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On page no 7 of the treatment file, the examination of the patient at time of admission is recorded as G E General Examination ; Conscious, Pulse 90 min, BP 120 70, GC better. Treatment given is recorded as Inj TT, Decadron, Mikacin, Dolonex, Fortwin, and Phenergan. SMO Senior Medical Officer ; was informed. After that notes on the file show time at 7.30 PM. There is no record of condition between 1Noon and 7.30 PM. At this time Thana Singh was referred to DMC A private medical Institute at Ludhiana ; RH PTI government Teaching institute cum Hospital at Patiala ; . While referring neither any reason was assigned as to need of that nor any examination of vital signs or condition was done before reaching the decision to send the patient to higher institute after more than 30 hours of patient under treatment. No intensive treatment was given before that, which could indicate serious condition of the patient. No investigation was done till this time. All vital signs as recorded showed good physical condition. Notes in the treatment files with one continuation file ; were so haphazard that it becomes essential to note the chronological order of the time and dates. Here under order of time and dates of medical notes are noted4: Page Date Time 7 6.2.00 1 Noon 7.30 8 14.2.00 Thana Singh declared dead on 14.2.00 at 8.50 ; 7.40 8.00 9 nil 10 7.2.00 nil 11 14.2.00 nil 12 Pulse, temperature, respiration record of 6 2, 8 and 11 2 without mentioning the time. 13 6.2.00 nil 6.2.00 nil 13.2.00 7.2.00 3.00PM nil 10.2.00 14 10.2.00 ineligible date 12.2.00 14.2.00 7.00 nil 21 14.2.00 8.15 Continuation file started, Page numbers 23, 24, 25, and 28 are blank. 29 14.2.00 nil 30 14.2.00 8.50 Investigation Team An investigation team was constituted of Mr. Ved Parkash Gupta, General Secretary PUCL Punjab ; , Mr. Balwant Singh Dhillon, Senior Vice-President, Lawyers for Human Rights, Mr. B. S Bhuller, Journalist, Mr. Surinder Sharma Advocate and Dr. Vineeta Gupta General Secretary Insaaf International as convenor of the investigation team. The and dexamethasone.

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Class: HIV protease inhibitor PI ; Standard dose: Two 200 50 mg tablets twice a day or four 250 50 mg tablets once daily for first time therapy no once-daily dose if taken with Lexiva, Sustiva, Viracept, or Viramune ; . Three tablets twice a day once daily not recomended ; for treatment experienced or those taking it with Lexiva, Sustiva, Viracept, or Viramune. Soft-gelatin capsules 133.3 mg lopinavir and 33.3 mg ritonavir each ; being phased out in early 2006. Take with or without food, preferably with food to lessen side effects; liquid formula available. Take missed dose as soon as possible, but do not double up on your next dose. AWP: $796.26 month for both tablets and capsules Manufacturer contact: Abbott Laboratories, kaletra , 1 800 ; 2226885 AIDS Treatment Information Service: 1 800 ; HIV0440 4480440 ; Potential side effects and toxicity: Rash, diarrhea, nausea, vomiting, stomach pain, headache, muscle weakness, increased cholesterol and triglycerides fats in the blood ; , and AST ALT liver function tests, a sign of liver damage; this may be more common in people with hepatitis B or C ; seen with all other protease inhibitors are increased levels of cholesterol and triglycerides, except possibly unboosted Reyataz atazanavir ; and these increased levels may be associated with heart disease. Other possible side effects are lipodystrophy body fat changes, including thinning of the face, arms and legs, with or without fat accumulation in the stomach, breasts and sometimes the upper back ; , onset of new cases or worsening of diabetes see your doctor promptly ; and increased bleeding in hemophiliacs. Potential drug interactions: Do not take with Versed, Halcion, Hismanol, Seldane, rifampin however, recent studies show that increasing the total daily dose of Kaletra may be an option ; , ergot derivatives such as Cafergot, Wigraine and Methergine, D.H.E. 45, in any form--serious interactions seen with dilation during gynecological exams ; , garlic supplements, or the herb St. John's wort. Do not use Zocor or Mevacor; lipid-lowering alternatives are Lipitor, Lescol, and Pravachol, but they should be used with caution due to potential for liver toxicity. Oral solution contains alcohol, so do not use with Antabuse or Flagyl. Avoid certain calcium channel blockers. Dosage of methadone may need to be increased when taken with Kaletra. Increase Kaletra dose to 4 capsules or three tablets twice-a-day with food recommended when using with Sustiva or Viramune in people who previously took HIV drugs, especially protease inhibitors. Not recommended to be taken with Lexiva. Kaletra may lower levels of Retrovir and Ziagen. Videx should be given an hour before or two hours after Kaletra, as Kaletra should be taken with food. Mycobutin rifabutin ; dosage should be reduced to 150 mg every other day or 150 mg three times per week ; when used with Kaletra. Phenobarbital, phenytoin or carbamazepine may lower blood levels of Kaletra. Reduces effectiveness of birth control pills; use alternative contraceptive. Mepron levels may be reduced with Kaletra. Avoid Sporanox doses greater than 200 mg per day with Kaletra. People with kidney impairment may require lower Biaxin doses with Kaletra. Transplant medicines require close monitoring with Kaletra. Kaletra may alter coumadin levels. Steroids, especially Decadron, may decrease levels of Kaletra and dibenzyline.

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NOTES ON SQUIRREL CONTROL Squirrel Control Introduction In Britain we have two species of squirrel. The smaller, native red squirrel Sciurus vulgaris ; and the larger grey squirrel Sciurus carolinensis ; , introduced from North America. The latter has displaced the former over much of southern Britain over the past 100 years and has moved into and colonised the urban environment. Here it thrives on hardwood trees in parks and recreation areas and in suburban gardens, where its diet is supplemented from bird tables etc. Red squirrels seldom achieve pest status and are protected by law, but grey squirrels can cause considerable damage to young trees, by their habit of bark-stripping to access the sappy tissue below. Additionally, in suburban areas they can also cause considerable noise disturbance in attics and lofts of human dwellings. Control of these damaging pests is hampered by the public perception of grey squirrels; they are indeed interesting animals to observe. However, where serious damage is resulting from squirrel populations, or where stress is caused by their presence in lofts and attics, control is necessary. Nonetheless, we need to be sensitive to public feelings when undertaking their control, and ensure we keep within the legal requirements pertaining to this species. Control Methods Control methods available for grey squirrels include: shooting and drey poking, trapping using cage or spring traps and the use of poison baits. These are dealt with in turn below. Shooting and Drey Poking. This method should be carried out during late winter early spring when the absence of leaves on the trees allows the dreys to be seen. It is more effective if the weather is cold, wet and windy, as under these conditions the squirrels are most likely to be sheltering in their dreys. On fine, sunny days squirrels can be foraging away from the drey and not return until after the operation has been completed. Squirrels resting in holes in trees will be missed, therefore the method needs to be used as part of an integrated control programme employing other methods. A drey poking team should consist of at least three people, ideally with a dog or dogs, capable of taking any squirrels that come to ground. Poles made of light aluminium tubing joined together with spring clips are available. These are usually in 2 metre sections and 10 sections usually gives sufficient length[1]. The top section has a hook to dislodge the dreys. One or two people operate the poles while the remainder, equipped with 12 bore shot guns, shoot the emerging squirrels. A softly-softly approach to the drey should be adopted. A light touch will often result in a cautious emergence of squirrels, often singularly, making for an easier target. If the pole and hook is brought crashing through the drey its occupants will dart away in all directions making shooting difficult. All dreys should be destroyed, even old dreys which may be used for cover once the operation has commenced. Cage Traps. Single or multi-catch traps are available for grey squirrels Single catch cage traps should be deployed, one for each hectare of vulnerable crop, spaced at least 100 metres apart and multi-catch traps one for every 3 hectares of vulnerable crop, spaced 200 metres apart. The best trap sites are under trees known to be used by squirrels travelling between the canopy and ground or along an old hedge or bank line with tree cover. The ground should be clear of vegetation, leaving a carpet of dead leaves on which the traps can be camouflaged and wedged or pegged into position. Pre-baiting of the traps using yellow whole maize is essential and should continue for five days. The maize should be placed inside the unset trap with is doors open and broadcast near the entrance and in the immediate vicinity. The trap should be visited on alternate days, gradually reducing the amount of maize outside and increasing the amount inside. On day five the trap should be set and maize placed only inside. Once set, the traps must be visited daily. Single catch traps in areas of high squirrel populations are worth visiting twice a day as they can be very effective after adequate pre-baiting. Most of the squirrels in the immediate area will be caught within the first two days and the traps should be moved to a new site or the operation discontinued after four days. If the trapping operation requires a number of trap areas on the same site, it is easy to pre-bait a second site while trapping at a first, then move the traps after the fourth day to the second site, cutting down on pre-baiting time. Squirrels caught in cage traps should be humanely destroyed by running them into a sack and striking them with a sharp blow to the head. Drowning is not permitted. Spring Traps. Also called humane traps or tunnel traps, these are sometimes more useful than cage traps as they give, for instance, decadrln dose.
The Centers for Medicare & Medicaid Services CMS ; periodically updates the lists of HCPCS codes subject to the consolidated billing provision of the Home Health Prospective Payment System HH PPS ; . This article provides the annual HH consolidated billing update effective January 1, 2005. Affected providers should be aware of these changes. Section 1842 b ; 6 ; of the Social Security Act SSA ; requires that payment for home health services provided under a home health plan of care be made to the Home Health Agency HHA ; . Billing for all such items and services is to be made by a single HHA overseeing that plan. This HHA is known as the primary agency for HH PPS for billing purposes. With the exception of therapies performed by physicians, supplies incidental to physician services, and supplies used in institutional settings, services appearing on this list that are submitted on claims to Medicare contractors will not be paid separately on dates when a beneficiary for whom such a service is being billed is in a home health episode i.e., under a home health plan of care administered by an HHA ; . Medicare periodically publishes Routine Update Notifications, which contain updated lists of non-routine supply and therapy codes that must be included in Home Health HH ; consolidated billing. The lists are always updated annually, effective January 1, as a result of changes in HCPCS codes that Medicare also publishes annually. This list may also be updated as frequently as quarterly if required by the creation of new HCPCS codes during the year and phenytoin.
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Was an accurate assumption as the grade of nurses recruited as APNs varied substantially across the pilot sites. Some informants suggested that the short length of the training inhibited an extensive exploration of the training topics and made it difficult to absorb all the information provided. However, it was acknowledged that the training materials provided a good reference source for the APNs to use later. Some of the more general 'learning events', which were organised by NatPaCT but included UHG staff appeared less well focused, more culturally alien APN1 site C ; and politicised: 'The learning events have been all the sites and it's tended to be the managers really that have got together, hasn't it? And I've only attended a couple. I don't know, I just never felt that you could give an answer that they didn't want to hear, and lots of us sitting around tables doing group work were saying, you know, "Well that's sort of like the party line, if you like, but this is probably the real, the reality of it", but when we gave the feedback that wasn't really what was noted down over all. So you've got, I do think that a lot of this is politically driven' Clinical lead, site B ; . Towards the latter phase of the Evercare pilots, PCT and UHG agendas seemed to diverge: 'The [UHG] clinicians have come across and they've been extremely helpful. So I think we've had a really good experience as far as the clinicians are concerned. From the Evercare team, as far as their management is concerned I think it was obvious there was another agenda through Ovations. We were all aware that they were looking to get a foothold, why would you have come; you have a billion dollar company, coming to work in the NHS. Taking that into account I think we noticed that they got very focussed on their need to for the final report to be justified in a sense. Whereas we've come towards the end of the pilot and we're looking very much at how we translate this into something which works. So we've probably had a slight separating of focus there.' Executive Sponsor site E ; UHG established a UK office in March 2004 and began actively presenting their services to NHS bodies SHAs, PCTs, NHS Trusts ; . For example Trent SHA and Manchester SHA have had widespread discussions with their constituent PCTs about implementing and Evercare model, or at least an assessment by UHG of the readiness of PCTs to implement such a model. Both SHAs propose to involve all the PCTs in their territory, but only if all the PCTs themselves are able to cover the costs and valsartan.
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