By J. Hanson. Vaughn College of Aeronautics.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned purchase 800mg zovirax. Errors and omissions excepted buy zovirax 800 mg overnight delivery, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpreta- tion and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Cost-effectiveness, feasibility and resource implications of antihypertensive and statin therapy. The underlying pathology is atherosclerosis, which develops over many years and is usually advanced by the time symptoms occur, generally in middle age. Acute coronary and cerebrovascular events frequently occur suddenly, and are often fatal before medical care can be given. Modification of risk factors has been shown to reduce mortality and morbidity in people with diagnosed or undiagnosed cardiovascular disease. This publication provides guidance on reducing disability and premature deaths from coronary heart disease, cerebrovascular disease and peripheral vascular disease in people at high risk, who have not yet experienced a cardiovascular event. People with established cardiovascular disease are at very high risk of recurrent events and are not the subject of these guidelines. Decisions about whether to initiate specific preventive action, and with what degree of intensity, should be guided by estimation of the risk of any such vascular event. The risk prediction charts that accompany these guidelinesb allow treatment to be targeted accord- ing to simple predictions of absolute cardiovascular risk. Recommendations are made for management of major cardiovascular risk factors through changes in lifestyle and prophylactic drug therapies. The guidelines provide a framework for the development of national guidance on prevention of cardiovascular disease that takes into account the particular political, economic, social and medical circumstances. Prevention of recurrent heart attacks and strokes in low and middle income populations. This proportion is equal to that due to infectious diseases, nutritional deficiencies, and maternal and perinatal conditions combined (1). It is important to recognize that a substantial pro- portion of these deaths (46%) were of people under 70 years of age, in the more productive period of life; in addition, 79% of the disease burden attributed to cardiovascular disease is in this age group (2). Between 2006 and 2015, deaths due to noncommunicable diseases (half of which will be due to cardiovascular disease) are expected to increase by 17%, while deaths from infectious diseases, nutritional deficiencies, and maternal and perinatal conditions combined are projected to decline by 3% (1). Almost half the disease burden in low- and middle-income countries is already due to noncommunicable diseases (3). A significant proportion of this morbidity and mortality could be prevented through population- based strategies, and by making cost-effective interventions accessible and affordable, both for people with established disease and for those at high risk of developing disease (3–5). In doing so, it placed noncommunicable diseases on the global public health agenda. However, population- wide public health approaches alone will not have an immediate tangible impact on cardiovascular morbidity and mortality, and will have only a modest absolute impact on the disease burden (3, 4). A combination of population-wide strategies and strategies targeted at high risk individuals is needed to reduce the cardiovascular disease burden. The extent to which one strategy should be emphasized over the other depends on achievable effectiveness, as well as cost-effectiveness and availability of resources (1–4). In this context, it is imperative to target the limited resources on those who are most likely to benefit. Thus, as envisioned in the Global Strategy for the Prevention 2 Prevention of cardiovascular disease Table 1 Effect of three preventive strategies on deaths from coronary heart disease over 10 years in Canadians aged 20–74 years* Strategy No. The objective is to reduce the incidence of heart attacks, strokes, and renal failure associated with hypertension and diabetes, as well as the need for amputation of limbs because of ischaemia, by reducing the cardiovascular risk. The focus is prevention of disability and early deaths and improvement of quality of life. This document should be considered as a framework, which can be adapted to suit different political, economic, social, cultural and medical circumstances. Interpretation and implications of recommendations (13, 14) The recommendations included here provide guidance on appropriate care. As far as possible, these are based on clear evidence that allows a robust understanding of the benefits, tolerabil- ity, harms and costs of alternative patterns of care. Recommendations can be defined as being strong when it is certain that their application will do more good than harm or that the net benefits are worth the costs.

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Course description This programme aims to ensure that practitioners have a sound understanding of basic pharmacology principles and practices generic 800mg zovirax with mastercard. Pharmacodynamic and pharmacokinetics principles will be taught using clinical examples buy zovirax 200mg without prescription. Reasons for individual variation, drug monitoring, and types of adverse drug reactions will be discussed using interactive and problem-based scenarios. Students will also learn and reflect on medication compliance: why medication errors occur and how safe prescribing guidelines can be formulated. Students will gain a good understanding of the mechanisms of action and effects of recreational misused drugs. They will discuss common clinical toxicology and poisoning case scenarios, developing analytical reasoning to aid diagnostic and management decisions. Intended learning outcomes At completion of this course the candidate should have sufficient understanding of the basic principles of pharmacology to guide prescribing in a general medical setting. Students should be able to diagnose and initiate appropriate treatment for common clinical toxicology presentations and understand why good prescribing practices are required to ensure patient safety. The basic framework of medicines management—internationally, nationally and locally—should be appreciated. Course description This programme aims to ensure that practitioners have a sound anatomical and physiological basis for treatment of common medical conditions encountered in adult acute and general medicine. Intended learning outcomes On completing this course the candidate should understand the anatomy, physiology and pathological processes that are important for the common diseases encountered in general medicine. Existing University of Edinburgh anatomy, physiology and pathology online e-learning tools will be utilised in combination with core reading (available in e-book format) as well as external resources to guide students through the various body systems. Course description This course aims to ensure that practitioners have a sound understanding of the laboratory techniques used to aid in the diagnosis of common general medical problems. Key clinical cases will be used to improve understanding in each of the disciplines; microbiology, haematology and biochemistry. Students will discuss how to interpret a blood film, diagnose coagulation disorders, make a microbiological diagnosis and conduct simple biochemistry assays. This module will also cover hospital-acquired infection, resistance patterns, lipid metabolism, porphyrias and some of the more unusual diagnoses requiring clinical biochemistry input. It will cover common clinical pitfalls and will be largely taught by way of problem-based learning using clinical scenarios. Intended learning outcomes On completing this course the candidate should have a basic understanding of the techniques used in laboratory medicine to aid in the diagnosis of clinical conditions. Course description This course aims to ensure that the candidate will have a good understanding of the principles and practice of clinical radiology. They will gain understanding about the physical properties and risk of x-rays, and discuss the benefits and disadvantages of the various modalities and techniques used in medical imaging. They will gain experience in the interpretation of clinical radiology images through the use of clinical case scenarios. This will focus on conditions encountered in the acute and general medical setting. Intended learning outcomes On completing this course the candidate should have an understanding of the principles and various techniques involved in imaging patients in a modern healthcare environment. They should be able to interpret x-ray images to diagnose the common conditions encountered in acute and general medicine using clinical case scenarios. The student should:  Understand how x-rays work, the physical principles and the risks. Elements of therapy and research methods have been introduced through the pharmacology and introductory courses. Year 2 will allow the students to develop increasing generic skills essential for good clinical care, diagnosis and clinical management. Students will now also be introduced to increasingly complex clinical problems based in specialty areas. While some specialty courses are compulsory, there will also be options for elective modules thus allowing students to develop deeper knowledge in areas where they may wish to sub-specialise in their future careers. Study will now focus more on the diagnosis of the illness or condition and ongoing management including recognised treatment options. Each course will cover current concepts of prevention, treatment and rehabilitation where relevant. Course description This course aims to ensure that the candidate understands how to examine patients appropriately and thoroughly and will make use of virtual examination resources such as virtual stethoscope. The theory underpinning good communication with patients will be discussed and described (as well as shown on video) using examples of good and bad consultations. Common ward-based medical procedures that middle grade doctors need to be familiar with will be covered using interactive tools to demonstrate the anatomy and clinical risks associated with these procedures. Intended learning outcomes On completing this course the student should know how to examine a patient competently and understand what makes a good patient consultation.

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However in life-threatening upper gastrointestinal Colonoscopy bleeding buy zovirax 200 mg visa, if gastric outflow obstruction develops or for The patient has to have bowel preparation cheap zovirax 200 mg with visa, which com- malignant gastric ulcers surgery is still indicated. Osmotic laxatives or large vol- tion but caused decreased motility and thus a drainage umes of electrolyte solutions are then taken to clear the procedure is required: bowel 12 hours before the procedure (essentially causing r Pyloroplasty in which a longitudinal cut is made in watery, frequent diarrhoea). In 20% of cases, due is linked to the stomach (the normal pyloric passage to insufficient preparation or patient intolerance, it is remains intact). Iron and folate are absorbed from the upper small Partial gastrectomy is usual (total gastrectomy is un- bowel. Complications following surgery: r Large bowel surgery Duodeno-gastric reflux, may lead to chronic gastritis. Resection of the large bowel often requires temporary or r Recurrenceoftheoriginaldisease(gastriculcer,gastric permanent stoma to allow healing of the relatively frag- carcinoma). Patients require counselling wherever possible r Nutritionalconsequencesincludeweightloss,ironde- prior to surgery. These are subdivided into two categories: r The dumping syndrome is due to the uncontrolled 1 Colostomy (exteriorisation of the colon), which is rapid emptying of hyperosmolar solution into the flush to the skin. Both ends may be exteriorised as small bowel characterised by a feeling of epigastric acolostomy and a mucous fistula or the rectal stump fullness after food associated with flushing, sweating can be closed off and left within the pelvis (Hartman’s 15–30 minutes after eating. Surgical re- 2 Ileostomy, which requires the creation of a cuff of vision may be indicated. Prior to emergency surgery ag- gastrectomy after a latent period of 20 years possibly gressive resuscitation is required. Resection of tumours, due to bacterial overgrowth with the generation of when of curative intent, involves removal of an adequate carcinogenic nitrosamines from nitrates in food. Complications of intestinal surgery include wound Small bowel surgery infection (see page 16) and anastomotic failure, the Smallbowelresectionisnormallyfollowedbyimmediate treatment for which is surgical drainage and exteriori- end-to-end anastomosis as the small bowel has a plen- sation. Small to medium resections have little functional consequence as there is a relative func- Gastrointestinal infections tional reserve; however, massive resections may result in malabsorption. Definition r Nutritional consequences are severe when more than Bacterial food poisoning is common and can be caused 75% of the bowel is resected. Chapter 4: Gastrointestinal infections 149 Aetiology and pathophysiology severity of each symptom and a careful history of food r Bacillus cereus has an incubation period of 30 min- intake over the past few days may point in the direction utes to 6 hours. Ingested Investigations spores (which are resistant to boiling) may cause diar- Microscopy and culture of stool is used to identify cause. Recovery All forms of bacterial food poisoning are notifiable to occurs within a few hours. The onset oftheclinicaldiseaseoccurs2–6hoursafterconsump- Management tion of the toxins. Canned food, processed meats, milk In most cases the important factor is fluid rehydration and cheese are the main source. Antibioticsare istic feature is persistent vomiting, sometimes with a not used in simple food poisoning unless there is ev- mild fever. There is a large animal reservoir (cattle, sheep, Bacilliary dysentery rodents, poultry and wild birds). Patients present with fever, headache and malaise, followed by diarrhoea, Definition sometimes with blood and abdominal pain. Recovery Bacilliary dysentery is a diarrhoeal illness caused by occurs within 3–5 days. It has an in- There are four species of Shigella known to cause diar- cubation period of 12–24 hours and recovery occurs rhoeal illness: within 2–3 days. There are more than 2000 species on the basis of r Shigella flexneri and Shigella boydii (travellers) cause antigens, which can help in tracing an outbreak. Salmonella enteritidis (one common serotype is called r Shigella dysenteriae is the most serious. The main reservoir of infection is poul- try, though person to person infection may occur. Di- Pathophysiology arrhoea results from invasion by the bacteria result- Shigella is a human pathogen without an animal reser- ing in inflammation. Spread is by person-to-person contact, faecal–oral with fever, malaise, cramping abdominal pain, bloody route or contaminated food. Acutewaterydiarrhoeawithsystemicsymptomsoffever, malaise and abdominal pain develops into bloody di- Clinical features arrhoea. Other features include nausea, vomiting and As outlined above the cardinal features of food poison- headaches. Complications include colonic perforation, ing are diarrhoea, vomiting and abdominal pain. Severe cases may be treated mon in the developing world but also found in with trimethoprim or ciprofloxacin. Outbreaks may oc- the United Kingdom, especially in immunocom- cur and require notification and source isolation. It has been suggested from retrospective studies Aetiology/pathophysiology that treatment of E. The tox- Pseudomembranous colitis ins are coded for on plasmids and can therefore be Definition transferred between bacteria.

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