VIOLENCE to protect distribution and production of marijuana, those involved in a growing operation may be armed with weapons, and have been known to carry out assaults or homicides. Criminal elements attracted to the area to purchase the marijuana may also be armed and violent, or commit residual crimes. INCREASED CRIME Marijuana from home grow operations are sold to children and other members of the community. The money raised from these sales are used to fund organized crime. In their 2002 Special Report, the Canadian Intelligence Service Canada stated that "the Hells Angels and Asian-based organized crime groups, particularly Vietnamese-based groups, continue to be extensively involved in the large-scale cultivation and exportation of marihuana." BOOBY TRAPS - traps may be set by growers to protect their product from unauthorized persons entering the home or property. These traps can be life threatening, and expose emergency responders and others entering the property ; to hazardous conditions. POWER OUTAGES the rewired electrical systems can become overloaded, and may even cause hydro transformers to blow HIGHER UTILITY COSTS the cultivation of marijuana requires large amounts of water and electricity, so utilities are tampered with and redirected from neighbouring sources. By stealing the utilities, the costs of growing the marijuana are lowered. However, this theft leads to higher utility bills. STRUCTURAL DAMAGE houses are modified to suit the growing operation, damage may be caused from the construction or the cultivation of marijuana. Extensive repairs are required to make the house habitable after the growing operation has been shut down. ENVIRONMENTAL DAMAGE - chemicals used in the grow operation are improperly disposed of, draining into the ground and water system. HAZARD TO CHILDREN - Children in the neighbourhood are exposed to the dangers mentioned above, and may be sold marijuana. Police have also found children living or brought by their parents to the grow houses, exposing them to these hazards.
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News ASPET's First Electronic Election . page 107 EB'04 Program Grid . page 110 Scientific & Regulatory Challenges Involving Dietary Supplements and Botanical Products . page 112 Team Learning: Small-group Activities in the Large-group Lecture Hall . page 112 ASPET Merck Fellowships Awarded . page 117 Mid-Atlantic Pharmacology Society Meeting & Abstracts . page 131 Features Journals . page 116 Public Affairs & Government Relations . page 117 Division News . page 119 Members in the News . page 122 Staff News . page 122 New Members . page 124 Obituaries . page 127 Death Notices . page 129 Chapter News . page 130 Contributors for 2003 . page 141 Membership Information & Application . page 145 Announcements Late-Breaking Abstracts for EB'04 . page 108 Instructions for Oral Presentations EB'04 . page 113 2nd RGS Proteins Colloquium . page 114 Pharmacotherapy of Obesity . page 115 2004 FASEB Summer Research Conferences . page 142 Call for Proposals FASEB Summer Research Conferences . page 143 and proventil.
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Medical Resident Dvorkin Lounge, WMHSC Dear Resident I pleased that you will be joining the GI Service rotation from DATES. I very much look forward to meeting you when you begin your rotation. May I suggest that you report to ATTENDING PHYSICIAN on Station 5E3 at 8: 00 your starting day to work on the Ward Service. For purposes of excellent patient care, we expect you to "take charge of the patient's care", to write progress notes on each patient at least three times a week and to dictate the discharge summary on all patients under your care within 48 hours of the patient's discharge. Would you kindly also remember to telephone the referring family doctor on the day of discharge telling them about the hospital inpatient stay and the care plan. You are also invited to attend the Tuesday afternoon 2: 15 - 3: teaching session, and are to round on your patients on Thursday before and after the GIM Academic Half Day. Please note that when the GI residents are on call, after hours and weekend consults from InPatient Services are the responsibility of the on-call GI Fellow, whereas consults from Emergency Room are the responsibility of the GI Resident on call. We are also offering you a learning oral examination towards the end of your rotation. This is intended to be supportive and informative. At the end of the various sub-specialty rotations, there will be a practice multiple-choice exam. I happy to welcome you to join my Thursday morning teaching clinic. The outline of the clinic is attached. The Division of Gastroenterology website, which we encourage you to visit, can be found at, " departmentofmedicine.ualberta gastro education ". On our website you will have access to: a. A training manual entitled: "General Internal Medicine Program in Gastroenterology, Training Handbook". b. A suggested reading resource list entitled: "Reading Lists for Gastroenterology Junior Resident". These articles are available in full text on the Chedesk Vividesk program available on many CHA computers and downloadable for personal use at cche . A temporary password for this GI specific online area can be obtained through the GI Education Secretary at 492-8243. Those residents who want extra or more detailed information are free to peruse the Senior Resident GI Fellow reading collection and or some major Gastroenterology reference texts also on Chedesk. I would urge you to read the GI section of MSKAP available through Dr. P. Hamilton's office ; c. A list of "Ward Rotation Specific Objectives" relating to the "Ward Service" that will help you achieve the knowledge-based objectives of the program. d. A schedule of the regular teaching activities. see attached ; e. Standing patient orders see attached.
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The figure above is highly stylised and drawn from published figures upon nifedipine. It has been drawn for illustrative purposes only to show the difference between nifedipine dosed three times daily in an immediate release formulation compared with an equal total dose as Pdocardia XL. The immediate release formulation produces three plasma level peaks approximately 30 minutes after each dose. The plasma half life of each peak is about two hours. The extended release tablet does not reach its peak until six hours and it is lower than those of the immediate release preparation. However, these levels are maintained for much longer periods. In fact, after a few doses of the XL tablet, plasma levels are almost constant, providing continuous protection. The important parameter for testing the bioequivalence of the two formulations is the area under each of the curves.
Chapter 3 Table 3.1: KD and pKi values of mepyramine for human H1 receptors transiently expressed in COS-7 cells, Sf9 cells and for reconstituted receptor purified from Sf9 cells. Receptor Kd nM ; pKi Ref and relafen.
26 Hohnloser SH, Kuck KH, Dorian P, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med. 2004; 351: 24818. Bristow MR, Saxon LA, Boehmer J, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004; 350: 214050. Freudenberger RS, Kim J, Tawfik I, et al. Optimal medical therapy is superior to transplantation for the treatment of class I, II, and III heart failure: a decision analytic approach. Circulation. 2006; 114: I62I66. 29 Taylor DO, Edwards LB, Boucek MM, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-second official adult heart transplant report 2005. J Heart Lung Transplant. 2005; 24: 94555. Oechslin E, Brunner-LaRocca HP, Solt G, et al. Prognosis of medically treated patients referred for cardiac transplantation. Int J Cardiol. 1998; 64: 7581. Aaronson KD, Schwartz JS, Chen TM, et al. Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation. 1997; 95: 26607. Mehra MR, Kobashigawa J, Starling R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates 2006. J Heart Lung Transplant. 2006; 25: 102442. Rickli H, Kiowski W, Brehm M, et al. Combining low-intensity and maximal exercise test results improves prognostic prediction in chronic heart failure. J Coll Cardiol. 2003; 42: 11622. Ponikowski P, Francis DP, Piepoli MF, et al. Enhanced ventilatory response to exercise in patients with chronic heart failure and preserved exercise tolerance: marker of abnormal cardiorespiratory reflex control and predictor of poor prognosis. Circulation. 2001; 103: 96772. Logeart D, Thabut G, Jourdain P, et al. Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure. J Coll Cardiol. 2004; 43: 63541. Latini R, Masson S, Anand I, et al. The comparative prognostic value of plasma neurohormones at baseline in patients with heart failure enrolled in Val-HeFT. Eur Heart J. 2004; 25: 2929. Akram K, Pearlman BL. Congestive heart failure-related anemia and a role for erythropoietin. Int J Cardiol. 2006. 38 Hampl H, Hennig L, Rosenberger C, et al. Effects of optimized heart failure therapy and anemia correction with epoetin beta on left ventricular mass in hemodialysis patients. J Nephrol. 2005; 25: 21120.
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N an otherwise enticing article by Schmitz et al. 1 ; in the February 2002 issue of Diabetes Care, the authors make several assertions that are difficult to support by the data presented in the article. The authors discuss "early-phase" insulin secretion numerous times throughout their article and seem to consider this term the same as "acute phase" insulin secretion CONCLUSIONS, paragraph two, line 13: "[ .] early-phase insulin release is one of the first defects to appear as type 2 diabetes develops" ; . Based on this assumption, they conclude that the study drug did indeed improve "early-phase" insulin secretion presumably within 10 min after administration, by their definition ; CONCLUSIONS, paragraph 2, line 9 ; but there are no data presented in their article to support this contention. As best as I could tell, Schmitz et al. measured blood samples 43 times over 24 h, but the intervals of measurement are not given. Even if they measured insulin levels at 1-min intervals after oral glucose administration, would this be equivalent to insulin secretion after intravenously administered glucose? Perhaps I missing something here, but are these two terms interchangeable acute-phase insulin release and early-phase insulin secretion ; ? I would greatly appreciate it if the authors could clarify this point for me. MARSHALL B. BLOCK, MD.
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According to a report from the National Pharmaceutical Council, some 125, 000 deaths each year in the United States can be attributed to the improper administration of prescription drugs. In addition, failure of patients to take the drugs properly accounts for 10% of all hospital admissions, 25% of hospital admissions among the elderly, and 23% of all nursing home admissions. The national cost of this widespread prescription misuse exceeds $77 billion a year. Many members of the medical establishment -- which calls these tragedies "drug misadventures" -- are quick to place the blame on pharmacists in an attempt to absolve themselves. One research study pointed out that fully one-third of the surveyed pharmacists failed to catch a potentially fatal prescription error. Yet, some medical experts admit modern medical care is so rushed that doctors often do not exercise the caution needed when writing prescriptions. Instead of blaming pharmacists, they're looking for ways to have them shoulder more of the responsibility. "In an age when physician visits are often limited to 10 or minutes, pharmacists could play a valuable role in reinforcing instructions, " noted an article in American Medical News. SOURCES: "Pharmaceutical care touted as way to cut drug errors, " by Sandra Lee Breisch, American Medical News, April 8, 1996. "Drug-related morbidity and mortality: a cost-of-illness model, " by Jeffrey A. Johnson and J. Lyle Bootman, Ph.D., Archives of Internal Medicine, Oct 9, 1995 v155 n18 p1949 8 ; . 83.
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Directions: Please indicate your level of experience by placing an x ; in the box. Experience level: No Experience Minimal experience - requires supervision Assistance A. ANTPARTEM 1. Assessment a. Assess for comfort b. Breathing relaxation techniques c. Coaching d. Positioning 2. Equipment & procedures a. Catheter insertion 1 ; Foley catheter 2 ; Straight catheter b. Delivery table set-up c. Sonogram 1 ; Amniotic fluid index 2 ; Assist with sonogram 3 ; Biophysical profile 4 ; Perform Sonogram B. LABOR ASSESSMENT 1. Fetal assessment a. Auscultate fetal heart rate 1 ; Doppler 2 ; Fetoscope b. Determine fetal position c. Document FHR patterns d. Identify normal & treat abnormal FHR patterns 1 ; Baseline 2 ; Early decelerations 3 ; Late decelerations 1 2 1 Variable decelerations 2. Mental assessment a. Deep tendon reflexes DTRs ; b. Edema c. Norms for perinatal vital signs d. Perform admission risk assessment e. Presence of clonus f. Progression of labor 1 ; Contraction Characteristics 2 ; Dilation 3 ; Effacement 4 ; Fetal presentation position 5 ; Station 6 ; Status of membranes 7 ; Sterile speculum exam 8 ; Vaginal exam g. Rupture of membranes 1 ; Fern test 2 ; Nitrazine 3. Equipment & procedures a. Artificial rupture of membranes assist ; 1 ; Prolapsed cord 2 ; Recognize potential complications 3 ; Vasa previa b. Collect blood urine specimens c. Collect vaginal cultures Moderate experience - requires initial review Very experienced - proficient 1 2 3 Prolonged decelerations 5 ; Variability First Name 3 ; Group B strep 4 ; Herpes d. Document labor status assessment & interventions 1 ; Anticonvulsants 2 ; Labor suppressants e. External fetal monitor application 1 ; Doppler 2 ; Phono or abdominal, ECG transducer 3 ; Tocotransducer, ultrasound f. Internal monitoring assist or perform insertion ; 1 ; Intrauterine pressure catheter a ; Fluid filled b ; Transducer tipped 2 ; Spiral electrode g. Perform Leopold's maneuvers h. Toxicology studies 4. Medications a. Administer IM SC b. Administer IV meds monitor IV drips 1 ; Antibiotics 2 ; Antihypertensives 3 ; Anti-Tocolytics 4 ; Heparin 5 ; Magnesium sulfate 6 ; Narcotics 7 ; Narcan 8 ; Oxytocin 9 ; Tocolytics c. Assist with prostin gel d. Cervidil insertion e. Use of Cytotec f. Use of prostin suppositories C. COMPLICATIONS OF PREGNANCY 1. Assessment a. Identify common arrhythmias b. Normal cardiac rhythms c. Patient education fetal movement counts 2. Equipment & procedures 1 2 3 Chlamydia 2 ; Fluid Last Name b. Assist with fetal scalp sampling c. Assist with percutaneous umbilical sampling d. Assist with umbilical blood sampling e. Circulate for Cesarean delivery f. Circulate, scrub for bilateral tubal ligation g. Conduct contraction stress test 1 ; Breast stimulation 2 ; Oxytocin challenge h. Conduct non-stress test 1 ; Stimulate fetus 2 ; Vibroacoustic stimulation i. Draw umbilical blood samples j. Glucose reflectometer k. Lines monitoring 1 ; Central venous lines 2 ; Invasive hemodynamic monitoring 3 ; PICC lines 4 ; Pulmonary artery catheters l. Scrub for Cesarean delivery m. Set up Cesarean delivery 3. Care fo the patient with: a. Abruptio placenta b. Asthma c. Cardiac disease d. Choriamnionitis e. Chronic hypertension f. Collagen vascular disease g. Diabetes h. Eclampsia i. HBV j. HELLP syndrome k. Hemolytic anemias l. Hemorrhage m. HIV positive n. Hypertension o. Malpresentations p. Multiple gestations 1 2 3 First Name r. Placenta previa s. Preeclampsia t. Premature labor u. Pyelonephritis v. RH disease w. Sickle cell disease 4. Medications a. Indomethacin b. Insulin c. Magnesium sulfate d. Procardia e. Ritodrine f. Terbutaline 1 ; IV 2 ; Pump 4 ; SC D. INTERVENTIONS DURING PREGNANCY 1. Cesarean section 2. Forceps vaginal delivery 3. Monitor patients with anesthesia a. Genearal anesthesia b. Regional anesthesia 1 ; Epidural 2 ; Local infiltration 3 ; Spinal 4. Spontaneous vaginal delivery 5. Vacuum extraction delivery.
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