By A. Yespas. University of Maryland University College.

The book has truly been a coming together of academic and practitioner minds purchase kamagra gold 100 mg with visa erectile dysfunction drugs forum, without whom this book would merely have remained a scintilla of an idea quietly percolating away in the deepest recesses of my mind order 100 mg kamagra gold fast delivery erectile dysfunction natural treatment. I thank all contributors of this book for their excellent chapters; many contributors also served as reviewers, and additional thanks are due to these hard-working soles for giving up so much of their valuable time and collective energies. Thanks also to every- body who submitted proposals for giving me that most rare and coveted of headaches: a plethora of high quality and relevant submissions from which to choose. Sincere thanks to Professor Swamy Laxminarayan, chief of biomedical information engi- neering at Idaho State University in the USA for writing such a fine foreword and for his kind words and unstinting support in recent years. Professor Raouf Naguib, head of the Biomedical Computing Research Group (BIOCORE) at Coventry University in the UK was a great source of encouragement and provided me with extensive insights into the crazy world of academia. Virtually his first words to me came in the form of advice: to focus on that which I did best, words which obviously stuck with me. I additionally thank Raouf for encouraging me to form my Knowledge Management for Healthcare (KMH) research subgroup, which generated immediate interest and recognition from international academic and healthcare institutions and which continues to go from strength to strength. Ashish Dwivedi for his seminal work in the area of clinical and healthcare knowledge management and for forming the granite-like founda- tion of the KMH subgroup. I appreciate also the expressions of interest and words of support from my numerous interactions with conference delegates in the USA, Singapore, Mexico and the UK. Last, but by no means least, I thank my family for their support during the management of this, my latest project. Warwickshire, UK August 2004 Section I Key Opportunities and Challenges in Clinical Knowledge Management Issues in Clinical Knowledge Management 1 ChapterI Issues inClinical Knowledge Management: Revisiting Healthcare M anagement Rajeev K. Bali, Coventry University, UK Ashish Dwivedi, The University of Hull, UK Raouf Naguib, Coventry University, UK Abstract The objective of this chapter is to examine some of the key issues surrounding the incorporation of the Knowledge Management (KM) paradigm in healthcare. We discuss whether it would it be beneficial for healthcare organizations to adopt the KM paradigm so as to facilitate effective decision-making in the context of healthcare delivery. Alternative healthcare management concepts with respect to their ability in providing a solution to the above-mentioned issue are reviewed. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Recent innovations in Information Technology (IT) have transformed the way that healthcare organizations function. Applications of concepts such as Data Warehousing and Data Mining have exponentially increased the amount of information to which a healthcare organization has access, thus creating the problem of “information explo- sion”. This problem has been further accentuated by the advent of new disciplines such as Bioinformatics and Genetic Engineering, both of which hold very promising solutions which may significantly change the face of the entire healthcare process from diagnosis to delivery (Dwivedi, Bali, James, Naguib, & Johnston, 2002b). Until the early 1980s, IT solutions for healthcare used to focus on such concepts as data warehousing. The emphasis was on storage of data in an electronic medium, the prime objective of which was to allow exploitation of this data at a later point in time. As such, most of the IT applications in healthcare were built to provide support for retrospective information retrieval needs and, in some cases, to analyze the decisions undertaken. Clinical data that was traditionally used in a supportive capacity for historical purposes has today become an opportunity that allows healthcare stakehold- ers to tackle problems before they arise. Healthcare Management Concepts Healthcare managers are being forced to examine costs associated with healthcare and are under increasing pressure to discover approaches that would help carry out activities better, faster and cheaper (Davis & Klein, 2000; Latamore, 1999). Workflow and associ- ated Internet technologies are being seen as an instrument to cut administrative expenses. Specifically designed IT implementations such as workflow tools are being used to automate the electronic paper flow in a managed care operation, thereby cutting administrative expenses (Latamore, 1999). One of the most challenging issues in healthcare relates to the transformation of raw clinical data into contextually relevant information. Advances in IT and telecommunica- tions have made it possible for healthcare institutions to face the challenge of transform- ing large amounts of medical data into relevant clinical information (Dwivedi, Bali, James, & Naguib, 2001b). This can be achieved by integrating information using workflow, context management and collaboration tools, giving healthcare a mechanism for effec- tively transferring the acquired knowledge, as and when required (Dwivedi, Bali, James, & Naguib, 2002a).

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Other physical characteristics of this remedy include burning discount kamagra gold 100mg line erectile dysfunction cholesterol lowering drugs, offensive purchase kamagra gold 100mg without a prescription erectile dysfunction 23, and watery discharges; palpitations; Arsenic was used as a remedy for certain types of profuse, sour sweat; and a red-tipped tongue. In the tendency to bleed easily and from any place, and vomit- seventeenth century, arsenic was applied topically to ing of blood and bleeding from lungs, throat, and mu- treat malignant ulcers and skin diseases in humans. When fre- quent and repeated doses of arsenic resulted in poisoning The mental and emotional symptoms of the patient and death, arsenic was pronounced unsafe for use. How- profile also include anxiety, nervousness, suspicion, im- ever, housewives and practitioners still used arsenic and pulsiveness, irritability, sadness, hopelessness, and de- were often successful in their treatments. They are critical and argumentative, easily of- were often used to increase strength and endurance, rem- fended, easily startled, insecure, forgetful, sensitive to edy anemia, and improve the skin and fur of animals. Patients may be unable to sleep due to their General use restlessness and anxiety or from physical discomforts Arsenicum album is one of the most frequently used such as fever or cough. When they do sleep, they may homeopathic remedies and is one of the most well- have anxious dreams or nightmares. A polychrest with a wide field of ac- are extremely weak, arsenicum album patients are clean tion, arsenicum album has the power to affect all parts of and tidy, partially to relieve their restlessness. The symptoms are aggravated by a change in tem- Arsenicum album is used to treat serious acute ail- perature, wet weather, cold food and drink, and by the ments, chronic diseases, and acute colds, bronchitis, and slightest exertion. Homeopaths prescribe this remedy to treat asthma, waking, with alcohol use, and during menstruation. The patient may be prone to vi- senicum album has also been used to treat malarial and olent fits of anger or rage or have an impulse to commit septic infections, alcoholism, syphilis, lupus, and cancer murder. It also can have a positive effect on alcoholism (when applied in the early stages of the disease). Arsenicum album can be used for the following con- ditions: Common characteristics • Throbbing, frontal headaches. These are accompanied People requiring arsenicum album generally fit a by a flushed or hot face, heat or burning inside the particular profile. They are anxious, restless, weak, pale, head, and a feeling that the head will explode. These GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 129 headaches occur with regularity and are reduced by cool air or cold applications. These sometimes alternate with Pustular—Resembling a blister and usually con- chills. It is accompanied by burning pain that is worse from swallowing or cold drinks and is reduced with hot drinks. They are worsened by the Jennifer Wurges cold, by fresh air, when lying down, at night (particu- larly after midnight), and during a fever. This is often accompanied by bleeding, constant sneezing, chills, fatigue, restless- arthritis ness, anxiety at night, troublesome dreams, and crusts in the back of the nose. Preparations Art therapy The homeopathic remedy is prepared by separating Definition arsenic from iron, cobalt, and nickel when the minerals are baked at high temperatures. The powder is then Art therapy, sometimes called creative arts therapy ground and diluted with milk sugar. Origins Precautions Humans have expressed themselves with symbols If symptoms do not improve after the recommended throughout history. Masks, ritual pottery, costumes, other time period, a homeopath or healthcare practitioner objects used in rituals, cave drawings, Egyptian hiero- should be consulted. In the late nineteenth century, French psychiatrists Ambrose Tardieu and Paul-Max Simon both published studies on the similar characteristics of and symbolism Interactions in the artwork of the mentally ill. Tardieu and Simon When taking any homeopathic remedy, consumers viewed art therapy as an effective diagnostic tool to iden- should not use peppermint products, coffee, or alcohol. Later, psychologists would use this diagnostic aspect to develop psychological drawing tests (the Draw-A-Man Resources test, the Draw-A-Person Questionnaire [DAP. Q]) and BOOKS projective personality tests involving visual symbol Cummings, Stephen, M. Milieu therapies (or environmental ther- apy) focus on putting the patient in a controlled thera- peutic social setting that provides the patient with oppor- tunities to gain self-confidence and interact with peers in a positive way.

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They have legs order kamagra gold 100 mg without a prescription trazodone causes erectile dysfunction, Two cases of acardia have been associated with but do not have arms buy generic kamagra gold 100 mg line erectile dysfunction after prostatectomy. Another report, in 2000, describes an acardiac twin pregnancy in an epileptic mother who took a different seizure medica- tion, oxcarbazepin. Diagnosis A mother carrying an acardiac twin pregnancy is not likely to have any unusual symptoms. During ultrasound, an acardiac twin may appear as tissue mass or it may appear to be a twin who has died in the womb. In 50% of cases the acardiac twin has only two, instead of the normal three, vessels in the umbilical cord. This infant shows partial development of the lower Ultrasound diagnostic criteria for the acardiac twin extremities and early development of the head. Acardia usually include: almost always occurs in monozygotic twins, with one twin (such as that shown here) unable to fully develop as a • absence of fetal activity result of severe heart complications. Medications like digoxin may be used to treat congestive heart failure in the normal twin. Current An acardiac fetus may also be missed on prenatal studies examining the success and failure rates of these ultrasound. A 1991 report describes an acardiac twin who treatments will be helpful in determining which therapy was missed on ultrasound and only detected at delivery. Fetal echocardiography is recommended to assist with early detection of heart failure in the normal twin. Chromosome studies are recommended for both fetuses Treatment and management in all pregnancies complicated by TRAP sequence. As of 2001, there is no consensus on which therapy is best for pregnancies complicated by TRAP sequence. Prognosis No treatment can save the acardiac twin, so the goal of prenatal therapy is to help the normal twin. The normal The acardiac or parasitic twin never survives as it is twin is not always saved by prenatal treatment. Complications associated with having an acardiac Specialists have used laser and electrical cauteriza- twin cause 50–70% of normal twins to die. The normal tion, electrodes, serial amniocentesis, medications, and twin is at risk for heart failure and complications associ- other treatments successfully. Heart failure in the normal mend prenatal interruption of the blood vessel connec- twin is common. The normal twin of an acardiac twin tions (thus sacrificing the acardiac twin) before heart pregnancy has about a 10% risk for malformations. Improvement of thera- be accomplished by cauterizing or burning the blood ves- pies will undoubtedly lead to a better outlook for preg- sel connections. GALE ENCYCLOPEDIA OF GENETIC DISORDERS 9 Resources The same cannot be said for drugs derived from vita- min A. Accutane, like other retinoids, displays some of PERIODICALS the same biologic properties as vitamin A, such as its role Arias, Fernando, et al. Four to five months of Accutane treatment usually leads to clearing of the acne for one Mohanty, C. Milder cases of acne that produce scarring or other related skin disorders ORGANIZATIONS may also be treated with this medication. Hawkins, MS Common side effects of Accutane are chapped lips, dry skin with itching, mild nosebleeds, joint and muscle pain, and temporary thinning of hair. Depression, includ- ing thoughts of suicide, has been reported more recently as another, much more serious, potential side effect. Severe acne on its own is associated with lower self- IAccutane embryopathy esteem. As of 2001, no studies have been published to try to determine if Accutane use somehow makes it more Definition likely for a person to be depressed or to attempt suicide. Accutane is commonly used to treat severe acne that The United States Food and Drug Administration has not responded to other forms of treatment. Accutane-related birth defects typi- provision that the drug label would describe its risk of cally include physical abnormalities of the face, ears, causing birth defects. Description The first report of an infant with Accutane-related Accutane is one of several man-made drugs derived birth defects was published in 1983. The generic name for Accutane is tional cases were subsequently reported to the FDA and isotretinoin.

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Circulating plasm inogen binds to the platelet activation by blocking specific purinergic recep- plasm inogen activator–fibrin com plex to form a ternary tors for A D P on the platelet m em brane purchase kamagra gold 100 mg otc erectile dysfunction and diabetes ppt. This action in- com plex consisting of fibrin order 100 mg kamagra gold with amex erectile dysfunction 70 year olds, activator, and plasm ino- hibits A D P-induced expression of platelet m em brane gen. Therefore, the specificity of t-PA and scu-PA bind- G PIIb/IIIa and fibrinogen binding to activated platelets. O ral ticlopidine is indicated for prevention of Circulating plasm in is rapidly neutralized by 2-an- throm botic stroke in patients who cannot tolerate as- tiplasm in, a physiological serine protease inhibitor that pirin and for patients who have had throm botic stroke. In contrast, fibrin- Inhibition of A D P-induced platelet aggregation occurs bound plasm in is resistant to inactivation by 2-an- within 4 days, and the full effect requires approxim ately tiplasm in. Ticlopidine is taken with food, is well absorbed, inactive because it is inhibited by PA I-1, while t-PA that binds extensively to plasm a proteins, and is m etabolized is bound to fibrin is unaffected by PA I-1. G astrointestinal disturbances, neutropenia, plasm a t-PA has a very rapid turnover in blood (half-life and agranulocytosis have been observed. Pharmacological agents, such as abciximab (ReoPro), A ctivation of the fibrinolytic system with throm - eptifibatide (Integrillin), and tirofiban (Aggrastat), that bolytic drugs can disturb the balance of these regulatory interrupt the interaction of fibrinogen and Von m echanism s and elevate circulating plasm in activity. A bciximab is used in conjunction with angioplasty and stent procedures and is an adjunct to fibrinolytic therapy (discussed later). Patients who Throm bolytic (Fibrinolytic) Drugs have murine protein hypersensitivity or who have re- Throm bolytic drugs cause lysis of form ed clots in both ceived abciximab previously may produce an immune re- arteries and veins and reestablish tissue perfusion. Eptifibatide, a cyclic peptide, and tirofiban, a small nonpeptide molecule, both M echanism of Action bind reversibly to the GPIIb/IIIa complex and competi- tively prevent the interaction of the clotting factors with Throm bolytic drugs are plasm inogen activators. O lder form s a 1:1 com plex with plasm inogen, which results in (first generation) throm bolytic agents are not clot selec- a conform ational change and exposure of an active site tive, and appreciable system ic fibrinogenolysis accom pa- that can convert additional plasm inogen into plasm in. Newer (second generation) The system ic adm inistration of streptokinase can pro- throm bolytic agents bind to fibrin and activate fibrinoly- duce significant lysis of acute deep vein and pulm onary sis m ore than fibrinogenolysis. Intravenous or intra- have im proved fibrin specificity and pharm acokinetic coronary artery (IC) streptokinase is effective in estab- properties. The greatest benefit of Pharmacological Actions and Clinical Uses streptokinase appears to be achieved by early intra- venous drug adm inistration. Com plications associated Thrombolytic drugs are indicated for the management of with the adm inistration of streptokinase include hem or- severe pulmonary embolism, deep vein thrombosis, and rhage, pyrexia, and allergic or anaphylactic reactions. The faster one myocardial or cerebral infarction, since clots become (11 to13 m inutes) is due to drug distribution and inhibi- more difficult to lyse as they age. Recanalization after ap- tion by circulating antibodies, and the slower one (23 to proximately 6 hours provides diminishing benefit to the 29 m inutes) is due to loss of enzym e activity. The incidence of rethrombosis and rein- Urokinase (Abbokinase) is a two-polypeptide chain farction is greater when thrombolytic drugs with shorter serine protease that does not bind avidly to fibrin and that plasma half-lives are used. Concurrent administration directly activates both circulating and fibrin-bound plas- with heparin followed by warfarin, as well as antiplatelet minogen. Urokinase is derived from hu- ticoagulant and antiplatelet drugs may contribute to man cells and thus is not antigenic. Adverse Effects Second- and Third-generation The principal adverse effect associated with throm - Thrombolytic Drugs bolytic therapy is bleeding due to fibrinogenolysis or fibrinolysis at the site of vascular injury. H ypo- The principal physiological activator of plasm inogen in fibrinogenem ia m ay occur and should be m onitored the blood, tissue-type plasm inogen activator (t-PA, al- with laboratory tests. A t effective throm bolytic doses, teplase) (Activase), has a high binding affinity for fibrin the second- and third-generation agents cause less ex- and produces, after IV adm inistration, a fibrin-selective tensive fibrinogenolysis, but bleeding occurs with a sim - activation of plasm inogen. Life-threatening intracra- solute; circulating plasm inogen also m ay be activated nial bleeding m ay necessitate stoppage of therapy, by large doses or lengthy treatm ent. A fter intravenous adm inistration of whole blood, platelets or fresh frozen adm inistration, alteplase is m ore efficacious than strep- plasm a, protam ine (if heparin is present), and an an- tokinase in establishing coronary reperfusion. The rate of rethrom bosis after t- PA is greater than after streptokinase, possibly because The contraindications to the use of throm bolytic drugs alteplase is rapidly cleared from the blood (half-life is 5 are sim ilar to those for the anticoagulant drugs. Reocclusion m ay be lessened by adm inistration diopulm onary resuscitation (traum a to thorax is possi- of heparin and antiplatelet drugs. Two genetically engineered variants of hum an t-PA First-Generation Thrombolytic Drugs have better pharm acological properties than alteplase.

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It is This condition is the hallmark of amyotrophic lateral thought that sporadic mutations result from both biologi- sclerosis discount kamagra gold 100mg on-line erectile dysfunction drugs in philippines. In rare cases buy kamagra gold 100 mg lowest price erectile dysfunction treatment in allopathy, a mutation in erating motor neurons to elicit a signal to the muscles that NFH, the gene encoding for neurofilament (a structure allow them to function and grow. Familial amy- symptoms for ALS are muscle cramps and twitching, otropic lateral sclerosis has been linked to other chromo- weakness in the hands, feet, or ankles, speech slurring, somal locations but the exact genes involved have not and swallowing difficulties. The Institutional Review Board at include arm and leg stiffness, foot drop, weight loss, Thomas Jefferson University in Philadelphia recently fatigue, and difficulty making facial expressions. The goal of the One of the earliest symptoms of ALS is weakness in project is to inject an adeno-associated virus carrying a the bulbar muscles. The hope Weakness of these muscle groups usually cause problems is that the cells in that area will not die off. Demographics Another symptom of ALS that usually occurs after Amyotrophic lateral sclerosis affects anyone and initial symptoms appear is persistent muscle twitching both men and women are at equal risk. Fasciculation is almost never the first any age, and the odds of developing it increase with age. A As the disease progresses the respiratory muscles person only needs to inherit a defective gene from one (breathing muscles) weaken, resulting in increased diffi- parent to cause the disease. The potential for lung infection increases Signs and symptoms and can cause death. Many patients find it more comfort- The disease starts slowly, affecting just one limb, able and extend their lives when assisted by ventilators at such as the hands or feet, and steadily progresses to more this stage of the disease. One way to accomplish feedback with others is ishment they require, they begin to thin and deteriorate. Blinking is one mode that GALE ENCYCLOPEDIA OF GENETIC DISORDERS 81 patients of amyotrophic lateral sclerosis will be forced to the disease, and is vital for family members as well as utilize, in order to continue communication. As the disease progresses, victims gradually lose the Although there are no set treatments for ALS there use of their feet, hand, leg, and neck muscles, and paral- are still many special considerations that can assist in the ysis results in affected muscle groups. Sexual dys- cal therapy program, providing a wheelchair or walker, function is not affected. Breathing will become increas- assistance when bathing, and suction machines to help ingly difficult and the patients of ALS may decide to evacuate accumulated secretions all help the ALS patient. Researchers have developed a drug approved by the Diagnosis Food and Drug Administration (FDA) called Rilutek (riluzole). There is no one set way in that it appears to extend the life of ALS patients by to test for the disease. Electro diagnostic tests such as elec- Another drug, Myotrophin (somatomedin C), tromyography (EMG) and nerve conduction velocity appears to prevent neuron loss and enhance neuron gen- (NCV) are used to help diagnose ALS. If the person involved is young is suspected since it is a fatal neurological disease. After and the initial symptoms appear in the limbs, the disease a complete medical exam and family history check has tends to develop more slowly. Improved medical care has been administered, other tests such as a CT (computed prolonged the lives of ALS patients and shows promise tomography) scan may be done to continue ruling out for more effective treatments in the future. Many symptoms mimic ALS such as tumors of the skull base or upper cervical spinal cord, Resources spinal arthritis, thyroid disease, lead poisoning, and BOOKS severe vitamin deficiency. ORGANIZATIONS Moderate activities are recommended in the early Association of America (ALSA). Androgens—A group of steroid hormones that stu- Laith Farid Gulli, MD mulate the development of male sex organs and Brian Veillette, BS male secondary sexual characteristics. Chromosome—A microscopic thread-like struc- ture found within each cell of the body and con- sists of a complex of proteins and DNA. IAndrogen insensitivity Changes in either the total number of chromo- syndrome somes or their shape and size (structure) may lead to physical or mental abnormalities. Definition Mullerian ducts—Structures in the embryo that Androgen insensitivity syndrome is a genetic condi- develop into the fallopian tubes, the uterus, the tion where affected people have male chromosomes and cervix and the upper vagina in females. The external genitals, however, Wolffian ducts—Structures in the embryo that have mild to complete feminization.

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