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In the curative domain there are various forms îf medical practice. They may be thought of generally as forming a pyramidal structure, with three tiers representing increasing degrees of specialization and tech¬nical sophistication but catering to diminishing numbers of patients as they are filtered out of the system at a lower level. Only those patients who require special attention or treatment should reach the second (advisory) or third (specialized treatment) tiers where the cost per item of service becomes increasingly higher. The first level represents primary health care, or first contact care, or which patients have their initial contact with the health-care system. atrovent principle investigator Patients in the United States may also choose to be treated by doctors of osteopathy. These doctors are fully qualified, but they make up only a small percentage of the country's physicians. They may also branch off into specialties, hut general practice is much more common in their group than among M.D.'s. atrovent di A developing field is aerospace medicine. This involves medical problems that were not experienced before space-flight, for the main reason that humans in space are not under the influence of gravity, a condition that has pro¬found physiological effects. atrovent unit dose nebulizer Most pregnant women can he safely delivered in sim¬ple circumstances without an elaborately trained staff or sophisticated technical facilities, provided that these can be called upon in emergencies. In developed countries it was customary in premodern times for the delivery to take place in the woman's home supervised by a qualified midwife or by the family doctor. By the mid-20th century women, especially in urban areas, usually preferred to have their babies in a hospital, either in a general hospital or in a more specialized maternity hospital. In many developing countries traditional birth attendants supervise the deliv¬ery. They are women, for the most part without formal training, who have acquired skill by working with others and from their own experience. Normally they belong to the local community where they have the confidence of atrovent unit dose nebulizer Expansion of knowledge both in depth and in range has encouraged the development of new forms of treat-ment that require high degrees of specialization, such as organ transplantation and exchange transfusion; the field of anesthesiology has grown increasingly complex as equipment and anesthetics have improved. New technolo¬gies have introduced microsurgery, laser beam surgery, and lens implantation (for cataract patients), all requiring the specialist's skill. Precision in diagnosis has markedly improved; advances in radiology, the use of ultrasound, computerized axial tomography (CAT scan), and nuclear magnetic resonance imaging are examples of the extension of technology requiring expertise in the field of medicine. atrovent and albuterol Persons dissatisfied with the methods of modern medicine or with its results sometimes seek help from those profess¬ing expertise in other, less conventional, and sometimes controversial, forms of health care. Such practitioners are not medically qualified unless they are combining such treatments with a regular (allopathic) practice, which in¬cludes osteopathy. In many countries the use of some forms, such as chiropractic, requires licensing and a de¬gree from an approved college. The treatments afforded in these various practices are not always subjected to objective assessment, yet they provide services that are al¬ternative, and sometimes complementary, to conventional practice. This group includes practitioners of homeopa¬thy, naturopathy, acupuncture, hypnotism, and various meditative and quasi-religious forms. Numerous persons also seek out some form of faith healing to cure their ills, sometimes as a means of last resort. Religions commonly include some advents of miraculous curing within their scriptures. The belief in such curative powers has been in part responsible for the increasing popularity of the television, or "electronic," preacher in the United States, a phenomenon that involves millions of viewers. Millions of others annually visit religious shrines, such as the one at Lourdes in France, with the hope of being miracu¬lously healed. atrovent nebulizersA developing field is aerospace medicine. This involves medical problems that were not experienced before space-flight, for the main reason that humans in space are not under the influence of gravity, a condition that has pro¬found physiological effects. 006 atrovent nasal spray Drug research. The administration of any medicament, especially a new drug, to a patient is fundamentally an experiment: so is a surgical operation, particularly if it involves a modification to an established technique or a completely new procedure. Concern for the patient, care¬ful observation, accurate recording, and a detached mind are the keys to this kind of investigation, as indeed to all forms of clinical study. Because patients are individuals reacting to a situation in their own different ways, the data obtained in groups of patients may well require statistical analysis for their evaluation and validation.0.06 atrovent nasal spray atrovent nasal sprayIndia. Ayurvedic medicine is an example of a well-organized system of traditional health care, both preven¬tive and curative, that is widely practiced in parts of Asia. Ayurvedic medicine has a long tradition behind it, having originated in India perhaps as long as 3.000 years ago. It is still a favoured form of health care in large parts of the Eastern world, especially in India, where a large percentage of the population use this system exclusively or combined with modern medicine. The Indian Medical Council was set up in 1971 by the Indian government to establish maintenance of standards for undergraduate and postgraduate education. It establishes suitable qualifi¬cations in Indian medicine and recognizes various forms of traditional practice including Ayurvedic. Unani. and Siddha. Projects have been undertaken to integrate the indigenous Indian and Western forms of medicine. Most Ayurvedic practitioners work in rural areas, providing health care to at least 500,000.000 people in India alone. They therefore represent a major force for primary health care, and their training and deployment are important to the government of India. The obvious alternative to general practice is the direct access of a patient to a specialist. If a patient has problems with vision, he goes to an eye specialist, and if he has a pain in his chest (which he fears is due to his heart), he goes to a heart specialist. One objection to this plan is that the patient often cannot know which organ is respon¬sible for his symptoms, and the most careful physician, after doing many investigations, may remain uncertain as to the cause. Breathlessness—a common symptom—may be due to heart disease, to lung disease, to anemia, or to emotional upset. Another common symptom is gen¬eral malaise—feeling run-down or always tired; others are headache, chronic low backache, rheumatism, abdominal discomfort, poor appetite, and constipation. Some patients may also be overtly anxious or depressed. Among the most subtle medical skills is the ability to assess people with such symptoms and to distinguish between symptoms that are caused predominantly by emotional upset and those that are predominantly of bodily origin. A specialist may be capable of such a general assessment, but, often, with emphasis on his own subject, he fails at this point. The generalist with his broader training is often the better choice for a first diagnosis, with referral to a specialist as the next option, albuterol atrovent nebulization MEDICAL PRACTICE IN. DEVELOPED COUNTRIES atrovent vocal cord dysfunstionThe medical branch may provide advice about disease prevention, but the actual execution of this advice is through the ordinary chains of command. It is the duty of the military, not of the medical, officer to ensure that the troops obey orders not to drink infected water and to take tablets to suppress malaria. xopenex and atrovent In some primitive elements of the societies of developing countries, and of some developed countries, there exists the belief that illness comes from the displeasure of an¬cestral gods and evil spirits, from the malign influence of evil disposed persons, or from natural phenomena that can neither he forecast nor controlled. To deal with such causes there are many varieties of indigenous healers who practice elaborate rituals on behalf of both the physically ill and the mentally afflicled. If it is understood that such beliefs, and other forms of shamanism, may provide a basis upon which health care can be based, then primary health care may he said to exist almost everywhere. It is not only easily available but also readily acceptable, and often preferred, to more rational methods of diagnosis and treatment. Although such methods may sometimes be harmful, they may often be effective, especially where the cause is psychosomatic. Other patients, however, may suffer from a disease for which there is a cure in mod¬ern medicine. atrovent hfa inhaler Historical notes. Although the most spectacular changes in the medical scene during the 20lh century, and the most widely heralded, have been the development of potent drugs and elaborate operations, another striking change has been the abandonment of most of the remedies of the past. In the mid-19th century, persons ill with numer¬ous maladies were starved (partially or completely), bled, purged, cupped (by applying a tight-fitting vessel filled with steam to some part and then cooling the vessel), and rested, perhaps for months or even years. Much more recently they were prescribed various restricted diets and were routinely kept in bed for weeks after abdominal oper¬ations, for many weeks or months when their hearts were thought to be affected, and for many months or years with tuberculosis. The abandonment of these measures may not be though of as involving research, but the physician who first encouraged persons who had peptic ulcers to eat normally (rather than to live on the customary bland foods) and the physician who first got his patients out of bed a week or two after they had had minor coronary thrombosis (rather than insisting on a minimum of six weeks of strict bed rest) were as much doing research as is the physician who first tries out a new drug on a patient. This research, by observing what happens when remedies are abandoned, has been of inestimable value, and the need for it has not passed.atrovent indications Drug research. The administration of any medicament, especially a new drug, to a patient is fundamentally an experiment: so is a surgical operation, particularly if it involves a modification to an established technique or a completely new procedure. Concern for the patient, care¬ful observation, accurate recording, and a detached mind are the keys to this kind of investigation, as indeed to all forms of clinical study. Because patients are individuals reacting to a situation in their own different ways, the data obtained in groups of patients may well require statistical analysis for their evaluation and validation.

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