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The number of drugs that have been placed on prior approval is low and already several have been recommended for removal. The net savings to NC Medicaid using this limited approach still exceeded $12 million last year. It is clear, however, that the prior approval process alone is inadequate to control pharmacy costs. The PAL list--NC Physician Advisory Group PAG ; and the leadership of the Community Care Program Access II III ; have partnered with NC Medicaid to further evaluate the pharmacy program and recommend strategies to control costs while maintaining our focus on quality care for our state's poorest citizens. When taking an objective look at pharmacy expenditures, several facts stand out: 1 ; the top 15-16 classes of medications by costs account for almost 60% of the total pharmacy cost, 2 ; the issues around medication use are complex since many of these medications are used for chronic disease and among our sickest patients, 3 ; there are opportunities for savings involving poly-pharmacy, evaluating off-label usage, disease management programs, and focused initiatives based on data none of which lend themselves to typical pharmacy management strategies ; . The single biggest impact on costs may be in educating physicians on the actual cost to Medicaid of the most expensive classes of medications and asking for voluntary help from physicians by prescribing less expensive medication when appropriate. This approach was tested in our Access II III networks. The Prescription Advantage List PAL ; project headed by Dr. Steve Wegner showed a 22% savings and good physician acceptance of such a volunteer approach. Feedback indicated that physicians wanted concise information about costs, a minimum number of drug classes to keep up with, and more evidencedbased information on efficacy. Defining relative costs--Determining the actual cost of medications to Medicaid however is a complex problem. Medicaid pays pharmacists average wholesale prices AWP ; minus 10% for medications and a professional fee of $5.60 for generics and $4.00 for brand medications. The patient is asked to pay $1.00 for generic and $3.00 for brand name medications. In addition, NC participates in the federal drug rebate program in which pharmaceutical companies agree to provide a formulabased rebate on the medications purchased by the state. These rebates vary by company and greatly affect the net cost of medications to the state. In effect, the state pays the absolute lowest price available, even for brand name medications. The information, however, is protected from public disclosure. To provide accurate information to providers, a method to show the relative cost of medications within classes including all costs and rebates was needed. The Physician Advisory Group leadership met with pharmaceutical industry representatives and state officials to develop a methodology to evaluate net cost of medications and provide physicians with accurate relative cost ranking without breaching rebate confidentiality. This information, which is reflected in the current state PAL, allows the ranking of drugs within a class from least to most expensive based on the net price to Medicaid. The list will be updated quarterly to maintain accuracy. In developing the initial statewide list, the Physician, for example, claritin make will.
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ASPET Phone number: 301 ; 530-7060 ASPET Fax number: 301 ; 530-7061 ASPET E-mail address: info aspet for general information and requests ; ASPET Web site home page from which you can link to all other pages on the site : faseb aspet ASPET Membership Information and Application Form : faseb aspet meminfo ASPET Publication Information, Subscription Forms and Instructions to Authors : faseb aspet PUBLPAGE ASPET Meeting Information; Registration Forms; Guidelines for ASPET Symposia, Ray Fuller Symposia, Colloquia, and Support of Meetings : faseb aspet cal ASPET Public Affairs Page with links to - Alerts - Bulletins - Positions Statements : faseb aspet pubaff ASPET Awards Information including Guidelines and Deadlines : faseb aspet awards2001 THE PHARMACOLOGIST VOL.43 NO.1 51.
On October 22, 1999, the Advisory Committee on Immunization Practices ACIP ; recommended that Rotashield rhesus rotavirus vaccine-tetravalent [RRV-TV] ; , the only U.S.-licensed rotavirus vaccine, no longer be used in the United States MMWR Vol. 48, No. 43, November 5, 1999 ; . Parents should be reassured that children who received rotavirus vaccine before July 1999 are not now at increased risk for intussusception. 1 This schedule indicates the recommended ages for routine administration of licensed childhood vaccines as of November 1, 1999. Any dose not given at the recommended age should be given as a "catch-up" vaccination at any subsequent visit when indicated and feasible. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine's other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations. 2Infants born to hepatitis B surface antigen HBsAg ; -negative mothers should receive the first dose of hepatitis B vaccine Hep B ; by age 2 months. The second dose should be administered at least 1 month after the first dose. The third dose should be administered at least 4 months after the first dose and at least 2 months after the second dose, but not before age 6 months. Infants born to HBsAg-positive mothers should receive Hep B and 0.5 mL hepatitis B immune globulin HBIG ; within 12 hours of birth at separate sites. The second dose is recommended at age 12 months and the third dose at age 6 months. Infants born to mothers whose HBsAg status is unknown should receive Hep B within 12 hours of birth. Maternal blood should be drawn at delivery to determine the mother's HBsAg status; if the HBsAg test is positive, the infant should receive HBIG as soon as possible no later than age 1 week ; . All children and adolescents through age 18 years ; who have not been vaccinated against hepatitis B may begin the series during any visit. Providers should make special efforts to vaccinate children who were born in or whose parents were born in areas of the world where hepatitis B virus infection is moderately or highly endemic. 3 The fourth dose of diphtheria and tetanus toxoids and acellular pertussis vaccine DTaP ; can be administered as early as age 12 months, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 1518 months. Tetanus and diphtheria toxoids Td ; is recommended at age 1112 years if at least 5 years have elapsed since the last dose of diphtheria and tetanus toxoids and pertussis vaccine DTP ; , DTaP, or diphtheria and tetanus toxoids DT ; . Subsequent routine Td boosters are recommended every 10 years. 4 Three Haemophilus influenzae type b Hib ; conjugate vaccines are licensed for infant use. If Hib conjugate vaccine PRP-OMP ; PedvaxHIB or ComVax [Merck] ; is administered at ages 2 months and 4 months, a dose at age 6 months is not required. Because clinical studies in infants have demonstrated that using some combination products may induce a lower immune response to the Hib vaccine component, DTaP Hib combination products should not be used for primary vaccination in infants at ages 2, 4, or 6 months unless approved by the Food and Drug Administration for these ages. 5 To eliminate the risk for vaccine-associated paralytic poliomyelitis VAPP ; , an all-inactivated poliovirus vaccine IPV ; schedule is now recommended for routine childhood polio vaccination in the United States. All children should receive four doses of IPV: at age 2 months, age 4 months, between ages 6 and 18 months, and between ages 4 and 6 years. Oral poliovirus vaccine OPV ; if available ; may be used only for the following special circumstances: 1 ; mass vaccination campaigns to control outbreaks of paralytic polio; 2 ; unvaccinated children who will be traveling in 4 weeks to areas where polio is endemic or epidemic; and 3 ; children of parents who do not accept the recommended number of vaccine injections. Children of parents who do not accept the recommended number of vaccine injections may receive OPV only for the third or fourth dose or both; in this situation, health-care providers should administer OPV only after discussing the risk for VAPP with parents or caregivers. During the transition to an all-IPV schedule, recommendations for the use of remaining OPV supplies in physicians' offices and clinics have been issued by the American Academy of Pediatrics Pediatrics Vol. 104, No. 6, December 1999 ; . 6 The second dose of measles, mumps, and rubella vaccine MMR ; is recommended routinely at age 46 years but may be administered during any visit, provided at least 4 weeks have elapsed since receipt of the first dose and that both doses are administered beginning at or after age 12 months. Those who previously have not received the second dose should complete the schedule no later than the routine visit to a health-care provider at age 1112 years. 7 Varicella Var ; vaccine is recommended at any visit on or after the first birthday for susceptible children, i.e., those who lack a reliable history of chickenpox as judged by a health-care provider ; and who have not been vaccinated. Susceptible persons aged 13 years should receive two doses given at least 4 weeks apart. 8 Hepatitis A vaccine Hep A ; is recommended for use in selected states and regions. Information is available from local public health authorities and MMWR Vol. 48, No. RR-12, October 1, 1999. Use of trade names and commercial sources is for identification only and does not constitute or imply endorsement by CDC or the U. S. Department of Health and Human Services. Source: Advisory Committee on Immunization Practices ACIP ; , American Academy of Family Physicians AAFP ; , and American Academy of Pediatrics AAP and clonazepam, because loratadine breastfeeding.
Risk Factors for Stroke and History of Stroke Risk factors for and history of ; stroke are presented in Table AF 5, along with the frequency and percentage each item was observed among all confirmed cases of atrial fibrillation. Nearly half of patients were identified as having hypertension 857 1734: 49% ; . Coronary artery disease was present in 501 patients 28.9% 438 patients 25.3% ; had heart failure; and 288 patients 16.6% ; were diabetic. Nearly 10% of patients had suffered a previous cerebrovascular accident 169 1734: 9.7% ; . The prevalence of all other PDMFs was below 5.
Hinch G, Lynch J, Nolan J, Leng R, Bindon B and Piper L[1996] Supplementation of high fecundity Border Leicester x Merino ewes with a high protein feed; its effects on lamb survival. Australian Journal of Experimental Agriculture 36, 129-136 Husband AJ [1995] The immune system and integrated homeostasis. Immune Cell Biology 73, 377-382 Ivan M, Dayrell deS, Mahadevan S and Hidiroglou M [1992] Effects of bentonite on wool growth and nitrogen metabolism in fauna free and faunated sheep. Journal of Animal Science 70, 3194-3202 Jessen C [2001] Temperature regulation in humans and other mammals. Springer New York Klasing KC 1998] Nutritional aspects of leucocytic cytokinines Journal of Nutrition 118, 1436-1446 Knox MR [1995] Medicated blocks to control parasites in ruminants. In `Recent Advances in Animal Nutrition in Australia' [editors JB Rowe and J V Nolan ], pp 116121University of New England Printing Unit, Armidale NSW 2351. Knox MR, Steel JR and Leng RA [1994] The effects of urea supplementation on gastrointestinal parasitism in sheep being fed low quality roughage diets Australian Society for Parasitology Annual General Meeting 1994 Knox MR [2003] Impact of non protein nitrogen supplements on nematode infected sheep Australian Journal of Experimental Agriculture. 43[12], 1463-1468 Lambert GP, Gisolfi CV, Berg DJ, Moseley PL, Oberley LW and Kregel KC [2002] Hyperthermia-induced intestinal permeability and the role of oxidative and nitrosative stress. Journal of Applied Physiology 92, 17501761. Leng RA[1990] Factors effecting the utilisation of "poor quality" forages by ruminantsparticularly under tropical conditions. Nutrition Research Reviews 3, 277-303 Leng RA[2003] Drought and dry season feeding strategies for cattle sheep and goats. Penambul Books, Coolum Beach, Qld 4573 Lipperheide C, Rabe M, Knura S, and Petersen B [2002]Effects of farm hygiene on blood chemical variables in fattening pigs Tierartzliche Umschau 55, 30-36 Litherland AJ, Layton DL, Boom CJ, Knight TL, Hyslop M, Lambert MG and Cook TL [2004] Ill-thrift in young growing cattle and sheep Proceedings of The New Zealand Society of Animal Production 64, 197- 202 Lobley GE, Hoskin SO and McNeil CJ [2001] Glutamine in animal science and production. Journal of Nutrition.131, 2525S-2531S and clonidine.
E1371 Procalcitonin-guided assessment of bacterial etiological role in patients admitted for severe COPD exacerbations: a double-blind study R. Dal Negro1 , M. Caputo2 , S. Bertacco1 , A. Conti1 , C. Micheletto1 . 1 Lung Dept, Orlandi Hospital, Bussolengo, VR, Italy; 2 Clin. Chem. & Microbiol. Lab., Orlandi Hospital, Bussolengo, VR, Italy The bacterial origin and the consequent antibiotic treatment of COPD exacerbations usually represents empiric decisions in clinics. Aim: to assess the clinical value of procalcitonin PCT ; serum levels in discriminating bacterial from non-bacterial COPD exacerbations in admitted severe patients. Methods: in 45 consecutive patients admitted for a severe exacerbation of COPD age 39-78; 29 males ; PCT levels were measured in serum TRACE method, Brahms, Hennigsdorf, Germany ; and bacteriological assessment carried out in bronchial secretions from protected broncoscopy ; according to a double-blind procedure. PCT levels measured at the patients' admission ; in patients with and without a significant 105 CFU ; bacterial load were compared t paired test, assuming p 0.05 ; . Results: mean PCT level in infected subjects n 17; 13 males ; was 0.065ng ml0.046sd, while in the non-infected ones n 28; 16 males ; it was 0.086ng ml 0.077sd, p ns. Isolated bacteria were: 13 Gram - and 4 Gram + strains. Conclusions: 1 ; PCT levels did not contribute to discriminate bacterial from non-bacterial COPD severe exacerbations; 2 ; a domiciliary antibacterial course assumed by the majority of patients before admission could represent a possible relevant bias which can work as a true confounding factor; 3 ; the precise selection of patients' sample proves to be crucial in drawing definitive conclusions. E1372 Increased intima-media thickness in stable COPD is systemic inflammation the cause? P. Eickhoff1, 3 , D. Kiss1 , M. Schreder2 , R. Kohansal1 , A. Valipour1 , K. Geyer1 , O.C. Burghuber1 . 1 Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Ludwig Boltzmann Institute for COPD, Vienna, Austria; 2 Department of Internal Medicine, Wilhelminen Hospital, Vienna, Austria; 3 Department of Anesthesiology and General Intensive Care B, Medical University of Vienna, Vienna, Austria Background and Hypothesis: COPD is associated with increased cardiovascular mortality which may be attributed to systemic inflammation and endothelial dysfunction ED ; . Similar to ED, an increase in intima-media thickness IMT ; precedes atherosclerosis and correlates independently with the presence of cardiovascular morbidity. We hypothesized that stable COPD is associated with increased IMT caused by systemic inflammation. Methods: After excluding COPD patients n 949 ; with concomitant diseases known to influence IMT and endothelial function cardiovascular disease, hypertension, hyperlipidemia, adipositas, diabetes, chronic renal failure, malignancy. 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Claritin pediatric syrupClaritin versus zyrtecSearch for a medication by name or alphabetically and depakote. Claritin reactionsBlazeblack forums forum index - fitness dieting general health author message posted: thu may 03, 2007 6: post subject: web site surgery for dozens of core. Based on the above statistics, we reckon Bolton PCT must have about 250 members of staff who are also Carers. If you combine working with caring for someone outside of work, Bolton PCT wants to be able to offer you support. To help us to do that Linda Green was asked to take on the role of Carers' Champion. She has been caring for her elderly father who has a number of medical problems including Alzheimers for the past few years and has had a lot of experience of the sort of problems working carers come up against. The first thing she needed to find out was who among our staff are also carers, and what sort of support they might benefit from. She launched the Bolton PCT Carers' Support Network at an event in the Friends Meeting House about a year ago. Staff who attended that event signed up to a totally voluntary and and diazepam. Whilst this sounds logical, there is in fact no body of evidence to link the assumptive links made by the authors. The Cochrane Reviews found that iron supplementation, had no detectable effect on any substantive measures of either maternal or fetal outcome.26 They concluded that there is inconclusive evidence on the effects of treating iron deficiency anaemia in pregnancy due to the shortage of good quality trials. Given that the vast majority of `anaemia' during pregnancy is due to haemodilution and is not microcytic, this is not surprising. Further literature recommends against the routine use of medicinal iron and suggests that only high risk mothers should be targeted for medicinal treatment.27 Given that such medicinal iron supplements have no significant positive effect and that low zinc status is a cause of low birth weight, there is a strong case for the abandonment of routing use of medicinal iron during pregnancy. Perhaps one of the more reasoned commentaries on incidences of exposure and causes of death are seen on Pediatric-Emergeny's website.28 In summarising the 1997 APPCC data they state; "Commentary on. Litovitz TL et al. 1997 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. J Emerg Med 1998; 16: 443-491. The AAPCC continues it's outstanding. Table 1: Summary Statistics Drug Characteristics Observation drug-month, Jan. 1994 to Dec. 2001 ; Month of drug entry Claritjn Apr. 1993 Mean 0.692 0.608 0.035 Zyrtec Feb. 1996 Mean 0.459 0.480 0.020 Allegra Sept. 1996 Mean 0.499 0.567 0.054. All participants were provided with advice about healthy diets and lifestyles, which was reinforced at each visit. Stage IIa to IIb Tauber et al17 ; and from stage I to II Mondino and Brown19 ; . The eye remained stable throughout the follow-up Table 3 ; . In patient 3, the right eye progressed from 36 to 32 mm. When the patient was treated with methotrexate, 25 mg wk, only 4 mm of conjunctival surface was subsequently lost in the follow-up period. This corresponds to a change from stage IIaIIIb 1 ; to IIbIIIb 1 ; Tauber et al17 ; and from stage I to II Mondino and Brown19 ; Table 3, for instance, claritin recall. 6. Chopra, I. C., and Chopra, N. R., "The use of cannabis drugs in India, " United Nations Bulletin on Narcotics, 1957, 9, 5 and climara. 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Why banned? Athletes may use narcotics to stop the pain resulting from an injury. This can be dangerous as these substances merely mask the pain. An athlete who continues to exercise on the injured part risks further damage to that part. Prolonged use may also produce physical dependence resulting in addiction. Narcotic overdoses are always a medical emergency and can lead to respiratory distress and death. This randomized study was conducted to evaluate the impact of improved sexually transmitted disease case management at primary health care level on the incidence of HIV infection in the rural Mwanza region of the United Republic of Tanzania. Objective To establish whether improved STD case management and treatment-seeking behaviour have an impact on HIV transmission and STD at a population level. Design Twelve large rural communities from Mwanza Region, the United Republic of Tanzania, six in the intervention arm and six in the comparison arm. Matched design: six pairs of communities with HIV prevalence expected to be similar within pairs. Randomization to intervention and comparison arms within each matched pair. Catchment population in each arm was about 150 000. Intervention Improved syndromic ; STD case management services integrated into the existing primary health care system of the United Republic of Tanzania. Components: training of health workers, regular and frequent supervision and in-service training, provision of effective low-cost drugs, and campaigns to improve the treatment-seeking behaviour of the population. In the comparison arm, continuation of existing services. Extension of the intervention into the comparison arm at the end of the trial. In addition, for ethical reasons, injections to treat syphilis were provided at baseline and follow-up to all persons in both arms with serological evidence of infection. Impact evaluation. 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