Visit following a diagnosis of type 2 diabetes, the most important message is that "the sugar level in your blood is too high, and you must start taking medication to lower it." Information about the potential complications of diabetes might be mentioned, but they are not the focus of the visit. After discussing the key information with the patient, it should be reviewed and repeated. Repetition is the key to learning and memory. Ideally, other members of the staff will be enlisted to go over the information again before the patient leaves in an effort to increase patient understanding. Some experts suggest calling patients several days after delivering important information to further reinforce education. 5. Use the teach-back or show-me technique. These techniques involve asking patients to explain or demonstrate what they have been told. Do not simply ask a patient, "Do you understand?" Experience shows that patients often answer "yes" to such questions, even when they understand nothing. Instead ask patients to explain in their own words or demonstrate how they will undertake a recommended treatment. If a patient does not explain correctly, assume that you have not provided adequate teaching or understandable instructions. Use an alternate approach to ensure patients learn what they need to know. It is important not to appear rushed, annoyed or bored during these efforts. 6. Create a shame-free environment. This can be accomplished by letting patients know that "many people have difficulty reading and understanding the medical information I give them, so please feel comfortable asking questions if there's something you don't understand." As discussed earlier, patients with limited literacy skills are often ashamed and rarely speak of it. Even patients with well-developed skills may pretend to understand materials to avoid seeming "stupid" or annoying to a physician. Another strategy is to ask patients during the visit if they would like a family member or friend to be with them during discussions about diagnoses and options for treatment. By asking in a routine, nonjudgmental way, you can help them feel comfortable about bringing others into the examination room to help at the time of the visit. Medical advances are outpacing improvements in patient-physician communication. Effective communication may be even more.
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Work Group Members: Christine Simonelli, MD Work Group Leader ; HealthEast Clinics ; Internal Medicine Bart Clarke, MD Mayo Clinic ; Endocrinology Daniel Cohan, DO North Clinic ; Family Practice Richard Kopher, MD HealthPartners Medical Group ; Gynecology Dana Battles, MD Aspen Medical Group ; Internal Medicine Philip Hoversten, MD Allina Medical Clinic ; Internal Medicine John Schousboe, MD Park Nicollet Health Services ; Rheumatology Vy Vy Vo, PharmD HealthPartners Medical Group ; Pharmacy Renee Compo, RN, CNP HealthPartners Medical Group ; Nursing Vivian Krug RN North Clinic ; Nursing Amy Murphy, MHHA Institute for Clinical Systems Improvement ; Measurement Implementation Advisor Jenelle Meyer, RN Institute for Clinical Systems Improvement ; Facilitator ; FINANCIAL DISCLOSURES CONFLICTS OF INTEREST In the interest of full disclosure, Institute for Clinical Systems Improvement ICSI ; has adopted a policy of revealing relationships work group members have with companies that sell products or services that are relevant to this guideline topic. The reader should not assume that these financial interests will have an adverse impact on the content of the guideline, but they are noted here to fully inform readers. Readers of the guideline may assume that only work group members listed below have potential conflict of interest to disclose. John Schousboe, MD receives grant support from Merck, Procter & Gamble, and Novartis, is a consultant to Procter & Gamble, and is a member of the Speaker's Bureau for Eli Lilly. Christine Simonelli, MD receives grant support from Merck, Novartis, Eli Lilly, and Procter & Gamble, serves as a consultant for Procter & Gamble and Merck, and is a member of the Speaker's Bureau for Merck, Eli Lilly, and Procter & Gamble. Bart Clarke, MD, receives grant support and serves as a consultant for Merck. Renee Compo, RN, CNP, is a member of the speaker's bureau for Wyeth. No other work group members have potential conflicts of interest to disclose. ICSI's conflict of interest policy and procedures are available for review on ICSI's website at icsi . GUIDELINE STATUS This is the current release of the guideline. It updates a previous version: Institute for Clinical Systems Improvement ICSI ; . Diagnosis and treatment of osteoporosis. Bloomington MN ; : Institute for Clinical Systems Improvement ICSI 2003 Jul. 68 p. GUIDELINE AVAILABILITY Electronic copies: Available from the Institute for Clinical Systems Improvement ICSI ; Web site. 24 of 26.
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Date: December 14, 2006 Subject: DRC Recommendations to DUCC and DHS To: DHHS, DUCC, Dean's Office From: Howell R. Foster, PharmD. At its 012 14 06 meeting, the Drug Review Committee considered the potential toxicity and therapeutic role of second generation antidepressants. Second generation antidepressants Bupropion Wellbutrin ; Citolapram Celexa ; Duloxetine Cymbalta ; Escitolapram Lexapro ; Fluoxetine Prozac ; Fluvoxamine Luvox ; Nefazodone generic ; Paroxetine Paxil ; Mirtazapine Remeton ; Sertraline Zoloft ; Venlafaxine Effexor ; Indications for the initial use of antidepressants under consideration in adults and geriatric patients unless otherwise specified Major depressive disorder Major depressive disorder in children Dysthymic disorder Generalized anxiety disorder Obsessive compulsive disorders Panic disorder Post-traumatic stress disorder Social anxiety disorder Premenstrual dysphoric disorder and late luteal phase disphoric disorder.
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Interaction with other medicaments and other forms of interaction: mirtazapine may potentiate the central nervous dampening action of alcohol; patients should therefore be advised to avoid alcohol during treatment with remeron and risperdal.
Table 5. Risk Category IC Treatment Options Young under 65? ; IMRT + ADT + -Taxotere ; Seeds + IMRT + ADT + -Taxotere ; Surgery + - ADT ; + - IMRT ; + -Taxotere ; Cryo + ADT + -Taxotere ; In Between IMRT + - ADT ; , Seeds + IMRT + - ADT ; Cryo + - ADT ; , ADT Old over 75? ; ADT, IMRT, Seeds + IMRT, Cryo.
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A 26-year-old female was treated with mirtazapine Eemeron ; 15 mg for a major depressive episode.3 She was already taking clonazepam, which had improved one of her symptoms, insomnia. She had previously taken paroxetine Paxil ; , but it had been tapered off due to ineffectiveness. By the fourth day of mirtazapine therapy, the patient developed an unusual visual side effect called "palinopsia." The authors state that palinopsia is a form of visual disturbance in which patients see an illusionary visual spread of moving.
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See also Table 4. --The physician can decide if it is reasonable to use erythropoietin in a terminally ill patient. Although treatment can be beneficial in relieving fatigue and improving quality of life, it is expensive and must be given for 4 to 6 weeks before benefits become apparent. Giving a dosage of 10, 000 units daily for two weeks may reduce this time. Adapted with permission from Berger A, Portenoy RK, Weissman DE, eds. Principles and practice of supportive oncology. Philadelphia: Lippincott-Raven, 1998: 295-308.
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Prior Auth Narc. Analgesics ACTIQ * COMBUNOX DURAGESIC * FENTORA * OXYCONTIN * REPREXAIN ULTRACET ULTRAM ER Alternatives Geq MS CONTIN Geq DARVOCET Geq TYLENOL #3 Geq ULTRAM Geq VICODIN ES Prior Auth Analgesics ARTHROTEC NAPRELAN Alternatives GENERIC NSAIDS nd 2 Line w Prior Auth CELEBREX Prior Auth Migraine Agents AXERT FROVA MAXALT & MLT ZOMIG & ZMT STADOL NS Alternatives AMERGE IMITREX RELPAX Prior Auth Muscle Relax. ALL SOMA PRODUCTS SKELAXIN ZANAFLEX CAPSULES Alternatives Geq FLEXERIL Geq ROBAXIN Geq NORFLEX Prior Auth Antibiotics AUGMENTIN XR DORYX FLAGYL ER KEFLEX 750mg ORACEA Alternatives AMOXICILLIN Geq AUGMENTIN Geq VIBRAMYCIN Geq FLAGYL Geq MACRODANTIN Geq MACROBID Prior Auth Quinolones AVELOX LEVAQUIN NOROXIN PROQUIN XR Alternatives Geq CIPRO Geq FLOXIN Prior Auth Antifungals PENLAC Alternatives Geq FULVICIN Geq NIZORAL Geq LOTRIMIN SOL. Geq LAMISIL TAB Geq SPORANOX Prior Auth Antivirals FAMVIR Alternatives Geq ZOVIRAX VALTREX Prior Auth Antihistamines ALLEGRA-D CLARINEX CLARINEX-D ZYRTEC ZYRTEC-D Alternatives Geq BENADRYL Geq CHLORTRIMETON OTC Geq CLARITIN OTC Geq CLARITIN D Geq ALLEGRA Prior Auth PPIs NEXIUM PREVACID PREVACID NAPRAPAC PRILOSEC RX ZEGERID Alternatives OTC PRILOSEC nd 2 Line w Prior Auth ACIPHEX PROTONIX Prior Auth Ulcerative Colitis COLAZAL DIPENTUM PENTASA Alternatives Geq AZULFIDINE ASACOL Prior Auth Anti-Spasmotics CANTIL Alternatives Geq BENTYL Geq LEVSINEX Geq LIBRAX Prior Auth Anti-Emetics ANZEMET * KYTRIL * ZOFRAN * Alternatives Geq COMPAZINE Geq REGLAN Geq TIGAN Prior Auth Hormone Replacement PREMARIN PREMPRO CENESTIN PROMETRIUM Alternatives Geq ESTRACE Geq OGEN Geq PROVERA Prior Auth For Cholesterol ADVICOR ALTOPREV CADUET PRAVIGARD PAC LOVAZA OMACOR ; TRICOR Alternatives Geq QUESTRAN Geq LOFIBRA Geq PRAVACHOL Geq ZOCOR ZETIA * nd 2 Line w Prior Auth LESCOL XL LIPITOR CRESTOR VYTORIN Prior Auth ACE Inhibitors ACEON ALTACE Alternatives Geq ACCUPRIL Geq CAPOTEN Geq MAVIK Geq PRINIVIL ZESTRIL Geq UNIVASC Geq VASOTEC Prior Auth ARBs ATACAND ATACAND HCT COZAAR HYZAAR MICARDIS MICARDIS HCT TEVETEN TEVETEN HCT Alternatives AVAPRO AVALIDE BENICAR BENICAR HCT DIOVAN DIOVAN HCT Prior Auth Beta Blockers CARTROL LEVATOL Alternatives Geq CORGARD Geq INDERAL Geq LOPRESSOR Geq TENORMIN Geq ZEBETA Geq TOPROL XL Prior Auth Cardiac Patches CATAPRES-TTS MINITRAN Geg NITRODUR PATCH Alternatives Geq CATAPRES-oral Geq IMDUR-oral Geq ISORDIL-oral Geq NITROBID-oral Prior Auth Antihyperglycemics FORTAMET GLUMETZA Alternatives Geq GLUCOPHAGE Geq GLUCOPHAGE XR Prior Auth Insulin Products ALL PREFILLED PENS OR PENFILLS Alternatives HUMULIN HUMALOG NOVOLIN NOVOLOG not pens or penfills ; APIDRA LEVEMIR Prior Auth Anticholinergics OXYTROL PATCH Alternatives Geq DITROPAN DETROL DETROL LA ENABLEX VESICARE Prior Auth Oral Contraceptives LYBREL ORTHO TRI-CYCLEN LO SEASONIQUE YASMIN YAZ Alternatives Geq ALESSE Geq LOESTRIN Geq NECON 7 GeqTRIVORA Geq TRI-NORINYL All GEQ Products Prior Auth Otic Preparations CIPRO HC COLY-MYCIN S CORTISPORIN-TC Alternatives Geq CORTISPORIN CIPRODEX FLOXIN Prior Auth Thyroid Preparations THYROLAR Alternatives Geq THYROID Geq SYNTHROID Geq LEVOTHROID Prior Auth SSRIs LEXAPRO PAXIL CR PEXEVA PROZAC WEEKLY SARAFEM Alternatives Geq PROZAC Geq CELEXA 18 Geq PAXIL 18 Geq ZOLOFT 18 Prior Auth SNRIs CYMBALTA LUDIOMIL NARDIL PARNATE SERZONE Alternatives Geq PROZAC Geq DESYREL Geq EFFEXOR Geq REMERON Geq REMERON SOLTAB Geq WELLBUTRIN SR WELLBUTRIN XL EFFEXOR XR Prior Auth Sedative Hypnotics AMBIEN CR LUNESTA ROZEREM SONATA Alternatives Geq BENADRYL Geq AMBIEN Geq DALMANE Geq HALCION Geq PROSOM Geq RESTORIL * max 15 per 30 days Prior Auth Anti-Anxiety XANAX XR NIRAVAM Alternatives Geq XANAX Prior Auth Opthalmics ELESTAT OPTIVAR Alternatives OTC NAPHCON NAPHCON-A nd 2 Line with Prior Auth PATANOL and temazepam and remeron.
Full list of antidepressants in warning anafranil clomipramine hcl ; aventyl nortriptyline hcl ; celexa citalopram hbr ; cymbalta duloxetine hcl ; desyrel trazodone hcl ; effexor venlafaxine hcl ; elavil amitriptyline hcl ; lexapro escitalopram oxalate ; limbitrol chlordiazepoxide amitriptyline ; ludiomil maprotiline hcl ; luvox fluvoxamine maleate ; marplan isocarboxazid ; nardil phenelzine sulfate ; norpramin desipramine hcl ; pamelor nortriptyline hcl ; parnate tranylcypromine sulfate ; paxil paroxetine hcl ; pexeva paroxetine mesylate ; prozac fluoxetine hcl ; remeron mirtazapine ; sarafem fluoxetine hcl ; serzone nefazodone hcl ; sinequan doxepin hcl ; surmontil trimipramine ; symbyax olanzapine fluoxetine ; tofranil imipramine hcl ; tofranil-pm imipramine pamoate ; triavil perphenaine amitriptyline ; vivactil protriptyline hcl ; wellbutrin bupropion hcl ; zoloft sertraline hcl ; zyban bupropion hcl ; sources: sandra kweeder, md, acting director, fda office of new drugs.
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Address correspondence to: Dr. Michael M. White, Department of Pharmacology and Physiology, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA 19102. E-mail: mikewhite drexel.
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Suppressive treatment: medication taken continuously to help prevent outbreaks.
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Dr. Allan Becker, Dr. LP. Boulet, Dr. D. Cockroft Genetec Inc. A phase II study of anti-CD11a in adult allergic subjects Current Year $120, 000 Term 1999-2000 Dr. Allan Becker, Dr. Wade Watson, Dr. Estelle Simons Merck & Co. Chronobiology of exercise-induced bronchoconstriction Current Year $50, 000 Term 1999-2000 Dr. Allan Becker, Dr. Wade Watson, Dr. Estelle Simons Merck Frosst Canada Inc. Evaluation of an asthma education project Current Year $50, 000 Term 1997-2001 Dr. Allan Becker, Dr. A, Sanfford, Dr. P. Pare, Dr. M. Yeung, Dr. J. Manfreda Medical Research Council of Canada Genetics of asthma Current Year $67, 000 Term 1999-2002 Dr. Kent HayGlass, Dr. Estelle Simons Medical Research Council of Canada Cytokine-mediated regulation of human immediate hypersensitivity Current Year $81, 950 Term 1998-2001 Dr. S. Mink, Dr. Allan Becker, Dr. Estelle Simons, Dr. Keith Simons Children's Hospital Foundation of Manitoba Inc. The pharmacodynamics and pharmacokinetics of epinephrine in the treatment of experimental anaphylactic shock Current Year $43, 735 Term 2000-2001 Dr. Zhikang Peng Children's Hospital Foundation of Manitoba Inc. Summer Studentship for Antonietta Versace Current Year $4, 000 Term 1999-2000 Dr. Zhikang Peng Health Sciences Centre Foundation Mosquito allergy Current Year $15, 000 Term 1999-2000 Dr. Zhikang Peng, Dr. Estelle Simons Children's Hospital Foundation of Manitoba Inc. Studentship for Nivez Rasic Current Year $4, 000 Term 1999-2000 Dr. Zhikang Peng, Dr. Estelle Simons MRC Regional Partnership with Children's Hospital Foundation of Manitoba Inc. Allergen DNA and CpG oligodeoxynucleotide vaccinations in allergic disorders Current Year $21, 060 CHF ; , $42, 120 MRC ; Term 1999-2000.
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