By M. Reto. Lycoming College. 2018.
The book has truly been a coming together of academic and practitioner minds order cefadroxil 250 mg with amex, without whom this book would merely have remained a scintilla of an idea quietly percolating away in the deepest recesses of my mind buy 250 mg cefadroxil amex. I thank all contributors of this book for their excellent chapters; many contributors also served as reviewers discount cefadroxil 250mg fast delivery, and additional thanks are due to these hard-working soles for giving up so much of their valuable time and collective energies cefadroxil 250mg line. Thanks also to every- body who submitted proposals for giving me that most rare and coveted of headaches: a plethora of high quality and relevant submissions from which to choose. Sincere thanks to Professor Swamy Laxminarayan, chief of biomedical information engi- neering at Idaho State University in the USA for writing such a fine foreword and for his kind words and unstinting support in recent years. Professor Raouf Naguib, head of the Biomedical Computing Research Group (BIOCORE) at Coventry University in the UK was a great source of encouragement and provided me with extensive insights into the crazy world of academia. Virtually his first words to me came in the form of advice: to focus on that which I did best, words which obviously stuck with me. I additionally thank Raouf for encouraging me to form my Knowledge Management for Healthcare (KMH) research subgroup, which generated immediate interest and recognition from international academic and healthcare institutions and which continues to go from strength to strength. Ashish Dwivedi for his seminal work in the area of clinical and healthcare knowledge management and for forming the granite-like founda- tion of the KMH subgroup. I appreciate also the expressions of interest and words of support from my numerous interactions with conference delegates in the USA, Singapore, Mexico and the UK. Last, but by no means least, I thank my family for their support during the management of this, my latest project. Warwickshire, UK August 2004 Section I Key Opportunities and Challenges in Clinical Knowledge Management Issues in Clinical Knowledge Management 1 ChapterI Issues inClinical Knowledge Management: Revisiting Healthcare M anagement Rajeev K. Bali, Coventry University, UK Ashish Dwivedi, The University of Hull, UK Raouf Naguib, Coventry University, UK Abstract The objective of this chapter is to examine some of the key issues surrounding the incorporation of the Knowledge Management (KM) paradigm in healthcare. We discuss whether it would it be beneficial for healthcare organizations to adopt the KM paradigm so as to facilitate effective decision-making in the context of healthcare delivery. Alternative healthcare management concepts with respect to their ability in providing a solution to the above-mentioned issue are reviewed. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Recent innovations in Information Technology (IT) have transformed the way that healthcare organizations function. Applications of concepts such as Data Warehousing and Data Mining have exponentially increased the amount of information to which a healthcare organization has access, thus creating the problem of “information explo- sion”. This problem has been further accentuated by the advent of new disciplines such as Bioinformatics and Genetic Engineering, both of which hold very promising solutions which may significantly change the face of the entire healthcare process from diagnosis to delivery (Dwivedi, Bali, James, Naguib, & Johnston, 2002b). Until the early 1980s, IT solutions for healthcare used to focus on such concepts as data warehousing. The emphasis was on storage of data in an electronic medium, the prime objective of which was to allow exploitation of this data at a later point in time. As such, most of the IT applications in healthcare were built to provide support for retrospective information retrieval needs and, in some cases, to analyze the decisions undertaken. Clinical data that was traditionally used in a supportive capacity for historical purposes has today become an opportunity that allows healthcare stakehold- ers to tackle problems before they arise. Healthcare Management Concepts Healthcare managers are being forced to examine costs associated with healthcare and are under increasing pressure to discover approaches that would help carry out activities better, faster and cheaper (Davis & Klein, 2000; Latamore, 1999). Workflow and associ- ated Internet technologies are being seen as an instrument to cut administrative expenses. Specifically designed IT implementations such as workflow tools are being used to automate the electronic paper flow in a managed care operation, thereby cutting administrative expenses (Latamore, 1999). One of the most challenging issues in healthcare relates to the transformation of raw clinical data into contextually relevant information. Advances in IT and telecommunica- tions have made it possible for healthcare institutions to face the challenge of transform- ing large amounts of medical data into relevant clinical information (Dwivedi, Bali, James, & Naguib, 2001b). This can be achieved by integrating information using workflow, context management and collaboration tools, giving healthcare a mechanism for effec- tively transferring the acquired knowledge, as and when required (Dwivedi, Bali, James, & Naguib, 2002a).
According to the Muscular Dystrophy Association discount cefadroxil 250 mg without a prescription, people who have central core disease are sometimes vul- Malignant hyperthermia—A condition brought on nerable to malignant hyperthermia (MH) 250mg cefadroxil otc, a condition by anesthesia during surgery proven cefadroxil 250 mg. Malignant Mitochondria—Organelles within the cell respon- hyperthermia causes a rapid discount cefadroxil 250mg on-line, and sometimes fatal, rise in sible for energy production. When sus- Myopathy—Any abnormal condition or disease of ceptible individuals are exposed to the most commonly the muscle. Sporadic inheritance—A status that occurs when a Prognosis gene mutates spontaneously to cause the disorder Fortunately, the outlook for children with this dis- in a person with no family history of the disorder. Although children with central core disease start their life with some developmental delays, many improve as they get older and stay active Demographics throughout their lives. The disease becomes noticeable in early childhood, when muscle cramps are often present after exercising or Resources performing other physical activities. Central core disease ORGANIZATIONS is often seen as “floppiness” in a newborn baby, followed Muscular Dystrophy Association. Signs and symptoms WEBSITES Symptoms of central core disease are usually not Coping with Central Core Disease. Individuals with CCD reach motor skill milestones much later than those without the Bethanne Black disorder. A child with the disease cannot run easily, and jumping and other physical activities are often impossi- Central core disease of muscle see Central ble. Central core disease also causes skin rash, muscular shrinkage, endocrine abnormalities, heart problems, or mental problems. Diagnosis ICerebral palsy The diagnosis of central core disease is made after Definition several neurological tests are completed. A serum caused by abnormal development of, or damage to, motor enzyme test might also be performed to measure how control centers of the brain. The abnormalities of mus- 212 GALE ENCYCLOPEDIA OF GENETIC DISORDERS cle control that define CP are often accompanied by other showed that only 5–10% of CP can be attributed to birth neurological and physical abnormalities. Other possible causes include abnormal develop- ment of the brain, prenatal factors that directly or indirectly Description damage neurons in the developing brain, premature birth, and brain injuries that occur in the first few years of life. Control of the skeletal muscles originates in the cerebral cortex, As noted, CP has many causes, making a discussion the largest portion of the brain. A number of heredi- may also be used to describe uncontrolled muscle move- tary/genetic syndromes have signs and symptoms similar ment. Therefore, cerebral palsy encompasses any disor- to CP, but usually also have problems not typical of CP. In truth, how- Isolated CP, meaning CP that is not a part of some other ever, CP does not include conditions due to progressive syndrome or disorder, is usually not inherited. For this reason, CP It might be possible to group the causes of CP into is also referred to as static (nonprogressive) encephalopa- those that are genetic and those that are non-genetic, but thy (disease of the brain). Grouping causes disorders of muscle control that arise in the muscles into those that occur during pregnancy (prenatal), those themselves and/or in the peripheral nervous system that happen around the time of birth (perinatal), and those (nerves outside the brain and spinal cord). CP related CP is not a specific diagnosis, but is more accurately to premature birth and multiple birth pregnancies considered a description of a broad but defined group of (twins, triplets, etc. Those with CP may have only minor difficulty with fine motor skills, such as grasping and manipulating Although much has been learned about human items with their hands. A severe form of CP could embryology in the last couple of decades, a great deal involve significant muscle problems in all four limbs, remains unknown. Studying prenatal human develop- mental retardation, seizures, and difficulties with vision, ment is difficult because the embryo and fetus develop in speech, and hearing. However, the relatively recent development of a number of prenatal Muscles that receive abnormal messages from the tests has opened a window on the process. Add to that brain may be constantly contracted and tight (spastic), more accurate and complete evaluations of newborns, exhibit involuntary writhing movements (athetosis), or especially those with problems, and a clearer picture of have difficulty with voluntary movement (dyskinesia). There can also be a lack of balance and coordination with unsteady movements (ataxia).
Harold Ellis 2006 xiii Acknowledgements I wish to thank the many students who have sent suggestions to me order cefadroxil 250 mg with amex, many of which have been incorporated into this new edition cheap cefadroxil 250mg mastercard. To Mrs Katherine Ellis go my grateful thanks for invaluable secretarial assistance order 250mg cefadroxil with visa. I am grateful to the following authors for permission to reproduce illus- trations: The late Lord Brock for Figs 20 and 21 (from Lung Abscess); and Professor R order cefadroxil 250 mg overnight delivery. Finally, I wish to express my debt to Martin Sugden and the staff of Blackwell Publishing for their continued and unfailing help. Harold Ellis xiv Part 1 The Thorax Surface anatomy and surface markings The experienced clinician spends much of his working life relating the surface anatomy of his patients to their deep structures (Fig. The following bony prominences can usually be palpated in the living subject (corresponding vertebral levels are given in brackets): •superior angle of the scapula (T2); •upper border of the manubrium sterni, the suprasternal notch (T2/3); •spine of the scapula (T3); •sternal angle (of Louis) — the transverse ridge at the manubrio-sternal junction (T4/5); •inferior angle of scapula (T8); •xiphisternal joint (T9); •lowest part of costal margin—10th rib (the subcostal line passes through L3). Since the 1st and 12th ribs are difficult to feel, the ribs should be enu- merated from the 2nd costal cartilage, which articulates with the sternum at the angle of Louis. The spinous processes of all the thoracic vertebrae can be palpated in the midline posteriorly, but it should be remembered that the first spinous process that can be felt is that of C7 (the vertebra prominens). The position of the nipple varies considerably in the female, but in the male it usually lies in the 4th intercostal space about 4in (10cm) from the midline. The apex beat, which marks the lowest and outermost point at which the cardiac impulse can be palpated, is normally in the 5th inter- costal space 3. The trachea is palpable in the suprasternal notch midway between the heads of the two clavicles. Surface markings of the more important thoracic contents (Figs 2–4) The trachea The trachea commences in the neck at the level of the lower border of the cricoid cartilage (C6) and runs vertically downwards to end at the level of the sternal angle of Louis (T4/5), just to the right of the mid-line, by divid- ing to form the right and left main bronchi. The pleura The cervical pleura can be marked out on the surface by a curved line drawn from the sternoclavicular joint to the junction of the medial and middle thirds of the clavicle; the apex of the pleura is about 1in (2. The lines of pleural reflexion pass from behind the sternoclavicular joint on each side to meet in the midline at the 2nd costal cartilage (the angle of Louis). The right pleural edge then passes vertically downwards to the 6th costal cartilage and then crosses: •the 8th rib in the midclavicular line; •the 10th rib in the midaxillary line; •the 12th rib at the lateral border of the erector spinae. On the left side the pleural edge arches laterally at the 4th costal carti- lage and descends lateral to the border of the sternum, due, of course, to its lateral displacement by the heart; apart from this, its relationships are those of the right side. The pleura actually descends just below the 12th rib margin at its medial extremity — or even below the edge of the 11th rib if the 12th is unusually short; obviously in this situation the pleura may be opened acci- dentally in making a loin incision to expose the kidney, perform an adrena- lectomy or to drain a subphrenic abscess. The lungs The surface projection of the lung is somewhat less extensive than that of the parietal pleura as outlined above, and in addition it varies quite consid- erably with the phase of respiration. The apex of the lung closely follows the line of the cervical pleura and the surface marking of the anterior border of the right lung corresponds to that of the right mediastinal pleura. On the left side, however, the anterior border has a distinct notch (the cardiac notch) which passes behind the 5th and 6th costal cartilages. The lower border of the lung has an excursion of as much as 2–3in (5–8cm) in the extremes of respi- ration, but in the neutral position (midway between inspiration and expira- tion) it lies along a line which crosses the 6th rib in the midclavicular line, the 8th rib in the midaxillary line, and reaches the 10th rib adjacent to the vertebral column posteriorly. The oblique fissure, which divides the lung into upper and lower lobes, is indicated on the surface by a line drawn obliquely downwards and out- wards from 1in (2. This can be rep- resented approximately by abducting the shoulder to its full extent; the line of the oblique fissure then corresponds to the position of the medial border of the scapula. The surface markings of the transverse fissure (separating the middle and upper lobes of the right lung) is a line drawn horizontally along the 4th costal cartilage and meeting the oblique fissure where the latter crosses the 5th rib. The heart The outline of the heart can be represented on the surface by the irregular quadrangle bounded by the following four points (Fig. The left border of the heart (indicated by the curved line joining points 1 and 4) is formed almost entirely by the left ventricle (the auricular appendage of the left atrium peeping around this border superiorly), the lower border (the horizontal line joining points 3 and 4) corresponds to the right ventricle and the apical part of the left ventricle; the right border (marked by the line joining points 2 and 3) is formed by the right atrium (see Fig. A good guide to the size and position of your own heart is given by placing your clenched right fist palmar surface down immediately inferior to the manubriosternal junction. The surface markings of the vessels of the thoracic wall are of im- portance if these structures are to be avoided in performing aspiration of the chest. The internal thoracic (internal mammary) vessels run vertically downwards behind the costal cartilages half an inch from the lateral border of the sternum. The intercostal vessels lie immediately below their corresponding ribs (the vein above the artery) so that it is safe to pass a needle immediately above a rib, dangerous to pass it immediately below (see Fig. The thoracic cage The thoracic cage is formed by the vertebral column behind, the ribs and intercostal spaces on either side and the sternum and costal cartilages in front.