Managerial accounting Efficient and inefficient workers are distinguished. More than one piece rate is determined. Standards are set for each operation or job. Efficient workers, i.e., those who attain or better the standard set are given a higher rate and inefficient ones are given a lower rate. Hence, there is encouragement to improve the performance. As the level of output increases the piece rate also increases. This ratio may be proportionate or proportionately less or more than the increase in output

21 Does the combination of aluminium and magnesium hydroxide, given as an antacid, decrease the absorption of omeprazole if these are co-administered to help relieve heartburn quickly?

22 Should proton pump inhibitors be used with caution in patients with renal impairment?

23 Has cisapride been withdrawn from the market because of the danger of ventricular fibrillation?

24 In peptic ulcer disease: 1. What are the indications for an upper gastrointestinal endoscopy? 2. As this is an invasive procedure, is an oesophagogastroduodenoscopy (OGD) or barium meal X-ray preferable?

25 Is telithromycin as, or more, effective than clarithromycin in the treatment of Helicobacter pylori? If so, what is the recommended dosage and how long should treatment be continued?

26 Currently favoured regimens for eradication of Helicobacter pylori are triple therapy with a proton pump inhibitor along with two antibiotics for 1 week. For example: Omeprazole 20 mg metronidazole 400 mg and clarithromycin 500 mg (all twice daily). Omeprazole 20 mg clarithromycin 500 mg and amoxicillin 1 g (all twice daily). Resistance to amoxicillin has not yet been demonstrated. Previously, regimens such as omeprazole, metronidazole, amoxicillin and clarithromycin were recommended; are these regimens no longer used? The reason behind this question is the 'sky-high' cost of clarithromycin in Pakistan, which is inversely proportional to patient compliance (that is, low-cost regimens tend to have a higher rate of compliance)

27 What is the difference between the management of a gastric and of a duodenal ulcer?

28 How does omeprazole suppress Helicobacter pylori?

29 Does omeprazole cause rebound hyperacidity? Does this also apply to H2-blockers?

30 On (K&C 7e, p. 249), you state that the postsynaptic neurotransmitter that inhibits the relaxation of lower oesophageal sphincter (LOS) is nitric oxide (NO). I have understood NO to promote relaxation of LOS by acting on the non-adrenergic, non-cholinergic (NANC) inhibitory neurones, which inhibits the action of cholinergic excitatory neurones. Could you please explain this paradox?