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Welcome to the spring 2003 edition of Notable Nursing, a newsletter produced by the Cleveland Clinic Division of Nursing. Now in its second year, we are pleased to broaden the distribution of this newsletter to our colleagues in the community and the nation. We also wish to welcome nursing faculty and students to our readership. In this issue, you'll read about our new nursing practice model that is based on a collaborative team approach. The model has been designed to elevate the stature of nursing at the Clinic by giving a voice to nursing practice -- demonstrating that nurses provide care that is complex, skilled and essential. You'll also learn about a new nonverbal pain assessment tool that we developed for use in our intensive care units. An update on feeding tube practices is provided, as well as a review of ventricular assist devices. Those interested in neuroscience nursing will want to read the highlights from our 5th Annual Neuroscience Nursing Conference. From a personal perspective, read how one couple, who met and fell in love in nursing school 20 years ago, continue to find their nursing careers professionally and personally fulfilling. Notable Nursing reflects the commitment that Cleveland Clinic nurses, because lanoxin classification.
S.B. Sirima. Centre National de Rechere et de Formation sur le Paludisme CNRFP ; , Ouagadougou, Burkina Faso Background: Recent WHO guidelines have urged the use of artemisinbased combination therapies ACTs ; in uncomplicated Plasmodium falci p a ru because of gr owing resistance to and reduced efficacy of a other available thera p i e Fixed-dose combinations FDCs ; could improve compliance, accessibility, and therefore, maximize the benefits of FDCs. Although malaria kills 23 million people ever year in Africa, no FDC for use in children and adults was available. Methods: In this randomized, controlled trial conducted in Burkina Faso, the non-inferi o rity of fixed-dose artesunate plus amodiaquine AS AQ ; was compared with the loose formulation of artesunate plus amodiaquine A S + children aged between 6 and 59 months. O ver a three-day ; treatment course, children aged 611 months and 15 years were given either one or t wo tablets of 25-mg 67.5-mg AS AQ respectively, or a half- or full-tablet each of 50-mg AS + 153-mg AQ respectively. Primary endpoints were parasite cure rate at day 28, parasite clearance time, and gametocyte carriage rate at day 28. Safety and tolerability were also assessed. Preliminary Results: Of 1426 children screened, 750 were enrolled. With the last patient visit in February 2006, preliminary analysis is currently being completed and will be presented at the congress. Conclusion: Field success of antimalarials depends on many factors, including compliance and safety. With its pediatric formulation, improved dosing course, and projected lower cost, AS AQ could be considered for first-line treatment of uncomplicated P. falciparum m a l ria if it is comparable to AS-AQ in terms of ove rall treatment outcomes. These results lend further support to the use of the AS AQ combination that is now available as a FDC.
The patient's medications were reviewed and I found that a different brand of digoxin from his Panoxin PG had been recommended. The box had a label of Sigmaxin PG, but it contained digoxin 250 microgram tablets. The patient had therefore been taking four times his usual dose. The digoxin was stopped and the concentration returned to normal. His pulse rate increased to 48 and gradually his xanthopsia disappeared. He developed marked oedema while off digoxin.
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Reaction time RT ; is given in ms, accuracy in percent of correct answers. Red: load levels and measures of significantly worse performance in patients with schizophrenia compared with healthy controls. Blue: load levels and measures in which cognitive performance of patients with schizophrenia showed a significant improvement after 78 weeks of treatment. t1 1st session, t2 2nd session after 78 weeks of treatment and
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ARE THERE BENEFITS TO TAKING PART IN THE STUDY? If you agree to take part in this study, there may or may not be direct medical benefit to you. We hope the information learned from this study will benefit other patients with cervical cancer in the future. WHAT OTHER OPTIONS ARE THERE? You may choose to not participate in this study. Other treatments that could be considered for your condition may include the following: 1 ; radiation therapy; 2 ; chemotherapy; 3 ; surgery; or 4 ; no treatment except medications to make you feel better. With the latter choice, your tumor would continue to grow and your disease would spread. These treatments could be given either alone or in combination with each other. Your doctor can tell you more about your condition and the possible benefits of the different available treatments. Please talk to your regular doctor about these and other options.
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Consider an Angiotensin II Receptor Blocker e.g., Diovan, Avapro, Benicar ; for patients who are contraindicated or intolerant to an ACE Inhibitor. 2. For NYHA I, II and III, may consider spironolactone if symptoms persist after achieving optimal dose of ACE Inhibitors, Beta-Blocker, digoxin and diuretic. FORMULARY AGENTS Beta-Blockers Diuretics ACE Inhibitors Accupril * quinapril ; Coreg carvedilol ; Lasix * furosemide ; Capoten * captopril ; Lopressor * metoprolol ; Hydrodiuril * hydrochlorothiazide ; Lotensin * benazepril ; Toprol XL Bumex * bumetanide ; Zestril * lisinopril ; Zaroxolyn * metolazone ; Demadex * torsemide ; Monopril * fosinopril ; Digitalis Vasotec * enalapril ; Lanoixn digoxin ; * Aldactone * spironolactone and
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Sample questions the pharmacist could ask: "I noticed you have been on Pantoloc for six months now; have you discussed with your doctor how long you need to be continued on this therapy?" 2 ; "Has your doctor told you why he would like to you to continue taking Pantoloc?" 3 ; "Do you still have symptoms of ulcer pain or other symptoms related to stomach upset e.g., heartburn, acid regurgitation, excessive burping or belching, increased abdominal fullness, nausea, feeling of slow digestion ; ? and
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LANOXIN digoxin ; Injection To allow adequate time for equilibration of digoxin between serum and tissue, sampling of serum concentrations should be done just before the next scheduled dose of the drug. If this is not possible, sampling should be done at least 6 to 8 hours after the last dose, regardless of the route of administration or the formulation used. On a once-daily dosing schedule, the concentration of digoxin will be 10% to 25% lower when sampled at 24 versus 8 hours, depending upon the patient's renal function. On a twice-daily dosing schedule, there will be only minor differences in serum digoxin concentrations whether sampling is done at 8 or hours after a dose. If a discrepancy exists between the reported serum concentration and the observed clinical response, the clinician should consider the following possibilities: 1. Analytical problems in the assay procedure. 2. Inappropriate serum sampling time. 3. Administration of a digitalis glycoside other than digoxin. 4. Conditions described in WARNINGS and PRECAUTIONS ; causing an alteration in the sensitivity of the patient to digoxin. 5. Serum digoxin concentration may decrease acutely during periods of exercise without any associated change in clinical efficacy due to increased binding of digoxin to skeletal muscle. Heart Failure: Adults: Digitalization may be accomplished by either of two general approaches that vary in dosage and frequency of administration, but reach the same endpoint in terms of total amount of digoxin accumulated in the body. 1. If rapid digitalization is considered medically appropriate, it may be achieved by administering a loading dose based upon projected peak digoxin body stores. Maintenance dose can be calculated as a percentage of the loading dose. 2. More gradual digitalization may be obtained by beginning an appropriate maintenance dose, thus allowing digoxin body stores to accumulate slowly. Steady-state serum digoxin concentrations will be achieved in approximately five half-lives of the drug for the individual patient. Depending upon the patient's renal function, this will take between 1 and 3 weeks. Rapid Digitalization with a Loading Dose: LANOXIN Injection is frequently used to achieve rapid digitalization, with conversion to LANOXIN Tablets or LANOXICAPS for maintenance therapy. If patients are switched from intravenous to oral digoxin formulations, allowances must be made for differences in bioavailability when calculating maintenance dosages see Table 1, CLINICAL PHARMACOLOGY: Pharmacokinetics and dosing Table 5 below ; . Intramuscular injection of digoxin is extremely painful and offers no advantages unless other routes of administration are contraindicated. Peak digoxin body stores of 8 to mcg kg should provide therapeutic effect with minimum risk of toxicity in most patients with heart failure and normal sinus rhythm. Because of altered digoxin distribution and elimination, projected peak body stores for patients with renal insufficiency should be conservative i.e., 6 to 10 mcg kg ; [see PRECAUTIONS]. The loading dose should be administered in several portions, with roughly half the total given as the first dose. Additional fractions of this planned total dose may be given at 6- to 8-hour intervals, with careful assessment of clinical response before each additional dose. If the patient's clinical response necessitates a change from the calculated loading dose of digoxin, then calculation of the maintenance dose should be based upon the amount actually given.
Women with the hormonal disorder, polycystic ovarian syndrome, may be unusually sensitive to certain hormones and may respond abnormally to usual doses of this drug.
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TITLE PAGE Reinfection and mixed infection cause changing Mycobacterium tuberculosis drug-resistance patterns. Annelies van Rie PhD ; 1, Thomas C. Victor PhD ; 2, Madalene Richardson MSc ; 2, Rabia Johnson MSc ; 2, Gian D. van der Spuy MSc ; 2, Emma J. Murray BSocSci Hon 3, Nulda Beyers PhD ; 3, Nico C. Gey van Pittius PhD ; 2, Paul D. van Helden PhD ; 2, Robin M. Warren PhD ; 2.
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