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Thank you for your offer of Assistance Physician On Scene This advanced life support team is operating under Washington State Law and EMS policy approved by the Medical Society of Snohomish County and the Snohomish County Emergency Medical Services and Trauma Care Council. The ALS team is functioning under standing orders from the Medical Program Director of Snohomish County and is in direct radio contact with an authorized Medical Control Physician at their base hospital emergency center. If you wish to assist, please see the other side for options Ron Brown MD Medical Program Director Snohomish County EMS In general, the physician who has the most expertise in management of the emergency should take control. This is usually the base hospital physician. You may: 1. Request to talk directly to the base hospital physician to offer your advice and assistance. 2. Offer your assistance to the ALS team with another pair of eyes, hands, or suggestions, but allow the ALS team to remain under Medical Control of the base hospital physician. 3. If you have an area of special expertise for the patient's problem, you may take total responsibility, if delegated by the base hospital physician, and accompany the patient to the hospital. Note: Use of this card is for physicians who are intervening ONLY. Nothing in this protocol precludes appropriate assistance from recognized physicians in the community.

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Grossfeld and Carroll cific antigen levels in women and in prostatectomized men with an ultrasensitive immunoassay technique. J Urol 1995; 153: 1004-8. Levesque M, Hu H, D'Costa M, et al. Prostate-specific antigen expression by various tumors. J Clin Lab Anal 1995; 9: 123-8. Stenman UH, Leinonen J, Alfthan H, et al. A complex between prostate-specific antigen and alpha 1-antichymotrypsin is the major form of prostate-specific antigen in serum of patients with prostatic cancer: assay of the complex improves clinical sensitivity for cancer. Cancer Res 1991; 51: 222-6. Lilja H, Christensson A, Dahlen U, et al. Prostate-specific antigen in serum occurs predominantly in complex with alpha 1-antichymotrypsin. Clin Chem 1991; 37: 1618-25. McCormack RT, Rittenhouse HG, Finlay JA, et al. Molecular forms of prostate-specific antigen and the human kallikrein gene family: a new era. Urology 1995; 45: 729 t4. Nadler RB, Humphrey PA, Smith DS, et al. Effect of inflammation and benign prostatic hyperplasia on elevated serum prostate specific antigen levels. J Urol 1995; 154: 407-13. Tchetgen MB, Song JT, Strawderman M, et al. Ejaculation increases the serum prostate-specific antigen concentration. Urology 1996; 47: 511-16. Chybowski FM, Bergstraih EJ, Oesterling JE. The effect of digital rectal examination on the serum prostate specific antigen concentration: results of a randomized study. J Urol 1992; 148: 83-6. Oesterling JE, Chan DW, Epstein JI, et al. Prostate specific antigen in the preoperative and postoperative evaluation of localized prostatic cancer treated with radical prostatectomy. J Urol 1988; 139: 766-72. Stamey TA, Yang N, Hay AR, et al. Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N EnglJMedl987; 317: 909-16. Guess HA, Heyse JF, Gormley GJ. The effect of finasteride on prostate-specific antigen in men with benign prostatic hyperplasia. Prostate 1993; 22: 31-7. Gormley GJ, Ng J, Cook T, et al. Effect of finasteride on prostate-specific antigen density. Urology 1994; 43: 53-8. Roehrborn CG, Oesterling JE, Olson PJ, et al. Serial prostatespecific antigen measurements in men with clinically benign prostatic hyperplasia during a 12-month placebo-controlled study with terazosin. HYCAT Investigator Group. Hytrin Community Assessment Trial. Urology 1997; 50: 556-61. Woolf SH. Screening for prostate cancer with prostatespecific antigen: an examination of the evidence. N Engl J Med 1995; 333: 1401-5. Cooner WH, Mosley BR, Rutherford CL Jr, et al. Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol 1990; 143: 1146-52. Catalona WJ, Richie JP, Ahmann FR, et al. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6, 630 men. J Urol 1994; 151: 1283-90. Ellis WJ, Chetner MP, Preston SD, et al. Diagnosis of prostatic carcinoma: the yield of serum prostate specific antigen, digital rectal examination and transrectal ultrasonography. J Urol 1994; 152: 1520-5. Brawer M. Prostate-specific antigen. CA Cancer J Clin 1999; 49: 264-81. Hammerer P, Huland H. Systematic sextant biopsies in 651 patients referred for prostate evaluation. J Urol 1994; 151: 99-102. Epstein JI, Walsh PC, Carmichael M, et al. Pathologic and clinical findings to predict tumor extent of nonpalpable stage Tic ; prostate cancer. JAMA 1994; 271: 368-74. Benson MC, Whang IS, Pantuck A, et al. Prostate specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol 1992; 147: 815-- Stamey TA, Kabalin JN, McNeal JE, et al. Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of Epidemiol Rev Vol. 23, No. 1, 2001.

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PHARMACISTS should not be absent from pharmacies for any great length of time, professional representatives say in a series of cautious responses to the Department of Health's "Vision for pharmacy". The Royal Pharmaceutical Society, the National Pharmaceutical Association and the Pharmaceutical Services Negotiating Committee have each responded to the vision document, which was issued in July this year PJ, 26 July, p106 ; . Overall, they note that additional and secure funding streams will be needed to support the parts of the vision document that describe enhanced roles for community pharmacists. As the National Pharmaceutical Association puts it: "If the Department is serious about harnessing community pharmacists' skills, enhancing community pharmacists' contribution to health care and fully integrating community pharmacists into the National Health Service, then it must be prepared to match these words with the necessary investment to secure the implementation of the process." Support for pharmacies in getting connected to the NHSnet is cited as an example of this by the three bodies. The responses also say that some parts of the vision are incompatible and that other parts are dependent on the outcomes of other issues, such as generics reimbursement, control of entry and the new pharmacy contract. On the subject of supervising dispensing and pharmacy sales, the pharmacy vision advocates allowing pharmacy technicians to dispense and sell without a pharmacist being present. The Society says that it would have and flagyl.
Since finasteride often takes 6 months or so to show an effect, doctors will often start a man on tamulosin to improve the contractions of the prostate, and at the same time start finasteride to eventually reduce the obstruction caused by the growth of the gland.

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A new study from the southwest oncology group strongly suggests that for men at risk of the disease - which strikes one in six men - finasteride also raises the odds that physicians will find fast-growing prostate cancers early, when they are most easily treatable and fluconazole.

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Patients who have been using a device for a long time and have demonstrated adequate technique in the past often contrive to use the device incorrectly because they believe it is as effective.68, 70 Therefore, it is essential to thoroughly assess and review techniques with all patients regularly. When to Refer to a Physician Physicians should always supervise the care of patients with COPD; however, front-line health care givers may have more frequent contact with individuals and should alert the physician to potential problems. A physician should be consulted if there is a change in the patient's condition ie, worsening symptoms despite adequate inhaled drug use, adverse effects, signs of infection, or new symptoms. This medicine can increase the drowsiness caused by alcohol and by medicines that affect your nervous system and galantamine.

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In an in vivo chromosome aberration assay in mice, no treatment-related increase in chromosome aberration was observed with finasterixe at the maximum tolerated dose of 250 mg kg day 228 times the human exposure ; as determined in the carcinogenicity studies. MA Schuhwerk1, J Richens2, M Prestage1, K Jones1, N De Esteban1, RH Behrens3 1Mortimer Market Centre, Camden Primary Care Trust, 2Centre for Sexual Health, University College Hospital, 3Hospital for Tropical Diseases, University College Hospital, London, UK Aim: To investigate whether stopping HAART during travelling is of concern. Methods: Questionnaire based survey of HIV positive individuals attending the HIV outpatient clinic detailing history of travel. Results: 12% 26 216 ; of individuals had stopped HAART whilst travelling. 35% had a CD4 count of 200 or less. The regular HIV physician was informed in 46% and only 30% had HIV inclusive travel insurance. At the time of stopping 19 % were on a triple nucleoside, 44% a PI and 38% an NNRTI regimen. Individuals were twice more likely to stop a PI regimen than an NNRTI regimen, 15% versus 7%. 65% had prior drug resistance. 50% reported `entering a country with HIV restrictions' as the main reason for stopping, 39 % `fear of being found out' and 23 % side-effects from tablets. Stopping had a clear relationship to ethnic background: white 11%, Black 30%, Asian 0%. 31 % had to end their journey prematurely versus 7 % who continued HAART ; , 50% had to see a doctor abroad versus 18 % ; and 62% needed to see a doctor on return versus 27% ; . Conclusion: A significant proportion stop HAART at low CD4 counts and are at greatly increased risk of developing medical problems. Development of drug resistance is a real concern and glibenclamide. Within 48 weeks of randomisation, men aged 40-49 years and 50-60 years who were assigned 1 mg day inasteride had a median decrease in serum psa concentration of 40% and 50%, respectively.
Hair follicles are the most androgen-sensitive, including the chin, upper lip, and cheeks. It affects between 5% and 15% of women. Hirsutism usually results from increased androgen production in the ovaries or adrenal glands. Most women with hirsutism have an exaggerated utilization of androgens as a result of enhanced local 5-reductase activity. Other clinical disorders that have been observed with acute or transient androgen excess include alopecia female pattern ; , seborrhea oily face and scalp, frequently with associated seborrheic dermatitis ; , and acne. If chronic androgen excess exists, the polycystic ovarian syndrome is the most common cause 40% of cases insulin resistance, androgen-secreting tumors, and androgenic drug intake are less frequent causes. The diagnostic evaluation of women with hirsutism first focuses on confirming the condition and the presence of excess levels of androgen. Other associated abnormalities and conditions need to be ruled out, including ovulatory dysfunction, adrenal hyperplasia, diabetes, and thyroidhormone abnormalities. Treatment for hirsutism focuses on a combination of therapies including hormonal drugs, peripheral androgen blockage, and mechanical depilation. A woman can remove hair by plucking, waxing, or shaving. Shaving is less traumatic than the other methods, but it may lead to folliculitis and ingrown hairs. Bleaching is also useful, particularly for mild conditions. Chemical depilatory agents may irritate the skin, especially facial skin. Electrolysis can usually destroy terminal hairs after 6 months of treatment. Laser treatment is effective for large areas. Eflornithine HCl cream Vaniqa; not available in Canada ; is a prescription topical enzyme inhibitor of hair growth. It is indicated for reducing unwanted facial hair in women. The cream is applied twice daily. Hormone therapy may delay the progression of hirsutism, but it will not change coarse terminal hairs into softer and less noticeable vellus hairs. Treatment options include combination OCs and antiandrogens eg, spironolactone ; as well as 5-reductase inhibitors eg, inasteride ; . To avoid progression of hirsutism symptoms, treatment of androgen excess should begin as soon as the diagnosis is established. Response to therapy may require 6 to 8 months. Hormonal suppression may need to be continued indefinitely. Androgen levels should be measured at regular intervals. Hair loss. Androgenic sometimes called androgenetic ; alopecia and hair thinning are typically genetically determined and respond to the shift in the androgen-toestrogen ratio. Hair follicles in balding skin differ from those in nonbalding skin with respect to androgen metabolism and glucovance. La.7 1 97 ; , 696 So.2d 1382. In this case, it is clear that Hardtner's actions in terminating Figueroa's indemnity benefits was based on the fact that Figueroa was working as a high school teacher. Even if the termination of benefits was legally incorrect, as stated above, we hold that Hardtner's termination does not amount to arbitrary or capricious behavior. J.E. Merit Constructors, Inc., supra. Therefore, we find that the WCJ's ruling denying Figueroa's request for penalties and attorney fees is without error. Conclusion For the reasons stated above, the Motion for Directed Verdict granted in favor of claimant, Levita Figueroa, is hereby affirmed. Also, the dismissal of Figueroa's reconventional demand on the issue of SEBs is hereby reversed and remanded for a proper calculation of the past due SEBs in accordance with our ruling above. In all other respects, the judgment of the lower court is hereby affirmed. Costs of this appeal are assessed to Hardtner Medical Center. 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