کنترل دیابت در کودکان نیز همانند بزرگسالان از طریق کنترل قند خون صورت می گیرد.اما مشکلاتی از قبیل اصرار بیش از حد و رفتار سختگیرانه برای کنترل قند یا مواردی از این دست می تواند مشکلاتی را از نظر روانی برای کودکان زیر شش سال ایجاد کند. در این بخش از کتاب روان شناسی در درمان دیابت به این موضوع پرداخته شده است و مشکلات و راه حل های این معضل کاملا بررسی شده اند
Once diagnosed, the basic goals ofdiabetes therapy for children under the
age of6 years are similar to those recommended to all children and
adolescents and include the avoidance ofhigh and low blood glucose
levels and the maintenance ofnormal growth and development. However,
due to the continued development ofthe central nervous system, young
children are particularly vulnerable to the debilitating consequences of
recurrent hypoglycaemia.
There is a growing body ofevidence supporting the negative conse-
quencesÐmild cognitive de®citsÐresulting from overly aggressive attempts
to normalize metabolism in young children. Ack et al.24 reported modest
cognitive de®cits in patients with a younger onset oftype 1 diabetes. Others
also reported brain damage as a result ofsevere hypoglycaemia, particularly
in young children25;26. A series ofstudies by Ryan et al.27 29, using a battery
of neurobehavioural tests, identi®ed signi®cant differences between youths
with diabetes compared with control subjects on measures ofverbal intelli-
gence, visual±motor coordination and critical ¯icker threshold. Additionally,
children diagnosed with diabetes under 5 years ofage manifested signi®cant
cognitive de®cits when evaluated during the adolescent years, probably
resulting from symptomatic or asymptomatic hypoglycaemia occurring
earlier in life, before ®nal maturation of the central nervous system. In
another study by Rovet et al.30, children diagnosed under 4 years ofage
scored lower than other children with diabetes diagnosed later in childhood,
and lower than non-diabetic sibling controls on tests ofvisual±spatial
orientation, but not on verbal ability. Hypoglycaemic seizures were found
to occur in greater frequency in the group of children diagnosed under 4
years ofage compared to those diagnosed at older ages, suggesting that
severe hypoglycaemia may impair later cognitive functioning3
در این بخش مبحث نیروی کار و آموزش در پزشکی جامع بررسی می شود. شما برای دریافت کامل این کتاب یا ترجمه آن می توانید از بخش نظرات وبلاگ استفاده کنید و با ما تماس بگیرید. در اینجا فقط ابتدای این بخش از کتاب که به اجلاس سال 2009 مربوط می شود برای شما عزیزان درج شده است.
Regulation has been viewed as necessary ever since Adam Smith
famously observed, in The Wealth of Nations, that “[p]eople of the same
trade seldom meet together, even for merriment and diversion, but the
conversation ends in a conspiracy against the public.” But, in The Theory
of Moral Sentiments, Smith suggested that it is the conscience of the pro-
fessional, not regulation, that provides the greatest protection to the pub-
lic.
To do some good, Chantler said, the evidence base for complemen-
tary medicine should be built on effectiveness. While it is always desir-
able to understand the efficacy of an intervention—that is, whether an
intervention works under ideal conditions, such as those of a clinical
trial—it is possible to study the effectiveness of a treatment for patients in
routine clinical care without having a full understanding of its efficacy.
This may be particularly important with complex interventions that have
psychological as well as pharmaceutical or physical components. Evalua-
tion should ensure that a treatment is safe, beneficial, and cost-effective.
The latter is especially important in establishing the value for public in-
vestment.
The evidence base, in Chantler’s opinion, should include a combina-
tion of clinical outcomes, measures of patient satisfaction, and patient
outcome measures, such as normal activities of daily living. It is impera-
tive to know how well patients with chronic diseases are functioning
over the course of time.
Most interventions, Chantler pointed out, now require integration—
within and among different professions, different care modalities, and
different locations, because much of the care provided takes place out-
side the hospital. This gives fundamental importance to maintaining an
up-to-date and thorough medication record, including treatments pro-
vided through complementary modalities. Even if a single electronic
health record for patients in all circumstances is not yet feasible, Web-
based systems are being developed so that a contemporary summary can
be made available to all practitioners involved in the patient’s care.
Chantler emphasized that integrative care requires such thorough com-
munication.
پزشکی جامع هدفی است که پزشکان زیادی در سراسر دنیا ان را دنبال می کنند در این پست مقدمه کتابی که از مقالات اجلاس سال 2009 در مورد این موضوع برگزار شده است را به شما علاقمندان به مباحث علم پزشکی عرضه می کنیم باشد که مورد توجه شما دوستان قرار بگیرد.و شاهد رشد روز افزون استفاده از پزشکی جامع در ایران عزیزمان باشیم
Health is a personal matter, as is the way each of us chooses to inte-
grate concerns about health into our lives. Like a Rorschach blot, the no-
tion of integrative medicine, or integrative health, means different things
to different people. As an approach to enhancing health, integrative
health seeks to combine the best scientific and evidence-based ap-
proaches to care with a focus on the full range of needs of the individual.
Integrative medicine seeks to enable everyone to maintain their health
insofar as possible, and to be empowered in partnering with health care
providers when illness occurs. With this approach, patients can be more
effective stewards of their own health and wellness.
This publication, Integrative Medicine and the Health of the Public:
A Summary of the 2009 Summit, provides an account of the discussion
and presentations of the two-and-a-half day summit in Washington, DC,
held February 25–27, 2009. While this summary captures the discussion,
it cannot adequately convey the energy and enthusiasm of the partici-
pants who filled the auditorium throughout the event. The Institute of
Medicine (IOM) was honored to host such a large and diverse group to
discuss such a timely topic, especially at such a critical time in American
health care policy making.
Under the direction of Ralph Snyderman, the summit planning com-
mittee assembled an outstanding group of speakers and discussants who
provided valuable insights on the potential and limitations of integrative
health care, models that might be most conducive to its delivery, the mul-
tiple dimensions of scientific endeavor that intersect as its support base,
and possible economic implications and incentives. Participants had an
exceptional opportunity to examine the role and value of integrative
medicine in meeting health needs and overcoming fragmentation in the
health care delivery system.
The summit discussions were fruitful and collaborative, and I believe
that every participant came away from the meeting having learned some-
thing each did not know before. It is my hope that this publication will
advance thoughtful consideration of integrative medicine and extend the
enthusiasm that was ignited at the summit.
I would like to thank the Bravewell Collaborative for their spirit of
partnership and support of this activity, Ralph Snyderman for his leader-
ship and guidance, the planning committee for their commitment and
wisdom, and the IOM staff for their hard work and dedication.
انکولوزی از رشته های بسیار تخصصی پزشکی است. در مقدمه کتابPolicy Issues in the Development of Personalized Medicine in Oncology: Workshop Summary که در این پست برای شما درج شده است شما با مشکلات توسعه ای مطرح شده در این رشته تخصصی آشنا می شوید.
Introduction
PERSONALIZED MEDICINE IN ONCOLOGY
• The current state of the art of personalized medicine technology,
including obstacles to its development and use by clinicians and
patients.
• The current approaches to test validation, including analytic valid-
ity, clinical validity, and clinical utility.
• The regulation of personalized medicine technologies, including the
approaches’ shortcomings.
• Reimbursement hurdles that can hamper both the development and
use of personalized medicine technologies.
• Potential solutions to the technological, regulatory, and reimburse-
ment obstacles to personalized medicine.
This document is a summary of the conference proceedings, which
will be used by an Institute of Medicine (IOM) committee to develop
consensus-based recommendations for moving the feld of personalized
cancer medicine forward. The views expressed in this summary are those
of the speakers and discussants, as attributed to them, and are not the con-
sensus views of the participants of the workshop or of the members of the
National Cancer Policy Forum.