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30591 - ERICS 07/04Using a specific massage technique on the hands or feet, the therapist focuses upon reflex points which represent other parts of the body. It is believed that the pressure assists the flow of energy and stimulates the body's self-healing mechanism. \2How can it help? Shiatsu Shiatsu was pioneered in Japan and is based on the same principles as acupuncture but without the needles. It involves creating pressure through manipulation using the fingers and thumbs along predetermined natural `pathways' along the body. The technique can be learnt, practised and applied by the patient themselves. Complementary medicine - efficacy for children with bowel & bladder difficulties Complementary medicine - additional ways to help relieve the stress of symptomsapr2003What are older people prepared to do to avoid falling? There is no evidence that primary prevention programmes reduce unintended teenage pregnancies Evidence-based Healthcare 2003 MAR 7 ( 1 ): 8 - 9 Preventative programmes evaluated to date did not delay first ual intercourse, improve the use of contraception or reduce pregnancy. Consultations with practice nurses may improve adolescent health behaviours slightly Evidence-based Healthcare 2003 MAR 7 ( 1 ): 14 - 15 Questionnaires were completed at baseline, 3 months and 12 months. Diets were improved at intervention, exercise at 3 months, but only positive mental health outcomes persisted at 12 months Smoke-free class competition may delay the onset of smoking in adolescence Evidence-based Healthcare 2003 MAR 7 ( 1 ): 18 - 19 Schools were sent fliers inviting classes to participate in a prize draw if they qualified by refraining from smoking. Self- assessed smoking status at baseline, 1 month and 1 year showed a decrease Untitled-3Heartlands and Solihull hospitals have been recognised as the UK's leading hospitals in the fi ght against MRSA. Figures released by the Government in June show that Heart of England NHS Foundation Trust has made the biggest reduction in cases of MRSA amongst acute hospitals in England, reducing them by 30%. We have carried out extensive research and come up with new ways of improving cleanliness at both Heartlands and Solihull hospitals, including: - Implementing the cleanyourhands campaign - all patients have alcohol gel hand rub by their bedside so they, and their visitors can keep their hands clean. Gel dispensers and hand washing facilities are at every ward entrance, and cleanyourhands staff champions make everyone clean their hands on entering and leaving the ward Cleaners have strict training procedures, and use colour coded mops for different areas to reduce the educe the ferent areas to r risk of spreading bacteriaeading bacteria We are proud to be one of the oud tountitledFor many years, the Division of Gastroenterology and Hepatology at Saint Louis University has sponsored one-half day "Updates in Gastroenterology and Hepatology". For those of us who have participated in these programs and we think for many of you, the attendees, the format of a half day or full day of lectures has become somewhat stale and often redundant. Accordingly, we have taken the initiative to totally revise our CME offerings for our colleagues and referring physicians. We have developed a series of four interactive dinner debates, featuring an outstanding set of clinician educators covering the practical aspects of clinical gastroenterology and hepatology. The design for the dinner series is to invite controversy and debate about practical problems that come up in every day clinical practice. As you can see from this calendar of events, the faculty are recognized experts and lively discussions will certainly ensue. In addition, the hepatology groupA121_05aprl_Intro_S4toS6Despite the wide-ranging physical manifes-tations of this disorder, which include cramping, abdominal pain, constipation, bloating, and diarrhea, IBS receives little attention compared with less prevalent con-ditions, perhaps because of the nature of the symptoms of IBS and/or because most peo-ple with IBS do not seek medical attention.2 It is also estimated that among patients with IBS, approximately 25% seek medical care for their symptoms, and only 5% are seen in the tertiary care setting. However, although it appears that the percentage of patients seeking medical care for IBS symptoms rep-resents a small percentage of those with IBS, the high prevalence of the disorder results in sizable direct costs for physician visits and pharmacologic treatments. Kozma and col-leagues3 have reported that IBS-related physician visits (adjusted for prevalence) occur at approximately the same rate as vis-its for asthma and migraine headaches. Economic Impact of Irritable Bowel SyndromeNo Slide TitleModel-based development is not really ready to replace classical empirical mode of development From an Architectural Perspective Empirically based development process is: Predictable in cost and schedule Informatic elements straightforward and relatively easy to acquire Reliable, repeatable, and determinable Programmatic - `recipe driven' development Outcome adequate for major stakeholders P value - driven concept of efficacy and safety From an Architectural Perspective Model based development is: Highly cost/schedule variable Data availability and quality problems Model dependent, analyst dependent, and multiply interpretable Non-programmatic - MBD is both a `hypothesis generator' and a confirmator Outcome is overly complex for historical stakeholder purposes Principal stakeholders must consciously want and accept the need for complex characterizations of efficacy and safety Nevertheless: "There's gold in them thar hills." Indication: For the treatmentChronic fatigue syndrome and neurocognitive function (abst). #247/248 p.50 Chronic fatigue syndrome and psychiatric disorders (abst). #247/248 p.51 Chronic fatigue syndrome and stress (abst). #247/248 p.51 Chronic fatigue syndrome/cognitive therapy (abst). #247/248 p.51 Chronic fatigue syndrome/genetic influences (abst). #247/248 Gastrointestinal disorders/psychosocial factors (abst). #252 p.142 Gingival health and stress (abst). #250 p.45 Head and neck cancer and optimism (abst). #251 p.50 Hostility, pro-inflammatory factors and acute coronary syndromes (abst). #250 p.44 Hostility, tumor necrosis factor and atherosclerotic cardiovascular Inflammation and stress (abst). #250 p.46 Information processing (abst). #246 p.52 Insomnia/stress (abst). #249 p.140 Intention/inanimate-animate systems (abst). #246 p.54 Irritable bowel syndrome and emotions (abst). #252 p.139 Irritable bowel syndrome and hypnosis (abst). #252 p.141 Irritable bowel syndrome and mind-body GSK Tummy Supp_nyNearly every HIVer--and non-HIVer for that matter--has tummy troubles at one time or other. But for HIVers, chronic gastrointestinal (GI) problems are especially common, often caused by HIV meds or other meds you take. Problems can range from mild nausea or diarrhea to serious conditions such as GERD (Gastroesophageal Reflux Disease). Dietary changes always form the critical foundation of any treatment strategy, and there are effective medications--both over the counter and by pre-scription--to alleviate most of these symptoms. Unfortunately, some of the best meds for your stom-ach problems don't play well with HIV meds, and not all doctors are hip to these interactions. Making smart choices could save you hours of writhing in pain and pre-vent the failure of your current HAART regimen. Both the nutrients in food and the active ingredients in your meds face an obstacle course on the way from your mouth to your bloodstream. From the moment they pass your lips, special musclesPGN0052 Phase 2a clinical trial continues on track, results due end 2004 PEGylation collaboration and potential co-development deal with Enzon for PGN 0052 in CF & other respiratory indications Significant new indication for R65 in glaucoma (patent filed) Active licensing discussions for 4 lead programmes progressing Healthy volunteers and asthma patients Intravenous form safe and effective in modifying FEV1 Very short pharmacokinetic & pharmacodynamic half-life 18 subjects with mild/moderate CF (3 UK trial centres) Primary endpoint mucociliary clearance rate On schedule to complete and report end Q4 2004 Agreement signed for feasibility of PEGylating secretin PEGylation likely to take 6-9 months Several versions to be tested for increase in half-life in vivo If success criteria are met companies can enter a co-development deal On entering this co-development agreement costs will be shared and Pharmagene eligible for significant (£26.5 CoberleyCarter 2.03 Final.ppt- AMHC programs have produced outcomes that bend the overall medical cost trend for health plans and their employer customers. Improve health of populations, Enhance patient satisfaction & care experience, Enhance physician satisfaction & delivery experience, Reduce total health care cost, and Improve work force productivity We leverage our proprietary system, Platform, tools and analytics to create a scalable"outcomes centric" intervention model "Care Enhancement" call centers and home-based telework teams are staffed by empathetic and highly skilled nurses Field-based nurses work face to face with patients, physicians, and other providers to ensure best outcomes AMHC Health Management Programs - Predictive Modeling refers to the process of finding rules (models) for predicting an event from prior patterns within a given time frame and applying these rules to current data in order to predict a future event. - American Healthways applies artificial intelligence1. Chronic pain is a disease in and of itself. Pain not only affects a person's physical well-being, but also his or her emotional, psychological and financial health. Chronic pain not only affects the individual pain sufferer, but also impacts the lives of family and friends. 2. Chronic pain represents a pervasive problem, with more than 75 million Americans suffering from chronic, debilitating pain. More than 50 million of these individuals are partially or totally disabled by pain. Over 55 percent of senior citizens report suffering from pain on a daily basis. 3. Chronic pain is an important public health issue that has a significant negative impact on the U.S. economy. Conditions most associated with pain include arthritis, headaches, neck and back problems, cancer, neuropathies, chronic regional pain syndrome (CRPS), irritable bowel syndrome, pelvic pain disorder and interstitial cystitis, shingles and soft tissue pain. (JCFS 11\(1\))Recent years have brought growing recognition of the need for clinical criteria for myalgic encephalomyelitis (ME), which is also called chronic fatigue syndrome (CFS). Diagnostic and treat-ment protocols, and a short overview of research are given to facilitate a comprehensive and integrated approach to this illness. While the pathogenesis is suggested to be multi-factorial, the hypothesis of initiation by a viral infection has been prominent. As antibody titers in standard laboratory tests usually employ a whole viral preparation or a single viral polypeptide, an incomplete or mutated pathogen replication could go undetected. Before acquiring the illness most patients were healthy, leading full and active lifestyles. Within days or weeks of the initiating event, patients show a progressive decline in health and develop a cascade of symp-toms. The subset of patients that have a gradual onset are less likely to show discrete triggering events. There has been a growing demandMC2024-0501Scope of Problem Stroke is the third-leading cause of death in the industrialized world. In the United States each year, an e stimated 750,000 people experience a new or recurrent stroke, which contributes to approximately 160,000 deaths. Carotid artery occlusive disease is an important cause of stroke. When carotid artery stenosis causes symptoms of transient ischemic attack (TIA) and the vessel lumen is narrowed by 70%, the chance of a stroke occurring is approximately 26% over 2 years if surgery is not performed to open the artery. This risk is reduced to 9% if the artery narrowing is treated surgically. Chronic abdominal pain that is not associated with altered bowel habits is n o t IBS. Mayo Clinic helped pioneer diagnostic technologies that contribute to optimal management of irritable bowel syndrome. Researchers are studying family bowel symptoms to determine if IBS affects families and is under genetic control. Patients are asked to complete a questionnaire aboutjama%20article_060904In a previous study, we surveyed 1725 women with ovarian cancer. Inter-estingly, gynecologic symptoms were the least common of the major groups of symptoms. When we evaluated symp-toms by stage of disease, we found that in contrast to what is published in most textbooks, 89% of women with stage I/II disease reported symptoms prior to their diagnosis and 97% of those with ad- Context Women with ovarian cancer frequently report symptoms prior to diagno-sis, but distinguishing these symptoms from those that normally occur in women re-mains problematic. Objective To compare the frequency, severity, and duration of symptoms between women with ovarian cancer and women presenting to primary care clinics. Severity of symptoms was rated on a 5-point scale, duration was recorded, and frequency was indicated as number of episodes per month. An identical survey was administered preoperatively to 128 women with a pelvic mass (84 benign and 44 malignant). Main Outcome Measures iansod 58268-R4-02-02-1864The pH range is between 3.0 and 5.0. CLINICAL PHARMACOLOGY Hyoscyamine sulfate inhibits specifically the actions of acetylcholine on structures innervated by postganglionic cholinergic nerves and on smooth muscles that respond to acetylcholine but lack cholinergic innervation. These peripheral cholinergic receptors are present in the autonomic effector cells of the smooth muscle, the cardiac muscle, the sinoatrial node, the atrioventricular node, and the exocrine glands. At therapeutic doses, it is completely devoid of any action on autonomic ganglia. Hyoscyamine sulfate inhibits gastrointestinal propulsive motility and decreases gastric acid secretion. Hyoscyamine sulfate also controls excessive pharyngeal, tracheal and bronchial secretions. Hyoscyamine sulfate is absorbed totally and completely by sublingual administration as well as oral administration. For use as adjunctive therapy in the treatment of irritable bowel syndrome (irritable colon, spastic colon, mucous35_1885_454A thorough assessment includes assessment of the psy-chological health of your patient. Mental health reflects a person's positive attitudes toward self, growth and development, self-actualization, integration, autonomy, reality perception, and environmental mastery (Stuart & Laraia, 2001). As you perform your assessment, look for clues that reflect the mental health status of your patient. AREA SIGNIFICANCE When obtaining a history, ask yourself, "What can the health history reveal about the mental health of the patient?" Identify factors that may affect mental health in either a positive or negative way. - Response to stressors differs with age - Identifies possible maturational crises related to developmental changes - Increased bowel sounds seen with excessive use of laxatives in eating disordersuntitledAs president and chief executive officer, I have been charged with developing and implementing a strategic plan to achieve growth by controlling medical costs. In this issue of Update, we've outlined our 2005 Health Management Strategy, which includes enhanced disease manage-ment programs designed to reach more of our members and reduce overall health care costs. If we can reach more of our membership while they are in the early stages of disease, we can go a long way in helping members get healthy and stay healthy. I've had the pleasure of meeting with a number of clients and brokers over the past two months, and I'm pleased to have received many positive responses to our plan of action. Clients and brokers alike have expressed their belief in the impor-tance of a strong Tufts Health Plan to the Massachusetts health care and business communities. Particularly gratifying is the attention that CareLinkSM, a national network plan developed jointly with CIGNA Health Care,1 | 2 | 3
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