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ClozarilChief Architect, ClinicalTrials.gov, US National Library of Medicine.
Department of hematology oncology, tokai university school of medicine, kanagawa, japan. Or Zyprexa in this study, there was extensive use of concomitant psychotropics: 84% with antipsychotics; 65% with anxiolytics; 53% with antidepressants, and 28% with mood stabilizers. There was significantly greater use of concomitant psychotropic medications among the patients in the Zyprexa group. The primary efficacy measure was time to 1 ; a significant suicide attempt, including a completed suicide, 2 ; hospitalization due to imminent suicide risk including increased level of surveillance for suicidality for patients already hospitalized ; , or 3 ; worsening of suicidality severity as demonstrated by "much worsening" or "very much worsening" from baseline in the Clinical Global Impression of Severity of Suicidality as assessed by the Blinded Psychiatrist CGI-SS-BP ; scale. A determination of whether or not a reported event met criterion 1 or 2 above was made by the Suicide Monitoring Board SMB, a group of experts blinded to patient data ; . A total of 980 patients were randomized to the study and 956 received study medication. Sixty-two percent of the patients were diagnosed with schizophrenia, and the remainder 38% ; were diagnosed with schizoaffective disorder. Only about one-fourth of the total patient population 27% ; was identified as "treatment resistant" at baseline. There were more males than females in the study 61% of all patients were male ; . The mean age of patients entering the study was 37 years range 18-69 ; . Most patients were Caucasian 71% ; , 15% were Black, 1% were Oriental, and 13% were classified as being of "other" races. Data from this study indicate that CLOZARIL had a statistically significant longer delay in the time to recurrent suicidal behavior in comparison with Zyprexa. This result should be interpreted only as evidence of the effectiveness of CLOZARIL in delaying time to recurrent suicidal behavior, and not a demonstration of the superior efficacy of CLOZARIL over Zyprexa. The probability of experiencing 1 ; a significant suicide attempt, including a completed suicide, or 2 ; hospitalization due to imminent suicide risk including increased level of surveillance for suicidality for patients already hospitalized ; was lower for CLOZARIL patients than for Zyprexa patients at Week 104: CLOZARIL 24% vs. Zyprexa 32%; 95% C.I. of the difference: 2%, 14% Figure 1 and amitriptyline. CLOZARIL may also potentiste the hypotensive effects of antihypertensive drugs and the antlcholinergic effects of atropine-type drugs. The administration of epinephrine should be avoided In the treatment of dreg-induced hypotension because of a possible reverse epinephrine effect. Pregnancy Category B There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, and in view of the desirability of keeping the administration of all drugs to a minimum during pregnancy, this drug should be used only if clearly needed. ADVERSE REACTIONS Adverse events observed in association with the use of CLOZARIL in clinical trials at an incidence of 5% or greater were: central nervous system complaints, including drowsiness sedation, dizziness. Treating bipolar disease is usually accomplished through a bipolar medication such as antidepressants, anticonvulsants and antipsychotic meds used in combination or alone. Such medications may also be coupled with psychotherapy to provide optimum results. Because bipolar disorder, also known as bipolar disease or depression, is so difficult to identify and treat, it's important to know that the disease can strike any gender or age group. Normal high and low moments are experienced on a daily basis by millions of Americans every day, but bipolar disorder takes such feelings to an extreme. Ongoing and recurring episodes of both depression and happiness are often the first signs of the disorder, coupled with extreme feelings on both ends of the spectrum. Mood stabilizing agents are the most common types of bipolar medication treatments. Antidepressants such as Lithium, Prozac, Zoloft and Paxil and Valium are used to treat various levels of depression and offer mood-stabilizing benefits, though in some cases, they can cause mania. For more severe episodes, Haldol or Thorazine are used to control mania. However, such drugs as Haldol and Thorazine, known as neuroeptics, can cause side effects such as muscle spasms, difficulty speaking and tremors. Lithium is the most commonly prescribed bipolar medication and is used for ongoing treatment, though its full effects may not be experienced for weeks, and sometimes, months. Lithium is also the oldest drug used to treat bipolar disorder. It may take four to ten days to achieve a therapeutic level within the bloodstream, and is not as effective on 'rapid-cyclers', or those who experience frequent and chronic episodes of depression coupled with mania. For 'rapid-cyclers', a bipolar medication known as Valproate is often prescribed. In some cases, antipsychotic drugs such as Colzaril have been used as a preventative treatment in some bipolar patients, though it tends to cause a rapid heart rate, hypotension, weight gain and constipation. Risperdal is also a common antipsychotic medication that has been successful when used in low doses, and since 2004, it has become the drug of choice in a vast number of bipolar patients. Side effects associated with Risperdal are mild compared to the side effects of other bipolar medication choices used in the past. Another antipsychotic drug known as Zyprexa, used in combination with lithium or valproate for severe manic episodes, may cause low blood pressure and dizziness. Another very common antipsychotic known as Seroquel has a long-term mood stabilizing affect, while its side effects may include dizziness and elevated blood sugar levels. Most bipolar medication antidepressants may cause manic episodes in those suffering from bipolar disorder, so they are used only on a short-term basis. More often, the class of drugs known as Selective Serotonin reuptake Inhibitors, more commonly known as SSRI's, are prescribed, and include such drugs as the aforementioned Prozac, Zoloft, and Paxil anti-anxiety drugs. The most important aspect of treating bipolar disorder is to first recognize the symptoms of the disease and seek treatment. A doctor will decide which medication is right for each individual. However, it's good to know that bipolar medication is available which may aid thousands of people diagnosed with bipolar disorder to live relatively happy, normal lives and abilify. Pretreatment clinical and bacteriologic findings. All patients were symptomatic with a combination of dysuria, urgency, and suprapubic pain; 23% of the patients had costovertebral angle tenderness, but none had a fever of -38C. Pretherapy clinical findings are shown in Table 1. The distribution of the urinary pathogens and their in vitro. Clozapine Clozarkl ; is one of the atypical antipsychotics. It is more selective for serotonin receptors, and has a lower effect on the dopamine type 2 receptors that are involved in brain functions such as movement. Therefore, clozapine is very effective in treating psychotic symptoms without causing EPS, and does not appear to increase prolactin levels. However, because it blocks many receptors in the brain in addition to dopamine and serotonin receptors, clozapine tends to cause other side effects, such as sedation and anticholinergic effects. In a small number of people, clozapine also causes significant weight gain, and can lead to seizures or drooling. Clozapine has also been known to cause a significant reduction in the number of infection-fighting white cells in the blood a condition called agranulocytosis ; . Because of this potentially dangerous complication, clozapine is typically reserved for individuals who have not responded to other types of antipsychotic medications, and requires that people taking this medication have blood tests at regular intervals. Another atypical antipsychotic is risperidone Risperdal ; . It is believed to block both dopamine and serotonin receptors. Like clozapine, risperidone is more selective for certain subtypes of receptors, and therefore has a reduced risk of EPS, anticholinergic effects, and sedation. It is safer than and anafranil. Earlier pickings clozaril clozapine is not for use in psychotic conditions related to dementedness. Burden 2 ; . The inflammatory component of asthma is typically treated with corticosteroids, whereas the bronchoconstriction is treated with b-agonist bronchodilators, which as a class are the most prescribed therapeutic for asthma treatment worldwide 3 ; . However, the clinical response to b-agonists in the treatment of asthma displays a high degree of interindividual variation that is not readily reconciled by and luvox. 10.3.1.2 Biodegradable microparticles of antitubercular drugs. It is difficult to draw conclusive observations on differences between the drugs that converted to full approval versus the four drugs that have not yet converted due to the small sample size. However, there are some interesting differences between the two groups. A majority of the drugs approved under AA 8 13 ; were approved based on the results of Phase 2 trials. However, there were more patients enrolled in the pivotal trials for the drugs that ended up converting mean of 399 patients ; versus the trials for drugs that are still not converted mean of 102 patients ; . In most cases, the FDA required an average of 2 post-marketing studies with an active control, particularly if AA was based on the results of single-arm Phase 2 studies. The sponsors of the drugs that eventually converted to full approval completed their postmarketing requirements in 3.9 years, on average. For the drugs that remain approved under accelerated approval, an average of 8 years has passed since the initial approval. The issue of patent protection and orphan drug exclusivity was discussed in the previous section but it is an important point to consider, especially when the sponsors are small biotechnology companies with limited resources versus large pharmaceutical companies with larger reserves. All the sponsors of the drugs that eventually converted to full approval were large well-capitalized pharmaceutical companies. Of the drugs and indications that remain unconverted, the two large pharmaceutical companies have actively conducted randomized post-marketing studies. JNJ has completed two randomized controlled trials comparing Doxil to active controls for the treatment of HIV-related KS and Pfizer has completed a number of post-marketing studies in other indications. The two small biotechnology companies, Ligand and Skye, are the sponsors that appear to be struggling with completing the post-marketing studies, although it is difficult to draw any conclusions based on these two case studies. While there are many advantages to AA, there appears to be a higher hurdle and standard that the FDA holds approved drugs to in the post-marketing clinical studies. In the case of Doxil for metastatic ovarian cancer, one of key post-marketing requirements is that the sponsor demonstrate superiority over existing therapy, topotecan, in a randomized clinical trial. This is consistent with the regulations for AA, which states that the therapy would have to provide "meaningful clinical benefit over existing therapy". In order to convert to full approval and stay on the market, the FDA appears to be holding the sponsor to a higher standard for efficacy or safety in the requirement for superiority in exchange for accelerated approval. The sponsor managed to clear that hurdle successfully since the drug was converted to full approval, but it does demonstrate that there is a price to be paid for getting to the market earlier. This higher hurdle is also seen for the other indication of Doxil in the treatment of refractory Kaposi's sarcoma. The sponsor completed the two ongoing randomized trials comparing Doxil to other chemotherapy regimens, BV and ABV. These trials were similar to the pivotal trial that was the basis of approval for another liposomal anthracycline agent, DaunoXome, which was granted full approval based on the results of the randomized trial comparing DaunoXome to ABV. In comparing the results of the two trials, Doxil had demonstrated better response rates to both DaunoXome and the and keppra. 6: 12 and one of his servants said, none, my lord, o king: but elisha, the prophet that is in israel, telleth the king of israel the words that thou speakest in thy bedchamber. No study has been published yet on the possible effect of ziprazodone Geodon ; and aripiprazole Abilify ; on PTSD symptoms clusters Wheatly and coll., investigated clozapine Clozagil ; usefulness in treatment-resistant abused adolescents, who presented with chronic PTSD and psychotic symptoms. Questionnaire responses from five participants indicated that clozapine treatment was associated with a reduction in hallucinatory experiences, but this might be a reduction in the intensity of psychotic experiences rather than core PTSD symptoms and bupropion. This patient was randomized to Cloaaril on Dec. 3, 1998 and 3 days later Dec. 6, 1998 ; was hospitalized with the diagnosis of " Hospitalization due to psychosis". The SAE report states that the patient's psychotic symptoms were not increased compared to baseline. The psychotic symptoms were also combined with depression and suicidal statement. She was known for vagabond lifestyle. The dose of Clozaril was increased in order to avoid further "sauntering" and losing the patient. PI was queried and respond on 20 01 confirmed that psychotic symptoms had not increased but that patient was hospitalized due to accompanying depression and suicidal ideation statement. The rating scales from 2 days earlier baseline ; were: CGI SS PI BP-3 moderately suicidal ; CGI SP5 markedly psychotic ; ISST PI BP- wish to die-2 moderately strong ; Living vs dying-2 dying outweigh for living ; Desire to make suicidal attemt-2 moderately strong ; Passive suicidal desire-2 would avoid steps necessary to save or maintain life ; Frequency of suicidal ideation-2 persistent or continuous ; CDS hopelessness - 3 severe ; , the rest of the ratings are 2 moderate ; Medical monitor queried the PI and reported: "Investigator confirmed that hospitalization was due to psychosis. The patient was hospitalized to ensure the proper level of psychiatric care and to prevent early discontinuation. No life treating condition occurred". Conclusion: Taking into consideration the time of the event 3 days after randomization ; , the rating scales at baseline 2 days prior the event ; and the confirmation from the investigator see above ; this event did not meet PEP criteria. Boxed Warning Updates Ketek telithromycin ; Audience: Infectious Disease, Hepatology and other healthcare professionals [Posted 01 20 2006] Annals of Internal Medicine published an article reporting three patients who experienced serious liver toxicity following administration of Ketek telithromycin ; . These cases were also reported to FDA MedWatch. Telithromycin is marketed and used extensively in many other countries, including countries in Europe and Japan. While it is difficult to determine the actual frequency of adverse events from voluntary reporting systems such as the MedWatch program, the FDA is continuing to evaluate the issue of liver problems in association with use of telithromycin in order to determine if labeling changes or other actions are warranted. As a part of this, FDA is continuing to work to understand better the frequency of liver-related adverse events reported for approved antibiotics, including telithromycin. Elidel Cream pimecrolimus ; Protopic Ointment tacrolimus ; Audience: Dermatological and other healthcare professionals [Posted 01 20 2006] The Food and Drug Administration announced the approval of updated labeling for two topical eczema drugs, Elidel Cream pimecrolimus ; and Protopic Ointment tacrolimus ; . The labeling will be updated with a boxed warning about a possible risk of cancer and a Medication Guide FDA-approved patient labeling ; will be distributed to help ensure that patients using these prescription medicines are aware of this concern. The new labeling also clarifies that these drugs are recommended for use as second-line treatments. This means that other prescription topical medicines should be tried first. Use of these drugs in children under 2 years of age is not recommended. Clozaril clozapine ; tablets Audience: Neuropsychiatric healthcare professionals and patients [Posted 01 13 2006] Novartis and FDA notified healthcare professionals of revisions to the BOXED WARNING, WARNINGS, CONTRAINDICATIONS, PRECAUTIONS Information for Patients and Pharmacokinetic-Related Interactions subsections ; , and ADVERSE REACTIONS Postmarketing Clinical Experience subsection ; sections of the prescribing information for Clozaril clozapine ; tablets. Recommendations from the FDA's Psychopharmacological Drugs Advisory Committee regarding the white blood cell monitoring schedule, required for all clozapine users, has resulted in modification in the monitoring schedule. Additional labeling changes address safety issues related to dementia-related psychosis, paralytic ileus, hypercholesterolemia and pharmacokinetic interaction with citalopram. Avandia rosiglitazone maleate ; Avandamet rosiglitazone maleate metformin HCl ; Audience: Endocrinologists, other healthcare professionals and patients [Posted 01 05 2006] GlaxoSmithKline and FDA notified healthcare professionals about postmarketing reports of new onset and worsening diabetic macular edema for patients receiving rosiglitazone. In the majority of these cases, the patients also reported concurrent peripheral and remeron and Cheap clozaril.
A fixed-price, indefinite-quantity contract for a base period of 1 year, with up to four 1-year options. Prior to releasing these solicitations, the VA made several decisions that are reflected in these two limited competitions. In summary--but discussed in greater detail below--these decisions were: 1 ; to not add an ARB to the VA's National Formulary for the treatment of hypertension; 2 ; to select for the formulary one of the two ARBs shown to be effective in treating diabetic nephropathy; and 3 ; to select for the formulary one of two other ARBs shown to be effective in treating heart failure. These decisions were made by doctors from the VA's Pharmacy Benefits Management PBM ; Section, together with the VA's Medical Advisory Panel MAP ; --a panel of 13 physicians throughout the VA and the Department of Defense. The process began with a Drug Class Review of all available ARBs, which is appended to both RFPs. Using the findings of the Drug Class Review, the VA's PBM and MAP doctors prepared a second document explaining the VA's approach to purchasing ARBs. This document--also appended to both RFPs--is entitled "Medical Determination of Minimum Needs for VA National Formulary Selection of an [ARB], " hereinafter the "Medical Needs Determination." The VA decided not to add an ARB to its National Formulary for the treatment of simple hypertension because ARBs are not the VA's preferred method of treating simple hypertension. Medical Needs Determination at 3; Declaration of the MAP Chairperson, Dec. 13, 2004, at 3-4. In fact, the VA noted that there are four different classes of antihypertensive medications, several of which should be tried prior to prescribing an ARB for simple hypertension. Medical Needs Determination at 3-4. As a result of the VA's guidelines establishing a hierarchy of preferred drug classes for the treatment of simple hypertension--which places ARBs as a third or fourth line of defense--the VA expects the use of ARBs to treat simple hypertension to be rare. Declaration of the MAP Chairperson, Dec. 13, 2004, at 4. The second and third decisions described above--i.e., to select an ARB for the formulary shown to be effective in treating diabetic nephropathy, and to select a second ARB shown to be effective in treating heart failure--are also set forth in the VA's Medical Needs Determination. Specifically, the VA took notice of medical literature describing research showing that two of the seven ARBs available in the U.S. had been shown to be effective in the treatment of diabetic nephropathy, and two others had been shown to be effective in the treatment of heart failure. Drug Class Review at 1; Medical Needs Determination at 2-3. The VA decided it could enhance the care of its patients by holding a limited competition to select one ARB from each of these two groups for the treatment of these conditions. Medical Needs Determination at 1. As indicated above, BI's ARB, Telmisartan, is not one of the four ARBs selected for these two limited competitions, as it was not one of the four ARBs identified by the. Diabetes Information Will Be Included In Anti-Psychotic Drug Labeling.The FDA has directed several drug manufacturers to change the labels of atypical antipsychotic treatments to note a relationship between the drugs and diabetes. Although the apparent link between diabetes and the antipsychotic drugs is not well understood, the Agency has determined that the risk potential justifies the requirement for additional information. The labeling change impacts Eli Lilly's Zyprexa olanzapine ; , Pfizer's Geodon ziprasidone ; , Bristol-Myers Squibb's Abilify aripiprazole ; , AstraZeneca's Seroquel quetiapine ; , Novartis' Clozaril clozapine ; and Janssen's Risperdal risperidone ; . Drugs Imported to Ghana to Carry English Labeling.Ghana's Deputy Chief Executive responsible for drugs for the country's board of food and drugs has advised industry that all drug products entering the country must carry English labels, or include translations into English if they are written in another language. Importers not observing Ghana's statute will be sanctioned. Labeling Update for Novartis's Cancer Drug, Zometa.Updated labeling for cancer drug Zometa will include information about the drug's long-term impact in treating cancerrelated bone problems including fractures and spinal cord compressions. According to Novartis study results filed with FDA, Zometa shows benefit in the longer term for patients with bone metastases from advanced cancers. Epilepsy Drug Depakote Receives Warning Box for Pediatric Use.FDA has approved Depakote ER for pediatric use with a warning label by manufacturer Abbott Laboratories that includes an alert regarding possible adverse events. The warning will address the drug's potential for causing birth defects such as neural tube disorders, as well as liver and pancreatic problems in young children. Since 2000, Depakote has carried a black-box warning for potentially life-threatening pancreatitis. In addition to epilepsy, Depakote is indicated for migraine and, in combination with Eli Lilly's Zyprexa, for schizophrenia. Glaxosmithkline Asthma Drug Labels to Carry New Warning.GSK aerosol and inhalation powder products containing salmeterol to dilate bronchial passageways will include a new boxed warning on their labels. The warning will be carried on labels for Serevent inhalation aerosol, Serevent Diskus inhalation powder, and Advair Diskus, all used to treat asthma and chronic obstructive pulmonary disease. The warning will advise users that the drugs may in rare cases increase the risk for lifethreatening asthma attacks or asthma-related death. FDA Seizes Questionable, Mislabeled Drugs From Illinois RePackager.Local Repack of Illinois was the target recently of an FDA product seizure after the agency determined that the company failed to meet regulatory standards for storage, record-keeping, packaging and quality control. FDA removed drugs labeled in a foreign language or labeled as repackaged. The charges FDA issued against Local Repack included failure to report customer complaints to FDA that the company's labels didn't match products packaged by the company. Also among the charges was a lack of accounting for labels and drug products that later were found to be missing. See LABELING, p. 8. Sequence Alignment Analysis--The hypothetical protein encoded by the yicI gene from E. coli shows sequence similarity of 50% or more to hypothetical proteins from a range of organisms as well as to known glycosyl hydrolase GH ; family 31 enzymes Fig. 1 ; . It also shows 20 29% similarity to mammalian, plant, and fungal -glucosidases and plant -xylosidases and 20% similarity to 1, 4-glucan lyases from family 31. The consensus sequence surrounding the catalytic aspartate nucleophile in this region of plant, mammalian, and fungal enzymes, including -glucosidases and -xylosidases, is WiDMnE, with a slight variation for 1, 4-glucan lyases to WiDMnX where X is V However, bacterial proteins are known to have the sequence KTDFGE and are absolutely invariant. These clear distinctions between amino acid sequences of family 31 enzymes of higher organisms and bacteria suggest that the bacterial proteins took a different path early in the evolution of GH family 31 36, 37 ; . Substrate Specificity--To investigate the enzyme activity of the YicI protein see "Materials and Methods" for cloning, overexpression, and purification ; , 12 different glycoside substrates were incubated with the protein in 0.05 M phosphate buffer pH 7.0 ; at 37 C. expected from the high sequence similarity to the GH family 31 -xylosidase from Lactobacillus pentosus, the YicI protein rapidly hydrolyzed pNP Xyl and -D-xylopyranosyl fluoride as substrates. Lower but significant activity was observed with p-nitrophenyl -D-glucopyranoside, whereas neither the aryl -glycosides of sugars such as galactose, mannose, and arabinose or any -glucosides were hydrolyzed at all Table III ; . Similarly, neither maltose nor maltotriose was cleaved, although the recent study of Okuyama et al. 22 ; showed that isoprimeverose Xyl- 1, 6 ; -Glc ; is an excellent substrate, consistent with the expected role of this enzyme in xyloglucan degradation. Okuyama et al. also reported the ability of YicI to bind disaccharide acceptors in the aglycone-binding site, raising the possibility of potential substrates with at least three sugar units. Values of kcat and Km for the hydrolysis of pNP Xyl by this protein are in the same range as those for two 0.21 s 1 and Km 1 mM other bacterial -xylosidases kcat for the enzyme from Bacillus sp. and kcat 0.1 s 1 and Km. BS - Bachelor of Science The vegetables and fruits listed are high in potassium, which increases nerve function and cellular activity. For healthy eating, eat only fresh fruits and vegetables and. Clozaril historyNumber % ; of Pts. Reporting SAE Clozaril Zyprexa N 479 ; N 477 ; 9 1.9% ; 7 1.5% ; 2 0.4% ; 2 0.4% ; 3 0.6% ; 2 0.4% ; 3 0.6% ; 0 0.0% ; 1 0.2% ; 1 0.2% ; 1 0.2% ; 1 0.2% ; 1 0.2% ; 0 0.0% ; 1 0.2% ; 0 0.0% ; 1 0.2% ; 0 0.0% ; 2 0.4% ; 0 0.0% ; 1 0.2% ; 0 0.0% ; 1 0.2% ; 0 0.0% ; 1 0.2% ; 0 0.0% ; 1 0.2% ; 0 0.0% ; 19 4.0% ; 12 2.5% ; 1 0.2% ; 0 0.0% ; 5 1.0% ; 4 0.8% ; 1 0.2% ; 0 0.0% ; 1 0.2% ; 0 0.0% ; 1 0.2% ; 0 0.0. CLOZARIL * is available only through a distribution system that requires weekly, every-two-week or every-four-week hematological testing prior to the dispensing of the next period's supply of medication see INDICATIONS ; . Novartis will provide the Non-rechallengeable Status Hematological Status of patients to the requesting approved suppliers of clozapine within 24 hours of receipt of a written request see INDICATIONS ; . The dosage of CLOZARIL * must be adjusted individually. For each patient the lowest effective dose should be used. Other monitoring and distribution systems The introduction of clozapine from other manufacturers has resulted in the establishment of manufacturer-specific registry and distribution systems. In order to ensure the safe use and continued monitoring of all patients taking clozapine, the physician must have obtained consent from the patient for the potential sharing of hematological and other safety data between clozapine registries. Patients may not be switched from one brand of clozapine to another without the completion of a new registry-specific patient registration form signed by the prescribing physician. If a patient is switched from one brand of clozapine to another, the frequency of hematological monitoring may continue unaltered unless a change is clinically indicated. The most commonly reported signs and symptoms associated with CLOZARIL clozapine ; overdose are: altered states of consciousness, including drowsiness, delirium and coma; tachycardia; hypotension; respiratory depression or failure; hypersalivation. Aspiration pneumonia and cardiac arrhythmias have also been reported. Seizures have occurred in a minority of reported cases. Fatal overdoses have been reported with CLOZARIL, generally at doses above 2500 mg. There have also been reports of patients recovering from overdoses well in excess of 4 g. Researcher introduces herself himself and explains that they wish to ask some follow-up questions relating to the water exercise and arthritis study. 1. Have you visited your doctor in the last three months specifically relating to your arthritis? No Yes If yes, how many times ?.
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