Therefore order aleve 500 mg without a prescription pain treatment center nashville tn, take the tops of elder and grind them and buy aleve 250 mg line treatment for pain with shingles, having extracted the juice cheap aleve 250mg with amex shingles and treatment for pain, mix with barley ﬂour and with the white of an egg buy aleve 250mg free shipping pain treatment center west hartford ct, and then make little wafers with suet for eating. On the Preservation of Celibate Women and Widows  There are some women to whom carnal intercourse is not permitted, sometimes because they are bound by a vow, sometimes because they are bound by religion, sometimes because they are widows, because to some women it is not permitted to take fruitful vows. Take some cotton and musk or penny- royal oil and anoint it and put it in the vagina. And if you do not have such an oil, take trifera magna6 and dissolve it in a little warm wine, and with cotton or damp wool place it in the vagina. Note that a pessary ought not be made lest the womb be damaged, for the mouth of the womb is joined to the vagina, like the lips to the mouth, unless, of course, conception occurs, for then the womb withdraws. But because some women are fat, as though they had dropsy, and some women thin, both the former and the latter are incapable of conceiving. If she is phlegmatic and fat,7 we should make her a bath of seawater, moderately salty, with rainwater. In this bath she should stay until she sweats suﬃciently; afterward let her be received in bed carefully and let her be well covered. Thus let there be made for her a bath three or four times that day, and likewise the following day. On the third day, let there be a very good, strong-smelling fumigation, as we described above. Queh postquam satis sudauerit, abluat se cum aqua pri[ra]oris balnei, et sic cautei intret lectum, et hocj ﬁat bis uel ter uel quater in ebdomada, et satis gracilis inuenitur. Facimus eis sepulcruma iuxta litusb maris in harena, et modo dicto illiniesc eos, et cum calor est fortissimus, quasid in sepulcro ponimus, quasi infundendo harenam calidam, et ibi facimus eos multum sudare, et post cum aqua priorise balnei optimef lauamus. Ponamusc patientem in lintheamine et faciamus tenere a quatuor fortibus ho- minibus per quatuor angulos, capited patientis aliquantulume leuato,f huc et illuc ab oppositis angulis fortiter trahere lintheum faciemus,g et statim pariet. Extrahimus succum porri et dis- temperamus cum oleo pulegino uel musceleoc uel succo borraginis, et de- ¶a. Then let her enter a steambath up to the neck, which steambath should be very hot from a ﬁre made of elder [wood], and in it, while she is covered, let her emit a lot of sweat, and as though in a sweat bath let her remain there until she has purged herself a little through the inferior members, and that which comes out will be rather greenish. After she has thoroughly sweated, let her wash herself with the water of the previous bath, and thus let her cautiously enter her bed. And let this be done twice or three times or four times a week, and she will be found to be suﬃciently thin. We make for them a grave next to the shore of the sea in the sand, and in the described manner you will anoint them, and when the heat is very great we place them halfway into the grave, halfway covered with hot sand poured over. On Extracting the Dead Fetus  Those who labor excessively in giving birth to a dead fetus we assist thus. Let us place the patient on a linen sheet and let us have it held by four strong men at the four corners, the head of the patient a little bit elevated. We will make the sheet be pulled strongly this way and that at the opposite corners, and immediately she will give birth. On Retention of the Afterbirth  There are some women to whom the afterbirth remains inside after birth, to whom we give aid for its expulsion thus. Extrahamusb succum arthimesie, saluie, pulegii, per- siccarie, et aliarum herbarum huiusmodi, et faciamusc crispellas et demusd ad comedendum, et collocemuse eas frequenterf in balneis,g et predicto modo ad restringendumh sanguinem subuenimus. Et si ﬂuxerit sanguis per nares, de hoc em- plaustro ponimus superd frontem et timpora, [va] ex transuerso timporae et frontemf attingendo. Matrici uinum calidum ponimusi in quo butyrum bullierit, et diligenter fomentamus quousque matrix eﬃciturj mollis, et tunc suauiter reponimus;k post modum rupturaml interm anum et uuluam tribus locis uel quatuor suimus cum ﬁlo serico. Et rupturam sanamus cum puluere facto de simphito, id esto de consolida maiori et minori,p13 et cimino. Nevertheless, the juice itself has such a power that it is suﬃcient for expulsion. On Excessive Flow of Blood After Birth  There are other women who after birth have an immoderate ﬂow of blood, to whom we give aid thus. Let us extract the juice of mugwort, sage, pennyroyal, willow-weed, and other herbs of this kind, and let us make little wafers and we give them to eat. And let us place them frequently in baths, and in the above-mentioned manner we aid them in order to restrain the blood. And if the blood ﬂows through the nose, we place some of this plaster on the forehead and the temples, stretching sideways across the temples and the forehead. On the Dangerous Things Happening to Women Giving Birth  There are some women for whom things go wrong in giving birth, and this is because of the failure of those assisting them: that is to say, this is kept hidden by the women. We put on the womb warm wine in which butter has been boiled, and diligently we foment it until the womb has been rendered soft, and then we gently replace it. Afterward we sew the rupture between the anus and the vagina in three or four places with a silk thread. And we heal the rupture with a powder made of comfrey, that is, of bruisewort, and daisy12 and cumin. The powder ought to be sprinkled [on the wound], and the woman should be placed in bed so that her feet are higher [than the rest of her body], lecto] om. Decet etiam abstinere ab omnibus quew tussim faciunt etx indigestibilibus, et maxime hoc faciendum est. Et si picem non habeamus, accipimuse pannum et iniungimus oleo [ra] calido puleginof uel muscelino, et inprimimus et illi- nimus uelg inponimush uulue, et ligamus quousque matrix recesseriti perseet calefacta fuerit. Vnde contingit quod Trotulab15 uocata fuitc quasi magistra operis16 cum quedam puella debuit incidid proptere huiusmodi uen- tositatem quasi ex ruptura laborasset, et admirata fuit quamplurimum. Fecit ergo eam uenire in domum suam ut in secretof cognosceret causam egritudi- nis, quag cognita quod non esset dolor ex ruptura uel inﬂatione matricis17 sed ex uentositate comparuit,h18 fecit itaque ei ﬁerii balneum in quo cocte fuerunt maluaj et peritaria et eam intromisit, et eas partes frequenter et satis plane trac- tauit molliﬁcando, et diu [rb] fecit eam in balneo morari, et post eius exitum, fecit ei emplaustrumk de succo rapistri et farina ordei, et totum talel ad ipsamm ¶a. On Treatments for Women and there let her do all her business for eight or nine days. And as much as nec- essary let her eat; there let her relieve herself and do all customary things. It is necessary that she abstain from baths until she seems to be able to tolerate them. Also, it is ﬁtting that she abstain from all things that cause coughing and from all things that are hard to digest, and this especially ought to be done. Let a cloth be prepared in the shape of an oblong ball and place it in the anus, so that in each eﬀort of push- ing out the child, it is to be pressed into the anus ﬁrmly so that there not be [another] solution of continuity of this kind. On the Entry of Wind into the Womb  There are some women who take in wind through the vagina, which, having been taken into the right or left part of the womb, generates so much windiness that they seem to be suﬀering from a rupture or intestinal problem. Therefore, she made her come to her own house so that in secret she might de- termine the cause of the disease. Whereupon, she recognized that the pain was not from rupture or inﬂation of the womb but from windiness. And so she saw to it that there be made for her a bath in which marsh mallow and pellitory- of-the-wall were cooked, and she put her into it. And she massaged her limbs frequently and smoothly, softening them, and for a long time she made her re- main in the bath. And after her exit, she made for her a plaster of the juice of wild radish and barley ﬂour, and she applied to her the whole thing somewhat De Curis Mulierum uentositatem consumendam aliquantulum calidum apposuit,n et iterum in bal- neo predicto insistere fecit, et sic curata remansit. Primo fomentemus patientem cum decoctione uini, in quo bullierit absinthium, et cum hac decoctioneb fomentemusc anum, et bened liniamus per totum cum incausto ad restringendum. Post factum cinerem de salice et radice eius et arista alicuius piscis salsi, superaspergimuse et reponamus anum cum panno lineo. Cum adhuc est tepidum, linum uelg lanam uel bombacem in eo intinge et ano inpone;h idi mitigat dolorem et inﬂationem anij aufert. Post pistamus cum sagiminee calido uel butyro sine sale uel oleo, et super ignem apponimus, et calidum super folium caulisf et super pannum lineumg positum, membrumh uirile circumdamus. Deinde prepucio euerso, cum aqua calida lauamus collum prepucii ulcerosum uel uulnerosum et puluerem de pice greca et cariej lignorum uel uermium et rosa et radice tapsi barbati et mirtillisk superasperge. Et si mirtil- lisl care[vb]as, ista quatuor suﬃciant, et sic ﬁat bis uel term singulisn diebus donec sanetur.
Recognize the importance of patient preferences when selecting among diagnostic options for common cancers aleve 250mg free shipping pain & depression treatment. Demonstrate ongoing commitment to self-directed learning regarding common cancers aleve 500 mg online pain treatment center london ky. Appreciate the impact common cancers have on a patient’s quality of life effective 500mg aleve advanced pain treatment center ky, well-being purchase aleve 500mg on-line pain treatment a historical overview, ability to work, and the family. Recognize the importance of and demonstrate a commitment to the utilization of other healthcare professions in the workup and treatment of common cancers. Cigarette smoking plays a major role in the progression of the disease, with survival rates lower among patients who continue to smoke cigarettes. The severity and debilitation of these disorders make them an important training problem for all third year medical students. The etiology, pathogenesis, evaluation, and management of hypoxemia and hypercapnia. The genetics and role of alpha-1 antitrypsin deficiency in some patients with emphysema. The epidemiology, risk factors, symptoms, signs, and typical clinical course of asthma. History-taking skills: Students should be able to obtain, document, and present an age-appropriate medical history, that differentiates among etiologies of disease including: • Existence, duration, and severity of dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, sputum production, wheezing, fever, chills, sweats, chest pain, hemoptysis. Physical exam skills: Students should be able to perform a physical exam to establish the diagnosis and severity of disease including: • Accurately determining respiratory rate and level of respiratory distress. Differential diagnosis: Students should be able to generate a prioritized differential diagnosis recognizing specific history and physical exam findings that suggest a diagnosis of chronic bronchitis, emphysema, asthma, or other conditions with similar findings. Laboratory interpretation: Students should be able to recommend when to order diagnostic and laboratory tests and be able to interpret them, both prior to and after initiating treatment based on the differential diagnosis, including consideration of test cost and performance characteristics as well as patient preferences. Laboratory and diagnostic tests should include, when appropriate: • Pulse oximitry. Communication skills: Students should be able to: • Communicate the diagnosis, treatment plan, and subsequent follow-up to the patient and his or her family. Management skills: Students should able to develop an appropriate evaluation and treatment plan for patients that includes: • The use of bronchodilators and inhaled corticosteroids. Appreciate the impact of working, living, and environmental conditions on the development and progression of respiratory tract disease; demonstrate understanding that patients are often unable to change these factors on their own. It is estimated that five to nine percent of American adults are diabetic with the illness appearing at earlier ages in some populations. All internists must identify those at risk and institute appropriate management to ameliorate the potentially fatal complications of this illness. Non-pharmacologic and pharmacologic (drugs and side effects) treatment of diabetes mellitus to maintain acceptable levels of glycemic control, prevent target organ disease, and other associated complications. Basic management of diabetic ketoacidosis and nonketotic hyperglycemic states, including the similarities and differences in fluid and electrolyte replacement. The Somogyi effect and the Dawn phenomenon and the implications of each in diabetes pharmacologic management. History-taking skills: Students should be able to obtain, document, and present an age-appropriate medical history, that differentiates among etiologies of disease, including: • Weight changes. Physical exam skills: Students should be able to perform a physical exam to establish the diagnosis and severity of disease, including: • Skin examination for diabetic dermopathy, furuncles/carbuncles, candidiasis, necrobiosis lipoidica diabeticorum, dermatophytosis, and acanthosis nigricans. Differential diagnosis: Students should be able to generate a prioritized differential diagnosis recognizing specific history and physical exam findings that suggest a specific etiology for: • Hyperglycemia. Communication skills: Students should be able to: • Communicate the diagnosis, treatment plan, and subsequent follow-up to patients. Basic and advanced procedural skills: Students should be able to: • Finger-stick capillary blood glucose determination. Demonstrate commitment to using risk-benefit, cost-benefit, and evidence- based considerations in the selection diagnostic and therapeutic interventions for diabetes mellitus. Recognize the importance of patient preferences when selecting among diagnostic and therapeutic options for diabetes mellitus. Respond appropriately to patients who are nonadherent to treatment for diabetes mellitus. Demonstrate ongoing commitment to self-directed learning regarding diabetes mellitus. Appreciate the impact diabetes mellitus has on a patient’s quality of life, well- being, ability to work, and the family. Recognize the importance of and demonstrate a commitment to the utilization of other healthcare professionals in the treatment of diabetes mellitus. The effect of intensive treatment of diabetes on the development and progression of long- term complications in insulin-dependent diabetes mellitus. Its pathophysiology is increasingly understood, diagnostic tests are readily available, and treatment modalities range from diet and exercise to a multitude of pharmacotherapies. Competency in the evaluation and management of this problem helps develop skills in rational test selection, patient education, and design of cost-effective treatment strategies. It also draws attention to the importance of community health education and nutrition. The basic principles of the role of genetics in dyslipidemia, particularly familial combined hyperlipidemia. Basic management of the common dyslipidemias, including diet, fiber, exercise, and risk/benefits/cost of drug therapy (statins, fibrates, ezetimide, nicotinic acid, resins). History-taking skills: Students should be able to obtain, document, and present an age-appropriate medical history, that differentiates among etiologies of disease including: • Prior patient or family history of dyslipidemia. Physical exam skills: Students should be able to perform a physical exam to establish the diagnosis and severity of disease, including: • Blood pressure elevation. Differential diagnosis: Students should be able to generate a prioritized differential diagnosis recognizing specific history and physical exam findings that suggest primary or secondary causes of dyslipidemia. Laboratory interpretation: Students should be able to recommend when to order diagnostic and laboratory tests and be able to interpret them, both prior to and after initiating treatment based on the differential diagnosis, including consideration of test cost and performance characteristics as well as patient preferences. Laboratory and diagnostic tests should include, when appropriate: • Fasting lipid profile. Communication skills: Students should be able to: • Communicate the diagnosis, treatment plan, and subsequent follow-up to patients. Appreciate the importance of encouraging patients to assume responsibility for modifying their diet and increasing their exercise level. Appreciate the difficulties and frustrations that patients and health care providers face with recommended dietary changes. Demonstrate commitment to using risk-benefit, cost-benefit, and evidence- based considerations in the selection diagnostic and therapeutic interventions for dyslipidemia. Recognize the importance of patient preferences when selecting among diagnostic and therapeutic options for dyslipidemia. Respond appropriately to patients who are nonadherent to treatment for dyslipidemia. Recognize the importance of and demonstrate a commitment to the utilization of other healthcare professionals in the treatment of dyslipidemia. Compensatory mechanisms of heart failure including cardiac remodeling and activation of endogenous neurohormonal systems. Role of critical pathways or practice guidelines in delivering high-quality, cost effective care for patients presenting with new or recurrent heart failure. History-taking skills: Students should be able to obtain, document, and present an age-appropriate medical history, including: • Differentiating between various etiologies of heart failure (answers the question: Why is the patient in heart failure?
A partial list of ● “Information breakage” despite return to original setting/ such complexities is shown in Table 3 order aleve 250 mg with mastercard treatment for shingles pain and itching. What coproduction of diagnosis really should mean —What follow-up surveillance is required and how to is that the patient is a partner in thinking through and testing interpret results the diagnostic hypothesis and has various important roles to ● Diagnosis of cure or failure to respond play discount aleve 500 mg myofascial pain treatment center boston, some of which are described below discount aleve 500 mg on-line treatment for pain caused by shingles. Building dialogue into the clinical diagnostic process buy cheap aleve 500 mg online heel pain treatment plantar fasciitis, Should I, as the physician of each of the actual patients whereby the patient tells the practitioner how he/she is cited above, have “taken a better history” and uncovered doing, represents an important premise. Each level, doing so demonstrates a degree of caring that extends emerged only through subsequent follow-up. It have asked more detailed probing questions during my ﬁrst is impossible to exaggerate the amazement and appreciation encounter with the patient? Shouldn’t I have asked fol- of my patients when I call to ask how they are doing a day low-up questions during the initial encounter that more or a week after an appointment to follow up on a clinical actively explored my differential diagnosis based on (what problem (as opposed to them calling me to complain that ideally should be) my extensive knowledge of various dis- they are not improving! The old tools—ad hoc Carefully reﬁned signals from downstream feedback repre- fortuitous feedback, individual idiosyncratic systems to track sent an important antidote to a well-known cognitive bias, patients, reliance on human memory, and patient adherence to anchoring, i. For experience, an uphill battle at best, lack the power to provide example, upon learning that a patient with a headache that the intelligence needed to inform learning organizations. What was initially dismissed as benign was found to have a brain is needed instead is a systematic approach, one that fully tumor, the physician works up all subsequent headache involves patients and possesses an infrastructure this is hard patients with imaging studies, even those with trivial histo- wired to capture and learn from patient outcomes. Thus, potentially useful feedback on the patient with a than such a linking of disease natural history to learning orga- missed brain tumor is given undue weight, thereby biasing nizations poised to hear and learn from patient experiences and future decisions and failing to properly account for the rarity physician practices will sufﬁce. Edwards Deming came Division of General Medicine into a factory, one of the ﬁrst ways he improved quality was Brigham and Women’s Hospital to stop the well-intentioned workers from “tampering,” i. As he dramatically showed with his classic funnel the sponsor of this supplement article or products discussed experiment, in which subjects dropped marbles through a in this article: funnel over a bull’s-eye target, the more the subject at- Gordon D. By overreacting to this random variation each time the target was missed, the subjects 1. Diagnosing diagnostic errors: If each time a physician’s discovery that his/her diagnos- lessons from a multi-institutional collaborative project. Overconﬁdence as a cause of diagnostic error in diagnosis, he/she vowed never to order so many tests, our medicine. Learning from malpractice claims about negligent, adverse events in diagnostic decision making is perhaps doing more harm primary care in the United States. It suggests a critical need to noses in the ambulatory setting: a study of closed malpractice claims. Judgment under uncertainty: heuristics and emperor’s clothes provide illusory court comfort. The pull system mystery explained: drum, buffer and Presented at: Annual Meeting of the Healthcare Management Di- rope with a computer. From the historical perspective, there is substan- many of these strategies show potential, the pathway to ac- tial good news: medical diagnosis is more accurate and complish their goals is not clear. Advances in the medical sciences enable has been done while in others the results are mixed. Innovation in have easy ways to track diagnostic errors; no organizations are the imaging and laboratory sciences provides reliable new ready or interested to compile the data even if we did. More- tests to identify these entities and distinguish one from over, we are uncertain how to spark improvements and align 1 another. It is perfectly ap- on overconﬁdence as a pivotal issue in an effort to engage propriate to marvel at these accomplishments and be thank- providers to participate in error-reducing strategies, this is just ful for the miracles of medical science. My goal in this commentary is nized discussion of what the goal should be in terms of to survey a range of approaches with the hope of stimulating diagnostic accuracy or timeliness and no established process discussion about their feasibility and likelihood of success. In This requires identifying all of the stakeholders interested in the history of medicine, progress toward improving medical diagnostic errors. Besides the physician, who obviously is at diagnosis seems to have been mostly a passive haphazard the center of the issue, many other entities potentially in- affair. Every day and are healthcare organizations, which bear a clear responsi- in every country, patients are diagnosed with conditions bility for ensuring accurate and timely diagnosis. Further- ful, however, that physicians and their healthcare organiza- more, patients are subjected to tests they don’t need; alter- tions alone can succeed in addressing this problem. Despite our best intentions to make diag- the help of another key stakeholder—the patient, who is nosis accurate and timely, we don’t always succeed. Patients are Our medical profession needs to consider how we can in fact much more than that. Goals that funding agencies, patient safety organizations, over- should be set, performance should be monitored, and sight groups, and the media can play to assist in the overall progress expected. The authors in this supplement to The American these parties, based on our current—albeit incomplete and untested— understanding of diagnostic error (Table 1). Statement of Author Disclosure: Please see the Author Disclosures section at the end of this article. Healthcare leaders need to expand their concept of prove both the speciﬁcity and sensitivity of cancer detection 4 patient safety to include responsibility for diagnostic errors, more than an independent reading by a second radiologist. These resources have substantial poten- aspects of diagnostic error can to some extent be mitigated 5 tial to improve clinical decision making, and their impact by interventions at the system level. Leaders of healthcare will increase as they become more accessible, more sophis- organizations should consider these steps to help reduce ticated, and better integrated into the everyday process of diagnostic error. System-related Suggestions Have Appropriate Clinical Expertise Available When Ensure That Diagnostic Tests Are Done on a Timely It’s Needed. Don’t allow front-line clinicians to read and Basis and That Results Are Communicated to Providers interpret x-rays. Encourage inter- “Morbidity and Mortality (M & M) Rounds on the Web” personal communication among staff via telephone, e-mail, sponsored by the Agency for Healthcare Research and and instant messaging. Establish pathways for physicians who to communicate information verbally and electronically saw the patient earlier to learn that the diagnosis has across all sites of care. Ensure medical prevent, detect, and mollify many system-based as well as records are consistently available and reviewed. Strive to cognitive factors that detract from timely and accurate di- make diagnostic services available on weekend/night/holi- agnosis. Minimize distractions and production pressures help reduce the likelihood of error. For patients to act so that staff have enough time to think about what they are effectively in this capacity, however, requires that physi- doing. Minimize errors related to sleep deprivation by at- cians orient them appropriately and reformulate, to some tention to work hour limits, and allowing staff naps if extent, certain aspects of the traditional relationship be- needed. Two new roles for patients to help reduce the chances for diagnostic error are proposed below. Take advantage of sugges- tions from the human-factors literature on how to improve Be Watchdogs for Cognitive Errors the detection of abnormal results. For example, graphic Traditionally, physicians share their initial impressions with displays that show trends make it more likely that clinicians a new patient, but only to a limited extent. Sometimes the will detect abnormalities compared with single reports or tab- suspected diagnosis isn’t explicitly mentioned, and the pa- ulated lists; use of these tools could allow more timely appre- tient is simply told what tests to have done or what treat- ciation of such matters as falling hematocrits or progressively ment will be used. Computer-aided per- checking for cognitive errors if they were given more in- ception might help reduce diagnostic errors (e. Controlled tri- its probability, and instructions on what to expect if this is als have shown that use of a computer algorithm can im- correct. They should be told what to watch for in the Graber A Safer Future: Measures for Timely Accurate Medical Diagnosis S45 Table 1 Recommendations to reduce diagnostic errors in medicine: stakeholders and their roles Direct and Major Role Physicians ● Improve clinical reasoning skills and metacognition ● Practice reﬂectively and insist on feedback to improve calibration ● Use your team and consultants, but avoid groupthink ● Encourage second opinions ● Avoid system ﬂaws that contribute to error ● Involve the patient and insist on follow-up ● Specialize ● Take advantage of decison-support resources Healthcare organizations ● Promote a culture of safety ● Address common system ﬂaws that enable mistakes —Lost tests —Unavailable experts —Communication barriers —Weak coordination of care ● Provide cognitive aids and decision support resources ● Encourage consultation and second opinions ● Develop ways to allow effective and timely feedback Patients ● Be good historians, accurate record keepers, and good storytellers ● Ask what to expect and how to report deviations ● Ensure receipt of results of all important tests Indirect and Supplemental Role Oversight organizations ● Establish expectations for organizations to promote accurate and timely diagnosis ● Encourage organizations to promote and enhance —Feedback —Availability of expertise —Fail-safe communication of test results Medical media ● Ensure an adequate balance of articles and editorials directed at diagnostic error ● Promote a culture of safety and open discussion of errors and programs that aim to reduce error Funding agencies ● Ensure research portfolio is balanced to include studies on understanding and reducing diagnostic error Patient safety organizations ● Focus attention on diagnostic error ● Bring together stakeholders interested to reduce errors ● Ensure balanced attention to the issue in conferences and media releases Lay media ● Desensationalize medical errors ● Promote an atmosphere that allows dialogue and understanding ● Help educate patients on how to avoid diagnostic error upcoming days, weeks, and months, and when and how to nated, and all medical records would be available and ac- convey any discrepancies to the provider. Until then, the patient can play a valuable role in If there is no clear diagnosis, this too should be con- combating errors related to latent ﬂaws in our healthcare veyed. Patients can and should function as conﬁdence and certainty, but an honest disclosure of uncer- back-ups in this regard. They should always be given their tainty and the probabilistic nature of diagnosis is probably a test results, progress notes, discharge summaries, and lists better approach in the long run.
Hypo- cholesterolemic effects of oat-bran or bean intake for hypercholesterolemic men order aleve 500 mg with amex pain medication for dogs dose. Cholesterol-lowering effects of psyllium hydrophilic mucilloid for hyper- cholesterolemic men buy aleve 250 mg line midsouth pain treatment center germantown tn. Prospective buy aleve 500 mg lowest price pain diagnosis and treatment center tulsa ok, randomized cheap aleve 500mg without a prescription tennova comprehensive pain treatment center, controlled comparison of the effects of low-fat and low-fat plus high-fiber diets on serum lipid concentrations. Cholesterol-lowering effects of psyllium-enriched cereal as an adjunct to a prudent diet in the treatment of mild to moderate hypercholesterolemia. Effects of psyllium on glucose and serum lipid responses in men with type 2 diabetes and hypercholesterolemia. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: Meta-analysis of 8 controlled trials. Long-term cholesterol-lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholester- olemia. Energy, nutrient intake and prostate cancer risk: A population- based case-control study in Sweden. Water supplemen- tation enhances the effect of high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation. Low body mass index in non- meat eaters: The possible roles of animal fat, dietary fibre and alcohol. Improved diabetic control and hypocholesterolaemic effect induced by long- term dietary supplementation with guar gum in type-2 (insulin-independent) diabetes. Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic con- stipation. Dietary fibre added to very low calorie diet reduces hunger and alleviates constipation. Effects of a very low fat, high fiber diet on serum hormones and men- strual function. A randomized controlled trial of low carbohydrate and low fat/high fiber diets for weight loss. Cholesterol-lowering effects of soluble-fiber cereals as part of a prudent diet for patients with mild to moderate hypercholesterolemia. Gastric emptying of a solid meal is accelerated by the removal of dietary fibre naturally present in food. Correla- tion between echographic gastric emptying and appetite: Influence of psyllium. Dietary intake and faecal excretion of carbohydrate by Australians: Importance of achieving stool weights greater than 150 g to improve faecal markers relevant to colon cancer risk. Long term effect of fibre supplement and reduced energy intake on body weight and blood lipids in overweight subjects. Does guar gum improve post-prandial hyperglycaemia in humans by reducing small intestinal contact area? Wheat bread supple- mented with depolymerized guar gum reduces the plasma cholesterol concen- tration in hypercholesterolemic human subjects. Dietary intake by food frequency questionnaire and odds ratios for coronary heart disease risk. Calcium and fibre supplementation in prevention of colorectal adenoma recurrance: A randomised intervention trial. Effect of wheat bran and pectin on bile acid and cholesterol excretion in ileostomy patients. Bouhnik Y, Flourié B, Riottot M, Bisetti N, Gailing M-F, Guibert A, Bornet F, Rambaud J-C. Effects of fructo-oligosaccharides ingestion on fecal bifidobacteria and selected metabolic indexes of colon carcinogenesis in healthy humans. Short-chain fructo-oligosaccharide administra- tion dose-dependently increases fecal bifidobacteria in healthy humans. High β-glucan oat bran and oat gum reduce postprandial blood glucose and insulin in subjects with and without type 2 diabetes. Oat beta-glucan reduces blood cholesterol concentration in hyper- cholesterolemic subjects. Symptomatic response to varying levels of fructo- oligosaccharides consumed occasionally or regularly. Effect of consumption of a ready-to-eat breakfast cereal containing inulin on the intestinal milieu and blood lipids in healthy male volunteers. Iron absorption from bread in humans: Inhibiting effects of cereal fiber, phytate and inositol phosphates with different numbers of phosphate groups. Dietary supplementa- tion of neosugar alters the fecal flora and decreases activities of some reductive enzymes in human subjects. Effect of dietary fibre on stools and transit-times, and its role in the causation of disease. Sustained post-ingestive action of dietary fibre: Effects of a sugar-beet-fibre-supplemented breakfast on satiety. Assessment of the effect of increased dietary fibre intake on bowel function in patients with spinal cord injury. Relationship between the intake of high- fibre foods and energy and the risk of cancer of the large bowel and breast. The effects of grapefruit pectin on patients at risk for coronary heart disease without alter- ing diet or lifestyle. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. Effect of dietary chitosans with different viscosity on plasma lipids and lipid peroxidation in rats fed on a diet enriched with cholesterol. Comparison of diarrhea induced by ingestion of fructooligosaccharide Idolax and disaccharide lactulose (role of osmolarity versus fermentation of malabsorbed carbohydrate). Toxicological evaluation of neosugar: Genotoxicity, carcinogenicity, and chronic toxicity. Coudray C, Bellanger J, Castiglia-Delavaud C, Remesy C, Vermorel M, Rayssignuier Y. Effect of soluble or partly soluble dietary fibres supplementation on absorption and balance of calcium, magnesium, iron and zinc in healthy young men. Fermentation and the production of short-chain fatty acids in the human large intestine. Colonic responses to dietary fibre from carrot, cabbage, apple, bran, and guar gum. Fecal weight, colon cancer risk, and dietary intake of nonstarch polysaccharides (dietary fiber). Digestion and physiological properties of resistant starch in the human large bowel. A case-control study of relationships of diet and other traits to colorectal cancer in American blacks. Long-term effects of consuming foods containing psyllium seed husk on serum lipids in subjects with hypercholesterolemia. Resistant starch decreases serum total cholesterol and triacylglycerol concentrations in rats. Effects of different soluble:insoluble fibre ratios at breakfast on 24-h pattern of dietary intake and satiety. Resistant starch has little effect on appetite, food intake and insulin secretion of healthy young men. A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation. Relation between dietary fiber consumption and fibrinogen and plasminogen activator inhibitor type 1: The National Heart, Lung, and Blood Institute Family Heart Study.