Silagra

W. Norris. Rose-Hulman Institute of Technology.

Prevention of accidents to patients undergoing radiation therapy Many accidents and mis-administrations have occurred involving patients undergoing treatment from external beam or solid brachytherapy sources generic silagra 50mg free shipping erectile dysfunction doctor called. Therapy involving unsealed sources is also a cause of mishaps cheap 50 mg silagra free shipping green tea causes erectile dysfunction, but affects a different kind of professional and should be treated separately. An effective approach for preventing such situations is to study illustrative severe accidents, discuss the causes of these events and contributory factors, summarize the sometimes devastating consequences of these events, and provide recommendations on their prevention. Challenges include institutional arrangements, staff training, quality assurance programmes, adequate supervision, a clear definition of responsibilities and prompt reporting. It addresses a diverse audience of professionals directly involved in radiotherapy procedures, hospital administrators, and health and regulatory authorities. In many of the accidental exposures that have occurred, a single cause cannot be identified. Usually, there was a combination of factors contributing to the accident, for example, deficient staff training, lack of independent checks, lack of quality control procedures and absence of overall supervision. Such combinations often point to an overall deficiency in management, allowing patient treatment in the absence of a comprehensive quality assurance programme. The use of radiation therapy in the treatment of cancer patients has grown considerably and is likely to continue to increase. Major accidents are rare, but are likely to continue to happen unless awareness is increased. Explicit requirements on measures to prevent radiotherapy accidents are needed with respect to regulations, education and quality assurance. Preventing accidental exposures from new external beam radiation therapy technologies New external beam radiation therapy technologies are becoming increasingly used. These new technologies are meant to bring substantial improvement to radiation therapy. However, this is often achieved with a considerable increase in complexity, which, in turn, brings with it opportunities for new types of human error and problems with equipment. It is based on lessons learned from accidental exposures, which are an invaluable resource for revealing vulnerable aspects of the practice of radiotherapy, and for providing guidance for the prevention of future occurrences. Dissemination of information on errors or mistakes as soon as they become available is crucial in radiation therapy with new technologies. In addition, information on circumstances that almost resulted in serious consequences (near misses) is also important, as the same type of event may occur elsewhere. Sharing information about near misses is, thus, a complementary and important aspect of prevention. Disseminating the knowledge and lessons learned from accidental exposures is crucial in preventing recurrence. This is particularly important in radiation therapy; the only application of radiation in which very high radiation doses are deliberately given to patients to achieve cure or palliation of disease. Notwithstanding the above, disseminating lessons learned from serious incidents is necessary but not sufficient when dealing with new technologies. It is of the utmost importance to be proactive and continually strive to answer questions such as: ‘What else can go wrong? While the recommendations specifically apply to new external beam therapies, the general principles for prevention are applicable to the broad range of radiotherapy practices in which mistakes could result in serious consequences for the patient and practitioner. The recommendations provide elements for mobilizing for future effective work as outlined below. Independent verification should be performed of beam calibration in beam radiation therapy. Independent calculation should be performed of the treatment times and monitor units for external beam radiotherapy. Prospective safety assessments should be undertaken for preventing accidental exposures from new external beam radiation therapy technologies, including failure modes and effects analysis, probabilistic safety assessment, and risk matrix, in order to develop risk informed and cost effective quality assurance programmes. Moderated electronic networks and panels of experts supported by professional bodies should be established in order to expedite the sharing of knowledge in the early phase of introducing new external beam radiation therapy technologies. A collaborating team of specifically trained personnel following quality assurance procedures is necessary to prevent accidents. Maintenance is an indispensable component of quality assurance; external audits of procedures reinforce good and safe practice, and identify potential causes of accidents. Accidents and incidents should be reported and the lessons learned should be shared with other users to prevent similar mistakes.

If movement exacerbates the pain safe silagra 50mg age related erectile dysfunction causes, this is suggestive r Pain arising from the midgut purchase 50 mg silagra with mastercard erectile dysfunction treatment singapore, which continues down of peritoneal inflammation. Patients with colic tend to to two thirds of the way along the transverse colon, is roll around in pain, whereas those with appendicitis lie felt in the paraumbilical region. Eating may relieve the pain of peptic 139 140 Chapter 4: Gastrointestinal system ulceration, whereas it may precipitate the pain of is- suggested by difficulty in initiating the swallow, or regur- chaemia of the bowel. Vomiting or the passage of stool gitation into the nose, whereas oesophageal obstruction or flatus may temporarily relieve pain. Causes are as follows: r Intraluminal blockage from the presence of a foreign Nausea and vomiting body. The pharyngeal pouch, mediastinal lymph node enlarge- causes of nausea and vomiting are diverse, for example ment, aortic aneurysm or paraesophageal hernia. See also under individual Nausea and vomiting can be due to stimulation of the conditions. Diarrhoea A history should elucidate the timing, precipitating Diarrhoea is the abnormal passage of loose or liquid and relieving factors of the nausea or vomiting and asso- stools more than three times daily and/or a volume of ciatedsymptomssuchasabdominalpain. Patients may use the term vomiting is characteristic of pregnancy, but also raised diarrhoea in different ways. Gastrointestinal obstruction may than 4 weeks is generally considered chronic, likely cause vomiting early or late in the condition depending to be of noninfectious aetiology and warrants further on the site of obstruction. Other symptoms of blood, which may appear fresh or partially digested such as pain, fever and vomiting may be present. It should be noted however that patients with inflamma- tory bowel disease might present in this way. Organic Dysphagia disease is suggested by a history of diarrhoea of less than Dysphagia or difficulty in swallowing usually indicates 3months duration, continuous or nocturnal diarrhoea, organic disease. The history should establish duration, the steatorrhoea (stool that is frothy, foul smelling and floats constant or intermittent nature, and whether it is worse because of a high fat content). If solids are affected more than History taking in chronic diarrhoea should include liquids, the cause is more likely to be obstruction, the following: whereas liquids are affected more in neurological dis- r Previous gastrointestinal surgery. Odynophagia that occurs with liquids suggests up- r Anycoexistent pancreatic, endocrine or multisystem peroesophageal ulceration. Chapter 4: Clinical 141 r Family history of gastrointestinal neoplasia, inflam- hypokalaemia) and neurological diseases (spinal cord matory bowel disease or coeliac disease. Associated symptoms In young patients (under 45 years) with symptoms r Constipation may cause colicky abdominal pains due suggestive of functional bowel disease, a normal exam- to peristalsis. This is common and not necessarily due ination and negative screening tests, no further investi- to aserious underlying disease. If atypical findings are present, a r Pain on passage of stool due to anorectal disease may sigmoidoscopy should be performed. In older patients lead to a deliberate suppression of the urge to defe- colonoscopy with ileoscopy should be performed with cate and therefore the accumulation of large, dry, hard biopsy and histological examination of any suspicious stools and constipation. Alternating It is important to determine if the bleeding is fresh bright constipation and diarrhoea, often with bloating, pas- red or dark,andwhetheritisonthesurfaceofthestoolor sage of mucus, and abdominal pains that are relieved mixed in. Bright red blood on the toilet paper after wip- by defecation, is commonly due to a functional bowel ing is usually due to haemorrhoids. However, it is im- in with the stool, or associated with various abdominal portant to exclude malignancy if patients are over 45 symptoms, other pathology should be sought, in partic- years or there are any suspicious features. Rectal blood with other conditions including depression and any ma- may occur with infection or inflammation of the bowel lignancy. It is important to consider gastrointestinal ma- together with weight loss, this suggests either malab- lignancy in any case of rectal bleeding. The history should establish the du- Constipation ration and severity of weight loss. Hard, dif- The acute abdomen introduction ficulttopassstoolsarealsoconsideredconstipation,even if frequent. The patient is often generally unwell and may be shocked due to dehydration and loss of fluid into extravascular Management spaces such as the lumen of the bowel and the abdominal Patients may require resuscitation, and general manage- cavity.

The signatories of the Ottawa charter pledged: to acknowledge people as the main health resource buy silagra 100mg on-line erectile dysfunction therapy; to support and enable them to keep themselves discount silagra 50mg otc erectile dysfunction brochure, their families and friends healthy through financial and other means, and to accept the community as the essential voice in matters of its health, living conditions and well-being. The British are traditionally a reticent people, taught to accept adversity with a stiff upper lip, to face the music with chin up and never to grumble. Thus views of visionaries such as Aleck Bourne in his book Health for the Future were seen 58 as eccentric. It should be our aim by coordinated effort to produce the Whole Man of high order. But it was only when public health in Britain fell under the dominating influence of American public health ideology that the health promotion rhetoric from both countries became indistinguishable. This ideology postulates that society needs anticipatory medicine both at individual level and at national level. At the same time, individuals need personal counselling about their lifestyle, and regular medical screen- ing. The agnostic Montaigne put it more strongly: Physicians are not content to deal only with the sick, but they will moreover corrupt health itself, for fear that men 59 should at any time escape their authority. Matters of daily living - habits, attitudes, sexuality, beliefs - they all become legitimate concerns of health promotionists. The American Journal of Health Promotion discussed vari- ous definitions of health promotion. Optimal health is defined as a balance of physical, emotional, social, spiritual and intellectual 62 health. As some of these barriers include racism, intolerance, bigotry, contempt for losers and victim-blaming, the job of health promotion officer would be quite a handful. In the London School of Hygiene and Tropical Medicine, there is now a unit called Health Promotion Sciences. The health promoter is not only a scientist, but also a doctor, psychologist cum psychiatrist, social expert, spiritual advisor and an intellectual! Because it deals with universal happiness it is immune to criticism, which, anyway, could only come from misanthropists or fools. Food industri- alists and manufacturers of pills have already joined the health promotion bandwagon. In 1987 the Faculty of Community Medicine of the Royal College of Physicians launched their Health for All by the Year 2000 bulletin. Serious doubts about the motives and value of the health 48 Healthism promotion movement have been expressed by medicine watchers, philosophers, and doctors themselves. The promissory notes issued by the prevention clergy (indulgences for non-indulgent behaviour? The general physician was in fact a professor of medicine with a special interest in preventive medicine. We are bothering and frightening people about far too many things, we campaign under the banner of denial of pleasure, and we cannot even agree on the scientific valid- 69 ity and importance of most of our recommendations. It automatically measures indices of health and disease in the stool and urine, and if the user inserts a finger into a device built into one side of the toilet, it gives an instant record of pulse rate and blood pressure. These harmless yearnings can be harnessed by the ideologies of healthism and forged into a political movement. Such romantic tendencies tend to flourish when times are out of joint, when traditional idols of authority have fallen. The ecologist John Horsfall noted that green ideology appeals to the scientifically innocent, who worry a lot about the environment, but cannot distinguish between real dangers and mere scare stories, between science and pseudoscientific 73 apocalyptics. And Andrew McHallam, of the Institute for European Defence and Strategic Studies, sounded a warning in his pamphlet The New Authoritarians: Reflections on the 14 Greens. Even though the Greens in Europe have a minimal parliamentary representation, their ideology is part of our Zeitgeist, reflecting the thinking and attitudes of the majority. Much of the appeal of the Greens is based on their apparent concern for the health of the people, believed to be endang- ered by capitalist industry which pollutes air, water, food and minds. Their promise of a happy future, and their apparent anti-authoritarianism appeals to the middle class.

Jigsaws discount silagra 100mg otc erectile dysfunction treatment pune, puzzles and toys that young pupils may be inclined to put in their mouths should be capable of being washed and disinfected buy cheap silagra 50mg on line impotence remedies. 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.