL 50 25 ATIVAN 0.5MG TABLET ATIVAN 1MG TABLET ATIVAN 2MG TABLET ATROHIST PEDIATRIC CAPSULE ATROHIST PEDIATRIC SUSP D F ATROHIST PLUS TABLET SA ATROPINE 1% EYE DROPS ATROVENT 0.02% SOLUTION ATROVENT 0.03% SPRAY ATROVENT 0.06% SPRAY ATROVENT INHALER ATUSS DM LIQUID ATUSS EX LIQUID ATUSS EX SYRUP ATUSS G SYRUP ATUSS HD LIQUID ATUSS MS LIQUID ATUSS MS SYRUP AUGMENTIN 125-31.25 SUSPEN AUGMENTIN 200-28.5 SUSPEN AUGMENTIN 200-28.5 TAB CHEW AUGMENTIN 250-125 TABLET AUGMENTIN 250-62.5 SUSPEN AUGMENTIN 250-62.5 TAB CHEW AUGMENTIN 400-57 SUSPEN AUGMENTIN 400-57 TAB CHEW AUGMENTIN 500-125 TABLET G P NP MAINT. x x x GENERIC ALTERNATIVE PREFERRED BRAND ALTERNATIVE NOTES and clozapine.
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Current Hatch-Waxman litigation is replete with new controversies -- all having substantial impact on the pharmaceutical patent endgame. The Federal Circuit has left many puzzled by its recent findings and reversals of inequitable conduct in certain Paragraph IV cases. In addition, the DC Circuit has now ruled that the FDA must make a decision regarding market entry of a follow-on biological product. Although this ruling leaves the FDA several options, it finally may force the agency to decide whether an abbreviated pathway for approval -- similar to that for small molecules -- now can be adopted safely for biologics. Last, but not least, the Supreme Court will be hearing the most pharmaceutical patent cases in recent memory. Meanwhile, on the legislative and regulatory front, the Generic Drug User Fee proposal, pediatric re-authorization under PDUFA, and patent reform and PTO rulemaking may also alter the endgame. As counsel to either a brand name or generic pharmaceutical company, you need a complete understanding of the latest legal developments and their implications for your company's life cycle strategies. It's time to come to the one and only event that has consistently allowed brand name and generic drug makers to benchmark their companies' current strategies and tactics against competitors in both camps. The seventh American Conference Institute event on Maximizing Pharmaceutical Patent Life Cycles will bring you the thoughtful and targeted commentary and in-depth analysis that you have come to expect from this industry-leading event. An outstanding faculty of leading in-house pharmaceutical counsel and expert attorneys for both the brand names and generics, as well as government representatives will provide insights on: How the patent endgame can be used by brand names and generics to ultimately benefit the public How Hatch-Waxman reform has affected: - Product development - Orange Book listing strategies - Market exclusivities - Paragraph IV challenges and lamivudine.
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Upon receipt of an acceptable corrective action plan, a six-month provisional license will be issued. If you do not agree to a provisional license, or fail to submit an acceptable corrective action plan, disciplinary action will result. If you desire technical assistance in addressing these issues, please feel free to contact me. In any event, the corrective action plan is due within 15 days.
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Here is a small subgroup of the general population that suffers inordinately from headachethe 3% to 4% of people who have chronic daily headache. While the numbers are small in the total population, approximately 35% to 40% of patients who seek treatment from headache clinics suffer from daily or near-daily headache. Chronic daily headache CDH ; is defined as having headaches for more than 15 days a month or 180 days a year. Chronic tension-type headache was identified long ago, while chronic migraine, termed "transformed migraine, " was recognized more recently. However, the majority of people with CDH are actually suffering from transformed migraine, a condition that is more severe and disabling. What is the difference? Individuals with chronic tensiontype headache CTTH ; exhibit typical tension-type headache symptoms mild to moderate pain with a pressing quality to it and an absence of classic migraine symptoms such as nausea or light or noise sensitivity but they have them more frequently and more severely. Medication overuse and familial links are more significant in the chronic condition. Transformed migraine TM ; is a and candesartan.
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Written and compiled by independent experts, this incisive management report from Business Insights includes interviews with key industry executives and quantifies the issues that will be of greatest strategic significance in the industry's future. In addition to detailed epidemiology forecasting models, The CNS Outlook, 1998-2010 draws on over 90 interviews with CNS opinion leaders, from managers in small biotechs to multinational pharmaceutical executives, to assess developments in the CNS market and the strategies of the main players: 35 Pharmaceutical Marketing Executives assessed different corporate strategies and best drivers of company growth. 30 R&D Executives evaluated the impact of new drug classes, currently in development. 30 CNS Licensing Managers highlighted the implications of types of integration and current agreements in the CNS market.
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The Plus Report is published as a community service for the members of Physicians Plus Insurance Corporation, 22 E. Mifflin St., Suite 200, Madison, WI 53703, 608 ; 282- 8900. Martin A. Preizler, President and CEO Scott Shoemaker, Editor, scott.shoemaker pplusic If you have any concerns or questions about specific content that may affect your health, please contact your health care provider. 2006 Physicians Plus Insurance Corporation.
Historically, the approach that many nursing homes have used for medication error reporting has been punitive, seeking to assign blame and to discipline the health care worker involved in the error. The root cause of the error was assumed to be the individual involved most directly with the error., and the health care worker involved in the incident was the focus of corrective action. Little attention was given to the many aspects of the medication use process and the health care system until a study done by Leape, et al. in 1995. This study highlighted the systems failures that contributed to adverse drug events and recommended that assessment of the system of medication use be the focus of the evaluation of a medication error. These recommendations have been endorsed many times since 1995 David, 2001; Stump, 2000; Cohen, 2000 ; but have been slow to translate to practice. Improving patient safety by reducing medication errors involves reformation of the error reporting system so that the individual who reports the error does not fear disciplinary action. The error report should provide meaningful and useful information that can be translated to system improvement rather than disorganized pieces of data that do not allow analysis. This is accomplished: 1. By performing a Root Cause Analysis of each error that is reported so that systematic and objective measures can be taken to determine what contributed to the error. A "culture change" that shifts the focus from blame and punishment to patient safety may frame an institutions' error reporting system. 2. Health care leaders are urged to create an environment focused on patient safety that actively promotes the reporting and tracking of medication errors. When medication errors are reported in a comprehensive manner, there is an opportunity to evaluate the reason the error occurred the root.
Starting January 2004, Fallon Community Health Plan is putting all medications new to the U.S. market on a review list for the first six months they are available. This allows the FCHP Pharmacy Services Department to see the real effect of the drug. If a new medication is medically necessary, the physician can make a special request to have it. There will have to be solid, clinical evidence as to why that particular medication is needed. To learn more about why FCHP has established this policy, see Connection online.
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