The rationale for needle exchange is simple; if the injection drug users had access to clean needles and syringes and would use them consistently without sharing them, the chain of HIV transmission from person to person through needle sharing would be broken.
Although this is a seemingly plausible idea, the effectiveness of these programs has been difficult to evaluate. The European Union is currently planning massive increases in needle exchange and methadone services along with expanded condom distribution in an attempt to better control the growing HIV epidemic among member states.
These programs, some operating illegally, continue to be controversial. The exclusion of editorials, letters, news items and review articles as well as other articles that lacked abstracts revealed few cohort studies of NEPs whose design and results might allow evaluation of their efficacy in reducing HIV transmission.
At the time most of these studies were inaugurated it was thought that risky injection behavior such as needle sharing was the principle route of HIV transmission among IDUs.
Drug Utilization Review
Now, however, high-risk sexual behavior is recognized to be equally important. It is reasonable to assume, nevertheless, that NEPs should confer some measurable protective effect at least if the participants use them regularly and avoid risky injection practices. Researchers in Montreal studied a cohort of nearly needle-exchange participants for an average of Am J Epidemiol.
The study revealed 89 incident cases of HIV infection with a seroconversion probability of 33 percent among needle exchange users and 13 percent among non-users.
LCZ696 : a new paradigm for the treatment of heart failure?
The case-control study suggested that consistent needle exchange use continued to be associated with HIV seroconversions during follow-up. Despite adjustments for confounders, the researchers noted that HIV risk elevations related to needle exchange remained both substantial and consistent in their cohort of intravenous drug users. The re-examination of the data showed that this was unlikely and due, in part, to the age youngdrug injected cocaineand sex trade among frequent attendees who seroconvert during the study period.
Looking back now, it appears likely that many, if not most, of the infections during the on-going epidemic were the result of sexual transmission rather than needle sharing. Epidemiol ; The participants were recruited between and and followed up through A total of 77 deaths occurred among the participants during the study period. When data were analyzed only for IDUs neither the daily use of methadone or participation in needle and syringe exchange programs were associated with lower mortality.
Another report from Amsterdam involved prospective studies of a cohort of HIV-negative drug users in a harm reduction program that included high dose methadone maintenance, needle exchange, counseling, and HIV testing. Langendam MW, et al. AIDS ; 13 13 : The authors stated that, in this setting, methadone use and needle exchange did not reduce the spread of HIV. During 1, person-years, 58 of the drug injectors became infected with HIV.
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The highest incidence of infection with both viruses occurred among current users of the exchange. The authors stated that the goal of elimination or substantial reduction in risk behavior that may transmit HIV among IDUs had not been achieved.Maxon burners service
The virological efficacy of a needle exchange program in Sweden was evaluated in a cohort study Mansson AS, et al. Scand J Infect Dis ; 32 3 : During a median time of 31 months, however, no spread of HIV was observed.
The authors observed that the low HIV prevalence at baseline, 2. Arch Intern Med. Study participants included 1, males and females. The median duration of injecting drug use at enrollment was 14 years. Younger age less than 30 was an independent predictor of seroconversion among both men and women. Significantly higher HIV incidence was seen among participants of both sexes who injected cocaine alone or in combination with other drugs.
Among male participants less than a high school education, needle sharing with multiple partners, daily injection and shooting gallery attendance were all independent predictors of HIV seroconversion.Drug utilization review DUR is defined as an authorized, structured, ongoing review of prescribing, dispensing and use of medication.
DUR encompasses a drug review against predetermined criteria that results in changes to drug therapy when these criteria are not met. It involves a comprehensive review of patients' prescription and medication data before, during and after dispensing to ensure appropriate medication decision-making and positive patient outcomes. As a quality assurance measure, DUR programs provide corrective action, prescriber feedback and further evaluations.
DUR programs play a key role in helping managed health care systems understand, interpret, evaluate and improve the prescribing, administration and use of medications. Employers and health plans find DUR programs valuable since the results are used to foster more efficient use of scarce health care resources. Pharmacists play a key role in this process because of their expertise in the area of medication therapy management.
DUR affords the managed care pharmacist the opportunity to identify trends in prescribing within groups of patients whether by disease-state such as those with asthma, diabetes or high blood pressure, or by drug-specific criteria. Pharmacists can then, in collaboration with prescribers and other members of the health care team, initiate action to improve drug therapy for patients. DUR is an ongoing, systematic process designed to maintain the appropriate and effective use of medications.Is it safe to grow vegetables in 5 gallon buckets
Pharmacists participating in DUR programs can directly improve the quality of care for patients, individually and as populations, by striving to prevent the use of unnecessary or inappropriate drug therapy, prevent adverse drug reactions and improve overall drug effectiveness. Medication therapy management MTM is a similar mandate introduced in the Medicare Prescription Drug Improvement and Modernization Act MMA ofwhich requires all prescription drug plan sponsors providing a drug benefit to offer medication reviews and appropriate interventions.
DUR is an authorized and structured ongoing review of practitioner prescribing, pharmacist dispensing and patient use of medications. The purpose of DUR is to ensure drugs are used appropriately, safely and effectively to improve patient health status.
Non-adherence to criteria results in drug therapy changes. In addition, continual improvement in the appropriate, safe and effective use of drugs has the potential to lower the overall cost of care.
DUR is typically classified in three different categories: prospective, concurrent and retrospective.Shark Gloves - Official Commercial
Prospective DUR: Prospective review involves evaluating a patient's planned drug therapy before a medication is dispensed. This process allows the pharmacist to identify and resolve problems before the patient has received the medication. Pharmacists routinely perform prospective reviews in their daily practice by assessing a prescription medications dosage and directions while reviewing patient information for possible drug interactions or duplicate therapy.
For example, a patient being treated with warfarin to prevent blood clots may be prescribed a new drug by another specialist to treat arthritis. If taken together, the patient could experience internal bleeding. Concurrent DUR: Concurrent review is performed during the course of treatment and involves the ongoing monitoring of drug therapy to foster positive patient outcomes.
It presents pharmacists with the opportunity to alert prescribers to potential problems and intervene in areas such as drug-drug interactions, duplicate therapy, over or underutilization and excessive or insufficient dosing. This type of review allows therapy for a patient to be altered if necessary. As electronic prescribing becomes more widely adopted, the concurrent DUR process may be performed by the prescriber at the time of prescription transmission to the pharmacy, allowing interventions before the drug is dispensed.
An important component of DUR will require complete and current drug and allergy records for the patient, as well as knowledge of appropriate therapeutic interchanges for individuals. As a safety net, pharmacists will perform a similar role as prescribers on the dispensing side of these transactions. Example: Concurrent DUR often occurs in institutional settings, where patients often receive multiple medications.COa late-stage biopharmaceutical company pioneering the Heat-Shock Protein response for the treatment of neurodegenerative orphan diseases, today announced that the U.
The FDA grants Priority Review to applications for potential therapies that, if approved, could offer a significant improvement in safety or effectiveness, diagnosis, or prevention of serious conditions. This designation shortens the review period from the standard 10 months to six months from the acceptance of the NDA.
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About About Drugs.Kasturirangan committee is a much-awaited and needed policy voicing the national and educational aspirations of the country. Since then the concerns of education have been dealt with by various committees or through five-year plans, but the vacuum remained. The new education policy laments less on the existing concerns in higher education but seeks to respond at the structural, aspirational and ideological level.
It does not situate the conversation in the existing discourse on quality, access or equity in higher education. In fact, it projects quality in education as a given and as a right of every learner and recognises education as a service.
The policy stands out for the revolutionary structural reforms suggested at the higher educational level promoting a flexible three or four years degree programme structure at the undergraduate level, accommodating multiple exits to learners. The degrees will be assigned based on credit attained, stored in an Academic Bank of Credits, a novel addition. While the concept of multiple exits is an important step towards reducing dropouts without a degree or certification, a question mark might remain on the value of such certifications or diplomas.
This is a concern that is currently manifesting in vocational education considering degrees and job prospects are still closely associated in the Indian psyche, even with the experience of diminishing returns on higher education and educated unemployability.
The policy attempts to depart from the current and conventional model of three-year undergraduate programmes and accords preference to the four-year model, inculcating a research component at the undergraduate level which will lead to a degree with research by the completion of the degree. Traditionally, research has been a reserve of postgraduate education in the country.Jokes in english for school
The four-year model allows one to pursue a PhD right after graduation. This, along with the discontinuation of the two-year MPhil programme, may give impetus to the number of students who opt for Doctoral programmes in the country, which is abysmally low at 0. The recommendation on including subject-specific teaching-education-pedagogy courses across disciplines for doctoral students is commendable considering the lack of formal training and orientation towards pedagogy and andragogy in the existing framework of teacher education, which focusses on training teachers for school and largely excludes pedagogy and practice at the higher education level.
Accordingly, the policy moots for higher autonomy for teachers in the curriculum, up-gradation and pedagogical innovations. Another major reform envisaged in the new NEP is the bifurcation of universities under three categories— research-intensive universities, teaching-intensive universities and degree-granting colleges that provide undergraduate degrees. It locates research as an important activity that should be undertaken by all types of universities, though in varying degrees.
In the context of research, the policy makes an important declaration in the establishment of National Research Foundation, that would fund peer-review journals and institutional research projects. The policy views universities as multi-disciplinary institutions and suggests gradual phasing out of single-disciplinary institutions, which have been a regulatory nightmare and have adversely impacted quality in Higher Education.
It emphasises on a multidisciplinary, broad-based, liberal education where rigid binaries of sciences and arts collapse in the pursuit of knowledge and learning, particularly in higher education, reclaiming Liberal Arts as Indian tradition of education, followed today in the western framework.
To this extent, the policy suggests turning IITs to multi-disciplinary institutions offering courses beyond engineering. The policy suggests increasing the number of higher education institutions. Each district must have at least one higher education institution, particularly in states and remote regions that have a dearth of higher education institutions. NEP recognizes the role of private providers of education in attaining the educational and national goals of the country, with suggestions to encourage private universities to offer increased scholarships.
It does not suggest how this may be achieved. The policy indicates the need for and continuance of greater public funding in higher education, which does not speak to the current realities. The policy strives to streamline the various regulatory bodies under the Higher Education Commission of India as an apex body overseeing regulation, accreditation, funding, and academic standards through four main regulatory bodies — the National Higher Education Regulatory Framework Council NHERCNational Accreditation Council NAC ; a meta accrediting body, Higher Education Grants Council HEGC ; a funding and financing body, and General Education Grants Council GECresponsible for framing expected learning outcomes of various higher education programmes along with existing discipline-specific regulatory bodies.Introduction: Heart failure HF represents a significant healthcare issue because of its ever-increasing prevalence, poor prognosis and complex pathophysiology.
Currently, blockade of the renin-angiotensin-aldosterone system RAAS is the cornerstone of treatment; however, the combination of RAAS blockade with inhibition of neprilysin NEPan enzyme that degrades natriuretic peptides, has recently emerged as a potentially superior treatment strategy.
This drug consists of a supramolecular complex containing the angiotensin receptor inhibitor valsartan in combination with the NEP inhibitor prodrug, AHU Aspects of the trial that might be relevant to clinical practice are also discussed. Expert opinion: Speculation that LCZ will pass the scrutiny of regulatory agencies for HF-REF appears to be justified, and it is likely to become a core therapeutic component in the near future.
Although long-term data remain to be generated, the promising results regarding hypertension are likely to expedite acceptance of the drug for HF-REF. Keywords: angiotensin receptor blocker; angiotensin receptor neprilysin inhibitor; heart failure; neprilysin; valsartan. Abstract Introduction: Heart failure HF represents a significant healthcare issue because of its ever-increasing prevalence, poor prognosis and complex pathophysiology.
Publication types Review.The new National Education Policy NEP aims to reorient the education system towards meeting the needs of the 21st century by achieving the twin objectives of inclusion and excellence, President Ram Nath Kovind said Saturday. Addressing the Visitors' Conference on 'Implementation of National Education Policy in Higher Education', the President said the policy sets the vision of developing an equitable and vibrant knowledge society by providing quality education to all.
He said the fundamental principles of the new policy include inculcating creativity and critical thinking in order to encourage logical decision-making and innovation.
Drawing inspiration from the "Bhagvad Gita" and the Krishna-Arjun dialogue, the President reiterated the concept of free communication and discussion between the teacher and the student. Listing the features of the new policy, Kovind said that it would also introduce the system of academic bank of credits.
Noting that the target of the NEP is to increase the Gross Enrolment Ratio or GER in higher education to 50 per cent bythe President observed that the online system of education can also be utilised to reach this target, especially in catering to the female students or those who do not have physical access to educational institutions as well as international students.
However, the share of female students is extremely low in institutions of national importance and particularly low in technical education, he said. It would be the role of head of institutions that would have an impact on the teachers and students and hence the heads of organizations should take active interest in implementing the policy," Kovind said.
The support of all sections is imperative in brainstorming about the implementing process," he said. The NEP approved by the Union Cabinet in July replaces the National Policy on Education framed in and is aimed at paving the way for "transformational reforms" in schools and higher education systems to make India a "global knowledge superpower".
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Opposition leaders to meet President over Delhi riots What's Brewing. Battling racism in British fashion.The introduction of these drugs increased appreciably the number of therapeutic combinations used in the treatment of epilepsy and with it, the risk of drug interactions. In general, these newer antiepileptic drugs exhibit a lower potential for drug interactions than the classic AEDs, like phenytoin, carbamazepine and valproic acid, mostly because of their pharmacokinetic characteristics.
For example, vigabatrin, levetiracetam and gabapentin, exhibit few or no interactions with other AEDs. Felbamate, tiagabine, topiramate and zonisamide are sensitive to induction by known anticonvulsants with inducing effects but are less vulnerable to inhibition by common drug inhibitors. Felbamate, topiramate and oxcarbazepine are mild inducers and may affect the disposition of oral contraceptives with a risk of failure of contraception. These drugs also inhibit CYP2C19 and may affect the disposition of phenytoin.Ala hazrat shayari lyrics
Lamotrigine is eliminated mostly by glucuronidation and is susceptible to inhibition by valproic acid and induction by classic AEDs such as phenytoin, carbamazepine, phenobarbital and primidone. Publication types Review. Substances Anticonvulsants.
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