Archive for October, 2014

Genetics are not your destiny

Wednesday, October 29th, 2014 No Commented
Under: Health care

Even by the most conservative geneticists’ standards, we have anywhere from 80% to 97% control over the expression of our genes. We have dormant genes for all sorts of things, both good and bad. A person is not just overweight because their mother and father were overweight. One is not destined to have a heart attack just because half the people in their family have had one; nor by the same token, diabetes or cancer. Genetics

Genetics can have some influence, but genes are turned on and off by regulatory genes that are mainly controlled by nutrients. A gene will not express itself unless the internal environment is conducive to its expression. So we have control over our genetic expression by the foods we choose to eat, the emotions we habitually experience, and the thoughts we consciously allow to govern our minds. We choose our lifestyle and that, in turn, impacts the expression of our genes.

We can also deliberately address the toxicity of our body’s internal environment. We all inherit our genetic code from our parents. While many physical features are genetically predetermined, they do little to define our health. The bad habits which we inherit impact us far more than we are willing to admit.

Learn to be the master of your own genetic destiny with the decisions you make each moment.


Many animals shed their fur (or molt) by completely losing their external skeleton to live a new life with a refreshed set of cells. My young niece was recently excited to share her science class project. She carried in a large glass aquarium, with multiple cocoons hanging inside. I was excited about her joy in biology and the continuous change that occurs in nature. She shared with me that in two weeks, their transformation into beautiful monarch butterflies would be complete.

We humans are the same. The healing body you have today is not the same one you had seven years ago. All cells replicate, die and are either removed from the body or dismantled into spare parts. For every cell that replicates, a newer one is born. This new cell has the potential to be stronger and healthier than its older twin, which will one day undergo apoptosis, an intrinsically timed cell death. In another few years, every cell, tissue and organ will belong to a completely new version of you.

Every cell in our body along with its components is totally replaced within nine months. Some cells have a faster turnover rate than others, but ALL cells are rejuvenated and replaced, even in our organs and endocrine glands. In the developing field of epigenetics, the biology of belief and behavior, we are learning more about how we live through our cells and can reach the full expression of our genetic potential. This becomes especially true when we live as our ancestors did in the hunter-gatherer days.

J-medicalnews: Pharmaceutical Selling in Canada

Thursday, October 23rd, 2014 No Commented
Under: Health care

Love and Other Drugs, a film featuring Anne Hathaway and Jake Cyllenhaal, provides an amusing depiction of pharmaceutical sales reps. The first 20 minutes of this movie provide an unbelievably accurate portrayal on how I, along with my storm trooper drug representative colleagues, literally invaded doctors’ offices from the 1980s through 2002.











Drug representatives were allowed to invite medical doctors to musicals, sporting events and expensive dinners, all on the company dime. Many of the more aggressive drug reps would even purchase season passes to sporting events.

Pharmaceutical companies are known to have flown many medical doctors to Rome and other international travel destinations for two-week, all expenses paid vacations. In order to earn the trip, the doctor must achieve the status of highest prescriber for a particular drug. It makes me wonder what the difference is between an expensive gift and a bribe.

I entered the pharmaceutical industry in Canada website in the year 2001. In early 2002, Pharmaceutical Research and Manufacturers of America (PhRMA) passed new guidelines to prevent drug reps from engaging in extravagant entertainment, bribes and lavish gifts. Needless to say, medical doctors were saddened, though loopholes existed since PhRMA is a collective establishment of all the major pharmaceutical companies and . It makes me wonder if there is any irony that pharmaceutical companies manage the 3rd party organization responsible for regulating the ethics of their own sales and marketing practices.

From 2002 to 2006, I was allowed to provide medical doctors educational meals to present clinical data specific to the drugs I promoted. Technically, I was supposed to provide information regarding specific indications, safety profiles, drug-to-drug interactions and potential for withdrawal syndrome. I spent an average of $5.000 monthly, catering lunches to doctors’ offices and hosting dinners at 5-star restaurants for doctors and their significant others. When I asked my manager what my monthly budget limit was, her words were, “Spend until I tell you to stop.” She knew the more meals I scheduled with doctors, the more my Viagra Pills would be prescribed.

I was never told to stop, even after spending $10.000 one month. We ordered bottles of wine that exceeded $200 each, ate full course meals, and tasted novel desserts as grand finales to evenings of superficial rapport and witty banter. If the doctor had a pet dog, he ordered the organic, pasture raised pork chop to.

Despite the benefits, the pressures to meet sales goals were very high, requiring me to engage in a certain level of activity that was known to directly increase sales.

Several great reasons to order Viagra online

Saturday, October 18th, 2014 No Commented
Under: Canadian Pharmacy, canadian pharmacy viagra

If you have ever ordered medicines at online pharmacy, there is no point in telling you about all the advantages of this way of shopping – you have already known about them. But until now many men experience difficulties and inconveniences buying Viagra at traditional pharmacies, being unaware of how beneficial, easy and safe it is to buy hqcanadianpharmacy. In fact, there are several good reasons in favor of online pharmacies.


Many men feel discomfort buying drugs for increasing potency at usual pharmacies. It is rather understandable, because it is really extremely inconvenient to declare the problems with potency in presence of other buyers. Men are embarrassed to even query pharmacist about other modern drugs against impotence and ask questions about Viagra. And some of the men don’t even work up the courage to buy necessary medicine when there are other people around. But when you order Viagra online in Canada, you do not experience such discomfort. You can take a look at the assortment of drugs against erectile dysfunction without any haste and order any of them in any quantity without wry glances. The medication will be delivered to the address specified by you and no one will even know that you have purchased it. Complete privacy is guaranteed!

Over the counter

In most cases you need a prescription from the physician to buy a medicine at a traditional pharmacy and it is very likely that nobody will sell Viagra to you without it. And this means that you have to spend time and visit a doctor and overcome the feeling of embarrassment again, telling the doctor about the problems of intimate nature. When you buy Viagra, there is no need to show a prescription since here the drugs for improving potency are available over the counter. All instruction regarding the use of medications and plenty of more information are posted on the site and you can decide if it is worth to go to a doctor for advice beforehand in your case or this will be unnecessary precaution.


Medications at online pharmacies turn out to be much cheaper than off-line. This is due to peculiarities of running an online business that requires fewer expenses than arranging and maintaining a real point of sale. In addition, you can purchase not only original but generic Viagra online from Canada, while at traditional pharmacies choice is often limited to only brand drugs. Purchasing high quality generic drugs from leading manufacturers, you get effective and safe remedy for potency at the best price, which is several times lower than the cost of original Viagra in any off-line pharmacy.

Also you should take into account that in general the choice of ED drugs at online pharmacies much richer, and this gives you the opportunity to experiment in search of optimal solution for your case in particular. Online Viagra in Canada is the most affordable, effective and comfortable way to overcome impotence and to obtain great improvement in sexual life of any men!

J-Medicalinfo: Treatment Erectile Dysfunction

Friday, October 17th, 2014 No Commented
Under: Erectile dysfunction, Treatment

What You Probably Know

These drugs, called PDE-5s by medical practitioners, have helped improve the sex lives of millions of men and their sexual partners. All three drugs work similarly, with their only significant difference being duration of action (Cialis erectile potentiating effects generally last longer than those of its competitors). The table below lists these products’ doses and time required for them to begin working. As you can see, Levitra® and Viagra® look very similar on paper while Cialis dramatically longer duration of action separates it from these two.



Although the PDE-5s have been an incredibly welcome addition to the lives of their men with ED, these Australia Pharmacy have three basic problems: first, they don’t work for everybody; second, in the people they do work for, some experience an incomplete, or somewhat unsatisfactory response (their erection is not as hard or doesn’t last long enough for them or their partner to have a mutually rewarding and satisfying sexual experience) and last, because of their mechanism of action (relaxing blood vessels), they can cause side effects ranging from mild (headaches, flushing, heartburn, nasal congestion and runny nose) to more severe (vision difficulty, dizziness and fainting spells that can result in injury). The likelihood of dizziness and fainting occurring are more likely if the person drinks alcohol or takes nitrates (nitroglycerin) for heart problems.

Does that mean the PDE-5s are bad things and their list of possible problems outweighs the benefits of using them? Absolutely not! These drugs are both effective and safe if used correctly. During the early years of their use, rumors abounded regarding risk of death with their use. The truth of the situation is that most of the initial users were older men, so it’s likely that many of these early users had heart problems. It makes sense that when these men with relatively severe medical problems began engaging in a vigorous activity requiring significant mental stimulation and physical exertion (sex), some would have heart attacks or other medical issues. Imagine the number of emergency department visits that would have resulted had these same sedentary men chosen to start playing racquetball or run wind sprints in their neighborhood instead of chasing their startled wife around the house with their newfound erections! Fortunately, the death risk was unsubstantiated. Long-term studies show the risk of a man dying from using PDE-5s for ED is the same as his dying from an automobile crash.

All that’s well and good; however, it would be nice if men suffering from ED had other treatment options which worked well and possessed few side effect concerns. Happily, men are in luck because numerous other effective and safe ED treatment options do exist!

J-Medicalinfo: Prevention Thoughts

Friday, October 17th, 2014 No Commented
Under: Prevention

Therefore if monotony appears in your life and the effect of this is sedative, start taking such thoughts into your head, which to bring some variety. It is better if you alone take them into your head and influence yourself than if others influence you. One can make use of suggestion to strengthen his health, to develop his abilities, to strengthen his memory, etc. In whatever conditions you are, keep in your mind a positive thought that you can still find a fertile soil to work.

Each bad thought is a dissonance. Correct it immediately. Dissonance is two scales that are disharmonious. There is no correspondence between them.

Replace immediately the bad thought by a bright and harmonious one.

Glands are to be developed. When you are in a difficulty, turn your attention to the gland, which is in the throat, or to the one that is in the pit of the stomach and you will get a response on how to get out of the difficulty.

Think for two minutes on the words “love” and “agreement”. If you do it for ten minutes a day, you will see the results. You shall strive to have harmony in your mind at each moment. Your mind should get used to focusing. It diverts a lot, but when you focus on harmony for 1-2 minutes, your mind will get used to focusing. By doing exercises, your cells, your nerves will start to train and if you have a headache or any discomfort, it will pass. If you do exercises of the kind, you can be treated. Each treatment is cleaning, and cleaning is health. By doing exercises for harmony, everything in you will be cleaned.

Air, water, fire, and earth – these four elements are symbols and show the different types of matter, of which man is made. There is consciousness and life in these elements. If a person attracts a certain type of matter through his thoughts, he will also acquire states and moods relevant to the matter. If he attracts solid matter by his thoughts, some hardening will also take place in him. People are worried what will happen to them when they get older, who will look after them and in this way they attract solid matter toward them and begin to harden and suffer with atherosclerosis. The latter disease occurs, because of disbelief. To make an old man to turn to God means your hair to turn white.

While thinking, you will often notice light, bright dots that appear from the left and then go the right and disappear. When the dots go from left to right, the thought that is projected towards you, is ascending. That thought is useful. And when that light dot goes from right to left, it is descending. This idea is dangerous and useless for you.

To be healthy, you have to connect mentally with good, strong, healthy people who have no weaknesses and infirmities and take a part of their energy. If you want to get up early, grab the thumb of your left hand with the thumb and forefinger of your right hand and say: “I want to get up tomorrow at 4 a.m.” Do the same with your right hand and say the same words. In this way you connect with the powers of the rational world and call them as witnesses.

Studies suggest that corticosteroids might affect tissue remodeling

Friday, October 17th, 2014 No Commented
Under: Critical Care

Corticosteroids are commonly used in the management of lung diseases induced or exacerbated byenvironmental tobacco smoke and characterized by airflow limitation such as asthma and COPD. The beneficial effects of corticosteroids in this setting are often ascribed to their powerful anti-inflammatory activity. However, studies suggest that corticosteroids might affect tissue remodeling as well. Vanacker et al showed that FP, the corticosteroid used here, inhibited the progression of allergen-induced structural changes in the airways of rats. These effects were associated with inhibition of epithelial cell proliferation, goblet cell hyperplasia, and airway wall thickening. Blyth et al showed significant resolution of established subepithelial fibrosis in a murine model of atopia.

Canadian News J-Medical


Moreover, Chetta et al showed that fluticasone can reduce the vascular component of airway remodeling. In humans, Hoshino et al showed that inhaled corticosteroids can reduce the lamina reticularis of the basement membrane by modulating insulin-like growth factor-I expression in bronchial asthma, and Olivieri et al showed that fluticasone might control the intensity of airway remodeling. Together, these studies suggest that corticosteroids can diminish lung tissue remodeling, thereby ameliorating the progression of disease Myviagrainaustralia. However, the exact mechanisms by which corticosteroids exert their anti-tissue remodeling effects remain to be fully elucidated.

We hypothesize that corticosteroids modulate lung tissue remodeling by affecting intracellular signaling pathways that control the expression of extracellular matrix genes. The data presented here suggest that this hypothesis is correct. We report that nicotine stimulates the production of fibronectin in transformed and primary lung fibroblasts. The induction of fibronectin was due to increased transcription of the fibronectin gene followed by accumulation of fibronectin mRNA and secretion of its protein.

Consistent with our hypothesis, we found that FP inhibited the production of fibronectin in lung fibroblasts by blocking the transcription of the fibronectin gene, thereby decreasing fibronectin protein production. This inhibitory effect was related to blockade of CREB phosphorylation, a transcription factor known to be important in regulation of fibronectin gene transcription. In turn, inhibition of CREB phosphorylation was associated with decreased CREB binding to DNA leading to diminished gene transcription.

The polymorphonuclear cell population

Tuesday, October 14th, 2014 No Commented
Under: Medicine

Nonspecific labeling was blocked by coating with normal goat serum (X0907 [diluted 1:20]; DAKO) for 20 min at room temperature. The following primary antibodies were used: for HO-1 staining, the anti-HO-1 rabbit polyclonal antihuman antibody (sc10789 [diluted 1:50]; Santa Cruz Biotechnology, Inc; Santa Cruz, CA) overnight at 4°C; for iNOS staining, the anti-iNOS rabbit polyclonal antihuman antibody (sc8310 [diluted 1:50]; Santa Cruz Biotechnology, Inc) overnight at 4°C; and for nitrotyrosine staining, the antinitrotyrosine rabbit antihuman antibody (diluted 1:100) [Upstate; Lake Placid, NY] for 1 h at room temperature.

After being incubated with the primary antibody Cheap Tadalafil Australia, the slides were washed, followed by staining with the secondary antibody-alkaline phosphatase anti-alkaline phosphatase complex for 30 min at room temperature. After washing, the slides were stained with Fast Red for 15 min at room temperature. Dilutions and washing steps were performed with the preincubation solution. Slides were counterstained with hematoxylin for 5 min and mounted (Glycergel, C0563; DAKO). Negative control experiments for nonspecific binding were performed in a similar manner but in the absence of the primary antibody. The primary antibody was replaced by nonspecific Ig of the same species as the primary antibody or the preincubation solution. On immunostained slides, polymorphonuclear cells and macrophages were identified by morphologic analysis, and positively stained cells within 300 cells of each population were counted using a light microscope. Results were expressed as the percentage of positive cells within each leukocyte population.

Within the polymorphonuclear cell population, there were mostly neutrophils and very few eosinophils, as was shown on slides stained with May-Grunwald-Giemsa stain (Table 2). However, to be precise we use the term polymorphonuclear cells for the entire analysis of the study. All analyses were performed in a blind fashion by two investigators, and the results were averaged. Three replicate measurements were performed by each observer in 10 randomly selected slides. Both intraobserver and interobserver coefficient of variation (CV) were < 10%. – canadian pharmacy viagra

Sunday, October 12th, 2014 No Commented
Under: canadian pharmacy viagra

Canadian Viagra is an oral medication that comes in the form of blue-tinted tablets and is used to treat ED – erectile dysfunction – if patient is having trouble getting stable erections. Canadian Viagra has been on the market for over 10 years and during this time the manufacturing company (Pfizer) has conducted a series of studies to ensure that the product is safe and side effects are minimized. Viagra has proven to be very effective for men of all ages, even those who suffer from conditions that might be construed as contraindications – diabetes, depression and high blood pressure.

Viagra is a powerful brand with good name recognition – according to opinion polls, almost all male and female adults in the U.S. have heard of this drug. It should be taken with a glass of water, if taken with a meal that is high in fat absorption rate may be decreased leading to more time is needed for an erection. Before you decide whether to take Viagra, it is advisable to speak to your doctor to find out if your state is actually ED (sometimes such problems are purely psychological and when taken away from the scene a man can perform sexually as before).

This is seen as a convenient option for thousands of shoppers who feel too time pressed to shop at an actual drugstore, or else, too shy to word their query in front of the pharmacist and possibly a few other customers waiting in line.

Canadian Viagra generic pills are commercially available in tablets of 25, 50 and 100 mg. It is typically prescribed in the dose of 50mg and then, depending on the effect achieved (or lack of effects), the dose is changed. It is advisable to start with the minimum dosage, increasing until you reach the desired effect.

This article contains information on Sildenafil; more information can be found on the package insert of the commercial product or on the website of the manufacturer and the medical studies in the literature before you start looking for Canadian Viagra for sale Canada. You should remember to always have supervision of a doctor and follow his or her directions, also the information could not be updated so it is advisable to immediately consult your doctor or pharmacist for more information, also it is recommended not to shop on the internet for the alleged dangers of pharmacies and especially without a physician. Having good health is essential but in order to take good care of it it’s essential to trust your doctor and pharmacist.

Abciximab was used in conjunction with the intervention when deemed clinically indicated

Friday, October 10th, 2014 No Commented
Under: Drugs

Troponin T and CK-MB were measured in a nonrandomized, nonconsecutive cohort of patients (n = 57) during the period of September to November 2000. Patients were referred for elective coronary angiography and PCI with the diagnosis of progressive symptomatic coronary artery disease. Thrombolysis in Myocardial Infarction (TIMI) grade coronary artery blood flow was established in all patients. Troponin T and CK-MB were measured at 2 h, 4 h, 8 h, and 12 to 20 h (mean ± SEM, 17.9 ± 0.46 h) postprocedure.

Abciximab was used in conjunction with the intervention when deemed clinically indicated. The dose was 0.25 mg/kg IV followed by 0.125 pg/kg/min for 12 h after PCI. All patients received aspirin (325 mg) before the intervention, and patients receiving stent implantation received clopidogrel (375 mg) prior to stent placement. Subsequently, peak biomarker levels were determined at each time interval. Any increase in cTnT > 0.03 ng/mL (the value at which the coefficient of variability of the assay is < 10%)12 and CK-MB > 6.2 ng/mL was defined as a clinically significant elevation. Troponin T assays were performed using highly sensitive and precise third-generation assay. The cTnT assay has a coefficient of variability of 10% at a value of 0.035 ng/mL and 20% at 0.015 ng/mL.

The limit of detection is < 0.01 ng/mL. Fifty-six percent of these patients received IIb/IIIa inhibitor therapy in association with the procedure, and 39% were stented without IIb/IIIa inhibitor. Four of the 57 patients (7%) were treated with percutaneous transluminal coronary angioplasty (PTCA) only therapy; of these, 1 patient received abciximab. Twenty four of 57 patients demonstrated cTnT elevations, with the majority receiving stent placement (92%) and abciximab (75%). Fourteen of 57 patients demonstrated elevations in CK-MB, with all patients receiving stents and 86% treated with abciximab.

Fourteen of 57 patients demonstrated elevations in CK-MB, with all patients receiving stents and 86% treated with abciximab. Postprocedure cTnT elevations were detected in 42% of patients. Of these, no patients demonstrated peak cTnT levels by 2 h after PCI. One of the 24 patients (4%) had peak cTnT elevation at 4 h after PCI (3.14 ng/mL), 3 of 24 patients (12.5%) had peak cTnT at 8 h after PCI (1.73 ± 0.48 ng/mL), and 20 of 24 patients (83%) had peak cTnT at 12 to 20 h (mean, 18 ± 0.5 h) after PCI (0.22 ± 0.06 ng/mL). The differences in cTnT levels late (12 to 20 h) were often substantial (range, 0.02 to 1.14 ng/mL; mean difference, > 0.1 ng/mL).

Drugs to prevent airway remodeling

Thursday, October 9th, 2014 No Commented
Under: Drugs

No therapy is currently demonstrated to unequivocally prevent or reverse airway remodeling. Here, we summarize the effects of current therapeutics and the factors contributing to airway remodeling drawn from both clinical studies and animal models.

Many drugs have been shown to prevent allergen-driven airway remodeling in animal models, but there are few studies that demonstrate their ability to reverse established airway remodeling. Since airway remodeling occurs even in childhood asthma, it is possible that airway remodeling is already present in many patients with asthma at the time of onset of clinical disease. It is, therefore, pertinent to ask ourselves if remodeling is even potentially reversible. In this respect, the recent publication by Leclere et al showing the partial reversal of ASM remodeling in horses with heaves, a naturally occurring asthma-like diseas e, following antigen avoidance as well as corticosteroid treatment Canadian Health&Care Mall provides a basis for optimism. The appropriate time to initiate therapeutic interventions deserves further consideration in addition to the search for novel therapeutic targets.

There are no studies reporting efficacy of therapies for cystic fibrosis airway remodeling. Indeed, this disease is not well modeled by cystic fibrosis transmembrane conductance regulator-deficient mice, but the porcine model shows more promise. Although bronchiectasis is likely intractable, the aspect of airway remodeling that may lead to the asthma syndrome often accompanying cystic fibrosis may be amenable to treatment.

Several clinical studies show that inhaled corticosteroid (ICS) reduces RBM thickness, although the clinical significance of such an effect is quite uncertain, and its impact on airway function seems unlikely to be major. Vascular remodeling reportedly improves with high-dose fluticasone. Whether the excessively rapid airway rewarming seen in patients with asthma after the cooling induced by hyperpnea challenge is attributable to excess vasculature or to vasodilation of existing vessels is not known. Its clinical significance is likewise uncertain but has been attributed a role in exercise-induced bronchoconstriction. A decrease of a-smooth muscle actin area in peripheral airways harvested by transbronchial biopsy in subjects treated with ICS has been reported, suggesting reversibility of this lesion in peripheral airways. Erectile dysfunction medications Canada

Similar Diseases Without Atopy

Wednesday, October 8th, 2014 No Commented
Under: Atopy, Canadian Pharmacy

Similar Diseases Without Atopy

Whether the same disease causes infantile eczema without positive skin test results or intrinsic asthma with its nasal equivalent is not entirely certain. There are a great many similarities.



Atopy Canadian Pharmacy

Atopy Canadian Pharmacy




Where allergic asthma is common, intrinsic asthma is common and visa versa. An example is the high rate of asthma in the isolated community on the island of Tristan da Cunha where 74% of asthma cases were extrinsic and 26% were intrinsic. The intrinsic asthma picture is clouded by a fairly large group of patients with earlier symptoms of atopy who become more chronically asthmatic, develop sinus disease, and behave more and more like persons in the intrinsic group. The onset of purely intrinsic asthma in adults can be quite sudden, and it is often chronic and severe from the start. Women in their childbearing years are particularly susceptible, and lung autoantibodies have been found. It joins the list of diseases involving autoantibodies that develop more commonly in women, with the immunologic changes of pregnancy and the postpartum period. Autoantibodies also have been found in persons with infantile eczema without atopy.

One curious finding in patients with aspirin-sensitive asthma, which is usually intrinsic, is that the herpes drug acyclovir, an inhibitor of DNA polymerase, reduces bronchial inflammation and protects against a reaction to aspirin. Does the antiviral effect have anything to do with this or do other pharmacologic effects cause this phenomenon?

Atopic respiratory symptoms may develop soon after positive skin test results occur or not for several years, as if some other event may be required for localization of the disease. A follow-up of university students tested and questioned as freshmen, and questioned again about symptoms 4 years later as seniors, gives a good example showing the variable latency period between the development of positive skin test results and the development of symptoms. Very occasionally, symptoms develop before positive skin test results occur, perhaps because of local IgE production. In the same university student population that was observed 23 years after their original testing as freshmen, both hay fever and strongly positive skin test results raised the rate of future asthma to about 10% compared with 3% in alumnae with neither previous hay fever nor positive skin test results. Thus, beyond childhood the risk for new asthma was small even for the atopic population. Although the 10% occurrence of asthma in those with previous hay fever or positive skin tests seems a low risk, half of those who developed asthma had previous atopy or hay fever. Thus, atopy remained a substantial risk factor.

Erectile Dysfunction and Asthma

Tuesday, October 7th, 2014 No Commented
Under: Erectile dysfunction

Our study was not aimed at providing information on potential changes in morbidity or health-care use by patients referred to AECs; this needs further assessment. Nevertheless, the program was based on previous projects and studies that have shown the potential of such interventions to significantly reduce asthma-related morbidity, particularly for patients with high morbidity or acute care use, for whom such intervention should be a priority. Our program is in keeping with the recommendations of these studies in that it promotes referrals to AECs. In only 4 months, the number of patients referred for formal asthma education increased more than tenfold. Additional data obtained from May to October suggest that the frequency of referrals remains stable. These results are significant when we consider the small number of referrals before the 1500 program was implemented. From January to April, referrals coming from hospitals accounted for > 60% of the total number of referrals received by the AECs. Other results support the hypothesis that this increase in referrals to AECs is directly related to the training given to the ED professionals.


Approximately half (48%) of the subjects referred to an AEC had consulted an ED for asthma at least twice during the preceding 12 months. An earlier study carried out in Quebec showed that approximately one third of the patients (32%) seen at the ED made more than one yearly visit. The fact that these patients had not previously received structured asthma education seems to indicate that even patients with a high rate of acute care visits are not often referred for such interventions.

Overall, approximately two thirds of referred patients agreed to make an appointment at the AEC, and approximately two thirds of these attended the program. These proportions are high if we consider the usually poor attendance at such programs among this population. However, this evaluation does not provide information on the reasons for refusal or nonattendance. In spite of a clear process  and dedicated staff, only a limited number of subsequently attended patients for asthma education.


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