By L. Tempeck. Southwest University. 2019.

A brief nutrition survey should be repeated periodically at follow-up visits to assess progress or deterioration purchase forzest 20mg on line. Nutrition/dietary treatment prescriptions should be based on the results of nutrition assessments and evidence-based nutrition research buy 20 mg forzest with amex. This can include a wide variety of activities such as providing nutrition clinics order forzest 20 mg free shipping, seminars and other resources, introducing patients to new foods at food sampling events, holding cooking classes, providing personalized meal plans with shopping lists, leading supermarket and farmers market tours, visiting urban farms, starting community gardens, organizing personal chef services and/or providing packaged foods services to make healthy food choices more convenient for busy patients. Every five years the Federal government issues dietary guidelines that are intended to promote health and also satisfy food industry interests. Current Federal dietary guidelines recommend decreasing cholesterol and saturated fat intake, and increasing intake of fruits, vegetables, legumes and whole grains. Dietary cholesterol crystals injure All ages and endothelial cells and start the inflammatory process that 36 genders leads to heart disease and strokes. The health benefits of exercise apply to children and adults of all ages and social groups and to patients with chronic diseases and disabilities. Any lifestyle improvement advice given by health care professionals is valuable, but exercise advice alone without dietary changes will be ineffective for many patients. Exercise without dietary changes may maintain current weight but will not lead to significant weight loss or reversal of lifestyle diseases such as atherosclerosis. A basic assessment measures flexibility, strength, and cardiovascular endurance, other parameters may be added as needed. Most of ¨When possible try to meet the Adolescents the time should be either moderate- or vigorous-intensity guidelines. If this is 64) minutes a week of vigorous-intensity aerobic physical activity not possible, patients should be as or an equivalent combination of moderate- and vigorous- physically active as their abilities intensity aerobic physical allow. Older Adults Follow the adult guidelines, or be as physically active as Develop an activity plan with (65+) possible. All patients should be screened initially and periodically for signs of unhealthy stress responses and stress-related conditions such as depression. Lifestyle Medicine providers should be knowledgeable about basic evidence-based stress management techniques that they can share with patients. Common evidence-based stress- management techniques include: Autogenic training/Guided Imagery,47 are relaxation techniques that involves visualizations to induce a state of relaxation. Patients can use an instructor, tapes, or scripts to guide them through the process. Practiced daily for 15 minutes 3 times a day the technique has been shown to alleviate many stress- related life conditions such as chronic pain, tension headache, anxiety, and depression. Distorted thoughts/cognitive distortions underlie many forms of unhealthy behaviors and mental illnesses. Diaphragmatic Breathing 47 is a breathing technique that focuses on movement of the abdomen when breathing. This type of breathing has been shown to lower blood pressure, reduce pain, and reduce anxiety especially in children with asthma. Meditation 47 is a catch-all term for a wide variety of practices where individuals attempt to focus awareness. Countless studies have shown the benefits of meditation as treatment for stress related health conditions. Measurable physiological changes such as decreased heart rate, respiration, blood pressure and positively altered brain wave activity have been documented during meditation. Meditation has been shown to promote relaxation, improve cognitive function and relieve depression, anxiety and chronic pain. This technique involves alternately tensing and relaxing muscle groups over the legs, abdomen, chest, arms and face in a sequential pattern while focusing on the difference between the feelings of the tension and the feelings of relaxation. Other evidence-based stress reduction techniques that Lifestyle Medicine Practitioners should be aware of include relaxation response, biofeedback, emotional freedom technique, mindfulness-based stress reduction exercises and emotional freedom techniques. Clinicians should be aware of motivational techniques to encourage patients who are not ready to make quit attempts. Tobacco use cessation counseling and medications can be effective when either one is used alone but they are most effective when used together. In a Lifestyle Medicine practice the method used should be individualized to suit patient needs and preferences. Tobacco use cessation medications are contraindicated in certain groups such as pregnant women, smokeless tobacco users, light smokers, and adolescents. Tobacco use cessation counseling may be conducted in individual one-on-one sessions, groups, or on telephone quit lines. Important components of tobacco use cessation counseling are practical problem solving/skills training and social support. The nicotine replacement products are available over-the-counter in 5 forms, as gum, inhaler, lozenge, nasal spray and patch. Tobacco use cessation treatment is an important part of Lifestyle Medicine treatment and may be offered alone or as part of a comprehensive lifestyle intervention program. The areas in our brain involved in processing social stimuli and decision making are noticeably larger in those with large social networks. People with seemingly caring families and demanding jobs may be most in need of genuine social connection. Lifestyle Medicine prescriptions for developing or improving social relationships should be personalized to meet the needs of individual patients. Advice to prevent social isolation may include volunteering for a meaningful cause, involvement in spiritual/religious activities or participation in communication skills workshops such as Compassionate (nonviolent) Communication. This is especially true when the changes involve new ideas and behaviors that are different from accepted sociocultural norms. The ability to understand criticism and handle rejection and possible social isolation will determine whether the new healthy behaviors are sustained. Helping patients to develop these skills should be a consideration in a Lifestyle Medicine practice. The practice may offer or facilitate access to workshops that assist patients to improve health literacy,63, 64 develop active listening skills, resolve internal and external conflicts to produce win-win solutions,65 improve intimacy,57 and improve workplace relationship with a view to negotiating successful personal lifestyle changes in possibly resistant family and other social settings. Committee on Nutrition in Medical Education, Food and Nutrition Board, National Research Council. A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men.

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The ethical background considerations to this situation are briefly reviewed and a strategy for improvement is proposed order 20 mg forzest otc, i generic forzest 20 mg with amex. It is easy to overlook justification and risk–benefit analysis in busy cheap forzest 20mg fast delivery, technically excellent departments, in which the scale of practice verges on the industrial. The approach is fundamentally based on ethical considerations although financial and health technology assessment issues are also important [2–4]. The Nordic countries have endorsed the three As approach and the heads of the European Regulatory Competent Authorities have also expressed support for the approach. Thus, the role of ethics has been critically important in revisiting and rethinking the concept of justification in radiology [3]. It allows us to subject our assumptions to critical evaluation, and can provide an early warning system in respect of problems that might otherwise go undetected [3, 5, 6]. General considerations and core principles in medical ethics The thinking behind the current framework for radiation protection in medicine is to be found in core publications of the International Commission on Radiological Protection from some decades ago. The core principles/values, which are still used, are justification, optimization and dose limitation [7, 8]. There is a disconnect between the way they are currently presented and prioritized for medicine/ radiology, on one hand, and ordinary medical ethics, on the other [2, 3]. Work over several decades has identified a small core set of values/principles for medical ethics. These are presented in the first section of Table 1 and are discussed more fully elsewhere [2, 3, 9]. The three principles/values are found to be universally accepted and relatively culture independent. It is reasonable to assume that this can be transferred to radiology, which also requires a globally acceptable high recognition value system [2, 3]. There are additional problems in radiology, particularly those arising from communicating and managing the incomplete knowledge and uncertainty about risk we have in respect of both patients and the public. These also need to be addressed in the context of clear values with an ethical content. This gives rise to two additional values which are widely, but possibly not universally, subscribed to [3, 4]: — The precautionary principle, often referred to as Pascal’s wager; — Openness, transparency and accountability. The precautionary principle requires that we act prudently when we have to act out of incomplete knowledge, an approach that appears to be consistent with the wisdom literature of all cultures but at variance with medical radiation damage skeptics [3, 10]. Utilitarian principle See text There is a significant demand for radiological screening of asymptomatic patients for latent disease. Generally, when such programmes are formally approved by governments or by professional bodies, it is on the basis that more good than harm for the greatest number of people will result. This is most easily justified on the basis of the utilitarian principle, which seeks the greatest good for the greatest number of people [2, 3, 9]. Values 4–6, and particularly 5, are not as culture free as the three basic principles. They are the means of ensuring that those referred for radiological examinations really need them, i. These are briefly introduced here and the effectiveness of these interventions is discussed elsewhere [1, 6]. The three As: Appropriateness and referral guidelines Referral guidelines for diagnostic and interventional radiology have been in existence for 20 years and have been published by the European Commission and in Australia; Canada; Hong Kong, China; New Zealand; the United Kingdom; the United States of America and elsewhere. Today’s guidelines are increasingly evidence based, are intended to support decision making and are not prescriptive. Guidelines will assist in avoiding: repeat investigations; investigations when results are unlikely to affect patient management; investigating too early; the wrong investigation; and over-investigation. The effectiveness of guidelines can be greatly enhanced by involving the relevant stakeholders at all stages. It is essential to develop and disseminate guidelines suitable for global application, and regional/local adaptation; and to ensure resource or intellectual property issues do not unduly inhibit this. Including guidelines in information technology embedded order entry/decision support algorithms can be advantageous. The three As: Audit (clinical) Most countries seek to establish transparent, tangible procedures for managing quality in health care. A key element of this is clinical audit, which has been applied to many health care practices but has been slow to find its place in imaging. To assist States with implementation of these requirements, the European Commission prepared guidance on clinical audit in radiology [12]. The approach is flexible and will enable the Member States to adopt a form of clinical audit consistent with their national arrangements. Justification is a cornerstone of radiation protection and should be among the top priorities in the audit programme. The audit of the compliance with guidelines can be a simple and effective tool for improving justification, appropriateness and referral patterns. The three As: Awareness and improved communication It is obvious that awareness about radiation dose and risk is poor among physicians in all parts of the world, irrespective of specialty. Simple, effective and scientifically more acceptable approaches have been proposed. These initiatives produce clear information on risk that acknowledges uncertainty and is readily accessible. For day-to-day use in clinical environments, a scale based on the equivalent number of chest X rays, or that state risk without citing dose, is likely to be adequate. Picano’s graphical approach to dose and risk for different patient groups (including children, adult males, adult females and the elderly) has much to recommend it [1]. Finally, clear transparent public education programmes are essential, where imaging services are marketed directly to the public and to the worried well. This conference devoted a full session to it and recognized it as a major area for attention during the coming decade. The approach derives from an analysis of justification based on ethical considerations. However, the justification may also benefit from approaches that seek to reduce overutilization based on health economic or health technology assessment grounds. There are several compelling reasons: first, it is universally accepted that a significant percentage of imaging worldwide is inappropriate, with both over- and underutilization. This leads to increased health care costs when imaging is overutilized and, in all likelihood, worsened quality of care with both over and under use.

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A retrospective study of intra-operative and postoperative maternal complications of cesarean section during a 10-year period discount forzest 20mg on line. Smoking and cancer: the cigarette papers: how the industry is trying to smoke us all buy 20mg forzest with amex. Consumer group criticizes Thompson letter dismissing report on dangerous staffing levels in nursing homes [news release] generic forzest 20 mg with visa. Multi-site study of incidence of pressure ulcers and the relationship between risk level, demographic characteristics, diagnoses and prescription of preventive interventions. Accuracy of death certificates for coding coronary heart disease as the cause of death. The relationship between physical restraint removal and falls and injuries among nursing home residents. California reaches $100 million multi-state settlement with drug giant Mylan over alleged price-fixing scheme [press release]. After talking to his doctor, he decides J to see a therapist and go on medication. Joe’s doctor gives him two weeks’ worth of samples for a brand name drug called SteadyMood and asks him to come back to see him in two weeks. When he returns, Joe’s feeling a little better and agrees to keep taking SteadyMood for another month. When he gets to the pharmacy, Joe learns that his insurance plan’s co-pay for a month’s supply of SteadyMood is $40. His pharmacist tells him that he’s fortunate to have insurance coverage; without it, the brand name would cost $100. His insurance co-pay would be $10 for a month’s supply of the generic, but his doctor would have to approve it. The pharmacist calls Joe’s doctor and gets approval to fill his prescription with the generic. He’s confused and believes there must be some kind of mistake since the SteadyMood samples his doctor gave him were pink ovals. Joe calls his phar- macist who tells him that the round, white pills are the generic form for SteadyMood and they should work just fine. He returns to the drugstore with another prescription from his doctor, and this time, it allows for generic substitution. The next morning, he opens the bottle to find a completely different-looking medi- cine—now, the pills are yellow and square. Should he simply stay with the brand name version that his doctor originally gave him? Many of us have found ourselves in situations like Joe’s and can understand his frustration. You’ll you want your prescription filled with learn that the decision to choose a the brand name medicine or the generic brand name or a generic is one that medicine. This brochure will “The decision to choose a brand name or a generic is one that involves you and your health care team. Generics only that’s dis- become available after the patent expires covered, on a brand name drug. Once brand name drug may also a new drug is discovered, the company produce the generic files for a patent to protect against other version. It’s important to remember that there are percent of all prescriptions are filled with brand name and generic versions of medi- generic drugs. For example, some people ■ It must have the same route of admin- have reactions to certain dyes used in istration (the way the medication is some drugs. Generics can cost amount of the drug into the blood- between 20 and 80 percent less, but stream within a similar time period keep in mind that cost is only one as the brand name drug). Both private and gov- ernment insurance companies promote using generic drugs when possible. Some insurance plans might require you to pay the entire cost of the brand name drug if you don’t accept the available generic. It takes several years, costly scientific “pioneer drugs”) usually take on the development and many clinical studies research and development costs for new to get a drug approved. These research and develop- of new brand name drugs (also called ment costs, along with marketing costs, account for most of the higher prices we pay for most brand name drugs. In contrast, generic drugs have less research and development costs since the original manufacturer has already done many studies to make sure the drug is safe. However, while the brand name form is still protected by its patent, no generics can be produced. And, if a brand name drug has only just recently lost its patent, there may only be one generic form avail- able. Usually, when there’s only one generic option available, it will be more expensive. Be sure to check your medication labels that the drug is identical if it looks differ- and confirm the name and dose of your ent. Generic forms of a brand you, and your doctor can also confirm this name drug should all have the same when you bring your medication bottle to name, no matter what company produced your appointment. If your original prescription was written prescription, to reduce confusion, ask for the brand name, and the doctor your pharmacist to refill your generic pre- allowed generic substitution, the bottle scription with the same drug, from the label should indicate this. Some doctors might not If you’re interested in be aware of recently trying a generic drug, approved generics. Our medical histories, usually tell you how much they will cost insurance and personal preferences may on your insurance plan. Different states have differ- scription specifically for the generic, that’s ent laws and regulations on generic what the pharmacist will give you. The ■ How difficult it is to pay for your answer is that it prescriptions, including whether depends. There your insurance covers prescriptions are several differ- ent things that you and your doctor can consider: Drug Formularies Each insurance plan has a formulary, a list of drugs that it approves and prefers for certain medical conditions. Ideally, insurance companies base this list on the best medical information available at the time. If you’re consider- ing changing insurance plans, com- pare the cost of your medications on the formularies. It’s important that we consult our doctors before deciding if a generic is right for us.

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Students are expected to clerk and follow the management of all patients under their care buy 20mg forzest with amex. The aim of the course is to enable the students to understand and manage emergency problems cheap forzest 20 mg amex. The sense professional etiquette in emergency will also be instilled into the students generic 20 mg forzest amex. The learning will be delivered via seminars, tutorials, and practice in the ward rounds, bedside teachings, clinic sessions and case presentation. Students are expected to clerk and follow the management of all patients under their care. The aim of the course is to enable the students to understand basic principles of conducting safe and comprehensive anaesthesia. Students will be exposed to the effective communication skill and work ethics in such challenging. The learning will be delivered vialectures, practice in the pre-operative visits, acute pain service and icu, bedside teachings in operation room and case presentation. Students are expected to clerk and follow the management of all patients under their care. The progress of the student will be monitored via clinical attendance, logbook and supervisor’s report. Students will be assessed through continuous assessment and end of posting assessment. Marks from the Semester Examination (40%) and Professional I Examination (60%) contribute to the total marks for Phase I Assessment. Semester 4 Examination 10 % Professional I Examination 60 % *Supplementary Professional I Examination *Supplementary exam uses similar format as the Professional 1 exam. Each of the semester examination contributes to 10% to the Professional I Examination. Professional I Examination This examination contributes 60% to the overall Phase I Assessment. Non-satisfactory attendance is defined on a case-by-case basis and not specified as a set percentage. Within the theory and practical components, the students are not required to pass individual papers, instead they are added up. Student who fails in the Professional 1 Examination will sit for the Supplementary Professional I Examination. Marks from Supplementary Professional 1 and previous marks from Semester Examination must be more than 50%. A student who fails the Supplementary Professional I Examination will leave the Doctor of Medicine Programme. Excellent candidates are called for a viva-voce to determine the eligibility to pass with distinction. Students must complete and show satisfactory progress in all modules / postings assigned in each year of study. Year 3 Module Examinations The details of module examination and allocation for Year 3 consist of Continuous Assessment and End-of-Module Examination. Year 4 Module Examinations The details of module examination and allocation for Year 4 consist of Continuos Assessment and End-of-Module Examination. Year 5 Module Examinations The details of module examination and allocation for Year 5 consist of Continuos Assessment and End-of-Module Examination. Within theory and clinical components, the students are not required to pass individual paper/cases, instead they are added up. Candidates will be called for a viva-voce to determine the eligibility to pass with distinction. Special awards The awards falls into the following categories : (a) Special Award for Leadership (3 recipients) Awarded to final year students who have exhibited prominent leadership qualities and have achieved, satisfactory academic performance throughout the course of study. E Moreira Memorial Award, is given by the Malaysian Medical Association on for the best individual student. Elective Award The Awards fall into 2 categories : (a) The best elective group according to the criteria of the Elective Committee for the Phase 2 Medical Doctor Course Elective Programme. Departmental Award Awarded to the best students as decided by the respective departments. Deans Certificate Award Awarded in two categories to final year students on the medical course. One is awarded to the student who achieves Grade A with Distinction, and the other to the student who achieves Grade A. Inpatient Services Ophtalmology, Orthopaedics, Otorhinolaryngology, Psychiatry, Surgery, Paediatrics Newborn, Paediatrics Surgery, Paediatrics Medical, Medical, Obstetric & Gynaecology, Dental and Neuroscience, Reconstructive, Cardiothorasic. The 2-storey block consists of :- Level 1 (i) Reception counter (ii) Meeting room (iii) Briefing rooms (iv) Tutorial rooms 66 (v) Students’on-call room (vi) Students’ Resource Centre/ Quarantine room (vii) Prayer rooms (viii) Dinning area & pantry (ix) Main office Level 2 (i) 108 bed examination wards (ii) Children play area (iii) Examiner rooms (iv) Secretariat rooms (v) Document examination rooms (vi) Communication room with one-way mirror (vii) Dark-rooms for ophtalmology examination (viii) Rest examiners’ room (ix) Work station (x) Medical doctors’ counter (xi) Nurses’ counter (xii) Student counter (xiii) Resource block (xiv) Resuscitation room (xv) Students’ waiting area (xvi) Patients’ waiting area (xvii) Prayer rooms (xviii) Equipment examination room 1. The library was officially operational in February 1980 at the Main Campus in Penang. A large number of the collection and staff were transferred from the Penang Campus to the University’s branch in Kubang Kerian in 1982 and was temporarily located at level 8 of the Hospital building. In November 1985, the collection and staff were subsequently shifted to its permanent building which houses the current Library. In 1990, the remaining collections as well as staff of the Medical Library were completely moved from the main campus to Kubang Kerian. The Kubang Kerian Campus was appropriately renamed as the Health Campus in 2001, thus bringing about the change of the Library’s name to the Health Campus Library. Thesis and Dissertation 2, 011 (2, 277) Services The services provided by the library are divided into two major activities : 1. Technical Services The activities include the process of selection and purchase of library materials. The selection process focuses on materials to fulfill the teaching, learning and research requirements of the Health Campus. Technical processing of library materials includes the cataloguing and classification of library materials : 1. The Laboratory has 17 packages of learning programmes and 5 packages of multimedia programmes. It is also equipped with 85 computers which consist of 12 Apple Macintosh’s and 71 Acer Veriton.