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TABLE II Quantitative Estimation of Gap Junction Development in Resting and Stimulated B-Cells Percent of membrane area occupied by gap junctions 0 .019 t 0.005 n 6 p .05 0 .068 t 0.011 n 8 0.022 t 0.007 n-8 N.S. 0 .035 t 0.008 n 8 No gap junctions per 100 jam' of plasma membrane 5 .48 1 n 6 .05 11 n 8 .80 t 1 .25 n 10 p 0.05 9 .74 , 1 .30 n 10 No. of gap junctions per B-cell 24 43 25 Mean No. of gap junction particles 26 .07 t 2 .72 n 6 p .005 44 .74 t 2.98 n 8 27 .60 n-8 N .S . 22 .49 t 1 .80 n 8 Median No . of gap junction particles 17 .44 p 0 .0005 25 .48 p 0 .005 16.03 Ratio of the gap junction area to the B-cell volume 10 - IPM -1 9 .28 t 2.40 n 6 p .01 30 .45 t 5.00 n 8 11 .31 n 8 N .36 t 3.50 n 8.
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Sometimes it seems that doctors who deliver health care and those who try to set up health care systems are from different planets. Their worlds are so different. Take the LOUIS CONSTAN, M.D. case of the Medicare Drug Plan. In the government's world-view, Medicare patients were so desperate for a drug financing plan they would jump at the chance to be in one. "Build it and they will come." Now that the patients are presented with the Byzantine details of the plans, they come to us and ask: "Is this worth it to me? Should I sign up?" How would I know? I don't understand it either, and have yet to find anyone who does. Maybe this will all settle down in a year and Medicare patients will have a drug plan they understand and use. And maybe not. The experience of one drug savings plan in Illinois is not encouraging. A year ago, Illinois started a mail-in program in which Illinois residents could import cheap drugs from other countries, saving them hundreds of millions of dollars in pharmacy costs. Do people use this? The answer is an emphatic NO. Of 141, 000, 000 prescriptions filled in Illinois last year, only 16, 200 were filled using the import plan. Recently AMA News interviewed doctors and patients about this plan. The doctors complained that no one from the state explained the plan to them so that they promote it to patients. A spokesman from the state insisted that they had indeed explained it to doctors. In fact, they sent a letter to each and every doctor in the state. Most doctors interviewed don't remember seeing the letter. Many patients hadn't even heard about the plan. Of those who did, and tried to use the web site to order their drugs, most found that they couldn't figure out how to get the site to work. Two worlds. The first world is oh-so-rational. Actuaries and MBAs work out a nice plan, and expect the public will embrace it. In their world, people automatically do what's in their financial interest. In our world, the one which we inhabit, it's not so pretty. We doctors are bombarded with mail each day. Who can read all of it? And the missals from the government are hopelessly poorly written, seemingly designed to confuse. One poorly written letter is not going to help us much. In our world, patients are hopelessly confused as well. They cannot or will not read the stuff on their prescription bottles. Many have not the slightest idea what is actually in that bottle, what it does to their bodies, when they filled it and when it needs to be refilled. They depend on their doctor, his staff, and the pharmacist to explain it to them. How in anyone's world will patients get this type of service on a web site assuming that they even know how to log on ; ? In their world, people are living on the edge. Not taking their pills because they cannot afford to. Desperately trying to make sense of their problems. In our world patients don't make an effort to understand their health problems and how they can solve them. They spend a fortune on worthless herbs and vitamins, then complain that their co-pay for real medicines went up to $20. They could lower their cholesterol by giving up burgers or actually exercising a little, but they don't, then expect us to give them a cheap pill that will correct the results of their poor lifestyle choices. If we can agree on anything about the current dysfunctional healthcare system, it is that it needs to change. How, of course, is another issue. But any change is incredibly difficult. Even small, fairly rational, relatively straightforward changes such as these drug savings plans are failing dismally. Is there any hope? Maybe. What would happen if we doctors stood together and expected more of our patients? Stopped treating them like medical novices and infants. What if we insisted they learn the names and actions of their drugs, when they need to take them and when they need to refill them? What if we insisted that they actually read a book about their disease rather than try to pick up snippets of information from magazine articles, the evening news, and television shows like "ER?" What if we answered their questions by referring them to resources where they can "read up" on their medical problems, taking ownership and responsibility for their problems? Familydoctor is an excellent start. Also generally excellent are Mayo Clinic's and AMA's medical encyclopedias, easily accessed from bookstores and libraries. Well informed patients would unquestionably lead to improved medical care for our patients. And what would happen if, instead of filing letters we don't have time to decode in the round file, we sent them back where they came from, requesting that the sender re-write them so that they are clear and concise? Let them know we don't have time for gobblety-gook. Get to the point. If you can't tell us what you want us to know on one page, you're wasting your time sending the letter. Maybe, in this way, we would find our two worlds closer.
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12. Using aseptic technique, insert the needle or butterfly ; of the Vacutainer device into the vein. It is often helpful to make counter-traction distally over the vein to stabilize it for needle puncture. If possible, always allow the full amount of blood to be drawn by each evacuated tube when using the Vacutainer system and tubes. After drawing, mix the blood in tubes containing additives by inverting the tubes several times. 13. After drawing the required blood samples, release the tourniquet if used ; . Remove the needle from the vein, cover the puncture site with a cotton swab, and hold or have the subject hold ; pressure at the puncture site for 3 minutes or until adequate haemostasis is visible. 14. Subjects occasionally feel dizzy or faint during phlebotomy. If the subject complains of dizziness or feels faint, stop the phlebotomy procedure, secure the vessel puncture site and help the subject lie down or sit with his her head between the knees. Do not allow subjects to stand until they have fully recovered. Summon medical assistance from other clinic staff if necessary. B. Paediatric Phlebotomy 1. Preparation a. Drawing blood from infants and small children may be physically traumatic for the infant and emotionally traumatic for the mothers. Therefore, it should be done by persons experienced in paediatric blood drawing to minimize the discomfort of both the mother and the child. b. As obtaining blood from newborns and young infants is sometimes difficult, if sufficient blood is not obtained on the first attempt, a second attempt may be made. If the second attempt also fails and an additional trained person is available, a second person may attempt to obtain the specimen. No more than three attempts should be made for any child at a time. If blood is not obtained after three attempts, the child may be scheduled to return on a later date for additional attempts by the most experienced staff member. c. All supplies required for the blood draw should be assembled in advance so that blood obtained can immediately be placed in the proper tubes. This preparation is especially important for specimens that must be anticoagulated. Delay in filling the tubes containing the anticoagulant may result in an inadequate clotted specimen, which would require an additional blood draw. d. Sterile, single use needles and tubes are to be used for each blood draw and after completion should be properly disposed of in a puncture resistant container. They are never to be cleaned and reused for any purpose. e. Tubes should be either pre-labelled with the patient's study identification number or labelled immediately after the specimen is obtained. A preprinted label should be used so as to avoid transcription errors in specimen.
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We have already communicated with physicians and pharmacies regarding the Half Tablet Program. Beginning October 1, 2005, we began a staggered mailing campaign to members informing them of the Half Tablet Program and encouraging them to discuss the program with their physicians. The letter also included instructions on how to obtain a free tablet splitter. If you have any questions regarding the Half Tablet Program, contact Andrew Hulce, IBA Health Plan's Director of Pharmacy Services at 269-341-7200 and vasotec.
INTRODUCTION The important strides of the past few years have firmly established the feasability of chemotherapy of viral diseases, and the major complaint now is that progress is slow. But the long and tortuous pathway from the laboratory to the clinic applies to all new drugs, due at least in part to public insistence on "totally safe drugs". The resulting regulations have been concisely analyzed in a recent article under the title "An end to the search for new drugs?" 1 ; . Amongst the numerous reviews on the subject of antiviral agents, that of Bucknall and Rutty 2 ; most systematically describes the problems that must be coped with.
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