By O. Kamak. Sam Houston State University. 2018.
Several day-to-day decisions in patient care are based on changing regulations and practice guidelines best 100 mg suhagra. In order to expedite such decision rule changes proven suhagra 100mg, it is important to maintain the rules themselves in databases, thus making the model database a meta-database. These third party objects may or may not include the model database bundled within the object. If they are bundled, it would become a direct interface with the decision support subsystem and the data management system. If they are not bundled, then the data is carefully placed either in the model database or in the medical database as appropriate. Decision support subsystems are independent decision support systems that can interface with any external subsystem directly or through the decision support user interface. The medical decision support system generally consists of both automated and interactive subsystems. The automated decision support subsystems may use the automated engine to integrate the automated decision making capabilities with existing automated functions. For decision support functions that require user interaction, the decision support system flexible interface is called from the user interface layer and presented to the decision maker. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. These decision support systems generally address the medical decision support functions listed in Table 1 (Raghavan, Ladik, & Meyer, 2005). These functions are generic in nature, while the knowledge base of the decision support systems is generally specific to a medical domain area like oncology, nephrology, pediatrics, and so on. The most common decision support function found in medical decision support systems is alerts and reminders. In a real time environment, these decision support functions are attached to the monitoring devices to provide immediate alerts as and when the trigger condition occurs. In a chronic setting, a simple scan of laboratory results and an email or pager alert to the corresponding decision maker are valuable decision support functions. A few medical decision support systems can provide image recognition and interpretation functions. These are extremely helpful in large hospitals where various radiology reports can be interpreted and alerts can be generated to gain the attention of the experts. Diagnostic support is a key function that several medical decision support systems attempt to offer to help the physicians in detecting the problem based on symptoms and etiology. Such systems are commonly used to detect rare diseases and also as an aid for inexperienced practitioners. A few medical decision support systems offer care plan Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Medical Decision Support Systems and Knowledge Sharing Standards 205 critiques by looking at data inconsistencies, errors, and omissions against practice guidelines. In the next section, the problem domain, and the decision support functions provided by various popular medical decision support systems will be discussed. While there are close to hundred known medical decision support systems in use, the most popular medical decision support systems based on the existing literature and usage will be discussed in this chapter. M edical Decision Support Systems HELP (Health Evaluation through Logical Processes) This is the most successful and popular medical decision support system in the United States.
Gradual accumulations may result in diges- eyes are sunken and glassy; their faces is yellowish or tive disturbances cheap 100 mg suhagra, nausea 100mg suhagra otc, vomiting, diarrhea, dehydra- ashy pale, and mouth, lips, and tongue are parched and tion, coma, shock, convulsions, paralysis, and death. The forehead, face, chest, knees, hands, and feet are often Common names for arsenicum album include ar- cold, so patients crave warmth. They may suffer from senic trioxide, white arsenic, white oxide of metallic ar- burning, pressing pains throughout the entire body. Arsenic is indestructible, even These pains are aggravated by cold and reduced by heat. It has Weakness is sudden and is reduced by lying down, al- been used to create pigmentation for wallpaper, carpet, though the other symptoms are worsened by it. Other physical characteristics of this remedy include burning, offensive, and watery discharges; palpitations; Arsenic was used as a remedy for certain types of profuse, sour sweat; and a red-tipped tongue. In the tendency to bleed easily and from any place, and vomit- seventeenth century, arsenic was applied topically to ing of blood and bleeding from lungs, throat, and mu- treat malignant ulcers and skin diseases in humans. When fre- quent and repeated doses of arsenic resulted in poisoning The mental and emotional symptoms of the patient and death, arsenic was pronounced unsafe for use. How- profile also include anxiety, nervousness, suspicion, im- ever, housewives and practitioners still used arsenic and pulsiveness, irritability, sadness, hopelessness, and de- were often successful in their treatments. They are critical and argumentative, easily of- were often used to increase strength and endurance, rem- fended, easily startled, insecure, forgetful, sensitive to edy anemia, and improve the skin and fur of animals. Patients may be unable to sleep due to their General use restlessness and anxiety or from physical discomforts Arsenicum album is one of the most frequently used such as fever or cough. When they do sleep, they may homeopathic remedies and is one of the most well- have anxious dreams or nightmares. A polychrest with a wide field of ac- are extremely weak, arsenicum album patients are clean tion, arsenicum album has the power to affect all parts of and tidy, partially to relieve their restlessness. The symptoms are aggravated by a change in tem- Arsenicum album is used to treat serious acute ail- perature, wet weather, cold food and drink, and by the ments, chronic diseases, and acute colds, bronchitis, and slightest exertion. Homeopaths prescribe this remedy to treat asthma, waking, with alcohol use, and during menstruation. The patient may be prone to vi- senicum album has also been used to treat malarial and olent fits of anger or rage or have an impulse to commit septic infections, alcoholism, syphilis, lupus, and cancer murder. It also can have a positive effect on alcoholism (when applied in the early stages of the disease). Arsenicum album can be used for the following con- ditions: Common characteristics • Throbbing, frontal headaches. These are accompanied People requiring arsenicum album generally fit a by a flushed or hot face, heat or burning inside the particular profile. They are anxious, restless, weak, pale, head, and a feeling that the head will explode. These GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 129 headaches occur with regularity and are reduced by cool air or cold applications. These sometimes alternate with Pustular—Resembling a blister and usually con- chills. It is accompanied by burning pain that is worse from swallowing or cold drinks and is reduced with hot drinks.
Diuretics 163 Normal Sulfonamide state diuretics Anion secretory Hypokalemia system Loss of+ + Uric acid Na cheap suhagra 100 mg visa, K H2O Thiazides Gout Na+ Cl- e order 100mg suhagra overnight delivery. Diuretics of the sulfonamide type Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. This diuretic effectiveness is relatively mi- response is mediated by vasopressin re- nor. At concentrations above act on the luminal membrane of tubule those required for antidiuresis, ADH cells. Both inhibit the entry of Na+, stimulates smooth musculature, includ- hence its exchange for K+ and H+. They ing that of blood vessels (“vasopres- are mostly used in combination with sin”). Blood pres- zide, because the opposing effects on K+ sure rises; coronary vasoconstriction excretion cancel each other, while the can precipitate angina pectoris. Lypres- effects on secretion of NaCl complement sin (8-L-lysine vasopressin) acts like each other. Its hor- cy), nocturnal enuresis, thrombasthe- monal effect on protein synthesis leads mia (p. The diuretic effect of spironolactone de- velops fully only with continuous ad- ministration for several days. Two pos- sible explanations are: (1) the conver- sion of spironolactone into and accumu- lation of the more slowly eliminated metabolite canrenone; (2) an inhibition of aldosterone-stimulated protein syn- thesis would become noticeable only if existing proteins had become nonfunc- tional and needed to be replaced by de novo synthesis. A particular adverse ef- fect results from interference with gon- adal hormones, as evidenced by the de- velopment of gynecomastia (enlarge- ment of male breast). Diuretics 165 Na+ K+ Triamterene Aldosterone Na+ Aldosterone + antagonists K or H+ Canrenone Protein synthesis Transport capacity Amiloride Spironolactone A. Potassium-sparing diuretics Nicotine Neuro- hypophysis Ethanol Vasoconstriction V2 Adiuretin = Vasopressin V1 H2O permeability of collecting duct Desmopressin Ornipressin Felypressin B. Antidiuretic hormone (ADH) and derivatives Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. Because of the uptake of Na+, tion occurs when the equilibrium use of NaHCO3 must be avoided in con- between the corrosive hydrochloric acid ditions requiring restriction of NaCl in- and acid-neutralizing mucus, which take, such as hypertension, cardiac fail- forms a protective cover on the mucosal ure, and edema. Drugs are employed with the fol- Because Mg(OH)2 produces a laxative lowing therapeutic aims: (1) to relieve effect (cause: osmotic action, p. Therapeu- both) and Al(OH)3 produces constipa- tic approaches are threefold: (a) to re- tion (cause: astringent action of Al3+, p. Acting on their respective receptors, the transmitter acetylcholine, the hormone I. Drugs for Lowering Acid gastrin, and histamine released intra- Concentration mucosally stimulate the parietal cells of the gastric mucosa to increase output of Ia. Histamine comes from entero- groups such as CO32–, HCO3– or OH–, to- chromaffin-like (ECL) cells; its release is gether with their counter ions, are con- stimulated by the vagus nerve (via M1 tained in antacid drugs. With nonabsorb- antagonists that reach parietal cells via able antacids, the counter ion is dis- the blood. Upon mixture renzepine, unlike atropine, prefers cho- with the alkaline pancreatic secretion in linoceptors of the M1 type, does not the duodenum, it is largely precipitated penetrate into the CNS, and thus pro- again by basic groups, e. The cholinoceptors on parietal systemic absorption of counter ions or cells probably belong to the M3 subtype.
The single supplement should be taken on an General use empty stomach because larger amounts of the amino acid can build up in the blood and brain suhagra 100mg sale, enhancing its The body only uses L-lysine to build protein buy cheap suhagra 100mg on line. Supplements are best used by individuals amino acid molecules are asymmetrical, each amino acid suffering from a herpes outbreak or by vegetarians and exists as both a right- and left-handed form, distin- low-fat dieters. L-lysine is used to treat the herpes simplex virus, help prevent osteoporosis and cataracts, and boost the im- mune system. Precautions Supplemental combinations of amino acids are not Herpes simplex virus remedy recommended to build muscle. In the 1950s, scientists discovered that foods con- taining certain amino acids could encourage or discour- Some consumers are sensitive or allergic to soy- age the growth of the herpes virus. When added to the beans, a popular food used by vegetarians to replace the herpes virus, the amino acid arginine increases the natural supply of lysine found in many meats. Lysine, on the other hand, suppress- in 2002, researchers announced progress in creating soy- GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1259 beans that could be tolerated by consumers with those Duke, James A. Emmaus, PA: Rodale sensitivities by shutting off a gene in soybean seeds be- Press, 1997. Odle 1260 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 M Ma huang see Ephedra have shown that a diet of this type can significantly re- duce the risk of diabetes, heart disease, stroke, and var- Mace see Nutmeg ious cancers. The macrobiotic diet is rich in vitamins, high in dietary fiber, and low in fatty foods. Description Macrobiotic diet In addition to its holistic approach to nutrition, Definition macrobiotics applies these beliefs to life in general. Its A macrobiotic diet is part of a philosophy of life that philosophy recommends the following behaviors: incorporates the ancient Oriental concept or theory of • eating two or three meals a day yin and yang. The diet itself consists mainly of brown • chewing each mouthful of food approximately 50 times rice, other whole grains, and vegetables. It requires foods to aid digestion and absorption of nutrients to be cooked over a flame, rather than by electricity or microwave. The macrobiotic • using grooming, cosmetic, and household products diet is believed to have originated in nineteenth century made from natural, non-toxic ingredients Japan, with the teachings of Sagen Ishizuka, a natural • wearing only cotton clothing and avoiding metallic healer. George Ohsawa (1893–1966), a Japanese teacher jewelry and writer, introduced macrobiotics to Europeans in the 1920s. Yin and yang are opposite energies that are GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1261 complementary and harmonious, such as day and night. Lunch should be quick everything in the universe is assigned a yin or yang qual- and light, since afternoon energy is active and expansive. Balance, harmony, order, and happiness are achieved In macrobiotics, it is believed that the dietary stan- when the forces of yin and yang are in balance. Its flexibility enhances entific studies support these claims, there are many peo- its appeal. The macrobiotic diet allows people to design ple who believe the diet helped rid them of the disease their own food regimens based on their personal require- when such conventional treatments as chemotherapy and ments, environment, and medical conditions. Others use the diet to help treat diabetes, One of the principles of the macrobiotic diet is that hypertension, arteriosclerosis, and other forms of heart people should primarily eat organically grown foods na- disease. Propronents of the macrobiotic diet claim that as Macrobiotic foods society has moved away from its traditional ecologically The primary food in the standard macrobiotic diet is based diet, there has been a corresponding rise in chronic whole cereal grains, including brown rice, barley, millet, illness.
Inhal: 20 mg (as powder in caps) inhaled qid or met-dose in- 22 haler 2 puffs qid buy 100 mg suhagra. Nasal instillation: Spray once 22 Commonly Used Medications 521 in each nostril 2–6 ×/d purchase 100 mg suhagra fast delivery. Preventive measures to avoid hemorrhagic cystitis often applied in high-dose regimens and may include continuous bladder irrigation and MESNA uroprotection (see page 567) Cyclosporine (Sandimmune, Neoral) COMMON USES: Organ rejection in kidney, liver, heart, and BMT in conjunction with adrenal corti- costeroids ACTIONS: Immunosuppressant; reversible inhibition of immunocompetent lymphocytes DOSAGE: Adults & Peds. Oral: 15 mg/kg/d beginning 12 h prior to transplant; after 2 wk, taper the dose by 5 mg/wk to 5–10 mg/kg/d. Systemic anticoagulation: 200 IU/kg/d SC or 100 IU/kg bid SC SUPPLIED: Inj 2500 IU (16 mg/0. Spasticity: Initially, 25 mg PO qd; ↑ to effect by 25 mg to a max dose of 100 mg PO qid PRN. Malignant hyperthermia: Treatment: Continuous rapid IV push beginning at 1 mg/kg until symptoms subside or 10 mg/kg is reached. Postcrisis follow-up: 4–8 mg/kg/d in 3–4 ÷ doses for 1–3 d to prevent recurrence SUPPLIED: Caps 25, 50, 100 mg; powder for inj 20 mg/vial NOTES: Monitor ALT and AST closely Dapsone [DDS] (Avlosulfon) COMMON USES: Rx and prevention of PCP; toxoplasmosis prophylaxis; leprosy ACTIONS: Unknown; bactericidal DOSAGE: Adults. Prophylaxis of PCP 1–2 mg/kg/24h PO qd; max 100 mg/d SUPPLIED: Tabs 25 mg, 100 mg NOTES: Absorption enhanced by an acidic environment; leprosy therapy in combination with ri- fampin and other agents Daunorubicin (Daunomycin, Cerubidine) COMMON USES: Acute leukemias ACTIONS: DNA intercalating agent; inhibits topoisomerase II; generates oxygen free radicals DOSAGE: 45–60 mg/m2/d for 3 consecutive d; 25 mg/m2/wk. Numerous drug interactions Demeclocycline (Declomycin) COMMON USES: SIADH ACTIONS: Antagonizes the action of ADH on renal tubules DOSAGE: 300–600 mg PO q12h SUPPLIED: Caps 150 mg; tabs 150, 300 mg NOTES: ↓ Dose in renal failure. DI possible Desipramine (Norpramin) COMMON USES: Endogenous depression, chronic pain, and peripheral neuropathy ACTIONS: Tricyclic antidepressant; increases synaptic concentration of serotonin or norepinephrine in CNS DOSAGE: 25–200 mg/d in single or ÷ doses; usually as a single hs dose. If converting from intranasal to parenteral dosing, use 1⁄10 of the intranasal dose. Ileus: IM: 500 mg stat, repeat in 2 h, followed by doses q6h, if needed SUPPLIED: Inj; tabs 50 mg; cream NOTES: Do NOT use if obstruction is suspected Dexrazoxane (Zinecard) COMMON USES: Prevention of anthracycline-induced (doxorubicin) cardiomyopathy in metastatic breast cancer and other therapies ACTIONS: Chelates heavy metals; binds intracellular iron and prevents anthracycline-induced free- radical generation DOSAGE: 10:1 ratio of dexrazoxane to doxorubicin, 30 min prior to each dose of anthracycline SUPPLIED: Inj 10 mg/mL NOTES: Toxicity symptoms: Myelosuppression (especially leukopenia), fever, infection, stomatitis, alopecia, diarrhea, and nausea and vomiting. Mild elevations of hepatic transaminases and local pain at injection site less frequent Dextran 40 [Low Molecular Weight Dextran] (Rheomacrodex) COMMON USES: Plasma expander for adjunctive therapy in shock, prophylaxis of DVT and throm- boembolism, adjunct in peripheral vascular surgery ACTIONS: Expands plasma volume; ↓ blood viscosity DOSAGE: Shock: 10 mL/kg infused rapidly with a max dose of 20 mL/kg in the first 24 h; max dosage beyond 24 h not to exceed 10 mL/kg; discontinue after 5 d. NOT recommended for patients <18 y Diazepam (Valium, others) [CIV] COMMON USES: Anxiety, alcohol withdrawal, muscle spasm, status epilepticus, panic disorders, amnesia, and preoperative sedation ACTIONS: Benzodiazepine DOSAGE: Adults. Preop: 5–10 mg PO or IM 20–30 min before procedure; can be given IV just prior to procedure. Titrate to agitation; avoid excessive sedation; may lead to aspiration or respiratory arrest. Children: 10 mg/dose tid–qid SUPPLIED: Caps 10, 20 mg; tabs 20 mg; syrup 10 mg/5 mL; inj 10 mg/mL NOTES: Anticholinergic side effects may limit dose Didanosine [DDI] (Videx) COMMON USES: HIV infection in zidovudine-intolerant patients ACTIONS: Nucleoside antiretroviral agent DOSAGE: Adults. Dose by following table 22 22 Commonly Used Medications 527 BSA (m2) Tablets (mg) Powder (mg) 1. Dose adjust in renal impairment; do not mix powder with fruit juice or other acidic beverages Diflunisal (Dolobid) COMMON USES: Mild to moderate pain; osteoarthritis ACTIONS: NSAID DOSAGE: Pain: 500 mg PO bid. Osteoarthritis: 500–1500 mg PO in 2–3 ÷ doses SUPPLIED: Tabs 250, 500 mg NOTES: May prolong bleeding time Digoxin (Lanoxin, Lanoxicaps) Used for emergency cardiac care (see Chapter 21) COMMON USES: CHF, AF and flutter, and PAT ACTIONS: Positive inotrope; increases the refractory period of the AV node DOSAGE: Adults. Preterm in- fants: Digitalization: 30 µg/kg PO or 25 µg/kg IV; give ⁄12 of dose initially, then ⁄14 of dose at 8–12-h intervals for 2 doses. Term in- fants: Digitalization: 25–35 µg/kg PO or 20–30 µg/kg IV; give 1⁄2 the dose initially, then 1⁄4 of the dose at 8–12 h. Toxicity symptoms: Nausea and vomiting, headache, fatigue, visual disturbances (yellow-green halos around lights), and cardiac arrhythmias; IM inj can be painful and has erratic absorption (See Drug Levels, Table 22–7, pages 631–634) Digoxin Immune Fab (Digibind) Used for emergency cardiac care (see Chapter 21) COMMON USES: Life-threatening digoxin intoxication ACTIONS: Antigen-binding fragments bind digoxin, rendering it inactive DOSAGE: Adults & Peds. See dosing charts provided with the drug SUPPLIED: Inj 38 mg/vial NOTES: Each vial binds ≅0.