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Assess fasting lipid profile. Immediately start cholesterol-lowering drugs when baseline LDL 130 mg dL LDL 100 mg dL No drug therapy LDL 100 to 129 mg dL Consider adding drug therapy to diet, as follows LDL 130 mg dL Add drug therapy to diet, as follows HDL 35 mg dL Emphasize weight management and physical activity Advise smoking cessation and diamicron, for example, clotrimazole. The tablet must not be crushed, broken or chewed.
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He obesity epidemic in the United States has generated a number of related health issues, such as increased prevalence of the metabolic syndrome and its comorbidities, including hypertriglyceridemia.1 The Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults NCEP ATP III ; describes hypertriglyceridemia as a key clinical feature of the metabolic syndrome.2 A 2005 study that examined data from the National Health and Nutrition Examination Survey NHANES ; III and NHANES 1999-2000 cited increases in high blood pressure, waist circumference, and hypertriglyceridemia as major factors in the rise in prevalence of the metabolic syndrome, especially among women.1 It is not surprising that an increased prevalence of hypertriglyceridemia among men and women parallels an increased prevalence of obesity, the metabolic syndrome, and cardiovascular disease CVD ; .3 Based on meta-analyses of prospective studies indicating that elevated triglycerides TGs ; are an independent risk factor for coronary heart disease CHD ; , the NCEP ATP III 2002 ; Classification of Serum Triglycerides Standards for Hypertriglyceridemia were revised substantially downward from ATP II levels2, 4: Normal TGs: 150 mg dL Borderline-high TGs: 150-199 mg dL High TGs: 200-499 mg dL Very high TGs: 500 mg dL A further complication is a lack of patient knowledge about hypertriglyceridemia and associated cardiovascular CV ; risks. Results from a survey of 2089 patients and 510 physicians by the National Lipid Association revealed that an overwhelming majority of physicians thought that patients had a poor understanding of TGs, including the independent risks that elevated levels of TGs pose to CV health.5. 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Intestinal failure IF ; occurs when there is reduced intestinal absorption so that macronutrient and or water and electrolyte supplements are needed to maintain health and or growth.4 If untreated, undernutrition and or dehydration result. IF may be defined and quantified by balance study techniques5; however, only few centres have the facilities for these difficult metabolic studies, and therefore nutrient fluid requirements determine whether IF is termed severe, moderate, or mild fig 1 ; . Severe is when parenteral, moderate when enteral, and mild when oral nutritional fluid supplements are needed.6 A patient may change, due to compensatory mechanisms for example, functional adaptation ; , from having severe to mild IF with time. IF can be acute or chronic fig 2 ; and encompasses a wide variety of underlying medical and surgical conditions. Chronic IF most commonly results from a bowel resection that leaves a short residual length of small bowel. Severe IF is a complex clinical and physiological situation that requires an experienced multidisciplinary input. These patients may be most appropriately managed in a centre with special interest and expertise in IF. These guidelines aim to help practicing clinicians manage patients with IF due to a short bowel. Complications of the short bowel are covered but specific complications relating to therapy for example, catheter related sepsis, hepatic or bone complications of parenteral nutrition ; are not included. While bowel length is often unknown, patients who have had several ileal resections and have diarrhoea and weight loss may be treated as jejunum-colon patients, and patients with ileostomy diarrhoea, dehydration, hypomagnesaemia, and undernutrition may be treated as jejunostomy patients and dramamine. Clarinex-D QL QD, E Climara Pro QL Clindagel Colyte Combipatch QL Combivent QL Combunox QL Concerta QL Cosopt QL Covera-HS Cryselle Cu6ivate Cymbalta QL Cytomel Denavir Derma-Smoothe FS Detrol Detrol LA QL Diprolene Ditropan XL QL Doryx Dostinex Duac Duoneb Duragesic QL QD Elidel N Elmiron Elocon Enbrel QL QD Epipen QL Epipen Jr. QL Estrostep FE Extendryl SR Factive Famvir QL FemHRT Finacea Finasteride N Flomax Flovent HFA QL Focalin QL Focalin XR QL Genotropin QD, N Glucometer Test Strips QL, DS Glucovance Gynazole-1 Gynodiol 1.5mg Tablet Humalog Humibid DM Humibid LA Humira QL QD Humulin Imitrex QL Inderal LA Intron A QL, N Kadian QL QD.

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CLINICAL GOVERNANCE STATISTICS FOR APRIL 2005 - MARCH 2006 AprMayJun05 05 Jul-05 3. Staff Indicators: use of locums, sick leave- sessions weekly unless otherwise stated Doctors Total number of contracted doctors FP, GU ; 48 47 Total number of clinical sessions worked by doctors 167.75 Number of sessions worked by contracted doctor 142 151 131 Number of sessions leave 18 26 83 Number of vacant sessions 7.5 5.5 23.5 Number of extra sessions worked by doctors non cont ; 0 0 1 Number of extra sessions worked by doctors cont ; 5 2 0 Nurses Total number of contracted nurses FP, GU ; 61 62 Total number of sessions worked by nurses 313 311 314 Number of sessions worked by contracted nurses 268 286 188 Number of sessions leave 86 60 26 Number of vacant sessions 9 7 Total number of nurse sessions 313 311 314 Number of extra sessions worked by nurses cont ; 46 28 51 Number of extra sessions worked by nurses non cont ; 0 0 0 Admin Total number of contracted admin staff 76 73 SICKNESS ABSENCE: % doctors 9.02 6.1 5.74 % nurses 8.75 5.06 5.35 % administration 5.94 3.69 3.65 CENTRE FOR WOMEN'S HEALTH Counsellors Total number of contracted Counsellors 20 19 Total number of client sessions 411 439 454 Number of trainee placements 7 Number of volunteers 6 4 Admin Total number of contracted admin staff 10 8 SICKNESS ABSENCE: % administration 2.02 0 0 0 % counsellors 7.71 0 0.36 1.1.

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