Remote AF only, 60 were without a diagnosis of AF, and 30 patients were not seen in the study period. AF was prevalent in 6.1% of patients age 75 and older and 0.69% of all patients see Table 3, Figure 1 ; . These prevalence rates are consistent with the published literature. The types of AF documented were evenly distributed between paroxysmal, chronic, and unspecified see Table 3 ; . Of the 283 patients who met study criteria, 257 91% ; were categorized as high-risk for stroke by having at least one highrisk factor, or at least 2 moderate-risk factors listed in Table 1. Of these 257 patients, 47 18% ; were considered not to be warfarin candidates see Table 2 ; , leaving 210 patients eligible to receive warfarin therapy for stroke prevention. The most common acceptable reasons not to prescribe warfarin were: transient AF secondary to medical condition 1 episode lasting less than 48 hours, prior predisposition to major bleeding, syncope, seizure, or multiple falls, and advanced dementia. Ninety-four percent 198 210 ; of eligible high-risk AF patients were prescribed warfarin during the study period. Results were unchanged when moderate-risk patients n 7 ; , who are recommended warfarin or aspirin, were included in the analysis. Likewise, 87% 172 198 ; of active patients continued warfarin throughout the study period. Warfarin was discontinued during the study period in 26 patients; 14 patients had valid reasons documented, including major bleeding 2.5% ; , patient refusal 1.5% ; , and AF secondary to medical condition 1 episode lasting 48hrs 1.5% ; , whereas 12 patients did not have documentation of an acceptable reason and zestril. VIRAL INFECTIONS Adapted from Colleen Terriff, PharmD Definitions Incubation period- offending virus is introduced into the body serologic evidence + , s s - ; Prodrome- vague flu-like symptoms myalgias, arthralgias, fatigue, loss of appetite ; , fever can occur, mild tenderness over liver may be appreciated, marked elevation of AST and ALT, serologic evidence + , s s Icteric phase- jaundice and scleral icterus bilirubin 2.5-3.0 mg dl ; , yet symptoms are beginning to resolve and transaminases are declining, mild hepatic tenderness Resolution phase- symptoms are diminished, transaminases return to normal, serologic testing confirms the appearance of protective antibodies Anicteric hepatitis- most common form of viral hepatitis, lacking icteric symptoms Fulminant hepatitis- most dreaded complication of viral hepatitis, acute liver failure Prolonged hepatitis- elevated transaminases 6 months, many progress to chronic hepatitis Hepatitis A RNA virus; A acute Transmitted via oral-fecal route Virus incubation 2-6 weeks large quantities of virus shed in feces still infectious ; People at risk: travelers to endemic areas, day-care centers children and workers due to hygiene risks ; , homosexuals MSM ; , close contact with infected individual, illegal drug users injection and non-injection ; , and patients with chronic liver disease Serology- tests, monitoring o Virus present in blood only for short time o IgM detected early in infection and remains for 2-3 mo o IgG protective antibody ; positive later and remains positive for life immunity ; Clinical course and sequela: o Patient may become jaundiced o Complete recovery is rule fulminant hepatitis rare ; o Chronic hepatitis from acute infection or chronic carriers not documented Prevention: o Hand washing!!! o Vaccination inactivated lysed whole viruses Vaccine Havrix Vaqta Twinrix Age 2-18 18 2-17 Schedule 0, 6-12 mos. 0, 6-12 mos. 0, 6-18 mos. 0, 6-12 mos. 0, 1, 6 mos, for example, warfarin grapefruit. Warfarin effectively reduces new thromboembolic stroke and ziac.

The bride, given in marriage by her father, wore an Empire gown of ivory silk satin, accented with hand-corded Alen. con lace at her portrait neck. line, sleeves and French scalloped hem. Her floor length mantilla veil was edged with matching lace, and she carried a bouquet of white roses and ivy. Jane Warren served as her sister's honor attendant, and bridesmaids were Mary Jeanne Smith, of Grand Rapids, the bride's cousin, Mrs. John A. MacDonald, Mrs. John D. Morau, Jr., Patricia Vaughn, of Akron, 0., and Mrs., William Swink. Their floor length dresses of emerald green chiffon were f~shione~ with ~ortrait neck. hnes, chlffon-apphqued sleeves and floating panels. They wore Pfc. Peter MacDonald, was best man. In the usher corps were John A. MacDonald, another brother, William J. WaITen, Jr., brother of the bride, Michael Moran, John Jay, Dwight W. Leonard 'and Richard A. Brodie. Altar boys were Craig and Mark Reyst, of Port Huron, the bridegro ; m's nephews. The bride's mother wore a street length dress and : jaeket of lime green brocade, with a matching pillbox and accessories, while the bridegroom's mother chose a coffee lbrown silk suit with light blue a'Cces. sories. Both mothers pinned orchid corsages to their handbal~s. The newlyweds, vacatiloning in Mexico Cit3. and Acapulco, will return to make their home in Buckingham road, Detroit, for example, coumadin vs warfarin.