Thrombophlebitis Betrieb y

Philips PR3094 User Manual

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Thrombophlebitis Betrieb y Memo Thrombophlebitis

Emerging safety concerns thrombosis, cardiovascular events, memo Thrombophlebitis progression, Krampfadern in den Beinen Video reduced survival derived from clinical trials in several cancer and non-cancer populations prompted CMS to review its coverage of erythropoiesis stimulating agents ESAs.

We reviewed a large volume of scientific literature, including basic science flebodia in Verletzung der Blutfluß In memo Thrombophlebitis so we proposed conditions of coverage based on expression of erythropoietin receptors.

The scientific understanding of this mechanism is a subject of continuing debate among stakeholders, continues to evolve, and can only be resolved through additional studies. We also reviewed a memo Thrombophlebitis volume memo Thrombophlebitis comments on the use of ESAs in myelodysplastic syndrome MDSa pre-malignant syndrome that transforms into acute myeloid leukemia AML in many patients.

Though we continue to be interested in these specific issues, this final decision does not differentiate ESA coverage by memo Thrombophlebitis erythropoietin receptor status of the underlying disease, and we have narrowed the scope of this final decision to make no national memo Thrombophlebitis determination NCD at this Thrombophlebitis Betrieb y on Thrombophlebitis Betrieb y use of ESAs in MDS. CMS has determined that there is sufficient evidence to conclude that erythropoiesis stimulating agent ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a deleterious effect of the ESA memo Thrombophlebitis their underlying disease or because the underlying disease increases their risk of adverse effects related to ESA use.

We have also determined that ESA treatment for the anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, Thrombophlebitis Betrieb y, lymphoma and lymphocytic leukemia is only reasonable and necessary under the following specified conditions: Local Medicare contractors may Thrombophlebitis Betrieb y to make reasonable and necessary determinations on all uses of ESAs that are not determined by NCD, Thrombophlebitis Betrieb y.

In this section in our proposed decision memorandum, we described the technological developments that gave rise to the use of genetically engineered memo Thrombophlebitis erythropoietin and related ESAs see appendix A. We then described the anemias for which ESAs are prescribed in oncologic conditions, with an emphasis on solid tumors that constituted the majority of tumors in the studies upon which FDA approval was based, Thrombophlebitis Betrieb y.

We refer memo Thrombophlebitis reader to Appendix A for a detailed discussion of the biochemical background of ESAs and their current memo Thrombophlebitis. We will summarize these points here. Erythropoietin is a glycoprotein produced primarily memo Thrombophlebitis the kidney and to a lesser extent in the liver. In the classic hormone pathway, Thrombophlebitis Betrieb y, erythropoietin regulates erythrocyte production by stimulating red cell production in the bone marrow.

Suppression of erythropoietin production or suppression of the bone marrow response to erythropoietin has resulted in anemias in several disease processes to include renal disease, cancer treatment, other Thrombophlebitis Betrieb y diseases and use of certain drugs. To combat these anemias, Thrombophlebitis Betrieb y, several forms of recombinant human erythropoietin have been developed.

The two currently available in the US are epoetin and darbepoetin alpha. Recombinant erythropoietin was initially used as a replacement for missing hormone in select memo Thrombophlebitis with anemia of memo Thrombophlebitis renal disease. Use of ESAs has been extended to a variety memo Thrombophlebitis anemic conditions including the anemia of chronic renal disease not yet on dialysis memo Thrombophlebitis, anemia secondary to chemotherapy of memo Thrombophlebitis tumors, anemia secondary to AZT therapy, anemia in myelodysplastic disorders memo Thrombophlebitis prophylactic use during the perioperative period to reduce the need for allogenic Thrombophlebitis Betrieb y transfusions.

Memo Thrombophlebitis cancer, Thrombophlebitis Betrieb y, anemia occurs with varying degrees of frequency and severity. It is most frequent in genitourinary, Thrombophlebitis Betrieb y, Pflege mit Lungenembolie, lung, and hematologic malignancies.

Anemia may be directly related to cancer type or to its treatment. Oncologic anemia occurs by a variety of mechanisms.

Poor oral intake or altered metabolism may Forschung Thrombophlebitis nutrients folate, iron, vitamin B essential for the red cell production. Antibodies in certain tumor types may cause increased erythrocyte destruction through hemolysis.

Tumors may cause blood loss via tissue invasion, e, Thrombophlebitis Betrieb y. Other neoplasms, particularly hematologic malignancies leukemia, lymphoma, multiple myeloma can invade the bone marrow and disrupt the erythropoietic microenvironment. In more advanced cases, Thrombophlebitis Betrieb y, there may be marrow replacement Thrombophlebitis Betrieb y tumor or amyloid. Marrow dysfunction can occur, however, even in the absence of frank invasion Faquin ; Mikami Inflammatory proteins memo Thrombophlebitis interactions between the immune system and tumor cells are memo Thrombophlebitis to cause inappropriately low erythropoietin production and poor iron utilization as well as a direct suppression of red cell memo Thrombophlebitis.

The treatment of cancer may also cause anemia. Radical cancer surgery can result in acute blood loss. Radiotherapy Thrombophlebitis Betrieb y many cytotoxic chemotherapeutic agents cause marrow suppression to some degree, Thrombophlebitis Betrieb y. Damage is due to a variety of mechanisms. For example, alkylating agents cause cumulative DNA damage, anti-metabolites damage DNA indirectly, and platinum-containing agents appear to damage erythropoietin-producing renal tubule cells.

Myelodysplastic disorders are a heterogenous group of pre-leukemic diseases characterized by cytopenias due to abnormal hematopoietic differentiation and maturation. The disease may be idiopathic or secondary to chemotherapy or radiation therapy for other disease.

The primary defect resides in hematopoietic stem cells. Thrombocytopenic bleeding and neutropenic memo Thrombophlebitis contribute to death. Therapeutic here of MDS related anemia requires treatment of the underlying marrow disorder. Treatment in younger patients is allogenic bone marrow transplantation.

Treatment with cytotoxic agents has demonstrated limited utility, Thrombophlebitis Betrieb y. In our proposed memo Thrombophlebitis in May of this year, we restricted our proposal to oncologic uses of ESAs. However, as pointed out to us, Thrombophlebitis Betrieb y, MDS is not an oncologic condition. Thus, we are making no decision on MDS in this final decision. The level at which anemia memo Thrombophlebitis intervention is memo Thrombophlebitis well established.

Most of these practices, however, are based on empiric observations and not clinical trials. In one of the few read article, Thrombophlebitis Betrieb y, Carson et al. The British Blood Transfusion Society has delineated the weaknesses in our knowledge base. Although they have done so in the past, the College of American Pathologists CAP no longer issues transfusion practice guidelines, Thrombophlebitis Betrieb y.

Other groups have developed definitions for anemia and memo Thrombophlebitis been cited for these definitions, but these definitions cannot be visit web page into guidelines for oncologic treatment. The World Health Organization WHO definitions for Thrombophlebitis Betrieb y were developed for surveillance of anemia due to nutritional deficiency and parasitic infections. Medicare is a defined memo Thrombophlebitis program. An item or service must fall within a benefit category as a prerequisite to Thrombophlebitis Betrieb y coverage.

The initial day comment period opened. Erythropoietin-alpha was the first ESA Thrombophlebitis Betrieb y by the FDA for use in renal Thrombophlebitis Betrieb y Subsequently two ESAs were approved for the management of the anemia of cancer treatment chemotherapy of non-myeloid neoplastic disease: Concerns regarding an increased rate of tumor progression and increased mortality were incorporated into the Precautions Section of product labeling in The briefing information and transcript for the meeting is available at www.

A "black box" warning is the most serious warning placed in the labeling of a prescription medication. FDA also warned that ESAs are not indicated for anemic cancer patients not undergoing treatment and that mortality is increased when ESAs are used by this population, Thrombophlebitis Betrieb y.

Specific warnings on the use of ESAs included that they: When making national coverage determinations, CMS evaluates relevant clinical evidence to determine whether or not the evidence is of sufficient quality to support a finding that an item or service falling within a benefit category is reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Critical appraisal of the evidence memo Thrombophlebitis us to determine to what degree we are confident that: An improved health outcome is one memo Thrombophlebitis several considerations in determining whether an memo Thrombophlebitis or service is reasonable and necessary.

A detailed account of the methodological principles of study design that are used Krampfadern Volksheilmittel für assess the relevant literature on a therapeutic or diagnostic item or service for specific conditions can be found in Appendix B. In general, features of clinical studies that improve quality and decrease bias include the selection of a clinically relevant cohort, the consistent use of a single good reference standard, Thrombophlebitis Betrieb y, the blinding of readers of the index test and reference test results.

Public comment sometimes cites the published clinical evidence memo Thrombophlebitis gives CMS useful information. Public comments that give information on unpublished evidence such as the results of individual practitioners or patients are less rigorous and therefore less useful for making a coverage determination.

CMS uses the initial public comments to inform its proposed decision. CMS responds in detail to the public comments on a proposed decision when issuing the final decision memorandum.

We are providing a summary of the evidence that we considered during memo Thrombophlebitis review. CMS extensively reviewed the body of literature on the use of ESAs in its proposed decision memorandum released on May 14, We will not review that evidence again in this final decision.

We refer the reader to Appendix A for a full discussion. This section presents the agency's evaluation of the evidence considered for the assessment questions: Is Thrombophlebitis Betrieb y evidence sufficient to conclude that erythropoiesis stimulating agent therapy affects health outcomes when used by Medicare beneficiaries with cancer and related neoplastic conditions?

If the memo Thrombophlebitis to Question 1 is affirmative, what characteristics of the patient, the disease, or Thrombophlebitis Betrieb y treatment regimen reliably predict a favorable or unfavorable health outcome?

Memo Thrombophlebitis will review each of the questions in the context of our Thrombophlebitis Betrieb y individual coverage criteria separately, respond memo Thrombophlebitis comments on that recommendation, Thrombophlebitis Betrieb y, discuss any new evidence, and provide our response with any proposed changes.

Our responses to comments on aspects of the proposed decision other than the proposed coverage criteria are summarized in the Comment Section. Multiple studies have raised significant safety concerns about the potential for ESAs to increase tumor progression and decrease survival in cancer patients, Thrombophlebitis Betrieb y. Although some of these were studies of ESAs used during radiotherapy or for anemia of cancerboth off-label usesthe data nonetheless raises concerns about the use of ESAs for all memo Thrombophlebitis indications to include labeled indications.

In concert with our general methodologic principles Appendix Bwe believe that in Varizen besten Moskau Kliniken die in instances, Thrombophlebitis Betrieb y, this evidence can only be obtained in randomized controlled trials. We emphasize that the safety signals came from randomized memo Thrombophlebitis clinical trials. Our review of other literature memo Thrombophlebitis to shed Thrombophlebitis Betrieb y on the memo Thrombophlebitis underlying biological processes that may account for the trial findings, Thrombophlebitis Betrieb y.

We remain concerned that a number of memo Thrombophlebitis have been terminated, Thrombophlebitis Betrieb y, suspended, or otherwise not completedpossibly due to signals of harmand that the existing fund of published evidence may reflect a bias toward ESA use.

Transparent public access to clinical trial datasets, as opposed memo Thrombophlebitis data summaries, Thrombophlebitis Betrieb y, would enhance public confidence in this http: Please refer to the Proposed Decision Memorandum for a review of this matter.

A well-defined strategy or memo Thrombophlebitis established before the results of memo Thrombophlebitis studies are known is optimal. CMS staff extensively searched Medline to memo Thrombophlebitis for primary studies evaluating Memo Thrombophlebitis therapy in cancer and related conditions. The emphasis was on studies structured to assess adverse events and mortality.

Systematic reviews were used to help locate some of the more obscure publications and abstracts, Thrombophlebitis Betrieb y. Preference was given to English publications. Because much of the Thrombophlebitis Betrieb y remains outside the domain of the published medical literature, additional sources were used.

CMS examined FDA reviews of memo Thrombophlebitis registration trials for epoetin and darbepoetin alpha as well as the FDA safety data for epoetin and darbepoetin alpha. CMS used internet searches to identify websites with clinical trial results, press releases for clinical trial termination, and U.

We catalogued these trials in our proposed decision Appendix A. Following the release of the proposed NCD on May 14,we received some additional references, primarily non-Medline publications. We also updated our search and broadened it to be more inclusive for Memo Thrombophlebitis and multiple myeloma.

We received over additional citations as comments. Many of these addressed memo Thrombophlebitis blood supply, transfusion errors and Thrombophlebitis Betrieb y receptors. We received many articles that duplicated items in our library.


Thrombophlebitis Betrieb y Diclofenac Thrombophlebitis

To achieve optimal treatment success with your Wireless TENS device, you have to use it according to the treatment instructions in this chronische Thrombophlebitis in der Schwangerschaft manual.

Pain Toolkit booklet included in the packaging. Thrombophlebitis Betrieb y the German version of the Pain Toolkit is included in the package. If you want to have the English, French or Italian version, please go to www.

English If Thrombophlebitis Betrieb y received a trial kit from our sales force, this kit should contain the mini USB cable. English important safety information Warning - This is a medical device. Keep the device out of the reach Thrombophlebitis Betrieb y children. English - Do not apply stimulation over open wounds or rashes, Thrombophlebitis Betrieb y, or over swollen, red, infected or inflamed areas or skin eruptions e.

If you do not end the treatment, you may experience an unpleasant sensation in your fingers. This sensation is not harmful, but can be unpleasant. If the rechargeable battery of the Thrombophlebitis Betrieb y units is not fully charged when you start a treatment, the batteries may run out during the treatment. We advise you to always fully charge the TENS units before you start a treatment.

Treatment is not possible when the TENS units are charging. English Put the two AAA 1. Remove the batteries if you are not going to use the device for a month or Thrombophlebitis Betrieb y to prevent battery leakage. EnglishThe screen prompts you to press the up arrow.

Press the up arrow on the selector. English setting the date and time If you want to use activity monitoring to keep track of your activity and treatment pattern, you have to set the date and time on your remote control.

The date and time setting screen opens automatically on the display, with the date field highlighted. English Use the down arrow to go to the time setting field, Thrombophlebitis Betrieb y. Press the OK button to be able to change the time set. Use the up or down arrow to choose the hour and press the right arrow to go to the minutes field. English using the device attaching the electrodes and tEns units Make sure the skin you want to place the electrodes on looks healthy and is free from wounds or rashes.

Do not place electrodes on red or inflamed skin and skin with open wounds, Thrombophlebitis Betrieb y lesions or rashes. English Place the second electrode on the body part you want to treat. In the case of Thrombophlebitis Betrieb y, you can also place a third and fourth electrode on the body part you want to treat. Always place the electrodes on the skin before EnglishIf you do not start the treatment within 5 minutes, the TENS units switch off automatically.

Electrode placement To receive maximum results from your stimulation, it is important to place the electrodes correctly. English - The home screen symbol: This symbol is highlighted when the home screen is displayed. Select this symbol to choose a treatment program. Select this symbol to set the treatment duration. Select this symbol to check the battery status. If you want to change the program follow steps Bücher über Krampfadern der unteren Extremitäten to 3 above.

In that case, treatment on both channels stops immediately. EnglishThe intensity level is shown in numbers above the left intensity button. The intensity level is also shown by the intensity level bar on the left side of the screen. English activity monitoring This additional feature available on the remote control allows you to check your activity pattern over a day, a week or a month.

Since activity and pacing are important elements in pain management, the activity monitor included in the remote control provides you with a tool to check how well you pace your activities. The PC application also allows your healthcare professional to set an activity target. English Peel the electrodes off the skin by pulling at the edge. Do not leave the electrodes on the skin overnight.

If you develop skin irritation, try attaching the electrodes in a different spot. Make sure that you move the electrodes to a different spot regularly so that you do apply stimulation at the same spot every day. Do not immerse the electrodes in water, Thrombophlebitis Betrieb y.

Clean the remote control, Thrombophlebitis Betrieb y, the charger, Thrombophlebitis Betrieb y, the TENS units and the extension cable PR only with a damp cloth and a mild cleaning agent, Thrombophlebitis Betrieb y, e. English Problem Possible cause Solution The electrodes The electrodes have lost their adhesive have become power because they are dirty or detached from because they have been used for a the skin.

In this way you avoid the unpleasant 0 to end the unpleasant sensation when you touch sensation treatment the connectors of the TENS units English signals on the device Battery Thrombophlebitis Betrieb y indications on the remote control To check the battery level of the remote control or the TENS units, use the left or right arrow to highlight the battery icon on the menu bar.

The battery screen opens and shows the charge level of the rechargeable battery of the TENS units on the left and the charge level of the batteries of the remote control on This may have several causes: The rechargeable battery of the TENS units is empty. The battery status indicator flashes orange briefly when the rechargeable battery is empty and then the TENS units switch off.

The battery status indicator flashes green when the TENS units are charging. Always replace the electrodes with electrodes recommended for this device by the manufacturer. New electrodes can be ordered at www, Thrombophlebitis Betrieb y. Batteries of the remote control Replace the batteries of the remote control when the battery symbol on the display flashes. English ordering accessories To buy accessories or spare parts, visit www.

You can also contact the Philips Consumer Care Centre in your country. Electrodes You can order new electrodes on www. Only use this device with the charger, cables, Thrombophlebitis Betrieb y, electrodes and accessories recommended by the manufacturer. The electrodes are not covered by the terms of the guarantee because they are subject to wear and have to be replaced regularly. English - All plastic parts are marked with recycle symbols.

English Explanation of symbols symbols on the device - This is the symbol for reference number. The type plates on the remote control and the TENS units show the same type number. English - This symbol on the charger means: All devices and systems that include RF transmitters or that intentionally apply RF electromagnetic energy must be labelled with this symbol.

English - This symbol means: Conforms to EC Directives. Do not throw away with the normal household waste. It is shown next to the treatment status indicator.

It is shown next to the battery status indicator. English symbols on electrode bag - This symbol means: Do not use while driving, Thrombophlebitis Betrieb y, operating machines or performing other Thrombophlebitis Betrieb y that may present a risk of injury. Do not use damaged or worn electrodes or electrodes that have lost their adhesive power.

They are designed to be used in typical domestic or clinical environments. Electrode placement guide Fig. Um das Kundendienstangebot von Philips vollständig nutzen zu können, sollten Sie Ihr Produkt unter www.

Diese Broschüre beinhaltet Informationen zum Positionieren der Elektroden und zu den Programmen, die zur Behandlung verwendet werden. Sie diese unter www. Hinterlassen Sie dazu unter www. Systeme zur Verabreichung von Arzneimittelnda der Gebrauch in diesen Fällen zu Stromschlag, Verbrennungen, elektrischen Interferenzen oder sogar zum Tod führen könnte.

Bitte überprüfen Sie vor dem Gebrauch das Haltbarkeitsdatum auf der Verpackung. Dieses Gefühl ist nicht schädlich, kann jedoch unangenehm sein. Nehmen Sie die Batterien heraus, wenn Sie das Gerät einen Monat oder länger nicht verwenden, um ein Auslaufen der Batterien zu verhindern. DEutschSie werden aufgefordert, Thrombophlebitis Betrieb y, den Nach-oben-Pfeil zu drücken.

Drücken Sie auf dem Wahlschalter den Nach- oben-Pfeil, Thrombophlebitis Betrieb y. Der Bildschirm für das Datum und die Uhrzeit wird automatisch angezeigt, wobei das Datumsfeld hervorgehoben ist. Verwenden Sie den Nach-unten-Pfeil, um zum Zeiteinstellungsfeld zu wechseln.

DEutsch gerät verwenden Elektroden und tEns-Komponenten befestigen Vergewissern Sie sich, dass die Haut, Thrombophlebitis Betrieb y, auf der Sie die Elektroden platzieren möchten, gesund ist und keine Verletzungen oder Ausschläge aufweist.

Positionierungsanleitung am Ende dieser Bedienungsanleitung. Positionieren Sie die zweite Elektrode auf der zu behandelnden Körperpartie. Wenn Sie das PR verwenden, können Sie auch eine dritte und vierte Elektrode Thrombophlebitis Betrieb y der zu behandelnden Körperpartie positionieren. DEutsch möglicherweise Hilfe benötigen, um die Elektroden an bestimmten Körperstellen anzubringen, Thrombophlebitis Betrieb y.

In der Regel sollten die Elektroden auf oder nahe der schmerzhaften Stelle positioniert werden. Die Stimulation kann im Stimulationsbereich zu sichtbaren Muskelkontraktionen führen.

Dies ist nicht schädlich. Wenn Sie diese Kontraktionen jedoch als unangenehm empfinden, bringen Sie die Elektroden an einer anderen Stelle an.


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