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Salzmann-Erikson, M; Eriksson, H. 2005 ; . Encountering touch: a path to affinity in psychiatric care. Issues in Mental Health Nursing; 26 8 p. 843-852. Shattell, M; Hogan, B. 2005 ; . Facilitating communication: how to truly understand what patients mean. Journal of Psychosocial Nursing & Mental Health Services; 43 10 p. 29-32. Available online via ProQuest. OBSESSIVE COMPULSIVE DISORDER Aardema, F; Emmelkamp, PMG; O Connor, KP. 2005 ; . Inferential confusion, cognitive change and treatment outcome in obsessivecompulsive disorder. Clinical Psychology and Psychotherapy; 12 5 p. 337-345. Derisley, J et al. 2005 ; . Mental health, coping and family-functioning in parents of young people with obsessive-compulsive disorder and with anxiety disorders. British Journal of Clinical Psychology; 44 3 p. 439444. Available online via ProQuest. OCCUPATIONAL THERAPY Desrosiers, J. 2005 ; . Participation and occupation. Canadian Journal of Occupational Therapy; 72 4 p. 195-204. Available online via ProQuest. Milner, T; Bossers, A. 2005 ; . Evaluation of an occupational therapy mentorship program. Canadian Journal of Occupational Therapy; 72 4 p. 205-211. Available online via ProQuest. PANIC DISORDER Bradwejn, J et al. 2005 ; . Venlacaxine extended-release capsules in panic disorder. Flexible-dose, double-blind, placebocontrolled study. British Journal of Psychiatry; 187 4 p. 352-359. Available online via Ovid. PERSONALITY DISORDER Bagge, CL; Stepp, SD; Trull, TJ. 2005 ; . Borderline personality disorder features and utilization of treatment over two years. Journal of Personality Disorders; 19 4 p. 420-439. Available online via ProQuest.
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No. 1 2 3 QUESTION 2 3rds of adults will become depressed at some time in their lives Men are more likely to become depressed than women Depressed women are more likely to commit suicide than depressed men Asylum seekers are more at risk of suicide than the general population A 70 yr old man is more likely to commit suicide than a 35 yr old man The 2 question screening tool for depression is 96% specific PHQ9 is indicated only if the answer to both screening questions is affirmative A PHQ9 score of 20 indicates mild depression Major depression may be treated with counselling only i.e. no medication A patient who ticks' several days' on all 9 questions in PHQ9 is diagnosed as depressed A negative response to Qs 1a PHQ9 indicates that the patient is not depressed The answer to Q2 in PHQ9 must be at least ` somewhat difficult' for a diagnosis of depression to be made A drop of 1 point from baseline in PHQ9 score indicates an adequate response to treatment Weight loss is a major side-effect of treatment with mitrazapine Vvenlafaxine is the treatment of choice in depressed hypertensives Fluoxetine may cause increased fit frequency in epileptics The dose of citalopram must be reduced in patients with CKD stage3 SSRIs cause an increased incidence of urinary retention in prostatism SSRIs are safe to use in patients with glaucoma Paroxetine is a safe drug to use in the first trimester of pregnancy Giving antidepressants during pregnancy prevents recurrence of post natal depression The maximum dose of citalopram is 80 mg daily Patients with severe depression should be included on the practice mental health register 50% of patients on the mental health register will have been sectioned in the past Patients on the mental health register of a practice need annual mental health reviews Patients on lithium need their serum creatinine levels measured every 15m A mental health care plan can only be produced by the CMHT or secondary care TFTs should be monitored annually in patients on lithium fluoxetine is a safe drug to give to breastfeeding mother who has post-natal depression fluoxetine has a long half life T F D.
AVI BioPharma Inc. Chromos Molecular Systems, Inc. Chroma Therapeutics Ltd. AGI Therapeutics, plc Nexell Therapeutics, Inc. Acadia Pharmaceuticals, Inc. Columbia Laboratories Durect Corp. Tripep AB Chrysalis BioTechnology, Inc. Chugai Biopharmaceuticals, Inc. Parke-Davis Parke-Davis Pfizer Inc. Onyx Pharmaceuticals Inc. Onyx Pharmaceuticals Inc. ICOS Corp. Gilead Sciences, Inc. Medtronic, Inc. Regeneron Pharmaceuticals, Inc. aaiPharma, Inc, for instance, venlafaxine side effects.
The French Red Cross and l'Organisation Panafricaine de Lutte contre le SIDA is financing ART for 300 patients at CTA Ouagadougou. The duration of this support is not yet specified; however, it is expected that patients currently treated under this program will be absorbed into other programs after Red Cross funding ends. Through the financing of a Burkinab philanthropist, several associations are providing treatment for up to 415 patients for one to two years. Ministry of Health funds from debt forgiveness under the Heavily Indebted Poor Countries HIPC ; Initiative are being used to pay for ARVs for 500600 people, although duration of this funding is not yet specified. Out-of-pocket payment by patients: currently, approximately 200 patients are paying out-of-pocket for ARVs at CAMEG. Approved doctors, who have been trained in ART, write patient prescriptions; patients then go to CAMEG in Ouagadougou to receive their medicines on a cash-and-carry basis at cost plus a small mark-up to cover CAMEG costs. As part of the Accelerated Treatment Initiative TAC ; , the World Bank has announced future funding for treatment for 12, 000 people, with much of the treatment to be channeled through associations. Other funding sources have been proposed, although details are not yet available: The African Development Bank ADB ; , through the African Development Fund ADF ; , has proposed funding treatment for 500 patients. The West African Development Bank is also prepared to finance treatment, although the terms and conditions of this support are not available. The Government of Brazil has proposed financing treatment for 100 patients over two years, with the possibility of renewing funding for a longer period. Other potential funding sources for HIV AIDS activities include Denmark, Italy, Belgium, the Netherlands, and religious institutions such as St. Camille. The United Nations Children's Emergency Fund UNICEF ; also supports the PMTCT program. Table 1: Summary Table of Financing of Current and Proposed ART Programs in Burkina Faso Finance Source.
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New world group was presented with the award of distinction by the community chest on 8 september 2005 in recognition of the group and its member companies' generous support towards the community chest's charitable initiatives from july 2004 to march 2005 and esidrix, for example, effexor suicide.
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Venlafaxine, a selective serotonin reuptake inhibitor SSRI ; , is usually prescribed for the symptomatic relief of depression and generalized anxiety disorder. Based on anecdotal evidence of potential benefit, Dr. Loprinzi and colleagues conducted a double-blind, placebo-controlled, randomized trial to assess the efficacy of venlafaxine in alleviating hot flashes in 229 women with a history of breast cancer.1 At the end of the 4-week trial, venlafaxine therapy had reduced median hot flash scores by 61% compared to baseline in the 92 evaluable patients receiving venlafaxine at 75 or 150 mg day p.o., with beneficial effects apparent within the first week of treatment. In comparison, the median decrease in the placebo group was 27% P .001 ; . For women recovering from breast cancer and thus with a contraindication for short-term hormone replacement therapy, venlafaxine might provide a nonhormonal treatment option for the alleviation of hot flashes affecting quality of daily life. | Venlafaxine blood levelsYasuyuki Mizumori Department of Medicine Shigeaki Muto2 Public Muraoka Hospital Hyogo 2 Department of Nephrology Shin-ichi Uchida3 Sei Sasaki3 Jichi Medical School Tochigi 3 Department of Nephrology Eiji Kusano2 Tokyo Medical and Dental University Tokyo, Japan Email: smuto jichi.ac.jp.These drugs reduce app title and may have other central or metabolic effects and microzide. Vaccines and Antisera. 251 Vagifem. 162, 165 Vaginal and Vulval Conditions, Treatment of. 164 Vaginal Atrophy. 165 Valproate. 58, 81 Valproate, Sodium . 70 Valproic Acid. 58, 257 Valsartan . 21 Vancomycin .101, 102, 115, Varicella-Zoster . 252 Vecuronium. 254 Venlafaxin3 . 60, 84, 85 Venofer . 185 Ventolin . 44 Verapamil. 17, 18, 22, Vigabatrin . 72 Vinblastine . 178 Vinca Alkaloids. 177 Vincristine. 178 Vindesine . 178 Vinorelbine . 178 ViraferonPeg . 179 Viscotears. 218 Vision Blue . 218 Vista-Methasone . 220 VitaE . 196 Vitamin B Group. 195 Vitamin B1. 195 Vitamin B6. 195 Vitamin C. 195 Vitamin D. 152, 195 Vitamin E . 196 Vitamin K. 25, 196 Vitapro . 192 Vitlipid N . 191 Volumatic. 44 Voluven . 190. |
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Eridemia apparently as a result of exposure to fluoxetine and later to venlafaxine extended-release, both within moderate dosage ranges while working effectively and without other variables or noticeable side effects. The abnormality was incidentally found because labwork was retested after having mildly elevated baseline readings. The initial elevation was fortunate, as monitoring likely would not have occurred otherwise. This is the second such case reported by this clinician over the past 18 months, 6 thus raising concern about the etiology, incidence, and potential underreporting and secondarily hidden risks for venlafaxine and SSRI-induced acute hypertriglyceridemia. Both cases included fluoxetine as the first antidepressant medication used upon discovery of the abnormality. Consequently, it is necessary to consider that fluoxetine and or norfluoxetine may in some manner prime hepatic triglyceride manufacturing to increase in an ongoing delayed fashion either directly, as a rebound phenomena, or as a predisposing factor prior to the use of another antidepressant medication. In summary, it is possible that routine monitoring of lipid profiles needs to occur with the use of venlafaxine or an SSRI even in individuals without physical complaints, obvious side effects, or histories of abnormal lipid profiles. There is no known reason to explain this induced effect or the specific physiologic etiology. Further investigation is warranted and flutamide. Duloxetine has an indication for diabetic peripheral neuropathy, and venlafaxine has an indication for anxiety and panic disorders.
Chance of remission was one that addressed a broad range of symptoms. The medicine best placed to address this broad range of symptoms was one that redressed the reduced levels and an imbalance of serotonin 5-HT ; and noradrenaline NA ; ie Cymbalta with its `balanced' dual action. Lundbeck alleged that this emphasis on balance disparaged SSRIs. There was neither any clinical evidence to support the claim that SSRIs were less effective in treating patients with major depressive episodes than Cymbalta, nor that Cymbalta 60mg od had a genuine `dual' action at 5-HT and NA reuptake sites in patients with a major depressive episode beyond what had been extrapolated from pre-clinical studies. Lundbeck considered that it should have been made clear that the claim that `Reduced levels and imbalance of 5-HT and NA are thought to be responsible for the psychological and somatic symptoms experienced by many patients with depression' was derived from a theory and not from a clinical trial and as such could not be extrapolated into the clinical setting. The Panel noted that pages 1-5 of the detail aid set out the arguments for treating depression and the role of 5-HT and NA. A hypothetical neurobehavioural model, based on mostly animal data, of symptoms mediated by 5-HT and NA was included on page 3. This was followed by the claim `Reduced levels and imbalance of 5-HT and NA are thought to be responsible for the psychological and somatic symptoms experienced by many patients with depression.' Pages 4 and 5 referred to binding affinities and ratios of the newer antidepressants giving details for fluoxetine, venlafaxine, Cymbalta and reboxetine. The Panel considered that it was not necessarily unacceptable to provide information about the mechanism of action of Cymbalta including in vitro information. Although pages 3, 4 and 5 were labelled as being based on either animal or preclinical data this was misleading due to the reference to `patients' on page 3. Further the relevance and significance to the clinical situation had not been established. Readers would interpret the data as applying to the clinical situation. Breaches of the Code were ruled. The Panel did not consider that the detail aid disparaged SSRIs. There was no implication that SSRIs were inferior treatments for depression compared to a balanced medicine. Nor that SRRIs did not address a broad range of symptoms and hence lead to remission of symptoms. The Panel ruled no breach of Code. Lundbeck alleged that the claim `As early as week 1 Cymbalta provided significant relief P 0.05 ; of depressed mood' was misleading; readers might assume that it related to the total depression score and not just a sub-item of it. In addition, there were other sub-items which were statistically significantly in favour of placebo at week one; to not mention these meant that the data had not been reflected in an accurate and balanced manner. Lundbeck further alleged that claims for somatic symptom relief were unsubstantiated. The Panel considered that the claim at issue was clearly about one item of the total depression score and raloxifene.
OBJECTIVES: To describe the patterns of stay on therapy among patients who used coxibs, meloxicam, NSAIDs or acetaminophen defined as drugs of interest, DOIs ; during a three-month period in the elderly. METHODS: Stay on therapy was defined as the percent of patients who did not change drugs from one prescription to the next within 3 months. Data for this study was obtained from the government of Quebec Health Insurance Agency, RAMQ. We formed a cohort of seniors 65 years ; comprising all those who filled a prescription for meloxicam, and a 25% random sample of all patients who filled a prescription for coxib, NSAID or acetaminophen between January and September 2001. Patients were considered at their first DOI prescription index date ; . Patients with cancer and those who had any DOI prescriptions during the 90 days prior to the index date were excluded. A decision tree analogue was formed to describe pattern of use of DOIs in a chronological order during the 3-month period. RESULTS: A total of 37, 842 patients were identified for the 4 cohorts, 1, 578 meloxicam, 18, 923 coxib, 4, 841 NSAID and 12, 500 acetaminophen. In the meloxicam cohort, 33.9 % filled a second prescription for one of the DOIs compared to 40.3% in the coxib cohort, 32.47% in the NSAID cohort and 32.2% in the acetaminophen cohort. Of those who filled a second prescription, 70.1% 95% confidence interval 66.2%, 74.0% in the meloxicam cohort stayed on their cohort drug compared to 85.6% 84.8%, 86.4% ; coxib, 68.77% 66.4%, 71.0% ; NSAID and 74.8% 73.5%, 76.1% ; acetaminophen. In the meloxicam cohort, 13.9% filled a third prescription for the DOIs compared to 18.1% in the coxib group. Among those who filled a third prescription, 78.2% in the meloxicam cohort stayed on meloxicam and 91.0% in the coxib cohort stayed on coxib. Similar utilization patterns were observed one we restricted the analysis to patients with osteoarthritis. CONCLUSION: A higher proportion of patients stayed on coxib therapy compared to meloxicam, NSAIDs or acetaminophen. 100 THE CLINICAL AND ECONOMIC VALUE OF ACHIEVING FULL REMISSION IN DEPRESSION MANAGEMENT Donald Han, Edward C.Y. Wang Wyeth Canada, Markham, Ontario Funding Source: Wyeth Canada BACKGROUND: Depression was the leading cause of years lived with a disability in 2000 and by 2020 is expected to be the second leading cause of disability-adjusted life-years worldwide. In Canada, the estimated burden of $14.4 billion 1998 ; places mental illness among the costliest medical conditions. The goal of depression treatment is sustained and full remission of depressive symptoms to prevent relapse and recurrence, with a return to previous levels of occupational and social functioning. The purpose of this review is to quantify the economic burden of failing to achieve remission from the employer and healthcare perspective. Studies comparing venlafaxibe versus alternative selective serotonin reuptake inhibitors SSRIs ; were assessed in an attempt to compare treatment options to support the goal of remission. METHODS: A review of the literature on depression was conducted from 1990 December, 2002 using an OVID interface and included the following databases: Premedline, Medline and EMBASE. Studies were limited to English and included all study designs. The search looking at the effectiveness and cost-benefit of treating depression to the level of response or remission was then used to identify and assess value determinants. RESULTS: Major depression is associated with an increased use of general and emergency medical services. As well, it was estimated that the average length of stay on medical surgical units is significantly higher in depressed patients not receiving antidepressant treatment. Treating these individuals to remission improves health outcomes and may lessen service use. With respect to productivity loss, a series of epidemiological studies over the last 10 years have consistently demonstrated an association between depression and lost productivity. Monthly productivity loss for each worker with major depression has been estimated at approximately US$200$400. Venlafaxin4 demonstrates superior ability to achieve and maintain remission of depression. Meta-analyses involving venkafaxine studies found greater remission rates for venlafaxine-treated patients compared to those treated with an SSRI. Patients treated with venlafaxinne had a 43% to 50% greater chance of achieving symptomatic remission when compared to those receiving SSRIs. CONCLUSION: The burden of not effectively treating depression to remission is significant since treatment failure is associated with an increased risk of relapse and recurrence, higher rates of chronicity, readmission to hospital, higher service utilization and a reduced quality of life. Given what we know about the clinical and economic benefits of achieving remission, an agent such as venlafaxine, with its relative efficacy versus other SSRIs in achieving remission, may be one of the most powerful ways to decrease the disease burden.
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The UDCA group and the placebo group were compared with regard to median levels of fecal bile acids by the Wilcoxon MannWhitney rank sum test. When concentrations were undetectable, the value was set to zero. Adherence to the assigned medication dose was calculated from returned capsule count at each clinic visit as follows: . External Data and Safety Monitoring An External Data and Safety Monitoring Committee met semiannually in Tucson, Arizona, or by teleconference. This committee was responsible for reviewing protocol amendments and human consent form documents, participant accrual and retention rates, participant safety, drug toxic effects, and outcome analyses. At the end of each semiannual meeting, the committee took a mandatory vote to continue or not continue the trial and provided a detailed summary report to the study statisticians who had access to unblinded data. This report was summarized to remove any items that could potentially compromise blinding and was sent to the study investigators. This summary report, including the results of each vote taken by the committee, was included with each annual progress report to the National Cancer Institute.
Gottsegen J, Prakash M, Lubarsky L, Coplan N, Hecht H. The Use of Computed Tomographic Angiography in the Assessment of Plaque Type and Its Relationship to Degree of Stenosis and Gender. Journal of Investigative Medicine 2007: 55; S258.
DISCUSSION Evidence is presented to suggest that the HIV protease inhibitor PI ; , nelfinavir, may contribute to adipose tissue atrophy by promoting adipocyte cell death and preventing replacement of lost adipocytes by inhibiting preadipocyte differentiation. The concentration of nelfinavir required to elicit these effects in vitro is within the range of that observed in plasma from patients administered therapeutic doses of nelfinavir reviewed in Ref. 3 ; . Thus, it is possible that the effects of nelfinavir on the 3T3-L1 cell line observed in vitro may also occur in vivo. The simplest explanation for PI-associated adipose tissue abnormalities would entail a common mechanism. Our initial studies with other PIs did reveal some effects similar to those elicited by nelfinavir. For example, ritonavir and saquinavir 20 M ; were capable of reducing the amount of cytoplasmic triacylglycerol in 3T3-L1 adipocytes as measured by Oil Red O staining Fig. 4A ; , and this effect was more pronounced at higher drug concentrations data not shown ; . 3T3-L1 adipocytes treated with ritonavir or saquinavir 20. Hypercalcemia was induced by feeding rats a DHT-containing diet. Blood-ionized calcium concentration, presented in Table I, was significantly elevated after 2 d of diet control, 1.33 0.03, for example, weaning off effexor.
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Education L7. What is the highest grade or level of school that you have completed? PROBE: Did you graduate with a diploma or degree? INTERVIEWER: Code Trade School or Technical School as "Some College or 2-Year Degree." 1 2 3 Health Insurance L8. Does CHILD NAME ; have any kind of health insurance, or is CHILD NAME ; enrolled in any kind of program that helps to pay for his her ; health care? 1 Yes L9. 5 No Skip to L12 8th Grade or less Some High School, but did not graduate High School graduate or GED Some College or 2-Year Degree 4-Year College graduate More than 4-Year College Degree.
He association of mood disorders with the reproductive cycle is well established, but many questions remain unanswered. Do menstrual cycle disturbances and the reproductive system contribute to mood disorders? Are psychiatric illnesses exaggerated by the menstrual cycle? Does the menstrual cycle cause mood and behavioral disturbances in an average woman? In this article, we will briefly describe the premenstrual dysphoric disorder PMDD ; , postpartum depression, and mood disorders of the climacteric. For each, we will review current concepts, diagnostic criteria, and management. We will also offer guidance on how to treat a woman whose pregnancy did not result in a live birth see "Perinatal loss, " page 212, because effexor ssri. Objective: The rate of adverse events following discontinuation of treatment with extendedrelease venlafaxine was compared with the rate associated with discontinuation of placebo administration. Method: The subjects were 20 outpatients with major depressive disorder who had participated in a multicenter, double-blind, placebo-controlled study of the efficacy of the new extended-release formulation of venlafaxine. Results: During the 3 days after discontinuation of treatment with the study drug, seven 78% ; of the nine venlafaxine-treated subjects and two 22% ; of the nine placebo-treated patients reported the emergence of adverse events, a statistically significant difference. Conclusions: These results suggest that clinicians discontinuing venlafaxine treatment should consider tapering the medication dose gradually. J Psychiatry 1997; 154: 17601762.
This PhD dissertation was accepted by the Faculty of Health Sciences of the University of Copenhagen, and defended October 4, 2004. Official opponents: Gitte Moos Knudsen, Michael Langemark and Eva Degerman, Sweden. Tutors: Christina Kruuse, Peer Tfelt-Hansen, Lars Edvinsson and Jes Olesen. Correspondence: Steffen Birk, M. Bechs Alle 170, 2650 Hvidovre, Denmark. E-mail: birk dadlnet Dan Med Bull 2004; 51: 440.
ANTIRETROVIRALS NRTIs- abacavir Ziagen ; , abacavir lamivudine zidovudine Trizivir ; , didanosine ddI, Videx ; , lamivudine Epivir, 3TC ; , lamivudine zidovudine Combivir ; , stavudine d4T, Zerit ; , tenofovir Viread ; , zalcitabine ddC, HIVID ; , zidovudine AZT, Retrovir ; . PIs- amprenavir Agenerase ; , indinavir Crixivan ; , lopinavir ritonavir Kaletra ; , nelfinavir Viracept ; , ritonavir Norvir ; , saquinavir Fortovase, Invirase ; . NnRTIs- delavirdine Rescriptor ; , efavirenz Sustiva ; , nevirapine Viramune ; . Other- hydroxyurea Hydrea ; . OI DRUGS PHS "A1 OI"s- acyclovir Zovirax ; , azithromycin Zithromax ; , cidofovir Vistide ; , clarithromycin Biaxin ; , famciclovir Famvir ; , fluconazole Diflucan ; , foscarnet Foscavir ; , ganciclovir Cytovene ; , itraconazole Sporonox ; , leucovorin Wellcovorin ; , pyrimethamine Daraprim ; , sulfadiazine, TMP SMX Bactrim, Septra ; . Other OIs- albendazole Albenza ; , amphotericin B Fungizone ; , amoxicillin Amoxil ; , atovaquone Mepron ; , ciprofloxacin Cipro ; , clindamycin Cleocin ; , clotrimazole Lotrimin, Mycelex ; , dapsone, erythromycin Erythrocin, Ery-Tab, EES ; , erythropoietin Epogen, EPO, Procrit ; , ethambutol Myambutol ; , filgrastim G-CSF, Neupogen ; , ketoconazole Nizoral ; , nystatin Mycostatin ; , paromomycin Humatin, Aminosidine, AMS ; , pentamidine NebuPent, Pentam, Pentacarinat ; , prednisone Deltasone, Meticorten, Orasone ; , rifabutin Mycobutin ; . Hepatitis C- none. TREATMENTS FOR METABOLIC DISORDERS Cardiac- doxazosim mesylate Cardura ; , lisinopril Zestril ; . Hyperlipidemia- atorvastatin Lipitor ; . Wasting- dronabinol Marinol ; , megestrol acetate Megace ; . ALL OTHERS acetaminophen codine Tylenol #3 ; , amantadine Symmetrel ; , amitriptyline Elavil ; , calcium acetate PhosLo ; , chlor-hexidene Peridex ; , diphenoxylate w atropine Lomotil ; , fludrocortisone Florinef ; , fluoxetine Prozac ; , gabapentin Neurontin ; , haloperidol Haldol ; , hepatitis B vaccine, influenza vaccine, loperamide Imodium ; , lorazepam Ativan ; , morphine Duramorph, Oramporph, Roxanol ; , morphine sulfate MS Contin ; , olanzapine Zyprexa ; , pantoprazole sodium Protonix ; , pneumococcal vaccine, prochlorperazine Compazine ; , propoxyphene N-100 Darvocet ; , ranitideine Zantac ; , sertraline Zoloft ; , trazodone Desyrel ; , venlafaxine Effexor ; , vitamin Nephrocap ; , zanamivir Relenza. Section 1 Basic Trauma Incident Procedure Safety: Of yourself, your colleagues, your patient, and others Fluorescent Jackets and Safety Helmets are mandatory at Road Traffic Accidents, on the public highway, at mass gatherings, on building sites and at any other scene where there is potential danger. Scene: Assess Resources required, e.g. more ambulances, medical support, officer support, Fire and Police support, helicopter, utilities etc. Triage if more than one casualty. Operational Sitrep. to control: State incident type, request necessary resources, report on casualty numbers, entrapments see Appendix 1 ; , special hazards, scene access, other relevant factors. Clinical Sitrep. to control: using the accepted MIMMS format of 'methane' M major incident standby or declared if appropriate ; E exact location of incident T type of incident H hazards both present and potential ; A access and egress routes N number, severity and type of casualties E emergency services present on scene and further resources required Remember to check the scene for other casualties e.g. the ejected casualty from an RTA.
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