martedì 29 aprile 2008

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In many parts of the world, particularly in developing countries, people get their primary health care, or first-contact care, where available at all, from nonmedically qualified personnel; these cadres of medical auxiliaries are being trained in increasing numbers to meet over¬whelming needs among rapidly growing populations. Even among the comparatively wealthy countries of the world, containing in all a much smaller percentage of the world's population, escalation in the costs of health services and in the cost of training a physician has precipitated some movement toward reappraisal of the role of the medical doctor in the delivery of first-contact care. http://amaryl-amoxil.freehostia.com//index7.html amaryl effects side In a war zone, medical officers have an aid post where, with the help of corpsmen, they apply first aid to the walking wounded and to the more seriously wounded who are brought in. The casualties are evacuated as quickly as possible by field ambulances or helicopters. At a com¬pany station, medical officers and medical corpsmen may provide further treatment before patients are evacuated to the main dressing station at the field ambulance head¬quarters, where a surgeon may perform emergency oper¬ations. Thereafter, evacuation may be to casualty clearing stations, to advanced hospitals, or to base hospitals. Air evacuation is widely used. http://amaryl-amoxil.freehostia.com//index7.html amaryl effects side In order to reduce bias and make the trial as objective as possible the double-blind technique is sometimes used. In this procedure, neither the doctor nor the patients know which of two treatments is being given. Despite such pre¬cautions the results of such trials can be prejudiced, so that rigorous statistical analysis is required. It is obvious that many ethical, not to say legal, considerations arise, and it is essential that all patients have given their informed consent to be included. Difficulties arise when patients are unconscious, mentally confused, or otherwise unable to give their informed consent. Children present a special difficulty because not all laws agree that parents can legally commit a child to an experimental procedure. Trials, and indeed all forms of clinical research that involve patients, must often be submitted to a committee set up locally to scrutinize each proposal. http://amaryl-amoxil.freehostia.com//index7.html amaryl effects side http://amaryl-amoxil.freehostia.com//index7.html amaryl effects side The situation is similar in other developed countries. Physicians are bound by legal restrictions and must report industrial diseases. The industrial physician's most impor¬tant function, however, is to prevent industrial diseases. Many of the measures to this end have become stan¬dard practice, but, especially in industries working with new substances, the physician should determine if work¬ers are being damaged and suggest preventive measures. The industrial physician may advise management about industrial hygiene and the need for safety devices and protective clothing and may become involved in building design. The physician or health worker may also inform the worker of occupational health hazards. http://amaryl-amoxil.freehostia.com//index7.html amaryl effects side In the developing world, countries are largely spared such geriatric problems, but not necessarily for positive reasons. A principal cause, for instance, is that people do not live so long. Another major reason is that in the extended family concept, still prevalent among developing countries, most of the caretaking needs of the elderly are provided by the family. http://amaryl-amoxil.freehostia.com//index7.html amaryl effects sideA general practitioner under the National Health Service remains an independent contractor, paid by a capitation fee; that is, according to the number of people registered with him. He may work entirely from his own office, and he provides and pays his own receptionist, secretary, and other ancillary staff. Most general practitioners have one or more partners and work more and more in premises built for the purpose. Some of these structures are erected by the physicians themselves, but many are provided by the local 'authority, me physicians paying rent for using them. Health centres, in which groups of general practi¬tioners work have become common. http://amaryl-amoxil.freehostia.com//amaryl-vs-micronase.html amaryl vs micronase While the number of doctors per 100,000 population in the United States has been steadily increasing, there has been a trend among physicians toward the use of trained medical personnel to handle some of the basic services normally performed by the doctor. So-called physician extender services are commonly divided into nurse prac¬titioners and physician's assistants, both of whom provide similar ancillary services for the general practitioner or specialist. Such personnel do not replace the doctor. Al¬most all American physicians have systems for taking each other's calls when they become unavailable. House calls in the United Stales, as in Britain, have become exceedingly rare.http://amaryl-amoxil.freehostia.com//index7.html amaryl effects side http://amaryl-amoxil.freehostia.com//index7.html amaryl effects sideArmy medical organisation. The medical doctor of first contact to the soldier in the armies of developed countries is usually an officer in the medical corps. In ðåàãåíòå the doctor sees the sick and has functions similar to those of the general practitioner, prescribing drugs and dressings and there may be a sick bay where slightly sick soldiers can remain for a few days. The doctor is usually assisted by trained nurses and corpsmen. If a further medical opinion is required, the patient can be referred to a specialist at a military or civilian hospital. Britain. Public health services in Britain are organized locally under the National Health Service. The medical officer of health is employed by the local council and is the adviser in health matters. The larger councils employ a number of mostly full-time medical officers; in some rural areas, a general practitioner may be employed part-time as medical officer of health: http://amaryl-amoxil.freehostia.com//index7.html amaryl effects side Developments in modem medical science have made it possible to detect morbid conditions before a person actually feels the effects of the condition. Examples arc many: they include certain forms of cancer; high blood pressure; heart and lung disease; various familial and congenital conditions; disorders of metabolism, like diabetes; and acquired immune deficiency syndrome (AIDS), the con¬sideration to be made in screening is whether or not such potential patients should be identified by periodic exam¬inations. To do so is to imply that the subjects should be made aware of their condition and, second, that there are effective measures that can be taken to prevent their condition, if they test positive, from worsening. Such so-called specific screening procedures are costly since they involve large numbers of people. Screening may lead to a change in the life-style of many persons, but not all such moves have been shown in the long run to be fully effective. Although screening clinics may not be run by doctors, they are a factor of increasing importance in the, preventive health service. http://amaryl-amoxil.freehostia.com//index7.html amaryl effects sideSupport services for the elderly provided by private or state-subsidized sources include domestic help, delivery of meals, day-care centres, elderly residential homes or nursing homes, and hospital beds either in general medical wards or in specialized geriatric units. The degree of acces¬sibility" of these services is uneven from country to country and within countries. In the United States, for instance, although there are some federal programs, each state has its own elderly programs, which vary widely. However, as the elderly become an increasingly larger part of the pop¬ulation their voting rights are providing increased leverage for obtaining more federal and state benefits. The gen¬eral practitioner or family physician working with visiting health and social workers and in conjunction with the pa¬tient's family often form a working team for elderly care. http://amaryl-amoxil.freehostia.com//amaryl-phentermine-nasonex-altace.html amaryl phentermine nasonex altace Historical notes. Although the most spectacular changes in the medical scene during the 20lh century, and the most widely heralded, have been the development of potent drugs and elaborate operations, another striking change has been the abandonment of most of the remedies of the past. In the mid-19th century, persons ill with numer¬ous maladies were starved (partially or completely), bled, purged, cupped (by applying a tight-fitting vessel filled with steam to some part and then cooling the vessel), and rested, perhaps for months or even years. Much more recently they were prescribed various restricted diets and were routinely kept in bed for weeks after abdominal oper¬ations, for many weeks or months when their hearts were thought to be affected, and for many months or years with tuberculosis. The abandonment of these measures may not be though of as involving research, but the physician who first encouraged persons who had peptic ulcers to eat normally (rather than to live on the customary bland foods) and the physician who first got his patients out of bed a week or two after they had had minor coronary thrombosis (rather than insisting on a minimum of six weeks of strict bed rest) were as much doing research as is the physician who first tries out a new drug on a patient. This research, by observing what happens when remedies are abandoned, has been of inestimable value, and the need for it has not passed. http://amaryl-amoxil.freehostia.com//index7.html amaryl effects side The minimal complement of a local health department is a health officer, a public health nurse, a sanitation ex-pert, and a clerk who is also a registrar of vital statistics. There may also be sanitation personnel, nutritionists, so¬cial workers, laboratory technicians, and others.http://amaryl-amoxil.freehostia.com//index7.html amaryl effects side In the curative domain there are various forms îf medical practice. They may be thought of generally as forming a pyramidal structure, with three tiers representing increasing degrees of specialization and tech¬nical sophistication but catering to diminishing numbers of patients as they are filtered out of the system at a lower level. Only those patients who require special attention or treatment should reach the second (advisory) or third (specialized treatment) tiers where the cost per item of service becomes increasingly higher. The first level represents primary health care, or first contact care, or which patients have their initial contact with the health-care system.

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