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Although the results following high-energy TUMT are excellent, changes to the Prostasoft, software have recently been reported. It was concluded from clinical experience that a shorter duration of treatment did not alter efficacy or decrease morbidity 36 ; . On conceptual basis, the so-called Prostasoft, 3.5 protocol differed significantly from former protocols. First, the principle of stepwise energy increments was abandoned and the treatment was initiated at an 80 energy level. Second, the urethral temperature feedback system was also abandoned. Energy delivery is now guided by the rectal temperature sensor via a feedback loop. Third, the cooling temperature starts at a lower value 8C ; and is also linked to rectal temperature. Finally, the total treatment duration is shortened to only 30 minutes. This Prostasoft, 3.5 protocol can therefore be considered to be high-intensity-dose TUMT. In principle, the whole treatment procedure is not altered and the same device and urethral probes are used. With the new software, no interruptions occur as microwave power is automatically adjusted to maintain a stable rectal temperature. This alteration in the algorithm results in a more effective treatment, without compromising safety parameters. In the high-energy protocol, the initial energy level starts at 20 W, with gradual increments up to 70 The approach was based on the effective levels best tolerated by patients, not on scientific evidence. Insufficient heating of the tissue was suggested as one possible reason for treatment failure. Gradual energy increments might cause tissue adaptation to temperature rise, with recruitment of tissue defence systems such as the `heat sink' mechanism. The immediate emission of energy at a higher level results in a `heat shock concept', eliminating these suggested limitations. In the initial protocol, the treatment duration was set at 1 hour. More recently, however, there has been strong clinical support for reducing the treatment duration 38 ; . The latest Prostasoft 3.5 protocol is based on a merging of these different concepts, resulting in a high-intensity-dose TUMT treatment. Initial clinical studies were started in January 1998. Data have been generated from a cohort of 93 patients with a mean age of 66 years and an average prostate volume of 60 cm3. An average total energy of 92 kJ was delivered, while the power emitted averaged 56 W. The majority of patients tolerated the treatment very well, and patient discomfort was comparable to that reported with the former 2.5 protocol, but with a limited treatment duration of 30 minutes. The demographics of this cohort were similar to those of patients in which earlier treatment protocols were assessed. Overall, the results were comparable to those achieved with the 2.5 high-energy protocol, for instance, cleocin price.
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1. Medications 2. Neuro-Fatigue 3. Immediate Release from the Emergency Room 4. Mild Traumatic Brain Injury Post-Concussive Syndrome 5. Returning to Work 6. Children and Adolescents 7. Elderly and Brain Injury 8. Aging and Brain Injury 9. Substance Abuse 10. Alternative Therapies 11. Caregiver Role 12. Sexual Functioning 13. Re-Injury 14. Support Systems 15. Legal 16. Long-Term Care Planning Note Page 1 2 3 and colchicine, for example, cleocin side effects.
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Mr. Calabrese presented the clinical overview on clindamycin phosphate 2% vaginal cream Clindesse ; . He noted that this product was FDA-approved as a single-dose application for the treatment of bacterial vaginosis, in non-pregnant women. Other treatment regimens recommended by the Centers for Disease Control last updated 2002 ; include oral and intravaginal forms of both clindamycin and metronidazole. Oral clindamycin and metronidazole, and intravaginal clindamycin phosphate 2% cream are available generically. Mr. Calabrese reported that none of the trials regarding this new product have been published in peerreviewed journals. The product labeling reported that single-dose administration of clindamycin phosphate 2% vaginal cream Clindesse ; was comparable in efficacy to a 7-day regimen of intravaginal Cleocib with therapeutic and clinical cure rates ranging from 30-42% and 41-64%, respectively. Overall, clindamycin phosphate 2% vaginal cream Clindesse ; was well-tolerated. Fungal vaginosis was the only adverse event that was reported significantly higher than placebo. In comparison to existing therapeutic standards, Mr. Calabrese noted that the clindamycin phosphate 2% vaginal cream Clindesse ; employs a bio-adhesive drug delivery system which allows for a more prolonged diffusion of drug within the vaginal tract thus permitting the single-dose therapy. Mr. Calabrese mentioned that single-dose administration may theoretically provide better compliance; however, there is no literature to support differences in compliance rates or therapeutic outcome for any of these products. Mr. Calabrese concluded that the intravaginal clindamycin products within this review were comparable to each other and to the generics and offered no significant advantage over other alternatives in general use. No brand of clindamycin phosphate 2% Clindesse ; was recommended for preferred status. There were no further discussions on the drugs in this class. Chairman Magouirk asked the P&T Committee Members to mark their ballots and erythromycin.
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Time, there may be no hypertensive emergency in an adult with a systolic pressure of 250 mm Hg. So, I think that John is absolutely right. We have to pair the BP with the level of acute organ damage as the first branch point for thinking. And I would only add to what he said that papilledema and hypertensive encephalopathy would also constitute a hypertensive emergency, along with heart failure, acute myocardial infarction, major bleeds, and central nervous system events. DR. MOSER: Let's go back to the BP level for a minute. A 55-year-old man with a BP of 250 150 mm Hg and no evidence of an acute myocardial infarction had a creatinine level of 1.4; fundi showing arteriosclerotic narrowing and nicking, but no hemorrhage, exudates, etc.; and an ECG showing left ventricular hypertrophy LVH ; . Is this an emergency? What do you do? DR. BISOGNANO: No, this is not an emergency. DR. MOSER: Okay. Joe? DR. IZZO: Not an emergency, but I still like the term urgency because we have to do something relatively quickly for this patient. DR. MOSER: Why not just call it severe hypertension rather than urgency? DR. IZZO: You could, but I like urgency because it is motivational. DR. MOSER: Okay. John, what would you do? DR. BISOGNANO: I agree, I think urgency is a good term because it implies something has to be done fairly soon. We want to verify that things are going in the right direction in a matter of hours and chronically after a number of days. There is another thing that we should look at: Is today's BP a major change from previous baseline BPs? Given this case with LVH and evidence of possible renal insufficiency, it suggests that BP has been elevated for quite a period of time and there is some chronic target organ damage. In this instance, a BP of 250 mm Hg may only be a 30% or 40% increase from what pressures have been previously. DR. MOSER: But what if I told you that the systolic BP had been about 140150 mm Hg 34 months ago? DR. BISOGNANO: That's a different story. This would suggest a hypertensive emergency with more target organ damage on top of a chronic less severe elevation of BP. In the same way that a young woman who may have a BP of 110 mm Hg or 120 mm Hg during pregnancy comes in with a headache and a BP of 180 mm Hg, this may be a patient with a hypertensive emergency. DR. MOSER: Alright, so we've said that the BP itself isn't the criterion for an emergency unless it's.
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