medicinehttp://www.sfetcu.com/taxonomy/term/3651/atom/feed2008-07-21T10:16:06-06:00Nobel Prize in Physiology or Medicine, 2008http://www.sfetcu.com/content/Nobel-Prize-Physiology-or-Medicine-20082008-10-06T05:33:52-06:002008-10-06T05:33:52-06:00nicolaeThe Nobel Prize in Physiology or Medicine in 2008 awarded Harald zur Hausen, "for his discovery of human papilloma viruses causing cervical cancer" and Françoise Barré-Sinoussi and Luc Montagnier, "for their discovery of human immunodeficiency virus".
]]>The Nobel Prize in Physiology or Medicine in 2008 awarded Harald zur Hausen, "for his discovery of human papilloma viruses causing cervical cancer" and Françoise Barré-Sinoussi and Luc Montagnier, "for their discovery of human immunodeficiency virus".
Harald zur Hausen, (born March 11, 1936) is a German medical scientist and professor emeritus. He has done research on cancer of the cervix, where he discovered the role of papilloma viruses, for which he received the Nobel Prize in Medicine 2008 along with Françoise Barré-Sinoussi and Luc Montagnier.
Zur Hausen studied Medicine at the Universities of Bonn, Hamburg and Düsseldorf and received a Doctorate degree (Dr. med.) in 1960. After that he became an Medical Assistant and two years later on, he joined the Institute for Micro Biology at the University of Düsseldorf as a scientific assistant. After three and a half years, he moved to Philadelphia and worked at the Virus Laboratories of the Children's Hospital. He became an Assistant Professor at the University of Pennsylvania. In 1969 he became a regular teaching and researching Professor at the University of Würzburg, where he worked at the Institute for Virology. In 1972 he moved to the then-founded combined University of Nuremburg-Erlangen, in 1977 he moved on to the University of Freiburg (Breisgau).
From 1983 until 2003 zur Hausen served as a chairman and member of the scientific advisory board of the german cancer research center (DKFZ). He also is editor-in-chief of the International Journal of Cancer.
Françoise Barré-Sinoussi (born 30.7.1947 in Paris, France) was awarded the Nobel Prize in Physiology or Medicine in 2008 together with Luc Montagnier for their discovery of the HIV virus.
Luc Montagnier (born 1932 in Chabris, France) is a French virologist and joint recipient of the 2008 Nobel Prize for Medicine. In 1982 he was asked for assistance with establishing the possible underlying retroviral cause of a mysterious new syndrome, AIDS, by Willy Rozenbaum, a clinician at the Hôpital Bichat hospital in Paris. Rozenbaum's role was vital, as he had been openly speculating at scientific meetings that the cause of the disease might be a retrovirus, and it was from a lymph node biopsy taken from one of Rozenbaum's patients that the breakthrough was to come. Jean-Claude Chermann's role was too vital.
Luc Montagnier is the co-founder of the World Foundation for AIDS Research and Prevention and co-directs the Program for International Viral Collaboration. He has received more than 20 major awards, including the Commandeur de la Légion d'Honneur, the Lasker Award (1986), the Gairdner Award (1987) and 2008 Nobel Prize winner for his work. (Wikipedia)
Like some other domesticated animals, cats live in a mutualistic arrangement with humans. Cats, however, have done so for a much shorter time than almost all other domesticated animals, and the degree of domestication of cats is somewhat disputed. Since the benefit of removing rats and mice from humans' food stores outweighed the cost of allowing a formerly wild animal to enjoy the relative safety of a human settlement, the relationship between cat and human flourished. Unlike the dog, which also kills rodents, the cat did not eat grains, fruits, or vegetables. A cat that is good at hunting rodents is referred to as a mouser.
The venerable simile "like herding cats" refers to the seeming intractability of the ordinary house cat to be trained in the manner of the dog. Despite occasional cohabitation in colonies, cats are lone hunters. It is no coincidence that cats are also "clean" animals, the chemistry of their saliva, expended in frequent grooming, acting as a natural deodorant. The "purpose" of this cleanliness is to help hide the cat's presence while stalking prey. A dog's odor, on the other hand, is an advantage, for a dog is a pack hunter; part of the pack stations itself upwind, and its odor drives prey towards the rest of the pack stationed downwind. This requires a cooperative effort, which in turn requires communications skills. No such communications skills are required of the lone hunter. Thus, communicating with such an animal is problematic, and cats in particular are labelled as opaque or inscrutable, if not obtuse, as well as aloof and self-sufficient. However, cats can be very affectionate towards their humans, especially if they imprint on them at a very young age and are treated with consistent affection.
Human attitudes toward cats vary widely. Some humans keep cats for companionship as pets. Some people (known as cat lovers) go to great lengths to pamper their cats, sometimes treating them almost as if they were children. When a cat bonds with its human owner, at times, the cat may display behaviors similar to that of the human. Such behavior may include a trip to the litter box before bedtime and snuggling up close to its companion in bed or on the sofa. Other behaviors could include mimicking sounds of the owner or using certain sounds the cat picks up from the human; sounds representing specific needs of the cat, which the owner would recognize. The cat may also be capable of learning to communicate with the human using non-spoken language or body language such as rubbing for affection (confirmation), facial expressions and making eye-contact with the owner if something needs to be addressed (e.g. finding a bug crawling on the floor for the owner to get rid of). Some owners like to train their cat to perform "tricks" commonly exhibited by dogs such as jumping.
Allergies to cat dander are one of the most common reasons people cite for disliking cats. However, in some instances, humans find the rewards of cat companionship outweigh the discomfort and problems associated with allergies. Many chose to cope with cat allergies by taking prescription allergy medicine and bathing their cats frequently, since weekly bathing will eliminate about 90% of the cat dander present in the environment. Recent studies have indicated the humans who are exposed to cats or dogs within the first year of their lives develop few animal allergies, while most adults who are allergic to animals did not have a cat or a dog as a pet in childhood.
In urban areas, some people find feral and free roaming pet cats annoying and intrusive. Unaltered animals can engage in persistent nighttime calling (caterwauling) and defecation or "marking" on private property. Indoor confinement of pets and TNR (Trap, Neuter, Return) programs for feral cats can help in this situation; some people also use cat deterrents to discourage cats from entering their property.
In rural areas, farms often have dozens of semi-feral cats. Hunting in the barns and the fields, they kill and eat rodents that would otherwise spoil large parts of the grain crop. Many pet cats successfully hunt and kill rabbits, rodents, birds, lizards, frogs, fish, and large insects by instinct, but might not eat their prey. They may even present such victims, dead or maimed, to a beloved owner, perhaps expecting their owner to praise or reward them, or possibly even complete the kill and eat the mouse.
Despite its reputation as a solitary animal, the domestic cat is social enough to form colonies, but does not attack in groups as do lions. Some breeds like bengal, ocicat and manx are very social, but these breeds are exceptions. While each cat holds a distinct territory (sexually active males having the largest territories, and neutered cats having the smallest), there are "neutral" areas where cats watch and greet one another without territorial conflict or aggression. Outside of these neutral areas, territory holders usually vigorously chase away strangers, at first by staring, hissing, and growling, and if that does not work by short but noisy and violent attacks. Fighting cats make themselves look larger by raising their fur and arching their backs. Attacks usually comprise powerful slaps to the face and body with the forepaws as well as bites, but serious damage is rarely done, and usually the loser runs away with little more than a few scratches to the face. Sexually active males may be engaged in many fights over their lives and often have decidedly weathered faces with obvious scars and cuts to the ears and nose. Not only males will fight; females will also fight over territory or to defend their kittens and even neutered cats will defend their small territories vigorously.
Feral cats
Feral farm cat showing effects of a rough life.
Feral cats are thought to be a major predator of Hawaiian coastal and forest habitats, and are one species among many responsible for the decline of endemic forest bird species as well as seabirds like the Wedge-tailed Shearwater. [1] In one study of 56 cat scats, the remains of 44 birds were found, 40 of which were endemic species. [2]
Feral cats may live alone, but most are found in large groups called feral colonies with communal nurseries, depending on resource availability. Many lost or abandoned pet cats join these colonies out of desperation. The average lifespan of these feral cats is much shorter than a domestic housecat, which can live an average of sixteen years or more. Urban areas are not native environments to the cat; most domestic cats were artificially selected from cats in desert climates and were distributed throughout the world by humans, but some feral cat colonies are found in large cities, for example, around the Colosseum and Forum Romanum in Rome. Although cats are adaptable, feral felines are unable to thrive in extreme cold and heat, and with a protein requirement of about 90%, few find adequate nutrition on their own in cities. In addition, they have little defense or understanding of the dangers from dogs, coyotes, and even automobiles. However, there are thousands of volunteers and organizations that trap these unadoptable feral felines, spay or neuter them, immunize the cats against rabies and feline leukemia, and treat them with long-lasting flea products. Before release back into their feral colonies, the attending veterinarian nips the tip off one ear to mark the feral as spayed/neutered and inoculated, as these cats will more than likely find themselves trapped again. Volunteers continue to feed and give care to these cats throughout their lives, and not only is their lifespan greatly increased, but behavior and nuisance problems, due to competition for food, are also greatly reduced. In time, if an entire colony is successfully spayed and neutered, no additional kittens are born and the feral colony disappears. Many hope to see an end to urban feral cat colonies through these efforts.
Environmental issues
Trapped Feral cat
The environmental impact of feral cat programs and of indoor/outdoor cats is a subject of debate. Part of this stems from humane concern for the cats themselves and part arises from concerns about cat predation on endangered species. Nearly all studies agree that abandoned animals lead hard lives. Owners who can no longer keep their cats would do best to give them to friends, rescue organizations, or shelters.
The amount of ecological damage done by indoor/outdoor cats depends on local conditions. The most severe impact occurs with island ecologies. Serious concerns also exist in places such as Florida where housecats are not native, where several small sized endangered species live near human populations, and where the climate allows cats to breed throughout the year. Environmental concerns may be minimal in most of England where cats are an established species and few to none of the local prey species are endangered.
Pet owners can contact veterinarians, ecological organizations, and universities for opinions about whether local conditions are suitable for outdoor cats. Additional concerns include potential dangers from larger predators and infectious diseases. Coyotes kill large numbers of housecats in the Southwestern United States, even in urban zones. FELV (feline leukemia), FIV (feline immunodeficiency virus), or rabies may be present in the area. If faced with conflicting evidence, the safe choice is to keep a cat indoors. Experts recommend a gradual transition to indoor life for cats who are accustomed to going outside.
]]>Education and science of medicinehttp://www.sfetcu.com/content/Education-and-science-medicine2008-08-12T05:58:10-06:002008-08-12T05:58:10-06:00nicolae
Branches of medicine
Working together as an interdisciplinary team, many highly trained health professionals besides medical practitioners are involved in the delivery of modern health care. Some examples include: nurses, laboratory scientists, pharmacists, physiotherapists, respiratory therapists, speech therapists, occupational therapists, dietitians and bioengineers.
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Branches of medicine
Working together as an interdisciplinary team, many highly trained health professionals besides medical practitioners are involved in the delivery of modern health care. Some examples include: nurses, laboratory scientists, pharmacists, physiotherapists, respiratory therapists, speech therapists, occupational therapists, dietitians and bioengineers.
The scope and sciences underpinning human medicine overlap many other fields. Dentistry and psychology, while separate disciplines from medicine, are considered medical fields.
Midlevel Practitioner
Physician assistants, nurse practitioners and midwives treat patients and prescribe medication in many legal jurisdictions.
Veterinary Medicine
Veterinarians applies similar techniques as physicians to the care of animals.
Physicians have many specializations and subspecializations which are listed below. There are variations from country to country regarding which specialities certain subspecialities are in.
Diagnostic specialties
Clinical laboratory sciences are the clinical diagnostic services which apply laboratory techniques to diagnosis and management of patients. In the United States these services are supervised by a pathologist. The personnel that work in these medical laboratory departments are technically trained staff, each of whom usually hold a medical technology degree, who actually perform the tests, assays, and procedures needed for providing the specific services.
Pathology is the branch of medicine that deals with the study of diseases and the morphologic, physiologic changes produced by them. As a diagnostic specialty, pathology can be considered the basis of modern scientific medical knowledge and plays a large rôle in evidence-based medicine. Many modern molecular tests such as flow cytometry, polymerase chain reaction (PCR), immunohistochemistry, cytogenetics, gene rearragements studies and fluorescent in situ hybridization (FISH) fall within the territory of pathology.
Radiology is concerned with imaging of the human body, e.g. by x-rays, x-ray computed tomography, ultrasonography, and nuclear magnetic resonance tomography.
Clinical disciplines
Anesthesiology (AE) or anaesthesia (BE) is the clinical discipline concerned with providing anesthesia. Pain medicine is often practiced by specialised anesthesiologists.
Dermatology is concerned with the skin and its diseases. In the UK, dermatology is a subspeciality of general medicine.
Emergency medicine is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies.
General practice, family practice, family medicine or primary care is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family practitioners are usually able to treat over 90% of all complaints without referring to specialists.
Hospital medicine is the general medical care of hospitalized patients. Physicians whose primary professional focus is hospital medicine are called hospitalists in the USA.
Internal medicine is concerned with systemic diseases of adults, i.e. those diseases that affect the body as a whole (restrictive, current meaning), or with all adult non-operative somatic medicine (traditional, inclusive meaning), thus excluding pediatrics, surgery, gynecology and obstetrics, and psychiatry. There are several subdisciplines of internal medicine:
Cardiology
Endocrinology
Gastroenterology
Hematology
Infectious Diseases
Intensive care medicine
Nephrology
Oncology
Pulmonology
Rheumatology
Neurology is concerned with the diagnosis and treatment of nervous system diseases. It is a subspeciality of general medicine in the UK.
Obstetrics and gynecology (often abbreviated as Ob/Gyn) are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine are generally practiced by gynecological specialists.
Palliative care is a relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal illnesses including cancer and heart failure.
Pediatrics (AE) or paediatrics (BE) is devoted to the care of infants, children, and adolescents. Like internal medicine, there are many pediatric subspecialities for specific age ranges, organ systems, disease classes, and sites of care delivery. Most subspecialities of adult medicine have a pediatric equivalent such as pediatric cardiology, pediatric endocrinology, pediatric gastroenterology, pediatric hematology, pediatric oncology, pediatric ophthalmology, and neonatology.
Physical medicine and rehabilitation (or physiatry) is concerned with functional improvement after injury, illness, or congenital disorders.
Preventive medicine is the branch of medicine concerned with preventing disease.
Psychiatry is the branch of medicine concerned with the bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related non-medical fields include psychotherapy and clinical psychology.
Radiation therapy is concerned with the therapeutic use of ionizing radiation and high energy elementary particle beams in patient treatment.
Radiology is concerned with the interpretation of imaging modalities including x-rays, ultrasound, radioisotopes, and MRI (Magnetic Resonance Imaging). A newer branch of radiology, interventional radiology, is concerned with using medical devices to access areas of the body with minimally invasive techniques.
Surgical specialties employ operative treatment. These include Orthopedics, Urology, Ophthalmology, Neurosurgery, Plastic Surgery, Otolaryngology and various subspecialties such as transplant and cardiothoracic. Some disciplines are highly specialized and are often not considered subdisciplines of surgery, although their naming might suggest so.
Urgent care focuses on delivery of unscheduled, walk-in care outside of the hospital emergency department for injuries and illnesses that are not severe enough to require care in an emergency department.
Gender-based medicine studies the biological and physiological differences between the human sexes and how that affects differences in disease.
Interdisciplinary fields
Interdisciplinary sub-specialties of medicine are:
Aerospace medicine deals with medical problems related to flying and space travel.
Bioethics is a field of study which concerns the relationship between biology, science, medicine and ethics, philosophy and theology.
Biomedical Engineering is a field dealing with the application of engineering principles to medical practice.
Clinical pharmacology is concerned with how systems of therapeutics interact with patients.
Conservation medicine studies the relationship between human and animal health, and environmental conditions. Also known as ecological medicine, environmental medicine, or medical geology.
Diving medicine (or hyperbaric medicine) is the prevention and treatment of diving-related problems.
Evolutionary medicine is a perspective on medicine derived through applying evolutionary theory.
Forensic medicine deals with medical questions in legal context, such as determination of the time and cause of death.
Medical humanities includes the humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice.
eHealth, Medical informatics, and medical computer science are relatively recent fields that deal with the application of computers and information technology to medicine.
Nosology is the classification of diseases for various purposes.
Pharmacogenomics is a form of individualized medicine.
PanVascular Medicine is an approach to deal with the problems of highly specialised but both, medical and economical inefficiently arranged human resources and medical equipment in today's vascular care facilities
Sports medicine deals with the treatment and preventive care of athletics, amateur and professional. The team includes specialty physicians and surgeons, athletic trainers, physical therapists, coaches, other personnel, and, of course, the athlete.
Therapeutics is the field, more commonly referenced in earlier periods of history, of the various remedies that can be used to treat disease and promote health [1] [2].
Travel medicine or emporiatrics deals with health problems of international travelers or travelers across highly different environments.
Medical education
Avicenna, considered the "Father of modern medicine", pioneered clinical pharmacology, and described inhalational anesthetics and various drugs and medications, in The Canon of Medicine (1025).
Medical education is education related to the practice of being a medical practitioner, either the initial training to become a physician or further training thereafter.
Medical education and training varies considerably across the world, however typically involves entry level education at a university medical school, followed by a period of supervised practice (Internship and/or Residency) and possibly postgraduate vocational training. Continuing medical education is a requirement of many regulatory authorities.
Various teaching methodologies have been utilised in medical education, which is an active area of educational research.
Legal restrictions
In most countries, it is a legal requirement for medical doctors to be licensed or registered. In general, this entails a medical degree from a university and accreditation by a medical board or an equivalent national organization, which may ask the applicant to pass exams. This restricts the considerable legal authority of the medical profession to physicians that are trained and qualified by national standards. It is also intended as an assurance to patients and as a safeguard against charlatans that practice inadequate medicine for personal gain. While the laws generally require medical doctors to be trained in "evidence based", Western, or Hippocratic Medicine, they are not intended to discourage different paradigms of health and healing, such as alternative medicine or faith healing.
Criticism
Criticism of medicine has a long history. In the Middle Ages, some people did not consider it a profession suitable for Christians, as disease was often considered God sent. God was considered to be the 'divine physician' who sent illness or healing depending on his will. However many monastic orders, particularly the Benedictines, considered the care of the sick as their chief work of mercy. Barber-surgeons (they had the sharpest knives) generally had a bad reputation that was not to improve until the development of academic surgery as a speciality of medicine, rather than an accessory field.
Through the course of the twentieth century, healthcare providers focused increasingly on the technology that was enabling them to make dramatic improvements in patients' health. The ensuing development of a more mechanistic, detached practice, with the perception of an attendant loss of patient-focused care, known as the medical model of health, led to further criticisms. This issue started to reach collective professional consciousness in the 1970s and the profession had begun to respond by the 1980s and 1990s.
Perhaps the most devastating criticism of modern medicine came from Ivan Illich. In his 1976 work Medical Nemesis, Illich stated that modern medicine only medicalises disease and causes loss of health and wellness, while generally failing to restore health by eliminating disease. This medicalisation of disease forces the human to become a lifelong patient.[3]Other less radical philosophers have voiced similar views, but none were as virulent as Illich. Another example can be found in Technopoly: The Surrender of Culture to Technology by Neil Postman, 1992, which criticises overreliance on technological means in medicine.
Criticism of modern medicine has led to some improvements in the curricula of medical schools, which now teach students systematically on medical ethics, holistic approaches to medicine, the biopsychosocial model and similar concepts.
The inability of modern medicine to properly address many common complaints continues to prompt many people to seek support from alternative medicine. Although most alternative approaches lack scientific validation, some may be effective in individual cases. The bioscience and alternative health care paradigms may differ to such an extent that what constitutes scientific evidence is contested. Many physicians practice alternative medicine alongside "orthodox" approaches but the general body of medical practitioners is often criticised for ignoring the purported value of alternative medicine.
Medical errors are also the focus of many complaints and negative coverage. Practitioners of human factors engineering believe that there is much that medicine may usefully gain by emulating concepts in aviation safety, where it was long ago realized that it is dangerous to place too much responsibility on one "superhuman" individual and expect him or her not to make errors. Reporting systems and checking mechanisms are becoming more common in identifying sources of error and improving practice.
Radical critics of certain medical traditions may hold that whole fields or traditions of medicine are intrinsically harmful or ineffective. They would reject any use or support of practices belonging to that tradition. However, generally, there is a spectrum of efficacy on which all traditions lie; some are more effective, some are less effective, but nearly all contain some harmful practices and some effective ones. Naturally, though, most individuals or groups seeking a health care practice to improve their own health would seek a tradition with the maximum degree of efficacy. There is no doubt whatsoever that Western Allopathic medicine, together with its cohorts of improved hygiene and nutrition, have been collectively responsible for most of the improvements in health worldwide over the last century or so, including: increasing longevity, decreased child mortality, increasing population numbers, better ability to monitor and halt disease spread and outbreaks, improved access to health care for all strata of society.
]]>Practice of medicinehttp://www.sfetcu.com/content/Practice-medicine2008-08-04T00:35:10-06:002008-08-04T00:36:15-06:00nicolae
The practice of medicine combines both science as the evidence base and art in the application of this medical knowledge in combination with intuition and clinical judgement to determine the treatment plan for each patient.
Central to medicine is the patient-physician relationship established when a person with a health concern seeks a physician's help; the 'medical encounter'. Other health professionals similarly establish a relationship with a patient and may perform various interventions, e.g. nurses, radiographers and therapists.
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The practice of medicine combines both science as the evidence base and art in the application of this medical knowledge in combination with intuition and clinical judgement to determine the treatment plan for each patient.
Central to medicine is the patient-physician relationship established when a person with a health concern seeks a physician's help; the 'medical encounter'. Other health professionals similarly establish a relationship with a patient and may perform various interventions, e.g. nurses, radiographers and therapists.
As part of the medical encounter, the healthcare provider needs to:
develop a relationship with the patient
gather data (medical history, systems enquiry, and physical examination, combined with laboratory or imaging studies (investigations))
analyze and synthesize that data (assessment and/or differential diagnoses), and then:
develop a treatment plan (further testing, therapy, watchful observation, referral and follow-up)
treat the patient accordingly
assess the progress of treatment and alter the plan as necessary (management).
The medical encounter is documented in a medical record, which is a legal document in many jurisdictions.
Artificial insemination
Health care delivery systems
Medicine is practiced within the medical system, which is a legal, credentialing and financing framework, established by a particular culture or government. The characteristics of a health care system have significant effect on the way medical care is delivered.
Financing has a great influence as it defines who pays the costs. Aside from tribal cultures, the most significant divide in developed countries is between universal health care and market-based health care (such as practiced in the U.S.). Universal health care might allow or ban a parallel private market. The latter is described as single-payor system.
Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality and pricing greatly affects the choice by patients / consumers and therefore the incentives of medical professionals. While US health care system has come under fire for lack of openness, new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and the possible exploitation of information for commercial gain on the other.
Health care delivery
Medical care delivery is classified into primary, secondary and tertiary care.
Primary care medical services are provided by physicians or other health professionals who has first contact with a patient seeking medical treatment or care. These occur in physician's office, clinics, nursing homes, schools, home visits and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sexes.
Secondary care medical services are provided by medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both ambulatory care and inpatient services, emergency rooms, intensive care medicine, surgery services, physical therapy, labor and delivery, endoscopy units, diagnostic laboratory and medical imaging services, hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.
Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include trauma centers, burn treatment centers, advanced neonatology unit services, organ transplants, high-risk pregnancy, radiation oncology, etc.
Modern medical care also depends on information - still delivered in many health care settings on paper records, but increasingly nowadays by electronic means.
Physician-patient relationship
The physician-patient relationship and interaction is a central process in the practice of medicine. There are many perspectives from which to understand and describe it.
An idealized physician's perspective, such as is taught in medical school, sees the core aspects of the process as the physician learning the patient's symptoms, concerns and values; in response the physician examines the patient, interprets the symptoms, and formulates a diagnosis to explain the symptoms and their cause to the patient and to propose a treatment. The job of a physician is similar to a human biologist: that is, to know the human frame and situation in terms of normality. Once the physician knows what is normal and can measure the patient against those norms, he or she can then determine the particular departure from the normal and the degree of departure. This is called the diagnosis.
The four great cornerstones of diagnostic medicine are anatomy (structure: what is there), physiology (how the structure/s work), pathology (what goes wrong with the anatomy and physiology) and psychology (mind and behaviour). In addition, the physician should consider the patient in their 'well' context rather than simply as a walking medical condition. This means the socio-political context of the patient (family, work, stress, beliefs) should be assessed as it often offers vital clues to the patient's condition and further management. In more detail, the patient presents a set of complaints (the symptoms) to the physician, who then obtains further information about the patient's symptoms, previous state of health, living conditions, and so forth. The physician then makes a review of systems (ROS) or systems enquiry, which is a set of ordered questions about each major body system in order: general (such as weight loss), endocrine, cardio-respiratory, etc. Next comes the actual physical examination; the findings are recorded, leading to a list of possible diagnoses. These will be in order of probability. The next task is to enlist the patient's agreement to a management plan, which will include treatment as well as plans for follow-up. Importantly, during this process the healthcare provider educates the patient about the causes, progression, outcomes, and possible treatments of his ailments, as well as often providing advice for maintaining health. This teaching relationship is the basis of calling the physician doctor, which originally meant "teacher" in Latin. The patient-physician relationship is additionally complicated by the patient's suffering (patient derives from the Latin patior, "suffer") and limited ability to relieve it on his/her own. The physician's expertise comes from his knowledge of what is healthy and normal contrasted with knowledge and experience of other people who have suffered similar symptoms (unhealthy and abnormal), and the proven ability to relieve it with medicines (pharmacology) or other therapies about which the patient may initially have little knowledge, although the latter may be better performed by a pharmacist.
The physician-patient relationship can be analyzed from the perspective of ethical concerns, in terms of how well the goals of non-maleficence, beneficence, autonomy, and justice are achieved. Many other values and ethical issues can be added to these. In different societies, periods, and cultures, different values may be assigned different priorities. For example, in the last 30 years medical care in the Western World has increasingly emphasized patient autonomy in decision making.
The relationship and process can also be analyzed in terms of social power relationships (e.g., by Michel Foucault), or economic transactions. Physicians have been accorded gradually higher status and respect over the last century, and they have been entrusted with control of access to prescription medicines as a public health measure. This represents a concentration of power and carries both advantages and disadvantages to particular kinds of patients with particular kinds of conditions. A further twist has occurred in the last 25 years as costs of medical care have risen, and a third party (an insurance company or government agency) now often insists upon a share of decision-making power for a variety of reasons, reducing freedom of choice of healthcare providers and patients in many ways.
The quality of the patient-physician relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient's disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient's knowledge about the disease. Where such a relationship is poor the physician's ability to make a full assessment is compromised and the patient is more likely to distrust the diagnosis and proposed treatment. In these circumstances and also in cases where there is genuine divergence of medical opinions, a second opinion from another physician may be sought.
In some settings, e.g. the hospital ward, the patient-physician relationship is much more complex, and many other people are involved when somebody is ill: relatives, neighbors, rescue specialists, nurses, technical personnel, social workers and others.
Clinical skills
A complete medical evaluation includes a medical history, a systems enquiry, a physical examination, appropriate laboratory or imaging studies, analysis of data and medical decision making to obtain diagnoses, and a treatment plan.
The components of the medical history are:
Chief complaint (CC): the reason for the current medical visit. These are the 'symptoms.' They are in the patient's own words and are recorded along with the duration of each one. Also called 'presenting complaint.'
History of present illness / complaint (HPI): the chronological order of events of symptoms and further clarification of each symptom.
Current activity: occupation, hobbies, what the patient actually does.
Medications: what drugs the patient takes including over-the-counter, and home remedies, as well as herbal medicines/herbal remedies such as St. John's Wort. Allergies are recorded.
Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past infectious diseases and/or vaccinations, history of known allergies.
Social history (SH): birthplace, residences, marital history, social and economic status, habits (including diet, medications, tobacco, alcohol).
Family history (FH): listing of diseases in the family that may impact the patient. A family tree is sometimes used.
Review of systems (ROS) or systems enquiry: an set of additional questions to ask which may be missed on HPI, generally following the body's main organ systems (heart, lungs, digestive tract, urinary tract, etc).
The physical examination is the examination of the patient looking for signs of disease ('Symptoms' are what the patient volunteers, 'signs' are what the healthcare provider detects by examination). The healthcare provider uses the senses of sight, hearing, touch, and sometimes smell (taste has been made redundant by the availability of modern lab tests). Four chief methods are used: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (listen); smelling may be useful (e.g. infection, uremia, diabetic ketoacidosis). The clinical examination involves study of:
Vital signs including height, weight, body temperature, blood pressure, pulse, respiration rate, hemoglobin oxygen saturation
General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or clubbing)
Skin
Head, eye, ear, nose, and throat (HEENT)
Cardiovascular (heart and blood vessels)
Respiratory (large airways and lungs)
Abdomen and rectum
Genitalia (and pregnancy if the patient is or could be pregnant)
Psychiatric (orientation, mental state, evidence of abnormal perception or thought)
Laboratory and imaging studies results may be obtained, if necessary.
The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the differential diagnoses), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem.
The treatment plan may include ordering additional laboratory tests and studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised.
This process is used by primary care providers as well as specialists. It may take only a few minutes if the problem is simple and straightforward. On the other hand, it may take weeks in a patient who has been hospitalized with bizarre symptoms or multi-system problems, with involvement by several specialists.
On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations.
In geology, rock is a naturally occurring aggregate of minerals and/or mineraloids. The Earth's lithosphere is made of rock. In general rocks are of three types, namely, igneous, sedimentary, and metamorphic. Petrology is the scientific study of rocks.
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In geology, rock is a naturally occurring aggregate of minerals and/or mineraloids. The Earth's lithosphere is made of rock. In general rocks are of three types, namely, igneous, sedimentary, and metamorphic. Petrology is the scientific study of rocks.
Iron oxides and carbonates play a large part in many sedimentary rocks and are especially important as coloring agents. The red sands and limestones, for example, which are so abundant, contain small amounts of iron(III) oxide (hematite), which in a finely divided state gives a red hue to all rocks in which it is present. Limonite and goethite, on the other hand, makes rocks yellow or brown; manganese oxides, asphalt and other carbonaceous substances are the cause of the black color of many sediments. Bluish tints result sometimes from the presence of phosphates or of fluorite; while green is most frequently seen in rocks which contain glauconite or chlorite.
If the quartz from natural crystalline stone (such as quartz, beryl, calcite, obsidian, or amethyst), it may display the natural colouring and structure of the mineral from which it was fashioned. Some authors advise students to place a sigil, seal, or talsimanic emblem beneath a clear sphere, but most do not. Most authors suggest that the work of crystal gazing should be undertaken in a dimly-lit and quiet room, so as to foster visions and more easily allow the onset of a trance state.
Film made by Dan Alexoae
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The crystal-gazer's trance can be induced with any shiny object, including a crystaline gem stone. The size of quarty preferred varies greatly among those who practice crystallomancy. Some gazers use a few inches diameter quarty that is held in the hand; others prefer a larger quarty mounted on a stand -- although most authors agree that the expense of a very large quatz is not always justified by added efficacy. The stereotypical image of a gypsy woman wearing a headscarf and telling fortunes for her clients by means of a very large crystal ball is widely depicted in the media and can be found in hundreds of popular books, advertising pages, and films of the 19th, 20th, and 21st centuries, and the pervasiveness of this image may have led to the increased use of fairly large crystal balls by those who can afford them.
Crystal gazing may be used by practitioners -- sometimes called "readers" or "seers" -- for a variety of purposes, including to predict distant or future events, to give character analyses, for fortune telling, or to help a client make choices about current situations and problems.
Film made by Dan Alexoae
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Crystal gazing may be used by practitioners -- sometimes called "readers" or "seers" -- for a variety of purposes, including to predict distant or future events, to give character analyses, for fortune telling, or to help a client make choices about current situations and problems.
Because crystal gazing has been developed by people of various cultures through a long period of time, the term crystal gazing denotes several different forms of a variety of objects, and there are several schools of thought as to the sources of the visions seen in the crystal gazing trance. (Wikipedia)
Because crystal gazing has been developed by people of various cultures through a long period of time, the term crystal gazing denotes several different forms of a variety of objects, and there are several schools of thought as to the sources of the visions seen in the crystal gazing trance. (Wikipedia)
Harald zur Hausen, (born March 11, 1936) is a German medical scientist and professor emeritus. He has done research on cancer of the cervix, where he discovered the role of papilloma viruses, for which he received the Nobel Prize in Medicine 2008 along with Françoise Barré-Sinoussi and Luc Montagnier.
Françoise Barré-Sinoussi (born 30.7.1947 in Paris, France) was awarded the Nobel Prize in Physiology or Medicine in 2008 together with Luc Montagnier for their discovery of the HIV virus.
Luc Montagnier (born 1932 in Chabris, France) is a French virologist and joint recipient of the 2008 Nobel Prize for Medicine. In 1982 he was asked for assistance with establishing the possible underlying retroviral cause of a mysterious new syndrome, AIDS, by Willy Rozenbaum, a clinician at the Hôpital Bichat hospital in Paris. Rozenbaum's role was vital, as he had been openly speculating at scientific meetings that the cause of the disease might be a retrovirus, and it was from a lymph node biopsy taken from one of Rozenbaum's patients that the breakthrough was to come. Jean-Claude Chermann's role was too vital.
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Feral farm cat showing effects of a rough life.
Trapped Feral cat
Avicenna, considered the "Father of modern medicine", pioneered clinical pharmacology, and described inhalational anesthetics and various drugs and medications, in The Canon of Medicine (1025).
Artificial insemination