Table S1. Data on IgG substitution for participants that were included in the per protocol analysis (n=62/arm).
|
|
|
- Letitia McCoy
- 5 years ago
- Views:
Transcription
1 Bergman et al, Vitamin D 3 supplementation in patients with frequent respiratory tract infections - a randomised, double blind intervention study Supplementary tables Table S1. Data on IgG substitution for participants that were included in the per protocol analysis (n=62/arm). Treatment with IgG per diagnosis Yes No Total Subclass deficiency IgA deficiency CVID ND Total: 124 Table S2. Primary endpoint. Unadjusted relative score per day calculated per 3 months periods as indicated. Values are expressed as mean +/- SD. (n=62/arm).
2 Table S3: Primary endpoint. Unadjusted score. Mean score / patient / year MWU (unadjusted) Endpoint Vitamin D Placebo Diff. p-value Total score ,023 Airway ,302 Ear* ,225 Sinus* ,126 Malaise ,041 Antibiotics* ,024 Table S4: Secondary endpoint. Number of bacterial cultures in relation to immunological diagnosis. Patients can have several bacteria or fungi in the same culture. Values within parentheses indicate the number of patients that provided the positive cultures. **p=0.0065, Fisher s exact test (12/22 vs 22/24). Number of bacterial cultures per diagnosis and treatment (n) H. infl. M. Cath S. pneum. S. aur Number of patients Fungi >1 culture taken Number of patients >1 culture positive Subclass deficiency Vitamin D 22 2(1) 3(3) 2(2) ** 5 Placebo 24 15(6) 3(2) 2(2) 13(5) 14(4) 22** 12 IgA deficiency Vitamin D 9 4(1) 1(1) Placebo 7 1(1) 2(2) 0 1(1) CVID Vitamin D 5 1(1) 3(2) Placebo 4 3(1) 0 2(1) 1(1) 3(1) 4 3 ND Vitamin D 26 21(7) 1(1) 5(2) 6(4) 11(4) Placebo 27 8(5) 1(1) 2(2) 18(7) 36(7) Total
3 Table S5: Secondary endpoint. Microbiological findings in relation to concomitant lung disease. Values within parentheses indicate the number of patients that provided the positive cultures. H. infl: Haemophilus influenza; M. cath: Moraxella catharralis; S. pne: Streptococcus pneumonia; S. aur: Staphylococcus aureus; Eba: Enterobacteriaceae spp; P. aer: Pseudomonas aeruginosa. **Fishers exact test, p= (0/27 vs 4/25). Asthma Vit D, n=27 Plac, n=25 BE Vit D, n=5 Plac, n=7 COPD Vit D, n=5 Plac, n=4 H. infl. M. cath S. pne S. aur Eba P. aer Fungi Sum 7(4) 4(2) 2(2) 2(2) 1(1) 1(1) 0** 17 9(5) 6(5) 1(1) 4(4) 2(2) 4(1) 11(4)** 37 5(2) 1(19 0 4(1) 2(1) 0 1(1) 13 1(1) 0 0 8(1) 1(1) 0 3(1) 13 9(2) 1(1) 0 3(1) 2(1) (2) Table S6: Genotyping. Influence of genetic factors on the outcome of vitamin D 3 treatment in patients with frequent respiratory tract infections. Mean infectious score (0-12 months) are presented per genotype and study group, along with the number of included patients. P-values refer to an interaction between genotype and study group. Gene / SNP VDR: TaqI VDR: FoqI CYP27B1: Rs GC: RS CYP2R1: Rs CYP24A1: Rs Allel-group tt tt /TT (reference) ff ff /FF (reference) CC AC/CC (reference) AA AC/CC (reference) AA AG/GG(reference) AA AT /TT(reference) Vitamin D 3 Mean inf score (n) 145 (11) 202 (49) 295 (5) 195 (56) 181 (27) 220 (34) 205 (39) 162 (21) 142 (8) 212 (53) 92 (2) 207 (59) Placebo Mean inf score (n) 225 (12) 253 (47) 331 (6) 238 (53) 211 (21) 268 (38) 214 (28) 283 (29) 315 (14) 227 (45) 221 (2) 249 (57) p- interaction
4 Table S7. Detailed description of adverse events. Group Adverse event Vit D Placebo Total CNS Headache 5 5 TIA (Transient Ischemic attack) 1 1 Vertigo 4 4 CNS Total Numbness - pain- shakings Numbness, pain 8 8 Paresthesias 2 2 Tremor 1 1 Numbness-pain-shakings Total Gastrointestinal symptoms Diarrhoea 2 2 Diverticulitis 4 4 Dyspepsia Gastroenteritis Helicobacter pylori infection 2 2 Gastrointestinal symptoms Total Heart/ vessels Congestive heart disease 2 2 Hypertension 2 2 Thrombosis 2 2 Heart/ vessels Total 6 6 Infections Herpes Zoster 1 1 Pneumonia 1 1 Sinusitis 2 2 Urinary tract infection 4 4 Pyelonephritis 2 2 Infections Total Body pain joint pain Bursitis 2 2 Body pain Joint pain fingers/ hands Joint pain hip 4 4 Pain in feet 1 1 Back pain 5 5 Elbow swelling 1 1 Body pain- joint pain Total Lungs Asthma exacerbation 1 1 Pneumothorax 2 2 Heavy breathing 2 2 Lungs Total Ears Hearing problems 1 1 Ears Total 1 1 Other Shivering 2 2 Menstruation too often 2 2 Nose bleeding 1 1 Toothache 1 1 Artheritis temporalis 2 2 Other Total Rash itch - blisters Tongue blisters 1 1 Hand rash 1 1 Foot rash 1 1 Facial rash when drinking alcohol 2 2 Facial rash 1 1 Chest rash, itching 1 1 Rash itch blisters Total Total
5 Supplementary figures Figure S1. The diary that was used for patients to register their daily symptoms. Symptoms from airways, ears and sinuses were calculated as maximum 1 point per anatomical site per day. Malaise and antibiotic consumption gave maximum 1 point per day. The occurrence of X-ray verified pneumonia resulted in 3 extra points per day for one week. Thus, 8 points was the maximum value that could be obtained per day. These data constituted the primary endpoint of the study. The diaries were filled out by the patient and sent monthly per mail to the study site. Figure S2. Primary endpoint. Temporal analysis of infectious score components. The adjusted one-year relative scores presented separately for each 3 month period. (A) airways, (B) malaise, (C) ear symptoms, (D) sinus symptoms and (E) antibiotic consumption. Effects are presented as relative scores (airway and malaise) or odds ratios (ear, sinus and antibiotics). Dashed lines indicate 95% confidence intervals. Figure S3. Secondary endpoint. Number of bacterial cultures in relation to concomitant lung disease. The number of bacterial cultures taken (A) and positive bacterial cultures (B). Asthma (vit D, n=22; Placebo, n=22). Bronchiectasis, BE (Vit D, n=5; Placebo, n=7). Chronic Obstructive Pulmonary Disease, COPD (Vit D, n=4; Placebo, n=4). Figure S4. Antimicrobial peptides in nasal fluid. Levels of LL-37 (A) and HNP1-3 (B) were measured in nasal fluid extracts at day 0, 6 and 12 months in a randomly selected group of patients (LL-37, n=12; HNP1-3, n=15). There were no statistically significant differences within or between the groups with regards to peptide levels (Mann-Whitney U test). Bacterial
6 growth in these samples were also recorded (C) and expressed as either no growth/normal flora or growth of a primary pathogen. The growth pattern of the vitamin D 3 and Placebo groups were compared at each time-point using Fisher s exact test. Figure S5. Blood chemistry. Plasma levels of calcium (mmol/l), phosphate (mmol/l), albumine (g/l) and creatinine (µmol/l) were measured at the time points 0, 3, 6, 9 and 12 months after inclusion. Values are expressed as mean values.
7 Figure S1.
8 Figure S2
9 Figure S3
10 Figure S4
11 Figure S5
Bronchiectasis in Adults - Suspected
Bronchiectasis in Adults - Suspected Clinical symptoms which may indicate bronchiectasis for patients Take full respiratory history including presenting symptoms, past medical & family history Factors
Community Acquired Pneumonia. Abdullah Alharbi, MD, FCCP
Community Acquired Pneumonia Abdullah Alharbi, MD, FCCP A 68 y/ male presented to the ED with SOB and productive coughing for 2 days. Reports poor oral intake since onset due to nausea and intermittent
Vitamin D 3 supplementation in patients with frequent respiratory tract infections: a randomised and double-blind intervention study
Open Access To cite: Bergman P, Norlin A-C, Hansen S, et al. Vitamin D 3 supplementation in patients with frequent respiratory tract infections: a randomised and double-blind intervention study. BMJ Open
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
Sound View Acupuncture and Chinese Herbs 5410 California Ave SW, #202, Seattle, WA
Sound View Acupuncture and Chinese Herbs 5410 California Ave SW, #202, Seattle, WA 98136 206.200.3595 Today s date Name Legal name (if different) Phone (primary) (secondary) Address City State Zip Email
Caspian Acupuncture -- Health History Form Anita Tayyebi EAMP, LAc. 652 SW 150 th St Burien WA 98166
Frist Name Last: Date Phone (H) (C) (W) E-mail Address City State Zip Age DOB Place of Birth _ Marital/Partnership Status Preferred Gender Pronoun _ Profession Family Physician Telephone # Referred By
NORTHERN VIRGINIA PULMONARY AND CRITICAL CARE ASSOCIATES, P.C.
NORTHERN VIRGINIA PULMONARY AND CRITICAL CARE ASSOCIATES, P.C. Past Medical History AIDS/HIV disease Anemia Asthma Bronchitis Cancer Date of last Chest X-ray Diabetes Mellitus, Type I Diabetes Mellitus,
Supplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Blum CA, Nigro N, Briel M, et al. Adjunct prednisone
TEXAS VASCULAR ASSOCIATES, P.A. PATIENT CLINICAL INTAKE FORM
TEXAS VASCULAR ASSOCIATES, P.A. PATIENT CLINICAL INTAKE FORM PATIENT NAME: DATE OF BIRTH: TVA Physician being seen: Date of Visit: PAST MEDICAL HISTORY HEART PROBLEMS NEUROLOGICAL Congestive Heart Failure
Upper Respiratory Tract Infections / 42
Upper Respiratory Tract Infections 1 Upper Respiratory Tract Infections Acute tonsillitispharyngitis Acute otitis media Acute sinusitis Common cold Acute laryngitis Otitis externa Mastoiditis Acute apiglottis
Patient Information Last Name: First Name: Middle Initial: Address: City: State: Zip Code:
Patient Information Last Name: First Name: Middle Initial: Address: City: State: Zip Code: Date of Birth (MM/DD/YY): Social Security #: Sex: Male Female Home Phone #: Mobile Phone #: Email Address: Marital
an inflammation of the bronchial tubes
BRONCHITIS DEFINITION Bronchitis is an inflammation of the bronchial tubes (or bronchi), which are the air passages that extend from the trachea into the small airways and alveoli. Triggers may be infectious
IgG subclass deficiencies
IgG subclass deficiencies hello@piduk.org 0800 987 8986 www.piduk.org About this booklet This booklet provides information on IgG subclass deficiencies. It has been produced by the PID UK Medical Advisory
Past Medical History. Chief Complaint: Patient Name: Appointment Date: Page 1
Appointment Date: Page 1 Chief Complaint: (Please write reason, symptoms, condition or diagnosis that prompts your appointment) Past Medical History PERSONAL SKIN HISTORY YES NO Yes - Details Melanoma
PIDS AND RESPIRATORY DISORDERS
PRIMARY IMMUNODEFICIENCIES PIDS AND RESPIRATORY DISORDERS PIDS AND RESPIRATORY DISORDERS 1 PRIMARY IMMUNODEFICIENCIES ABBREVIATIONS COPD CT MRI IG PID Chronic obstructive pulmonary disease Computed tomography
SPECIFIED PHYSICAL CONDITIONS MATRIX
SPECIFIED PHYSICAL CONDITIONS MATRIX I. Compensation for ACUTE CONDITIONS A1 Proof Lump Sum Enhancer Declaration under penalty of perjury (1) asserting the manifestation of one or more conditions (or the
BROADWAY SPORTS & INTERNAL MEDICINE, P.S TH AVE NE SUITE 202 BELLEVUE, WA P: F:
BROADWAY SPORTS & INTERNAL MEDICINE, P.S. 1600 116 TH AVE NE SUITE 202 BELLEVUE, WA 98004 P: 206 215-2288 F:206 215-2289 MEDICAL HISTORY QUESTIONNAIRE Date Name Date of Birth HT WT Current Medical Complaints
Medical History Form
Medical History Form Full Name Title: Mr/Mrs/Ms/Miss Address Date of Birth Date Telephone: Mobile: Email: How did you hear about the Garden of health? G.P s Name and Address Are you currently seeing your
LECOM Health Ophthalmology
Patient Name: Date of Birth: New Patient Questionnaire Your answers will be used by your healthcare provider get an accurate history of your medical conditions and ocular concerns. If you are uncomfortable
Study No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
Bronchiectasis Domiciliary treatment. Prof. Adam Hill Royal Infirmary and University of Edinburgh
Bronchiectasis Domiciliary treatment Prof. Adam Hill Royal Infirmary and University of Edinburgh Plan of talk Background of bronchiectasis Who requires IV antibiotics Domiciliary treatment Results to date.
Skin reactivity to autologous bacteria isolated from respiratory tract of patients with obstructive pulmonary disease
Skin reactivity to autologous bacteria 149 Original Article Skin reactivity to autologous bacteria isolated from respiratory tract of patients with obstructive pulmonary disease J. Halasa 1, M. Halasa
* CC* PATIENT QUESTIONNAIRE
Pain Center of Michigan *0290341CC* PATIENT QUESTIONNAIRE Patient Name Birthdate Age Home Address City State Zip Home Phone Alternate Phone Referring Physician Primary Care Physician MEDICAL HISTORY Please
Please mark the severity of your pain on the following line: On your worst days with a W On your average days with an A On your best days with a B
Today s Date: NEUROSURGERY Name: (Last) (First) (MI) Age: Birth Date: Female Male Dominant hand: Right Left Pharmacy- Name: Phone: Location: What are you being seen for today? Location of pain (indicate
ACUTE PAEDIATRIC EAR PRESENTATIONS PROF IAIN BRUCE PAEDIATRIC OTOLARYNGOLOGIST & ADULT OTOLOGIST
www.manchesterchildrensent.com ACUTE PAEDIATRIC EAR PRESENTATIONS PROF IAIN BRUCE PAEDIATRIC OTOLARYNGOLOGIST & ADULT OTOLOGIST A CHILD WITH EARACHE UNCOMPLICATED AOM ACUTE OTITIS MEDIA Acute otitis media
Johanna M. Hoeller, DC PS
ENTRANCE FORM Birth date: Height: Weight: Emergency Contact: Emergency Contact Phone: ( ) Spouse/Partner or Parent s name: Children s names: Occupation (Your): Employer: Address: City/State/Zip: Phone:
New Patient Documentation. Name: (Last) (First) (Middle) Address: (Street) (Apt#) (City) (State) (Zip) Home Phone: ( ) Cell: ( ) Work: ( )
New Patient Documentation Name: (Last) (First) (Middle) Address: (Street) (Apt#) (City) (State) (Zip) Home Phone: ( ) Cell: ( ) Work: ( ) Age: Birthdate: E Email: Social: Sex: Male Female Height: Weight:
READ THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE PATIENT MEDICATION INFORMATION. [new-ka la] Mepolizumab for Injection
![READ THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE PATIENT MEDICATION INFORMATION. [new-ka la] Mepolizumab for Injection](/thumbs/93/111890101.jpg "READ THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE PATIENT MEDICATION INFORMATION. [new-ka la] Mepolizumab for Injection")
READ THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE PATIENT MEDICATION INFORMATION Pr NUCALA [new-ka la] Mepolizumab for Injection Read this carefully before you start taking NUCALA and each time you
PATIENT INFORMATION FORM (WOMEN ONLY)
PATIENT INFORMATION FORM (WOMEN ONLY) Name: Age: Sex: Birthdate: / / SS # A. Describe briefly your present symptom(s) or the reason(s) for seeing the doctor today: B. Name all illnesses or conditions for
Laser Vein Center Thomas Wright MD Page 1 of 4
Demographics Laser Vein Center Thomas Wright MD Page 1 of 4 Patient Name: Address: City, St, Zip Primary Phone: Alternate: DOB: Social Security #: Insurance Information Primary Insurance ID# Group# Subscriber
DATE OF BIRTH: MELANOMA INTAKE
MELANOMA INTAKE GENERAL INFORMATION How was your first diagnosed? (Check the diagnosis that describes your condition.) Melanoma Merkel Cell Carcinoma Squamous Cell Carcinoma Basal Cell Carcinoma Other
Welcome to Big Sky Country. Pediatrics Infectious disease update. Todd TwogoodMD
Welcome to Big Sky Country Pediatrics Infectious disease update Todd TwogoodMD My kid is always sick!! We have to deal with parents Snotty nose kids Average number of colds in children from Oct to March
Amarillo Surgical Group Doctor: Date:
Office Visit Information (General Surgery) Amarillo Surgical Group Doctor: Date: Patient s Information Name: Last First Middle Social Security #: Date of Birth: Age Gender: [ Male / Female ] Marital Status:
My kid is always sick!!
Welcome to Big Sky Country My kid is always sick!! Pediatrics Infectious disease update Todd Twogood MD We have to deal with parents Snotty nose kids Average number of colds in children from Oct to March
In your own words, please write the reason you are here. Please be specific, putting in dates as necessary. Use the back of the form if needed.
Name: SS# In your own words, please write the reason you are here. Please be specific, putting in dates as necessary. Use the back of the form if needed. Patient Medical, Surgical and Family History Review
Room # Critical Care & Pulmonary Consultants, P.C.
Room # Critical Care & Pulmonary Consultants, P.C. Health History You have been scheduled for an appointment with Critical Care and Pulmonary Consultants, P.C. This health history will help us facilitate
ANY FAMILY HISTORY OF ANEURYSM OR DVT?
NAME: D/O/B: DATE: MR# WHAT PROBLEM(S) BRINGS YOU HERE TODAY? WHO SENT YOU TO US? DOCTOR/OTHER WHICH DOCTOR? WHAT SURGERY HAVE YOU HAD AND WHEN? (LIST) 1. 2. 3. 4. 5. 6. 7. HOW MUCH ALCOHOL DO YOU DRINK
Who is filling out this intake form? Self Spouse Parent Guardian
Office Use Only: Reviewed with Patient Data Entry Scan & File Date: Date: Date: Initials: Initials: Initials: Today s Date: Who is filling out this intake form? Self Spouse Parent Guardian If you are not
Allina Health United Lung and Sleep Clinic
Medical History Form Date Allina Health United Lung and Sleep Clinic Name Last First MI Date of birth What lung problem do you want us to help you with: Who is your primary care provider? Social History
Name: Date: Street Address: Referring Physician: How long have you had your current problem?
3851 Piper Street, Suite U464 Anchorage, AK 99508 p 907.339.4800 f 907.339.4801 New Patient Health Questionnaire Name: Date: Street Address: City: State Zip Sex: Age: Birth Date: Insurance: SS# Home Phone:
Florida Hospital Spine Center Patient Intake Form
Florida Hospital Spine Center Patient Intake Form Today s Date Last Name First Name Middle Street Address DOB (Address, City, State, Zip Code) First Contact # Please Circle: Home Cell Other Second Contact
Patient Information. Marital Status (Single, Married, Life Partner, Divorced, Widowed) CHIEF COMPLAINT
Patient Information Name Date Home Address City State Zip Phone E-mail Address Cell Phone: Business Address City State Zip Phone Occupation Place of Birth Date of Birth Age Height Weight Soc. Sec. # Sex
Patient Interview Form
Page 1 of 5 Patient Interview Form Patient Information First Name: MRN: Last Name: Date Of Birth: Contact Preference Email Telephone call- Work Telephone call - Home Email Please check one as your preferred
ICD-9-CM CODING FUNDAMENTALS CODING EXERCISES
Steps to Accurate Coding Underline the main term, then locate code: Stenosis of Carotid Artery Transient Ischemic Attack Gastrointestinal hemorrhage Degenerative Joint Disease Coronary Artery Disease Alcoholic
MANAGEMENT OF RHINOSINUSITIS IN ADULTS IN PRIMARY CARE
PROFESSOR DR SALINA HUSAIN DEPUTY HEAD DEPARTMENT OF OTORHINOLARYNGOLOGY-HEAD NECK SURGERY UKM MEDICAL CENTRE MANAGEMENT OF RHINOSINUSITIS IN ADULTS IN PRIMARY CARE CLINICAL PRACTICE GUIDELINES ON MANAGEMENT
The Bacteriology of Bronchiectasis in Australian Indigenous children
The Bacteriology of Bronchiectasis in Australian Indigenous children Kim Hare, Amanda Leach, Peter Morris, Heidi Smith-Vaughan, Anne Chang Presentation outline What is bronchiectasis? Our research at Menzies
KAMIREN PACKAGE LEAFLET: INFORMATION FOR THE USER. What is in this leaflet? 1. WHAT KAMIREN IS AND WHAT IT IS USED FOR
PACKAGE LEAFLET: INFORMATION FOR THE USER KAMIREN 2 mg, 4 mg TABLETS DOXAZOSIN This leaflet is a copy of the Summary of Product Characteristics and Patient Information Leaflet for a medicine, which outlines
Initial Consultation
Today s Date: Initial Consultation Thank you for choosing Apollo Health and Wellness. Please take your time to fill out this form. It will help us to concentrate on areas of your health that need attention
Featured Topic: Sinus Care (4 slides)
Featured Topic: Sinus Care (4 slides) Some signs you have a problem with your sinuses Pain around and behind the eyes and on the face Headaches A stuffed up nose, or nasal discharge and postnasal drip
Pathogenesis of Infectious Diseases. CLS 212: Medical Microbiology
Pathogenesis of Infectious Diseases CLS 212: Medical Microbiology Definitions Path- means disease. Pathogenesis The steps or mechanisms involved in the development of a disease. Infection The presence
PAGE 1 NEURO-OPHTHALMIC QUESTIONNAIRE NAME: AGE: DATE OF EXAM: CHART #: (Office Use Only)
PAGE 1 NEURO-OPHTHALMIC QUESTIONNAIRE NAME: AGE: DATE OF EXAM: CHART #: (Office Use Only) 1. What is the main problem that you are having? (If additional space is required, please use the back of this
Influenza-Associated Pediatric Deaths Case Report Form
STATE USE ONLY DO NOT SEND INFORMATION IN THIS SECTION TO CDC Form approved OMB No. 0920-0007 Last Name: First Name: County: Address: City: State, Zip: Patient Demographics 1. State: 2. County: 3. State
Patient information: Pneumonia in adults (Beyond the Basics)
Page 1 of 8 Official reprint from UpToDate www.uptodate.com 2014 UpToDate Patient information: Pneumonia in adults (Beyond the Basics) Authors Thomas J Marrie, MD Thomas M File, Jr, MD Section Editor John
MCKAY UROLOGY LINCOLNTON OFFICE PATIENT HISTORY FORM
Patient name: MRN #: Current Medications (prescription and over the counter medications including vitamins, herbs, aspirin, antacids, injectables, hormones and birth control medication) If you brought
RESPIRATORY TRACT INFECTIONS. CLS 212: Medical Microbiology Zeina Alkudmani
RESPIRATORY TRACT INFECTIONS CLS 212: Medical Microbiology Zeina Alkudmani Lower Respiratory Tract Upper Respiratory Tract Anatomy of the Respiratory System Nasopharynx Oropharynx Respiratory Tract Infections
Study No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
City State Zip Code. Ethnic Background: Caucasian African-American Asian Hispanic Native American. Previous. Hobbies/Leisure activities:,,,
History # UPIN # (Please leave blank) Name: First M.I. Last Address: Street (Apt #) City State Zip Code Phone number: ( ) ( ) Home Business Birth Date: / / Day-Month-Year Gender: M F Marital status: (Maiden
Patient Intake Form for Allegany Ear, Nose, & Throat
Patient Intake Form for Allegany Ear, se, & Throat Patient Name: What brings you to the office today? Who is your primary care doctor? Please list your current medications: Are you allergic to any medications?
Pathogens!! What are Pathogens? 12/7/14. Infectious Diseases are Caused by Pathogens
Pathogens!! Copyright 2011. PEER.tamu.edu Infectious Diseases are Caused by Pathogens What are Pathogens? Pathogens are microbes (microscopic living organisms) or other agents that cause diseases. Ex:
MEDICAL HISTORY FORM FOR FOLLOW-UP
MEDICAL HISTORY FORM FOR FOLLOW-UP ID NUMBER: 0a) Form Date... / / 0b) Staff Code... Instructions: Whenever numerical responses are required, enter the number so that the last digit appears in the rightmost
Secondary Immunodeficiency
A guide for patients, their families, friends and healthcare professionals Raising awareness and supporting patients with immunodeficiencies in Australia. Secondary Immunodeficiency Edition 1 Date 15 th
2. Approx. Date of Onset: 3. Approx. Date of Onset:
Healthy Balance Lisa A. Dulac, L.Ac. Acupuncture Patient Intake Form Present Health Concerns: Please list your most important health concerns in order of their significance. 1. Approx. Date of Onset: 2.
NEW PATIENT INTAKE FORM
NEW PATIENT INTAKE FORM NAME: DOB: SEX: MALE FEMALE ADDRESS: ZIP CODE: PHONE #: - - WORK#: - - PHARMACY: PHARMACY #: - - WOULD YOU BE INTERESTED IN HAVING ACCESS TO YOUR MEDICAL RECORDS ONLINE? YES / NO
Antibiotics, Expectorants, and Cough Suppressants. Center For Cardiac Fitness Pulmonary Rehab The Miriam Hospital
Antibiotics, Expectorants, and Cough Suppressants Center For Cardiac Fitness Pulmonary Rehab The Miriam Hospital Objectives Review the mechanism of action (MOA), dosing, benefits, and various options for:
Management of Acute Exacerbations
15 Management of Acute Exacerbations Cenk Kirakli Izmir Dr. Suat Seren Chest Diseases and Surgery Training Hospital Turkey 1. Introduction American Thoracic Society (ATS) and European Respiratory Society
L. AUegra', N. Konietzko*, P. Leophonte% J. Hosie', R. Pauwels', J. N. Guyei/ and P. Petitpretz'
Journal of Antimicrobial Chemotherapy (1996) 37, Suppl. A, 93-104 Comparative safety and efficacy of sparfloxacin in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a double-blind,
Wisconsin Integrative Pain Specialists
Patient Information Today s Date: Patient s Name: DOB: Age: Gender: Marital Status: M S D What would you like us to call you? Address: City, State, Zip: Home Phone: Cell Phone: Work Phone: Email: Preferred
When should a Primary Immunodeficiency be Suspected?
When should a Primary Immunodeficiency be Suspected? Ricardo U Sorensen. MD Head, Jeffrey Modell Diagnostic Center for Primary Immunodeficiencies. LSUHSC, New Orleans Learning Objectives Define Primary
Respiratory System Virology
Respiratory System Virology Common Cold: Rhinitis. A benign self limited syndrome caused by several families of viruses. The most frequent acute illness in industrialized world. Mild URT illness involving:
doi:
Nig. J. Pure &Appl. Sci. Vol. 30 (Issue 1, 2017) ISSN 0794-0378 (C) 2017 Faculty of Physical Sciences and Faculty of Life Sciences, Univ. of Ilorin, Nigeria www.njpas.com.ng doi: http://dx.doi.org/10.19240/njpas.2017.a10
TOMBALL REGIONAL INTERNAL MEDICINE ASSOCIATES Medical Complex Drive, Suite 6 Tomball, TX
TOMBALL REGIONAL INTERNAL MEDICINE ASSOCIATES 13414 Medical Complex Drive, Suite 6 Tomball, TX 77375 281-516-0212 Welcome! We are glad that you have chosen Tomball Regional Internal Medicine Associates
JAC Efficacy and tolerance of roxithromycin versus clarithromycin in the treatment of lower respiratory tract infections
Journal of Antimicrobial Chemotherapy (1998) 41, Suppl. B, 69 73 JAC Efficacy and tolerance of roxithromycin versus clarithromycin in the treatment of lower respiratory tract infections G. Tatsis*, G.
New Patient History. Name: DOB: Sex: Date: If yes, give the name of the physician who did your evaluation or ordered your tests:
New Patient History Name: DOB: Sex: Date: Chief Complaint: 1. Give a brief description of the problem you are seeking treatment for today: 2. Have you been evaluated for this problem or had any tests for
Health History Questionnaire Date: / /.
Health History Questionnaire : / /. Name: Gender: M F Age: Address: City: State: Zip Code: Home Phone: Cell Phone: Email: of Birth: Place of Birth: Height : Weight: Employer: Relationship Status: Occupation:
Supplementary materials for:
Supplementary materials for: Cecil E, Bottle A, Sharland M, Saxena S. Impact of UK primary care policy reforms on short-stay unplanned hospital admissions for children with primary care-sensitive conditions.
PLEASE COMPLETE ALL SECTIONS OF THIS FORM
PLEASE COMPLETE ALL SECTIONS OF THIS FORM Patient Name: Date of Birth: Referring Doctor? (Name, telephone number and address) Chief Complaint: Why have you come here? How did it start? What are the symptoms?
Medical History Form
Medical History Form NAME DOB / / TODAY S DATE MEDICAL HISTORY What medical Conditions do you have? Select all that apply, or write in if not listed: Diabetes High Blood Pressure Thyroid Disorder Heart
Session Guidelines. This is a 15 minute webinar session for CNC physicians and staff
Respiratory Disease Session Guidelines This is a 15 minute webinar session for CNC physicians and staff CNC holds webinars monthly to address topics related to risk adjustment documentation and coding
Mast Cell Activation Syndrome
Mast Cell Activation Syndrome Clinical Questionnaire Description Today s Date: Patient Name: Please indicate yes or no for the following symptoms and traits: (If you are not familiar with a particular
Influenza-Associated Pediatric Mortality Case Report Form Form Approved OMB No
Influenza-Associated Pediatric Mortality Case Report Form Form Approved OMB No. 0920-0004 STATE USE ONLY DO NOT SEND INFORMATION IN THIS SECTION TO CDC Last Name: First Name: County: Address: City: State,
Past Medical History. Chief Complaint: Appointment Date: Page 1
Appointment Page 1 Chief Complaint: (reason, symptoms, condition or diagnosis that prompts your appointment) Past Medical History EYES Yes No Yes Details Glaucoma EAR, NOSE AND THROAT Hearing difficulty
PRIMARY IMMUNODEFICIENCIES CVID MANAGEMENT CVID MANAGEMENT
PRIMARY IMMUNODEFICIENCIES CVID MANAGEMENT CVID MANAGEMENT 1 PRIMARY IMMUNODEFICIENCIES KEY ABBREVIATIONS CVID CT IgA IgG IgM IPOPI IVIG SCIG PID Common Variable Immune Deficiency Computerised tomography
Health History Questionnaire
Health History Questionnaire Name: Gender: M F Age: Address: City: State: Zip Code: Home Phone: Mobile Phone: Email: Date of Birth: Place of Birth: Height: Weight: Relationship Status: Employer: Single
PHARMACOLOGICAL CLASSIFICATION A Ophthalmic preparations with antibiotics and/or sulphonamides
Page 1 of 6 SCHEDULING STATUS Schedule 4 PROPRIETARY NAME AND DOSAGE FORM ZYMAR eye drops (ophthalmic solution) COMPOSITION Each ml contains 3 mg gatifloxacin (0,3 % m/v) Preservative: benzalkonium chloride
Pneumonia. Definition of pneumonia Infection of the lung parenchyma Usually bacterial
Pneumonia Definition of pneumonia Infection of the lung parenchyma Usually bacterial Epidemiology of pneumonia Commonest infectious cause of death in the UK and USA Incidence - 5-11 per 1000 per year Worse
X-linked agammaglobulinemia (XLA)
X-linked agammaglobulinemia (XLA) hello@piduk.org 0800 987 898 www.piduk.org About this booklet This booklet provides information on X-linked agammaglobulinemia (XLA). It has been produced by the PID UK
Symptom Review (page 1) Name Date
v2.4, 2/13 JonathanTreasure.com Botanical Medicine & Cancer Herb Drug Interactions Herbalism 3.0 Symptom Review (page 1) Name Date INSTRUCTIONS Please read each section below carefully and, after each
By the end of this lecture physicians will:
No disclosure By the end of this lecture physicians will: 1. Be able to identify patients who need immune work-up. 2. Be able to recognize the manifestation of food allergies. 3. Be knowledgeable about
Inner Balance Acupuncture
Patient Information Inner Balance Acupuncture 274 Southland Drive, Suite 101, Lexington, KY 40503 859-595-2164 www.acupunctureky.com Name: Today s date: Age: Male Female Marital status: Date of Birth:
Upper Respiratory Tract Infections
Upper Respiratory Tract Infections OTITIS MEDIA Otitis media is an inflammation of the middle ear. There are more than 709 million cases of otitis media worldwide each year; half of these cases occur in
Cardiovascular Genetics Clinic Vascular Questionnaire
Name: Address: Home Phone: Cell Phone: Email Address: Date of Birth: Primary Care Physician: Why have you been referred for a Cardiovascular Genetics Appointment? Have you had a genetics evaluation? If
1/9/ :00:00AM 1/9/ :40:15AM 6/9/2017 9:19:16AM A/c Status. Test Name Results Units Bio. Ref. Interval. Nasal Swab
LL - LL-ROHINI (NATIONAL REFERENCE 135091523 Age 36 Years Gender Female 1/9/2017 120000AM 1/9/2017 114015AM 6/9/2017 91916AM Ref By Final RESIRATORY COMREHENSIVE ANEL (33 ATHOGENS) RESIRATORY ANEL 1 #
Salt Lake Orthopaedic Clinic Initial Visit Form
Salt Lake Orthopaedic Clinic Initial Visit Form Name: Today s Date: Date of Birth: Age: Height: Weight: Handedness (R/L): Referring Physician: Primary Care Physician: Chief Complaint Why are you seeing
Laser Vein Center Thomas Wright MD RVT Page 1 of 4
Demographics Laser Vein Center Thomas Wright MD RVT Page 1 of 4 Patient Name: Address: City, St, Zip Primary Phone: Alternate: DOB: Social Security #: Marital Status: Married Single Other Emergency Contact:
Bridges Family Wellness PC. New Patient Intake. Bridges Family Wellness Intake Form SE Lake Rd, Suite 102 Milwaukie, OR
New Patient Intake Bridges Family Wellness Intake Form Full Name: * What is your birthdate? MM/DD/YYYY * What is your gender identity? * Home address: * Cell Phone * Other Phone number(s): Emergency Contact
Supplementary Online Content
Supplementary Online Content Lind M, Polonsky W, Hirsch IB, et al. Effect of continuous glucose monitoring vs conventional therapy on glycemic control among patients type 1 diabetes treated multiple daily
COMMON VARIABLE IMMUNODEFICIENCY
COMMON VARIABLE IMMUNODEFICIENCY This booklet is intended for use by patients and their families and should not replace advice from a clinical immunologist. 1 COMMON VARIABLE IMMUNODEFICIENCY Also available
THE PHARMA INNOVATION - JOURNAL Acute exacerbation of chronic obstructive pulmonary disease, caused by viruses: the need of combined antiinfective
Received: 19-11-2013 Accepted: 28-12-2013 ISSN: 2277-7695 CODEN Code: PIHNBQ ZDB-Number: 2663038-2 IC Journal No: 7725 Vol. 2 No. 11. 2014 Online Available at www.thepharmajournal.com THE PHARMA INNOVATION