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Jigsaws discount 40mg benicar amex blood pressure chart who, puzzles and toys that young pupils may be inclined to put in their mouths should be capable of being washed and disinfected buy generic benicar 10mg line arrhythmia facts. Disinfection Procedure In some situations toys/equipment may need to be disinfected following cleaning. If disinfection is required: • A chlorine releasing disinfectant should be used diluted to a concentration of 1,000ppm available chlorine (see Chapter 3). Waste Disposal The majority of waste produced in schools is non hazardous and can be disposed of in black plastic bags in the normal waste stream through the local authority. Disposal of Sharps Pupils who require injections may need to bring needles and syringes to school (e. However, some animals including exotic species such as reptiles, fsh or birds that are often kept as pets can be a source of human infection. There is no means of knowing which animals may be carrying infection, so one must act at all times on the basis that an animal might be infected. However, sensible precautions, such as effective hand washing, can reduce any risk of infection. The principal of the school should ensure that a competent person is responsible for any animals brought into the school and that there is no risk of contravening the relevant Health & Safety legislation. The following principles should underpin the management of pets in any school: • Only animals in good health should be allowed into a school. Farm and zoo visits Visits to farms and zoos have grown in popularity over recent years; they are considered to be both educational and an enjoyable leisure pastime. Such visits give pupils the chance to have contact with animals they otherwise might not see and also to understand where food comes from. There are many potential infection hazards (as there are with domestic pets) on open farms, including pet- and animal- farms, and zoos. It is important to remember that diseases affecting animals can sometimes be passed to humans. A number of germs acquired from animals can cause diarrhoea and/or vomiting – which is usually a mild or temporary illness. Infection is mainly acquired by eating contaminated material, sucking fngers that have been contaminated, or by eating without washing hands. Recommendations to Follow in Relation to Open Farm Visits: Before the Visit Before the visit, the organiser should make contact with the farm or zoo being visited to discuss visit arrangements and to ensure that adequate infection control measures are in place. The organiser should be satisfed that the pet farm/zoo is well managed and precautions are in place to reduce the risk of infection to visitors. The organiser should ensure that hand washing facilities are adequate, accessible to pupils, with running hot and cold water, liquid soap, disposable paper towels, clean towels or air dryers, and waste containers. They should also ensure that all supervisors understand the need to make sure the pupils wash, or are helped to, wash their hands after contact with animals. The school authorities should also contact their local Department of Public Health as further action may be necessary. Coli, available on the Health Protection Surveillance Centre’s website at http://www. The close contact in some sports can allow infections to spread by direct skin-to-skin contact, inhalation of infected droplets or aerosols, or injuries resulting in breaks to the skin which disrupt the body’s natural defence mechanism. Some sports activities involve closer and more frequent body-to-body contact with other players or contact with equipment and are associated with a higher risk of injury or trauma. Evidence to date suggests that the highest risk sports are full-contact martial arts, boxing, and wrestling. Terminology can vary and the defnitions applied in this guidance are as follows: • High-risk contact / collision sports – e. Infections of particular relevance to contact sports include skin infections, blood-borne virus infections, glandular fever and tetanus. Therefore all need to be educated about the necessary precautions and hygiene requirements. General Precautions for All Sports, Including High Risk Sports Pupils and teachers should: • Wash hands regularly with liquid soap. To minimise the risk of infection bars of soap should not be provided in communal shower / wash rooms. Sports such as boxing, wrestling and tae kwon do have the highest, although still extremely low, risk. Hepatitis B is the highest risk virus as it is present in greater concentrations in blood; it is resistant to simple detergents; and it can survive on environmental surfaces for up to 7 days. Research has shown that athletes are more likely to acquire blood borne virus infections in off-the-feld settings e. Individuals with acute viral infections may not be well enough to participate for a period of time after the initial infection and their treating doctor will advise on when they can return to sporting activities. In the event of an acute bleeding injury during an activity pupils cannot return to the feld of play until the wound has been cleaned and disinfected, bleeding has stopped completely, and the wound is covered with a secure, occlusive dressing. If the wound cannot be securely occluded then the pupil cannot return to the sporting activity.
The uncertainty of cancer risk after exposure to ionizing radiation is buy cheap benicar 10mg on-line prehypertension myth, therefore purchase 40 mg benicar fast delivery arrhythmia only at night, often underestimated. For solid cancer risk after an exposure of 100 mSv, upper and lower boundaries of the 95% confidence interval differ by a factor of 5. The uncertainty of excess risk for a specific cancer type is considerably higher than for all solid cancers . It is important to distinguish between a manifest ‘health effect’ and ‘health risk’ (likelihood of a future health effect to occur), when describing such health implications for an individual or a population. A manifest health effect in an individual could be unequivocally attributed to radiation exposure only if other possible causes for an observable tissue reaction (such as skin burns; deterministic effect) were excluded. Cancer (stochastic effects) in individuals cannot be unequivocally attributed to radiation exposure because radiation is not the only possible cause and there are, at present, no known biomarkers that are specific to radiation exposure. An increased incidence of stochastic effects in a population could be attributed to radiation exposure through epidemiological analysis, provided the increased incidence is sufficient to overcome the inherent statistical uncertainties . In general, a manifest increased incidence of health effects in a population cannot reliably be attributed to radiation exposures at levels that are typical of the global average background levels of radiation or the levels applied at medical radiological diagnostics. The reasons are: (i) the uncertainties associated with risk assessment at low doses; (ii) the absence of radiation specific biomarkers; and (iii) the insufficient statistical power of epidemiological studies . When estimating radiation induced health effects in a population exposed to incremental doses at levels equivalent to or below natural background, it is not recommended to do this simply by multiplying the very low doses by a large number of individuals. However, it is recognized that there is a need for such estimations by health authorities to allocate resources or to compare health risks. This is valid if applied consistently and the uncertainties in the estimations are fully taken into account, and the projected health effects are notional . While the magnitude of medical exposures can be assessed, it is very difficult to estimate the health risks from such uses as there are still many uncertainties in estimating cancer risk due to ionizing radiation and in attributing other health effects to and inferring risk from medical radiation exposure. Thus, the uncertainty increases when extrapolating risk estimates from moderate dose to low dose. Therefore, it is not surprising to note that a statistically significant increase in radiation induced cancer is seen only when the exposure is 100 mSv or above . Varna, 2010), National Centre of Radiobiology and Radiation Protection, Varna (2010). It highlights some of the more important presentations at the conference as well as issues that arose during discussion and that require further investigation and action. At the conference, the necessity of a commitment to a safety culture within institutions and organizations providing health care to patients was emphasized. The safety culture must support and reinforce efforts to provide adequate protective measures for patients and staff exposed to ionizing radiation used for diagnosis of disease and injury, and for the treatment of cancer. Elements of a safety culture are: (i) leadership; (ii) evidence based practice; (iii) teamwork; (iv) accountability; (v) communication; (vi) continuous learning; and (vii) justice. These elements are essential to a safety culture and must, therefore, be present in any organization that reinforces radiation protection. Over 25 years (1982–2006) in the United States of America alone, the average individual dose from medical radiation increased by a factor of 5. These increases occurred even though the actual dose delivered to individual patients decreased for many imaging procedures. The increases in average and collective dose reflect the growing usefulness of medical imaging as a consequence of improved technologies, new procedures and applications, and increased access to imaging. This is encouraging news, because it demonstrates that increasing numbers of patients are receiving the medical benefits of imaging and therapeutic procedures employing ionizing radiation. The tracking of imaging procedures and radiation doses is recommended as a way for institutions and agencies to monitor trends in procedures and radiation doses delivered collectively to patients. This process lends a sense of personal empowerment to individuals, but may also mislead patients into thinking that their collective exposure can be estimated by adding doses to different body regions from separate modalities. In any event, the decision to administer an imaging procedure to a patient should always be based on the benefits/risks of the procedure without regard to previous exposures the patient may have received. There was considerable discussion about justification and optimization of imaging procedures at the conference, while less attention was paid to proper implementation and evaluation of the procedures. The four elements collectively comprise the continuous quality improvement cycle for imaging procedures shown in Fig. It was recognized that both overutilization and underutilization of medical imaging compromise the concept of justification of imaging procedures. However, these shortcomings can be addressed relatively successfully through the use of decision support systems to guide the referring physician in selecting the proper imaging examination for the patient. Digital radiography presents a number of challenges with regard to patient protection and procedure optimization.
On the contrary benicar 10mg with mastercard pulse pressure exercise, the Government uses financial incentives (from the public purse) to entice general practitioners into participation benicar 20 mg sale blood pressure jogging, as agents of the state, in health screening schemes. Moreover, screening for disease has so far been largely exempted from ethical guidelines since most doctors believe that screening is a good thing and the public, believing their doctors, have not yet questioned this faith. Private clinics and laboratories are ready to catch any remain- ing hypochondriacs. Misguided politicians, besides liking to be seen as benefactors of mankind, actually believe that screen- ing will save money, which could be used in underfinanced 34 Healthism departments such as the civil service, the army or the police. To ask about the ethics of screening, generally aimed to make healthy people healthier, sounds, if not perverse, then definitely superfluous. The fact that screening is a swinging, lucrative business is an incidental phenomenon - a rare example of goodness being rewarded on this earth. It does not make much sense to screen only women, and only for some rare disease, such as cervical cancer. Why not screen also for hypertension, diabetes, glaucoma, toxoplasmosis, coronary heart disease risk factors, ovarian cancer, lung cancer, breast cancer, gastric cancer, prostatic cancer, mela- noma, testicular cancer. And surely the more often we screen, the better the chances of detecting something wrong. Is not the person invited for screening entitled to full dis- closure of the likelihood of any adverse effects besides the promise of benefit? The likelihood of having a false-positive result is a function of a number of the tests. The resulting anxiety, further diagnostic tests which are not necessarily harmless, and occasionally unnecessary surgery due to false- positive tests in large numbers of healthy people may well outweigh the potential benefit for the lucky few. If a doctor does not inform healthy clients about these complications he should expect to run the risk of being sued. However, to admit that some screening tests are not very accurate, that treatment for the screened condition is not very successful, and that he has not himself been screened, may be more than discouraging for potential screening candidates. If the doctor tells the truth that her husband does not know his cholesterol number, and that she does not test the stools of other members of the family for occult blood every six months, the patient may not be terribly keen to have it done himself. In the first case you practise ordinary medicine: you may not know what is wrong with the patient, and you may have no cure, but the poor lassie or chap is in trouble and has nowhere else to go (except perhaps down the road to an acupuncturist). You console the patient, give him hope and reassurance, you treat him (often with informed consent) and hope for the best. You are soliciting custom without a guarantee of benefit, and things can go wrong. The argument that they have been asking for it is not going to hold water for much longer, as the demand has been created by false promises emanating from the medical profession. Syl- vester Graham, a Bostonian health eccentric taught the importance of abstinence, bran and chastity. His followers, because of their gaunt, sickly looks, were locally known as the Bran and Sawdust Pathological Society. Nowadays the message is not preached from soap boxes, but transmitted through official governmental channels. That acute diagnos- tician of health follies, Lewis Thomas, noticed the change some twenty years ago. It would appear to be only a matter of time before a new medi- cal specialty is established - orthobiostylist consultants, who advise on correct lifestyle. Nearly all Americans (96 per cent) say they would like to change something about their bodies. Particularly vulnerable to this obsession are the middle and upper-middle classes. It is important for the image of the American President to be seen jogging, and for his wife to ban ashtrays from the White House. For example, the British Health Minister, Virginia Bottomley banned biscuits at coffee breaks (to be replaced with fruit) and made it publicly known that she would abstain from alcohol two days in a week. Keith Botsford, writing in The Independent described the American scene as follows: Americans are indeed in a constant state of alarm about the immortality to which they seem to think they are consti- tutionally entitled. This state of affairs is not orchestrated by some worldwide conspiracy, but is rather the result of a positive feedback between the masses stricken by fear of death and the health promotionists seeking enrichment and power. Simple minds, stupefied by the sterilised pap of television and the bland diet 38 Healthism of bowdlerised culture and semi-literacy, are a fertile ground for the gospel of the new lifestyle. The American sociologist Renee Fox has argued that the input by the medical profession into the increased preoccu- pation with health is only one variable in the equation. In the past medicine and magico- religious rituals were fused into one explanatory system that accounted for health, disease, strength, fecundity and invul- nerability, all of them being supernaturally conferred.
This is because professional consensus on what best practice is or ought to be is only now emerging generic benicar 10 mg without prescription blood pressure medication names. Perhaps most signiﬁcantly generic benicar 40mg mastercard pulse pressure pediatrics, more complex, highly trained health professionals collide at the point of care than in any other business in our economy. Each profession has its own unique view of the patient’s needs, its own language for describing those needs, and an intensely territorial view of its involvement in care. Collaboration The Information Quagmire 7 among professionals is vital to effective care, yet professions compete for resources and control over patients. It is on the verge of revolutionizing medi- cal practice, dramatically improving communication among physi- cians and between physicians and patients. Whereas hospitals and major insurers have been connected elec- tronically for years through dedicated, high-bandwidth telephone conduits called T1 lines, the advent of the Internet has recently brought affordable broadband connect ivity to doctors and patients. The Internet has not only brought new options for physicians and patients to connect with one another, it has made possible con- nectivity to and networking with thousands of colleagues and tens of thousands of patients worldwide. Complex software can now be maintained efﬁciently at a single site on remote servers, which hospital and physician users can reach by way of a web browser and high-speed 8 Digital Medicine Internet connections. Clinical and ﬁnancial information can be sent rapidly to remote locations and returned to the institutions or care- givers that need it to make care decisions. It markedly reduces the time and cost of ﬁnding answers to medical questions on the Internet and may be more important to medicine than any other knowledge domain. Computer-assisted Diagnosis Computer-assisted diagnosis will penetrate into the nucleus of hu- man cells, providing an extraordinarily detailed and highly personal map of a patient’s potential health risks, including the risks of various The Information Quagmire 9 forms of therapy. This in turn will enable the custom fabrication of therapies to control unique risks for disease and adverse reactions to treatment and eventually extinguish diseases before they ﬂower into illness or threaten our lives. Genetic information will play a part in computer-assisted diagnosis, enabling physicians to reduce adverse drug reactions, adjust dosages to an optimal therapeutic result, and avoid wasting drugs on patients who are unlikely to re- spond to them. Genetic information will become an essential part of our health records and help provide a basis for a new, exquisitely personal, and proactive form of medicine. Powerful computing engines have dramatically enhanced mature diagnostic imaging technologies like magnetic resonance imaging and computed tomography. These technologies can today create live, three-dimensional images of internal organs that provide not only vivid anatomical detail, but also indicate whether the organs are functioning properly. These imaging technologies will be powerful enough to detect threatening molecular and genetic changes in our cells as they are occurring. Thanks to growing broadband Internet capacity and internal communications networks (or intranets), dig- ital images and their interpretations can be moved, literally at light speed, to the desktops of clinicians anywhere in the world without being translated into ﬁlm or paper. Almost 30 years of frustrating progress in medical informatics are yielding promising new “intel- ligent” clinical applications that will save both lives and dollars. Computer systems that can communicate with clinicians, patients, and patients’ families and respond intelligently to the health risks they confront are within realization. Intelligent clinical information systems will be continuously aware of a patient’s condition and will alert the care team to prob- 10 Digital Medicine lems as they arise, as well as recommend courses of action to achieve the best outcome. Clinical information systems will no longer pas- sively record what physicians do. Rather, they will actively shape the care process, providing a “navigational system” for guiding care and a “ﬂight plan” for improving health. This plan will be transparent, accessible to patients and their families, and customizable, enabling the clinical team and patients to examine the studies, data, and justiﬁcations for recommended care. Dissemination and Care-decision Capabilities Information technology will enable expert medical knowledge to pervade our societies, transcending the constraints of geography, language, and local infrastructure. Finally, information will enable pa- tients and their families to have more control over their own lives and health. It will provide them secure and reliable personal health records and a “dashboard” on their home computer’s web browser that will help them manage their relationship to their doctors, hos- pitals, pharmacies, and the rest of the health system. The technologies you will learn more about in this book—electronic medical records, clinical decision support, genetic diagnosis, medical imaging, telemedicine, The Information Quagmire 11 digital business systems in health insurance and health systems— are all connected by the Internet to one another. The Internet pro- vides both the connectivity for all these different but reinforcing technologies and the lubricant of information ﬂow throughout the health system. Between this potential and today’s information quagmire stands a huge societal commitment: an expenditure that could exceed $300 billion in the United States alone over the next ten years. Healthcare or- ganizations of all types face a large skill gap in adapting these power- ful new tools and a steep learning curve for the ﬁrms providing the technology. However, healthcare institutions and professions must take on the challenge to implement technology, a task that includes the concepts and processes described in this book. In the pre-digital age we are leaving, the vital knowledge about medical history and treat- ment options would have been found imprisoned in paper and ﬁlm—in the form of multiple medical records, medical texts, and journals—or locked in the memories of those who have recently provided care. The only way for the care team to use this informa- tion was to have physical possession of it, read it, and interpret it in an effort to ﬁgure out a treatment plan.