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Ata collected through the and dispensing 23.5% ; were the and last name. Fortunately, the U.S. Pharmacopeia's two source of wrong-patient errors. parent at the outpatient pharmanational medication error- Therefore, it is prudent to look cy noticed the error, and a correct reporting programs support the beyond just the administering prescription was obtained. need for improvement in patient phase when targeting wrong- Documenting: Nursing staff entered orders for one patient identification. From January 2000 patient error events. The top five leading causes of into the computer system under through November 2003, 105 wrong-patient errors were re- wrong-patient errors are out- another patient's profile. The ported to the Medication Errors lined in the table below. Perfor- patient profile was found to have Reporting MER ; program. For- mance deficit was the leading the same last four digits in the tunately, the vast majority of reported cause of error listed in account number, and the first letthese errors 101, or 96.2% ; were over 50% of the records ; . Exami- ter of both patients' last name not harmful, with four 3.8% ; nation of records listing per- was the same. The error was disformance deficit as the cause covered on day three of a hospicausing patient harm. In calendar year 2002, the MED- showed distractions were often tal stay. Dispensing: Metformin 500 mg MARX program collected 8, 196 listed as a contributing factor. twice a day ; was wrong-patient medordered for a paication errors, makLeading causes of error tient in room 205-1 ing it the seventhbut entered in the most frequent type involving wrong patients pharmacy computof error accounting Cause of error Number of errors Percent er system under for approximately Performance deficit 4, 148 53.5% room 204-2. The 5% of all reports ; Procedure protocol 2, 364 30.5 wrong patient was in this database. not followed given two doses. Analysis of the Administering: A MEDMARX data Computer entry 1, 143 * 14.7 Incorrect or incomplete ; nurse accessed the also revealed that computerized medmost of the reported Documentation 948 12.2 ication administrawrong-patient errors Transcription 636 8.2 tion record MAR ; , 7, 284, or 89% ; did inaccurate omitted not realizing it renot result in harm, * Computer entry is defined as "incorrect or incomplete information was entered into lated to a different and a small percenta computer system associated with the medication use process." 2002 MEDMARX Data Summary Report patient and subseage 1.4% ; were quently mistakenly harmful. ApproxiComputer entry was the third- administered methocarbamol to mately 10% 800 ; were categorized as potential errors. However, a most frequently cited cause of the wrong patient. The physician considerable number still man- error for wrong-patient events, was notified and the patient did aged to slip past safety checks, indicating that technology has not experience any adverse with more than half 4, 226 or 52% ; the potential both to reduce and sequelae. of these errors reaching the create medication errors. Exampatient. These data signal that ples of computer entry errors in Minimizing wrong-patient errors more needs to be done to improve various MUP medication use Here are some suggestions on the interception of these errors, process ; phases are as follows: how to reduce the risk of giving enhance safety nets, and refine Prescribing: A physician selected drugs to the wrong patients. processes around patient identifi- the patient's father from the com- Some of these suggestions were puter screen when the order was adapted in part from Texas Chilcation. Although the administering actually intended for the son. dren's Hospital's Houston ; draft phase had the highest reported Both patients had the same first policy on patient identification. percentage of where these types 1. Conduct a review of the proof errors originated, there were cesses used in the admission of by numerous times when docuthe patient into the facility. What John P. Santell, M.S., R.Ph. menting transcribing 29.3% ; patient-specific identifiers are.
Parents want to help but are confused Today's parents want to talk to their teenagers about sex. But we parents are baffled by the situation and caught between Puritan prohibition of premarital sex and modern sexual liberalism. That's understandable; there is no one correct position. Should we parents say sex is bad or that sex can be fantastic? If we were to say sex is great, doesn't that encourage young people to have sex? If we emphasize the potential problems associated with having sex pregnancy, hurtful rejection, AIDS and STD, reputation, etc. ; , doesn't that imply sex is all trouble and no pleasure? Since we aren't sure what to say to our teenaged sons and daughters even Hugh Heffner didn't advocate free love to his daughter ; , we parents aren't saying much at all about sex to our children. We don't know if we should restrict our children or let them go free; we want to protect them either way. We don't know whether to say, "Don't do it" or "Use some protection." Sex educations classes taught in only 35% of our high schools ; offer mostly plumbing facts and almost no psychological-interpersonal reasons for and against sex in different circumstances. How can we persuade a 13 or 15-year-old to not have sex if we believe that sex is fine for college students if they are caring, responsible, in love, and use birth control? The argument "you're too young" may not be good enough. If we, as parents, avoid discussing with our 16-year-old son or daughter the possibility of having sex, there is little possibility of helping him her consider the ramifications of unprotected sex and little chance to prepare to use contraceptives. Where else can a 16-year-old get sound, detailed advice about when, how, and with whom to have sex, except from Mom and Dad? Telling them to wait until they're older might work up to 16 17, but not beyond that. Telling them "it's a sin, " may be both ineffective and unwise. Telling them to wait until they are married when many don't expect to get married until they are 30 ; , just isn't "going to fly." Better "get real " and get detailed with them in the early teens.
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At 52 weeks Mean no. of days taking medication Compliance -- % Average rate of attendance at monthly follow-up visits -- % Drinking calendars at week 52 -- no. % ; Complete data for patient Complete or partial data for patient * Plusminus values are means SD. These groups were the same for the first 13 weeks and methotrexate.
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I reported in the Fall edition of this newsletter that the Irish company Elan was testing a promising vaccine against Alzheimer's disease. Recently the company announced that it has completely halted the development of the promising vaccine after a number of patients taking part in a clinical trial became very sick. The failure of the experimental vaccine, AN-1792, is a major setback in general for attempts to combat Alzheimer's, the fourth-leading cause of death in developed countries and the most common cause of dementia. The Irish company's vaccine had increased expectations of a possible cure for the disease, because the vaccine was the only medication to make it to the midstage of human-testing. According to analysts, the failure of the experimental vaccine will probably set back Elan's Alzheimer's program by between nine months and a year. The experimental vaccine had always been controversial. Elan's scientists used a peptide called beta amyloid that collects and forms into plaques to spark an immune response in patients. Critics of the approach warned, however, that such an approach could potentially kill patients.
Altius Health Plans is committed to improving the healthy outcome of our members, expanding the knowledge of our employers, building relationships with our business partners, and increasing the success of our providers. If there is a "quality of care" concern expressed by our members or identified by the provider, please notify Altius Health Plans at 801-933-3660, and we will attempt to resolve the issue. Health Plan Employer Data and Information Set HEDIS ; HEDIS is a set of standardized performance measures that are designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of Altius Health Plans. The HEDIS measures are related to many significant public health issues such as cancer, heart disease, asthma, diabetes and utilization of preventive health guidelines. HEDIS also includes a standardized survey of consumer experiences that evaluate health plan performance in areas of customer service, access to care, and claims processing. HEDIS data is collected by Altius each year usually in the spring. The provider's office is given a list of Altius members who have medical records that need to be reviewed and is asked to pull the charts. The nurse will call to schedule a mutually agreeable date and time to review the records. The nurse will need a place to sit to conduct the review and methysergide.
A second strand entailed the development of spatial context through interior rooms and exterior landscapes. This owed much to the secular literature ranging from the Provenal, courtly love poems and Arthurian legends to chronicles which linked historical events with contemporary happenings such as the crusades. This second strand emerged partly in France, but predominantly through the Burgundian Court, which brought the rise of Netherlandish art. Elsewhere, in Siena, Simone Martini also introduced a new emphasis on spatial context in his famous frescoes in the Palazzo Pubblico. Connections through the papal court of Avignon, brought interplay between the French and Burgundian traditions and these Sienese developments, partly through the direct sojourn in Avignon of Simone Martini himself. In the next generation, the Sienese tradition evolved through painters such as the Lorenzetti brothers and Giovanni di Paolo. These two strands of spatial mastery, namely, spatial forms isolated objects ; and spatial contexts interiors, landscapes ; evolved in parallel. Their integration came slowly. Assisi can be seen as one of the first attempts at synthesis. Giotto's Saint Francis cycle c. 12901300 ; dealt with both spatial objects such as a niche, a chapel or an interior ; and spatial contexts a landscape with figures ; . Giotto's subsequent cycles in the Arena Chapel at Padua 1304-1308 ; and the Peruzzi Chapel in Santa Croce Florence, c. 1327 ; pursued this quest as did Lorenzetti's work in Siena and Assisi during the 1330's and 1340's. Further experience led Lorenzetti 1344 ; to master these proto-perspectival elements and discover practical solutions in terms of vanishing points. Renaissance 1400-1500 ; The better part of a century passed before these practical solutions led to practical demonstrations by Brunelleschi c.1415-1425 ; and almost as much time again before these practical demonstrations had been transformed into quantitative experimental demonstrations by Leonardo 1492 ; . In the course of the fifteenth century artists also discovered that perspectival elements which emphasized scenes offered new possibilities in creating variations thereof. Spatial harmony now outweighed symbolic harmony. The key developments in these new explorations took place in Florence in chapels such as the Brancacci in the Chiesa del Carmine, in Santa Croce; in Santa Maria della Novella and Santa Trinit. With respect to contents, sacred ; faith and secular ; reason were treated increasingly on equal terms. High Renaissance 1500-1527 ; These principles were then applied to an entire space such as the Sistine Chapel or the Stanze in the Vatican. By now spatial harmony of the individual elements determined symbolic harmony and gave the whole a dramatically new effect. In order to appreciate the element of continuity, it is instructive to compare the ceiling at St. Michael's, Hildesheim, with the Sistine Chapel in the Vatican. Their basic elements are surprisingly similar: both have central panels with episodes from the Old and New Testaments. Both are flanked by religious prophets and pagan sibyls. But Michelangelo's version has a number of additional elements: further Old Testament scenes in the roundels, Christ's forebears, the children of Israel, etc. We are back at Panofsky's theme of Renaissance and Renascences. There is a continuity between St. Michael's in Hildesheim and the Sistine Chapel in the Vatican. What sets them apart is that organization in Saint Michael's is a principle of harmony based mainly on symbolic elements, usually in.
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DAF COMP 2004 ; 24 drafted, which became an ongoing project. Ms. Deane noted that a summary of the expert group's discussions and the current draft of the guidelines are available on OLIS DSTI STP BIO M 2004 ; 2 ; . It was envisioned by the expert group that the guidelines would be presented to the OECD Council. The Chairman then opened the floor for general discussion. A delegate from the United States began the discussion by asking the delegate from BIAC to clarify his criticism of U.S. law, particularly in light of the recent Trinko decision, which established firmly that there is no antitrust liability in the U.S. for unilateral refusals to license. The BIAC delegate agreed with the U.S. delegate, but mentioned a lower court case that has been largely discredited but still has not been invalidated. It therefore leaves some uncertainty in the business community. A delegate from Sweden commented that the Swedish competition authority does not receive any complaints or tips involving the biotechnology industry. This is not because participants are unaware of the agency, the delegate continued, but is probably because problems in this industry tend to be resolved by settlements. That may be due to the rapid pace at which the sector is developing, and a resulting unwillingness to wait for lengthy judicial procedures. Therefore, the delegate queried whether competition legislation is perhaps not the most appropriate legislation for a dynamic industry such as biotechnology, and if not, what should medium or small sized competition authorities do? In other words, what would be the most important area for competition authorities to work on? A delegate from Italy posed two additional questions. First, he noted that despite the U.S. Supreme Court's Trinko decision, it is still the case in the U.S. that if a company has monopoly power or has an essential facility, then it is obliged to deal with competitors under some circumstances. Although patents do not necessarily confer monopolies, he continued, they might nevertheless lead to it in some instances, and thus there should be no reason why IP should not have to deal with competitors in some circumstances, as well. He therefore posed the question, are there any exceptional circumstances when a patent leads to monopoly power and a refusal to license can be a violation of antitrust law? Second, the delegate from Italy asked the E.C. delegation whether, in mandatory licensing cases, merely requiring an IP owner to license is an adequate remedy. The licensor might achieve its exclusionary objective simply by setting an excessively high licence fee. Therefore, he asked whether the remedy should also have a pricing component. A delegate from Spain then mentioned an interesting dilemma faced by the Spanish competition authority. It began to investigate a refusal to license case several years ago, but then the target of the investigation was acquired by another operator, which in turn was required to sell the patent in question as a condition for the approval of the merger. The patent therefore moved through three different companies after the initial refusal to license. This presents a philosophical problem of having to punish an entity that had nothing to do with the refusal to deal. Therefore, it can be seen that in the biotechnology industry, not only is patent development unusually dynamic, but the companies themselves are, as well. A delegate from the U.S. then addressed the Italian delegate's first question. The American delegate agreed that Trinko does not specifically resolve the question of mandatory IP licensing. However, he added, many Supreme Court cases involving patent laws make it clear that the right to unilaterally withhold a licence is a core right of U.S. IP law. The relevance of Trinko is that it answers the question whether the narrow group of cases in which a monopolist has been held to have a duty to deal should be expanded. In the delegate's view, Trinko makes it clear that the Supreme Court would not use antitrust law to find a new duty to deal in the IP area when there are already so many cases construing IP law that hold otherwise. On the other hand, IP owners are not immune to antitrust laws. The Microsoft appeals court and micafungin.
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