These findings provide early evidence that the patients who were managed at a pharmacy-based anticoagulation clinic in an evolving healthcare system experienced optimal anticoagulation management.

Therapeutic drug monitoring data collected during routine clinical practice can provide a useful tool for understanding factors affecting methotrexate pharmacokinetics. Patient weight and hematocrit levels may play a clinically important role in determining methotrexate serum exposure and dosing requirements. Future prospective studies are needed to validate results of the developed model and evaluate its usefulness to predict methotrexate exposure and optimize dosing regimens.

Objectives: A Relationship between volume and outcome for complex medical procedures has been used as an argument for regionalization; however, this must be balanced against preferences to have care delivered close to home. The objective of our study was to determine how families trade-off variations in risk against the ability to have complex pediatric care delivered locally. MethOds: Twenty parents of children without serious medical problems seen in an outpatient clinic participated in a probability trade-off experiment involving two scenarios in which they were asked to imagine their child required a complex medical procedure ('lowrisk'= 5% mortality, 'high-risk'= 30% mortality) available locally or at an alternate large center 2.5 hours away by air. Numeric and graphic representations of mortality risk were reduced in a stepwise fashion for procedures performed at the alternate center. Thresholds at which participants chose to travel were identified. Participant's decisions were then challenged by increasing the costs incurred by travelling to the alternate center. Results: In the low-risk scenario, participants chose not to travel until absolute risk was reduced by 2±0.2% (relative risk reduction of 39±3%). In the high-risk scenario, a larger absolute risk reduction (5.1±0.8%, p= 0.0001) but smaller relative risk reduction (17±3%, p= 0.0001) triggered a decision to travel. In the low-risk scenario, only 2 of 8 participants with household income > $100,000/ yr changed their decision to travel when faced with additional costs; however 8 of 12 with lower income changed their decision (p= 0.07). In the high-risk scenario, 1 of 8 in the high income group changed their decision compared to 7 of 12 in the low income group (p= 0.04). cOnclusiOns: Many families would trade substantially higher risk to have complex pediatric care delivered locally. These results have implications for policy development related to delivery of complex care at smaller children's hospitals located far from large urban centers.Objectives: Aim of this study was to determine the prevalence and pattern of selfmedication among different classes in Bahawalpur community MethOds: It was a cross-sectional descriptive study targeting residents of Bahawalpur including almost every class and gender. Sample size was calculated and 10% was added to encounter non response, respondents were selected through convenience sampling method. The data was collected using a pre-tested self-administered questionnaire. The data collection tool was tested and restructured after a pilot study on a small number (10% of the calculated sample) of population was tested and re-structured. The data was analyzed using SPSS version 15 and the results were tabulated Results: A total 420 of the participants responded including literate 280 (66%) illiterate 140 (33%). Most of the respondents were motivated towards self-medication due to high cost of prescription medicines (n= 312; 74.3%), weak trust on physicians (n= 404; 96.2%) and drug sellers (n= 217; 51.7%). Significantly...

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