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Bloodtestsdone
Glucosealittlebetter
HerbloodpressurealittlebetterbutnotsogreatBadthings:
Cholesterolnotsogreat
Herweightalittleup
HerbonesalittlethinonherlastDEXAscan4
4、Thesituation:
Theauthorwasinamoderatestateofpanic:
jugglingsomanythoughtsaboutMrs.Osorio’sconditionsandtryingtoresolvethemallbeforetheclockrandown.
Mrs.Osoriomadeatrivialrequest,notsoimportantascomparedtoherconditions.
Mrs.Osorioseemedtocareonlyabouther“innocent—andcompletelyjustified—request”:
theformsignedbyherdoctor.
Thedoctortriedtooratleastpretendedtopayattentiontothepatientwhilecompletingdocumentation.
5、Similarities:
Incomputermultitasking,amicroprocessoractuallyperformsonlyonetaskatatime.Likemicroprocessors,wehumanbeingscarftactuallyconcentrateontwothoughtsatthesameexacttime.Multitaskingisjustanillusionbothincomputersandhumanbeings.
Differences:
Theconceptofmultitaskingoriginatedincomputerscience.
Atbest,humanbeingscanjuggleonlyahandfulofthoughtsinamultitaskingmanner,butcomputerscandomuchbetter.
Themorethoughtshumanbeingsjuggle,thelesshumanbeingsareabletoattunefullytoanygiventhought,butcomputerscandomuchbetter.
6、
7medicalissuestoconsider
5separatethoughts,atleast,foreachissue
7x5=35thoughts
10patientsthatafternoon
35x10=350thoughts
5residentsundertheauthorssupervision
4patientsseenbyeachresident
10thoughts,atleast,generatedfromeachpatient
5x4x10=anther200thoughts
350+200=550thoughtstobehandledintotal
Ifthedoctordoesagoodjobjuggling98%ofthetime,thatstillleavesabout10thoughtsthatmightgetlostintheprocess.
7、Possiblesolutions:
Computer-generatedreminders
Casemanagers
Ancillaryservices
Thesimplestsolution:
time
Unit2
1、Theauthorimplies:
•Peoplesinadequateconsciousnessabouttheconsequenceofneglectingthere-emerginginfectiousdiseases
Unjustifiabilityofpeoplescomplacencyaboutthepreventionandcontroloftheinfectiousdiseases
Unfinishedwaragainstinfectiousdiseases
2、Victorydeclarations:
SurgeonGeneralWilliamStewart'
shyperbolicstatementofclosing“thebookoninfectiousdisease”.
Astringofimpressivevictoriesincurredbyantibioticsandvaccines
ThethoughtthatthewaragainstinfectiousdiseaseswasalmostoverWhatfollowedeversince:
AppearanceofnewdiseasessuchasAIDSandEbola
Comebackoftheoldafflictions:
»
DiphtheriaintheformerSovietUnion
TBinurbancenterslikeNewYorkCity
RisingGroupAstreptococcalconditionslikescarletfever
Thefearofapowerfulnewflustrainsweepingtheworld
3、Elaborateonthejoinedbattle:
WHOestablishedanewdivisiondevotedtoworldwidesurveillanceandcontrolofemergingdiseaseinOctober1995.
CDClaunchedapreventionstrategyin1994.
Congressraisedfundfrom$6.7millionin1995to$26millionin1997.
4、Thebordersaremeaninglesstopathogenicmicrobes,whichcantravelfromonecountrytoanotherremotecountryinaveryshorttime.
5、TB:
PrisonsandhomelesssheltersasidealplacesforTBspread
Emergingofdrug-resistantstrainorevenmulti-drug-resistantstrain
ArideontheHIVw^onbyattackingtheimmunocompromised
GroupAstrep:
Achangeinvirulence
Mutationintheexteriorofthebacterium
Flu:
Constantchangesinitscoat(surfaceantigens)andresultantchangesinitslevelofvirulence
6、Examples:
ExperimentinEnglandisseeingthewaningimmunitybecauseofnovaccination.
Duetopoorvaccinationefforts,thediphtheriasituationintheformerSovietUnionisserious.'
•ThevaccinationratesaredroppinginsomeAmericancities,anditwillleadtomorediphtheriaandwhoopingcough.
7、Thefourareasoffocus:
Theneedforsurveillance
Updatedsciencecapableofdealingwithdiscoveriesinthefield
Appropriatepreventionandcontrol
Strongpublichealthinfrastructure
8、TheinfectiousdiseasessuchasTB,flu,diphtheriaandscarletfeverwillneverreallygoaway,andthewaragainstthemwillneverend.
Unit3
1、Terry'
slifebefore
ShelovedpracticingTaeKwonDo
Shelovedthesurgeofadrenalinethatcamewiththecontrolledcombatoftournaments.
Shecompetednationally,evenwonbronzemedalinthetrialsforthePanAmericanGames.
Sheattendedmedicalschool,practicedasaninternalmedicineresident,andbecameanacademicgeneralinternist.
Shegotmarriedandgotasonandadaughter.
2、ThesymptomsofMSandautoimmunedisease:
Lossofstaminaandstrength
Problemswithbalance
Boutsofhorrificfacialpain
Dipsinvisualacuity
3、Terrydidthefollowingbeforesheself-experimented:
Shestartedinjections.
Sheadoptedmanypharmacotherapies.
Shebeganherownstudyofliterature:
ShereadarticlesonwebsitessuchasPubMed.
ShesearchedforarticlestestingnewMSdrugsinanimalmodels.
Sheturnedtoarticlesconcerningneurodegenerationofalltypes—dementia,Parkinson'
sdisease,Huntington'
sdisease,andLouGehrig'
sdisease.
Sherelearnedbasicsciencessuchascellularphysiology,biochemistry,andneurophysiology.
4、ApproachesTerrymainlyused:
Self-experimentationwithvariousnutrientstoslowneurodegenerationbasedonliteraturereportsonanimalmodels
Self-experimentationwithneuromuscularelectricalstimulationwhichisnotanapprovedtreatmentforMS
Onlinesearchtoidentifythesourcesofmicronutrientsandhavinganewdiet
Reductionoffoodallergiesandtoxicload
5、Casesmentionedinthetext:
Increasedmercurystoresinthebrainsofpeoplewithdentalfillings
HighlevelsoftheherbicideatrazineinprivatewellsinIowa
Thestrongassociationbetweenpesticideexposureandneurodegeneration
Theassociationofsinglenucleotidepolymorphismsinvolvingmetabolismofsulfurand/orBvitamins
Inefficientclearingoftoxins
6、With70%to90%oftheriskfordiabetes,heartdisease,cancer,andautoimmunitybeingduetoenvironmentalfactorsotherthanthegenes,wecantakemanyhealthproblemsandthehealthcarecrisisunderourcontrol,forexample,optimizingournutritionandreducingourtoxicload.
Unit4
1、Twoconcepts:
Complementarymedicinereferstotheuseofconventionaltherapiestogetherwithalternativetreatmentssuchasusingacupunctureinadditiontousualcaretohelplessenpain.ComplementaryandalternativemedicineisshortenedasCAM.
Alternativemedicinereferstohealingtreatmentsthatarenotpartofconventionaltherapies—likeacupuncture,massagetherapy,orherbalmedicine.Theyarecalledsobecausepeopleusedtoconsiderpracticesliketheseoutsidethemainstream.
2
TCMdoesnotrequireadvanced,complicated,andinmostcases,expensivefacilities.
TCMemploysneedles,cups,coins,tomentionbutafew.
MostproceduresandoperationsofTCMarenoninvasive.
Thesubstancesusedasmedicinearerawherbsorabstractsfromthem,andtheyareindeedallnatural,fromnature.
TCMhasbeenpracticedaslongastheChinesehistory,sotheefficiencyisprovenandensured.
Ongoingresearcharoundtheworldonacupuncture,herbs,massageandTaiChihaveshedlightonsomeofthetheoriesandpracticesofTCM
3、Itmaybeusedasanadjuncttreatment,analternative,orpartofacomprehensivemanagementprogramforanumberofconditions:
post-operativeandchemotherapyinducednauseaandvomiting,post-operativedentalpain,addiction,strokerehabilitation,headache,menstrualcramps,tenniselbow,fibromyalgia,myofascialpain,osteoarthritis,lowbackpain,carpaltunnelsyndrome,andasthma.
4、Awell-justifiedNO:
Moreintenseresearchtouncoveradditionalareasfortheuseofacupuncture
Higheradoptionofacupunctureasacommontherapeuticmodalitynotonlyintreatmentbutalsoinpreventionofdiseaseandpromotionofwellness
Explorationandperfectionofinnovativemethodsofacupuncturepointstimulationwithtechnologicaladvancement
Improvedunderstandingofneuroscienceandotheraspectsofhumanphysiologyandfunctionbybasicresearchonacupuncture
Greaterinterestbystakeholders
Anincreasingnumberofphysicianacupuncturists
5、
Appropriateusesofherbsdependonproperguidance:
ProperTCMdiagnosisofthezhengofthepatient
Correctselectionofthecorrespondingtherapeuticstrategiesandprinciplesthatguidethechoiceofherbsandherbalformulas
Digressionfromeitheroftheaboveguidencewillleadtomisusesofherbs,andwillresultincomplicationsinpatient
Randomizedcontrolledtrials
Advantages:
»
Eliminationofthepotentialbiasintheallocationofparticipantstotheinterventiongrouporcontrolgroup
Tendencytoproducecomparablegroups
Guaranteedvalidityofstatisticaltestsofsignificance
Limitations:
Difficultyingeneralizingtheresultsobtainedfromtheselectedsamplingtothepopulationasawhole
Apoorchoiceforresearchwheretemporalfactorsareanissue
Extremelyheavyresources,requiringverylargesamplegroups
•Quasi-experiments
Controlgroupcomparisonspossible
Reducedthreatstoexternalvalidityasnaturalenvir