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None of the patients experienced er during the frst four weeks after the earthquake in Nepal purchase 20mg protonix with amex. When confronted with a specifc approach based on only one pathology like spina bifda and hydro- J protonix 40mg on-line. After closure 1Sichuan University and Hongkong Polytechnic University, Insti- of the meningomyelocoele or shunting for hydrocephalus, these tute for Disaster Management and Reconstruction, Chengdu, China children return to their homestead having a high complication risk. Results: Physical independence of the pa- Introduction/Background: Stroke is a major cause of death and dis- tients varied from severe to mild dependence. Pain and neurogenic ability worldwide, limited information is available about the out- bladder were the most frequently reported medical complications. Aim: To investigate stroke rehabilitation Many of the patients were emotionally unstable and showed mild outcomes, and factors predicting these outcomes in stroke patients. None of the patients had returned Material and Methods: Design: A one-year hospital-based, obser- to work or education although this was a frequently uttered desire. Sample: One hundred and thirty The economic situation of all patients and often their families was nine (139) stroke patients were recruited from two main hospitals considered diffcult and environmental barriers to social participa- in Hebron city. Procedure: Objective assessment, patient interview, tion were also frequently perceived. Rehabilitation measures avail- fle screening and observation of the recruited cases was performed, able to the patients were deemed insuffcient. Sample showed complex medical and psychosocial needs, most of which description: Mean age of the sample was 67. Lower level of functional activity at six months, was pre- dicted by the age patient (B. Rehabilitation response community projects needs to be prioritized assuming these are the basic building blocks of Disaster Rehab response grass root units. Kawate1 them closer, as well there are many grassroots political committees 1Showa University School of Medicine, Rehabilitation Medicine, that this bondage can be utilized in the management of pre disaster Yokohama, Japan rehab programs and post disaster injuries; specifcally during the post disaster periods they can be working as early responders at the Introduction/Background: Acupuncture is used as one of the tech- disaster site. Although Bangladesh is a Muslim majority country; niques for muscle re-education and facilitation to re-establish it has huge number of mosques and other common religious places voluntary control of body movements in patients. Using surface where number of religious leaders are placed to conduct the reli- electromyogram we showed in a previous study that patients with gious works. We have been conducting sessions of training Muslim chronic hemiparesis increased their gait speed signifcantly after leaders (imam and muazzin) to work as the early responder dur- cutaneous acupuncture and showed a trend of modifying mus- ing the cyclones at the coastal districts of Bangladesh following cle hyperactivities. Results: Initial reports of the project were promis- cutaneous acupuncture to hemiparetic gait patterns. Local Methods: Video recordings were taken of sixteen healthy volunteers people can respond disasters earlier. Acupuncture with uninsertable brush shaped J Rehabil Med Suppl 55 Poster Abstracts 281 needles (11 mm diameter, made of resin) on the plaster were ap- Department of Neurology, The Second Affliated Hospital of plied on affected lower extremity, mainly around on Gastrocnemius Chongqing Medical University, Chongqing, China and Achilles tendon. Results: Both, patients and healthy volunteers, did not show any signifcant differences in their gait patterns after Objective: To investigate the effect and mechanism of enriched stimulation. Material and Methods: A total of 30 healthy participants were assigned into group 1 (n=16) and group 2 (n=14). Health, Brunei, Brunei, 3Jerudong Park Medical Center, Jerudong Group 1 and group 2 were provided with low- and high-dose heat Park Medical Center, Brunei, Brunei respectively. Muscle blood fow was measured using Laser Doppler fowmetry (PeriFlux 5000 ®, Sweden) before and after intervention Introduction/Background: In many regions of the world there are in all subjects. Meanwhile, the ranges of neck motion and pressure- isolated physicians who hope to build rehabilitation medicine. Data there is a compelling public health need for more locally trained was collected, recorded and analyzed. However didactic education can be chal- onstrated signifcant improvement in muscle blood fow (p=0. A videoconferencing parisons, there was no statistically signifcant difference between program was established in which the Brunei physician provided the two groups for muscle blood fow (p=0. Results: Sessions clusion: The results indicated that the application of far-infrared were interactive, for example the local speech pathologist co-taught spectrum irradiation combined with ergonomics intervention could swallowing, the Bruneians mimicking various gait patterns for the improve the micro-circulation of neck muscles. Experiential ‘homework’ involved observing gait from a coffee shop and spending a day in a wheelchair. The frst two months of training and Introduction/Background: Ultrasound has proven to be of immense frst on-site visitor have gone well. However, in- cine department of the Ghana College of Physicians are preparing corporating ultrasound into a musculoskeletal practice requires to submit this program for credentialing. Conclusion: The skype overcoming signifcant barriers, including gaining adequate clini- lecture sessions have permitted rapid education and advice over cal training and familiarity with the ultrasound device. The fellowship in the southeastern United States was obtained from the leading ul- also needs accreditation by the Ghana College of Physicians.

Participants swallowed saliva discount protonix 20mg without a prescription, 3 ml thin liquid buy cheap protonix 20mg, 3ml nectar thick liquid, and 20 ml thin liquid, and 20 ml nectar 140 thick liquid. Two trials were performed for each bolus and the task order was randomly assigned. They had signifcantly longer duration compared to saliva (428±90 ms), 3 ml thin liquid (519±83 ms), or 3 ml nectar thick Y. Palmer3 pharyngeal pressure of 20 ml thin liquid was signifcantly larger 1Fujita Health Univesity, Faculty of Rehabilitation, Toyoake, Ja- than that of 20 ml thin liquid (p<0. Maximum velopharyngeal pan, 2Fujita Health Univesity, Department of Rehabilitation Medi- pressure of 3 ml thin liquid was signifcantly larger than that of 3 cine I, Toyoake, Japan, 3Johns Hopkins Univerisity, Department of ml thin liquid (p<0. The purpose of this study was to examine the effects of respiratory phase on the shape and size of pharynx and larynx. For patients after radiotherapy of nasopharyngeal measurement to fnd unmet needs in post stroke patient. Without the proper nutritional support, even the best rehabilitation regimen may not yield targeted results. Lin1 In this study, we analyzed the current situation of tube feeding and 1Changhua Christian Hospital, Physical Medicine & Rehabilita- dysphagia therapy in our rehabilitation ward. Material and Meth- tion, Changhua, Taiwan ods: Patients admitted into our rehabilitation ward from Jan 2012 to Dec 2014 (three years) were screened. However, its design was based on Delphi rehabilitation ward during the three year period. The patients were requested to answer the questionnaire and to viding the nutritional needs of patients with post-stroke dysphagia. Hundred Supervision, Kita-ku- Tokyo, Japan and thirty nine subjects participated to the inter-rater reliability as- sessment; thirty were enrolled in the intra-rater reliability assess- Introduction/Background: There are few well-established statistical ment. Two observers measured the spinal sagittal curves of each methods to assess the validities of content (Selected items of measure- participant with the surface goniometer IncliMed®. Hundred and ment) and of construct (Meaning of measurement) in psychometric thirty nine subjects were measured by the two raters within a tem- measures such questionnaire. There has been only choice to depend poral range of 10 minutes, in the same setting. Thirty returned at a upon the opinion of experts with long experience or upon the com- mean distance of 28 days for the intra-rater data collection. We present a new method ment limit and coeffcient of repeatability were calculated according to confrm the items structure in questionnaire, which is refected in to the linear regression analysis, and the Bland and Altman method content and construct validities, using statistical calculation in place applied to obtain the average of the differences and the standard er- of expert’s knowledge. Results: The inter-observer vari- for psychometric assessment usually deal with categorical data as ability for IncliMed® measurements was ±11° both for the kyphosis form of a contingency table. Conclu- with graphical model could provide domain structures to describe the sion: The IncliMed® method represents a reliable, non-invasive and degree of association among items. The proposed method is intended user-friendly tool for the clinical measurement and monitoring of to estimate the probability distribution on the basis of the comparison the spinal sagittal curves in children and adolescents. Results: This combined method could provide do- 146 main structures supported content and/or construct validity by com- puter software automatically. Conclusion: With this approach we will be able to analyze the relationship of each of the questionnaire items mathematically of Medical Sciences, Tehran, Iran and to confrm latent structures within outcome instruments. Introduction/Background: Strategic planning has been used and ap- plied for many industrial disciplines. Urabe5 tion medicine is among those medical specialties that seems to be 1Nishi-Hiroshima Rehabilitation Hospital, Department of Rehabili- analyzed in this way. Once the appropriate (and correct) data has been composed Department of Rehabilitation Medicine, Tokyo, Japan, 3Kawakita and analyzed, the capabilities of the specialty are evaluated. The strengths and weaknesses of the feld are inter- Department of Rehabilitation Medicine, Kyoto, Japan nal factors, while opportunities and threats normally are a result of external factors playing their part. Once the appropriate (and correct) data has been composed core set might be a useful clinical assessment tool for measuring and analyzed, the capabilities of the specialty are evaluated. The strengths and weaknesses of the feld are in- at four medical institutions in Japan were enrolled. Results: During the period between May 1 and Oct 31, the data of 25 patients (11 men, 14 women). Mueller1 1University Clinic of Munich, Orthopedic Surgery- Physical Medi- Introduction/Background: Core strength training, which usually done on stable surfaces, is an effective way to enhance physical ft- cine and Rehabilitation, Munich, Germany ness in youth. Previous study revealed that core strength training Introduction/Background: Local anesthetics are frequently preferred on unstable surfaces could improve some components of physical for intraarticular pain Management and in arthroscopic surgery. Training period lasted for 6 weeks (2 ses- acaine necrosis-inducing effects on all cell lines, the cell toxicity ef- sions/week), including frontal, dorsal and lateral core strength train- fect increasing steadily with the concentrations. Conclusion: Our results advise to prefer ropivacaine jumping sideways, Y balance, 20-m sprint and standing long jump), over bupivacaine in clinical use, e.

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Trophs will be killed Concentration To concentrate parasites & separate from fecal debris Sedimentation method Formalin-ethyl acetate protonix 40 mg generic. May miss operculated eggs buy generic protonix 20 mg line, unfertilizedAscaris Permanent stained slides For Dx of protozoa. Cryptosporidium parvum Ingestion of oocysts from Modified acid-fast stain of feces. Microsporidia Ingestion of spores Chromotrope or calcofluor white Obligate intracellular parasites. Small comma-shaped protuberance One of the most undercooked, dried, ducts at posterior. Plasmodium Sporozoan Anopheles mosquito Wright’s-stained thick & thin blood smears. Onchocerca volvulus Nematode Black fly Microfilariae from skin snips or River blindness. Sabouraud dextrose agar with antibiotics Antibiotics inhibit fungal contaminants & bacteria. Brain-heart infusion agar For isolation & conversion of dimorphic fungi from mold to yeast phase. Brain-heart infusion agar with antibiotics Selective medium used for isolation of pathogenic fungi from specimens contaminated with bacteria. Inhibitory mold agar For recovery of fungi from specimens contaminated with bacteria. Usually in farmers (Gilchrist’s disease) hyphae with small oval nected by wide neck. Gram pos cigar-shaped Found in Mississippi & Missouri (rose gardener’s Clusters of pear-shaped cells. Found on rose disease) conidia at tips of conid- direct smears unless by bushes, barberry bushes, sphag- iophores. Serious infections most often (cuticles), endocarditis, hyphae (no constrictions). Geotrichum candidum Uncommon cause of wound Forms hockey stick–shaped arthro- No blastoconidia. Cryptococcus neoformans Lung infection that can Irregularly sized, spherical cells In bird & bat droppings, decaying disseminate to brain surrounded by capsule. Capsule seen to brown-black colonies on niger with India ink prep in about 50% of seed agar. In systemic infections, recovered slightly curved septate hyphae may from blood cultures. Pneumocystis jiroveci Atypical interstitial plasma Cysts are 4–12 μm spheres with Can’t be cultured. Front is Septate hyphae, branching at Can cause invasive infec- fluffy, granular, or powdery 45°angle. Unbranched conid- Can cause eye, skin, nail, is white & cottony, develop- iophores. Conidiophores Can cause subcutaneous is gray-white & wooly at of variable length, sometimes infection. Dark branching is green-brown or black with conidiophores producing 2 or more velvety nap. Simple or Can cause sinusitis, dark olive green to brown or branched conidiophores, bent keratitis. Penetration Virus enters host cell by direct penetration, endocytosis (entering in a vacuole), or fusion with cell membrane. Direct fluorescent antibody stain Fluorescent-labeled antibody added to patient cells fixed to slide. Useful in evaluating immune status or diagnosing viral infections where culture is difficult or impossible. Lymphs (%) 18–38 42–72 37–73 23–53 18–42 Newborns: A few benign immature B cells may be seen (“baby” or “kiddie” lymphs). Liver & spleen may be reactivated (extramedullary hematopoiesis) if bone marrow fails to keep up with demand. Sickle cells (drepanocytes) Crescent, S or C shaped, boat shaped, Sickle cell anemia. Teardrops (dacryocytes) Teardrop shaped Myelofibrosis, thalassemia & other anemias. Staining Hypochromia Central pallor >1/3 cell diameter Iron deficiency anemia, thalassemia. May be artifact due to delay in spreading drop of blood or smear that’s too thick. Usually accelerated or & megaloblastic only 1 per cell abnormal anemias, sickle cell erythropoiesis anemia Cabot rings Wright’s Reddish purple May be part of mitotic Rapid blood regen- Megaloblastic anemia, rings or figure-8s spindle, remnant of eration, abnormal thalassemia, microtubules, or erythropoiesis postsplenectomy fragment of nuclear membrane Pappenheimer Wright’s (siderotic Small purplish blue Iron particles Faulty iron Sideroblastic anemias, bodies granules with granules. Amino acid sequence of globin sequence of globin chain, not in amount of globin chains is normal, but underproduction of 1 or more globin produced.

Greek physician Journal Intime  December () The physician should look upon the patient as a To me the ideal doctor would be a man endowed besieged city and try to rescue him with every with profound knowledge of life and of the soul order 40mg protonix with mastercard, means that art and science place at his command buy protonix 40 mg online. English physician, historian, Professor of Medicine, Journal Intime  August () Cambridge, and inventor of the short thermometer There is no curing a sick man who believes himself Lister saw the vast importance of the discoveries to be in health. He saw it because he was watching on Journal Intime  February () the heights, and he was watching there alone. To know how to grow old is the master-work of Attributed wisdom, and one of the most difficult chapters in Another source of fallacy is the vicious circle of the great art of living. Attributed John Allan Dalrymple Anderson – In science, law is not a rule imposed from without, British pharmacologist but an expression of an intrinsic process. The laws of the lawgiver are impotent beside the laws of The view that a peptic ulcer may be the hole in a human nature, as to his disillusion many a man’s stomach through which he crawls to escape lawgiver has discovered. London ()     ·  Sir Christopher Andrews – Abstinence is a good thing, but it should always be Director, World Influenza Centre, London practised in moderation. It behaves A rash of dermatologists, a hive of allergists, a epidemiologically in a way different from that of scrub of interns, a giggle of nurses, a flood of any other known infection. Heinemann, London () ophthalmologists, a whiff of anesthesiologists, a cast of orthopaedic rheumatologists, a gargle of laryngologists. Professor ‘Tommy’ Annandale – Asthma is a disease that has practically the same Professor of Surgery, Edinburgh symptoms as passion except that with asthma it They say it doesn’t matter how long one washes lasts longer. Michael Joseph, coronary heart disease, stroke, respiratory, London () diseases and many cancers will be wiped out. Irish Times  April () Anonymous An adult is one who has ceased to grow vertically Children are one third of our population and all but not horizontally. Choose your specialist and you choose your Penguin Dictionary of Modern Humorous Quotations p. Penguin Books, London () The Westminster Review  May () A doctor who cannot take a good history and a patient who cannot give one are in danger of Coughs and sneezes spread diseases. British wartime slogan () Clues in the Diagnosis and Treatment of Heart Diseases Introduction, Paul Dudley White Dermatology is the best specialty. The patient An epidemiologist is a doctor broken down by age never—dies and never gets well. Dr Bell fell down the well The Sunday Times  July , as a phrase of the suicide And broke his collar bone Svetozar Milosˇovic´, father of Slobodan Milosˇovic´, President Doctors should attend the sick of Serbia on trial for war crimes And leave the well alone A man’s liver is his carburettor. An observant parent’s evidence may be disproved Doctor says he would be a very sick man if were but should never be ignored. Lancet :  () Even a good operation done poorly is still a poor A minor operation: one performed on operation. Penguin Books, London () Everyone faces at all times two fateful possibilities: one is to grow older, the other not. Exploratory operation: a remunerative A surgeon is someone who does reconnaissance. A psychiatrist is someone who knows Fifty years ago the successful doctor was said to nothing and does nothing. A surgeon should give as little pain as possible Lancet :  () while he is treating the patient, and no pain at all when he charges his fee. Never let the sun set or rise on a small bowel Here lies one who for medicines would not give obstruction. Surgical Clinics of I fancy now he’d wish again to live, North America : – () Could he but guess how much his funeral cost. Not so much attention is paid to our children’s Homeopathy waged a war of radicalism against minds as is paid to their feet. Neale in The Advancement of Child Health profession’s attitude toward homeopathy if it had aimed, like other doctrines advanced by No woman wants an abortion. Either she wants a physicians, to gain a foothold among medical men child or she wishes to avoid pregnancy. Report to the Connecticut Medical Society (), quoted by Palliative care should not be associated exclusively Coulter in Divided Legacy with terminal care. If I were summing up the qualities of a good Report of the Expert Advisory Group on Cancer to the Chief teacher of medicine, I would enumerate human Medical Officers of England and Wales, Calman-Hine () sympathy, moral and intellectual integrity, enthusiasm, and ability to talk, in addition, of Parenthood is the only profession that has been course, to knowledge of his subject. If three simple questions and one well chosen Patients and their families will forgive you for laboratory test lead to an unambiguous diagnosis, wrong diagnoses, but will rarely forgive you for why harry the patient with more? Lancet :  () the more chary you get about offering iron clad prognoses, good or bad. If you resolve to give up smoking, drinking and David Seegal Journal of Chronic Diseases :  () loving, you don’t actually live longer; it just seems that way. Physicians and politicians resemble one another in this respect, that some defend the constitution In diagnosis, the young are positive and the and others destroy it. Acton or the Circle of Life Lancet :  () In the nineteenth century men lost their fear of Physicians are rather like undescended testicles, God and acquired a fear of microbes.

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