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By T. Frithjof. William Jewell College. 2018.

A stock card is established for each product (drugs and supplies) and updated at each movement cheap 20mg lipitor amex. Stock cards are used to: – identify all stock movements: in and out order 10 mg lipitor free shipping; – determine at any moment the theoretical level of stocks generic lipitor 5 mg free shipping; – follow–up the consumption of different facilities; – correctly plan and prepare orders; – determine losses (differences between theoretical stock and actual stock). The following may also be included: – average monthly consumption; – stock levels: buffer stock, running stock; – other stock areas for a product; – unit price; – current orders and dates. Write a single operation per line, even if several operations take place the same day. Note: stock cards are always equired, even when computer assisted stock management is used. Buffer stock quantities are generally evaluated as half of the consumption during the period between two deliveries. It depends on risks that a programme may run: stock ruptures or drug expiration in specific situations (resources, seasonal supply problems, etc. For example, if the delivery delay is two months, the buffer stock corresponds to the quantity consumed in one month. Two copies are sent to the supplier: one serves as a way bill and may also be used for invoicing, the second stays with the supplier. Example: Health facility order form, 6-month supply period, minimum stock of 3 months (2 month delivery delay + 1 month buffer stock) Health structure: Beboro Head of structure: Jeanne Maritoux, Ph Date: 26. On reception, the number of parcels should be checked, then their contents should be verified: – ensure that products delivered correspond to products ordered, and that the quantities conform to those on the packing list; – packaging, labelling and expiry dates of each product should be checked, as well as the aspect of the product; – look for special storage conditions (cold chain). Way bills, invoices and packing lists are to be classed with orders in an "orders" file and kept for 3 years or more according to current regulations. Stock cards give a theoretical figure of stock quantities, but actual quantities of each product should be verified (physical stock). Distribution – Distribution to health facilities Each health facility sends the central warehouse two copies of the order form. On both copies, actual quantities supplied by the central warehouse are recorded in the “Qty delivered” column. After verifying that all products have been correctly recorded on their respective stock cards, the second copy is placed in a file established for health facility. Put the number of tablets corresponding to a complete treatment and the label into the bag. In busy centres it is better to have two people responsible for dispensing drugs in order to double check prescription deliveries; the first collects the drugs prescribed, the second verifies and gives them to patients with all necessary explanations, slightly away from other patients. So that patients correctly follow treatment, adequate explanations should be given: • how to take the drug, • for how long, • possible adverse effects (e. Persons dispensing drugs should be able to give patients the information they need. Interpreters are needed if several languages exist in the same region Donations of recuperated medicines and medical samples It is not recommended to solicit or accept supplies coming from collections of drugs recuperated from consumers in industrialised countries, or free samples distributed by manufacturers. They are very often specialised drugs unknown to prescribers and unsuitable for local pathologies. The multiplication of different drugs supplied interfere with the implementation of standardised therapeutic regimens and makes any form of management impossible. Quality depends on correct manufacturing and storage: high-quality drugs are available when using rational buying procedures and when suppliers are reliable. Quality standards Each drug is characterised by particular norms written in pharmacopoeia or files presented by manufacturers and recognised by competent authorities in each country. Analysis certificates guarantee that products from one batch (products from the same production cycle) conform to official quality standards in the country of manufacture. Storage conditions Stability of drugs depends on both environmental factors such as temperature, air, light and humidity, and drug-related factors such as the active ingredient itself, the dosage form (tablet, solution, etc. It is therefore necessary to respect storage instructions given in this guide or by manufacturers (on notices and labels) if the recommendations are not identical. Storage temperatures are defined by European pharmacopoeia as follows: freezer - 15 to 0°C refrigerator + 2 to + 8°C cool + 8 to + 15°C ambient temperature + 15 to + 25°C During transit and transportation temperatures may attain 50 to 60°C inside vehicles, shipping containers or on docks and, in this case, shelf life and expiry dates may no longer be guaranteed. Freezing may be detrimental, particularly for solutions, leading to the deterioration or precipitation of active ingredients as well as the breaking of ampoules and vials. Even though new techniques produce vaccines that are less sensitive to heat (called "thermostable"), they still have to be stored in the refrigerator between 2°C and 8°C, and the cold chain must be strictly respected during transport. The square on the monitor changes colour when exposed to heat over a period of time: if the square is lighter than the circle, the vaccine can be used. If the square is the same colour or darker than the circle, the vial must be destroyed. The maximum temperature of 40°C is monitored by a peak threshold indicator in each vaccine carrier used for transport and vaccination in the field. Air and humidity In a store, relative humidity should not be above 65% (there are several devices for humidity measurement).

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These media are empowering patients and changing the relationships between patients and their doctors lipitor 10mg with mastercard. The following additional points were made:  Europe needs a ‘new ecosystem’ for personalised medicine generic 40mg lipitor with visa;  The Eurobarameter survey might be used to find out how European citizens view their healthcare buy lipitor 5 mg otc, and what they understand about personalised medicine. Then, over the next five to seven years, it will be necessary to establish standards for electronic health records. The two initiatives could start in parallel, but the focus should be on achieving something concrete in the short-term. The 1-2 June 2016 conference advanced these discussions for example by showing how integrated healthcare models are working in specific places – Scotland and Estonia – and how business models for personalised medicine can involve patients more directly in their healthcare. Policymakers need to find ways of specifically engaging older people in the management of their own health. What patients want from their medicines may be different from what the clinical trial outcomes tell the regulators. This already happens at the European Medicines Agency, but it might be implemented at the national drug agencies. More clarity on the form and purposes of the electronic patient record is required. Steps also need to be taken to ensure data quality and maturity and standardisation. Are current methods for obtaining consent from patients adequate for the new digital age? If a large company acquires a smaller company giving it access to patient records for the first time, can it assume that the patient consent is transferable? What if the new owner has a different plan for the use of this data than the previous owner? If a patient has consented to the use of his/her records in a biobank, can that consent be withdrawn at any time? They need to be collected and analysed for use in trial design, regulation and reimbursement. But for translation, there also needs to be a better understanding and use of phenotypic data. The phenotypic variations among individuals need to be explained and how this affects their responses to treatment. Biobanks should be a standard feature of clinical trials, to enable these analyses to take place. Challenge 4: Bringing innovation to the market  The clinical descriptions of diseases need to be standardised to enable a better comparison and analysis of data. This could include the development of biomarkers to differentiate responders from non-responders. This could be an efficient way of predicting the success, or failure, of a drug in the clinic. Challenge 5: Shaping sustainable healthcare  The French molecular testing programme for cancer patients should be reviewed for possible wider application. This report is a summary of the presentations and discussions which took place at the Personalised Medicine Conference 2016 on 1-2 June in Brussels. Personalised medicine is an approach to healthcare that puts the citizen in the centre. By developing tailor-made diagnostic, treatment and prevention strategies, patients receive therapies that specifically work for them. It also allows people to participate in the management of their own health by having access to information about the prevention and treatment of disease. The Personalised Medicine Conference 2016 aimed to discuss personalised medicine through a research policy lens. Our graduates are highly skilled, and decision about entering a vocational training > psychiatry well-equipped to meet today’s medical program offered by a professional college. We focus on case-based There are a wide range of career > rehabilitation medicine learning and group work. Graduates may work in areas small groups in a carefully planned series > sexual health medicine such as general practice, surgery, medicine of patient-centred problems, designed to or public health. They may work in rural > sports medicine highlight the many principles and issues Australia or as a university clinical academic. They may combine clinical practice with Early patient contact and clinical-training research and education. Alternative study options equips students with high skill levels and Medical practitioners work in a variety medical knowledge. The curriculum has been of areas including the community, public Entry into the Bachelor of Medicine is highly developed to capture the enthusiasm and hospitals, private practice, public health, competitive, with only a small portion of maturity of our new students and help them academia, teaching, clinical research, aid applicants admitted. All applicants are develop into highly-skilled medical graduates, organisations and the defence forces. Undergraduate degrees Examples include: To learn more about alternative degrees, visit: > Bachelor of Medicine and > accident and emergency www.

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Tere is commercial non availability of the frst-line drugs pyrrolidone solution to form nanodispersion purchase lipitor 5mg visa. Recent research [37] shows applications of various nanoparticulate Pharmaceutical industry faces enormous pressure to deliver high- systems like microemulsions generic 20 mg lipitor overnight delivery, nanosuspensions purchase 10 mg lipitor overnight delivery, nanoparticles, quality products to patients while maintaining proftability. Terefore liposomes, niosomes, dendrimers and cyclodextrins in the feld of pharmaceutical companies are using nanotechnology to enhance the ocular drug delivery and also depicts how the various upcoming of drug formulation and drug target discovery. Nano pharmaceutical nanotechnology like nanodiagnostics, nanoimaging and nanomedicine makes the drug discovery process cost efective, resulting in the can be utilized to explore the frontiers of ocular drug delivery and improved Research and Development success rate, thereby reducing therapy. Surgery Application of Nanotechnology in Modifed Medicated Te technique developed by Rice University, two pieces of chicken Textiles meat is fused by a fesh welder, by placing two pieces of chicken touching each other. In this technique, green liquid containing gold- Using nanotechnology newer antibacterial cotton has been coated nano shells is allowed to dribble along the seam and two sides developed and used for antibacterial textiles. Tis method can be used arteries which have been using nanotechnology, new modifed antibacterial textiles have been cut during organ transplant. Application of conventional antimicrobial agents to textiles artery perfectly [38]. Tis technique has been advanced by a focus on inorganic nano structured materials that acquire good antibacterial Visualization activity and application of these materials to the textiles [41]. Drug distribution and its metabolism can be determined by tracking Conclusion movement. Tese dyes excited by light of a certain wavelength Nano materials have increased surface area and nano scale efects, to glow. As have unique physicochemical and biological properties as compared a result, sizes are selected so that the frequency of light used to make to their larger counterparts. Te properties of nano materials can a group of quantum dots fuoresce, and used to make another group greatly infuence their interactions with bio molecules and cells, due incandesce. For example, nano particles Tissue engineering can be used to produce exceptional images of tumor sites; single- In tissue engineering, nanotechnology can be applied to reproduce walled carbon nanotubes, have been used as high-efciency delivery or repair damaged tissues. Tere is a very bright future scafolds and growth factors, artifcially stimulated cell proliferation, in to nano technology, by its merging with other technologies and the organ transplants or artifcial implants therapy nano technology can be subsequent emergence of complex and innovative hybrid technologies. Biology-based technologies are intertwined with nanotechnology- nanotechnology is already used to manipulate genetic material, and Antibiotic resistance nano materials are already being built using biological components. Antibiotic resistance can be decreased by use of nano particles Te ability of nanotechnology to engineer matter at the smallest scale is in combination therapy. Zinc Oxide nano particles can decrease revolutionizing areas such as information technology cognitive science the antibiotic resistance and enhance the antibacterial activity of and biotechnology and is leading to new and interlinking these and Ciprofoxacin against microorganism, by interfering with various other felds. By further research in nanotechnology, it can be useful for proteins that are interacting in the antibiotic resistance or pharmacologic every aspect of human life. Immune response References Te nano device bucky balls have been used to alter the allergy/ 1. Tey prevent mast cells from releasing histamine oxide (f: SnO/sub 2/) thin flms for solar cell applications. Faculty of Engineering into the blood and tissues, as these bind to free radicals better than any & Technology. Wang Z, Ruan J, Cui D (2009) Advances and prospect of nanotechnology in stem cells. Hollmer M (2012) Carbon nanoparticles charge up old cancer treatment to bioactives. Wyss Institute (2012) Harvard’s Wyss Institute Develops Novel Nano therapeutic treatment of retinal and optic nerve diseases. Curr Opin Pharmacol 13: 134- that Delivers Clot-Busting Drugs Directly to Obstructed Blood Vessels. This material may be reproduced in whole or in part for educational, personal or public non-commercial purposes only. As described Guide were identifed by a panel of experts—physicians who by Puddester in the Introduction, physician health used to be work with other physicians who have health concerns. Today, the page spread that introduces readers to the topic, provides a feld has expanded in scope and depth. As which there is a world shortage of health professionals, and no a result, readers can quickly access information on any topic prospect for relief in our practice lifetime. More than ever, we area and fnd a succinct summary of information along with need every available health professional to possess the healthy the tools for further exploration. Numerous pioneering leaders As the nature of contemporary health care evolves and de- have developed physician health, not only as an area of practice, velops, so does the role of physician. In health” has become one of the cornerstone ideas to improving this book, Puddester, Flynn, and Cohen et al, answer this call. Medicine can be a very rewarding career but it ready resource for those thinking or teaching about physician is also a very demanding profession. The chapters are created to be accessible cine by creating resources and Train-the-trainer Workshops within the busy schedule many physicians maintain.

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Those on the receiving end were never asked whether their idea of happiness had any resemblance to a correct lifestyle as set down in government publications order lipitor 10 mg fast delivery. As de Jouvenel put it lipitor 40mg free shipping, The handling of public affairs gets entrusted to a class which stands in physical need of certitudes and takes dubi- ous truths to its bosom with the same fanaticism as did in other times the Hussites and Anabaptists purchase lipitor 10mg mastercard. Like Leninism, healthism, with its wonderful promises, attracts dedicated altruists and otherwise intelligent people. Some of them may even acknowledge that people may get hurt in the process, but as Marxist-Leninist activists used to say, when you are clearing a wood, splinters fly around. The glorious visions of Health for All, or of the Smoke-free Planet by the Year 2000 can only be criticised by irresponsible lack- eys on the payroll of industries which thrive on making people sick, or by moral idiots. Their power is, in practice, uncontested because of the legitimacy they have spuriously borrowed from medicine and science and their concerned beneficence. A benign form of paternalism or a puri- tanical zeal to establish behavioral conformity? While the medical profession is not renowned for an exemplary puritanical lifestyle, the control of the lifestyle of others enhances their power. The power of the medical profession is jealously guarded and is vested in their moral, charismatic and scientific authority. The moral authority of doctors has rarely been questioned as doctors are on the side of the angels; they fight evil, suffering and death. The study of human behaviour is not a science in that it discovers no universal laws. It constructs moral stories, meaningful only for a particular society, time and place. This is not to imply that human behaviour is not an important and intriguing subject, but not everything interesting is a science. In medi- cine, blinks correspond to the objective signs of disease, but the concept of disease is in part a wink-construct, and the purpose of medicine is to give blinks meaning. More recently, the urge to normalise has been extended to the behaviour of healthy people, as part of the new policy of health promotion and disease prevention. According to one, the Senior Minister of State for Education announced a new government strategy to combat obesity among schoolchildren - they were to be given marks for their weight in their report books, so that their parents when checking on their academic progress 4 would also see their grade for health and fitness. The Straits Times quoted a cardiologist who called for a tax rebate for those who joined health clubs or purchased sports equip- 5 ment, such as treadmills or exercycles. Health propaganda is disseminated in English, Mandarin, Tamil, and Malay in order to reach as many Singaporeans as possible. Even chew- ing gum is banned in Singapore, though according to the Singapore Ministry of Health, only those who chew in places 6 of food consumption are to be prosecuted. This argument is difficult to refute if those who have power to coerce others to change their ways also have a monopoly of defining what is foolish, stupid or irresponsible. I love banquettes of quail eggs with hollandaise sauce, and clambakes with lobsters and crepes filled with cream. And if I am abbreviating my stay on this earth for an hour or so, I say only that I have no desire to be a Methuselah, a hundred or more years old and still alive, 7 grace be to something that plugs into an electric outlet. Health education should provide useful, factual infor- mation to enhance rational decision-making, that is, reasoned choice. One of the possible outcomes of such a decision is to ignore the health warning and to accept the risk. As Wikler pointed out, Health education may call for actual or deliberate misinfor- mation: directives may imply or even state that the scien- tific evidence in favour of a given health practice is unequivocal even when it is not. Similarly, from the economic point of view, the fairness principle does not apply, which, as Wikler pointed out, would require penalising non-smokers who by their extended living consume an unfair share of social security and pension payments. Some ethicists have tried to defend the paternalistic role of the State by arguing that only sensible measures are being adopted and that there is no danger that the State will turn into Big Brother. This is a specious distinction since paternalism untainted with moralism is an abstract entity with no real counterpart; lifestylism is moralistic paternalism par excellence. An example of useful coercion, given by Oppenheim, was to make the granting of a driving licence conditional on proof that the applicant had submitted to specified health screening tests. Yet, the evidence that cycle helmets prevent serious head injuries is questionable. Mark McCarthy, a director of public health in London, maintained that helmets did not improve safety but only placed the responsibility for injury protection on 14 the victim. If policy makers really believed that helmets prevented head injury, he added, then all pedestrians and car users should wear them, since many more head injuries 144 Coercive medicine 15 occur in these two groups than among cyclists. In New South Wales, the law requires that all domestic swimming pools are fenced - to prevent toddlers falling in. There is no end to legislation in the name of preventive medicine by which the state increases its powers of surveillance, control and punishment. The characteristic feature of paternalists, or to use a different word, authoritarians, is their conviction that they possess more wisdom and better morality than their charges.

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Several types of germs cause infection including trusted 10 mg lipitor; bacteria proven 10mg lipitor, viruses trusted 40mg lipitor, fungi, protozoa and parasites. Fungal infections include ringworm and athlete’s foot and parasites include head lice and scabies. Ear infections are caused by germs that are not usually passed from person to person. Chicken pox on the other hand rapidly spreads from person to person and is an example of a highly contagious infectious disease. Once a person comes in contact with an infectious agent or germ, a number of factors infuence whether or not that person becomes ill. These include; the germ itself, the number of germs required to cause infection (i. Other factors depend on us; how strong is our immune system, have we met that germ before, are we resistant to it? Some infections result in lifelong immunity which is why most of us will only develop chicken pox or measles once in our lives, while other infections like the common cold can be caught again and again. Through direct contact, (skin contact, contact with saliva and other body fuids, sexual contact), e. The interval between contact with infection and the time symptoms develop is called the incubation period. For example children with measles are infectious for about 3 days before the appearance of a rash. Spread through the gastrointestinal tract or gut Some diseases are caused by germs which live and multiply in the intestines or gut and are passed out of the body in the faeces. For disease to spread, faeces containing these germs must be carried to the mouth and swallowed. Disease can spread when even very small amounts of faeces, amounts so small that they cannot be seen by the naked eye, contaminate hands or objects and are unknowingly brought to the mouth and swallowed. This is also known as the faecal-oral (faeces to mouth) route of transmission and usually occurs when hands are contaminated after using the toilet. Hands can also contaminate objects such as pencils and door-handles which are then handled, allowing the germs to pass to the next pair of hands and ultimately to the mouth of the next person, and so the infectious chain continues. Gastrointestinal spread is responsible for the spread of most infectious diarrhoea as well as some more generalised infections such as hepatitis A. Spread through the respiratory tract Some infectious diseases are spread by germs that can live and multiply in the eyes, airways (including the nose and mouth), and the lungs. These germs are easily passed from our nose or mouth to our hands and from there to other objects. Some infections are spread by droplets that are expelled by an infected person when they sneeze, cough or talk. Droplet spread usually requires the infected person and the susceptible contact to be relatively close to one another, within about 3 feet. Examples include; common cold, infuenza, meningococcal disease, mumps, rubella and pertussis (whooping cough). Other infections are spread by small aerosol droplets that remain in the air where they are carried on air currents (airborne spread) for some time after they are expelled e. Direct contact A number of infections and infestations (an infestation is when a person is infected with a parasite e. Some infections require only superfcial contact with an infected site for infection to spread e. With others, infection is only passed if there is either direct contact with the infected site or with contaminated objects. All of these infections, as well as many others can also be transmitted by sexual contact. This usually requires a breach in the skin or mucous membranes (the mucous membranes are the delicate linings of the body orifces; the nose, mouth, rectum and vagina). Intact skin provides an effective barrier to these germs and infection following contact with intact skin is extremely unlikely. However, infection can occur if the skin is broken, if someone has open cuts, or if the infected blood is carried through the skin e. It is also possible for infection to occur through sexual intercourse with an infected person. Infection can also be passed from mother-to-infant during pregnancy or at the time of delivery. The potentially serious consequence of acquiring these diseases means that all blood and body fuids must be treated as potentially infectious. This is particularly important because clinical illness is not always obvious in infected individuals. Indeed most infected individuals, pupils and staff, may not even be aware that they are carriers of these viruses. School staff should therefore assume that all blood is infectious, regardless of its source.

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