Abbreviations as in Table 2. Fisher exact test, P .39. * OR vulvovaginal candidiasis vs all other diagnoses ; . 95% CI for OR.
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Corrections; Wisconsin Legislative Audit Bureau Audit Summary, Report 01-9, May, 2001; Administrative Directive, AD-39.1, Mental Health Screening of Inmate Candidates for Supermax; and Mental Illness Screening Tool for SMCI DOC-2056, 4 00 ; . 8. Based on the tours and interviews I conducted and the files and documents I reviewed, I have formed the opinion that many of the prisoners confined in the SMCI currently suffer from serious mental illnesses and are not receiving the mental health treatment their psychiatric condition requires. I have further concluded that confinement at SMCI of prisoners suffering from serious mental illnesses, prone to serious mental illness and or prone to suicide is an extreme hazard to their mental health and well-being, and causes irreparable emotional damage and psychiatric disability as well as extreme mental anguish and suffering, and in some cases presents a risk of death by suicide. I have identified seven prisoners who should be transferred out of the SMCI on an urgent basis and undergo thorough psychiatric examination in a less stressful mental health treatment setting. In addition, all prisoners in the SMCI should undergo rigorous psychiatric examination and psychological assessment within the next one to two months, and those exhibiting significant signs and symptoms of serious mental illness and or suicide risk should be transferred immediately to a correctional or secure psychiatric setting where their psychiatric condition can be adequately evaluated and they can receive competent psychiatric treatment. Monthly re-assessments of all prisoners in the SMCI should be conducted to determine which prisoners develop psychopathological conditions, and any that do should be transferred to a secure psychiatric setting for assessment and treatment. 9. Confinement in a supermaximum security prison such as the SMCI is well known to cause severe psychiatric morbidity, disability, suffering and mortality. The prisoners are confined to their cells 23 or 24 hours per day, there is very limited social interaction, very sparse possessions are permitted, there are very few if any contacts between prisoners, staff contact with prisoners is limited mainly to the handing out and collection of food trays and disciplinary activities, prisoners eat alone in their cells, programming is extremely minimal, discipline is very strict and punishments are frequent. Prisoners are left alone to their own devices in cells that are often extremely hot and humid. The incidence of suicide attempts is quite high. And the prisoners might spend years in this kind of near-solitary confinement and enforced inactivity. Sheilagh Hudgins and Gilles Cote performed a research evaluation of penitentiary inmates in a Supermaximim Security Housing Unit and discovered that 29% suffered from severe mental disorders, notably schizophrenia. "The Mental Health of Penitentiary Inmates in Isolation, " Canadian Journal of Criminology, 177-182, April, 1991. ; 10. Psychiatrist Stuart Grassian examined a large number of prisoners during their stay in segregated, near-solitary confinement units and concluded that these units, like the sensory deprivation environments that were studied by psychologists in the 1960's, often induce psychosis, especially in prisoners who have histories of mental illness or a predisposition to psychiatric breakdown. Even prisoners who do not become frankly psychotic frequently report a number of serious psychiatric symptoms, including but not limited to: a. Massive free-floating anxiety; b. Hyper-responsiveness to external stimuli, including a startle response; c. Perceptual distortions and hallucinations in multiple spheres auditory, visual, olfactory d. Derealization experiences; e. Difficulty with and famotidine.
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In Alberta, the low birth weight LBW ; rate remained stable between 1995 and 2001; it then increased to 6.5 per 100 live births in 2002 and was at 6.4 per 100 live births in 2004. It is lower in the Capital Health Region and higher in the Calgary Health Region Figure 2 ; . Preterm birth rates are also increasing in both Canada and Alberta. The Canadian preterm rate was 7.5% while the Alberta rate was 8.6% in 2002. In 2004, the Alberta rate was 9.1%. The small for gestational age SGA ; rate for 200002 was 7.8% in Alberta.
Table 3. Tests of Heterogeneity and Publication Bias and
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Randomized sequence to each patient. Seizure duration was measured by bifrontal EEG electrode placement Thymatron ; and by clinical observation of the cuffed lower limb. For this report, individual data were analyzed by the Kruskal-Wallis nonparametric test and the Fisher Behrens dtest. Results: A total of 60 ECT sessions were analyzed for six patients range 5 to 15 sessions ; . Seizure duration ranged from 11 to 114 seconds by EEG monitoring. The outcome was clinically satisfactory across all ECT sessions: 41 were 30 sec.; 17 were between 20 and 29 sec.; and 2 less than 20 sec. Patient means SD ; for clinical seizure grouped by ESM, NIC, and COM, respectively, were 20.1 7.01, 21.1 and 24.1 7.98; and for EEG monitoring were 35.9 7.56, 33.8 and 40.2 8.29 sec., respectively. Conclusion: These data support a conclusion that there are no significant differences between esmolol, nicardepine, and a combination of the two drugs as to the effect on seizure duration during ECT. 52. Competence to Provide Informed Consent in Patients Undergoing Bone Marrow Transplantation T.S. Zaubler, MD; J.R. Fann, MD; S. Roth-Roemer, PhD; R. Pearlman, MD; M. Sullivan, MD, PhD; W.J. Katon, MD, FAPM; K. Beach, RN; K. Syrjala, PhD ntroduction: Impairments of competence to provide informed consent has been shown to be associated with severe medical illness. Cancer patients undergoing bone marrow transplantation may be particularly predisposed to impaired competency because they typically present with systemic disease and receive high-dose chemotherapy, often with total-body irradiation. However, there have been no studies examining the impact that bone marrow transplantation may have on competence. The present study describes the prevalence of impaired competence to provide informed consent, and the associations between impaired competence, mood states, delirium, and various medical risk factors in cancer patients undergoing bone marrow transplantation. Methods: Twenty patients admitted to the Fred Hutchinson Cancer Research Center for bone marrow transplantation were assessed at three different time-points during their treatment. At pretreatment, 30 days, and 90 days after bone marrow transplantation, patients were administered a semistructured interview MacArthur Competency Assessment Tool [MacCAT] ; to assess their competence to provide informed consent. The MacCAT measures four different standards for competency with separate scores for each of these standards. The standards.
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Prefers to keep these matters secret. This kind of promotion masquerading as "education" is what largely accounts for the market success of new and expensive drugs that are not significantly different or better than less expensive existing drugs. And for this both the industry and the medical profession must take responsibility. Although there has been criticism from some members of the profession, medical societies and associations have taken no effective steps to oppose these practices. Most of the profession, it seems, finds it difficult to break the habit of taking money and gifts from the drug industry. Over a decade ago the AMA issued guidelines on accepting gifts from industry, but they were voluntary and quite permissive. They have not been observed in practice nor monitored by the AMA. PhRMA recently issued guidelines of its own, which closely follow those of the AMA, but, not surprisingly, they are also voluntary and permissive. It remains to be seen whether this latest effort will have any significant effect on drug-industry practices or will prove to be just another public relations ploy. The Office of the Inspector General OIG ; of the Department of Health and Human Services recently placed in The Federal Register for comment a draft of proposed guidelines for ethical and legal relationships between the pharmaceutical industry on the one hand and physicians, pharmacists, and various purchasers of drugs on the other. The OIG notes that many of the existing practices involving gifts and payments to physicians are intended to influence the prescribing of a drug company's products and may potentially violate federal antikickback laws. It urges drug companies to review existing laws and regulations to avoid civil and criminal penalties. The code recently adopted by industry, to which we have already referred, is a minimum standard that certainly ought to be met, the OIG says, but mere compliance with that code does not guarantee protection against persecution for illegal conduct. Although they are only general recommendations, not regulations, the tone of these proposed guidelines from the OIG is stern. It remains to be seen what will happen to them when the drug industry and other interested parties weigh in. In any event, the introduction of such guidelines suggests a rising concern about the influence of the industry on the.
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1. Did all participants have established epilepsy with a constant and predictable seizure frequency and type? 2. Was the crossover design appropriate? 3. Was an appropriate washout allowed between the different treatments? i.e. the investigators should justify their choice of washout period. They may monitor blood levels of the treatment drugs or perform statistical analysis to look for treatment period interactions ; . 4. Was an appropriate analysis using paired data performed?.
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Synopsis AstraZeneca's experimental cancer drug, named ZD6126 has been sent back to the laboratory for further testing after producing toxic side effects in phase II studies. It is reported that the drug damages the blood vessels that feed tumours.
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Prof WFO Marasas ?? Adjunct Professor, Dept of Plant Pathology, Pennsylvania State University, University Park, USA. ?? Extraordinary Professor, Dept of Microbiology and Biochemistry, University of the Orange Free State, Bloemfontein. ?? Extraordinary Professor, FABI, Faculty of Agricultural and Natural Sciences, University of Pretoria, Pretoria. ?? Editorial Boards: Applied and Environmental Microbiology USA. Dr WCA Gelderblom ?? Invited by the WHO to participate as an expert on fumonisins in the 56 Meeting of the WHO FAO Joint Expert Committee on Food Additives JECFA ; , Geneva, Switzerland, 6 - 15 February 2001. Dr V Sewram ?? Member of the Analytical Expert Committee of the Medicines Control Council and estrace.
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Chapter of Catholic Charities of Eastern Virginia CCEVA ; hosted an event on Medicare Part D in Williamsburg sponsored by the Center for Medicare and Medicaid Services and the U.S. Department of Health and Human Services. The event, held at the Grove Christian Outreach Center on Pocahontas Trail, was offered in cooperation with Rx Partnership, an organization that helps uninsured Virginians gain access to free prescription medications. Local seniors who transitioned to Medicare Part D offered their stories, while guest speaker Gordon Woodrow, regional director of the U.S. Office of Health and Human Services, asked the audience questions about their individual coverage. It was an opportunity for area seniors to clearly define their concerns about the new benefit plan. Woodrow spoke with Katherine Crow, a client of CCEVA's Medication Access Program MAP ; , which advocates for free maintenance drugs from participating pharmaceutical companies in collaboration with Williamsburg partnering organizations ; . He then discussed Medicare Part D with the staff of Williamsburg CCEVA. Crow, a nine-year volunteer with CCEVA , explained how the MAP program helped her obtain the life-saving drugs she so desperately needed, and how easy and cost-effective her transition to Medicare Part D was. She can save $4, 000 a year, allowing her to utilize her limited funds for other essentials such as food, shelter and utilities. Woodrow says he gained a clear sense of the needs and concerns of Williamsburg's senior population. He says he left with a positive outlook after experiencing the excellent collaboration of agencies helping our elder population stay healthy and active. WHJ For more information about programs offered locally through Catholic Charities of Eastern Virginia, call 253-2847.
Prof. Dr. Gilberto Fontes, a pharmacist, is currently heading a research project whose main goal is to eradicate filariasis a parasitic infection ; in Macei. This project is financially supported by WHO, OPAS, the Brazilian government and the university; it was started 10 years ago and has now almost reached its objective: the prevalence of this disease has dropped from 5% down to 0.1% in this period. Students of pharmacy, medicine, nursing and biology are the project's main engine; they diagnose and treat the patients, and they conduct research on the disease. The integration of students is crucial for this project, because they bring together specialized knowledge from their respective fields of study. It is also a great opportunity for them to apply classroom knowledge in a real world setting. In the morning, the "Agentes Comunitrios de Sade" Community Health Agents ; register the patients, recording their name, age and address. Subsequently, they give this information to the laboratory and prepare everything they need for the examination. Every night the students examine about 100 patients, collecting some drops of blood from the finger and then preparing them to be checked the following day. The examination begins at 10PM due the microfilaria nocturnal periodicity. There are only 3 districts in Macei where patients infected with filariasis can be found: Jacitinho, Feitosa and Pitanguinha. The problem with these districts is a river that crosses them, because it's an excellent place for mosquitoes to reproduce. A study was conducted to check if there is contamination of other districts but none was found. The pharmacy students also visited infected patients to provide pharmaceutical treatment for them. The patient must first take albedazole before finishing with diethylcarbamazine, because the latter alone will only irritate the worm Ascaris lumbricoides ascariasis ; , causing further clinical complications. 65% of students working on project are from pharmacy program. The reason is that pharmacy students are more flexible in laboratory and field work The medical students check the clinical aspects of elephantiasis, examining the legs, arms, breasts and scrotum, avoiding their chronic aspects. Biology students study the biological aspects of the disease, looking at the different stages of the worm's growth. Every student receives a certificate that is included in their university's curriculum vitae, and the best students working on the project also have to write papers for publication in scientific journals. WHO liked the project so much that they asked Dr. Fontes to implement it in other countries, like Haiti. Rodger Rocha Universidade Federal de Alagoas. Macei AL, Brazil.
SECTION 1: PRESCRIBING SAFETY ISSUES Scenario # Statement: "When selecting a drug, the computer should alert the prescriber if." A 3 . the drug is contraindicated because of pregnancy B 6 . the drug is contraindicated because of a previous allergy C 1 .the drug may be contraindicated because of the patient's age D 7 . the drug is contraindicated because of previous exposure E 8 . the drug is contraindicated because of a diagnosis of a recorded diagnosis of renal impairment F 10 . the drug is contraindicated because of elevated serum creatinine 150Mol L ; G 14 the drug is contraindicated because of a recorded diagnosis of heart failure H 15 . the drug is contraindicated because of a recorded diagnosis of coronary heart disease I 18 . the drug is contraindicated because of a documented history of porphyria J 20 . the drug is contraindicated because of a recorded diagnosis of thyroid dysfunction K 22 . there is a clinically significant potential interaction with another drug that the patient has recently been prescribed Statement: "When selecting a dosage regimen the computer should alert the prescriber if." L 26 .the frequency of dose may be inappropriate and dangerous M 27 .the preparation is contraindicated by a specific route N 28 .the drug has been prescribed using contraindicated administration instructions O 29 .the drug regimen is contraindicated because the patient has elevated creatinine levels P 30 .the drug is contraindicated for administration at the same time as another drug already prescribed Q 32 . the drug requires a test dose prior to administration SECTION 2: GENERAL SAFETY ISSUES Decision support A-K 33 When selecting a drug, the computer system should be capable of providing the clinician with information on the safety of this drug A-R 34 Hazard alerts need to provide clinicians with sufficient detail to enable them to make informed decisions A-R 35 Hazard alerts need to be designed so that they do not provide clinicians with irrelevant or spurious information Interface A-R 36 Hazard alert messages should be displayed clearly on the computer screen A-R 37 It should be difficult to override alerts if there is a risk of serious patient harm as a consequence A-R 38 If a clinician decides to override a clinically relevant hazard alert, they should be prompted to record a reason for this. R 39 When selecting a drug from a drop-down menu there should be mechanisms in place to make it difficult to erroneously issue a drug with a similar name if this could cause serious patient harm Reporting and clinical audit S 41 It should be possible to run reports on patients at risk from their medication T 42 It should be possible to run reports on clinicians' actions in response to hazard alerts U 43 It should be possible to run reports to identify situations where a clinician has overridden a clinically important hazard alert, for example, esomeprazole sodium.
Fathy M. El-Bassouny, Nabeel A. Hasan, Nagy Abd El-Hady, Ihab M. Mahmoud, Amr A. El- Huseiny, Mohamed A. Sobh. Nephrology, Urology and Nephrology Center, Mansoura, Dakahlia, Egypt This study reports the results of CsA treatment in 207 patients with INS of whom 175 were children. One hundred and eight patients were steroiddependent. The underlying pathology was focal segmental glomerulosclerosis FSGS ; , minimal change disease MCD ; , diffuse mesangial proliferation DMP ; , membranous nephropathy MN ; and membranoproliferative glomerulonephritis MPGN ; in 126, 48, 15, and 8 patients respectively. All patients had normal renal function before CsA therapy. CsA induced complete remission in 137 66.2% ; and partial remission in 17 8.2% ; . The rest of patients were resistant to therapy. Response to CsA was significantly better in: children compared with adults p 0.04 steroid dependent patients versus steroid resistant ones p 0.001 MCD, DMP and FSGS compared with other pathological lesions p 0.003 ; and in those who had lower quantities of pre-treatment proteinuria p 0.02 ; . CsA was received for a period of 22.16 12.21 6-72 ; months. Discontinuation of the drug in 37 patients resulted in relapse in 73% while the remaining 27% maintained remission until the last follow up 11.1 5.3 months ; . Eighteen out of 26 patients showed complete remission when CsA was resumed. Renal dysfunction serum creatinine ; developed in 17 patients 8.2% ; of whom 11 recovered completely on drug discontinuation. Hypertension developed in 36 17.4% ; patients while hypertrichosis 108 52.2% ; and gum hyperplasia 51 24.6% ; were the most frequent CsA-related side effects. With the exception of hypertrichosis, all side effects were significantly more prevalent in CsA-resistant patients. We conclude that CsA is generally effective in the treatment of INS. Renal dysfunction and hypertension may be CsAinduced or due to disease progression.
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