a medicineto makeup themissed dose.
Keep takingdiclofenac andtalk toyour doctorif youhave anyof theseless seriousside effects:upset stomach,mild heartburnor stomachpain, diarrhea,constipation; bloating,gas; dizziness,headache, nervousness;skin itchingor rash;blurred vision;or ringingin yourears.
Sideeffects otherthan thoselisted heremay alsooccur.
Talkto yourdoctor aboutany sideeffect thatseems unusualor thatis especiallybothersome.
Beforetaking diclofenac,tell yourdoctor ifyou aretaking anyof thefollowing drugs:a bloodthinner suchas warfarin(Coumadin); cyclosporine(Neoral, Sandimmune);lithium (Eskalith,Lithobid); methotrexate(Rheumatrex, Trexall);diuretics (waterpills) suchas furosemide(Lasix).
Ifyou areusing anyof thesedrugs, youmay notbe ableto usediclofenac oryou mayneed dosageadjustments orspecial testsduring treatment.
There maybe otherdrugs notlisted thatcan affectdiclofenac.
Thisincludes vitamins,minerals, herbalproducts, anddrugs prescribedby otherdoctors.
Donot startusing anew medicationwithout tellingyour doctor.
Diclofenac isavailable witha prescriptionunder thebrand namesCataflam andVoltaren.
Otherbrand orgeneric formulationsmay alsobe available.
Ask yourpharmacist anyquestions youhave aboutthis medication,especially ifit isnew toyou.
Version:7.01. Revisiondate: 6/2/06.
Do notuse thismedicine justbefore orafter havingheart bypasssurgery (alsocalled coronaryartery bypassgraft, orCABG).
Seekemergency medicalhelp ifyou havesymptoms ofheart orcirculation problems,such aschest pain,weakness, shortnessof breath,slurred speech,or problemswith visionor balance.
This medicinecan alsoincrease yourrisk ofserious effectson thestomach orintestines, includingbleeding orperforation (formingof ahole).
Theseconditions canbe fataland gastrointestinaleffects canoccur withoutwarning atany timewhile youare takingMobic.
Olderadults mayhave aneven greaterrisk ofthese seriousgastrointestinal sideeffects.
Callyour doctorat onceif youhave symptomsof bleedingin yourstomach orintestines.
Thisincludes black,bloody, ortarry stools,or coughingup bloodor vomitthat lookslike coffeegrounds.
Mobicworks byreducing hormonesthat causeinflammation andpain inthe body.
Mobic isused totreat painor inflammationcaused byarthritis.
Mobicmay alsobe usedfor purposesother thanthose listedin thismedication guide.
This riskwill increasethe longeryou usean NSAID.
Do notuse thismedicine justbefore orafter havingheart bypasssurgery (alsocalled coronaryartery bypassgraft, orCABG).
NSAIDscan alsoincrease yourrisk ofserious effectson thestomach orintestines, includingbleeding orperforation (formingof ahole).
Theseconditions canbe fataland gastrointestinaleffects canoccur withoutwarning atany timewhile youare takingan NSAID.
Older adultsmay havean evengreater riskof theseserious gastrointestinalside effects.
Before takingMobic, tellyour doctorif youare allergicto anydrugs, orif youhave: ahistory ofheart attack,stroke, orblood clot;heart disease,congestive heartfailure, highblood pressure;a historyof stomachulcers orbleeding, bowelproblems, diverticulosis;asthma; polypsin yournose; orif yousmoke.
Ifyou haveany ofthese conditions,you maynot beable touse Mobic,or youmay needa dosageadjustment orspecial testsduring treatment.
Take thismedication exactlyas itwas prescribedfor you.
Do nottake themedication inlarger amounts,or takeit forlonger thanrecommended byyour doctor.
Follow thedirections onyour prescriptionlabel.
Themaximum amountof Mobicfor adultsis 15milligrams (mg)per day.
Know theamount ofmeloxicam inthe specificproduct youare taking.
If youtake Mobicfor along periodof time,your doctormay wantto checkyou ona regularbasis tomake surethis medicationis notcausing harmfuleffects.
Donot missany scheduledvisits toyour doctor.
This medicationcan causeyou tohave unusualresults withcertain medicaltests.
Tellany doctorwho treatsyou thatyou areusing Mobic.
Take themissed doseas soonas youremember.
Ifit isalmost timefor yournext dose,skip themissed doseand takethe medicineat yournext regularlyscheduled time.
Do nottake extramedicine tomake upthe misseddose.
Keeptaking Mobicand talkto yourdoctor ifyou haveany ofthese lessserious sideeffects: upsetstomach, mildheartburn orstomach pain,diarrhea, constipation;bloating, gas;dizziness, headache,nervousness; skinitching orrash; drymouth; increasedsweating, runnynose; blurredvision; orringing inyour ears.
Side effectsother thanthose listedhere mayalso occur.
Talk toyour doctorabout anyside effectthat seemsunusual orthat isespecially bothersome.
If youare usingany ofthese drugs,you maynot beable touse Mobicor youmay needdosage adjustmentsor specialtests duringtreatment.
Theremay beother drugsnot listedthat canaffect Mobic.
This includesvitamins, minerals,herbal products,and drugsprescribed byother doctors.
Do notstart usinga newmedication withouttelling yourdoctor.
Meloxicamis availablewith aprescription underthe brandname Mobic.
Other brandor genericformulations mayalso beavailable.
Askyour pharmacistany questionsyou haveabout thismedication, especiallyif itis newto you.
It issimilar tomorphine.
OxyContinis usedto treatmoderate tosevere pain.
OxyContin isnot fortreating painjust aftera surgeryunless youwere alreadytaking OxyContinbefore thesurgery.
OxyContinmay alsobe usedfor purposesother thanthose listedin thismedication guide.
You shouldalso nottake OxyContinif youare havingan asthmaattack orif youhave abowel obstructioncalled paralyticileus.
Beforeusing OxyContin,tell yourdoctor ifyou areallergic toany drugs,or ifyou have:asthma, COPD,sleep apnea,or otherbreathing disorders;underactive thyroid;curvature ofthe spine;a historyof headinjury orbrain tumor;epilepsy orother seizuredisorder; lowblood pressure;gallbladder disease;Addison's diseaseor otheradrenal glanddisorders; enlargedprostate, urinationproblems; mentalillness; ora historyof drugor alcoholaddiction.
Takethis medicationexactly asit wasprescribed foryou.
Nevertake OxyContinin largeramounts, oruse itfor longerthan recommendedby yourdoctor.
Followthe directionson yourprescription label.
Tell yourdoctor ifthe medicineseems tostop workingas wellin relievingyour pain.
Never crusha tabletor otherpill tomix intoa liquidfor injectingthe druginto yourvein.
Thispractice hasresulted indeath withthe misuseof OxyContinand similarprescription drugs.
Keep trackof howmany pillshave beenused fromeach newbottle ofthis medicine.
OxyContin isa drugof abuseand youshould beaware ifany personin thehousehold isusing thismedicine improperlyor withouta prescription.
After youhave stoppedusing thismedication, flushany unusedpills downthe toilet.
Overdose symptomsmay includeextreme drowsiness,muscle weakness,confusion, coldand clammyskin, pinpointpupils, shallowbreathing, slowheart rate,fainting, orcoma.
Lessserious sideeffects aremore likelyto occur,such as:nausea, vomiting,constipation, lossof appetite;dizziness, headache,tired feeling;dry mouth;sweating; oritching.
Thislist isnot completeand otherside effectsmay occur.
Tell yourdoctor aboutany unusualor bothersomeside effect.
Before takingOxyContin, tellyour doctorif youare usingpentazocine (Talwin),nalbuphine (Nubain),butorphanol (Stadol),or buprenorphine(Buprenex, Subutex).
If youare usingany ofthese drugs,you maynot beable touse OxyContin,or youmay needdosage adjustmentsor specialtests duringtreatment.
Thislist isnot completeand theremay beother drugsthat caninteract withOxyContin.
Thisincludes vitamins,minerals, herbalproducts, anddrugs prescribedby otherdoctors.
Donot startusing anew medicationwithout tellingyour doctor.
Your dailyintake offat, protein,and carbohydratesshould beevenly dividedover allof yourdaily meals.
Follow yourdiet, medication,and exerciseroutines veryclosely.
Readthe labelof allfood itemsyou consume,paying specialattention tothe numberof servingsper container.
Your doctor,nutrition counselor,or dietitiancan helpyou developa healthyeating plan.
Your doctormay recommendyou takevitamin andmineral supplementswhile youare takingalli.
Takethe supplementat least2 hoursbefore orafter youtake alli.
If youhave anyof theseconditions, youmay notbe ableto usealli, oryou mayneed adosage adjustmentor specialtests duringtreatment.
Takealli exactlyas directedon thelabel, oras itwas prescribedfor you.
Do nottake themedication inlarger amounts,or takeit forlonger thanrecommended byyour doctor.
Follow thedirections onyour prescriptionlabel.
Followthese directionscarefully.
Askyour doctoror pharmacistif youhave anyquestions.
Yourdaily intakeof fat,protein, andcarbohydrates shouldbe evenlydivided overall ofyour dailymeals.
Followyour diet,medication, andexercise routinesvery closely.
If youskip ameal oryou eata mealthat doesnot containany fat,skip youralli dosefor thatmeal.
Thefat contentof yourdaily dietshould notbe greaterthan 30%of yourtotal dailycaloric intake.
For example,if youeat 1200calories perday, nomore than360 ofthose caloriesshould bein theform offat.
Readthe labelof allfood itemsyou consume,paying specialattention tothe numberof servingsper container.
Your doctor,nutrition counselor,or dietitiancan helpyou developa healthyeating plan.
Your doctormay recommendyou takevitamin andmineral supplementswhile youare takingalli.
Takethe supplementat least2 hoursbefore orafter youtake alli.
Keep trackof howmany pillshave beenused fromeach newbottle ofthis medicine.
Take themissed doseas soonas youremember, butno morethan 1hour aftereating ameal.
Ifit hasbeen morethan anhour sinceyour lastmeal, skipthe misseddose andtake themedicine atyour nextregularly scheduledtime.
Donot takeextra medicineto makeup themissed dose.
If youmiss ameal, orif youhave ameal withoutfat, youcan skipyour doseof allifor thatmeal also.
Symptoms ofan allioverdose arenot known.
The followingside effectsoccur commonlywith theuse ofalli.
Theseside effectsare usuallytemporary andmay lessenas youcontinue treatmentwith alli:oily spottingin yourundergarments; oilyor fattystools; orangeor browncolored oilin yourstool; gaswith discharge,an oilydischarge; loosestools, oran urgentneed togo tothe bathroom,inability tocontrol bowelmovements; anincreased numberof bowelmovements; orstomach pain,nausea, vomiting,diarrhea, rectalpain.
Otherside effectsthat mayoccur whiletaking alliinclude: problemswith yourteeth orgums; coldor flusymptoms; headache,back pain;or skinrash oritching.
Sideeffects otherthan thoselisted heremay alsooccur.
Talkto yourdoctor aboutany sideeffect thatseems unusualor thatis especiallybothersome.
Beforetaking alli,tell yourdoctor ifyou areusing anyof thefollowing drugs:cyclosporine (Gengraf,Neoral, Sandimmune);digoxin (digitalis,Lanoxin, Lanoxicaps);or ablood thinnersuch aswarfarin (Coumadin).
If youare usingany ofthese drugs,you maynot beable touse alli,or youmay needdosage adjustmentsor specialtests duringtreatment.
Theremay beother drugsnot listedthat canaffect alli.
This includesvitamins, minerals,herbal products,and drugsprescribed byother doctors.
Do notstart usinga newmedication withouttelling yourdoctor.
Otherbrand orgeneric formulationsmay alsobe available.
Ask yourpharmacist anyquestions youhave aboutalli, especiallyif itis newto you.
This riskwill increasethe longeryou useibuprofen.
Donot usethis medicinejust beforeor afterhaving heartbypass surgery(also calledcoronary arterybypass graft,or CABG).
Seek emergencymedical helpif youhave symptomsof heartor circulationproblems, suchas chestpain, weakness,shortness ofbreath, slurredspeech, orproblems withvision orbalance.
Thismedicine canalso increaseyour riskof seriouseffects onthe stomachor intestines,including bleedingor perforation(forming ofa hole).
These conditionscan befatal andgastrointestinal effectscan occurwithout warningat anytime whileyou aretaking ibuprofen.
Older adultsmay havean evengreater riskof theseserious gastrointestinalside effects.
Call yourdoctor atonce ifyou havesymptoms ofbleeding inyour stomachor intestines.
This includesblack, bloody,or tarrystools, orcoughing upblood orvomit thatlooks likecoffee grounds.
Ibuprofen worksby reducinghormones thatcause inflammationand painin thebody.
Ibuprofenis usedto reducefever andtreat painor inflammationcaused bymany conditionssuch asheadache, toothache,back pain,arthritis, menstrualcramps, orminor injury.
Ibuprofen mayalso beused forpurposes otherthan thoselisted inthis medicationguide.
Thisrisk willincrease thelonger youuse anNSAID.
Donot usethis medicinejust beforeor afterhaving heartbypass surgery(also calledcoronary arterybypass graft,or CABG).
NSAIDs canalso increaseyour riskof seriouseffects onthe stomachor intestines,including bleedingor perforation(forming ofa hole).
These conditionscan befatal andgastrointestinal effectscan occurwithout warningat anytime whileyou aretaking anNSAID.
Olderadults mayhave aneven greaterrisk ofthese seriousgastrointestinal sideeffects.
Beforetaking ibuprofen,tell yourdoctor ifyou areallergic toany drugs,or ifyou have:a historyof heartattack, stroke,or bloodclot; heartdisease, congestiveheart failure,high bloodpressure; ahistory ofstomach ulcersor bleeding;asthma; polypsin yournose; orsystemic lupuserythematosus (SLE);a bleedingor bloodclotting disorder;or ifyou smoke.
If youhave anyof theseconditions, youmay notbe ableto useibuprofen, oryou mayneed adosage adjustmentor specialtests duringtreatment.
Takethis medicationexactly asdirected onthe label,or asit hasbeen prescribedby yourdoctor.
Donot usethe medicationin largeramounts, oruse itfor longerthan recommended.
The ibuprofenchewable tabletmust bechewed beforeyou swallowit.
Ifyou takeibuprofen fora longperiod oftime, yourdoctor maywant tocheck youon aregular basisto makesure thismedication isnot causingharmful effects.
Do notmiss anyscheduled visitsto yourdoctor.
Sinceibuprofen issometimes takenas needed,you maynot beon adosing schedule.
If youare takingthe medicationregularly, takethe misseddose assoon asyou remember.
If itis almosttime forthe nextdose, skipthe misseddose andwait untilyour nextregularly scheduleddose.
Donot takeextra medicineto makeup themissed dose.
Keep takingibuprofen andtalk toyour doctorif youhave anyof theseless seriousside effects:upset stomach,mild heartburn,diarrhea, constipation;bloating, gas;dizziness, headache,nervousness; skinitching orrash; blurredvision; orringing inyour ears.
Side effectsother thanthose listedhere mayalso occur.
Talk toyour doctorabout anyside effectthat seemsunusual orthat isespecially bothersome.
If youare usingany ofthese drugs,you maynot beable touse ibuprofenor youmay needdosage adjustmentsor specialtests duringtreatment.
Theremay beother drugsnot listedthat canaffect ibuprofen.
This includesvitamins, minerals,herbal products,and drugsprescribed byother doctors.
Do notstart usinga newmedication withouttelling yourdoctor.
Askyour pharmacistany questionsyou haveabout thismedication, especiallyif itis newto you.
There maybe otherdrugs thatcan affectLipitor.
Thisincludes vitamins,minerals, herbalproducts, anddrugs prescribedby otherdoctors.
Donot startusing anew medicationwithout tellingyour doctor.
Lowering yourcholesterol canhelp preventheart diseaseand hardeningof thearteries, conditionsthat canlead toheart attack,stroke, andvascular disease.
Lipitor isused totreat highcholesterol.
Lipitoris alsoused tolower therisk ofstroke, heartattack, orother heartcomplications inpeople withcoronary heartdisease ortype 2diabetes.
Lipitormay alsobe usedfor purposesother thanthose listedin thismedication guide.
Before takingLipitor, tellyour doctorif youare allergicto anydrugs, orif youhave: diabetes;underactive thyroid;a muscledisorder.
Ifyou haveany ofthese conditions,you maynot beable touse Lipitor,or youmay needa dosageadjustment orspecial testsduring treatment.
Take thismedication exactlyas itwas prescribedfor you.
Do nottake themedication inlarger amounts,or takeit forlonger thanrecommended byyour doctor.
Follow thedirections onyour prescriptionlabel.
Lipitorcan betaken withor withoutfood.
Lipitoris usuallytaken oncea day.
Try totake yourdose atthe sametime eachday.
Followyour doctor'sinstructions.
Tobe surethis medicationis helpingyour condition,your bloodwill needto betested ona regularbasis.
Yourliver functionmay alsoneed tobe tested.
Do notmiss anyscheduled visitsto yourdoctor.
Lipitoris onlypart ofa completeprogram oftreatment thatalso includesdiet, exercise,and weightcontrol.
Followyour diet,medication, andexercise routinesvery closely.
Take themissed doseas soonas youremember.
Ifit isalmost timefor thenext dose,skip themissed doseand takeonly thenext regularlyscheduled dose.
Do nottake extramedicine tomake upthe misseddose.
Avoideating foodsthat arehigh infat orcholesterol.
Grapefruitand grapefruitjuice mayinteract withLipitor andlead topotentially dangerouseffects.
Discussthe useof grapefruitproducts withyour doctor.
Do notincrease ordecrease theamount ofgrapefruit productsin yourdiet withoutfirst talkingto yourdoctor.
Keeptaking Lipitorand talkto yourdoctor ifyou haveany ofthese lessserious sideeffects: mildstomach pain,gas, bloating,stomach upset,heartburn; nausea,stomach painor upset;constipation, bloating,gas; stuffynose; itching,skin rash;or musclepain.
Sideeffects otherthan thoselisted heremay alsooccur.
Talkto yourdoctor aboutany sideeffect thatseems unusualor thatis especiallybothersome.
Ifyou areusing anyof thesedrugs, youmay notbe ableto useLipitor, oryou mayneed dosageadjustments orspecial testsduring treatment.
There maybe otherdrugs notlisted thatcan affectLipitor.
Thisincludes vitamins,minerals, herbalproducts, anddrugs prescribedby otherdoctors.
Donot startusing anew medicationwithout tellingyour doctor.
Atorvastatin isavailable witha prescriptionunder thebrand nameLipitor.
Otherbrand orgeneric formulationsmay alsobe available.
Ask yourpharmacist anyquestions youhave aboutthis medication,especially ifit isnew toyou.
Version:4.04. RevisionDate: 2/14/03.
Follow yourdoctor's instructions.
Some drugscan makeDesogen lesseffective, whichmay resultin pregnancy.
Do notstart usinga newmedication withouttelling yourdoctor.
Desogencontains acombination offemale hormonesthat preventovulation (therelease ofan eggfrom anovary).
Thismedication alsocauses changesin yourcervical mucousand uterinelining, makingit harderfor spermto reachthe uterusand harderfor afertilized eggto attachto theuterus.
Desogenare usedas contraceptionto preventpregnancy.
Desogenmay alsobe usedfor purposesother thanthose listedin thismedication guide.
Before usingthis medication,tell yourdoctor ifyou haveany ofthe followingconditions.
Youmay notbe ableto useDesogen, oryou mayneed adosage adjustmentor specialtests duringtreatment.
Takethis medicationexactly asit wasprescribed foryou.
Donot takelarger amounts,or takeit forlonger thanrecommended byyour doctor.
You willtake yourfirst pillon thefirst dayof yourperiod oron thefirst Sundayafter yourperiod begins(follow yourdoctor's instructions).
Follow yourdoctor's instructions.
Your periodwill usuallybegin whileyou areusing thesereminder pills.
Take onepill everyday, nomore than24 hoursapart.
Whenthe pillsrun out,start anew packthe followingday.
Youmay getpregnant ifyou donot usethis medicationregularly.
Getyour prescriptionrefilled beforeyou runout ofpills completely.
If youneed tohave anytype ofmedical testsor surgery,or ifyou willbe onbed rest,you mayneed tostop usingthis medicationfor ashort time.
Any doctoror surgeonwho treatsyou shouldknow thatyou areusing Desogen.
Your doctorwill needto seeyou ona regularbasis whileyou areusing thismedication.
Donot missany appointments.
Missing apill increasesyour riskof becomingpregnant.
Followthe directionson thepatient informationsheet providedwith yourmedicine.
Ifyou donot havean informationsheet, callyour doctorfor instructionsif youmiss adose.
Ifyou missone "active"pill, taketwo pillson theday thatyou remember.
Then takeone pillper dayfor therest ofthe pack.
If youmiss two"active" pillsin arow inweek oneor two,take twopills perday fortwo daysin arow.
Thentake onepill perday forthe restof thepack.
Ifyou misstwo "active"pills ina rowin week3, orif youmiss threepills ina rowduring anyof thefirst 3weeks, throwout therest ofthe packand starta newone thesame dayif youare aDay 1starter.
Ifyou area Sundaystarter, keeptaking apill everyday untilSunday.
OnSunday, throwout therest ofthe packand starta newone thatday.
Ifyou missthree "active"tablets ina rowduring anyof thefirst 3weeks, throwout therest ofthe packand starta newpack onthe sameday ifyou area Day1 starter.
If youare aSunday starter,keep takinga pillevery dayuntil Sunday.
On Sunday,throw outthe restof thepack andstart anew onethat day.
If youmiss anyreminder pills,throw themaway andkeep takingone pillper dayuntil thepack isempty.
Seekemergency medicalattention ifyou thinkyou haveused toomuch ofthis medicine.
Symptoms ofan overdosemay includenausea, vomiting,and vaginalbleeding.
Usinga condomis theonly wayto protectyourself fromthese diseases.
Continue usingyour Desogenand talkto yourdoctor ifyou haveany ofthese lessserious sideeffects: mildnausea, vomiting,bloating, stomachcramps; breastpain, tenderness,or swelling;freckles ordarkening offacial skin;increased hairgrowth, lossof scalphair; changesin weightor appetite;problems withcontact lenses;vaginal itchingor discharge;changes inyour menstrualperiods, decreasedsex drive;or headache,nervousness, dizziness,tired feeling.
Side effectsother thanthose listedhere mayalso occur.
Talk toyour doctorabout anyside effectthat seemsunusual orthat isespecially bothersome.
Some drugscan makeDesogen lesseffective, whichmay resultin pregnancy.
Before usingthis medication,tell yourdoctor ifyou areusing anyof thefollowing drugs:acetaminophen (Tylenol)or ascorbicacid (vitaminC); antibioticssuch asamoxicillin (Augmentin),ampicillin (Omnipen),doxycycline (Doryx,Vibramycin), griseofulvin(Grisactin, GrifulvinV, FulvicinPG), minocycline(Minocin), penicillin(Veetids, PenVee K,Bicillin), rifampin(Rifadin), rifabutin(Mycobutin), tetracycline(Sumycin, Achromycin,Robitet), andothers; phenylbutazone(Azolid, Butazolidin);St.
John'swort; seizuremedicines suchas phenytoin(Dilantin), carbamazepine(Tegretol), felbamate(Felbatol), oxcarbazepine(Trileptal), topiramate(Topamax), orprimidone (Mysoline);a barbituratesuch asamobarbital (Amytal),butabarbital (Butisol),mephobarbital (Mebaral),secobarbital (Seconal),or phenobarbital(Luminal, Solfoton);or HIVmedicines suchas amprenavir(Agenerase), atazanavir(Reyataz), tipranavir(Aptivus), indinavir(Crixivan), saquinavir(Invirase), lopinavir/ritonavir(Kaletra), fosamprenavir(Lexiva), ritonavir(Norvir), ornelfinavir (Viracept).
There maybe otherdrugs notlisted thatcan affectthis medication.
This includesvitamins, minerals,herbal products,and drugsprescribed byother doctors.
Do notstart usinga newmedication withouttelling yourdoctor.
Ethinylestradiol anddesogestrel isavailable witha prescriptionunder severalbrand namesand mayalso beavailable asa generic.
Ask yourpharmacist anyquestions youhave aboutthis medication,especially ifit isnew toyou.
Version:4.03. Revisiondate: 7/26/061:47:43 PM.
Phentermine isan appetitesuppressant thataffects thecentral nervoussystem.
Phentermineis usedtogther withdiet andexercise totreat obesity(overweight) inpeople withrisk factorssuch ashigh bloodpressure, highcholesterol, ordiabetes.
Phenterminemay alsobe usedfor purposesother thanthose listedin thismedication guide.
Do nottake phenterminewith anyother dietmedications withoutyour doctor'sadvice.
Youmay havewithdrawal symptoms,such asdepression andextreme tiredness,when youstop usingphentermine afterusing itover along periodof time.
Do notstop usingphentermine suddenlywithout firsttalking toyour doctor.
You mayneed touse lessand lessbefore youstop themedication completely.
Do nottake phenterminewith anyother dietmedications withoutyour doctor'sadvice.
Beforetaking phentermine,tell yourdoctor ifyou areallergic toany drugs,or ifyou have:problems withyour thyroid,an anxietydisorder, epilepsyor anotherseizure disorder,or diabetes.
If youhave anyof theseconditions, youmay notbe ableto usephentermine, oryou mayneed adosage adjustmentor specialtests duringtreatment.
Takethis medicationexactly asit wasprescribed foryou.
Donot takethe medicationin largeramounts, ortake itfor longerthan recommendedby yourdoctor.
Followthe directionson yourprescription label.
Phentermine shouldbe takenonly fora shorttime, suchas afew weeks.
You mayhave withdrawalsymptoms whenyou stopusing phentermineafter usingit overa longperiod oftime.
Donot stopusing thismedication suddenlywithout firsttalking toyour doctor.
You mayneed touse lessand lessbefore youstop themedication completely.
Do nottake phenterminein theevening becauseit maycause sleepproblems (insomnia).
Stop takingphentermine ifyou haveincreased hungeror ifyou otherwisethink themedication isnot workingproperly.
Donot takemore phenterminefor anincreased effect.
Take themissed doseas soonas youremember.
Ifit isalmost timefor yournext dose,skip themissed doseand takethe medicineat yournext regularlyscheduled time.
Do nottake extramedicine tomake upthe misseddose.
Lessserious sideeffects maybe morelikely tooccur, suchas: feelingnervous oranxious; headache,dizziness, tremors;trouble sleeping(insomnia); drymouth oran unpleasanttaste inyour mouth;diarrhea orconstipation; oritching.
Sideeffects otherthan thoselisted heremay alsooccur.
Talkto yourdoctor aboutany sideeffect thatseems unusualor thatis especiallybothersome.
Beforetaking phentermine,tell yourdoctor ifyou areusing anyof thefollowing drugs:medicines totreat highblood pressure;insulin ordiabetes medicationyou takeby mouth;guanadrel (Hylorel),guanethidine (Ismelin);antidepressants suchas citalopram(Celexa), escitalopram(Lexapro), fluoxetine(Prozac, Sarafem),fluvoxamine (Luvox),paroxetine (Paxil),or sertraline(Zoloft); orantidepressants suchas amitriptyline(Elavil, Etrafon),amoxapine (Ascendin),clomipramine (Anafranil),desipramine (Norpramin),doxepin (Sinequan),imipramine (Janimine,Tofranil), nortriptyline(Pamelor), protriptyline(Vivactil), ortrimipramine (Surmontil).
If youare usingany ofthese drugs,you maynot beable touse phentermine,or youmay needdosage adjustmentsor specialtests duringtreatment.
Theremay beother drugsnot listedthat canaffect phentermine.
This includesvitamins, minerals,herbal products,and drugsprescribed byother doctors.
Do notstart usinga newmedication withouttelling yourdoctor.
Phentermineis availablewith aprescription underthe brandnames Adipexand Fastin.
Other brandor genericformulations mayalso beavailable.
Askyour pharmacistany questionsyou haveabout thismedication, especiallyif itis newto you.
This medicineis availableonly withyour doctor'sprescription, inthe followingdosage form(s):In decidingto usea medicine,the risksof usingthe medicinemust beweighed againstthe goodit willdo.
Thisis adecision youand yourdoctor willmake.
Foramifostine, thefollowing shouldbe considered:Allergies Tellyour doctorif youhave everhad anyunusual orallergic reactionto amifostine.
Pregnancy Amifostinehas notbeen studiedin pregnantwomen.
However,in animalstudies, largedoses causedtoxic orharmful effectsin thefetus.
Beforereceiving thistreatment, makesure yourdoctor knowsif youare pregnantor ifyou maybecome pregnant.
Because amifostinemay causebirth defectsor otherharmful effectsin thefetus, itis usuallyrecommended thatwomen beingtreated forcancer usebirth control.
Children Althoughthis medicinehas beengiven toa limitednumber ofchildren, thereis nospecific informationcomparing useof amifostinein childrenwith usein otherage groups.
Older adultsMany medicineshave notbeen studiedspecifically inolder people.
Therefore, itmay notbe knownwhether theywork exactlythe sameway theydo inyounger adultsor ifthey causedifferent sideeffects orproblems inolder people.
Although amifostinehas beengiven toa limitednumber ofelderly people,there isno specificinformation comparinguse ofamifostine inthe elderlywith usein otherage groups.
Other medicinesAlthough certainmedicines shouldnot beused togetherat all,in othercases twodifferent medicinesmay beused togethereven ifan interactionmight occur.
In thesecases, yourdoctor maywant tochange thedose, orother precautionsmay benecessary.
Whenyou arereceiving amifostine,it isespecially importantthat yourhealth careprofessional knowif youare takingany ofthe following:Other medicalproblems Thepresence ofother medicalproblems mayaffect theuse ofamifostine.
Makesure youtell yourdoctor ifyou haveany othermedical problems,especially: DosingThe doseof amifostinewill bedifferent fordifferent patients.
It dependson thepatient's size.
The medicinewill begiven by,or underthe immediatesupervision of,the doctortreating youfor cancer.
Along withits neededeffects, amedicine maycause someunwanted effects.
Although notall ofthese sideeffects mayoccur, ifthey dooccur theymay needmedical attention.
Tell thedoctor orthe persongiving youthe injectionright awayif youfeel dizzyor faintwhile theinjection isbeing given.
Also, checkwith yourdoctor assoon aspossible ifany ofthe followingside effectsoccur lateron: Morecommon Blurredvision; confusion;dizziness, faintness,or lightheadednesswhen gettingup froma lyingor sittingposition suddenly;fainting orloss ofconsciousness; fastor irregularbreathing; itching;nausea andvomiting; red,scaly, swollen,or peelingareas ofskin; swellingof eyesor eyelids;trouble inbreathing; tightnessin chest;wheezing; skinrash; sweating;unusual tirednessor weaknessRare Burningor tinglingsensation; convulsions;fast, slowor irregularheartbeat orpulse; lossof bladdercontrol; musclecramps; musclespasm orjerking ofall extremities;palpitations Otherside effectsmay occurthat usuallydo notneed medicalattention.
Theseside effectsmay goaway duringtreatment asyour bodyadjusts tothe medicine.
However, checkwith yourdoctor ifany ofthe followingside effectscontinue orare bothersome:Less commonor rarefever; headache;nervousness; poundingin theears; sleepiness(severe) Otherside effectsthat sometimesoccur areharmless andwill goaway withouttreatment.
Theseare: Lesscommon orrare Feelingunusually warmor cold;flushing orredness offace orneck; hiccupsOther sideeffects notlisted abovemay alsooccur insome patients.
If younotice anyother effects,check withyour doctor.
Once amedicine hasbeen approvedfor marketingfor acertain use,experience mayshow thatit isalso usefulfor othermedical problems.
Although thisuse isnot includedin theproduct labeling,amifostine isused incertain patientswith thefollowing medicalconditions: Otherthan theabove information,there isno additionalinformation relatingto properuse, precautions,or sideeffects forthis use.
Developed: 06/29/1998Revised: 11/28/2005The informationcontained inthe ThomsonHealthcare (Micromedex)products asdelivered byDrugs.com isintended asan educationalaid only.
It isnot intendedas medicaladvice forindividual conditionsor treatment.
It isnot asubstitute fora medicalexam, nordoes itreplace theneed forservices providedby medicalprofessionals.
Talkto yourdoctor, nurseor pharmacistbefore takingany prescriptionor overthe counterdrugs (includingany herbalmedicines orsupplements) orfollowing anytreatment orregimen.
Onlyyour doctor,nurse, orpharmacist canprovide youwith adviceon whatis safeand effectivefor you.
The useof theThomson Healthcareproducts isat yoursole risk.
These productsare provided"AS IS"and "asavailable" foruse, withoutwarranties ofany kind,either expressor implied.
Thomson Healthcareand Drugs.commake norepresentation orwarranty asto theaccuracy, reliability,timeliness, usefulnessor completenessof anyof theinformation containedin theproducts.
Additionally,THOMSON HEALTHCAREMAKES NOREPRESENTATION ORWARRANTIES ASTO THEOPINIONS OROTHER SERVICEOR DATAYOU MAYACCESS, DOWNLOADOR USEAS ARESULT OFUSE OFTHE THOMSONHEALTHCARE PRODUCTS.
ALL IMPLIEDWARRANTIES OFMERCHANTABILITY ANDFITNESS FORA PARTICULARPURPOSE ORUSE AREHEREBY EXCLUDED.
Thomson Healthcaredoes notassume anyresponsibility orrisk foryour useof theThomson Healthcareproducts.
Version:8.01. Revisiondate: 5/17/06.
Not sureabout someof thoseleftover pillsstill inthe bathroomcabinet?
There'sa goodchance thatour PillIdentification Wizardcan helpyou matchsize, shape,colour...
Thesafest betis tokeep allmedications intheir originalbottles orpackets, withpertinent labelingand instructionsattached, toavoid confusionand mistakes.
In orderto proceedto thePill Identifier,you mustread andagree tothe followingterms.Before takinglorazepam, tellyour doctorif youhave anybreathing problems,glaucoma, kidneyor liverdisease, ora historyof depression,suicidal thoughts,or addictionto drugsor alcohol.
Avoid usingother medicinesthat makeyou sleepy.
They canadd tosleepiness causedby lorazepam.
It isdangerous totry andpurchase lorazepamon theInternet orfrom vendorsoutside ofthe UnitedStates.
Medicationsdistributed fromInternet salesmay containdangerous ingredients,or maynot bedistributed bya licensedpharmacy.
Samplesof lorazepampurchased onthe Internethave beenfound tocontain haloperidol(Haldol), apotent antipsychoticdrug withdangerous sideeffects.
Formore information,contact theU.S.
Foodand DrugAdministration (FDA)or visitwww.fda.gov/buyonlineguide.
Lorazepamaffects chemicalsin thebrain thatmay becomeunbalanced andcause anxiety.
Lorazepam isused totreat anxietydisorders.
Lorazepammay alsobe usedfor purposesother thanthose listedin thismedication guide.
It isdangerous totry andpurchase lorazepamon theInternet orfrom vendorsoutside ofthe UnitedStates.
Medicationsdistributed fromInternet salesmay containdangerous ingredients,or maynot bedistributed bya licensedpharmacy.
Samplesof lorazepampurchased onthe Internethave beenfound tocontain haloperidol(Haldol), apotent antipsychoticdrug withdangerous sideeffects.
Formore information,contact theU.S.
Foodand DrugAdministration (FDA)or visitwww.fda.gov/buyonlineguide.
Beforetaking lorazepam,tell yourdoctor ifyou areallergic toany drugs,or ifyou have:glaucoma; asthma,emphysema, bronchitis,chronic obstructivepulmonary disorder(COPD), orother breathingproblems; kidneyor liverdisease; ahistory ofdepression orsuicidal thoughtsor behavior;or ahistory ofdrug oralcohol addiction.
If youhave anyof theseconditions, youmay notbe ableto uselorazepam, oryou mayneed adosage adjustmentor specialtests duringtreatment.
Takethis medicationexactly asit wasprescribed foryou.
Donot takethe medicationin largeramounts, ortake itfor longerthan recommendedby yourdoctor.
Followthe directionson yourprescription label.
Your doctormay occasionallychange yourdose tomake sureyou getthe bestresults fromthis medication.
Your symptomsmay returnwhen youstop usinglorazepam afterusing itover along periodof time.
You mayalso haveseizures orwithdrawal symptomswhen youstop usinglorazepam.
Withdrawalsymptoms mayinclude tremor,sweating, musclecramps, stomachpain, vomiting,unusual thoughtsor behavior,and seizure(convulsions).
Tobe surethis medicationis notcausing harmfuleffects, yourdoctor mayneed tocheck yourprogress ona regularbasis.
Donot missany scheduledvisits toyour doctor.
Keep trackof howmany pillshave beenused fromeach newbottle ofthis medicine.
Benzodiazepines aredrugs ofabuse andyou shouldbe awareif anyperson inthe householdis usingthis medicineimproperly orwithout aprescription.
Takethe misseddose assoon asyou remember.
If itis almosttime foryour nextdose, skipthe misseddose andtake themedicine atyour nextregularly scheduledtime.
Donot takeextra medicineto makeup themissed dose.
Symptoms ofa lorazepamoverdose mayinclude extremedrowsiness, confusion,muscle weakness,fainting, orcoma.
Avoidusing othermedicines thatmake yousleepy (suchas coldmedicine, painmedication, musclerelaxers, andmedicine forseizures, depressionor anxiety).
They canincrease someof theside effectsof lorazepam.
Less seriousside effectsare morelikely tooccur, suchas: drowsiness,dizziness, tiredness;blurred vision;sleep problems(insomnia); muscleweakness, lackof balanceor coordination;amnesia orforgetfulness, troubleconcentrating; nausea,vomiting, constipation;appetite changes;or skinrash.
Sideeffects otherthan thoselisted heremay alsooccur.
Talkto yourdoctor aboutany sideeffect thatseems unusualor thatis especiallybothersome.
Ifyou areusing anyof thesedrugs, youmay notbe ableto uselorazepam, oryou mayneed dosageadjustments orspecial testsduring treatment.
There maybe otherdrugs notlisted thatcan affectlorazepam.
Thisincludes vitamins,minerals, herbalproducts, anddrugs prescribedby otherdoctors.
Donot startusing anew medicationwithout tellingyour doctor.
Lorazepam isavailable witha prescriptionunder thebrand nameAtivan.
Otherbrand orgeneric formulationsmay alsobe available.
Ask yourpharmacist anyquestions youhave aboutthis medication,especially ifit isnew toyou.
Biomedicineis usuallynot concernedwith thepractice ofmedicine asmuch asit iswith thetheory, knowledgeand researchof it;its resultsrender possiblenew drugsand adeeper, molecularunderstanding ofthe mechanismsunderlying decease,and thuslays thefoundation ofall medicalapplication, diagnosisand treatment.
Category: MedicinestubsThe RoyalSociety ofMedicine (RSM)was foundedon the22nd ofMay 1805when leadingmembers ofthe MedicalSociety ofLondon splitfrom thesociety toform anew societythat wouldbring togetherbranches ofthe medicalprofession "forthe purposeof conversationon professionalsubjects, forthe receptionof communicationsand forthe formationof alibrary".
Itwas originallyknown asThe Medicaland ChirurgicalSociety ofLondon.
Itis notto beconfused withthe olderRoyal MedicalSociety ofEdinburgh, Scotland.
It takesmembers froma widerange ofprofessions includingmedicine, dentistry,veterinary sciencesand alliedhealthcare specialities.
It alsowelcomes studentsof medicine,dentistry andveterinary scienceto join.
Its mainpurpose isas aprovider ofmedical educationrunning over350 meetingsand conferenceseach year.
The headquartersof theRSM areat 1Wimpole Street,London andcontain oneof thelargest postgraduatemedical libraryin Europe.
The Societypublishes aneponymous Journal,the JRSM.
For thosepotentially interestedin becominga doctorand wantingto knowwhat itentails, thesociety alsopublishes acomprehensive guideto medicalschool application,entitled Acareer inmedicine.
Thesociety alsoowns thenearby ChandosHouse, designedby theeighteenth centuryarchitect RobertAdam, whichit runsas avenue facility.
As of2006, thePresident ofthe Societyis ProfessorThe BaronessFinlay ofLlandaff FRCPFRCGP.
Tibetanacupuncture, moxabustion,etc.) totreat illness.
The Tibetanmedical systemis basedupon asynthesis ofthe Indian(Ayurveda), Persian(Unani), Greek,indigenous Tibetan,and Chinesemedical systems,and itcontinues tobe practicedin Tibet,India, Nepal,Bhutan, Ladakh,Siberia, Chinaand Mongolia,as wellas morerecently inparts ofEurope andNorth America.
It embracesthe traditionalBuddhist beliefthat allillness ultimatelyresults fromthe "threepoisons" ofthe mind:ignorance, attachmentand aversion.
Like othersystems oftraditional Asianmedicine, andin contrastto biomedicine,Tibetan medicinefirst putsforth aspecific definitionof healthin itstheoretical texts.
Veterinary scienceis vitalto thestudy andprotection ofanimal productionpractices, herdhealth andmonitoring thespread ofdisease.
Itrequires theacquisition andapplication ofscientific knowledgein multipledisciplines anduses technicalskills directedat diseaseprevention inboth domesticand wildanimals.
Veterinaryscience helpssafeguard humanhealth throughthe carefulmonitoring oflivestock, companionanimal andwildlife health.
Veterinary medicineis informallyas oldas thehuman/animal bondbut inrecent yearshas expandedexponentially becauseof theavailability ofadvanced diagnosticand therapeutictechniques formost species.
Animals nowadaysoften receiveadvanced medical,dental, andsurgical careincluding insulininjections, rootcanals, hipreplacements, cataractextractions, andpacemakers.
Veterinaryspecialization hasbecome morecommon inrecent years.
Currently 20veterinary specialtiesare recognizedby theAmerican VeterinaryMedical Association(AVMA), includinganesthesiology, behavior,dermatology, emergencyand criticalcare, internalmedicine, cardiology,oncology, neurology,radiology andsurgery.
Inorder tobecome aspecialist, aveterinarian mustcomplete additionaltraining aftergraduation fromveterinary schoolin theform ofan internshipand residencyand thenpass arigorous examination.
Veterinarians assistin ensuringthe quality,quantity, andsecurity offood suppliesby workingto maintainthe healthof livestockand inspectingthe meatitself.
Veterinaryscientists occupyimportant positionsin biological,chemical, agriculturaland pharmaceuticalresearch.
Inmany countries,equine veterinarymedicine isalso aspecialized field.
Clinical workwith horsesinvolves mainlylocomotor andorthopedic problems,digestive tractdisorders (includingequine colic,which isa majorcause ofdeath amongdomesticated horses),and respiratorytract infectionsand disease.
Zoologic medicine,which encompassesthe healthcareof zooand wildanimal populations,is anotherveterinary specialtythat hasgrown inimportance andsophistication inrecent yearsas wildlifeconservation hasbecome moreurgent.
Asin thehuman healthfield, veterinarymedicine (inpractice) requiresa diversegroup ofindividuals tomeet theneeds ofpatients.
Theythen mustsit forexamination inthose statesin whichthey wishto becomelicensed practitioners.
It iswidely believedthat veterinaryschool isthe hardestto gainacceptance intoamong thevarious medicalprofessions.
Infact, amongmedical practitioners,veterinarians areroutinely rankedthe mostintelligent andtrustworthy.
Theyare expectedto diagnoseand treatdisease ina varietyof differentspecies withoutbenefit ofverbal communicationwith theirpatients.
Inaddition toveterinarians, manyveterinary hospitalsutilize ateam ofveterinary techniciansand veterinaryassistants toprovide carefor sickas wellas healthyanimals.
Doctorsof internalmedicine, alsocalled "internists",are requiredto haveincluded intheir medicalschooling andpostgraduate trainingat leastthree yearsdedicated tolearning howto prevent,diagnose, andtreat diseasesthat affectadults.
Internistsare sometimesreferred toas the"doctor's doctor,"because theyare oftencalled uponto actas consultantsto otherphysicians tohelp solvepuzzling diagnosticproblems.
Whilethe name"internal medicine"may leadone tobelieve thatinternists onlytreat "internal"problems, thisis notthe case.
Doctors ofinternal medicinetreat thewhole person,not justinternal organs.
Internists holdeither anM.D.
MedicalDoctor), D.O.(Doctor ofOsteopathic Medicine)or aBiomedical sciencedegree asBiomedical Doctors.
They arenot tobe confusedwith "MedicalInterns," whoare physiciansin theirfirst yearof residencytraining.
AlthoughInternists mayact asprimary carephysicians, theyare not"family physicians,""family practitioners,"or "generalpractitioners" (whosetraining incertain countriesincludes themedical careof children,and mayinclude surgery,obstetrics andpediatrics).
GeneralInternists practicemedicine froma primarycare perspectivebut theycan treatand managemany ailmentsand areusually themost adeptat treatinga broadrange ofdiseases affectingadults.
Theprimary careof adolescentsis providedby familypractice, internistsand pediatricians.
The primarycare ofchildren andinfants isprovided byFamily Practiceor Pediatricians.
Thus, thereis overlap.
Internists aretrained tosolve puzzlingdiagnostic problemsand handlesevere chronicillnesses andsituations whereseveral differentillnesses maystrike atthe sametime.
Theyalso bringto patientsan understandingof preventativemedicine, men'sand women'shealth, substanceabuse, mentalhealth, aswell aseffective treatmentof commonproblems ofthe eyes,ears, skin,nervous systemand reproductiveorgans.
Mostolder adultsin theUnited Statessee aninternist astheir primaryphysician.
Internistscan chooseto focustheir practiceon generalinternal medicine,or maytake additionaltraining to"subspecialize" inone of13 areasof internalmedicine, generallyorganized byorgan system.
Cardiologists, forexample, aredoctors ofinternal medicinewho subspecializein diseasesof theheart.
Thetraining aninternist receivesto subspecializein aparticular medicalarea isboth broadand deep.
Subspecialty training(often calleda "fellowship")usually requiresan additionalone tothree yearsbeyond thestandard threeyear generalinternal medicineresidency.
Residenciescome aftera studenthas graduatedfrom medicalschool.) Inthe UnitedStates, thereare twoorganizations responsiblefor certificationof subspecialistswithin thefield, theAmerican Boardof InternalMedicine, andthe AmericanOsteopathic Boardof InternalMedicine.
TheABIM alsorecognizes additionalqualifications inthe followingareas Internistsmay alsospecialize inallergy andimmunology.
TheAmerican Boardof Allergy,Asthma, andImmunology isa conjointboard betweeninternal medicineand pediatrics.
Subtle descriptionsof disease(e.g.
Inthe medicalhistory, the"Review ofSystems" servesto pickup symptomsof diseasethat apatient mightnot normallyhave mentioned,and thephysical examinationtypically followsa structuredfashion.
Atthis stage,a doctoris generallyable togenerate adifferential diagnosis,or alist ofpossible diagnosesthat canexplain theconstellation ofsigns andsymptoms.
Occam'srazor dictatesthat, whenpossible, allsymptoms shouldbe presumedto bemanifestations ofthe samedisease process,but oftenmultiple problemsare identified.
In orderto "narrowdown" thedifferential diagnosis,blood testsand medicalimaging areused.
Theycan alsoserve screeningpurposes, e.g.
At thisstage, thephysician willoften havealready arrivedat adiagnosis, ormaximally alist ofa fewitems.
Specifictests forthe presumeddisease areoften required,such asa biopsyfor cancer,microbiological cultureetc.
Medicineis mainlyfocused onthe artof diagnosisand treatmentwith medication,but manysubspecialties administersurgical treatment:Content basedon authoritativeinformation fromthe Websites ofthe AmericanCollege ofPhysicians, ABIM,and ACOI.
Alternative MedicalSystems 2.
Biologically BasedTherapy 4.
In fact,TCM isa moderncompilation oftraditional Chinesemedicine.
TCMpractices includetheories, diagnosisand treatmentssuch asherbal medicine,acupuncture andmassage; oftenQigong isalso stronglyaffiliated withTCM.
TCMtheory assertsthat processesof thehuman bodyare interrelatedand inconstant interactionwith theenvironment.
Signsof disharmonyhelp theTCM practitionerto understand,treat andprevent illnessand disease.
In theWest, traditionalChinese medicineis consideredalternative medicine.
In mainlandChina andTaiwan, TCMis consideredan integralpart ofthe healthcare system.
For example,TCM treatmentsmay beprescribed tocounter theside effectsof chemotherapy,cravings andwithdrawal symptomsof drugaddicts, anda varietyof chronicconditions.
Diagnosisand treatmentare conductedwith referenceto theseconcepts.
Muchof thephilosophy oftraditional Chinesemedicine derivedfrom thesame philosophicalbases thatcontributed tothe developmentof Taoistphilosophy, andreflects theclassical Chinesebelief thatindividual humanexperiences expresscausative principleseffective inthe environmentat allscales.
AD.During theTang dynasty,Wang Pingclaimed tohave locateda copyof theoriginals ofthe NeijingSuwen, whichhe expandedand editedsubstantially.
Thiswork wasrevisited byan imperialcommission duringthe 11thcentury AD.
Classical ChineseMedicine (CCM)is notablydifferent fromTraditional ChineseMedicine (TCM).
The Nationalistgovernment electedto abandonand outlawthe practiceof CCMas itdid notwant Chinato beleft behindby scientificprogress.
For30 years,CCM wasforbidden inChina andseveral peoplewere prosecutedby thegovernment forengaging inCCM.
Inthe 1960's,Mao Zedongfinally decidedthat thegovernment couldnot continueto outlawthe useof CCM.
He commissionedthe top10 doctors(M.D.'
CCM andcreate astandardized formatfor itsapplication.
Thisstandardized formis nowknown asTCM.
Today,TCM iswhat istaught innearly allthose medicalschools inChina, mostof Asiaand NorthernAmerica, thatteach traditionalmedical practicesat all.
To learnCCM typicallyone mustbe partof afamily lineageof medicine.
Recently, therehas beena resurgencein interestin CCMin China,Europe andUnited States,as aspecialty.
Forexample, seethe programof ClassicalChinese Medicineat NationalCollege ofNatural Medicine.
Contact withWestern cultureand medicinehas notdisplaced TCM.
While theremay betraditional factorsinvolved inthe persistentpractice, tworeasons aremost obviousin thewestward spreadof TCMin recentdecades.
Firstly,TCM practicesare believedby manyto bevery effective,sometimes offeringpalliative efficacywhere thebest practicesof Westernmedicine fail,especially forroutine ailmentssuch asflu andallergies, andmanaging toavoid thetoxicity ofsome chemicallycomposed medicines.
Secondly, TCMprovides theonly careavailable toill people,when theycannot affordto trythe westernoption.
Onthe otherhand, thereis, forexample, nolonger adistinct branchof Chinesephysics orChinese biology.
TCM formedpart ofthe barefootdoctor programin thePeople's Republicof China,which extendedpublic healthinto ruralareas.
Itis alsocheaper tothe PRCgovernment, becausethe costof traininga TCMpractitioner andstaffing aTCM hospitalis considerablyless thanthat ofa practitionerof Westernmedicine; henceTCM hasbeen seenas anintegral partof extendinghealth servicesin China.
There issome notionthat TCMrequires supernaturalforces oreven cosmologyto explainitself.
Theearliest classicof TCMpassed onto thepresent.
Thefoundation principlesof Chinesemedicine arenot necessarilyuniform, andare basedon severalschools ofthought.
Since1200 BC,Chinese academicsof variousschools havefocused onthe observablenatural lawsof theuniverse andtheir implicationsfor thepractical characterisationof humanity'splace inthe universe.
Infection, whilehaving aproximal causeof amicroorganism, wouldhave anunderlying causeof animbalance ofsome kind.
There isa popularsaying inChina: Chinesemedicine treatshumans whilewestern medicinetreats diseases.
Traditional Chinesemedicine islargely basedon thephilosophical conceptthat thehuman bodyis asmall universewith aset ofcomplete andsophisticated interconnectedsystems, andthat thosesystems usuallywork inbalance tomaintain thehealthy functionof thehuman body.
The balanceof yinand yangis consideredwith respectto qi("breath", "lifeforce", or"spiritual energy"),blood, jing("kidney essence"or "semen"),other bodilyfluids, theFive elements,emotions, andthe soulor spirit(shen).
TCMhas aunique modelof thebody, notablyconcerned withthe meridiansystem.
Unlikethe Westernanatomical modelwhich dividesthe physicalbody intoparts, theChinese modelis moreconcerned withfunction.
Thus,the TCMSpleen isnot aspecific pieceof flesh,but anaspect offunction relatedto transformationand transportationwithin thebody, andof themental functionsof thinkingand studying.
There aresignificant regionaland philosophicaldifferences betweenpractitioners andschools whichin turncan leadto differencesin practiceand theory.
There arealso separatemodels thatapply tospecific pathologicalinfluences, suchas theFour stagestheory ofthe progressionof warmdiseases, theSix levelstheory ofthe penetrationof colddiseases, andthe Eightprinciples systemof diseaseclassification.
Followinga macrophilosophy ofdisease, traditionalChinese diagnosticsare basedon overallobservation ofhuman symptomsrather than"micro" levellaboratory tests.
A trainingperiod ofyears ordecades issaid tobe necessaryfor TCMpractitioners tounderstand thefull complexityof symptomsand dynamicbalances.
Accordingto oneChinese saying,A good(TCM) doctoris alsoqualified tobe agood primeminister ina country.
Some ofthese specialistsmay alsouse orrecommend otherdisciplines ofChinese medicaltherapies (orWestern medicinein moderntimes) ifserious injuryis involved.
The Jingfangschool relieson theprinciples containedin theChinese medicineclassics ofthe Hanand Tangdynasty, suchas HuangdiNeijing andShenlong Bencaojing.
The morerecent Wenbingschool's practiseis largelybased onmore recentbooks includingCompendium ofMateria Medicafrom Mingand QingDynasty, althoughin theorythe schoolfollows theteachings ofthe earlierclassics aswell.
Currently,there isno scientificconsensus asto whetheracupuncture iseffective oronly hasvalue asa placebo.
Though thesegroups disagreeon thestandards andinterpretation ofthe evidencefor acupuncture,there isgeneral agreementthat itis relativelysafe, andthat furtherinvestigation iswarranted.
The1997 NIHConsensus DevelopmentConference Statementon acupunctureconcluded: ...promisingresults haveemerged, forexample, showingefficacy ofacupuncture inadult postoperativeand chemotherapynausea andvomiting andin postoperativedental pain.
There areother situationssuch asaddiction, strokerehabilitation, headache,menstrual cramps,tennis elbow,fibromyalgia, myofascialpain, osteoarthritis,low backpain, carpaltunnel syndrome,and asthma,in whichacupuncture maybe usefulas anadjunct treatmentor anacceptable alternativeor beincluded ina comprehensivemanagement program.
Further researchis likelyto uncoveradditional areaswhere acupunctureinterventions willbe useful.
Much lessscientific researchhas beendone onChinese herbalmedicines, whichcomprise muchof TCM.
While thedoctrine ofsignatures doesunderlie theselection ofmany ofthe ingredientsof herbalmedicines, thisdoes notnecessarily meanthat somesubstances maynot (perhapsby coincidence)possess attributedmedicinal properties.
For example,it ispossible thatwhile herbsmay havebeen originallyselected onerroneous grounds,only thosethat weredeemed effectivehave remainedin use.
Many Chineseherbal medicinesare marketedas dietarysupplements inthe West,and thereis considerablecontroversy overtheir effectiveness,safety, andregulatory status.
For example,ma huang,or ephedra,which containsephedrine andpseudoephedrine, isrestricted inthe UnitedStates, dueto therisk ofadverse impacton thecardiovascular systemand somedeaths dueto consumptionof extractsin highdoses, usuallyfor weightloss purposesor forthe makingfor crystalmeth.
Acupressureand acupunctureare largelyaccepted tobe safefrom resultsgained throughmedical studies.
Several casesof pneumothorax,nerve damageand infectionhave beenreported asresulting fromacupuncture treatments.
These adverseevents areextremely rareespecially whencompared toother medicalinterventions, andwere foundto bedue topractitioner negligence.
Dizziness andbruising willsometimes resultfrom acupuncturetreatment.
Somegovernments havedecided thatChinese acupunctureand herbaltreatments shouldonly beadministered bypersons whohave beeneducated toapply themsafely.
Akey findingis thatthe riskof adverseevents islinked tothe lengthof educationof thepractitioner, withpractitioners graduatingfrom extendedTraditional ChineseMedicine educationprograms experiencingabout halfthe adverseevent rateof thosepractitioners whohave graduatedfrom shorttraining programs."
CertainChinese herbalmedicines involvea riskof allergicreaction andin rarecases involvea riskof poisoning.
Cases ofacute andchronic poisoningdue totreatment throughingested Chinesemedicines arefound inChina, HongKong, andTaiwan, witha fewdeaths occurringeach year.
Many ofthese deathsdo occurhowever, whenpatients selfprescribe herbsor takeunprocessed versionsof toxicherbs.
Theraw andunprocessed formof aconite,or fuziis themost commoncause ofpoisoning.
Theuse ofaconite inChinese herbalmedicine isusually limitedto processedaconite, inwhich thetoxicity isdenatured byheat treatment.
Furthermore, potentiallytoxic andcarcinogenic compoundssuch asarsenic andcinnabar aresometimes prescribedas partof amedicinal mixtureor usedon thebasis of"using poisonto curepoison".
Unprocessedherbals aresometimes adulteratedwith chemicalsthat mayalter theintended effectof aherbal preparationor prescription.
Much ofthese arebeing preventedwith moreempirical studiesof Chineseherbals andtighter regulationregarding thegrowing, processing,and prescriptionof variousherbals.
TheEphedra banwas meantto combatthe useof thisherb inWestern weightloss products,a usagethat directlyconflicts withtraditional Asianuses ofthe herb.
There wereno casesof Ephedrabased fatalitieswith patientsusing traditionalAsian preparationsof theherb forits traditionallyintended uses.
This banwas orderedlifted inApril 2005by aUtah federalcourt judge.
Many Chinesemedicines havedifferent namesfor thesame ingredientdepending onlocation andtime, butworse yet,ingredients withvastly differentmedical propertieshave sharedsimilar oreven samenames.
WithinChina, therehas beena greatdeal ofcooperation betweenTCM practitionersand Westernmedicine, especiallyin thefield ofethnomedicine.
Chineseherbal medicineincludes manycompounds whichare unusedby Westernmedicine, andthere isgreat interestin thosecompounds aswell asthe theorieswhich TCMpractitioners useto determinewhich compoundto prescribe.
For theirpart, advancedTCM practitionersin Chinaare interestedin statisticaland experimentaltechniques whichcan betterdistinguish medicinesthat workfrom thosethat donot.
Oneresult ofthis collaborationhas beenthe creationof peerreviewed scientificjournals andmedical databaseson traditionalChinese medicine.
Outside ofChina, therelationship betweenTCM andWestern medicineis morecontentious.
Whilemore andmore medicalschools areincluding classeson alternativemedicine intheir curricula,older Westerndoctors andscientists arefar morelikely thantheir Chinesecounterparts toskeptically viewTCM asarchaic pseudoscienceand superstition.
This skepticismcan comefrom anumber ofsources.
Forone, TCMin theWest tendsto beadvocated eitherby Chineseimmigrants orby thosethat havelost faithin conventionalmedicine.
Manypeople inthe Westhave astereotype ofthe Eastas mysticaland unscientific,which attractsthose inthe Westwho havelost hopein scienceand repelsthose whobelieve inscientific explanations.
As anexample ofthe differentroles ofTCM inChina andthe West,a personwith abroken bonein theWest (i.e.
Chinese medicinepractitioner orvisit amartial artsschool toget thebone set,whereas thisis routinein China.
As anotherexample, mostTCM hospitalsin Chinahave electronmicroscopes andmany TCMpractitioners knowhow touse one.
Most Chinesein Chinado notsee traditionalChinese medicineand Westernmedicine asbeing inconflict.
Incases ofemergency andcrisis situations,there isgenerally noreluctance inusing conventionalWestern medicine.
At thesame time,belief inChinese medicineremains strongin thearea ofmaintaining health.
As asimple example,you seea Westerndoctor ifyou haveacute appendicitis,but youdo exercisesor takeChinese herbsto keepyour bodyhealthy enoughto preventappendicitis, orto recovermore quicklyfrom thesurgery.
Veryfew practitionersof Westernmedicine inChina rejecttraditional Chinesemedicine, andmost doctorsin Chinawill usesome elementsof Chinesemedicine intheir ownpractice.
Adegree ofintegration betweenChinese andWestern medicinealso existsin China.
For instance,at theShanghai cancerhospital, apatient maybe seenby amultidisciplinary teamand betreated concurrentlywith radiationsurgery, Westerndrugs anda traditionalherbal formula.
A reportby theVictorian stategovernment inAustralia onTCM educationin Chinanoted: Inother countriesit isnot necessarilythe casethat traditionalChinese andWestern medicineare practicedconcurrently bythe samepractitioner.
TCMeducation inAustralia, forexample, doesnot qualifya practitionerto providediagnosis inWestern medicalterms, prescribescheduled pharmaceuticals,nor performsurgical procedures.
While thatjurisdiction notesthat TCMeducation doesnot qualifypractitioners toprescribe Westerndrugs, aseparate legislativeframework isbeing constructedto allowregistered practitionersto prescribeChinese herbsthat wouldotherwise beclassified aspoisons.
Itis worthnoting thatthe practiceof Westernmedicine inChina issomewhat differentfrom thatin theWest.
Incontrast tothe West,there arerelatively fewallied healthprofessionals toperform routinemedical proceduresor toundertake proceduressuch asmassage orphysical therapy.
In addition,Chinese practitionersof Westernmedicine havebeen lessimpacted bytrends inthe Westthat encouragepatient empowerment,to seethe patientas anindividual ratherthan acollection ofparts, andto donothing whenmedically appropriate.
It islikely thatthese medicines,which aregenerally knownto beuseless againstviral infections,would provideless reliefto thepatient thantraditional Chineseherbal remedies.
TCM doctorsoften criticizeWestern doctorsfor payingtoo muchattention tolaboratory testsand showinginsufficient concernfor theoverall feelingsof patients.
Modern TCMpractitioners willrefer patientsto Westernmedical facilitiesif amedical conditionis deemedto haveput thebody toofar outof "balance"for traditionalmethods toremedy.
Animalproducts areused incertain Chineseformulae, whichmay presenta problemfor vegansand vegetarians.
If informedof suchrestrictions, practitionerscan oftenuse alternativesubstances.
Theuse ofendangered speciesis controversialwithin TCM.
According toCompendium ofMateria Medica,it's goodat strengtheningthe waist,supplementing vitalenergy, nourishingblood, invigoratingkidney andlung andimproving digestion.
Furthermore, theyhave beenfound tocontain highlevels ofmercury, whichis knownfor itsill effects.
The animalrights movementnotes thata fewtraditional Chinesemedicinal solutionsuse bearbile.
Toextract maximumamounts ofthe bile,the bearsare oftenfitted witha sortof permanentcatheter.
Thetreatment itselfand especiallythe extractionof thebile isvery painful,causes damageto theintestines ofthe bear,and oftenkills thebears.
Startingfrom late19th century,politicians andChinese scholarswith backgroundin Westernmedicine havebeen tryingto phaseout TCMtotally inChina.
Someof theprominent advocatesof theelimination ofTCM include:The attemptsto curtailTCM inChina alwaysprovoke largescale debatesbut havenever completelysucceeded.
Still,many researchersand practitionersof TCMin Chinaand theUnited Statesargue theneed todocument TCM'sefficacy withcontrolled, doubleblind experiments.
However, inthe 1920sa movementemerged thatattempted torestore traditionalmedical practice,especially acupuncture.
This movement,known asthe MeridianTherapy movement(Keiraku Chiryoin Japanese)persists tothis day.
While remedieswere sometimescharacterized bymagical incantationsand dubiousingredients, theyoften hada rationalbasis.
Medicaltexts specifiedspecific stepsof examination,diagnosis, prognosisand treatmentsthat wereoften rationaland appropriate.
Until the19th century,the mainsources ofinformation aboutancient Egyptianmedicine werewritings fromlater inantiquity.
Plinythe Elderalso wrotefavorably ofthem inhistorical review.
Hippocrates (the"father ofmedicine"), Herophilos,Erasistratus andlater Galenstudied atthe templeof Amenhotep,and acknowledgedthe contributionof ancientEgyptian medicineto Greekmedicine.
In1822, thetranslation ofthe Rosettastone finallyallowed thetranslation ofancient Egyptianhieroglyphic inscriptionsand papyri,including manyrelated tomedical matters.
The resultantinterest inEgyptology inthe 19thcentury ledto thediscovery ofseveral setsof extensiveancient medicaldocuments, includingthe Eberspapyrus, theEdwin SmithPapyrus, theHearst Papyrusand othersdating backas faras 3000BC.
Imhotepin the3rd dynastyis creditedas theoriginal authorof thepapyrus text,and founderof ancientEgyptian medicine.
The earliestknown surgerywas performedin Egyptaround 2750BC (seesurgery).
Itmay alsocontain theearliest documentedawareness oftumors, ifthe badlyunderstood ancientmedical terminologyhas beencorrectly interpreted.
Other informationcomes fromthe imagesthat oftenadorn thewalls ofEgyptian tombsand thetranslation ofthe accompanyinginscriptions.
Advancesin modernmedical technologyalso contributedto theunderstanding ofancient Egyptianmedicine.
Electronmicroscopes, massspectrometry andvarious forensictechniques allowedscientists uniqueglimpses ofthe stateof healthin Egypt4000 yearsago.
Egyptianshad someknowledge ofhuman anatomy,even thoughthey neverdissected thebody.
Forexample, inthe classicmummification process,they knewhow toinsert along hookedimplement througha nostril,breaking thethin boneof thebrain caseand removethe brain.
Egyptian physiciansalso wereaware ofthe importanceof thepulse, andof aconnection betweenpulse andheart.
Theauthor ofthe SmithPapyrus evenhad avague ideaof acardiac system,although notof bloodcirculation andhe wasunable, ordeemed itunimportant, todistinguish betweenblood vessels,tendons, andnerves.
Theydeveloped theirtheory of"channels" thatcarried air,water andblood tothe bodyby observingthe RiverNile; ifit becameblocked, cropsbecame unhealthyand theyapplied thistheory tothe body.
Mostly, thephysicians' advicefor stayinghealthy wasto washand shavethe body,including underthe arms,and thismay haveprevented infections.
They alsoadvised patientsto lookafter theirdiet, andavoid foodssuch asraw fishor otheranimals consideredto beunclean.
Somepractices wereineffective orharmful.
Beingunable todistinguish betweenthe originalinfection andthe unwholesomeeffects ofthe dungtreatment, theymay havebeen impressedby thefew caseswhen itimproved thepatient's condition.
Magic andreligion werepart ofeveryday lifein ancientEgypt.
Godsand demonswere thoughtto beresponsible formany ailments,so oftenthe treatmentsinvolved asupernatural element.
Often, thefirst recoursewas anappeal toa deity.
Often priestsand magicianswere calledon totreat diseaseinstead of,or inaddition to,a physician.
Physicians themselvesoften usedincantations andmagical ingredientsas partof treatment,and manymedicines apparentlylacked activeingredients.
Thewidespread beliefin magicand religionmay havecontributed toa powerfulplacebo effect;that is,the perceivedvalidity ofthe curemay havecontributed toits effectiveness.
The impactof theemphasis onmagic isseen inthe selectionof remediesor ingredientsfor them.
Ingredients weresometimes selectedseemingly becausethey werederived froma substance,plant oranimal thathad characteristicswhich insome waycorresponded tothe symptomsof thepatient.
Thisis knownas theprinciple ofsimila similibus("similar withsimilar") andis foundthroughout thehistory ofmedicine upto themodern practiceof homeopathy.
Thus anostrich eggis includedin thetreatment ofa brokenskull, andan amuletportraying ahedgehog mightbe usedagainst baldness.
Amulets ingeneral werevery popularlyworn formany magicalpurposes.
Healthrelated amuletsare classifiedas homeopoetic,phylactic andtheophoric.
Homeopoeticamulets portrayan animalor partanimal fromwhich thewearer hopesto assimilatepositive attributeslike strengthor speed.
Phylactic amulatesprotected againstharmful godsand demons.
The famousEye ofHorus wasoften usedon aphylactic amulet.
Theophoric amuletsrepresented Egyptiangods; onerepresented thegirdle ofIsis andsupposedly stemmedthe flowof bloodat miscarriage.
The ancientEgyptian wordfor doctoris swnw.
There isa longhistory ofswnw inancient Egypt.
There weremany ranksand specializationsin medicine.
Royalty hadtheir ownswnw, eventheir ownspecialists.
Therewere inspectorsof doctors,overseers andchief doctors.
Known ancientEgyptian specialistsare ophthalmologist,gastroenterologist, proctologist,dentist, "doctorwho supervisesbutchers" andan unspecified"inspector ofliquids".
Theancient Egyptianterm forproctologist, neruphuyt, literallytranslates as"shepherd ofthe anus".
Medical institutions,so calledHouses ofLife, areknown tohave beenestablished inancient Egyptsince asearly asthe 1stDynasty.
Throughoutthe world,illness hasoften beenattributed towitchcraft, demons,averse astralinfluence, orthe willof thegods, ideasthat retainsome power,with faithhealing andshrines stillcommon, althoughthe riseof scientificmedicine inthe pasttwo centurieshas alteredor replacedmany historichealth practices.
Over timeand withtrial anderror, asmall baseof knowledgewas acquiredwithin earlytribal communities.
As thisknowledge baseexpanded overthe generations,tribal culturedeveloped intospecialized areas.
These 'specializedjobs' becamewhat arenow knownas healersor shamans.
In Mehrgarh,Pakistan, archeologistsmade thediscovery thatthe peopleof IndusValley Civilization,even fromthe earlyHarappan periods(c.
BC),had knowledgeof medicineand dentistry.
Later researchin thesame areafound evidenceof teethhaving beendrilled, datingback 9,000years.
Ayurveda(the scienceof living),is theliterate, scholarlysystem ofmedicine thatoriginated over2000 yearsago inSouth Asia.
Both theseancient compendiainclude detailsof theexamination, diagnosis,treatment, andprognosis ofnumerous ailments.
The teachingof varioussubjects wasdone duringthe instructionof relevantclinical subjects.
For example,teaching ofanatomy wasa partof theteaching ofsurgery, embryologywas apart oftraining inpediatrics andobstetrics, andthe knowledgeof physiologyand pathologywas interwovenin theteaching ofall theclinical disciplines.
At theclosing ofthe initiation,the gurugave asolemn addressto thestudents wherethe gurudirected thestudents toa lifeof chastity,honesty, andvegetarianism.
Thestudent wasto strivewith allhis beingfor thehealth ofthe sick.
He wasnot tobetray patientsfor hisown advantage.
He wasto dressmodestly andavoid strongdrink.
Hewas toconstantly improvehis knowledgeand technicalskill.
Inthe homeof thepatient hewas tobe courteousand modest,directing allattention tothe patient'swelfare.
Hewas notto divulgeany knowledgeabout thepatient andhis family.
If thepatient wasincurable, hewas tokeep thisto himselfif itwas likelyto harmthe patientor others.
The normallength ofthe student'straining appearsto havebeen sevenyears.
Beforegraduation, thestudent wasto passa test.
In addition,the vaidyasattended meetingswhere knowledgewas exchanged.
The earliestknown surgeryin Egyptwas performedin Egyptaround 2750BC (seesurgery).
Imhotepin the3rd dynastyis sometimescredited withbeing thefounder ofancient Egyptianmedicine andwith beingthe originalauthor ofthe EdwinSmith papyrus,detailing cures,ailments andanatomical observations.
The EdwinSmith papyrusis regardedas acopy ofseveral earlierworks andwas writtencirca 1600BC.
TheEbers papyrusalso providesour earliestpossible documentationof ancientawareness oftumors, butancient medicalterminology beingbadly understood,cases pEbers546 and547 forinstance mayrefer tosimple swellings.
Also, theearliest knownwoman physician,Peseshet, practicedin AncientEgypt atthe timeof the4th dynasty.
See alsothe articleon ancientEgyptian medicineposted atIndiana University:Medicine inAncient Egypt.
The practiceand studyof medicinein Persiahas along andprolific history.
Being atthe crossroadsof theEast andthe Westfrequently putPersia inthe midstof developmentsin bothancient Greekand Indianmedicine.
Thefirst generationof Persianphysicians wastrained atthe Academyof Jundishapur,where theteaching hospitalhas sometimesbeen claimedto havebeen invented.
Rhazes, forexample, becamethe firstphysician tosystematically usealcohol inhis practiceas aphysician.
Init, Rhazesrecorded clinicalcases ofhis ownexperience andprovided veryuseful recordingsof variousdiseases.
TheMutazilite philosopherand doctorIbn Sina(also knownas Avicennain thewestern world)was anotherinfluential figure.
His TheCanon ofMedicine, sometimesconsidered themost famousbook inthe historyof medicine,remained astandard textin Europeup untilits Ageof Enlightenment.
China alsodeveloped alarge bodyof traditionalmedicine.
Muchof thephilosophy oftraditional Chinesemedicine derivedfrom empiricalobservations ofdisease andillness byTaoist physiciansand reflectsthe classicalChinese beliefthat individualhuman experiencesexpress causativeprinciples effectivein theenvironment atall scales.
These causativeprinciples, whethermaterial, essential,or mystical,correlate asthe expressionof thenatural orderof theuniverse.
A.D.During theTang dynasty,Wang Pingclaimed tohave locateda copyof theoriginals ofthe NeijingSuwen, whichhe expandedand editedsubstantially.
Thiswork wasrevisited byan imperialcommission duringthe eleventhcentury A.D.,and theresult isour bestextant representationof thefoundational rootsof traditionalChinese medicine.
Most ofour knowledgeof ancientHebrew medicineduring the1st millenniumBCE comesfrom theTorah, i.e.
He wasaged about46 andhad over40 tattoos,most ofthem inlocations wheremedical analysisalso showedhe haddisease orpain suchas arthritis.
His deathoccurred in3300 BCand hisbody, heldin themuseum inBolzano, isthe oldestpreserved Europeanmummy.
Associeties developedin Europeand Asia,belief systemswere replacedwith adifferent naturalsystem.
TheGreeks, fromHippocrates, developeda humoralmedicine systemwhere treatmentwas torestore thebalance ofhumours withinthe body.
Ancient Medicineis atreatise onmedicine, writtenroughly 400BC byHippocrates.
Similarviews wereespoused inChina andin India.
See Medicinein ancientGreece formore details.)In Greece,through Galenuntil theRenaissance themain thrustof medicinewas themaintenance ofhealth bycontrol ofdiet andhygiene.
Anatomicalknowledge waslimited andthere werefew surgicalor othercures, doctorsrelied ona goodrelation withpatients anddealt withminor ailmentsand soothingchronic conditionsand coulddo littlewhen epidemicdiseases, growingout ofurbanization andthe domesticationof animals,then ragedacross theworld.
Medievalmedicine wasan evolvingmixture ofthe scientificand thespiritual.
Inthe earlyMiddle Ages,following thefall ofthe RomanEmpire, standardmedical knowledgewas basedchiefly uponsurviving Greekand Romantexts, preservedin monasteriesand elsewhere.
Ideas aboutthe originand cureof diseasewere not,however, purelysecular, butwere alsobased ona spiritualworld view,in whichfactors suchas destiny,sin, andastral influencesplayed asgreat apart asany physicalcause.
Medicinewas notablynot oneof theseven classicalArtes liberales,and wasconsequently lookedupon moreas ahandicraft thanas ascience.
Medicinedid, nevertheless,establish itselfas afaculty, alongwith lawand theologyin thefirst EuropeanUniversities fromthe 12thcentury.
IbnNafis (d.1288) describedhuman bloodcirculation.
Thisdiscovery wouldbe 'rediscovered'by WilliamHarvey in1628.
Althoughit isstartling thatIbn Nafishad madethe discoveryso longbefore Harvey,there isno indicationthat Harveyhad readthe treatise,or thatIbn Nafis'works wereavailable tothe Westat thattime.
Maimonides,although aJew himself,made variouscontributions toArabic medicinein the13th century.
The ComprehensiveBook ofMedicine waswritten byRhazes.
TheLarge Comprehensive,was themost soughtafter ofall hiscompositions.
Init, Rhazesrecorded clinicalcases ofhis ownexperience andprovided veryuseful recordingsof variousdiseases.
The"Comprehensive Bookof Medicine",with itsintroduction onmeasles andsmallpox, wasalso veryinfluential inEurope.
TheMutazilite philosopherand doctorIbn Sinawas anotherinfluential figure.
His "TheCanon ofMedicine" remaineda standardtext inEurope upuntil therenewal ofthe Muslimtradition ofscientific medicine.
Ibn Nafisdescribed humanblood circulation.
This discoverywould berediscovered, orperhaps merelydemonstrated, byWilliam Harveyin 1628.
He generallyreceives mostof hiscredit inWestern history.
Avicenna, whois consideredone ofthe greatestmedical scholarsin history,wrote TheCanon ofMedicine andThe Bookof Healing,which remainedpopular textbooksin theIslamic worldand medievalEurope forcenturies.
Thusit canhardly havebeen accidentalthat thoseresearches shouldhave ledthem thatwere inevitablybeyond thereach ofGreek masters.
That mindwas incapableof viewingman, whetherin healthor sicknessas isolatedfrom God,from fellowmen, andfrom theworld aroundhim.
Itwas probablyinevitable thatthe Muslimsshould havediscovered thatdisease neednot beborn withinthe patienthimself butmay reachfrom outside,in otherwords, thatthey shouldhave beenthe firstto establishclearly theexistence ofcontagion."
For athousand yearshe hasretained hisoriginal renownas oneof thegreatest thinkersand medicalscholars inhistory.
Hismost importantmedical worksare theQanun (Canon)and atreatise onCardiac drugs.
It containssome ofthe mostilluminating thoughtspertaining todistinction ofmediastinitis frompleurisy; contagiousnature ofphthisis; distributionof diseasesby waterand soil;careful descriptionof skintroubles; ofsexual diseasesand perversions;of nervousailments."
We havereason tobelieve thatwhen, duringthe crusades,Europe atlast beganto establishhospitals, theywere inspiredby theArabs ofnear East....
This ideaof medicinewas challengedin Europeby therise ofexperimental investigation,principally indissection, examiningbodies ina manneralien toother cultures.
The workof individualslike AndreasVesalius andWilliam Harveychallenged acceptedfolklore withscientific evidence.
Understanding anddiagnosis improvedbut withlittle directbenefit tohealth.
Importantfigures: Medicinewas revolutionizedin the19th centuryand beyondby advancesin chemistryand laboratorytechniques andequipment, oldideas ofinfectious diseaseepidemiology werereplaced withbacteriology.
Hisdiscovery predatedthe germtheory ofdisease.
The1953 discoveryof thestructure ofDNA byWatson andCrick wouldopen thedoor tomolecular biologyand moderngenetics.
Duringthe late19th centuryand thefirst partof the20th century,several physicians,such asNobel prizewinner AlexisCarrel, supportedeugenics, atheory firstformulated in1865 byFrancis Galton.
Eugenics wasdiscredited asa scienceafter theNazis' experimentsin WorldWar IIbecame known;however, compulsorysterilization programscontinued tobe usedin moderncountries (includingthe US,Sweden orPeru) untilmuch later.
Semmelweis's workwas supportedby thediscoveries madeby LouisPasteur, whoproduced in1880 thevaccine againstrabies.
Linkingmicroorganisms withdisease, Pasteurbrought abouta revolutionin medicine.
His experimentsconfirmed thegerm theory.
Claude Bernardaimed atestablishing scientificmethod inmedicine; hepublished AnIntroduction tothe Studyof ExperimentalMedicine in1865.
Besidethis, Pasteur,along withRobert Koch(who wasawarded theNobel Prizein 1905),founded bacteriology.
Koch wasalso famousfor thediscovery ofthe tuberclebacillus (1882)and thecholera bacillus(1883) andfor hisdevelopment ofKoch's postulates.
The participationof womenin medicalcare (beyondserving asmidwives, sittersand cleaningwomen) wasbrought aboutby thelikes ofFlorence Nightingale.
These womenshowed apreviously maledominated professionthe elementalrole ofnursing inorder tolessen theaggravation ofpatient mortalitywhich resultedfrom lackof hygieneand nutrition.
Elizabeth Blackwellbecame thefirst womanto formallystudy, andsubsequently practice,medicine inthe UnitedStates.
Itwas inthis erathat actualcures weredeveloped forcertain endemicinfectious diseases.
However thedecline inmany ofthe mostlethal diseaseswas moredue toimprovements inpublic healthand nutritionthan tomedicine.
Itwas notuntil the20th centurythat theapplication ofthe scientificmethod tomedical researchbegan toproduce multipleimportant developmentsin medicine,with greatadvances inpharmacology andsurgery.
Theantibiotic preventedthe deathsof thousandsduring theconquest ofVichy Francein 1944.
This knowledgewas lostwith the1945 UnitedStates' occupationof Germany.
Ref: TheNazi Waron CancerRobert N.
In the1920s surrealistopposition topsychiatry wasexpressed ina numberof surrealistpublications.
Inthe 1930sseveral controversialmedical practiceswere introducedincluding inducingseizures (byelectroshock, insulinor otherdrugs) orcutting partsof thebrain apart(leucotomy orlobotomy).
Bothcame intowidespread useby psychiatry,but therewere graveconcerns andmuch oppositionon groundsof basicmorality, harmfuleffects, ormisuse.
Inthe 1950snew psychiatricdrugs, notablythe antipsychoticchlorpromazine, weredesigned inlaboratories andslowly cameinto preferreduse.
Althoughoften acceptedas anadvance insome ways,there wassome opposition,due toserious adverseeffects suchas tardivedyskinesia.
Patientsoften opposedpsychiatry andrefused orstopped takingthe drugswhen notsubject topsychiatric control.
Campaigns againstmasturbation weredone inthe Victorianera andelsewhere.
Lobotomywas useduntil the1970s totreat schizophrenia.
Category: Historyof medicine1.
Alternative MedicalSystems 2.
Biologically BasedTherapy 4.
In fact,TCM isa moderncompilation oftraditional Chinesemedicine.
TCMpractices includetheories, diagnosisand treatmentssuch asherbal medicine,acupuncture andmassage; oftenQigong isalso stronglyaffiliated withTCM.
TCMtheory assertsthat processesof thehuman bodyare interrelatedand inconstant interactionwith theenvironment.
Signsof disharmonyhelp theTCM practitionerto understand,treat andprevent illnessand disease.
In theWest, traditionalChinese medicineis consideredalternative medicine.
In mainlandChina andTaiwan, TCMis consideredan integralpart ofthe healthcare system.
For example,TCM treatmentsmay beprescribed tocounter theside effectsof chemotherapy,cravings andwithdrawal symptomsof drugaddicts, anda varietyof chronicconditions.
Diagnosisand treatmentare conductedwith referenceto theseconcepts.
Muchof thephilosophy oftraditional Chinesemedicine derivedfrom thesame philosophicalbases thatcontributed tothe developmentof Taoistphilosophy, andreflects theclassical Chinesebelief thatindividual humanexperiences expresscausative principleseffective inthe environmentat allscales.
AD.During theTang dynasty,Wang Pingclaimed tohave locateda copyof theoriginals ofthe NeijingSuwen, whichhe expandedand editedsubstantially.
Thiswork wasrevisited byan imperialcommission duringthe 11thcentury AD.
Classical ChineseMedicine (CCM)is notablydifferent fromTraditional ChineseMedicine (TCM).
The Nationalistgovernment electedto abandonand outlawthe practiceof CCMas itdid notwant Chinato beleft behindby scientificprogress.
For30 years,CCM wasforbidden inChina andseveral peoplewere prosecutedby thegovernment forengaging inCCM.
Inthe 1960's,Mao Zedongfinally decidedthat thegovernment couldnot continueto outlawthe useof CCM.
He commissionedthe top10 doctors(M.D.'
CCM andcreate astandardized formatfor itsapplication.
Thisstandardized formis nowknown asTCM.
Today,TCM iswhat istaught innearly allthose medicalschools inChina, mostof Asiaand NorthernAmerica, thatteach traditionalmedical practicesat all.
To learnCCM typicallyone mustbe partof afamily lineageof medicine.
Recently, therehas beena resurgencein interestin CCMin China,Europe andUnited States,as aspecialty.
Forexample, seethe programof ClassicalChinese Medicineat NationalCollege ofNatural Medicine.
Contact withWestern cultureand medicinehas notdisplaced TCM.
While theremay betraditional factorsinvolved inthe persistentpractice, tworeasons aremost obviousin thewestward spreadof TCMin recentdecades.
Firstly,TCM practicesare believedby manyto bevery effective,sometimes offeringpalliative efficacywhere thebest practicesof Westernmedicine fail,especially forroutine ailmentssuch asflu andallergies, andmanaging toavoid thetoxicity ofsome chemicallycomposed medicines.
Secondly, TCMprovides theonly careavailable toill people,when theycannot affordto trythe westernoption.
Onthe otherhand, thereis, forexample, nolonger adistinct branchof Chinesephysics orChinese biology.
TCM formedpart ofthe barefootdoctor programin thePeople's Republicof China,which extendedpublic healthinto ruralareas.
Itis alsocheaper tothe PRCgovernment, becausethe costof traininga TCMpractitioner andstaffing aTCM hospitalis considerablyless thanthat ofa practitionerof Westernmedicine; henceTCM hasbeen seenas anintegral partof extendinghealth servicesin China.
There issome notionthat TCMrequires supernaturalforces oreven cosmologyto explainitself.
Theearliest classicof TCMpassed onto thepresent.
Thefoundation principlesof Chinesemedicine arenot necessarilyuniform, andare basedon severalschools ofthought.
Since1200 BC,Chinese academicsof variousschools havefocused onthe observablenatural lawsof theuniverse andtheir implicationsfor thepractical characterisationof humanity'splace inthe universe.
Infection, whilehaving aproximal causeof amicroorganism, wouldhave anunderlying causeof animbalance ofsome kind.
There isa popularsaying inChina: Chinesemedicine treatshumans whilewestern medicinetreats diseases.
Traditional Chinesemedicine islargely basedon thephilosophical conceptthat thehuman bodyis asmall universewith aset ofcomplete andsophisticated interconnectedsystems, andthat thosesystems usuallywork inbalance tomaintain thehealthy functionof thehuman body.
The balanceof yinand yangis consideredwith respectto qi("breath", "lifeforce", or"spiritual energy"),blood, jing("kidney essence"or "semen"),other bodilyfluids, theFive elements,emotions, andthe soulor spirit(shen).
TCMhas aunique modelof thebody, notablyconcerned withthe meridiansystem.
Unlikethe Westernanatomical modelwhich dividesthe physicalbody intoparts, theChinese modelis moreconcerned withfunction.
Thus,the TCMSpleen isnot aspecific pieceof flesh,but anaspect offunction relatedto transformationand transportationwithin thebody, andof themental functionsof thinkingand studying.
There aresignificant regionaland philosophicaldifferences betweenpractitioners andschools whichin turncan leadto differencesin practiceand theory.
There arealso separatemodels thatapply tospecific pathologicalinfluences, suchas theFour stagestheory ofthe progressionof warmdiseases, theSix levelstheory ofthe penetrationof colddiseases, andthe Eightprinciples systemof diseaseclassification.
Followinga macrophilosophy ofdisease, traditionalChinese diagnosticsare basedon overallobservation ofhuman symptomsrather than"micro" levellaboratory tests.
A trainingperiod ofyears ordecades issaid tobe necessaryfor TCMpractitioners tounderstand thefull complexityof symptomsand dynamicbalances.
Accordingto oneChinese saying,A good(TCM) doctoris alsoqualified tobe agood primeminister ina country.
Some ofthese specialistsmay alsouse orrecommend otherdisciplines ofChinese medicaltherapies (orWestern medicinein moderntimes) ifserious injuryis involved.
The Jingfangschool relieson theprinciples containedin theChinese medicineclassics ofthe Hanand Tangdynasty, suchas HuangdiNeijing andShenlong Bencaojing.
The morerecent Wenbingschool's practiseis largelybased onmore recentbooks includingCompendium ofMateria Medicafrom Mingand QingDynasty, althoughin theorythe schoolfollows theteachings ofthe earlierclassics aswell.
Currently,there isno scientificconsensus asto whetheracupuncture iseffective oronly hasvalue asa placebo.
Though thesegroups disagreeon thestandards andinterpretation ofthe evidencefor acupuncture,there isgeneral agreementthat itis relativelysafe, andthat furtherinvestigation iswarranted.
The1997 NIHConsensus DevelopmentConference Statementon acupunctureconcluded: ...promisingresults haveemerged, forexample, showingefficacy ofacupuncture inadult postoperativeand chemotherapynausea andvomiting andin postoperativedental pain.
There areother situationssuch asaddiction, strokerehabilitation, headache,menstrual cramps,tennis elbow,fibromyalgia, myofascialpain, osteoarthritis,low backpain, carpaltunnel syndrome,and asthma,in whichacupuncture maybe usefulas anadjunct treatmentor anacceptable alternativeor beincluded ina comprehensivemanagement program.
Further researchis likelyto uncoveradditional areaswhere acupunctureinterventions willbe useful.
Much lessscientific researchhas beendone onChinese herbalmedicines, whichcomprise muchof TCM.
While thedoctrine ofsignatures doesunderlie theselection ofmany ofthe ingredientsof herbalmedicines, thisdoes notnecessarily meanthat somesubstances maynot (perhapsby coincidence)possess attributedmedicinal properties.
For example,it ispossible thatwhile herbsmay havebeen originallyselected onerroneous grounds,only thosethat weredeemed effectivehave remainedin use.
Many Chineseherbal medicinesare marketedas dietarysupplements inthe West,and thereis considerablecontroversy overtheir effectiveness,safety, andregulatory status.
For example,ma huang,or ephedra,which containsephedrine andpseudoephedrine, isrestricted inthe UnitedStates, dueto therisk ofadverse impacton thecardiovascular systemand somedeaths dueto consumptionof extractsin highdoses, usuallyfor weightloss purposesor forthe makingfor crystalmeth.
Acupressureand acupunctureare largelyaccepted tobe safefrom resultsgained throughmedical studies.
Several casesof pneumothorax,nerve damageand infectionhave beenreported asresulting fromacupuncture treatments.
These adverseevents areextremely rareespecially whencompared toother medicalinterventions, andwere foundto bedue topractitioner negligence.
Dizziness andbruising willsometimes resultfrom acupuncturetreatment.
Somegovernments havedecided thatChinese acupunctureand herbaltreatments shouldonly beadministered bypersons whohave beeneducated toapply themsafely.
Akey findingis thatthe riskof adverseevents islinked tothe lengthof educationof thepractitioner, withpractitioners graduatingfrom extendedTraditional ChineseMedicine educationprograms experiencingabout halfthe adverseevent rateof thosepractitioners whohave graduatedfrom shorttraining programs."
CertainChinese herbalmedicines involvea riskof allergicreaction andin rarecases involvea riskof poisoning.
Cases ofacute andchronic poisoningdue totreatment throughingested Chinesemedicines arefound inChina, HongKong, andTaiwan, witha fewdeaths occurringeach year.
Many ofthese deathsdo occurhowever, whenpatients selfprescribe herbsor takeunprocessed versionsof toxicherbs.
Theraw andunprocessed formof aconite,or fuziis themost commoncause ofpoisoning.
Theuse ofaconite inChinese herbalmedicine isusually limitedto processedaconite, inwhich thetoxicity isdenatured byheat treatment.
Furthermore, potentiallytoxic andcarcinogenic compoundssuch asarsenic andcinnabar aresometimes prescribedas partof amedicinal mixtureor usedon thebasis of"using poisonto curepoison".
Unprocessedherbals aresometimes adulteratedwith chemicalsthat mayalter theintended effectof aherbal preparationor prescription.
Much ofthese arebeing preventedwith moreempirical studiesof Chineseherbals andtighter regulationregarding thegrowing, processing,and prescriptionof variousherbals.
TheEphedra banwas meantto combatthe useof thisherb inWestern weightloss products,a usagethat directlyconflicts withtraditional Asianuses ofthe herb.
There wereno casesof Ephedrabased fatalitieswith patientsusing traditionalAsian preparationsof theherb forits traditionallyintended uses.
This banwas orderedlifted inApril 2005by aUtah federalcourt judge.
Many Chinesemedicines havedifferent namesfor thesame ingredientdepending onlocation andtime, butworse yet,ingredients withvastly differentmedical propertieshave sharedsimilar oreven samenames.
WithinChina, therehas beena greatdeal ofcooperation betweenTCM practitionersand Westernmedicine, especiallyin thefield ofethnomedicine.
Chineseherbal medicineincludes manycompounds whichare unusedby Westernmedicine, andthere isgreat interestin thosecompounds aswell asthe theorieswhich TCMpractitioners useto determinewhich compoundto prescribe.
For theirpart, advancedTCM practitionersin Chinaare interestedin statisticaland experimentaltechniques whichcan betterdistinguish medicinesthat workfrom thosethat donot.
Oneresult ofthis collaborationhas beenthe creationof peerreviewed scientificjournals andmedical databaseson traditionalChinese medicine.
Outside ofChina, therelationship betweenTCM andWestern medicineis morecontentious.
Whilemore andmore medicalschools areincluding classeson alternativemedicine intheir curricula,older Westerndoctors andscientists arefar morelikely thantheir Chinesecounterparts toskeptically viewTCM asarchaic pseudoscienceand superstition.
This skepticismcan comefrom anumber ofsources.
Forone, TCMin theWest tendsto beadvocated eitherby Chineseimmigrants orby thosethat havelost faithin conventionalmedicine.
Manypeople inthe Westhave astereotype ofthe Eastas mysticaland unscientific,which attractsthose inthe Westwho havelost hopein scienceand repelsthose whobelieve inscientific explanations.
As anexample ofthe differentroles ofTCM inChina andthe West,a personwith abroken bonein theWest (i.e.
Chinese medicinepractitioner orvisit amartial artsschool toget thebone set,whereas thisis routinein China.
As anotherexample, mostTCM hospitalsin Chinahave electronmicroscopes andmany TCMpractitioners knowhow touse one.
Most Chinesein Chinado notsee traditionalChinese medicineand Westernmedicine asbeing inconflict.
Incases ofemergency andcrisis situations,there isgenerally noreluctance inusing conventionalWestern medicine.
At thesame time,belief inChinese medicineremains strongin thearea ofmaintaining health.
As asimple example,you seea Westerndoctor ifyou haveacute appendicitis,but youdo exercisesor takeChinese herbsto keepyour bodyhealthy enoughto preventappendicitis, orto recovermore quicklyfrom thesurgery.
Veryfew practitionersof Westernmedicine inChina rejecttraditional Chinesemedicine, andmost doctorsin Chinawill usesome elementsof Chinesemedicine intheir ownpractice.
Adegree ofintegration betweenChinese andWestern medicinealso existsin China.
For instance,at theShanghai cancerhospital, apatient maybe seenby amultidisciplinary teamand betreated concurrentlywith radiationsurgery, Westerndrugs anda traditionalherbal formula.
A reportby theVictorian stategovernment inAustralia onTCM educationin Chinanoted: Inother countriesit isnot necessarilythe casethat traditionalChinese andWestern medicineare practicedconcurrently bythe samepractitioner.
TCMeducation inAustralia, forexample, doesnot qualifya practitionerto providediagnosis inWestern medicalterms, prescribescheduled pharmaceuticals,nor performsurgical procedures.
While thatjurisdiction notesthat TCMeducation doesnot qualifypractitioners toprescribe Westerndrugs, aseparate legislativeframework isbeing constructedto allowregistered practitionersto prescribeChinese herbsthat wouldotherwise beclassified aspoisons.
Itis worthnoting thatthe practiceof Westernmedicine inChina issomewhat differentfrom thatin theWest.
Incontrast tothe West,there arerelatively fewallied healthprofessionals toperform routinemedical proceduresor toundertake proceduressuch asmassage orphysical therapy.
In addition,Chinese practitionersof Westernmedicine havebeen lessimpacted bytrends inthe Westthat encouragepatient empowerment,to seethe patientas anindividual ratherthan acollection ofparts, andto donothing whenmedically appropriate.
It islikely thatthese medicines,which aregenerally knownto beuseless againstviral infections,would provideless reliefto thepatient thantraditional Chineseherbal remedies.
TCM doctorsoften criticizeWestern doctorsfor payingtoo muchattention tolaboratory testsand showinginsufficient concernfor theoverall feelingsof patients.
Modern TCMpractitioners willrefer patientsto Westernmedical facilitiesif amedical conditionis deemedto haveput thebody toofar outof "balance"for traditionalmethods toremedy.
Animalproducts areused incertain Chineseformulae, whichmay presenta problemfor vegansand vegetarians.
If informedof suchrestrictions, practitionerscan oftenuse alternativesubstances.
Theuse ofendangered speciesis controversialwithin TCM.
According toCompendium ofMateria Medica,it's goodat strengtheningthe waist,supplementing vitalenergy, nourishingblood, invigoratingkidney andlung andimproving digestion.
Furthermore, theyhave beenfound tocontain highlevels ofmercury, whichis knownfor itsill effects.
The animalrights movementnotes thata fewtraditional Chinesemedicinal solutionsuse bearbile.
Toextract maximumamounts ofthe bile,the bearsare oftenfitted witha sortof permanentcatheter.
Thetreatment itselfand especiallythe extractionof thebile isvery painful,causes damageto theintestines ofthe bear,and oftenkills thebears.
Startingfrom late19th century,politicians andChinese scholarswith backgroundin Westernmedicine havebeen tryingto phaseout TCMtotally inChina.
Someof theprominent advocatesof theelimination ofTCM include:The attemptsto curtailTCM inChina alwaysprovoke largescale debatesbut havenever completelysucceeded.
Still,many researchersand practitionersof TCMin Chinaand theUnited Statesargue theneed todocument TCM'sefficacy withcontrolled, doubleblind experiments.
However, inthe 1920sa movementemerged thatattempted torestore traditionalmedical practice,especially acupuncture.
This movement,known asthe MeridianTherapy movement(Keiraku Chiryoin Japanese)persists tothis day.
Acute pain,such asoccurs withtrauma, oftenhas areversible causeand mayrequire onlytransient measuresand correctionof theunderlying problem.
In contrast,chronic painoften resultsfrom conditionsthat aredifficult todiagnose andtreat, andthat maytake along timeto reverse.
Some examplesinclude cancer,neuropathy, andreferred pain.
Often, painpathways areset upthat continueto transmitthe sensationof paineven thoughthe underlyingcondition orinjury thatoriginally causedpain hasbeen healed.
In suchsituations, thepain itselfis frequentlymanaged separatelyfrom theunderlying conditionof whichit isa symptom,or thegoal oftreatment isto managethe painwith notreatment ofany underlyingcondition (e.g.
Pain managementpractitioners comefrom allfields ofmedicine.
Mostoften, painfellowship trainedphysicians areanesthesiologists, neurologists,physiatrists orpsychiatrists.
Somepractitioners focusmore onthe pharmacologicmanagement ofthe patient,while othersare veryproficient atthe interventionalmanagement ofpain.
Overthe lastseveral yearsthe numberof interventionalprocedures donefor painhas grownto avery largenumber.
Aswell asmedical practitioners,the areaof painmanagement mayoften benefitfrom theinput ofSpecialist Nurses,Physiotherapists, ClinicalPsychologists Occupationaltherapists, amongstothers.
Togetherthe multidisciplinaryteam canhelp createa packageof caresuitable tothe patient.
Pain Talk:The nationaldiscussion forumand communityfor UKHealthcare Professionalswith aninterest inacute, chronic,or palliativePain Management.
Patients requiringintensive careusually requiresupport forhemodynamic instability(hypertension/hypotension), airwayor respiratorycompromise (suchas ventilatorsupport), acuterenal failure,potentially lethalcardiac dysrhythmias,and frequentlythe cumulativeaffects ofmultiple organsystem failure.
Patients admittedto theintensive careunit notrequiring supportfor theabove areusually admittedfor intensive/invasivemonitoring, suchas thecrucial hoursafter majorsurgery whendeemed toounstable totransfer toa lessintensively monitoredunit.
Sincethe criticallyill areclose todying theoutcome ofthis interventionis difficultto predict.
Many patientstherefore stilldie inthe IntensiveCare Unit.
Therefore treatmentis merelymeant towin timein whichthe acuteaffliction canbe resolved.
For example,adjusted ICUmortality (fora patientat averagepredicted riskfor ICUdeath) was21.2% inhospitals with87 to150 mechanicallyventilated patientsannually, and14.5% inhospitals with401 to617 mechanicallyventilated patientsannually.
Hospitalswith intermediatenumbers ofpatients hadoutcomes betweenthese extremes.
It isgenerally themost expensive,high technologyand resourceintensive areaof medicalcare.
Intensivecare usuallytakes asystem bysystem approachto treatment,rather thanthe SOAP(subjective, objective,analysis, plan)approach ofhigh dependencycare.
Aswell asthe keysystems Intensivecare treatmentalso raisesother issuesincluding psychologicalhealth, pressurepoints, mobilisationand physiotherapy,and secondaryinfections.
Theprovision ofintensive careis generallyadministered ina specializedunit ofa hospitalcalled theIntensive CareUnit (ICU)or CriticalCare Unit(CCU).
Manyhospitals alsohave designatedintensive careareas forcertain specialitiesof medicine,such asthe CoronaryCare Unit(CCU) forheart disease,Medical IntensiveCare Unit(MICU), SurgicalIntensive CareUnit (SICU),Pediatric IntensiveCare Unit(PICU), NeuroscienceCritical CareUnit (NCCU),Overnight IntensiveRecovery (OIR),Shock/Trauma IntensiveCare Unit(STICU), NeonatalIntensive CareUnit (NICU),and otherunits asdictated bythe needsand availableresources ofeach hospital.
The namingis notrigidly standardized.
For atime inthe early1960s itwas notclear thatspecialized intensivecare unitswere neededand intensivecare resources(see below)were broughtto theroom ofthe patientwho neededthe additionalmonitoring, care,and resources.
It becamerapidly evident,though, thata fixedlocation whereintensive careresources andpersonnel wereavailable providedbetter carethan adhoc provisionof intensivecare servicesspread throughouta hospital.
Common equipmentin anintensive careunit (ICU)includes mechanicalventilation toassist breathingthrough anendotracheal tubeor atracheotomy; hemofiltrationequipment foracute renalfailure; monitoringequipment; intravenouslines fordrug infusionsfluids ortotal parenteralnutrition, nasogastrictubes, suctionpumps, drainsand catheters;and awide arrayof drugsincluding inotropes,sedatives, broadspectrum antibioticsand analgesics.
Critical caremedicine isa relativelynew butincreasingly importantmedical specialty.
Physicians whohave trainingin criticalcare medicineare referredto asintensivists.
Thespecialty requiresadditional fellowshiptraining forphysicians whocomplete theirprimary residencytraining ininternal medicine,anesthesiology, orsurgery.
Boardcertification incritical caremedicine isavailable throughall threespecialty boards.
Intensivists witha primarytraining ininternal medicinesometimes pursuecombined fellowshiptraining inanother subspecialtysuch aspulmonary medicine,cardiology, infectiousdisease, ornephrology.
TheSociety ofCritical CareMedicine isa wellestablished multiprofessionalsociety forpracitioners whowork inthe ICU,including intensivists.
Medical researchhas repeatedlydemonstrated thatICU careprovided byintensivists producesbetter outcomesand morecost effectivecare.
Unfortunatelythere isa criticalshortage ofintensivists inthe UnitedStates andmost hospitalslack thiscritical physicianteam member.
In veterinarymedicine, criticalcare medicineis recognizedas aspecialty andis closelyallied withemergency medicine.
Patient managementin intensivecare differssignificantly betweencountries.
InAustralia, whereIntensive CareMedicine isa wellestablished speciality,ICUs aredescribed as'closed'.
Ina closedunit theintensive carespecialist takeson thesenior rolewhere thepatient's primarydoctor nowacts asa consultant.
Other countrieshave openIntensive CareUnits, wherethe primarydoctor choosesto admitand generallymakes themanagement decisions.
In 1854the CrimeanWar, inwhich England,France andTurkey declaredwar onRussia, began.
Because ofthe lackof criticalcare andthe highrate ofinfection, therewas ahigh mortalityrate ofhospitalised soldiers,reaching ashigh as40% ofthe deathsrecorded duringthe war.
Florence and38 othervolunteers hadto leavefor theFields ofScurati, andtook their"critical careprotocol" withthem.
Uponarriving, andpracticing, themortality ratefell to2%.
Nightingalecontracted typhoid,and returnedin 1856from thewar.
ASchool ofNursing wasformed in1859 inEngland dedicatedto her.
The Schoolwas recognisedfor itsprofessional valueand technicalcalibre, receivingprizes throughoutthe Englishgovernment.
TheSchool ofNursing wasestablished inSaint ThomasHospital, asa oneyear course,and wasgiven todoctors.
Itutilised theoreticaland practicallessons, asopposed topurely academiclessons.
Herwork, andthe school,paved theway forIntensive CareMedicine.
WalterEdward Dandywas bornin Sedalia,Missouri.
Hereceived hisBA in1907 throughthe Universityof Missouriand hisM.D.
JohnsHopkins UniversitySchool ofMedicine.
Dandyworked oneyear withDr.
HarveyCushing inthe HunterianLaboratory ofJohns Hopkinsbefore enteringits boardingschool andresidence inthe JohnsHopkins Hospital.
He workedin theJohns HopkinsCollege in1914 andremained thereuntil hisdeath in1946.
Thistechnique wasextremely successfulfor identifyingbrain injuries.
Dr. Dandywas alsoa pioneerin theadvances inoperations forillnesses ofthe brainaffecting theglossopharyngeal aswell asMeniere's syndrome,and hepublished studiesthat showthat highactivity cancause sciaticpain.
PeterSafar, thefirst Intensivistdoctor, wasborn inAustria.
Hewas theson oftwo doctors,who migratedto theUnited Statesafter beingin aNazi concentrationcamp.
Thedoctor firstgot certificationas ananesthetist, andin the1950s hestarted andpraised the"Urgency Emergency"room setup(now knownas anICU).
Itwas atthis timethe ABC's(Airway, Breathing,and Circulation)protocols wereformed, andartificial ventilationas wellas externalcardiac massagebecame popular.
These experimentscounted onvolunteers ofits teamwhich onlyused minimumsedation.
Itwas throughthese experimentsthat thetechniques formaintaining lifein thecritical patientwere established.
In thecity ofBaltimore, thefirst surgicalICU wasestablished, andin 1962,in theUniversity ofPittsburgh, thefirst CriticalCare Residencywas establishedin theUnited States.
It wasaround thistime thatthe inductionof hypothermiain criticalpatients wasalso tested.
More recently,the WorldAssociation forDisaster andEmergency Medicinewas formed,and sowas theSCCM (Societyof CriticalCare Medicine).
Just asclinicians operateby immediacyrules underlarge emergencysystems, emergencyphysicians andother alliedhealth careworkers inthe emergencydepartment basetheir practiceon atriage system.
Emergency medicinefocuses ondiagnosis andtreatment ofacute illnessesand injuriesthat requireimmediate medicalattention.
UrgentCare Centersare oftenstaffed byphysicians, nursesand nursepractitioners whomay ormay notbe formallytrained inemergency medicine.
They offerprimary caretreatment topatients whodesire orrequire immediatecare, butwho donot reachthe acuitythat requirescare inan emergencydepartment.
Theemergency physicianrequires abroad fieldof knowledgeand advancedprocedural skillsoften includingsurgical procedures,trauma resuscitation,advanced cardiaclife supportand advancedairway management.
International Federationfor EmergencyMedicine 1991During theFrench Revolution,after seeingthe speedwith whichthe carriagesof theFrench flyingartillery maneuveredacross thebattlefields, Frenchmilitary surgeonDominique JeanLarrey appliedthe ideaof FlyingAmbulances forrapid transportof woundedsoldiers toa centralplace wheremedical carewas moreaccessible andeffective.
DominiqueJean Larreyis sometimescalled thefather ofEmergency Medicinefor hisstrategies duringthe Frenchwars.
EmergencyMedicine (EM)as amedical specialtyis relativelyyoung.
Priorto the1960's and70's, hospital"emergency rooms"were generallystaffed byphysicians onstaff atthe hospitalon arotating basis,among themgeneral surgeons,internists, psychiatrists,and dermatologists.
Physicians intraining (internsand residents),foreign medicalgraduates andsometimes nursesalso staffedthe ED.
EM wasborn asa specialtyin orderto fillthe timecommitment requiredby physicianson staffto workin thegrowingly chaoticemergency departments(EDs) ofthe time.
During thisperiod, groupsof physiciansbegan toemerge whohad lefttheir respectivepractices inorder todevote theirwork completelyto theED.
Soon,the problemof the"ER", propagatedby publishedreports andmedia coverageof thepoor stateof affairsfor emergencymedical carehad culminatedwith theestablishment ofthe firstemergency medicinetraining programat CincinnatiGeneral Hospital,with BruceJaniak, M.D.
During the1970's, severalother residencyprograms developedthroughout thecountry.
Atthis time,EM wasnot yeta recognizedspecialty andhence hadno primaryboard certificationexam.
Itwas notuntil theestablishment ofACEP, therecognition ofemergency medicinetraining programsby theAMA andthe AOA,and in1979 ahistorical voteby theAmerican Boardof MedicalSpecialties thatEM becamea recognizedmedical specialty.
In theUnited States,the AmericanCollege ofEmergency Physicians(ACEP) ispresently thelargest memberorganization ofemergency physicians(EPs), andActive membershipis opento bothallopathic (M.D.)and osteopathic(D.O.) legacyphysicians (physiciansengaged inthe practiceof emergencymedicine priorto 2000)and thosephysicians whohave completedan emergencymedicine residencyapproved bythe AccreditationCouncil onGraduate MedicalEducation (ACGME),the AmericanOsteopathic Association(AOA), orare certifiedby anemergency medicinecertifying bodyrecognized byACEP.
Originallyfounded in1968, itwas thefirst EmergencyMedicine societyformed inthe UnitedStates.
Fellowsuse thedesignation FACEP.
Membership census:unknown (2006)The AmericanCollege ofOsteopathic EmergencyPhysicians (ACOEP)was foundedseven yearslater in1975.
Activemembership isopen toosteopathic (D.O.)physicians whohave practicedemergency medicinefor thepast threeyears and/orhave completedan emergencymedicine residencyapproved bythe AOAor ACGME.
Fellows usethe designationFACOEP.
Membershipcensus: 2,300(2006) Foundedin 1991,the Associationof EmergencyPhysicians (AEP),distinguishes itselfby offeringmembership toany practicingemergency physicianregardless oftraining.
Byso doing,the AEPacknowledges thatmore thanhalf ofpracticing emergencyphysicians inthe UnitedStates, muchlike theircolleagues inother countries,completed residenciesin otherrelated specialtieswhich includedtraining inthe practiceof emergencymedicine.
TheAmerican Academyof EmergencyMedicine (AAEM)was formedin 1993and hasbeen thesubject ofsome controversydue toits traditionalposition statementsconcerning boardcertification, resident"moonlighting", andthe practiceof "corporatemedicine".
Nevertheless,AAEM hasworked cooperativelyalongside theACEP andthe ACOEPwhen theinterests ofemergency medicinehave calledfor aunited front.
Active membershipis opento bothallopathic (M.D.)and osteopathic(D.O.) physicianswho havecompleted anemergency medicineresidency approvedby ACGMEor theAOA.
Fellowsuse thedesignation FAAEM.
Membership census:5,000 members(2007) TheAmerican Boardof EmergencyMedicine (ABEM)provides boardcertification toallopathic (M.D.)or osteopathic(D.O.) emergencyphysicians.
LikeABEM, theAOBEM atone timeoffered certificationeligibility viaa practicetrack, allowingtraining inanother specialty,practicing emergencymedicine, andthen passingthe AOBEMcertification exam.
The Boardof Certificationin EmergencyMedicine (BCEM)provides boardcertification toboth allopathicand osteopathicphysicians thathave completedan emergencymedicine orprimary careresidency andperformed 5years ofemergency medicinepractice, followedby awritten andoral examinationprocess.
Manyof theabove mentionedlegacy physiciansare certifiedvia thispathway.
TheBritish Associationfor EmergencyMedicine isthe memberorganization inthe UK.
In 2005, thetwo organizationsinitiated stepsto mergeas theCollege ofEmergency Medicine.
In Australiaand NewZealand, advancedtraining inEmergency Medicineis overseenby theAustralasian Collegefor EmergencyMedicine (ACEM).
In Canada,there aretwo routesto practiceemergency medicine.
More thantwo thirdsof physicianscurrently practicingemergency medicineacross theCanadian nationhave nospecific emergencymedicine residencytraining.
Physicianspracticing inmajor urban/tertiarycare hospitalswill oftenpursue a5 yearspecialist residencyin EmergencyMedicine, certifiedby theRoyal Collegeof Physiciansand Surgeonsof Canada.
These memberstypically spenda greatdeal oftime inacademic andleadership roleswithin emergencymedicine, EMS,research, andother avenues.
There isno significantdifference inremuneration orclinical practicetype betweenphysicians certifiedvia eitherroute.
Seemedical emergencyfor specificlists ofmedical emergenciesand howbest torespond.
Inthe US,Emergency Medicineis amoderately competitivespecialty formedical graduatesto enter,ranking 7of 16specialties interms ofpercentage ofU.S.
However,over 90%of applicantsfrom USmedical schoolsto USEmergency Medicineresidencies aresuccessful.
Inaddition tothe didacticexposure, muchof anemergency medicineresidency involvesrotating throughother specialtieswith amajority ofsuch rotationsthrough theemergency departmentitself.
Bythe endof theirtraining, emergencyphysicians areexpected tohandle avast fieldof medical,surgical, andpsychiatric emergencies,and areconsidered specialistsin thestabilization andtreatment ofemergent condition.
A numberof fellowshipsare availablefor emergencymedicine graduatesincluding toxicology,sports medicine,ultrasound, andpediatric emergencymedicine.
Theemployment arrangementof emergencyphysician practicesare eitherprivate (ademocratic groupof EPsstaff anED undercontract), institutional(EPs withan independentcontractor relationshipwith thehospital), corporate(EPs withan independentcontractor relationshipwith athird partystaffing companythat servicesmultiple emergencydepartments) orgovernmental (employedby theUS armedforces, theUS publichealth service,the Veteran'sAdministration orother governmentagency).
Mostemergency physiciansstaff hospitalemergency departmentsin shifts,a jobstructure necessitatedby the24/7 natureof theemergency department.
A GP/FPtreats acuteand chronicillnesses, providespreventive careand healtheducation forall agesand bothsexes.
Thesynomyms familypractitioner orfamily physicianhave becomewidespread inCanada andthe USA(see below).
The termgeneral practitioneris commonin theUnited Kingdomand someother Commonwealthcountries, wherethe wordphysician islargely reservedfor certainother typesof medicalspecialists, notablyin internalmedicine.
Traditionally,GPs maycare forhospitalized patients;where theyhave hospitalprivileges, theymay performminor surgeryand/or obstetrics.
Many GPsdo someminor procedures,such asremoval ofskin lesions,in theiroffices (theirrooms inUK Commonwealthusage).
Inthe past,GPs frequentlycarried outmore majorsurgery, suchas tonsillectomies,hernia repairs,and appendectomies.
In themore ruralparts ofmany OECDcountries, thisstyle ofmedical practicecontinues.
However,throughout muchof theworld inthe lastfew decades,there hasbeen anincrease inthe numberand typeof medicalspecialists, matchedby asteady decreasein familyphysicians.
Thesechanges mayhave manycauses, includingdue tothe longworking hours,the relativeisolation ofsolo generalpractice, andthe lowerpay comparedto thatof mostspecialists.
Themajority ofBrazilian GPsare locatedin thepublic healthsector andis constitutedmostly byyoung, recentlygraduated physicians.
The reasonis thatGP isnot terriblyprofitable andabout 40%of Braziliandoctors preferto dospecialized practice,instead.
Todo this,they arerequired todo medicalresidence ofvariable durationand submitto aboard ofmedical examinersin orderto getthe titleof specialist.
Each medicalsociety isin chargeof organizingthe examinations(which usuallyare carriedout oncea year)and grantingthe titlesto thosephysicians whopassed therequirements.
Thetitle isrecognized bythe FederalCouncil ofMedicine (theFederal professionalregulatory body),the Ministryof Educationand theMinistry ofHealth.
Familymedicine, onthe otherhand, hasevolved onlyrecently inBrazil asa separatespecialization ofgeneral practice.
It isa conceptwhich wasadapted fromseveral communityhealth modelsin Europe,such asin Italy,but particularlythe onewhich wascreated successfullyin Cuba,and whichwas feltto bethe mostadequate toBrazilian reality.
Specific intensivetraining programsand recruitingefforts wereset upin thecountry inorder toform thePSF teams,which currentlyinvolve about3,000 municipalities,with morethan 45,000teams alreadyin operation;so thatit canbe consideredone ofthe largestfamily healthprograms inthe world.
Family physiciansper seare stilla rarespecialty inBrazil, asthe professionis generallyshunning it(although economicalincentive isno longera validreason, sincephysicians whowork inthe PSFunits aregenerally wellpaid incomparison toprimary healthcare physiciansin thepublic sector).
A fewyears agoa BrazilianSociety ofFamily andCommunity Medicinewas foundedand haslobbied tohave itsown specialtytitle andboard ofexaminers, butit hasso farremained relativelysmall.
InCanada, thereare nonewly qualifyinggeneral practitioners:all medicalstudents goon toa specialty,and familymedicine accountsfor almost40% ofthe residencypositions forgraduating students.
Many hospitalsand healthregions nowrequire thiscertification.
Tomaintain theircertificate, doctorsmust documentongoing learningand upgradeactivities toaccumulate "MainPro"credits.
Somedoctors addan extrayear oftraining inemergency medicineand canthus beadditionally certifiedas CCFP(EM).
Extra trainingin anesthesia,surgery andobstetrics mayalso berecognized butthis isnot standardizedacross thecountry.
Thereis verylittle privatefamily medicinepractice inCanada.
Thereis increasinginterest inthe latteras ameans topromote bestpractices withina managedeconomic environment.
As standardoffice practicehas becomeless financiallyviable inrecent years,many FPsnow pursueareas ofspecial interest.
Manpower inequitiesin ruralareas arenow beingaddressed withsome innovativetraining andinducement mechanisms.
An imbalancebetween physicianmanpower anda growingpatient loadhas resultedin orphanpatients whofind itdifficult toaccess primarycare, butthis isnot uniqueto Canada.
Doctor ofMedicine ora D.O.
Doctor ofOsteopathic Medicinedegree.
Still,many chooseto teachmedicine atmedical schoolsor familymedicine residencyprograms, thoughusually formuch lesspay.
Otherschose topractice asconsultants tovarious medicalinstitutions, includinginsurance companies.
Training isfocused ontreating anindividual throughoutall ofhis orher lifestages.
Familyphysicians willsee anyonewith anyproblem, butare expertsin commonproblems.
Manyfamily physiciansdeliver babiesas wellas takingcare ofpatients ofall ages.
Family physicianscomplete undergraduateschool, medicalschool, andthree moreyears ofspecialized medicalresidency trainingin FamilyMedicine.
Threehundred hoursof continuingmedical educationwithin theprior sixyears isalso requiredto beeligible tosit forthe exam.
Between 2003and 2009the boardcertification processis beingchanged infamily medicineand allother AmericanSpecialty Boardsto acontinuous seriesof yearlycompetency testson differingareas withinthe givenspecialty.
Certificatesof AddedQualifications (CAQs)in adolescentmedicine, geriatricmedicine, orsports medicineare availablefor thoseboard certifiedfamily physicianswho meetadditional trainingand testingrequirements.
Additionally,fellowships areavailable forfamily physiciansin adolescentmedicine, geriatrics,sports medicine,rural medicine,faculty development,obstetrics, research,and preventativemedicine.
Thefamily medicine(FM) paradigmis bolsteredby primarycare physicianstrained ininternal medicine(IM); althoughthese physiciansare trainedin internalmedicine only,adult patientsprovide themajority ofthe patientbase ofmany familymedicine practices.
A significantnumber offamily medicinepractices (especiallyin suburbanand urbanareas) donot provideobstetric servicesanymore (dueto litigationissues andprovider preference),and assuch, thisblurs theline betweenthe FMand IM/Pedsdifference.
Thereis currentlya shortageof familyphysicians (andalso otherprimary careproviders) dueto severalfactors, notablythe lesserprestige associatedwith theyoung specialty,the lesserpay, andthe increasinglyfrustrating practiceenvironment inthe U.S.
Physicians areincreasingly forcedto domore administrativework, shoulderhigher malpracticepremiums dueto highlyprofitable insurancemonopolies thatcharge excessivepremiums, thusforcing doctorsto spendless andless timewith patientcare dueto thecurrent payormodel stressingpatient volumevs.
Thingsare startingto changeas moreinsurance carriersconsolidate.
Theyare notstressing performancebut moreand morevolume, thusincreasing insurancecompany profitmargins.
Physiciansare startingto shuninsurance carriersto lessenthe paperworkin orderto focusmore onpatient careas theyare originallytrained todo.
GeneralPractice inAustralia hasundergone manychanges intraining requirementsover thepast decade.
Since 1996this qualificationor itsequivalent hasbeen requiredin orderfor theGP toaccess Medicarerebates asa generalpractitioner.
Medicareis Australia'suniversal healthinsurance system,and withoutaccess toit, apractitioner cannoteffectively workin privatepractice inAustralia.
Thereis ashortage ofGPs inrural areasand increasinglyouter metropolitanareas oflarge cities,which hasled tothe utilisationof overseastrained doctors(OTDs).
Indiahas thehighest numberof medicalschools inthe world,with approximately262.
InIndia tobecome aGP ora FamilyPhysician, onehas toenroll ina MedicalCouncil OfIndia (MCI)recognised medicalcollege andcomplete theBachelors ofMedicine andSurgery (M.B.,B.S)course, whichis offour anda halfyears durationto beawarded thedegree ofM.B.,B.S andprovisionally registeredwith theMedical Councilof India.
After onefurther yearof compulsoryrotatory internship,the MedicalCouncil ofIndia (orany ofthe StateMedical Councils)confer permanentregistration whichlicences theholder topractise asa GP.
One canalso optto jointhe NationalBoard ofExaminations (NBE)'sfellowship forFamily Medicineat anyof theNBE designatedand recognisedHealth carecenter orhospital andappear forqualifying examsfor fellowshipto theNational Boardon successfulcompletion ofwhich, oneis awardedthe "Diplomateof NationalBoard" degreeand title.
Other thanallopathic doctors,graduates ofhomeopathy, ayurveda,and unanicourses fromrecognised medicalcolleges andinstitutions andduly registeredwith therespective stateor nationalboards ofthese medicalsystems canalso practiceas familypractitioners.
ThePakistan Medicaland DentalCouncil thenconfers permenantregistration, afterwhich thecandidate maychoose topractice asa GPor optfor specialtytraining.
Upto 1994there wasno specifictraining forgeneral practiceand GPswere practicingon theirown.
Thefirst departmentof familymedicine wasestablished inAga KhanUniversity inthe 2000.
This impliesprevention, education,care ofthe diseasesand traumasthat donot requirea specialist,and orientationtowards aspecialist whennecessary.
Theyhave arole inthe surveyof epidemics,a legalrole (constatationof traumasthat canbring compensation,certificates forthe practiceof asport, deathcertificate, certificatefor hospitalisationwithout consentin caseof mentalincapacity), anda rolein theemergency care(they canbe calledby thesamu, theFrench EMS).
The studiesconsist ofsix yearsin theuniversity (commonto allmedical specialties),and twoyears anda halfas ajunior practitioner(interne): Thisends witha doctorate,a researchwork whichusually consistof astatistical studyof casesto proposea carestrategy ofa specificaffection (inan epidemiological,diagnostic, ortherapeutic pointof view).
General practicein TheNetherlands isconsidered fairlyadvanced.
Manyhave aspecialist interest,e.g.
Trainingconsists ofthree yearsof specialisationafter completionof internships.
After thegraduation inmedicine (witha durationof 6years), themedical doctorspass anational writtenexam calledMIR (InternalResident Doctor).
The specialitydevoted toprimary careis "Familyand CommunityMedicine Specialist".
Some ofthe specialistin familypractice inSpain areforced towork inother countries(mainly UK,Portugal andFrance) dueto lackof stablework offersin thepublic healthsystem.
Inthe UnitedKingdom, doctorswishing tobecome GPstake atleast 4years trainingafter medicalschool, whichis usuallyan undergraduatecourse offive tosix years(or agraduate courseof fourto sixyears) leadingto thedegrees ofBachelor ofMedicine andBachelor ofSurgery (MBChB/BS).
Upuntil 2005,those wishingto becomea GPhad todo aminimum ofthe followingpostgraduate training:This processhas changedunder theprogramme ModernisingMedical Careers.
Doctors graduatingfrom 2005onwards willhave todo aminimum of5 yearspostgraduate training:At theend ofthe oneyear registrarpost, thedoctor mustpass anexamination inorder tobe allowedto practiceindependently asa GP.
This summativeassessment consistsof avideo oftwo hoursof consultationswith patients,an auditcycle completedduring theirregistrar year,a multiplechoice questionnaire(MCQ), anda standardisedassessment ofcompetencies bytheir trainer.
Membership ofthe RoyalCollege ofGeneral Practitionersis optionaland canbe awardedby examination,or bysystematic assessmentof anexisting practitioner.
General practitionersare notrequired tohold theMRCGP, butit isconsidered desirable.
In addition,many holdqualifications suchas theDCH (Diplomain ChildHealth ofthe RoyalCollege ofPaediatrics andChild Health)and/or theDRCOG (Diplomaof theRoyal Collegeof Obstetriciansand Gynaecologists)and/or theDGH (Diplomain GeriatricMedicine ofthe RoyalCollege ofPhysicians.
SomeGeneral Practitionersalso holdthe MRCP(Member ofthe RoyalCollege ofPhysicians) orother specialistqualifications, particularlyif theyhad acareer inanother specialtybefore cominginto GeneralPractice.
Thereare manyarrangements underwhich generalpractitioners canwork inthe UK.
Whichever ofthese rolesthey fillthe vastmajority ofGPs receivemost oftheir incomefrom theNational HealthService (NHS).
The MBChB medicaldegree isgenerally consideredequivalent tothe NorthAmerican MDmedical degree.
Doctors educatedin theUnited States,Canada, Ireland,and GreatBritain havemore abilityto movebetween thecountries thanother nationalsystems.
Visitsto GPsurgeries arefree inthe UnitedKingdom, butmost adultsof workingage whoare noton benefitshave topay astandard chargefor prescriptiononly medicine.
Recent reformsto theNHS haveincluded changingthe GPcontract.
Generalpractitioners arenow notrequired towork unsociablehours, andget paidto someextent accordingto theirperformance, e.g.
Quality andOutcomes Framework.
They areencouraged toprescribe medicinesby theirgeneric names.
The ITsystem usedfor assessingtheir incomebased onthese criteriais calledQMAS.
Doctorswhose primaryprofessional focusis hospitalmedicine arecalled hospitalists.
The termhospitalist wasfirst usedby Dr.
The majorityof hospitalistsare physicianswith aDoctor ofOsteopathy (D.O.)or MedicalDegree (M.D.).
About 78%of practicinghospitalists aretrained ingeneral internalmedicine.
Another4% aretrained inan internalmedicine subspecialty,most commonlypulmonology orintensive caremedicine.
Whileit wascommonly believedthat anyresidency programwith aheavy inpatientcomponent providedgood hospitalisttraining, studieshave foundthat generalresidency trainingis inadequatebecause commonhospitalist problemslike neurology,hospice andpalliative care,consultative medicine,and qualityassurance tendto beglossed over.
To addressthis, residencyprograms arestarting todevelop hospitalisttracks withmore tailorededucation.
Severaluniversities havealso startedfellowship programsspecifically gearedtoward hospitalistmedicine.
Hospitalmedicine isa relativelynew phenomenonin Americanmedicine.
Almostunheard ofa generationago, thistype ofpractice arosefrom threepowerful shiftsin medicalpractice: Hospitalistsrepresent oneof themost rapidlygrowing formsof medicalpractice inthe US.
As residencyprograms areencouraged tolimit inpatientduty hoursand providemore outpatienteducation, thispattern mayshift.
Ifthis specialtyevolves asemergency andintensive caremedicine did,it willbecome aformal specialitywith itsown residenciesand boardcertification withina decadeor two.
A fewdistinct residencyand fellowshiptraining programsare currentlyoperating atmajor universities.
In additionto patientcare duties,hospitalists areoften involvedin developingand managingaspects ofhospital operationssuch asinpatient flowand qualityassurance.
Theformation ofhospitalist trainingtracks inresidency programshas beendriven inpart bythe needto educatefuture hospitalistsabout businessand operationalaspects ofmedicine, asthese topicsare notcovered intraditional residencies.
Category: MedicalspecialtiesInternal medicineis thebranch andspecialty ofmedicine concerningthe diagnosisand nonsurgicaltreatment ofdiseases inadults, especiallyof internalorgans.
Doctorsof internalmedicine, alsocalled "internists",are requiredto haveincluded intheir medicalschooling andpostgraduate trainingat leastthree yearsdedicated tolearning howto prevent,diagnose, andtreat diseasesthat affectadults.
Internistsare sometimesreferred toas the"doctor's doctor,"because theyare oftencalled uponto actas consultantsto otherphysicians tohelp solvepuzzling diagnosticproblems.
Whilethe name"internal medicine"may leadone tobelieve thatinternists onlytreat "internal"problems, thisis notthe case.
Doctors ofinternal medicinetreat thewhole person,not justinternal organs.
Internists holdeither anM.D.
MedicalDoctor), D.O.(Doctor ofOsteopathic Medicine)or aBiomedical sciencedegree asBiomedical Doctors.
They arenot tobe confusedwith "MedicalInterns," whoare physiciansin theirfirst yearof residencytraining.
AlthoughInternists mayact asprimary carephysicians, theyare not"family physicians,""family practitioners,"or "generalpractitioners" (whosetraining incertain countriesincludes themedical careof children,and mayinclude surgery,obstetrics andpediatrics).
GeneralInternists practicemedicine froma primarycare perspectivebut theycan treatand managemany ailmentsand areusually themost adeptat treatinga broadrange ofdiseases affectingadults.
Theprimary careof adolescentsis providedby familypractice, internistsand pediatricians.
The primarycare ofchildren andinfants isprovided byFamily Practiceor Pediatricians.
Thus, thereis overlap.
Internists aretrained tosolve puzzlingdiagnostic problemsand handlesevere chronicillnesses andsituations whereseveral differentillnesses maystrike atthe sametime.
Theyalso bringto patientsan understandingof preventativemedicine, men'sand women'shealth, substanceabuse, mentalhealth, aswell aseffective treatmentof commonproblems ofthe eyes,ears, skin,nervous systemand reproductiveorgans.
Mostolder adultsin theUnited Statessee aninternist astheir primaryphysician.
Internistscan chooseto focustheir practiceon generalinternal medicine,or maytake additionaltraining to"subspecialize" inone of13 areasof internalmedicine, generallyorganized byorgan system.
Cardiologists, forexample, aredoctors ofinternal medicinewho subspecializein diseasesof theheart.
Thetraining aninternist receivesto subspecializein aparticular medicalarea isboth broadand deep.
Subspecialty training(often calleda "fellowship")usually requiresan additionalone tothree yearsbeyond thestandard threeyear generalinternal medicineresidency.
Residenciescome aftera studenthas graduatedfrom medicalschool.) Inthe UnitedStates, thereare twoorganizations responsiblefor certificationof subspecialistswithin thefield, theAmerican Boardof InternalMedicine, andthe AmericanOsteopathic Boardof InternalMedicine.
TheABIM alsorecognizes additionalqualifications inthe followingareas Internistsmay alsospecialize inallergy andimmunology.
TheAmerican Boardof Allergy,Asthma, andImmunology isa conjointboard betweeninternal medicineand pediatrics.
Subtle descriptionsof disease(e.g.
Inthe medicalhistory, the"Review ofSystems" servesto pickup symptomsof diseasethat apatient mightnot normallyhave mentioned,and thephysical examinationtypically followsa structuredfashion.
Atthis stage,a doctoris generallyable togenerate adifferential diagnosis,or alist ofpossible diagnosesthat canexplain theconstellation ofsigns andsymptoms.
Occam'srazor dictatesthat, whenpossible, allsymptoms shouldbe presumedto bemanifestations ofthe samedisease process,but oftenmultiple problemsare identified.
In orderto "narrowdown" thedifferential diagnosis,blood testsand medicalimaging areused.
Theycan alsoserve screeningpurposes, e.g.
At thisstage, thephysician willoften havealready arrivedat adiagnosis, ormaximally alist ofa fewitems.
Specifictests forthe presumeddisease areoften required,such asa biopsyfor cancer,microbiological cultureetc.
Medicineis mainlyfocused onthe artof diagnosisand treatmentwith medication,but manysubspecialties administersurgical treatment:Content basedon authoritativeinformation fromthe Websites ofthe AmericanCollege ofPhysicians, ABIM,and ACOI.
While amajor focusof REIis infertility,reproductive endocrinologistsalso evaluateand treathormonal dysfunctionsin femaleand malesoutside ofinfertility.
Reproductivesurgeons operateon anatomicaldisorders thataffect fertility.
Reproductive endocrinologistshave aspecialty trainingin obstetricsand gynecologybefore theyundergo subspecialtytraining (fellowship)in reproductiveendocrinology andinfertility.
Asignificant partof reproductiveendocrinology andinfertility isconcerned withthe diagnosisand managementof infertility.
Reproductive endocrinologistalso arecalled uponto utilizepreimplantation geneticdiagnosis toprevent geneticdiseases incouples thatcarry suchdiseases orfor genderselection.
Complexsurgery inwomen ormen thataims topreserve reproductivepotential isoften doneby REspecialist.
Reproductiveendocrinologists arealso especiallytrained todeal withcomplex hormonalissues inwomen ormen.
Ina numberof countriesthe pathwayto becomea subspecialistin REIis regulated.
Thus inthe UnitedStates theAmerican Boardof Obstetricsand Gynecology(ABOG) setsthe standardsfor subspecialtiststo becomecertified.
Tobe boardcertified inreproductive endocrinolgyand infertility,one mustfirst completeboard certificationin obstetricsand gynecology(written andoral exams)and thencertify inreproductive edncrinologyand infertility(written oraland thesisexams).
Reproductiveendocrinologists oftenbelong tospecific medicalsocieties, suchas ASRMor ESHRE.
Patients requiringintensive careusually requiresupport forhemodynamic instability(hypertension/hypotension), airwayor respiratorycompromise (suchas ventilatorsupport), acuterenal failure,potentially lethalcardiac dysrhythmias,and frequentlythe cumulativeaffects ofmultiple organsystem failure.
Patients admittedto theintensive careunit notrequiring supportfor theabove areusually admittedfor intensive/invasivemonitoring, suchas thecrucial hoursafter majorsurgery whendeemed toounstable totransfer toa lessintensively monitoredunit.
Sincethe criticallyill areclose todying theoutcome ofthis interventionis difficultto predict.
Many patientstherefore stilldie inthe IntensiveCare Unit.
Therefore treatmentis merelymeant towin timein whichthe acuteaffliction canbe resolved.
For example,adjusted ICUmortality (fora patientat averagepredicted riskfor ICUdeath) was21.2% inhospitals with87 to150 mechanicallyventilated patientsannually, and14.5% inhospitals with401 to617 mechanicallyventilated patientsannually.
Hospitalswith intermediatenumbers ofpatients hadoutcomes betweenthese extremes.
It isgenerally themost expensive,high technologyand resourceintensive areaof medicalcare.
Intensivecare usuallytakes asystem bysystem approachto treatment,rather thanthe SOAP(subjective, objective,analysis, plan)approach ofhigh dependencycare.
Aswell asthe keysystems Intensivecare treatmentalso raisesother issuesincluding psychologicalhealth, pressurepoints, mobilisationand physiotherapy,and secondaryinfections.
Theprovision ofintensive careis generallyadministered ina specializedunit ofa hospitalcalled theIntensive CareUnit (ICU)or CriticalCare Unit(CCU).
Manyhospitals alsohave designatedintensive careareas forcertain specialitiesof medicine,such asthe CoronaryCare Unit(CCU) forheart disease,Medical IntensiveCare Unit(MICU), SurgicalIntensive CareUnit (SICU),Pediatric IntensiveCare Unit(PICU), NeuroscienceCritical CareUnit (NCCU),Overnight IntensiveRecovery (OIR),Shock/Trauma IntensiveCare Unit(STICU), NeonatalIntensive CareUnit (NICU),and otherunits asdictated bythe needsand availableresources ofeach hospital.
The namingis notrigidly standardized.
For atime inthe early1960s itwas notclear thatspecialized intensivecare unitswere neededand intensivecare resources(see below)were broughtto theroom ofthe patientwho neededthe additionalmonitoring, care,and resources.
It becamerapidly evident,though, thata fixedlocation whereintensive careresources andpersonnel wereavailable providedbetter carethan adhoc provisionof intensivecare servicesspread throughouta hospital.
Common equipmentin anintensive careunit (ICU)includes mechanicalventilation toassist breathingthrough anendotracheal tubeor atracheotomy; hemofiltrationequipment foracute renalfailure; monitoringequipment; intravenouslines fordrug infusionsfluids ortotal parenteralnutrition, nasogastrictubes, suctionpumps, drainsand catheters;and awide arrayof drugsincluding inotropes,sedatives, broadspectrum antibioticsand analgesics.
Critical caremedicine isa relativelynew butincreasingly importantmedical specialty.
Physicians whohave trainingin criticalcare medicineare referredto asintensivists.
Thespecialty requiresadditional fellowshiptraining forphysicians whocomplete theirprimary residencytraining ininternal medicine,anesthesiology, orsurgery.
Boardcertification incritical caremedicine isavailable throughall threespecialty boards.
Intensivists witha primarytraining ininternal medicinesometimes pursuecombined fellowshiptraining inanother subspecialtysuch aspulmonary medicine,cardiology, infectiousdisease, ornephrology.
TheSociety ofCritical CareMedicine isa wellestablished multiprofessionalsociety forpracitioners whowork inthe ICU,including intensivists.
Medical researchhas repeatedlydemonstrated thatICU careprovided byintensivists producesbetter outcomesand morecost effectivecare.
Unfortunatelythere isa criticalshortage ofintensivists inthe UnitedStates andmost hospitalslack thiscritical physicianteam member.
In veterinarymedicine, criticalcare medicineis recognizedas aspecialty andis closelyallied withemergency medicine.
Patient managementin intensivecare differssignificantly betweencountries.
InAustralia, whereIntensive CareMedicine isa wellestablished speciality,ICUs aredescribed as'closed'.
Ina closedunit theintensive carespecialist takeson thesenior rolewhere thepatient's primarydoctor nowacts asa consultant.
Other countrieshave openIntensive CareUnits, wherethe primarydoctor choosesto admitand generallymakes themanagement decisions.
In 1854the CrimeanWar, inwhich England,France andTurkey declaredwar onRussia, began.
Because ofthe lackof criticalcare andthe highrate ofinfection, therewas ahigh mortalityrate ofhospitalised soldiers,reaching ashigh as40% ofthe deathsre