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By Z. Ismael. Antioch University Yellow Springs OH. 2018.

Any assistance in this critical step can be of immense value to the medical decision makers kamagra polo 100mg with visa. The second is the beliefs and opinions about the objective states effective kamagra polo 100 mg, and the processes including input and outcomes states. The third is the values and consequences attached to each outcome of the event-choice-action combination. The decision support literature classifies problems into three major categories: struc- tured, semi-structured, and unstructured (Gorry & Morton, 1971). Structured problems are routine and repetitive: solutions exist, are standard, and pre-defined. Unstructured problems are complex and fuzzy; they lack clear and straight-forward solutions. Semi- structured problems combine the features of the two previous categories; their solution requires human judgment as well as the application of standard procedures (Simon, 1971). Thus the complexity involved in a decision making process can be grouped as a knowledge gathering process, knowledge storage, knowledge retrieval, and information processing. The literature categorizes the decision making process into four distinct phases: intelligence, design, choice, and review (Stohr & Konsynski, 1992). During the intelligence phase of the decision making process, the need for a decision making (or the trigger) event is recognized and the clinical problem or opportunity is properly identified and defined. This is done by eliciting two different types of knowledge domains: public and private. Private knowledge generally is heuristic and experience- based knowledge that usually comes from the clinical practitioners. Public knowledge can be gathered from standards, guidelines, text books and journals. The office of technology assessment (1995) suggests usage of the following questions in identifying the problems and opportunities for medical decision support. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Can the solution to the problem/opportunity assist in determining what the proper drug dosage level should be? Can the solution to the problem/opportunity remind the appropriate care giver about the preventative services to be administered to a patient or to patient care related function? Can the solution to the problem/opportunity assist in carrying out diagnostic procedure by recommending specific treatments or tests? Can the solution to the problem/opportunity assist in carrying out medical procedures by alerts regarding potential adverse events? Can the solution to the problem/opportunity assist in providing cost effective medical care by reminding previous orders, results, frequency rule checks, and schedule of treatment or procedure? During the design phase, the problems or opportunities identified during the intelligence phase are further analyzed to develop possible courses of actions to construct decision models. A thorough search for ready made solutions, customized off the shelf solution, or a decision to custom solution development is made.

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There growth factor receptors can result in oncogenes that pro- appear to be environmental triggers such as exposure to duce receptors that do not require growth factors to stim- toxic chemicals kamagra polo 100mg line. Overstimulation of cells to enter the since changes in other genes in a particular cell can trig- cell cycle can result and promote uncontrolled cell ger changes in proto-oncogenes buy kamagra polo 100mg line. Most proto-oncogene growth factor receptors are called tyrosine kinases and are very involved in control- The mechanisms through which proto-oncogenes are ling cell shape and growth. The RET (rearranged during Proto-oncogenes are transformed into oncogenes transfection) oncogene is a mutated form of GDFNR and through: 1) mutation 2) chromosomal translocation, and is commonly found in cancerous thyroid cells. A tiny change, called a mutation, in a proto-oncogene SIGNAL TRANSDUCERS Signal transducers are pro- can convert it into an oncogene. The mutation results in teins that relay cell cycle stimulation signals, from an oncogene that produces a protein with an abnormal growth factor receptors to proteins in the nucleus of the structure. The transfer of signals to the nucleus is a stepwise ant to regulation and cause uncontrolled and continuous process that involves a large number of proto-oncogenes activity of the protein. Signal transducer oncogenes are the Chromosomal translocations, which result from largest class of oncogenes. The RAS family is a group of errors in mitosis, have also been implicated in the trans- 50 related signal transducer oncogenes that are found in formation of proto-oncogenes into oncogenes. Benign—A non-cancerous tumor that does not Parathyroid glands—A pair of glands adjacent to spread and is not life-threatening. The tumor causes Chromosome—A microscopic thread-like structure uncontrolled and irregular secretion of certain hor- found within each cell of the body and consists of a mones. Changes in Protein—Important building blocks of the body, either the total number of chromosomes or their composed of amino acids, involved in the forma- shape and size (structure) may lead to physical or tion of body structures and controlling the basic mental abnormalities. Gene—A building block of inheritance, which con- tains the instructions for the production of a partic- Proto-oncogene—A gene involved in stimulating ular protein, and is made up of a molecular the normal growth and division of cells in a con- sequence found on a section of DNA. Leukemia—Cancer of the blood forming organs Somatic cells—All the cells of the body except for which results in an overproduction of white blood the egg and sperm cells. Translocation—The transfer of one part of a chro- Lymphoma—A malignant tumor of the lymph nodes. A balanced translocation occurs when pieces cell not destined to become a sperm or egg—dupli- from two different chromosomes exchange places cates its chromosomes and divides to produce two without loss or gain of any chromosome material. An unbalanced translocation involves the unequal loss or gain of genetic information between two Mutation—A permanent change in the genetic chromosomes. The Sometimes this translocation results in the transfer of a resulting oncogene produces an unregulated protein proto-oncogene next to a gene involved in the immune that is involved in stimulating uncontrolled cell prolif- system. The first discovered fusion oncogene resulted the immune system gene and as a result becomes dereg- from a Philadelphia chromosome translocation. One example of this mechanism is the transfer of type of translocation is found in the leukemia cells of the c-myc proto-oncogene from its normal location on greater than 95% of patients with a chronic form of chromosome 8 to a location near an immune system gene leukemia. It is not GALE ENCYCLOPEDIA OF GENETIC DISORDERS 835 known how this protein contributes to the formation of Oncogenes as targets for cancer treatment cancer cells.

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Although oral ingestion of mari- 9 Increased appetite is frequently attributed to smok- juana produces similar pharmacological effects purchase kamagra polo 100mg without prescription, -THC ing marijuana purchase kamagra polo 100 mg. Impairment on particularly in treating emesis arising during chemo- various performance measures related to driving skills 9 therapy. This time discordance between blood concentrations of 9-THC and effects has The most consistent pharmacological effect produced made it difficult to establish a meaningful relationship by marijuana is tachycardia, which is closely associated between blood concentrations and effects. There is relatively lit- 9-THC is rapidly distributed to all tissues despite tle effect on blood pressure unless large quantities of being tightly bound by plasma proteins. Traces of 9-THC have been found vasodilatory, which results in the characteristic conjunc- in adipose tissue more than 30 days after the subject tival reddening following marijuana smoking. The terminal half-life of 9-THC reduce intraocular pressure and are capable of produc- in plasma ranges from 18 hours to 4 days. Mechanism of Action Adverse Effects A cannabinoid receptor identified in the brain of sev- Marijuana is unique among drugs of abuse in that there eral species, including humans, is termed CB1. The 35 Contemporary Drug Abuse 417 most prominent effect of acute marijuana use is intoxi- responsive fashion include phencyclidine (PCP), methyl- cation, which can impair the cognitive and motor skills enedioxymethamphetamine (MDMA), and methylene- needed to complete complex tasks. The indole alkylamines include LSD, psilocybin, 9-THC causes its greatest effects on short-term mem- psilocin, dimethyltryptamine (DMT), and diethyltrypta- ory, as measured in free-recall tasks. Marijuana does not mine (DET), all of which are structurally similar to affect the retrieval of previously learned facts. The other chemical subclass of hallucinogens trast to alcohol, there is no residual hangover from a contains phenylethylamine derivatives such as mesca- single use of high quantities of marijuana. A related stimulatory hallucinogen, PCP, is some individuals have evidence of precancerous lung a piperidine analogue that produces unique effects. However, definitive evidence of the rela- tionship between marijuana smoking and the incidence Extent and Pattern of Abuse of lung cancer is lacking. Because of the rapid tolerance produced does not result in severe withdrawal symptoms, numer- with these drugs, the typical abuser does not use the ous case reports attest to development of dependence drug on a daily basis. The most prominent symptoms were irritability and Illicit PCP abuse began in the 1960s, primarily by restlessness; others included insomnia, anorexia, in- oral ingestion. Cessation of mild or PCP frequently produced dysphoria, which was unpre- moderate use of marijuana, however, does not produce dictable. The HALLUCINOGENS specific acute effects of a drug like LSD include eupho- The term hallucinogen is often used to describe a drug ria, depersonalization, enhanced awareness of sensory that produces a change in sensory perception, usually ei- input, alterations in the perception of time or space or ther visual or auditory. Drugs commonly assigned to this body image, and to some extent, minor stimulant ef- class include lysergic acid diethylamide (LSD), mesca- fects. Sometimes the dreamlike quality of the experi- line (derived from the peyote cactus), and psilocybin ence produces relaxation, good humor, and a sense of (derived from a mushroom). For this reason the term is sometimes used in- the use of the hallucinogen may have drug-induced anx- terchangeably with psychedelic or psychotomimetic, the iety, panic, or even paranoid ideation.

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However is it acceptable for an employer to provide systems that can deliberately deceive or mislead a clinician by suppressing information discount kamagra polo 100 mg line, while giving no indication that informa- tion is being withheld? Biopsychosocial Healthcare (Engel buy kamagra polo 100 mg overnight delivery, 1977) should be related to Biopsychosocial Pattern Recognition. From an information system perspective, assistance with pathology recognition and general treatment advice may be helpful, for example if a patient presents with certain symptoms and signs, the clinician is provided with list of potential diagnoses and general investigation and management advice. Pattern recognition and appropriate interventions are often related to subtle changes for that specific patient. Longitudinal history and knowing not just how a patient is presenting now but how they have presented and responded over time is one of the major benefits of a longstanding relationship between a patient and a trusted clinician. In an environment where patient and clinician relationships may be increasingly fragmen- tary, with multiple short term interventions by multiple caregivers, a health knowledge system should seek to act as an organisational glue and organisational memory, holding together and integrating both the shared collective and longitudinal knowledge of a patient and appropriately co-ordinated responses. A Health Knowledge System should aim to bring together as soon as possible the required “pieces” that will increase the “capacity to act” (Sveiby, 2001), or capacity to C. Like a jigsaw, the more pieces already in place, the quicker it is to start seeing the overall picture and what pieces Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Indeed, in terms of biopsychosocial pattern recognition, a clinician may sometimes think they are working on putting together the pieces to build one picture, but get more pieces and realise they are actually working on another. Media reviews of adverse events or deaths using a “retrospectascope” often see simple clarity where none was evident to clinicians involved at the time. Using the “retrospectascope” often one can see all the pieces of the jigsaw at a single place and point in time when in reality the pieces will have emerged from multiple sources over time. In reality, a clinician often needs to solve the jigsaw, as if riding around it in a roller coaster through a dark tunnel with only glimpses from different perspectives of not only the index problem, but multiple problems for multiple patients they may be being asked to solve at the same time. A machine or computerised jigsaw, with increasing levels of intelligence, could bring pieces together for you, sort and frame pieces into groups and provide decision support telling you a piece is missing or a piece cannot go here as it does not fit with another (e. If you switch on the privacy mode of this “intelligent” jigsaw should it place mittens on you, slowing the problem solving process or say “sorry you cannot see that piece” or even withhold pieces without even telling you? There will undoubtedly be situations where the withholding of specific information from specific caregivers can be justified. However the concept of informed consent should at least seek to convey an understanding of not just the perceived privacy risks and benefits of information flowing or not flowing, but also the clinical risks and benefits. However there are different perceptions or perspectives of what those risks and benefits are, and these can differ for each disorder, patient, caregiver, and can vary over time. For example information typically considered sensitive includes that related to infectious and sexually transmitted diseases, alcohol, and drug and mental health history and obstetric and gynaecological history (particularly in relation to induced abortion).

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