By U. Aila. Northwest Christian College.
Meta-analysis A statistical technique for combining (pooling) the results of a number of studies that address the same question and report on the same outcomes to produce a summary result order 2.5 mg cialis mastercard. Methodological Features of the design or reporting of a clinical study which are known to limitations be associated with risk of bias or lack of validity discount cialis 5 mg free shipping. Where a study is reported in this guideline as having significant methodological limitations, a recommendation has not been directly derived from it. A screening tool comprising 5 steps which help identify which adults are malnourished or at risk of malnourishment. Null hypothesis The ‘no difference’ or ‘no association’ hypothesis that can be tested against an alternative hypothesis that postulates a difference or association that is non-zero. Observational study Retrospective or prospective study in which the investigator observes the natural course of events with or without control groups, for example cohort studies and case-control studies. The odds of an event happening in the treatment group, expressed as a proportion of the odds of it happening in the control group. Open-label study In the context of study design, a study in which the physicians or investigators are not blinded to which patients are allocated to which treatment arm. A gastroscope is used to insert a tube through the wall of the abdomen into the stomach. Quality of life Refers to the level of comfort, enjoyment and ability to pursue daily activities. A trial in which people are randomly assigned to two (or more) groups: one (the experimental group) receiving the treatment that is being tested, and the other (the comparison or control group) receiving an alternative treatment, a placebo (dummy treatment) or no treatment. The two groups are followed up to compare differences in outcomes to see how effective the experimental treatment was. Sensitivity The proportion of individuals classified as positive by the gold or reference standard, who are correctly identified by the study test. Sensitivity analysis A measure of the extent to which small changes in parameters and variables affect a result calculated from them. Specialist A clinician whose practice is limited to a particular branch of medicine or surgery, especially one who is certified by a higher medical educational organisation. Specificity The proportion of individuals classified as negative by the gold (or reference) standard, who are correctly identified by the study test. Stakeholder Any national organisation, including patient and carers’ groups, healthcare professionals and commercial companies with an interest in the guideline under development. Statistical A result is deemed statistically significant if the probability of the result significance occurring by chance is less than 1 in 20 (p<0. Stenting A metal mesh tube is placed in an artery or blood vessel to increase blood flow to an area blocked by stenosis. Stroke The damaging or killing of brain cells starved of oxygen as a result of the blood supply to part of the brain being cut off. Types of stroke include Ischaemic stroke caused by blood clots to the brain or haemorrhagic stroke caused by bleeding into/of the brain. Neurologic abnormalities similar to a stroke can also be the result of imbalances of glucose, sodium and calcium. Systematic review Research that summarises the evidence on a clearly formulated question according to a pre-defined protocol using systematic and explicit methods to identify, select and appraise relevant studies, and to extract, collate and report their findings. Venous stroke The formation of a blood clot in the intracerebral veins and venous sinuses. Videofluoroscopy Videofluoroscopy is a test for assessing the integrity of the oral and pharyngeal stages of the swallowing process. It involves videotaping fluoroscopic images as the patient swallows a bolus of barium. Other tools have been developed to improve the speed of diagnosis on arrival in the A&E department to avoid delay in the delivery of specialist assessment and management. Level 2+ Studies varied considerably with respect to patient selection, setting (e. Physical assessment: facial weakness, arm weakness, leg weakness, speech disturbance and visual field defects. There was a high correlation between the physicians’ total scores and the pre-hospital providers. Agreement on scoring on specific items between physicians and pre-hospital personnel was high for all three items. R2 In people with sudden onset of neurological symptoms, hypoglycaemia should be excluded as the cause of these symptoms. The mode of access and time of treatment initiation changed but the referral criteria remained consistent throughout. Treatment initiated in the second phase included aspirin 300 mg taken in the clinic, together with a 4-week prescription for any other medication prescribed by the clinic. In addition, 29 Stroke clopidogrel 300 mg loading dose was given to all patients initiated on aspirin. In contrast, in phase one, primary care physicians were generally recommended to prescribe aspirin or clopidogrel if the former was contraindicated. But these costs will be at least partly offset by cost savings from reduced stroke treatment over the lifetime. The effect of different treatment strategies is first modelled in terms of effect on stroke incidence. Patients are then divided into whether or not the stroke was fatal and whether or not the stroke left them dependent. Long-term quality adjusted life expectancy was estimated for each group and for the patients who do not experience a stroke.
Private pharmacies in tuberculosis control- a neglected link International Journal of Tuberculosis and Lung Disease order cialis 2.5mg otc, 2002 best cialis 10mg, 6(2):171-173. Survey of knowledge, attitudes and practices for tuberculosis among general practitioners in Delhi, India. Use of thiacetazone, thiophen-2-carboxylic acid hydrazide and triphenyltetrazolium chloride. Advances in techniques of testing mycobacterial drug sensitivity, and the use of sensitivity tests in tuberculosis control programmes. Human Development Report 2003: Millennium Development Goals: A compact among nations to end human poverty. A comparison of three molecular assays for rapid detection of rifampin resistance in Mycobacterium tuberculosis. Evaluation of a commercial probe assay for detection of rifampin resistance in Mycobacterium tuberculosis directly from respiratory and non respiratory clinical specimens. European Journal of Clinical Microbiology and Infectious Diseases, 1998, 17:189-192. Detection of rifampicin resistance in Mycobacterium tuberculosis isolates from diverse countries by a commercial line probe assay as an initial indicator of multidrug resistance. Rifampin- and multidrug-resistant tuberculosis in Russian civilians and prison inmates: dominance of the beijing strain family. Low levels of drug resistance amidst rapidly increasing tuberculosis and human immunodeficiency virus: co-epidemics in Botswana. Epidemiological analysis of tuberculosis treatment outcome as a tool for changing tuberculosis control policy in Israel. Drug- resistant pulmnonary tuberculosis in Israel, a society of immigrants: 1985-1994. Screening and management of tuberculosis in immigrants: the challenge beyond professional competence. The new National Tuberculosis Control Programme in Israel, a country of high immigration. Drug-resistant tuberculosis in Poland in 2000: second national survey and comparison with the 1997 survey. Drug resistance among failure and relapse cases of tuberculosis: is the standard re-treatment regimen adequate? P was established 1948 early Notification all cases (rate) /100,000 Year of Rifampicin introduction 1970s early Estimated incidence (all cases) 5. P was established 1963 Notification all cases (rate) 10 /100,000 Year of Rifampicin introduction 1982 Estimated incidence (all cases) 10. P was established 1973 Notification all cases (rate) 47 /100,000 Year of Rifampicin introduction 1983 Estimated incidence (all cases) /100,000 Year of Isoniazid introduction 1973 Notification new sputum smear + 4439 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 34. P was established 1989 Notification all cases (rate) 16 /100,000 Year of Rifampicin introduction 1980 Estimated incidence (all cases) 29 /100,000 Year of Isoniazid introduction 1970s Notification new sputum smear + 4889 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 7. P was established 1950 Notification all cases (rate) 72 /100,000 Year of Rifampicin introduction 1985 Estimated incidence (all cases) >80 /100,000 Year of Isoniazid introduction 1970 Notification new sputum smear + 2802 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 45. P was established 1962 Notification all cases (rate) 120 /100,000 Year of Rifampicin introduction 1969 Estimated incidence (all cases) 190. P was established 1998 Notification all cases (rate) /100,000 Year of Rifampicin introduction 1972 Estimated incidence (all cases) 74. P was established 1989 Notification all cases (rate) 125 /100,000 Year of Rifampicin introduction 1990 Estimated incidence (all cases) 201 /100,000 Year of Isoniazid introduction 1965 Notification new sputum smear + 13683 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 58 /100,000 % Use of Short Course Chemotherapy Yes % Treatment Success 86 % Use of Directly Observed Therapy Yes 70. P was established 1963 Notification all cases (rate) 28 /100,000 Year of Rifampicin introduction 1970 Estimated incidence (all cases) 28. P was established 1931 Notification all cases (rate) 3 /100,000 Year of Rifampicin introduction 1971 Estimated incidence (all cases) 3. P was established 1920 Notification all cases (rate) 93 /100,000 Year of Rifampicin introduction 1972 Estimated incidence (all cases) /100,000 Year of Isoniazid introduction 1950s Notification new sputum smear + 380 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 40. P was established 1957 Notification all cases (rate) /100,000 Year of Rifampicin introduction 1970s Estimated incidence (all cases) 44. P was established (revised programme) Notification all cases (rate) 251 /100,000 Year of Rifampicin introduction 1979 Estimated incidence (all cases) 827 /100,000 Year of Isoniazid introduction 1968 Notification new sputum smear + 12393 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 135 /100,000 % Use of Short Course Chemotherapy Yes 100 % Treatment Success 58. P was established (revised programme) Notification all cases (rate) 400 /100,000 Year of Rifampicin introduction 1979 Estimated incidence (all cases) 875 /100,000 Year of Isoniazid introduction 1968 Notification new sputum smear + 15346 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 219 /100,000 % Use of Short Course Chemotherapy Yes 100 % Treatment Success 60. P was established (revised programme) Notification all cases (rate) 188 /100,000 Year of Rifampicin introduction 1979 Estimated incidence (all cases) 578 /100,000 Year of Isoniazid introduction 1968 Notification new sputum smear + 4296 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 138 /100,000 % Use of Short Course Chemotherapy Yes 100 % Treatment Success 67. P was established (revised programme) Notification all cases (rate) 423 /100,000 Year of Rifampicin introduction 1979 Estimated incidence (all cases) 530 /100,000 Year of Isoniazid introduction 1968 Notification new sputum smear + 6455 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 228 /100,000 % Use of Short Course Chemotherapy Yes 100 % Treatment Success 69. P was established (revised programme) Notification all cases (rate) 632 /100,000 Year of Rifampicin introduction 1979 Estimated incidence (all cases) 932 /100,000 Year of Isoniazid introduction 1968 Notification new sputum smear + 15264 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 359 /100,000 % Use of Short Course Chemotherapy Yes 100 % Treatment Success 70. P was established 1953 Notification all cases (rate) 6 /100,000 Year of Rifampicin introduction 1971 Estimated incidence (all cases) 5. Surveillance of resistance to anti-tuberculosis drugs is an essential component of a monitoring system. The benefits of surveillance are multiple: strengthening of laboratory networks, evaluation of programme performance, and the collection of data that inform appropriate therapeutic strategies. Most importantly, global surveillance identifies areas of high resistance and draws the attention of national health authorities to the need to reduce the individual or collective shortcomings that have created them. Prevalence of resistance among previously untreated patients reflects programme performance over a long period of time (the previous 10 years), and indicates the level of transmission within the community. The prevalence of bacterial resistance among patients with a history of previous treatment has received less attention because surveillance of this population is a more complex process. Re-treatment patients are a heterogeneous group composed of chronic patients, those who have failed a course of treatment, those who have relapsed, and those who have returned after defaulting.
Acute leukemia A malignant hematopoietic stem cell disorder characterized by proliferation and accumulation of immature and nonfunctional hematopoietic cells in the bone marrow and other organs order 2.5mg cialis with amex. Peripheral blood smear reveals the presence of many undifferentiated or minimally differentiated cells cheap cialis 2.5 mg overnight delivery. Acute phase reactant Plasma protein that rises rapidly in response to inflammation, infection, or tissue injury. This plasma is one of the reagents used in the substitution studies to determine a specific factor deficiency. It may be caused by a mutation in the gene controlling the production of fibrinogen or by an acquired condition in which fibrinogen is pathologically converted to fibrin. This serum is one of the reagents used in the substitution studies to determine a specific factor deficiency. Agglutinate Clumping together of erythrocytes as a result of interactions between membrane antigens and specific antibodies. Aggregating reagent Chemical substance (agonist) that promotes platelet activation and aggregation by attaching to a receptor on the platelet’s surface. Alloimmune hemolytic A hemolytic anemia generated when blood cells anemia from one person are infused into a genetically unrelated person. Antigens on the infused donor cells are recognized as foreign by the recipient’s lymphocytes, stimulating the production of antibodies. Alpha granules Platelet storage granules containing a variety of proteins that are released into an area after an injury. Antigen Any foreign substance that evokes antibody production (an immune response) and reacts specifically with that antibody. One of the components is retained, and the remaining constituents are recombined and returned to the individual. Apoptosis Programmed cell death resulting from activation of a predetermined sequence of intracellular events; "cell suicide. Auer rods Reddish blue staining needle-like inclusions within the cytoplasm of leukemic myeloblasts that occur as a result of abnormal cytoplasmic granule formation. Their presence on a Romanowsky stained smear is helpful in differentiating acute myeloid leukemia from acute lymphoblastic leukemia. Autosome Chromosomes that do not contain genes for sex differentiation; in humans, chromosome pairs 1 —22. Azurophilic granules The predilection of some granules (primary granules) within myelocytic leukocytes for the aniline component of a Romanowsky type stain. These granules appear bluish purple or bluish black when observed microscopically on a stained blood smear. Basophilic stippling Erythrocyte inclusions composed of precipitated ribonucleoprotein and mitochondrial remnant. Observed on Romanowsky stained blood smears as diffuse or punctate bluish black granules in toxic states such as drug (lead) exposure. Bilineage leukemia A leukemia that has two separate populations of leukemic cells, one of which phenotypes as lymphoid and the other as myeloid. Biphenotypic leukemia An acute leukemia that has myeloid and lymphoid markers on the same population of neoplastic cells. Birefringent Characteristic of a substance to change the direction of light rays that are directed at the substance; can be used to identify crystals. As the H+ concentration in tissues increases, the affinity of hemoglobin for oxygen is decreased, permitting unloading of oxygen. Bone marrow trephine Removal of a small piece of the bone marrow biopsy core that contains marrow, fat, and trabeula. Examination of the trephine biopsy is useful in observing the bone marrow architecture and cellularity and allows interpretation of the spatial relationships of bone, fat, and marrow cellularity. Cabot ring Reddish-violet erythrocyte inclusion resembling the figure 8 on Romanowsky stained blood smears that can be found in some cases of severe anemia. Carboxyhemoglobin Compound formed when hemoglobin is exposed to carbon monoxide; it is incapable of oxygen transport. It is produced by the choroid plexus cells, absorbed by the arachnoid pia and circulates in the subarachnoid space. In the chronic phase, there are less than 30% blasts in the bone marrow or peripheral blood, whereas in the blast crisis phase there are more than 30% blasts. An absolute monocytosis (>1 X 109/L) is present and immature erythrocytes and granulocytes may also be present. The bone marrow is hypercellular with proliferation of abnormal myelocytes, promonocytes, and monoblasts, and there are <20% blasts. Chylous A body effusion that has a milky, opaque appearance due to the presence of lymph fluid and chylomicrons. Circulating leukocyte The population of neutrophils actively circulating pool within the peripheral blood stream. Can be detected by the identification of only one of the immunoglobulin light chains (kappa or lambda) on B cells or the presence of a population of cells with a common phenotype. Clot Extravascular coagulation, whether occurring in vitro or in blood shed into the tissues or body cavities. Retraction of the clot occurs over a period of time and results in the expression of serum and a firm mass of cells and fibrin. Cold agglutinin disease Condition associated with the presence of cold- reacting autoantibodies (IgM) directed against erythrocyte surface antigens. Colony forming unit A visible aggregation (seen in vitro) of cells that developed from a single stem cell. Colony stimulating factorCytokine that stimulates the growth of immature leukocytes in the bone marrow. The common pathway includes three rate-limiting steps: (1) activation of factor X by the intrinsic and extrinsic pathways, (2) conversion of prothrombin to thrombin by activated factor X, and (3) cleavage of fibrinogen to fibrin.
Purpose • To approximate wound edges until healing occurs • To speed up healing of wound • To minimize the chance of infection • For esthetic purpose Equipment • Tray or trolley covered with a sterile towel • Sterile needle holder 145 • Sterile round needle (2) • Sterile cutting needle (2) • Sterile silk • Sterile cat- gut • Sterile tissue forceps • Sterile suture scissors • Sterile cotton swabs in a galipot • Sterile solution for cleaning • Sterile dressing forceps • Sterile receiver • Sterile gauze • Sterile plaster • Dressing scissors • Local anesthesia • Sterile needle & syringes • Sterile gloves • Sterile hole- towel (Fenestrated towel) Procedure • Explain procedure to patient • Adjust light • Wash your hands • Clean the wound thoroughly • Wash your hands again • Put on sterile gloves • Drape the Wound with the hold- sheet • Infiltrate the edges of the wound to be sutured with local anesthesia generic cialis 20mg amex. How ever cheap cialis 10 mg free shipping, such wounds have to be seen by a doctor since excision of all dead & devitalized tissue and eventual suturing may be required. Removal of the Stitch Technique: Use aseptic technique Principles • Sutures may be removed all at a time or may be removed alternatively. Remove – gum with benzene or ether and discard the forceps 147 • Place sterile gauze to receive pleases or sutures. Clips Definition: Metal suture used to stitch the skin Purpose Some as suturing with stitch Equipment • Michel clip applier • Tissue forceps (toothed dissecting forceps • Cleaning material- same as stuttering with stitch. Procedure The first part of procedure is the same as for suturing with stitch Except that instead of suturing the skin with thread and needle you would apply clips with the applier. Removal of Clips Technique Use aseptic technique 148 Equipment • Sterile gauze • Sterile cotton balls • Sterile kidney dish • Sterile forceps 3 • Sterile clip removal forceps • Antiseptic solution (Savalon 1% and iodine) • Receiver • Benzene or ether • Adhesive tape or bandage Procedure Explain procedure to the patient and organize the needed equipment • Drape and position patient • Protect bedding with rubber sheet and its cover • Remove old dressing and discard. Pre-operative Purpose • To prepare the patient emotionally, mentally and physically for surgery. Equipment As necessary • It is important that the patient be in a good state of physical health before he has surgery. Try to relieve his fears about the operation and any fear of death: explain to him what will be done and that every measure will be taken for his safety. If the surgery is on the face, neck, shoulders or upper chest, the hair should be the roughly washed, combed and tied up to keep it from touching the operative area. Any thing abnormal such as pain, fever cough rapid pulse or elevated blood pressure must be reported immediately. Just before surgery • Just before it is time to take the patient void, if he is unable to void inform the doctor. The patient may be very sleepy or dizzy from the preoperative medications and may hurt himself. Shaving Purpose To minimize the danger of infection by decreasing the number of bacteria on the skin. Specific Area to be Shaved: Head Operations • Explain the reason for having the head to the patient 154 • If the hair is long, it must be cut short • Wash the head and hair well • Shave the area of the operation as directed. Face Operation • Shave the side of the face there the operation will be • If the patient is a man, make sure that the face is completely free from beard. Anterior Neck Operations: • Wash the patient’s head and neck • If the patient is a woman, tie her hair, and keep it away from her neck, or cut it short. Breast Operations • Shave the anterior and posterior chest from neck to the waist line on the side where the surgery will be • Shave the axilla on that side and the arm as far down as the elbow. Abdominal operations • Shave the whole abdomen from the end of the sternum down to the pubes. Equipment • Anesthetic bed • Oxygen • Sphygmomanometer • Stereoscope • Suction machine (as needed) • Extra rubber sheet (as needed) • I. V stand • Emergency drugs (to be ready in wards) • Bed blocks (as needed) for shock Procedure • Prepare anesthetic bed (see section on bed making) • Assist operating room nurse or health assistance in planning patient in bed. An unconscious patient may be placed on either his right or left side unless his right or left side unless specifically o Orders. Charting • Time of return • General condition and appearance ⇐ State of consciousness ⇐ Color of skin ⇐ Temperature of skin to touch ⇐ Skin- moist or dry ⇐ Blood pressure, plus and respiration ⇐ Any unusual condition such as bleeding drainage, Vomiting etc. Generals Instructions • If patient shows any signs of shock immediate action should be taken and then be reported to the doctor. The head of the bed should be lowered (If no gatches on bed, bed blocks may be used) • Do not leave unconscious patient alone. Breast Surgery • Encourage deep breathing often, because of danger of pneumonia • Special arm exercises should be given Abdominal Surgery • Encourage deep breathing • Turn from side to side often st • Sit patient on edge of bed 1 day postoperatively and • Start walking second day post operatively (unless contra-indicated) • Intake and output should be recorded • If gastric suction is present make sure it is working properly • Frequent mouth care for patients who are not allowed to drink. Eye Surgery • Must lie very still because the incision and sutures can be damaged by pulling on the eye muscles. Spinal Surgery • Must lie on abdomen of back with bed flat, and supported by fracture board mattress. This will make it easier to breathe since the pressure of dressing and swelling may give choking feeling. Tonsillectomy Child • Lie on abdomen or side to prevent blood drainage into throat, lunge or stomach. Adult • If conscious, he may sit in semi- fowler’s positron in order to spit the blood more easily. List some important equipment to provide care for immediate postoperative patients. Legal death is the total absence of brain activities as assessed and pronounced by the physician. If the dying patient is in a ward, move him to a room where there are no other patients, if possible, if this is impossible, put screen around his bed. To show kindness to the family Equipment • Basin for water, wash cloth and towel • Cotton • Gauze • Dressings and tape if necessary • Clean sheet • Stretcher • Forceps • Name tag • Gloves, if necessary Procedure • Note the exact time of death and chart it • If the doctor is present call him to pronounce death • If the family members are not present, send for them • Wash hands and wear clean gloves according to agency policy • Close doors to room or pull curtain • Raise bed to comfortable working level (when necessary) • Arrange for privacy and prevent other patients from seeing in to room. Autoclave Equipment that decontaminates materials by exposing them to steam under pressure. Asphyxia A condition produced by prolonged lack of oxygen Asepsis Absolute freedom from all microorganisms Antiseptic Harmless chemicals that can kill microorganisms or prevent them from multiplying. Aseptic technique Procedure used to prevent microorganisms from reaching the operation site. Blood pressure The force exerted by the heart to pump the blood around the body Bradycardia Abnormally slow heartbeat. Cyanosis Bluish color of lips, tip of the nose, and ear lobes due to lack of or shortage of oxygen in the blood.
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