Virus Evolution Group, Laboratory for Clinical and Molecular Virology, University of Edinburgh, Edinburgh EH9 1QH, UK; National Blood Service, Birmingham; Department of Virology, Windeyer Institute of Medical Sciences, University College London, London e-mail: Peter.Simmonds ed.ac ; 1 A & ORS v National Blood Authority & ORS. All England Law Reports 2001; 3: 289.
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Department for Correctional Services DCS ; supports the concept of Prison Peer Supporters Educators ; . The Health Promotion Officer for DCS conducts this program at selected prisons. The idea of prisoners supporting each other is not new and is an essential component of prison life. What the Peer Support program does is skill up selected prisoners to provide accurate information, utilise communication skills and access appropriate referral services when required. The selected prisoners must have had some goal experience, a sentence longer than 12 months, be considered to have creditability with staff and prisoners and a have altruistic outlook. The programs vary from 20-30 hours, some session are done by outside providers including the Hepatitis C Council. The content of the program varies from general health information, mental health stress management, blood borne viruses, harm minimisation, communication skills including listening, conflict resolution, assertiveness and negotiation skills through to values and ethics. Peer Supporters are often used by other prisoners for a variety of reasons, anything from health advice on current information or in a counselling capacity. This can take place on a casual basis or be used in a more official capacity by prison staff if they have concerns about a certain prisoner. Many peer supporters report gaining a sense of self-satisfaction from completing training and the development of skills that not only help others but themselves during incarceration and upon their release, for example, tramadol pills.
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Robbins, L. The Prevalence of Anxiety and Depression in Cluster Headache Patients Presented at the 46th Annual Scientific Meeting of the American Headache Society, Vancouver, British Columbia, June, 2004, and the 28th Scientific Session of the Midwest Pain Society, 2004, and published in Headache, May 2004: 1 ; Robbins, L., and Gokani, T. Triggers that Precipitate Cluster Headache: A Retrospective Review 2 ; Tramadl for Tension Headache 3 ; Oxycodone CR Oxycontin ; for Severe, Refractory Chronic Daily Headache 4 ; Robbins, L., and Gokani, T. Anxiety, Depression, and Insomnia in Cluster Headache Patients 5 ; Long-term Efficacy and Adverse Events of Botulinum Toxin in Headache Patients 6 ; The Use of Stimulants in Headache Patients 7 ; Robbins, L., and Gokani, T. The Bipolar Spectrum in Cluster Headache Patients The above abstracts were also accepted by the 17th Annual Practicing Physicians's Approach to the Difficult Headache Patient, Rancho Mirage, California, February 2004. ; Presented at the 157th Annual Meeting of the American Psychiatric Society, New York, May 2004: 1 ; Robbins, L., and Gokani, T. The Bipolar Spectrum in Cluster Headache Patients.
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Most travelers suffer from traveler's diarrhea shortly after arriving in a foreign country. It is possible to get a prescription for Dukoral Oral, an antibiotic taken before travel, which protects against traveler's diarrhea. You should also have a skin test for tuberculosis TB ; performed before you depart and a follow-up skin test 3 months after your return to Canada to ensure that you have not become infected. It is important to keep a record of any personal health issues such as asthma, allergies or medications with you at all times. It is a good idea to translate these into Chinese as well. If you have any pre-existing medical conditions, it would be a good idea to wear a MedicAlert bracelet. Through MedicAlert your medical facts are stored in a database that can be accessed 24 hours a day from anywhere in the world. For more information go to : medicalert or call 1-800-668-1507. If you need to take personal medications with you, KEEP THEM IN THEIR ORIGINAL, LABELLED CONTAINERS to avoid any problems. For more travel health information The International Association for Medical Assistance to Traveler's IAMAT ; puts out a number of publications on traveler's health. You can contact them and request them to send you a package specific to China or the East Asia region. Their website is : iamat and email is info iamat . They can also be contacted by mail or phone at: IAMAT 40 Regal Rd. Guelph, ON N1K 1B5 Phone: 519 ; 836-0102 Fax: 519 ; 836-3412 OR 1287 St. Claire Ave. West, Suite #1 Toronto, ON M6E 1B8 Phone: 416 ; 652-0137.
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Point in time when others were already becoming ill. Is that an issue that in your mind is a legitimate one and secondly if it is, how do you deal with that in the future so that, I appreciate there's issues of confidentiality and whatnot but some of them were pretty concerned that they weren't aware how much was going on amongst their colleagues, how ill some of their colleagues were. Ms. Raymond: I'm sure it was a very, very difficult time for those particular staff. Some of them I saw personally when they came back to work and they talked to me about their experiences. I think in particular it was very difficult for the CCU staff, the cardiac staff, to be as aware as the ICU staff of what was happening. Keep in mind that our focus of attention was on our index patient. That was the methodology of infection control and the tracking that was in place that we knew about, that we were being advised were the patients of concern. We didn't know that there had been transmission already occurred back on the 7th and the 8th in the emergency department and that one of those patients went to the CCU. It was an unknown disease and the threat of that was not known, and so the focus of the attention was on ICU as opposed to CCU. And when the first staff in CCU reported ill, because it is a small place, CCU and ICU staff intermingled to a certain extent to cover off for each other, to support each other. Again, through the outbreak team and through that work that both infection control and Public Health were doing, we were tying the transmission to that sharing of, there must have been some sharing of something in terms of sharing the staff, as opposed to realizing that there was a patient in CCU that was ill with this disease as well. And in an infection control outbreak hindsight is wonderful to look back and be able to pinpoint where and how the transmission occurred. Back this weekend, our focus was on Mr. T and his family, and then the ICU staff, and then the CCU 182.
Among elderly patients with mania table 1 ; , 26% have no past history of mood disorder, 30% have pre-existing depression, 13% have past mania and 24% have organic brain disease and zantac.
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1. Stark Rd, Binks SM, Dutka VN, O'Connor KM, Arnstein MJ, Glen JB: A review of the safety and tolerance of propofol `Diprivan' ; . Postgrad Med J 1985; 61 Suppl.3 ; : 152-6. 2. Tan CH, Onsiong MK. Pain on injection of propofol. Anaesthesia 1998, 53: 468-76. Hennies HH, Friderichs E, Wilsmann K, Flohe L. Effect of the opioids analgesia tramadol on inactivation of norepinephrine and serotonin. Biochem Pharmacol 1982; 31: 1654-55. Stein C. The control of pain in peripheral tissue by opioids. New England J Med 1995 Jun 22; 332 25 ; : 1685-90. 5. Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing pain on injection. Anaesthesia 1988; 43: 492-4. Klement W, Arndt JO. Pain on intravenous injection of some anaethetic agents is evoked by the unphysiological osmolality or pH of their formulations. Br J Anaesth 1991; 66: 189-5. Lamotte C, Pert CB, Synder SH. Opiate receptor binding in primate spinal cord; distribution and changes after dorsal root section. Brain Res 1976; 112: 407-12. Fields HL, Emson PC, Leigh BK, Gilbert RF, Iversen LL. Multiple opiate receptor sites on primary afferent fibres. Nature 1980; 284: 351-3. Stein C, Hassan AHS, Przewlocki R, Gramsch C, Peter K, Herz A. Opioids from immunocytes interact with receptors on sensory nerves to inhibit nociception in inflammation. Proc Natl Acad Sci USA 1990; 87: 5935-9. Russell NJ, Schaible HG, Schmidt RF. Opiates inhibit the discharges of fine afferent units from inflamed knee joint of the cat. Neurosci Lett 1987; 76: 107-12 Yaksh TL. Substance P release from knee joint afferent terminals: modulation by opioids. Brain Res 1988; 458: 319-24. Mangar D, Holak EJ Tourniquet at 50 mmHg followed by intravenous lignocaine diminishes hand pain associated with propofol injection. Anesth Analg 1992; 74: 250-2. Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol. A comparison of lidocaine and alfentanil. Anesth Analg 1996; 82: 469-71. Wrench IJ, Girling KJ, Hobbs GJ. Alfentanil-mediated analgesia during propofol injection: no evidence for a peripheral action. Br J Anaesth 1996; 77: 162-4. Briggs LP, White M. The effects of premedication on anaesthesia with propofol `Diprivan' ; . Postgrad Med J 1985; 61 Suppl. 3 ; : 35-7. 16. Fletcher JE, Seavell CR, Boweri DJ. Pretreatment with alfentanil reduces pain caused by propofol. Br J Anaesth 1994; 72: 342-4. Houmes RJ, Voets MA, Verkaaik A, Erdmann W, Lachmann B. Efficacy and safety of tramadol versus morphine for moderate and severe postoperative pain with special regard to respiratory depression. Anesth Analg 1992; 74: 510-4. James MFM, Heijke SAM, Gordon PC. Intravenous tramadol versus epidural morphine for post thoracotomy pain relief - a placebo-controlled double-blind trial. Anesth Analg 1996; 83: 87-91. Vickers MD, O'Flaherty, Szekely, Read M, Yoshizumi J. Rramadol : Pain relief by an opioid without depression of respiration. Anaesthesia 1992; 47: 291-6.
Labopharm announced on December 12, 2000 the initiation of a second pilot study on a once-a-day formulation of the analgesic, Tramadol, incorporating Labopharm's patented controlled release technology, Contramid. The study will assess the pharmacokinetic profile of two improved formulations of this drug, under fed and fasting conditions, compared to a drug currently on the market as a reference. The study will involve 18 healthy volunteers and results are expected in midJanuary. They will be used to confirm final formulations for a full pivotal study to be initiated in 2001. Labopharm plans to file for market registration for this drug in Europe during the first half of 2002. Tramodol hydrochloride is a centrally acting analgesic for the treatment of moderate to severe pain. It is highly prescribed in Europe and the US for the alleviation of acute and chronic pain. A once-a-day formulation of this drug has been difficult to develop and Labopharm's formulations have "Tramadol is our highest priority in-house project at this time, " said James R. HowardTripp, President and CEO of Labopharm. "A once-a-day formulation of this product, comparable to ours, does not presently exist. shown excellent promise. With worldwide sales for existing formulations of this product approaching $1 billion, our formulations of Traadol should have significant potential for Labopharm. Our intent is to develop this product with our own resources to registration and only to license it out at late-stage in order to maximize the commercial return for the Company, " he added and celecoxib.
Page 2 Opioids: These drugs are sometimes used to treat neuropathic pain. Tramarol and morphine may have some effect on nerve pain. The effect of these strong painkillers on nerve pain is much less than the effect when they are used for pain after surgery. HOW DO THESE DRUGS WORK? ARE THERE ANY SIDE EFFECTS? Anti-depressants: There are 3 main types of anti-depressants which can reduce nerve pain.
M. Kupczewska, S. Czerczak. The Nofer Institute of Occupational Medicine, Lodz, Poland Calcium cyanamide is a nonvolatile, noncombustible, white crystalline solid. Calcium cyanamide is a commercially used as raw material for the manufacture of calcium cyanide and dicyanamide. It is also used in the desulfurization of some types of steels. The product is used as a defoliant, fertilizer, or herbicide. Most cases of industrial calcium cyanamide poisoning involve primary skin irritation or sensitizing dermatitis. Skin irritation develops in the form of an erythematous rash over the surfaces of the body that are exposed to the substance of those body surfaces irritated by clothing or perspiration. In addition, exposed workers may develop temporary vasomotor disturbances of the upper body, with susceptibility increasing with alcohol intake. The literature on the effects of exposure to calcium cyanamide CaCN2 ; in farmers and production workers was reviewed. 65 workers exposed to CaCN2 at levels in the range 0.238.36mg m3 were examined and no evidence of damage to the skin, respiratory system, gastrointestinal tract, kidneys or nervous and circulatory systems was found. When alcohol was taken 17 hours after the workshift, a moderate flush reaction occurred in 6 workers and a weak reaction in 7. Calcium cyanamide is used medically for its antabuse-like effect, and the maintenance dose in adults is between 50 and 100 mg day. Based on the human data and the therapeutic dose The Experts Group of Chemical Agent Intersectoral Commission of MAC Value in Poland, established the 8-hour MAC-TWA value of 1 mg m3 . No STEL is recommended. This value is intended to minimize the potential for irritation of the skin and respiratory tract and for antabuse-like effects in calcium cyanamide exposed workers consuming alcoholic beverages after work hours. 699 and cleocin.
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25. Tamminga CA. Schizophrenia and glutamatergic transmission. Crit Rev Neurobiol. 1998; 12: 21-36. Coyle JT. The glutamatergic dysfunction hypothesis for schizophrenia. Harv Rev Psychiatry. 1996; 3: 241-253. Goff DC, Coyle JT. The emerging role of glutamate in the pathophysiology and treatment of schizophrenia. J Psychiatry. 2001; 158: 1367-1377. Carlsson A, Waters N, Holm-Waters S, Tedroff J, Nilsson M, Carlsson ML. Interactions between monoamines, glutamate, and GABA in schizophrenia: new evidence. Annu Rev Pharmacol Toxicol. 2001; 41: 237-260. Javitt DC, Zukin SR. Recent advances in the phencyclidine model of schizophrenia. J Psychiatry. 1991; 148: 1301-1308. Olney JW, Farber NB. Glutamate receptor dysfunction and schizophrenia. Arch Gen Psychiatry. 1995; 52: 998-1007. Olney JW, Newcomer JW, Farber NB. NMDA receptor hypofunction model of schizophrenia. J Psychiatr Res. 1999; 33: 523-533. Miyamoto Y, Yamada K, Noda Y, Mori H, Mishina M, Nabeshima T. Hyperfunction of dopaminergic and serotonergic neuronal systems in mice lacking the NMDA receptor 1 subunit. J Neurosci. 2001; 21: 750-757. Feighner JP, Robins E, Guze SB, Woodruff RA Jr, Winokur G, Munoz R. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry. 1972; 26: 57-63. Kingsbury AE, Foster OJ, Nisbet AP, et al. Tissue pH as an indicator of mRNA preservation in human post-mortem brain. Brain Res Mol Brain Res. 1995; 28: 311-318. Harrison PJ, Heath PR, Eastwood SL, Burnet PW, McDonald B, Pearson RC. The relative importance of premortem acidosis and postmortem interval for human brain gene expression studies: selective mRNA vulnerability and comparison with their encoded proteins. Neurosci Lett. 1995; 200: 151-154. Eastwood SL, Kerwin RW, Harrison PJ. Immunoautoradiographic evidence for a loss of propionatepreferring non N-methyl-d-aspartate glutamate receptors within the medial temporal lobe in schizophrenia. Biol Psychiatry. 1997; 41: 636-643. Benes FM. Altered glutamatergic and GABAergic mechanisms in the cingulate cortex of the schizophrenic brain. Arch Gen Psychiatry. 1995; 52: 1015-1024. Lewis DA. GABAergic local circuit neurons and prefrontal cortical dysfunction in schizophrenia. Brain Res Brain Res Rev. 2000; 31: 270-276. Reynolds GP, Beasley CL. GABAergic neuronal subtypes in the human frontal cortex: development and deficits in schizophrenia. J Chem Neuroanat. 2001; 22: 95-100. Heckers S, Stone D, Walsh J, Shick J, Koul P, Benes FM. Differential hippocampal expression of glutamic acid decarboxylase 65 and 67 messenger RNA in bipolar disorder and schizophrenia. Arch Gen Psychiatry. 2002; 59: 521-529. Constantinidis C, Williams GV, Goldman-Rakic PS. A role for inhibition in shaping the temporal flow of information in prefrontal cortex. Nat Neurosci. 2002; 5: 175-180.
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Whilst medications like the COX 2 inhibitors may have significant side effects if taken indiscriminately and for prolonged periods, there is really no evidence at this moment to discredit its use for short term and may really be very useful as adjuncts for pain management. Other medications like tramadol may have a small side effects profile of nausea and vomiting, but may really be useful for the medium and long term. Many cancer patients spend the last weeks, months or even years of their lives in needless discomfort and disability because of unrelieved pain. Intrathecal neurolysis, which ablates the nerves innervating segments of the tumour, has met with some success in the management of late-stage cancer pain. Other useful and tested modalities include the placement of catheters into the spinal column to deliver drugs so as to achieve optimal pain relief.
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40 Pauletto P, Sartore S, Giuriato L, et al. Calcium antagonists and vascular smooth muscle cells in atherogenesis. J Cnrdiovasc Phannrol. 1992; 19 suppl ? ; : S8-S16. 41 Robertson RM, Robertson D. Drugs used for the treatment of myocardial ischemia. In: Hardman JG. Limbird LE, eds. 7'ht P h a cological Basis of Therapeutics. 9th ed. New York, NY McGraw-Hill Book Co: 1996: 759-779.
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Incidence of dementia almost twice that of noncarriers. The rates of dementia found was similar to other studies except for vascular dementia was found to higher than reported in other studies. McCallion, P., Toseland, R. W., Gerber, T., & Banks, S. 2004 ; . Increasing the use of formal services by caregivers of people with dementia. National Association of Social Workers, 49, 441-450. Caregivers N 608 ; of community-residing persons with dementia were surveyed about their need for and use of community services. One-third 203 ; agreed to be referred to the Alzheimer's Association, AA, Other research suggest 1 3 of people will seek help ; . The average respondent was a Caucasian, 60-year old, with some college education, daughter of a parent with dementia. Four significant predictors p .05 ; of willingness to be referred to the AA; 1 ; high school education or less, 2 ; unmarried caregivers, 3 ; felt more services would make it easier to provide care, and 4 ; caregiver who believed more services would help ensure the person with dementia remained at home. The study recommends local AA chapters target outreach efforts to caregivers with less formal educations, pay particular attention to helping unmarried caregivers, and focus referral efforts that help the person with dementia remain at home. Models of Intervention Fillit, H., Knopman, D., Cummings, J., & Appel, F., 1999 ; . Opportunities for improving managed care for individuals with dementia: Part 1 and Part 2 A framework for care. American Journal of Managed Care, 5, 309-324. In a 2-part article the authors stress the need to for managed care organizations to become aware that dementia is a manageable chronic illness that proactive management of can reduce cost, excessive service utilization and improve quality of life. On average caregivers of patients waited 1.7 years between the onset of symptoms and consultation with a physician about memory concerns. Among patients who subsequently proved to have dementia, the correct diagnosis was conveyed to caregivers in only 30% of cases during the early phase and more than 1 year elapsed until the correct diagnosis was made. Data indicates patients with dementia have considerably higher utilization than patients with other chronic diseases and have per capita expenditures of $7682 annually, compared to $4524 for individuals with no mental-health conditions. The ways in which dementia drives excess cost are not fully understood. However, the majority of patients with dementia have comorbid medical conditions that often require medication, hospitalization and skilled-care nursing. Noncompliance with medication and other therapies is a problem, delirium is present at times and 75% eventually reside in nursing homes and remain there for about three years. The authors recommend a disease management approach, a proactive way to deliver healthcare that integrates care across the continuum, enhances the traditional physician paradigm with efforts to reduce the frequency or severity of exacerbations of chronic diseases and employs non-physician practitioners specializing in the disease. These programs should include population-based screening efforts, the development of practice guidelines, the use of case managers, education of caregivers, case managers, and physicians in issues such as availability of community services, patient caregiver self-management techniques, and the latest.
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