Soumerai SB, Ross-Degnan D, Fortess EE, Abelson J. A critical analysis of studies of state drug reimbursement policies: research in need of discipline. Milbank Quarterly 1993; 71 2 ; : 217252; Tamblyn R, Laprise R, Hanley JA, Abrahamowicz M, Scott S, Mayo N, et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. Journal of the American Medical Association 2001; 285 4 ; : 421-429.
Aug 13, 2006 halcion r ; triazolam ; , ergot medications cafergot r ; , migranal r ; , dhe 45 r ; , and others ; , propulsid r ; cisapride ; , versed r ; midazolam ; , orap r ; pimozide.
McDaniel JS, Musselman DL, Porter MR, et al: Depression in patients with cancer. Diagnosis, biology, and treatment. Arch Gen Psychiatry. 1995; 52 2 ; : 89-99. Robinson RG, Starr LB, Price TR: A two year longitudinal study of mood disorders following stroke. Prevalence and duration at six month follow-up. Br J Psychiatry. 1984; 144: 256-262. Rickels K, Schweizer E. Clinical overview of serotonin reuptake inhibitors. J Clin Psychiatry. 1990; 51 Suppl B ; : 9-12. Burrows GD, McIntyre IM, Judd FK, et al. Clinical effects of serotonin reuptake inhibitors in the treatment of depressive illness. J Clin Psychiatry. 1988; 49 Suppl ; : 1822. Aberg-Wistedt A. The antidepressant effects of 5-HT uptake inhibitors. Br J Psychiatry Suppl. 1989; 8: 32-40. Finley PR. Selective serotonin reuptake inhibitors: Pharmacologic profiles and potential therapeutic distinctions. Ann Pharmacother. 1994; 28 12 ; : 1359-1369.
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SECTION VII - SPILL OR LEAK PROCEDURES STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED: Evacuate unprotected personnel from area. Maintain adequate ventilation. Use proper Safety Equipment. Sweep up material into containers and dispose of properly. Flush remaining area with water and neutralize with Soda Ash or Lime and dispose of properly. Avoid direct discharge to sewers and surface waters. Notify authorities if entry occurs. WASTE DISPOSAL METHOD: Observe all Local, State, and Federal Regulations. Dispose of at approved Waste Treatment Facility. If approved, neutralize material and flush to sewer. DO NOT pressurize, cut, weld, braze, solder, drill, grind or expose empty containers to heat, flame, sparks or other sources of ignition. SECTION VIII - SPECIAL PROTECTION INFORMATION CONSULT SAFETY EQUIPMENT DISTRIBUTOR RESPIRATORY PROTECTION: NIOSH-Approved respirator for dusts and mists. Do not exceed limits established by the respirator manufacturer. Respiratory protection programs must comply with 29 CFR 1910.134. VENTILATION: Maintain adequate ventilation. Do not use in closed or confined space. Keep levels below recommended Exposure Limits. To determine exposure levels, monitoring should be performed as required by 29 CFR 1910.1052. Avoid accumulation of dust. Avoid mist formation. PROTECTIVE GLOVES: Rubber Latex ; . Neoprene. Chemical-resistant gloves. EYE PROTECTION: Chemical Safety Goggles. Face shield. Do not wear contact lenses. OTHER PROTECTIVE EQUIPMENT: Eye-wash station. Safety shower. Rubber apron. Chemical safety shoes. Protective clothing.
1. Akiyama H, Yamasaki O, Tada J, Arata J. Adherence characteristics and susceptibility to antimicrobial agents of Staphylococcus aureus strains isolated from skin infections and atopic dermatitis. Journal of Dermatology Science 23: 155-160, 2000. Alghaithy AA, Bilal NE, Gedebou M, Weily AH. Nasal carriage and antibiotic resistance of Staphylococcus aureus isolates from hospital and non-hospital personnel in Abha, Saudi Arabia. Transaction Royal Society of Tropical Medicine and Hygiene 94: 504-507, 2000. Costa EO, Benites NR, Guerra JL, Melville PA. Antimicrobial susceptibility of Staphylococcus spp. Isolated from mammary parenchyma's of slaughtered dairy cows. Journal of Veterinary Medicine of Cows and Infectious Disease and Veterinary Public Health 47: 99-103, 2000. Gosbell IB, Mercer JL, Neville SA, Crone SA, Chant KG, Jalaludin BB, Munro R. Non-multiresistant and multiresistant methicillinresistant Staphylococcus aureus in community-acquired infections. Medical Journal of Australia 174: 627-630, 2001. Groom AV, Wosley DH, Naimi TS, Smith K, Johnson S, Boxrud D, Moore KA , Cheek JE. Community-acquired methicillinresistant Staphylococcus aureus in a rural American Indian community. The Journal of American Medical Association 286: 1201-1205, 2001. Naimi TS, Le Dell KH, Boxrud DL, Groom AV, Steward CD, Johnson SK, Besser JM, O'Boyle C, Danila RN, Cheek JE and calan.
Tell your doctors and pharmacists about all medicines you take. This includes those you buy over-the-counter and herbal or natural remedies, such as St. John's Wort. Bring all your medicines when you see a doctor, or make a list of their names, how much you take, and how often you take them. Your doctor can then tell you if you need to change the dosages of any of your medications. The following medications should not be taken while you are being treated with Reyataz: HIV protease inhibitors: Crixivan indinavir ; Acid reflux heartburn medications: Propulsid cisapride ; , Prevacid lansoprazole ; , Nexium esomeprazole ; , Prilosec omeprazole ; , Protonix pantoprazole ; , and all other proton-pump inhibitors. Antibiotics: Rifadin rifampin ; Cancer chemotherapeutics: Camptosar irinotecan ; Antimigraine medications: Methergine, Methylergometrine methylergonovine Ergostat, Cafergot, Ercaf, Wigraine ergotamine Ergotrate, Methergine ergonovine or D.H.E. 45, Migranal dihydroergotamine ; Antihistamines: Hismanal astemizole ; or Seldane terfenadine ; Cholesterol-lowering drugs statins ; : Zocor simvastatin ; and Mevacor lovastatin ; Antipsychotics: Orap pimozide ; Sedatives: Versed midazolam ; and Halcion triazolam ; Herbal medications: St. John's wort If Reyataz is combined with low-dose Norvir, the following medications should also be avoided: Antifungals: Vfend voriconazole ; Heart medications: Cordarone amiodarone ; , Tambocor flecainide ; , Vascor bepridil ; , Rythmol propafenone ; , or Quinaglute Quinidex quinidine ; Enlarged prostate: Uroxatral alfuzosin ; Anticonvulsants, such as Tegretol carbamazepine ; , Luminal phenobarbital ; , and Dilantin phenytoin ; , may decrease the amount of Reyataz in the bloodstream. It might be necessary to increase your dose of Reyataz if you are taking any of these drugs.
Experimenting with targeting molecules, attaching specific antibodies to the surface of the nanocrystals, which would then be injected into the body. "So far we've been working with antibodies, targeting cells that have become inflamed, " Roman explained. "The nanocrystals block the receptors on the cell and prevent that mechanism from happening." This process could have applications in combating the effects of certain diseases involving inflammation of blood vessels, such as diabetes, rheumatoid arthritis or some cancers. It's also hoped that the process could be applied to create a new generation of vaccines. Dow and Colorcon in Controlled Release Collaboration in-pharmatechnologist : March 27, 2007 Major chemical manufacturer Dow has struck a deal with long-term partner Colorcon, forming an alliance to offer a unified package for the development and production of drug ingredients and products. According to the deal, Colorcon will be responsible for the global marketing, sales, technical service, and development and distribution of Dow pharmaceutical products for use in oral controlled release applications. The deal only applies to certain polymers and resins from Dow's range, specifically the company's Methocel hypromellose polymers, premium- or NF-grade Ethocel ethylcellulose polymers, and all Polyox polyethylene oxide resins used in pharmaceutical applications. The emphasis of the agreement is on polymers used in controlled release applications, as it has been marked as a high growth area for the companies' customers. According to a Colorcon spokesperson, the company aims to expand the applications of Methocel, Ethocel, and Polyox and provide improved predictive modeling tools for products covered by the partnership. The alliance is in effect now, though there is a transition period during which distributors will be able to order Dow excipients from the list that will ultimately be covered through the alliance to fulfill customer requirements. This will last until June for the United States, Canada, and Puerto Rico, and September for Europe, Asia Pacific, and Latin America. Colorcon has been a distributor for the products covered by the alliance for almost three and capoten, for instance, cafergot drug.
Andrea bonny of metrohealth medical center in cleveland and colleagues looked at 450 girls ages 12 to 1 according to the study, 21% of the girls had a body mass index of 30 or more, which researchers classified as obese.
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Figure 13. Pharmacokinetics of rifampicin in healthy volunteers. from181 by the permission of the publisher ASM Press.
Bisacodyl magnesium citrate, 30 bismuth subsalicylate + metronidazole + tetracycline, 31 BLEPH-10, 39 BONIVA inj, 27 BONIVA tabs, 27 BRETHINE, 35 brimonidine 0.1%, 0.15%, 40 brimonidine 0.2%, 40 brinzolamide, 40 BROMFENEX, 34 BROMFENEX-PD, 34 bromocriptine, 23 brompheniramine pseudoephedrine ext-rel 12 mg 120 mg, 34 brompheniramine pseudoephedrine ext-rel 6 mg 60 mg, 34 budesonide spray, 35 budesonide susp, 35 bumetanide, 21 BUMEX, 21 bupropion, 23 bupropion ext-rel, 23, 25 BUSPAR, 22 buspirone, 22 busulfan, 19 butalbital acetaminophen, 16 butalbital acetaminophen caffeine, 16 butalbital aspirin caffeine, 16 butenafine, 37 butoconazole, 31 butorphanol spray, 15 BYETTA, 26 cabergoline, 29 CAFCIT, 36 CAFERGOT, 24 caffeine citrate, 36 calamine lotion, 38 CALAN, 21 CALAN SR, 21 calcipotriene, 37 calcitonin-salmon, 27 calcitriol 1, 25-D3 ; , 33 calcium acetate, 29 calcium carbonate vitamin D, 33 CALTRATE-600 PLUS, 33 CAMPRAL, 25 CANASA, 30 capecitabine, 19 CAPITAL w CODEINE, 15 CAPOTEN, 19 captopril, 19 CARAC, 36 CARAFATE, 31 carbamazepine, 22 carbamazepine ext-rel, 22 carbamide peroxide 6.5%, 40 CARBATROL, 22 carbidopa levodopa, 23 carbidopa levodopa ext-rel, 23 carbidopa levodopa entacapone, 23 carboxymethylcellulose sodium, 40 CARDIZEM CD, 21 and levodopa.
Boots Multivit Tab OAD Centrum Jnr Multivit Tab Dalivit Dps Dialyvit Zn Forte Tab Dialyvit Tab Forceval Jnr Cap Forceval Cap Ketovite Supp Liq S F Ketovite Tab Lloyds Multivit Tab Mother & Child Multivit Dps Multivit Tab Natravits Multivit Tab Nephro-Vite Tab Nucare Multivit Tab Omega-3 Fish Oil Cap Pure Health Multi-Vit Tab OAD Superdrug Multivit Tab Tesco Multivit Tab Unichem Multivit Tab Valupak Multivit Tab OAD Vivioptal Cap Total for chemical entity O ther Preparations : Health Aid Multivit Cap Vit Cap Total for chemical entity V itamins Caps : Total for BNF : 9 . Total for BNF : 9 . Total for BNF : 9 . Vitamins 0.
GSK Corporate Responsibility Report 2003, p23. : gsk ser 2001 ser01 ser3 . 36 : phrma publications policy 2002-06-24.430 . 37 GSK Corporate Responsibility Report 2003, p32. 38 GSK Corporate Responsibility Report 2003, p28. 39 CoreRatings 2003 ; . Philanthropy or Good Business? Emerging market issues for the global pharmaceutical industry. See : coreratings . For a general information on the protection of indigenous knowledge, see SOMO 2004 ; . Sector profile of the pharmaceutical industry. 40 For a short discussion of marketing codes, see SOMO 2004 ; . Sector profile of the pharmaceutical industry. 41 GSK Corporate Responsibility Report 2003, p1, 19 and carvedilol!
Significance Only the odd ratio for the concomitant use of cannabis and alcohol had a p value of less than 0.05 at which associations are considered statistically robust Table 22 ; . The odd ratio for the alcohol category total use ; showed some statistical meaning but not enough to reach the conventional value for significance p 0.05 ; . Except in the case of the cannabis-alcohol category, the small sample size used for comparisons reflects lack of statistical significance too small to represent the population and to give fair statistical significance ; . Therefore a larger statistical sample like the 2000 samples originally set for Study 2 ; will reveal a better picture of the risk and responsibility of drug use prior driving, for example, prednisone.
PRINCIPLES A range of procedures will not be provided by the NHS for Doncaster residents unless in exceptional circumstances. These are: Procedures or treatments, which it would be clinically inappropriate to provide, because they do not generally address a health problem. For example breast implants for purely cosmetic reasons. ; Treatments and procedures, which are not effective clinical effectiveness is usually demonstrated in published clinical trials in peer reviewed journals ; . Procedures, which fall outside national, North Derbyshire, South Yorkshire & Bassetlaw Commissioning Consortium NORCOM ; or other guidelines agreed by the PCTs' executives. Clinicians who believe that their patient represents an exception for whom an intervention should be purchased may discuss this with a consultant public health physician or medical or pharmaceutical advisor employed by the Primary Care Trust. This list represents proposed clinical policy which have been formulated together as a result of local discussions e.g. on guideline working groups, and between South Yorkshire Primary Care Trusts through NORCOM. In these settings the currently available evidence is discussed. In many cases the evidence has been appraised in an academic setting. National advice from the National Institute for Clinical Excellence NICE ; or National Service Frameworks will be implemented across the PCTs. Where implementation is not immediate for clinical, logistical or financial reasons this will be stated in the document. Doncaster Primary Care Trusts will always be prepared to consider exceptional circumstances. PRIVATE CARE The PCTs will not normally fund treatment privately where an NHS provider offers treatment unless it can be demonstrated that the private provider can offer a more cost effective service or where the delay in accessing NHS treatment exceeds 12 months and
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Safety of a medication after a new dosage has been approved. Nor is there any protocol to review new indications for previously approved medications. This is a concern for all the members of the health care team who are responsible for the safety of patients. The concern for those who manage formularies is even greater, as providers often prescribe medications for nonFDA-approved indications and dosages after a new drug enters the marketplace. We, as health care providers, must empower our patients. The patient is in a better position than the physician to control the risk of deleterious side effects of taking a statin. The wellinformed patient, for example, is more inclined to alert the provider to the presence of myalgias. This early notification allows the provider to begin a diagnostic evaluation and to alter the therapy sooner. The hope is that the earlier the change in therapy, the less likely the patient is to have longterm negative effects from the therapy. All patients should be educated that even a moderate change in lifestyle can have a positive effect on LDL levels, obviating the need to increase the dose and decreasing the chance for side effects. The problem with most physicians is that after they make the decision to place a patient on a statin, they have a tendency to de-emphase non-pharmacologic cholesterol reduction. During the year or so that it takes to titrate to the proper dose, the degree of change in the patient's lifestyle will ultimately determine the maximum dose required. The focus should be on identifying patients with multiple risk factors for coronary artery disease CAD ; . The new ATP III guidelines raise persons with diabetes without coronary heart disease CHD ; to a CHD risk equivalent. Type 2 diabetes is a fast-growing epidemic. These new guidelines use projections based on the Framingham data of 10-year absolute risk to identify patients with multiple risk factors for more intensive treatment.3 The guidelines also identify patients with the dysmetabolic profile those with abdominal obesity, low HDL, hypertriglyceridemia, hypertension, and impaired glucose tolerance ; who are candidates for therapeutic lifestyle modification. Modifications of the lipid and lipoprotein classification now identify LDL cholesterol below 100 mg dl as optimal. What is now considered to be low HDL cholesterol has changed to values below 40 mg dl, up from the previous 35 mg dl. The optimal triglyceride level has been determined to be less than 150 mg dl. The new guidelines suggest a comprehensive lipoprotein panel total, LDL-C, HDL-C, and triglycerides ; as the preferred initial test, rather than the previous recommen and
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Congestive heart failure CHF ; has been recognized recently as the first cause of cardiovascular death in chronic kidney disease CKD ; [6]. Once established, CHF in dialysis subjects is associated with a catastrophic survival [7]. Moreover, cardiac abnormalities are early and progressive ; events in CKD patients, often precluding clinical signs of heart failure. There are sufficient arguments for a standard optimal medical therapy for patients with CHF on dialysis. Unfortunately, patients with significant renal dysfunction and cardiovascular disease are definitely underdiagnosed and undertreated [8]. The reasons for this `renalism' are unclear, but may be related to insufficient and
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He wrote an editorial to accompany the study, published in thursday's new england journal of medicine and
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OPINION MITCHELL, J. Kimberly White was a student at Eastern Illinois University "EIU" residing from August, 1983 to December, 1984 in Lawson Hall. In January, 1985 she moved to room 429 in Taylor Hall. In anticipation of her junior year, she signed a housing contract dated April 8, 1985, with the university. The cost of $1, 074 per semester can be proportioned to 57% $612.18 ; for food costs and 43% $461.82 ; for room costs. Meeting with Lou Hencken, housing director for EIU, in mid-November of 1985, she told him of her wish to move into Sigma sorority house in January. There was no mention by her of any health problems. Hencken replied that university policy would not allow her to cancel the contract, but she could live in a different dorm or a different room in her current dorm. White declined the.
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Ethical issues: "There is control at the individual level through informed consent, at the social level through the regional ethics committee which screens all research proposals, and at the population level, since local politicians sit as non-voting members on the boards of both the company and the Medical Bank" quoted in Abbott 1999 ; . Klaus Hyer's 2002b ; ethnographic fieldworks indicates how many participants in UmanGenomics database do not actually read the informed consent sheet that is provided to them, tacitly consenting to participate in this study, and only engaging in the public arena of informed consent when confronted in the context of the anthropological interview and clobetasol.
Patient: Donna Doe MR Number: 123456789 DOB: December 03, 1931 Gender: F Summary: 1. Device surgery: A triple-chamber cardioverter defibrillator Guidant, Contak Renewal, H135, SN 1234568 ; was attached to the lead s ; and implanted. 2. Electrophysiology testing: Ventricular defibrillation threshold testing. Device-based arrhythmia conversion testing was performed. The energy safety margin was satisfactory. Discharge and follow-up: The patient should call primary cardiologist immediately if symptoms recur, or for any problems. Procedures: Defibrillation setup. Left subclavian vein access. Peripheral intravenous access. Coronary sinus angiography. Pocket construction. Successful lead implantation. Triple-chamber cardioverter defibrillator implantation. Wound closure. Noninvasive programmed stimulation device testing. Ventricular defibrillation threshold testing. Vascular hemostasis. Indications: The patient is here for an intervention. Non-sustained ventricular tachycardia with coronary disease, prior myocardial infarction, LV dysfunction, and inducible ventricular tachycardia or fibrillation at electrophysiologic study. Asymptomatic dilated cardiomyopathy. History: Health history was acquired from the patient's chart and the patient. Problem list Ventricular tachycardia nonsustained ; . Left ventricular dysfunction, with NYHA class III congestive heart failure. The ejection fraction was 20 %. The LV dysfunction was primarily systolic. Risk factors: Current tobacco use within the last month ; . Hypertension. Diabetes mellitus; on therapy with diet and oral hypoglycemics. Diagnostic procedures: 6 months ago: Catheterization. Procedure narrative: The risks, benefits, and alternatives to the procedure and sedation were explained to the patient and informed consent was obtained. The patient was in the fasting state. A grounding pad was placed. A 14 Fr Foley catheter was already in place when the patient arrived. The patient was set up for monitoring of surface ECG leads. Signals were recorded with a multichannel device. Blood pressure was monitored. The procedure was performed under IV conscious sedation supplemented with intermittent deep sedation during arrhythmia conversion testing. The left infraclavicular region was shaved and prepped with DuraPrep. The patient was then draped in the usual sterile fashion. 1. Defibrillator setup. Self-adhesive anterior-posterior defibrillation pads were applied. 2. Left subclavian vein access was obtained for electrode placement. The puncture site was infiltrated with 1 % lidocaine. The vessel was accessed with three separate punctures. 3. Peripheral intravenous access was obtained for intravenous fluid administration. 4. Coronary sinus angiography. A Rapido steerable catheter was placed into the coronary sinus. 5. A subcutaneous left infraclavicular pocket was constructed. 6. Successful lead implantation. Using fluoroscopic guidance, ventricular, atrial, and coronary vein lead s ; were inserted. The lead s ; were secured with anchoring sleeves and non-absorbable suture. 7. A triple-chamber cardioverter defibrillator Guidant, Contak Renewal, H135, SN 1234568 ; was attached to the lead s ; and implanted. 8. Wound closure. The pocket was flushed with vancomycin. Hemostasis was obtained with electrocautery and a sealant FloSeal ; . The wound was closed in three layers. The skin was approximated with subcuticular suture and steri-strips. 9. Two-way communication was established between the device and its programmer; telemetered electrograms and pacing and sensing thresholds were measured. Ventricular fibrillation was induced with T-wave shocks. Ventricular energy requirements were measured using a one-shock success protocol. 10. Ventricular defibrillation threshold testing. Device-based arrhythmia conversion testing was performed. The energy safety margin was satisfactory. 11. Hemostasis was obtained. The site was compressed. There were no complications. The patient was transferred to the coronary care unit via cart accompanied by a nurse. Fluoroscopy time 28 min. Administered medications: Fentanyl. Midazolam. Methohexital. Vancomycin. Lead parameters.
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Remarkable delayed symptoms were observed beginning with the first day of exposures and continued through the next day Fig. 3 ; . No marked differences were apparent in the nasal and ocular symptom scores between the placebo and BB536 groups. There was no difference in the scores for each of the nasal or ocular symptoms between groups data not shown ; . Throat symptom scores tended to be lower on the day after the exposures, and scores for disruption of normal activities tended to be lower on the two days following exposure in the BB536 group compared with the placebo. AUC analysis indicated a significant difference p 0.011 ; for the scores of disruption of normal activities between the two groups, but there was no difference for the other symptoms Table 2 ; . Medication use for relieving symptoms was observed in some subjects, particularly on both the first, for example, rxlist.
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Lant nucleation in the atomizer, 9 and 3 ; increased evaporation rates.10 The significance of particle size changes is readily observed in the altered deposition patterns of medicinal aerosols. However, the mechanism of particle size changes resulting from the transition from CFCs to HFAs has not been widely explored other than to observe the phenomenon in the context of known physicochemical characteristics. Vapor pressure of pressurized metered-dose inhaler pMDI ; formulations has significant effect on the emitted particle size.11 The vapor pressure, relative to atmospheric pressure, can be used as an indicator of the energy propulsion from the pMDI device that occurs during the atomization process. Increasing the ethanol concentration results in a decrease in the vapor pressure of the HFA134a solution formulation.2, 12, 13 There is also a positive deviation from ideality. This deviation implies that, in a binary mixture, components favor cohesive molecular associations with like molecules rather than adhesion with a second species.14 It has been suggested that because of the positive deviation from Raoult's Law, addition of ethanol to HFA-134a may not reduce vapor pressure significantly. Consequently, there may not be an adverse influence on the emitted droplet size.2 Recently it was observed that HFA solution formulations displayed multimodal particle size distributions.15 The present study explores the implications of formulation factors of solutions of HFA-134a ethanol pMDIs with particular reference to the changes in the particle size distribution. Specifically, multimodal droplet size distributions obtained by increasing the proportion of ethanol in solution formulations were investigated.
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Orlando, Fla. June 16, 2003 ; -- It can sometimes be a challenge to zero in on a packaging solution that not only meets consumer requirements but also addresses regulatory demands. Nephron Pharmaceuticals Corp. has been able to do just that with a unit dose packaging approach for its line of inhalation solutions used in respiratory therapy. Nephron was a pioneer in using blow-fill-seal and laminated foil technology to bring its products to market. However, more recent regulatory and market demands have prompted the pharmaceutical manufacturer to focus more toward individual pouches for its unit dose vials and away from multiple vials in a bulk package. "We wanted to be proactive in our approach so that we could address both consumer and regulatory sides of the packaging issue, " explains Steve Simmons, president, Nephron. To better protect patients, hospitals had been looking to packaging to provide them with a way to improve drug safety and dispensing. The Food & Drug Administration had also been continuing on its path to improve product safety for both the hospital and home-care markets.
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III. CONSUMER EDUCATION The mission of Attorney General McGraw's Consumer Protection Division is to protect West Virginia citizens from those that would harm them. Undoubtedly, the best protection is education and the division embarks each year on educating citizens about the latest scams, consumer fraud, and abuse. The Division employs five consumer advocates and a senior citizen liaison officer in an effort to reach citizens all over the state and in all age groups. Attorney General McGraw's efforts in educating consumers about fraud and abuse were recognized this year by the National Association of Consumer Agency Administrators NACAA ; . During its annual conference in San Diego, California, NACAA presented McGraw's office with the Achievement in Consumer Education Award. McGraw's office won the award because of three public service announcements it created to inform consumers about their rights to a refund under several antitrust settlements. All three cases had been filed against large pharmaceutical companies that engaged in anti-competitive conduct, which resulted in high prices for prescription drugs for consumers. After litigating numerous cases involving the illegal pricing of prescription drugs, McGraw realized that consumer education on this critical issue was necessary. In.
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SCIENTISTS AND POLICYMAKERS often differ, but they do agree on two points: the inevitability of a flu pandemic, and the need to produce as much vaccine as feasible in the shortest time. Pandemics are global disease outbreaks that can occur when a microbe infects people for the first time. Disease can spread rapidly around the world because people's immune systems struggle to fight something they have not encountered before. A flu pandemic would be doubly bad news for developing countries, as they are the least prepared to detect and deal with one emerging and will probably be last in line for any vaccine that can be made. Vaccines can protect people from infectious diseases. They present our bodies with a `sneak preview' of a dangerous microbe, allowing our immune systems to prepare defences. But researchers simply do not have the ingredients needed to make a pandemic flu vaccine ahead of time. "Production cannot start before a pandemic strain of flu emerges, " explains Klaus Sthr, head of the World Health Organisation's WHO ; global flu programme. THE MISSING INGREDIENT If one of the dozens of bird flu viruses that occasionally infects humans' changes, becoming able to spread easily between people, it could spark the next flu pandemic. But until that happens, the pandemic virus does not exist. So 8 | The Healhcare journal what is there to give a sneak preview of? And would it ever be possible to produce enough vaccine to protect everyone at risk? "We would be guilty of negligence if we just sat on our hands and waited, " says John Oxford, a professor of virology at Queen Mary School of Medicine in London, United Kingdom. Oxford is referring to the H5N1 bird flu virus that first killed a person in 1997 in Hong Kong, resurfacing in Asia in 2003. H5N1 has killed fewer people in the past three years just over 100 people than seasonal flu kills every day. More alarming is that over half those infected have died and that the virus is so widespread among birds. Governments and international agencies are preparing for the possibility of H5N1 getting better at infecting people and spreading between them. Even though this could take years, at least 12 companies and 17 governments are developing potential vaccines in 28 different clinical trials. GAMBLING ON SIMILARITY Researchers are gambling that the pandemic flu virus will at least resemble H5N1, and that a vaccine based on the virus circulating now will provide some protection. Such a pre-pandemic vaccine could buy time during an initial outbreak, while researchers rush to produce a true pandemic vaccine from the new virus. What a race it would be. Based on 20th century flu pandemics, computer models suggest that within three months of emerging, a pandemic virus could have reached every continent. Within 6-9 months, it could have reached every country. Yet, according to Sthr, it will take at least three months from the virus' emergence until full-scale vaccine production can begin. "Over the next nine months, vaccine production would increase until, if everything went well, one billion doses were produced one year after the virus was first identified, " he says. Because flu vaccines are made from the virus itself, making a global or even national supply requires first producing large amounts of virus. Traditionally, researchers mass-produce the viral component of vaccines by injecting the virus into chicken eggs, where it replicates within the embryo. But the method is slow, needs a lot of space and requires a large supply of chicken eggs, usually 1-2 eggs per dose of vaccine something that could be problematic if H5N1 continues to plague the poultry industry. A WIN-WIN ANSWER? As a partial solution, the WHO is urging countries to make more seasonal flu vaccine. "The seasonal flu vaccine is underused, " says Sthr, "Yet it is cost effective and cost limiting". Sthr points out there will always be the threat of another pandemic, even though it could be years before one emerges. He says boosting production and use of the seasonal flu vaccine would be a "win-win solution" because by the time a pandemic hits, "there would be enough production capacity for pandemic flu vaccine too". Licensing a vaccine based on one.
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