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A case-control study using data from GPRD has found a significantly increased risk of hip-fracture associated with long-term PPI therapy, particularly among long-term users of high-dose PPIs. The authors recommended that physicians should be aware of this potential association when considering PPI therapy and use the lowest effective dose for patients with appropriate indications. An audit has shown that switching patients from atorvastatin 10mg and 20mg to simvastatin 40mg can achieve considerable cost savings without significantly affecting patient care. The FDA has recommended that aspirin plus clopidogrel should be continued for 12 months in patients with drug-eluting stents who are not at high risk of bleeding. The TORCH study did not show any statistically significant difference between a fluticasone-salmeterol combination-regime and placebo on reduction in all-cause mortality in patients diagnosed with COPD. In December 2006 the MHRA issued updated advice on the use of salmeterol and formoterol in asthma. The MHRA are currently conducting a full review of the overall risks and benefits of using long-acting 2 agonists in asthma and COPD. Daily use of SSRIs may be associated with increased risk of fragility fracture, was the findings of a study of elderly people in Canada. But these risks need to be balanced against the benefits gained from treating depression with SSRIs in this age group. NICE guidelines on the management of antenatal and postnatal mental health make recommendations for the prediction, detection and treatment of mental disorders in women during pregnancy and the postnatal period. It covers the care of women with anxiety disorders, depression and postnatal psychotic disorders bipolar disorder and schizophrenia ; . According to a study published in the Journal of the American Medical Association, the SSRI citalopram in combination with clinical management improves symptoms of major depression among patients with coronary artery disease CAD.

The long-acting 2-stimulants are used to give relief for at least 12 hours versus the 4 to 6 hours associated with administration of short-acting or 2-selective agonists. This group includes salmeterol SereventTM ; , a partial agonist and formoterol ForadilTM ; , a full agonist Sommers 2002: 212 ; . Salmetrol has a slower reaction onset, less total bronchodilator capacity at high dose, and are less likely to develop tachyphylaxis to bronchodilation Walters, Wood-Baker & Walters 2005: 384 ; . Formoterol has long lasting effects, i.e., greater than 12 hours, and a fast onset, i.e., one to three minutes from.

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Salmeterol online Generally, salmeterol should not be used more often than every 12 hours and advil. Isolation and Preparation of Rabbit Corpus Cavernosum RbCC ; . Male New Zealand White rabbits 2.53.0 kg ; were anesthetized with pentobarbital sodium Sagatal, 30 40 mg kg i.v. ; and exsanguinated via the carotid artery. After penectomy, the RbCC was rapidly removed and immersed in Krebs' solution of the following composition: 118 mM NaCl, 25 mM NaHCO3, 5.6 mM glucose, 4.7 mM KCl, 1.2 mM KH2PO4, 1.17 mM MgSO4 7H2O, 2.5 mM CaCl2 2H2O. Tissues were dissected and cleared of the tunica albuginea and surrounding tissues. All procedures were designed in accordance with the guidelines for animal care of the State University of Campinas. Bioassay Cascade. Strips of RbCC were superfused in a cascade system with warmed 37C ; and oxygenated 95% O2 5% CO2 ; Krebs' solution at a flow rate of 5 ml min 1. The tissue responses tension of 25 mN ; were detected with auxotonic levers attached to Harvard heart smooth muscle isotonic transducers and displayed on a Watanabe multichannel pen recorder model WTR 381 ; . After a 60to 90-min period of equilibration, RbCC strips were precontracted with noradrenaline 3 M ; to increase the basal tone. The tissues were continuously infused with indomethacin 5.6 M ; and 17- estradiol 5 M ; to inhibit the generation of prostanoids and extraneuronal uptake for catecholamines, respectively. -Adrenoceptor agonists isoproterenol, metaproterenol, ritodrine, fenoterol, TA 2005, salbutamol, salmeterol, terbutaline, procaterol, and ; -4-[2-[ 2- 3-chlorophenyl ; -2-hydroxyethyl ; amino]propyl]phenoxyacetic acid [BRL 37344] ; and other substances glyceryl trinitrate and acetylcholine ; were administered as single bolus injections 10 100 l ; . N -Nitro-L-arginine methyl ester L-NAME ; , L-arginine, 1H-[1, 2, 4]-oxadiazolo-[4, -a]quinoxalin-1-one ODQ ; , 9- 2-tetrahydrofuryl ; adenine SQ 22, 536 ; , sildenafil, rolipram, propranolol, atenolol, 1-[2- 3-carbamoyl-4-hydroxy ; phenoxy ; ethylamino]-3-[4- ; -phenoxy]-2-propanol methanesulfonate CGP 20712A ; , butoxamine, ; -1-[2, 3- dihydro-7methyl-1H-inden-4-yl ; oxy]-3-[ 1-methylethyl ; amino]-2-butanol hydrochloride ICI 118, 551 ; , and tetrodotoxin were infused over RbCC tissues 25 min before and during bolus injection of the agents mentioned above. The relaxations induced by -adrenoceptor agonists and other agents were expressed relative to the submaximal relaxation induced by glyceryl trinitrate GTN; 1.3 nmol ; , which was taken as 100%. Organ Bath. Strips of RbCC were mounted in 10-ml organ baths containing Krebs' solution at 37C continuously bubbled with a mixture of 95% O2 5% CO2, pH 7.4. The strips were connected to force. Administrative rule 15A NCAC 18A .2820 d ; requires all medications to be stored in a locked cabinet or container. There have been requests to keep specific emergency medications unlocked as an exception to this rule. Dr. Dale Newton at East Carolina University and his pediatrician colleagues were consulted to consider this issue. They concluded that emergency medications where a delay of minutes could result in a serious negative outcome ; should remain unlocked. They also provided a list of such medications below ; that are often used by children. Therefore, the following emergency medications may be left unlocked so long as they are stored out of the reach of children. Exceptions to 15A NCAC 18A .2820 d ; Epi-Pen Glucagon Diazapam suppositories The following medications, which may be administered by a metered dose inhaler for use in an aerosol machine ; , are also exempt. Albuterol Proventil, Ventolin, Volmax ; Terbutaline Brethine, Bricanyl ; Combivent albuterol pratropium ; DuoNeb albuterol pratropium ; Foradil formoterol ; Ipratropium Maxair pirbuterol ; Metaprotererol Salmet4rol Serevent ; Xoprenex cc: Environmental Health Listserv Local Health Director Listserv and theophylline.

Chronic obstructive pulmonary disease COPD ; is worldwide the only major disease with increasing mortality rates 1 ; . Clinical hallmarks of COPD are a never fully reversible and usually progressive airflow limitation 2 ; . Moreover, the majority of patients demonstrates airway hyperresponsiveness AHR ; 3 ; , which is associated with accelerated lung function loss 4 ; . This highly prevalent disease is characterized by an abnormal inflammatory response in the airways to noxious particles and gases, which is dominated by neutrophils, macrophages, T lymphocytes mainly CD8 + cells ; , and B lymphocytes 5-7 ; . In addition, sputum CD8 + cells in patients with COPD have increased cytotoxicity 8 ; and the number of bronchial CD8 + cells is positively associated with the severity of the disease 5; 9 ; . International guidelines recommend bronchodilators, such as long-acting 2-agonists, as first-line pharmacological therapy in patients with COPD 2 ; since they improve airway obstruction, symptoms, and health status 10-12 ; , and reduce lung hyperinflation 13 ; . Moreover, addition of inhaled corticosteroids ICS ; is advised for patients with more severe COPD and or frequent exacerbations 2 ; . This is supported by clinical improvements, i.e. short-term treatment 6 months ; with the ICS fluticasone provides a significant improvement in prebronchodilator FEV1 and symptoms in patients with mild to severe COPD 14 ; , and long-term treatment 12 months ; additionally improves exacerbation rates 15; 16 ; and reduces mortality in moderate to very severe COPD 17 ; . Individual studies do not report significant effects of ICS on lung function decline, but demonstrate that ICS produce a small increase of postbronchodilator FEV1 in the first months which is sustained during follow-up 15; 18 ; . One meta-analysis suggested that decline in FEV1 is diminished, yet with an extremely small effect 19 ; . Study results on the effects of ICS on AHR in COPD show variable results, i.e. no effect 20 ; or a positive effect 21 ; . In contrast to their clinical efficacy, effects of ICS on airway inflammation in COPD appear to be limited. So far, ICS have been suggested to reduce the percentage of neutrophils in bronchoalveolar lavage 22 ; and the number of bronchial mast cells, yet without an effect on the number of bronchial CD8 + lymphocytes and macrophages or the number of sputum neutrophils 23-25 ; . Treatment with a combination of ICS and long-acting 2-agonists in patients with moderate to very ; severe COPD resulted in significantly greater improvement in lung function than monotherapy with either of these drugs 16; 26; 27 ; . In addition, combined therapy resulted in fewer exacerbations 16 ; and a clinically significant improvement in quality of life compared to placebo 16; 27 ; . To our knowledge, no studies have investigated the effect of combination therapy on the severity of AHR, and only one recent study assessed its effect on airway inflammation in COPD 28 ; . It demonstrated a decrease in several inflammatory cells, including the number of sputum neutrophils and bronchial CD4 + and CD8 + cells, after three months treatment with fluticasone salmeterol versus placebo, accompanied by an improvement in prebronchodilator FEV1. However, these results were not compared with effects of fluticasone monotherapy. The aim of the present study was to compare the effect of six months treatment with fluticasone monotherapy FP ; with fluticasone salmeterol combination therapy FSC ; and placebo on inflammatory cell counts in bronchial biopsies and induced sputum, airway hyperresponsiveness, and lung function in patients with COPD.
See also: 545, 546, 547, Respiratory system 516. The Bronchodilatory Effects of Loratadine, Terbutaline, and Both Together Versus Placebo in Childhood Asthma - Orhan F. and Baki A. [Dr. F. Orhan, K.T.U. tip Fakultesi, Cocuk Allerji BD, TR-61080 Trabzon, Turkey] - J. INVEST. ALLERGOL. CLIN. IMMUNOL. 2003 13 3 ; - summ in ENGL Aim: To assess the bronchodilatory effect of loratadine in children with mild-to-moderate asthma and to determine whether loratadine interacts with terbutaline. Methods: The effect on pulmonary functions of a 10 mg oral dose of loratadine, with and without inhaled terbutaline powder 0.5 mg ; , was determined in 13 patients with a mean SE ; age of 10.63 0.77 ; years range from eight to 17 years ; at 11 time points during 8 h in randomized, double-blind, placebo controlled, crossover study. Forced expiratory volume in 1 s FEV1 ; was the primary measure of efficacy. Results: Although loratadine alone produced an increase in FEV1 relative to baseline, this was not statistically significant p 0.05 ; . Terbutaline with, and without loratadine, significantly increased FEV1 from 1 to 5 according to baseline p 0.004 ; . When compared with the placebo, loratadine significantly increased FEV1 from 150 min to 8 h 0.05 ; . Also, terbutaline alone, or in combination with loratadine, significantly increased FEV1 from 30 min to 7h p 0.004, from 30 min to 5 h; p 0.05, between 6-7 h ; . Although the mean increase in FEV1 , with terbutaline + loratadine in combination, was greater than with terbutaline alone, the difference was not significant p 0.05 ; . Conclusion: Loratadine has a mild bronchodilatory effect in the study period and does not interfere with the bronchodilatory effect of terbutaline in childhood asthma. 517. State of the art in 2-agonist therapy: A safety review of long-acting agents - Rabe K.F. [Prof. K.F. Rabe, University Medical Centre Leiden, Department of Pulmonology, Albinusdreef 2, 2333 ZA Leiden, Netherlands] - INT. J. CLIN. PRACT. 2003 57 8 ; - summ in ENGL Despite concerns in the 1970s and 1980s about the safety of shortacting 2 -agonists, it is now generally accepted that these agents, used at appropriate doses, provide safe and effective treatment for asthma symptoms. After their introduction, 2 -agonists with a long duration of action - formoterol and salmeterol - became widely used as maintenance therapy with inhaled corticosteroids ICS ; . Both 2 agonists are well tolerated in long-term studies, with no reduction in lung function observed over time, indicating a lack of clinically relevant tolerance development in patients with asthma and COPD. High-dose studies have indicated that formoterol produces systemic effects of similar duration to, but less pronounced than, salbutamol and terbutaline. Formoterol produces long-lasting bronchoprotection against exercise-induced bronchoconstriction, even in patients receiving regular maintenance therapy; its fast onset of effect similar to salbutamol ; allows formoterol to be used as a reliever. Clinically the safety of formoterol and salmeterol has been demonstrated in several studies, both with ICS and alone. 518. Insulin induces a hypercontractile airway smooth muscle phenotype - Gosens R., Nelemans S.A., Hiemstra M. et al. [R. Gosens, Department of Molecular Pharmacology, University Centre for Pharmacy, A. Deusinglaan 1, 9713 AV Groningen, Netherlands] - EUR. J. PHARMACOL. 2003 481 1 ; - summ in ENGL This study aims to investigate the effects of insulin on bovine tracheal smooth muscle phenotype in vitro. Contractility of muscle strips and DNA-synthesis [3 H]thymidine incorporation ; of isolated cells were used as parameters for smooth muscle phenotyping. Insulin 1 M ; was mitogenic for bovine tracheal smooth muscle and potentiated DNA-synthesis induced by other growth factors. In contrast, after pretreatment of unpassaged bovine tracheal smooth muscle cells in culture, the mitogenic response induced by growth factors was strongly diminished, with no difference in the basal incorporation. Pretreatment of bovine tracheal smooth muscle strips in organ culture with insulin increased maximal contraction to methacholine and KCl. These results show that insulin acutely augments DNA-synthesis in the presence of other growth factors. In contrast, Section 30 vol 126.2 and albenza. If needing more than once day regularly need to go to step 2, but first check technique and address fears. In children best to use MDI and spacer ?paediatric volumatic ; rather than salbutamol syrup less effective ; . Step 2 Add low dose inhaled steroids budesonide 100-400g bd or flixatide 50-200g daily. Or try first with chrmoglycate or nedocromil, esp. in children - 20mg tds qds as drypowder or 10mg tds via MDI and spacer. Step 3 Add either high-dose inhaled steroids budesonide 800-2000g daily or flixitide 4001000g daily ; via large-volume spacer or low-dose plus long-acting bronchodiator eg salmeterol 50g bd. Can also try chromoglycate or theophylline. Step 4 High dose steroids & ventolin plus a sequential trial of a ; salmeterol, b ; theophylline, c ; inhaled ipratropium, d ; long-acting -agonist tablets, e ; chromoglycate. Note that theophyllines in children cause GI side-effects in 1 3, and sleep disturbance in some. Step 5 Add regular prednisolone in a single daily dose of 30-60mg. Status Asthmaticus asthma attack ; Uncontrolled asthma has a PEF 50-75% normal, pulse 110bpm, resps. 25 breaths min. A severe asthma attack is defined as a PEF 50% predicted or best, a respiratory rate 25 breaths minute, and a heart rate 110bpm and unable to complete sentences. An audible wheeze may be heard. A lifethreatening asthma attack is defined as a PEF 33% of predicted or best. The patient is pale, clammy, cyanosed and the chest is SILENT shallow breathing as exhausted ; . Bradycardia and hypotensive with reduced level of con. The 33% figure is based upon published evidence. The 50% figure is arbitrary but widely accepted and supported empirically by the BTS audit. However the figures do not take into account PMH, whether on oral steroids with this value or not etc. In children PEF is not a good measure of severity, and so should base on if too breathless to talk or feed and on pulse and resps. NB - features indicating severity PEF, RR, HR and inability to complete sentences. Clinical features and assessment of severity Wheeze Resp. rate Pulse rate. Use of accessory muscles Silent chest poor resp. effort - sinister sign of life-threatening! Pulsus paradoxicus - indicates sig. airways obstruction but not reliable sign.
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In the present study, we compare the potency of clenbuterol with that of the new long-acting compound salmeterol, when given at equimolar doses to female wistar rats by different routes of administration. To their doctor to get the ball rolling. The care managers also obtained letters recommending needed screenings from the clinicians of women who said their doctors had never discussed screening with them. In this study, the care managers were research assistants who had gone through about 7 hours of training, which covered the rationale for cancer screening, screening guidelines issued by the US Preventive Services Task Force, techniques for motivational interviewing, and role playing. However, the curriculum is designed for people at the level of a medical assistant so that primary care practices would not have to rely on registered nurses or physicians' assistants to act as care managers. That helps keep the costs of the program down, said Dietrich. He and his colleagues are preparing a cost-benefit analysis of the intervention based on their current data. They are also launching a new study to test this strategy working with Medicaid managed care organizations. Telephone outreach staff from these organizations will be trained as prevention care managers, and Medicaid billing records will be used to determine who needs screening outreach. The new study will target women who are not frequent visitors to the health clinics, as well as those who visit more frequently, like the women in the current study. That's an important step in learning just how transferable this intervention is to other settings, Dietrich and Tobin said, though they both think it could be implemented by other health care providers. "This is ready for translation and dissemination to sites that are committed to providing preventive services and able to respond when women request these services, " said Dietrich. "We'd be doing harm if we encouraged women to get screening and sent them to places that couldn't respond." Funding is also a concern, Tobin said. "Implementing this method requires the addition of new staff to be prevention care man and spironolactone.
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PP-364 TR ; USING RATES AND FEATURES OF LONG ACTING BETA-2 AGONIST AND INHALED CORTICOSTEROIDS IN ASTHMA AND COPD PATIENTS C. Sevin1, E. Ceylan 1, S. fiahbaz1, F. Fidan 1, A. Hayretda1, O. K l n1, O. til1, A. C mr n1, E. Uan 1, M. Gk 2, A. Akkolu2 1 Department of Chest Diseases, Medical Faculty of Dokuz Eyll University, zmir 2 Medical Faculty of Dokuz Eyll University 4th Year Student ; , zmir We collected all the information about 81 asthmatic and 72 COPD total 153 ; patients at the time of their admission of our clinic in JanuaryFebruary 2002. All of those patients were diagnosed and classified according to national and international guidelines. We found out that 72.8% of asthmatic patients and 76.4% COPD patients were using inhaled long acting beta-2 agonist LAB2A ; medication. Using ratio of LAB2A in mild-moderate-severe persistent asthmatics were 70.8%, 71.4% and 100.0% respectively p 0.193 ; . In COPD cases these ratios were 73.3%, 71.8 and 88.9% p 0.309 ; . 84.7% of COPD patients were using inhaled corticosteroids ICS ; . Using ratios of ICS in mild-moderate and severe COPD were 66.7%, 89.7% and 88.9% respectively p 0.128 ; . 68.05% of COPD patients were using LAB2A and ICS synchronously. In asthmatic patients 55.9% were using salmaterole and 44.1% were using formoterole, in COPD patients 60.0% were using salmeterole, 40.0% were using formoterole as a LAB2A. Preferred ICS were 8.6% BDP, 63.0% FP and 28.4% budesonide in asthmatic patients, 34.4% BDP, 45.9% FP and 19.7% budesonide in COPD patients. As an inhalation device for LAB2A in asthmatic patients were 57.6% MDI, 13.6% turbuhaler, 28.8 % discus, and in COPD patients were 78.2% MDI, 5.5% turbuhaler, 9.1% discus and 7.3% inhaler capsule preferred. For ICS, 66.7% MDI, 16.0% turbuhaler, 17.3% discus in asthmatic patients and 80.3% MDI, 8.2% turbuhaler and 11.5% discus in COPD patients were preferred. Conclusion: Both groups were using LAB2A in high rates. Contrary to our classical information COPD patients were using ICS in high rates. And MDI, cheaper then other inhalation devices, was being used more common in both groups and glimepiride.

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Inhaled long-acting 2-agonists salmetero and formoterol ; may be considered as an alternative to increased doses of inhaled glucocorticosteroids and should be used as an add-on therapy to moderate or higher doses of inhaled glucocorticosteroids to achieve control of persistent asthma symptoms level I ; . Long-acting 2-agonists are not recommended for relief of acute symptoms or for use in the absence of inhaled anti-inflammatory therapy level II. Family Interview with Moira Moira's family is made up of her father, mother and brother. Her parents are divorced and her mother has remarried. Moira lives with her mother, stepfather, brother and stepsister. Her brother and stepsister are both four years older than her. Moira was 12 years old and in grade 7 when diagnosed with leukemia. During the course of her chemotherapy treatment, her mother and stepfather separated. Moira is now 18 years old and is providing information about her health care experience. Salient Themes: IV Information Sharing 2. Value respect patient and family information and requests d. respecting children and youth patient ; Learning Elements: Teenage independence Collaborative relationship "Having a voice and a place to voice my concerns was important even if they were just little concerns that arose. My mother felt comfortable talking to one of the head nurses and I was comfortable talking to any of the nurses. There was always a nurse on the unit that I trusted and could talk to because there were always little bumps and problems along the way." "Sometimes I felt health care professionals listened to me and sometimes my mom had to go to reinforce my wishes. We had a big incident and my mom had to talk to management. They started to take me more seriously and I was not just coming up to them to complain because I felt like it. This incident was regarding when I went to the bathroom and had the door closed. A nurse opened the door and stood watching me while I went to the bathroom. I understood if I was a younger kid or unsteady on my feet and they had to make sure I was alright but I was completely capable to use the bathroom myself. I requested to be left alone in the bathroom. When I said to please leave, it was not followed through. My mom went to complain and said that this was horrible and not appropriate. Something was said to all the staff on the cluster about teenage independence." Health Provider Discussion Questions: 1. When working with teenage patients, what ways do you change your practice in order to have a good working relationship with them? 2. What rights do teenage patients have in your area of practice? Parent Discussion Questions: 1. What experiences has your teen had with health care professionals regarding teen independence? 2. Which process worked best in order to develop a good working relationship between them? and anacin. JAN-MAR 2005 Selection tips: Use lean meats and skim or low fat dairy products Use unsaturated vegetable oils Read the nutrition label on foods to check for the amount and type of fat it includes Limit foods that contain a large amount of saturated fats Limit foods high in sugar and avoid adding extra sugar to your foods examples Food Servings Grams of Fat Butter, 1 tsp. 4 Mayonnaise, 1 tbs. 11 Salad dressing, 1 tbs. 7 Sour cream, 2 tbs. 6 Cream cheese, 1 oz. 10 Chocolate bar, 1 oz. 9 Milk, Curds and Cheese Dairy products provide protein, vitamins and minerals and are an excellent source of calcium. Your adolescent should have 2 to 3 servings of milk, yogurt and cheese each day. Selection tips: Choose skim milk and nonfat yogurt Avoid high fat cheese and ice cream examples Food Servings Grams of Fat Skim milk, 1 cup 1 Trace Nonfat Curds, 8 oz. 1 Trace Low fat milk, 1 cup 1 5 Whole milk, 1 cup 1 8 Chocolate milk, 2%, 1 cup 1 5 Low fat Curds, 1 cup 1 4 Processed cheese, 2 oz. 1 18 Cottage cheese, 1 2 cup 1 4 5 Ice cream, 1 2 cup 1 3 7 Ice milk, 1 2 cup 1 3 Frozen yogurt, 1 2 cup 1 2 Meat, Poultry, Fish , Dry Beans, Eggs and Nuts Foods in this group provide protein, and vitamins and minerals, including B vitamins, iron and zinc. You should have 2 to 3 servings of foods from this group each day, including the equivalent of 5 to ounces of lean meat. Selection tips: A serving from this food group can include 2-3 ounces of lean meat, poultry or fish, which may be an average hamburger or medium chicken breast half. Choices with the least fat include lean meat, poultry without skin, fish, and dry beans and peas. Prepare meats in low fat ways, by trimming away fat, and broiling, roasting, or boiling rather than frying. Remember that nuts and seed are high in fat, and egg yolks are high in cholesterol, so you should eat them in moderation.
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The Freedom of Information Act 2000 received Royal Assent on 30 November 2000. The Act gives a general right of access to all types of recorded information held by public authorities, therefore any member of the public will be able to apply for access to information held across the public sector. The act set out exemptions and places a number of obligations on public authorities including community pharmacies ; . Public authorities will have two main responsibilities under the Act. They will have to produce a `publication scheme' effectively a guide to the information they hold which is publicly available ; and they will have to deal with individual requests for information. The duty to adopt a publication scheme will come into force first 31st October 2003 for Community Pharmacies ; . All public authorities will also be required to deal with individual requests for information from the 1st January 2005 when the general right of access to information held by public authorities comes into force. The Act will be enforced by the Information Commissioner and failure to comply carries a maximum punishment of two years imprisonment. A web-based publication scheme has been provided for Community Pharmacies with easy steps to complete your own publication scheme this has to be done by the 31st October 2003 ; . What you need to do now is: Go to foi.nhs pharmacy and first read the guidance from 27 June ; . Fill out your details in the Pharmacy Publication Scheme Form. Click approve and it will be automatically displayed on the Freedom of Information Website. The NPA are in the process of developing their own template based on the Model Publication Scheme. NPA members can contact the Information Department at the NPA for fur ther information on 01727 858687 ext 3470. A more detailed briefing on the Freedom of Information Act is available in the Resources Guidance and Briefings section of the PSNC Website psnc . Get in on the Act: foi.nhs and acetaminophen. Levalbuterol, salmererol ; , beta blockers e, g. 1 Japan Medical Association, Tokyo Correspondence to: Shin Fujimura MD, Japan Medical Association, 2-28-16, Honkomagome, Bunkyo-ku, Tokyo 113-8621, Japan. Tel: 81-3-3946-2121, Fax: 81-3-3946-6295, E-mail: jmaintl po.med.or.jp. The dose schedules were chosen as 'minimum recommended dose' of 12 µ g for formoterol and 'optimum recommended dose' of 50 µ g for salmeterol.

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REFERENCES Antiviral Planning Antiviral delivery, stocking, storage, security, distribution : phac-aspc.gc cpip-pclcpi pdf-cpip-03 cpip-appendix-e Clinical Practice Guidelines : phac-aspc.gc cpip-pclcpi pdf-cpip-03 cpip-appendix-g Patient Information Materials : bchealthguide kbase list msindex search search "influenza" ; also check BC CDC website Resources: Canadian Pandemic Plan : phac-aspc.gc cpip-pclcpi British Columbia CDC Pandemic Preparedness Plan : bccdc downloads pdf epid, for example, salmeterol and fluticasone.
Figure 1 Patient disposition. SM FP: salmeterol fluticasone combination product and fluticasone.

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Chapter 23 THE MEDICINE KIT . 331. 1996; 9: 1427-1432. Sim D, Griffiths A, Armstrong D, Clarke C, Rodda C, Freezer N. Adrenal suppression from highdose inhaled fluticasone in children with asthma. Eur Respir J. 2003; 21: 633-636. Todd GRG, Acerini CL, RossRussell R, Zahra S, Warner JT, McCrane D. Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom. Arch Dis Child. 2002; 87: 457-461. Childhood Asthma Management Program Research Group. Longterm effects of budesonide or nedocromil in children with asthma. N Engl J Med. 2000; 343: 1054-1063. Agertoft L, Pedersen S. Effect of long-term treatment with inhaled budesonide on adult height in children with asthma. N Engl J Med. 2000; 343: 1064-1069. Tinkelman DG, Reed CE, Nelson HS, Offord KP. Aerosol beclomethasone dipropionate compared with theophylline as primary treatment of chronic, mild to moderately severe asthma in children. Pediatrics. 1993; 92: 64-77. Doull IJM, Freezer NJ, Holgate ST. Growth of prepubertal children with mild asthma treated with inhaled beclomethasone dipropionate. J Respir Crit Care Med. 1995; 151: 1715-1719. Verberne AAPH, Frost C, Roorda RJ, Van Der Laag H, Kerrebijn KJ. One year treatment with salmeterol compared with beclomethasone in children with asthma. J Respir Crit Care Med. 1997; 156: 688-695. Simons FER, and the Canadian Beclomethasone DipropionateSalmeterol Xinafoate Study Group. A comparison of beclomethasone dipropionate, salmeterol, and placebo in children with asthma. N Engl J Med. 1997; 337: 16591665.

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ADOPTION IS FOREVER continued from page 6 Once you have made the decision to pursue an adoption, there are three ways to proceed. Each varies in terms of the process, duration, cost, and regulations involved. 1. A domestic adoption matches families or individuals with newborns and infants whose birth parents have made an adoption plan for them. The wait time for a healthy newborn placement can be discouraging and the phone call telling you that your baby is ready to come home can come suddenly. Many couples prefer the idea of adopting a newborn whose racial and social characteristics are similar to their own. That's perfectly fine, but don't overlook the other choices. 2. Intercountry adoption encompasses children who were born in another country and who were usually placed in orphanages or foster care at an early age. Each country has their own set of standards and bureaucracy that can make the adoption process "interesting." The majority of international adoptions in BC involve children from China, Thailand, Russia, and the United States. These children can range in age from a few months to several years of age and may have physical or psychological special needs. 3. BC's Waiting Child Program is facilitated by the Ministry of Children and Family Development. These children are generally older, may have been in foster care for some time, and have varying degrees of special needs. They are matched with prospective adoptive families and the adoption is only finalized after a series of pre-placement visits and a probationary period. The AFA runs BC's Waiting Child Information toll-free line, 1-877-ADOPT-07. The most important thing to remember is that you are not going to be doing this alone. Every step of the way there are peer groups and professionals you can lean on for information and support. Use us; that's exactly what we're here for.

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