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Gender bias in medical textbooks: Examples from coronary heart disease order cheap gemfibrozil on line good cholesterol ratio but high ldl, depression discount gemfibrozil 300mg on line which cholesterol ratio is most important, alcohol abuse and pharmacology discount gemfibrozil on line definition du cholesterol. A narrative approach to explore grief experiences and treatment adherence in people with chronic pain after participation in a pain-management program: A 6-year follow-up study. Listening for feelings: Identifying and coding empathic and potential empathic opportunities in medical dialogues. The enlightened eye: Qualitative inquiry and the enhancement of educational practice. An association between depression, anxiety and thyroid function: A clinical fact or an artefact? Exploring and validating patient concerns: Relation to prescribing for depression. Trace element levels in Hashimoto thyroiditis patients with subclinical hypothyroidism. To lie or not to lie: Resident physician attitudes about the use of deception in clinical practice. Prospective associations of concerns about physique and the development of obesity, binge drinking, and drug use among adolescent boys and young adult men. The good, the normal and the healthy: The social construction of medical knowledge about women. Effects of gender on performance in medicine: Men may have higher output than women, but this is possibly offset by litigation and disciplinary action. Interruptions, status and gender in medical interviews: The harder you brake, the longer it takes. Guideline for the study and evaluation of sex differences in clinical evaluation of drugs. Living with chronic illness: A phenomenological study of the health effects of the patient–provider relationship. Patient-provider interactions in the management of chronic pain: Current findings within the context of shared medical decision making. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. The physician–patient working alliance and patient psychological attachment, adherence, outcome expectations, and satisfaction in a sample of rheumatology patients. Patient preferences for physician characteristics in university-based primary care clinics. Patients’ perspectives on depression case management in general practice – A qualitative study. Patient narratives on person- centeredness in the integrated care context: a qualitative study. Identification with the role of doctor at the end of medical school: A nationwide longitudinal study. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam study. Being in the patient position: Experiences of health care among people with irritable bowel syndrome. Nonverbal sensitivity in medical students: Implications for clinical interactions. Analogue patients’ satisfaction with male and female physicians’ identical behaviors. Male and female physicians show different patterns of gender bias: A paper-case study of management of irritable bowel syndrome. Still far to go – An investigation of gender perspective in written cases used at a Swedish medical school. Medically unexplained symptoms, somatisation disorder and hypochondriasis: Course and prognosis. A web-based patient information system—Identification of patients’ information needs. Ways to optimize understanding health related information: The patients’ perspective. Screening for subclinical thyroid dysfunction in nonpregnant adults: A summary of the evidence for the U. Social and virtual networks: Evaluating synchronous online interviewing using instant messenger.

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These symptoms may explain why people with this dementia often falsely believe that they are being persecuted order gemfibrozil toronto cholesterol levels ldl. Half or more of those affected by dementia with Lewy bodies have movement problems when the dementia is diagnosed order genuine gemfibrozil on line cholesterol free foods, and this proportion increases as dementia progresses buy genuine gemfibrozil on-line quick cholesterol lowering foods. These symptoms are like those of Parkinson’s disease, such as slowness of movement, stiffness and sometimes tremor. The person may also have diffculty judging distances and be prone to problems with balance, falls and fainting. As dementia with Lewy bodies progresses, some of the symptoms become more like those of middle or late stage Alzheimer’s disease, including greater problems with day-to-day memory and behaviours that challenge, such as agitation, restlessness or shouting out. Worsening of Parkinson-type symptoms means that walking gets slower and less steady. The combination of symptoms in a person with dementia with Lewy bodies can be particularly stressful for family and carers. Frontotemporal dementia (including Pick’s disease) This type of dementia is caused by damage to the frontal and/or temporal lobes at the front and sides of the brain by the ears. These are the areas responsible for our behaviour, our emotional responses and our language skills. There are three different types of frontotemporal dementia – one type that affects behaviour frst, and two that affect language frst. During the early stages of frontotemporal dementia, memory of recent events may be unaffected. A person with behavioural variant frontotemporal dementia may appear uncharacteristically selfsh and unfeeling. Other early symptoms may include loss of inhibition, ritualised behaviour (such as tapping or repeatedly walking the same route) or compulsions and a liking for sweet foods. It is much more likely for those around the person to be aware of these changes than the person is themselves. In a small number of people with frontotemporal dementia, the frst symptoms are problems with recalling the names of objects and understanding words (semantic dementia) or with producing fuent speech (progressive non-fuent aphasia). As frontotemporal dementia progresses, differences between these types lessen: people with the behavioural variant develop language problems and those with language problems develop behaviour changes. In the later stages, the symptoms of frontotemporal dementia become more similar to those of Alzheimer’s disease. There are some differences – for example, day-to-day memory loss and problems judging distance or seeing objects in three dimensions develop later in frontotemporal dementia, whereas changes in behaviour, such as agitation or aggression, develop earlier. Supporting a person with frontotemporal dementia can be a 12The progression of Alzheimer’s disease and other dementias challenge as they may be younger and will have changes in behaviour and communication. Each person’s experience of frontotemporal dementia will be different, but on average people live for six to eight years after symptoms begin. We 9am–5pm Thursday–Friday provide information 10am–4pm Saturday–Sunday and support, improve care, fund This publication contains information and general research, and create advice. It should not be used as a substitute for lasting change for personalised advice from a qualifed professional. Please refer to our website for the latest version and for full terms and conditions. Except for personal use, no part of this work may be distributed, reproduced, downloaded, transmitted or stored in any form without the written permission of Alzheimer’s Society. Within a decade of its development, 9 methicillin resistance to Staphylococcus aureus emerged. Most of the resistance was secondary to production of beta-lactamase enzymes or intrinsic resistance with alterations in penicillin-binding proteins. Staphylococcus aureus is the most frequent cause of nosocomial pneumonia and surgical- wound infections and the second most common cause of nosocomial bloodstream 12 infections. Other risk factors include intravascular catheters, tracheostomy, gastrostomy, indwelling urinary catheters and decubitus ulcers. Another important consideration is careful evaluation of culture and sensitivity reports. Infection is often confused with colonization and can lead to unnecessary utilization of antimicrobial agents. Potential anatomical sites of colonization include the anterior nares, axillae, upper extremities, urinary tract and perineum. Consultation with an infectious-disease specialist is advised regarding management when there is question as to infection versus colonization.

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These techniques include Lean discount gemfibrozil 300 mg amex cholesterol test explained, six sigma cheap 300 mg gemfibrozil visa cholesterol values blood test, and the use of modeling and prediction tools to analyze order cheapest gemfibrozil and gemfibrozil elevated cholesterol levels definition, improve, and optimize the performance of complex systems, including health care (Litvak and Bisognano, 2011; Toussaint and Berry, 2013; Pocha, 2010; DelliFrane et al. The methods developed by operations research and systems engineering to match supply and demand has led to substantial improvements in cost, efficiency, and patient satisfaction in select hospitals, patient populations, and clinics (Litvak and Fineberg, 2014; Rohleder et al. Yet, these efforts are nascent, localized, and not necessarily scalable (Watts et al. Commitment to creating a high-value patient experience is required in order to affect real change in institutional practices and outcomes. Although leaders are well meaning, too often they lack simple awareness of alternative approaches, or, if known, there is a lack of commitment to do the hard work of system redesign. Our organizations include a pediatric hospital, a safety net health care system, local and national integrated health care systems, an integrated community-owned health system, and a managed care health care system. Although our organizations differ in size, populations served, and institutional constructs, these themes and the strategies described are broadly applicable to all of U. Accordingly, while examples are given from some institutions, each of our institutions employed these strategies, and they are broadly applicable in health care. Attention to the barriers to flow and removing waste will increase capacity, enable timely care delivery, and improve care. It must be noted that these approaches were part of a larger, comprehensive effort to redesign care delivery. It should be underscored that efforts to improve access within our organizations are ongoing. Our organizations are committed to continuous process improvement and recognize that improvement is not static but rather an iterative process. As such, the examples contained within this discussion paper often reflect efforts within a single service line, practice, or geographic location. It is widely recognized that much more remains to be done before effective scheduling and access is a systemwide characteristic. That being said, and recognizing the unique constraints of each organization, three overarching principles are common throughout all of our efforts: the application of a systems-thinking approach, the use of a disciplined methodology for system redesign, and a foundation of respect for people. A common strategy of our organizations was the consideration of our institutions as complex systems. Tantamount to determining how to best implement change and mitigate unanticipated outcomes was recognizing that, rather than discrete environments or services, our organizations are complex groups of interdependent processes, personnel, and incentives. For example, looking beyond the immediate problem of delayed clinic visits enabled us to see problems with referrals for subspecialty appointments, difficulties with weekend discharges, or inadequate communication during appointment requests. A systems-level approach ensures that all aspects of a complex system are considered, including how the system elements interact with one another over time. Our organizations used system-thinking strategies to tackle access challenges, and they all used a disciplined methodology, albeit different methods, to ensure that improvements would be effective, efficient, and provide value to patients and their families and the organization. The two best known approaches, Lean and six sigma, are management philosophies and tools successfully used in other industries that are now being adopted in health care. Lean focuses on eliminating waste from the patient perspective to achieve uninterrupted flow from the beginning to end of the process. Six sigma is another management technique aimed at eliminating defects by reducing variations, in order to enable more capable products and processes (Revere and Black, 2004). The use of a disciplined approach removes blame and politics from process improvement, and focuses priorities on improvement for the patient or family. An underlying characteristic of our health care organizations is a respect for peoplefor everyonepatients, families, and the many people that keep our health systems running. Patient and family needs are placed at the center of the care process, and they are involved in the redesign of our health care system. They are encouraged and enabled through system design to become stewards of their own health. Too often respect for patients or patient engagement amounts only to empty words; however, for our organizations, moving to a culture of respect was key to our system redesign. It provided a principle to guide every decision, every change, and every interaction. As a pillar of Lean philosophy, respect for people also refers to those working in our medical practices or hospitals. This includes a culture that gives everyone the 11 tools and the opportunity to become problem solvers; enhances individual creativity, values teamwork; and engenders communication, trust, and respect between frontline staff and senior levels of management.

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A thorough search of the literature order gemfibrozil toronto cholesterol total test, using the search terms secret-keeping gemfibrozil 300mg visa cholesterol index chart, withholding information best purchase gemfibrozil ldl cholesterol definition wikipedia, lying, and disclosure, in relation to trust resulted in numerous studies related to patients seeking pain medication (e. However, a gap in the literature was discovered 187 regarding the practice of secret-keeping by patients in an attempt to regain control over their own health. According to Fainzang (2005), the purpose of secret-keeping on the part of the patient is “not the exercise of power but the expression of resistance to the power of [the doctor]” (p. For example, in the current study, Sarah shared that her doctor did not listen to her or take her seriously when she complained that she did not feel well on Synthroid. Through the lenses of feminism and social constructionism, medical knowledge regarding women’s bodies is understood as being influenced by cultural factors and social norms (Docherty & McColl, 2003; Fernandes et al. Concepts of women’s health, illness, and methods for managing illness are created and managed by pharmaceutical companies and physicians who maintain positions of authority over patients (Findlay, 1993; Hearn, 2009; Lupton, 2003; 188 Munch, 2004). However, feminists argue that patients are the experts of their own medical conditions (Chrisler, 2001; Fernandes et al. As such, when an individual experiences a phenomenon that she considers to be abnormal for her body and takes action based on her own interpretation of the phenomenon, she is reclaiming power and control over her body (Fainzang, 2005, 2015). Kim is 82 years old and has been receiving treatment for thyroid disease for 66 years. I just told him I was seeing another doctor for my thyroid treatment…We sometimes have to resort to trickery! As discussed previously in section “Belief that ‘Doctor Knows Best,’” Kim seems to be willing to tolerate a paternalistic approach from a male doctor, and this could be due to her age. As such, Kim likely considers her primary care doctor to be an authority figure—an “authority in the face of which one does not dare to openly show resistance or refusal” (Fainzang, 2005, p. According to Fainzang (2005), patients who do not wish 189 to demonstrate “open opposition” to their doctors will sometimes lie in order to “avoid conflict, criticism, or blame” (p. Nevertheless, while it is considered unacceptable for patients to withhold information from their doctors, for a doctor to withhold information “comes within the framework of permissible lying” (Fainzang, 2005, p. According to Fainzang (2005), “Numerous doctors claim the privilege of knowledge concerning the patient’s body and tend not to disclose information that might enable the patient to make his own choices concerning his being” (p. In addition, patients’ knowledge tends to be undervalued by doctors (Risberg, 2006); and decisions regarding diagnosis and treatment are based on “objective evidence” of disease (e. Research indicates that patients are more likely to trust doctors who listen to them and show a genuine interest in their well-being (Houle et al. In turn, trust in one’s doctor increases the likelihood that patients will disclose information to their doctors (Copeland et al. Considering that the majority of patients wish to actively participate in their healthcare (Barry & Edgman- Levitan, 2012; Chin, 2002; Flynn et al. Six out of the nine participants who indicated that their ability to communicate with their doctors was influenced by their level of trust in their doctors explained that they had engaged in self-treatment. As with the issue of secret-keeping, the majority of the literature on self-treatment places patients in a subservient position to the doctor and largely focuses on “self-medication” with unauthorized drugs and alcohol (e. Self-medication is defined by Verma, Mohan, and Pandey (2010) as “the use of medication by a patient on his own initiative or on the advice of a pharmacist or a lay person instead of consulting a medical practitioner” (p. Fainzang (2013) argued that patient self-medication is a form of self-advocacy that involves a thoughtful process of “self-examination, self-diagnosis, and self-prescription” (p. Because female patients in particular often need to prove the validity of their complaints (Hoffman & Tarzian, 2001; Munch, 2004) and patients who challenge their doctors tend to be thought of as “difficult” (Frosch et al. In the current study, the term “self-treatment” was chosen instead of “self- medication” due to its negative connotation in the majority of the literature. In the current study, six participants chose to either stop or start taking a medication or supplement without consulting their doctors. For example, Jenna shared that she was struggling with symptoms from thyroid cancer, which remained undiagnosed 191 for approximately four months because her blood work continued to show as “normal. During the fourth month period before her diagnosis, Jenna spoke with a friend “who has thyroid issues [and] got [her] on a multivitamin and 10k units of vitamin D3. As a result, Carla explained, “I started self- treating in July of 2002 and pretty much consider myself to still be self-treating [and] the current doc/insurance just run my labs.

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