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8.1. - Description of Required Services: Contractor shall be responsible for activities that require a high degree of experience and expertise for developing, implementing and managing the Department's patient assistance program PAP ; . In doing so, Contractor shall play a key role in the County's effort to maximize nocost or low-cost pharmaceutical products and services through formulary management and an aggressive administrative program in concert with pharmaceutical manufacturers, providers, the Department, and HCHP clients. In order to meet the following requirements in an effective and timely manner Contractor must maintain a local presence. A local presence means, Contractor must maintain an office within Hillsborough County. Such office must be within one hour driving time during normal driving conditions ; from the Department's administrative offices, located in downtown Tampa, Florida. Specifically, Contractor shall: 8.1.1. Assist the Department in developing and managing a PAP that will apply to all eligible HCHP clients. PAP should be up and running within 60 days of contract notice to proceed date. 8.1.2. Make formulary recommendations that will maximize the client pool eligible to utilize the PAP. Formulary changes must be approved by the Department Director prior to implementation. Contractor's formulary or the Department's current formulary may be used when the contract is awarded. 8.1.3. Provide an appropriate staff to manage the PAP program with operating hours Monday through Friday, 8 A.M. to 5 P.M., except for approved County holidays. 8.1.4. Ensure patients enrolled in the PAP program receive PAP drugs without a break in therapy through an aggressive partnership between providers, drug manufacturers, the Department, and clients. 8.1.5. Utilize a computer software program that ensures drug manufacturer PAP application procedures are up-to-date, provides a suspense file to ensure renewal applications are initiated with enough time to prevent a break in drug therapy, and provides a monthly report of drugs received by HCHP clients utilizing the PAP. The report should include the client's name, SSAN, case number, NDC number, drug nomenclature, quantity received, and cost avoidance using the County's drug costs paid to the County's contracted pharmacy dispensing entity. 9. 9.1. Compensation Pharmacy Benefits Management.
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Drugs. Crit Rev Therap Drug Carr Syst., 2002, 19 6 ; , 499551. Vassallo, M., Camilleri, M., Phillips, S.F., Brown, M.L., Chapman, N.J., Thomforde, G.M. Transit through the proximal colon influences stool weight in the irritable bowel syndrome. Gastroenterology, 1992, 102, 102-108. Reddy, S.N., Bazzocchi, G., Chan, S., Akashi, K., Villanueva-Meyer, J., Yanni G., Mena, I., Snape, W.J. Jr. Colonic motility and transit in health and ulcerative colitis. Gastroenterology, 1991, 101, 12891297. Basit AW. Advances in colonic drug delivery. Drugs. 2005, 65, 19912007. Chourasia, M.K., Jain, S.K. Pharmaceutical approaches to colon targeted drug delivery systems. J Pharm Pharmaceut Sci 2003, 6 1 ; , 3366. Klotz U, Schwab M. Topical delivery of therapeutic agents in the treatment of inflammatory bowel disease. Adv Drug Del Rev., 2005, 57, 26779. Jain, A., Gupta, Y., Jain, S.K. Azo-chemistry and its potential for colonic delivery. Crit. Rev. Ther. Drug Carrier Syst., 2006, 23 5 ; , 349-400. Nutrition and Health Educator, Inc. DBA Nutrigenesis Approach. Available at, . nutrigenesis page images Digesti ve XL . Accessed July 27, 2006. Rubinstein A. Colonic drug delivery. Drug Discov Today: Technol., 2005, 2 1 ; , 337. Gruber, P., Longer, M.A., and Robinson, J.R. Some biological issues in oral, controlled drug delivery. Adv. Drug Del. Rev., 1987, 1, Simon, G.L., Gorbach, S.L. 1983. Bacteriology of the colon, in Colon, Structure and Function, Bustos-Fernandez, L. Ed. Plenum Medical Book Company, New York, 103. Hardy, J.G., Wilson, C.G., and Wood, E. Drug delivery to the proximal colon. J. Pham.Pharmacol., 1985, 37, 874. McLeod, A.D., Tozer, T.N. 1992. Kinetic perspectives in colonic drug delivery, in Oral Colon-Specific Drug Delivery, Friend, D. R. Ed. CRC Press, Boca Raton, 85. Evans, D.F., Pye, G., Bramley, R., Clark, A.G., Dyson, T.J., Hardcastle, J.D. Measurement of gastrointestinal pH profiles in normal ambulant human subjects. Gut, 1988, 29, 1035. Kenyon, C.J., Cole E. T., Wilding, I.R. The effect of food on the in vivo behavior of enteric coated starch capsules. Int. J. Pharmacol., 1994, 112, 207. Adkin, D.A., Davis, S.S., Sparrow, R.A., Wilding, I.R. Colon transit of different sized tablets in healthy subjects, J. Control. Rel., 1993, 23, 147 and venlafaxine.
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MIYAZAKI, T., and ZIPES, D. P. 1990 ; : `Presynaptic modulation of efferent sympathetic and vagal neurotransmission in the canine heart by hypoxia, high K, low pH and adenosine: Possible relevance to ischemia-induced denervation', Circ. Res., 66, pp. 289301 PICHOT, V., GASPOZ, J. M., MOLLIEX, S., ANTONIADIS, A., BUSSO, T., ROCHE, F., COSTES, F., QUINTIN, L., LACOUR, J. R., and BARTHELEMY, J. C. 1999 ; : `Wavelet transform to quantify heart rate variability and to assess its instantaneous changes', J. Appl. Physiol., 86, pp. 10811091 POLA, A., MACERATA, A., EMDIN, M., and MARCHESI, C. 1996 ; : `Estimation of the power spectral density in nonstationary cardiovascular time series: assessing the role of the time-frequency representations TFR ; ', IEEE Trans. Biomed. Eng., 43, pp. 4659 RIOUL, O., and VETTERLI, M. 1991 ; : `Wavelets and signal processing', IEEE Signal Process. Mag., pp. 1438 TADDEI, A., BIAGINI, A., DISTANTE, G., EMDIN, M., MAZZEI, M. G., PISANI, P., ROGGERO, N., VARANINI, M., MARK, R. G., MOODY, G. B., BRAAKSON, L., ZEELEMBERG, C., and MARCHESI, C. 1990 ; : `The European ST-T database: development, distribution and use', Comput. Cardiol., pp. 177180 TADDEI, A., CONSTANTINO, G., SILIPO, R., EMDIN, M., and MARCHESI, C. 1995 ; : `A system for the detection of ischemic episodes in ambulatory ECG', Comput. Cardiol., pp. 705708 TASK FORCE OF EUROPEAN SOCIETY OF CARDIOLOGY AND NORTH AMERICAN SOCIETY OF PACING AND ELECTROPHYSIOLOGY 1996 ; : `Heart rate variability: standards of measurement, physiological interpretation and clinical use', Circulation, 93, pp. 10431065 THAMES, M. D., KLOPFENSTEIN, H. S., ABBOUD, F. M., MARK, A. L., and WALKER, J. L. 1978 ; : `Preferential distribution of inhibitory cardiac receptors with vagal afferents to the inferoposterior wall of the left ventricle activated during coronary occlusion in the 1dog', Circ. Res., 43, pp. 512519 THAMES, M. D., DIBNER-DUNLAP, M. E., and MINISI, A. 1993 ; : `Cardiovascular reflex during myocardial ischemia', in `Cardiovascular reflex control in health and disease' Saunders, 1993 ; VILA, J., BARRO, S., PRESEDO, J., RUIZ, R., and PALACIOS, F. 1992 ; : `Analysis of heart rate variability with evenly spaced time values'. 14th Annual International Conference of IEEE-EMBS, 2, pp. 575 576 VILA, J., PALACIOS, F., PRESEDO, J., FERNANDEZ-DELGADO, M., FELIZ, P., and BARRO, S. 1997 ; : `Time frequency analysis of heart rate variability: an improved method for monitoring and diagnosing myocardial ischemia', IEEE Eng. Med. Biol. Mag., 16, pp. 119126.
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Bess H. Marcus, Ph.D., Behavioral Medicine, Brown Medical School Physical activity is an important component of both primary and secondary prevention of coronary heart disease CHD; Miller & Fletcher, 1998 ; . A recent meta-analysis indicated that physical activity participation is associated with reduced risk of CHD Williams, 2001 ; . Despite this reduction in risk, approximately 75 percent of the U.S. population do not engage in regular physical activity CDC, 2001 ; . Consequently, interventions that reach a large segment of the population are needed. The purpose of this presentation is to review the literature examining mediated interventions e.g., print materials, telecommunications, information technology, and mass media ; , which have the potential to reach the large proportion of sedentary Americans. Research indicates that individually tailored print materials and telephone-based interventions are effective in promoting physical activity. There is less evidence that mass media i.e., television commercials, brochures ; are effective, perhaps because they are not tailored to the individual. Finally, there is preliminary evidence that Internet-based interventions are effective for increasing physical activity. However, large randomized controlled trials are needed that compare this newer technology to mediated interventions previously shown to be effective. Future studies should examine the public health impact of these mediated interventions for physical activity and esidrix.
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Ment goal is to return the patient to Class II, if possible. See Staging heart failure. ; When should patients be hospitalized? HFSA guidelines recommend hospitalization for patients with evidence of severely decompensated HF, such as hypotension, declining renal function, altered mentation, dyspnea at rest defined by resting tachypnea and oxygen saturation below 90% ; , and hemodynamic arrhythmia ventricular tachycardia, ventricular fibrillation, or atrial fibrillation ; . The guidelines advise clinicians to consider hospitalization for patients with increased fluid congestion weight gain of 5 kg [11 lb] or more ; , signs and symptoms of pulmonary or systemic congestion despite weight gain, pneumonia, pulmonary embolus, diabetic ketoacidosis, transient ischemic attack or stroke, new-onset HF, or repeated firings of an implantable cardioverter-defibrillator. Diagnostic testing On admission, patients with HF typically undergo echocardiography, electrocardiography ECG ; , chest Xrays, and various laboratory tests. Echocardiography. Echocardiography evaluates the left ventricle, including size, valvular function, wall thickness, and pumping function, as measured by the ejection fraction EF ; . EF indicates the percentage of blood ejected from the ventricle with each heartbeat; normally, it measures between 50% and 65%. In patients with HF, reduced EF indicates systolic dysfunction, whereas normal "preserved" ; EF indicates diastolic dysfunction--distinctions that help clinicians make treatment decisions. Patients with either systolic or diastolic dysfunction may experience acute decompensation. ECG. An ECG shows cardiac rhythm and conduction and QRS duration, and can detect myocardial ischemia or previous MI and hydrodiuril.
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The complex relationship between a woman's nutritional status and birth outcomes requires thorough screening of her diet, food preferences, food security, and weight gain. Poor maternal nutrition is known to cause insufficient gestation weight gain; pregnancyinduced hypertension, preterm and small for gestational age SGA ; births; LBW; and several congenital anomalies Shah and Ohlsson 2002, Fowles 2004; Ramakrishnan 2004, and Goh et al. 2006 ; . Emerging evidence suggests that heart disease may originate during foetal development; however, additional research is required to support this hypothesis in practice Gilbert 2006 and Tappia 2006 ; . Epidemiological studies on human populations have linked income and LBW to an increased incidence of hypertension, diabetes, obesity, and cardiovascular disease Gilbert 2006 ; . Supplementation of certain micronutrients e.g., vitamins A, C, and B complex and minerals such as iron, calcium, magnesium, and zinc ; have demonstrated improved physiological parameters in both mother and foetus as well as reduced incidence of preterm and LBW rates Shah and Ohlsson, 2002 ; . Despite these findings, health care providers should inform their patients that they need to caution against excessive use of fat soluble vitamins e.g., Vitamin A dosages exceeding 800 RE or 4, 000 IU is a.
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