ABSTRACT
During the last decade, the traditional medical model has endeavoured to retrieve an improvement in the patient-physician relationship by means of propositions for humanization in the areas of education, medical care and policies. To enhance holistic characteristics of non-conventional practices in health, the incorporation of several aspects of humanities in understanding the process of the individual's illness, stressing that the physician's interest in aspects apparently not related to the impaired organ (history of the patients life, personality, interests, etc.) should be added to the technical and less humanized consultation. Since homeopathy embraces this wide semiological approach as inherent practice, using the totality of characteristic symptoms to evaluate organic unbalance and choose means of treatment, homeopathic clinical practice can significantly contribute to humanism in medicine.
Subject(s)
Homeopathy , Humanism , Physician-Patient Relations , Clinical Medicine , Humans , Physical ExaminationABSTRACT
Placebos are allegedly used widely in general practice. Surveys reporting high level usage, however, have combined two categories, 'pure' and 'impure' placebos. The wide use of placebos is explained by the high level usage of impure placebos. In contrast, the prevalence of the use of pure placebos has been low. Traditional pure placebos are clinically ineffective treatments, whereas impure placebos form an ambiguous group of diverse treatments that are not always ineffective. In this paper, we focus on the impure placebo concept and demonstrate problems related to it. We also show that the common examples of impure placebos are not meaningful from the point of view of clinical practice. We conclude that the impure placebo is a scientifically misleading concept and should not be used in scientific or medical literature. The issues behind the concept, however, deserve serious attention in future research.
Subject(s)
General Practice , Physician-Patient Relations , Placebo Effect , Placebos , Quality of Life , Anti-Bacterial Agents/administration & dosage , Concept Formation , General Practice/methods , General Practice/standards , Humans , Materia Medica/administration & dosage , Mentha piperita , Physical Examination , Phytotherapy , Plant Extracts/administration & dosage , Probiotics/administration & dosage , Suggestion , Terminology as Topic , Vitamins/administration & dosageABSTRACT
T0001 is the first mutant of etanercept with a higher affinity to tumor necrosis factor α (TNF-α) than etanercept. In order to investigate the safety and tolerability of T0001, a study was carried out in healthy Chinese subjects. A first-in-human, dose escalation study was conducted in healthy Chinese subjects. Fifty-six subjects were divided into six dose cohorts (10 mg, 20 mg, 35 mg, 50 mg, 65 mg and 75 mg) to receive a single subcutaneous injection of T0001. Safety and tolerability assessment were based on the records of vital signs, physical examinations, clinical laboratory tests, 12-lead electrocardiograms and adverse events (AEs). All subjects were in good compliance and none withdraw due to AEs. No serious AEs occurred. A total of twenty-three AEs in sixteen subjects were recorded, and eighteen of these AEs were believed to be related to T0001. The most frequently reported AEs were injection site reactions and white blood cell count increase. All these AEs were of mild to moderate intensity and most of them recovered spontaneously within 14 days. In this study, no dose-limiting toxicity was observed, and the maximum tolerated dose was identified as 75 mg. T0001 was considered safe and generally well tolerated at doses up to 75 mg in healthy Chinese volunteers
Subject(s)
Humans , Male , Female , Adolescent , Adult , Safety , Volunteers , Single Dose/drug effects , Etanercept/analogs & derivatives , Physical Examination , Arthritis, Rheumatoid/pathology , Tumor Necrosis Factor-alpha/classification , Clinical Laboratory Techniques , Asian People/classification , Electrocardiography , Injection Site Reaction , Injections, Subcutaneous/classificationABSTRACT
Both general practice and homeopathic consultations are organized around the key task of treating patients' health-related problems. Despite their different theories of healing, interactions between professionals and patients in both share many features, though there are also clear differences in the ways in which patients and professionals go about the process of problem solving. This paper compares the ways in which a specific activity, the delivery and reception of the reason for the visit, is managed in these two institutional environments. Through the comparison, it discusses ways in which participants are informed by the different theories of healing and 'ideal' models of interaction in their activities at the consultation, and points at some discrepancies between theories on treatment and theories on interaction. Furthermore, the paper shows how other contextual features, such as the institutionalized structure of a service encounter, may be consequential for the interaction analyzed. Finally, the paper discusses the potential benefits of this analysis to the practices studied.
Subject(s)
Communication , Family Practice , Homeopathy , Interviews as Topic , Professional-Patient Relations , Finland , Humans , Linguistics , Physical ExaminationABSTRACT
A pesar de los avances tecnológicos, la historia clínica y el examen físico continúan y continuarán siendo la base de un buen enfoque y aproximación diagnóstica correcta, por ésto, la semiología sigue siendo un área muy importante en la medicina. En ésta revisión se plantea una guía sistemática e integral para la evaluación del sistema nefro-urológico en el niño desde las herramienta básicas y fundamentales como la historia clínica, el examen físico con sus componentessemiológicos en lo normal y lo patológico, integrando además los métodos diagnósticos de laboratorio e imagen disponibles en la actualidad, para lograr un buen enfoque y aproximación diagnóstica en niños con enfermedad renal.
Despite technological advances, medical history and physical examination remain the foundation of a good approach and correct diagnosis; semiology remains a very important area in medicine. In this review a systematic and comprehensive guide for the evaluation of nephron urological system in children is presented, with emphasis in medical history, physical examination and semiotic aspects, in normal and pathological conditions; additionally laboratory and imaging studies available to achieve a good diagnostic approach in children with renal disease are presented.
Subject(s)
Humans , Male , Female , Child , Physical Examination/classification , Physical Examination , Physical Examination/methods , Homeopathic Semiology , Nephrology/classification , Nephrology/education , Nephrology/methods , Urology/classification , Urology/methods , Dysuria/classification , Dysuria/complications , Dysuria/diagnosis , Dysuria/epidemiology , Dysuria/pathology , Dysuria/prevention & control , Oliguria/classification , Oliguria/complications , Oliguria/diagnosis , Oliguria/pathology , Oliguria/prevention & controlABSTRACT
This invitation for co-operation is addressed to all interested groups. Its purpose is data collection for clinical verification of symptoms from homeopathic proving and collection of clinical symptoms not derived from homeopathic pathogenetic trials (provings). To date no consensus exists on this topic. The European Committee for Homoeopathy (ECH) research sub-committee has created a working group on this topic. This paper is the result of a review of papers on the topic, exchanges between members and a meeting.
Subject(s)
Data Collection , Homeopathy , Physical Examination , Education , HumansABSTRACT
This study is based on a survey involving 117 physicians in Austria, working in private practice and under the National Health Plan on a homeopathic basis. The questionnaire covered such topics as socio-demographic data, individual methods of working, office organization, application of alternative therapies, health awareness, and perception of the general acceptance of homeopathy. The results showed that considerably more time is taken for treating patients homeopathically than for patients treated traditionally under the National Health Plan. More than half the physicians use homeopathic remedies exclusively, whereas homeopathic combination remedies were rarely administered. Neural therapy, microbiological therapy (bacterial immunostimulation) and phytotherapy are those alternative therapies most frequently used in addition. A spiritual approach seems to be a significant component of the working methods of these doctors. Their working method is generally traditional: exact medical history and physical examination are ranked high, whereas biochemical data are regarded to be less important for diagnosis.
Subject(s)
Complementary Therapies , Homeopathy , Physician-Patient Relations , Practice Patterns, Physicians' , Adult , Aged , Attitude of Health Personnel , Austria , Diagnostic Tests, Routine , Female , Humans , Male , Middle Aged , Physical Examination , Private Practice , Treatment OutcomeABSTRACT
Na última década, o modelo médico vigente busca resgatar um incremento na relação médico-paciente, com propostas de humanização nas áreas da educação, assistência e política médica. Valorizar características holísticas das práticas não convencionais em saúde sugere a incorporação de aspectos diversos das ciências humanas no entendimento do processo de adoecimento do indivíduo, ressaltando que o interesse do médico por aspectos aparentemente não relacionados ao órgão acometido (história de vida do paciente, personalidade, interesses etc.) deve ser acrescentado à consulta médica técnica e não-humanizada. Tendo em vista que a homeopatia utiliza esta ampla abordagem semiológica como prática inerente, empregando a totalidade de sintomas característicos do enfermo para avaliar o desequilíbrio orgânico e escolher o meio de tratamento, a prática clínica homeopática tem muito a contribuir com o humanismo da medicina.
During the last decade, the traditional medical model has endeavoured to retrieve an improvement in the patient-physician relationship by means of propositions for humanization in the areas of education, medical care and policies. To enhance holistic characteristics of non-conventional practices in health, the incorporation of several aspects of humanities in understanding the process of the individual's illness, stressing that the physician's interest in aspects apparently not related to the impaired organ (history of the patients life, personality, interests, etc.) should be added to the technical and less humanized consultation. Since homeopathy embraces this wide semiological approach as inherent practice, using the totality of characteristic symptoms to evaluate organic unbalance and choose means of treatment, homeopathic clinical practice can signnificantly contribute to humanism in medicine.
Subject(s)
Humans , Homeopathy , Humanism , Physician-Patient Relations , Clinical Medicine , Physical ExaminationSubject(s)
Employment , Occupational Medicine , Substance-Related Disorders/urine , Adult , Age Factors , Barbiturates/urine , Chromatography, Thin Layer , Ethnicity , Humans , Male , Mass Screening , Methadone/urine , Narcotics/urine , New York City , Opium/urine , Phenothiazines/urine , Physical Examination , Pilot Projects , Quinine/urine , Substance-Related Disorders/diagnosis , TelephoneABSTRACT
Este manual para el examen físico del normal es una aportación fundamental a la enseñanza de la Semiología. No existe ningún manual de esta clase con el cual el estudiante aprenda la teoría y destrezas necesarias para ejecutar la inspección de una persona sana. Es pues, el manual del Dr. Uribe, la consulta obligada de todo alumno que se prepara para el inicio de la clínica. La organización curricular corriente introduce de una vez al estudiante a la Semiología, lo cual es inconveniente, dado que no se tiene la referencia de la normalidad. Sise da una enseñanza del examen físico del normal se aprende el concepto de normalidad y es más fácil para el alumno comprender el fenómeno de lo patológico. El manual está ampliamente ilustrado con esquemas y dibujos hechos por el autor, los cuales facilitan enormemente la comprensión de los temas tratados. El Dr. Uribe, como docente de la Facultad de Medicina del Instituto CES, preparó este manual que ha tenido amplia acogida en todas las Facultades de Medicina del país. A su diligencia y vocación docente debemos este gran aporte a la educación médica de nuestro país...
Subject(s)
Handbook , Homeopathic Semiology , Physical ExaminationABSTRACT
El siguiente estudio continúa la serie de publicaciones sobre decisiones clínicas en el diagnóstico, tratamiento y costo-utilidad en Hepatología, usando las herramientas de la Medicina Basada en Evidencia (MBE). En un escenario clínico en que se sospecha la presencia de ascitis, la real utilidad de los hallazgos clínicos no ha sido bien establecida. Usando un modelo de búsqueda basado en una pregunta clínica, tres estudios y un artículo de revisión son identificados. Uno de estos estudios es extensamente analizado, incluyendo criterio de validez interna (gold standard, criterios de selección de pacientes, reproducibilidad de los hallazgos y temporalidad), análisis de resultados y discusión de la aplicabilidad. Cuatro signos clínicos (flancos abultados, matidez en los flancos, matidez desplazable y signo de la ola) fueron examinados de manera independiente por tres gastroenterólogos. Los resultados muestran que, usando la ultrasonografía como gold standard, 21 por ciento de los pacientes tenía ascitis. La sensibilidad y especificidad de las maniobras examinadas fue de 50 por ciento a 94 por ciento, y 29 por ciento a 82 por ciento, respectivamente. La matidez en los flancos fue el más sensible y el signo de la ola el más específico. La metodología del estudio está limitada por el reducido número de pacientes, la falta de adecuados criterios de selección de casos y la ausencia de información acerca la temporalidad de los síntomas. Otros signos presentes en cirrosis son descritos y brevemente analizados, usando MBE. Concluimos que los signos del examen físico son útiles en el diagnóstico de ascitis, siendo la matidez en los flancos y el signo de la ola los más útiles. La ecotomografía se recomienda en casos de duda diagnóstica.
Subject(s)
Humans , Middle Aged , Ascites/diagnosis , Liver Cirrhosis/diagnosis , Physical Examination/methods , Evidence-Based Medicine , Splenomegaly/physiopathology , Jaundice/physiopathology , Biomedical Research/methods , Periodical , Reproducibility of Results , Signs in Homeopathy , Sensitivity and Specificity , Signs and Symptoms , Telangiectasis/physiopathologyABSTRACT
Os autores relatam o atendimento e evoluçäo de uma criança com constipaçäo intestinal crônica funcional dentro de um projeto de pesquisa sobre psicossomática na criança por um período de um ano e meio em dezessete atendimentos. Chamam a atençäo para o papel da relaçäo médico-mäe-criança na transformaçäo das relaçöes familiares, que tem como consequência o desaparecimento dos sintomas. Näo se trata de um relato raro, mas uma nova abordagem clínica
Subject(s)
Humans , Female , Child , Constipation , Family , Intestines/pathology , Physician-Patient Relations , Psychosomatic Medicine , Abdominal Pain , Brazil , Medical History Taking , Physical Examination , Signs in HomeopathyABSTRACT
Se revisan retrospectivamente 89 fichas clínicas de carcinomas in situ; 15 con CLIS, 57 con CDIS y 17 con MI. El promedio de edad fue de 48,7 años. La mayoría de las pacientes tenía menos de 50 años, lo que no sucede con los carcinomas infiltrantes de nuestra casuística. Un 73,1 por ciento presentaba algún tipo de sintomatología clínica: masa palpable, descarga por el pezón o ulceración del pezón con características de Paget. Cuando hubo flujo por el pezón éste fue hemático en el 86,3 por ciento. El diagnóstico fue sugerido por la mamografía exclusivamente en el 19 por ciento y constituyó un hallazgo histopatológico en 7 pacientes. Se discuten las controversias terapéuticas y los cambios en enfoque de las mismas en el curso de los años y se presenta la evolución en un tiempo promedio de 8 años de observación; una sola pacientes ha fallecido de su cáncer de mama y correspondió al grupo con MI
Subject(s)
Humans , Female , Middle Aged , Breast Neoplasms/surgery , Carcinoma in Situ/surgery , Biopsy , Breast Neoplasms/diagnosis , Breast Neoplasms/physiopathology , Clinical Diagnosis , Clinical Evolution , Clinical Record , Mammography , Mastectomy, Simple , Physical Examination , Retrospective Studies , Signs and SymptomsABSTRACT
Um caso de infecçäo por Shigella flexneri em uma mulher de 34 anos de idade com hipogamaglobulinemia e diarréia é apresentado; o problema diagnóstico representado por diarréia no paciente com hipogamaglobulinemia é discutido. A revisäo de 7 outros pacientes com hipogamaglobulinemia tratados no HCRP é apresentado e é enfatizado que vários agentes patogênicos podem causar diarréia nesses pacientes
Subject(s)
Humans , Female , Adult , Agammaglobulinemia/diagnosis , Anti-Bacterial Agents/therapeutic use , Antidiarrheals/therapeutic use , Diarrhea/etiology , Shigella flexneri/isolation & purification , Agammaglobulinemia/etiology , Brazil , Clinical Laboratory Techniques , Diarrhea/drug therapy , Physical Examination , Signs in Homeopathy , Immunologic Deficiency Syndromes , Symptomatology , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
Los estudios preoperatorios tienen como objetivo principal apoyar los hallazgos detectados por interrogatorio y exploración física previos a cirugía electiva. El presente estudio tiene como finalidad demostrar la utilidad de los estudios preoperatorios convencionales apoyados por una historia clínica apropiada que pueda simplificarlos en función de costo-benefico para los pacientes. Se analizaron 1000 pacientes sometidos a cirugía electiva previa valoración preanestésica, los exámenes preoperatorios fueron: biometría hemática, glicemia, nitrógeno ureico en sangre, creatinina, electrólito séricos, pruebas de coagulación, examen general de orina, proteínas séricas, electrocardiograma y radiografía tele de tórax. Se analizaron los datos obtenidos en función a complicaciones por órganos y sistemas así como la correlación entre estos mediante análisisi univeriado con el método de Chi cuadrada de Pearson, así como significancia estadística con la prueba de Bonferroni considerándose como datos significativos p< 0.05