Evidence-based medicine Prostamol

La chemioterapia dopo lintervento chirurgico alla prostata

Medicine is the science and practice of establishing the diagnosisprognosistreatmentand evidence-based medicine Prostamol of disease. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciencesbiomedical researchgeneticsand medical technology to diagnosetreat, and prevent injury and disease, typically through pharmaceuticals or surgerybut also through therapies as diverse as psychotherapyexternal splints and tractionmedical devicesbiologicsand ionizing radiationamongst evidence-based medicine Prostamol.

Medicine has been around for thousands of years, during most of which it was an art an area of skill and knowledge frequently having connections to the religious and philosophical beliefs of local culture. For example, a medicine man would apply herbs and say prayers for healing, or an ancient philosopher and physician would apply bloodletting according to the theories of humorism.

In recent centuries, since the advent of modern sciencemost medicine has become a combination of art and science both basic and appliedunder the umbrella of medical science. While stitching technique for sutures is an art learned through practice, the knowledge of what happens at the cellular and molecular level in the evidence-based medicine Prostamol being stitched arises through science. For example, evidence on the effectiveness of acupuncture is "variable and inconsistent" for any condition, [2] but is generally safe when done by an appropriately trained practitioner.

Quackery evidence-based medicine Prostamol encompass an array of practices and practitioners, irrespective of whether they are prescientific traditional medicine and folk medicine or modern pseudo-scientificincluding chiropractic which rejects modern scientific germ theory of disease instead believing without evidence that human diseases are caused by invisible subluxation of the bones, predominately of the spine and less so of other boneswith just over half of chiropractors also rejecting the science of immunization.

Medical availability and clinical practice varies across the world due to regional differences in culture and technology. Modern scientific medicine is evidence-based medicine Prostamol developed in the Western worldwhile in developing countries such evidence-based medicine Prostamol parts of Africa or Asia, the population may rely more heavily on traditional medicine with limited evidence and efficacy and no required formal training for practitioners.

In modern clinical practice, physicians personally assess patients in order to diagnoseprognosetreat, and prevent disease using clinical judgment. The doctor-patient relationship typically begins an interaction with an examination of the patient's evidence-based medicine Prostamol history and medical recordfollowed by a medical interview [10] and a physical examination. Basic diagnostic medical devices e.

After examination for signs and interviewing for symptomsthe doctor may order medical tests e. Differential diagnosis methods help to rule out conditions based on the information provided.

During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust. The medical encounter is then documented in the medical record, evidence-based medicine Prostamol is a legal document in many jurisdictions. The diagnosis and treatment may take only a few minutes or a few weeks depending upon the complexity of the issue. The components of the medical interview [10] and encounter are:.

The physical examination is the examination of the patient for medical signs of disease, which are objective and observable, in contrast to symptoms which are volunteered by the patient and not necessarily objectively observable. Four actions are the basis of physical examination: inspectionpalpation feelpercussion tap to determine resonance characteristicsand auscultation listengenerally in that order although auscultation occurs prior to percussion and palpation for abdominal assessments.

It is to likely focus on areas of interest highlighted in the medical history and may not include everything listed above.

The treatment plan may include ordering additional medical laboratory tests and medical imaging studies, starting therapy, referral to a specialist, or watchful observation.

Follow-up may be advised. Depending upon the health insurance plan and the managed care system, various forms of " utilization review ", such as prior authorization of tests, may place barriers on accessing expensive services.

The medical decision-making MDM process involves analysis and synthesis of all the evidence-based medicine Prostamol data to come up with a list of possible diagnoses the differential diagnosesalong with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem.

On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations.

Contemporary medicine is in general conducted within health care systems. Legal, credentialing and financing frameworks are established by individual governments, augmented on occasion by international organizations, such as evidence-based medicine Prostamol.

The characteristics of any given health care system have significant impact on the way medical care is provided. From ancient times, Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals and the Catholic Church today remains the largest non-government provider of medical services in the world.

This is intended to ensure that the entire population has access to medical care on the basis of need rather evidence-based medicine Prostamol ability to pay. Delivery may be via private medical practices or by state-owned hospitals and clinics, or by charities, most commonly by a combination of all three.

Most tribal societies evidence-based medicine Prostamol no guarantee of healthcare for the population as a whole. In such societies, healthcare is available to those that can afford to pay for it or have self-insured it either directly or as part of an evidence-based medicine Prostamol contract or who may be covered by care financed by the government or tribe directly.

Transparency of information is another factor defining a delivery system. While the US healthcare system has come under fire for lack of openness, [18] new legislation may encourage greater openness. There is a perceived tension between the need for evidence-based medicine Prostamol on the one hand and evidence-based medicine Prostamol issues as patient confidentiality and the possible exploitation of information for commercial gain on the other.

Primary care medical services are provided by physiciansphysician assistantsnurse practitionersor other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, clinicsnursing homesschools, home visits, and other places close to patients.

These include treatment of acute and chronic illnesses, preventive care and health education for all ages and evidence-based medicine Prostamol sexes. Secondary care medical services are provided by medical specialists evidence-based medicine Prostamol their offices or clinics or at local community hospitals evidence-based medicine Prostamol a patient referred by a primary care provider who first diagnosed or treated the patient.

Referrals are made for those patients who required the expertise or procedures performed by specialists. Evidence-based medicine Prostamol include both ambulatory care and inpatient services, Emergency departmentsintensive care medicinesurgery services, physical therapylabor and deliveryevidence-based medicine Prostamol units, diagnostic laboratory and medical imaging services, hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.

Tertiary care medical services are provided by specialist hospitals or evidence-based medicine Prostamol centers equipped with diagnostic and treatment facilities not generally available at local hospitals.

These include trauma centersburn treatment centers, advanced neonatology unit services, organ transplantshigh-risk pregnancy, radiation oncologyetc. Modern medical care also depends on information — still delivered in many health care settings on paper records, but increasingly nowadays by electronic means.

In low-income countries, modern healthcare is often too expensive for the average person. International healthcare policy researchers have advocated that "user fees" be removed in these areas to ensure access, although even after removal, significant costs and barriers remain.

Separation of prescribing and dispensing is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug. In the Western world there are centuries of tradition for separating pharmacists from physicians. In Asian countries it is traditional for physicians to also provide drugs.

Working together as an interdisciplinary teammany highly trained health professionals besides medical practitioners are involved in the delivery of modern health care. Examples include: nursesemergency medical technicians and paramedics, laboratory scientists, pharmacistspodiatristsphysiotherapistsrespiratory therapistsspeech therapistsoccupational therapistsradiographers, dietitiansand bioengineerssurgeonssurgeon's assistantsurgical technologist.

The scope and sciences underpinning human medicine overlap many other fields. Dentistrywhile considered by some evidence-based medicine Prostamol separate discipline from medicine, is a medical field. A patient admitted to the hospital is usually under the care of a specific team based on their main presenting problem, e. Physicians have many specializations and subspecializations into certain branches of medicine, which are listed evidence-based medicine Prostamol.

There are variations from country to country regarding which specialties certain subspecialties are in. In the broadest evidence-based medicine Prostamol of "medicine", there are many different specialties.

In the UK, most evidence-based medicine Prostamol have their own body or college, which have its own entrance examination. These are collectively known as the Royal Colleges, although not all currently use the term "Royal".

The development of a speciality is often driven by new technology such as the development of effective anaesthetics or ways of working such as emergency departments ; the new specialty leads to the formation of a unifying body of doctors and the prestige of administering their own examination.

Within medical circles, specialities usually fit into one of two broad categories: "Medicine" and "Surgery. At present, some specialties of medicine do not fit easily into either evidence-based medicine Prostamol these categories, such as radiology, pathology, or anesthesia.

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a pathological condition such as disease or injuryto help improve bodily function or appearance or to repair unwanted ruptured areas for example, a perforated ear drum. Surgeons must also manage pre-operative, post-operative, and potential surgical candidates on the hospital wards.

Surgery has many sub-specialties, including evidence-based medicine Prostamol surgeryophthalmic surgerycardiovascular surgerycolorectal surgeryneurosurgeryoral and maxillofacial surgeryoncologic surgeryorthopedic surgeryotolaryngologyplastic surgerypodiatric surgerytransplant surgerytrauma surgeryurologyvascular surgeryand pediatric surgery.

In some centers, anesthesiology is part of the division of surgery for historical and logistical reasonsalthough it is not a surgical discipline. Other medical specialties may evidence-based medicine Prostamol surgical procedures, such as ophthalmology and dermatologyevidence-based medicine Prostamol are not considered surgical sub-specialties per se. Surgical training in the U. Sub-specialties of surgery often require seven or more years.

In addition, fellowships can evidence-based medicine Prostamol an additional one to three years. Because post-residency fellowships can be competitive, many trainees devote two additional years to research.

Thus in some cases surgical training will not finish until more than evidence-based medicine Prostamol decade after medical school. Furthermore, surgical training can be very difficult and time-consuming. Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. According to some sources, an emphasis on internal structures is implied.

Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized; such general physicians would see any complex nonsurgical problem; this style of practice has become much less common.

In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, gastroenterologists and nephrologists specialize respectively in diseases of the gut and the kidneys. In the Commonwealth of Nations and some other countries, specialist pediatricians and geriatricians are also described as specialist physicians or internists who have subspecialized by age of patient rather than by organ system.

Elsewhere, especially in North America, general pediatrics is often a form of primary care. There are many subspecialities or subdisciplines of internal medicine :. Training in internal medicine as opposed to surgical trainingvaries considerably across the world: see the articles on medical education and physician for more details.

In North America, it requires at least three years of residency training after medical school, which can then be followed by evidence-based medicine Prostamol one- to three-year fellowship in the subspecialties listed above. In general, resident work hours in medicine are less than those in surgery, averaging about 60 hours per week in evidence-based medicine Prostamol US.

This difference does not apply in the UK evidence-based medicine Prostamol all doctors are now required by law to work less than 48 hours per week on average. Evidence-based medicine Prostamol following are some major medical specialties that do not directly fit into any of the above-mentioned groups:.

Medical education and training varies around the world. It typically involves entry level education at a university medical schoolfollowed by a evidence-based medicine Prostamol of supervised practice or internshipor residency.

This can be followed by postgraduate vocational training. A variety of teaching methods evidence-based medicine Prostamol been employed in medical education, still itself a focus of active research. Since knowledge, techniques, and medical technology continue to evolve at a rapid rate, many regulatory authorities require continuing medical education.

Medical practitioners upgrade their evidence-based medicine Prostamol in various ways, including medical journalsseminars, conferences, and online programs. In most countries, it is a legal requirement for a medical doctor to be licensed or registered.