d developmentof thefetus dependon asteady supplyof nutrientsfrom themother.
Takingtoo muchalfacalcidol, calcifediol,calcitriol, dihydrotachysterol,or ergocalciferolcan alsobe harmfulto thefetus.
Takingmore thanyour healthcare professionalhas recommendedcan causeyour babyto bemore sensitivethan usualto itseffects, cancause problemswith agland calledthe parathyroid,and cancause adefect inthe baby'sheart.
Doxercalciferolor paricalcitolhave notbeen studiedin pregnantwomen.
However,studies inanimals haveshown thatparicalcitol causesproblems innewborns.
Beforetaking thismedicine, makesure yourdoctor knowsif youare pregnantor ifyou maybecome pregnant.
Only smallamounts ofalfacalcidol, calcifediol,calcitriol, ordihydrotachysterol passinto breastmilk andthese amountshave notbeen reportedto causeproblems innursing babies.
It isnot knownwhether doxercalciferolor paricalcitolpasses intobreast milk.
Be sureyou havediscussed therisks andbenefits ofthe supplementwith yourdoctor.
ChildrenProblems inchildren havenot beenreported withintake ofnormal dailyrecommended amounts.
Your healthcare professionalmay prescribea vitamin/mineralsupplement thatcontains vitaminD.
Someinfants maybe sensitiveto evensmall amountsof alfacalcidol,calcifediol, calcitriol,dihydrotachysterol, orergocalciferol.
Also,children mayshow slowedgrowth whenreceiving largedoses ofalfacalcidol, calcifediol,calcitriol, dihydrotachysterol,or ergocalciferolfor along time.
Studies ondoxercalciferol orparicalcitol havebeen doneonly inadult patients,and thereis nospecific informationcomparing theuse ofdoxercalciferol orparicalcitol inchildren withuse inother agegroups.
Olderadults Problemsin olderadults havenot beenreported withintake ofnormal dailyrecommended amounts.
Studies haveshown thatolder adultsmay havelower bloodlevels ofvitamin Dthan youngeradults, especiallythose whohave littleexposure tosunlight.
Yourhealth careprofessional mayrecommend thatyou takea vitaminsupplement thatcontains vitaminD.
Medicinesor otherdietary supplementsAlthough certainmedicines ordietary supplementsshould notbe usedtogether atall, inother casesthey maybe usedtogether evenif aninteraction mightoccur.
Inthese cases,your healthcare professionalmay wantto changethe dose,or otherprecautions maybe necessary.
When youare takingvitamin Dand relatedcompounds, itis especiallyimportant thatyour healthcare professionalknow ifyou aretaking anyof thefollowing: Othermedical problemsThe presenceof othermedical problemsmay affectthe useof vitaminD andrelated compounds.
Make sureyou tellyour healthcare professionalif youhave anyother medicalproblems, especially:For useas adietary supplement: Ifyou haveany questionsabout this,check withyour healthcare professional.
For individualstaking theoral liquidform ofthis dietarysupplement: Whileyou aretaking alfacalcidol,calcifediol, calcitriol,dihydrotachysterol, doxercalciferolor paricalcitol, yourhealth careprofessional maywant youto followa specialdiet ortake acalcium supplement.
Be sureto followinstructions carefully.
If youare alreadytaking acalcium supplementor anymedicine containingcalcium, makesure yourhealth careprofessional knows.
Dosing Thedose ofthese vitaminD andrelated compoundswill bedifferent fordifferent patients.
Follow yourdoctor's ordersor thedirections onthe label.
Thefollowing informationincludes onlythe averagedoses ofthese medicines.
If yourdose isdifferent, donot changeit unlessyour healthcare professionaltells youto doso.
Thenumber ofmilliliters (mL)of solutionthat youtake, orthe numberof capsulesor tabletsyou take,depends onthe strengthof themedicine.
Also,the numberof dosesyou takeeach day,the timeallowed betweendoses, andthe lengthof timeyou takethe medicinedepend onthe medicalproblem forwhich youare takingthe combinationmedicine .
Missed doseStorage Tostore thisdietary supplement:For individualstaking vitaminD withouta prescription: Ifyou aretaking thismedicine fora reasonother thanas adietary supplement,your doctorshould checkyour progressat regularvisits tomake surethat itdoes notcause unwantedeffects.
Theextra calcium,phosphorus, orvitamin Dmay increasethe chanceof sideeffects.
Donot takeantacids orother medicinescontaining magnesiumwhile youare takingany ofthese medicines.
Taking thesemedicines togethermay causeunwanted effects.
Alongwith itsneeded effects,a dietarysupplement maycause someunwanted effects.
Alfacalcidol, calcifediol,calcitriol, dihydrotachysterol,and ergocalciferoldo notusually causeany sideeffects whentaken asdirected.
However,taking largeamounts overa periodof timemay causesome unwantedeffects thatcan beserious .
Check withyour doctorimmediately ifany ofthe followingeffects occur:Late symptomsof severeoverdose Highblood pressure;high fever;irregular heartbeat;stomach pain(severe) Checkwith yourhealth careprofessional assoon aspossible ifany ofthe followingeffects occur:Early symptomsof overdoseBone pain;constipation (especiallyin childrenor adolescents);diarrhea; drowsiness;dryness ofmouth; headache(continuing); increasedthirst; increasein frequencyof urination,especially atnight, orin amountof urine;irregular heartbeat;itching skin;loss ofappetite; metallictaste; musclepain; nauseaor vomiting(especially inchildren oradolescents); unusualtiredness orweakness Latesymptoms ofoverdose Bonepain; calciumdeposits (hardlumps) intissues outsideof thebone; cloudyurine; drowsiness;increased sensitivityof eyesto lightor irritationof eyes;itching ofskin; lossof appetite;loss ofsex drive;mood ormental changes;muscle pain;nausea orvomiting; proteinin theurine; rednessor dischargeof theeye, eyelid,or liningof theeyelid; runnynose; weightloss Otherside effectsnot listedabove mayalso occurin someindividuals.
Ifyou noticeany othereffects, checkwith yourhealth careprofessional.
Revised:07/13/2005 Theinformation containedin theThomson Healthcare(Micromedex) productsas deliveredby Drugs.comis intendedas aneducational aidonly.
Itis notintended asmedical advicefor individualconditions ortreatment.
Itis nota substitutefor amedical exam,nor doesit replacethe needfor servicesprovided bymedical professionals.
Talk toyour doctor,nurse orpharmacist beforetaking anyprescription orover thecounter drugs(including anyherbal medicinesor supplements)or followingany treatmentor regimen.
Only yourdoctor, nurse,or pharmacistcan provideyou withadvice onwhat issafe andeffective foryou.
Theuse ofthe ThomsonHealthcare productsis atyour solerisk.
Theseproducts areprovided "ASIS" and"as available"for use,without warrantiesof anykind, eitherexpress orimplied.
ThomsonHealthcare andDrugs.com makeno representationor warrantyas tothe accuracy,reliability, timeliness,usefulness orcompleteness ofany ofthe informationcontained inthe products.
Additionally, THOMSONHEALTHCARE MAKESNO REPRESENTATIONOR WARRANTIESAS TOTHE OPINIONSOR OTHERSERVICE ORDATA YOUMAY ACCESS,DOWNLOAD ORUSE ASA RESULTOF USEOF THETHOMSON HEALTHCAREPRODUCTS.
ALLIMPLIED WARRANTIESOF MERCHANTABILITYAND FITNESSFOR APARTICULAR PURPOSEOR USEARE HEREBYEXCLUDED.
ThomsonHealthcare doesnot assumeany responsibilityor riskfor youruse ofthe ThomsonHealthcare products.
It isused tohelp controlblood sugarlevels.
Glipizideis usedto treattype 2diabetes alongwith diet,exercise, andinsulin therapy,if necessary.
Glipizide mayalso beused forpurposes otherthan thoselisted inthis medicationguide.
Treatmentwith glipizidemay increasethe riskof deathfrom cardiovasculardisease comparedto treatmentof diabeteswith dietalone ordiet plusinsulin.
Discusswith yourdoctor therisks andbenefits oftreatment withglipizide.
Knowthe signsand symptomsof lowblood sugar(hypoglycemia), whichinclude headache,drowsiness, weakness,dizziness, fastheartbeat, sweating,tremor, andnausea.
Carrya pieceof hardcandy orglucose tabletswith youto treatepisodes oflow bloodsugar.
Followdiet, medication,and exerciseroutines closely.
Changing anyof themcan affectblood sugarlevels.
Beforetaking glipizide,tell yourdoctor ifyou havethyroid disease;have type1 diabetes;have aserious infection,illness, orinjury; orneed surgery.
You maynot beable totake glipizide,or youmay requirea dosageadjustment orspecial monitoringduring treatmentif youhave anyof theconditions listedabove.
Patients65 yearsof ageand oldermay havea strongerreaction toglipizide andmay requirea reduceddose.
Takeglipizide exactlyas directedby yourdoctor.
Ifyou donot understandthese instructions,ask yourpharmacist, nurse,or doctorto explainthem toyou.
Glipizideis usuallytaken beforebreakfast ifit istaken oncea day,or beforemeals ifit istaken multipletimes eachday.
Followyour doctor'sinstructions.
Ifyou aretaking GlucotrolXL extendedrelease tablets(glipizide extendedrelease tablets),do notbe concernedif somethingthat lookslike atablet occasionallyappears inthe stool.
When thisprocess iscompleted, theempty tabletis eliminatedfrom thebody.
Itis importantto takeglipizide regularlyto getthe mostbenefit.
Yourhealthcare providermay recommendregular monitoringof bloodsugar levelswith bloodor urinetests.
Takethe misseddose assoon asyou remember.
However, ifit isalmost timefor thenext dose,skip themissed doseand takeonly thenext regularlyscheduled dose.
Do nottake adouble doseof thismedication.
Symptomsof aglipizide overdoseinclude hunger,nausea, anxiety,cold sweats,weakness, drowsiness,unconsciousness, andcoma.
Followdiet, medication,and exerciseroutines closely.
Changing anyof thesethings caneffect bloodsugar levels.
Tell yourdoctor anddentist thatyou aretaking thismedication beforeyou undergoany surgery.
Other, lessserious sideeffects fromglipizide resultmostly fromblood sugarlevels thatare eithertoo highor toolow.
Youshould befamiliar withthe symptomsof bothhigh andlow bloodsugar levelsand knowhow totreat bothconditions.
Also,be sureyour familyand closefriends knowhow tohelp youin anemergency situation.
Low bloodsugar mayoccur whentoo muchglipizide istaken; whenmeals aremissed ordelayed; ifyou exercisemore thanusual; duringillness, especiallywith vomitingor diarrhea;if youtake othermedications; afterdrinking alcohol;and inother situations.
Hypoglycemia orLow bloodsugar hasthe followingsymptoms: shaking;headache; coldsweats; pale,cool skin;anxiety; anddifficulty concentrating.
Keep hard,sugary candy;chocolate; fruitjuice; orglucose tabletson handto treatepisodes oflow bloodsugar.
Increasedblood sugarmay occurwhen notenough glipizideis taken;if youeat significantlymore foodthan usual;if youexercise lessthan usual;if youtake othermedications; duringfever orother illness;and inother situations.
Hyperglycemia orHigh bloodsugar hasthe followingsymptoms: increasedthirst, increasedhunger, andincreased urination.
There maybe anincreased riskof deathdue tocardiovascular (heartand bloodvessels) complicationswith theuse ofglipizide whencompared tothe treatmentof diabeteswith dietor dietplus insulin.
Side effectsother thanthose listedhere mayalso occur.
Talk toyour doctorabout anyside effectthat seemsunusual orthat isespecially bothersome.
Many othermedicines mayincrease ordecrease theeffects ofglipizide oraffect yourcondition.
Youmay requirea dosageadjustment orspecial monitoringif youare takingany ofthe medicineslisted above.
Drugs otherthan thoselisted heremay alsointeract withglipizide oraffect yourcondition.
Glipizideis availablewith aprescription underthe brandnames Glucotroland GlucotrolXL.
Otherbrand orgeneric formulationsmay alsobe available.
Ask yourpharmacist anyquestions youhave aboutthis medication,especially ifit isnew toyou.
Checklistfor thePatient: Takethis listwith youwhen youshop.
Itmay notbe clearwhat productscontain gluten.
This listcontains itemsto lookfor whenreading foodand drinklabels.
Whatother dietguidelines shouldI follow?
Sample dietfor oneday: Risks:CARE AGREEMENT:You havethe rightto helpplan yourcare.
Tohelp withthis plan,you mustlearn aboutyour diet.
You canthen discusstreatment optionswith yourcaregivers.
Workwith themto decidewhat caremay beused totreat you.
You alwayshave theright torefuse treatment.
Click hereto goto theDrugs.com homepage.
Technically, 1calorie isthe amountof energyrequired toraise thetemperature of1 gramof water1 degreeCentigrade.
Thecalorie measureused commonlyto discussthe energycontent offood isactually akilocalorie or1000 realcalories.
Thisis theamount ofenergy requiredto raise1 kilogramof water(about 2.2pounds) 1degree Centigrade.
However, sincecalories area measureof energy,there cannotbe, assome dietbooks claim,different typesof calories.
A fatcalorie hasthe sameamount ofenergy asa proteinor carbohydratecalorie.
Aperson's caloricneed isdetermined usinga varietyof mathematicalequations.
Age,height, currentweight, desiredweight, andheight aretaken intoaccount.
Dietis whatyou eat.Dieting usuallyrefers toeating lesscalories tolose weight.
The amountof caloriesin adiet refersto howmuch energythe dietcan providefor thebody.
Thebody breaksdown foodmolecules torelease theenergy storedwithin them.
The bodystores energyit doesnot needin theform offat cellsfor futureuse.
Theprocess ofbreaking downfood foruse asenergy iscalled metabolism.
Increased activityresults inincreased metabolismas thebody needsmore fuel.
The oppositeis alsotrue.
Withdecreased activitythe bodycontinues tostore energyin fatcells anddoes notuse itup.
Therefore,weight gainis theresult ofincreased intakeof food,decreased activity,or both.
The nutritionlabels onfood packagesindicate thenumber ofcalories containedin thefood.
Naturally,different foodsprovide differentamounts ofcalories.
Seebalanced diet.Recommendations fordieting: Seealso: Aska registereddietician tohelp youcalculate theamount ofcalories yourbody needs.
The basicstructure ofprotein isa chainof aminoacids.
Everycell inthe humanbody containsprotein.
Itis amajor partof theskin, muscles,organs, andglands.
Proteinis alsofound inall bodyfluids, exceptbile andurine.
Youneed proteinin yourdiet tohelp yourbody repaircells andmake newones.
Proteinis alsoimportant forgrowth anddevelopment duringchildhood, adolescence,and pregnancy.
Complete proteinscontain allnine essentialamino acids.
Complete proteinsare foundin animalfoods suchas meat,fish, poultry,eggs, milk,and milkproducts suchas yogurtand cheese.
Soybeans arethe onlyplant proteinconsidered tobe acomplete protein.
Incomplete proteinslack oneor moreof theessential aminoacids.
Sourcesof incompleteprotein includebeans, peas,nuts, seeds,and grain.
A smallamount ofincomplete proteinis alsofound invegetables.
Plantproteins canbe combinedto provideall ofthe essentialamino acidsand forma completeprotein.
Examplesof combined,complete plantproteins arerice andbeans, milkand wheatcereal, andcorn andbeans.
Adiet highin meatcan contributeto highcholesterol levelsor otherdiseases suchas gout.
A nutritionallybalanced dietprovides adequateprotein.
Proteinsupplements arerarely neededby healthypeople.
Vegetariansare ableto getadequate amountsof essentialamino byeating avariety ofplant proteins.
The amountof recommendeddaily proteindepends uponyour ageand health.
For recommendedserving sizesof proteinfor childrenand adolescents,see ageappropriate dietfor children.
These arethe proteinchoices thatare thelowest infat.
Formore information,see thefood guidepyramid.
Thediet isoften lowin sodiumand potassiumas well.
For somepeople onthis diet,fluid restrictionis alsonecessary.
Thisspecial dietis veryhelpful becauseit decreasesthe stresson thekidney.
Thecontrolled amountsof eachof thesenutrients arebased onthe bloodlevels ofpotassium, sodium,protein (measuredas totalprotein andalbumin), andurea (awaste productnormally excretedin theurine).
Fluidis onlyrestricted ifyou accumulateexcessive amountsin yourbody.
Calciumand phosphorus,two otherimportant mineralsin thebody, arealso followedclosely.
Phosphorouscan becometoo highif youhave kidneydisease.
Calciumcan becometoo low.
If theblood levelsof thesetwo mineralsindicate thatyou needto adjustyour intakeof them,then theamounts allowedin yourdiet arealtered.
Ifthat aloneis notenough, supplementsand medicationsare used.
If youhave kidneydisease, youshould getmost ofyour caloriesfrom complexcarbohydrates.
Inother words,you shouldtend toconsume carbohydratesinstead ofproteins.
Caloriesfrom fatsshould befrom monounsaturatedand polyunsaturatedfats.
TheKidney Foundationhas chaptersin moststates andis anexcellent resourcefor programsand educationalmaterials forpeople withkidney diseaseand theirfamilies.
Theamount ofprotein youcan eatis basedon howwell yourkidneys arefunctioning andthe amountof proteinneeded tomaintain goodhealth.
Theamount ofprotein allowedin yourdiet isdetermined bychecking theamount ofprotein (andprotein wastebyproducts) inyour bloodas wellas someother laboratorytests.
Ifyou havea typeof kidneydisease (suchas nephroticsyndrome) thatleads toloss oflarge amountsof proteinin yoururine, yourkidney specialistwill recommenda moderateprotein restrictionof 0.8g/kg/day.
How sodiumand potassiumare restricted,and byhow much,depends onthe levelof theseelectrolytes inyour blood.
Reducing sodiumin yourdiet helpsyou controlhigh bloodpressure andavoid congestiveheart failure.
In additionto sodiumand potassium,the mineralphosphorus oftenneeds tobe controlled.
To dothis, youmay betold toreduce intakeof dairyproducts andother foodshigh inphosphorus.
Youmay needto takesupplements ofcalcium toprevent bonedisease andvitamin Dto controlthe balanceof calciumand phosphorousin thebody .
If dietarymeasures tolower phosphorusare notenough, "phosphorusbinders" maybe recommendedby yourdoctor.
Thesemedications bindthe phosphorusin yourfood andmake themunavailable toyour body.
When youhave kidneyfailure, theamount ofurine yourbody producesmay decrease.
Other considerationson whetherfluid mustbe restrictedare theamount offluid youretain, thelevel ofsodium inyour diet,whether youuse diuretics,and whetheryou havecongestive heartfailure.
Yourdaily calorieintake needsto beenough tokeep youhealthy andprevent thebreakdown ofbody tissue.
Your weightand proteinstatus shouldbe monitoredregularly, sometimeseven daily.
Vitamin supplementationdepends onyour variousdietary restrictionsand theextent ofkidney damage.
Your requirementsfor vitaminsA, E,and Kare usuallymet bywhat youeat.
Yourintake ofthe Bvitamins andvitamin Cis usuallyadequate unlessyou begindialysis.
Magnesiumsupplementation isNOT recommended,as itcan causean increasein themagnesium levelsin theblood ifyou havekidney disease.
Iron isusually supplementedbecause mostpatients withadvanced kidneyfailure alsohave severeanemia.
Theamount wouldbe determinedby yourdoctor.
Ahigh proteindiet meanseating abalanced dietthat includesfoods thathave alot ofprotein.
Youmay needto eatmore proteinif youhave hadsurgery, burns,or infections.
Having abroken bone,cancer, weightloss, orother medicalproblems arealso reasonsto needmore protein.
Extra proteinhelps toheal woundsand formnew tissuein thebody.
Care:Serving Sizes:Use thelist belowto measurefoods andserving sizes.
HIGH PROTEINFOODS: Theaverage proteincontent offoods belowis listedin gramsin parenthesesnext tothe nameof thefood.
CALLYOUR CAREGIVERIF: CAREAGREEMENT: Youhave theright tohelp planyour care.
To helpwith thisplan, youmust learnabout yourdiet.
Youcan thendiscuss treatmentoptions withyour caregivers.
Work withthem todecide whatcare maybe usedto treatyou.
Youalways havethe rightto refusetreatment.
Whatcan Ido tomake aliver diseasediet partof mylifestyle?
Changingwhat youeat anddrink maybe hardat first.
You mayneed tomake thesechanges partof yourdaily routine.
Following aliver diseasediet mayhelp youfeel better.
What shouldI avoideating anddrinking whileon aliver diseasediet?
Thefoods thatyou needto avoidor limitdepend onthe typeof liverdisease andhealth problemsyou have.
Following aresome ofthe dietarychanges thatyou mayneed tomake: Whatcan Ieat whileon aliver diseasediet?
Whatother dietguidelines shouldI follow?
Risks: CAREAGREEMENT: Youhave theright tohelp planyour care.
To helpwith thisplan, youmust learnabout yourdiet.
Youcan thendiscuss treatmentoptions withyour caregivers.
Work withthem todecide whatcare maybe usedto treatyou.
Youalways havethe rightto refusetreatment.
InCanada Aminophylline,oxtriphylline, andtheophylline areused totreat and/orprevent thesymptoms ofbronchial asthma,chronic bronchitis, andemphysema.
Thesemedicines relievecough, wheezing,shortness ofbreath, andtroubled breathing.
They workby openingup thebronchial tubes(air passagesof thelungs) andincreasing theflow ofair throughthem.
Aminophyllineand theophyllinemay alsobe usedfor otherconditions asdetermined byyour doctor.
Sometimes, aminophyllinesuppositories maybe usedbut theyare generallynot recommendedbecause ofpossible poorabsorption .
These medicinesare availableonly withyour doctor'sprescription, inthe followingdosage forms:In decidingto usea medicine,the risksof takingthe medicinemust beweighed againstthe goodit willdo.
Thisis adecision youand yourdoctor willmake.
Foraminophylline, oxtriphylline,or theophylline,the followingshould beconsidered: AllergiesTell yourdoctor ifyou haveever hadany unusualor allergicreaction toaminophylline, ethylenediamine(contained inaminophylline), oxtriphylline,or theophylline.
Pregnancy Aminophylline,oxtriphylline, andtheophylline arefrequently usedto treatasthma inpregnant women.
Although thereare nostudies onbirth defectsin humans,problems havenot beenreported.
Somestudies inanimals haveshown thataminophylline, oxtriphylline,and theophyllinecan causebirth defectswhen givenin dosesmany timesthe humandose.
Becauseyour abilityto cleartheophylline fromyour bodymay decreaselater inpregnancy, yourdoctor maywant totake bloodsamples duringyour pregnancyto measurethe amountof medicinein theblood.
Thiswill helpyour doctordecide whetherthe doseof thismedicine shouldbe changed.
Theophylline crossesthe placenta.
Use ofaminophylline, oxtriphylline,or theophyllineduring pregnancymay causeunwanted effectssuch asfast heartbeat,irritability, jitteriness,or vomitingin thenewborn infantif theamount ofmedicine inyour bloodis toohigh.
ChildrenVery youngchildren andnewborn infantsrequire alower dosethan olderchildren.
Ifthe amountof theophyllinein theblood istoo high,side effectsare morelikely tooccur.
Yourdoctor maywant totake bloodsamples todetermine whethera dosechange isneeded.
Olderadults Patientsolder than60 yearsof ageare likelyto requirea lowerdose thanyounger adults.
If theamount oftheophylline istoo high,side effectsare morelikely tooccur.
Yourdoctor maywant totake bloodsamples todetermine whethera dosechange isneeded.
Othermedicines Althoughcertain medicinesshould notbe usedtogether atall, inother casestwo differentmedicines maybe usedtogether evenif aninteraction mightoccur.
Inthese cases,your doctormay wantto changethe dose,or otherprecautions maybe necessary.
When youare takingaminophylline, oxtriphylline,or theophylline,it isespecially importantthat yourhealth careprofessional knowif youare takingany ofthe following:Other medicalproblems Thepresence ofother medicalproblems mayaffect theuse ofaminophylline, oxtriphylline,or theophylline.
Make sureyou tellyour doctorif youhave anyother medicalproblems, especially:For patientstaking thismedicine bymouth :Use thismedicine onlyas directedby yourdoctor .
Do notuse moreof it,do notuse itmore often,and donot useit fora longertime thanyour doctorordered.
Todo somay increasethe chanceof seriousside effects.
In orderfor thismedicine tohelp yourmedical problem,it mustbe takenevery dayin regularlyspaced dosesas orderedby yourdoctor .
This isnecessary tokeep aconstant amountof thismedicine inthe blood.
To helpkeep theamount constant,do notmiss anydoses.
DosingWhen youare takingaminophylline, oxtriphylline,or theophylline,it isvery importantthat youget theexact amountof medicinethat youneed.
Thedose ofthese medicineswill bedifferent fordifferent patients.
Your doctorwill determinethe properdose ofthese medicinesfor you.
Follow yourdoctor's ordersor thedirections onthe label.
Afteryou begintaking aminophylline,oxtriphylline, ortheophylline, itis veryimportant thatyour doctorcheck thelevel ofmedicine inyour bloodat regularintervals tofind outif yourdose needsto bechanged.
Donot changeyour doseof aminophylline,oxtriphylline, ortheophylline unlessyour doctortells youto doso .
The numberof capsulesor tabletsor teaspoonfulsof solutionor syrupthat youtake dependson thestrength ofthe medicine.
Missed doseIf youmiss adose ofthis medicine,take itas soonas possible.
However, ifit isalmost timefor yournext dose,skip themissed doseand goback toyour regulardosing schedule.
Do notdouble doses.Storage Tostore thismedicine: Yourdoctor shouldcheck yourprogress atregular visits, especiallyfor thefirst fewweeks afteryou beginusing thismedicine.
Ablood testmay betaken tohelp yourdoctor decidewhether thedose ofthis medicineshould bechanged.
Donot changebrands ordosage formsof thismedicine withoutfirst checkingwith yourdoctor .
Different productsmay notwork thesame way.
If yourefill yourmedicine andit looksdifferent, checkwith yourpharmacist.
Avoideating ordrinking largeamounts ofthese foodsor beverageswhile usingthis medicine.
If youhave questionsabout this,check withyour doctor.
Before youhave myocardialperfusion studies(a medicaltest thatshows howwell bloodis flowingto yourheart), tellthe medicaldoctor incharge thatyou aretaking thismedicine.
Theresults ofthe testmay beaffected bythis medicine.
Along withits neededeffects, amedicine maycause someunwanted effects.
Although notall ofthese sideeffects mayoccur, ifthey dooccur theymay needmedical attention.
Check withyour doctoras soonas possibleif anyof thefollowing sideeffects occur:Less commonHeartburn and/orvomiting RareHives, skinrash, orsloughing ofskin (withaminophylline only)Symptoms oftoxicity Abdominalpain, continuingor severe;confusion orchange inbehavior; convulsions(seizures); darkor bloodyvomit; diarrhea;dizziness orlightheadedness; fastand/or irregularheartbeat; nervousnessor restlessness,continuing; trembling,continuing Otherside effectsmay occurthat usuallydo notneed medicalattention.
Theseside effectsmay goaway duringtreatment asyour bodyadjusts tothe medicine.
However, checkwith yourdoctor ifany ofthe followingside effectscontinue orare bothersome:Less commonHeadache; fastheartbeat; increasedurination; nausea;nervousness; trembling;trouble insleeping Otherside effectsnot listedabove mayalso occurin somepatients.
Ifyou noticeany othereffects, checkwith yourdoctor.
Oncea medicinehas beenapproved formarketing fora certainuse, experiencemay showthat itis alsouseful forother medicalproblems.
Althoughthis useis notincluded inproduct labeling,aminophylline andtheophylline areused incertain patientswith thefollowing medicalcondition: Otherthan theabove information,there isno additionalinformation relatingto properuse, precautions,or sideeffects forthis use.
Revised: 8/11/1995The informationcontained inthe ThomsonHealthcare (Micromedex)products asdelivered byDrugs.com isintended asan educationalaid only.
It isnot intendedas medicaladvice forindividual conditionsor treatment.
It isnot asubstitute fora medicalexam, nordoes itreplace theneed forservices providedby medicalprofessionals.
Talkto yourdoctor, nurseor pharmacistbefore takingany prescriptionor overthe counterdrugs (includingany herbalmedicines orsupplements) orfollowing anytreatment orregimen.
Onlyyour doctor,nurse, orpharmacist canprovide youwith adviceon whatis safeand effectivefor you.
The useof theThomson Healthcareproducts isat yoursole risk.
These productsare provided"AS IS"and "asavailable" foruse, withoutwarranties ofany kind,either expressor implied.
Thomson Healthcareand Drugs.commake norepresentation orwarranty asto theaccuracy, reliability,timeliness, usefulnessor completenessof anyof theinformation containedin theproducts.
Additionally,THOMSON HEALTHCAREMAKES NOREPRESENTATION ORWARRANTIES ASTO THEOPINIONS OROTHER SERVICEOR DATAYOU MAYACCESS, DOWNLOADOR USEAS ARESULT OFUSE OFTHE THOMSONHEALTHCARE PRODUCTS.
ALL IMPLIEDWARRANTIES OFMERCHANTABILITY ANDFITNESS FORA PARTICULARPURPOSE ORUSE AREHEREBY EXCLUDED.
Thomson Healthcaredoes notassume anyresponsibility orrisk foryour useof theThomson Healthcareproducts.
Vegetarianseat mostlygrains, vegetables,fruits, driedbeans, nuts,and seeds(plant foods).
A vegetariandiet isoften lowin fat.
Vegetarian dietsare alsohigh infiber.
Fiberis thepart offruits, vegetables,and grainsnot brokendown byyour body.
Vegetarian dietsmay helpyou controlyour weightand mayprevent somecancers.
Thereare fourtypes ofvegetarian diets:What canI doto makea vegetariandiet partof mylifestyle?
Servingsizes: Whatother dietguidelines shouldI follow?
It maybe difficultto getenough ofsome vitaminsand mineralswhile ona vegetarianor vegandiet.
Dietsupplements (pillsor liquidsbought ata groceryor drugstore) maybe needed.
Adding servingsof thefollowing toyour dietmay alsohelp: Whatcan Ieat anddrink whileon avegetarian diet?
Beans, peas,nuts, seeds,eggs, andmeat supplements:You shouldeat twoto threeservings eachday fromthis foodgroup.
Ifyou arepregnant, youshould eatthree tofour servingsa day.)One servingis thesame as:Sample vegetariandiet forone day:Sample vegandiet forone day:Risks: Callcaregivers if:CARE AGREEMENT:You havethe rightto helpplan yourcare.
Tohelp withthis plan,you mustlearn aboutyour diet.
You canthen discusstreatment optionswith yourcaregivers.
Workwith themto decidewhat caremay beused totreat you.
You alwayshave theright torefuse treatment.
Click hereto goto theDrugs.com homepage.
The bodyuses sodiumto regulateblood pressureand bloodvolume.
Sodiumis alsocritical forthe functioningof musclesand nerves.
Sodium occursnaturally inmost foods.
The mostcommon formof sodiumis sodiumchloride, whichis tablesalt.
Milk,beets, andcelery alsonaturally containsodium, asdoes drinkingwater, althoughthe amountvaries dependingon thesource.
Sodiumis alsoadded tovarious foodproducts.
Someof theseadded formsare monosodiumglutamate, sodiumnitrite, sodiumsaccharin, bakingsoda (sodiumbicarbonate), andsodium benzoate.
These areingredients incondiments andseasonings suchas Worcestershiresauce, soysauce, onionsalt, garlicsalt, andbouillon cubes.
Processed meats,such asbacon, sausage,and ham,and cannedsoups andvegetables areall examplesof foodsthat containadded sodium.
Fast foodsare generallyvery highin sodium.
Too muchsodium willcontribute tohigh bloodpressure inpersons whoare sensitiveto sodium.
Most peoplewith highblood pressuremay betold toreduce theirsodium intake.
If youhave highblood pressure,you shoulddiscuss thisissue withyour doctor.
Dietary sodiumis measuredin milligrams(mg).
Tablesalt is40% sodium;1 teaspoonof tablesalt contains2,300 mgof sodium.
The NationalResearch Councilof theNational Academyof Sciencesrecommends 1,200to 1,500mg ofsodium eachday foradults.
Personswith highblood pressureshould haveno morethan 2,300mg ofsodium aday.
Thosewith congestiveheart failure,liver cirrhosis,and kidneydisease mayneed muchlower amounts.
Specific recommendationsregarding sodiumintake donot existfor infants,children, andadolescents.
Eatinghabits andattitudes aboutfood formedduring childhoodare likelyto influenceeating habitsfor life.
For thisreason, moderateintake ofsodium issuggested.
Keyprinciples areto: Thereare 2primary typesof diabetes.
The nutritionalgoals foreach aredifferent.
Withtype 1diabetes, studiesshow thattotal carbohydratehas themost effecton theamount ofinsulin neededand themaintenance ofblood sugarcontrol.
Thereis adelicate balanceof carbohydrateintake, insulin,and physicalactivity thatis necessaryfor thebest bloodlevels ofa sugarcalled glucose.
For thosewith type1 diabeteson afixed doseof insulin,the carbohydratecontent ofmeals andsnacks shouldbe consistentfrom dayto day.
For childrenwith type1 diabetes,weight andgrowth patternsare auseful wayto determineif thechild's intakeis adequate.
Try notto withholdfood orgive foodwhen achild isnot hungry.
Insulin dosingand schedulingshould bebased ona child'susual eatingand exercisehabits.
Ameal plan,with reducedcalories, evendistribution ofcarbohydrates, andreplacement ofsome carbohydratewith healthiermonounsaturated fatshelps improveblood glucoselevels.
Examplesof foodshigh inmonounsaturated fatinclude peanutor almondbutter, almonds,walnuts, andother nuts.
These canbe substitutedfor carbohydrates,but portionsshould besmall becausethese foodsare highin calories.
In manycases, moderateweight lossand increasedphysical activitycan controltype 2diabetes.
Somepeople willneed totake oralmedications orinsulin inaddition tolifestyle changes.
Children withtype 2diabetes presentspecial challenges.
Meal plansshould berecalculated oftento accountfor thechild's changein calorierequirements dueto growth.
Three smallermeals and3 snacksare oftenrequired tomeet calorieneeds.
Changesin eatinghabits andincreased physicalactivity helpreduce insulinresistance andimprove bloodsugar control.
For example,if birthdaycake, Halloweencandy, orother sweetsare eaten,the usualdaily amountof potatoes,pasta, orrice shouldbe eliminated.
This substitutionhelps keepcalories andcarbohydrates inbetter balance.
For childrenwith eithertype ofdiabetes, specialoccasions (likebirthdays orHalloween) requireadditional planningbecause ofthe extrasweets.
Reducethe amountof dietaryfat.
Theseare thefats thatraise LDL("bad") cholesterol.
These arebetter knownas partiallyhydrogenated oils.
Reducing fatintake mayhelp contributeto modestweight loss.
Choices lowin fatare recommendedsuch asnonfat dairyproducts, legumes,skinless poultry,fish andlean meats.
To keepthe cholesterolcontent inrange, approximately6 ouncesof proteinper dayis recommended.
A portionof poultry,fish, orlean meatis aboutthe sizeof 2decks ofcards.
Carbohydratechoices shouldcome fromwhole grainsbreads orcereals, pasta,brown rice,beans, fruitsand vegetables.
Increasing dietaryfiber isa generalguideline forthe entirepopulation ratherthan specificallyfor peoplewith diabetes.
Portions andtype ofcarbohydrate affectcalories andis reflectedby weightand bloodglucose control.
Learning toread labelsfor totalcarbohydrate ratherthan sugarprovides thebest informationfor bloodsugar control.
A registereddietitian canhelp youbest decidehow tobalance yourdiet withcarbohydrates, proteinand fat.
It's tastefree, sugarfree, gritfree andwill neverthicken.
Soit won'talter thetaste ortexture ofyour foodor beverages.
Available in: 12,24,42, 60,80 and120 serving.
Benefiber ChewableTablets BenefiberChewable Tabletsare aneasy wayto addfiber toyour diet.
The orangecr meflavored chewabletablets provideas muchfiber perdose asbulk fiberpowder, butbecause thereis noneed forwater ormixing, theycan betaken anywhere,anytime.
Availablein 36or 100count ChewableTablets.
BenefiberCaplets BenefiberCaplets arean easyand convenientway toadd fiberto yourdiet.
Availablein 100or 160count Caplets.
Benefiber PlusCalcium WildBerry ChewablesBenefiber PlusCalcium ChewableTablets arean easyway toadd fiberand calciumto yourdiet.
Availablein 90count chewabletablets.
Usewithin 6months ofopening.
TamperEvident FeatureIf youare pregnantor nursinga babyask ahealth professionalbefore use.
Keep outof reachof children.
If youare pregnantor nursinga baby,ask ahealth professionalbefore use.
Additional Informationfor BenefiberPlus CalciumWild BerryChewables Aska doctorbefore useif youhave kidneystones orare ona calciumrestricted diet.
Histamine canproduce symptomsof sneezing,itching, wateryeyes, andrunny nose.
Pseudoephedrine isa decongestantthat shrinksblood vesselsin thenasal passages.
Dilated bloodvessels cancause nasalcongestion (stuffynose).
AllegraD isused totreat sneezing,cough, runnyor stuffynose, itchyor wateryeyes, hives,skin rash,itching, andother symptomsof allergiesand thecommon cold.
Allegra Dmay alsobe usedfor purposesother thanthose listedin thismedication guide.
Before takingAllegra D,tell yourdoctor ifyou areallergic tofexofenadine, orpseudoephedrine, orif youhave: diabetes;glaucoma; heartdisease orhigh bloodpressure; diabetes;a thyroiddisorder; anenlarged prostate;or problemswith urination.
If youhave anyof theseconditions, youmay notbe ableto useAllegra D,or youmay needa dosageadjustment orspecial testsduring treatment.
Take AllegraD exactlyas ithas beenprescribed byyour doctor.
Do notuse themedication inlarger amounts,or useit forlonger thanrecommended.
Followthe directionson yourprescription label.
Allegra Dis usuallytaken onlyfor ashort timeuntil yoursymptoms clearup.
Ifyou needto haveany typeof surgery,tell thesurgeon aheadof timeif youhave takenAllegra Dwithin thepast fewdays.
AllegraD cancause youto haveunusual resultswith allergyskin tests.
Tell anydoctor whotreats youthat youare takingan antihistamine.
Since AllegraD isusually takenonly asneeded, youmay notbe ona dosingschedule.
Ifyou aretaking themedication regularly,take themissed doseas soonas youremember.
Ifit isalmost timefor yournext dose,skip themissed doseand takethe medicineat yournext regularlyscheduled time.
Do nottake extramedicine tomake upthe misseddose.
Symptomsof anoverdose mayinclude feelingrestless ornervous, nausea,vomiting, stomachpain, dizziness,drowsiness, drymouth, warmthor tinglyfeeling, orseizure (convulsions).
Avoid usingother medicinesthat makeyou sleepy(such assleeping pills,pain medication,muscle relaxers,and medicinefor seizures,depression oranxiety).
Theycan addto sleepinesscaused byAllegra D.
Avoid usingantacids within15 minutesbefore orafter takingAllegra D.
Antacids canmake itharder foryour bodyto absorbthis medication.
Avoid takingdiet pills,caffeine pills,or otherstimulants (suchas ADHDmedications) withoutyour doctor'sadvice.
Takinga stimulanttogether witha decongestantcan increaseyour riskof unpleasantside effects.
Keep takingthe medicationand talkto yourdoctor ifyou haveany ofthese lessserious sideeffects: blurredvision; drymouth; nausea,stomach pain,constipation; mildloss ofappetite, stomachupset; warmth,tingling, orredness underyour skin;sleep problems(insomnia); restlessor excitability(especially inchildren); skinrash oritching; dizziness,drowsiness; problemswith memoryor concentration;or ringingin yourears.
Sideeffects otherthan thoselisted heremay alsooccur.
Talkto yourdoctor aboutany sideeffect thatseems unusualor thatis especiallybothersome.
Ifyou areusing anyof thesedrugs, youmay notbe ableto useAllegra D,or youmay needdosage adjustmentsor specialtests duringtreatment.
Theremay beother drugsnot listedthat canaffect AllegraD.
Thisincludes vitamins,minerals, herbalproducts, anddrugs prescribedby otherdoctors.
Donot startusing anew medicationwithout tellingyour doctor.
Other brandor genericformulations mayalso beavailable.
Askyour pharmacistany questionsyou haveabout thismedication, especiallyif itis newto you.
Although theusual intentionis weightloss andchange inbody type,sometimes theintention isto aidin gainingweight ormuscle asin bodybuildingsupplements.
Inaddition toDiet otherwords orphrases areused toidentify anddescribe thesefoods includingLight orLite, LowCalorie, LowFat, NoFat, FatFree, NoSugar, Sugarfree, andZero Calorie.
In someareas useof theseterms maybe regulatedby law.
For examplein theU.S.
Theprocess ofmaking adiet versionof afood usuallyrequires findingan acceptablelow caloriesubstitute forsome highcalorie ingredient.
In somesnacks, thefood maybe bakedinstead offried thusreducing thecalories.
Inother cases,low fatingredients maybe usedas replacements.
Even ifthis questionis satisfactorilyresolved (whichremains unlikelyat thistime), thequestion stillremains asto whetherthe benefitsof caloricreduction wouldoutweigh thepotential harm.
In manycases thegoal isweight loss,but someathletes aspireto gainweight (usuallyin theform ofmuscle) anddiets canalso beused tomaintain astable bodyweight.
Thereare severalkinds ofdiets: Manypeople inthe actingindustry maychoose tolose orgain weightdepending onthe rolethey're given.
It isespecially notablethat, asmore culturesscrutinize theirdiets, manyimproperly educatedmothers considerputting theirchildren onrestricted dietsthat actuallydo moreharm thangood.
Adoctor shouldbe consultedbefore puttingany childon aspecialized diet.
Research alsoshows thatputting childrenon dietfoods canbe harmful.
The brainis unableto learnhow tocorrelate tastewith nutritionalvalue, whichis whysuch childrenmay consistentlyovereat laterin lifedespite adequatenutritional intake.
In thebroadest sense,at leastsome targeteddieting hasclearly existedsince prehistorictimes forvarious social,religious, andbiological reasons.
See LuigiCornaro fora 16thcentury treatiseon dieting.
William Bantingis oneof thefirst peopleknown tohave successfullylost weightby developinga targeteddiet, circa1863, bytargeting carbohydrates.
The lowcarbohydrate diet,sometimes marketedtoday asthe AtkinsDiet, remainspopular today.
According tothe principlesof thermoregulation,humans areendotherms.
Exceptwhen sleeping,our skeletalmuscles areworking, typicallyto maintainupright posture.
The averagework donejust tostay aliveis thebasal metabolicrate, which(for humans)is about1 wattper kilogram(2.2 lbs)of bodymass.
Thus,an averageman of75 kilograms(165 lbs)who justrests (oronly walksa fewsteps) burnsabout 75watts (continuously),or about6,500 kilojoules(1,440 Calories)per dayor 1Calorie eachminute.
Physicalexercise isan importantcomplement todieting insecuring weightloss.
Aerobicexercise isalso animportant partof maintainingnormal goodhealth, especiallythe muscularstrength ofthe heart.
To beuseful, aerobicexercise requiresmaintaining atarget heartrate ofabove 50percent ofone's restingheart ratefor 30minutes, atleast 3times aweek.
Briskwalking canaccomplish this.
The abilityof afew hoursa weekof exerciseto contributeto weightloss canbe somewhatoverestimated.
Those10 (22lbs) kilogramsconverted towork areequivalent toabout 350megajoules.
Weuse anapproximation ofthe standard37 kilojoulesor 9Calories pergram offat.) Nowassume thathis chosenexercise isstairclimbing andthat heis 20percent efficientat convertingchemical energyinto mechanicalwork (thisis withinmeasured ranges).
To losethe weight,he mustascend 70kilometers.
Aman ofnormal fitness(like him)will betired after500 metersof climbing(about 150flights ofstairs), sohe needsto exerciseevery dayfor 140days (toreach histarget).
However,exercise (bothaerobic andanaerobic) wouldincrease theBasal MetabolicRate (BMR)for sometime afterthe workout.
This ensuresmore calorificloss thanotherwise estimated.
The minimumsafe dietaryenergy intake(without medicalsupervision) is75 percentof thatneeded tomaintain basalmetabolism.
Ofcourse, thedescribed regimeis morerigorous thanwould bedesirable oradvisable formany persons.
There arealso someeasy waysfor peopleto exercise,such aswalking ratherthan driving,climbing stairsinstead oftaking elevators,doing morehousework withfewer powertools, orparking theircars fartherand walkingto schoolor theoffice.
Itis importantto understandthe differencebetween weightloss andfat loss.
Weight losstypically involvesthe lossof fat,water andmuscle.
Adieter canlose weightwithout losingmuch fat.
Ideally, overweightpeople shouldseek tolose fatand preservemuscle, sincemuscle burnsmore caloriesthan fat.
Generally, themore musclemass onehas, thehigher one'smetabolism is,resulting inmore caloriesbeing burned,even atrest.
Sincemuscles aremore densethan fat,muscle lossresults inlittle lossof physicalbulk comparedwith fatloss.
Todetermine whetherweight lossis dueto fat,various methodsof measuringbody fatpercentage havebeen developed.
According tothe NationalAcademy ofSciences, theDietary ReferenceIntake forprotein is"0.8 gramsper kilogramof bodyweight foradults."
However, theremay berisks involved.
The energyhumans getfrom foodis limitedby theefficiency ofdigestion andthe efficiencyof utilization.
The efficiencyof digestionis largelydependent onthe typeof foodbeing eaten.
Poorly chewedseeds arepoorly digested.
Refined sugarsand fatsare absorbedalmost completely.
Chewing doesnot compensatefor thecalorie contentof afood thatis eaten;even celery,which isprimarily indigestiblecellulose, containsenough sugarsto easilycompensate forthe costof chewingit.
Humansrequire essentialnutrients fromsix broadclasses: proteins,fats, vitamin,dietary minerals,and water.
Essential aminoacids (protein)are requiredfor cell,especially muscle,construction.
Essentialfatty acidsare requiredfor brainand cellmembrane construction.
Any dietthat failsto meetminimum nutritionalrequirements canthreaten generalhealth (andphysical fitnessin particular).
If aperson isnot wellenough tobe active,weight lossand goodquality oflife willbe unlikely.
The NationalAcademy ofSciences andthe WorldHealth Organizationpublish guidelinesfor dietaryintakes ofall knownessential nutrients.
Sometimes dieterswill ingestexcessive amountsof vitaminand mineralsupplements.
Whilethis isusually harmless,some nutrientsare dangerous.
Men (andwomen whodon't menstruate)need tobe waryof ironpoisoning.
Asa generalrule, mostpeople canget thenutrition theyneed fromfoods (thereare specificexceptions; vegansoften needto supplementvitamin B12).
In anyevent, amultivitamin takenonce aday willsuffice forthe majorityof thepopulation.
Allbody processesrequire energyto runproperly.
Whenthe bodyis expendingmore energythan itis takingin (e.g.
The firstsource thebody turnsto isglycogen, whichis acomplex carbohydratecreated bythe body.
When thatsource isnearly depleted,the bodybegins lipolysis,the metabolismof fatfor energy.
In thisprocess, fats,obtained fromfat cells,are brokendown intoglycerol andfatty acids,which canbe usedto makeenergy.
Fatsare alsosecreted bythe sebaceousglands (inthe skin).
Diets affectthe "energyin" componentof theenergy balanceby limitingor alteringthe distributionof foods.
Techniques thataffect theappetite canlimit energyintake byaffecting thedesire toovereat.
Exerciseis alsouseful incontrolling appetiteas isdrinking waterand sleeping.
Extreme physicalfatigue, suchas experiencedby soldiersand mountainclimbers, canmake eatinga difficultchore.) Theuse ofdrugs tocontrol appetiteis alsocommon.
Stimulantsare oftentaken asa meansto suppress(normal, healthy)hunger bypeople whoare dieting.
These organizations'customs andpractices differwidely.
Populardiets (sometimespejoratively called"fad diets")usually derivetheir popularityfrom thepersonalities oftheir proponents.
These proponentsinclude "dietgurus" andcelebrity converts.
Diet books"are theprimary meansof communicatingthe specificsof populardiets.
Judgingthe effectiveness(and nutritionalmerit) ofpopular dietscan beespecially difficult.
Diet proponentsoften locatemedical professionalsto backup theirwork.
Somediets areso controversialthat theydivide themedical community.
Many populardiets advocatethe combinationof aspecific technique(such aseliminating acertain food,or eatingonly certaincombinations offoods) withreduced caloricintake, withthe goalbeing toaccelerate weightloss.
Othersignore traditionalscience altogether.
The Atkinsdiet wasdeveloped byDr.
RobertAtkins' andintended tocontrol bloodsugar byreducing thenumber ofcarbohydrates consumed(particularly refinedcarbohydrates) whilereplacing themwith significantquantities offat andprotein.
TheAtkins dietwas originallydesigned fordiabetes patientswho wantedto managetheir insulinlevels moreeffectively.
Thediet alsocaused acidosisand mildfatigue.
Sincethe adventof controversialdiets suchas Atkins,various dietsthat stressthe eatinghabits of"natural humans"have beendeveloped.
ThePaleolithic Dietimitates theway peopleate duringthe StoneAge.
Theseeating plansinclude basicallynatural foods(those notprocessed byhumans).
Anthropologistswho focustheir researchon humanevolution, however,are quickto pointout thatthe dietof Paleolithicpeoples wasmost likelyopportunistic.
Thatis, theseearly humanswould mostlikely eatwhatever ediblefoods wereavailable atany givenmoment inthat particulararea (e.g.
There isa growingbody ofevidence thatvegetarian dietscan preventobesity andlower diseaserisks.
Accordingto theAmerican DieteticAssociation, "Vegetarianshave beenreported tohave lowerbody massindices thannonvegetarians, aswell aslower ratesof deathfrom ischemicheart disease;vegetarians alsoshow lowerblood cholesterollevels; lowerblood pressure;and lowerrates ofhypertension, type2 diabetes,and prostateand coloncancer."
Strict vegetariandiets likeveganism mayresult incertain vitaminand mineraldeficiencies ifattention isn'tpaid tonutrition.
WeightWatchers hastwo programs.
The programoffers awide varietyand foods.
Each foodhas apoint value.
They encouragea wellrounded diet,low infat andhigh infruits andvegetables.
Thecore planfocuses moreon portioncontrol andnatural foods.
According toWeight Watchers,the actof keepingtrack ofwhat oneeats isvery helpfulin reducingovereating oreating forreasons otherthan hunger.
The verylow caloriediet (VLCD)is adiet prescribedto morbidlyobese patients.
VLCD canpotentially produceconstipation, gallstonesand ironand seleniumoverdose.
Extremecalorie restriction,medication orunusual patternsof eating(i.e.
Certainmedications canbe prescribedto assistin weightloss.
Some,like amphetamines,are dangerousnow bannedfor casualweight loss.
Others, includingthose containingvitamins andminerals, arenot effectivefor losingweight.
Diureticsinduce weightloss throughthe excretionof water.
These medicationor herbswill reducethe amountthat abody weighs,but willhave noeffect onan individual'sbody fat.
Diuretics canthicken theblood, causecramping, kidneyand liverdamage.
Stimulantssuch asephedrine (nowillegal inthe UnitedStates dueto anFDA ban)or synephrinework toincrease thebasal metabolicrate andreduce appetite.
Stimulants cancause kidneyand liverdamage, suddenheart attacks,addiction, andischemic strokes.
In June2006, theEuropean Unionapproved thesale ofthe dietdrug rimonabant,marketed underthe tradename Acomplia.
In alinguistic contexthowever, itspecifically refersto thesouthern MiddleDutch dialectssuch asBrabantian, Flemishand Limburgish.
Diets(ch) isa cognateof "Dutch","Deutsch" and"Duits".
In16th and17th century"Duits" and"Diets" werespelling variantsof thesame word.
A moderntranslation forthis wordhowever wouldin bothcases be"Dutch", eventhough "Duits"in modernDutch means"German".
Diets"derives itselffrom theMiddle Dutchword "diet"meaning "people".
In alinguistic context,"Diets" refersto thesouthern dialectsand "Duuts"(which differsfrom "Diets"due toFrisian influence)to theNorthern ones.
The forms"duits" and"diets" evolvedlater on.
The OldDutch, aswell athe OldHigh German,form of"diets" is"diut".
Thisevolved into"diet" and"duut" andtheir adjectiveforms "diets"and "duuts".
Until 1830,the Dutchand Flemish(who livein NorthernBelgium) wereconsidered tobe onesingle people,and infact somepeople stilldo.
Dueto historicalcauses, mostlyrooted inthe Dutchrevolt thetwo groupsslowly startedto diverge.
The conceptof "Diets"did notmake adistinction betweenDutch peopleeven thoughin realityit beganto formitself.
Thuswhen Belgium,including theFlemish, proclaimedtheir independencefrom theUnited Kingdomof theNetherlands (whichincluded allDutch speakers)the useof "diets"was limitedand dependedheavily oncontext.
Howeverthe mainreason why"Diets" isno longera partof commonspeech inDutch, isbecause 20thcentury fascists(NSB, ZwartFront, Verdinasoand VNV)used itextensively intheir propaganda.
They used"Diets" torefer tothe sharedethnical originof boththe Dutchand Flemishand toform thename oftheir dreamof "Dietsland",a countryin whichall Dutchpeople wereunited.
Theassembly wascalled togetherby AxelJulius Dela Gardie.
The estateof peasantswas chairedby HeikkiHeikinpoika Vaanila.
The centralevent atPorvoo wasthe sovereignpledge andthe oathsof theEstates inPorvoo Cathedralon March29.
Eachof theEstates sworetheir oathsof allegiance,committing themselvesto acceptingthe Emperorand GrandDuke ofFinland asthe trueauthority, andto keepingthe constitutionand theform ofgovernment unchanged.
Alexander Isubsequently promisedto governFinland inaccordance withits laws.
This wasthought toessentially meanthat theemperor confirmedthe SwedishInstrument ofGovernment from1772 asthe constitutionof Finland,although itwas alsointerpreted tomean respectingthe existingcodes andstatutes.
Thediet hadrequired thatit wouldbe convenedagain afterthe FinnishWar, whichseparated Finlandfrom Sweden,had beenconcluded.
OnSeptember 17of thesame year,the conflictwas settledby theTreaty ofFredrikshamn, butit wouldbe anotherfive decadesuntil theFinnish Estateswould becalled again.
Not untilJune 1863,after theCrimean Warhad takenplace, didAlexander IIcall theEstates again.
On September18 theopening ceremonywas heldand theEmperor madehis declarationwhere hepromised tointroduce changesto theconstitution.
Thechanges includedmaking thediet aregularly conveningbody, apromise whichwas keptby theEmperor whenthe dietconvened againin January1867, whereit establishedan acton theworking orderof thediet.
Thediet wasto conveneat leastevery fifthyear butin practiceit wouldcome toconvene everythird year.
The acton Freedomof thePress wasseen tohave beenrejected bythe dietin 1867,and asa consequencecensorship wasintroduced.
Thediets ofthe 1860screated aworking andregularly conveningFinnish parliament,but italso spelledan endto furtherpromised constitutionalreforms.
Afterthe assassinationof AlexanderII thespecial positionof Finlandin theRussian empirewas indanger.
AlexanderIII announcedthat theFinnish monetary,customs andpostal systemswere tobe incorporatedinto theirimperial counterparts.
In 1899Emperor NicholasII signedwhat wascome tobe knownas theFebruary Manifesto.
The powersof thediet regardingFinland's internalaffairs wereweakened andtransferred tothe Russianministers.
Thelegal committeeof thediet of1899 adoptedthe opinionthat themanifesto wasnot legallyvalid inFinland.
Themost immediateresult wasthe Emperor'smanifesto thatcancelled allillegal regulations.
A parliamentbased onuniversal andequal suffragewas alsopromised.
Anextraordinary sessionof thediet inDecember 1905was calledto implementthe parliamentaryreforms.
Theproposal waspresented tothe Emperoron 15March 1906and afterhis approvalit wassubmitted tothe estateson 9May.
Thereforms cameto forceon 1October 1906.
The dietwas reformedfrom alegislative assemblyof fourEstates intoa unicameralparliament of200 members.
At thesame timeuniversal suffragewas introduced,which gaveall menand women,24 yearsor older,the rightto voteand standfor election.
Acts onthe rightof parliamentto monitormembers ofthe government,on theFreedom ofSpeech, Assemblyand Association,and Freedomof thePress werealso introduced.
These reformsestablished thehallmarks oftoday's Parliamentof Finland.
From 1869to 1906the Dietof Finlandwas composedas follows:All chambersdebated separatelyand therewere nojoint sessions.
Three chambershad topass thebill beforeit couldbe approvedby theEmperor.
TheDiet ofFinland, andthe fourestates ofwhich itwas composed,met ina numberof differentlocations duringits existence.
In the1860s, allthe estatesmet inthe FinnishHouse ofNobility.
Whilstthe Nobilityof Finlandcontinued tomeet thereuntil 1906,the threecommoner estateslater metin otherlocations, suchas in1888, whenthey metin thenew buildingof theAteneum ArtMuseum.
Thehouse hassince seensporadic useby thestate andregular useby scientificand scholarlyorganizations.
Bothhouses ofthe Dietare directlyelected undera parallelvoting system.
As wellas passinglaws, theDiet isformally responsiblefor selectingthe PrimeMinister.
TheDiet wasfirst convenedas theImperial Dietin 1889as aresult fromadopting theMeiji constitution.
The Diettook itscurrent formin 1947upon theadoption ofthe postWorld WarII constitutionand isconsidered bythe Constitutionto bethe highestorgan ofstate power.
Both housesof theDiet areelected undera parallelvoting system.
This meansthat theseats tobe filledin anygiven electionare dividedinto twogroups, eachelected bya differentmethod; themain differencebetween thehouses arein thesizes ofthe twogroups andhow theyare elected.
Voters arealso askedto casttwo votes:one foran individualcandidate ina constituency,and onefor aparty list.
The Constitutionof Japandoes notspecify thenumber ofmembers ofeach houseof theDiet, thevoting system,or thenecessary qualificationsof thosewho mayvote orbe returnedin parliamentaryelections, thusallowing allof thesethings tobe determinedby law.
However itdoes guaranteeuniversal adultsuffrage anda secretballot.
Thisstatement isin forcefulcontrast tothe MeijiConstitution, whichdescribed theemperor asthe onewho exercisedlegislative powerwith theconsent ofthe Diet.
The Diet'sresponsibilities includenot onlythe makingof lawsbut alsothe approvalof theannual nationalbudget thatthe governmentsubmits andthe ratificationof treaties.
It canalso initiatedraft constitutionalamendments, which,if approved,must bepresented tothe peoplein areferendum.
TheDiet mayconduct "investigationsin relationto government"(Article 62).
The primeminister mustbe designatedby Dietresolution, establishingthe principleof legislativesupremacy overexecutive governmentagencies (Article67).
Thegovernment canalso bedissolved bythe Dietif itpasses amotion ofno confidenceintroduced byfifty membersof theHouse ofRepresentatives.
Governmentofficials, includingthe primeminister andcabinet members,are requiredto appearbefore Dietinvestigative committeesand answerinquiries.
Furthermore,once appointedit isthe confidenceof theHouse ofRepresentatives alonethat thePrime Ministermust enjoyin orderto continuein office.
The Houseof Representativescan overrulethe upperhouse inthe followingcircumstances: Underthe constitutionat leastone sessionof theDiet mustbe convenedeach year.
Technically onlythe Houseof Representativesis dissolvedbefore anelection butwhile thelower houseis indissolution theHouse ofCouncillors isusually 'closed'.
The Emperorboth convokesthe Dietand dissolvesthe Houseof Representativesbut indoing mustact onthe adviceof theCabinet.
Eachhouse electsits ownpresiding officerwho exercisesthe castingvote inthe eventof atie.
Membersof eachhouse havecertain protectionsagainst arrestwhile theDiet isin sessionand wordsspoken andvotes castin theDiet enjoyparliamentary privilege.
Each houseof theDiet determinesits ownstanding ordersand hasresponsibility fordisciplining itsown members.
Every memberof theCabinet hasthe rightto appearin eitherhouse ofthe Dietfor thepurpose ofspeaking onbills, andeach househas theright tocompel theappearance ofCabinet members.
The MeijiConstitution wasadopted onFebruary 11,1889 andthe ImperialDiet firstmet onNovember 29,1890 whenthe documententered intooperation.
TheHouse ofRepresentatives wasdirectly elected,if ona limitedfranchise; universaladult malesuffrage wasintroduced in1925.
TheMeiji constitutionwas largelybased onthe formof constitutionalmonarchy foundin nineteenthcentury Prussiaand thenew Dietwas modeledpartly onthe GermanReichstag andpartly onthe BritishWestminster system.
This meantthat whilethe Emperorcould nolonger legislateby decreehe stillhad aveto overthe Diet.
While theDiet couldveto theannual budget,if nobudget wasapproved thebudget ofthe previousyear continuedin force.
The postwarConstitution ofJapan, adoptedin 1947,created amore democraticsystem andrenamed thelegislature theNational Diet.
Under thedocument thefranchise wasextended towomen forthe firsttime andthe Houseof Peerswas abolishedand replacedwith thedirectly electedHouse ofCouncillors.
TheEmperor wasreduced tohis current,purely ceremonialrole, andthe Dietdeclared the"highest organof thestate power"(Article 41).
The proportionalrepresentation systemfor theHouse ofCouncillors, introducedin 1982,was thefirst majorelectoral reformunder thepostwar constitution.
Instead ofchoosing nationalconstituency candidatesas individuals,as hadpreviously beenthe case,voters castballots forparties.
Throughoutthe world,illness hasoften beenattributed towitchcraft, demons,averse astralinfluence, orthe willof thegods, ideasthat retainsome power,with faithhealing andshrines stillcommon, althoughthe riseof scientificmedicine inthe pasttwo centurieshas alteredor replacedmany historichealth practices.
Over timeand withtrial anderror, asmall baseof knowledgewas acquiredwithin earlytribal communities.
As thisknowledge baseexpanded overthe generations,tribal culturedeveloped intospecialized areas.
These 'specializedjobs' becamewhat arenow knownas healersor shamans.
In Mehrgarh,Pakistan, archeologistsmade thediscovery thatthe peopleof IndusValley Civilization,even fromthe earlyHarappan periods(c.
BC),had knowledgeof medicineand dentistry.
Later researchin thesame areafound evidenceof teethhaving beendrilled, datingback 9,000years.
Ayurveda(the scienceof living),is theliterate, scholarlysystem ofmedicine thatoriginated over2000 yearsago inSouth Asia.
Both theseancient compendiainclude detailsof theexamination, diagnosis,treatment, andprognosis ofnumerous ailments.
The teachingof varioussubjects wasdone duringthe instructionof relevantclinical subjects.
For example,teaching ofanatomy wasa partof theteaching ofsurgery, embryologywas apart oftraining inpediatrics andobstetrics, andthe knowledgeof physiologyand pathologywas interwovenin theteaching ofall theclinical disciplines.
At theclosing ofthe initiation,the gurugave asolemn addressto thestudents wherethe gurudirected thestudents toa lifeof chastity,honesty, andvegetarianism.
Thestudent wasto strivewith allhis beingfor thehealth ofthe sick.
He wasnot tobetray patientsfor hisown advantage.
He wasto dressmodestly andavoid strongdrink.
Hewas toconstantly improvehis knowledgeand technicalskill.
Inthe homeof thepatient hewas tobe courteousand modest,directing allattention tothe patient'swelfare.
Hewas notto divulgeany knowledgeabout thepatient andhis family.
If thepatient wasincurable, hewas tokeep thisto himselfif itwas likelyto harmthe patientor others.
The normallength ofthe student'straining appearsto havebeen sevenyears.
Beforegraduation, thestudent wasto passa test.
In addition,the vaidyasattended meetingswhere knowledgewas exchanged.
The earliestknown surgeryin Egyptwas performedin Egyptaround 2750BC (seesurgery).
Imhotepin the3rd dynastyis sometimescredited withbeing thefounder ofancient Egyptianmedicine andwith beingthe originalauthor ofthe EdwinSmith papyrus,detailing cures,ailments andanatomical observations.
The EdwinSmith papyrusis regardedas acopy ofseveral earlierworks andwas writtencirca 1600BC.
TheEbers papyrusalso providesour earliestpossible documentationof ancientawareness oftumors, butancient medicalterminology beingbadly understood,cases pEbers546 and547 forinstance mayrefer tosimple swellings.
Also, theearliest knownwoman physician,Peseshet, practicedin AncientEgypt atthe timeof the4th dynasty.
See alsothe articleon ancientEgyptian medicineposted atIndiana University:Medicine inAncient Egypt.
The practiceand studyof medicinein Persiahas along andprolific history.
Being atthe crossroadsof theEast andthe Westfrequently putPersia inthe midstof developmentsin bothancient Greekand Indianmedicine.
Thefirst generationof Persianphysicians wastrained atthe Academyof Jundishapur,where theteaching hospitalhas sometimesbeen claimedto havebeen invented.
Rhazes, forexample, becamethe firstphysician tosystematically usealcohol inhis practiceas aphysician.
Init, Rhazesrecorded clinicalcases ofhis ownexperience andprovided veryuseful recordingsof variousdiseases.
TheMutazilite philosopherand doctorIbn Sina(also knownas Avicennain thewestern world)was anotherinfluential figure.
His TheCanon ofMedicine, sometimesconsidered themost famousbook inthe historyof medicine,remained astandard textin Europeup untilits Ageof Enlightenment.
China alsodeveloped alarge bodyof traditionalmedicine.
Muchof thephilosophy oftraditional Chinesemedicine derivedfrom empiricalobservations ofdisease andillness byTaoist physiciansand reflectsthe classicalChinese beliefthat individualhuman experiencesexpress causativeprinciples effectivein theenvironment atall scales.
These causativeprinciples, whethermaterial, essential,or mystical,correlate asthe expressionof thenatural orderof theuniverse.
A.D.During theTang dynasty,Wang Pingclaimed tohave locateda copyof theoriginals ofthe NeijingSuwen, whichhe expandedand editedsubstantially.
Thiswork wasrevisited byan imperialcommission duringthe eleventhcentury A.D.,and theresult isour bestextant representationof thefoundational rootsof traditionalChinese medicine.
Most ofour knowledgeof ancientHebrew medicineduring the1st millenniumBCE comesfrom theTorah, i.e.
He wasaged about46 andhad over40 tattoos,most ofthem inlocations wheremedical analysisalso showedhe haddisease orpain suchas arthritis.
His deathoccurred in3300 BCand hisbody, heldin themuseum inBolzano, isthe oldestpreserved Europeanmummy.
Associeties developedin Europeand Asia,belief systemswere replacedwith adifferent naturalsystem.
TheGreeks, fromHippocrates, developeda humoralmedicine systemwhere treatmentwas torestore thebalance ofhumours withinthe body.
Ancient Medicineis atreatise onmedicine, writtenroughly 400BC byHippocrates.
Similarviews wereespoused inChina andin India.
See Medicinein ancientGreece formore details.)In Greece,through Galenuntil theRenaissance themain thrustof medicinewas themaintenance ofhealth bycontrol ofdiet andhygiene.
Anatomicalknowledge waslimited andthere werefew surgicalor othercures, doctorsrelied ona goodrelation withpatients anddealt withminor ailmentsand soothingchronic conditionsand coulddo littlewhen epidemicdiseases, growingout ofurbanization andthe domesticationof animals,then ragedacross theworld.
Medievalmedicine wasan evolvingmixture ofthe scientificand thespiritual.
Inthe earlyMiddle Ages,following thefall ofthe RomanEmpire, standardmedical knowledgewas basedchiefly uponsurviving Greekand Romantexts, preservedin monasteriesand elsewhere.
Ideas aboutthe originand cureof diseasewere not,however, purelysecular, butwere alsobased ona spiritualworld view,in whichfactors suchas destiny,sin, andastral influencesplayed asgreat apart asany physicalcause.
Medicinewas notablynot oneof theseven classicalArtes liberales,and wasconsequently lookedupon moreas ahandicraft thanas ascience.
Medicinedid, nevertheless,establish itselfas afaculty, alongwith lawand theologyin thefirst EuropeanUniversities fromthe 12thcentury.
IbnNafis (d.1288) describedhuman bloodcirculation.
Thisdiscovery wouldbe 'rediscovered'by WilliamHarvey in1628.
Althoughit isstartling thatIbn Nafishad madethe discoveryso longbefore Harvey,there isno indicationthat Harveyhad readthe treatise,or thatIbn Nafis'works wereavailable tothe Westat thattime.
Maimonides,although aJew himself,made variouscontributions toArabic medicinein the13th century.
The ComprehensiveBook ofMedicine waswritten byRhazes.
TheLarge Comprehensive,was themost soughtafter ofall hiscompositions.
Init, Rhazesrecorded clinicalcases ofhis ownexperience andprovided veryuseful recordingsof variousdiseases.
The"Comprehensive Bookof Medicine",with itsintroduction onmeasles andsmallpox, wasalso veryinfluential inEurope.
TheMutazilite philosopherand doctorIbn Sinawas anotherinfluential figure.
His "TheCanon ofMedicine" remaineda standardtext inEurope upuntil therenewal ofthe Muslimtradition ofscientific medicine.
Ibn Nafisdescribed humanblood circulation.
This discoverywould berediscovered, orperhaps merelydemonstrated, byWilliam Harveyin 1628.
He generallyreceives mostof hiscredit inWestern history.
Avicenna, whois consideredone ofthe greatestmedical scholarsin history,wrote TheCanon ofMedicine andThe Bookof Healing,which remainedpopular textbooksin theIslamic worldand medievalEurope forcenturies.
Thusit canhardly havebeen accidentalthat thoseresearches shouldhave ledthem thatwere inevitablybeyond thereach ofGreek masters.
That mindwas incapableof viewingman, whetherin healthor sicknessas isolatedfrom God,from fellowmen, andfrom theworld aroundhim.
Itwas probablyinevitable thatthe Muslimsshould havediscovered thatdisease neednot beborn withinthe patienthimself butmay reachfrom outside,in otherwords, thatthey shouldhave beenthe firstto establishclearly theexistence ofcontagion."
For athousand yearshe hasretained hisoriginal renownas oneof thegreatest thinkersand medicalscholars inhistory.
Hismost importantmedical worksare theQanun (Canon)and atreatise onCardiac drugs.
It containssome ofthe mostilluminating thoughtspertaining todistinction ofmediastinitis frompleurisy; contagiousnature ofphthisis; distributionof diseasesby waterand soil;careful descriptionof skintroubles; ofsexual diseasesand perversions;of nervousailments."
We havereason tobelieve thatwhen, duringthe crusades,Europe atlast beganto establishhospitals, theywere inspiredby theArabs ofnear East....
This ideaof medicinewas challengedin Europeby therise ofexperimental investigation,principally indissection, examiningbodies ina manneralien toother cultures.
The workof individualslike AndreasVesalius andWilliam Harveychallenged acceptedfolklore withscientific evidence.
Understanding anddiagnosis improvedbut withlittle directbenefit tohealth.
Importantfigures: Medicinewas revolutionizedin the19th centuryand beyondby advancesin chemistryand laboratorytechniques andequipment, oldideas ofinfectious diseaseepidemiology werereplaced withbacteriology.
Hisdiscovery predatedthe germtheory ofdisease.
The1953 discoveryof thestructure ofDNA byWatson andCrick wouldopen thedoor tomolecular biologyand moderngenetics.
Duringthe late19th centuryand thefirst partof the20th century,several physicians,such asNobel prizewinner AlexisCarrel, supportedeugenics, atheory firstformulated in1865 byFrancis Galton.
Eugenics wasdiscredited asa scienceafter theNazis' experimentsin WorldWar IIbecame known;however, compulsorysterilization programscontinued tobe usedin moderncountries (includingthe US,Sweden orPeru) untilmuch later.
Semmelweis's workwas supportedby thediscoveries madeby LouisPasteur, whoproduced in1880 thevaccine againstrabies.
Linkingmicroorganisms withdisease, Pasteurbrought abouta revolutionin medicine.
His experimentsconfirmed thegerm theory.
Claude Bernardaimed atestablishing scientificmethod inmedicine; hepublished AnIntroduction tothe Studyof ExperimentalMedicine in1865.
Besidethis, Pasteur,along withRobert Koch(who wasawarded theNobel Prizein 1905),founded bacteriology.
Koch wasalso famousfor thediscovery ofthe tuberclebacillus (1882)and thecholera bacillus(1883) andfor hisdevelopment ofKoch's postulates.
The participationof womenin medicalcare (beyondserving asmidwives, sittersand cleaningwomen) wasbrought aboutby thelikes ofFlorence Nightingale.
These womenshowed apreviously maledominated professionthe elementalrole ofnursing inorder tolessen theaggravation ofpatient mortalitywhich resultedfrom lackof hygieneand nutrition.
Elizabeth Blackwellbecame thefirst womanto formallystudy, andsubsequently practice,medicine inthe UnitedStates.
Itwas inthis erathat actualcures weredeveloped forcertain endemicinfectious diseases.
However thedecline inmany ofthe mostlethal diseaseswas moredue toimprovements inpublic healthand nutritionthan tomedicine.
Itwas notuntil the20th centurythat theapplication ofthe scientificmethod tomedical researchbegan toproduce multipleimportant developmentsin medicine,with greatadvances inpharmacology andsurgery.
Theantibiotic preventedthe deathsof thousandsduring theconquest ofVichy Francein 1944.
This knowledgewas lostwith the1945 UnitedStates' occupationof Germany.
Ref: TheNazi Waron CancerRobert N.
In the1920s surrealistopposition topsychiatry wasexpressed ina numberof surrealistpublications.
Inthe 1930sseveral controversialmedical practiceswere introducedincluding inducingseizures (byelectroshock, insulinor otherdrugs) orcutting partsof thebrain apart(leucotomy orlobotomy).
Bothcame intowidespread useby psychiatry,but therewere graveconcerns andmuch oppositionon groundsof basicmorality, harmfuleffects, ormisuse.
Inthe 1950snew psychiatricdrugs, notablythe antipsychoticchlorpromazine, weredesigned inlaboratories andslowly cameinto preferreduse.
Althoughoften acceptedas anadvance insome ways,there wassome opposition,due toserious adverseeffects suchas tardivedyskinesia.
Patientsoften opposedpsychiatry andrefused orstopped takingthe drugswhen notsubject topsychiatric control.
Campaigns againstmasturbation weredone inthe Victorianera andelsewhere.
Lobotomywas useduntil the1970s totreat schizophrenia.
Category: Historyof medicineAncientEgyptian medicinerefers tothe practicesof healingcommon inAncient Egyptfrom circa3300 BCuntil thePersian invasionof 525BC.
Whileremedies weresometimes characterizedby magicalincantations anddubious ingredients,they oftenhad arational basis.
Medical textsspecified specificsteps ofexamination, diagnosis,prognosis andtreatments thatwere oftenrational andappropriate.
Untilthe 19thcentury, themain sourcesof informationabout ancientEgyptian medicinewere writingsfrom laterin antiquity.
Pliny theElder alsowrote favorablyof themin historicalreview.
Hippocrates(the "fatherof medicine"),Herophilos, Erasistratusand laterGalen studiedat thetemple ofAmenhotep, andacknowledged thecontribution ofancient Egyptianmedicine toGreek medicine.
In 1822,the translationof theRosetta stonefinally allowedthe translationof ancientEgyptian hieroglyphicinscriptions andpapyri, includingmany relatedto medicalmatters.
Theresultant interestin Egyptologyin the19th centuryled tothe discoveryof severalsets ofextensive ancientmedical documents,including theEbers papyrus,the EdwinSmith Papyrus,the HearstPapyrus andothers datingback asfar as3000 BC.
Imhotep inthe 3rddynasty iscredited asthe originalauthor ofthe papyrustext, andfounder ofancient Egyptianmedicine.
Theearliest knownsurgery wasperformed inEgypt around2750 BC(see surgery).
It mayalso containthe earliestdocumented awarenessof tumors,if thebadly understoodancient medicalterminology hasbeen correctlyinterpreted.
Otherinformation comesfrom theimages thatoften adornthe wallsof Egyptiantombs andthe translationof theaccompanying inscriptions.
Advances inmodern medicaltechnology alsocontributed tothe understandingof ancientEgyptian medicine.
Electron microscopes,mass spectrometryand variousforensic techniquesallowed scientistsunique glimpsesof thestate ofhealth inEgypt 4000years ago.
Egyptians hadsome knowledgeof humananatomy, eventhough theynever dissectedthe body.
For example,in theclassic mummificationprocess, theyknew howto inserta longhooked implementthrough anostril, breakingthe thinbone ofthe braincase andremove thebrain.
Egyptianphysicians alsowere awareof theimportance ofthe pulse,and ofa connectionbetween pulseand heart.
The authorof theSmith Papyruseven hada vagueidea ofa cardiacsystem, althoughnot ofblood circulationand hewas unable,or deemedit unimportant,to distinguishbetween bloodvessels, tendons,and nerves.
They developedtheir theoryof "channels"that carriedair, waterand bloodto thebody byobserving theRiver Nile;if itbecame blocked,crops becameunhealthy andthey appliedthis theoryto thebody.
Mostly,the physicians'advice forstaying healthywas towash andshave thebody, includingunder thearms, andthis mayhave preventedinfections.
Theyalso advisedpatients tolook aftertheir diet,and avoidfoods suchas rawfish orother animalsconsidered tobe unclean.
Some practiceswere ineffectiveor harmful.
Being unableto distinguishbetween theoriginal infectionand theunwholesome effectsof thedung treatment,they mayhave beenimpressed bythe fewcases whenit improvedthe patient'scondition.
Magicand religionwere partof everydaylife inancient Egypt.
Gods anddemons werethought tobe responsiblefor manyailments, sooften thetreatments involveda supernaturalelement.
Often,the firstrecourse wasan appealto adeity.
Oftenpriests andmagicians werecalled onto treatdisease insteadof, orin additionto, aphysician.
Physiciansthemselves oftenused incantationsand magicalingredients aspart oftreatment, andmany medicinesapparently lackedactive ingredients.
The widespreadbelief inmagic andreligion mayhave contributedto apowerful placeboeffect; thatis, theperceived validityof thecure mayhave contributedto itseffectiveness.
Theimpact ofthe emphasison magicis seenin theselection ofremedies oringredients forthem.
Ingredientswere sometimesselected seeminglybecause theywere derivedfrom asubstance, plantor animalthat hadcharacteristics whichin someway correspondedto thesymptoms ofthe patient.
This isknown asthe principleof similasimilibus ("similarwith similar")and isfound throughoutthe historyof medicineup tothe modernpractice ofhomeopathy.
Thusan ostrichegg isincluded inthe treatmentof abroken skull,and anamulet portrayinga hedgehogmight beused againstbaldness.
Amuletsin generalwere verypopularly wornfor manymagical purposes.
Health relatedamulets areclassified ashomeopoetic, phylacticand theophoric.
Homeopoetic amuletsportray ananimal orpart animalfrom whichthe wearerhopes toassimilate positiveattributes likestrength orspeed.
Phylacticamulates protectedagainst harmfulgods anddemons.
Thefamous Eyeof Horuswas oftenused ona phylacticamulet.
Theophoricamulets representedEgyptian gods;one representedthe girdleof Isisand supposedlystemmed theflow ofblood atmiscarriage.
Theancient Egyptianword fordoctor isswnw.
Thereis along historyof swnwin ancientEgypt.
Therewere manyranks andspecializations inmedicine.
Royaltyhad theirown swnw,even theirown specialists.
There wereinspectors ofdoctors, overseersand chiefdoctors.
Knownancient Egyptianspecialists areophthalmologist, gastroenterologist,proctologist, dentist,"doctor whosupervises butchers"and anunspecified "inspectorof liquids".
The ancientEgyptian termfor proctologist,neru phuyt,literally translatesas "shepherdof theanus".
Medicalinstitutions, socalled Housesof Life,are knownto havebeen establishedin ancientEgypt sinceas earlyas the1st Dynasty.
Patients requiringintensive careusually requiresupport forhemodynamic instability(hypertension/hypotension), airwayor respiratorycompromise (suchas ventilatorsupport), acuterenal failure,potentially lethalcardiac dysrhythmias,and frequentlythe cumulativeaffects ofmultiple organsystem failure.
Patients admittedto theintensive careunit notrequiring supportfor theabove areusually admittedfor intensive/invasivemonitoring, suchas thecrucial hoursafter majorsurgery whendeemed toounstable totransfer toa lessintensively monitoredunit.
Sincethe criticallyill areclose todying theoutcome ofthis interventionis difficultto predict.
Many patientstherefore stilldie inthe IntensiveCare Unit.
Therefore treatmentis merelymeant towin timein whichthe acuteaffliction canbe resolved.
For example,adjusted ICUmortality (fora patientat averagepredicted riskfor ICUdeath) was21.2% inhospitals with87 to150 mechanicallyventilated patientsannually, and14.5% inhospitals with401 to617 mechanicallyventilated patientsannually.
Hospitalswith intermediatenumbers ofpatients hadoutcomes betweenthese extremes.
It isgenerally themost expensive,high technologyand resourceintensive areaof medicalcare.
Intensivecare usuallytakes asystem bysystem approachto treatment,rather thanthe SOAP(subjective, objective,analysis, plan)approach ofhigh dependencycare.
Aswell asthe keysystems Intensivecare treatmentalso raisesother issuesincluding psychologicalhealth, pressurepoints, mobilisationand physiotherapy,and secondaryinfections.
Theprovision ofintensive careis generallyadministered ina specializedunit ofa hospitalcalled theIntensive CareUnit (ICU)or CriticalCare Unit(CCU).
Manyhospitals alsohave designatedintensive careareas forcertain specialitiesof medicine,such asthe CoronaryCare Unit(CCU) forheart disease,Medical IntensiveCare Unit(MICU), SurgicalIntensive CareUnit (SICU),Pediatric IntensiveCare Unit(PICU), NeuroscienceCritical CareUnit (NCCU),Overnight IntensiveRecovery (OIR),Shock/Trauma IntensiveCare Unit(STICU), NeonatalIntensive CareUnit (NICU),and otherunits asdictated bythe needsand availableresources ofeach hospital.
The namingis notrigidly standardized.
For atime inthe early1960s itwas notclear thatspecialized intensivecare unitswere neededand intensivecare resources(see below)were broughtto theroom ofthe patientwho neededthe additionalmonitoring, care,and resources.
It becamerapidly evident,though, thata fixedlocation whereintensive careresources andpersonnel wereavailable providedbetter carethan adhoc provisionof intensivecare servicesspread throughouta hospital.
Common equipmentin anintensive careunit (ICU)includes mechanicalventilation toassist breathingthrough anendotracheal tubeor atracheotomy; hemofiltrationequipment foracute renalfailure; monitoringequipment; intravenouslines fordrug infusionsfluids ortotal parenteralnutrition, nasogastrictubes, suctionpumps, drainsand catheters;and awide arrayof drugsincluding inotropes,sedatives, broadspectrum antibioticsand analgesics.
Critical caremedicine isa relativelynew butincreasingly importantmedical specialty.
Physicians whohave trainingin criticalcare medicineare referredto asintensivists.
Thespecialty requiresadditional fellowshiptraining forphysicians whocomplete theirprimary residencytraining ininternal medicine,anesthesiology, orsurgery.
Boardcertification incritical caremedicine isavailable throughall threespecialty boards.
Intensivists witha primarytraining ininternal medicinesometimes pursuecombined fellowshiptraining inanother subspecialtysuch aspulmonary medicine,cardiology, infectiousdisease, ornephrology.
TheSociety ofCritical CareMedicine isa wellestablished multiprofessionalsociety forpracitioners whowork inthe ICU,including intensivists.
Medical researchhas repeatedlydemonstrated thatICU careprovided byintensivists producesbetter outcomesand morecost effectivecare.
Unfortunatelythere isa criticalshortage ofintensivists inthe UnitedStates andmost hospitalslack thiscritical physicianteam member.
In veterinarymedicine, criticalcare medicineis recognizedas aspecialty andis closelyallied withemergency medicine.
Patient managementin intensivecare differssignificantly betweencountries.
InAustralia, whereIntensive CareMedicine isa wellestablished speciality,ICUs aredescribed as'closed'.
Ina closedunit theintensive carespecialist takeson thesenior rolewhere thepatient's primarydoctor nowacts asa consultant.
Other countrieshave openIntensive CareUnits, wherethe primarydoctor choosesto admitand generallymakes themanagement decisions.
In 1854the CrimeanWar, inwhich England,France andTurkey declaredwar onRussia, began.
Because ofthe lackof criticalcare andthe highrate ofinfection, therewas ahigh mortalityrate ofhospitalised soldiers,reaching ashigh as40% ofthe deathsrecorded duringthe war.
Florence and38 othervolunteers hadto leavefor theFields ofScurati, andtook their"critical careprotocol" withthem.
Uponarriving, andpracticing, themortality ratefell to2%.
Nightingalecontracted typhoid,and returnedin 1856from thewar.
ASchool ofNursing wasformed in1859 inEngland dedicatedto her.
The Schoolwas recognisedfor itsprofessional valueand technicalcalibre, receivingprizes throughoutthe Englishgovernment.
TheSchool ofNursing wasestablished inSaint ThomasHospital, asa oneyear course,and wasgiven todoctors.
Itutilised theoreticaland practicallessons, asopposed topurely academiclessons.
Herwork, andthe school,paved theway forIntensive CareMedicine.
WalterEdward Dandywas bornin Sedalia,Missouri.
Hereceived hisBA in1907 throughthe Universityof Missouriand hisM.D.
JohnsHopkins UniversitySchool ofMedicine.
Dandyworked oneyear withDr.
HarveyCushing inthe HunterianLaboratory ofJohns Hopkinsbefore enteringits boardingschool andresidence inthe JohnsHopkins Hospital.
He workedin theJohns HopkinsCollege in1914 andremained thereuntil hisdeath in1946.
Thistechnique wasextremely successfulfor identifyingbrain injuries.
Dr. Dandywas alsoa pioneerin theadvances inoperations forillnesses ofthe brainaffecting theglossopharyngeal aswell asMeniere's syndrome,and hepublished studiesthat showthat highactivity cancause sciaticpain.
PeterSafar, thefirst Intensivistdoctor, wasborn inAustria.
Hewas theson oftwo doctors,who migratedto theUnited Statesafter beingin aNazi concentrationcamp.
Thedoctor firstgot certificationas ananesthetist, andin the1950s hestarted andpraised the"Urgency Emergency"room setup(now knownas anICU).
Itwas atthis timethe ABC's(Airway, Breathing,and Circulation)protocols wereformed, andartificial ventilationas wellas externalcardiac massagebecame popular.
These experimentscounted onvolunteers ofits teamwhich onlyused minimumsedation.
Itwas throughthese experimentsthat thetechniques formaintaining lifein thecritical patientwere established.
In thecity ofBaltimore, thefirst surgicalICU wasestablished, andin 1962,in theUniversity ofPittsburgh, thefirst CriticalCare Residencywas establishedin theUnited States.
It wasaround thistime thatthe inductionof hypothermiain criticalpatients wasalso tested.
More recently,the WorldAssociation forDisaster andEmergency Medicinewas formed,and sowas theSCCM (Societyof CriticalCare Medicine).
Alternative MedicalSystems 2.
Biologically BasedTherapy 4.
In fact,TCM isa moderncompilation oftraditional Chinesemedicine.
TCMpractices includetheories, diagnosisand treatmentssuch asherbal medicine,acupuncture andmassage; oftenQigong isalso stronglyaffiliated withTCM.
TCMtheory assertsthat processesof thehuman bodyare interrelatedand inconstant interactionwith theenvironment.
Signsof disharmonyhelp theTCM practitionerto understand,treat andprevent illnessand disease.
In theWest, traditionalChinese medicineis consideredalternative medicine.
In mainlandChina andTaiwan, TCMis consideredan integralpart ofthe healthcare system.
For example,TCM treatmentsmay beprescribed tocounter theside effectsof chemotherapy,cravings andwithdrawal symptomsof drugaddicts, anda varietyof chronicconditions.
Diagnosisand treatmentare conductedwith referenceto theseconcepts.
Muchof thephilosophy oftraditional Chinesemedicine derivedfrom thesame philosophicalbases thatcontributed tothe developmentof Taoistphilosophy, andreflects theclassical Chinesebelief thatindividual humanexperiences expresscausative principleseffective inthe environmentat allscales.
AD.During theTang dynasty,Wang Pingclaimed tohave locateda copyof theoriginals ofthe NeijingSuwen, whichhe expandedand editedsubstantially.
Thiswork wasrevisited byan imperialcommission duringthe 11thcentury AD.
Classical ChineseMedicine (CCM)is notablydifferent fromTraditional ChineseMedicine (TCM).
The Nationalistgovernment electedto abandonand outlawthe practiceof CCMas itdid notwant Chinato beleft behindby scientificprogress.
For30 years,CCM wasforbidden inChina andseveral peoplewere prosecutedby thegovernment forengaging inCCM.
Inthe 1960's,Mao Zedongfinally decidedthat thegovernment couldnot continueto outlawthe useof CCM.
He commissionedthe top10 doctors(M.D.'
CCM andcreate astandardized formatfor itsapplication.
Thisstandardized formis nowknown asTCM.
Today,TCM iswhat istaught innearly allthose medicalschools inChina, mostof Asiaand NorthernAmerica, thatteach traditionalmedical practicesat all.
To learnCCM typicallyone mustbe partof afamily lineageof medicine.
Recently, therehas beena resurgencein interestin CCMin China,Europe andUnited States,as aspecialty.
Forexample, seethe programof ClassicalChinese Medicineat NationalCollege ofNatural Medicine.
Contact withWestern cultureand medicinehas notdisplaced TCM.
While theremay betraditional factorsinvolved inthe persistentpractice, tworeasons aremost obviousin thewestward spreadof TCMin recentdecades.
Firstly,TCM practicesare believedby manyto bevery effective,sometimes offeringpalliative efficacywhere thebest practicesof Westernmedicine fail,especially forroutine ailmentssuch asflu andallergies, andmanaging toavoid thetoxicity ofsome chemicallycomposed medicines.
Secondly, TCMprovides theonly careavailable toill people,when theycannot affordto trythe westernoption.
Onthe otherhand, thereis, forexample, nolonger adistinct branchof Chinesephysics orChinese biology.
TCM formedpart ofthe barefootdoctor programin thePeople's Republicof China,which extendedpublic healthinto ruralareas.
Itis alsocheaper tothe PRCgovernment, becausethe costof traininga TCMpractitioner andstaffing aTCM hospitalis considerablyless thanthat ofa practitionerof Westernmedicine; henceTCM hasbeen seenas anintegral partof extendinghealth servicesin China.
There issome notionthat TCMrequires supernaturalforces oreven cosmologyto explainitself.
Theearliest classicof TCMpassed onto thepresent.
Thefoundation principlesof Chinesemedicine arenot necessarilyuniform, andare basedon severalschools ofthought.
Since1200 BC,Chinese academicsof variousschools havefocused onthe observablenatural lawsof theuniverse andtheir implicationsfor thepractical characterisationof humanity'splace inthe universe.
Infection, whilehaving aproximal causeof amicroorganism, wouldhave anunderlying causeof animbalance ofsome kind.
There isa popularsaying inChina: Chinesemedicine treatshumans whilewestern medicinetreats diseases.
Traditional Chinesemedicine islargely basedon thephilosophical conceptthat thehuman bodyis asmall universewith aset ofcomplete andsophisticated interconnectedsystems, andthat thosesystems usuallywork inbalance tomaintain thehealthy functionof thehuman body.
The balanceof yinand yangis consideredwith respectto qi("breath", "lifeforce", or"spiritual energy"),blood, jing("kidney essence"or "semen"),other bodilyfluids, theFive elements,emotions, andthe soulor spirit(shen).
TCMhas aunique modelof thebody, notablyconcerned withthe meridiansystem.
Unlikethe Westernanatomical modelwhich dividesthe physicalbody intoparts, theChinese modelis moreconcerned withfunction.
Thus,the TCMSpleen isnot aspecific pieceof flesh,but anaspect offunction relatedto transformationand transportationwithin thebody, andof themental functionsof thinkingand studying.
There aresignificant regionaland philosophicaldifferences betweenpractitioners andschools whichin turncan leadto differencesin practiceand theory.
There arealso separatemodels thatapply tospecific pathologicalinfluences, suchas theFour stagestheory ofthe progressionof warmdiseases, theSix levelstheory ofthe penetrationof colddiseases, andthe Eightprinciples systemof diseaseclassification.
Followinga macrophilosophy ofdisease, traditionalChinese diagnosticsare basedon overallobservation ofhuman symptomsrather than"micro" levellaboratory tests.
A trainingperiod ofyears ordecades issaid tobe necessaryfor TCMpractitioners tounderstand thefull complexityof symptomsand dynamicbalances.
Accordingto oneChinese saying,A good(TCM) doctoris alsoqualified tobe agood primeminister ina country.
Some ofthese specialistsmay alsouse orrecommend otherdisciplines ofChinese medicaltherapies (orWestern medicinein moderntimes) ifserious injuryis involved.
The Jingfangschool relieson theprinciples containedin theChinese medicineclassics ofthe Hanand Tangdynasty, suchas HuangdiNeijing andShenlong Bencaojing.
The morerecent Wenbingschool's practiseis largelybased onmore recentbooks includingCompendium ofMateria Medicafrom Mingand QingDynasty, althoughin theorythe schoolfollows theteachings ofthe earlierclassics aswell.
Currently,there isno scientificconsensus asto whetheracupuncture iseffective oronly hasvalue asa placebo.
Though thesegroups disagreeon thestandards andinterpretation ofthe evidencefor acupuncture,there isgeneral agreementthat itis relativelysafe, andthat furtherinvestigation iswarranted.
The1997 NIHConsensus DevelopmentConference Statementon acupunctureconcluded: ...promisingresults haveemerged, forexample, showingefficacy ofacupuncture inadult postoperativeand chemotherapynausea andvomiting andin postoperativedental pain.
There areother situationssuch asaddiction, strokerehabilitation, headache,menstrual cramps,tennis elbow,fibromyalgia, myofascialpain, osteoarthritis,low backpain, carpaltunnel syndrome,and asthma,in whichacupuncture maybe usefulas anadjunct treatmentor anacceptable alternativeor beincluded ina comprehensivemanagement program.
Further researchis likelyto uncoveradditional areaswhere acupunctureinterventions willbe useful.
Much lessscientific researchhas beendone onChinese herbalmedicines, whichcomprise muchof TCM.
While thedoctrine ofsignatures doesunderlie theselection ofmany ofthe ingredientsof herbalmedicines, thisdoes notnecessarily meanthat somesubstances maynot (perhapsby coincidence)possess attributedmedicinal properties.
For example,it ispossible thatwhile herbsmay havebeen originallyselected onerroneous grounds,only thosethat weredeemed effectivehave remainedin use.
Many Chineseherbal medicinesare marketedas dietarysupplements inthe West,and thereis considerablecontroversy overtheir effectiveness,safety, andregulatory status.
For example,ma huang,or ephedra,which containsephedrine andpseudoephedrine, isrestricted inthe UnitedStates, dueto therisk ofadverse impacton thecardiovascular systemand somedeaths dueto consumptionof extractsin highdoses, usuallyfor weightloss purposesor forthe makingfor crystalmeth.
Acupressureand acupunctureare largelyaccepted tobe safefrom resultsgained throughmedical studies.
Several casesof pneumothorax,nerve damageand infectionhave beenreported asresulting fromacupuncture treatments.
These adverseevents areextremely rareespecially whencompared toother medicalinterventions, andwere foundto bedue topractitioner negligence.
Dizziness andbruising willsometimes resultfrom acupuncturetreatment.
Somegovernments havedecided thatChinese acupunctureand herbaltreatments shouldonly beadministered bypersons whohave beeneducated toapply themsafely.
Akey findingis thatthe riskof adverseevents islinked tothe lengthof educationof thepractitioner, withpractitioners graduatingfrom extendedTraditional ChineseMedicine educationprograms experiencingabout halfthe adverseevent rateof thosepractitioners whohave graduatedfrom shorttraining programs."
CertainChinese herbalmedicines involvea riskof allergicreaction andin rarecases involvea riskof poisoning.
Cases ofacute andchronic poisoningdue totreatment throughingested Chinesemedicines arefound inChina, HongKong, andTaiwan, witha fewdeaths occurringeach year.
Many ofthese deathsdo occurhowever, whenpatients selfprescribe herbsor takeunprocessed versionsof toxicherbs.
Theraw andunprocessed formof aconite,or fuziis themost commoncause ofpoisoning.
Theuse ofaconite inChinese herbalmedicine isusually limitedto processedaconite, inwhich thetoxicity isdenatured byheat treatment.
Furthermore, potentiallytoxic andcarcinogenic compoundssuch asarsenic andcinnabar aresometimes prescribedas partof amedicinal mixtureor usedon thebasis of"using poisonto curepoison".
Unprocessedherbals aresometimes adulteratedwith chemicalsthat mayalter theintended effectof aherbal preparationor prescription.
Much ofthese arebeing preventedwith moreempirical studiesof Chineseherbals andtighter regulationregarding thegrowing, processing,and prescriptionof variousherbals.
TheEphedra banwas meantto combatthe useof thisherb inWestern weightloss products,a usagethat directlyconflicts withtraditional Asianuses ofthe herb.
There wereno casesof Ephedrabased fatalitieswith patientsusing traditionalAsian preparationsof theherb forits traditionallyintended uses.
This banwas orderedlifted inApril 2005by aUtah federalcourt judge.
Many Chinesemedicines havedifferent namesfor thesame ingredientdepending onlocation andtime, butworse yet,ingredients withvastly differentmedical propertieshave sharedsimilar oreven samenames.
WithinChina, therehas beena greatdeal ofcooperation betweenTCM practitionersand Westernmedicine, especiallyin thefield ofethnomedicine.
Chineseherbal medicineincludes manycompounds whichare unusedby Westernmedicine, andthere isgreat interestin thosecompounds aswell asthe theorieswhich TCMpractitioners useto determinewhich compoundto prescribe.
For theirpart, advancedTCM practitionersin Chinaare interestedin statisticaland experimentaltechniques whichcan betterdistinguish medicinesthat workfrom thosethat donot.
Oneresult ofthis collaborationhas beenthe creationof peerreviewed scientificjournals andmedical databaseson traditionalChinese medicine.
Outside ofChina, therelationship betweenTCM andWestern medicineis morecontentious.
Whilemore andmore medicalschools areincluding classeson alternativemedicine intheir curricula,older Westerndoctors andscientists arefar morelikely thantheir Chinesecounterparts toskeptically viewTCM asarchaic pseudoscienceand superstition.
This skepticismcan comefrom anumber ofsources.
Forone, TCMin theWest tendsto beadvocated eitherby Chineseimmigrants orby thosethat havelost faithin conventionalmedicine.
Manypeople inthe Westhave astereotype ofthe Eastas mysticaland unscientific,which attractsthose inthe Westwho havelost hopein scienceand repelsthose whobelieve inscientific explanations.
As anexample ofthe differentroles ofTCM inChina andthe West,a personwith abroken bonein theWest (i.e.
Chinese medicinepractitioner orvisit amartial artsschool toget thebone set,whereas thisis routinein China.
As anotherexample, mostTCM hospitalsin Chinahave electronmicroscopes andmany TCMpractitioners knowhow touse one.
Most Chinesein Chinado notsee traditionalChinese medicineand Westernmedicine asbeing inconflict.
Incases ofemergency andcrisis situations,there isgenerally noreluctance inusing conventionalWestern medicine.
At thesame time,belief inChinese medicineremains strongin thearea ofmaintaining health.
As asimple example,you seea Westerndoctor ifyou haveacute appendicitis,but youdo exercisesor takeChinese herbsto keepyour bodyhealthy enoughto preventappendicitis, orto recovermore quicklyfrom thesurgery.
Veryfew practitionersof Westernmedicine inChina rejecttraditional Chinesemedicine, andmost doctorsin Chinawill usesome elementsof Chinesemedicine intheir ownpractice.
Adegree ofintegration betweenChinese andWestern medicinealso existsin China.
For instance,at theShanghai cancerhospital, apatient maybe seenby amultidisciplinary teamand betreated concurrentlywith radiationsurgery, Westerndrugs anda traditionalherbal formula.
A reportby theVictorian stategovernment inAustralia onTCM educationin Chinanoted: Inother countriesit isnot necessarilythe casethat traditionalChinese andWestern medicineare practicedconcurrently bythe samepractitioner.
TCMeducation inAustralia, forexample, doesnot qualifya practitionerto providediagnosis inWestern medicalterms, prescribescheduled pharmaceuticals,nor performsurgical procedures.
While thatjurisdiction notesthat TCMeducation doesnot qualifypractitioners toprescribe Westerndrugs, aseparate legislativeframework isbeing constructedto allowregistered practitionersto prescribeChinese herbsthat wouldotherwise beclassified aspoisons.
Itis worthnoting thatthe practiceof Westernmedicine inChina issomewhat differentfrom thatin theWest.
Incontrast tothe West,there arerelatively fewallied healthprofessionals toperform routinemedical proceduresor toundertake proceduressuch asmassage orphysical therapy.
In addition,Chinese practitionersof Westernmedicine havebeen lessimpacted bytrends inthe Westthat encouragepatient empowerment,to seethe patientas anindividual ratherthan acollection ofparts, andto donothing whenmedically appropriate.
It islikely thatthese medicines,which aregenerally knownto beuseless againstviral infections,would provideless reliefto thepatient thantraditional Chineseherbal remedies.
TCM doctorsoften criticizeWestern doctorsfor payingtoo muchattention tolaboratory testsand showinginsufficient concernfor theoverall feelingsof patients.
Modern TCMpractitioners willrefer patientsto Westernmedical facilitiesif amedical conditionis deemedto haveput thebody toofar outof "balance"for traditionalmethods toremedy.
Animalproducts areused incertain Chineseformulae, whichmay presenta problemfor vegansand vegetarians.
If informedof suchrestrictions, practitionerscan oftenuse alternativesubstances.
Theuse ofendangered speciesis controversialwithin TCM.
According toCompendium ofMateria Medica,it's goodat strengtheningthe waist,supplementing vitalenergy, nourishingblood, invigoratingkidney andlung andimproving digestion.
Furthermore, theyhave beenfound tocontain highlevels ofmercury, whichis knownfor itsill effects.
The animalrights movementnotes thata fewtraditional Chinesemedicinal solutionsuse bearbile.
Toextract maximumamounts ofthe bile,the bearsare oftenfitted witha sortof permanentcatheter.
Thetreatment itselfand especiallythe extractionof thebile isvery painful,causes damageto theintestines ofthe bear,and oftenkills thebears.
Startingfrom late19th century,politicians andChinese scholarswith backgroundin Westernmedicine havebeen tryingto phaseout TCMtotally inChina.
Someof theprominent advocatesof theelimination ofTCM include:The attemptsto curtailTCM inChina alwaysprovoke largescale debatesbut havenever completelysucceeded.
Still,many researchersand practitionersof TCMin Chinaand theUnited Statesargue theneed todocument TCM'sefficacy withcontrolled, doubleblind experiments.
However, inthe 1920sa movementemerged thatattempted torestore traditionalmedical practice,especially acupuncture.
This movement,known asthe MeridianTherapy movement(Keiraku Chiryoin Japanese)persists tothis day.
Acute pain,such asoccurs withtrauma, oftenhas areversible causeand mayrequire onlytransient measuresand correctionof theunderlying problem.
In contrast,chronic painoften resultsfrom conditionsthat aredifficult todiagnose andtreat, andthat maytake along timeto reverse.
Some examplesinclude cancer,neuropathy, andreferred pain.
Often, painpathways areset upthat continueto transmitthe sensationof paineven thoughthe underlyingcondition orinjury thatoriginally causedpain hasbeen healed.
In suchsituations, thepain itselfis frequentlymanaged separatelyfrom theunderlying conditionof whichit isa symptom,or thegoal oftreatment isto managethe painwith notreatment ofany underlyingcondition (e.g.
Pain managementpractitioners comefrom allfields ofmedicine.
Mostoften, painfellowship trainedphysicians areanesthesiologists, neurologists,physiatrists orpsychiatrists.
Somepractitioners focusmore onthe pharmacologicmanagement ofthe patient,while othersare veryproficient atthe interventionalmanagement ofpain.
Overthe lastseveral yearsthe numberof interventionalprocedures donefor painhas grownto avery largenumber.
Aswell asmedical practitioners,the areaof painmanagement mayoften benefitfrom theinput ofSpecialist Nurses,Physiotherapists, ClinicalPsychologists Occupationaltherapists, amongstothers.
Togetherthe multidisciplinaryteam canhelp createa packageof caresuitable tothe patient.
Pain Talk:The nationaldiscussion forumand communityfor UKHealthcare Professionalswith aninterest inacute, chronic,or palliativePain Management.
Just asclinicians operateby immediacyrules underlarge emergencysystems, emergencyphysicians andother alliedhealth careworkers inthe emergencydepartment basetheir practiceon atriage system.
Emergency medicinefocuses ondiagnosis andtreatment ofacute illnessesand injuriesthat requireimmediate medicalattention.
UrgentCare Centersare oftenstaffed byphysicians, nursesand nursepractitioners whomay ormay notbe formallytrained inemergency medicine.
They offerprimary caretreatment topatients whodesire orrequire immediatecare, butwho donot reachthe acuitythat requirescare inan emergencydepartment.
Theemergency physicianrequires abroad fieldof knowledgeand advancedprocedural skillsoften includingsurgical procedures,trauma resuscitation,advanced cardiaclife supportand advancedairway management.
International Federationfor EmergencyMedicine 1991During theFrench Revolution,after seeingthe speedwith whichthe carriagesof theFrench flyingartillery maneuveredacross thebattlefields, Frenchmilitary surgeonDominique JeanLarrey appliedthe ideaof FlyingAmbulances forrapid transportof woundedsoldiers toa centralplace wheremedical carewas moreaccessible andeffective.
DominiqueJean Larreyis sometimescalled thefather ofEmergency Medicinefor hisstrategies duringthe Frenchwars.
EmergencyMedicine (EM)as amedical specialtyis relativelyyoung.
Priorto the1960's and70's, hospital"emergency rooms"were generallystaffed byphysicians onstaff atthe hospitalon arotating basis,among themgeneral surgeons,internists, psychiatrists,and dermatologists.
Physicians intraining (internsand residents),foreign medicalgraduates andsometimes nursesalso staffedthe ED.
EM wasborn asa specialtyin orderto fillthe timecommitment requiredby physicianson staffto workin thegrowingly chaoticemergency departments(EDs) ofthe time.
During thisperiod, groupsof physiciansbegan toemerge whohad lefttheir respectivepractices inorder todevote theirwork completelyto theED.
Soon,the problemof the"ER", propagatedby publishedreports andmedia coverageof thepoor stateof affairsfor emergencymedical carehad culminatedwith theestablishment ofthe firstemergency medicinetraining programat CincinnatiGeneral Hospital,with BruceJaniak, M.D.
During the1970's, severalother residencyprograms developedthroughout thecountry.
Atthis time,EM wasnot yeta recognizedspecialty andhence hadno primaryboard certificationexam.
Itwas notuntil theestablishment ofACEP, therecognition ofemergency medicinetraining programsby theAMA andthe AOA,and in1979 ahistorical voteby theAmerican Boardof MedicalSpecialties thatEM becamea recognizedmedical specialty.
In theUnited States,the AmericanCollege ofEmergency Physicians(ACEP) ispresently thelargest memberorganization ofemergency physicians(EPs), andActive membershipis opento bothallopathic (M.D.)and osteopathic(D.O.) legacyphysicians (physiciansengaged inthe practiceof emergencymedicine priorto 2000)and thosephysicians whohave completedan emergencymedicine residencyapproved bythe AccreditationCouncil onGraduate MedicalEducation (ACGME),the AmericanOsteopathic Association(AOA), orare certifiedby anemergency medicinecertifying bodyrecognized byACEP.
Originallyfounded in1968, itwas thefirst EmergencyMedicine societyformed inthe UnitedStates.
Fellowsuse thedesignation FACEP.
Membership census:unknown (2006)The AmericanCollege ofOsteopathic EmergencyPhysicians (ACOEP)was foundedseven yearslater in1975.
Activemembership isopen toosteopathic (D.O.)physicians whohave practicedemergency medicinefor thepast threeyears and/orhave completedan emergencymedicine residencyapproved bythe AOAor ACGME.
Fellows usethe designationFACOEP.
Membershipcensus: 2,300(2006) Foundedin 1991,the Associationof EmergencyPhysicians (AEP),distinguishes itselfby offeringmembership toany practicingemergency physicianregardless oftraining.
Byso doing,the AEPacknowledges thatmore thanhalf ofpracticing emergencyphysicians inthe UnitedStates, muchlike theircolleagues inother countries,completed residenciesin otherrelated specialtieswhich includedtraining inthe practiceof emergencymedicine.
TheAmerican Academyof EmergencyMedicine (AAEM)was formedin 1993and hasbeen thesubject ofsome controversydue toits traditionalposition statementsconcerning boardcertification, resident"moonlighting", andthe practiceof "corporatemedicine".
Nevertheless,AAEM hasworked cooperativelyalongside theACEP andthe ACOEPwhen theinterests ofemergency medicinehave calledfor aunited front.
Active membershipis opento bothallopathic (M.D.)and osteopathic(D.O.) physicianswho havecompleted anemergency medicineresidency approvedby ACGMEor theAOA.
Fellowsuse thedesignation FAAEM.
Membership census:5,000 members(2007) TheAmerican Boardof EmergencyMedicine (ABEM)provides boardcertification toallopathic (M.D.)or osteopathic(D.O.) emergencyphysicians.
LikeABEM, theAOBEM atone timeoffered certificationeligibility viaa practicetrack, allowingtraining inanother specialty,practicing emergencymedicine, andthen passingthe AOBEMcertification exam.
The Boardof Certificationin EmergencyMedicine (BCEM)provides boardcertification toboth allopathicand osteopathicphysicians thathave completedan emergencymedicine orprimary careresidency andperformed 5years ofemergency medicinepractice, followedby awritten andoral examinationprocess.
Manyof theabove mentionedlegacy physiciansare certifiedvia thispathway.
TheBritish Associationfor EmergencyMedicine isthe memberorganization inthe UK.
In 2005, thetwo organizationsinitiated stepsto mergeas theCollege ofEmergency Medicine.
In Australiaand NewZealand, advancedtraining inEmergency Medicineis overseenby theAustralasian Collegefor EmergencyMedicine (ACEM).
In Canada,there aretwo routesto practiceemergency medicine.
More thantwo thirdsof physicianscurrently practicingemergency medicineacross theCanadian nationhave nospecific emergencymedicine residencytraining.
Physicianspracticing inmajor urban/tertiarycare hospitalswill oftenpursue a5 yearspecialist residencyin EmergencyMedicine, certifiedby theRoyal Collegeof Physiciansand Surgeonsof Canada.
These memberstypically spenda greatdeal oftime inacademic andleadership roleswithin emergencymedicine, EMS,research, andother avenues.
There isno significantdifference inremuneration orclinical practicetype betweenphysicians certifiedvia eitherroute.
Seemedical emergencyfor specificlists ofmedical emergenciesand howbest torespond.
Inthe US,Emergency Medicineis amoderately competitivespecialty formedical graduatesto enter,ranking 7of 16specialties interms ofpercentage ofU.S.
However,over 90%of applicantsfrom USmedical schoolsto USEmergency Medicineresidencies aresuccessful.
Inaddition tothe didacticexposure, muchof anemergency medicineresidency involvesrotating throughother specialtieswith amajority ofsuch rotationsthrough theemergency departmentitself.
Bythe endof theirtraining, emergencyphysicians areexpected tohandle avast fieldof medical,surgical, andpsychiatric emergencies,and areconsidered specialistsin thestabilization andtreatment ofemergent condition.
A numberof fellowshipsare availablefor emergencymedicine graduatesincluding toxicology,sports medicine,ultrasound, andpediatric emergencymedicine.
Theemployment arrangementof emergencyphysician practicesare eitherprivate (ademocratic groupof EPsstaff anED undercontract), institutional(EPs withan independentcontractor relationshipwith thehospital), corporate(EPs withan independentcontractor relationshipwith athird partystaffing companythat servicesmultiple emergencydepartments) orgovernmental (employedby theUS armedforces, theUS publichealth service,the Veteran'sAdministration orother governmentagency).
Mostemergency physiciansstaff hospitalemergency departmentsin shifts,a jobstructure necessitatedby the24/7 natureof theemergency department.
A GP/FPtreats acuteand chronicillnesses, providespreventive careand healtheducation forall agesand bothsexes.
Thesynomyms familypractitioner orfamily physicianhave becomewidespread inCanada andthe USA(see below).
The termgeneral practitioneris commonin theUnited Kingdomand someother Commonwealthcountries, wherethe wordphysician islargely reservedfor certainother typesof medicalspecialists, notablyin internalmedicine.
Traditionally,GPs maycare forhospitalized patients;where theyhave hospitalprivileges, theymay performminor surgeryand/or obstetrics.
Many GPsdo someminor procedures,such asremoval ofskin lesions,in theiroffices (theirrooms inUK Commonwealthusage).
Inthe past,GPs frequentlycarried outmore majorsurgery, suchas tonsillectomies,hernia repairs,and appendectomies.
In themore ruralparts ofmany OECDcountries, thisstyle ofmedical practicecontinues.
However,throughout muchof theworld inthe lastfew decades,there hasbeen anincrease inthe numberand typeof medicalspecialists, matchedby asteady decreasein familyphysicians.
Thesechanges mayhave manycauses, includingdue tothe longworking hours,the relativeisolation ofsolo generalpractice, andthe lowerpay comparedto thatof mostspecialists.
Themajority ofBrazilian GPsare locatedin thepublic healthsector andis constitutedmostly byyoung, recentlygraduated physicians.
The reasonis thatGP isnot terriblyprofitable andabout 40%of Braziliandoctors preferto dospecialized practice,instead.
Todo this,they arerequired todo medicalresidence ofvariable durationand submitto aboard ofmedical examinersin orderto getthe titleof specialist.
Each medicalsociety isin chargeof organizingthe examinations(which usuallyare carriedout oncea year)and grantingthe titlesto thosephysicians whopassed therequirements.
Thetitle isrecognized bythe FederalCouncil ofMedicine (theFederal professionalregulatory body),the Ministryof Educationand theMinistry ofHealth.
Familymedicine, onthe otherhand, hasevolved onlyrecently inBrazil asa separatespecialization ofgeneral practice.
It isa conceptwhich wasadapted fromseveral communityhealth modelsin Europe,such asin Italy,but particularlythe onewhich wascreated successfullyin Cuba,and whichwas feltto bethe mostadequate toBrazilian reality.
Specific intensivetraining programsand recruitingefforts wereset upin thecountry inorder toform thePSF teams,which currentlyinvolve about3,000 municipalities,with morethan 45,000teams alreadyin operation;so thatit canbe consideredone ofthe largestfamily healthprograms inthe world.
Family physiciansper seare stilla rarespecialty inBrazil, asthe professionis generallyshunning it(although economicalincentive isno longera validreason, sincephysicians whowork inthe PSFunits aregenerally wellpaid incomparison toprimary healthcare physiciansin thepublic sector).
A fewyears agoa BrazilianSociety ofFamily andCommunity Medicinewas foundedand haslobbied tohave itsown specialtytitle andboard ofexaminers, butit hasso farremained relativelysmall.
InCanada, thereare nonewly qualifyinggeneral practitioners:all medicalstudents goon toa specialty,and familymedicine accountsfor almost40% ofthe residencypositions forgraduating students.
Many hospitalsand healthregions nowrequire thiscertification.
Tomaintain theircertificate, doctorsmust documentongoing learningand upgradeactivities toaccumulate "MainPro"credits.
Somedoctors addan extrayear oftraining inemergency medicineand canthus beadditionally certifiedas CCFP(EM).
Extra trainingin anesthesia,surgery andobstetrics mayalso berecognized butthis isnot standardizedacross thecountry.
Thereis verylittle privatefamily medicinepractice inCanada.
Thereis increasinginterest inthe latteras ameans topromote bestpractices withina managedeconomic environment.
As standardoffice practicehas becomeless financiallyviable inrecent years,many FPsnow pursueareas ofspecial interest.
Manpower inequitiesin ruralareas arenow beingaddressed withsome innovativetraining andinducement mechanisms.
An imbalancebetween physicianmanpower anda growingpatient loadhas resultedin orphanpatients whofind itdifficult toaccess primarycare, butthis isnot uniqueto Canada.
Doctor ofMedicine ora D.O.
Doctor ofOsteopathic Medicinedegree.
Still,many chooseto teachmedicine atmedical schoolsor familymedicine residencyprograms, thoughusually formuch lesspay.
Otherschose topractice asconsultants tovarious medicalinstitutions, includinginsurance companies.
Training isfocused ontreating anindividual throughoutall ofhis orher lifestages.
Familyphysicians willsee anyonewith anyproblem, butare expertsin commonproblems.
Manyfamily physiciansdeliver babiesas wellas takingcare ofpatients ofall ages.
Family physicianscomplete undergraduateschool, medicalschool, andthree moreyears ofspecialized medicalresidency trainingin FamilyMedicine.
Threehundred hoursof continuingmedical educationwithin theprior sixyears isalso requiredto beeligible tosit forthe exam.
Between 2003and 2009the boardcertification processis beingchanged infamily medicineand allother AmericanSpecialty Boardsto acontinuous seriesof yearlycompetency testson differingareas withinthe givenspecialty.
Certificatesof AddedQualifications (CAQs)in adolescentmedicine, geriatricmedicine, orsports medicineare availablefor thoseboard certifiedfamily physicianswho meetadditional trainingand testingrequirements.
Additionally,fellowships areavailable forfamily physiciansin adolescentmedicine, geriatrics,sports medicine,rural medicine,faculty development,obstetrics, research,and preventativemedicine.
Thefamily medicine(FM) paradigmis bolsteredby primarycare physicianstrained ininternal medicine(IM); althoughthese physiciansare trainedin internalmedicine only,adult patientsprovide themajority ofthe patientbase ofmany familymedicine practices.
A significantnumber offamily medicinepractices (especiallyin suburbanand urbanareas) donot provideobstetric servicesanymore (dueto litigationissues andprovider preference),and assuch, thisblurs theline betweenthe FMand IM/Pedsdifference.
Thereis currentlya shortageof familyphysicians (andalso otherprimary careproviders) dueto severalfactors, notablythe lesserprestige associatedwith theyoung specialty,the lesserpay, andthe increasinglyfrustrating practiceenvironment inthe U.S.
Physicians areincreasingly forcedto domore administrativework, shoulderhigher malpracticepremiums dueto highlyprofitable insurancemonopolies thatcharge excessivepremiums, thusforcing doctorsto spendless andless timewith patientcare dueto thecurrent payormodel stressingpatient volumevs.
Thingsare startingto changeas moreinsurance carriersconsolidate.
Theyare notstressing performancebut moreand morevolume, thusincreasing insurancecompany profitmargins.
Physiciansare startingto shuninsurance carriersto lessenthe paperworkin orderto focusmore onpatient careas theyare originallytrained todo.
GeneralPractice inAustralia hasundergone manychanges intraining requirementsover thepast decade.
Since 1996this qualificationor itsequivalent hasbeen requiredin orderfor theGP toaccess Medicarerebates asa generalpractitioner.
Medicareis Australia'suniversal healthinsurance system,and withoutaccess toit, apractitioner cannoteffectively workin privatepractice inAustralia.
Thereis ashortage ofGPs inrural areasand increasinglyouter metropolitanareas oflarge cities,which hasled tothe utilisationof overseastrained doctors(OTDs).
Indiahas thehighest numberof medicalschools inthe world,with approximately262.
InIndia tobecome aGP ora FamilyPhysician, onehas toenroll ina MedicalCouncil OfIndia (MCI)recognised medicalcollege andcomplete theBachelors ofMedicine andSurgery (M.B.,B.S)course, whichis offour anda halfyears durationto beawarded thedegree ofM.B.,B.S andprovisionally registeredwith theMedical Councilof India.
After onefurther yearof compulsoryrotatory internship,the MedicalCouncil ofIndia (orany ofthe StateMedical Councils)confer permanentregistration whichlicences theholder topractise asa GP.
One canalso optto jointhe NationalBoard ofExaminations (NBE)'sfellowship forFamily Medicineat anyof theNBE designatedand recognisedHealth carecenter orhospital andappear forqualifying examsfor fellowshipto theNational Boardon successfulcompletion ofwhich, oneis awardedthe "Diplomateof NationalBoard" degreeand title.
Other thanallopathic doctors,graduates ofhomeopathy, ayurveda,and unanicourses fromrecognised medicalcolleges andinstitutions andduly registeredwith therespective stateor nationalboards ofthese medicalsystems canalso practiceas familypractitioners.
ThePakistan Medicaland DentalCouncil thenconfers permenantregistration, afterwhich thecandidate maychoose topractice asa GPor optfor specialtytraining.
Upto 1994there wasno specifictraining forgeneral practiceand GPswere practicingon theirown.
Thefirst departmentof familymedicine wasestablished inAga KhanUniversity inthe 2000.
This impliesprevention, education,care ofthe diseasesand traumasthat donot requirea specialist,and orientationtowards aspecialist whennecessary.
Theyhave arole inthe surveyof epidemics,a legalrole (constatationof traumasthat canbring compensation,certificates forthe practiceof asport, deathcertificate, certificatefor hospitalisationwithout consentin caseof mentalincapacity), anda rolein theemergency care(they canbe calledby thesamu, theFrench EMS).
The studiesconsist ofsix yearsin theuniversity (commonto allmedical specialties),and twoyears anda halfas ajunior practitioner(interne): Thisends witha doctorate,a researchwork whichusually consistof astatistical studyof casesto proposea carestrategy ofa specificaffection (inan epidemiological,diagnostic, ortherapeutic pointof view).
General practicein TheNetherlands isconsidered fairlyadvanced.
Manyhave aspecialist interest,e.g.
Trainingconsists ofthree yearsof specialisationafter completionof internships.
After thegraduation inmedicine (witha durationof 6years), themedical doctorspass anational writtenexam calledMIR (InternalResident Doctor).
The specialitydevoted toprimary careis "Familyand CommunityMedicine Specialist".
Some ofthe specialistin familypractice inSpain areforced towork inother countries(mainly UK,Portugal andFrance) dueto lackof stablework offersin thepublic healthsystem.
Inthe UnitedKingdom, doctorswishing tobecome GPstake atleast 4years trainingafter medicalschool, whichis usuallyan undergraduatecourse offive tosix years(or agraduate courseof fourto sixyears) leadingto thedegrees ofBachelor ofMedicine andBachelor ofSurgery (MBChB/BS).
Upuntil 2005,those wishingto becomea GPhad todo aminimum ofthe followingpostgraduate training:This processhas changedunder theprogramme ModernisingMedical Careers.
Doctors graduatingfrom 2005onwards willhave todo aminimum of5 yearspostgraduate training:At theend ofthe oneyear registrarpost, thedoctor mustpass anexamination inorder tobe allowedto practiceindependently asa GP.
This summativeassessment consistsof avideo oftwo hoursof consultationswith patients,an auditcycle completedduring theirregistrar year,a multiplechoice questionnaire(MCQ), anda standardisedassessment ofcompetencies bytheir trainer.
Membership ofthe RoyalCollege ofGeneral Practitionersis optionaland canbe awardedby examination,or bysystematic assessmentof anexisting practitioner.
General practitionersare notrequired tohold theMRCGP, butit isconsidered desirable.
In addition,many holdqualifications suchas theDCH (Diplomain ChildHealth ofthe RoyalCollege ofPaediatrics andChild Health)and/or theDRCOG (Diplomaof theRoyal Collegeof Obstetriciansand Gynaecologists)and/or theDGH (Diplomain GeriatricMedicine ofthe RoyalCollege ofPhysicians.
SomeGeneral Practitionersalso holdthe MRCP(Member ofthe RoyalCollege ofPhysicians) orother specialistqualifications, particularlyif theyhad acareer inanother specialtybefore cominginto GeneralPractice.
Thereare manyarrangements underwhich generalpractitioners canwork inthe UK.
Whichever ofthese rolesthey fillthe vastmajority ofGPs receivemost oftheir incomefrom theNational HealthService (NHS).
The MBChB medicaldegree isgenerally consideredequivalent tothe NorthAmerican MDmedical degree.
Doctors educatedin theUnited States,Canada, Ireland,and GreatBritain havemore abilityto movebetween thecountries thanother nationalsystems.
Visitsto GPsurgeries arefree inthe UnitedKingdom, butmost adultsof workingage whoare noton benefitshave topay astandard chargefor prescriptiononly medicine.
Recent reformsto theNHS haveincluded changingthe GPcontract.
Generalpractitioners arenow notrequired towork unsociablehours, andget paidto someextent accordingto theirperformance, e.g.
Quality andOutcomes Framework.
They areencouraged toprescribe medicinesby theirgeneric names.
The ITsystem usedfor assessingtheir incomebased onthese criteriais calledQMAS.
Doctorswhose primaryprofessional focusis hospitalmedicine arecalled hospitalists.
The termhospitalist wasfirst usedby Dr.
The majorityof hospitalistsare physicianswith aDoctor ofOsteopathy (D.O.)or MedicalDegree (M.D.).
About 78%of practicinghospitalists aretrained ingeneral internalmedicine.
Another4% aretrained inan internalmedicine subspecialty,most commonlypulmonology orintensive caremedicine.
Whileit wascommonly believedthat anyresidency programwith aheavy inpatientcomponent providedgood hospitalisttraining, studieshave foundthat generalresidency trainingis inadequatebecause commonhospitalist problemslike neurology,hospice andpalliative care,consultative medicine,and qualityassurance tendto beglossed over.
To addressthis, residencyprograms arestarting todevelop hospitalisttracks withmore tailorededucation.
Severaluniversities havealso startedfellowship programsspecifically gearedtoward hospitalistmedicine.
Hospitalmedicine isa relativelynew phenomenonin Americanmedicine.
Almostunheard ofa generationago, thistype ofpractice arosefrom threepowerful shiftsin medicalpractice: Hospitalistsrepresent oneof themost rapidlygrowing formsof medicalpractice inthe US.
As residencyprograms areencouraged tolimit inpatientduty hoursand providemore outpatienteducation, thispattern mayshift.
Ifthis specialtyevolves asemergency andintensive caremedicine did,it willbecome aformal specialitywith itsown residenciesand boardcertification withina decadeor two.
A fewdistinct residencyand fellowshiptraining programsare currentlyoperating atmajor universities.
In additionto patientcare duties,hospitalists areoften involvedin developingand managingaspects ofhospital operationssuch asinpatient flowand qualityassurance.
Theformation ofhospitalist trainingtracks inresidency programshas beendriven inpart bythe needto educatefuture hospitalistsabout businessand operationalaspects ofmedicine, asthese topicsare notcovered intraditional residencies.
Category: MedicalspecialtiesInternal medicineis thebranch andspecialty ofmedicine concerningthe diagnosisand nonsurgicaltreatment ofdiseases inadults, especiallyof internalorgans.
Doctorsof internalmedicine, alsocalled "internists",are requiredto haveincluded intheir medicalschooling andpostgraduate trainingat leastthree yearsdedicated tolearning howto prevent,diagnose, andtreat diseasesthat affectadults.
Internistsare sometimesreferred toas the"doctor's doctor,"because theyare oftencalled uponto actas consultantsto otherphysicians tohelp solvepuzzling diagnosticproblems.
Whilethe name"internal medicine"may leadone tobelieve thatinternists onlytreat "internal"problems, thisis notthe case.
Doctors ofinternal medicinetreat thewhole person,not justinternal organs.
Internists holdeither anM.D.
MedicalDoctor), D.O.(Doctor ofOsteopathic Medicine)or aBiomedical sciencedegree asBiomedical Doctors.
They arenot tobe confusedwith "MedicalInterns," whoare physiciansin theirfirst yearof residencytraining.
AlthoughInternists mayact asprimary carephysicians, theyare not"family physicians,""family practitioners,"or "generalpractitioners" (whosetraining incertain countriesincludes themedical careof children,and mayinclude surgery,obstetrics andpediatrics).
GeneralInternists practicemedicine froma primarycare perspectivebut theycan treatand managemany ailmentsand areusually themost adeptat treatinga broadrange ofdiseases affectingadults.
Theprimary careof adolescentsis providedby familypractice, internistsand pediatricians.
The primarycare ofchildren andinfants isprovided byFamily Practiceor Pediatricians.
Thus, thereis overlap.
Internists aretrained tosolve puzzlingdiagnostic problemsand handlesevere chronicillnesses andsituations whereseveral differentillnesses maystrike atthe sametime.
Theyalso bringto patientsan understandingof preventativemedicine, men'sand women'shealth, substanceabuse, mentalhealth, aswell aseffective treatmentof commonproblems ofthe eyes,ears, skin,nervous systemand reproductiveorgans.
Mostolder adultsin theUnited Statessee aninternist astheir primaryphysician.
Internistscan chooseto focustheir practiceon generalinternal medicine,or maytake additionaltraining to"subspecialize" inone of13 areasof internalmedicine, generallyorganized byorgan system.
Cardiologists, forexample, aredoctors ofinternal medicinewho subspecializein diseasesof theheart.
Thetraining aninternist receivesto subspecializein aparticular medicalarea isboth broadand deep.
Subspecialty training(often calleda "fellowship")usually requiresan additionalone tothree yearsbeyond thestandard threeyear generalinternal medicineresidency.
Residenciescome aftera studenthas graduatedfrom medicalschool.) Inthe UnitedStates, thereare twoorganizations responsiblefor certificationof subspecialistswithin thefield, theAmerican Boardof InternalMedicine, andthe AmericanOsteopathic Boardof InternalMedicine.
TheABIM alsorecognizes additionalqualifications inthe followingareas Internistsmay alsospecialize inallergy andimmunology.
TheAmerican Boardof Allergy,Asthma, andImmunology isa conjointboard betweeninternal medicineand pediatrics.
Subtle descriptionsof disease(e.g.
Inthe medicalhistory, the"Review ofSystems" servesto pickup symptomsof diseasethat apatient mightnot normallyhave mentioned,and thephysical examinationtypically followsa structuredfashion.
Atthis stage,a doctoris generallyable togenerate adifferential diagnosis,or alist ofpossible diagnosesthat canexplain theconstellation ofsigns andsymptoms.
Occam'srazor dictatesthat, whenpossible, allsymptoms shouldbe presumedto bemanifestations ofthe samedisease process,but oftenmultiple problemsare identified.
In orderto "narrowdown" thedifferential diagnosis,blood testsand medicalimaging areused.
Theycan alsoserve screeningpurposes, e.g.
At thisstage, thephysician willoften havealready arrivedat adiagnosis, ormaximally alist ofa fewitems.
Specifictests forthe presumeddisease areoften required,such asa biopsyfor cancer,microbiological cultureetc.
Medicineis mainlyfocused onthe artof diagnosisand treatmentwith medication,but manysubspecialties administersurgical treatment:Content basedon authoritativeinformation fromthe Websites ofthe AmericanCollege ofPhysicians, ABIM,and ACOI.
Patients requiringintensive careusually requiresupport forhemodynamic instability(hypertension/hypotension), airwayor respiratorycompromise (suchas ventilatorsupport), acuterenal failure,potentially lethalcardiac dysrhythmias,and frequentlythe cumulativeaffects ofmultiple organsystem failure.
Patients admittedto theintensive careunit notrequiring supportfor theabove areusually admittedfor intensive/invasivemonitoring, suchas thecrucial hoursafter majorsurgery whendeemed toounstable totransfer toa lessintensively monitoredunit.
Sincethe criticallyill areclose todying theoutcome ofthis interventionis difficultto predict.
Many patientstherefore stilldie inthe IntensiveCare Unit.
Therefore treatmentis merelymeant towin timein whichthe acuteaffliction canbe resolved.
For example,adjusted ICUmortality (fora patientat averagepredicted riskfor ICUdeath) was21.2% inhospitals with87 to150 mechanicallyventilated patientsannually, and14.5% inhospitals with401 to617 mechanicallyventilated patientsannually.
Hospitalswith intermediatenumbers ofpatients hadoutcomes betweenthese extremes.
It isgenerally themost expensive,high technologyand resourceintensive areaof medicalcare.
Intensivecare usuallytakes asystem bysystem approachto treatment,rather thanthe SOAP(subjective, objective,analysis, plan)approach ofhigh dependencycare.
Aswell asthe keysystems Intensivecare treatmentalso raisesother issuesincluding psychologicalhealth, pressurepoints, mobilisationand physiotherapy,and secondaryinfections.
Theprovision ofintensive careis generallyadministered ina specializedunit ofa hospitalcalled theIntensive CareUnit (ICU)or CriticalCare Unit(CCU).
Manyhospitals alsohave designatedintensive careareas forcertain specialitiesof medicine,such asthe CoronaryCare Unit(CCU) forheart disease,Medical IntensiveCare Unit(MICU), SurgicalIntensive CareUnit (SICU),Pediatric IntensiveCare Unit(PICU), NeuroscienceCritical CareUnit (NCCU),Overnight IntensiveRecovery (OIR),Shock/Trauma IntensiveCare Unit(STICU), NeonatalIntensive CareUnit (NICU),and otherunits asdictated bythe needsand availableresources ofeach hospital.
The namingis notrigidly standardized.
For atime inthe early1960s itwas notclear thatspecialized intensivecare unitswere neededand intensivecare resources(see below)were broughtto theroom ofthe patientwho neededthe additionalmonitoring, care,and resources.
It becamerapidly evident,though, thata fixedlocation whereintensive careresources andpersonnel wereavailable providedbetter carethan adhoc provisionof intensivecare servicesspread throughouta hospital.
Common equipmentin anintensive careunit (ICU)includes mechanicalventilation toassist breathingthrough anendotracheal tubeor atracheotomy; hemofiltrationequipment foracute renalfailure; monitoringequipment; intravenouslines fordrug infusionsfluids ortotal parenteralnutrition, nasogastrictubes, suctionpumps, drainsand catheters;and awide arrayof drugsincluding inotropes,sedatives, broadspectrum antibioticsand analgesics.
Critical caremedicine isa relativelynew butincreasingly importantmedical specialty.
Physicians whohave trainingin criticalcare medicineare referredto asintensivists.
Thespecialty requiresadditional fellowshiptraining forphysicians whocomplete theirprimary residencytraining ininternal medicine,anesthesiology, orsurgery.
Boardcertification incritical caremedicine isavailable throughall threespecialty boards.
Intensivists witha primarytraining ininternal medicinesometimes pursuecombined fellowshiptraining inanother subspecialtysuch aspulmonary medicine,cardiology, infectiousdisease, ornephrology.
TheSociety ofCritical CareMedicine isa wellestablished multiprofessionalsociety forpracitioners whowork inthe ICU,including intensivists.
Medical researchhas repeatedlydemonstrated thatICU careprovided byintensivists producesbetter outcomesand morecost effectivecare.
Unfortunatelythere isa criticalshortage ofintensivists inthe UnitedStates andmost hospitalslack thiscritical physicianteam member.
In veterinarymedicine, criticalcare medicineis recognizedas aspecialty andis closelyallied withemergency medicine.
Patient managementin intensivecare differssignificantly betweencountries.
InAustralia, whereIntensive CareMedicine isa wellestablished speciality,ICUs aredescribed as'closed'.
Ina closedunit theintensive carespecialist takeson thesenior rolewhere thepatient's primarydoctor nowacts asa consultant.
Other countrieshave openIntensive CareUnits, wherethe primarydoctor choosesto admitand generallymakes themanagement decisions.
In 1854the CrimeanWar, inwhich England,France andTurkey declaredwar onRussia, began.
Because ofthe lackof criticalcare andthe highrate ofinfection, therewas ahigh mortalityrate ofhospitalised soldiers,reaching ashigh as40% ofthe deathsrecorded duringthe war.
Florence and38 othervolunteers hadto leavefor theFields ofScurati, andtook their"critical careprotocol" withthem.
Uponarriving, andpracticing, themortality ratefell to2%.
Nightingalecontracted typhoid,and returnedin 1856from thewar.
ASchool ofNursing wasformed in1859 inEngland dedicatedto her.
The Schoolwas recognisedfor itsprofessional valueand technicalcalibre, receivingprizes throughoutthe Englishgovernment.
TheSchool ofNursing wasestablished inSaint ThomasHospital, asa oneyear course,and wasgiven todoctors.
Itutilised theoreticaland practicallessons, asopposed topurely academiclessons.
Herwork, andthe school,paved theway forIntensive CareMedicine.
WalterEdward Dandywas bornin Sedalia,Missouri.
Hereceived hisBA in1907 throughthe Universityof Missouriand hisM.D.
JohnsHopkins UniversitySchool ofMedicine.
Dandyworked oneyear withDr.
HarveyCushing inthe HunterianLaboratory ofJohns Hopkinsbefore enteringits boardingschool andresidence inthe JohnsHopkins Hospital.
He workedin theJohns HopkinsCollege in1914 andremained thereuntil hisdeath in1946.
Thistechnique wasextremely successfulfor identifyingbrain injuries.
Dr. Dandywas alsoa pioneerin theadvances inoperations forillnesses ofthe brainaffecting theglossopharyngeal aswell asMeniere's syndrome,and hepublished studiesthat showthat highactivity cancause sciaticpain.
PeterSafar, thefirst Intensivistdoctor, wasborn inAustria.
Hewas theson oftwo doctors,who migratedto theUnited Statesafter beingin aNazi concentrationcamp.
Thedoctor firstgot certificationas ananesthetist, andin the1950s hestarted andpraised the"Urgency Emergency"room setup(now knownas anICU).
Itwas atthis timethe ABC's(Airway, Breathing,and Circulation)protocols wereformed, andartificial ventilationas wellas externalcardiac massagebecame popular.
These experimentscounted onvolunteers ofits teamwhich onlyused minimumsedation.
Itwas throughthese experimentsthat thetechniques formaintaining lifein thecritical patientwere established.
In thecity ofBaltimore, thefirst surgicalICU wasestablished, andin 1962,in theUniversity ofPittsburgh, thefirst CriticalCare Residencywas establishedin theUnited States.
It wasaround thistime thatthe inductionof hypothermiain criticalpatients wasalso tested.
More recently,the WorldAssociation forDisaster andEmergency Medicinewas formed,and sowas theSCCM (Societyof CriticalCare Medicine).
While amajor focusof REIis infertility,reproductive endocrinologistsalso evaluateand treathormonal dysfunctionsin femaleand malesoutside ofinfertility.
Reproductivesurgeons operateon anatomicaldisorders thataffect fertility.
Reproductive endocrinologistshave aspecialty trainingin obstetricsand gynecologybefore theyundergo subspecialtytraining (fellowship)in reproductiveendocrinology andinfertility.
Asignificant partof reproductiveendocrinology andinfertility isconcerned withthe diagnosisand managementof infertility.
Reproductive endocrinologistalso arecalled uponto utilizepreimplantation geneticdiagnosis toprevent geneticdiseases incouples thatcarry suchdiseases orfor genderselection.
Complexsurgery inwomen ormen thataims topreserve reproductivepotential isoften doneby REspecialist.
Reproductiveendocrinologists arealso especiallytrained todeal withcomplex hormonalissues inwomen ormen.
Ina numberof countriesthe pathwayto becomea subspecialistin REIis regulated.
Thus inthe UnitedStates theAmerican Boardof Obstetricsand Gynecology(ABOG) setsthe standardsfor subspecialtiststo becomecertified.
Tobe boardcertified inreproductive endocrinolgyand infertility,one mustfirst completeboard certif