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By D. Gunock. Concordia College, Moorhead Minnesota.

Clinicians and health services will increasingly need to “respect buy generic bystolic 5 mg on line high blood pressure medication and sperm quality, value and protect” health information if they are to maintain patient confidence 2.5 mg bystolic with mastercard prehypertension 30 years old, and the comprehensiveness and integrity and validity of information volunteered by patients for entry into electronic systems. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. The Challenge of Privacy and Security 93 is respected, valued and protected within wider society. If the fears of discrimination and creation of an uninsurable, unemployable underclass come to pass it will be the result of individual and collective actions of all us. Assessing or predicting the impact or future consequences of current actions will remain an ongoing challenge for health knowledge management system developments. We may certainly carry out Privacy Impact Assessments and risk benefit analysis, based on our current knowledge and context. However, as a global community, it is likely that the challenges of grasping the double-headed sword of electronic health knowledge man- agement systems have only just begun. Some unintended consequences of information technology in health care: The nature of patient care information system-related errors. Attitudes of first year medical students toward the confidentiality of computerised patient records. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Non-linear dynamics for clinicians: Chaos Ttheory, fractals, and complexity at the bedside. Evaluating computerised health information systems: Hard lessons still to be learnt. Information technology – Code of practice for information security management, AS/NZS ISO/IEC 17799:2001. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. The Challenge of Privacy and Security 95 Section II Organisational, Cultural and Regulatory Aspects of Clinical KnowledgeManagement Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. It is a problem that comes out of constructivist thinking and relates to the ability of people, once they start to communicate, to share knowledge. The popular knowledge management paradigm argues the importance of knowledge to management processes and organizational health. It may be said that it is likely that this paradigm will in due course give way to the “intelligent organization” paradigm that addresses how knowledge can be used intelligently for the viability of the organization. Part of the knowledge management paradigm centers on the use of knowledge sharing. This takes the view that while knowledge is necessary for people to do their jobs competently, there is also a need to have the potential for easy access to the knowledge of others. This chapter centers on the capacity of organizations to know what knowledge they have and to coordinate this knowledge. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Knowledge Cycles and Sharing 97 Introduction The incapacity of healthcare organizations to coordinate such knowledge is typified by the old joke1 about a hospital asking its consultant doctors to provide some guidance in coming to a decision about the construction of a new wing at the hospital. The message that this joke gives is that people working together in an organization see things from their own perspectives, which are formed by the knowledge that they have. The minimum requirement for an organization to work as a single system is for perspectives to be coordinated, and this can only occur through knowledge sharing: one can only coordinate perspective when one knows what perspec- tives there are to coordinate. Positivists normally see knowledge as a commodity that has value to individuals within a social context. It can be identified, coded, transferred through communications, decoded, and then used. The message that is provided in this chapter is that this commodity model is not only inadequate, but is actually dangerous for organizations because it allows them to assume that no work has to be put into the process of knowledge sharing.

New tests will be developed to research endeavors are now providing information that is monitor the effects of drugs bystolic 2.5mg on line heart attack under 40, and new medications will be allowing a better understanding of the underlying causes found that will specifically target a particular genetic of pharmacogenetic anomalies with the hope that eventu- abnormality purchase 2.5mg bystolic with mastercard blood pressure value ranges. Increased knowledge in this field should ally the number of negative episodes can be reduced. In time, these advances will improve the prac- The cytochrome P450 system is a group of related tice of medicine and become the standard of care. Stein, PhD 918 GALE ENCYCLOPEDIA OF GENETIC DISORDERS Phenotype see Genotypes and phenotypes Nerve cells have specialized extensions called dendrites and axons. Stimulating a nerve cell triggers nerve impulses, or signals, that speed down the axon. These nerve impulses then stimulate the end of an axon to release chemicals called neurotransmitters that spread IPhenylketonuria out and communicate with the dendrites of neighboring nerve cells. Definition Many nerve cells have long, wire-like axons that are Phenylketonuria (PKU) can be defined as a rare covered by an insulating layer called the myelin sheath. PKU is the most serious form of a class of nine levels in the blood and brain can produce nerve cells diseases referred to as “hyperphenylalaninemia,” all of with abnormal axons and dendrites, and cause imperfec- which involve above normal (elevated) levels of pheny- tions in the myelin sheath referred to as hypomyelination lalanine in the blood. This loss of myelin can “short circuit” PKU, mental retardation, is the result of consuming nerve impulses (messages) and interrupt cell communi- foods that contain the amino acid phenylalanine, which is cation. It patients who have not maintained adequate dietary con- is the most common genetic disease involving amino acid trol. PKU is incurable, but early, effective treat- PKU can also affect the production of one of the ment can prevent the development of serious mental inca- major neurotransmitters in the brain, called dopamine. PKU patients who do not consume enough tyrosine in Description their diet cannot produce sufficient amounts of dopamine. This is the only Some preliminary research suggests that nerve cells role of PAH in the body. A lack of PAH results in the of PKU patients also have difficulty absorbing tyrosine. Above normal who receive sufficient dietary tyrosine still experience levels of phenylalanine are toxic to the cells that make up some form of learning disability. Teratogens are any IQ (intelligence quotient) tests provide a measure of substance or organism that can cause birth disorders in a cognitive function. They generally very large molecules composed of strings of may require special tutoring and need to repeat some of smaller building blocks or molecules called amino acids. The body grams may experience problems with typical academic breaks down proteins from food into individual amino tasks such as math, reading, and spelling. Ten years of age seems to be an impor- sues, and are the key components of enzymes, antibodies, tant milestone for PKU patients. PKU and the human nervous system People with PKU tend to avoid contact with others, The extensive network of nerves in the brain and the appear anxious, and show signs of depression. KEY TERMS It is also interesting to note that people with PKU are less likely to display such habits as lying, teasing, and active Amino acid—Organic compounds that form the disobedience. There are 20 types of research findings are still quite preliminary and more amino acids (eight are “essential amino acids” extensive research is needed to clearly show how abnor- which the body cannot make and must therefore mal phenylalanine levels in the blood and brain might be obtained from food). Genetic profile Enzyme—A protein that catalyzes a biochemical reaction or change without changing its own PKU symptoms are caused by alterations or muta- structure or function. Mutations in the PAH gene prevent the liver from producing ade- Gene—A building block of inheritance, which quate levels of the PAH enzyme needed to break down contains the instructions for the production of a phenylalanine. The PAH gene and its PKU mutations are particular protein, and is made up of a molecular found on chromosome 12 in the human genome. Each gene is detail, PKU mutations can involve many different types found on a precise location on a chromosome. The term autosomal means that the gene for inheritance and expression of a genetic mutation. A recessive genetic trait, such as PKU, is one true or chronological age and multiplies that ratio that is expressed—or shows up—only when two copies by 100. A person with one normal and one PKU gene is Metabolism—The total combination of all of the called a carrier.

Even though the conditions are neither life-threatening nor significant in terms of loss of function cheap bystolic 5mg with visa hypertension united states, patients commonly seek treatments for relief generic bystolic 5 mg online arrhythmia and alcohol. For example, periph- eral nerve, spinal cord and midbrain/thalamic stimulation have been used commonly for more than 30 years for the relief of pain, in part driven by patient suffering and need for treatment. For example, patients with hemisphere or brainstem strokes may show hemiplegia (inability to move on one side), while patients with spinal cord injuries commonly have upper or lower extremity impairments or both. While lower extremity impairments interfere with walking, the inability can often be overcome by simple use of a wheelchair or other assistive device. Attempts to achieve com- puter-generated walking through direct muscle stimulation (known as functional electrical stimulation or FES) have shown some ability in aiding muscle movement. Upper extremity and hand function deficits are much more devastating and preclude most tasks; they also have minimal rehabilitation potential and usually require significant assistance even for activities of daily living. Another type of deficit is caused by ALS, a disease that may also affect the brainstem and upper cervical spinal cord, resulting in intact cognition but impaired speech and hand motion — a severely debilitating combination for interactions with the external world. Peripheral injuries and congenital defects, including lack of upper extremities (iatrogenic or traumatic amputation, for example) may also prevent translation of thoughts into actions. For all these conditions, a residual peripheral output such as a small muscle contraction could be useful for device control, but only in a highly limited format and with minimal information transfer for complex output of thoughts. Because most human interac- tions consist of speech and vocalization, persons with communication deficits may have severe problems defining and stating even their basic daily living needs. Most current approaches to enhancement of communication problems depend on residual output such as muscle contractions that can then trigger devices to achieve external speech or virtual choice output, but such devices are highly limited in terms of letter and word throughput. Conceivably, a highly efficient, more direct connection among people could bypass the need for vocaliza- tion altogether. Augmentation beyond normal innate human function has been a common thread in the entire history of human development. For example, eyeglasses, laser keratotomy, microscopes, and telescopes all enhance vision beyond normal ability. Most plastic surgery procedures, joint replacements, and other medical approaches are not always performed only to treat medical conditions; they are intended to improve function beyond what a patient normally experiences. The difference between ordinary augmentations and neuroprosthetics lies in using devices to mimic inherent brain signals for enhanced or direct sensory input into the brain, and decoding of normal brain signals for alternate channeling of motor output function. Although a variety of methods have been utilized, many current (and projected) neuroprosthetic devices are implanted directly into the brain. Implantation has the advantage of bypassing peripheral inputs and outputs, hence decreasing the time © 2005 by CRC Press LLC between signal and brain response. For example, a motor output could be channeled directly to a device for enhancing motor control on a microscopic, macroscopic, or larger-than-human level, resulting in considerable scaling of effort, far beyond the capabilities of the ordinary human motor system. Additionally, the time to response could be far less with direct inputs and outputs into the brain by speeding up a reflex loop, assuming the brain can keep pace with such external devices. Time and physical scaling enhancements have obvious practical importance for extending human control to environments that are hostile to biological tissue or, for example, aiding space exploration by decreasing delay in transmission. As argued in a recent article by noted ethicist Arthur Caplan,1 such augmentation is a natural extension of the long human interest in tool use and extends our understanding of the universe beyond our meager physical senses and motor capabilities although it potentially requires brain implants to access the nervous system directly. The main limitations of a scheme for enhancing brain function are deciphering inherent brain encoding of sensation and motor function and achiev- ing a stable interface between electrodes and the nervous system at a sufficiently small level to be meaningful for brain components, particularly axons and neurons on the micron scale. Excessive stimulation or recording interfaces may lead to unrealistic stimulation of multiple nervous elements, resulting in less-than-specific responses or noise and ranging across too many neural elements for decoding of neural output. Since enhancement of human performance and nervous system function are commonly employed now, how would such system be perceived and used in a wider arena? Clearly, the ethical issues point to self-determination and use, in other words, coercion to use a device would argue strongly against self-determination and free choice, particularly for implantable devices. Another ethical aspect to consider is universal access to such self-enhancements to prevent unfair advantage. Of course, most current self-enhancement advantages (expensive colleges, SAT preparation courses, etc. Whoever applies augmentation technology should bear these ethical principles in mind, particularly for implantable devices, to avoid coercion (as with other types of medical care), maintain individual self-determination, and allow the widest access possible. For example, unidirectional sensory stimulation of the nervous system has been used for many years to control pain at the thalamic, midbrain, spinal cord, and peripheral nerve levels; cochlear implants are more recent innovations. However, most devices could be improved by expanding the degree of control provided by feedback, which will be discussed in subsequent sections.

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