By S. Pavel. University of Pittsburgh at Johnstown. 2018.

Dosage is very important allegra 180mg discount allergy on dogs, since patients with from acute or chronic loss of blood or insufficient iron severe megaloblastic anemia may develop hypokalemia intake during physiological stress discount 180 mg allegra otc allergy treatment ottawa. This type of mega- growth, pregnancy, and loss of blood during menstrua- loblastic anemia causes neurological damage if it is not tion. Treatment of Vitamin B12–deficient megaloblas- by the hookworm parasite is a common cause of iron tic anemia with folic acid may improve the symptoms; deficiency. Parenteral injections of tigue, weakness, shortness of breath, and soreness of the vitamin B12must be given. Oral administration of ferrous Sideroblastic Anemia salts (generic ferrous sulfate, Feosol, Slo Fe) is preferred, but parenteral iron (iron dextran, InfeD) can be given if Sideroblastic anemia is characterized by excessive iron in oral therapy fails. Toxic reactions occur more frequently the cells that cannot be incorporated into porphyrin to after parenteral iron administration. A patient with pancreatic disease complains of diffi- (D) No vitamin supplement culty driving at night because of vision problems. An epileptic patient who is taking phenytoin and tant to determine whether megaloblastic anemia is lamotrigine to control her seizures is in the first from a deficiency of folic acid or vitamin B12. Vitamin A defi- tion with vitamins C and E, beta carotene, and zinc ciency symptoms include night blindness that can for age-related macular degeneration and vision lead to corneal ulceration. Pregnancy increases the need for vitamins and Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, iron in general. B Vitamins, homocysteine, and neu- of the patient to determine whether higher levels of rocognitive function. Case Study Vitamin Deficiency and Alcoholism patient has muscular weakness, apathy, and ANSWER: The symptoms resemble those you remem- Aedema in both legs. You schedule a series of ber from medical school for beriberi, but you fail to tests, including a cardiac stress test. If the pa- the stress test suggest that the patient is in moder- tient were consuming most of his calories as alco- ate congestive heart failure. The patient suffered a hol, he may have a nutritional deficiency, a beriberi- personal loss last year with the death of a son. You prescribe a daily vitamin tablet and suspect that the drinking is responsible for his pres- admonish the patient to cut back on alcohol intake. This does not include the pharmacognosy, which includes the study of herbal many (up to 25%) pharmaceutical products used in medicine. The resurgence of herbal medicine use has conventional practice that originally were, and in some once again made pharmacognosy extremely relevant to cases still are, derived from plants (Table 69. HERBAL MEDICINE TRADITIONS In addition, they are available without prescription, of- ten at much lower cost. Proponents of is also sometimes described as eclectic, since it has drawn herbal therapy also state that the multiple compounds on many other traditions, including the native American found in most herbal preparations have the advantage and Chinese. Chinese traditional medicine, Ayurvedic of acting synergistically; that is, they act in concert to (Indian), and Tibetan traditions use complex herbal produce a more enhanced effect than would a single recipes and nutrition to achieve “balance” in the ill pa- isolated component. Although these practices are most commonly found (Hypericum perfoliatum), which contains not only hy- in ethnic populations, they are also becoming popular in pericin, the ingredient it is usually standardized for, but some western complementary and alternative circles. It Homeopathic treatments frequently bear herbal is now believed that these other ingredients, far from names and are often confused with allopathic herbal 785 786 VII DRUGS AFFECTING THE ENDOCRINE SYSTEM TABLE 69. The difference is that homeopathic reme- Capsule Encapsulated herbal material dies are serially diluted and shaken until they may lack Syrup Concentrated sugar solution to preserve any molecule of the original herb ingredient. Therefore, infusion there is no risk of pharmacological toxicity from a Compress Cloth soaked in herbal solution Poultice Application of moist herbal paste homeopathic preparation. Thus, herbal products like digitalis, while quite and spiritual rather than specific physical complaints. Other herbs may not be superior to better- treat mood or physical problems either topically (as an researched pharmaceuticals, or they may delay the use adjunct to massage) or through inhalation. While herbal research has un- these oils are quite potent, and if not used in proper di- derstandably lagged far behind that of patented med- lution, they may cause skin irritation or contact allergy.

General use PERIODICAL Aucklandia is used in China and India to treat three “Complementary generic 180 mg allegra overnight delivery allergy treatment children, Alternative Medicine Being Used by Parents main categories of complaints that center around the diges- for ADHD buy 120 mg allegra with visa allergy shots and xanax. Nematodes are ized and condensed to separate out different com- parasitic roundworms. Another 1998 study done in pounds), the material that is obtained through that Korea found that an extract of Saussurea lappa killed process is called the distillate. One compound isolated in the brine Yin aspects—Yin aspects are the opposite of yang shrimp investigation is known to be moderately effective aspects and are represented by qualities such as in killing some types of human tumor cell types in labo- cold, stillness, darkness, and passiveness. It appears that the use of aucklandia as an antiseptic has some basis in scientific fact. The oil gated in regulated scientific studies include using it as a also is used by the cosmetic and perfume industry, where treatment for water retention and lung tumors. In addi- it blends well with other fragrances such as patchouli tion to its medicinal uses, aucklandia is a fragrance and and floral fragrances. It is used in the Asian food industry to flavor alcoholic beverages, soft drinks, and sweets. Precautions In Chinese medicine, aucklandia should not be used by people with deficient yin, which means people who Preparations are dehydrated or have a lot of dryness. Aucklandia can be prepared as either a distilled ex- tract or as an essential oil. The dried roots are chopped Side effects fine and softened in warm water, then distilled with steam. The resulting water-based distillate is then sub- When used externally, aucklandia causes skin irrita- jected to a solvent extraction to remove the active ingre- tion (contact dermatitis) in some sensitive individuals. Interactions Aucklandia is used in formulas to treat both diges- Aucklandia has been used safely in Asia as a medici- tive and respiratory complaints. It is used to relieve is often used in conjunction with other herbs with no re- pain and encourage digestion. Since aucklandia has been used al- also used to treat chronic hepatitis, newly developed cir- most exclusively in Asian medicine, there are no available rhosis of the liver, and abdominal pain. The oil of aucklandia is more commonly used in India than in China, and it is also used in Western aro- Tish Davidson GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 161 Auditory integration training Definition Origins Description 162 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 Benefits Description GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 165 Acupuncture needles should be sterilized before use. The ears should be disinfected before acupuncture as well, which is usually done with a cotton ball dipped in rubbing alcohol. Auriculotherapy, like all acupuncture, should not be performed on weak or exhausted patients, nor on those who are very hungry or have just eaten a meal or drunk alcohol. Auriculotherapy should not be performed on pregnant women during the first two trimesters (six months) of, and afterwards only on very par- Fleischman, Dr. Patients with ner- vous conditions should be thoroughly relaxed and pre- pared before treatment. Some patients may experience uncomfortable side American Academy of Medical Acupuncture. These reactions may be due to National Commission for Certification of Acupuncturists. Side effects can be alleviated by removing the needles and allowing the Douglas Dupler patient to lie down under supervision. Odle that occur during treatment, such as, in- creased pulse, and temporarily increased symptoms, are considered normal and usually disappear quickly. The American Academy of Medical Acupuncture (AAMA) was chartered in 1987 to support the education and correct practice of physician-trained acupuncturists. Autism is a chronic and often severe disorder of Its members must be either MDs or DOs who have com- brain functioning that begins during childhood. The American Association of Acupuncture and Ori- Autism is a lifelong disorder that interferes with the ental Medicine (AAAOM) is the largest organization for ability to understand what is seen, heard, and touched. Antidepressant Asperger syndrome Encephalitis Fragile X syndrome Phenylketonuria (PKU) Allopathic treatment Rubella Tuberous sclerosis Prevention Resources BOOKS Expected results 172 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 doshasvata, pitta, and kapha prakriti prana chi be treated differently. Much more scientific research has been conducted over the past several decades in India.

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Patients with preexisting Intrahepatic cholestasis and hepatitis similar to that hepatic insufficiency may develop acute hepatic failure seen in chronic active hepatitis can rarely occur; fatali- due to the small quantities of ammonia formed during ties have been reported order allegra 180 mg amex allergy kvue. Which of the following prophylactic agents (A) Acute urosepsis; add a broad-spectrum antibi- is appropriate for the prevention of both PCP and otic to nitrofurantoin generic 180mg allegra amex allergy treatment for mold. Urinalysis of a 38-year-old woman with recurrent (E) Nitrofurantoin-induced hemolysis; requires UTIs revealed pH 6. Which of the following produces a nosed with a ciprofloxacin-resistant Pseudomonas bacteriostatic urinary environment for P. Which of the following mechanisms (D) Inhibition of synthesis of peptidoglycan sub- is involved in sulfonamide-induced kernicterus? Nitrofurantoin (A) is a urinary antiseptic agent tal red blood mass active against many of the Enterobacteriaceae. TMP-SMX (B) daily (E) Primary biliary cirrhosis of the liver or three times a week has proved to prevent both 4. Which of the following is the roquinolones are known for their antipseudomonal basic mechanism of action of the sulfonamides? The antimicrobial (A) Selective inhibition of incorporation of PABA activity is exerted through inhibition of DNA gyrase into human cell folic acid synthesis. Methenamine (D) is (B) Competitive inhibition of incorporation of active against various Enterobacteriaceae; it has no PABA into microbial folic acid. Formaldehyde denatures (C) Inhibition of transpeptidation reaction in bac- proteins and is bactericidal. Proteus species produce urease (A) that pro- (E) Structural changes in dihydropteroate synthase duces ammonia and urea, alkalizing urine. Evaluation of a yearly chest radiograph of a 73- (B), mandelic, or ascorbic acids or methionine are year-old patient taking nitrofurantoin prophylacti- urinary acidifying agents. The normal acidic urinary cally for recurrent UTIs revealed new findings of environment is disturbed by recurrent Proteus in- 524 VI CHEMOTHERAPY fections. The catalase test differentiates Staphylococci (2) chronic progressive bilateral interstitial fibrosis; from Streptococci. Humans cannot syn- patients who are taking chronic prophylaxis, but his thesize folic acid, which must be obtained from the examination produced benign findings. A coagulase enzyme (E) is produced by munity-acquired streptococcal pneumonia (D) Staphylococcus aureus. Sulfonamides (A) compete for bilirubin binding in G6PD patients, but physical examination pro- sites on plasma albumin and increase fetal blood duced benign findings; G6PD patients usually pres- levels of unconjugated bilirubin. Overproduction (A) of PABA is one of the re- in the basal ganglia and subthalamic nuclei causing sistance mechanisms of sulfonamides. Defective biliru- the synthesis of DNA gyrases (B) is a well- bin hepatic conjugation (B) is due to glucuronyl described mechanism for quinolone resistance. Physiological port of drug out of the cell has been described for jaundice (C) usually occurs in the newborn within a quinolone resistance, but it is not plasmid mediated. It is due to the immature fetal acetyl- Inhibition of structural blocks (D) in bacterial cell transferase system resulting in peripheral destruc- wall synthesis is a basic mechanism of action of - tion of a large fetal red cell mass. Inhibition of folic acid synthesis hepatic congestion (D), cholestasis, and acute chole- (E) by blocking different steps is the basic mecha- cystitis are seen in pregnant women, not in the new- nism of action of sulfonamides. It is a chronic progressive SUPPLEMENTAL READING autoimmune disorder requiring steroids and some- Guay DR. Urinary tract agents: Nitrofurantoin and tion is synergistic because it acts at different steps in methenamine. Inhibition of the transpeptidation re- Principles and Practice of Infectious Diseases, 5th action (C) involved in the synthesis of the bacterial ed. Fluoroquinolone toxicity tam antibiotics Changes in DNA gyrases (D) and profiles: A review focusing on newer agents. Emergence of trimethoprim-sul- dihydropteroate synthetase and overproduction of famethoxazole resistance in the AIDS era. He has a history of (D) He has cumulative CNS toxicity of chronic bilateral osteoarthritis of the knees and was ciprofloxacin secondary to poor urinary and prosta- recently diagnosed with diet-controllable diabetes tic tissue penetration.

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Both IDS and CHIN are very similar in nature and both refer to an integrated network for allowing the delivery of personalized healthcare buy 120mg allegra with visa allergy testing no antihistamines. CHINs were founded on the premise that patient information should be shared by competitors (Morrissey buy allegra 180mg visa allergy symptoms from pollen, 2000). The main aim of CHIN was to enable hospitals and other healthcare stakeholders to electronically exchange patient encounter summaries and medical records between emergency departments and related departments. Another factor responsible for emphasis on CHIN was the perception in the healthcare industry that, for small-scale players to survive as individual entities, it was essential for them to form some sort of technological alliances (Huston & Huston, 2000). The original technological objective of CHIN was to enhance data-sharing capabilities amongst different healthcare stakeholders. The original technological infrastructure supported the creation of “point to point” connections. This did not succeed primarily due to limitations in technology coupled with the high amount of financial resources required to establish the “point to point” technological infrastructure (Morrissey, 2000). The objective behind the incorporation of the CHIN concept is that it allows users to collect data which could be used to formulate “best practice protocols for effective treatment at a low-cost”, that is, clinical best evidence practices for both healthcare diagnosis and delivery (Kennedy, 1995). It was anticipated that the advent of CHINs in conjunction with Internet technologies would empower healthcare stakeholders to provide healthcare to patients in real time whilst being in geographically distinct locations (Kennedy, 1995). Copying or distributing in print or electronic forms without written permission of Idea Group Inc. It has been argued that KM evolved from the applications of expert systems and artificial intelligence (Liebowitz & Beckman, 1998; Sieloff, 1999). Almost all of the definitions of KM state that it is a multi-disciplinary paradigm (Gupta, Iyer & Aronson, 2000) that has further accentuated the controversy regarding the origins of KM. One of the main factors behind widespread interest in KM is its role as a possible source of competitive advantage (Havens & Knapp, 1999; Nonaka, 1991). A number of leading management researchers have affirmed that the Hungarian chemist, economist and philosopher Michael Polanyi was among the earliest theorists who popularized the concept of characterizing knowl- edge as “tacit or explicit” which is now recognized as the accepted knowledge catego- rization approach (Gupta et al. The cornerstone of any KM project is to transform tacit knowledge to explicit knowledge so as to allow its effective dissemination (Gupta et al. Authors such as Blackler (1995) have reiterated that the concept of knowledge is complex and, in an organizational context, its relevance to organization theory has not yet been sufficiently understood and documented. This is one of the fundamental reasons why KM does not have a widely accepted framework that can enable healthcare institutions in creating KM systems and a culture conducive to KM practices. KM is underpinned by information technology paradigms such as Workflow, Intelligent Agents and Data Mining. According to Manchester (1999), a common point about software technologies such as (1) information retrieval, (2) document management and (3) workflow processing is that they blend well with the Internet and related technologies (i. As KM deals with the tacit and contextual aspects of information, it allows an organi- zation to know what is important for it in particular circumstances, in the process maximizing the value of that information and creating competitive advantages and wealth. Applicability of the KM Paradigm in Healthcare A KM solution would allow healthcare institutions to give clinical data context, so as to allow knowledge derivation for more effective clinical diagnoses. In the future, healthcare systems would see increased interest in knowledge recycling of the collaborative Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Issues in Clinical Knowledge Management 7 learning process acquired from previous healthcare industry practices. This chapter puts forward the notion that this sector has been exclusively focused on IT to meet the challenges described above and reiterates that this challenge cannot be met by an IT led solution. KM initiatives should be incorporated within the technological revolution that is speeding across healthcare industry. There has to be balance between organizational and technological aspects of the healthcare process, that is, one cannot exist without the other (Dwivedi et al. This chapter emphasizes the importance of clinicians taking a holistic view of their organization. Clinicians therefore need to have an understanding of IT in a healthcare context and a shared vision of the organization. Clinicians and healthcare administrators thus need to acquire both organizational and technological insights if they are to have a holistic view of their organization. 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.

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