METHODS This study was conducted at two sleep centers, both affiliated with the Centre for Human Drug Research in The Netherlands, between December 2002 and June 2004. The study was approved by the central ethics committee and the local ethics committees and conducted in accordance with the declaration of Helsinki South Africa 1996 amendment ; , Good Clinical Practice and all applicable local laws and regulations. All patients gave written informed consent prior to screening.
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On November 11, about 30 members of the NJMA Culinary Group presented a dinner of Andean foods, primarily those of Peru. About 20 dishes were served. Highlights of the evening were the ceviches typically, seafood dishes that are "cooked" with citrus juices. ; We Until the Penn State researchers developed their testing had one with flounder, another with bay scallops, and approach, known as an assay, there was no method an atypical one made with three types of mushrooms. employing the most sensitive modern instrumentation and analytical techniques to quantify the amount of ergoth- We decided that the Mushroom Ceviche would be a ioneine in fungi. The researchers say that their assay can be great way to use wild mushrooms which we'll collect during the upcoming season. It keeps well and would used for other plants, too, not just mushrooms. make a nice change from the usual pickled mushJoy Dubost, doctoral candidate in food science who rooms. We're reprinting the recipe on the next page if conducted the study, says, "Numerous studies have you'd like to use it. ; If you do make the recipe, I would shown that consuming fruits and vegetables which are suggest reducing the salt to 1 4 cup or even less ; and high in antioxidants may reduce the risk of developing increasing the garlic to at least four cloves, minced. chronic diseases. Ergothioneine, a unique metabolite The mirasol chile called for in the recipe is rather mild, produced by fungi, has been shown to have strong so if you want some zing, feel free to substitute other antioxidant properties and to provide cellular protec- hotter peppers. tion within the human body." Other unusual dishes for me, at least ; were the two Dubost detailed the new assay and the amounts of versions of Papas a la Huancahina potatoes in a cheese ergothioneine in the most common and exotic in mush- sauce served as an appetizer ; , the Aji de Gallina chicken rooms typically available in U.S. food stores in a paper in a spicy sauce ; , a very interesting treatment of Quinoa, presented at the 230th meeting of the American Rocoto rellano stuffed peppers ; , and Mazamorra Chemical Society in Washington, D. C. Her paper was Morado a dessert made with purple corn and fruit. ; titled "Identification and Quantification of Ergo- Photos of all the dishes, along with the recipes, are availthioneine in Cultivated Mushrooms by Liquid able at : web jimrich17 iWeb. You will Chromatography-Mass Spectroscopy." also find photos from the Holiday Party and our PanAsian BBQ at the same web address. The Penn State researchers found that among the most commonly consumed mushrooms, portabellas and The next dinner will be on March 24, and we will be criminis have the most ergothioneine, followed closely "traveling" to Northwestern Italy to sample the risottos, by the white button mushrooms. A standard 3 oz. USPA polentas and other dishes from the region that many serving of these mushrooms [all Agaricus brunnescens], feel has the best food in all of Italy. about the amount you'd put on a cheese steak or mushFor information, or to register, please contact John Horvath room-topped burger, supplies up to 5 mg. at 732 ; 249-4257 email address: johnterryh verizon ; The exotic mushrooms have even more ergothioneine. or Jim Richards at 908 ; 852-1674 you can also reach him The same standard serving size of shiitake Lentinula by email at jimrich35 verizon ; . Remember, Culinary edodes ; , oyster mushrooms Pleurotus ostreatus ; , king Group events are based upon a themed menu; they are not oyster mushrooms Pleurotus eryngii ; , or maitake potlucks. Before the day of the dinner, we will send out Grifola frondosa ; can contain up to 13 mg in a 3 oz. "recipe assignments" based on our theme. To maintain authenticity, we ask that you stick to those recipes. serving, or about 40 times as much as wheat germ!
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Refractory disease than in those with fistulising CD 17 vs. 7; P 0.02 ; , despite the majority of these patients being in concomitant treatment with steroids and or immunosuppressive drugs. It is very difficult to establish what may have caused this difference. Although this finding may depend by chance, hypothetically, several other factors may be involved, such as different patterns of cytokines in the two subsets of disease. The 10-week evaluation of the 31 patients with refractory inflammatory CD 4 weeks after the end of the third infusion ; showed that 25 80.6% ; were clinical responders, 22 71% ; were in clinical remission and 14 74% ; had discontinued steroid treatment; at the same time point, 15 of the 32 patients with fistulising CD 46.9% ; were complete responders, eight 25% ; partial responders and nine 28.1% ; non-responders. Our data provide further evidence that infliximab is effective in inducing the rapid remission of CD, and that ANA formation is not related to the clinical response. In a controlled trial, Baert et al.17 found that the presence of autoantibodies was a risk factor for the development of adverse effects, but our results clearly show that there was no correlation between these antibodies and adverse events. We did not measure anti-TNF-a antibodies, but the low incidence of infusion reactions suggest that they were probably rare.17 Infliximab therapy can lead to the formation of anti-infliximab antibodies, whose presence has been associated with infusion reactions in 6.919% of patients. Infusion reactions are important immunological events induced by the presence of substantial serum concentrations of such antibodies, after which infliximab rapidly disappears from the serum and becomes undetectable within 4 weeks.37, 38 Once an infusion reaction has occurred, the duration of the response to subsequent infusions decreases but, although there was a clear relationship between the duration of response and infliximab concentrations, it was no stronger than the correlation with antibody concentrations. In conclusion, ANA formation is frequently seen in CD patients receiving induction treatment with infliximab, especially in those with inflammatory refractory disease. Most patients develop autoantibodies early after the first infusion, and most remain ANA-positive only a minority become seronegative however, only one of our patients developed a lupus-like syndrome with clinical symptoms of polyarthritis, a clear butterfly facial rash and anti-dsDNA antibodies, and without any and co-trimoxazole.
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Page 43 MTM Services are provided by a pharmacist who may or may not be associated with the pharmacy that dispenses medication to the patient. Some MTM Services are associated with the dispensing of a drug product, and are provided by the dispensing pharmacy. Medication Therapy Management Services should be distinguished from the pharmacist services required by OBRA '90 and most state boards of pharmacy during the prescription dispensing process. The OBRA '90 pharmacist services are provided in conjunction with the dispensing of a single prescription, such as counseling patients on possible side effects or how to take the medication. MTM Services focus on the entire patient or on management of a disease, such as congestive heart failure. It is more comprehensive in scope. The goals of MTM Services listed above ; provide an overview of the purposes of these services. The settings in which pharmacists provide these services include: A visit to the patient's home An office at the pharmacist's home or business setting Senior center or adult day service center Area Agency on Aging office Assisted living community A separate office within a community pharmacy setting Physician office or physician group practice The services provided by these pharmacists include: Comprehensive review of the patient drug regimen to identify, resolve, and prevent MRPs; this includes review of over-the-counter and herbal or alternative medicine products, along with prescription drugs Evaluation of outcomes of drug therapy e.g. whether pain medications are providing adequate relief ; or recommendations for achieving optimal outcomes of drug therapy e.g. recommending dose or medication change to enhance pain management ; Evaluation of possible adverse effects of drug therapy in the elderly, medication side-effects are often misinterpreted and treated with new medications ; Evaluation of patient compliance or adherence to drug therapy, and patient counseling or education to improve adherence to drug therapy Collaboration with the prescriber s ; to provide feedback on drug therapy and assist in coordination of drug therapy Development and implementation of a medication management plan, in collaboration with the caregiver and others, to prevent the patient from having to move to a higher level of care such as a nursing home ; Forty states now permit collaborative drug therapy management agreements between physicians and pharmacists. Pharmacists are often able to adjust dosages of medication or order needed laboratory tests for patients as part of these protocol arrangements. The services provided by pharmacists through such agreements should also qualify for compensation as part of MTM Services for Medicare beneficiaries.
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Dr Jackson said he asked Dr Breeze about an exploratory laparotomy and washout but was told this was definitely not indicated. During the course of this telephone conversation Dr Breeze indicated he would visit the patient the next day and that he would contact the surgical registrar on call who in turn would be expected to contact Dr Breeze if there was any deterioration in the patient's condition. Dr Breeze believed he telephoned the acute general surgical registrar on call, Dr Martin, and that together they planned to trial conservative management. Dr Martin gave evidence in which he was adamant Dr Breeze did not contact him. Dr Martin relied on the fact that there is no record in the clinical notes of his speaking to Dr Breeze and he is certain that he would have made an entry in the notes if he had been asked to participate in the patient's management. Dr Breeze went home soon after 1700 hrs and he went out to an end-of-year function that evening. During the night of 17 December the patient's condition continued to deteriorate. At 0245 hrs on 18 December the patient required resuscitation but his condition was so bad that Dr Jackson decided no further resuscitation attempts would be made. Dr Breeze visited the patient on 18 December but by this time the patient's fate was sealed. The patient's life was maintained in the Tauranga ICU until the morning of 21 December when he passed away. A post mortem was carried out on 22 December. The pathologist's report noted that: `In the region of the rectum, there is an 18 defect, which has surrounding staples. There are fibrous adhesions in the lower abdominal cavity. Approximately 150 mls of brown stained fluid and admixed faecal material are present in the abdominal cavity.' Finding: The Tribunal found Dr Breeze guilty of professional misconduct. The Tribunal was not satisfied Particular 1 of the charge was established. The Tribunal was satisfied that Dr Breeze was justified in asking that the patient be given a Fleet enema after he learned his patient had broken his fast. The Tribunal was concerned Dr Breeze appeared not to have appreciated the patient was in fact administered a Microlax enema. It would appear Dr Breeze did not read or properly read the nurses' notes before operating on his patient. The Tribunal was of the view that this oversight did not in itself justify a disciplinary finding against Dr Breeze. The Tribunal was very satisfied Particular 2 was established and that his failing in this regard amounted to professional misconduct. The Tribunal considered Dr Breeze should have personally attended upon and assessed the patient well before he visited his patient on the morning of 18 December. The Tribunal considered Dr Breeze had a responsibility to personally assess and monitor his patient's progress, particularly as Dr Breeze had resolved to pursue a conservative course of management. The Tribunal found Dr Breeze should have attended upon, examined and carefully assessed his patient as soon as his operation commitments finished on 17 December 1999, and was very concerned he gave priority to an end-of-year function over attending to his critically ill patient. The Tribunal did not believe Dr Breeze spoke to the surgical.
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