Memantine is a drug that gives hope for patients with moderate to severe Alzheimer's Disease AD ; . It during this stage when people with AD develop problems with daily activities such as bathing and dressing, behavioral problems may become more significant, and families move their loved ones with AD into assisted living homes. Originally developed and used in Germany for the past 10 years, memantine was approved in May 2002 by the European Union for the treatment of moderate to severe AD. Currently, the U.S. Food and Drug Administration FDA ; is conducting a review and has until November 30, 2003, to either approve or not approve memantine as a treatment for AD. Forest Laboratories, Inc., is developing memantine for marketing in the U.S. Memantine seems to regulate the interaction between brain cells and a messenger chemical called glutamate. Low levels of glutamate interfere with the memory and learning processes in healthy brain cells. On the other hand, excess glutamate allows too much calcium to flow into brain cells, which causes cell death. Memantine appears to increase memory and learning activity in brain cells while preventing calcium from entering the cells. Additional Information For more information about memantine, telephone the Alzheimer's Association at 800-272-3900 or go to our Web site at alz . You can also telephone Forest Laboratories at 800-678-1605 and ask for their Professional Affairs Division.
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Reducing variability has always been an important goal of quality assurance. Do our findings of greater uniformity in use of drugs mean good news? We cannot be certain. When variability is great, similar patients may receive very different interventions. In that circumstance, reducing variation has the potential to improve quality. In contrast, our finding of minimal variability does not mean that patients received the "right amount" of care. Generally, the same proportion of patients received therapy across the state, but it is unclear whether the "right" patients were treated or whether the "right level" of therapy was given. To answer this more fundamental question, a set of appropriateness criteria must be applied to examine medication use. Unfortunately, when such criteria have been applied to surgical procedures, high and low rates of use did not correlate with appropriateness. Perhaps when these criteria are applied to use of medications, the answers will be more straightforward. For many of the conditions we studied, no equivalently effective alternative exists--thus, higher use may equate to more appropriate use. For example, most patients with asthma need inhaled corticosteroids, and patients with congestive heart failure have improved outcomes with ACE inhibitors. Surgery or physical therapy does not represent medication replacements. Thus, high-use areas for these medications may well achieve better health outcomes than low-use areas do. Moreover, despite relatively little variability, for certain conditions such as congestive heart failure and asthma, even the small amount of variability that exists suggests underuse of highly effective medications and opportunities for improvement in care and captopril.

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Copies of a further booklet entitled "tips for taking medicines" is available from your pharmacist or through the health service executive. Table 1. Ratings of Parameters Over the 3 Month Study at 4-week Intervals and doxazosin. History of Soybeans Soybeans come to us from the Orient. During the Chou Dynasty 1134-246 BC ; the soybean was designated one of the five sacred grains, along with barley, wheat, millet and rice. However, the pictograph for the soybean, which dates from earlier times, indicates that it was not first used as a food; for whereas the pictographs for the other four grains show the seed and stem structure of the plant, the pictograph for the soybean emphasizes the root structure. Agricultural literature of the period speaks frequently of the soybean and its use in crop rotation. Apparently the soy plant was initially used as a method of fixing nitrogen. The soybean did not serve as a food until the discovery of fermentation techniques, sometime during the Chou Dynasty. Thus the first soy foods were fermented products like tempeh, natto, miso and shogu soy or tamari sauce ; . At a later date, possibly in the 2nd century B.C., Chinese scientists discovered that a puree of cooked soybeans could be precipitated with calcium sulfate or magnesium sulfate plaster of Paris or Epsom salts ; to make a smooth pale curd -tofu or bean curd. The use of fermented and precipitated soy products soon spread to other parts of the Orient, notably Japan and Indonesia. Although the highly flavored fermented products have elicited greater interest among scientists and epicures, it is the bland precipitated products that are most frequently used, accounting for approximately 90% of the processed soybeans consumed in Asia today. The increased reliance on bean curd as a source of protein, which occurred between 700 A. D. and the present time, has not necessarily been a beneficial change for the populations of the Orient and Southeast Asia. Fit for Human Consumption? The Chinese, did not eat the soybean as they did other pulses legumes ; such as the lentil, because the soybean contains large quantities of a number of harmful a substances. First among them are potent enzyme inhibitors which block the action of trypsin and other enzymes needed for protein digestion. These"antinutrients" are not completely deactivated during ordinary cooking and can produce serious gastric distress, reduced protein digestion and chronic deficiencies in amino acid uptake. In test animals, diets high in trypsin inhibitors cause enlargement and pathological conditions of the pancreas, including cancer. The soybean also contains hemagglutinin, a clot promoting substance that causes red blood cells to clump together. Trypsin inhibitors and hemagglutinin have been rightly labeled growth depressant substances. Fortunately they are deactivated during the process of fermentation. However, in precipitated products, enzyme inhibitors concentrate in the soaking liquid rather than in the curd. Thus in tofu and bean curd, these enzyme inhibitors are reduced in quantity, but not completely eliminated.
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Fewer than half of the post-marketing studies that manufacturers have made commitments to undertake as a condition of approval have been completed and many have not even been initiated" american medical association jama, 11 04. Psychiatric Nursing Applications on Violence Leyla Baysan Arabac Department of Psychiatric Nursing, Ege University, Izmir, Turkey In a world in which competitive social conditions dominate, violence may occur in every population and in almost every environment family, sports, war.etc ; and cause physical and psychological damage. Violence promoted by economic troubles and features of patriarchal social structures has not only physical reflections injury, disabilities ; , but also psychological ones depression, suicide, alcohol and narcotic addiction ; . In this respect, the importance of healthcare professionals who are responsible for management of the service delivery system, care and rehabilitation of patients, preventative healthcare programming, and improving the functioning of both families and society by offering services to patients who have faced violence cannot be denied. Nurses, and especially psychiatric nurses, are in a strategic position for delivering this management with their abilities of establishing close relationships with people and their totalitarian approach, as they are more accessible to patients as compared to others. Psychiatric nurses play an important role in both relieving psychological symptoms and understanding the individual and social dynamics of the people who have been exposed to violence. It is possible to classify or subdivide their roles as therapist, consultant, educator, researcher, and rehabilitation care provider. Psychiatric nurses acting on a wide application spectrum do use nursing process based on certain standards and problem-solving abilities during the planning of interventions for individuals exposed to violence and in their care-providing role. Additionally, nurses take part in the prevention of and rehabilitation of psychological disorders resulting from violence. Psychiatric nurses realize this process in 4steps: 1. Definition: Here, definition means the results diagnosis of nurse ; obtained from analysis of comprehensive patient history, including lack of strength, hopelessness, fear, disorders in social communication, changes in sleep behaviors, and risk of suicide. Diagnosis of the nurse defines the present and potential problems covered by the management of the psychiatric nurse. 2. Planning: In this step, psychiatric nurses make plans to meet the requirements of the patient and indirectly solve the problem diagnosed by nurse ; in accordance with nursing interventions determined according to special aims. 3. Application: Psychiatric nurses apply the suitable strategy, which guides the nursing healthcare plan, in order to maintain and improve the physical and physiological condition of the patient. 4. Evaluation: Psychiatric nurses evaluate the individual data obtained from the patient, diagnosis of the nurse, and results of the care plan, and re-arranges the nursing strategy, if necessary. Psychiatric nurses are extremely likely to meet individuals who have been exposed to violence in every phase of healthcare delivery. Additionally, they support activities that promote the psychological health of future generations with their determinative and preventive roles. ReS.23 User Involvement in Mental Health Research Michaela Amering, Diana Rose, Jasna Russo, Kim Hopper Involvement of service users in research is currently happening in different clinical specialities including the field of mental health. Today some of the consequences, potentials, and pitfalls of this development are visible in the psychiatric academic arena. User-led as well as collaborative research have resulted in new and important data published in peer-reviewed journals. The acknowledgement of the importance of user involvement in and catapres. STHMA is a common problem in older adults, and one that may be underdiagnosed and undertreated. A group of 80 elderly patients with asthma were studied. Symptoms and pulmonary function measures were assessed to determine the severity of disease. House dust samples were collected to evaluate the associated indoor allergens, and 75 subjects underwent skin testing to common airborne allergens. Juniper's Asthma Quality of Life Questionnaire and the Short Form Health Survey Medical Outcome Questionnaire were administered to assess asthma's impact on quality of life and health status. The asthmatic subjects were 61 women and 19 men, mean age 73.5 years. Most subjects were white and had at least a high-school education. Sixty-five percent were rated as having moderate to severe persistent asthma. Seventy-five percent of skin-tested subjects had a positive response to at least one allergen, with cat hair being the most frequent positive allergen. High levels of dust mite, cockroach, cat, and dog allergen were detected in the subjects' homes, often high enough to put the subjects at risk of symptoms or sensitization. As asthma severity increased, quality-of-life scores decreased in most domains. There was also a trend toward decreased health status. More than three-fourths of subjects used 2-agonists on a regular or as-needed basis, and more than two-thirds used inhaled corticosteroids regularly. Asthma is a common problem in the elderly. Many affected patients had moderate to severe persistent asthma, positive skin-test results, and high allergen levels in the home. More severe asthma has a significant impact on quality of life. The authors urge skin testing in elderly patients with moderate to severe asthma, followed by appropriate medications and allergen-control measures. COMMENT: As the demographics of our population change, allergists will be increasingly called upon to evaluate and care for elderly patients. This important article and an accompanying editorial highlight the importance of identifying allergic triggers in the elderly. There is little question that an allergy consultation can directly impact the cause of atopic disease even in the sixth and seventh decades of life. See AllergyWatch, because atenolol. 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