Steve Anthony: True Canadian Pharmacy

With new medical research increasingly discouraging the use of antibiotics against mild sinus infections, what else can you do to treat sinusitis symptoms at home? U.S. News asked two medical specialists for advice.

Wash your nose. “Nasal irrigation is an excellent way to help get over an acute sinus problem,” says Stanley Chia, a staff otolaryngologist at Washington Hospital Center in Washington, D.C. Cleansing your nose “tends to mechanically remove the bacteria that are clogging the sinuses and any allergens…and remove the pus drainage that is coming from the sinuses.” U.S. News offers tips for at-home nasal washings.

Consider oral decongestants, but not without a doctor’s approval if you have high blood pressure—which can be worsened by taking these medicines, Chia says. Nasal spray decongestants are also an option, and are less of a concern for those with high blood pressure, but they shouldn’t be used for longer than three days at a time because they can cause a rebound effect involving constriction of the blood vessels in the nose, he says.

Try pain relievers for the pain, pressure, and elevated temperature often associated with sinusitis, advises Richard Rosenfeld, professor and chairman of otolaryngology at Long Island College Hospital in Brooklyn, N.Y.

Avoid antihistamines. Don’t take medicines like Benadryl, Claritin, and Zyrtec unless you know allergies are at least partially responsible for your symptoms. Taking antihistamines simply to treat sinus infections is “not beneficial and could theoretically worsen the congestion because they dry out the mucous membranes in the nose,” Rosenfeld says.

Take a nasal steroid. “There is some evidence [that] nasal steroids may give some relief,” Rosenfeld says. Prescription nasal sprays like Nasonex and Flonase may ease symptoms by reducing inflammation, which promotes sinus drainage, he says.

Be patient. One conclusion shared by all of the recent research is that it takes time to recover from sinusitis, whether or not you take an antibiotic. It may take as long as 10 to 14 days—or longer, in some cases—to feel like your old self again.

Article taken from http://health.usnews.com/articles/health/respiratory-disorders/2008/04/16/antibiotic-free-tips-for-treating-sinus-infections.html

ALL drugs should be legalised to help address addiction and prison overloading, a doctor told the Australia 2020 summit today.

Wendell Rosevear, a GP who has worked in the prison system for more than 30 years, said people would change their behaviour only if they were given choices.

“I want to give drug addicts choices and I want to legalise all drugs in Australia,” he said.

“Drugs are illegal, so we put people in jail to solve the problem and we label people who use drugs as bad – it doesn’t make them feel valuable.

“We need honesty to deal with the issue.

“If we think that we can just put it out of sight, out of mind, we are actually devaluing people and not solving the problem.”

Dr Rosevear said the billions of dollars spent on prisons would be better spent on drug intervention and education programs.

He made the call in front of federal Housing Minister Tanya Plibersek in the summit’s communities stream.

The 100 delegates in the stream have split into six groups focusing on disadvantage, common values, social inclusion, strong families, leadership structures and building community ownership.

Each of the groups has been asked to come up with one strong idea by the end of the day.

JAMES CITY – A James City County doctor who prescribed painkillers to friends and family members has had his doctor’s license suspended by the Virginia Board of Medicine.

According to state inspectors, Douglas Allen Brown wrote prescriptions for Ambien, Vicodin, Xanax and Prozac, among other drugs, to two members of his family and a friend between about May 2006 and January 2007.

As of April 1, Brown lost his license for 30 days. Following the suspension, Brown will get his license back but will be placed on indefinite probation. He will have to complete 12 hours of education, with three hours on proper prescribing and six in the area of ethics, according to the agreement signed by Brown and the executive director of the state Board of Medicine.

The agreement was signed to avoid a formal administrative hearing. Brown did not respond to a request for comment left at his residence.

Investigators also found that Brown submitted a fraudulent academic transcript when he applied for admission to St. Georges University School of Medicine in Grenada, located in the Caribbean. The transcript said he graduated from the University of Michigan in 1973 with a bachelor’s degree, though he never attended Michigan nor got a bachelor’s degree from any university.

In later applications for medical employment, Brown continued to state he got his undergraduate degree from the University of Michigan, according to the state paperwork.

Board-certified in family medicine, Brown began working at Patient First in Newport News in March 2007. Officials with Patient First, which describes itself on its Web site as neighborhood medical centers, did not respond to several queries concerning Brown’s status with the facility.

Brown prescribed at least 11 prescriptions to the three people cited in the medical board’s agreement. In interviews with investigators for the Department of Health Professions, Brown couldn’t produce evidence that he kept medical records for those patients.

Should Brown fail to complete the 12 hours of education within nine months of being placed on probation, he would lose his license long-term, likely for three years or more.

In 2007, roughly 30 Virginia doctors had their licenses suspended, said Jennifer Deschenes, deputy executive director for discipline at the state Board of Medicine. There are about 29,000 licensed doctors in Virginia.

Brown’s trouble with state medical investigators goes back a decade. In 1998, a committee of the Board of Medicine met him to discuss its discovery that from April 1992 through November 1994 he ordered more than a thousand drugs from pharmaceutical companies for direct delivery to his residence, according to state records.

The committee voted to not impose any sanctions against Brown’s license to practice medicine at the time.

Investigators found he failed to maintain an accurate inventory or distribution record of the drugs, which were Schedule III through VI controlled substances. Drugs in these categories have accepted medical uses but have some potential for abuse.

Brown admitted during this time he once self-medicated with a sample of Fioricet, which is most commonly used to treat headaches and other pains, and provided Xanax to a friend for panic attacks.

In about July 1994, while employed by Riverside Express Care in Newport News, Brown was reported to the state for exhibiting symptoms of chemical dependency, according to state records. And in August 1994, he underwent a comprehensive addictive disease and psychiatric assessment at a recovery center in Atlanta.

No evidence was found there for chemical abuse or significant psychiatric impairment, according to state documentation. But Brown failed to follow the recommendations of the assessment committee, including continuing individual therapy and random urine drug screens.

By Scott Anderson

TORONTO, April 8 (Reuters) – Labopharm Inc’s (DDS.TO: Quote, Profile, Research) lengthy struggle to get U.S. Food and Drug Administration approval for its once-daily version of the pain killer tramadol could be over in about four months, its president and chief executive, James Howard-Tripp, told Reuters on Tuesday.

The company, which has been seeking the approval since May 2007, expects to meet with the director of the FDA’s Center for Drug Evaluation and Research sometime this month. After the meeting, the FDA has another 30 days to hand down a decision.

Once the decision is announced, the company must complete labeling requirements, which could take 60 more days. When all these steps are completed, an approval announcement could be made sometime in August, Howard-Tripp said.

He said the company considered jettisoning the product at one time due to the regulatory delays, but decided instead to fight for approval, convinced that it had the data needed to back its case.

“You have to be convinced that you have a good product and you have to be convinced that you have the right data. But you also have to be convinced that there is a fair process,” he said.

Regulatory delays have been costly for the company and its development partner, Purdue Pharma LLP, Howard-Tripp said. The company expected approval in September 2006, and had prepared for its launch in both 2006 and mid-2007.

“Through this process we have had to conduct additional clinical trials, which at the end of the day are more trials than normally asked for. That has cost a considerable amount of time and money,” he said.

Howard-Tripp said the delays were the result of the FDA’s decision to alter data requirements midstream. The company has maintained that the statistical method the FDA proposed for a new analysis of the data was different from that previously requested by the FDA.

Labopharm argues that additional analysis, requested recently by the agency, confirmed the efficacy of its once-daily tramadol formulation, which was demonstrated in previous analyses that were included in its New Drug Application and additional submissions.

Labopharm received notification from the FDA in May 2007 that the tramadol treatment would not be approved until certain conditions were met. At the time, the FDA said Labopharm had not demonstrated the efficacy of its formula because statistical methods used to analyze data from clinical trials didn’t adequately address missing data relating to those who had dropped out and didn’t complete the study. (Editing by Peter Galloway)

The government has announced it will investigate how community pharmacy access to the NHS Care Records Service could be achieved.

The news comes despite BMA concerns about the impact on patient confidentiality of extending access to an additional professional group working in the commercial sector.

The newly-published white paper on community pharmacy, Pharmacy in England: Building on strengths – delivering the future, outlines the government’s plans to look at pharmacy access to the CRS as part of its aim to extend pharmacists’ role within the NHS. It wants to give pharmacists a greater role in treating minor ailments, supporting patients with long term conditions and providing health promotion.

The investigation into pharmacy access to the CRS will include work with an early adopter PCT for the Summary Care Record (SCR) to look at the benefits, governance and practical arrangements of community pharmacists having access to the SCR.

The white paper adds: “This work and experience will be used to inform a key programme to consider how community pharmacy’s access to the Care Records Service might be achieved. This programme will include the Clinical Reference Panel, the National Advisory Group and Patient Advisory group, together with professional and representative organisations.”

Pharmacy bodies and MPs have been pressing for role-based read and write access to the CRS which they argue would enable better coordinated care between hospitals, GPs and pharmacies.

However the BMA has expressed reservations about the potential impact on patients’ confidentiality, particularly in a commercial environment.

The white paper acknowledges that there have been specific concerns about pharmacy access to the CRS and says it will be important to ensure mechanisms are in place to address concerns about patient consent and maintaining confidentiality.

The white paper also says that the government will look at how community pharmacists can access other parts of the NHS IT programme such as Choose and Book as they offer more clinically-orientated services.

It says further work is also exploring how the Electronic Prescription Service (EPS) could be developed to enable pharmacists to use it for other services that may involve the supply of a medicine, such as minor ailment schemes.

The white paper outlines the government’s intention to promote closer working relationships between GPs and pharmacists and says NHS Employers will set up a working group including pharmacy, medical and public representatives. The working group will start by looking at repeat dispensing and the EPS.

The white paper states that only 1.5% of prescriptions are currently issued for repeat dispensing which it describes as “disappointing.” It says that although prescribers may be waiting for release 2 of EPS before starting repeat dispensing there are issues that need to be tackled, such as patient recruitment and communication between prescribers and dispensers, whether prescriptions are issued on paper or electronically.

The white paper outlines a role for pharmacists in contributing to public health and says CfH will be asked to scope arrangements for electronically capturing information centrally about interventions made or advice given by pharmacists as part of the promotion of healthy lifestyles.

However it says electronic data capture will not be available immediately and adds: “Local work needs to start now on how best to support the recording of information using, for example, appropriate patients information where needed (such as the NHS number) and recognised clinical coding such as the Dictionary of Medical devices(dm+d) and Systematised Nomenclature of Medicines (SNOMED).”

The white paper further states that the government is also recommending that the GS1 system for radio frequency identification and barcoding should be adopted through the healthcare system in England for both products and coding systems used within healthcare settings such as patient identification codes on wristbands.

It says the use of auto-identification and data capture (AIDC) technologies in health care has been limited but that there is evidence of improvements to patient safety when coding systems are used to match patients to their care. Benefits include reduction in medication and dispensing errors, reduced risk of wrong-site surgery, accurate tracking and tracing of surgical instruments, equipments and other devices and much better record-keeping.

The white paper adds: “The case for coding is compelling but all patients need to work to commonly agreed standards if the benefits are to be realised fully.”

The government will now hold a series of public events on the white paper for patients and NHS professionals beginning on 1 May and intends consult on the key proposals later this year.

Pharmacists will be able to prescribe for minor ailments, do health promotion, manage people with chronic conditions and offer screening under the government’s new enhanced role for them, announced today.

Health Minister Ben Bradshaw said the white paper, Building on Strengths, Delivering the Future, gives pharmacists a complementary role to general practitioners that goes beyond what pharmacy services already offer.

“These proposals are not about pharmacists taking over the work of GPs – it’s about taking pressure off GPs and enabling them to spend more time with those patients who really need it,” he said.

Pharmacists will have additional powers to prescribe certain medicines and the government hopes patients will turn to their local pharmacy for any minor ailments so freeing up GPs to deal with more sick patients. It estimates this will save each GP one hour a day – or 57 million GP consultations a year.

The government will encourage pharmacists to increase their support of people with long-term conditions and offer screening for vascular diseases as part of the health checks initiative for 40-74 year olds announced earlier this week.

Direct communications with hospitals on care of discharged patients and more work around vaccination are two other areas pharmacists are expected to take on.

Two pharmacist clinical directors will front the developments, says the Department of Health.

Discussion on the white paper proposals begins on May 1, when both health staff and patients will have a chance to respond during public meetings from that date held across the country. Consultation on it will follow later this year.

“Pharmacists have an important role to play in providing access to healthcare for the most vulnerable members of the community and in providing joined-up medicines advice across primary & secondary care. The recognition of this is long overdue – but nevertheless welcome. There has been some resistance by those commissioning local services to include pharmacists as key providers of advice and treatment for their communities,” said Hemant Patel, President of the Royal Pharmaceutical Society of Great Britain.

Pharmacists must grasp this opportunity and make sure it worked for the public, he added.

The RPSGB is setting out a set of professional standards to maintain quality services which it will be discussing with the Government.

The BMA welcomed the government plan, saying it was “a helpful move” commissioning pharmacists to help improve health outcomes.

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