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The studies presented here serve as a platform for the exploration of the function of 'endogenous morphine' in the neurosciences and immunosciences.

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The rise in gratuitous and senseless violence is a disturbing recent addition to the community landscape. Psychiatrists have tried to sell us on all the wrong reasons for this -- everything from a person's mental illness, poverty and broken families to genetic makeup; however, the fact missed by most is that psychiatric drugs, on an ever increasing rise in society and amongst school children, are actually creating acts of violence. The rise in senseless violence in America is date coincident with the increased use of mind-altering drugs. How many times must history repeat itself before we start looking for the common factors present in case after case of brutal and violent acts? In the recent cases where children have become murderous, one must ask the question, even if children have access to guns or the means to make bombs, what is it that is making them pull the trigger? What twists a child so that he would kill his classmates, friends or even people that he loves? What could possibly push children over the edge to a point where their acts are unrecognizable even by those who know them? Consider the following: In the U.S. alone, approximately 4 million children are currently on the psychiatric drug Ritalin, a drug which the Drug Enforcement Agency DEA ; places in the same category a schedule II drug ; as opium, morphine and cocaine. Psychotic episodes and violent behavior are associated with chronic Ritalin abuse. Ritalin is the amphetamine-like drug widely prescribed to children for the contrived mental disease, "Attention Deficit Hyperactivity Disorder" ADHD ; . Even Ritalin's manufacturer warns that "frank psychotic episodes can occur" with abusive use. And even the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders lists the major complication of Ritalin withdrawal is suicide. In the U.S. today, over 909, 000 children and adolescents between the ages six and eighteen are on psychiatric antidepressant drugs.
Conversely, probes targeted against exons 2 or 3 affect antinociception produced by m6g, but not morphine rossi et al.

He takes it away and orders two 2 milligrams of morphine to be administered to this patient.

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Department of pharmacology at ucl james randi educational foundation quackwatch the original inprobable science page ← evil advice from homeopaths about malaria prevention institute of science in society → lethal advice from homeopaths about malaria prevention july 13th, 2006 · no comments it is often said that, although homeopathy does no good, at least it does no harm and naproxen.

Lack of metabolism: enhanced plasma concentrations and exaggerated pharmacological responses. Lack of a metabolic pathway in certain individuals: compound is bioactivated by a different enzyme. Enhanced toxicity due the lack of a detoxification pathway. Lack of a bioactivation pathway: poor metabolisers at less risk Increased protein expression or catalytic activity, with subsequent increase in the formation of toxic metabolites.
Drug Therapy Prior to Admission Husband brought printed out sheet from oncologist's office ; Drug Name Dose Strength Route Prescribed Schedule Duration StartStop Dates Compliance Dosing Issue 1. gemcitabine 800mg m2 IV Day 1, 8 every 21 days 7 25 06 present Oncologist plans on treating patient for 4 cycles and then repeating CT scans to determine response 2. carboplatin AUC 2 IV Day 1, 8 every 21 days 7 25 06 present Oncologist plans on treating patient for 4 cycles and then repeating CT scans to determine response 3. ondansetron 8mg PO On days of chemo and 7 25 06 present Also took with other then q8 hours as chemotherapy regimens needed for nausea or vomting 4. lorazepam 1mg PO Every 6 hours as 7 25 present Husband reports she has taken 2 needed for nausea, doses each of the last 2 days vomiting or anxiety 5. prochlorperazine 10mg PO Every 6 hours as 7 25 present needed for nausea or vomiting 6. zoledronic acid 4mg IV Every 28 days 9 19 05 present 7. epoetin alfa 40, 000 units SQ Every week 5 29 06 present Last dose on 8 22 escitalopram 10mg PO Q Day 11 20 05 escitalopram 20mg PO Q Day 6 present 10. morphine sulfate sustained release Twice a day 3 17 06 morphine sulfate sustained release Twice a day 5 18 06 morphine sulfate sustained release Twice a day 7 5 06 present 60mg PO 13. morphine sulfate immediate release Every 4 hours as 2 11 present Has been taking every 2 hours 15mg PO needed for pain for last 5 days 14. docusate sodium 100mg PO Twice a day 2 11 06 Senokot 8.6mg PO Twice a day 3 17 06 and nasonex.

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When the Board of Nursing established regulations that allowed school nurses to delegate certain medications to an unlicensed school employee or teacher, the route of the medication was specified rather than the names of medicines. An absolute prohibition exists for injectable medications. School nurses are prohibited from delegating assisting with medications that must be delivered by injection except for pre-mixed anti-allergy injections Epi-pen. ; Objective: Demonstrate assisting with oral medications. ASSISTING WITH ORAL MEDICATIONS Check order form and pharmacy label for instructions. Assemble necessary equipment. ALWAYS wash your hands before giving any medication to a student. If the student will touch or handle the medication, the student should wash his or her hands first. Pills Tablets Capsules: Pour the medication into a medicine cup, the cap of the medication bottle, or a small paper cup. Ask the student to pick up the medication and put into his her mouth. The student should follow the medication with 6-8 ounces of water. If the student is not physically able to pick up the medication and you have to place the medication inside the student's mouth, you should put on gloves to avoid transferring any infection to the student or to and norvasc. The prosecutor asked him no questions regarding morphine. Later, during the testimony of Denise Elliot, the prosecutor began handing the forensic chemist various prescription containers, and, with each container, she would testify regarding the results of the tests run on tablets found in each container. During this rather lengthy process, the.
ADAMS, R.H. Opioids. In: BOOTH, N.H.; MCDONALD, L.E. Veterinary pharmacology and therapeutics. Ames: Iowa State University, 1995. Cap.9, p.149-395. BERNARDS, C.M.; HILL, H.F. Morpuine and alfentanil permeability through the spinal dura, arachnoid, and pia mater of dogs and monkeys. Anesthesiology, Philadelphia, v.73, p.1214-1219, 1990. CAMU, F.; DEBUCQUOY, F. Alfentanil infusions for postoperative pain: A comparison of epidural and intravenous routes. Anesthesiology, Philadelphia, v.75, p.171-176, 1991. CHAUVIN, M. et al. Plasma pharmacokinetics of morphine after IM, extradural and intrathecal administration. British Journal of Anaesthesia, London, v.54, p.843-847, 1981. CHAUVIN, M. et al. Equivalence of postoperative analgesia with patient-controlled intravenous or epidural alfentanil. Anesthesia and Analgesia, Philadelphia, v.76, p.1251-1258, 1993. CODA, B.A. et al. Equivalent analgesia and side effects during epidural and pharmacokinetically tailored intravenous infusion with matching plasma alfentanil concentration. Anesthesiology, Philadelphia, v.90, p.98-108, 1999. COMBIE, J. et al. Pharmacology of narcotic analgesics in the horse: selective blockade of narcotic-induced locomotor activity. American Journal of Veterinary Research, Chicago, v.42, p.716-721, 1981. COMBIE, J. et al. The pharmacology of narcotic analgesics in the horse. IV. Dose and time response relationships for behavioral responses to morphine, meperidine, pentazocine, anileridine, methadone, and hydromorphone. Journal of Equine Medcine and Surgery, Philadelphia, v.3, p.377385, 1979. COUSINS, M.J; MATHER, L.E. Intrathecal and epidural administration of opioids. Anesthesiology, Philadelphia, v.61, p.276-310, 1984. DAHLSTROM, B. et al. Patient controlled analgesic therapy. IV: Pharmacokinetics and analgesic plasma concentrations of morphine. Clinical Pharmacokinetics, New Haven, v.7, p.266-279, 1982. GELLER, E. et al. A randomized double-blind comparison of epidural sufentanil versus intravenous sufentanil or epidural fentanyl analgesia after major abdominal surgery. Anethesia and Analgesia, Philadelphia, v.76, p.1243-1250, 1993 and ortho.
Morphine is just the standard to which all other opiates are compared and the first to be used intrevenously with the invention of the syringe. There are a number of different and complex rules used by that court to decide choice-oflaw questions. If the suit is filed in federal court, or removed to federal court at the request of the defendant, the federal court will apply the choice-of-law rules of the state in which the federal court is sitting. Federal courts may exercise so-called diversity jurisdiction over tort suits even when they involve questions of state law. Basically, the prerequisites for diversity jurisdiction are that the plaintiffs be from different states than every defendant and that the amount in controversy exceed $75, 000 per plaintiff.148 Whether the forum turns out to be a federal court or a state court, the underlying substantive tort law will be state law, not federal.149 The Supreme Court recognized that it must preserve state law even in federal diversity cases. Otherwise, diversity jurisdiction would effectively nationalize areas of law that were meant to be left to the states. In other words, federal diversity jurisdiction provides procedural protection to out-of-state litigants but not substantive uniformity across states. A citizen of one state is not immune from the laws of another state, but his out-ofstate citizenship should not subject him to prejudice from a state court.150 That still means that plaintiffs will select the most favorable forum state, basing their choice in part on the choice-of-law rules of each state. The resultant tort law will no doubt be least hospitable to the defendant and might even be contrary to the defendant's home-state law in important respects. The defendant, in essence, will be at the mercy of the plaintiff. Of course, there would be no involuntary extraterritoriality and less of a liability crisis if consumers and sellers could choose both their forum and their law by contract. Transacting parties should be able to designate the state whose laws will govern any disputes arising out of their agreements. Unfortunately, however, many transactions are not covered by written agreements, and choice-of-law clauses in consumer contracts are generally unenforceable.151 and oxycodone. REFERENCES 1. Anesth Analg 1993; 76; 1154-7 Reg Anesth 1996; 21: 26-9 Anesth Analg 1980; 59: 452-4 Anesth Analg 1984; 63 4 ; : 445-7 P-30 OSSEOUS RECONSTRUCTIVE ANKLE SURGERY- IMPACT OF ANESTHETIC AND ANALGESIC TECHNIQUES ON RECOVERY AND AMBULATORY TRANSITION Daniel Kendall, 1 Edward Yaghmour, 1 Mark C. Kendall, 1 Radha Sikhani, 1 Robert J. McCarthy.1 1 Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, IL. Introduction: Reconstructive ankle surgery RAS ; requiring osseous manipulation produces moderate severe postoperative pain. General and central neuroaxial anesthesia spinal epidural ; supplemented with opioids may produce several side effects. A single injection sciatic nerve block SNB ; using long acting local anesthetic provides extended postoperative analgesia permitting ambulatory transition with high patient satisfaction 1, 2 ; . The present prospective, study evaluated the perioperative analgesia and recovery profiles of patients receiving general or spinal anesthesia versus single injection extended SNB for osseous RAS. Methods: IRB approval was obtained for this 2 phase study. Phase 1 patients gave written informed consent and received SNB plus sedation Group 1 ; . Phase 1 patients had a SNB with 25-35 ml of 0.625% levobupivacaine plus 1: 200, 000 epinephrine. Additional femoral or saphenous nerve block was performed as needed. Postoperatively patient received a standardized oral analgesic regimen consisting of oxycodone hydrochloride 20-30 mg every 12 hours, supplemented with hydrocodone 5mg with acetaminophen 325mg every 4-6 hours for breakthrough pain, and rofecoxib 25mg every 12 hours. Twenty-fours hours following surgery patients were questioned by a trained observer not involved in clinical care of the patient regarding the duration of analgesia as well their satisfaction with the perioperative anesthesia and analgesia. Phase 2 involved retrospective review of medical records of 30 patients who received general or spinal anesthesia Group 2 ; for osseous reconstructive surgery. The Mann-Whitney U test and statistic were used to compare demographic and recovery parameters between groups. A P 0.05 was required to reject the null hypothesis. Results: Demographic parameters were comparable in the two groups. Of the 70 patients in Group 1, 5 patients required rescue popliteal block; in all cases, surgery was completed under SNB plus sedation. Postoperative analgesia duration with SNB was 19 6 hours. The table presents recovery parameters between the two study groups. The total opioid analgesic dose is presented as morphine equivalents in mg. Conclusions: The important finding of this study was that in comparison to general or spinal anesthesia, SNB for osseous RAS provided a significant reduction in emetic sequelae, recovery room admissions, and the need for IV opioids as well as 24 hour opioid requirements. SNB provided effective perioperative analgesia 19 6 hours ; with high patient satisfaction 97% rated satisfaction 8 on a scale of 0-10 with 0 very unsatisfied, 10 very satisfied ; . References: 1. Rongstad K, Mann RA, Prieskorn D et al: Foot & Ankle International, 1996; 17: 378-82. Hansen E, Eshelman MR, Cracchioloa III A: Foot & Ankle International, 2000; 21: 38-44. Demographic and Recovery Parameters Group 1 SNB ; n 70 Group 2 Gen SP ; n 30 Age y ; 4314 4211 Gender % Male ; 59 60 Weight kg ; 8416 8921 Surgical duration min ; 8831 * 10536 Ankle reconstruction % ; 43 41 Fracture fixation % ; 57 59 Recovery room bypass % ; 96 * 0 Ambulatory discharge % ; 66 * 10 Post op IV opioids % ; 0 * 90 Nausea % ; 47 67 Vomiting % ; 23 * 63 Antiemetic intervention % ; 4 * 63 24 morphine equivalent mg ; median; range ; 18 0-62 ; * 30 14-97 ; SNB- Sciatic nerve block, Gen Sp- General or Spinal Anesthesia; * different from Group 2, P 0.05. I was taking something like morphnie after my back surgery and was given a nausea medicine to stop me from feeling ill and oxycontin. Simply put, a lab value can be too low or too high. The key approach to sorting out this sort of thing is repetition of the test, with as much control over the circumstances as possible. Due to human and machine error, laboratories will produce a range of values, when repeatedly running exactly the same test. If a value looks too low or too high, the test should be repeated. Because of individual variation in absorbtion and metabolism of opioids it is impossible to know what a patient's blood level of a particular medication should be, without repeated testing. Levels are more meaningful when the patient is observed taking a dose of medication, usually about 1 hour prior to having his blood drawn. Certain opioids are not active in the form they are taken, and must be converted within the body to substances that effectively treat pain. Codeine and hydrocodone are the most notable examples. Codeine is converted primarily to morphine, and hydrocodone is converted to hydromorphone. Not every patient has the enzymes required to perform these metabolic conversions, and this has implications for what substances will be discovered upon testing.

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New KALETRA Tablets Now Available; Will REPLACE Kaletra Capsules In consultation with the FDA, Abbott is planning for a rapid conversion from capsules to tablets to reduce patient confusion between the two formulations. KALETRA tablets will begin replacing capsules in pharmacies over the next few weeks. Abbott will discontinue the distribution of Kaletra Capsules through regular channels on December 21, 2005. KALETRA tablets and capsules should not be co-administered. Abbott is working to raise patient awareness about the change in formulation and is providing patient education materials to health care providers, pharmacists, and patients. Look for a package from PDQ containing support materials for pharmacists. Prescriptions for KALETRA Tablets KALETRA tablets should be prescribed in the following manner: "KALETRA 200 50 mg 4 tablets once daily" or "KALETRA 200 50 mg 2 tablets twice daily" Kaletra oral solution liquid ; will remain available for patients. The NDC number for the new KALETRA tablet is 0074-6799-22. Please order the new KALETRA tablets in your usual manner or contact Abbott Customer Service at 1-800-2555162. For Additional Information About KALETRA Tablets 1-866-KALETRA 1-866-525-3872 ; or Kaletra Abbott Medical Information: 1-800-633-9110 and paxil.
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The primary treatment modality is total thyroidectomy and central node dissection. In the presence of disseminated disease, surgery can still be considered for palliative aims. The same approach is appropriate for persistent or recurrent disease. Prophylactic surgery must be considered for disease-free carriers of germ line RET mutations, identified by genetic screening programmes of affected kindred. Data would indicate this is optimally performed before the age of five years, though the decision is balanced by the difficulty of the procedure and associated morbidity in younger patients. The possibility of surgery being required should be discussed with parents before testing children B ; . In patients with scan or clinical evidence of nodal disease, the appropriate neck dissection should be considered and is as described in the sections dealing with papillary and follicular thyroid cancer see section 5. 1. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. In: Merskey H, Bogduk N, editors. Task force on taxonomy of the IASP. 2nd edition. Seattle: IASP Press; 1994, p. 209-14. 2. Dworkin RH, Backonja M, Rowbotham MC, et al. Advances in neuropathic pain. Arch Neurol 2003; 60: 1524-34. Boulton AJ, Armstrong WD, Scarpello JH, et al. The natural history of painful diabetic neuropathy -- a 4-year study. Postgrad Med J 1983; 59: 556-9. Max MB, Schafer SC, Culnane M, et al. Association of pain relief with drug side effects in postherpetic neuralgia: a single-dose study of clonidine, codeine, ibuprofen, and placebo. Clin Pharmacol Ther 1988; 43: 363-71. Fields HL, Rowbotham M, Baron R. Postherpetic neuralgia: irritable nociceptors and deafferentation. Neurobiol Dis 1998; 5: 209-27. Jensen TS, Gottrup H, Sindrup SH, et al. The clinical picture of neuropathic pain. Eur J Pharmacol 2001; 429: 1-11. Foley KM. Opioids and chronic neuropathic pain. N Engl J Med 2003; 348: 1279-81. Heliovaara M, Impivaara O, Sievers K, et al. Lumbar disc syndrome in Finland. J Epidemiol Community Health 1987; 41: 251-8. Schmader KE. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clin J Pain 2002; 18: 350-4. Davis MP, Walsh D. Epidemiology of cancer pain and factors influencing poor pain control. J Hosp Palliat Care 2004; 21: 137-42. Verma S, Estanislao L, Simpson D. HIV-associated neuropathic pain: epidemiology, pathophysiology and management. CNS Drugs 2005; 19: 325-34. Werhagen L, Budh CN, Hultling C, et al. Neuropathic pain after traumatic spinal cord injuryrelations to gender, spinal level, completeness, and age at the time of injury. Spinal Cord 2004; 42: 665-73. Sandroni P, Benrud-Larson LM, McClelland RL, et al. Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study. Pain 2003; 103: 199-207. Melzack R. The short-form McGill Pain Questionnaire. Pain 1987; 30: 191-7. Masson EA, Hunt L, Gem JM, et al. A novel approach to the diagnosis and assessment of symptomatic diabetic neuropathy. Pain 1989; 38: 25-8. Gilron I, Bailey JM, Tu D, et al. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med 2005; 352: 1324-34. Atlas SJ, Deyo RA, Patrick DL, et al. The Quebec Task Force classification for Spinal Disorders and the severity, treatment, and outcomes of sciatica and lumbar spinal stenosis. Spine 1996; 21: 2885-92. Coplan PM, Schmader K, Nikas A, et al. Development of a measure of the burden of pain due to herpes zoster and postherpetic neuralgia for prevention trials: adaptation of the brief pain inventory. J Pain 2004; 5: 344-56. Berger A, Dukes EM, Oster G. Clinical characteristics and economic costs of patients with painful neuropathic disorders. J Pain 2004; 5: 143-9. Turk DC. Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clin J Pain 2002; 18: 355-65. Galer B, Jensen M. Development and preliminary validation of a pain measure specific to neuropathic pain. The neuropathic pain scale. Neurology 1997; 48: 332-8 and pepcid. Ndc list ANTARA 130 MG CAPSULE FORTICAL 200 UNITS NASAL SPRAY ACTOPLUS MET 15 MG 500 MG TAB ACTOPLUS MET 15 MG 500 MG TAB ARIXTRA 7.5 MG SYRINGE ARIXTRA 7.5 MG SYRINGE ARIXTRA 7.5 MG SYRINGE ENALAPRIL HCTZ 5-12.5MG TAB ENALAPRIL HCTZ 5-12.5 MG TAB METFORMIN HCL 750 MG ER TABLET METFORMIN HCL 750 MG ER TABLET CELEBREX 400 MG CAPSULE ETH-OXYDOSE 20 MG ML SOLUTION MORPHINE SULF 20 MG ML SOLN PRASCION CLEANSER CLOBEX 0.05% SPRAY ATROVENT HFA INHALER LOFIBRA 200 MG CAPSULE LOFIBRA 200 MG CAPSULE ALTOPREV 40 MG TABLET ALPRAZOLAM XR 0.5 MG TABLET PROPOXY-N APAP 100-500 TABLET ACTONEL WITH CALCIUM TABLET LEVOXYL 137 MCG TABLET ACEBUTOLOL 200 MG CAPSULE CYCLOSPORINE 100 MG CAPSULE CADUET 10 MG 80 TABLET METOPROLOL-HCTZ 100 25MG TAB METOPROLOL-HCTZ 100 25MG TAB DEPAKOTE ER 250 MG TAB SA DEPAKOTE ER 250 MG TAB SA CHOLESTYRAMINE LIGHT PACKET AXERT 12.5 MG TABLET RELPAX 40 MG TABLET POT CITRATE-CITRIC ACID PACKET LYRICA 100 MG CAPSULE LYRICA 100 MG CAPSULE HEMATINIC PLUS TABLET CEFTRIAXONE 500 MG VIAL PHENYTOIN SOD EXT 100 MG CAP LIDOCAINE 3% CREAM ESTRING 2 MG VAGINAL RING PREMPRO 0.625 5 MG TABLET PHENYLTOL-PHEN-CHLOR TABLET VOSPIRE ER 4 MG TABLET VOSPIRE ER 4 MG TABLET ISOSORBIDE MN 120 MG TAB SA RITALIN LA 30 MG CAPSULE RITALIN LA 30 MG CAPSULE RITALIN LA 30 MG CAPSULE FLUTICASONE 50 MCG NASAL SPRAY ASMANEX TWISTHALER 220 MCG #60 Page 615.
Constipation may be caused by a number of factors. Being less active, not consuming enough liquids, and some pain medications are the main causes. Constipation is almost always present when people are taking codeine, morphine, or similar drugs for pain control. Chronic constipation is a major cause of loss of appetite. The problem is readily treated if people are conscious of its importance and follow a regular laxative routine. Following a high fibre meal plan and increasing fluids may help to alleviate constipation. Natural laxatives such as prune juice or grape juice may help. Note that high fibre foods are beneficial only if you are able to accompany them with an increased fluid intake. If you can't take adequate fluids , high fibre foods can make constipation worse. We wish to help you prevent constipation as once it becomes severe, management is more difficult. It may even cause a bowel obstruction. You must inform your health care team if you are not passing gas or having a bowel movement. HIGH FIBRE s Use whole grain and bran cereals All-Bran, Bran Flakes, Raisin Bran, Red River Cereal, Shredded Wheat, and Shreddies ; s Use whole wheat flour, whole grain and multi grain breads and bran instead of white flour and white bread. s Bake using whole wheat flour. s Use brown rice instead of white. s Have at least 5 servings of vegetables and fruit per day. s Have fresh fruits and vegetables instead of juices. s Include dried fruits apricots, dates, prunes, raisins ; , candied fruits and peel in your diet. s Legumes such as dried peas and beans, lentils, nuts and seeds are good sources of fibre. Add legumes to spaghetti sauce, soups and or chilli. s Popcorn is a great high fibre snack. s An easy way to increase your fibre is to add bran to your diet. See below for "Tips for Adding Bran to Your Diet". s Consume 6 to 8 glasses 1500 to 2000 ml ; of water a day. s Lazy abdominal muscles and lack of exercise often contribute to constipation. It is important to exercise daily if you are able. Physical dependence develops very quickly in abusers who are exposed to high doses of morphine.

Abstract Background: The introduction of Hemophilus influenzae type b Hib ; conjugate vaccine as part of the routine childhood vaccination schedule in Canada has resulted in a dramatic reduction in the cases of Hib meningitis. We describe the epidemiology and outcome of bacterial meningitis in Canadian children six years after the introduction of Hib conjugate vaccine and prior to the introduction of the conjugate Streptococcus pneumoniae vaccine. Methods: A retrospective chart review from January 1998 to December 1999 of children with meningitis identified at eight Canadian tertiary care children's hospitals belonging to the PICNIC network. Results: Bacterial meningitis was documented in 104 11% ; of 970 children presenting with meningitis. The most common isolated organisms were: Streptococcus pneumoniae 54% ; , group B streptococci 13% ; , and Neisseria meningitidis 11% ; . The mean age was 2.2 3.5 yr. Forty seven percent of the children required admission to Intensive Care Unit ICU ; , and 19% required artificial ventilation. Sequelae were documented among 32 children 31% ; prior to discharge and there were 6 5.6% ; deaths attributable to meningitis and sepsis. Conclusions: Bacterial meningitis is an important cause of morbidity in Canadian children with S. pneumoniae replacing H. influenzae as the leading, because morphine dosing!

Carry out a search on the system using all the H3 codes except H33, the code for asthma. The search should look at all patients over the age of 35 years with one of the above codes or a prescription for inhaled medication in the past year. A manual check of the records of these patients computer and written ; should be made looking for: Smokers and ex smokers don't exclude notes that have no smoking status recorded ; Patients with an existing diagnosis of COPD , Chronic Asthma or Emphysema but who have not had the diagnosis confirmed with spirometry Patients with a confirmed diagnosis FEV1 80% of predicted and FEV1 FVC 70% ; Patients who have presented with symptoms of recurrent or persistent breathlessness, wheezing, chronic cough, sputum, bronchitis or frequent chest infections in the past 12 months Patients with prescriptions for anti-biotics and oral steroids, or evidence of exacerbations and naproxen.

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