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Overall Effects of the Internet on Healthcare What the Internet has provided is affordable and nearly universal connectivity discount finasteride 1 mg fast delivery japanese hair loss cure, enabling physicians and consumers to connect to one another and to the rest of the health system through their existing communications channels cheap 5 mg finasteride visa hair loss in men 0f, such as the telephone line or cable. By democratizing connectivity, the Internet has brought the health system and its users closer together. The Internet has also provided a new communications back- bone to speed transactions and reduce clerical expenses in the vast bureaucratic sprawl that the American health system has become. As discussed earlier in this chapter, it has also provided a readily usable platform for projecting clinical information across different care sites. One way to think about the Internet is as a technology enabler or, in military jargon, a force multiplier, that helps lower 30 Digital Medicine communications and transaction cost, time, and complexity. It is also a lubricant of information flow and a solvent of organizational boundaries. It may take at least another decade before the health system realizes the full extent of its transformative potential. However, the reason why digi- tizing vital health information is important is that it enables this information to be assembled electronically and directed to the point of medical decisions. Early experimenters included academic health centers like the University of Indiana and Boston’s Brigham and Women’s Hospital and multihospital systems like Utah’s Intermountain Health Care. These early efforts involved creating a clinical data repository into which medical record in- formation was entered for later retrieval and analysis. Physicians and other caregivers could then enter orders electronically and get test results and other clinical data on their patients. However, data storage and database management technologies were so primitive, and computing power so modest, that it was extremely cumbersome for physicians to retrieve information at the point of care (e. Until the advent of the Apple Macintosh and, later, the Windows operating system in the mid-1980s, physicians who wanted to undertake computerized physician order entry had to learn an awkward language of computer commands and type those commands into the computer to manage their patients or to retrieve or use clinical information. As will be seen in Chapter 3, these efforts were also hampered by the highly fragmented record structure of hospitals. Hospitals 32 Digital Medicine have historically maintained separate record systems in each clinical department (for the laboratory, the operating room, the radiology department, the emergency room, etc. These so-called “legacy” systems were constructed primarily for billing purposes, not for care management. Legacy clinical systems are like a gigantic tangle of weedy undergrowth that strangles the care process as well as the efforts of those nurses, physicians, and other caregivers who use them. Even small hospitals may have as many as two dozen legacy clin- ical information systems. Unbelievably, large health systems with multiple hospitals may have as many as 500 legacy systems, pur- chased from different vendors, written in different software lan- guages, and operating on different, often incompatible hardware. As a consequence of this tangle, slightly different versions of our clinical reality exist in as many as 15 different places inside the hospital. The fact that there is no unified picture of an individual’s health status is a hazard to that person’s health. Creating a unified repository of all information requires a common format for clinical information, a single patient identifier applied across departments, and an agreement by all those who provide care to contribute what they know to the digital record. Clinical Decision Support Clinical decision support played an increasingly prominent role in emerging clinical systems. In the mid-1980s, intensive care special- ists at George Washington University led by Dr. Altogether, these tools may be the most complex commercial software products ever built, considering that they are automating what may be the most complex process in the economy—health service. Clinical systems are becoming “context aware,” meaning that they will be wired to diagnostic devices and patient monitoring equipment. They can track real-time changes in the patient’s health and will follow patients as they move through different levels of care—from an ambulatory diagnosis through surgery, into recov- ery, or even into home healthcare. These new systems now alert care providers when the patient’s condition changes, prompting the clinical team to take specific actions to deal with an emerging problem. Most importantly, however, clinical systems are reaching a suf- ficient level of intelligence to bring up-to-date medical knowledge to the physician’s office, exam room, or hospital bed. As medical science better defines how to treat patients, that knowledge will flow through computer systems to the point of care.

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As discussed elsewhere used to be manufactured with a compound which became toxic as it broke down – this no longer occurs generic finasteride 1mg without a prescription hair loss cure jo. Should be used with another broad-spectrum antibiotic for any one with possible faecal contamination of a wound or intra-abdominal sepsis (such as severe appendicitis) buy finasteride 5mg hair loss weight loss. The treatment course is usually shorter with generally less side effects and is cheaper. For further information you should consult any major antibiotic guide (see Reference Books chapter). Which bacteria are sensitive to which antibiotics varies to a degree depending on local resistance patterns among the bacteria – local hospitals will normally be able to tell you what the local patterns are for common bacteria Pregnancy and Breastfeeding: In pregnancy penicillins and cephalosporins are safe to use. You should always check if any drug you are using is safe, before using in pregnancy and breast-feeding. This is especially true when performing any surgical procedure - from suturing a small cut or dressing a wound, to dealing with a major injury or performing an operation. An item is sterile when it is made completely free of measurable levels of microorganisms (bacteria, viruses, fungal spores) by a chemical or physical process of sterilization. Disinfection describes the process of destroying microorganisms or inhibiting their growth but is generally less absolute. In some cases disinfection removes most but not all of the microbes, or removes all bacteria but not fungal spores, etc. Sterility is only a temporary state – once sterile packaging is open or the product has been removed from an autoclave colonization begins almost immediately just from exposure to air and bacteria present in the environment. Infection rates are no greater if a superficial wound has been irrigated and cleaned with tap water vs. The studies supporting this are based on municipal tap water supply – so is not completely applicable to all situations. The following sections will deal specifically with how to do the actual disinfection or sterilising. The main differences relate to the material used to make the barrel and plunger of the syringe. A reusable syringe’s body and plunger will either be made of glass or a plastic that can be autoclaved. The rubber on a “reusable” plastic plunger will break down with autoclaving or the glazing on the glass plunger will eventually wear out. Reusable needles will generally have a Luer lock attachment to attach to the syringe (as do many disposable ones) and will be made of a harder metal so they can be re- sharpened. They will also come with a needle plunger so anything trapped in the needle cylinder can be removed. Disposable syringes will generally melt when heated to sterilising temperatures but can be autoclaved several times before deforming beyond usefulness. The best method to sterilise syringes is to use a rack to suspend the barrel and plunger. A large part of this failure rate is thought to be due to laying the components in a tray. A rack should be made of metal and constructed so that the syringe bodies, plungers, and needles can be suspended in them with minimal contact with the rack itself so as to be hanging relatively freely. If you do not have access to a pressure cooker or autoclave boiling is acceptable but a distant second choice. The type of water used in an autoclave or pressure cooker will probably effect the life - 46 - Survival and Austere Medicine: An Introduction span of permanent syringes – the harder the water the less reuses – a very rough guide is: hard water = 50-60 reuses, soft water = 200+ reuses. Using hard water may also create maintenance problems for a pressure cooker although many home canners have used hard water for years with minimal problems. Sharpening permanent needles: Place a drop of light oil (sewing machine, light machine, or gun oil) on a fine sharpening stone. Draw the bevel (flat part of tip) of the needle back and forth at a uniform angle with no rocking.

She compressed the slippery pencil sized tube deftly as he prepared to sew up its end purchase 1mg finasteride amex hair loss update. He sutured the other large vessels and tested his work by having her release the tourniquet buy finasteride 1 mg mastercard hair loss on arms. He spread an antibiotic cream over the entire area of the stump and covered it with gauze. He studied the book for a few minutes, then attached two traction strips to the skin above the wound using wide adhesive tape. Dave called Nick and Anne, directed them as to how to apply the traction ropes after they had moved Jack to a cot in the living room. The worst part of the whole thing in that this operation has made a helluva hole in the medical supplies. This story was posted on an internet preparedness forum and is a reflection on what might be possible in a major long term collapse. It made her residency seem like a walk in the park – 80 hour weeks for 4 years – she thought that had been tough. What she would give now to go back to it, she wouldn’t curse the hours or call what she felt then exhaustion. She heard rumours that a community to the north had a nurse and most of the communities had healers – with varying levels of skill, training, and quality – she had heard a number of frightening stories. But she was tired ****************************************************** When it happened New Zealand had been relatively spared. Small hits in the north Pacific had resulted in the massive waves, which had travelled south. They had tried various things to knock it off course, but all that they achieved was to blow it into smaller pieces – it had all seemed like the plot of some really bad B-grade 90’s movie. Her husband was away at a conference in Australia and she had taken the opportunity to spend some time with her sister. Although only 20 kilometres from the coast, the rapid climb in altitude had spared the valley the farm was located in. The watermark for the wave was 10kms away and 700m lower down – and still even after 10 years the line of destruction was clear. The secondary growth was well established, but the magnitude of what had occurred had scared the land. Despite the warnings many hadn’t evacuated the coastal areas and some of those who had evacuated under-estimated the size of the wave – moving only to the foot hills several hundred metres above the see level. Many had also gone to watch – believing that a few 100 metres of altitude would be enough to save them. More still had believed the Government line that a solution was a hand and it was not going to be a problem. No one expected a 50-metre wall of water – that was bad enough, but many died from the - 200 - Survival and Austere Medicine: An Introduction enormous surge wave when it hit the coast that went kilometres inland and 800m high into the hills. Fortunately both islands of New Zealand were dominated by mountain ranges and plateaus. It allowed many people to survive by quirk of geography – some inland towns and their people were almost untouched by the wave. The first quakes began with the strike, even before the wave had rushed south from the North Pacific, the tremors had started. Everyone knew that all the tectonic plates were connected, but again no one for a moment thought that all would move with the strike. The small tremors evolved to larger ones – the largest that struck New Zealand would have measured 8. The land strikes in the Northern hemisphere through up millions of tons of dust, debris, and water into the atmosphere. For month’s daylight became twilight and the rain torrential – fortunately the southern skies were less heavily contaminated – rather than the constant twilight of the northern hemisphere it was more just overcast with little clear sunlight and much muddy rain. New Zealand’s 4 million population was decimated to 50,000 or so - scattered all around the islands in isolated pockets.

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