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FIG. 13. Uracil transport by wild type NlSl-67 cells. A, samples of a suspension of 1 X lo7 cells ml of BM42B at 18" ; were supplemented with the indicated concentrations of [3H]uracil 70 cpm pmol ; and incubated at 18". Duplicate l-ml samples of the suspension were analyzed for radioactivity in total cell material. B, the maximum intracellular concentrations of uracil Ura ; based on a volume of 20 J lo7 cells 18 ; are plotted as a function of the extracellular uracil concentration. C, LineweaverBurk plot of the initial rates of uracil uptake. The 1-min values in A served as estimates of the initial rates of uptake. D, samples of a suspension of 1 X 10' cells ml of BM42B were supplemented with 10 NM Peraantine PER&`. ; A-A ; , 8 cytochalasin B CB ; O-O ; , 100 cytosine Q t ; A-A ; , or pretreated with 50 p-chloromercuribenzoate PCMB ; at 37" for 20 min V-0 ; . Another sample remained untreated O-O ; . All samples were supplemented with 5 NM [3H]uracil 70 cpm pmol ; , incubated at 18" and duplicate l-ml samples were analyzed for radioactivity in total cell material.

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I thank Dr Silverman1 for speaking out about the selfish motives that compel neonatologists to torture miscarried fetuses into extrauterine life and harm so many families. As the parent of a 23-weeks' gestation baby, I was deceived and manipulated by the neonatologists and the obstetrician concerning outcomes of such infants in general and of my son in particular.2 The neonatologists put him through months of painful, experimental treatment; caused him severe iatrogenic disabilities; generated more than 1 million dollars in medical bills; and created a lifetime of pain and stress for him and his family. We now most likely have a perpetual child who will never achieve independent living. Our emotional, physical, and financial resources will continue to be sucked into an ever-expanding black hole of medical need. I recall that one neonatologist used to refer to himself as "Father Joe" because of the many fetal infants he had rescued. Well, Father Joe, where are you now? Are you just another "deadbeat dad" driving off in your Lexus? Where is your sense of shame? and disopyramide.

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Note that any referrals you have extended to Basic Health members through Regence BlueShield will terminate on Dec. 31, 2004. All new referrals will be loaded in our system with an end date of Dec. 31, 2004, or the date specified on the referral if it is before Dec. 31, 2004.

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I'd have to say that I watch a fair bit of TV. Certainly not as much as I did as a child and teenager when TV watching was seen as less evil and more normal ; than reading a book, but still I'd get in around 10 hours in a normal week. One of my favourite programs from last year was the US version of "The Biggest Loser". The current Australian version is not on at a convenient time so I can't comment on it. Apart from the morbid curiosity of seeing a lot of jiggling fat on the screen and being relieved that `but for the grace of God there go I', the thing I found most striking was how hard it was to lose those huge amounts of weight. Their diet needed to be impeccable at all times, not the slightest deviation or exception to the low calorie intake every day. No birthday morning teas, no too tired to cook takeaways, no depression-related Tim Tams. Coupled with this were several hours a day every day of strenuous supervised exercise. There was no opportunity for injury time, an off day or poor motivation. I came to admire them for their dedication. I admired them even more when footage was shown of how they continued to progress in weight loss and healthy lifestyle after returning home. Permanent changes in lifestyle involve giving up habits held as part of our personalities. The wonder isn't that so few morbidly obese people are able to lose weight but that a few actually do. Our place is to watch out for those who might be ready to make permanent changes and to advise and encourage them when the time comes. Our priority should be with children on the slippery slope of obesity. Children are more able to change their dietary and activity habits with so much to gain in the medium to long term. More work needs to be done researching the best ways of bringing about these changes and norpace, for example, persantine aminophylline.

Conclusions: Currently pending. Disclosures: Sherry Mathew has nothing to disclose, Cindy Zoellner has nothing to disclose, Philip Keiser has nothing to disclose, and Laura Armas-Kolostroubis has nothing to disclose. R-22 Assessment of Teaching Experiences Completed in Accredited Pharmacy Residency Programs Danny McNatty, Craig D. Cox Texas Tech University Health Sciences Center, Lubbock, TX. Background: The number of pharmacy students in the U.S. has been increasing to account for the growing demand for pharmacists. The ramification of this increase is the development of a shortage of pharmacy faculty. Residents are the group of pharmacists that compose the biggest reservoir of faculty candidates with the necessary training for a career in academia. A possible contributing factor to the career choices of pharmacists after completing residencies is lack of exposure to and training in the variety of teaching experiences that will be encountered in a faculty position. We feel that our study will provide evidence that the relative lack of teaching experience during a residency is a contributing factor to both resident career decisions and inadequate preparation for the challenges of academic careers. Objective: To determine the number of teaching experiences a pharmacy resident completes during an accredited residency and to assess the effect of teaching experiences on post-residency career decisions. Methods: An online survey will be developed asking former residents about the number and type of teaching experiences completed during their residency and how this affected career decisions. An email will be sent out to all residency directors asking them to forward the survey link to residents from the past 3 years 2003-2006 ; . All responses will be maintained and tabulated within web surveying program. Results and Conclusions: Will be presented at TSHP meeting. Disclosure: None. R-23 Virtually There: A Novel Approach to Compliance with JCAHO Medication Management Standard MM.4.10 MAJ Jeffrey J. Neigh, PharmD, BCPS Brooke Army Medical Center, Fort Sam Houston, TX Background: JCAHO Standard MM.4.10 requires that "All Medication Orders are Reviewed for Appropriateness". This presents a unique challenge in our hospitals' ambulatory clinic areas. Historically, medications given in the clinic setting were not prospectively screened by pharmacy due to the sheer volume of orders. Objectives: To determine a means of prospectively screening clinic medication orders for drug allergy interactions with minimal impact on pharmacy and clinic workload and without a change in manpower requirements. Methods: The majority of the pharmacy screening process is conducted through CHCS. In the absence of available pharmacists, a "virtual pharmacy" was built in CHCS to screen these medication orders. Clinic stock lists were reduced to allow only high volume low risk medications to be stored as clinic stock. Prior to removal of a medication from clinic stock, the provider enters the order in CHCS or AHLTA which performs drug drug, drug allergy interaction screening. Education on this process was performed by drafting a document describing the process as well as provider education. Results: The "virtual pharmacy" was well accepted by the provider staff. Between 1200-1400 medication orders are screened on a monthly basis through this process. Evaluation of the system revealed over 90% compliance throughout our largest clinical areas. Conclusions: The "virtual pharmacy" provides real time medication screening prior to administration. This is more beneficial in preventing medication errors than a retrospective review by pharmacy. Disclosure: No disclosures. R-24 Rasburicase Use in Adult Leukemia Patients T.M. Newcomb, D.A. Blamble University of Texas M. D. Anderson Cancer Center 24 Poster Presentations.

Prerequisites for commercial and development success of nasally administered drugs. Because nasal formulations are liquid formations, the drug needs to be highly soluble in aqueous formulations. For example, in order to deliver 10 to 15 mg of drug in 100-ml volume, you are talking about solubility higher than 100 to 150 mg ml. This can pose limitations for a number of new chemical entities. The formulation needs to be simple and compatible with the nasal mucosa. Stability of the drug in liquid formulation to meet intended shelf-life and storage conditions can be problematic for some drugs. Cost of the delivery device contribution toward cost per unit dose also needs and motilium.

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Medicare must deny any service submitted, ordered or prescribed by a sanctioned provider. The beneficiary is not liable for any service denied due to the provider's sanctioned status. If claims are submitted by a sanctioned provider for items or services furnished under the Medicare program after the date of the sanction, the provider is liable for criminal prosecution as well as additional civil penalties. WPS will not issue payments for services performed, ordered or referred by these providers after the indicated dates. The effective date for the following sanctions or reinstatements is August 20, 2003, unless otherwise indicated. In addition to the following, current listings of sanctioned providers are available on the HHS Office Inspector General website at: : oig.hhs.gov fraud exclusions.
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These results, albeit in three relatively small but high-quality trials, look very good. Using the outcome of complete or almost complete relief of restless leg symptoms, the best information is that 16 19 patients benefited with pergolide compared with 1 19 controls. This would give a relative benefit of 11 95% confidence interval 2.3 to 52 ; and a number needed to treat of 1.3 1.0 to 1.7 ; . Whether this is sufficient evidence to institute this treatment in primary care is another matter. The results are such that local prescribing committees might like to examine it as part of formulating guidelines, and update that as more studies are reported. Because the studies we have were done on patients with bad symptoms they were referred to neurologists, after all ; , a trial in primary care might be justified. An old-fashioned review has some interesting comments on diagnosis [4]. As always, Bandolier shows that evidence can be found, and where it can be found, even if, as here, it is for an unlicensed indication. Whether and how it should be used is up to the reader. References: 1 J Staedt et al. Pergolide: treatment of choice in restless legs syndrome and nocturnal myoclonus syndrome. A randomized crossover trial of pergolide versus Ldopa. Journal of Neural Transmission 1999 104: 461-8. CJ Early et al. Randomized, double-blind, placebocontrolled trial of pergolide in restless leg syndrome. Neurology 1998 51: 1599-1602. TC Wetter et al. A randomized controlled study of pergolide in patients with restless legs syndrome. Neurology 1999 52: 944-50. VG Evidente, CH Adler. How to help patients with restless leg syndrome. Postgraduate Medicine 1999 105: 59-74 and epivir.

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On the issue of heroin addiction being "self-inflicted" and not worth treating, it is useful to provide an analogy. A significant number of cardiologists treat a large number of middle-aged men who require coronary bypass operations. These individuals are generally overweight, eating unhealthy food, and drinking unhealthy amounts of alcohol in addition to smoking several packs of cigarettes everyday [sic]. Should the cardiac surgeon deny treatment to these individuals because their cardiac disease is "self-inflicted" through years of neglecting their own health? If an inmate in any system required critical health care for his disease, should the officials deny him access to such care based on perception of "self-infliction"?44.

In general, the assessment may include: Pulmonary Function Test PFT ; : measures how the lungs manage airflow. Chest X-ray: determines the extent of damage to the tissues and heart size. CT Scan of Chest: looks at the heart and lungs in more detail than a chest X-ray. Arterial Blood Gas: shows how the lungs are using oxygen. Ventilation-Perfusion VQ ; scan: shows the amount of blood flow to each lung. X-ray or CT scan of sinuses: looks for presence of chronic sinus infections and determines the extent of damage to the tissues. Abdominal ultrasound: evaluates digestive organs, including liver and kidney. MUGA Scan: evaluates the function of the right and left side of the heart. 2D Echo: evaluates the effectiveness of the heart valves and the pumping action of the heart chambers. Electrocardiogram ECG ; : shows the patterns of electrical waves in the heart. Thallium Psrsantine Scan: assesses blood circulation in the heart muscle. Bone Density Scan: evaluates the strength of the bones. Sputum analysis: evaluates the types of organisms found within a candidate's airway, and indicates what antibiotics could be used in case of infections. Six-minute walk test: tests the level of fitness as a candidate walks as fast and as far as he she can in six minutes, to determine the amount of oxygen required at rest and during exercise. During a pre-transplant assessment, candidates will also meet with other members of the transplant team. Individual health care issues will determine whether candidates need to see any other specialists. I. Rationale Controlled studies demonstrate that the prevalence of lumbar zygapophysial z ; joint pain ranges from 15%1 to 40%2 in those with chronic low back pain. Lumbar z-joint pain cannot be diagnosed by history, clinical examination1, 2, 3, CT4, or SPECT scanning5. Diagnostic blocks of these joints or their nerve supply are the only means available to confirm or deny these structures as pain generators. Indications Lumbar z-joint intra-articular ; injections are both diagnostic and therapeutic and may facilitate other treatment options such as manual or physical therapy. Injection should be limited to those with low back or somatic referred pain, who failed to respond to conservative treatments including NSAIDS, corticosteroids, or therapies. With severe limitation of function, one could consider performing the injection prior to the initiation more conservative options to facilitate those options. There is no role for a series of z-joint injections given without regard to response of initial corticosteroid and or anesthetic injection6. The injection should not be repeated on a patient who experienced no significant relief during the anesthetic phase of a prior z-joint injection, which rules out the diagnosis of intra-articular z-joint pain. Contraindications Absolute Bacterial infection: systemic or localized at injection site Bleeding diathesis: due to anticoagulants or hematological disease Relative Allergy to injectants; history of steroid psychosis Pregnancy NSAIDs, aspirin, or other antiplatelet agents e.g., Ticlid, Plavix, Coumadin, Trental, Pletal, Heparin, Lovenox, Innohep, Fragmin, Normiflo, Persantine, Aggrenox, Ginko Biloba, Orgaran, and Damaparoid ; Hyperglycemia, adrenal suppression, immune compromise, or congestive heart failure IV. Objective To deliver up to 1.0 ml of injectant, including contrast, anesthetic, and possibly corticosteroid, into the z-joint space, to both test the hypothesis that the joint is the source of pain and decrease intraarticular inflammation. Materials A. Equipment and Supplies 1. Fluoroscopy is mandatory 2. 22-26 gauge spinal or chiba needle is recommended 3. Medication and contrast syringes 4. Connection tubing optional ; 5. Physiologic monitor optional ; 6. Skin marker optional ; B. Medications Agents 1. Contrast medium Radiographic contrast medium is essential to confirm extra-vascular and intraarticular needle placement. A nominal amount 0.1-0.3ml ; is sufficient. It is used to obtain an arthrogram prior to any subsequent injection. Examples include Omnipaque 240 and Isovue 300 370. 2. Local anesthetics Agents commonly used include lidocaine 1%-2% and bupivacaine 0.25%-0.50% 3. Corticosteroids Isolated role is controversial. Should be used to facilitate more aggressive conservative care and not as a treatment isolation6 Page 3 of 30. The FDA has issued a warning letter to HydroMed Products, saying the manufacturer's devices are considered adulterated under the Federal Food, Drug, and Cosmetic Act because the company's manufacturing facilities and controls are not in conformance with current GMP requirements. Hydro-Med, a division of Spectrum Laboratories, manufactures surgical drapes, sterile Esmarch bandages and sterile equipment drapes for ultrasound, arthroscopic, camera and endoscopic accessories. Significant quality system regulation violations found by the FDA included: The failure of management with executive responsibility to ensure an adequate and effective quality system has been fully implemented and maintained at all levels of the organization and failure to allocate necessary resources. The FDA found that not only did the company not provide sufficient personnel to make sure all procedures were carried out as the quality system requires, but the quality manager was also only a part-time employee. Failure to adequately investigate the cause of nonconformities relating to product, processes and the quality system. In September 2000, the company recalled 350 of its sterile ultrasound probe drapes because of defective pouch seals. The 350 recalled drapes were part of a larger shipment. However, Hydro-Med did not investigate and document the potential packaging defects for the rest of the pouches. Failure to adequately validate manufacturing processes with a high degree of assurance and approve them according to established procedures to ensure that product specifications can be consistently met. The agency found Hydro-Med's validation of its heat-sealing process for sealing its device packaging to be inadequate in that the company had not defined process limits for worst case conditions for pouch size and, for example, prsantine generic.
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Table 5 Recovery from anaesthesia mean; median range ; or number % . * Time between end of administration of anaesthetics and eye opening on request Tropisetron Placebo n : 97 ; Waking time min ; * Level of consciousness 30 min after arrival in recovery Awake Reacts to verbal command Reacts to physical stimuli Not arousable 12.3 10 275 ; 75 77 % ; 19 0.5 mg n : 97 ; 11.9 12 140 ; 82 85 % ; 14 mg n : 95 ; 12.6 12 232 ; 78 82 % ; 16 mg n : 96 ; 13.9 13 350 ; 76 79 % ; 20 Table 6 Number of adverse events. * Not all cases of bradycardia treated with an anticholinergic number in brackets ; were reported as an adverse event Tropisetron Placebo n : 97 ; Events during anaesthesia: Difficulty in intubation Rash during induction Allergic reaction during induction Wheezing at expiration Hypertension Bradycardia * Intestinal perforation Uterine haemorrhage Uterine perforation Postoperative events: Headache Dizziness Hypotension Hyperventilation Haematemesis Stomach ache Pruritus Eczema Local allergic reaction skin ; Eye irritation All adverse events: Patients with adverse events 0 1 0 0.5 mg n : 97 ; 0 mg n : 95 ; 0 mg n : 96 ; 1 are listed in table 6. There were no allergic reactions or other adverse events in the period between study drug administration and start of induction of anaesthesia. Most adverse events occurred only once. With perhaps the exception of headache, there was no increased frequency of adverse events in patients who received a higher dose of tropisetron. Intraoperative bradycardia, reported as adverse event or treated with an anticholinergic, did not occur more frequently in any of the tropisetron groups compared with placebo, nor did heart rate, systolic and diastolic arterial pressure show a differential pattern of response to the anaesthesia for the four study groups. There were five cases of intraoperative hypertension documented as adverse event, distributed over all treatment groups, and one case of postoperative hypotension, which occurred 12 h after administration of tropisetron 5 mg in a patient suffering from severe nausea. Four ECG recordings per patient were obtained in a single centre for 47 patients. There were no ECG abnormalities other than a single case of a transient first degree AV block and a transient QTc prolongation in another patient, both observed in the immediate postoperative period. The patient showing a transient first degree AV block already had a PQ PR interval at baseline of 0.18 s after a history of complete thyroidectomy for Hashimoto thyroiditis with treatment-resistant hyperthyroidism. This patient had received tropisetron 2 mg. The patient with the transient prolongation of the QTc for the 2-h ECG and the 4-h ECG had received tropisetron 0.5 mg and had a `double hump' aspect of the T wave at baseline.

ADMINISTRATIVE CATEGORY A-1 The effect of age and race or ethnicity on pharmacy and medical resource utilization in a male prison population Quality Improvement project in progress ; B Habeger, HG Anderson, R Lenz, S Nelson, T Revell Texas Tech University Health Sciences Center School of Pharmacy, Amarillo, TX Background: It is documented in medical literature that significant contributors to increases in consumption of pharmacy and medical services in the general population are the patient's increasing age and certain races or ethnicities. Within the Texas Department of Criminal Justice TDCJ ; , the proportion of patients with multiple co-morbidities and or advanced disease progression is known to be significantly greater than in the general population. The extent that the TDCJ population contributes to pharmacy and medical resource utilization is unknown. The extent that pharmacy and medical resource utilization is affected by differences in TDCJ facility population mix for age and race or ethnicity is unknown. Objective: To determine the relationship of prison population age and race or ethnicity with pharmacy and medical resource utilization within TDCJ prison facilities located in West Texas. Methodology: Monthly prison facility population demographics pertaining to average age in increments of 10 years ; and race or ethnicity for a twelve-month period will be obtained from the TDCJ mainframe computer. The proportion of the population of age 40 and 50, as well as the proportion of the population who are of white, black, Hispanic or "other" race or ethnic groups will be tabulated. Pharmacy and medical resource utilization indicator report data will be statistically compared to the population data. Results: The results will be separately reported for the two age groups in aggregate for all TDCJ facilities together and for individual facilities. Conclusions: The results of this study will be reported to the controlling Pharmacy and Therapeutics Committee. A-2 Bar Code Technology Use in a Nuclear Pharmacy An FDA Exempt Entity ; : Maximizing Patient Safety M.C. Villarreal 1, R.A. Patry 2, L.G. Candelaria1, L.M. Frietze-Chastain2 1 Biotech Pharmacy, Inc., El Paso; 2 Texas Tech University Health Sciences Center School of Pharmacy, Amarillo and Dallas ; Background: Following in the footsteps of the Institute of Medicine's IOM ; 1999 report to Congress entitled, "To Err is Human, Building a Safer Health System, " which attributed 7, 000 patients deaths year to medication errors, the Food and Drug Administration FDA ; issued a new ruling. This rule, effective April 26, 2004, "Bar Code Label Requirement for Human Drug Products and Biological Products, " was designed to assist health care systems in decreasing medication errors, thereby improving patient safety. This rule requires manufacturers of human drug and biological products provide bar code technology on their product labels. These bar coded labels must contain the product's National Drug Code NDC ; number. Studies have shown that bar code technology may decrease medication errors by 50%. 3 ; Objective of this report: Nuclear pharmacies are exempt from this FDA bar code ruling to avoid increased exposure to radiation by staff. This poster will illustrate how the FDA mandated bar code technology can successfully be implemented in a nuclear pharmacy without increased exposure to radiation by nuclear pharmacy personnel. Methods: This poster will detail how a nuclear pharmacy utilizes bar code technology in dispensing nuclear pharmaceuticals. Exposure rates prior to and after implementation of bar code technology in this pharmacy will be compared and presented. Conclusions: The FDA mandated bar code technology, which is exempt for nuclear pharmacies, may be safely implemented in a nuclear pharmacy. The FDA has justified the cost of implementation of bar code technology by citing a decrease in medication errors, thereby increasing patient safety. 2 TSHP 58th Annual Seminar.
Some have not been transmitted. T Clinical pharmacy should periodically audit refill records of elderly or high-risk members to monitor gross noncompliance.

Generic prescription drugs are proven to be as safe and effective as more costly brand-name drugs. Generic equivalents produce the same effects in the body as their brand-name counterparts because both contain the identical active ingredients and are approved by the federal Food and Drug Administration FDA. WhoshouldundergopharmacologicMPIstresstestwithPersantine dipyridamole ; ?.

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