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Explanatory research – experimental Study in which the independent variable (usually a treatment) is changed by the researcher who then observes the effect of this change on the dependent variable (usually an outcome) purchase bystolic 5 mg line prehypertension stress. Explanatory research – observational Study looking for possible causes of disease (dependent variable) based upon exposure to one or more risk factors (independent variable) in the population bystolic 2.5mg on line blood pressure 14090. A drug, a surgical procedure, risk factor, even a diagnostic test can be an exposure. In therapy, prognosis, or harm studies the “exposure” is the intervention being studied. Framing effect How a question is worded (or framed) will influence the answer to the question. Functional status An outcome which describes the ability of a person to interact in society and carry on with their daily living activities (e. Gold standard The reference standard for evaluation of a measurement or diagnostic test. The “gold-standard” test is assumed to correctly identify the presence or absence of disease 100% of the time. Homogeneity Whether the results from a set of independently performed studies on a particular question are similar enough to make statistical pooling valid. Hypothetico-deductive strategy A diagnosis is made by advancing a hypothesis and then deducing the correctness or incorrectness of that hypothesis through the use of statistical methods, specifically the characteristics of diagnostic tests. The number of new cases (or other events of interest) divided by the total population at risk. Incorporation bias The test being measured is part of the gold standard or inclusion criteria for entry into a study. The change in the pretest probability of a diagnosis as a result of performing a diagnostic test. Independent variable(s) The treatment or exposure variable that is presumed to cause some effect on the outcome or dependent variable. Inferential statistics Drawing conclusions about a population based on findings from a sample. Instrumental rationality Calculation of a treatment strategy which will produce the greatest benefit for the patient. Intention-to-treat Patients assigned to a particular treatment group by the study protocol are retained in that group for the purpose of analysis of the study results no matter what happens. Inter-observer reliability Consistency between two different observers’ measurements. Justice Equal access to medical care for all patients who require it based only upon the severity of their disease. Level of significance (confidence level) Describes the probability of incorrectly rejecting the null hypothesis and concluding that there is a difference when in fact none exists (i. The amount by which the pretest probability of disease is reduced in patients with a negative test. The amount by which the pretest probability is increased in patients with a positive test. Likelihood ratio A single number which summarizes test sensitivity and specificity and modifies the pretest probability of disease to give a post-test probability. Linear rating scale A scale from zero to one on which patients can place a mark to determine their value for a particular outcome. Markov models A method of decision analysis that considers all possible health states and their interactions at the same time. Matching An attempt in an experiment to create equivalence between the control and treatment groups. Control subjects are matched with experimental subjects based upon one or more variables. Measurement The application of an instrument or method to collect data systematically. Meta-analysis A systematic review of a focused clinical question following rigorous methodological criteria and employing statistical techniques to combine data from multiple independently performed studies on that question. Non-inferiority trial A study that seeks to show that one of two treatments is not worse than the other.

The practicability of it (already available – green boxes cheap bystolic 2.5mg with visa heart attack 2013 film; in progress – orange boxes bystolic 2.5mg arteria znaczenie; and still needs time – red boxes) The infographic represents the way I see the development of key trends and innovations in the process of delivering healthcare. Some elements could certainly be added to other parts as well, although I chose the points with the most potential. Examples or summaries from the industry and relevant start-ups are listed next to each trend or innovation. Printing medical devices in underdeveloped areas, printing living tissues, then cells or drugs might not be far from the everyday use. It will re-structure the whole pharmaceutical industry and the world of biotechnology, but regulation will be a huge challenge as anyone will be able to print drugs containing patented molecules at home. Bionic ears and simpler organs will be printed at the patient’s bedside while printing transplantable human organs could eradicate waiting lists. Current technological issues such as the lack of available models and blueprints will be solved through crowdsourced and open access databases from communities of designers. Adherence Control Adherence and compliance represent crucial issues in improving the patients’ health and decreasing the cost of delivering healthcare. Several start-ups have targeted this issue with different solutions such as the pill bottle that glows blue when a medication should be taken and red when a dose is missed alerting family members about it. In another example, tiny digestible sensors can be placed in pills and transmit pill digestion data to physicians and family members. In the future, it is going to be extremely difficult not to fully comply with the prescribed therapy. Moreover, compliance with medication should be as simple and comfortable for patients as possible. Artificial Intelligence in Medical Decision Support The knowledge of even the most acclaimed professors cannot compete with cognitive computers and as the amount of information is exponentially growing, the use of such computing solutions in assisting medical decision making is imminent. This is why Watson has been tested in oncology centers to see whether it could be used in the decision making process of doctors regarding cancer treatments. Watson does not answer medical questions, but based on the input data, it comes up with the most relevant and potential outcomes, and the doctor has the final call. Artificial Organs An artificial organ is a device or biomaterial that is implanted into the body to replace a natural organ or its function. Surgeons have been able to implant artificial skin, cartilage, synthetic windpipes and artificial blood vessels. In the near future, we will be able not only to replace the functionality of our organs with biomaterials and synthetic devices, but to grow organs which can replace a non-functioning natural organ in its full physiological capacity. Although probably, a certain number of such organs would be used for cosmetic purposes instead of life support. Getting information from the internet by wearing a Google Glass or digital contact lenses would be a huge addition to the process of practicing medicine. Operations have already been streamed live from the surgeon’s perspective; but it could also display the patient’s electronic medical records real-time; or organize live consultations with colleagues. Google Glass can be controlled through voice and hand gestures; while the contact lenses will be controlled with brain waves as there are developments in this area. The whole potential of leveraging the power of augmented reality is huge, although medical professionals should deal with patient privacy and put evidence behind using it in practice. Augmenting Human Capabilities Medical research is meant to discover and develop methods to replace non-functioning organs, capabilities or restore certain functions in the human body. But with the rapid advances of research, instead of only replacing functions, it would be possible to add to our current capabilities and create „super powers”. We could decide what to dream about, how to metabolize drugs, how to digest different types of food; to increase brain function or improve our strength through powered exoskeletons. Curated Online Information In the near future, whether it is the right and reliable medical information, dynamic resources or medical records online; everything will simply be available to everyone which would purely be the most important development in the history of medicine. As people have to deal with false or unreliable information and resources, curating these with medical professionals and expert patients is the key. Customized Mobile Apps The number of medical mobile applications has been rising for years, therefore patients and doctors find it harder and harder to choose the right app for their health management or work. Customized mobile apps such as the pApp that lets doctors create mobile apps for their patients could be the next step. The functions the app should have such as logging blood pressure or medications can be chosen from a menu; and the patient can download the app right away.

In: Field manual of wildlife websites diseases: general field procedures and diseases of birds bystolic 5mg with visa arteriogram complications. Also known as bilharzia purchase bystolic 5 mg line heart attack grill death, schistosomiasis is a disease caused by trematode worms which inhabit the blood circulatory system of their host. The worms require freshwater snails as an intermediate host to develop infectious larvae that penetrate the skin of a wide range of animal hosts following contact with infested water bodies. Infected animals pass worm eggs out in their urine or faeces which, if in contact with freshwater, hatch out and infect freshwater snails, producing another larval stage which is infective to the final animal host thus completing the life cycle. Eighty-five percent of the 207 million people who are infected with schistosomiasis worldwide live in developing African countries. Causal agent Parasitic flatworms called blood flukes of the genera Schistosoma and Orientobilharzia. Many domestic farm animals and birds have their own species-specific schistosomes, each with varying impacts on health and subsequent economic importance. Species affected Schistosomes have a broad host range encompassing many species of wild animals including waterbirds, however, humans and livestock aremost at risk of clinical disease. In Asia, 40 different species of wild and domestic animals are known to be infected by S. Geographic distribution Africa: all freshwater in southern and sub-Saharan Africa, including the great lakes and rivers as well as smaller bodies of water, is considered to present a risk of schistosomiasis transmission. Caribbean: Antigua, Dominican Republic, Guadeloupe, Martinique, Montserrat, Saint Lucia (lower risk). Environment Freshwater, particularly associated with irrigation schemes, reservoirs and water holes. Parasite distribution is dependent on habitats suitable for the snail intermediate host which range from still to slow-moving water. How is the disease Eggs laid by mature flukes in the blood vessels surrounding the gut and the transmitted to animals? When the eggs reach freshwater they hatch into infectious free-living miracidia and infect only suitable snail vectors. Within the snail, the parasite propogates by asexual reproduction and several thousand free-swimming larvae, known as cercariaeare, are released and remain infectious to the final animal host for up to 48 hours. How does the disease Eggs shed in the faeces and urine of infected animals and humans spread between groups of contaminate water sources inhabited by snail intermediate hosts, which in animals? Risk of infection is exacerbated by increased host density and by the wide definitive host range of schistosome species. How is the disease In contaminated freshwater bodies, infective schistosome cercariae transmitted to humans? Schistosome infections are maintained by a range of mammals, however, field transmission is increased when water sources such as dams and irrigation ditches are shared with infected human populations (e. Herein lies the potential for a human settlement with poor sanitation to significantly impact on the health of surrounding livestock and wildlife. Human population displacement and refugee movements can introduce the disease to new areas (e. The infective cercariae of these non- human species can penetrate the skin of humans but rarely develop further. Recommended action if Contact and seek assistance from human and animal health professionals suspected immediately if there is suspected infection in people and/or livestock. Diagnosis Diagnosis is based on identification of characteristic schistosome eggs by microscopic examination of faeces and urine samples, or biopsy specimens. Serological tests may be sensitive and specific but do not provide information about the size of worm burden or clinical status. In areas where mammalian host density is low, this high fecundity enables the parasite to maintain a low level population without causing disease in humans or livestock. In environments where water sources supporting populations of susceptible snails are contaminated with high levels of infected human and livestock excreta, rates of transmission will also rise along with the probability and severity of disease. Control measures should therefore focus on preventing contamination of water sources through improved sanitation, as well as public health education, large scale medical treatment of infected individuals [► Humans], ring-fencing contaminated water bodies and reducing snail populations. Vector control - snail control Strategies should be implemented with specific knowledge of the ecology of the causative snail.

This chapter provides some guidance in ways of minimizing the intakes of these three nutrients while consuming a nutritionally adequate diet order 2.5 mg bystolic mastercard pulse pressure uk. Thus buy bystolic 2.5 mg lowest price zolpidem arrhythmia, for a certain level of energy intake, increasing the proportion of one macronutrient necessitates decreasing the proportion of one or both of the other macronutrients. Therefore, a high fat diet (high percent of energy from fat) is usually low in carbohydrate and vice versa. In addition to these macronutrients, alcohol can provide on average up to 3 percent of energy of the adult diet (Appendix Table E-18). A small amount of carbohydrate and as n-6 (linoleic acid) and n-3 (α-linolenic acid) polyunsaturated fatty acids and a number of amino acids that are essential for metabolic and physiological processes, are needed by the brain. The amounts needed, however, each constitute only a small percentage of total energy requirements. While some nutrients are present in both animal- and plant-derived foods, others are only present or are more abundant in either animal or plant foods. For example, animal-derived foods contain significant amounts of protein, saturated fatty acids, long-chain n-3 polyunsaturated fatty acids, and the micronutrients iron, zinc, and vitamin B12, while plant-derived foods provide greater amounts of carbohydrate, Dietary Fiber, linoleic and α-linolenic acids, and micronutrients such as vitamin C and the B vitamins. It may be difficult to achieve sufficient intakes of certain micronutrients when consuming foods that contain very low amounts of a particular macronutrient. Alternatively, if intake of certain macronutrients from nutrient-poor sources is too high, it may also be difficult to consume sufficient micronutrients and still remain in energy balance. Therefore, a diet containing a variety of foods is considered the best approach to ensure sufficient intakes of all nutrients. This concept is not new and has been part of nutrition education pro- grams since the early 1900s. Department of Agriculture in 1916 and suggested consumption of a combination of five different food groups (Guthrie and Derby, 1998). Similarly, Canada has developed Canada’s Food Guide to Healthy Eating (Health Canada, 1997). However, these studies demonstrate associa- tions; they do not necessarily infer causality, such as would be derived from controlled clinical trials. Robust clinical trials with specified clinical endpoints are generally lacking for macronutrients. It is not possible to determine a defined level of intake at which chronic disease may be prevented or may develop. For example, high fat diets may predispose to obesity, but at what percent of energy intake does this occur? The answer depends on whether energy intake exceeds energy expenditure or is balanced with physical activity. This chapter reviews the scientific evidence on the role of macro- nutrients in the development of chronic disease. In addition, the nutrient limitations that can occur with the consumption of too little or too much of a particular macronutrient are discussed. These ranges represent (1) intakes that are asso- ciated with reduced risk of chronic disease, (2) intakes at which essential dietary nutrients can be consumed at sufficient levels, and (3) intakes based on adequate energy intake and physical activity to maintain energy balance. Furthermore, chronic consumption of a low fat, high carbohydrate or high fat, low carbohydrate diet may result in the inadequate intake of certain essential nutrients. In this section, the rela- tionship between total fat and total carbohydrate intakes are considered. For example, a low fat diet signifies a lower percentage of fat relative to total energy. It does not imply that total energy intake is reduced because of consumption of a low amount of fat. The distinction between hypocaloric diets and isocaloric diets is important, particularly with respect to impact on body weight. The failure to identify this distinction has led to considerable confusion in terms of the role of dietary fat in chronic disease.