Estrace

L. Steve. Hope College.

Copyright (c) 2012 The Accreditation Council for Graduate Medical Education and The American Board of Internal Medicine discount 1 mg estrace free shipping. The copyright owners grant third parties the right to use the Internal Medicine Milestones on a non-exclusive basis for educational purposes effective estrace 1 mg. The Milestones provide a framework for the assessment of the development of the resident physician in key dimensions of the elements of physician competency in a specialty or subspecialty. They neither represent the entirety of the dimensions of the six domains of physician competency, nor are they designed to be relevant in any other context. They are descriptors and targets for resident performance as a resident moves from entry into residency through graduation. For each reporting period, review and reporting will involve selecting the level of milestones that best describes a resident’s current performance level in relation to milestones, using evidence from multiple methods, such as direct observation, multi-source feedback, tests, and record reviews, etc. Selection of a level implies that the resident substantially demonstrates the milestones in that level, as well as those in lower levels (See the diagram on page v). A general interpretation of levels for emergency medicine is below: Level 1: The resident demonstrates milestones expected of an incoming resident. Level 2: The resident is advancing and demonstrates additional milestones, but is not yet performing at a mid-residency level. Level 3: The resident continues to advance and demonstrate additional milestones; the resident demonstrates the majority of milestones targeted for residency in this sub-competency. Level 4: The resident has advanced so that he or she now substantially demonstrates the milestones targeted for residency. Level 5: The resident has advanced beyond performance targets set for residency and is demonstrating “aspirational” goals which might describe the performance of someone who has been in practice for several years. Answers to Frequently Asked Questions about Milestones are available on the Milestones web page: http://www. For each reporting period, a resident’s performance on the milestones for each sub-competency will be indicated by:  selecting the level of milestones that best describes the resident’s performance in relation to the milestones or  selecting the “Has not Achieved Level 1” response option Selecting a response box in the middle of a Selecting a response box on the line in between levels level implies that milestones in that level and indicates that milestones in lower levels have been in lower levels have been substantially substantially demonstrated as well as some milestones demonstrated. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. Has not Achieved Level 1 Level 2 Level 3 Level 4 Level 5 Level 1 Knows the different Applies medical knowledge Considers array of drug Selects the appropriate Participates in developing classifications of pharmacologic for selection of therapy for treatment. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. Has not Achieved Level 1 Level 2 Level 3 Level 4 Level 5 Level 1 Identifies pertinent Performs patient assessment, Determines a backup Performs indicated Teaches procedural anatomy and physiology obtains informed consent and strategy if initial attempts procedures on any patients competency and corrects for a specific procedure ensures monitoring equipment is to perform a procedure are with challenging features mistakes in place in accordance with unsuccessful (e. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. Has not Achieved Level 1 Level 2 Level 3 Level 4 Level 5 Level 1 Discusses with the patient Knows the indications, Knows the indications, Performs procedural Develops pain indications, contraindications contraindications, contraindications, potential sedation providing management and possible complications of potential complications complications and appropriate doses effective sedation protocols/care plans local anesthesia and appropriate doses of of medications used for procedural with the least risk of analgesic/sedative sedation complications and Performs local anesthesia using medications minimal recovery time appropriate doses of local Performs patient assessment and through selective anesthetic and appropriate Knows the anatomic discusses with the patient the most dosing, route and technique to provide skin to landmarks, indications, appropriate analgesic/sedative choice of medications sub-dermal anesthesia for contraindications, medication and administers in the procedures potential complications most appropriate dose and route and appropriate doses of local anesthetics used for Performs pre-sedation assessment, regional anesthesia obtains informed consent and orders appropriate choice and dose of medications for procedural sedation Obtains informed consent and correctly performs regional anesthesia Ensures appropriate monitoring of patients during procedural sedation Comments: Suggested Evaluation Methods: Procedural competency forms, checklist assessment of procedure and simulation lab performance, global ratings, patient survey, chart review Copyright (c) 2012 The Accreditation Council for Graduate Medical Education and The American Board of Emergency Medicine. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. Has not Achieved Level 1 Level 2 Level 3 Level 4 Level 5 Level 1 Prepares a simple wound for Uses medical terminology Performs complex wound Achieves hemostasis in a Performs advanced wound suturing (identify appropriate to clearly describe/classify repairs (deep sutures, bleeding wound using repairs, such as tendon suture material, anesthetize a wound (e. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. Has not Achieved Level 1 Level 2 Level 3 Level 4 Level 5 Level 1 Performs a venipuncture Describes the indications, Inserts a central venous Successfully performs 20 Teaches advanced vascular contraindications, anticipated catheter without central venous lines access techniques Places a peripheral undesirable outcomes and ultrasound when intravenous line complications for the various appropriate Routinely gains venous vascular access modalities access in patients with Performs an arterial Places an ultrasound difficult vascular access puncture Inserts an arterial catheter guided deep vein catheter (e. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes. Has not Achieved Level 1 Level 2 Level 3 Level 4 Level 5 Level 1 Adheres to standards for Routinely uses basic patient Describes patient safety Participates in an Uses analytical tools to maintenance of a safe safety practices, such as time- concepts institutional process assess healthcare quality working environment outs and ‘calls for help’ improvement plan to and safety and reassess Employs processes (e. The copyright owners grant third parties the right to use the Emergency Medicine Milestones on a non-exclusive basis for educational purposes.

order 2mg estrace

People suffering from chronic illnesses such as asthma estrace 1mg with amex, diabetes 2mg estrace otc, or epilepsy would be severely affected with many dying (especially insulin-dependent diabetics). There would be no anaesthetic agents resulting in return to tortuous surgical procedures with the patient awake or if they were lucky drunk or stoned. The same would apply to painkillers; a broken leg would be agony, and dying of cancer would be distressing for the patient and their family. Without reliable oral contraceptives or condoms the pregnancy rate would rise and with it the maternal and neonatal death rates, women would die during pregnancy and delivery again, and premature babies would die. Women would still seek abortions, and without proper instruments or antibiotics death from septic abortion would be common again. In the absence of proper dental care teeth would rot, and painful extractions would have to be performed. Our definition is: "The practice of medicine in an environment or situation where standard medical care and facilities are unavailable, often by persons with no formal medical training". This includes medical care while trekking in third world countries, deep-water ocean sailing, isolated tramping and trekking, and following a large natural disaster or other catastrophe. The basic assumption is that trained doctors and hospital care will be unavailable for a prolonged period of time, and that in addition to providing first aid - definitive medical care and rehabilitation (if required) will need to be provided. Austere medicine is the provision of medical care without access to modern investigations or technology. As is the case with any aspects of preparedness you need to decide what you are preparing for and plan accordingly. For some it will only be a 72-hour crisis, for others it will be a major long-term event, and for yet others a multiple generation scenario. Your medical preparations will need to reflect your own risk assessments in terms of what knowledge and skills you develop and what supplies/equipment/medicines you store. This book is more slanted towards preparation for medium to longer term disasters. A recent Internet survey asking about medical risk assessments in a major disaster came up with the following results: “What do you see as the most likely common source of medical problems? Battlefield injuries 5 % Lack of surgical care 36 % Environmental related 8 % Infectious disease (naturally occurring) 64 % Infectious disease (biological warfare) 20 % Nuclear conflict (radiation, blast, burns) 4 % ” (Frugal’s forum 1/04 with permission. However, regardless of whatever the initial triggering event after the initial wave of injuries or illness associated with it the majority of medical problems that happen will be common, and mundane, and not nearly as interesting as the above survey results suggests. The record keeping was a bit unreliable at times, but the following summary is reasonably accurate. Abdominal pain (2 confirmed acute appendix + 1 gangrenous gall bladder; no cause found. Morphine The above gives you a variety of insights into what medical problems might occur and what medications are likely to be required. You should - 11 - Survival and Austere Medicine: An Introduction focus on dealing with the common problems, and doing common procedures well, and you will save lives, and improve the quality of people’s lives. While major trauma and surgical emergencies occur – they are reassuringly not that common. To deal with these will require additional knowledge and resources over and above what is require to safely manage 95% of common medical problems. Perhaps the single most important piece of advice in this book: While the focus of this book is on practicing medicine in an austere environment it does not address one key area which must be considered as part of your preparations: That is optimising your health prior to any disaster; losing weight, keeping fit, maintaining a healthy diet, and managing any chronic health problem aggressively. This is well covered in 100s of books about getting fit and staying healthy, but if you do not take some action in this regard all of your other preparations may be in vain when you drop dead of a heart attack from the stress of it all. Then try and learn as much anatomy and physiology as possible –A & P are the building blocks of medicine. Once you understand how the body is put together and how it works you are in a much better position to understand disease and injury and apply appropriate treatments. Then you should try and obtain some more advanced medical education and practical experience. There is no syllabus that we can list that will tell you what you need to know to cover every eventuality. Ultimately what you need to be able to do is: “Know how to perform a basic assessment, established a rough working diagnosis, and know where to look to find further information about what to do next. Anyone with a bit of intelligence, a good A&P book, and a good basic medical text can easily learn the basics. The ideal is a trained health care professional and anything else is taking risks, but in a survival situation any informed medical care is better than no medical care. Formal training Professional medical training: The ideal option is undertaking college study in a medical area e.

purchase 2 mg estrace otc

Accessing and utilizing effective estrace 2mg, when appropriate generic estrace 1mg with visa, information resources to help develop an appropriate and timely therapeutic plan. Explaining the extent to which the therapeutic plan is based on pathophysiologic reasoning and scientific evidence of effectiveness. Beginning to estimate the probability that a therapeutic plan will produce the desired outcome. Counseling patients about how to take their medications and what to expect when doing so, including beneficial outcomes and potential adverse effects. Recognizing when to seek consultation for additional diagnostic and therapeutic recommendations. Recognizing when to screen for certain conditions based on age and risk factors and what to do with the results of the screening tests. Demonstrate commitment to using risk-benefit, cost-benefit, and evidence- based consideration in the selection of therapeutic interventions. Demonstrate ongoing commitment to self-directed learning regarding therapeutic interventions. Seek feedback regularly regarding therapeutic decision making and respond appropriately and productively. Incorporate the patient in therapeutic decision making, explaining the risks and benefits of treatment. Respect patients’ autonomy and informed choices, including the right to refuse treatment. Demonstrate an understanding of the importance of close follow-up of patients under active care. Recognize the importance of and demonstrate a commitment to the utilization of other health care professionals in therapeutic decision making. During the internal medicine core clerkship, the student can put into practice some of the ethical principles learned in the preclinical years, especially by participating in discussions of informed consent and advance directives. Additionally, the student learns to recognize ethical dilemmas and respect different perceptions of health, illness, and health care held by patients of various religious and cultural backgrounds. Basic ethical principles (autonomy, beneficence, nonmaleficence, truth- telling, confidentiality, and autonomy). The role of the physician in making decisions about the use of expensive or controversial tests and treatments. Circumstances when it may be unavoidable or acceptable to breach the basic ethical principles. Participating in a preceptor’s discussion with a patient about a requested treatment that may not be considered appropriate (e. Participating in family and interdisciplinary team conferences discussing end- of-life care and incorporating the patient’s wishes in that discussion. Recognize the importance of patient preferences, perspectives, and perceptions regarding health and illness. Demonstrate a commitment to caring for all patients, regardless of the medical diagnosis, gender, race, socioeconomic status, intellect/level of education, religion, political affiliation, sexual orientation, ability to pay, or cultural background. Recognize the importance of allowing terminally ill patients to die with comfort and dignity when that is consistent with the wishes of the patient and/or the patient’s family. Recognize the potential conflicts between patient expectations and medically appropriate care. Therefore, they must master and practice self- directed life-long learning, including the ability to access and utilize information systems and resources efficiently. Key sources for obtaining updated information on issues relevant to the medical management of adult patients. Key questions to ask when critically appraising articles on diagnostic tests: • Was there an independent, blind comparison with a reference (“gold”) standard? Key questions to ask when critically appraising articles on medical therapeutics: • Was the assignment of patients to treatments randomized? Performing a computerized literature search to find articles pertinent to a focused clinical question. Summarizing and presenting to colleagues what was learned from consulting the medical literature. Recognize the value and limitations of other health care professionals when confronted with a knowledge gap. Appropriate care by internists includes not only recognition and treatment of disease but also the routine incorporation of the principles of preventive health care into clinical practice. All physicians should be familiar with the principles of preventive health care to ensure their patients receive appropriate preventive services. Criteria for determining whether or not a screening test should be incorporated into the periodic health assessment of adults. General types of preventive health care issues that should be addressed on a routine basis in adult patients (i. Methods for counseling patients about risk-factor modification, including the “stages of change” approach to helping patients change behavior. General categories of high-risk patients in whom routine preventative health care must be modified or enhanced (e.

The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government purchase estrace 2 mg amex. Functioning in accordance with general policies determined by the Academy buy cheap estrace 1 mg online, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientifc and engineering communities. The Coun- cil is administered jointly by both Academies and the Institute of Medicine. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Palmer Beasley (Chair), Ashbel Smith Professor and Dean Emeritus, University of Texas, School of Public Health, Houston, Texas Harvey J. Alter, Chief, Infectious Diseases Section, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland Margaret L. Brandeau, Professor, Department of Management Science and Engineering, Stanford University, Stanford, California Daniel R. Church, Epidemiologist and Adult Viral Hepatitis Coordinator, Bureau of Infectious Disease Prevention, Response, and Services, Massachusetts Department of Health, Jamaica Plain, Massachusetts Alison A. Maroushek, Staff Pediatrician, Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota Randall R. McMahon, Medical Director, Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, Alaska Martín Jose Sepúlveda, Vice President, Integrated Health Services, International Business Machines Corporation, Somers, New York Samuel So, Lui Hac Minh Professor, Asian Liver Center, Stanford University School of Medicine, Stanford, California David L. Thomas, Chief, Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland Lester N. Wright, Deputy Commissioner and Chief Medical Offcer, New York Department of Correctional Services, Albany, New York Study Staff Abigail E. McGraw, Senior Program Assistant Norman Grossblatt, Senior Editor Rose Marie Martinez, Director, Board on Population Health and Public Health Practice v Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The purpose of this independent review is to provide candid and critical comments that will assist the institution in mak- ing its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confdential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Scott Allen, Brown University Medical School Jeffrey Caballero, Association of Asian Pacifc Community Health Organizations Colleen Flanigan, New York State Department of Health James Jerry Gibson, South Carolina Department of Health and Environmental Control Fernando A. Guerra, San Antonio Metropolitan Health District Theodore Hammett, Abt Associates Inc. Jay Hoofnagle, National Institute of Diabetes and Digestive and Kidney Diseases Charles D. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Wong, Tufts Medical Center Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the fnal draft of the report before its release. Appointed by the Institute of Medicine and the National Research Council, they were responsible for making cer- tain that an independent examination of the report was carried out in ac- cordance with institutional procedures and that all review comments were carefully considered. Responsibility for the fnal content of the report rests entirely with the author committee and the institution. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. We are also grateful for the thoughtful written and verbal testimony provided by members of the public affected by hepatitis B or hepatitis C. This report would not have been possible without the diligent assistance of Jeffrey Efrd and Daniel Riedford, of the Centers for Disease Control and ix Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. We appreciate the assistance of Ronald valdiserri, of the De- partment of Veterans Affairs, for providing literature for the report. The committee thanks the staff members of the Institute of Medicine, the National Research Council, and the National Academies Press who contributed to the development, production, and dissemination of this report. The committee thanks the study director, Abigail Mitchell, and program offcer Heather Colvin for their work in navigating this complex topic and Kathleen McGraw for her diligent management of the committee logistics. This report was made possible by the support of the Division of Viral Hepatitis and Division of Cancer Prevention and Control of the Centers for Disease Control and Prevention, the Department of Health and Human Services Offce of Minority Health, the Department of Veterans Affairs, and the National Viral Hepatitis Roundtable. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www.

Estrace
8 of 10 - Review by L. Steve
Votes: 214 votes
Total customer reviews: 214