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International MS Nursing Care Plan experiencing pain as a current symptom of their MS. Six items from the Medical Outcomes Study Stewart and Ware, 1992 ; assessing the effects of pain on behavior and mood are incorporated in the MSLQI. Note that the SF-36 Bodily Pain Scale BP ; provides an additional, independent measure of the severity and impact of pain on the patient's life. ; b ; Administration These items are designed to be self-explanatory. Some patients may ask what to include in the definition of "pain." Patients should be told that pain is defined broadly, and can include any unpleasant sensory symptom related to MS, as well as pain unrelated to MS e.g., headaches ; . Some patients may indicate that their pain and sensory symptoms have been severe, but that they have not allowed their symptoms to restrict their activities. These patients should circle the response that indicates how much their activities have actually been restricted, not how much they could have been restricted. c ; Scoring Raw scores on the 6 items that constitute this scale are simply added to form a PES total score. Thus, scores can range from 6-30. Items are scaled so that higher scores indicate a greater impact of pain on a patient's mood and behavior. 6. Sexual Satisfaction Scale SSS ; a ; Background Changes in sexual functioning and sexual relationships are also common in MS, although health care practitioners are often unaware of these problems because many patients are reluctant to bring them up. Of the 25 items covering sexual function and satisfaction that were adapted from the Sexual History Form Schover, Friedman, Weiler, Heiman, & LoPiccolo, 1982 ; for the MSQLI Field Test, only four sexual satisfaction items were retained for the final MSQLI. Investigators and clinicians who are interested in problems in sexual function per se are directed to other sources e.g., Stewart & Ware, 1992 ; . ; b ; Administration The items are generally self-explanatory. However, due to the sensitive nature of these questions, some patients may need to be reassured about the confidentiality of their responses. If a patient indicates that s he is not sexually active and wonders whether s he should respond to these items, the interviewer should say: "These questions concern your satisfaction with your sexual relationships in general, so please try to answer them as best you can." 25. University of Texas, Office of Public Affairs, "New Texas Generic Drug Law Could Save Patients Millions, Researchers at the University of Texas at Austin Say, " June 28, 2002. 194 National Conference of State Legislatures, "2001 Prescription Drug Discount, Bulk Purchasing, and PriceRelated Legislation, " May 9, 2002, : ncsl programs health drugdisc01 accessed May 13, 2002 and National Conference of State Legislatures, "2002 Prescription Drug Discount, Bulk Purchasing, and Price-Related Legislation, " May 9, 2002, : ncsl programs health drugdisc02 accessed May 13, 2002 195 Richard Cauchi and Donna Folkemer, "Medicaid Prescription Drug Laws and Strategies, 2001-2002, " National Conference of State Legislatures, May 16, 2002, : ncsl programs health medicaidrx accessed May 17, 2002 ; . 196 Bart Jansen, "Federal Official Gives Maine Rx a Boost, " Portland Press Herald, June 1, 2002, because exelon powerlabs.
American Association of Oriental Medicine 5530 Wisconsin Ave., Suite 1210, Chevy Chase, MD 20815 Phones: 301-941-1064, toll-free: 888-500-7999; fax: 301-986-9313 E-mail: info aaom Web site: : aaom AAOM provides referrals to practitioners who are state-licensed or certified by various respected certifying organizations. They also have an online state-by-state referral search for TCM and acupuncture practitioners at : aaom referral . National Certification Commission for Acupuncture and Oriental Medicine 11 Canal Center Plaza, Suite 300, Alexandria, VA 22314 Phone: 703-548-9004; fax: 703-548-9079 E-mail: info nccaom. Medicare Patients Go Begging For Docs In Colorado, Paper Says. Only four in 10 primary-care physicians in Colorado are accepting new Medicare patients, and in some areas that ratio is down to one in 10, the Los Angeles Times reported Nov. 4. "For many physicians, the math is fairly simple, " says the paper, which recounts tales of state legislators, retired judges and others who were dumped by their longtime physicians and undertook sometimes fruitless quests to find new ones without leaving the state. "In Colorado, private insurers reimburse doctors at rates often 25 percent above what Medicare pays for the same services. Faced with that, individual physicians and group practices have made a business decision that no more than some fixed percentage of their patients can be on Medicare." Some social service agencies "now count Medicare beneficiaries with the homeless and the uninsured as being `medically underserved, '" according to the Times. Diabetes Hospitalizations Rise, Pennsylvania Finds. Even as efforts burgeoned to manage diabetic patients better, diabetes-related hospitalizations rose over the past five years, the Pennsylvania Health Care Cost Containment Council finds in a new study. Hospitalizations for diabetes-related conditions rose 16.8 percent from 1997 to 2001. The number and rate of hospitalizations for Type 1 -- so-called juvenile onset -- diabetes dropped over the period, while hospitalizations for Type 2 diabetes -- which is lifestyle-related -- have increased steadily. Hospitalizations increased for all age groups, but grew most -- by 26.1 percent -- for people aged 30 to 39. Hospitalizations for people aged 40 to 49 increased at the second-highest rate -- 18.4 percent. Docs Who Napped Less Drowsy In Study. In a study of 11 emergency department physicians working 24-hour shifts, the subjects showed less physical evidence of drowsiness during nighttime working hours when they'd been offered a four-hour rest during the shift and, especially, if they'd napped during the rest period. The study, published in the October issue of Critical Care Medicine, demonstrates that sleep deprivation impairs physician performance and that napping can reverse some of the impairment, its authors say. Meanwhile, in an article in the Oct. 17 New England Journal of Medicine, patient-safety researchers from the Department of Veterans' Affairs argue that, even without conclusive clinical evidence that tired doctors harm patients, the potential dangers posed by overtired physicians are obvious in light of the proven fatigue-related dangers in other high-hazard occupations such as piloting airplanes or driving trucks. To promote harmony with people's natural sleep, because .
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Ventional therapy a progression of the disease by 2.1 % with an increase in minimal lesion diameter of 0.05 0.14 mm was seen. The two intervention groups showed a regression of stenoses by 0.7 and 0.9 % respectively with a decrease in minimal lesion diameter of 0.012 0.16 mm and 0.035 0.13 mm p 0.005 ; . In 1993 Vos [9] pooled the data of 6 trials with interventions on diet, drug therapy, or ileal bypass surgery and trial periods of 2 to years and found an overall relative risk for progression of 0.62 95 % CI 0.540.72 ; and an odds ratio of regression of 2.13 95 % CI 1.532.98 ; with intervention. In an editorial Loscalzo [10] commented on the importance of the study of Brown and of a surgical intervention study by Buchwald [11] examining the effect of partial ileal bypass for the treatment of hyperlipidaemia. He emphasized the important complementary information about the dynamic evolution of coronary atherosclerosis and its lipid determinants, but also stressed that the extent of change in luminal diameter measured in the study of Brown was small, and that statistical significance was achieved only by virtue of the power and precision of the computerized edge-detection techniques used to assess the coronary angiograms. In summary major studies using coronary angiography have shown that intensive lipid modification by a variety of interventions retards the progression of atherosclerotic lesions and in a subset of patients lead to their regression. However, the clinical benefit of lipid lowering in terms of event reduction by far outweighs the angiographic improvement which is modest and rather disappointing. In order to solve this paradox we have to focus on plaque composition and vulnerability to rupture and plaque thrombogenicity, rather than on plaque size and stenosis severity. Most acute coronary syndromes are caused by plaque rupture and superimposed thrombosis. The vulnerable plaque concept and the role of inflammation An unstable stable plaque is a lipid-rich, friable plaque, which is ready to rupture. The three major determinants for plaque1 rupture are shown in Table 1. Accumulation of lipids in the plaque with an inadequate fibrotic response and high.

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