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THE EVALUATION OF JNC VII ADHERENCE IN AN INTERDISCIPLINARY OUTPATIENT SETTING Kathryn R. Wylie * , Christopher G. Green, Mitchell A. Medow The Ohio State University College of Pharmacy, 500 West 12th Ave., Columbus, OH, 43215 wylie.19 osu PURPOSE: To assess an outpatient interdisciplinary clinic's hypertension management and its adherence to JNC VII guidelines via a retrospective quality assurance analysis. METHODS: Patients were first identified via ICD-9 codes 401.X ; for hypertension. In addition to a hypertension diagnosis by the clinic's primary care physician PCP ; , he she must have been seen by the PCP since the implementation of JNC VII 05 14 03 ; Exclusion criteria include pregnancy, age less than 18 years, and or if the patient is primarily managed by Nephrology at any surrounding medical centers. Medical charts were physically pulled on site and were reviewed in detail by the principal and or co-investigators using JNC VII criteria. If the patient was not at goal, documented interventions i.e. R.Ph. consult, smoking cessation, nutrition exercise consult ; were noted. Once data collection is complete, percentage of patients both at goal and not at goal will be presented to the clinic's healthcare team. Secondary discussions will involve interventions currently being implemented and also those in need of reinforcement. RESULTS: After inclusion and exclusion criteria were applied, 75 charts were pulled for review. Currently, data collection is still in progress. Results are pending. CONCLUSION: Besides providing feedback regarding how well the healthcare team is managing the clinic's primary care hypertensive population, the project will also highlight the importance of intraprofessional communication and involvement. Overall, the project was performed to increase awareness regarding specifics of JNC VII and interventions, which when implemented reinforce optimal hypertension management. Learning Objectives: Identify the pharmacist's role regarding hypertension management in various community ambulatory settings. Discuss key interventions needed to optimize hypertension management in various populations. Self Assessment Questions: What is the blood pressure goal for the diabetic population? The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial ALLHAT ; concluded the use of which antihypertensive class greatly prevented the cardiovascular complications associated with hypertension?.
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Assessment of mitochondrial function and respiratory complex function using mitochondrial containing blood cells following membrane permeabilization. Joseph F Clark, TJ DeGrauw, GJ Pyne-Geithman Dept. Neurology, Univ. Cincinnati, Medical Center, Cincinnati, OH 45267-0525, USA. clarkjf email.uc Assessing mitochondrial function for the diagnosis of metabolic disorders and inborn errors of metabolism is generally performed using a muscle biopsy. In the pediatric population this generally means an invasive surgical procedure with substantial emotional stress and concomitant morbidity. What is needed is a method for assessing mitochondrial function that is less invasive and usable on functional coupled ; mitochondria. From normal healthy adult volunteers, we obtained 50 ml of blood into EDTA containing vacutainer tubes. The red blood cells were separated using the Lymphoprep method from Granier. Membrane permeabilization was accomplished in the oxygraph chamber using 40 g ml saponin. The mitochondrial containing cells were then assessed for oxidative phosphorylation by measuring oxygen consumption in the presence of specific inhibitors or substrates. Cells were aliquoted and frozen in the presence of 20 % DMSO, quickly frozen on dry ice slurry, and stored for a minimum of 24 hours, at 70 C, and tested in the oxygraph. Coupled respiration was 1.16 + 0.35 Mmin-1g-1 protein for the freshly isolated cells and 0.95 + 0.14 Mmin-1g-1 protein for the frozen cells. Rotenone complex I inhibitor ; produced a 29 % decrease in respiration and atractyloside adenine nucleotide translocase inhibitor ; produced a 52 % decrease in respiration. Frozen cells retained their ability to be inhibited by rotenone and atractyliside 43 and 38 % respectively ; . We conclude from this study that the isolation of mitochondrial containing blood cells and saponin permeabilization of these cells results in coupled respiration of the mitochondria and provides an avenue for assessing the mitochondrial complex activity. Following freeze thaw of these cells there is still coupled respiration and an opportunity for measuring coupled respiration and oxidative complexes and terbinafine.
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Abstinence or barrier method through fertile period ie abstinence for a given cycle begins as soon as the woman notices any cervical secretions ; Intercourse without restriction beginning 4th day after the last day of wet, clear, slippery mucus post ovulation ; 4. Basal Body Temperature Method BBT ; Assumes early morning temperature measured before arising will increase noticeably 0.4-0.80 F ; with ovulation; fertile period is defined as the day of first temperature drop or first elevation through 3 consecutive days of elevated temperature. Temperature drop not safe ; does NOT always occur Figure 17.1 Basal body temperature Abstinence begins first day variations during a menstrual cycle of mentrual bleeding and lasts through 3 consecutive days of sustained temperature rise at least 0.20 C or 0.40 F ; 5. Post-ovulation Method Permits unprotected intercourse only after signs of ovulation BBT, cervical mucus, etc ; have subsided 6. Symptothermal Method Combines at least two methods -- usually cervical mucus changes with BBT May also include mittelschmerz, change in libido, and changes in cervical texture, position and dilation to detect ovulation: During preovulatory and ovulatory periods, cervix softens, opens and is moister During postovulatory period, cervix drops, becomes firm and closes EFFECTIVENESS see Table 13.2, page 38 ; NFP FAM First-year failure rate 100 women-years of use ; Method Typical use * Perfect use Calendar 25 Standard Days Method 12 Ovulation Method 25 Symptothermal 25 Post-ovulation 25 * FAM usually more effective than NFP 9 5 3.
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Results, as demonstrated by our case 1, and can turn positive because of the underlying inflammatory response Figure 1 ; . Cultures of exposed bone may point to Actinomyces infection, but care must be taken to distinguish between a true suppurative infection and mere surface colonization by Actinomyces, as seen in case 1, because such organisms are a common component of dental plaque. Risk factors ONJ is an uncommon condition that involves the loss or breakdown of the jaw bone as a natural consequence of a wide variety of systemic and local factors compromising blood flow to the bone Table 4 ; . Some possible factors that may increase the risk of ONJ include radiation therapy to the head or neck, chemotherapy, corticosteroid therapy, underlying cancer, and poor dental health. Symptoms include pain, swelling, or infection of the gums; loosening of the teeth; poor healing of the gums; and numbness or the feeling of heaviness in the jaw. Scientists do not know exactly what causes ONJ or how often it occurs. This disease has mainly been seen in cancer patients receiving bisphosphonates. There is no pathognomonic feature of osteonecrosis. A clinical diagnosis is appropriately made in a symptomatic patient when imaging findings are compatible with ONJ and other causes of pain and bony abnormalities either are unlikely or have been excluded by appropriate testing. Length of exposure to bisphosphonates seems to be the most important risk factor for this complication. The type of bisphosphonate may play a role, and previous dental procedures may be a precipitating factor. The most important predisposing factors for the development of bisphosphonate-associated ONJ are the type and total dose of bisphosphonate and history of trauma, dental surgery, or dental infection. In all, 94% of patients with ONJ received.
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Table 4. Allelic Frequencies of APOE Allele General population AD study n 359 ; APOE 2 0.08 0.04 APOE 3 0.78 0.56 APOE 4 0.14 0.39 and valaciclovir.
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1 Cohen O, Abrahamson J, Ben-Ari J, Frajewicky V, Eldar S. Sclerosing encapsulating peritonitis. J Clin Gastroenterol 1996; 22: 54-57 Abul S, Al-Oazweni H, Zalat S, Al-Sumait B, Asfar S. Cocoon abdomen in a liver transplant patient. J R Coll Surg Edinb 2002; 47: 579-581 Narayana R, Bhargava BN, Kabra SG, Sangal BC. Idiopathic sclerosing encapsulating peritonitis. Lancet 1989; 2: 127-129 Brown P, Baddeley H, Read AE, Davies JD, McGarry J. Sclerosing peritonitis, an unusual reaction to a beta-adrenergic blocking drug practolol ; . Lancet 1974; 2: 1477-1481 Yamamoto S, Sato Y, Takeishi T, Kobayashi T, Hatakeyama K. Sclerosing encapsulating peritonitis in two patients with liver cirrhosis. J Gastroenterol 2004; 39: 72-175 Klimopoulos S, Kalsoulis IE, Margellos V, Nikolopoulou N. Sclerosing encapsulating peritonitis secondary to CAPD: the effect of fibrotic debridement on further dialysis. J R Coll Surg Edinb 2002; 47: 485-490 Science Editor Guo SY Language Editor Elsevier HK and vardenafil.
71 ; RADIANT MEDICAL, INC. [US US]; 250 Chesapeake Drive, Redwood City, CA 94063 US ; . 72 ; DAE, Michael, W.; 1714 Notre Dame Avenue, Belmont, CA 94002 US ; . KELLER, Wade, A.; 6183 Dunn Avenue, San Jose, CA 95123 US ; . MACHOLD, Timothy, R.; 65 Bernal Avenue, Moss Beach, CA 94038 US ; . 74 ; BUYAN, Robert, D. et al. etc.; Stout, Uxa, Buyan, & Mullins, LLP, #300, 4 Venture, Irvine, CA 92618 US ; . 81 ; ZW. 84 ; AP GH A61F 2 01 11 ; 43662 21 ; PCT US00 33905 22 ; 14 Dec dc 2000 14.12.2000 ; 25 ; en 30 ; 466, 366 ; en 17 Dec dc 1999 17.12.1999 ; US 13 ; A1.
Selective Serotonin Reuptake Inhibitors Year of First Introduction Demographics: Mean Age Mean Education Years Mean Income Percentage of Male Patients Percentage of White Patients Percentage of Medicare Enrollees Percentage of Medicaid Enrollees Percentage of Private Insurance Enrollees Percentage of Patients with No Insurance Coverage Average Healthcare Expenditures $ ; : Important Drugs: Other Drugs: Drug Expenditures Nondrug Expenditures Drug Expenditures Nondrug Expenditures $81.4 306.2 53.3 455.4 $85.1 714.6 42.4 1, $44.5 833.7 43.6 943.8 $95.2 696.6 41.3 1688.1 $57.7 662.5 41.6 1236.3 $63.2 832.7 29.5 418.9 $17, 386 32.5 86.9 $22, 883 47.8 85.4 $20, 218 43.2 77.7 $18, 468 41.3 84.2 $20, 752 43.2 79.4 $18, 525 28.7 87.6 ACE Inhibitors 1981 H2 Antagonists Proton Inhibitors 1977 Calcium Channel Blockers 1981 and voltaren.
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From the Departments of Obstetrics and Gynecology at Wayne State University, Detroit, Michigan; Allergy at Kaiser Permanente, San Diego, California; Pulmonary Medicine at Johns Hopkins University, Baltimore, Maryland; the Biostatistics Center at George Washington University, Washington, DC; the National Institute of Child Health and Human Development, Bethesda, Maryland; and the Departments of Obstetrics and Gynecology at Ohio State University, Columbus, Ohio; University of Tennessee, Memphis, Tennessee; Medical College of South Carolina, Charleston, South Carolina; the University of Alabama, Birmingham, Alabama; the University of Chicago, Chicago, Illinois; the University of PittsburghMagee Women's Hospital, Pittsburgh, Pennsylvania; UT Southwestern Medical Center, Dallas Texas; Wake Forest University, Winston-Salem, North Carolina; the University of Cincinnati, Cincinnati, Ohio; Thomas Jefferson University, Philadelphia, Pennsylvania; the University of Southern California, Los Angeles, California; University of Utah, Salt Lake City, Utah; University of Miami, Miami, Florida; University of Oklahoma, Oklahoma City, Oklahoma; and the University of Texas, San Antonio, Texas. Supported by the National Institute of Child Health and Human Development HD21410, HD21414, HD21434, HD27869, HD27917, HD27905, HD27889, HD27860, HD27861, HD27915, HD27883, HD34122, HD34116, HD34208, HD34136, HD36801 ; and the National Heart, Lung, and Blood Institute. Presented at the Society of Maternal Fetal Medicine 2000 Annual Meeting, January 31February 5, 2000, Miami, Florida. The authors thank the participating institutions and staff members listed in the Appendix.
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