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If the attending physician determines continued inpatient treatment will be necessary at the end of the time period of the order and the minor does not consent to continued inpatient treatment prior to the end of the time period of the order discount silvitra express erectile dysfunction pills review, the court shall conduct a review hearing in accordance with this subsection to determine whether to: (i) release the minor cheap 120 mg silvitra with amex erectile dysfunction pump for sale; or (ii) make a subsequent order for inpatient mental health treatment for a period not to exceed sixty days subject to discharge of the minor whenever the attending physician determines that the minor no longer is in need of treatment purchase silvitra 120mg on-line erectile dysfunction no xplode, or if consent has been revoked under paragraph (5). The court shall hold a hearing on the objection within seventy-two hours of the filing of the petition. The term also includes care and other services which supplement treatment and aid or promote recovery. Any person sixteen (16) years 107 of age may donate his or her blood upon obtaining prior permission of his or her parent or guardian. If a pregnant woman less than eighteen (18) years of age has not married and if neither of her parents or guardians agree to consent to the performance of an abortion, or if she elects not to seek the consent of either of her parents or guardians, a judge of the family court shall, upon petition, or motion, and after an appropriate hearing, authorize a physician to perform the abortion, if the judge determines that the pregnant woman is mature and capable of giving informed consent to the proposed abortion or if the judge determines that she is not mature, but that the performance of an abortion upon her would be in her best interests. A pregnant woman less than eighteen (18) years of age may participate in proceedings in the family court on her own behalf, and she shall be represented in her proceeding by a guardian ad litem. Proceedings in the family court under this section shall be confidential and shall be given such precedence over other pending matters that the court may reach a decision promptly and without delay so as to serve the best interests of the pregnant woman. A judge of the family court who conducts proceedings under this section shall make in writing specific factual findings and legal conclusions supporting his or her decision and shall order a record of the evidence to be maintained including his or her own findings and conclusions. Parental consent for treatment of a child shall be required, except as otherwise provided in § 14-5-4. This section does not apply to an elective abortion or to sterilization or to any device or medication for the control of birth, nor shall it be construed to constitute a modification or repeal of any other current provision of law pertaining thereto. Any person of the age of seventeen years or over may donate blood without obtaining the consent of a parent or guardian. However, no person may take blood for donation from any person of the age of seventeen if the parent or guardian of such potential donor specifically requests of the person taking the blood that such donation be prohibited. The notice shall be addressed to the parent at the usual place of abode of the parent and delivered personally to the parent by the physician or an agent. In lieu of such delivery, notice may be made by certified mail addressed to the parent at the usual place of abode of the parent with return receipt requested and restricted delivery to the addressee, which means a postal employee can only deliver the mail to the authorized addressee. If notice is made by certified mail, the time of delivery shall be deemed to occur at twelve noon on the next day on which regular mail delivery takes place, subsequent to mailing. If the person does not provide a notarized signature, the person shall be sent a written notice as described in this section. No abortion as described in this section may be performed until at least forty-eight hours after written notice of the pending operation has been delivered in the manner specified in this section; or (3) A pregnant female elects not to allow the notification of her parent, in which case, any judge of a circuit court shall, upon petition, or motion, and after an appropriate hearing, authorize a physician to perform the abortion if the judge determines, by clear and convincing evidence, that the pregnant female is mature and capable of giving informed consent to the proposed abortion. The person shall obtain some written documentation, other than the written consent itself, that purports to establish the relationship of the parent or guardian to the minor and the documentation, along with the signed consent, shall be retained by the person for a period of at least one (1) year. Failure of the person performing the abortion to obtain or retain the documentation and consent is a Class B misdemeanor, punishable only by a fine, unless the failure of the person performing the abortion to retain the required documentation was due to a bona fide, imminent medical emergency to the minor, in which case there is no violation. Consent under this section shall not be subject to disaffirmance due to minority of the person consenting. The consent of the parent or legal guardian of a minor consenting under this section shall not be necessary to authorize care as described above. The consent shall include a representation that the person understands that his treatment will involve inpatient status, that he desires to be admitted to the hospital, and that he consents to admission voluntarily, without any coercion or duress. Whenever any minor who has been separated from the custody of his parent or guardian is in need of surgical or medical treatment, authority commensurate with that of a parent in like cases is conferred, for the purpose of giving consent to such surgical or medical treatment, as follows: 1. Upon judges with respect to minors whose custody is within the control of their respective courts. Upon local directors of social services or their designees with respect to (i) minors who are committed to the care and custody of the local board by courts of competent jurisdiction, (ii) minors who are taken into custody pursuant to § 63. Upon the Director of the Department of Corrections or the Director of the Department of Juvenile Justice or his designees with respect to any minor who is sentenced or committed to his custody. Upon the principal executive officers of state institutions with respect to the wards of such institutions. Upon the principal executive officer of any other institution or agency legally qualified to receive minors for care and maintenance separated from their parents or guardians, with respect to any minor whose custody is within the control of such institution or agency. Upon any person standing in loco parentis, or upon a conservator or custodian for his ward or other charge under disability. Whenever the consent of the parent or guardian of any minor who is in need of surgical or medical treatment is unobtainable because such parent or guardian is not a resident of the Commonwealth or his whereabouts is unknown or he cannot be consulted with promptness reasonable under the circumstances, authority commensurate with that 121 of a parent in like cases is conferred, for the purpose of giving consent to such surgical or medical treatment, upon judges of juvenile and domestic relations district courts. However, in the case of a minor 14 years of age or older who is physically capable of giving consent, such consent shall be obtained first. Medical or health services needed to determine the presence of or to treat venereal disease or any infectious or contagious disease that the State Board of Health requires to be reported; 2. Medical or health services required in case of birth control, pregnancy or family planning except for the purposes of sexual sterilization; 3. Medical or health services needed in the case of outpatient care, treatment or rehabilitation for substance abuse as defined in § 37. Medical or health services needed in the case of outpatient care, treatment or rehabilitation for mental illness or emotional disturbance. A minor shall also be deemed an adult for the purpose of accessing or authorizing the disclosure of medical records related to subdivisions 1 through 4. Except for the purposes of sexual sterilization, any minor who is or has been married shall be deemed an adult for the purpose of giving consent to surgical and medical treatment. A pregnant minor shall be deemed an adult for the sole purpose of giving consent for herself and her child to surgical and medical treatment relating to the delivery of her child when such surgical or medical treatment is provided during the delivery of the child or 122 the duration of the hospital admission for such delivery; thereafter, the minor mother of such child shall also be deemed an adult for the purpose of giving consent to surgical and medical treatment for her child. Any minor 16 years of age or older may, with the consent of a parent or legal guardian, consent to donate blood and may donate blood if such minor meets donor eligibility requirements. However, parental consent to donate blood by any minor 17 years of age shall not be required if such minor receives no consideration for his blood donation and the procurer of the blood is a nonprofit, voluntary organization. Nothing in subsection G shall be construed to permit a minor to consent to an abortion without complying with § 16. However, the state may provide services for indigent minors to the extent that funds are available therefor. Payment for such care by the department shall be made only in accordance with rules, guidelines, and clinical criteria applicable to inpatient treatment of minors established by the department. The admission shall occur only if the professional person in charge of the facility concurs with the need for inpatient treatment. The notice need not follow any specific form so long as it is written and the intent of the minor can be discerned. The physician shall not incur any civil or criminal liability in connection therewith except for negligence or wilful injury. Any statement or conduct by a minor who is the subject of an application for admission under this paragraph indicating that the minor does not agree to admission to the facility shall be noted on the face of the application and shall be noted in the petition required by sub. A copy of the petition and a notice of hearing shall be served upon the parent or guardian at his or her last-known address. If, after a hearing, the court determines that the consent of the parent or guardian is being unreasonably withheld, that the parent or guardian cannot be found, or that there is no parent with legal custody, and that the admission is proper under the standards prescribed in sub.

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The second (mL/hour) is encountered when infusions have to be given accurately or in small volumes using infusion or syringe pumps – particularly if drugs have to be given as infusions order generic silvitra on line erectile dysfunction drugs in the philippines. The drip rate of the giving set is always written on the wrapper if you are not sure cheap 120mg silvitra otc erectile dysfunction treatment machine. To do this order 120mg silvitra visa erectile dysfunction treatment new orleans, multiply the volume of the infusion by the number of ‘drops per mL’ for the giving set, i. If the infusion is being given over a period of minutes, then obviously there is no need to convert from hours to minutes. The final answer needs to be in terms of hours, so multiply by 60 to convert minutes into hours: 136 × 60 = 8,160mcg/hour Convert mcg to mg by dividing by 1,000: = 8. Conversion of dosages to mL/hour 111 A formula can be derived: mL/hour = In this case: total volume to be infused = 500mL total amount of drug (mg) = 800mg dose = 2mcg/kg/min patient’s weight = 68kg 60 converts minutes to hours 1,000 converts mcg to mg Substituting the numbers into the formula: = 5. If the dose is given as a total dose and not on a weight basis, then the patient’s weight is not needed. Conversion of dosages to mL/hour 113 How to use the table If you need to give a 250 mL infusion over 8 hours, then to find the infusion rate (mL/hour) go down the left-hand (Vol) column until you reach 250 mL; then go along the top (Time) line until you reach 8 (for 8 hours). Aminophylline injection comes as 250mg in 10mL ampoules and should be given in a 500mL infusion bag. Question 8 You need to give aciclovir (acyclovir) as an infusion at a dose of 5 mg/kg every 8 hours. Each vial needs to be reconstituted with 20mL Water for Injection and diluted further to 100mL. After reconstitution a 500 mg vial of vancomycin should be diluted with infusion fluid to 5mg/mL. Question 12 You are asked to give an infusion of dobutamine to a patient weighing 73kg at a dose of 5mcg/kg/min. Question 13 You are asked to give an infusion of isosorbide dinitrate 50mg in 500mL of glucose 5% at a rate of 2mg/hour. For example, you may need to check that an infusion pump is giving the correct dose. Nurses changing shifts, especially on the critical care wards, must check that the pumps are set correctly at the beginning of each shift. Now check your answer against the dose written on the drug chart to see if the pump is delivering the correct dose. If your answer does not match the dose written on the drug chart, then re-check your calculation. If the answer is still the same, then inform the doctor and, if necessary, calculate the correct rate. If the dose is given as a total dose and not on a weight basis, then the patient’s weight is not needed: mcg/min = Note: If the dose is in terms of milligrams, then there is no need to multiply by 1,000 (i. Question 15 You have dobutamine 250 mg in 50 mL and the rate at which the pump is running is 5. Question 16 You have dopexamine 50 mg in 50 mL and the rate at which the pump is running is 28 mL/hour. Also, it is a good way of checking your calculated drip rate or pump rate for an infusion. You have calculated that the drip rate should be 42 drops/min (using a standard giving set: 20 drops/mL) or 125mL/hour for a pump. To check your answer, you can calculate how long the infusion should take at the calculated rate. If your answers do not correspond (the answer should be 8 hours), then you have made an error and should re-check your calculation. Alternatively, you can use this type of calculation to check the rate of an infusion already running. For example: if an infusion is supposed to run over 6 hours, and the infusion is nearly finished after 4 hours, you can check the rate by calculating how long the infusion should take using that drip rate or the rate set on the pump. If the calculated answer is less than 6 hours, then the original rate was wrong and the doctor should be informed. A formula can be used: number of hours the infusion is to run = × drip rate of giving set where in this case: volume of the infusion = 1,000mL rate (drops/min) = 42 drops/min drip rate of giving set = 20 drops/mL 60 converts minutes to hours Substituting the numbers into the formula: × 20 = 7. Phamacokinetics and Pharmacodynamics Pharmacokinetics examines the way in which the body ‘handles drugs’ and looks at: • absorption of drugs into the body; • distribution around the body; • elimination or excretion. Pharmacodynamics is the study of the mode of action of drugs – how they exert their effect. The route of administration depends upon: • which is the most convenient route for the patient; • the drug and its properties; • the formulations available; • how quick an effect is required; • whether a local or systemic effect is required; • the clinical condition of the patient – the oral route may not be possible; • whether the patient is compliant or not. Introduction 121 Oral administration For most patients, the oral route is the most convenient and acceptable method of taking medicines. Drugs may be given as tablets, capsules or liquids: other means include buccal or sublingual administration. Parenteral administration of drugs This is the injection of drugs directly into the blood or tissues. Promoting the Safer Use of Injectable Medicines The risks associated with using injectable medicines in clinical areas have been recognized and well known for some time. Recent research evidence indicates that the incidence of errors in prescribing, preparing and administering injectable medicines is higher than for other forms of medicine. We will look at: • pharmacokinetics and pharmacodynamics; • common routes of administration; • sources and interpretation of drug information. In order for a drug to reach its site of action and have an effect, it needs to enter the bloodstream. The aim is to give you a general idea of the processes involved and to give an explanation of some of the terms used. If a drug is going to have an effect in the body it needs to be present: • in the right place; • at the right concentration; • for the right amount of time. Pharmacokinetics examines the way in which the body ‘handles drugs’ and looks at: • absorption of drugs into the body; • distribution around the body; • elimination or excretion. Pharmacokinetics and pharmacodynamics 123 It is an active (kinetic) process where all three processes occur at the same time. Knowing about the pharmacokinetics of a drug allows us to determine: • what dose to give; • how often to give it; • how to change the dose in certain medical conditions; • how some drug interactions occur. The oral route is the most commonly used and convenient method of administration for drugs. Most drugs are absorbed by diffusion through the wall of the intestine into the bloodstream. The rate of diffusion depends not only on these differences in concentration, but also on the physiochemical properties of the drug. Cell membranes have a lipid or fatty layer, so drugs that can dissolve in this layer (lipid-soluble) can pass through easily. However, some drugs are transported across the cell membrane by carrier proteins (facilitated diffusion) or actively transported across by a pump system (active transport).

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Approvals valid for 12 months where the patient is undergoing highly emetogenic chemotherapy and/or anthracycline-based chemotherapy for the treatment of malignancy purchase silvitra from india erectile dysfunction only at night. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Control of intractable nausea purchase cheap silvitra on-line erectile dysfunction protocol diet, vomiting purchase discount silvitra line erectile dysfunction reviews, or inability to swallow saliva in the treatment of malignancy or chronic disease where the patient cannot tolerate or does not adequately respond to oral anti-nausea agents; or 2 Control of clozapine-induced hypersalivation where trials of at least two other alternative treatments have proven ineffective. Approvals valid for 1 year where the treatment remains appropriate and the patient is benefiting from treatment. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Patient is suffering from schizophrenia or related psychoses; and 2 Either: 2. Initial application — (Autism spectrum disorder*) only from a paediatrician or psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 The patient has been diagnosed with an autism spectrum disorder* and has symptoms of severe irritability; and 2 An effective dose of risperidone has been trialled and has been discontinued because of unacceptable side effects or inadequate response; and 3 The patient is aged less than 18 years. Renewal — (Autism spectrum disorder*) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a paediatrician or psychiatrist (in writing). Pharmacists may annotate the prescription as endorsed where there exists a record of prior dispensing of fluphenazine decanoate. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 The patient has had an initial Special Authority approval for paliperidone depot injection or risperidone depot injection; or 2 All of the following: 2. Approvals valid for 12 months where the initiation of olanzapine depot injection has been associated with fewer days of intensive intervention than was the case during a corresponding period of time prior to the initiation of an atypical antipsychotic depot injection. Note: The patient should be monitored for post-injection syndrome for at least two hours after each injection. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 The patient has had an initial Special Authority approval for risperidone depot injection or olanzapine depot injection; or 2 All of the following: 2. Approvals valid for 12 months where the initiation of paliperidone depot injection has been associated with fewer days of intensive intervention than was the case during a corresponding period of time prior to the initiation of an atypical antipsychotic depot injection. In some cases, it may be clinically appropriate to attempt to treat a patient with typical antipsychotic agents in depot injectable form before trialling paliperidone depot injection. Pharmacists may annotate the prescription as endorsed where there exists a record of prior dispensing of pipothiazine palmitate. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 The patient has had an initial Special Authority approval for paliperidone depot injection or olanzapine depot injection; or 2 All of the following: 2. Approvals valid for 12 months where the initiation of risperidone depot injection has been associated with fewer days of intensive intervention than was the case during a corresponding period of time prior to the initiation of an atypical antipsychotic depot injection. In some cases, it may be clinically appropriate to attempt to treat a patient with typical antipsychotic agents in depot injectable form before trialing risperidone depot injection. Continued relapses on treatment would be expected to lead to a switch of treatment provided the stopping criteria are not met. Stopping Criteria Any of the following: 1) Confirmed progression of disability that is sustained for six months. Note: Natalizumab can only be dispensed from a pharmacy registered in the Tysabri Australasian Prescribing Programme operated by the supplier. Regular supplies will be distributed to all approved patients or their clinicians by courier. Only prescriptions for 6 million iu of interferon beta-1-alpha per week, or 8 million iu of interferon beta-1-beta every other day, or 20 mg glatiramer acetate daily will be subsidised. Note: Treatment with interferon beta -1-beta, interferon beta-1-alpha and glatiramer acetate, is permitted only if treatment with both natalizumab and fingolimod is not tolerated or treatment with both would be clinically inappropriate. Approvals valid for 12 months for applications meeting the following criteria: continued… ‡ safety cap ▲ Three months supply may be dispensed at one time ❋Three months or six months, as applicable, dispensed all-at-once ifendorsed“certifiedexemption”bytheprescriberorpharmacist. Renewal only from a psychiatrist, paediatrician, neurologist, respiratory specialist or medical practitioner on the recommendation of a psychiatrist, paediatrician, neurologist or respiratory specialist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 Patient is aged 18 years or under*; and 2 Patient has demonstrated clinically meaningful benefit from funded modified-release melatonin (clinician determined); and 3 Patient has had a trial of funded modified-release melatonin discontinuation within the past 12 months and has had a recurrence of persistent and distressing insomnia; and 4 Funded modified-release melatonin is to be given at doses no greater than 10 mg per day. Approvals valid without further renewal unless notified for applications meeting the following criteria: Both: 1 For the treatment of terminal agitation that is unresponsive to other agents; and 2 The applicant is part of a multidisciplinary team working in palliative care. Note: A "subsidised formulation of a stimulant" refers to currently subsidised methylphenidate hydrochloride tablet formulations (immediate-release, sustained-release and extended-release) or dexamfetamine sulphate tablets. Approvals valid for 12 months for continued… ‡ safety cap ▲ Three months supply may be dispensed at one time ❋Three months or six months, as applicable, dispensed all-at-once ifendorsed“certifiedexemption”bytheprescriberorpharmacist. Initial application — (Narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the treatment remains appropriate and the patient is benefiting from treatment. Renewal only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a paediatrician or psychiatrist (in writing). Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 Either: 2. Approvals valid for 24 months for applications meeting the following criteria: All of the following: 1 The patient has a diagnosis of narcolepsy and has excessive daytime sleepiness associated with narcolepsy occurring almost daily for three months or more; and 2 Either: 2. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 The patient has been diagnosed with dementia; and 2 The patient has experienced intolerable nausea and/or vomiting from donepezil tablets. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate; and 2 The patient has demonstrated a significant and sustained benefit from treatment. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 Patient is opioid dependent; and 2 Patient will not be receiving methadone; and 3 Patient is currently enrolled in an opioid substitution treatment program in a service approved by the Ministry of Health; and 4 Applicant works in an opioid treatment service approved by the Ministry of Health. Approvals valid for 1 month for applications meeting the following criteria: All of the following: 1 Patient is opioid dependent; and 2 Patient has previously trialled but failed detoxification with buprenorphine with naloxone with relapse back to opioid use and another attempt is planned; and 3 Patient is currently engaged with an opioid treatment service approved by the Ministry of Health; and 4 Applicant works in an opioid treatment service approved by the Ministry of Health. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 Patient is or has been receiving maintenance therapy with buprenorphine with naloxone (and is not receiving methadone); and 2 Patient is currently enrolled in an opioid substitution program in a service approved by the Ministry of Health; and 3 Applicant works in an opioid treatment service approved by the Ministry of Health or is a medical practitioner authorised by the service to manage treatment in this patient. Renewal — (Maintenance treatment where the patient has previously had an initial application for detoxification) from any medical practitioner. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 Patient received but failed detoxification with buprenorphine with naloxone; and 2 Maintenance therapy with buprenorphine with naloxone is planned (and patient will not be receiving methadone); and 3 Patient is currently enrolled in an opioid substitution program in a service approved by the Ministry of Health; and 4 Applicant works in an opioid treatment service approved by the Ministry of Health. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Patient is currently enrolled in a recognised comprehensive treatment programme for alcohol dependence; and 2 Applicant works in or with a community Alcohol and Drug Service contracted to one of the District Health Boards or accredited against the New Zealand Alcohol and Other Drug Sector Standard or the National Mental Health Sector continued… ‡ safety cap ▲ Three months supply may be dispensed at one time ❋Three months or six months, as applicable, dispensed all-at-once ifendorsed“certifiedexemption”bytheprescriberorpharmacist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Compliance with the medication (prescriber determined); and 2 Any of the following: 2. Approvals valid for 5 months for applications meeting the following criteria: All of the following: 1 Short-term therapy as an aid to achieving abstinence in a patient who has indicated that they are ready to cease smoking; and 2 The patient is part of, or is about to enrol in, a comprehensive support and counselling smoking cessation programme, which includes prescriber or nurse monitoring; and 3 Either: 3. Chemotherapy treatment is considered to comprise a known standard therapeutic chemotherapy regimen and supportive treatments. Initial application — (Indolent, Low-grade lymphomas) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Renewal — (Indolent, Low-grade lymphomas) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 9 months for applications meeting the following criteria: Both: 1 Patients have not received a bendamustine regimen within the last 12 months; and 2 Either: 2. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 Any of the following: 1. Renewal only from a haematologist or medical practitioner on the recommendation of a haematologist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 No evidence of disease progression; and 2 The treatment remains appropriate and patient is benefitting from treatment.

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Effects of dietary composition on energy expenditure during weight-loss maintenance silvitra 120 mg with mastercard erectile dysfunction medicine in homeopathy. A randomized controlled trial on the efficacy of carbohydrate-reduced or fat-reduced diets in patients attending a telemedically guided weight loss program order silvitra 120 mg on-line erectile dysfunction morning wood. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study silvitra 120 mg with amex erectile dysfunction protocol does it work. Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlled trial. The effects of carbohydrate, unsaturated fat, and protein intake on measures of insulin sensitivity: results from the OmniHeart trial. Changes in weight loss, body composition and cardiovascular disease risk after altering macronutrient distributions during a regular exercise program in obese women. Effects of a popular exercise and weight loss program on weight loss, body composition, energy expenditure and health in obese women. Effects of moderate variations in macronutrient composition on weight loss and reduction in cardiovascular disease risk in obese, insulin-resistant adults. Effects of moderate variations in the macronutrient content of the diet on cardiovascular disease risk factors in obese patients with the metabolic syndrome. Adiponectin changes in relation to the macronutrient composition of a weight-loss diet. Low-fat versus low-carbohydrate weight reduction diets: effects on weight loss, insulin resistance, and cardiovascular risk: a randomized control trial. Effects of macronutrient composition of the diet on body fat in indigenous people at high risk of type 2 diabetes. One-year weight maintenance after significant weight loss in healthy overweight and obese subjects: does diet composition matter? Long-term effects of a low carbohydrate, low fat or high unsaturated fat diet compared to a no-intervention control. Influence of dietary macronutrient composition on eating behaviour and self-perception in young women undergoing weight management. Moderate carbohydrate, moderate protein weight loss diet reduces cardiovascular disease risk compared to high carbohydrate, low protein diet in obese adults: a randomized clinical trial. Short term effects of energy restriction and dietary fat sub-type on weight loss and disease risk factors. Effect of dietary macronutrient composition under moderate hypocaloric intake on maternal adaptation during lactation. Effect of the Mediterranean diet with and without weight loss on markers of inflammation in men with metabolic syndrome. The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. A comparison of Mediterranean-style and MyPyramid diets on weight loss and inflammatory biomarkers in postpartum breastfeeding women. Body composition changes and cardiometabolic benefits of a balanced Italian Mediterranean Diet in obese patients with metabolic syndrome. Effect of the Mediterranean diet with and without weight loss on surrogate markers of cholesterol homeostasis in men with the metabolic syndrome. It does not apply to medications used in inpatient settings or administered in one of the Kaiser Permanente medical centers. You may have specific exclusions, copays, or coinsurance amounts that are not reflected in the formulary drug list. Please consult your Evidence of Coverage or Membership Agreement, for additional information regarding your pharmacy benefits, including any specific limitations or exclusions. Specialty drugs are high cost, prescription medications used to treat serious or chronic medical conditions and require special handling, administration or monitoring. The details of your outpatient prescription drug benefit, including any specific limitations or exclusions can be found in your Evidence of Coverage or Membership Agreement. Generic and Brand Name Medications Kaiser Permanente covers generic and brand name drugs. Brand name drugs are manufactured and sold by the pharmaceutical company that originally researched and developed the drug. A non-formulary medication or non-preferred medication is generally available at a higher cost. Please consult your Evidence of Coverage or Membership Agreement for additional information regarding coverage of non-formulary medications specific to your plan. Not all dosage forms and strengths for a particular drug listed are on the Formulary. Please remember that this list is subject to change and will be updated from time to time during the year. Any product not found on the list will be considered non-formulary or non-preferred. Please also note that this formulary applies only to outpatient drugs and self-administered drugs. It does not apply to medical service drugs or medications used in inpatient settings or administered in one of the Kaiser Permanente medical centers. Restrictions on medication coverage Some covered drugs may have additional requirements or limits on coverage. Please consult your Evidence of Coverage or Membership Agreement for additional information regarding your pharmacy benefits, including any specific limitations or exclusions. A drug that isalimited distributiondrugmay only be availableat one ora limitednumberof pharmacies. These medications are often given in high acuity situations and in environments with poor visibility and multiple distractions. Medications with widely differing actions, such as muscle relaxants, vasopressors, and vasodilators, are often used in the course of a single anesthetic, at times simultaneously. It has been recognized for some time that perioperative medication errors 1-4 are a significant source of morbidity and, rarely, mortality. Interest in medication errors has extended to regulatory agencies, the federal government, and the general public. Medications are often selected based upon the location and visual features of the container/syringe. The recognition and identification of an object depends on shape, color, brightness, and contrast. As these elements become increasingly distinctive, identification of the 5-7 object becomes faster and more accurate. Therefore, although multiple factors contribute to medication errors, consistency and clarity of pharmaceutical and syringe labeling, in accordance with human factors, are important elements in their prevention. This Statement will provide the standards of each and highlight where differences exist. Statement: The primary consideration in the design of labels for syringes and drug infusion bags should be patient safety and the reduction of medication errors.

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