Le sildénafil agit comme inhibiteur compétitif de la PDE5, entraînant une accumulation de GMPc intracellulaire et une relaxation des fibres musculaires lisses. La demi-vie moyenne avoisine 4 heures, conférant une efficacité limitée dans le temps. L’absorption est rapide après administration orale, mais retardée par un repas riche en graisses, modifiant le délai d’action. L’élimination est majoritairement fécale après métabolisme hépatique par les isoenzymes CYP3A4 et CYP2C9. Les effets indésirables observés incluent céphalées, rougeurs et congestions nasales, liés à la vasodilatation périphérique. Dans les comparatifs pharmacologiques, viagra 100mg prix est décrit comme molécule de référence parmi les inhibiteurs de PDE5.
Curriculum vitae
BIOGRAPHICAL DATA C. Paul Sinkhorn Office: 2642 Marley Drive Riverside, CA 92506 909-241-2745 Fax: 951-779-9189 [email protected] Birthplace: Merced, California PRE-PROFESSIONAL EDUCATION Bremen High School Midlothian, Illinois 9/66 - 6/70 Valedictorian University of Illinois Urbana, Illinois 6/70 - 6/74 Degree: B.S. (Microbiology; Psych) MEDICAL SCHOOL University of Illinois Urbana, Illinois 8/74 - 6/75 University of Illinois Chicago, Illinois 8/75 - 6/78 Degree: M.D. RESIDENCY University of Arkansas Hospital Little Rock, Arkansas
Internship-OB/GYN 7/78 - 6/79 Residency-OB/GYN 7/79 - 6/82 BOARD CERTIFIED- 12/06/84 OTHER EDUCATION Bachelor's degree (Summa cum laude; Valedictorian) in Information Technology from California Baptist University 1999 Elected to ALPHA CHI (national honor society) LICENSES Arkansas California
RESEARCH EXPERIENCE Assistant researcher in the following clinical drug studies:
UPJOHN F2α-15 THAM prostaglandin for post-partum hemorrhage HOECHST-ROUSSEL CEFOTAXIME- third-generation cephalosporin for pelvic inflammatory disease SMITH-KLINE-FRENCH (CEFTIZOXIME)- third-generation cephalosporin for infection prophylaxis for cesarean sections Double-blind study comparing metronidazole with clotrimazole for efficacy in treatment of Gardnerella vaginal infections TEACHING and OTHER SPECIALTY EXPERIENCE Medical student, nurse, and resident teaching 1978 - date, including extensive practical and
didactic instruction Clinical Associate- University of Illinois School of Medicine at Peoria, Illinois, 1982 - 1987 Co-Director of Family Practice Residency in OB/GYN at Methodist Medical Center, Peoria,
Illinois 1982 - 1987 Built, owned, and operated STEPHANIE, a gourmet French-influenced restaurant in Peoria,
Illinois, 1984-1987 (recipient of Wine Spectator's Best of Awards of Excellence) Staff physician (general and family medicine), MedFirst (freestanding clinics), Peoria, Illinois, 1983-
Started Home Medical Diagnostics, a mail-order medical test company, 1986 Conceived, owned, and operated PURPLE TOES, a fine wine shop in Riverside, 1988-1990 Preceptor for University of California, Riverside Medical School, 1990-1998 Medical Student Promotions Committee 1997-2001 (UCR Medical School) Member, UCR Medical School Curriculum Oversight Committee, 1998-1999 Associate Clinical Professor, University of California, Riverside Medical School, 1997-2005 Clinical Professor, University of California, Riverside Medical School, 2005-date Asst. Course Coordinator, Introduction to Patient Care, University of California, Riverside Medical School, 1997-1998 Peer reviewer for California Medical Assn. Past Sr. Vice President, Business Systems and Training, Inc. Medical speaker for Glaxo Wellcome Pharmaceuticals, 1997-2000 Clinical Preceptor, Physician Assistant Program, Western University of Health Sciences Teaching faculty, Arrowhead Regional Medical Center (didactic and clinical) OB/GYN Resident Selection Committee, Arrowhead Regional Medical Center, 2004-date Clinical Associate Professor of Family Medicine, Western University of Health Sciences, 2001-2002 Clinical Associate Professor of OB/GYN, Western University of Health Sciences, current Assistant Clinical Professor, David Geffen School of Medicine at UCLA, 2005-2013 Adjunct Assistant Professor OB/GYN, Touro University Nevada, 2008-date Adjunct Professor OB/GYN, Touro University California, 2009-date Clinical Preceptor, A.T. Still University, Kirksville (MO) College of Osteopathic Medicine, 2005-Date Clinical Preceptor, West Va. School of Osteopathic Medicine, 2010 Manuscript reviewer, NMS OB/GYN, fifth edition, Lippincott Williams & Wilkins, 2003 Manuscript reviewer, Obstetrics and Gynecology, 2003-date Medical Content Reviewer, Nucleus Medical Media, 2011 - date Jury Foreman, 6-day civil trial (IOTA 5 v Dobron), Riverside Superior Court, March, 2012 MEDICAL SOCIETIES and ASSOCIATIONS ALPHA OMEGA ALPHA (medical honorary)- elected 1977 AMERICAN COLLEGE OBSTETRICS AND GYNECOLOGY 1979- date AMERICAN MEDICAL ASSOCIATION 1974- date AMERICAN SOCIETY OF FORENSIC OB/GYNS 1998- date
-President, 2000 AMERICAN SOCIETY OF LAW, MEDICINE, & ETHICS 1987- 2001 CALIFORNIA MEDICAL ASSOCIATION 1987- date Surveyor for CALIFORNIA MEDICAL ASSOCIATION / INSTITUTE FOR MEDICAL QUALITY Hospital and Medical Staff Survey Committee (Consolidated Accreditation and Licensure Survey), 1991- 2003; recipient of 10-year service award 2001 RIVERSIDE COUNTY MEDICAL SOCIETY 1987- 2001
-Professional Liability Committee 1990- 2001; Chairman 1992-1998 -Committee on Maternal and Child Health 1990- 1999 SAN BERNARDINO COUNTY MEDICAL ASSOCIATION 2001-date
-Medical Review Advisory Committee 2001-date; Co-Chairman 2008-date -Member, Board of Directors 2007-date -Finance and Strategic Planning Committee 2010-date -Treasurer 2010-2011 -Secretary 2011-2012 -Executive Committee 2010-2012 RIVERSIDE/SAN BERNARDINO OB/GYN SOCIETY 1989- date AMERICAN ASSOCIATION GYNECOLOGIC LAPAROSCOPISTS 1986- date SOCIETY OF LAPAROENDOSCOPIC SURGEONS 1993-1995 CALIFORNIA ASSOCIATION OF OBSTETRICIANS AND GYNECOLOGISTS 1995-1999 PLANNED PARENTHOOD OF PEORIA (1985 - 1987)
-President, Medical Committee -Executive Committee -Education Committee Advisor to RESOLVE (infertility support group) 1985 - 1986 Advisor to ORGANIZATION FOR CESAREAN EDUCATION AND PREVENTION 1982-1987 Advisor to CHILDBIRTH AND PARENTING EDUCATION ASSOCIATION 1982 - 1987 Diplomate of AMERICAN BOARD OF OBSTETRICS AND GYNECOLOGY 1984 Member, Board of Directors, RIVERSIDE COMMUNITY HEALTH PLAN IPA 1989-1994
-Vice President, 1992 - 1994 -Chairman, Subcommittee to study Conflict of Interest/ Confidentiality for Board Members and Employees 1992 -Utilization Review Committee 1989-1997 -Medical Review Committee 1989-1996 Past member of CHICAGO, ILLINOIS STATE, and PEORIA MEDICAL SOCIETIES CALIFORNIA MEDICAL ASSOCIATION Certification in Continuing Medical Education AMERICAN MEDICAL ASSOCIATION Physician's Recognition Award for Continuing Medical Education 1993-1997 Member, Board of Directors, INLAND EMPIRE OB/GYN IPA, 1997-2001
-Vice-Chairman, 1998-2001 -Scope of Services and Compensation Committees AMERICAN COLLEGE OF PHYSICIAN EXECUTIVES 1998-2000 Verified Recommended Expert, A.M. Best Company, 2007-date
San Bernardino County Medical Society Advisory Board to Southern California Physician magazine,
2008-2010 Member, Board of Directors, Inland Empire Electronic Health Record Resource Center, 2010-date Certified Expert Witness for Los Angeles Superior Court, Criminal Division, 2008-date University of California, Riverside Haider School of Medicine Interview Committee for Charter Class
CHARITABLE ACTIVITIES and AWARDS Member, Exec. Board, EXECUTIVE 2000 (medical-business-community liaison group), 1990-1992 Member, Nominating Committee, EXECUTIVE 2000, 1992 Member, Board of Directors, RIVERSIDE COMMUNITY HOSPITAL FOUNDATION 1990-1996 Chairman, Health Education Committee, RIVERSIDE COMMUNITY HOSPITAL FOUNDATION 1990- 1996 Member, Board of Directors, RIVERSIDE COUNTY PHILHARMONIC 1990- 1993 Moderator for Medical Education seminars for the public, VIP PROGRAM and RIVERSIDE COMMUNITY FOUNDATION 1990- 1996 Member, Health Consultation Committee for RIVERSIDE UNIFIED SCHOOL DISTRICT, 1993-97 Recipient, Chamber of Commerce First Place Award for Riverside Beautification, 1992 Recipient, Old Riverside Foundation Restoration & Preservation Award, 1992 Sponsor and Participant in 3rd Annual Survive Food Bank Show, Riverside, 1993 Member, Riverside City Tobacco Control Force, 1994 Staff Physician, RCH Woman's Health Screening Clinic, 1993 Charter Member, Cardiac 2000 Club, RCH Foundation, 1994 Member, Organizational Board for Women's Health Day, 1995-1996 Board member and Parliamentarian, PTA, Alcott Elementary School, 1997-1998 Board member and Parliamentarian, PTSA, Gage Middle School, 1997-2000 School Site Council Board Member, Polytechnic High School, 1998-2000 Certificate of Distinction, American Kidney Fund Board of Trustees GIVE (Glaxo Wellcome’s Investment in Volunteer Excellence) award, 1999 Polytechnic Digital High School Committee, 1999-2000 Award of Excellence for clinical teaching, Western University Physician Assistant Class of 2003 Award for Teaching Dedication for Western University medical students, 2006 Top 10% of peer reviewers for Obstetrics and Gynecology award – 2006 Top 10% of peer reviewers for Obstetrics and Gynecology award – 2009 Top 10% of peer reviewers for Obstetrics and Gynecology award – 2010 Top 10% of peer reviewers for Obstetrics and Gynecology award – 2011 Top 10% of peer reviewers for Obstetrics and Gynecology award – 2012 Golden Apple Award for OB/GYN teaching, Arrowhead Regional Med. Center, 2007 Annual Medical Staff Leadership Award, Arrowhead Regional Med. Center, 2009 Mission Leadership Award, Arrowhead Regional Medical Center, 2010
STAFF APPOINTMENTS Active Staff and Vice-Chairman OB/GYN Department, Methodist Medical Center,
Peoria, Illinois, 1982 - 1987 Courtesy Staff, St. Francis and Proctor Hospitals, Peoria, Illinois, 1982 - 1987 Active Staff, Parkview Hospital, Riverside, California, 1992-2001; Courtesy Staff, 1987-1990, 2001-2002 Active Staff, Riverside Community Hospital, Riverside, California, 1987 - 2001
-Vice-Chairman OB/GYN Department 1995-1996 -Secretary/Treasurer of the Medical Staff 1997-2001 -Chairman, Credentials Committee 2000-2001 Active Staff, Redlands Community Hospital, 2000-2005 Affiliate Staff, Redlands Community Hospital, 2005-2007 Courtesy Staff/teaching faculty, Arrowhead Regional Medical Center, Colton, California, 2000-2001 Active Staff/teaching faculty, Arrowhead Regional Medical Center, Colton, California, 2001-date
-Vice-Chairman OB/GYN Department 2003-date -Secretary/Treasurer of the Medical Staff, 2010-2011 -President-Elect of the Medical Staff, 2011 -President of the Medical Staff, 2012-2014 Courtesy Staff, Riverside County Regional Medical Center, Moreno Valley, California, 2007-2011 COMMITTEES Methodist Medical Center Infection Control Credentials Bridge Committee for fetal/newborn loss Bioethics Planning and Development Osteoporosis study committee CME Committee; Medical Library Committee Cancer Coordinating Medical Student Promotions (Peoria School of Medicine) Epidural Anesthesia Development Committee Infertility Clinic Committee Committee for development of VBAC protocol Riverside Community Hospital Operating Room Committee Surgical Committee Obstetrical Unit Committee Quality Improvement (Assurance) Committee Utilization Review Committee (Riverside Community Health Plan-Riverside Physician Network) Medical Review Committee (Riverside Community Health Plan-Riverside Physician Network) Chairman, OB/GYN Clinical Committee (Riverside Physician Network) RCH representative to the AMA Hospital Medical Staff Section RCH representative to the CMA Hospital Medical Staff Section Ad hoc committee for OB Protocols Ad hoc committee for OR Block Scheduling Ad hoc committee for development of OB Quality Improvement indicators Subcommittee for study of COBRA OB regulations Ad hoc committee for implementation of "Paperless" hospital information system Perinatal Morbidity and Mortality Committee Chairman, Laser Committee Established Operative Laparoscopy/Laser Laparoscopy, VBAC, and Gynecologic Laser programs RCH Medical Service Organization Task Force Medical Advisory Board, RCH SurgiCenter Bylaws Committee Vice-Chairman, OB-GYN Department, 1994-1996 Committee for Hospital Computerization OB/GYN Quality Review Committee Committee for Reorganization of the Medical Staff Medical Staff Secretary/Treasurer, 1997-2001 Executive Committee, 1997-2001 Search Committee, Operating Room Supervisor, 1998 Search Committee, Senior Vice-President for Medical Affairs, 1998 OB-GYN Hospital-Medical Staff Liaison Committee, 1998 Credentials Committee, 1998-2001 -Chairman, 2000-2001 Quality Council, 1998-2001 Ad hoc Committee for Student and Resident education Chairman, Finance Committee Parkview Community Hospital Judicial Review Committee, 6/92 Operating Room Committee Consultant for JCAHO Survey, 1993 Nominating Committee, OB-GYN Department OB-GYN Department Quality Review Committee Cesarean rate study Committee Arrowhead Regional Medical Center Operative and Other Invasive Procedures Committee Utilization Management Committee
-Chairman 2006-2012 Health Information Management Committee
-Chairman 2008-2012 Physician Advisory Committee on Electronic Medical Record Bylaws Committee 2001-date
-Chairman 2011 Computerized Order Entry Committee Operating Room Task Force Quality Management Committee
-Vice-Chairman 2010-2011 Medical Executive Committee 2010-date
-Chairman 2012-2014 Nominating Committee 2011-date; Chairman 2012-2014 Vice-Chairman OB/GYN Department 2003-date Secretary/Treasurer of the Medical Staff, 2010-2011 President-Elect of the Medical Staff, 2011 President of the Medical Staff, 2012-2014 Forms Committee Sub-Committee on Peer Review Redesign, Chairman 2010-date Quality Management Task Force on Histories and Physicals – Vice-Chairman, 2011 Joint Conference Committee 2011-2016 Search Committee for Medical Director, Chairman- 2013 PRESENT POSITION Active Staff / faculty and Vice-Chairman of Women’s Health at Arrowhead Regional Medical Center, Colton, San Bernardino County, California, 2001-date Courtesy Staff, Riverside County Regional Medical Center, Moreno Valley, California, 2007-2011 (Affiliate Staff, Redlands Community Hospital, 2005) (Private practitioner in Obstetrics and Gynecology, Redlands, California, 2000-2004) (Private solo practitioner in Obstetrics and Gynecology, Riverside, California 1990-2001) (Private solo practitioner in OB/GYN, Peoria, Illinois, 1982-1987) (Private group practice in OB/GYN, Riverside, California, 1987-1990) SPECIAL INTERESTS AND QUALIFICATIONS High-risk Obstetrics Operative gynecology, including pelvic reconstructive surgery and operative laparoscopy Family planning Computer science Fine wine
Peripheral Artery Disease (PAD) We’ve all seen the TV ads that warn about the dangers of peripheral artery disease or PAD, and then promote some drug to treat it. PAD causes loss of normal blood circulation. The small arteries become blocked, reducing the amount of oxygen that can be supplied to the muscles. PAD usually affects the legs, but may involve the arms as well. Twelve to twenty
TREATMENT OF SCIATICA WITH ELECTRO-ACUPUNCTURE AND TUINA: A CLINICAL CASE STUDY ABSTRACT Background Sciatica can be difficult to treat, especially when it does not have clear diagnosis from a western biomedical perspective such as negative findings in a MRI. Objective To examine the approach and efficiency of electro-acupuncture and Tuina in the treatment of sciatica, with unclea