This document discusses the importance of combining both the art and science of clinical reasoning in diagnosis. It draws parallels between doctors and detectives, emphasizing the value of careful observation, deduction, and considering what information is both present and absent. While technology has advanced diagnosis, overreliance on protocols or algorithms can be flawed if not applied judiciously. The ideal clinician utilizes both up-to-date medical knowledge and detective-like analytical skills to fully understand the patient and identify any inconsistencies that may point to the underlying disease.
In this presentation, our radiation safety expert provides the guidance you need to prove your facility is safe, compliant and inspection-ready. Learn how to get your paperwork in place, including proper documentation and licensing; train your employees on radiation safety; and gain best practice techniques to optimize your radiation safety program.
Neo4j is a powerful and expressive tool for storing, querying and manipulating data. However modeling data as graphs is quite different from modeling data under a relational database. In this talk, Michael Hunger will cover modeling business domains using graphs and show how they can be persisted and queried in Neo4j. We'll contrast this approach with the relational model, and discuss the impact on complexity, flexibility and performance.
In this presentation, our radiation safety expert provides the guidance you need to prove your facility is safe, compliant and inspection-ready. Learn how to get your paperwork in place, including proper documentation and licensing; train your employees on radiation safety; and gain best practice techniques to optimize your radiation safety program.
Neo4j is a powerful and expressive tool for storing, querying and manipulating data. However modeling data as graphs is quite different from modeling data under a relational database. In this talk, Michael Hunger will cover modeling business domains using graphs and show how they can be persisted and queried in Neo4j. We'll contrast this approach with the relational model, and discuss the impact on complexity, flexibility and performance.
Quicker, more efficient diagnosis method, using hepatitis #scichallenge2017Blaise Cloran
This is my project for the #scichallenge2017. It's a quicker diagnosis method for poverty stricken countries using hepatitis to demonstrate how my method works. Blaise Cloran
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what SPECT scans are, how they are a tool in diagnosing a patient in psychiatry, 7 types of ADD, how it helps understanding and acceptance of having a mental illness
Quicker, more efficient diagnosis method, using hepatitis #scichallenge2017Blaise Cloran
This is my project for the #scichallenge2017. It's a quicker diagnosis method for poverty stricken countries using hepatitis to demonstrate how my method works. Blaise Cloran
Tok Essay
TOK Knowledge Essay
Tok Sense Perception
Essay Magnetic Resonance Imaging
Platos Theory of Knowledge Essay
Tok Emotion Essay
Possession of Knowledge Tok Essay
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what SPECT scans are, how they are a tool in diagnosing a patient in psychiatry, 7 types of ADD, how it helps understanding and acceptance of having a mental illness
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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1. Doctor As Detective
Dr Jitendra Ingole
MD Internal Medicine
Associate Professor, SKNMC & GH, Pune
2. Diagnosis …Art or Science ?
Best answer would be a judicial
combination of both.
History & Clinical examination are
paramount importance.
For they provide foundation for planning
out investigations or treatment.
4. White Coats and finger prints
Isn’t much of a doctor’s work alike to that
of a detective?
5. Current scenario
Routine use of sophisticated diagnostic
tools is killing the art of clinical
reasoning.
Blind faith in technology
Pre determined diagnostic algorithms
6. How to confront the problems posed
by burgeoning number of available
technologies….
7. The need of hour is ……
Harmonic fusion of all investigative
methods of fictional detectives.
Avoid slavish adherence to protocols.
8. What is happening today is……
Burn money to make diagnostic work
up superficial
Losing intellectual pleasure that comes
from careful diagnostic reasoning.
10. Some analogies between detective
and clinical methods
Try to restore status quo undermined by
crime or disease
Thrive on climate of faith in capabilities
of science and base their methods on
interpretation of clues and s/s.
Reach final conclusion by decoding
signs and symptoms often meaning
less to layman.
13. Shared qualities of detectives &
Clinicians
Ability in Observation
Ability in Deduction
Knowledge
Ability to reconstruct psychological &
social profile
Ability to spot inconsistencies
14. Observation & reasoning…..
Three qualities
Deduction
Induction
Abduction
General to particular
Particular to general
Forming an explanatory
hypothesis
Not only presence of evidence but also their absence is important.
15. So, here is the flaw…..
Flawed belief that disease can be
diagnosed accurately from its specific
external signs
16. And Lo Behold……
We are taught similar way from UG
days…. Only to learn hard fact later,
that signs/symptoms may not follow
books.
Overcoming the blind faith is very
important.
18. Knowledge
There comes a time, when for every
addition, there is deletion of previous
knowledge from our memory.
19. So……..
It is important to know what is important
& what’s not.
And do not allow useless to replace
useful knowledge.
20. I have internet connection……hence
I am invincible doctor….because I
have every possible answer in the
world.
21. The Armchair Specialist…?
Having access to knowledge does not
mean that it will be utilised accurately.
Net searches are worth if & only if
clinician conserves his bedside role.
23. A detective says ……
“ I will identify murderer when I fully know
victim. ”
24. A doctor says …..
“ I will identify the disease when I fully
know patient. ”
25. Ability to Recognise Inconsistencies
Normal or low voltage ECG, HOCM
Cardiac Amyloidosis
26. Sherlock Holmes Aphorisms……
You see but you do not observe.
My method is founded upon observation of trifles.
Never trust general impressions, but concentrate on
details.
It is capital mistake to theorise before one has the data.
27. Sherlock Holmes Aphorisms……
There is nothing like first hand evidence.
There is nothing more deceptive than an obvious fact.
The world is full of obvious things which nobody by any
chance observes.
When you have eliminated all impossible, whatever
remain, however improbable, must be the truth.
28. And the punch line is …….
Do not try to twist the facts to suit theories. Rather,
theories should suit the facts.
29. Adherence to protocols and
procedures……
Though guidelines raise average quality
of care, but if applied uncritically and
blindly, can cause pitfalls.
30. Thus the need of hour is…….
Proper and Juridical use of clinical or
treatment guidelines.
32. Clinical method as science and art
of investigation
Mature Clinician
Spot inconsistencies among clinical ,
instrumental and lab exam
Consider not only what is present but also
what is missing.
Capacity to establish links – physical lab.,
instrumental finding.
Simple logical clinical exam has same
value as complex expensive investigation.
34. The lady detective….Mma Ramotswe
Waiting to see doctor for about an hour
outside his consulting room
Makes accurate & intelligent
observations…which then she narrates
to doctor
35. First patient was butcher……
How ?
Lost a finger on his left hand
Scratching his body
36. Second female patient unable to
sleep at night…… How ?
Slept off while waiting
Had to be awakened on her turn
Milk stains on her clothes… must have
been awake due to baby
38. And then, her doctor tells detective not
to eat too much doughnuts…….How ?
Because her weight not decreasing
since last few years.
Sugar in front of her dress which was
spilled from doughnuts.
39. The Message is clear…….
In other words, history taking and
clinical examination should not become
too structured ritual.
40. Think And Act……
It also means to have a clear
systematic approach in mind whether
taking history or doing clinical
examination.