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Notice-board welcomes information relevant to pharmacists, which can be e-mailed to notice-board pharmj . There is no charge for inclusion but The Journal cannot guarantee a particular publication date or that the item will be published. An organisation wishing to guarantee inclusion can arrange an advertisement, for which there would be a charge contact advertdept rpsgb ; . Bristol-Myers Squibb has discontinued Zeriit stavudine ; capsules 15mg. Zerkt capsules 20mg, 30mg and 40mg, and Zfrit powder for solution 200mg remain available. Medical information on 0800 7311736 and
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Rajagopalan, S. & Shiffman, M. A.: Guide to simple sanitary measures for the control of enteric diseases, 268 Rao, M. N., see Passmore, R-, 266 Renin-angiotensin system, 44 after birth, 48 at parturition, 48 in fetal life, 47 Research, medical: Medical research: a statistical and epidemiological approach, 268 Respiration, fetal, 3 in newborn, 6 Respiratory distress syndrome, management, 18 prevention, 15 REYNOLDS, E. O. R.: Management of hyaline membrane disease, 18 Risks, acceptance of, 184 evaluation of, 188.
Cruikshank, J. 1998 ; . The social life of narratives: Narrative and knowledge in the Yukon Territory. Lincoln, Nebraska: University of Nebraska Press. p. 27 ; . Mattingly, C. 1994 ; . The concept of therapeutic emplotment. Social Science and Medicine, 38 6 ; , 811-822. Mattingly, C. 1989 ; . Thinking with stories: Story and experience in a clinical practice. Massachusetts Institute of Technology. Good, B. 1996 ; . Medicine, rationality and experience: An anthropological perspective. Cambridge: Cambridge UP. Goffman, E. 1963 ; . Stigma: Notes on the management of spoiled identity. New York: Simon and Schuster. Giddens, A. 1997 ; . Modernity and self-identity: Self and society in the late modern age. Stanford: Stanford UP. Saris, AJ. 1994 ; . The proper place for lunatics: Asylum, person and history in a rural Irish community. University of Chicago. pp. 46-50 ; . This phrase is borrowed from Arthur Franks 1997 ; book, beautifully titled: The wounded storyteller: Body, illness and ethics. University of Chicago Press and
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7. Calculate the percentages of women starting on each ARV first line regimen per month for the last six months These percentages will be used to forecast the needs for new patients starting on ARVs assuming that the profile of female patients starting on ART remains the same. Using Table 4A iii ; count only the new FEMALE patients in each month. Enter data for the last six months or total program time if less. Round the number in the last column r ; up down to the nearest whole number. NOTE for stable programs: Calculating these percentages every month may not be necessary. Once the program has stabilised rechecking the profile of female patients entering the program every 3 to 6 months should be sufficient and
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Resistance and cross resistance. Viread selects for the K65R mutation, the same mutation selected for by Ziagen and Videx. Patients with mutations associated with other classes of anti-HIV drugs maintained susceptibility to Viread and their viral load drops ranged from 0.04 to 1.0 log. In persons with no mutations associated with Retrovir at codons 41, 67, 70, or 219; also referred to as nucleoside analog mutations or NAMs ; , the average viral load drop was 0.85 log. In patients with 1 or 2 NAMs, the average viral load dropped 0.6 log. In patients with 3 or more NAMs, including 41L and 210W, the viral load drop was reduced to 0.23 log. In patients with 3 or more NAMs, not including 41L or 210W, the average viral load drop was 0.65 log. In addition, this study seems to indicate that mutations emerged more slowly in patients who added Viread than persons who added placebo to their standard background therapy. Nucleoside reverse transcriptase inhibitor NRTI ; mutations occurred in 24% of patients in the placebo group versus 16% taking Viread. Similarly, non-nucleoside reverse transcriptase inhibitor NNRTI ; mutations arose in 10% of patients in the placebo arm versus 5% in the Viread group. Protease inhibitor mutations emerged in 8% of the patients in the placebo arm versus 2% in the Viread arm. Clinical data. Approval for Viread was based primarily on 2 efficacy studies. Study 907 was a 24-week, double-blind placebo controlled multicenter study of Viread added to a stable background treatment SBT ; regimen of anti-HIV drugs in 550 treatment-experienced patients. CD4 T cell counts of patients at baseline ranged from 23 to 1385 cells mm3 median 426 cells mm3 and plasma HIV RNA ranged from 50 to 75, 900 copies mL median 2340 copies mL ; . The mean duration of prior HIV treatment was 5.4 years. At baseline 368 patients were randomized to the Viread arm and 182 patients were randomized to the placebo arm. Through week 24, the time-weighted average change from baseline HIV RNA in the Viread arm was -0.61 log versus -0.03 log in the placebo arm; similarly, the mean change in the absolute CD4 T cell count in the Viread arm was + 11 versus -5 cells mm3 in the placebo arm. At week 24 a total of 149 patients 40% ; in the Viread arm had 400 copies mL versus 20 patients 11% ; in the placebo arm. In addition, 71 patients 19% ; in the Viread arm versus 2 patients 1% ; in the placebo arm had 50 copies mL at week 24. Data through 48-weeks are reported for Study 903, a double-blind, active-controlled multicenter study comparing Viread 300 mg once daily ; given in combination with Epivir lamivudine ; + Sustiva efavirenz ; versus Z3rit stavudine ; + Epivir + Sustiva in 600 antiretroviral-nave patients. The mean baseline CD4 cell count was 279 cells mm3 range 3956 ; and median baseline plasma HIV-1 RNA was 77, 600 copies mL range 4175, 130, 000 ; . Patients were stratified by baseline HIV-1 RNA and CD4 count. Forty-three percent of patients had baseline viral loads 100, 000 copies mL and 39% had CD4 cell counts 200 cells mL. At baseline, 299 patients were placed on the Viread arm and 301 patients were placed on the Zerif arm. Achievement of plasma HIV-1 RNA concentrations of 400 copies mL at week 48 was similar between the 2 treatment groups for the population stratified at baseline on the basis of HIV-1 RNA concentration or 100, 000 copies mL ; and CD4 cell count or 200 cells mm3 ; . Through 48 weeks of therapy, 79% of patients in the Viread arm had 400 copies mL versus 82% in the Zerit arm. In addition, 76% and 79% of patients in the Viread and Zerit arms, respectively achieved HIV-1 RNA 50 copies mL. The mean increase from baseline in CD4 cell count was 169 cells mm3 for the Viread arm and 167 cells mm3 for the Zerit arm. Six percent of patients on the Viread arm experienced virologic failure versus 4% in the Zerit arm. Through 48 weeks, 8 patients in the Viread group and 6 patients in the stavudine group experienced a new CDC Class C event.
Improve the Information, Education, Communication IEC ; skills of health workers. Clearly, the introduction of a shorter duration of treatment means that more responsibility for self-care and self-monitoring is put on the shoulders of the patient. This requires effective education of the patient, facilitated by good and
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There are many other techniques in use for the treatment of LUTS. These include microwave therapy TUMT ; , needle ablation TUNA ; and ultrasound HIFU ; . These can be performed on an outpatient basis and produce an improvement in symptoms comparable to TURP. Unfortunately, many reported series are small, of a short duration and are not randomised. There is a high need for subsequent therapy of 15-50%. The long-term data on many of these newer techniques are awaited before any conclusions can be made. SUMMARY There are many reasons for LUTS in men, of which BOO is a common cause a management algorithm is displayed in Figure 1 ; . Assessment must include a physical examination, prostatic examination, MSU, PSA and, where available, flow rate and post-void residual estimation. Mild-to-moderate symptoms can be managed expectantly or with medication such as alpha blockers and occasionally phytotherapy. Moderateto-severe symptoms may be managed medically with alpha blockers in combination with 5-reductase inhibitors or surgically by TURP or another similar technique. References available on request and
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Conclusions: A major drawback of this study is a small sample size. Even though it does not provide conclusive evidence, favorable trends seen in patient satisfaction scores and frequency of emergency room visits suggest a positive impact of pharmacist involvement. However, further research is warranted. E-2 The Benefits of a Multi-Year Paid Intern Program in a Community Hospital R.L. Ball, MBA, R.Ph. Harris Methodist Fort Worth Hospital, Fort Worth, TX. Background: Many pharmacy students enter pharmacy school without experience or knowledge related to hospital pharmacy practice. Hospital pharmacy practice is complex and opportunities for pharmacy students to experience the depth of practice in a large, clinically oriented hospital pharmacy are limited. A six week hospital clerkship rotation is not adequate to develop a student for a career in a large hospital. Objective: The objective of our multi-year paid intern program is to develop an in depth knowledge of hospital pharmacy practice within our interns, allowing them to grow in hospital knowledge and practice consistent with their advancement through the pharmacy curriculum. Methods: Annually, two students completing their first year of pharmacy school are hired for the summer. These interns begin by learning the jobs of our pharmacy technicians. Just prior to returning to school, the interns spend one week rounding with decentralized pharmacists, gaining exposure to the work our clinical pharmacists perform. Each summer, the level of expectation is raised and the amount of time spent on clinical pharmacy activities is increased. Results: This program has been very successful with four interns completing residencies to date and four currently in the application process. Additionally, over the four years this program has been in place, six interns have accepted positions within our health system. Conclusions: This program has successfully prepared interns for residencies and for clinical pharmacy practice positions. E-3 Pharmacists Response to Continuing Professional Development CPD ; Survey Renee Bellanger and Mark Granberry University of the Incarnate Word, San Antonio, Texas Background: Continuing professional development considers expanding beyond traditional continuing education into a life long learning system. Objective: To discover the knowledge and attitudes of Texas pharmacists towards continuing professional development CPD ; . Methods: An electronic survey was developed that incorporated demographic and informational questions about CPD. All responses were included in the data collection. The results of the survey were compiled into a spreadsheet for analysis. Results: A total of 320 responses were received from 1500 pharmacist recipients. Respondents stated that self reflection on professional needs and questions from patients inspired them to learn about pharmacy related issues. Respondents 35% ; were cognizant of continuing professional development CPD ; prior to taking the survey. Most respondents felt a computerized template would aid development of a written learning plan. More than 15% of respondents currently have some record of self-identified learning needs, objectives, activities and outcomes. Half of respondents felt that a written learning plan would improve their ability to provide health care. The respondents felt that they would self-monitor CPD. Many pharmacists 47% ; were unsure if changing from a traditional CE approach to a CPD approach would benefit the profession. Conclusions: Since only a third of respondents had prior knowledge of CPD, the need is evident to educate pharmacists about the process and potential for their futures. An open dialogue among pharmacists from all career paths should follow and a broader survey of pharmacists nationally undertaken before intense work is made on a national CPD system. March 31 - April 3, 2006 11, for example, gilead.
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Interest in drug or xenobiotic foreign compounds ; metabolism can be dated back to the early 19th century. Metabolism then was known as a "detoxication" mechanism in the body. In late 1930s, with the discovery of the synthetic azo-dye Prontosil's metabolism to antibacterial agent sulfanilamide in the body, studying metabolism has become an important priority. This year BAS and the International Society for the Study of Xenobiotics ISSX ; produced a historical calendar celebratin g many o f the o riginal contributions to our knowledge of the metabolism of organic compounds 3 ; . Metabolism is the mechanism of elimination of foreign and undesirable compounds from the body and the control of levels of desirable compounds such as vitamins in the body. Since information on the metabolism of a drug plays a significant role in selection and further characterization of the drug, an in-depth look at the mechanism of drug metabolism is worth the effort. The major site of metabolism in the body is the liver. Metabolism in liver occurs in two stages: Phase I pathways in liver microsomes where the drug is functionalized and Phase II pathways in liver cells where the parent or the metabolite from Phase I gets conjugated. Liver microsomes are in the endoplasmic reticulum of liver cells or hepatocytes. Phase I reactions in microsomes are catalyzed by a group of enzymes known as the cytochrome P450 system that plays a significant role in drug metabolism. The common chemical reactions involved in Phase I are aromatic hydroxylation, aliphatic hydroxylation, oxidative N-dealkylation, oxidative O-dealkylation, S-oxidation, reduction and hydrolysis. Most often this simple functionalization could be sufficient to make a drug more soluble, facilitating elimination and ticlid.
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Therefore, the current Cochrane Collaboration Stroke Review concludes that it remains unclear whether high BP should, or should not, be altered therapeutically during the acute phase of stroke. However, this is a common clinical problem, not least because 40% of acute stroke patients are already taking antihypertensive therapy on hospital admission. The Royal College of Physicians guidelines reflect the lack of evidence to inform the management of this common area of clinical concern. The Continue Or Stop post-Stroke Antihypertensives Collaborative Study will establish the efficacy and safety of BP manipulation in the acute stroke period by the continuation or stopping of pre-existing therapy. This will provide important information for the design of future studies to manipulate BP in all stroke patients, including those who are not on antihypertensive therapy pre-stroke. 3. Study Objectives 3.1. Primary Objective To assess whether continuing or discontinuing existing antihypertensive therapy within the first 48 hours following acute ischaemic or haemorrhagic stroke onset influences short- 2 weeks ; and long-term 6 months ; outcome in terms of death and disability. 3.2. Secondary Objectives To assess if any potential differences are related to patient age 75 years versus 75 years ; . To assess if differences in BP between the continued and discontinued treatment groups over the first two weeks following acute stroke onset account for any differences in the outcome measures. To determine the short-, medium- and long-term cost effectiveness of continuing or discontinuing existing hypertensive therapy in stroke patients. 4. Study Protocol 4.1. Study Design A multi-centre, prospective, randomized, open, blinded-endpoint PROBE ; study. 4.2. Study Population 2900 patients admitted to Acute Stroke Units Medical Units at at least 25 United Kingdom Teaching and District General Hospitals within 48 hours of onset of suspected stroke and within 48 hours of last dose of medication with a recognized antihypertensive effect see Sample Size Calculation, Section 6.4.
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