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Clinicians therefore need to have an understanding of IT in a healthcare context and a shared vision of the organization generic 100mg extra super levitra overnight delivery. Clinicians and healthcare administrators thus need to acquire both organizational and technological insights if they are to have a holistic view of their organization order extra super levitra 100mg mastercard. The KM paradigm can enable the healthcare sector to successfully overcome the information and knowledge explosion, made possible by adopting a KM framework that is specially customized for healthcare institutions in light of their ICT implementation level. Adoption of KM is essential for healthcare institutions as it would enable them to identify, preserve and disseminate “best context” healthcare practices to different healthcare stakeholders. Prefatory Analysis of Alternative Healthcare Concepts The failure of some healthcare management concepts propelled a new stream of thought that advocated the incorporation of the KM paradigm in healthcare (Health Canada, 1999; Mercer, 2001). KM could allow healthcare organizations to truly take advantage of the driving forces behind the creation of the CHIN concept. However, very few organizations have adopted a comprehensive healthcare KM system. The main reason attributed is the failure of healthcare stakeholders in properly creating a conducive organizational Table 1. Prefatory analysis of alternative healthcare concepts Concept Support for People Support for Process Support for Technology Limitations CG Present Insufficient Present Policy initiative EBM Insufficient Insufficient Present Tacit Processes? CHIN Insufficient Absent Present Limited Trials IHCDS Insufficient Insufficient Present Technology focus IPP Insufficient Present Present Tacit Knowledge? Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Based on a literature review above, a preliminary conceptual analysis of alternative healthcare management concepts is presented in Table 1. Healthcare institutions have realized that existing concepts such as EBM and CG do not enable healthcare stakeholders to achieve this challenge as they do not holistically support effective integration of IT within specific organizational cultures and processes. Contem- porary concepts such as EBM, CHIN, ICHDS and IPP focus on IT at the expense of having too little emphasis on people. This is further aggravated by the presence of dysfunctional organizational processes in the majority of healthcare institutions. Conclusion For any healthcare organization to succeed, it needs to excel in a number of key processes (i. Modern IT applications in healthcare are not sufficient in meeting the information needs of current healthcare institutions as they lack the ability to deliver precise, accurate and contextual information to the desired caregiver at the desired time. This chapter has presented an analysis of alternative healthcare management concepts with respect to their ability in providing a solution to the issue of information manage- ment. Furthermore, this chapter has examined the feasibility of the KM paradigm in solving the problem of information explosion in healthcare and has found validation for the proposition that the current focus on technological solutions will aggravate the problem of explosion in clinical information systems for healthcare institutions. The chapter has also presented the key requirements for creating a KM framework, which can act as a template in enabling healthcare institutions in their attempts to initiate KM projects. This chapter concludes that any potential solution has to come from a domain that synergistically combines people, organizational processes and technology, thereby enabling healthcare stakeholders to have a holistic view of the entire healthcare continuum. This chapter further concludes that KM is the only paradigm that combines the above-mentioned perspectives (i.

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Vitamin D intoxication 100 mg extra super levitra with amex, sarcoidosis generic extra super levitra 100mg without a prescription, other granulomatous dis- ease • High Bone Turnover. Thiazide diuretics, milk–alkali syndrome, exogenous intake Symptoms • Stones (renal colic) bones (osteitis fibrosa), moans (constipation), and groans (neu- ropsychiatric symptoms—confusion), as well as polyuria, polydipsia, fatigue, anorexia, nausea, vomiting Signs • Hypertension, hyporeflexia, mental status changes • Shortening of the QT interval on the ECG. Treatment: Usually emergency treatment if patient is symptomatic and Ca+2 >13 mEq/L (3. Oral medications (prednisone 30 mg PO bid or phosphorus/potassium/sodium supplement [Neutra-Phos] 250–500 mg PO qid) can be effective in chronic therapy for such dis- eases as breast cancer or sarcoidosis. Sepsis and other ICU-related conditions can cause decreased cal- cium because of the fall in albumin often seen in critically ill patients, ionized cal- cium may be normal. Acquired (surgical excision or injury, infiltrative diseases such as amyloidosis or hemachromatosis and irradiation) hereditary hypoparathyroidism (pseudo-hypoparathyroidism), hypomagnesemia • Vitamin D deficiency. Chronic renal failure, liver disease, use of phenytoin or phe- nobarbital, malnutrition, malabsorption (chronic pancreatitis, postgastrectomy) • Other. Calcium supplements Calcium carbonate (Os-Cal) 650 mg PO qid (28% calcium) Calcium citrate (Critical) 950-mg tablets (21% calcium) 9 Calcium gluconate 500- or 1000-mg tablets (9% calcium) Calcium glubionate (Neo-Calglucon) syrup 115 mg/5 mL (6. Rhabdomyolysis, adrenal insufficiency Symptoms and Signs • 3–5 mEq/L(mmol/L): Nausea, vomiting, hypotension • 7–10 mEq/L (mmol/L): Hyperreflexia, weakness, drowsiness • >12 mEq/L (mmol/L): Coma, bradycardia, respiratory failure Treatment: Clinical hypermagnesemia requiring therapy is infrequently encountered in the patient with normal renal function. Malabsorption, chronic GI losses, deficient in- take (alcoholics), TPN without adequate supplementation • Increased Loss. Diuretics, other medications (gentamicin, cisplatin, amphotericin B, others), RTA, diabetes mellitus (especially DKA), alcoholism, hyperaldostero- nism, excessive lactation • Other. Symptoms • Weakness, muscle twitches, asterixis • Vertigo • Symptoms of hypocalcemia (hypomagnesemia may cause hypocalcemia and hy- pokalemia) Signs • Tachycardia, tremor, hyperactive reflexes, tetany, seizures • ECG may show prolongation of the PR, QT, and QRS intervals as well as ventricular ectopy, sinus tachycardia 9 Treatment • Severe: Tetany or Seizures Monitor patient with ECG in ICU setting. These patients are often hypokalemic and hypophosphatemic as well and should be supple- mented. Iatrogenic, abuse of laxatives or enemas containing phosphorus, vitamin D, granulomatous disease • Decreased Excretion (Most Common Cause). Renal failure, hypoparathyroidism, adrenal insufficiency, hyperthyroidism, acromegaly, sickle cell anemia • Redistribution/Cellular Release. Starvation, alcoholism, iatrogenic (hyperalimentation without adequate supplementation), malabsorption, vitamin D deficiency, phos- 9 phate-binding antacids (ie, ALTernaGEL) • Redistribution. Conditions associated with respiratory or metabolic alkalosis (alco- hol withdrawal, salicylate poisoning, etc), endocrine (insulin, catecholamine, etc), anabolic steroids, hyper- or hypothermia, leukemias and lymphomas, hypercalcemia, hypomagnesemia • Renal Losses. RTA, diuretic phase of ATN, hyperparathyroidism, hyperthyroidism, hypokalemia, diuretics, hypomagnesemia, alcohol abuse, diabetes mellitus (poorly controlled) • Other. Refeeding in the setting of severe protein-calorie malnutrition, severe burns, treatment of DKA Symptoms and Signs: < 1 mg/dL (0.

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The form ation of alkaline urine and to m etabolic acidosis as Na –Cl cotransport takes place on the lum inal surface a result of both H CO 3 loss and im paired H secretion trusted extra super levitra 100mg. Thus 100mg extra super levitra sale, to exert their diuretic The m ain therapeutic use of carbonic anhydrase in- action, the thiazides m ust reach the lum inal fluid. Since hibitors is not for the production of diuresis but in the the thiazide diuretics are largely bound to plasm a pro- treatm ent of glaucom a. This is true especially of the top- teins and therefore are not readily filtered across the ically applied com pound dorzolam ide (Trusopt). The pends on carbonic anhydrase, acetazolam ide has proved drugs then travel along the nephron, presum ably being to be a useful adjunct to the usual therapy for lowering concentrated as fluid is abstracted, until they reach their intraocular pressure. O ral carbonic anhydrase inhibitors are iazide shows any appreciable carbonic anhydrase in- also useful in preventing or treating acute m ountain hibitory activity. A dverse reactions are m inor; they include loss of appetite, drowsiness, confusion, and tingling in the Renal Response extrem ities. A nim al studies have shown som e terato- genic potential, so the use of carbonic anhydrase in- W hen adm inistered at m axim al doses, chlorothiazide hibitors is not recom m ended during the first trim ester m arkedly increases excretion of Na,K,C l, and of pregnancy. M axim al diuresis m ay approach values as high 3 Thiazide Diuretics Thiazide diuretics consist of two distinct groups: those T A B L E 21. The lat- Generic Name Trade Names ter are called thiazidelike diuretics; they include metola- Bendroflum ethiazide Naturetin zone, xipamide, and indapamide. The major thiazide and Benzthiazide A quatag, Exna thiazidelike drugs available in the United States are Chlorothiazide D iuril bendroflumethiazide, benzthiazide, chlorothiazide, hy- H ydrochlorothiazide Esidrix, H ydroD IU RIL H ydroflum ethiazide Saluron, D iucardin drochlorothiazide, hydroflumethiazide, methyclothiazide, M ethyclothiazide Enduron,A quatensen polythiazide, and trichlormethiazide; and chlorthalidone, Polythiazide Renese indapamide, metolazone, and quinethazone, respectively. Trichlorm ethiazide Naqua, M etahydrin D espite the structural distinctions, the drugs share Chlorthalidone H ygroton the functional attribute of increasing sodium and chlo- Indapam ide Lozol M etolazone Zaroxolyn, D iulo ride excretion by inhibiting Na –Cl cotransport in dis- Q uinethazone H ydrom ox tal convoluted tubules. A t usual clinical gestive heart failure, cirrhosis, prem enstrual tension, doses, however, the thiazide diuretics generally increase and horm one therapy. They are widely used in the treat- excretion of Na and Cl, with an accom panying loss of m ent of hypertension whether or not it is accom panied K. They can be used in patients hibitors, the diuresis produced by thiazide and thiazide- with renal disease; however, their diuretic activity is like diuretics is of NaCl and not NaH CO 3. The urinary proportional to the residual tubular functional capacity K wasting induced by the thiazides is prim arily a con- of the kidney. The thiazides do not prevent toxem ia in sequence of the increased Na delivered to the distal pregnancy, nor are they useful in the treatm ent of it. W ith these com pounds, Na excre- tion is increased, while Ca excretion is decreased, pri- Thiazides should be used cautiously in the presence of m arily and directly because of increased distal Ca re- severe renal and hepatic disease, since azotem ia and absorption, secondarily and indirectly because of a com a m ay result. The m ost im portant toxic effect associ- com pensatory elevation of proxim al solute absorption, ated with this class of diuretics is hypokalem ia, which m aking this class of diuretics useful in treating hypercal- m ay result in m uscular and central nervous system ciuria. This effect, which m ay not be evident upon initial sym ptom s, as well as cardiac sensitization (see adm inistration of the drug, is particularly beneficial in H ypokalem ia). A ppropriate dietary and therapeutic m easures their utility in treating nephrogenic diabetes insipidus. The thiazides also possess som e diabetogenic whose kidneys fail to respond to A D H excrete large potential, and although pancreatitis during thiazide volum es of very dilute urine, not unlike those who have therapy has been reported in a few cases, the m ajor an A D H deficiency.

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The powder is then Art therapy buy extra super levitra 100 mg online, sometimes called creative arts therapy ground and diluted with milk sugar buy extra super levitra 100mg line. Origins Precautions Humans have expressed themselves with symbols If symptoms do not improve after the recommended throughout history. Masks, ritual pottery, costumes, other time period, a homeopath or healthcare practitioner objects used in rituals, cave drawings, Egyptian hiero- should be consulted. In the late nineteenth century, French psychiatrists Ambrose Tardieu and Paul-Max Simon both published studies on the similar characteristics of and symbolism Interactions in the artwork of the mentally ill. Tardieu and Simon When taking any homeopathic remedy, consumers viewed art therapy as an effective diagnostic tool to iden- should not use peppermint products, coffee, or alcohol. Later, psychologists would use this diagnostic aspect to develop psychological drawing tests (the Draw-A-Man Resources test, the Draw-A-Person Questionnaire [DAP. Q]) and BOOKS projective personality tests involving visual symbol Cummings, Stephen, M. Milieu therapies (or environmental ther- apy) focus on putting the patient in a controlled thera- peutic social setting that provides the patient with oppor- tunities to gain self-confidence and interact with peers in a positive way. Activities that encourage self-discovery and empowerment such as art, music, dance, and writing are important components of this approach. Educator and therapist Margaret Naumburg was a follower of both Freud and Jung, and incorporated art into psychotherapy as a means for her patients to visual- ize and recognize the unconscious. She published exten- sively on the subject and taught seminars on the tech- nique at New York University in the 1950s. In the 1930s, Karl, William, and Charles Menninger introduced an art therapy program at their Kansas-based psychiatric hospital, the Menninger Clinic. The Men- ninger Clinic employed a number of artists in residence in the following years, and the facility was also consid- ered a leader in the art therapy movement through the Art therapist with students. This therapy can promote physiological healing when patients identify and Art therapy provides the client-artist with critical in- work through anger, resentment, and other emotional sight into emotions, thoughts, and feelings. It is often prescribed to accompany pain control of the art therapy process include: therapy for chronically and terminally ill patients. The creation of a tangible reward Art therapy, sometimes called expressive art or art can build confidence and nurture feelings of self-worth. It is a two part process, involving both the cre- the analytical components of the artistic process. Patients are encouraged to visualize, and then create, the • Relaxation and stress relief. Stress can weaken and resulting artwork is then reviewed and its meaning inter- damage the immune system, can cause insomnia and preted by the patient. When The “analysis” of the artwork produced in art thera- used alone or in combination with other relaxation py typically allows patients to gain some level of insight GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 131 into their feelings and lets them to work through these is- string, adhesives, clay, wood, glazes, wire, bendable metals, sues in a constructive manner.

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Related to this role in disease immunity proven extra super levitra 100 mg, MHC is important in organ and tissue transplantation purchase 100 mg extra super levitra with amex, as well as There is significant variability of the frequencies of playing a role in susceptibility to certain diseases. This is reflected in typing can also provide important information in parent- anthropologic studies attempting to use HLA-types to age, forensic, and anthropologic studies. These various determine patterns of migration and evolutionary rela- roles and the practical applications of HLA typing are tionships of peoples of various ethnicity. Generally speaking, populations that have been subject to Genetic profile significant patterns of migration and assimilation with other populations tend to have a more diverse HLA gene Present on chromosome 6, the major histocompati- pool. For example, it is unlikely that two unrelated indi- bility complex consists of more than 70 genes, classified into class I, II, and III MHC. There are multiple alleles, viduals of African ancestry would have matched HLA or forms, of each HLA gene. Conversely, populations that have been isolated as proteins on the surface of various cells in a co-domi- due to geography, cultural practices, and other historical nant manner. This diversity is important in maintaining influences may display a less diverse pool of HLA types, an effective system of specific immunity. Altogether, the making it more likely for two unrelated individuals to be MHC genes span a region that is four million base pairs HLA-matched. Although this is a large region, 99% of the time these closely-linked genes are transmitted to the next Testing generation as a unit of MHC alleles on each chromosome Organ and tissue transplantation 6. Most commonly, HLA typing is used to Class I MHC genes include HLA-A, HLA-B, and establish if an organ or tissue donor is appropriately HLA-C. In the special case of bone marrow transplantation, the risk is for graft-versus- HLA disease associations host disease (GVHD), as opposed to tissue rejection. As advances occur in transplantation Hemochromatosis A3 6–20 medicine, HLA typing for transplantation occurs with Lupus DR3 1–3 increasing frequency and in various settings. For example, a patient with DR4 is three to six times more likely to have rheumatoid arthritis and five to seven times are thought to be autoimmune in nature. Autoimmune more likely to develop type 1 diabetes than an individual without the DR4 allele. The basis of the HLA association is not well understood, although there are some hypotheses. Most autoimmune diseases are charac- terized by the expression of class II MHC on cells of the Parentage body that do not normally express these proteins. This Among other tests, HLA typing can sometimes be may confuse the killer T-cells, which respond inappropri- used to determine parentage, most commonly pater- ately by attacking these cells. Whatever HLA-typing can provide valuable DNA-based evi- the underlying mechanism, certain HLA-types are known dence contributing to the determination of identity in factors that increase the relative risk for developing spe- criminal cases. Additionally, it is a technology that has carry the HLA B-27 allele have a relative risk of 77–90 been applied internationally in the human-rights arena. The period under the dictatorship was marked by the murder and disappearance of thousands who were one in the general population.

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