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title: "Internal environment"
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The internal environment (or milieu intérieur in French; French pronunciation: [mi.ljø ɛ̃.te.ʁjœʁ]) was a concept developed by Claude Bernard, a French physiologist in the 19th century, to describe the interstitial fluid and its physiological capacity to ensure protective stability for the tissues and organs of multicellular organisms.
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== Etymology ==
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Claude Bernard used the French phrase milieu intérieur (internal environment in English) in several works from 1854 until his death in 1878. He most likely adopted it from the histologist Charles Robin, who had employed the phrase "milieu de l’intérieur" as a synonym for the ancient hippocratic idea of humors. Bernard was initially only concerned with the role of the blood but he later included that of the whole body in ensuring this internal stability. He summed up his idea as follows:
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The fixity of the milieu supposes a perfection of the organism such that the external variations are at each instant compensated for and equilibrated.... All of the vital mechanisms, however varied they may be, have always one goal, to maintain the uniformity of the conditions of life in the internal environment.... The stability of the internal environment is the condition for the free and independent life.
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Bernard's work regarding the internal environment of regulation was supported by work in Germany at the same time. While Rudolf Virchow placed the focus on the cell, others, such as Carl von Rokitansky (1804–1878) continued to study humoral pathology particularly the matter of microcirculation. Von Rokitansky suggested that illness originated in damage to this vital microcirculation or internal system of communication. Hans Eppinger (1879–1946), a professor of internal medicine in Vienna, further developed von Rokitansky's point of view and showed that every cell requires a suitable environment which he called the ground substance for successful microcirculation. This work of German scientists was continued in the 20th century by Alfred Pischinger (1899–1982) who defined the connections between the ground substance or extracellular matrix and both the hormonal and autonomic nervous systems and saw therein a complex system of regulation for the body as a whole and for cellular functioning, which he termed the ground regulatory (das System der Grundregulation).
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== History ==
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Bernard created his concept to replace the ancient idea of life forces with that of a mechanistic process in which the body's physiology was regulated through multiple mechanical equilibrium adjustment feedbacks. Walter Cannon's later notion of homeostasis (while also mechanistic) lacked this concern, and was even advocated in the context of such ancient notions as vis medicatrix naturae.
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Cannon, in contrast to Bernard, saw the self-regulation of the body as a requirement for the evolutionary emergence and exercise of intelligence, and further placed the idea in a political context: "What corresponds in a nation to the internal environment of the body? The closest analogue appears to be the whole intricate system of production and distribution of merchandise". He suggested, as an analogy to the body's own ability to ensure internal stability, that society should preserve itself with a technocratic bureaucracy, "biocracy".
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The idea of milieu intérieur, it has been noted, led Norbert Wiener to the notion of cybernetics and negative feedback creating self-regulation in the nervous system and in nonliving machines, and that "today, cybernetics, a formalization of Bernard's constancy hypothesis, is viewed as one of the critical antecedents of contemporary cognitive science".
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=== Early reception ===
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Bernard's idea was initially ignored in the 19th century. This happened in spite of Bernard being highly honored as the founder of modern physiology (he indeed received the first French state funeral for a scientist). Even the 1911 edition of Encyclopædia Britannica does not mention it. His ideas about milieu intérieur only became central to the understanding of physiology in the early part of the 20th century. It was only with Joseph Barcroft, Lawrence J. Henderson, and particularly Walter Cannon and his idea of homeostasis, that it received its present recognition and status. The current 15th edition notes it as being Bernard's most important idea.
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=== Idea of internal communication ===
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In addition to providing the basis for understanding the internal physiology in terms of the interdependence of the cellular and extracellular matrix or ground system, Bernard's fruitful concept of the milieu intérieur has also led to significant research regarding the system of communication that allows for the complex dynamics of homeostasis.
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==== Work by Szent-Györgyi ====
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Initial work was conducted by Albert Szent-Györgyi who concluded that organic communication could not be explained solely by the random collisions of molecules and studied energy fields as well as the connective tissue. He was aware of earlier work by Moglich and Schon (1938) and Jordan (1938) on non-electrolytic mechanisms of charge transfer in living systems. This was further explored and advanced by Szent-Györgyi in 1941 in a Koranyi Memorical Lecture in Budapest, published in both Science and Nature, wherein he proposed that proteins are semi-conductors and capable of rapid transfer of free electrons within an organism. This idea was received with skepticism, but it is now generally accepted that most if not all parts of the extracellular matrix have semiconductor properties. The Koranyi Lecture triggered a growing molecular-electronics industry, using biomolecular semiconductors in nanoelectronic circuits.
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In 1988 Szent-Györgyi stated that "Molecules do not have to touch each other to interact. Energy can flow through... the electromagnetic field" which "along with water, forms the matrix of life." This water is related also to the surfaces of proteins, DNA and all living molecules in the matrix. This is a structured water that provides stability for metabolic functioning, and related to collagen as well, the major protein in the extracellular matrix and in DNA. The structured water can form channels of energy flow for protons (unlike electrons that flow through the protein structure to create bio-electricity). Mitchell (1976) refers to these flow as 'proticity'.
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==== Work in Germany ====
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Work in Germany over the last half-century has also focused on the internal communication system, in particular as it relates to the ground system. This work has led to their characterization of the ground system or extracellular matrix interaction with the cellular system as a 'ground regulatory system', seeing therein the key to homeostasis, a body-wide communication and support system, vital to all functions.
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In 1953 a German doctor and scientist, Reinhold Voll, discovered that points used in acupuncture had different electrical properties from the surrounding skin, namely a lower resistance. Voll further discovered that the measurement of the resistances at the points gave valuable indications as to the state of the internal organs. Further research was done by Dr. Alfred Pischinger, the originator of the concept of the 'system of ground regulation', as well as Drs. Helmut Schimmel, and Hartmut Heine, using Voll's method of electro-dermal screening. This further research revealed that the gene is not so much the controller but the repository of blueprints on how cells and higher systems should operate, and that the actual regulation of biological activities (see Epigenetic cellular biology) lies in a 'system of ground regulation'. This system is built on the ground substance, a complex connective tissue between all the cells, often also called the extra-cellular matrix. This ground substance is made up of 'amorphous' and 'structural' ground substance. The former is "a transparent, half-fluid gel produced and sustained by the fibroblast cells of the connective tissues" consisting of highly polymerized sugar-protein complexes.
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The ground substance, according to German research, determines what enters and exits the cell and maintains homeostasis, which requires a rapid communication system to respond to complex signals (see also Bruce Lipton).
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This is made possible by the diversity of molecular structures of the sugar polymers of the ground substance, the ability to swiftly generate new such substances, and their high interconnectedness. This creates a redundance that makes possible the controlled oscillation of values above and below the dynamic homeostasis present in all living creatures. This is a kind of fast-responding, "short term memory" of the ground substance. Without this labile capacity, the system would quickly move to an energetic equilibrium, which would bring inactivity and death.
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For its biochemical survival, every organism requires the ability to rapidly construct, destroy and reconstruct the constituents of the ground substance.
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Between the molecules that make up the ground substance there are minimal surfaces of potential energy. The charging and discharging of the materials of the ground substance cause 'biofield oscillations' (photon fields). The interference of these fields creates short lived (from 10–9 to up to 10–5 seconds) tunnels through the ground substance. Through these tunnels, shaped like the hole through a donut, large chemicals may traverse from capillaries through the ground substance and into the functional cells of organs and back again. All metabolic processes depend upon this transport mechanism.
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Major ordering energy structures in the body are created by the ground substance, such as collagen, which not only conducts energy but generates it, due to its piezoelectric properties.
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Like quartz crystal, collagen in the ground substance and the more stable connective tissues (fascia, tendons, bones, etc.). transforms mechanical energy (pressure, torsion, stretch) into electromagnetic energy, which then resonates through the ground substance (Athenstaedt, 1974). However, if the ground substance is chemically imbalanced, the energy resonating through the body loses coherence.
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This is what occurs in the adaptation response described by Hans Selye. When the ground regulation is out of balance, the probability of chronic illness increases. Research by Heine indicates that unresolved emotional traumas release a neurotransmitter substance P which causes the collagen to take on a hexagonal structure that is more ordered than their usual structure, putting the ground substance out of balance, what he calls an "emotional scar "providing" an important scientific verification that diseases can have psychological causes." (see also Bruce Lipton)
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==== Work in the U.S. ====
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While the initial work on identifying the importance of the ground regulatory system was done in Germany, more recent work examining the implications of inter and intra-cellular communication via the extra-cellular matrix has taken place in the U.S. and elsewhere.
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Structural continuity between extracellular, cyst skeletal and nuclear components was discussed by Hay, Berezny et al. and Oschman. Historically, these elements have been referred to as ground substances, and because of their continuity, they act to form a complex, interlaced system that reaches into and contacts every part of the body. Even as early as 1851 it was recognized that the nerve and blood systems do not directly connect to the cell, but are mediated by and through an extracellular matrix.
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Recent research regarding the electrical charges of the various glycol-protein components of the extracellular matrix shows that because of the high density of negative charges on glycosaminoglycans (provided by sulfate and carboxylate groups of the uronic acid residues) the matrix is an extensive redox system capable of absorbing and donating electrons at any point. This electron transfer function reaches into the interiors of cells as the cytoplasmic matrix is also strongly negatively charged. The entire extracellular and cellular matrix functions as a biophysical storage system or accumulator for electrical charge.
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From thermodynamic, energetic and geometrical considerations, molecules of the ground substance are considered to form minimal physical and electrical surfaces, such that, based on the mathematics of minimal surfaces, minuscule changes can lead to significant changes in distant areas of the ground substance. This discovery is seen as having implications for many physiological and biochemical processes, including membrane transport, antigen–antibody interactions, protein synthesis, oxidation reactions, actin–myosin interactions, sol to gel transformations in polysaccharides.
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One description of the charge transfer process in the matrix is, "highly vectoral electron transport along biopolymer pathways". Other mechanisms involve clouds of negative charge created around the proteoglycans in the matrix. There are also soluble and mobile charge transfer complexes in cells and tissues (e.g. Slifkin, 1971; Gutman, 1978; Mattay, 1994).
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Rudolph A. Marcus of the California Institute of Technology found that when the driving force increases beyond a certain level, electron transfer will begin to slow down instead of speed up (Marcus, 1999) and he received a Nobel Prize in chemistry in 1992 for this contribution to the theory of electron transfer reactions in chemical systems. The implication of the work is that a vectoral electron transport process may be greater the smaller the potential, as in living systems.
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== Notes ==
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The following is a list of nerves in the human body:
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== Location ==
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Structure of the nervous system
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Development of the nervous system
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The spinal cord or medulla spinalis
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The brain or encephalon
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The hindbrain or rhombencephalon
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The midbrain or mesencephalon
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The forebrain or prosencephalon
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Composition and central connections of the spinal nerves
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Pathways from the brain to the spinal cord
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The meninges of the brain and medulla spinalis
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The cerebrospinal fluid
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The cranial nerves
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The olfactory nerves
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The optic nerve
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The oculomotor nerve
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The trochlear nerve
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The trigeminal nerve
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The abducens nerve
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The facial nerve
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The vestibulocochlear nerve
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The glossopharyngeal nerve
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The vagus nerve
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The accessory nerve
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The hypoglossal nerve
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The spinal nerves
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The posterior divisions
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The anterior divisions
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The thoracic nerves
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The lumbosacral plexus
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The sacral and coccygeal nerves
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The sympathetic nerves
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The cephalic portion of the sympathetic system
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The cervical portion of the sympathetic system
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The thoracic portion of the sympathetic system
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The abdominal portion of the sympathetic system
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The pelvic portion of the sympathetic system
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The great plexuses of the sympathetic system
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== Alphabetical list ==
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Abdominal aortic plexus
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Abducens nerve
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Accessory nerve
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Accessory obturator nerve
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Alderman's nerve
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Anococcygeal nerve
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Ansa cervicalis
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Anterior interosseous nerve
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Anterior superior alveolar nerve
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Auerbach's plexus
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Auriculotemporal nerve
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Axillary nerve
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Brachial plexus
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Buccal branch of the facial nerve
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Buccal nerve
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Cardiac plexus
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Cavernous nerves
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Cavernous plexus
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Celiac ganglia
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Cervical branch of the facial nerve
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Cervical plexus
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Chorda tympani
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Ciliary ganglion
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Coccygeal nerve
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Cochlear nerve
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Common fibular nerve
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Common palmar digital nerves of median nerve
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Deep branch of the radial nerve
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Deep fibular nerve
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Deep petrosal nerve
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Deep temporal nerves
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Diagonal band of Broca
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Digastric branch of facial nerve
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Dorsal branch of ulnar nerve
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Dorsal nerve of clitoris
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Dorsal nerve of the penis
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Dorsal scapular nerve
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Esophageal plexus
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Ethmoidal nerves
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External laryngeal nerve
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External nasal nerve
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Facial nerve
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Femoral nerve
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Frontal nerve
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Gastric plexuses
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Geniculate ganglion
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Genital branch of genitofemoral nerve
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Genitofemoral nerve
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Glossopharyngeal nerve
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Greater auricular nerve
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Greater occipital nerve
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Greater petrosal nerve
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Hepatic plexus
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Hypoglossal nerve
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Iliohypogastric nerve
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Ilioinguinal nerve
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Inferior alveolar nerve
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Inferior anal nerves
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Inferior cardiac nerve
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Inferior cervical ganglion
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Inferior gluteal nerve
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Inferior hypogastric plexus
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Inferior mesenteric plexus
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Inferior palpebral nerve
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Infraorbital nerve
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Infraorbital plexus
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Infratrochlear nerve
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Intercostal nerves
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Intercostobrachial nerve
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Intermediate cutaneous nerve
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Internal carotid plexus
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Internal laryngeal nerve
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Interneuron
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Jugular ganglion
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Lacrimal nerve
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Lateral cord
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Lateral cutaneous nerve of forearm
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Lateral cutaneous nerve of thigh
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Lateral pectoral nerve
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Lateral plantar nerve
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Lateral pterygoid nerve
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Lesser occipital nerve
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Lingual nerve
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Long ciliary nerves
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Long root of the ciliary ganglion
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Long thoracic nerve
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Lower subscapular nerve
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Lumbar nerves
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Lumbar plexus
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Lumbar splanchnic nerves
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Lumboinguinal nerve
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Lumbosacral plexus
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Lumbosacral trunk
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Mandibular nerve
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Marginal mandibular branch of facial nerve
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Masseteric nerve
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Maxillary nerve
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Medial cord
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Medial cutaneous nerve of arm
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Medial cutaneous nerve of forearm
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Medial cutaneous nerve
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Medial pectoral nerve
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Medial plantar nerve
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Medial pterygoid nerve
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Median nerve
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Meissner's plexus
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Mental nerve
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Middle cardiac nerve
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Middle cervical ganglion
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Middle meningeal nerve
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Motor nerve
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Muscular branches of the radial nerve
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Musculocutaneous nerve
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Mylohyoid nerve
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Nasociliary nerve
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Nasopalatine nerve
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Nerve of pterygoid canal
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Nerve to obturator internus
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Nerve to quadratus femoris
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Nerve to the Piriformis
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Nerve to the stapedius
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Nerve to the subclavius
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Nervus intermedius
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Nervus spinosus
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Nodose ganglion
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Obturator nerve
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Oculomotor nerve
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Olfactory nerve
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Ophthalmic nerve
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Optic nerve
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Otic ganglion
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Ovarian plexus
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Palatine nerves
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Palmar branch of the median nerve
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Palmar branch of ulnar nerve
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Pancreatic plexus
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Patellar plexus
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Pelvic splanchnic nerves
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Perforating cutaneous nerve
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Perineal branches of posterior femoral cutaneous nerve
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Perineal nerve
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Petrous ganglion
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Pharyngeal branch of vagus nerve
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Pharyngeal branches of glossopharyngeal nerve
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Pharyngeal nerve
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Pharyngeal plexus
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Phrenic nerve
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Phrenic plexus
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Posterior auricular nerve
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Posterior branch of spinal nerve
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Posterior cord
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Posterior cutaneous nerve of arm
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Posterior cutaneous nerve of forearm
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Posterior cutaneous nerve of thigh
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Posterior scrotal nerves
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Posterior superior alveolar nerve
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Proper palmar digital nerves of median nerve
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Prostatic plexus (nervous)
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Pterygopalatine ganglion
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Pudendal nerve
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Pudendal plexus
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Pulmonary branches of vagus nerve
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Radial nerve
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Recurrent laryngeal nerve
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Renal plexus
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Sacral plexus
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Sacral splanchnic nerves
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Saphenous nerve
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Sciatic nerve
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Semilunar ganglion
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Sensory nerve
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Short ciliary nerves
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Sphenopalatine nerves
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Splenic plexus
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Stylohyoid branch of facial nerve
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Subcostal nerve
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Submandibular ganglion
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Suboccipital nerve
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Superficial branch of the radial nerve
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Superficial fibular nerve
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Superior cardiac nerve
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Superior cervical ganglion
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Superior ganglion of glossopharyngeal nerve
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Superior ganglion of vagus nerve
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Superior gluteal nerve
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Superior hypogastric plexus
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Superior labial nerve
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Superior laryngeal nerve
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Superior lateral cutaneous nerve of arm
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Superior mesenteric plexus
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Superior rectal plexus
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Supraclavicular nerves
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Supraorbital nerve
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Suprarenal plexus
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Suprascapular nerve
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Supratrochlear nerve
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Sural nerve
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Sympathetic trunk
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Temporal branches of the facial nerve
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Third occipital nerve
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Thoracic aortic plexus
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Thoracic splanchnic nerves
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Thoraco-abdominal nerves
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Thoracodorsal nerve
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Tibial nerve
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Transverse cervical nerve
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Trigeminal nerve
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Trochlear nerve
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Tympanic nerve
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Ulnar nerve
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Upper subscapular nerve
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Uterovaginal plexus
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Vagus nerve
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Ventral ramus
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Vesical nervous plexus
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Vestibular nerve
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Vestibulocochlear nerve
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Zygomatic branches of facial nerve
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Zygomatic nerve
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Zygomaticofacial nerve
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Zygomaticotemporal nerve
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== Related topic ==
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Human brain
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Spinal cord
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Outline of the human nervous system
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List of skeletal muscles of the human body
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List of bones of the human skeleton
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Circulatory system
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Blood vessel
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== External links ==
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List of nerves
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date_saved: "2026-05-05T07:30:20.105318+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Medical eponyms are diseases, disorders, or syndromes named after people, and occasionally places or things. Eponyms are widely used and new ones continue to be coined, although some physicians argue against their use.
|
||||
Eponyms are most typically named after the physician or researcher who first described the condition, such as Parkinson's disease, after James Parkinson (1755-1824) or Alzheimer's disease, after Alois Alzheimer (1864–1915). Some diseases are commonly known by a famous patient's name, such as Lou Gehrig disease, although amyotrophic lateral sclerosis is the clinical name. A few clinical names come from a patient's name, such as Hartnup disease (formally pellagra-like dermatosis with transitory cerebellar ataxia), named for a family with this hereditary disease. Sometimes conditions are named after multiple physicians or scientists, such as Waterhouse–Friderichsen syndrome. Lyme disease is named for two towns where the symptoms were first identified. The eponym may even be a fictional character with no direct relationship to the disease. For example, Munchausen syndrome was coined because, like Baron von Munchausen, "the persons affected have always travelled widely, and their stories, like those attributed to him, are both dramatic and untrue."
|
||||
Eponyms are widely used in medicine and continue to be coined. There are no rules around the coining of eponyms:
|
||||
|
||||
...the physician scientist whose name becomes the eponym is often distinguishable from other parallel observers for reasons other than being first. It may be the individual's reputation, standing, accuracy, details contained in the report or publication, or a fortuitous rediscovery often decades later by someone who then associates the disease with one or more of the earlier physician scientists. Sometimes luck plays a major role. There are no rules on eponym development. It may take an extraordinary period of time, be different in different languages and cultures, and evolve as more is known about the physician or the disease.
|
||||
Whether medicine should use eponyms is debated. Arguments in favor include honoring the discoverers; bringing color to medicine; and providing a convenient shorthand. The names may be easier to remember than by their pathological description: compare Hodgkin lymphoma and nodular sclerosing, mixed cellularity, lymphocyte depleted, lymphocyte rich, and nodular lymphocyte-predominant lymphomas. Eponyms have replaced some older disease names which were problematic in various ways: "Mongolism" is racist, while Down syndrome is neutral; leprosy has centuries of stigmatizing connotations, while Hansen's disease does not, so was promoted as a more human name.
|
||||
Eponyms also have disadvantages. Using an eponym also often oversimplifies the history, which may have involved multiple clinicians and researchers. Some eponyms vary from country to country. And some names are used for multiple diseases: there are twelve named for Harvey Cushing. Some are named after persons with negative associations.
|
||||
Arguments for replacing eponyms by biologically-descriptive names include better communication with patients and medical trainees and better understanding by medical students. One medical conference in 1975 concluded that "The possessive use of an eponym should be discontinued, since the author neither had nor owned the disorder."
|
||||
Some eponyms have been replaced. For example, Reiter's syndrome, named after a Nazi medical war criminal, is now called reactive arthritis.
|
||||
All agree that eponyms are widely used and unlikely to change quickly. Indeed, new discoveries continue to be named for their discoverers.
|
||||
|
||||
List of eponymous diseases
|
||||
List of eponymous fractures
|
||||
List of eponymous medical devices
|
||||
List of eponymous medical signs
|
||||
List of eponymous medical treatments
|
||||
List of eponymous surgical procedures
|
||||
List of eponymous tests
|
||||
List of human anatomical parts named after people
|
||||
List of medical eponyms with Nazi associations
|
||||
List of orthopaedic eponyms
|
||||
List of eponyms in neuroscience, neurology and neurosurgery
|
||||
|
||||
|
||||
== References ==
|
||||
|
||||
|
||||
== External links ==
|
||||
Media related to Diseases and disorders named after people at Wikimedia Commons
|
||||
WhoNamedIt.com, a dictionary of medical eponyms.
|
||||
MedEponyms.com, a dictionary of pathology eponyms.
|
||||
22
data/en.wikipedia.org/wiki/Localized_disease-0.md
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22
data/en.wikipedia.org/wiki/Localized_disease-0.md
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@ -0,0 +1,22 @@
|
||||
---
|
||||
title: "Localized disease"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Localized_disease"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:21.591704+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
A localized disease is an infectious or neoplastic process that originates in and is confined to one organ system or general area in the body, such as a sprained ankle, a boil on the hand, an abscess of finger.
|
||||
A localized cancer that has not extended beyond the margins of the organ involved can also be described as localized disease, while cancers that extend into other tissues are described as invasive. Tumors that are non-hematologic in origin but extend into the bloodstream or lymphatic system are known as metastatic.
|
||||
Localized diseases are contrasted with disseminated diseases and systemic diseases.
|
||||
Some diseases are capable of changing from local to disseminated diseases. Pneumonia, for example, is generally confined to one or both lungs but can become disseminated through sepsis, in which the microorganism responsible for the pneumonia "seeds" the bloodstream or lymphatic system and is transported to distant sites in the body. When that occurs, the process is no longer described as a localized disease, but rather as a disseminated disease.
|
||||
|
||||
|
||||
== See also ==
|
||||
Disease
|
||||
Nosology
|
||||
|
||||
|
||||
== References ==
|
||||
19
data/en.wikipedia.org/wiki/Long-term_care-0.md
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19
data/en.wikipedia.org/wiki/Long-term_care-0.md
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|
||||
---
|
||||
title: "Long-term care"
|
||||
chunk: 1/5
|
||||
source: "https://en.wikipedia.org/wiki/Long-term_care"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:24.445699+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Long-term care (LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long-term care is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time.
|
||||
It is common for long-term care to provide custodial and non-skilled care, such as assisting with activities of daily living like dressing, feeding, using the bathroom, meal preparation, functional transfers and safe restroom use. Increasingly, long-term care involves providing a level of medical care that requires the expertise of skilled practitioners to address the multiple long-term conditions associated with older populations. Long-term care can be provided at home, in the community, in assisted living facilities or in nursing homes. Long-term care may be needed by people of any age, although it is a more common need for senior citizens.
|
||||
|
||||
== Types of long-term care ==
|
||||
Long-term care can be provided formally or informally. Facilities that offer formal LTC services typically provide living accommodation for people who require on-site delivery of around-the-clock supervised care, including professional health services, personal care, and services such as meals, laundry and housekeeping. These facilities may go under various names, such as nursing home, personal care facility, residential continuing care facility, etc. and are operated by different providers.
|
||||
While the US government has been asked by the LTC (long-term care) industry not to bundle health, personal care, and services (e.g., meal, laundry, housekeeping) into large facilities, the government continues to approve that as the primary use of taxpayers' funds instead (e.g., new assisted living). Greater success has been achieved in areas such as supported housing which may still utilize older housing complexes or buildings or may have been part of new federal-state initiatives in the 2000s.
|
||||
Long-term care provided formally in the home, also known as home health care, can incorporate a wide range of clinical services (e.g. nursing, drug therapy, physical therapy) and other activities such as physical construction (e.g. installing hydraulic lifts, renovating bathrooms and kitchens). These services are usually ordered by a physician or other professional. Depending on the country and nature of the health and social care system, some of the costs of these services may be covered by health insurance or long-term care insurance.
|
||||
Modernized forms of long-term services and supports (LTSS), reimbursable by the government, are user-directed personal services, family-directed options, independent living services, benefits counseling, mental health companion services, family education, and even self-advocacy and employment, among others. In home services can be provided by personnel other than nurses and therapists, who do not install lifts, and belong to the long-term services and supports (LTSS) systems of the US.
|
||||
Informal long-term home care is care and support provided by family members, friends and other unpaid volunteers. It is estimated that 90% of all home care is provided informally by a loved one without compensation and in 2015, families are seeking compensation from their government for caregiving.
|
||||
25
data/en.wikipedia.org/wiki/Long-term_care-1.md
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25
data/en.wikipedia.org/wiki/Long-term_care-1.md
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@ -0,0 +1,25 @@
|
||||
---
|
||||
title: "Long-term care"
|
||||
chunk: 2/5
|
||||
source: "https://en.wikipedia.org/wiki/Long-term_care"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:24.445699+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
== Long-term services and supports ==
|
||||
"Long-term services and supports" (LTSS) is the modernized term for community services, which may obtain health care financing (e.g., home and community-based Medicaid waiver services), and may or may not be operated by the traditional hospital-medical system (e.g., physicians, nurses, nurse's aides).
|
||||
The Consortium of Citizens with Disabilities (CCD) which works with the U. S. Congress, has indicated that while hospitals offer acute care, many non-acute, long-term services are provided to assist individuals to live and participate in the community. An example is the group home international emblem of community living and deinstitutionalization, and the variety of supportive services (e.g., supported housing, supported employment, supported living, supported parenting, family support), supported education.
|
||||
The term is also common with aging groups, such as the American Association of Retired Persons (AARP), which annually surveys the US states on services for elders (e.g., intermediate care facilities, assisted living, home-delivered meals). The new US Support Workforce includes the Direct Support Professional, which is largely non-profit or for-profit, and the governmental workforces, often unionized, in the communities in US states. Core competencies (Racino-Lakin, 1988) at the federal-state interface for the aides "in institutions and communities" were identified in aging and physical disabilities, intellectual and developmental disabilities, and behavioral ("mental health") health in 2013 (Larson, Sedlezky, Hewitt, & Blakeway, 2014).
|
||||
President Barack Obama, US House Speaker John Boehner, Minority Leader Nancy Pelosi, Majority Leader Harry Reid, and Minority Leader Mitch McConnell received copies of the US Senate Commission on Long Term Care on the "issues of service delivery, workforce and financing which have challenged policymakers for decades" (Chernof & Warshawsky, 2013). The new Commission envisions a "comprehensive financing model balancing private and public financing to insure catastrophic expenses, encourage savings and insurance for more immediate LTSS (Long Term Services and Supports) costs, and to provide a safety net for those without resources."
|
||||
The direct care workforce envisioned by the MDs (physicians, prepared by a medical school, subsequently licensed for practice) in America (who did not develop the community service systems, and serve different, valued roles within it) were described in 2013 as: personal care aides (20%), home health aides (23%), nursing assistants (37%), and independent providers (20%) (p. 10). The US has varying and competing health care systems, and hospitals have adopted a model to transfer "community funds into hospital"; in addition, "hospital studies" indicate M-LTSS (managed long-term care services) as billable services. In addition, allied health personnel preparation have formed the bulk of the preparation in specialized science and disability centers which theoretically and practically supports modernized personal assistance services across population groups and "managed" behavioral health care "as a subset of" mental health services.
|
||||
Long-term services and supports (LTSS) legislation was developed, as were the community services and personnel, to address the needs of "individuals with disabilities" for whom the state governments were litigated against, and in many cases, required to report regularly on the development of a community-based system. These LTSS options originally bore such categorical services as residential and vocational rehabilitation or habilitation, family care or foster family care, small intermediate care facilities, "group homes", and later supported employment, clinics, family support, supportive living, and day services (Smith & Racino, 1988 for the US governments).The original state departments were Intellectual and Developmental Disabilities, Offices of Mental Health, lead designations in Departments of Health in brain injury for communities, and then, Alcohol and Substance Abuse dedicated state agencies.
|
||||
Among the government and Executive initiatives were the development of supportive living internationally, new models in supportive housing (or even more sophisticated housing and health), and creative plans permeating the literature on independent living, user-directed categories (approved by US Centers for Medicaid and Medicare), expansion of home services and family support, and assisted living facilities for the aging groups. These services often have undergone a revolution in payment schemes beginning with systems for payment of valued community options. then termed evidence-based practices.
|
||||
Interventions for preventing delirium in older people in institutional long-term care
|
||||
The current evidence suggests that software-based interventions to identify medications that could contribute to delirium risk and recommend a pharmacist's medication review probably reduces incidence of delirium in older adults in long-term care. The benefits of hydration reminders and education on risk factors and care homes' solutions for reducing delirium is still uncertain.
|
||||
Physical rehabilitation for older people in long-term care
|
||||
Physical rehabilitation can prevent deterioration in health and activities of daily living among care home residents. The current evidence suggests benefits to physical health from participating in different types of physical rehabilitation to improve daily living, strength, flexibility, balance, mood, memory, exercise tolerance, fear of falling, injuries, and death. It may be both safe and effective in improving physical and possibly mental state, while reducing disability with few adverse events.
|
||||
The current body of evidence suggests that physical rehabilitation may be effective for long-term care residents in reducing disability with few adverse events. However, there is insufficient to conclude whether the beneficial effects are sustainable and cost-effective. The findings are based on moderate quality evidence.
|
||||
|
||||
== Demand for long-term care ==
|
||||
22
data/en.wikipedia.org/wiki/Long-term_care-2.md
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22
data/en.wikipedia.org/wiki/Long-term_care-2.md
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@ -0,0 +1,22 @@
|
||||
---
|
||||
title: "Long-term care"
|
||||
chunk: 3/5
|
||||
source: "https://en.wikipedia.org/wiki/Long-term_care"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:24.445699+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Life expectancy is going up in most countries, meaning more people are living longer and entering an age when they may need care. Meanwhile, birth rates are generally falling. Globally, 70 percent of all older people now live in low or middle-income countries. Countries and health care systems need to find innovative and sustainable ways to cope with the demographic shift. As reported by John Beard, director of the World Health Organization's Department of Ageing and Life Course, "With the rapid ageing of populations, finding the right model for long-term care becomes more and more urgent."
|
||||
The demographic shift is also being accompanied by changing social patterns, including smaller families, different residential patterns, and increased female labour force participation. These factors often contribute to an increased need for paid care.
|
||||
In many countries, the largest percentages of older persons needing LTC services still rely on informal home care, or services provided by unpaid caregivers (usually nonprofessional family members, friends or other volunteers). Estimates from the OECD of these figures often are in the 80 to 90 percent range; for example, in Austria, 80 percent of all older citizens. The similar figure for dependent elders in Spain is 82.2 percent.
|
||||
The US Centers for Medicare and Medicaid Services estimates that about 9 million American men and women over the age of 65 needed long-term care in 2006, with the number expected to jump to 27 million by 2050. It is anticipated that most will be cared for at home; family and friends are the sole caregivers for 70 percent of the elderly. A study by the U.S. Department of Health and Human Services says that four out of every ten people who reach age 65 will enter a nursing home at some point in their lives. Roughly 10 percent of the people who enter a nursing home will stay there five years or more.
|
||||
Based on projections of needs in long-term care (LTC), the US 1980s demonstrations of versions of Nursing Homes Without Walls (Senator Lombardi of New York) for elders in the US were popular, but limited: On LOK, PACE, Channeling, Section 222 Homemaker, ACCESS Medicaid-Medicare, and new Social Day Care. The major argument for the new services was cost savings based upon reduction of institutionalization. The demonstrations were significant in developing and integrating personal care, transportation, homemaking/meals, nursing/medical, emotional support, help with finances, and informal caregiving. Weasart concluded that: "Increased life satisfaction appears to be relatively consistent benefit of community care" and that a "prospective budgeting model" of home and community-based long-term care (LTC) used "break-even costs" to prevent institutional care.
|
||||
|
||||
== Long-term care costs ==
|
||||
A recent analysis indicates that Americans spent $219.9 billion on long-term care services for the elderly in 2012. Nursing home spending accounts for the majority of long-term care expenditures, but the proportion of home and community based care expenditures has increased over the past 25 years. The US federal-state-local government systems have supported the creation of modernized health care options, though new intergovernmental barriers continue to exist.
|
||||
The Medicaid and Medicare health care systems in the US are relatively young, celebrating 50 years in 2015. According to the Health Care Financing Review (Fall 2000), its history includes a 1967 expansion of to ensure primary and preventive services to Medicaid-eligible children (EPSDT), the use home and community-based Medicaid waivers (then HCBS services), Clinton administration health care demonstrations (under 1115 waiver authority), the new era of SCHIP to cover uninsured children and families, coverage for the HIV/AIDS population groups, and attention to ethnic and racial-based service delivery (e.g., beneficiaries). Later, managed care plans which used "intensive residential children's" options and "non-traditional out-patients services (school-based services, partial hospitalization, in-home treatment and case management) developed "behavioral health care plans".
|
||||
In 2019, the average annual cost of nursing home care in the United States was $102,200 for a private room. The average annual cost for assisted living was $48,612. Home health care, based on a 44 average week, cost $52,654 a year Genworth 2019 Cost of Care Survey]. The average cost of a nursing home for one year is more than the typical family has saved for retirement in a 401(k) or an IRA. As of 2014, 26 states have contracts with managed care organizations (MCO) to deliver long-term care for the elderly and individuals with disabilities. The states pay a monthly capitated rate per member to the MCOs that provide comprehensive care and accept the risk of managing total costs.
|
||||
When the percentage of elderly individuals in the population rises to nearly 14% in 2040 as predicted, a huge strain will be put on caregivers' finances as well as continuing care retirement facilities and nursing homes because demand will increase dramatically. New options for elders during the era of choice expansion (e.g., seniors helping seniors, home companions), which includes limitations on physician choices, assisted living facilities, retirement communities with disability access indicators, and new "aging in place" plans (e.g., aging in a group home, or "transfer" to a home or support services with siblings upon parents' deaths-intellectual and developmental disabilities).
|
||||
Politically, the 21st Century has shifted to the cost of unpaid family caregiving (valued by AARP in aging at $450 billion in 2009), and the governments in the US are being asked to "foot part of the bill or costs" of caregiving for family members in home. This movement, based in part on feminist trends in the workplace, has intersected with other hospital to home, home health care and visiting nurses, user-directed services, and even hospice care. The government's Medicaid programs is considered the primary payer of Long Term Services and Supports (LTSS), according to the American Association of Retired Persons, Public Policy Institute. New trends in family support and family caregiving also affect diverse disability population groups, including the very young children and young adults, and are expected to be high increases in Alzheimer's due to longevity past age 85.
|
||||
25
data/en.wikipedia.org/wiki/Long-term_care-3.md
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25
data/en.wikipedia.org/wiki/Long-term_care-3.md
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@ -0,0 +1,25 @@
|
||||
---
|
||||
title: "Long-term care"
|
||||
chunk: 4/5
|
||||
source: "https://en.wikipedia.org/wiki/Long-term_care"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:24.445699+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
== Long-term care funding ==
|
||||
Governments around the world have responded to growing long-term care needs to different degrees and at different levels. These responses by governments, are based in part, upon a public policy research agenda on long-term care which includes special population research, flexible models of services, and managed care models to control escalating costs and high private pay rates.
|
||||
|
||||
=== Europe ===
|
||||
Most Western European countries have put in place a mechanism to fund formal care and, in a number of Northern and Continental European countries, arrangements exist to at least partially fund informal care as well. Some countries have had publicly organized funding arrangements in place for many years: the Netherlands adopted the Exceptional Medical Expenses Act (ABWZ) in 1967, and in 1988 Norway established a framework for municipal payments to informal caregivers (in certain instances making them municipal employees). Other countries have only recently put in place comprehensive national programs: in 2004, for example, France set up a specific insurance fund for dependent older people and in 2006, Portugal created a public funded national network for long-term care. Some countries (Spain and Italy in Southern Europe, Poland and Hungary in Central Europe) have not yet established comprehensive national programs, relying on informal caregivers combined with a fragmented mix of formal services that varies in quality and by location.
|
||||
In the 1980s, some Nordic countries began making payments to informal caregivers, with Norway and Denmark allowing relatives and neighbors who were providing regular home care to become municipal employees, complete with regular pension benefits. In Finland, informal caregivers received a fixed fee from municipalities as well as pension payments. In the 1990s, a number of countries with social health insurance (Austria in 1994, Germany in 1996, Luxembourg in 1999) began providing a cash payment to service recipients, who could then use those funds to pay informal caregivers.
|
||||
In Germany, funding for long-term care is covered through a mandatory insurance scheme (or Pflegeversicherung), with contributions divided equally between the insured and their employers. The scheme covers the care needs of people who as a consequence of illness or disability are unable to live independently for a period of at least six months. Most beneficiaries stay at home (69%). The country's LTC fund may also make pension contributions if an informal caregiver works more than 14 hours per week.
|
||||
Major reform initiatives in health care systems in Europe are based, in part on an extension of user-directed services demonstrations and approvals in the US (e.g., Cash and counseling demonstrations and evaluations). Clare Ungerson, a professor of Social Policy, together with Susan Yeandle, Professor of Sociology, reported on the Cash for Care Demonstrations in Nation-States in Europe (Austria, France, Italy, Netherlands, England, Germany) with a comparative USA ("paradigm of home and community care").
|
||||
In addition, direct payment schemes were developed and implemented in the UK, including in Scotland, for parents with children with disabilities and people with mental health problems. These "health care schemes" on the commodification of care were compared to individualised planning and direct funding in the US and Canada.
|
||||
|
||||
=== North America ===
|
||||
|
||||
==== Canada ====
|
||||
In Canada, facility-based long-term care is not publicly insured under the Canada Health Act in the same way as hospital and physician services. Funding for LTC facilities is governed by the provinces and territories, which varies across the country in terms of the range of services offered and the cost coverage. In Canada, from April 1, 2013, to March 31, 2014, there were 1,519 long-term care facilities housing 149,488 residents.
|
||||
Canada-US have a long-term relationship as border neighbors on health care; however, Canada, has a national health care system in which providers remain in private practice but payment is covered by taxpayers, instead of individuals or numerous commercial insurance companies. In the development of home and community-based services, individualised services and supports were popular in both Nations. The Canadian citations of US projects included the cash assistance programs in family support in the US, in the context of individual and family support services for children with significant needs. In contrast, the US initiatives in health care in that period involved the Medicaid waiver authority and health care demonstrations, and the use of state demonstration funds separate from the federal programs.
|
||||
34
data/en.wikipedia.org/wiki/Long-term_care-4.md
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34
data/en.wikipedia.org/wiki/Long-term_care-4.md
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@ -0,0 +1,34 @@
|
||||
---
|
||||
title: "Long-term care"
|
||||
chunk: 5/5
|
||||
source: "https://en.wikipedia.org/wiki/Long-term_care"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:24.445699+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
==== United States ====
|
||||
Long-term care is typically funded using a combination of sources including but not limited to family members, Medicaid, long-term care insurance and Medicare. All of these include out-of-pocket spending, which often becomes exhausted once an individual requires more medical attention throughout the aging process and might need in-home care or be admitted into a nursing home. For many people, out-of-pocket spending for long-term care is a transitional state before eventually being covered by Medicaid, which requires impoverishment for eligibility. Personal savings can be difficult to manage and budget and often deplete rapidly. In addition to personal savings, individuals can also rely on an Individual retirement account, Roth IRA, Pension, Severance package or the funds of family members. These are essentially retirement packages that become available to the individual once certain requirements have been met.
|
||||
In 2008, Medicaid and Medicare accounted for approximately 71% of national long-term care spending in the United States. Out-of-pocket spending accounted for 18% of national long-term care spending, private long-term care insurance accounted for 7%, and other organizations and agencies accounted for the remaining expenses. Moreover, 67% of all nursing home residents used Medicaid as their primary source of payment.
|
||||
Private Long-Term Care Insurance in 2017 paid over $9.2 Billion in benefits and claims for these policies continue to grow. The largest claim to one person is reported to be over $2 million in benefits
|
||||
Medicaid is one of the dominant players in the nation's long-term care market because there is a failure of private insurance and Medicare to pay for expensive long-term care services, such as nursing homes. For instance, 34% of Medicaid was spent on long-term care services in 2002.
|
||||
Medicaid operates as distinct programs which involve home and community-based (Medicaid) waivers designed for special population groups during deinstitutionalization then to community, direct medical services for individuals who meet low income guidelines (held stable with the Affordable Care Act Health Care Exchanges), facility development programs (e.g., intermediate care facilities for individuals with intellectual and developmental disabilities), and additional reimbursements for specified services or beds in facilities (e.g., over 63% beds in nursing facilities). Medicaid also fund traditional home health services and is payor of adult day care services. Currently, the US Centers for Medicaid and Medicare also have a user-directed option of services previously part of grey market industry.
|
||||
In the US, Medicaid is a government program that will pay for certain health services and nursing home care for older people (once their assets are depleted). In most states, Medicaid also pays for some long-term care services at home and in the community. Eligibility and covered services vary from state to state. Most often, eligibility is based on income and personal resources. Individuals eligible for Medicaid are eligible for community services, such as home health, but governments have not adequately funded this option for elders who wish to remain in their homes after extended illness aging in place, and Medicaid's expenses are primarily concentrated on nursing home care operated by the hospital-nursing industry in the US.
|
||||
Generally, Medicare does not pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, certain conditions must be met for Medicare to pay for even those types of care. The services must be ordered by a doctor and tend to be rehabilitative in nature. Medicare specifically will not pay for custodial and non-skilled care. Medicare will typically cover only 100 skilled nursing days following a 3-day admission to a hospital.
|
||||
A 2006 study conducted by AARP found that most Americans are unaware of the costs associated with long-term care and overestimate the amount that government programs such as Medicare will pay. The US government plans for individuals to have care from family, similar to Depression days; however, AARP reports annually on the Long-term services and supports (LTSS) for aging in the US including home-delivered meals (from senior center sites) and its advocacy for caregiving payments to family caregivers.
|
||||
Long-term care insurance protects individuals from asset depletion and includes a range of benefits with varying lengths of time. This type of insurance is designed to protect policyholders from the costs of long-term care services, and policies are determined using an "experience rating" and charge higher premiums for higher-risk individuals who have a greater chance of becoming ill.
|
||||
There are now a number of different types of long-term care insurance plans including traditional tax-qualified, partnership plans (providing additional dollar-for-dollar asset protect offered by most states), short-term extended care policies and hybrid plans (life or annuity policies with riders to pay for long-term care).
|
||||
Residents of LTC facilities may have certain legal rights, including a Red Cross ombudsperson, depending on the location of the facility.
|
||||
Unfortunately, government funded aid meant for long-term care recipients are sometimes misused. The New York Times explains how some of the businesses offering long-term care are misusing the loopholes in the newly redesigned New York Medicaid program. Government resists progressive oversight which involves continuing education requirements, community services administration with quality-of-life indicators, evidence-based services, and leadership in use of federal and state funds for the benefit of individual and their family.
|
||||
For those that are poor and elderly, long-term care becomes even more challenging. Often, these individuals are categorized as "dual eligibles" and they qualify for both Medicare and Medicaid. These individuals accounted for 319.5 billion in health care spending in 2011.
|
||||
|
||||
== See also ==
|
||||
|
||||
== References ==
|
||||
|
||||
== External links ==
|
||||
|
||||
California Partnership for Long-Term Care
|
||||
Cost of care calculator for UK residents
|
||||
American Association for Long Term Care Insurance
|
||||
39
data/en.wikipedia.org/wiki/MHealth-0.md
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
category: "reference"
|
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tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:51.903089+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
mHealth (also written as m-health or mhealth), an abbreviation for mobile health, is the practice of medicine and public health supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones, tablet computers and personal digital assistants (PDAs), and wearable devices such as smart watches, for health services, information, and data collection. The mHealth field has emerged as a sub-segment of eHealth and digital health, the use of information and communication technology (ICT), such as computers, mobile phones, communications satellite, patient monitors, etc., for health services and information. mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery/sharing of healthcare information for practitioners, researchers and patients, real-time monitoring of patient vital signs, the direct provision of care (via mobile telemedicine) as well as training and collaboration of health workers.
|
||||
In 2019, the global market for mHealth apps was estimated at US$17.92 billion, with a compound annual growth rate of 45% predicted from 2020 to 2027. While mHealth has application for industrialized nations, the field has emerged in recent years as largely an application for developing countries, stemming from the rapid rise of mobile phone penetration in low-income nations. The field, then, largely emerges as a means of providing greater access to larger segments of a population in developing countries, as well as improving the capacity of health systems in such countries to provide quality healthcare.
|
||||
Within the mHealth space, projects operate with a variety of objectives, including increased access to healthcare and health-related information (particularly for hard-to-reach populations); improved ability to diagnose and track diseases; timelier, more actionable public health information; and expanded access to ongoing medical education and training for health workers.
|
||||
|
||||
== Definitions ==
|
||||
|
||||
mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies in health and medical care. The field broadly encompasses the use of mobile telecommunication and multimedia technologies in health care delivery. The term mHealth was coined by Robert Istepanian as use of "emerging mobile communications and network technologies for healthcare".
|
||||
A definition used at the 2010 mHealth Summit of the Foundation for the National Institutes of Health (FNIH) was "the delivery of healthcare services via mobile communication devices". The GSM Association representing the worldwide mobile communications industry published a report on mHealth in 2010 describing a new vision for healthcare and identified ways in which mobile technology might play a role in innovating healthcare delivery systems and healthcare system cost management.
|
||||
While there are some projects that are considered solely within the field of mHealth, the linkage between mHealth and eHealth is unquestionable. For example, an mHealth project that uses mobile phones to access data on HIV/AIDS rates would require an eHealth system in order to manage, store, and assess the data. Thus, eHealth projects many times operate as the backbone of mHealth projects.
|
||||
In a similar vein, while not clearly bifurcated by such a definition, eHealth can largely be viewed as technology that supports the functions and delivery of healthcare, while mHealth rests largely on providing healthcare access. Because mHealth is by definition based on mobile technology such as smartphones, healthcare, through information and delivery, can better reach areas, people, and/or healthcare practitioners with previously limited exposure to certain aspects of healthcare. The National Institute for Health and Care Research (NIHR) has published a review of research on how mHealth and digital health technologies can help manage health conditions.
|
||||
|
||||
== Medical uses ==
|
||||
mHealth apps are designed to support diagnostic procedures, to aid physician decision-making for treatments, and to advance disease-related education for physicians and people under treatment. Mobile health has much potential in medicine and, if used in conjunction with human factors may improve access to care, the scope, and quality of health care services that can be provided. Some applications of mobile health may also improve the ability to improve accountability in healthcare and improve continuum of care by connecting interdisciplinary team members. A dissemination strategy is required to drive potential users discover, download and use mHealth apps. mHealth apps can be disseminated via paid and unpaid marketing strategies using various communication channels. These channels include among others social media, e-mail, posters/flyers, radio and TV broadcasting.
|
||||
mHealth is one aspect of eHealth that is pushing the limits of how to acquire, transport, store, process, and secure the raw and processed data to deliver meaningful results. mHealth offers the ability of remote individuals to participate in the health care value matrix, which may not have been possible in the past. Participation does not imply just consumption of health care services. In many cases remote users are valuable contributors to gather data regarding disease and public health concerns such as outdoor pollution, drugs and violence.
|
||||
While others exist, the 2009 UN Foundation and Vodafone Foundation report presents seven application categories within the mHealth field:
|
||||
|
||||
Education and awareness
|
||||
Helpline
|
||||
Diagnostic and treatment support
|
||||
Communication and training for healthcare workers
|
||||
Disease and epidemic outbreak tracking
|
||||
Remote monitoring
|
||||
Remote data collection
|
||||
|
||||
=== Education and awareness ===
|
||||
Education and awareness programs within the mHealth field are largely about the spreading of mass information from source to recipient through short message services (SMS). In education and awareness applications, SMS messages are sent directly to users' phones to offer information about various subjects, including testing and treatment methods, availability of health services, and disease management. SMSs provide an advantage of being relatively unobtrusive, offering patients confidentiality in environments where disease (especially HIV/AIDS) is often taboo. Additionally, SMSs provide an avenue to reach far-reaching areas—such as rural areas—which may have limited access to public health information and education, health clinics, and a deficit of healthcare workers.
|
||||
|
||||
=== Helpline ===
|
||||
Helpline typically consists of a specific phone number that any individual is able to call to gain access to a range of medical services. These include phone consultations, counseling, service complaints, and information on facilities, drugs, equipment, and/or available mobile health clinics.
|
||||
21
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|
||||
---
|
||||
title: "MHealth"
|
||||
chunk: 2/6
|
||||
source: "https://en.wikipedia.org/wiki/MHealth"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:51.903089+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
=== Diagnostic support, treatment support, communication and training for healthcare workers ===
|
||||
Diagnostic and treatment support systems are typically designed to provide healthcare workers in remote areas advice about diagnosis and treatment of patients. While some projects may provide mobile phone applications—such as a step-by-step medical decision tree systems—to help healthcare workers diagnose, other projects provide direct diagnosis to patients themselves. In such cases, known as telemedicine, patients might take a photograph of a wound or illness and allow a remote physician to diagnose to help treat the medical problem. Both diagnosis and treatment support projects attempt to mitigate the cost and time of travel for patients located in remote areas.
|
||||
mHealth projects within the communication and training for healthcare workers subset involve connecting healthcare workers to sources of information through their mobile phone. This involves connecting healthcare workers to other healthcare workers, medical institutions, ministries of health, or other houses of medical information. Such projects additionally involve using mobile phones to better organize and target in-person training. Improved communication projects attempt to increase knowledge transfer amongst healthcare workers and improve patient outcomes through such programs as patient referral processes. For example, the systematic use of mobile instant messaging for the training and empowerment of health professionals has resulted in higher levels of clinical knowledge and fewer feelings of professional isolation.
|
||||
|
||||
=== Disease surveillance, remote data collection, and epidemic outbreak tracking ===
|
||||
Projects within this area operate to utilize mobile phones' ability to collect and transmit data quickly, cheaply, and relatively efficiently. Data concerning the location and levels of specific diseases (such as malaria, HIV/AIDS, TB, Avian Flu) can help medical systems or ministries of health or other organizations identify outbreaks and better target medical resources to areas of greatest need. Such projects can be particularly useful during emergencies, in order to identify where the greatest medical needs are within a country
|
||||
Policymakers and health providers at the national, district, and community level need accurate data in order to gauge the effectiveness of existing policies and programs and shape new ones. In the developing world, collecting field information is particularly difficult since many segments of the population are rarely able to visit a hospital, even in the case of severe illness. A lack of patient data creates an arduous environment in which policy makers can decide where and how to spend their (sometimes limited) resources. While some software within this area is specific to a particular content or area, other software can be adapted to any data collection purpose.
|
||||
|
||||
=== Treatment support and medication adherence for patients ===
|
||||
Remote monitoring and treatment support allows for greater involvement in the continued care of patients. Recent studies seem to show also the efficacy of inducing positive and negative affective states, using smart phones. Within environments of limited resources and beds—and subsequently an 'outpatient' culture—remote monitoring allows healthcare workers to better track patient conditions, medication regimen adherence, and follow-up scheduling. Such projects can operate through either one- or two-way communications systems. Remote monitoring has been used particularly in the area of medication adherence for AIDS, cardiovascular disease, chronic lung disease, diabetes, antenatal mental health, mild anxiety, and tuberculosis. Technical process evaluations have confirmed the feasibility of deploying dynamically tailored, SMS-based interventions designed to provide ongoing behavioral reinforcement for persons living with HIV. among others. Specific mobile applications might also support adherence to taking medications.
|
||||
In conclusion, the use of mobile phone technology (in combination with a web-based interface) in health care results in an increase in convenience and efficiency of data collection, transfer, storage and analysis management of data as compared with paper-based systems. Formal studies and preliminary project assessments demonstrate this improvement of efficiency of healthcare delivery by mobile technology. Nevertheless, mHealth should not be considered as a panacea for healthcare. Possible organizational issues include the ensuring of appropriate use and proper care of the handset, lost or stolen phones, and the important consideration of costs related to the purchase of equipment. There is therefore a difficulty in comparison in weighing up mHealth interventions against other priority and evidence-based interventions.
|
||||
32
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---
|
||||
title: "MHealth"
|
||||
chunk: 3/6
|
||||
source: "https://en.wikipedia.org/wiki/MHealth"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:51.903089+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
== Criticism and concerns ==
|
||||
The extensive practice of mhealth research has sparked criticism, for example on the proliferation of fragmented pilot studies in low- and middle-income countries, which is also referred to as "pilotitis." The extent of un-coordinated pilot studies prompted for instance the Ugandan Director General Health Services Dr Jane Ruth Aceng in 2012 to issue a notice that, "in order to jointly ensure that all eHealth efforts are harmonized and coordinated, I am directing that ALL eHealth projects/Initiatives be put to halt." The assumptions that justify mhealth initiatives have also been challenged in recent sociological research. For example, mobile phones have been argued to be less widely accessible and usable than is often portrayed in mhealth-related publications; people integrate mobile phones into their health behavior without external intervention; and the spread of mobile phones in low- and middle-income countries itself can create new forms of digital and healthcare exclusion, which mhealth interventions (using mobile phones as a platform) cannot overcome and potentially accentuate. Mhealth has also been argued to alter the practice of healthcare and patient-physician relationships as well as how bodies and health are being represented. Another widespread concern relates to privacy and data protection, for example in the context of electronic health records. Of practical concern for mHealth studies is the high drop-out rate amongst participants, reaching up to 98% in extreme cases, while careful co-design can help minimize this effect.
|
||||
Studies looking into the perceptions and experiences of primary healthcare professionals using mheath have found that most health care professionals appreciated being connected to their colleagues, however some prefer face to face communication. Some healthcare workers also felt that while reporting was improved and team members who require help or training could be more easily identified, some healthcare professionals did not feel comfortable being monitored continuously. A proportion of healthcare professionals prefer paper reporting. The use of mobile apps may sometimes lead to healthcare professionals spending more time performing additional tasks such as filling out electronic forms and may generate more workload in some cases. Some healthcare professionals also do not feel comfortable with work-related contact from patients/clients outside of business hours (however some professionals did find this useful for emergencies).
|
||||
Communicating with clients/patients while using a mobile device may need to be considered. A decrease in eye contact and the potential to miss non-verbal cues due to concentrating on a screen while speaking with patients is a potential consideration.
|
||||
|
||||
== Society and culture ==
|
||||
|
||||
=== Healthcare in low- and middle-income countries ===
|
||||
|
||||
Middle income and especially low-income countries face a plethora of constraints in their healthcare systems. These countries face a severe lack of human and physical resources, as well as some of the largest burdens of disease, extreme poverty, and large population growth rates. Additionally, healthcare access to all reaches of society is generally low in these countries.
|
||||
According to a World Health Organization (WHO) report from June 2011, higher-income countries show more mHealth activity than do lower-income countries (as consistent with eHealth trends in general). Countries in the European Region are currently the most active and those in the African Region the least active. The WHO report findings also included that mHealth is most easily incorporated into processes and services that historically use voice communication through conventional telephone networks. The report was the result of a mHealth survey module designed by researchers at the Earth Institute's Center for Global Health and Economic Development, Columbia University.
|
||||
The WHO notes an extreme deficit within the global healthcare workforce. The WHO notes critical healthcare workforce shortages in 57 countries—most of which are characterized as developing countries—and a global deficit of 2.4 million doctors, nurses, and midwives. The WHO, in a study of the healthcare workforce in 12 countries of Africa, finds an average density of physicians, nurses and midwives per 1000 population of 0.64. The density of the same metric is four times as high in the United States, at 2.6.
|
||||
The burden of disease is additionally much higher in low- and middle-income countries than high-income countries. The burden of disease, measured in disability-adjusted life year (DALY), which can be thought of as a measurement of the gap between current health status and an ideal situation where everyone lives into old age, free of disease and disability, is about five times higher in Africa than in high-income countries. In addition, low- and middle-income countries are forced to face the burdens of both extreme poverty and the growing incidence of chronic diseases, such as diabetes and heart disease, an effect of new-found (relative) affluence.
|
||||
Considering poor infrastructure and low human resources, the WHO notes that the healthcare workforce in sub-Saharan Africa would need to be scaled up by as much as 140% to attain international health development targets such as those in the Millennium Declaration.
|
||||
The WHO, in reference to the healthcare condition in sub-Saharan Africa, states:
|
||||
|
||||
The problem is so serious that in many instances there is simply not enough human capacity even to absorb, deploy and efficiently use the substantial additional funds that are considered necessary to improve health in these countries.
|
||||
|
||||
Mobile technology has made a recent and rapid appearance into low- and middle-income nations. While, in the mHealth field, mobile technology usually refers to mobile phone technology, the entrance of other technologies into these nations to facilitate healthcare are also discussed here.
|
||||
|
||||
==== Health and development ====
|
||||
The link between health and development can be found in three of the Millennium Development Goals (MDGs), as set forth by the United Nations Millennium Declaration in 2000. The MDGs that specifically address health include reducing child mortality; improving maternal health; combating HIV and AIDS, malaria, and other diseases; and increasing access to safe drinking water. A progress report published in 2006 indicates that childhood immunization and deliveries by skilled birth attendants are on the rise, while many regions continue to struggle to achieve reductions in the prevalence of the diseases of poverty including malaria, HIV and AIDS and tuberculosis.
|
||||
34
data/en.wikipedia.org/wiki/MHealth-3.md
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34
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|
||||
---
|
||||
title: "MHealth"
|
||||
chunk: 4/6
|
||||
source: "https://en.wikipedia.org/wiki/MHealth"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:51.903089+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
=== Healthcare in developed countries ===
|
||||
In developed countries, healthcare systems have different policies and goals in relation to the personal and population health care goals.
|
||||
In the US and EU many patients and consumers use their cell phones and tablets to access health information and look for healthcare services. In parallel the number of mHealth applications grew significantly in the last years.
|
||||
Clinicians use mobile devices to access patient information and other databases and resources.
|
||||
Physicians also use mobile devices as an streamlined tool for exchanging patient information, for educational purposes, and as a tool for decision support.
|
||||
|
||||
== Technology and market ==
|
||||
Basic SMS functions and real-time voice communication serve as the backbone and the current most common use of mobile phone technology. The broad range of potential benefits to the health sector that the simple functions of mobile phones can provide should not be understated.
|
||||
The appeal of mobile communication technologies is that they enable communication in motion, allowing individuals to contact each other irrespective of time and place. This is particularly beneficial for work in remote areas where the mobile phone, and now increasingly wireless infrastructure, is able to reach more people, faster. As a result of such technological advances, the capacity for improved access to information and two-way communication becomes more available at the point of need.
|
||||
|
||||
=== Mobile phones ===
|
||||
|
||||
With the global mobile phone penetration rate drastically increasing over the last decade, mobile phones have made a recent and rapid entrance into many parts of the low- and middle-income world. Improvements in telecommunications technology infrastructure, reduced costs of mobile handsets, and a general increase in non-food expenditure have influenced this trend. Low- and middle-income countries are utilizing mobile phones as "leapfrog technology" (see leapfrogging). That is, mobile phones have allowed many developing countries, even those with relatively poor infrastructure, to bypass 20th century fixed-line technology and jump to modern mobile technology.
|
||||
The number of global mobile phone subscribers in 2007 was estimated at 3.1 billion of an estimated global population of 6.6 billion (47%). These figures are expected to grow to 4.5 billion by 2012, or a 64.7% mobile penetration rate. The greatest growth is expected in Asia, the Middle East, and Africa. In many countries, the number of mobile phone subscribers has bypassed the number of fixed-line telephones; this is particularly true in developing countries. Globally, there were 4.1 billion mobile phones in use in December 2008. See List of countries by number of mobile phones in use.
|
||||
While mobile phone penetration rates are on the rise, globally, the growth within countries is not generally evenly distributed. In India, for example, while mobile penetration rates have increased markedly, by far the greatest growth rates are found in urban areas. Mobile penetration, in September 2008, was 66% in urban areas, while only 9.4% in rural areas. The all India average was 28.2% at the same time. So, while mobile phones may have the potential to provide greater healthcare access to a larger portion of a population, there are certainly within-country equity issues to consider.
|
||||
Mobile phones are spreading because the cost of mobile technology deployment is dropping and people are, on average, getting wealthier in low- and middle-income nations. Vendors, such as Nokia, are developing cheaper infrastructure technologies (CDMA) and cheaper phones (sub $50–100, such as Sun's Java phone). Non-food consumption expenditure is increasing in many parts of the developing world, as disposable income rises, causing a rapid increase in spending on new technology, such as mobile phones. In India, for example, consumers have become and continue to become wealthier. Consumers are shifting their expenditure from necessity to discretionary. For example, on average, 56% of Indian consumers' consumption went towards food in 1995, compared to 42% in 2005. The number is expected to drop to 34% by 2015. That being said, although total share of consumption has declined, total consumption of food and beverages increased 82% from 1985 to 2005, while per-capita consumption of food and beverages increased 24%. Indian consumers are getting wealthier and they are spending more and more, with a greater ability to spend on new technologies.
|
||||
|
||||
=== Smartphones ===
|
||||
From the first quarter of 2015 through the first quarter of 2021, 107,033 mHealth apps in the health and fitness category were available via the Apple Store and Google Play, an increase of 11.37% from the previous quarter. More advanced mobile phone technologies are enabling the potential for further healthcare delivery. Smartphone technologies are now in the hands of a large number of physicians and other healthcare workers in low- and middle-income countries. Although far from ubiquitous, the spread of smartphone technologies opens up doors for mHealth projects such as technology-based diagnosis support, remote diagnostics and telemedicine, preprogrammed daily self-assessment prompts, video or audio clips, web browsing, GPS navigation, access to web-based patient information, post-visit patient surveillance, and decentralized health management information systems (HMIS).
|
||||
While uptake of smartphone technology by the medical field has grown in low- and middle-income countries, it is worth noting that the capabilities of mobile phones in low- and middle-income countries has not reached the sophistication of those in high-income countries. The infrastructure that enables web browsing, GPS navigation, and email through smartphones is not as well developed in much of the low- and middle-income countries. Increased availability and efficiency in both voice and data-transfer systems in addition to rapid deployment of wireless infrastructure will likely accelerate the deployment of mobile-enabled health systems and services throughout the world.
|
||||
|
||||
=== Other technologies ===
|
||||
Beyond mobile phones, wireless-enabled laptops and specialized health-related software applications are currently being developed, tested, and marketed for use in the mHealth field. Many of these technologies, while having some application to low- and middle-income nations, are developing primarily in high-income countries. However, with broad advocacy campaigns for free and open source software (FOSS), applications are beginning to be tailored for and make inroads in low- and middle-income countries.
|
||||
Some other mHealth technologies include:
|
||||
52
data/en.wikipedia.org/wiki/MHealth-4.md
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52
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|
||||
---
|
||||
title: "MHealth"
|
||||
chunk: 5/6
|
||||
source: "https://en.wikipedia.org/wiki/MHealth"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:51.903089+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Patient monitoring devices
|
||||
Mobile telemedicine/telecare devices
|
||||
Microcomputers
|
||||
Data collection software
|
||||
Mobile Operating System Technology
|
||||
Mobile applications (e.g., gamified/social wellness solutions)
|
||||
Chatterbots
|
||||
|
||||
==== Mobile device operating system technology ====
|
||||
Technologies relate to the operating systems that orchestrate mobile device hardware while maintaining confidentiality, integrity and availability are required to build trust. This may foster greater adoption of mHealth technologies and services, by exploiting lower cost multi purpose mobile devices such as tablets, PCs, and smartphones. Operating systems that control these emerging classes of devices include Google's Android, Apple's iPhone OS, Microsoft's Windows Mobile, and RIM's BlackBerry OS.
|
||||
Operating systems must be agile and evolve to effectively balance and deliver the desired level of service to an application and end user, while managing display real estate, power consumption and security posture. With advances in capabilities such as integrating voice, video and Web 2.0 collaboration tools into mobile devices, significant benefits can be achieved in the delivery of health care services. New sensor technologies such as HD video and audio capabilities, accelerometers, GPS, ambient light detectors, barometers and gyroscopes can enhance the methods of describing and studying cases, close to the patient or consumer of the health care service. This could include diagnosis, education, treatment and monitoring.
|
||||
|
||||
==== Air quality sensing technologies ====
|
||||
Environmental conditions have a significant impact on public health. Per the World Health Organization, outdoor air pollution accounts for about 1.4% of total mortality. Utilizing Participatory sensing technologies in mobile telephone, public health research can exploit the wide penetration of mobile devices to collect air measurements, which can be utilized to assess the impact of pollution. Projects such as the Urban Atmospheres are utilizing embedded technologies in mobile phones to acquire real time conditions from millions of users mobile phones. By aggregating this data, public health policy shall be able to craft initiatives to mitigate the risk associated with outdoor air pollution.
|
||||
|
||||
=== Data ===
|
||||
Data has become an especially important aspect of mHealth. Data collection requires both the collection device (mobile phones, computer, or portable device) and the software that houses the information. Data is primarily focused on visualizing static text but can also extend to interactive decision support algorithms, other visual image information, and also communication capabilities through the integration of e-mail and SMS features. Integrating use of GIS and GPS with mobile technologies adds a geographical mapping component that is able to "tag" voice and data communication to a particular location or series of locations. These combined capabilities have been used for emergency health services as well as for disease surveillance, health facilities and services mapping, and other health-related data collection.
|
||||
|
||||
== History ==
|
||||
The motivation behind the development of the mHealth field arises from two factors. The first factor concerns the myriad constraints felt by healthcare systems of developing nations. These constraints include high population growth, a high burden of disease prevalence, low health care workforce, large numbers of rural inhabitants, and limited financial resources to support healthcare infrastructure and health information systems. The second factor is the recent rapid rise in mobile phone penetration in developing countries to large segments of the healthcare workforce, as well as the population of a country as a whole. With greater access to mobile phones to all segments of a country, including rural areas, the potential of lowering information and transaction costs in order to deliver healthcare improves.
|
||||
The combination of these two factors has motivated much discussion of how greater access to mobile phone technology can be leveraged to mitigate the numerous pressures faced by developing countries' healthcare systems.
|
||||
mHealth has a rich research history starting in the early 2000s and has since transformed healthcare delivery and patient engagement. The evolution of mHealth can be traced through significant milestones and initiatives:
|
||||
|
||||
=== Timeline of key events ===
|
||||
|
||||
==== Early 2000s – Emergence of mHealth research ====
|
||||
Research initiatives exploring the potential of mobile devices in healthcare and medical settings began to surface. Academic institutions and technology companies started investigating the feasibility of using mobile phones for health-related purposes.
|
||||
2006 – The Genes, Environment, and Health Initiative (GEI)
|
||||
The GEI program was launched, emphasizing prospective cohort studies. This program laid the groundwork for understanding the interplay between genetics, the environment, and health outcomes.
|
||||
2007 – Technological advancements
|
||||
A critical year with the introduction of the first iPhone, marking the beginning of the smartphone era that would significantly impact mHealth.
|
||||
2008 – WHO mHealth Summit
|
||||
The World Health Organization (WHO) organized a summit that recognized the potential of mobile technology in improving global healthcare access, marking a significant milestone in mHealth advocacy.
|
||||
2009 – Launch of mHealth Alliance
|
||||
The United Nations Foundation established the mHealth Alliance, focusing on leveraging mobile technology to improve health outcomes, especially in developing countries.
|
||||
2010 – Pioneering mHealth projects
|
||||
Several groundbreaking mHealth projects were initiated worldwide, including programs for remote patient monitoring, disease management, health education via SMS, and mobile apps for healthcare professionals.
|
||||
mHealth Training Institute (mHTI)
|
||||
|
||||
The first NIH mHealth Training Institute was held at UCLA to serve as an incubator for developing transdisciplinary scientists capable of co-creating mHealth solutions for complex healthcare problems. The week-long workshop is grounded in a team science model that emphasizes both information transaction and relationship development in the advancement of transdisciplinary mHealth teams capable of impactful healthcare solutions.
|
||||
2011 – The mHealth Evidence Workshop
|
||||
A collaborative effort involving NSF, NIH, RWJF, and McKesson Foundation, explored mobile health technology evaluation to outline an approach to evidence generation in the field of mHealth that would ensure research is conducted on a rigorous empirical and theoretic foundation.
|
||||
82
data/en.wikipedia.org/wiki/MHealth-5.md
Normal file
82
data/en.wikipedia.org/wiki/MHealth-5.md
Normal file
@ -0,0 +1,82 @@
|
||||
---
|
||||
title: "MHealth"
|
||||
chunk: 6/6
|
||||
source: "https://en.wikipedia.org/wiki/MHealth"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:51.903089+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
==== Open mHealth ====
|
||||
Open mHealth architecture was introduced, fostering innovation in healthcare through facilitating access and harmonization of digital health data from disparate sources using a global community of developers and health tech decision-makers to make sense of that digital health data through an open interoperability standard.
|
||||
2012 – mHealth app revolution
|
||||
The proliferation of smartphone apps dedicated to health and fitness catalyzed the mHealth revolution, allowing users to track fitness, monitor vitals, access medical information, and engage in telemedicine.
|
||||
Smart Health and Wellbeing (SHB)
|
||||
|
||||
As a follow-up to the mHealth Evidence Workshop, NSF launched the Smart Health and Wellbeing program to address fundamental technical and scientific issues that would support the much-needed transformation of healthcare from reactive and hospital-centered to preventive, proactive, evidence-based, person-centered, and focused on wellbeing rather than disease.
|
||||
ASSIST Engineering Research Center (ERC)
|
||||
|
||||
NSF and NIH initiated a joint research program specifically focusing on mHealth, following up on the insights gained from the mHealth Evidence Workshop. The Engineering Research Center ASSIST ERC at NC State University was established to further mHealth research by developing leading-edge systems for high-value applications such as healthcare and IoT by integrating fundamental advances in energy harvesting, low-power electronics, and sensors with a focus on usability and actionable data.
|
||||
2013 – Wearable technology
|
||||
Around this time, Fitbit (originally Healthy Metrics Research, Inc.) also emerged, pioneering wearable health technology.
|
||||
2014 – The Big Data To Knowledge (BD2K) Initiative
|
||||
The NIH BD2K Centers of Excellence program provided a significant boost to mHealth research, leading to 12 research centers, like the Mobile Data To Knowledge (MD2K) headquartered at the University of Memphis and Stanford's Center for Mobility Data Integration to Insight (Mobilize), to facilitate studies and innovation in the field.
|
||||
2015 – Advancements in wearable technology
|
||||
Wearable devices, such as smartwatches and fitness trackers, have become more sophisticated, enabling continuous health monitoring, activity tracking, and integration with mobile health apps.
|
||||
All of Us
|
||||
|
||||
mHealth gained prominence in the All of Us program, a precision medicine initiative aiming to collect health data from diverse populations. The launch of smartwatches, particularly the Apple Watch, further emphasized the integration of wearables and health tracking.
|
||||
'mHealthHUB
|
||||
|
||||
The mHealthHUB is launched as a virtual forum where technologists, researchers, and clinicians connect, learn, share, and innovate on mHealth tools to transform healthcare. Focused on creating an innovation ecosystem that fosters the collaborative team science essential for mHealth and data science innovations, the site becomes a collaboratory "watering hole" for the mHealth research community.
|
||||
2017 – NSF Center for Underserved Populations
|
||||
The NSF established the Engineering Research Center for Precise Advanced Technologies and Health Systems for Underserved Populations, emphasizing the integration of engineering research and education with technological innovation to transform national prosperity, health, and security.
|
||||
|
||||
==== Research and development expansion ====
|
||||
Pharmaceutical companies, tech giants, and healthcare institutions increased their investment in mHealth R&D, exploring AI-driven health apps, remote diagnostics, and personalized medicine.
|
||||
2020 – Biomedical Technology Resource Centers (BTRCs)
|
||||
Novel mHealth research centers funded by NIH spring from the remnants of the BD2K initiative. mHealth-focused P41 awards for new centers, like the mHealth Center for Discovery, Optimization, and Translation of Temporally-Precise Interventions (mDOT Center) headquartered at the University of Memphis and Stanford's Mobilize Center, were established to focus on innovative biomedical technologies for healthcare.
|
||||
|
||||
==== During the COVID-19 pandemic ====
|
||||
The COVID-19 pandemic accelerated the adoption of mHealth solutions for remote consultations, contact tracing apps, telehealth services, and remote patient monitoring to maintain healthcare access during lockdowns.
|
||||
Present – Ongoing research and integration
|
||||
Current research focuses on AI-driven diagnostics, blockchain for secure health data management, machine learning for predictive analytics, and the integration of mHealth into mainstream healthcare systems.
|
||||
|
||||
== Research ==
|
||||
Emerging trends and areas of interest:
|
||||
|
||||
Emergency response systems (e.g., road traffic accidents, emergency obstetric care).
|
||||
Human resources coordination, management, and supervision.
|
||||
Mobile synchronous (voice) and asynchronous (SMS) telemedicine diagnostic and decision support to remote clinicians.
|
||||
Clinician-focused, evidence-based formulary, database and decision support information available at the point of care.
|
||||
Pharmaceutical supply chain integrity and patient safety systems (e.g. Sproxil and mPedigree).
|
||||
Clinical care and remote patient monitoring
|
||||
Health extension services.
|
||||
Inpatient monitoring.
|
||||
Health services monitoring and reporting.
|
||||
Health-related mLearning for the general public.
|
||||
Public health services, for example, tobacco cessation
|
||||
Mental health promotion and illness prevention
|
||||
Training and continuing professional development for health care workers.
|
||||
Health promotion and community mobilization.
|
||||
Support of long-term conditions, for example medication reminders and diabetes self-management.
|
||||
Peer-to-peer personal health management for telemedicine.
|
||||
Patient participation and social mobilisation for infectious disease prevention (e.g. Participatient).
|
||||
Surgical follow-up, such as for major joint arthroplasty patients.
|
||||
Mobile social media for global health personnel; for example, the capacity to facilitate professional connectedness, and to empower health workforce.
|
||||
According to the Vodafone Group Foundation on February 13, 2008, a partnership for emergency communications was created between the group and United Nations Foundation. Such partnership will increase the effectiveness of the information and communications technology response to major emergencies and disasters around the world.
|
||||
|
||||
== See also ==
|
||||
|
||||
Health 2.0
|
||||
Health informatics
|
||||
Healthcare workforce information systems
|
||||
Hospital-at-home
|
||||
Open source software packages for mHealth
|
||||
Telehealth
|
||||
Telemedicine service providers
|
||||
|
||||
== References ==
|
||||
|
||||
== Further reading ==
|
||||
22
data/en.wikipedia.org/wiki/Maculopapular_rash-0.md
Normal file
22
data/en.wikipedia.org/wiki/Maculopapular_rash-0.md
Normal file
@ -0,0 +1,22 @@
|
||||
---
|
||||
title: "Maculopapular rash"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Maculopapular_rash"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:25.719082+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
A maculopapular rash is a type of rash characterized by a flat, red area on the skin that is covered with small confluent bumps. It may only appear red in lighter-skinned people. The term "maculopapular" is a compound: macules are small, flat discolored spots on the surface of the skin; and papules are small, raised bumps. It is also described as erythematous, or red.
|
||||
This type of rash is common in several diseases and medical conditions, including scarlet fever, measles, Ebola virus disease, rubella, HIV, secondary syphilis (congenital syphilis, which is asymptomatic, the newborn may present this type of rash), erythrovirus (parvovirus B19), chikungunya (alphavirus), Zika fever, smallpox (which has been eradicated), varicella (when vaccinated persons exhibit symptoms from the modified form), heat rash, and sometimes dengue fever. It is also a common manifestation of a skin reaction to the antibiotic amoxicillin or chemotherapy drugs. Cutaneous infiltration of leukemic cells may also have this appearance. Maculopapular rash is seen in graft-versus-host disease (GVHD) developed after a hematopoietic stem cell transplant (bone marrow transplant), which can be seen within one week or several weeks after the transplant. In the case of GVHD, the maculopapular lesions may progress to a condition similar to toxic epidermal necrolysis. In addition, this is the type of rash that some patients presenting with Ebola virus hemorrhagic (EBO-Z) fever will reveal but can be hard to see on dark skin people. It is also seen in patients with Marburg hemorrhagic fever, a filovirus not unlike Ebola.
|
||||
This type of rash can be as a result of large doses of niacin or no-flush niacin (2000 – 2500 mg), used for the management of low HDL cholesterol.
|
||||
This type of rash can also be a symptom of sea bather's eruption. This stinging, pruritic, maculopapular rash affects swimmers in some Atlantic locales (such as Florida, the Caribbean, and Long Island). It is caused by hypersensitivity to stings from the larvae of the sea anemone (Edwardsiella lineata) or the thimble jellyfish (Linuche unguiculata). The rash appears where the bathing suit contacts the skin.
|
||||
This type of rash can also be a symptom of acute arsenic intoxication, appearing two weeks later.
|
||||
|
||||
|
||||
== See also ==
|
||||
List of cutaneous conditions
|
||||
|
||||
|
||||
== References ==
|
||||
29
data/en.wikipedia.org/wiki/Malacia-0.md
Normal file
29
data/en.wikipedia.org/wiki/Malacia-0.md
Normal file
@ -0,0 +1,29 @@
|
||||
---
|
||||
title: "Malacia"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Malacia"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:27.021333+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Malacia is abnormal softening of a biological tissue, most often cartilage. The word is derived from Greek μαλακός, malakos = soft. Usually the combining form -malacia suffixed to another combining form that denotes the affected tissue assigns a more specific name to each such disorder, as follows:
|
||||
|
||||
Osteomalacia (rickets), a bone disorder from vitamin D deficiency
|
||||
Chondromalacia, softening of cartilage (often refers to chondromalacia patellae when mentioned without further specification)
|
||||
Chondromalacia patellae, a disorder of cartilage under the kneecap
|
||||
Bronchomalacia, a disorder of the bronchial tubes' cartilage
|
||||
Laryngomalacia, a disorder of the larynx's cartilage
|
||||
Tracheomalacia, a disorder of the trachea's cartilage
|
||||
Keratomalacia, an eye disorder from vitamin A deficiency
|
||||
Myelomalacia, a disorder of the spinal cord
|
||||
Cerebral softening (encephalomalacia), localized softening of brain tissue
|
||||
|
||||
|
||||
== References ==
|
||||
|
||||
|
||||
== External links ==
|
||||
|
||||
Definition at MedineNet.com
|
||||
35
data/en.wikipedia.org/wiki/Malignancy-0.md
Normal file
35
data/en.wikipedia.org/wiki/Malignancy-0.md
Normal file
@ -0,0 +1,35 @@
|
||||
---
|
||||
title: "Malignancy"
|
||||
chunk: 1/2
|
||||
source: "https://en.wikipedia.org/wiki/Malignancy"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:28.374982+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Malignancy (from Latin male 'badly' and -gnus 'born') is the tendency of a medical condition to become progressively worse; the term is most familiar as a characterization of cancer.
|
||||
A malignant tumor contrasts with a non-cancerous benign tumor in that a malignancy is not self-limited in its growth, is capable of invading into adjacent tissues, and may be capable of spreading to distant tissues.
|
||||
A benign tumor has none of those properties, but may still be harmful to health. The term benign in more general medical use characterizes a condition or growth that is not cancerous, i.e. does not spread to other parts of the body or invade nearby tissue. Sometimes the term is used to suggest that a condition is not dangerous or serious, although this is not always the case.
|
||||
Malignancy in cancers is characterized by anaplasia, invasiveness, and metastasis. Malignant tumors are also characterized by genome instability: cancers, as assessed by whole genome sequencing, frequently have between 10,000 and 100,000 mutations in their entire genomes. Cancers usually show tumour heterogeneity, containing multiple subclones. They also frequently have reduced expression of DNA repair enzymes due to epigenetic methylation of DNA repair genes or altered microRNAs that control DNA repair gene expression.
|
||||
Tumours often manifest as a visible lump on the body. A mammogram or MRI scan can be used to determine or detect a suspected tumour, particularly if there is no visible lump. If an apparent tumour is detected, a biopsy—examination of a small sample of the tissue in a laboratory—is required to make a definitive diagnosis, and distinguish whether the tumour is malignant or benign. Malignant, and some benign, tumours usually require treatment, which is most effective at an early stage of tumour development.
|
||||
Treatment may be by chemotherapy, surgery, ionising radiation, hyperthermia, and other means.
|
||||
|
||||
== Signs and symptoms ==
|
||||
When malignant cells form, symptoms do not typically appear until there has been a significant growth of the mass. Once signs and symptoms do arise, they are dependent on the location, size and type of malignancy. Usually, it is quite general and can be associated with other illnesses or diseases and thus, can be difficult to diagnose or can be misdiagnosed.
|
||||
Signs include observable or measurable aspects such as weight loss (without trying), a fever or unusual bleeding. On the other hand, symptoms are felt internally by the individual such as fatigue or changes in appetite. A general list of common signs and symptoms includes pain (headaches or bone aches), skin changes (new moles or bumps), coughing and unusual bleeding. There are also signs and symptoms specific to females including belly pain and bloating or breast changes i.e., the formation of a lump. Signs and symptoms specific to males include pain or growths in the scrotum or difficulty urinating.
|
||||
|
||||
== Causes ==
|
||||
Malignant cells often evolve due to a combination of reasons rather than one definitive reason. Reasons which can explain their development include genetics and family history, triggers such as infectious diseases, and exposure to risk factors.
|
||||
|
||||
=== Triggers ===
|
||||
Infectious diseases play a role in the development of malignancy, with agents of infectious disease being able to produce a multitude of malignant cells. These include bacterial causes, fungal and parasitic causes, and viral causes. Bacteria, fungi and similar pathogens have the ability to form an environment within states of chronic inflammation which gives rise to oncogenic potential. Viral agents are able to assist the formation of malignant tumours due to a mechanism of cell transformation. This cell transformation can occur through either "DNA integration or cellular-DNA alteration of growth regulator genes". Inflammation can also play a role in triggering malignancy as it can promote stages of tumour formation. The main purpose of inflammation is to repair tissue, defend the body against pathogens and regenerate cells. At the same time, inflammatory cells can also interact with malignant cells to form an inflammatory tumour microenvironment. This environment increases the likelihood of forming malignant cells through blockage of anti-tumour immunity. Once this occurs, the inflammatory tumour microenvironment begins to send out tumour-promoting signals to epithelial cells, triggering the formation of malignant cells.
|
||||
|
||||
=== Risk factors ===
|
||||
Traditional risk factors of developing malignancy include smoking, sun exposure, and having a history of cancer in the family. Other risk factors include developing post-transplant malignancy which occurs subsequent to solid organ transplantations.
|
||||
|
||||
==== Post-transplant malignancy ====
|
||||
Individuals who undergo organ transplant surgery have an increased risk of developing malignancy in comparison to the general population. The most common form of malignancy being "nonmelanoma skin cancer and posttransplant lymphoproliferative disorders". The different types of malignancy developed post-transplant depend on which organ was transplanted. This is linked to recipients being at a higher risk when exposed to traditional risk factors as well as, the type and intensity of the operation, the duration of their immunosuppression post-operation, and the risk of developing oncogenic viral infections.
|
||||
|
||||
== Management ==
|
||||
There are various treatment forms available to help manage malignancy. Common treatments include chemotherapy, radiation, and surgical procedures. Photoradiation and hyperthermia are also used as treatment forms to kill or reduce malignant cells. A large portion of patients are at risk of death when diagnosed with malignancy as the disease has usually progressed for a number of years before detection.
|
||||
52
data/en.wikipedia.org/wiki/Malignancy-1.md
Normal file
52
data/en.wikipedia.org/wiki/Malignancy-1.md
Normal file
@ -0,0 +1,52 @@
|
||||
---
|
||||
title: "Malignancy"
|
||||
chunk: 2/2
|
||||
source: "https://en.wikipedia.org/wiki/Malignancy"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:28.374982+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
=== Surgery ===
|
||||
Surgery can help manage or treat malignancy by either removing the tumour, localising it and/or determining whether there has been a spread to other organs. When undertaking surgery for malignancy, there are six major objectives which are considered. These include "prevention of cancer, diagnosis and staging of disease, disease cure, tumour debulking, symptom palliation and patient rehabilitation".
|
||||
Surgical prevention of cancer largely consists of removing the organ at risk of developing malignancy. This would occur if an individual is predisposed to the formation of malignant cells as a result of inherited genetic mutations and acquired diseases.
|
||||
Surgical diagnosis of malignancy involves completing a biopsy. This process requires a sufficient amount of tissue to make a confident diagnosis, and the handling of specimen to expand information provided from testing. Biopsies are categorised into four different processes: "fine-needle aspirate (FNA), core needle, incisional, and excisional".
|
||||
Curative surgery (also known as primary surgery) can be conducted when the malignant tumour has only invaded one area of the body. The objective is to remove the entirety of the malignant cells without violating the tumour; if the tumour is violated, the risk of both tumour spillage and wound implantation would increase.
|
||||
The surgical procedure of tumour debulking can be undertaken to increase the effectiveness of postoperative forms of treatment. Symptom palliation and patient rehabilitation do not play a role in controlling or reducing malignancy growth rather, they increase the patient's quality of life.
|
||||
|
||||
=== Photoradiation ===
|
||||
Hematoporphyrin derivative (HPD) is a drug which was developed to be absorbed by malignant cells and only becomes active when exposed to light. It is commonly used to identify and localise cancers as when it is under activation of blue light the red fluorescence of the malignant tumour (due to the HPD) can be observed easily.
|
||||
The combination of HPD with red light (photoradiation) has been used on various malignant tumours including malignant melanomas and carcinomas on a range of different organs including the breast and colon. This form of treatment produces a singlet oxygen through the photodynamic process; where the oxygen molecule exists in an electronically excited state. The singlet oxygen is a cytotoxic agent which holds the ability to eradicate malignant cells by preventing both nucleic acid and protein synthesis. The treatment process also utilises HPD's capability of accumulating at higher levels in malignant tissues compared to most other tissues.
|
||||
In the case of deeply pigmented or larger tumours, a stronger course of this treatment process is required in order to be effective.
|
||||
|
||||
=== Hyperthermia ===
|
||||
Malignancy can be treated through the use of hyperthermia by applying either surgical perfusion or interstitial techniques to the body. The use of this treatment type largely depends on the fact that malignant and normal cells have differing responses to the energy source used. This dependency is due to the intracellular changes which occur during hyperthermia; as the nucleic acids, cell membrane, and cytoskeleton within each cell is affected indirectly and/or through multiple pathways. The combination of these intracellular changes means there is no specific target of cell death in the hyperthermic process.
|
||||
|
||||
=== Chemotherapy ===
|
||||
Chemotherapy is commonly used as either the primary treatment or in conjunction with other treatment forms such as radiotherapy or surgery. It can be administered through "injection, intra-arterial (IA), intraperitoneal (IP), intrathecal (IT), intravenous (IV), topical or oral".
|
||||
The purpose of chemotherapy is to use cytotoxic agents which kill rapidly dividing cells within the body. It targets the cellular mechanisms which allow the development of malignancy throughout the body. There are no specific areas which are targeted and so, there is a lack of differentiation between normal and malignant cells, resulting in a range of side effects. This includes bone marrow suppression, gastrointestinal problems, and alopecia. Some side effects are specific to the anticancer drug used, the most common being bone marrow suppression as bone marrow has the ability to divide rapidly due to high growth fraction. This is because anticancer drugs have the highest activity in high growth fraction tissues.
|
||||
Alkylating agents are used in chemotherapy as these are chemically reactive drugs which form covalent bonds when reacting with DNA. This results in breaks within DNA strands causing either inter-strand or intra-strand DNA cross-linking. The sub-classes of alkylating agents are "nitrogen mustards, oxazaphosphorines, alkyl alkane, sulfonates, nitrosoureas, tetrazines, and aziridines."
|
||||
|
||||
== Epidemiology ==
|
||||
Malignancy has been a constant global health concern for a number of years, resulting in significant social and economic impacts on individuals with malignancy and their families. The risk of developing malignancy is 20.2%. In 2018, 18 million patients were diagnosed with a malignant tumour with lung, breast and prostate being the most common form. Additionally, there were approximately 10 million mortalities due to cancer in 2020, and there is an overall trend which demonstrated that malignant mortality has increased by 28% over the past 15 years.
|
||||
Lung cancer has the highest mortality rate in comparison to other forms of cancer, with the leading cause of development due to smoking. The number of smokers in China is rapidly increasing with tobacco killing approximately 3000 people each day. The diagnosis of lung cancer is most common within the 50–59-year age bracket. Further, it caused 1.8 million deaths in 2020 alone.
|
||||
In those aged 14 or younger, leukaemia is the most frequent form of malignancy with the brain and nervous system subsequent. These individuals account for approximately 1% of the cancer mortality rate – about 110,000 children each year. In the 15–49-year-old age bracket the most common form of malignancy is breast cancer with liver and lung cancer following. Finally, those aged 60 and over mainly develop lung, colorectal, stomach, and liver malignancy.
|
||||
Uses of "malignant" in oncology include:
|
||||
|
||||
Malignancy, malignant neoplasm and malignant tumor are synonymous with cancer
|
||||
Malignant ascites
|
||||
Malignant transformation
|
||||
Non-oncologic disorders referred to as "malignant" include:
|
||||
|
||||
Malignant hypertension
|
||||
Malignant hyperthermia
|
||||
Malignant otitis externa
|
||||
Malignant tertian malaria (malaria caused specifically by Plasmodium falciparum)
|
||||
Neuroleptic malignant syndrome
|
||||
|
||||
== See also ==
|
||||
|
||||
Precancerous condition
|
||||
|
||||
== References ==
|
||||
27
data/en.wikipedia.org/wiki/Mammoplasia-0.md
Normal file
27
data/en.wikipedia.org/wiki/Mammoplasia-0.md
Normal file
@ -0,0 +1,27 @@
|
||||
---
|
||||
title: "Mammoplasia"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Mammoplasia"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:29.680473+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Mammoplasia is the normal or spontaneous enlargement of human breasts. Mammoplasia occurs normally during puberty and pregnancy in women, as well as during certain periods of the menstrual cycle. When it occurs in males, it is called gynecomastia and is considered to be pathological. When it occurs in females and is extremely excessive, it is called macromastia (also known as gigantomastia or breast hypertrophy) and is similarly considered to be pathological. Mammoplasia may be due to breast engorgement, which is temporary enlargement of the breasts caused by the production and storage of breast milk in association with lactation and/or galactorrhea (excessive or inappropriate production of milk). Mastodynia (breast tenderness/pain) frequently co-occurs with mammoplasia.
|
||||
During the luteal phase (latter half) of the menstrual cycle, due to increased mammary blood flow and/or premenstrual fluid retention caused by high circulating concentrations of estrogen and/or progesterone, the breasts temporarily increase in size, and this is experienced by women as fullness, heaviness, swollenness, and a tingling sensation.
|
||||
Mammoplasia can be an effect or side effect of various drugs, including estrogens, antiandrogens such as spironolactone, cyproterone acetate, bicalutamide, and finasteride, growth hormone, and drugs that elevate prolactin levels such as D2 receptor antagonists like antipsychotics (e.g., risperidone), metoclopramide, and domperidone and certain antidepressants like selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). The risk appears to be less with serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine. The "atypical" antidepressants mirtazapine and bupropion do not increase prolactin levels (bupropion may actually decrease prolactin levels), and hence there may be no risk with these agents. Other drugs that have been associated with mammoplasia include D-penicillamine, bucillamine, neothetazone, ciclosporin, indinavir, marijuana, and cimetidine.
|
||||
A 1997 study found an association between the SSRIs and mammoplasia in 23 (39%) of its 59 female participants. Studies have also found associations between SSRIs and galactorrhea. These side effects seem to be due to hyperprolactinemia (elevated prolactin levels) induced by these drugs, an effect that appears to be caused by serotonin-mediated inhibition of tuberoinfundibular dopaminergic neurons that inhibit prolactin secretion. The mammoplasia these drugs can cause has been found to be highly correlated with concomitant weight gain (in the 1997 study, 83% of those who experienced weight gain also experienced mammoplasia, while only 30% of those who did not experience weight gain experienced mammoplasia). The mammoplasia associated with SSRIs is reported to be reversible with drug discontinuation. SSRIs have notably been associated with a modestly increased risk of breast cancer. This is in accordance with higher prolactin levels being associated with increased breast cancer risk.
|
||||
In puberty induction in hypogonadal girls and in feminizing hormone therapy in transgender women, as well as hormonal breast enhancement in women with breast hypoplasia or small breasts, mammoplasia is a desired effect.
|
||||
|
||||
|
||||
== See also ==
|
||||
Breast atrophy
|
||||
Micromastia
|
||||
Galactogogue
|
||||
|
||||
|
||||
== References ==
|
||||
|
||||
|
||||
== External links ==
|
||||
45
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|
||||
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|
||||
title: "Manner of death"
|
||||
chunk: 1/2
|
||||
source: "https://en.wikipedia.org/wiki/Manner_of_death"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:31.066625+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
In many legal jurisdictions, the manner of death is a determination, typically made by the coroner, medical examiner, police, or similar officials, and recorded as a vital statistic. Within the United States and the United Kingdom, a distinction is made between the cause of death, which is a specific disease or injury, such as a gunshot wound or cancer, versus manner of death, which is primarily a legal determination, versus the mechanism of death (also called the mode of death), which does not explain why the person died or the underlying cause of death and is usually not specific to the cause or manner of death, such as asphyxiation, arrhythmia or exsanguination.
|
||||
Different categories are used in different jurisdictions, but manner of death determinations include everything from very broad categories like "natural" and "homicide" to specific manners like "traffic accident" or "gunshot wound". In some cases an autopsy is performed, either due to general legal requirements, because the medical cause of death is uncertain, upon the request of family members or guardians, or because the circumstances of death were suspicious.
|
||||
International Classification of Disease codes are sometimes used to record manner and cause of death in a systematic way that makes it easy to compile statistics and feasible to compare events across jurisdictions.
|
||||
|
||||
== Terminology ==
|
||||
|
||||
=== Natural causes of death ===
|
||||
|
||||
There is no single definition as to what constitutes death by natural causes. In the broadest sense, a natural cause of death occurs due to illness and its complications, or internal body malfunctions. Examples include pneumonia, diarrheal diseases, cancer, a stroke, heart disease, and sudden organ failure. Sometimes, infectious diseases are excluded from this definition. Whether a specific manner of death is considered "natural" depends on the deceased’s age, medical history, and specific context. For example, a 25-year old who suddenly dies of pneumonia is unlikely to be considered a natural cause when discussed in most contexts. However, in the case of an 80-year old patient who had experienced significant decline previously who dies of the same illness, the death is much more likely to be considered natural, even if the pneumonia is infectious, because significant decline has already occurred. Fatal heart attacks, strokes, cardiac arrests, and other sudden causes of death may be separated from "natural causes", especially if they were unexpected or occurred in an otherwise healthy individual. However, chronic, life-threatening illnesses such as cancer and ALS are much more likely to be considered causes of death in their own right, rather than being considered natural. "Natural causes" is often used as a euphemism for death following a period of progressive decline in elderly people.
|
||||
As organisms age, various health-related consequences arise. In humans, a few examples include slower healing of skin tissue, thickening of blood vessel walls, and a less effective immune system. For example, a fall may be more likely to cause internal bleeding, plaque buildup becomes more likely to cause a heart attack, and a cold may be more likely to result in pneumonia.
|
||||
Historically, most doctors had little to no understanding of medicine and as such attributed unknown causes to "old age." With modern medicine and medical machinery, it is possible to uncover true causes of death, though "old age" is still widely used for comforting loved ones.
|
||||
There is particular ambiguity around the classification of cardiac deaths, triggered by a traumatic incident such as in stress cardiomyopathy. Liability for a death classified as by natural causes may still be found if a proximate cause is established, as in the 1969 California case People v. Stamp.
|
||||
|
||||
=== Unnatural causes of death ===
|
||||
An unnatural cause of death results from an external cause, typically including homicides, suicides, accidents, medical errors, alcohol intoxications and drug overdoses. Jurisdictions differ in how they categorize and report unnatural deaths, including level of detail and whether they are considered a single category with subcategories, or separate top-level categories. There is no international standard on whether or how to classify a death as natural vs. unnatural.
|
||||
"Mechanism of death" is sometimes used to refer to the proximate cause of death, which might differ from the cause that is used to classify the manner of death. For example, the proximate cause or mechanism of death might be brain ischemia (lack of blood flow to the brain), caused by a malignant neoplasm (cancer), in turn caused by a dose of ionizing radiation administered by a person with intent to kill or injure, leading to certification of the manner of death as "homicide".
|
||||
The manner of death can be recorded as "undetermined" if there is not enough evidence to reach a firm conclusion. For example, the discovery of a partial human skeleton indicates a death, but might not provide enough evidence to determine a cause.
|
||||
|
||||
== Categories by jurisdiction ==
|
||||
|
||||
=== United States ===
|
||||
In the United States, a manner of death is expressed as belonging to one classification of a group of six possible:
|
||||
|
||||
Natural
|
||||
Accident
|
||||
Suicide
|
||||
Homicide
|
||||
Undetermined
|
||||
Pending
|
||||
In some jurisdictions, some more detailed manners may be reported in numbers broken out from the main four or five. For example:
|
||||
|
||||
Legal intervention (e.g. capital punishment)
|
||||
Act of war
|
||||
Automobile accidents
|
||||
Deaths of prison inmates by acute intoxication
|
||||
48
data/en.wikipedia.org/wiki/Manner_of_death-1.md
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|
||||
---
|
||||
title: "Manner of death"
|
||||
chunk: 2/2
|
||||
source: "https://en.wikipedia.org/wiki/Manner_of_death"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:31.066625+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
=== United Kingdom ===
|
||||
In the United Kingdom, when people die, either a doctor writes an acceptable natural cause of death medical certificate, or a coroner (procurator fiscal in Scotland) investigates the case. Coroners are independent judicial officers who investigate deaths reported to them, and subsequently whatever inquiries are necessary to discover the cause of death, this includes ordering a post-mortem examination, obtaining witness statements and medical records, or holding an inquest. In the unified legal jurisdiction of England and Wales, most deaths are certified by doctors without autopsy or coroner involvement. Almost all deaths certified by the coroner involve an autopsy but most do not involve a formal inquest.
|
||||
In England and Wales, a specific list of choices for verdicts is not mandated, and "narrative verdicts" are allowed, which are not specifically classified. The verdicts aggregated by the Ministry of Justice are:
|
||||
|
||||
Homicide
|
||||
Killed unlawfully
|
||||
Killed lawfully
|
||||
Suicide
|
||||
Attempted or self-induced abortion
|
||||
Cause of death aggravated by lack of care, or self-neglect
|
||||
Dependence on drugs
|
||||
Non-dependent abuse of drugs
|
||||
Want of attention at birth
|
||||
Death from industrial diseases
|
||||
Death by accident or misadventure
|
||||
Stillborn
|
||||
Death from natural causes
|
||||
Open verdict
|
||||
Disaster
|
||||
|
||||
=== Other jurisdictions ===
|
||||
Some jurisdictions place deaths in absentia, such as deaths at sea and missing persons declared dead in a court of law, in the "Undetermined" category on the grounds that due to the fact-finder's lack of ability to examine the body, the examiner has no personal knowledge of the manner of (assumed) death; others classify such deaths in an additional category "Other", reserving "Undetermined" for deaths in which the fact-finder has access to the body, but the information provided by the body and examination of it is insufficient to provide sufficient grounds for a determination.
|
||||
The Norwegian Medical Association classifies what other jurisdictions might call "undetermined" as "unnatural":
|
||||
|
||||
Sudden and unexpected death of an unknown cause
|
||||
Deaths in prison or while in civilian or military detention
|
||||
|
||||
== Legal implications ==
|
||||
A death ruled as homicide or unlawful killing is typically referred to police or prosecutor or equivalent official for investigation and criminal charges if warranted. Deaths caused by capital punishment, though homicides, are themselves sanctioned by prosecution and therefore lawful and not prosecuted. Most deaths due to war are not prosecuted, unless there is evidence of a war crime, in which case troops on foreign territory might be prosecuted by the military justice system, domestic law enforcement, or the International Criminal Court if under its jurisdiction.
|
||||
Some insurance contracts, such as life insurance policies, have special rules for certain manners of death. Suicide, for example, may invalidate claims under terms of such a contract.
|
||||
|
||||
== References ==
|
||||
|
||||
== Further reading ==
|
||||
S.A.Koehler. "Chapter 7 – Death Investigation". Forensic Epidemiology: Principles and Practice. doi:10.1016/B978-0-12-404584-2.00007-0.
|
||||
|
||||
== External links ==
|
||||
Death From Natural Causes – Certificate of Treating or Examining Doctor – Form 3 – Burial and Cremation Act 2013 (section 10) Archived 2022-08-11 at the Wayback Machine (Australia)
|
||||
17
data/en.wikipedia.org/wiki/Mass_effect_(medicine)-0.md
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|
||||
---
|
||||
title: "Mass effect (medicine)"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Mass_effect_(medicine)"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:32.354081+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
In medicine, a mass effect is the effect of a growing mass that results in secondary pathological effects by pushing on or displacing surrounding tissue.
|
||||
In oncology, the mass typically refers to a tumor.
|
||||
For example, cancer of the thyroid gland may cause symptoms due to compressions of certain structures of the head and neck; pressure on the laryngeal nerves may cause voice changes, narrowing of the windpipe may cause stridor, pressure on the gullet may cause dysphagia and so on. Surgical removal or debulking is sometimes used to palliate symptoms of the mass effect even if the underlying pathology is not curable.
|
||||
In neurology, a mass effect is the effect exerted by any mass, including, for example, hydrocephalus (cerebrospinal fluid buildup) or an evolving intracranial hemorrhage (bleeding within the skull) presenting with a clinically significant hematoma. The hematoma can exert a mass effect on the brain, increasing intracranial pressure and potentially causing midline shift or deadly brain herniation. In the past this effect held additional diagnostic importance since prior to the invention of modern tomographic soft-tissue imaging utilizing MRI or CT it was not possible to directly image many kinds of primary intracranial lesions. Therefore, in those days, the mass effect of these abnormalities on surrounding structures was sometimes used to indirectly infer the existence of the primary abnormalities themselves, for example by using a cerebral angiography to observe the secondary vascular displacement caused by a subdural hematoma pushing on the brain, or by looking for a distortion caused by a tumor on the normal outline of the ventricles as depicted on a pneumoencephalogram. These studies were often invasive and uncomfortable for patients and provided only a partial assessment of the primary condition being evaluated. Nowadays modern diagnostic tools exist which allow physicians to easily locate and visualize all kinds of intracranial lesions without having to rely on indirect effects to make a reliable diagnosis.
|
||||
|
||||
|
||||
== References ==
|
||||
32
data/en.wikipedia.org/wiki/Maternal_death-0.md
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|
||||
---
|
||||
title: "Maternal death"
|
||||
chunk: 1/10
|
||||
source: "https://en.wikipedia.org/wiki/Maternal_death"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:33.740084+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pregnancy, underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while she is pregnant or within six weeks of resolution of the pregnancy. The CDC definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy. Pregnancy associated death, as defined by the American College of Obstetricians and Gynecologists (ACOG), are all deaths occurring within one year of a pregnancy resolution. Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.
|
||||
There are two main measures used when talking about the rates of maternal mortality in a community or country. These are the maternal mortality ratio and maternal mortality rate, both abbreviated as "MMR". By 2017, the world maternal mortality rate had declined 44% since 1990; however, every day 808 women die from pregnancy or childbirth related causes. According to the United Nations Population Fund (UNFPA) 2017 report, about every 2 minutes a woman dies because of complications due to childbirth or pregnancy. For every woman who dies, there are about 20 to 30 women who experience injury, infection, or other birth or pregnancy-related complications.
|
||||
UNFPA estimated that 303,000 women died of pregnancy or childbirth-related causes in 2015. The WHO divides causes of maternal deaths into two categories: direct obstetric deaths and indirect obstetric deaths. Direct obstetric deaths are causes of death due to complications of pregnancy, birth or termination. For example, these could range from severe bleeding to obstructed labor, for which there are highly effective interventions. Indirect obstetric deaths are caused by pregnancy interfering or worsening an existing condition, like a heart problem.
|
||||
As women have gained access to family planning and skilled birth attendant with backup emergency obstetric care, the global maternal mortality ratio has fallen from 385 maternal deaths per 100,000 live births in 1990 to 216 deaths per 100,000 live births in 2015. Many countries halved their maternal death rates in the last 10 years. Although attempts have been made to reduce maternal mortality, there is much room for improvement, particularly in low-resource regions. Over 85% of maternal deaths are in low-resource communities in Africa and Asia. In higher resource regions, there are still significant areas with room for growth, particularly as they relate to racial and ethnic disparities and inequities in maternal mortality and morbidity rates.
|
||||
Overall, maternal mortality is an important marker of the health of the country and reflects on its health infrastructure. Lowering the amount of maternal death is an important goal of many health organizations worldwide.
|
||||
|
||||
== Causes ==
|
||||
|
||||
=== Direct obstetric deaths ===
|
||||
|
||||
==== Overview ====
|
||||
Direct obstetric deaths are due to complications of pregnancy, birth, termination, or complications arising from their management.
|
||||
The causes of maternal death vary by region and level of access. According to a study published in the Lancet which covered the period from 1990 to 2013, the most common causes of maternal death world-wide are postpartum bleeding (15%), complications from unsafe abortion (15%), hypertensive disorders of pregnancy (10%), postpartum infections (8%), and obstructed labor (6%). Other causes include blood clots (3%) and pre-existing conditions (28%).
|
||||
|
||||
==== Descriptions by condition ====
|
||||
Postpartum bleeding happens when there is uncontrollable bleeding from the uterus, cervix, or vaginal wall after birth. This can happen when the uterus does not contract correctly after birth, there is leftover placenta in the uterus, or there are cuts in the cervix or vagina from birth.
|
||||
Hypertensive disorders of pregnancy happen when the body does not regulate blood pressure correctly. In pregnancy, this is due to changes at the level of the blood vessels, likely because of the placenta. This includes medical conditions like gestational hypertension and pre-eclampsia.
|
||||
Postpartum infections are infections of the uterus or other parts of the reproductive tract after the resolution of a pregnancy. They are usually bacterial and cause fever, increased pain, and foul-smelling discharge.
|
||||
Obstructed labor happens when the baby does not properly move into the pelvis and out of the body during labor. The most common cause of obstructed labor is when the baby's head is too big or angled in a way that does not allow it to pass through the pelvis and birth canal.
|
||||
Blood clots can occur in different vessels in the body, including vessels in the arms, legs, and lungs. They can cause problems in the lungs and travel to the heart or brain, thereby leading to complications.
|
||||
|
||||
==== Unsafe abortion ====
|
||||
25
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|
||||
---
|
||||
title: "Maternal death"
|
||||
chunk: 2/10
|
||||
source: "https://en.wikipedia.org/wiki/Maternal_death"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:33.740084+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
When abortion is legal and accessible, it is widely regarded as safer for the mother than carrying a pregnancy to term and delivery. In fact, a study published in the journal Obstetrics & Gynecology reported that in the United States, carrying a pregnancy to term and delivering a baby comes with a 14 times increased risk of death for the mother as compared to a legal abortion. However, in many regions of the world, abortion is not legal and can be unsafe for the mother. Maternal deaths caused by improperly performed procedures are preventable and contribute 13% to the maternal mortality rate worldwide. This number is increased to 25% in countries where other causes of maternal mortality are low, such as in Eastern European and South American countries. This makes unsafe abortion practices the leading cause of maternal death worldwide.
|
||||
Unsafe abortion is another major cause of maternal death worldwide. In regions where abortion is legal and accessible, abortion is safe and does not contribute greatly to overall rates of maternal death. However, in regions where abortions are not legal, available, or regulated, unsafe abortion practices can cause significant rates of maternal death. According to the World Health Organization in 2009, every eight minutes a woman died from complications arising from unsafe abortions.
|
||||
The WHO defined unsafe abortion practices as procedures performed by someone without the appropriate training and/or ones that are performed in an environment that is not considered safe or clean. Using this definition, the WHO estimates that out of the 45 million abortions that are performed each year globally, 19 million of these are considered unsafe, and 97% of these unsafe abortions occur in developing countries. Complications include hemorrhage, infection, sepsis and genital trauma.
|
||||
|
||||
==== Rates ====
|
||||
|
||||
Four primary types of data sources are used to collect abortion-related maternal mortality rates: confidential enquiries, registration data, verbal autopsy, and facility-based data sources. A verbal autopsy is a systematic tool that is used to collect information on the cause of death from laypeople and not medical professionals.
|
||||
Confidential enquiries for maternal deaths do not occur very often on a national level in most countries. Registration systems are usually considered the "gold standard" method for mortality measurements. However, they have been shown to miss anywhere between 30 and 50% of all maternal deaths. Another concern for registration systems is that 75% of all global births occur in countries where vital registration systems do not exist, meaning that many maternal deaths occurring during these pregnancies and deliveries may not be properly recorded through these methods. There are also issues with using verbal autopsies and other forms of surveys in recording maternal death rates. For example, the family's willingness to participate after the loss of a loved one, misclassification of the cause of death, and under-reporting all present obstacles to the proper reporting of maternal mortality causes. Finally, a potential issue with facility-based data collection on maternal mortality is the likelihood that women who experience abortion-related complications will seek care in medical facilities. This is due to fear of social repercussions or legal activity in countries where unsafe abortion is common since it is more likely to be legally restrictive and/or more highly stigmatizing. Another concern for issues related to errors in proper reporting for accurate understanding of maternal mortality is the fact that global estimates of maternal deaths related to a specific cause present those related to abortion as a proportion of the total mortality rate. Therefore, any change, whether positive or negative, in the abortion-related mortality rate is only compared relative to other causes, and this does not allow for proper implications of whether abortions are becoming safer or less safe with respect to the overall mortality of women.
|
||||
|
||||
==== Prevention ====
|
||||
The prevention and reduction of maternity death is one of the United Nations' Sustainable Development Goals, specifically Goal 3, "Good health and well being". Promoting effective contraceptive use and information distributed to a wider population, with access to high-quality care, can make steps towards reducing the number of unsafe abortions. For nations that allow contraceptives, programs should be instituted to allow easier accessibility to these medications. However, this alone will not eliminate the demand for safe services, awareness on safe abortion services, health education on prenatal check-ups, and proper implementation of diets during pregnancy and lactation also contribute to its prevention.
|
||||
|
||||
=== Indirect obstetric deaths ===
|
||||
Indirect obstetric deaths are caused by preexisting health problem worsened by pregnancy or newly developed health problem unrelated to pregnancy . Fatalities during but unrelated to a pregnancy are termed accidental, incidental, or non-obstetrical maternal deaths.
|
||||
Indirect causes include malaria and anaemia. HIV/AIDS, and cardiovascular disease, all of which may complicate pregnancy or be aggravated by it. Risk factors associated with increased maternal death include the age of the mother, obesity before becoming pregnant, other pre-existing chronic medical conditions, and cesarean delivery.
|
||||
38
data/en.wikipedia.org/wiki/Maternal_death-2.md
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38
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|
||||
---
|
||||
title: "Maternal death"
|
||||
chunk: 3/10
|
||||
source: "https://en.wikipedia.org/wiki/Maternal_death"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:33.740084+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
=== Risk factors ===
|
||||
According to a 2004 WHO publication, sociodemographic factors such as age, access to resources, and income level are significant indicators of maternal outcomes. Young mothers face higher risks of complications and death during pregnancy than older mothers, especially adolescents aged 15 years or younger. Adolescents have higher risks for postpartum hemorrhage, endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for-gestational-age infants, all of which can lead to maternal death. The leading cause of death for girls at the age of 15 in developing countries is complications during pregnancy and childbirth. They have more pregnancies, on average, than women in developed countries, and it has been shown that 1 in 180 15-year-old girls in developing countries who become pregnant will die due to complications during pregnancy or childbirth. This is compared to women in developed countries, where the likelihood is 1 in 4900 live births. However, in the United States, as many women of older age continue to have children, the maternal mortality rate has risen in some states, especially among women over 40 years old.
|
||||
Women in low-income countries face a lifetime risk of maternal death—defined as the probability that a 15-year-old girl will die from maternal causes—of 1 in 66, versus 1 in 7,933 in high-income countries.
|
||||
Structural support and family support influence maternal outcomes. Furthermore, social disadvantage and social isolation adversely affects maternal health which can lead to increases in maternal death. Additionally, lack of access to skilled medical care during childbirth, the travel distance to the nearest clinic to receive proper care, number of prior births, barriers to accessing prenatal medical care and poor infrastructure all increase maternal deaths.
|
||||
|
||||
=== Causes of maternal death in the US ===
|
||||
Pregnancy-related deaths between 2011 and 2014 in the United States have been shown to have major contributions from non-communicable diseases and conditions. The following are some of the more common causes related to maternal death: cardiovascular diseases (15.2%.), non-cardiovascular diseases (14.7%), infection or sepsis (12.8%), hemorrhage (11.5%), cardiomyopathy (10.3%), pulmonary embolism (9.1%), cerebrovascular accidents (7.4%), hypertensive disorders of pregnancy (6.8%), amniotic fluid embolism (5.5%), and anesthesia complications (0.3%).
|
||||
In June 2022, the U.S. Supreme Court overturned Roe v. Wade (Dobbs v. Jackson Women's Health Organization), removing federal abortion protections. By 2020, maternal mortality rates were 62 % higher in abortion-restriction states than in abortion-access states (28.8 vs. 17.8 per 100,000 births). Analysis of CDC data (2019–2023) indicates that mothers in abortion-ban states are twice as likely to die during pregnancy, childbirth, or postpartum than those in states with legal abortion access.
|
||||
|
||||
=== Three delays model ===
|
||||
The three delays model describes three critical factors that prevent women from receiving appropriate maternal health care. These factors include:
|
||||
|
||||
Delay in seeking care
|
||||
Delay in reaching care
|
||||
Delay in receiving adequate and appropriate care
|
||||
Delays in seeking care are due to decisions made by pregnant women and/or other individuals. Decision-making individuals can include a spouse and family members. Examples of reasons for delays in seeking care include lack of knowledge about when to seek care, inability to afford health care, and women needing permission from family members.
|
||||
Delays in reaching care include factors such as limitations in transportation to a medical facility, inadequate medical facilities in the area, and a lack of confidence in medicine.
|
||||
Delays in receiving adequate and appropriate care may result from an inadequate number of trained providers, a lack of appropriate supplies, and a lack of urgency or understanding of an emergency.
|
||||
The three delays model illustrates that there are a multitude of complex factors, both socioeconomic and cultural, that can result in maternal death.
|
||||
|
||||
== Measurement ==
|
||||
The four measures of maternal death are the maternal mortality ratio (MMR), maternal mortality rate, lifetime risk of maternal death, and proportion of maternal deaths among deaths of women of reproductive age (PM).
|
||||
Maternal mortality ratio (MMR) is the ratio of the number of maternal deaths during a given time period per 100,000 live births during the same time period. The MMR is used as a measure of the quality of a health care system.
|
||||
Maternal mortality rate (MMRate) is the number of maternal deaths in a population divided by the number of women of reproductive age, usually expressed per 1,000 women.
|
||||
The lifetime risk of maternal death is a calculated prediction of a woman's risk of death after each consecutive pregnancy. The calculation pertains to women during their reproductive years. The adult lifetime risk of maternal mortality can be derived using either the maternal mortality ratio (MMR), or the maternal mortality rate (MMRate).
|
||||
The proportion of maternal deaths among deaths of women of reproductive age (PM) is
|
||||
the number of maternal deaths in a given time period divided by the total deaths among women aged 15–49 years.
|
||||
Approaches to measuring maternal mortality include civil registration systems, household surveys, census, reproductive age mortality studies (RAMOS), and verbal autopsies. The most common household survey method, recommended by the WHO as time- and cost-effective, is the sisterhood method.
|
||||
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|
||||
|
||||
=== Trends ===
|
||||
The United Nations Population Fund (UNFPA; formerly known as the United Nations Fund for Population Activities) has established programs that support efforts in reducing maternal death. These efforts include education and training for midwives, supporting access to emergency services in obstetric and newborn care networks, and providing essential drugs and family planning services to pregnant women or those planning to become pregnant. They also support efforts for review and response systems regarding maternal deaths.
|
||||
According to the 2010 United Nations Population Fund report, low-resource nations account for ninety-nine percent of maternal deaths, with the majority of those deaths occurring in Sub-Saharan Africa and Southern Asia. Globally, high and middle-income countries experience lower maternal deaths than low-income countries. The Human Development Index (HDI) accounts for between 82 and 85 percent of the maternal mortality rates among countries. In most cases, high rates of maternal deaths occur in the same countries that have high rates of infant mortality. These trends reflect that higher-income countries have stronger healthcare infrastructure, more doctors, use more advanced medical technologies, and have fewer barriers to accessing care than low-income countries. In low-income countries, the most common cause of maternal death is obstetrical hemorrhage, followed by hypertensive disorders of pregnancy. This is in contrast to high-income countries, for which the most common cause is thromboembolism.
|
||||
Between 1990 and 2015, the maternal mortality ratio decreased from 385 deaths per 100,000 live births to 216 maternal deaths per 100,000 live births. Some factors that have been attributed to the decreased maternal deaths seen between this period are in part to the access that women have gained to family planning services and skilled birth attendance, meaning a midwife, doctor, or trained nurse), with back-up obstetric care for emergencies that may occur during the process of labor. This can be examined further by looking at statistics in some areas of the world where inequities in access to health care services reflect an increased number of maternal deaths. The high maternal death rates also reflect disparate access to health services between resource communities and those that are high-resource or affluent.
|
||||
From 2000 to 2020, the global maternal mortality ratio declined 34.8%—from 342 to 223 deaths per 100,000 live births—since 2000; however, over 700 women still died each day from preventable pregnancy- or childbirth-related causes. According to the World Health Organization, in 2023, a maternal death occurred almost every two minutes. In 2023, just over 90 % of maternal deaths occurred in low- and lower-middle-income countries. The maternal mortality ratio in these countries was 346 per 100,000 live births, compared with 10 per 100,000 live births in high-income countries. In high-income settings, racial, ethnic, and income disparities continue to impact maternal outcomes.
|
||||
|
||||
== Prevention ==
|
||||
According to UNFPA, there are four essential elements for preventing maternal death. These include prenatal care, assistance with birth, access to emergency obstetric care, and adequate postnatal care. It is recommended that expectant mothers receive at least four antenatal visits to check and monitor the health of the mother and fetus. Second, skilled birth attendance with emergency backup, such as doctors, nurses, and midwives who can manage normal deliveries and recognize the onset of complications. Third, emergency obstetric care to address the major causes of maternal death, which are hemorrhage, sepsis, unsafe abortion, hypertensive disorders, and obstructed labor. Lastly, postnatal care, which is the six weeks following delivery. During this time, bleeding, sepsis, and hypertensive disorders can occur, and newborns are extremely vulnerable in the immediate aftermath of birth. Therefore, follow-up visits by a health worker to assess the health of both mother and child in the postnatal period are strongly recommended.
|
||||
Additionally, reliable access to information, compassionate counseling, and quality services for the management of any issues that arise from abortions (whether safe or unsafe) can be beneficial in reducing the number of maternal deaths. In regions where abortion is legal, abortion practices need to be safe to reduce the number of maternal deaths related to abortion effectively.
|
||||
Maternal Death Surveillance and Response is another strategy that has been used to prevent maternal death. This is one of the interventions proposed to reduce maternal mortality, where maternal deaths are continuously reviewed to learn the causes and factors that led to the death. The information from the reviews is used to make recommendations for action to prevent future similar deaths. Maternal and perinatal death reviews have been in practice for a long time worldwide, and the World Health Organization (WHO) introduced the Maternal and Perinatal Death Surveillance and Response (MPDSR) with a guideline in 2013. Studies have shown that acting on MPDSR recommendations can reduce maternal and perinatal mortality by improving the quality of care in the community and health facilities.
|
||||
According to a 2023 systematic review published by the Patient Centered Outcomes Research Institute (PCORI) and the Agency for Healthcare Research and Quality (AHRQ), "More than 60 percent of pregnancy-related deaths are considered preventable". The World Health Organization (WHO) has developed a global goal to end preventable death related to maternal mortality. A major goal of this strategy is to identify and address the causes of maternal and reproductive morbidities and mortalities. This strategy aims to address inequalities in access to reproductive, maternal, and newborn services, as well as the quality of care, with universal health coverage. Maternal mortality is difficult to measure. Health information systems, such as the CRVS (Civil Registration and Vital Statistics), in most low-income countries are weak. Therefore, these systems cannot provide accurate assessments of maternal mortality. Even estimates derived from a complete system, such as the CRVs, suffer misclassification and underreporting of maternal death statistics. The WHO strategy also aims to ensure quality data collection to better respond to the needs of women and girls while improving the equity and quality of care provided to women.
|
||||
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|
||||
|
||||
=== Prenatal care ===
|
||||
It was estimated that in 2015, a total of 303,000 women died due to causes related to pregnancy or childbirth. The majority of these were due to severe bleeding, sepsis or infections, eclampsia, obstructed labor, and consequences from unsafe abortions. Most of these causes are either preventable or have highly effective interventions. An important factor that contributes to the maternal mortality rate is access and opportunity to receive prenatal care. Women who do not receive prenatal care are between three and four times more likely to die from complications resulting from pregnancy or delivery than those who receive prenatal care. Even in high-resource countries, many women do not receive the appropriate preventative or prenatal care. For example, 25% of women in the United States do not receive the recommended number of prenatal visits. This number increases for women among traditionally marginalized populations—32% of African American women and 41% for American Indian and Alaska Native women do not receive the recommended preventative health services before delivery.
|
||||
In 2023, a study reported that deaths among Native American women were three-and-a-half times that of white women. The report attributed the high rate in part to the fact that Native American women are cared for under a poorly funded Federal Health Care System that is so stretched that the average monthly visit lasts only from three to seven minutes. Such a short visit allows neither time for performing an adequate health assessment nor time for the patient to discuss any problems she may be experiencing.
|
||||
|
||||
=== Medical technologies ===
|
||||
The decline in maternal deaths has been due largely to improved aseptic techniques, better fluid management and quicker access to blood transfusions, and better prenatal care.
|
||||
Technologies have been designed for resource-poor settings that have been effective in reducing maternal deaths as well. The non-pneumatic anti-shock garment is a low-technology pressure device that decreases blood loss, restores vital signs and helps buy time in delay of women receiving adequate emergency care during obstetric hemorrhage. It has proven to be a valuable resource. Condoms used as uterine tamponades have also been effective in stopping post-partum hemorrhage.
|
||||
|
||||
=== Medications and surgical management ===
|
||||
Some maternal deaths can be prevented through medication use. Injectable oxytocin can be used to prevent death due to postpartum bleeding. Additionally, postpartum infections can be treated using antibiotics. In fact, the use of broad-spectrum antibiotics both for the prevention and treatment of maternal infection is common in low-income countries. Maternal death due to eclampsia can also be prevented through the use of medications such as magnesium sulfate.
|
||||
Many complications can be managed with procedures and/or surgery if there is access to a qualified surgeon and appropriate facilities and supplies. For example, the contents of the uterus can be cleaned if there is concern for remaining pregnancy tissue or infection. If there is concern for excess bleeding, special ties, stitches or tools (Bakri Balloon) can be placed if there is concern for excess bleeding.
|
||||
|
||||
=== Public health ===
|
||||
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|
||||
|
||||
A public health approach to addressing maternal mortality includes gathering information on the scope of the problem, identifying key causes, and implementing interventions, both before pregnancy and during pregnancy, to combat those causes and prevent maternal mortality.
|
||||
Public health has a role to play in the analysis of maternal death. One important aspect in the review of maternal death and its causes are Maternal Mortality Review Committees or Boards. The goal of these review committees is to analyze each maternal death and determine its cause. After this analysis, the information can be combined to determine specific interventions that could prevent future maternal deaths. These review boards are generally comprehensive in their analysis of maternal deaths, examining details that include mental health factors, public transportation, chronic illnesses, and substance use disorders. All of this information can be combined to give a detailed picture of what is causing maternal mortality and help determine recommendations to reduce its impact.
|
||||
Many states in the US are taking Maternal Mortality Review Committees a step further and are collaborating with various professional organizations to improve the quality of perinatal care. These teams of organizations form a "perinatal quality collaborative" (PQC) and include state health departments, the state hospital association, and clinical professionals such as doctors and nurses. These PQCs can also involve community health organizations, Medicaid representatives, Maternal Mortality Review Committees, and patient advocacy groups. By involving all of these major players within maternal health, the goal is to collaborate and determine opportunities to improve the quality of care. Through this collaborative effort, PQCs can aim to make an impact on quality both at the direct patient care level and through larger system devices like policy. It is thought that the institution of PQCs in California was the main contributor to the maternal mortality rate decreasing by 50% in the years following. The PQC developed review guides and quality improvement initiatives aimed at the most preventable and prevalent maternal deaths: those due to bleeding and high blood pressure. Success has also been observed with PQCs in Illinois and Florida.
|
||||
Several interventions before pregnancy have been recommended in efforts to reduce maternal mortality. Increasing access to reproductive healthcare services, such as family planning services and safe abortion practices, is recommended to prevent unintended pregnancies. Several countries, including India, Brazil, and Mexico, have seen some success in efforts to promote the use of reproductive healthcare services. Other interventions include high quality sex education, which includes pregnancy prevention and sexually transmitted infection (STI) prevention and treatment. By addressing STIs, this not only reduces perinatal infections, but can also help reduce ectopic pregnancy caused by STIs. Adolescent mothers are between two and five times more likely to die than a female twenty years or older. Access to reproductive services and sex education could make a large impact, specifically on adolescents, who are generally uneducated regarding carrying a healthy pregnancy. Education level is a strong predictor of maternal health as it gives women the knowledge to seek care when it is needed. Public health efforts can also intervene during pregnancy to improve maternal outcomes. Areas for intervention have been identified in access to care, public knowledge, awareness of signs and symptoms of pregnancy complications, and improving relationships between healthcare professionals and expectant mothers.
|
||||
Access to care during pregnancy is a significant issue in the face of maternal mortality. "Access" encompasses a wide range of potential difficulties, including costs, location of healthcare services, appointment availability, availability of trained healthcare workers, transportation services, and cultural or language barriers that could inhibit a woman from receiving proper care. For women carrying a pregnancy to term, access to necessary antenatal (before delivery) healthcare visits is crucial to ensuring healthy outcomes. These antenatal visits allow for early recognition and treatment of complications, treatment of infections, and the opportunity to educate the expecting mother on how to manage her current pregnancy and the health advantages of spacing pregnancies apart.
|
||||
Access to a birthing facility with a skilled healthcare provider present has been associated with safer deliveries and better outcomes. The two areas bearing the largest burden of maternal mortality, Sub-Saharan Africa and South Asia, also had the lowest percentage of births attended by a skilled provider, at just 45% and 41% respectively. Emergency obstetric care is also crucial in preventing maternal mortality by offering services like emergency cesarean sections, blood transfusions, antibiotics for infections, and assisted vaginal delivery with forceps or vacuum. In addition to physical barriers that restrict access to healthcare, financial barriers also exist. Approximately one in seven women of childbearing age has no health insurance. This lack of insurance impacts access to pregnancy prevention, treatment of complications, as well as perinatal care visits contributing to maternal mortality.
|
||||
By increasing public knowledge and awareness through health education programs about pregnancy, including signs of complications that need addressed by a healthcare provider, this will increase the likelihood of an expecting mother to seek help when it is necessary. Higher levels of education have been associated with increased use of contraception and family planning services as well as antenatal care. Addressing complications at the earliest sign of a problem can improve outcomes for expecting mothers, which makes it extremely important for a pregnant woman to be knowledgeable enough to seek healthcare for potential complications. Improving the relationships between patients and the healthcare system as a whole will make it easier for a pregnant woman to feel comfortable seeking help. Good communication between patients and providers, as well as cultural competence of the providers, could also assist in increasing compliance with recommended treatments.
|
||||
Another important preventive measure being implemented is specialized education for mothers. Doctors and medical professionals providing simple information to women, especially women in lower socioeconomic areas will decrease the miscommunication that often occurs between doctors and patients. Training health care professionals will be another important aspect in decreasing the rate of maternal death, "The study found that white medical students and residents often believed incorrect and sometimes 'fantastical' biological fallacies about racial differences in patients. For these assumptions, researchers blamed not individual prejudice but deeply ingrained unconscious stereotypes about people of color, as well as physicians' difficulty in empathizing with patients whose experiences differ from their own."
|
||||
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|
||||
|
||||
=== Policy ===
|
||||
The largest global policy initiative for maternal health came from the United Nations' Millennium Declaration, which created the Millennium Development Goals. In 2012, this evolved at the United Nations Conference on Sustainable Development to become the Sustainable Development Goals (SDGs) with a target year of 2030. The SDGs are 17 goals that call for global collaboration to tackle a wide variety of recognized problems. Goal 3 focuses on ensuring health and well-being for women of all ages. A specific target is to achieve a global maternal mortality ratio of less than 70 per 100,000 live births. So far, specific progress has been made in births attended by a skilled provider, now at 80% of births worldwide compared with 62% in 2005.
|
||||
Countries and local governments have taken political steps to reduce maternal deaths. Researchers at the Overseas Development Institute studied maternal health systems in four apparently similar countries: Rwanda, Malawi, Niger, and Uganda. In comparison to the other three countries, Rwanda has an excellent record of improving maternal death rates. Based on their investigation of these varying country case studies, the researchers conclude that improving maternal health depends on three key factors:
|
||||
|
||||
reviewing all maternal health-related policies frequently to ensure that they are internally coherent;
|
||||
enforcing standards on providers of maternal health services;
|
||||
any local solutions to problems discovered should be promoted, not discouraged.
|
||||
In terms of aid policy, proportionally, aid given to improve maternal mortality rates has shrunken as other public health issues, such as HIV/AIDS and malaria, have become major international concerns. Maternal health aid contributions tend to be lumped together with newborn and child health, so it is difficult to assess how much aid is given directly to maternal health to help lower the rates of maternal mortality. Regardless, there has been progress in reducing maternal mortality rates internationally.
|
||||
In countries where abortion practices are not considered legal, it is necessary to look at the access that women have to high-quality family planning services, since some of the restrictive policies around abortion could impede access to these services. These policies may also affect the proper collection of information for monitoring maternal health globally.
|
||||
As a result of cuts to foreign aid during the second administration of US president Donald Trump, maternal health clinics closed, disrupting "vital services for maternal, newborn and child health" according to the World Health Organization (WHO).
|
||||
Significant progress has been made since the United Nations made reducing maternal mortality part of the Millennium Development Goals (MDGs) in 2000. Bangladesh, for example, cut the number of deaths per live births by almost two-thirds from 1990 to 2015. A further reduction of maternal mortality is now part of the Agenda 2030 for sustainable development. The United Nations recently developed a list of goals termed the Sustainable Development Goals. Some of the specific aims of the Sustainable Development Goals are to prevent unintended pregnancies by ensuring more women have access to contraceptives, as well as providing women who become pregnant with a safe environment for delivery with respectful and skilled care. This initiative also included access to emergency services for women who developed complications during delivery.
|
||||
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|
||||
|
||||
==== Policies in the United States ====
|
||||
Additionally, in the United States, Black women are more likely to die during and from childbirth than any other demographic. While researchers have documented the higher rate of maternal mortality in black women, they have not extensively researched the ways to improve the outcomes of maternal mortality in black mothers positively. In 2022, President Joe Biden signed the “Data Mapping to Save Moms’ Lives Act” into law, just before Christmas, and with the support of the AMA (American Medical Association). The law called for the Federal Communications Commission—in consultation with the Centers for Disease Control and Prevention (CDC) to incorporate publicly available data on maternal mortality and severe maternal morbidity for at least one year postpartum into its Mapping Broadband Health in America platform Regardless, a concerted study on the policy outcome on black women’s mortality rate is a rarity.
|
||||
Additionally, in February of 2021, Senator Cory Booker and Representatives Lauren Underwood and Alma Adams reintroduced the Black Maternal Health Momnibus Act. It consisted of thirteen bills aimed at improving maternal health. Six of the bills specifically target Black maternal health or related factors that impact it. The legislation aimed to save lives, reduce health care disparities, and ensure all mothers received proper care, regardless of race or circumstances. The Momnibus is a set of laws focused on improving maternal health in the United States. However, the bill was only introduced, not passed.
|
||||
There have been varying policies regarding maternal mortality that have aimed to prevent or lower the rate of maternal mortality for women in the U.S. during and post-partum. An example of such policies is the IMPROVE initiative, started by the National Institutes of Health (NIH) in 2019 to address maternal health issues. The initiative aimed to reduce preventable maternal deaths, lower serious health problems during pregnancy, and promote health equity. It then examined various factors—biological, behavioral, social, and structural—to create better care and outcomes for specific groups and areas. The initiative emphasized the importance of collaborating with new partners and communities to find solutions to the problem of maternal health crisis. The NIH also started the Connecting the Community for Maternal Health Challenge to help community groups build their research skills. They offered training and support to create research proposals that address local needs.
|
||||
Before the IMPROVE initiative in 2019, other past policies were either passed or made regarding maternal mortality. An example of this was in 2014, when the US Department of Health and Human Services funded the American College of Obstetrics and Gynecology to create the Alliance for Innovation on Maternal Health (AIM) program. The point of AIM was to collaborate with state and hospital partners for the purpose of implementing safety measures aimed at improving maternal care quality and outcomes. Through evidence-based practices, such as a toolkit for managing hemorrhage and hypertension in pregnancy, AIM had helped reduce maternal morbidity rates from 22.1% to 8.3%.
|
||||
California could be used as an exemplar of how to implement policies regarding maternal health. California implemented three measures to battle maternal mortality: (1) Increase funding for federal programs to address social determinants of maternal health (2) Support health care strategies to improve maternal health, including developing national standards and goals for health care systems (3) Increase investments in maternal health monitoring and surveillance. For the first measure, an example was how California created the Black Infant Health Program (BIH) to support black mothers, reduce their stress, and build social support. The program was funded by Federal Title V Maternal and Child Health Block Grant, Federal Title XIX Medicaid Funds, and State General Funds.
|
||||
Some policies regarding maternal health are nuanced. For example, it was discovered that states with stricter abortion laws had a 7% higher maternal mortality rate than states with much less strict laws. Access to healthcare for pregnant individuals from low-income backgrounds is very crucial.
|
||||
|
||||
== Epidemiology ==
|
||||
|
||||
Maternal mortality and morbidity are leading contributors to women's health. It is estimated that 303,000 women are killed each year in childbirth and pregnancy worldwide. The global rate in 2017 is 211 maternal deaths per 100,000 live births and 45% of postpartum deaths occur within 24 hours. Whereas in 2020, the global rate was 223 deaths per 100,000 live births. Ninety-nine percent of maternal deaths occur in low-resource countries.
|
||||
|
||||
=== Prevalence by country ===
|
||||
|
||||
India (19% or 56,000) and Nigeria (14% or 40,000) accounted for roughly one third of the maternal deaths in 2010. Democratic Republic of the Congo, Pakistan, Sudan, Indonesia, Ethiopia, United Republic of Tanzania, Bangladesh and Afghanistan accounted for between 3 and 5 percent of maternal deaths each. These ten countries combined accounted for 60% of all the maternal deaths in 2010, according to the United Nations Population Fund report. Countries with the lowest maternal deaths were Greece, Iceland, Poland, and Finland.
|
||||
In 2017, countries in Southeast Asia and Sub-Saharan Africa accounted for approximately 86% of all maternal deaths worldwide. As of 2020, Sub-Saharan African countries such as South Sudan, Chad, and Nigeria had the highest maternal deaths per 100,000 live births. Since 2000, Southeast Asian countries have seen a significant decrease in maternal mortality of almost 60%. Sub-Saharan Africa also saw an almost 40% decrease in maternal mortality between 2000 and 2017.
|
||||
The maternal mortality ratio (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes).
|
||||
|
||||
=== Prevalence by race and ethnicity ===
|
||||
|
||||
==== In the United States ====
|
||||
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|
||||
|
||||
In the United States, women who are black and non-Hispanic experience pregnancy-related death at a significantly higher rate. They are three to four times as likely to succumb to maternal mortality than non-Hispanic white women. In the United States between the years of 2007 and 2014, women who identify as non-Hispanic and black had a significant increase in death related to pregnancy.
|
||||
In the United States, according to the Centers for Disease Control and Prevention (CDC), the maternal mortality rate in 2021 was 32.9 deaths per 100,000 live births. This is significantly higher than the rates in 2020, defined as 23.8 deaths per 100,000 live births and 20.1 in 2019. In 2021, the maternal mortality rate for non-Hispanic Black women was 69.9 deaths per 100,000 live births, which is 2.6 times higher than non-Hispanic White women. The mortality rate for women over the age of 40 was 6.8 times higher than the rate for women under the age of 25.
|
||||
Research indicates that these disparities in the U.S. are not due to genetic differences, but rather systemic factors, including racial bias in healthcare, inadequate access to high-quality maternity care, and higher rates of chronic conditions like hypertension and preeclampsia.
|
||||
Implicit bias among healthcare providers has been documented as a contributing factor to these disparities, leading to the dismissal of Black women's pain and symptoms, resulting in delayed or inadequate treatment. Studies have found that some healthcare providers incorrectly believe that Black patients feel less pain, which has been linked to delays in diagnosing and managing pregnancy-related complications like preeclampsia and hemorrhage
|
||||
Additionally, Black women face barriers to high-quality maternal care, including living in maternity care deserts, a lack of access to midwifery and doula services, and financial challenges due to inadequate insurance coverage. Many states have restrictive policies on midwifery care, which further limits Black women's access to alternatives that have been shown to improve maternal outcomes
|
||||
The disparities in maternal health outcomes are also present among racial groups. Black and American Indian/Alaska Native (AI/AN) women experience pregnancy-related mortality rates over three times those of White women. In 2020, rates were 55.9 and 63.4 per 100,000 live births for Black and AI/AN women, respectively, versus 18.1 for White women; Native Hawaiian/Pacific Islander women had a rate of 62.8. In 2023, the CDC's Pregnancy Mortality Surveillance System reported pregnancy-related mortality ratios of 49.4 for Black women and 14.9 for White women per 100,000 live births.
|
||||
In the United States, black women are 3-4 times more likely to die from maternal mortality than white women. Unequal access to quality medical care, socioeconomic disparities, and systemic racism by health care providers are factors that have contributed to the high maternal mortality rates among black women. Discounting factors such as pre-existing conditions, do not impact the rate of this disparity.
|
||||
The COVID-19 pandemic heightened maternal mortality rates, disproportionately impacting communities of color. Multiple factors contribute to this widening disparity, notably, social factors such as implicit bias, repeated racial discrimination, and limited access to healthcare. All issues are further exacerbated for people of color who face systemic barriers to adequate medical care. Overall, the maternal mortality rate increased from 23.8 deaths per 100,000 live births in 2020, to 32.9 deaths per 100,000 live births in 2021. An apparent spike in this rate can be noted in 2021. For non-hispanic black women the rate of maternal deaths per 100,00 live births increased from 44.0 in 2019 to 69.9 in 2021.
|
||||
|
||||
==== Elsewhere ====
|
||||
Similar patterns exist in other countries. In Brazil, women who are not white were 3.5 times as likely to die because of obstetric mortality compared to white women. The maternal mortality ratio is larger in women who are from Sub-Saharan Africa in France.
|
||||
|
||||
=== COVID-19 effects ===
|
||||
Global maternal mortality and fetal outcomes have worsened during the COVID-19 pandemic. Increases in maternal deaths, stillbirths, ruptured ectopic pregnancies, and maternal depression occurred globally during this time. According to The Lancet Global Health, their search, which included over 40 studies, identified significant increases in stillbirth and maternal death during the pandemic versus before the pandemic. According to the United Nations Population Fund, UNFPA, a proportion of total COVID-19 deaths were indirect obstetric deaths where a woman's death was due to the aggravation between the disease and the state of pregnancy. Some outcomes show considerable disparity between low- and high-resource settings. This drives the urgent global need to prioritize safe, equitable, and accessible maternal care in future healthcare crises.
|
||||
|
||||
=== Variation within countries ===
|
||||
There are significant maternal mortality intra-country variations, especially in nations with large inequality gaps in income and education and high healthcare disparities. Women living in rural areas experience higher maternal mortality than women living in urban and suburban centers because those living in wealthier households, having higher education, or living in urban areas, have higher use of healthcare services than their poorer, less-educated, or rural counterparts. There are also racial and ethnic disparities in maternal health outcomes which increases maternal mortality in marginalized groups.
|
||||
|
||||
== Related terms ==
|
||||
25
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||||
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|
||||
title: "Maternal death"
|
||||
chunk: 10/10
|
||||
source: "https://en.wikipedia.org/wiki/Maternal_death"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:33.740084+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
=== Severe maternal morbidity ===
|
||||
Severe maternal morbidity (SMM) is an unanticipated acute or chronic health outcome after labor and delivery that detrimentally affects a woman's health. Severe Maternal Morbidity (SMM) includes any unexpected outcomes from labor or delivery that cause both short and long-term consequences to the mother's overall health. There are nineteen total indicators used by the CDC to help identify SMM, with the most prevalent indicator being a blood transfusion. Other indicators include an acute myocardial infarction ("heart attack"), aneurysm, and kidney failure. All of this identification is done by using ICD-10 codes, which are disease identification codes found in hospital discharge data. Using these definitions that rely on these codes should be used with careful consideration since some may miss some cases, have a low predictive value, or may be difficult for different facilities to operationalize. There are certain screening criteria that may be helpful and are recommended through the American College of Obstetricians and Gynecologists as well as the Society for Maternal-Fetal Medicine (SMFM). These screening criteria for SMM are for transfusions of four or more units of blood and admission of a pregnant woman or a postpartum woman to an ICU facility or unit.
|
||||
The greatest proportion of women with SMM are those who require a blood transfusion during delivery, mostly due to excessive bleeding. Blood transfusions given during delivery due to excessive bleeding have increased the rate of mothers with SMM. The rate of SMM has increased almost 200% between 1993 (49.5 per 100,000 live births) and 2014 (144.0 per 100,000 live births). This can be seen with the increased rate of blood transfusions given during delivery, which increased from 1993 (24.5 per 100,000 live births) to 2014 (122.3 per 100,000 live births).
|
||||
In the United States, severe maternal morbidity has increased over the last several years, impacting more than 50,000 women in 2014 alone. There is no conclusive reason for this dramatic increase. It is thought that the overall state of health of pregnant women is impacting these rates. For example, complications can derive from underlying chronic medical conditions like diabetes, obesity, HIV/AIDS, and high blood pressure. These underlying conditions are also thought to lead to increased risk of maternal mortality.
|
||||
The increased rate for SMM can also be indicative of potentially increased rates for maternal mortality, since without identification and treatment of SMM, these conditions would lead to increased maternal death rates. Therefore, diagnosis of SMM can be considered a "near miss" for maternal mortality. With this consideration, several different expert groups have urged obstetric hospitals to review SMM cases for opportunities that can lead to improved care, which in turn would lead to improvements with maternal health and a decrease in the number of maternal deaths.
|
||||
|
||||
== See also ==
|
||||
|
||||
== References ==
|
||||
|
||||
== Bibliography ==
|
||||
|
||||
== External links ==
|
||||
|
||||
The World Health Report 2005 – Make Every Mother and Child Count
|
||||
22
data/en.wikipedia.org/wiki/Mayer_waves-0.md
Normal file
22
data/en.wikipedia.org/wiki/Mayer_waves-0.md
Normal file
@ -0,0 +1,22 @@
|
||||
---
|
||||
title: "Mayer waves"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Mayer_waves"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:35.053060+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Mayer waves are cyclic changes or waves in arterial blood pressure brought about by oscillations in the baroreceptor reflex control system. The waves are seen both in the ECG and in continuous blood pressure curves and have a frequency about 0.1 Hz (10-second waves). These waves were originally described by Siegmund Mayer, Ewald Hering and Ludwig Traube hence originally called "Traube–Hering–Mayer waves".
|
||||
Mayer waves can be defined as arterial blood pressure (AP) oscillations at frequencies slower than respiratory frequency and which show the strongest, significant coherence (strength of linear coupling between fluctuations of two variables in the frequency domain) with efferent sympathetic nervous activity (SNA). In humans, AP oscillations which meet these properties have a characteristic frequency of approx. 0.1 Hz; 0.3 Hz in rabbits and 0.4 Hz in rats.
|
||||
The hemodynamic basis of Mayer waves are oscillations of the sympathetic vasomotor tone of arterial blood vessels, because Mayer waves are abolished or at least strongly attenuated by pharmacological blockade of alpha-adrenoreceptors. Within a given biological species, their frequency is fairly stable; in humans it has been shown that this frequency does not depend on gender, age or posture. It has been suggested that Mayer waves trigger the liberation of endothelium-derived nitric oxide (NO) by cyclic changes of vascular shear stress which could be beneficial to end organ functioning.
|
||||
Mayer waves are correlated with heart rate variability.
|
||||
Takalo et al. (1999) state that "the frequency shift of Mayer waves to lower frequencies is associated with an increased risk of developing established hypertension."
|
||||
|
||||
|
||||
== See also ==
|
||||
Vasomotion
|
||||
|
||||
|
||||
== References ==
|
||||
55
data/en.wikipedia.org/wiki/Me-too_drug-0.md
Normal file
55
data/en.wikipedia.org/wiki/Me-too_drug-0.md
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@ -0,0 +1,55 @@
|
||||
---
|
||||
title: "Me-too drug"
|
||||
chunk: 1/2
|
||||
source: "https://en.wikipedia.org/wiki/Me-too_drug"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:36.255172+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
The term "me-too drug" or "follow-on drug" refers to a medication that is similar to a pre-existing drug, usually by making minor modifications to the prototype, reflected in slight changes in the profiles of side effects or activity, and used to treat conditions for which drugs already exist. While pharmaceutical companies have justified the development of me-toos as offering incremental improvements in efficacy, side-effects, compliance and cost, critics have questioned the increasing marketing of me-toos, their absorption of research and development resources and their impact on the innovation of new treatments.
|
||||
In 1956, Louis S. Goodman, co‐editor of Goodman and Gilman, referred to “the problem of the introduction of ‘me too’ drugs, that is, drugs without signal advantage of any sort”. However, me-too drugs can be novel compounds themselves. They are commonly used and include several beta blockers, antidepressants and stomach acid reducing and cholesterol lowering drugs.
|
||||
|
||||
== History ==
|
||||
|
||||
The term "me‐too drugs" was coined in the 1950s. In 1956, Louis S. Goodman, co‐editor of Goodman and Gilman, referred to “the problem of the introduction of ‘me too’ drugs, that is, drugs without signal advantage of any sort”. Once a new drug class was discovered, other major drug companies made efforts to produce their own similar versions. Pharmacologist Milton Silverman and physician Philip R. Lee noted "the great drug therapy era was marked not only by the introduction of new drugs in great profusion and by the launching of large promotional campaigns but also by the introduction of what are known as 'duplicative' or 'me-too' products".
|
||||
Between 1960 and 1962, Estes Kefauver, then Senator of Tennessee, led a series of hearings enquiring about the pharmaceutical industry's motive to produce me-too drugs after it was noted that much of their time and resources were spent producing them. Subsequently, the FDA required drug companies to prove their drugs were safe and effective. In 1964, Louis Lasagna described me-too drugs as being “hard to justify putting into man at all, let alone on the market”. Three years later, the term appeared in the Oxford English Dictionary. In the early 1970s, Silverman and Lee reported that there were almost 100 tranquillisers, 130 antihistamines, greater than 270 antibiotics and more than 200 sulfonamides.
|
||||
In 1994, Desmond Laurence's textbook Clinical Pharmacology referred to me-too as "me-again".
|
||||
|
||||
== Definition ==
|
||||
There is no agreed definition, however, several have been proposed, including:
|
||||
|
||||
"multiple drugs within the same therapeutic class"
|
||||
"drugs that are chemically related to the prototype, or other chemical compounds which have an identical mechanism of action"
|
||||
"drugs which have more or less identical clinical outcomes to pre‐existing drugs"
|
||||
"a drug with a similar chemical structure or the same mechanism of action as a drug that is already marketed".
|
||||
Biosimilars are compared with other biosimilars and are therefore not me-toos.
|
||||
|
||||
== Examples ==
|
||||
Me-too drugs include diazepam, ranitidine and esketamine.
|
||||
|
||||
=== Beta blockers ===
|
||||
The first-in-class β-blocker pronethalol was developed by James Black at ICI Pharmaceuticals. It was followed by propranolol, sotalol, practolol, metoprolol, labetalol, acebutolol and bisoprolol. Successive differences between β-blockers have had a combined cumulative effect and are seen as "innovative".
|
||||
|
||||
=== Benzodiazepines ===
|
||||
15 benzodiazepines were marketed in the UK between 1960 and 1982, of which seven were produced by Roche.
|
||||
|
||||
=== Proton pump inhibitors ===
|
||||
The proton-pump inhibitor Nexium by AstraZeneca is a me-too which was granted its patent by showing that it was effective for heartburn, not that it was better than its precursor, Prilosec. It was shown to preserve revenues of Prilosec, whose U.S. patent expired in 2001. Considered a new drug by the FDA, Nexium was patented separately, sold for eight times the cost of its generic esomeprazole and advertised as significantly better than its predecessor, a move the company received much criticism for, with a subsequent class action lawsuit filed against them.
|
||||
|
||||
=== H2 antagonists ===
|
||||
Both Tagamet's and Zantac's prices increased following the arrival of further me-too drugs Pepcid and Axid.
|
||||
|
||||
=== ACE inhibitors ===
|
||||
Several me-toos followed the prototype of the ace inhibitor, captopril, with enalapril being its first me-too. Most were as efficient as each other and had similar adverse effect profiles.
|
||||
|
||||
=== Statins ===
|
||||
When Merck's cholesterol-lowering statin Mevacor (lovastatin) was approved by the U.S. Food and Drug Administration (FDA) in 1987, the understanding of the link between cholesterol and heart disease was improving, and the potential market for the drug became significant. Subsequently, several other companies developed similar drugs: Merck developed Zocor (simvastatin) and Crestor (rosuvastatin), Pfizer developed Lipitor (atorvastatin), Bristol-Myers Squibb developed Pravachol (pravastatin), and Novartis developed Lescol (fluvastatin). Others include pitavastatin (Livalo).
|
||||
|
||||
=== Antidepressants ===
|
||||
Imipramine was the first-in-class of the tricyclic antidepressants. Amitriptyline, Nortriptyline, Dosulepin and Doxepin are some of the me-toos that followed. Several me-too Selective serotonin reuptake inhibitors have been developed for maintenance treatment in chronic depression. These include Paxil (paroxetine), Celexa (citalopram), Zoloft (sertraline), Lexapro (escitalopram) and Prozac (fluoxetine).
|
||||
For example, Celexa is a mixture of a left-handed and right-handed version of the same compound ("citalopram"), but only the left-handed version ("es-citalopram") is biologically active. Lexapro, the "me too" drug released several years after Celexa thus extending the patent life, is a purified form of just the left-handed version (the "es" in "es-citalopram").
|
||||
|
||||
=== Antivirals ===
|
||||
Gilead Science's Descovy is a me-too drug of Truvada, a popular Antiretroviral also used to prevent HIV infection in healthy people. Both versions are prodrugs that metabolize into the same active compound. Gilead has been accused in lawsuits of "slow walking" the development of the me-too drug; however, such lawsuits further a market perception of the me-too drug as "safer." This drives sales of the more expensive me-too drug when both drugs have virtually identical safety profiles. Similarly, Valtrex, first FDA approved in 2001 to treat persistent herpes outbreaks is a prodrug of acyclovir, first FDA approved in the mid-1980s. Valtrex metabolizes into acyclovir in the liver, but when it first entered the market, it cost many times than the generic.
|
||||
26
data/en.wikipedia.org/wiki/Me-too_drug-1.md
Normal file
26
data/en.wikipedia.org/wiki/Me-too_drug-1.md
Normal file
@ -0,0 +1,26 @@
|
||||
---
|
||||
title: "Me-too drug"
|
||||
chunk: 2/2
|
||||
source: "https://en.wikipedia.org/wiki/Me-too_drug"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:36.255172+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
== Debate ==
|
||||
In 2005, a report by the International Policy Network defended me-toos, describing their development as "incremental improvements on already existing drugs". The report stated:
|
||||
|
||||
... this often represent(s) advances in safety and efficacy, along with providing new formulations and dosing options that significantly increase patient compliance. From an economic standpoint, expanding drug classes represent the possibility of lower drug prices as competition between manufacturers is increased. Additionally, pharmaceutical companies depend on incremental innovations to provide the revenue that will support the development of more risky “block-buster” drugs. Policies aimed at curbing incremental innovation will ultimately lead to a reduction in the overall quality of existing drug classes and may ultimately curb the creation of novel drugs.
|
||||
This incremental innovation has led to some referring to me-toos as "me-betters".
|
||||
Many physicians are unaware that me-toos are compared to placebos rather than pre-existing drugs. Me-toos are seen as patentable new drugs and therefore substantial profit makers, where innovative drugs may be more risky to develop.
|
||||
|
||||
== Statistics ==
|
||||
Between 1998 and 2003, the U.S. Food and Drug Administration (FDA) approved 487 drugs, of which 78 per cent appeared to have similar characteristics to pre-existing marketed drugs.
|
||||
More than 60% of medicines listed on the World Health Organization's essential list are me‐too drugs.
|
||||
In September 2019, half of antibiotics under clinical development were “me-too” drugs. At the beginning of 2020, the WHO stated that only two of the 50 antibiotics in clinical development are active against serious drug resistant gram-negative bacteria, and most are not significant "upgrades" of drugs.
|
||||
|
||||
== See also ==
|
||||
Unique selling point
|
||||
|
||||
== References ==
|
||||
36
data/en.wikipedia.org/wiki/Medical_advice-0.md
Normal file
36
data/en.wikipedia.org/wiki/Medical_advice-0.md
Normal file
@ -0,0 +1,36 @@
|
||||
---
|
||||
title: "Medical advice"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Medical_advice"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:37.668231+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Medical advice is the provision of a formal professional opinion regarding what a specific individual should or should not do to restore or preserve health. Typically, medical advice involves giving a diagnosis and/or prescribing a treatment for medical condition.
|
||||
Medical advice is not the same as personal advice even if the advice concerns medical care.
|
||||
|
||||
|
||||
== Doctor–patient relationship ==
|
||||
In industrializd countries, medical advice is given in the context of a doctor–patient relationship. A licensed health care professional can be held legally liable for the advice he or she gives to a patient. Giving bad advice may be considered medical malpractice under specified circumstances.
|
||||
The doctor–patient relationship is one factor in determining the patient's compliance with medical advice. Patients adhere more closely to medical advice when the healthcare provider is friendly, doesn't interrupt the patient, or has good verbal communication skills. Patients are less likely to comply with medical advice if the advice is not what the patients expected, if the patients do not agree with the proposed treatment, if the patient is not confident in the provider's competence, or if the patient cannot understand what the provider says due to language barriers or overuse of medical jargon. Patients are also less likely to comply with medical advice if the healthcare provider seems disrespectful of the patient or appears to hold negative stereotypes of the patients' race, class, or other characteristics.
|
||||
|
||||
|
||||
== Difference to medical information ==
|
||||
Medical advice can be distinguished from medical information, which is the relation of facts.
|
||||
Medical information pertaining to an individual is called protected health information.
|
||||
Discussing medical information is considered a fundamental free speech right and is not considered medical advice.
|
||||
|
||||
|
||||
== See also ==
|
||||
Physician
|
||||
Against medical advice
|
||||
Duty of care
|
||||
Standard of care
|
||||
Scope of practice
|
||||
Medical direction
|
||||
Legal advice
|
||||
|
||||
|
||||
== References ==
|
||||
28
data/en.wikipedia.org/wiki/Medical_case_management-0.md
Normal file
28
data/en.wikipedia.org/wiki/Medical_case_management-0.md
Normal file
@ -0,0 +1,28 @@
|
||||
---
|
||||
title: "Medical case management"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Medical_case_management"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:38.918494+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Medical case management is a collaborative process that facilitates recommended treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals. It is a role frequently overseen by patient advocates.
|
||||
It refers to the planning and coordination of health care services appropriate to achieve the goal of medical rehabilitation. Medical case management may include, but is not limited to, care assessment, including personal interview with the injured employee, and assistance in developing, implementing and coordinating a medical care plan with health care providers, as well as the employee and his/her family and evaluation of treatment results.
|
||||
Medical case management requires the evaluation of a medical condition, developing and implementing a plan of care, coordinating medical resources, communicated healthcare needs to the individual, monitors an individual's progress and promotes cost-effective care.
|
||||
The term also has usage in the USA health care system, referring to the case management coordination in the managed care environment.
|
||||
|
||||
|
||||
== See also ==
|
||||
Case management (mental health)
|
||||
Disease management (health)
|
||||
Case management (US healthcare system)
|
||||
|
||||
|
||||
== References ==
|
||||
|
||||
|
||||
== External links ==
|
||||
Case Management at the U.S. National Library of Medicine Medical Subject Headings (MeSH)
|
||||
"Medical case management do's & dont's". michigan.gov. Worker's Compensation Agency, State of Michigan.
|
||||
35
data/en.wikipedia.org/wiki/Medical_consensus-0.md
Normal file
35
data/en.wikipedia.org/wiki/Medical_consensus-0.md
Normal file
@ -0,0 +1,35 @@
|
||||
---
|
||||
title: "Medical consensus"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Medical_consensus"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:40.055733+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Medical consensus is a public statement on a particular aspect of medical knowledge at the time the statement is made that a representative group of experts agree to be evidence-based and state-of-the-art (state-of-the-science) knowledge. Its main objective is to counsel physicians on the best possible and acceptable way to diagnose and treat certain diseases or how to address a particular decision-making area. It is usually, therefore, considered an authoritative, community-based expression of a consensus decision-making and publication process.
|
||||
|
||||
|
||||
== Methods ==
|
||||
There are many ways of producing medical consensus, but the most usual way is to convene an independent panel of experts, either by a medical association or by a governmental authority.
|
||||
Since consensus statements provide a "snapshot in time" of the state of knowledge in a particular topic, they must periodically be re-evaluated and published again, replacing the previous consensus statement.
|
||||
Consensus statements differ from medical guidelines, another form of state-of-the-science public statements. According to the NIH, "Consensus statements synthesize new information, largely from recent or ongoing medical research, that has implications for reevaluation of routine medical practices. They do not give specific algorithms or guidelines for practice."
|
||||
|
||||
|
||||
== History ==
|
||||
From 1977 to 2013, the National Institutes of Health (United States) promoted about five to six consensus panels per year, and organized this knowledge by means of a special Consensus Development Program, managed by the NIH's Office of Disease Prevention (ODP). It was retired in 2013 in deference to other agencies and organizations that had picked up the lead, such as the U.S. Preventive Services Task Force, the Community Preventive Services Task Force, Institute of Medicine, and Cochrane. Its archive is available in printed form as well as for downloading from the Internet.[1]
|
||||
|
||||
|
||||
== See also ==
|
||||
|
||||
|
||||
== References ==
|
||||
|
||||
|
||||
== External links ==
|
||||
U.S. Preventive Services Task Force
|
||||
The Guide to Community Preventive Services
|
||||
Institute of Medicine
|
||||
Cochrane
|
||||
NIH Consensus Development Conference archives (through the end of the program in 2013)
|
||||
38
data/en.wikipedia.org/wiki/Medical_diagnosis-0.md
Normal file
38
data/en.wikipedia.org/wiki/Medical_diagnosis-0.md
Normal file
@ -0,0 +1,38 @@
|
||||
---
|
||||
title: "Medical diagnosis"
|
||||
chunk: 1/3
|
||||
source: "https://en.wikipedia.org/wiki/Medical_diagnosis"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:41.364881+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Medical diagnosis (abbreviated as Dx, Dx, or Ds) is the process of determining which disease or condition explains a person's symptoms and signs. It is most often referred to as a diagnosis with the medical context being implicit. The information required for a diagnosis is typically collected from a history and physical examination of the person seeking medical care. Often, one or more diagnostic procedures, such as medical tests, are also done during the process. Sometimes the posthumous diagnosis is considered a kind of medical diagnosis.
|
||||
Diagnosis is often challenging because many signs and symptoms are nonspecific. For example, redness of the skin (erythema), by itself, is a sign of many disorders and thus does not tell the healthcare professional what is wrong. Thus differential diagnosis, in which several possible explanations are compared and contrasted, must be performed. This involves the correlation of various pieces of information followed by the recognition and differentiation of patterns. Occasionally the process is made easy by a sign or symptom (or a group of several) that is pathognomonic.
|
||||
Diagnosis is a major component of the procedure of a doctor's visit. From the point of view of statistics, the diagnostic procedure involves classification tests. The study of patient outcomes following diagnosis is the field of survival epidemiology.
|
||||
|
||||
== Medical uses ==
|
||||
A diagnosis, in the sense of diagnostic procedure, can be regarded as an attempt at classification of an individual's condition into separate and distinct categories that allow medical decisions about treatment and prognosis to be made. Subsequently, a diagnostic opinion is often described in terms of a disease or other condition. (In the case of a wrong diagnosis, however, the individual's actual disease or condition is not the same as the individual's diagnosis.) A total evaluation of a condition is often termed a diagnostic workup.
|
||||
A diagnostic procedure may be performed by various healthcare professionals such as a physician, physiotherapist, dentist, podiatrist, optometrist, nurse practitioner, healthcare scientist or physician assistant. This article uses diagnostician as any of these person categories.
|
||||
A diagnostic procedure (as well as the opinion reached thereby) does not necessarily involve elucidation of the etiology of the diseases or conditions of interest, that is, what caused the disease or condition. Such elucidation can be useful to optimize treatment, further specify the prognosis or prevent recurrence of the disease or condition in the future.
|
||||
The initial task is to detect a medical indication to perform a diagnostic procedure. Indications include:
|
||||
|
||||
Detection of any deviation from what is known to be normal, such as can be described in terms of, for example, anatomy (the structure of the human body), physiology (how the body works), pathology (what can go wrong with the anatomy and physiology), psychology (thought and behavior) and human homeostasis (regarding mechanisms to keep body systems in balance). Knowledge of what is normal and measuring of the patient's current condition against those norms can assist in determining the patient's particular departure from homeostasis and the degree of departure, which in turn can assist in quantifying the indication for further diagnostic processing.
|
||||
A complaint expressed by a patient.
|
||||
The fact that a patient has sought a diagnostician can itself be an indication to perform a diagnostic procedure. For example, in a doctor's visit, the physician may already start performing a diagnostic procedure by watching the gait of the patient from the waiting room to the doctor's office even before she or he has started to present any complaints.
|
||||
Even during an already ongoing diagnostic procedure, there can be an indication to perform another, separate, diagnostic procedure for another, potentially concomitant, disease or condition. This may occur as a result of an incidental finding of a sign unrelated to the parameter of interest, such as can occur in comprehensive tests such as radiological studies like magnetic resonance imaging or blood test panels that also include blood tests that are not relevant for the ongoing diagnosis.
|
||||
|
||||
== Procedure ==
|
||||
General components which are present in a diagnostic procedure in most of the various available methods include:
|
||||
|
||||
Complementing the already given information with further data gathering, which may include questions of the medical history (potentially from other people close to the patient as well), physical examination and various diagnostic tests. A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of disease. Diagnostic tests can also be used to provide prognostic information on people with established disease.
|
||||
Processing of the answers, findings or other results. Consultations with other providers and specialists in the field may be sought.
|
||||
There are a number of methods or techniques that can be used in a diagnostic procedure, including performing a differential diagnosis or following medical algorithms. In reality, a diagnostic procedure may involve components of multiple methods.
|
||||
|
||||
=== Differential diagnosis ===
|
||||
|
||||
The method of differential diagnosis is based on finding as many candidate diseases or conditions as possible that can possibly cause the signs or symptoms, followed by a process of elimination or at least of rendering the entries more or less probable by further medical tests and other processing, aiming to reach the point where only one candidate disease or condition remains as probable. The result may also remain a list of possible conditions, ranked in order of probability or severity. Such a list is often generated by computer-aided diagnosis systems.
|
||||
The resultant diagnostic opinion by this method can be regarded more or less as a diagnosis of exclusion. Even if it does not result in a single probable disease or condition, it can at least rule out any imminently life-threatening conditions.
|
||||
Unless the provider is certain of the condition present, further medical tests, such as medical imaging, are performed or scheduled in part to confirm or disprove the diagnosis but also to document the patient's status and keep the patient's medical history up to date.
|
||||
If unexpected findings are made during this process, the initial hypothesis may be ruled out and the provider must then consider other hypotheses.
|
||||
71
data/en.wikipedia.org/wiki/Medical_diagnosis-1.md
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71
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@ -0,0 +1,71 @@
|
||||
---
|
||||
title: "Medical diagnosis"
|
||||
chunk: 2/3
|
||||
source: "https://en.wikipedia.org/wiki/Medical_diagnosis"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:41.364881+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
=== Pattern recognition ===
|
||||
In a pattern recognition method the provider uses experience to recognize a pattern of clinical characteristics. It is mainly based on certain symptoms or signs being associated with certain diseases or conditions, not necessarily involving the more cognitive processing involved in a differential diagnosis.
|
||||
This may be the primary method used in cases where diseases are "obvious", or the provider's experience may enable him or her to recognize the condition quickly. Theoretically, a certain pattern of signs or symptoms can be directly associated with a certain therapy, even without a definite decision regarding what is the actual disease, but such a compromise carries a substantial risk of missing a diagnosis which actually has a different therapy so it may be limited to cases where no diagnosis can be made.
|
||||
|
||||
=== Diagnostic criteria ===
|
||||
|
||||
The term diagnostic criteria designates the specific combination of signs and symptoms, and test results that the clinician uses to attempt to determine the correct diagnosis.
|
||||
Some examples of diagnostic criteria, also known as clinical case definitions, are:
|
||||
|
||||
Amsterdam criteria for hereditary nonpolyposis colorectal cancer
|
||||
McDonald criteria for multiple sclerosis
|
||||
ACR criteria for systemic lupus erythematosus
|
||||
Centor criteria for strep throat
|
||||
|
||||
=== Clinical decision support system ===
|
||||
Clinical decision support systems are interactive computer programs designed to assist health professionals with decision-making tasks. The clinician interacts with the software utilizing both the clinician's knowledge and the software to make a better analysis of the patients data than either human or software could make on their own. Typically the system makes suggestions for the clinician to look through and the clinician picks useful information and removes erroneous suggestions. Some programs attempt to do this by replacing the clinician, such as reading the output of a heart monitor. Such automated processes are usually deemed a "device" by the FDA and require regulatory approval. In contrast, clinical decision support systems that "support" but do not replace the clinician are deemed to be "Augmented Intelligence" if it meets the FDA criteria that (1) it reveals the underlying data, (2) reveals the underlying logic, and (3) leaves the clinician in charge to shape and make the decision.
|
||||
|
||||
=== Other diagnostic procedure methods ===
|
||||
Other methods that can be used in performing a diagnostic procedure include:
|
||||
|
||||
Usage of medical algorithms
|
||||
An "exhaustive method", in which every possible question is asked and all possible data is collected.
|
||||
|
||||
== Adverse effects ==
|
||||
Diagnosis problems are the dominant cause of medical malpractice payments, accounting for 35% of total payments in a study of 25 years of data and 350,000 claims.
|
||||
|
||||
=== Overdiagnosis ===
|
||||
|
||||
Overdiagnosis is the diagnosis of "disease" that will never cause symptoms or death during a patient's lifetime. It is a problem because it turns people into patients unnecessarily and because it can lead to economic waste (overutilization) and treatments that may cause harm. Overdiagnosis occurs when a disease is diagnosed correctly, but the diagnosis is irrelevant. A correct diagnosis may be irrelevant because treatment for the disease is not available, not needed, or not wanted.
|
||||
|
||||
=== Errors ===
|
||||
|
||||
Most people will experience at least one diagnostic error in their lifetime, according to a 2015 report by the National Academies of Sciences, Engineering, and Medicine.
|
||||
Causes and factors of error in diagnosis are:
|
||||
|
||||
the manifestation of disease are not sufficiently noticeable
|
||||
a disease is omitted from consideration
|
||||
too much significance is given to some aspect of the diagnosis
|
||||
the condition is a rare disease with symptoms suggestive of many other conditions
|
||||
the condition has a rare presentation
|
||||
|
||||
=== Lag time ===
|
||||
When making a medical diagnosis, a lag time is a delay in time until a step towards diagnosis of a disease or condition is made. Types of lag times are mainly:
|
||||
|
||||
Onset-to-medical encounter lag time, the time from onset of symptoms until visiting a health care provider
|
||||
Encounter-to-diagnosis lag time, the time from first medical encounter to diagnosis
|
||||
Long lag times are often called "diagnostic odyssey".
|
||||
|
||||
== History ==
|
||||
|
||||
The first recorded examples of medical diagnosis are found in the writings of Imhotep (2630–2611 BC) in ancient Egypt (the Edwin Smith Papyrus). A Babylonian medical textbook, the Diagnostic Handbook written by Esagil-kin-apli (fl.1069–1046 BC), introduced the use of empiricism, logic and rationality in the diagnosis of an illness or disease. Traditional Chinese Medicine, as described in the Yellow Emperor's Inner Canon or Huangdi Neijing, specified four diagnostic methods: inspection, auscultation-olfaction, inquiry and palpation. Hippocrates was known to make diagnoses by tasting his patients' urine and smelling their sweat.
|
||||
|
||||
== Word ==
|
||||
|
||||
Medical diagnosis or the actual process of making a diagnosis is a cognitive process. A clinician uses several sources of data and puts the pieces of the puzzle together to make a diagnostic impression. The initial diagnostic impression can be a broad term describing a category of diseases instead of a specific disease or condition. After the initial diagnostic impression, the clinician obtains follow up tests and procedures to get more data to support or reject the original diagnosis and will attempt to narrow it down to a more specific level. Diagnostic procedures are the specific tools that the clinicians use to narrow the diagnostic possibilities.
|
||||
The plural of diagnosis is diagnoses. The verb is to diagnose, and a person who diagnoses is called a diagnostician.
|
||||
|
||||
=== Etymology ===
|
||||
The word diagnosis is derived through Latin from the Greek word διάγνωσις (diágnōsis) from διαγιγνώσκειν (diagignṓskein), meaning "to discern, distinguish".
|
||||
|
||||
== Society and culture ==
|
||||
86
data/en.wikipedia.org/wiki/Medical_diagnosis-2.md
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86
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@ -0,0 +1,86 @@
|
||||
---
|
||||
title: "Medical diagnosis"
|
||||
chunk: 3/3
|
||||
source: "https://en.wikipedia.org/wiki/Medical_diagnosis"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:41.364881+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
=== Social context ===
|
||||
Diagnosis can take many forms. It might be a matter of naming the disease, lesion, dysfunction or disability. It might be a management-naming or prognosis-naming exercise. It may indicate either degree of abnormality on a continuum or kind of abnormality in a classification. It is influenced by non-medical factors such as power, ethics and financial incentives for patient or doctor. It can be a brief summation or an extensive formulation, even taking the form of a story or metaphor. It might be a means of communication such as a computer code through which it triggers payment, prescription, notification, information or advice. It might be pathogenic or salutogenic. It is generally uncertain and provisional.
|
||||
Once a diagnostic opinion has been reached, the provider is able to propose a management plan, which will include treatment as well as plans for follow-up. From this point on, in addition to treating the patient's condition, the provider can educate the patient about the etiology, progression, prognosis, other outcomes, and possible treatments of her or his ailments, as well as providing advice for maintaining health.
|
||||
A treatment plan is proposed which may include therapy and follow-up consultations and tests to monitor the condition and the progress of the treatment, if needed, usually according to the medical guidelines provided by the medical field on the treatment of the particular illness.
|
||||
Relevant information should be added to the medical record of the patient.
|
||||
A failure to respond to treatments that would normally work may indicate a need for review of the diagnosis.
|
||||
Nancy McWilliams identifies five reasons that determine the necessity for diagnosis:
|
||||
|
||||
diagnosis for treatment planning;
|
||||
information contained in it related to prognosis;
|
||||
protecting interests of patients;
|
||||
a diagnosis might help the therapist to empathize with his patient;
|
||||
might reduce the likelihood that some fearful patients will go-by the treatment.
|
||||
|
||||
== Types ==
|
||||
Sub-types of diagnoses include:
|
||||
|
||||
Clinical diagnosis
|
||||
A diagnosis made on the basis of medical signs and reported symptoms, rather than diagnostic tests
|
||||
Laboratory diagnosis
|
||||
A diagnosis based significantly on laboratory reports or test results, rather than the physical examination of the patient. For instance, a proper diagnosis of infectious diseases usually requires both an examination of signs and symptoms, as well as laboratory test results and characteristics of the pathogen involved.
|
||||
Radiology diagnosis
|
||||
A diagnosis based primarily on the results from medical imaging studies. Greenstick fractures are common radiological diagnoses.
|
||||
Electrography diagnosis
|
||||
A diagnosis based on measurement and recording of electrophysiologic activity.
|
||||
Endoscopy diagnosis
|
||||
|
||||
A diagnosis based on endoscopic inspection and observation of the interior of a hollow organ or cavity of the body.
|
||||
Tissue diagnosis
|
||||
A diagnosis based on the macroscopic, microscopic, and molecular examination of tissues such as biopsies or whole organs. For example, a definitive diagnosis of cancer is made via tissue examination by a pathologist.
|
||||
Principal diagnosis
|
||||
The single medical diagnosis that is most relevant to the patient's chief complaint or need for treatment. Many patients have additional diagnoses.
|
||||
Admitting diagnosis
|
||||
The diagnosis given as the reason why the patient was admitted to the hospital; it may differ from the actual problem or from the discharge diagnoses, which are the diagnoses recorded when the patient is discharged from the hospital.
|
||||
Differential diagnosis
|
||||
A process of identifying all of the possible diagnoses that could be connected to the signs, symptoms, and lab findings, and then ruling out diagnoses until a final determination can be made.
|
||||
Diagnostic criteria
|
||||
Designates the combination of signs, symptoms, and test results that the clinician uses to attempt to determine the correct diagnosis. They are standards, normally published by international committees, and they are designed to offer the best sensitivity and specificity possible, respect the presence of a condition, with the state-of-the-art technology.
|
||||
Prenatal diagnosis
|
||||
Diagnosis work done before birth
|
||||
Diagnosis of exclusion
|
||||
A medical condition whose presence cannot be established with complete confidence from history, examination or testing. Diagnosis is therefore by elimination of all other reasonable possibilities.
|
||||
Dual diagnosis
|
||||
The diagnosis of two related, but separate, medical conditions or comorbidities. The term almost always referred to a diagnosis of a serious mental illness and a substance use disorder, however, the increasing prevalence of genetic testing has revealed many cases of patients with multiple concomitant genetic disorders.
|
||||
Self-diagnosis
|
||||
The diagnosis or identification of a medical conditions in oneself. Self-diagnosis is very common.
|
||||
Remote diagnosis
|
||||
A type of telemedicine that diagnoses a patient without being physically in the same room as the patient.
|
||||
Nursing diagnosis
|
||||
Rather than focusing on biological processes, a nursing diagnosis identifies people's responses to situations in their lives, such as a readiness to change or a willingness to accept assistance.
|
||||
Computer-aided diagnosis
|
||||
Providing symptoms allows the computer to identify the problem and diagnose the user to the best of its ability. Health screening begins by identifying the part of the body where the symptoms are located; the computer cross-references a database for the corresponding disease and presents a diagnosis.
|
||||
Overdiagnosis
|
||||
The diagnosis of "disease" that will never cause symptoms, distress, or death during a patient's lifetime
|
||||
Wastebasket diagnosis
|
||||
A vague, or even completely fake, medical or psychiatric label given to the patient or to the medical records department for essentially non-medical reasons, such as to reassure the patient by providing an official-sounding label, to make the provider look effective, or to obtain approval for treatment. This term is also used as a derogatory label for disputed, poorly described, overused, or questionably classified diagnoses, such as pouchitis and senility, or to dismiss diagnoses that amount to overmedicalization, such as the labeling of normal responses to physical hunger as reactive hypoglycemia.
|
||||
Retrospective diagnosis
|
||||
The labeling of an illness in a historical figure or specific historical event using modern knowledge, methods and disease classifications.
|
||||
|
||||
== See also ==
|
||||
|
||||
=== Lists ===
|
||||
List of diagnostic classification and rating scales used in psychiatry
|
||||
List of diseases
|
||||
List of disorders
|
||||
List of medical symptoms
|
||||
Category:Diseases
|
||||
|
||||
== References ==
|
||||
|
||||
== Further reading ==
|
||||
Paul Taylor, "A Way to Be a Person" (review of Suzanne O'Sullivan, The Age of Diagnosis: Are Medical Labels Doing Us More Harm Than Good?, Hachette, March 2026, 308 pp., ISBN 978 1 3997 2766 2), London Review of Books, vol. 48, no. 4 (5 March 2026), pp. 23–26.
|
||||
|
||||
== External links ==
|
||||
|
||||
Media related to Medical diagnosis at Wikimedia Commons
|
||||
76
data/en.wikipedia.org/wiki/Medical_guideline-0.md
Normal file
76
data/en.wikipedia.org/wiki/Medical_guideline-0.md
Normal file
@ -0,0 +1,76 @@
|
||||
---
|
||||
title: "Medical guideline"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Medical_guideline"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:42.677693+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
A medical guideline (also called a clinical guideline, standard treatment guideline, or clinical practice guideline) is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare. Such documents have been in use for thousands of years during the entire history of medicine. However, in contrast to previous approaches, which were often based on tradition or authority, modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine. They usually include summarized consensus statements on best practice in healthcare. A healthcare provider is obliged to know the medical guidelines of their profession, and has to decide whether to follow the recommendations of a guideline for an individual treatment.
|
||||
|
||||
|
||||
== Background ==
|
||||
Modern clinical guidelines identify, summarize and evaluate the highest quality evidence and most current data about prevention, diagnosis, prognosis, therapy including dosage of medications, risk/benefit and cost-effectiveness. Then they define the most important questions related to clinical practice and identify all possible decision options and their outcomes. Some guidelines contain decision or computation algorithms to be followed. Thus, they integrate the identified decision points and respective courses of action with the clinical judgement and experience of practitioners. Many guidelines place the treatment alternatives into classes to help providers in deciding which treatment to use.
|
||||
Additional objectives of clinical guidelines are to standardize medical care, to raise quality of care, to reduce several kinds of risk (to the patient, to the healthcare provider, to medical insurers and health plans) and to achieve the best balance between cost and medical parameters such as effectiveness, specificity, sensitivity, resoluteness, etc. It has been demonstrated repeatedly that the use of guidelines by healthcare providers such as hospitals is an effective way of achieving the objectives listed above, although they are not the only ones.
|
||||
|
||||
|
||||
== Publication ==
|
||||
Guidelines are usually produced at national or international levels by medical associations or governmental bodies, such as the United States Agency for Healthcare Research and Quality. Local healthcare providers may produce their own set of guidelines or adapt them from existing top-level guidelines. Healthcare payers such as insurers practicing utilization management also publish guidelines.
|
||||
Special computer software packages known as guideline execution engines have been developed to facilitate the use of medical guidelines in concert with an electronic medical record system.
|
||||
The Guideline Interchange Format (GLIF) is a computer representation format for clinical guidelines that can be used with such engines.
|
||||
The US and other countries maintain medical guideline clearinghouses. In the US, the National Guideline Clearinghouse maintains a catalog of high-quality guidelines published by various health and medical associations. In the United Kingdom, clinical practice guidelines are published primarily by the National Institute for Health and Care Excellence (NICE). In The Netherlands, two bodies—the Institute for Healthcare Improvement (CBO) and College of General Practitioners (NHG)—have published specialist and primary care guidelines, respectively. In Germany, the German Agency for Quality in Medicine (ÄZQ) coordinates a national program for disease management guidelines. All these organisations are now members of the Guidelines International Network (G-I-N), an international network of organisations and individuals involved in clinical practice guidelines.
|
||||
|
||||
|
||||
== Compliance ==
|
||||
The New York Times reported in 2004 that some simple clinical practice guidelines are not routinely followed to the extent they might be. It has been found that providing a nurse or other medical assistant with a checklist of recommended procedures can result in the attending physician being reminded in a timely manner regarding procedures that might have been overlooked.
|
||||
Checklists have been used in medical practice to attempt to ensure that clinical practice guidelines are followed. An example is the Surgical Safety Checklist developed for the World Health Organization by Atul Gawande. According to a meta-analysis after introduction of the checklist mortality dropped by 23% and all complications by 40%, but further high-quality studies are required to make the meta-analysis more robust. In the UK, a study on the implementation of a checklist for provision of medical care to elderly patients admitting to hospital found that the checklist highlighted limitations with frailty assessment in acute care and motivated teams to review routine practices, but that work is needed to understand whether and how checklists can be embedded in complex multidisciplinary care.
|
||||
|
||||
|
||||
== Problems ==
|
||||
|
||||
|
||||
=== Quality ===
|
||||
Guidelines may have both methodological problems and conflict of interest. As such, the quality of guidelines may vary substantially, especially for guidelines that are published online and have not had to follow methodological reporting standards often required by reputable clearinghouses.
|
||||
Guidelines may make recommendations that are stronger than the supporting evidence.
|
||||
|
||||
|
||||
=== Exclusion of non-expert stakeholders ===
|
||||
Patients and caregivers are frequently excluded from clinical guidelines development, in part because there is a lack of guidance for how to include them in the process.
|
||||
|
||||
|
||||
=== Timeliness ===
|
||||
Guidelines may lose their clinical relevance as they age and newer research emerges. Even 20% of strong recommendations, especially when based on opinion rather than trials, from practice guidelines may be retracted.
|
||||
In response to many of the problems with traditional guidelines, the BMJ created a new series of trustworthy guidelines focused on the most pressing medical issues called BMJ Rapid Recommendations.
|
||||
|
||||
|
||||
== Examples ==
|
||||
The American Heart Association Guidelines for the Prevention of Infective Endocarditis
|
||||
BMJ Rapid Recommendations guideline on transcatheter aortic valve implantation versus surgical aortic valve replacement for aortic stenosis
|
||||
Maudsley Prescribing Guidelines
|
||||
WHO SMART guidelines
|
||||
|
||||
|
||||
== See also ==
|
||||
Clinical formulation
|
||||
Clinical prediction rule
|
||||
Clinical trial protocol
|
||||
Medical algorithm
|
||||
The Medical Letter on Drugs and Therapeutics
|
||||
|
||||
|
||||
== References ==
|
||||
|
||||
|
||||
== External links ==
|
||||
British Columbia Medical Guidelines – In Canada, British Columbia's guidelines and protocols are developed under the direction of the Guidelines and Protocols Advisory Committee (GPAC), jointly sponsored by the B.C. Medical Association and the B.C. Ministry of Health Services.
|
||||
The Cochrane Collaboration – An international, independent, not-for-profit organisation of over 27,000 contributors from more than 100 countries, dedicated to making up-to-date, accurate information about the effects of health care readily available worldwide.
|
||||
GuiaSalud. Clinical Practice Guidelines for the National Health System (Spain) – Contains clinical practice guidelines developed in Spain translated into English.
|
||||
Guideline Elements Model – The Guideline Elements Model (GEM) is an ASTM standard for the representation of practice guidelines in XML format.
|
||||
Guideline Interchange Format – The Guideline Interchange Format (GLIF) is a specification for structured representation of guidelines.
|
||||
Guidelines International Network – Contains the largest online guideline library.
|
||||
Hospital Quality Alliance – A project of the Hospital Quality Initiative (HQI) of the Centers for Medicare and Medicaid Services (USA).
|
||||
National Guideline Clearinghouse (NGC) – A public resource for evidence-based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.
|
||||
Scottish Intercollegiate Guidelines Network (SIGN) – Contains 113 evidence-based clinical guidelines – published, in development, or under review.
|
||||
German guidelines (AWMF) – A collection of current German health care-related professional associations' guidelines.
|
||||
@ -4,7 +4,7 @@ chunk: 1/2
|
||||
source: "https://en.wikipedia.org/wiki/Medical_history"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T06:40:58.506510+00:00"
|
||||
date_saved: "2026-05-05T07:30:44.019225+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
|
||||
@ -4,7 +4,7 @@ chunk: 2/2
|
||||
source: "https://en.wikipedia.org/wiki/Medical_history"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T06:40:58.506510+00:00"
|
||||
date_saved: "2026-05-05T07:30:44.019225+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
|
||||
25
data/en.wikipedia.org/wiki/Medical_logistics-0.md
Normal file
25
data/en.wikipedia.org/wiki/Medical_logistics-0.md
Normal file
@ -0,0 +1,25 @@
|
||||
---
|
||||
title: "Medical logistics"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Medical_logistics"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:22.898880+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Medical logistics is the logistics of pharmaceuticals, medical and surgical supplies, medical devices and equipment, and other products needed to support doctors, nurses, and other health and dental care providers. Because its final customers are responsible for the lives and health of their patients, medical logistics is unique in that it seeks to optimize effectiveness rather than efficiency.
|
||||
Medical logistics functions comprise an important part of the health care system: after staff costs, medical supplies are the single most expensive component of health care. To drive costs out of the health-care sector, medical logistics providers are adopting supply chain management theories.
|
||||
This organizational chart is as follows and separated into three key areas.
|
||||
|
||||
Medical Materiel
|
||||
Facilities Management.
|
||||
Biomedical Engineering (BMET) or Clinical Engineering
|
||||
These areas are managed by a qualified Director of Logistics. The Director of Logistics' educational background holds some type of accredited graduate degree (MBA or M.S.)
|
||||
|
||||
|
||||
== See also ==
|
||||
Medical device
|
||||
|
||||
|
||||
== References ==
|
||||
236
data/en.wikipedia.org/wiki/Medical_procedure-0.md
Normal file
236
data/en.wikipedia.org/wiki/Medical_procedure-0.md
Normal file
@ -0,0 +1,236 @@
|
||||
---
|
||||
title: "Medical procedure"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Medical_procedure"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:45.214641+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
A medical procedure is a course of action intended to achieve a result in the delivery of healthcare.
|
||||
A medical procedure with the intention of determining, measuring, or diagnosing a patient condition or parameter is also called a medical test. Other common kinds of procedures are therapeutic (i.e., intended to treat, cure, or restore function or structure), such as surgical and physical rehabilitation procedures.
|
||||
|
||||
|
||||
== Definition ==
|
||||
"An activity directed at or performed on an individual with the object of improving health, treating disease or injury, or making a diagnosis." - International Dictionary of Medicine and Biology
|
||||
"The act or conduct of diagnosis, treatment, or operation." - Stedman's Medical Dictionary by Thomas Lathrop Stedman
|
||||
"A series of steps by which a desired result is accomplished." - Dorland's Medical Dictionary by William Alexander Newman Dorland
|
||||
"The sequence of steps to be followed in establishing some course of action." - Mosby's Medical, Nursing, & Allied Health Dictionary
|
||||
|
||||
|
||||
== List of medical procedures ==
|
||||
|
||||
|
||||
=== Propaedeutic ===
|
||||
Auscultation
|
||||
Medical inspection (body features)
|
||||
Palpation
|
||||
Percussion (medicine)
|
||||
Vital signs measurement, such as blood pressure, body temperature, or pulse (or heart rate)
|
||||
|
||||
|
||||
=== Diagnostic ===
|
||||
Lab tests
|
||||
Biopsy test
|
||||
Blood test
|
||||
Stool test
|
||||
Urinalysis
|
||||
Cardiac stress test
|
||||
Electrocardiography
|
||||
Electrocorticography
|
||||
Electroencephalography
|
||||
Electromyography
|
||||
Electroneuronography
|
||||
Electronystagmography
|
||||
Electrooculography
|
||||
Electroretinography
|
||||
Endoluminal capsule monitoring
|
||||
Endoscopy
|
||||
Colonoscopy
|
||||
Colposcopy
|
||||
Cystoscopy
|
||||
Gastroscopy
|
||||
Laparoscopy
|
||||
Laryngoscopy
|
||||
Ophthalmoscopy
|
||||
Otoscopy
|
||||
Sigmoidoscopy
|
||||
Esophageal motility study
|
||||
Evoked potential
|
||||
Magnetoencephalography
|
||||
Medical imaging
|
||||
Angiography
|
||||
Aortography
|
||||
Cerebral angiography
|
||||
Coronary angiography
|
||||
Lymphangiography
|
||||
Pulmonary angiography
|
||||
Ventriculography
|
||||
Chest photofluorography
|
||||
Computed tomography
|
||||
Echocardiography
|
||||
Electrical impedance tomography
|
||||
Fluoroscopy
|
||||
Magnetic resonance imaging
|
||||
Diffuse optical imaging
|
||||
Diffusion tensor imaging
|
||||
Diffusion-weighted imaging
|
||||
Functional magnetic resonance imaging
|
||||
Positron emission tomography
|
||||
Radiography
|
||||
Scintillography
|
||||
SPECT
|
||||
Ultrasonography
|
||||
Contrast-enhanced ultrasound
|
||||
Gynecologic ultrasonography
|
||||
Intravascular ultrasound
|
||||
Obstetric ultrasonography
|
||||
Thermography
|
||||
Virtual colonoscopy
|
||||
Neuroimaging
|
||||
Posturography
|
||||
|
||||
|
||||
=== Therapeutic ===
|
||||
|
||||
Thrombosis prophylaxis
|
||||
Precordial thump
|
||||
Politzerization
|
||||
Hemodialysis
|
||||
Hemofiltration
|
||||
Plasmapheresis
|
||||
Apheresis
|
||||
Extracorporeal membrane oxygenation (ECMO)
|
||||
Cancer immunotherapy
|
||||
Cancer vaccine
|
||||
Cervical conization
|
||||
Chemotherapy
|
||||
Cytoluminescent therapy
|
||||
Insulin potentiation therapy
|
||||
Low-dose chemotherapy
|
||||
Monoclonal antibody therapy
|
||||
Photodynamic therapy
|
||||
Radiation therapy
|
||||
Targeted therapy
|
||||
Tracheal intubation
|
||||
Unsealed source radiotherapy
|
||||
Virtual reality therapy
|
||||
Physical therapy/Physiotherapy
|
||||
Speech therapy
|
||||
Phototerapy
|
||||
Hydrotherapy
|
||||
Heat therapy
|
||||
Shock therapy
|
||||
Insulin shock therapy
|
||||
Electroconvulsive therapy
|
||||
Symptomatic treatment
|
||||
Fluid replacement therapy
|
||||
Palliative care
|
||||
Hyperbaric oxygen therapy
|
||||
Oxygen therapy
|
||||
Gene therapy
|
||||
Enzyme replacement therapy
|
||||
Intravenous therapy
|
||||
Phage therapy
|
||||
Respiratory therapy
|
||||
Vision therapy
|
||||
Electrotherapy
|
||||
Transcutaneous electrical nerve stimulation (TENS)
|
||||
Laser therapy
|
||||
Combination therapy
|
||||
Occupational therapy
|
||||
Immunization
|
||||
Vaccination
|
||||
Immunosuppressive therapy
|
||||
Psychotherapy
|
||||
Drug therapy
|
||||
Acupuncture
|
||||
Antivenom
|
||||
Magnetic therapy
|
||||
Craniosacral therapy
|
||||
Chelation therapy
|
||||
Hormonal therapy
|
||||
Hormone replacement therapy
|
||||
Opiate replacement therapy
|
||||
Cell therapy
|
||||
Stem cell treatments
|
||||
Intubation
|
||||
Nebulization
|
||||
Inhalation therapy
|
||||
Particle therapy
|
||||
Proton therapy
|
||||
Fluoride therapy
|
||||
Cold compression therapy
|
||||
Animal-Assisted Therapy
|
||||
Negative Pressure Wound Therapy
|
||||
Nicotine replacement therapy
|
||||
Oral rehydration therapy
|
||||
|
||||
|
||||
=== Surgical ===
|
||||
Ablation
|
||||
Amputation
|
||||
Biopsy
|
||||
Cardiopulmonary resuscitation (CPR)
|
||||
Cryosurgery
|
||||
Endoscopic surgery
|
||||
Facial rejuvenation
|
||||
General surgery
|
||||
Hand surgery
|
||||
Hemilaminectomy
|
||||
Image-guided surgery
|
||||
Knee cartilage replacement therapy
|
||||
Laminectomy
|
||||
Laparoscopic surgery
|
||||
Lithotomy
|
||||
Lithotriptor
|
||||
Lobotomy
|
||||
Neovaginoplasty
|
||||
Radiosurgery
|
||||
Stereotactic surgery
|
||||
Vaginoplasty
|
||||
Xenotransplantation
|
||||
|
||||
|
||||
=== Anesthesia ===
|
||||
Dissociative anesthesia
|
||||
General anesthesia
|
||||
Local anesthesia
|
||||
Topical anesthesia (surface)
|
||||
Epidural (extradural) block
|
||||
Spinal anesthesia (subarachnoid block)
|
||||
Regional anesthesia
|
||||
|
||||
|
||||
=== Other ===
|
||||
Interventional radiology
|
||||
Screening (medicine)
|
||||
|
||||
|
||||
== See also ==
|
||||
Algorithm (medical)
|
||||
Autopsy
|
||||
Complication (medicine)
|
||||
Consensus (medical)
|
||||
Contraindication
|
||||
Course (medicine)
|
||||
Drug interaction
|
||||
Extracorporeal
|
||||
Guideline (medical)
|
||||
Iatrogenesis
|
||||
Invasive (medical)
|
||||
List of surgical instruments
|
||||
Medical error
|
||||
Medical prescription
|
||||
Medical test
|
||||
Minimally invasive
|
||||
Nocebo
|
||||
Non-invasive
|
||||
Physical examination
|
||||
Responsible drug use
|
||||
Surgical instruments
|
||||
Vital signs
|
||||
|
||||
|
||||
== References ==
|
||||
55
data/en.wikipedia.org/wiki/Medical_state-0.md
Normal file
55
data/en.wikipedia.org/wiki/Medical_state-0.md
Normal file
@ -0,0 +1,55 @@
|
||||
---
|
||||
title: "Medical state"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Medical_state"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:46.589956+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Medical state is a term used to describe a hospital patient's health status, or condition. The term is most commonly used in information given to the news media, and is rarely used as a clinical description by physicians.
|
||||
Two aspects of the patient's state may be reported. The first aspect is the patient's current state, which may be reported as "good" or "serious," for instance. Second, the patient's short-term prognosis may be reported. Examples include that the patient is improving or getting worse. If no immediate change is expected, the term stable is frequently used as a qualifier to denote conditions where a patient has stable vital signs.
|
||||
|
||||
|
||||
== United States ==
|
||||
A wide range of terms may be used to describe a patient's condition in the United States. The American Hospital Association advises physicians to use the following one-word conditions in describing a patient's condition to those inquiring, including the media.
|
||||
|
||||
Undetermined
|
||||
Patient awaiting physician and/or assessment.
|
||||
Good
|
||||
Vital signs are stable and within normal limits. Patient is conscious and comfortable. Indicators are excellent.
|
||||
Fair
|
||||
Vital signs are stable and within normal limits. Patient is conscious, but may be uncomfortable. Indicators are favorable.
|
||||
Serious
|
||||
Vital signs may be unstable and not within normal limits. Patient is acutely ill. Indicators are questionable.
|
||||
Critical
|
||||
Vital signs are unstable and not within normal limits. Patient may be unconscious. Indicators are unfavorable.
|
||||
Dead
|
||||
Vital signs have ceased. Patient has died.
|
||||
|
||||
|
||||
=== Other terms ===
|
||||
Other terms used include grave, extremely critical, critical but stable, serious but stable, guarded, and satisfactory.
|
||||
The American Hospital Association has advised doctors not to use the word "stable" either as a condition or in conjunction with another condition, especially one that is critical, as it inherently implies unpredictability and the instability of vital signs. Despite this, "critical but stable" conditions are frequently reported, likely because the word "critical" in mainstream usage is often used to denote a condition that is severe and immediately life-threatening.
|
||||
The use of such condition terminology in the U.S. media has increased since the passing of the HIPAA in 1996. Concern for patient privacy and desire to avoid litigation associated with its breach have prompted doctors and hospitals to use these terms as an alternative to disclosing specific medical conditions.
|
||||
Definitions vary among hospitals, and it is even possible for a patient to be upgraded or downgraded simply by being moved from one place to another, with no change in actual physical state. Furthermore, medical science is a highly complex discipline dealing with complicated and often overlapping threats to life and well-being. In the case of possibly life-threatening illness, a patient may be treated by a dozen or more specialists, each with their area of medical expertise. There can be a range of opinions concerning that patient's condition.
|
||||
|
||||
|
||||
== United Kingdom ==
|
||||
Each National Health Service (NHS) trust has its own guidance for statements to the press. The Department of Health's code of practice has no official definitions of the standard phrases use. Terms typically used by NHS trusts include:
|
||||
|
||||
Deceased
|
||||
Brain dead
|
||||
Critical
|
||||
Critical but stable
|
||||
Serious
|
||||
Stable
|
||||
Satisfactory
|
||||
Comfortable
|
||||
Progressing well
|
||||
Discharged
|
||||
The release of patient information to the press is strictly controlled in the NHS. The Department of Health publishes a guideline to NHS Trusts. In general, no information can be released without patient consent, unless there are exceptional circumstances. If consent is withheld, the hospital cannot state even that to the press, as it would confirm that the patient was receiving treatment.
|
||||
|
||||
|
||||
== References ==
|
||||
59
data/en.wikipedia.org/wiki/Medical_textiles-0.md
Normal file
59
data/en.wikipedia.org/wiki/Medical_textiles-0.md
Normal file
@ -0,0 +1,59 @@
|
||||
---
|
||||
title: "Medical textiles"
|
||||
chunk: 1/3
|
||||
source: "https://en.wikipedia.org/wiki/Medical_textiles"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:47.911170+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Medical textiles are numerous fiber-based materials intended for medical purposes. Medical textile is a sector of technical textiles that emphasizes fiber-based products used in health care applications such as prevention, care, and hygiene.
|
||||
The spectrum of applications of medical textiles ranges from simple cotton bandages to advanced tissue engineering. Common examples of products made from medical textiles include dressings, implants, surgical sutures, certain medical devices, healthcare textiles, diapers, menstrual pads, wipes, and barrier fabrics.
|
||||
Medical textiles include many fiber types, yarns, fabrics, non-woven materials, woven, braided, as well as knitted fabrics. Physical and chemical alterations of fiber architectures, the use of functional finishes, and the production of stimuli-sensitive materials are major approaches for developing innovative medical textiles.
|
||||
Advances in textile manufacturing and medical technologies have made medical healthcare an important industry in textiles. Textiles are used in the production of a variety of medical devices, including replacements for damaged, injured, or non-functioning organs. The manufacture of medical textiles is a growing sector. There are many reasons for its growth, such as new technology in both textiles and medicine; ageing populations; growing populations; changes in lifestyles; and longer life expectancies. Additionally, the COVID-19 pandemic generated higher demand for certain medical textile applications [such as PPE, medical gowns and face masks], and there were shortages worldwide. Even China, the world's largest manufacturer of such applications, has struggled to keep up with demand.
|
||||
|
||||
== History ==
|
||||
|
||||
Natural fibers have been used in medical applications since ancient times. The use of splints, bandages, and gauges is very old. An ancient Sanskrit text on medicine and surgery, the Sushruta Samhita, categorises Kausheya under the "articles of bandaging." The concept of personal protective equipment (PPE) for medical practitioners dates all the way back to the 17th century. Plague doctor costumes were intended to protect plague doctors from the disease during outbreaks of the Bubonic Plague in Europe. According to descriptions, the costumes were typically composed of heavy fabric or leather and was waxed.
|
||||
|
||||
== Significance ==
|
||||
|
||||
Medical textiles have a critical role in preserving human life. So, e.g., medical textile applications (PPE cover all, N95 masks), were in high demand and scarce supply during the COVID-19 pandemic, resulting in severe shortages. Considering the shortage, in February 2020, the World Health Organization restricted the use of medical essentials such as PPE and masks, etc. to front-line workers only (PPE includes gowns, aprons, masks, gloves, medical masks, goggles, face shields, and respirators, i.e., N95 or FFP2). PPE protects medical professionals from illness, infections [from virus or bacteria]. The PPE cloth acts as a barrier with the capacity to prevent contaminants from entering the body through respiratory secretions, blood, and bodily fluids.
|
||||
Masks can protect healthy people from illness by limiting the spread of respiratory droplets and aerosols.
|
||||
|
||||
== Types ==
|
||||
|
||||
=== Categories of fibers, fabrics and materials ===
|
||||
There are four different groups of fibers, fabrics and materials used in medical textile products.
|
||||
|
||||
Different types of fibers and manufacturing systems are utilized for the production of the various medical textile products.
|
||||
|
||||
=== Extracorporeal devices category ===
|
||||
Extracorporeal devices are the artificial organs that remain outside the body while treating a patient. Extracorporeal devices are useful in hemodialysis and cardiac surgery.
|
||||
|
||||
=== Implantable materials category ===
|
||||
Implants are medical devices used to replace a missing biological structure, to sustain a damaged biological structure, or to improve an existing biological structure. In contrast to a transplant, which is biomedical tissue that has been transplanted, medical implants are man-made devices such as artificial ligaments and vascular grafts, etc.
|
||||
|
||||
=== Non-implantable materials category ===
|
||||
Non-implantable materials are used externally and may or may not contact skin. For example, bandages, plaster, orthopedic belts, pressure garments, etc.
|
||||
|
||||
=== Hygiene and healthcare products category ===
|
||||
The term "hygiene and healthcare products" refers to a variety of materials used to maintain the hygiene, safety, and care of medical professionals and patients. Surgical drapes, gowns, uniforms, clothing, caps, wipes, masks, and hospital bed linens are all included in this category
|
||||
|
||||
=== Human textiles ===
|
||||
Human textiles refer to textiles that utilize human materials, including bioengineered yarns made from human cells, for tissue regeneration. Textiles manufactured from human tissue-based 'yarn' can be intricately woven, knitted, or braided and have the potential to contribute to various applications, ranging from simple biocompatible sutures to complex woven tissues for surgical repairs, thereby aiding in the healing process of injuries. Human textiles offer a potential solution to mitigate the drawbacks associated with foreign agents that may induce adverse side effects.
|
||||
|
||||
==== Cell-Assembled extracellular Matrix (CAM) ====
|
||||
The Cell-Assembled Extracellular matrix (CAM) is both biologically sound and resilient, allowing for large-scale production suitable for clinical applications utilizing regular, adult human fibroblasts.
|
||||
|
||||
== Foreign body reaction ==
|
||||
In the medical field, most permanent synthetic biomaterials are considered foreign by the innate immune system. This can lead to a foreign body reaction when implanted.
|
||||
|
||||
== Properties ==
|
||||
Products made from medical textiles are specially engineered textile-based products used in medical applications. These products are used for prevention, care, and hygiene purposes. A combination of properties are considered while selecting the materials, which largely depends upon the particular use. The materials used in medical textile products must have the following properties: strength, softness, biocompatibility, elasticity, flexibility, nontoxicity, noncarcinogenic, non-allergenic, and air and water permeability.
|
||||
Biotextiles are constructions made of textile fibers that are employed in both implantable and non-implant applications. Their performance is assessed according to their biofunctionality, biocompatibility, and biostability. For example, biostability in the presence of body fluids and cells.
|
||||
|
||||
== Material and technologies ==
|
||||
|
||||
=== Fibers ===
|
||||
42
data/en.wikipedia.org/wiki/Medical_textiles-1.md
Normal file
42
data/en.wikipedia.org/wiki/Medical_textiles-1.md
Normal file
@ -0,0 +1,42 @@
|
||||
---
|
||||
title: "Medical textiles"
|
||||
chunk: 2/3
|
||||
source: "https://en.wikipedia.org/wiki/Medical_textiles"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:47.911170+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
==== Overview ====
|
||||
Medical devices are commonly made in whole or part from fibers. A medical device is defined as any device intended for medical purposes. It could be a machine, a reagent for use in the lab, software, an appliance, an instrument, or an implant. For medical use, fiber selection is based on certain criteria of intended use. Primarily, fibers are chosen on the basis of their biodegradability or non-biodegradability. Other than biodegradability, strength, elasticity, and absorbency are also considered.
|
||||
|
||||
==== Natural fibers ====
|
||||
Natural fibers such as cotton, silk, and viscose (a regenerated cellulosic fiber) are used in hygiene and healthcare products, as well as non-implantable materials. Polyester, nylon, polypropylene, glass, and carbon are all examples of synthetic fibers used in Medical textiles. Fibers absorbed within three months by our biological system are considered biodegradable, and fibers that require more than six months to absorb are called non-biodegradable. These fibers are categorized as below:
|
||||
|
||||
==== PLA and PGA fibers ====
|
||||
|
||||
Polylactic acid, also called PLA, is a biodegradable, biosorbable or bioabsorbable polymer used in producing many type of implants such as naturally dissolving stents. Polyglycolide or polyglycolic acid, also called PGA, is a biodegradable and thermoplastic polymer. PGA suture is categorized as an absorbable synthetic braided multifilament.
|
||||
|
||||
==== Other polymers ====
|
||||
|
||||
=== Recent developments ===
|
||||
The term "medical textile" refers to various products made of textile materials (fiber, yarn, or fabric) that are used in the medical environment. Although both natural and synthetic fibers are used in medical textiles, properties such as modulus of elasticity, tensile strength, and hardness are mostly fixed factors in natural fibers, and have proven to be more manageable in synthetic fibers. Recent fiber developments have a significant impact on four primary areas of medical textiles: hygiene products, implants, non-implantable medical textiles, and extracorporeal medical textiles.
|
||||
Medical textiles serve as a bridge between biological sciences and engineering. The advancement of materials science and related research has resulted in the introduction of new fiber materials and manufacturing processes for the medical sector. As a result of new technologies such as 3D printing, electrospinning and melt blowing technology in textiles, medical professions now have access to a diverse choice of textile materials with varying designs and qualities.
|
||||
Melt blowing is a well-established technology for fabricating micro- and nanofibers, in which a polymer melt is extruded via small nozzles surrounded by a high-speed blowing gas. Melt-blown microfibers typically have a fiber diameter of 2–4 μm, but can be as small as 0.3–0.6 μm or as large as 15–20 μm. Melt blowing technology helps in producing filtering products such as N95 masks, and female hygiene products.
|
||||
Medical textiles use tubular fabrics with carefully chosen materials that are biocompatible, nonallergic, and nontoxic. For example, Dyneema, PTFE, Polyester, and Teflon are used for implants. The material type varies depending on the implant area; for example, Polytetrafluoroethylene is preferred for stent implants due to its non-stick properties, while polyolefin is used for mesh implants.
|
||||
Vectran, a manufactured fiber from liquid-crystal polymer, is used in producing medical devices, for example, implants and certain surgical devices.
|
||||
Intelligent textiles can be used for disease management as well as remote monitoring. Intelligent textiles can monitor heart rate and blood pressure, which are critical components of medical diagnosis, and controlling them considerably reduces the incidence of serious health disorders. Movement patterns and electroencephalograms are used to diagnose neurological illnesses and to guide treatment decisions.
|
||||
Phase-change materials are helpful in medical textiles because they can be utilized to reheat hypothermia patients softly and precisely. Additionally, the PCM can be incorporated therapeutically into elastic wraps or orthopedic joint supports. It makes it easy to provide heat or cold therapy to joints or muscles while wearing a bandage.
|
||||
Materials with shape-memory polymers that have the capabilities of temperature adaptive moisture management can improve the thermo-physiological comfort of patients.
|
||||
Nonwoven fabrics with two or more fibers layers are widely used in a variety of applications, including tissue engineering scaffolds, wipes, wound dressings, and barrier materials.
|
||||
Microfluidic spinning technology is used for fabricating many type of fibers. Due to its ease of manipulation, high efficiency, controllability, and environmentally friendly chemical process, microfluidic systems have been identified as an appropriate microreactor platform for the production of anisotropic fibers.
|
||||
|
||||
== Applications ==
|
||||
Medical textiles cover a vast area of application that includes wound care, disease management, preventive clothing, bandages, hygiene (hospital linen), etc. Medical textiles are useful in first aid, treating a wound or keeping a wound or illness in the right condition during medical treatment, they also helps in protecting the healthcare workers from Infection and infectious diseases.
|
||||
|
||||
=== Wound care ===
|
||||
Knitting, weaving, braiding, crocheting, composite materials, and non-woven technologies are all different fabric manufacturing systems used in contemporary wound care. Research subjects in medical textiles include materials and products with significantly superior attributes produced using advanced technology and novel methodologies. New medical textiles are an emerging field with significant growth in wound treatment products. These are all important characteristics of wound care fibers and dressings. They are non-toxic, non-allergic, absorbent, hemostatic, biocompatible, breathable, and non-toxic. They also have good mechanical properties. Chitosan, Alginate, Collagen, branan ferulate, and carbon fiber-based goods offer numerous advantages over conventional materials. Materials used in wound care also include foams, hydrogels, films, hydrocolloids, and matrix (tissue engineering).
|
||||
|
||||
==== Tissue engineering ====
|
||||
Textile technologies are now being considered for biofabrication. The physical and chemical properties of fibers, the size of the pores, and the strength of the fabric all play a role in how textile technologies can be used in tissue engineering. Fibrous structures can be made and shaped with textile technology to meet the needs of a wide range of tissue engineering applications. Tissue engineering is the process of putting together scaffolds, cells, and biologically active molecules to make functional tissues.
|
||||
56
data/en.wikipedia.org/wiki/Medical_textiles-2.md
Normal file
56
data/en.wikipedia.org/wiki/Medical_textiles-2.md
Normal file
@ -0,0 +1,56 @@
|
||||
---
|
||||
title: "Medical textiles"
|
||||
chunk: 3/3
|
||||
source: "https://en.wikipedia.org/wiki/Medical_textiles"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:47.911170+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
It is possible to make meter-long core-shell hydrogel microfibers that contain ECM proteins and mature cells or somatic stem cells in a microfluidic device. and these microfibers have the morphologies and functions of live tissues. The fibers also have the potential to be reeled and spin or weave
|
||||
Electrospinning can produce nanofibers with a range of desired fine microns that is usable to make nano- and submicron-sized fibrous scaffolds from polymer solutions that could be used as cell and tissue substrates.
|
||||
|
||||
===== Biomedical scaffolds =====
|
||||
Hydrogel fibers are used to construct scaffolds for the development of cells and the release of drugs.
|
||||
|
||||
==== Antimicrobial dressing ====
|
||||
Chitosan may function as an inhibitor of bacterial and fungal development. In 2003, the United States Food and Drug Administration approved chitosan-based wound dressings for medical use. Combat medics use Hemcon dressings, which is a dressing with Chitosan, to treat wounds because it stops the blood flow with its hemostasis properties. Chitosan hemostatic agents are salts formed when chitosan is combined with an organic acid (lactic acid, or Succinic acid). The hemostatic agent operates by interacting with the erythrocytes' (negatively charged) cell membrane and the protonated chitosan (positively charged), resulting in platelet involvement and fast thrombus formation. When the bandage comes into contact with blood, it becomes sticky, creating an adhesive-like effect that seals the cut.
|
||||
|
||||
==== Surgical suture thread ====
|
||||
Materials in surgical sutures are textile based products. Suture material is frequently subdivided into absorbable thread and non-absorbable thread, and then into synthetic fibers and natural fibers. Whether a suture material is monofilament or polyfilament is an additional critical distinction.
|
||||
|
||||
=== Bandages ===
|
||||
A bandage is a piece of fabric used to cover, dress, and bind wounds. Bandages are typically manufactured from various textile materials. The dressing or splint is held in place using a bandage. Bandages are also used for medical purposes (strengthening and compressing) to support and restrict specific body parts.
|
||||
|
||||
==== Compression bandages ====
|
||||
Compression bandages are used to apply pressure while directed pressure is used to treat lymphatic disease or venous disease, such as in the treatment of deep vein thrombosis. The most common classifications for compression bandages are inelastic and elastic.
|
||||
|
||||
=== Antimicrobial textiles ===
|
||||
Antimicrobial textiles are the textile materials (fibers, yarns and fabrics) treated with antimicrobial agents, they are used in hygiene care. Antimicrobial treated textiles either kill the bacteria or inhibit the growth of microorganisms. The exemplary products are wipes, gowns, Odorless clothes, etc. Antimicrobial scrubs are hospital garments treated with anti bacterial chemicals. Their primary objective is to prevent the spread of hazardous microorganisms between healthcare staff and between patients. The applied chemicals work differently, for example, chemical binds to the microbe's DNA, effectively rendering reproduction impossible. Some antimicrobial chemicals dissolve the protein necessary for their growth, there are antimicrobials which attack specific bacteria such as Staphylococcus, Salmonella, and Escherichia coli.
|
||||
|
||||
==== Antiviral textiles ====
|
||||
Antiviral textiles are an extension of antimicrobial surfaces. These surfaces, which have antiviral capabilities, may be able to inactivate lipid-coated viruses. Polyhexamethylene biguanide (PHMB) treated CVC fabric (fabric with chief value cotton) kills 94% of the coronavirus in two hours. Henceforth, it is suitable for PPE for health workers. Chitosan, a natural polymer that is biocompatible, non-allergenic, biodegradable, and non-toxic, was also looked at for its antiviral properties. The chitosan-based compound also shows efficacy against severe acute respiratory syndrome coronavirus 2 and cotton fabrics treated with copper along with chitosan and citric acid. The treated material sustains the antiviral properties five to ten home laundry washes.
|
||||
|
||||
=== Medical gowns ===
|
||||
|
||||
Medical gowns are a kind of PPE for medical professionals. Gowns are a component of a comprehensive infection-control approach. They protect the wearer from getting sick or getting infected if they come into contact with liquids or solids that could be contagious or harmful. Operating room gowns, surgical gowns, isolation gowns, nonsurgical gowns, and procedural gowns are all terms used to describe different gowns used in health care settings. The names of products are not standardized. The specifications of the products are important. ANSI/AAMI PB70 specifies a classification system for protective gear [including isolation gowns and surgical gowns] used in healthcare facilities in the United States based on its liquid barrier performance. Quality requirements for various gowns include seam strength, lint generation, tear resistance, evaporative resistance, and breathability. ASTM International [ASTM F2407] guidelines include a list of them which are approved by FDA.
|
||||
These gowns are either impermeable or made of a densely woven, water-resistant fabric. 510(K) is a premarket submission made to the Food and Drug Administration in order to demonstrate that the device to be sold is safe and effective. Surgical and surgical isolation gowns are regulated by the FDA as Class II medical devices that require a 510(k). Non-surgical gowns are class I medical devices that do not need a 510(k) clearance.
|
||||
The different levels are categorized as follows:
|
||||
|
||||
Some more examples of medical textile applications in the medical environment include the following:
|
||||
|
||||
Surgical mask is a mouth and nose cover against bacterial aerosols, these are often used for a particular purpose.
|
||||
N95 respirators masks were one of the most effective means of protection against the coronavirus.
|
||||
Personal protective equipment or PPE protects the wearer from health hazards. For example, Viral barrier gowns can protect against viruses of nanometer size.
|
||||
Implants, textile based implants, surgical meshes, hernia repair, and regenerative medicines.
|
||||
Odor control materials for medical purposes.
|
||||
Drug loaded and drug releasing materials.
|
||||
Bandages
|
||||
Compression garments.
|
||||
|
||||
== Gallery ==
|
||||
|
||||
.
|
||||
|
||||
== References ==
|
||||
@ -0,0 +1,42 @@
|
||||
---
|
||||
title: "Medically unexplained physical symptoms"
|
||||
chunk: 1/2
|
||||
source: "https://en.wikipedia.org/wiki/Medically_unexplained_physical_symptoms"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:49.258781+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Medically unexplained physical symptoms (MUPS or MUS) are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the cause for the symptoms is unknown or disputed—there is no scientific consensus. Not all medically unexplained symptoms are influenced by identifiable psychological factors. However, in practice, most physicians and authors who use the term consider that the symptoms most likely arise from psychological causes. Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored.
|
||||
|
||||
== Prevalence ==
|
||||
It is estimated that between 15% and 30% of all primary care consultations are for medically unexplained symptoms. About 1 in 4 people who see a UK GP have physical symptoms that cannot be explained.
|
||||
Women are significantly more likely than men to be diagnosed with Medically Unexplained Symptoms.
|
||||
|
||||
== Symptoms ==
|
||||
A large Canadian community survey revealed that the most common medically unexplained symptoms are musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue, and dizziness. Other medically unexplained symptoms are headaches, feeling faint, heart palpitations, fits (seizures), breathlessness, weakness and paralysis, and numbness and tingling.
|
||||
|
||||
== Definition and terminology ==
|
||||
The term MUPS can be used to refer to syndromes whose etiology remains unclear or contested, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity and Gulf War illness. Pathogenesis may be suspected.
|
||||
The term medically unexplained symptoms is in some cases treated as synonymous to older terms such as psychosomatic symptoms, conversion disorders, somatic symptoms, somatisations or somatoform disorders; as well as contemporary terms such as functional disorders, bodily distress, and persistent physical symptoms. The plethora of terms reflects imprecision and uncertainty in their definition, controversy, and care taken to avoid stigmatising affected people.
|
||||
|
||||
=== Related terms ===
|
||||
Functional somatic syndrome refers to disturbances in bodily functioning where aetiology is unknown, including that psychogenesis is not assumed.
|
||||
"Persistent physical symptoms" includes situations where persistent physical symptoms are caused by a known illness, such as arthritis.
|
||||
In somatic symptom disorder chronic physical symptoms, which may or may not be linked to a known illness, coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms.
|
||||
|
||||
== Risk factors ==
|
||||
Risk factors for medically unexplained symptoms are complex and include both psychological and organic features, and such symptoms are often accompanied by other somatic symptoms attributable to organic disease. As such it is recognised that the boundary defining symptoms as medically unexplained is blurred.
|
||||
Childhood adversity and/or abuse, and the death or serious illness of a close family member are significant risk factors.
|
||||
Many patients presenting with medically unexplained symptoms also meet the diagnostic criteria for anxiety and/or depression. The likelihood of meeting such criteria increases with the number of unexplained symptoms reported. However, anxiety and depression are also very common in individuals with medically explained illnesses, and again, the likelihood of a person receiving one of these diagnoses increases with the number of symptoms reported.
|
||||
Physical symptoms have been associated with adverse psychosocial and functional outcome across different cultures, irrespective of etiology (either explained or unexplained).
|
||||
|
||||
== Doctor-patient relations ==
|
||||
The lack of known etiology in MUPS cases can lead to conflict between patient and health-care provider over the diagnosis and treatment of MUPS. Most physicians will consider that MUPS most probably have a psychological cause (even if the patient displays no evidence of psychological problems). Many patients, on the other hand, reject the implication that their problems are "all in their head", and feel their symptoms have a physical cause. Diagnosis of MUPS is seldom a satisfactory situation for the patient, and can lead to an adversarial doctor-patient relationship. The situation may lead a patient to question the doctor's competence.
|
||||
A 2008 review in the British Medical Journal stated that a doctor must be careful not to tell a patient that nothing is wrong, "as clearly this is not the case". The symptoms that brought the patient to the doctor are real, even when the cause is not known. The doctor should try to explain the symptoms, avoid blaming the patient for them, and work with the patient to develop a symptom management plan.
|
||||
|
||||
== Evaluation ==
|
||||
When a cause for MUPS is found, the symptom(s) are no longer medically unexplained. Some cases of ulcers and dyspepsia were considered MUPS until bacterial infections were found to be their cause. Similarly, in illnesses where long diagnostic delays are common (e.g., certain types of autoimmune disease and other rare illnesses), the patients' symptoms are classifiable as MUPS right up until the point where a formal diagnosis is made (which, in some instances, can take upwards of five years). Even when a person has received a confirmed medical disease diagnosis, they may nonetheless be considered to have MUPS, if they present with symptoms that are either not fully explained by their disease diagnosis, or are considered by the physician to be more severe than would be predicted by their disease. For example, severe fatigue in patients with systemic lupus erythematosus (SLE) has been interpreted as MUPS because the fatigue cannot be clearly linked to any of the known biological markers for SLE.
|
||||
|
||||
== Treatment ==
|
||||
@ -0,0 +1,33 @@
|
||||
---
|
||||
title: "Medically unexplained physical symptoms"
|
||||
chunk: 2/2
|
||||
source: "https://en.wikipedia.org/wiki/Medically_unexplained_physical_symptoms"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:49.258781+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
The most effective current treatment for some medically unexplained symptoms is a combination of therapeutic approaches tailored to the individual patient. Most MUS patients are in need of psychotherapy, relaxation therapy and physiotherapy under medical supervision. A combined therapeutic approach which is at least twice as effective as other therapeutic modalities published to date is described in Steele RE et al. "A novel and effective treatment modality for medically unexplained symptoms". The next best documented approach is cognitive behavioral therapy (CBT), with evidence from multiple randomized controlled trials. Antidepressants may also help, but the evidence is "not yet conclusive." The effectiveness of CBT and antidepressants has not been studied for all medically unexplained symptoms, however. Evidence for a positive effect of CBT has been found in trials for fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, unexplained headaches, unexplained back pain, tinnitus, and non-cardiac chest pain. Overall, CBT has been shown to be effective in reducing psychological distress and improving medical status in MUPS patients. However the quality of many CBT studies remains low, and many studies lack an attention-placebo control. As of 2006, CBT had not been tested for menopausal syndrome, chronic facial pain, interstitial cystitis, or chronic pelvic pain.
|
||||
Some high quality studies have been conducted examining the effectiveness of antidepressants in MUPS. Those antidepressants that have been investigated include tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). For example, TCAs have effects on IBS, fibromyalgia, back pain, headaches, and possibly tinnitus, and single studies show a possible effect in chronic facial pain, non-cardiac chest pain, and interstitial cystitis. SSRIs are usually not effective or have only a weak effect. One exception is menopausal syndrome, where SSRIs are "possibly effective" as well as a third class of antidepressants, the serotonin-norepinephrine reuptake inhibitors (SNRIs).
|
||||
A 2010 Cochrane review examined the use of Consultation Letters for MUPS with psychiatrist and found some evidence of their effectiveness in terms of medical cost and patient physical functioning. The studies reviewed were small and of moderate quality and completed primarily in the United States so generalizing results to other settings should be done with caution.
|
||||
|
||||
=== Theories ===
|
||||
There is no consensus as to what causes MUPS. However, a number of theories have been put forward. Many of these share the common assumption that MUPS are somehow caused by psychological distress or disturbance. One classical theory is that MUPS arise as a reaction to childhood trauma in vulnerable individuals. More contemporary theories place less emphasis on trauma and suggest that an individual's personality and psychological characteristics play a central role. For example, it has been suggested that people who have anxiety or depression or who focus excessively on their body might be particularly prone to these symptoms.
|
||||
For certain MUPSs that occur within recognized syndromes (e.g. chronic fatigue syndrome and fibromyalgia), there is wide disagreement across disciplines as to the causes of the symptoms. Research in the domains of psychology and psychiatry frequently emphasizes psychological causal factors, whereas research in the biomedical sciences – relating to immunology and rheumatology, for example – commonly emphasizes biological factors.
|
||||
|
||||
== See also ==
|
||||
Amplified musculoskeletal pain syndrome
|
||||
Cryptogenic disease
|
||||
Culture-bound syndrome
|
||||
Diagnosis of exclusion
|
||||
Functional disorder
|
||||
Idiopathy
|
||||
Idiosyncratic drug reaction
|
||||
Somatoform disorders
|
||||
|
||||
== References ==
|
||||
|
||||
== External links ==
|
||||
Medically Unexplained Physical Symptoms DHCC/DOD Pamphlet.
|
||||
Medically unexplained physical symptoms R. Mayou, British Medical Journal, 1991 September 7: 534–535.
|
||||
20
data/en.wikipedia.org/wiki/Metabolic_flexibility-0.md
Normal file
20
data/en.wikipedia.org/wiki/Metabolic_flexibility-0.md
Normal file
@ -0,0 +1,20 @@
|
||||
---
|
||||
title: "Metabolic flexibility"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Metabolic_flexibility"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:50.563120+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Metabolic flexibility is the capacity to alter metabolism in response to exercise or available fuel (especially fats and carbohydrates). Metabolic inflexibility was first described as the ability to generate energy through either aerobic or anaerobic respiration or as the inability of muscle to increase glucose oxidation in response to insulin.
|
||||
An organism can also be said to have metabolic flexibility if it is capable of metabolizing either carbohydrate or fat efficiently, depending on availability of those fuels. By this definition, metabolic flexibility can be quantified using respiratory quotient. This form of metabolic flexibility is reduced by insulin resistance.
|
||||
With aging there is a decrease in metabolic flexibility due to a decline in pyruvate dehydrogenase activity which results in pyruvate increasingly being anaerobically converted to lactate rather than aerobically converted to acetyl-CoA. Similarly, a virus-induced cytokine storm can compromise metabolic flexibility by inactivating the pyruvate dehydrogenase complex and other enzymes.
|
||||
|
||||
|
||||
== See also ==
|
||||
Insulin resistance
|
||||
|
||||
|
||||
== References ==
|
||||
65
data/en.wikipedia.org/wiki/Minimally_invasive_surgeries-0.md
Normal file
65
data/en.wikipedia.org/wiki/Minimally_invasive_surgeries-0.md
Normal file
@ -0,0 +1,65 @@
|
||||
---
|
||||
title: "Minimally invasive surgeries"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Minimally_invasive_surgeries"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:54.325370+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Minimally invasive surgery (also known as minimally invasive procedure) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definition is invasive, and many operations requiring incisions of some size are referred to as open surgery. Incisions made during open surgery can sometimes leave large wounds that may be painful and take a long time to heal. Advancements in medical technologies have enabled the development and regular use of minimally invasive procedures. For example, endovascular aneurysm repair, a minimally invasive surgery, has become the most common method of repairing abdominal aortic aneurysms in the US as of 2003. The procedure involves much smaller incisions than the corresponding open surgery procedure of open aortic surgery.
|
||||
Interventional radiologists were the forerunners of minimally invasive procedures. Using imaging techniques, radiologists were able to direct interventional instruments through the body by way of catheters instead of the large incisions needed in traditional surgery. As a result, many conditions once requiring surgery can now be treated non-surgically.
|
||||
Diagnostic techniques that do not involve incisions, puncturing the skin, or the introduction of foreign objects or materials into the body are known as non-invasive procedures. Several treatment procedures are classified as non-invasive. A major example of a non-invasive alternative treatment to surgery is radiation therapy, also called radiotherapy.
|
||||
|
||||
|
||||
== Medical uses ==
|
||||
|
||||
Minimally invasive procedures were pioneered by interventional radiologists who had first introduced angioplasty and the catheter-delivered stent. Many other minimally invasive procedures have followed where images of all parts of the body can be obtained and used to direct interventional instruments by way of catheters (needles and fine tubes), so that many conditions once requiring open surgery can now be treated non-surgically. A minimally invasive procedure typically involves the use of arthroscopic (for joints and the spine) or laparoscopic devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope or large scale display panel, and is carried out through the skin or through a body cavity or anatomical opening. Interventional radiology now offers many techniques that avoid the need for surgery.
|
||||
By use of a minimally invasive procedure, a patient may require only an adhesive bandage on the incision, rather than multiple stitches or staples to close a large incision. This usually results in less infection, a quicker recovery time and shorter hospital stays, or allow outpatient treatment. However, the safety and effectiveness of each procedure must be demonstrated with randomized controlled trials. The term was coined by John E. A. Wickham in 1984, who wrote of it in British Medical Journal in 1987.
|
||||
|
||||
|
||||
== Specific procedures ==
|
||||
|
||||
Many medical procedures are called minimally invasive; those that involve small incisions through which an endoscope is inserted, end in the suffix -oscopy, such as endoscopy, laparoscopy, arthroscopy. Other examples of minimally invasive procedures include the use of hypodermic injection, and air-pressure injection, subdermal implants, refractive surgery, percutaneous surgery, cryosurgery, microsurgery, keyhole surgery, endovascular surgery using interventional radiology (such as angioplasty or embolization), coronary catheterization, permanent placement of spinal and brain electrodes, stereotactic surgery, the Nuss procedure, radioactivity-based medical imaging methods, such as gamma camera, positron emission tomography and SPECT (single photon emission tomography). Related procedures are image-guided surgery, and robot-assisted surgery.
|
||||
|
||||
|
||||
== Equipment ==
|
||||
Special medical equipment may be used, such as fiber optic cables, miniature video cameras and special surgical instruments handled via tubes inserted into the body through small openings in its surface. The images of the interior of the body are transmitted to an external video monitor and the surgeon has the possibility of making a diagnosis, visually identifying internal features and acting surgically on them.
|
||||
|
||||
|
||||
== Benefits ==
|
||||
Minimally invasive surgery should have less operative trauma, other complications and adverse effects than an equivalent open surgery. It may be more or less expensive (for dental implants, a minimally invasive method reduces the cost of installed implants and shortens the implant-prosthetic rehabilitation time with four–six months). Operative time is longer, but hospitalization time is shorter. It causes less pain and scarring, speeds recovery, and reduces the incidence of post-surgical complications, such as adhesions and wound rupture. Some studies have compared heart surgery.
|
||||
|
||||
|
||||
== Risks ==
|
||||
Risks and complications of minimally invasive procedures are the same as for any other surgical operation, among the risks are: death, bleeding, infection, organ injury, and thromboembolic disease.
|
||||
There may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold, dry gases during insufflation. The use of surgical humidification therapy, which is the use of heated and humidified CO2 for insufflation, may reduce this risk.
|
||||
|
||||
|
||||
== Invasive procedures ==
|
||||
|
||||
Sometimes the use of non-invasive methods is not an option, so that the next level of minimally invasive techniques are looked to. These include the use of hypodermic injection (using the syringe), an endoscope, percutaneous surgery which involves needle puncture of the skin, laparoscopic surgery commonly called keyhole surgery, a coronary catheter, angioplasty and stereotactic surgery.
|
||||
|
||||
|
||||
=== Open surgery ===
|
||||
|
||||
"Open surgery" is any surgical procedure where the incision made is enough to allow the surgery to take place. With tissues and structures exposed to the air, the procedure can be performed either with the unaided vision of the surgeon or with the use of loupes or microscopes. Some examples of open surgery used are for herniated disc commonly called a "slipped disc", and most types of cardiac surgery and neurosurgery.
|
||||
|
||||
|
||||
== Associations ==
|
||||
Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) for adults.
|
||||
International Pediatric Endosurgery Group (IPEG) for pediatrics.
|
||||
|
||||
|
||||
== See also ==
|
||||
|
||||
|
||||
== References ==
|
||||
|
||||
|
||||
== Further reading ==
|
||||
|
||||
|
||||
== External links ==
|
||||
Minimally invasive heart surgery. Medical Encyclopedia, MedlinePlus.
|
||||
91
data/en.wikipedia.org/wiki/Multiple_of_the_median-0.md
Normal file
91
data/en.wikipedia.org/wiki/Multiple_of_the_median-0.md
Normal file
@ -0,0 +1,91 @@
|
||||
---
|
||||
title: "Multiple of the median"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Multiple_of_the_median"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:56.807785+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
A multiple of the median (MoM) is a measure of how far an individual test result deviates from the median. MoM is commonly used to report the results of medical screening tests, particularly where the results of the individual tests are highly variable.
|
||||
MoM was originally used as a method to normalize data from participating laboratories of Alpha-fetoprotein (AFP) so that individual test results could be compared. 35 years later, it is the established standard for reporting maternal serum screening results.
|
||||
An MoM for a test result for a patient can be determined by the following:
|
||||
|
||||
|
||||
|
||||
|
||||
M
|
||||
o
|
||||
M
|
||||
(
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
t
|
||||
)
|
||||
=
|
||||
|
||||
|
||||
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
|
||||
|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
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|
||||
|
||||
|
||||
|
||||
|
||||
|
||||
{\displaystyle MoM(Patient)={\frac {Result(Patient)}{Median(PatientPopulation)}}}
|
||||
|
||||
|
||||
As an example, Alpha-fetoprotein (AFP) testing is used to screen for a neural tube defect (NTD) during the second trimester of pregnancy. If the median AFP result at 16 weeks of gestation is 30 ng/mL and a pregnant woman's AFP result at that same gestational age is 60 ng/mL, then her MoM is equal to 60/30 = 2.0. In other words, her AFP result is 2 times higher than median.
|
||||
|
||||
|
||||
== References ==
|
||||
|
||||
|
||||
== External links ==
|
||||
Parvin CA, DL Gray, G Kessler (1991). "Influence of assay method differences on multiple of the median distributions: maternal serum alpha-fetoprotein as an example". Clinical Chemistry. 37 (5): 637–642. doi:10.1093/clinchem/37.5.637. PMID 1709595. Retrieved 2008-02-16.
|
||||
30
data/en.wikipedia.org/wiki/Multiple_sex_partners-0.md
Normal file
30
data/en.wikipedia.org/wiki/Multiple_sex_partners-0.md
Normal file
@ -0,0 +1,30 @@
|
||||
---
|
||||
title: "Multiple sex partners"
|
||||
chunk: 1/2
|
||||
source: "https://en.wikipedia.org/wiki/Multiple_sex_partners"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:58.086508+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Multiple sex partners (MSP) is the measure and incidence of engaging in sexual activities with two or more people within a specific time period. Sexual activity with MSP can happen simultaneously or serially. MSP includes sexual activity between people of a different gender or the same gender.
|
||||
MSP describes the behavior in clinical terms only. A similar term, promiscuity, may imply a moral judgement. The term polyamorous describes a behavior and not a measure of multiple sexual relationships at the same time.
|
||||
A complete medical history includes a patient's social history and an assessment of the number of sexual partners they have had within a certain time period. Young people having MSP in the past year is an indicator used by the United States Centers for Disease Control and Prevention (CDC) in evaluating risky sexual behavior in adolescents and a tool for monitoring HIV/AIDS infection rates and deaths worldwide.
|
||||
|
||||
== Definitions and quantification ==
|
||||
Epidemiologists and clinicians who quantify risks associated with MSP do so to identify those who have had sexual intercourse with more than one partner in the past 12 months. For the purposes of the World Health Organization (WHO)'s effort to eliminate HIV infection, quantifying measures progress in reducing the percentage of those with AIDS. The World Health Organization (WHO) has described their rationale by assuming that the spread of HIV in most locales depends upon the number of MSP. Those who have MSP possess a higher risk of HIV transmission than individuals that do not have multiple sex partners.
|
||||
WHO uses indicators, such as MSP, age, mortality, morbidity, geographical location and signs and symptoms of disease. This is done so that change can be measured and so that the effect of indicators can be assessed.
|
||||
Following the initial quantification of the number of MSP, the respondent is again surveyed three and then five years later. In addition to the survey, respondents' sexual histories are obtained. Analysis assists those conducting the study to verify and help define the term MSP.
|
||||
For the indicator MSP, WHO has defined a summary of what it measures, rationale for the indicator, numerator, denominator and calculation, recommended measurement tools, measurement, frequency, and the strengths and weaknesses of the indicator.
|
||||
WHO's definition of MSP has some strengths and weaknesses The quantification is an indicator and a picture of the levels of higher-risk sex in a locale. If those surveyed changed their activity to one sexual partner, the change will be quantified by changes in the indicator. This disadvantage is that though a respondent may reduce the number of MSP in a 12-month period, the indicator will not reflect this change in sexual activity. Even so, decreasing the number of MSP may not indicate a change. Potentially this definition and quantification may have a significant impact on the pandemic of HIV and used as a measure of program success. WHO recommends that additional indicators that quantify MSP more precisely to capture the reduction in multiple sexual partners in general.
|
||||
According to the CDC's Youth Risk Behavior Surveillance System, having multiple sex partners has been quantified to mean that those age 25 or older had four or more sex partners in one year. In 2002, the CDC defined MSP for adolescents as having had four or more sex partners during one's lifetime.
|
||||
Some clinicians define MSP by also taking into account concurrent sexual relationships.
|
||||
|
||||
=== Body count ===
|
||||
|
||||
Body count is a sexual slang term referring to the total number of people an individual has had sexual intercourse with over their lifetime. The term is frequently used in dating and social media, particularly on TikTok, with studies showing 25% of Americans conceal this number, while 16% understate it.
|
||||
Body count was originally defined literally in a military context, being a count of (dead) bodies resulting from battles. This use was popularised during the Vietnam War. The meaning shifted over time to also refer to the number of people doing an activity. The usage of the term to refer to a number of sexual partners date back at least to 2004, as it was used in a film released that year. The word is used commonly in Namibia, India, the United States and UK. According to Google NGram, the phrase gained popularity during the 1960s and reached its peak in 2010.
|
||||
|
||||
== Other examples ==
|
||||
Epidemiologists in Tanzania used the indicator MSP in their study of AIDS incidence among 15–19-year-olds by documenting the respondent as being sexually active and having MSP in the last 12 months.
|
||||
34
data/en.wikipedia.org/wiki/Multiple_sex_partners-1.md
Normal file
34
data/en.wikipedia.org/wiki/Multiple_sex_partners-1.md
Normal file
@ -0,0 +1,34 @@
|
||||
---
|
||||
title: "Multiple sex partners"
|
||||
chunk: 2/2
|
||||
source: "https://en.wikipedia.org/wiki/Multiple_sex_partners"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:58.086508+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
== Prevalence ==
|
||||
A Durex Global Sex Survey found that men in New Zealand had claimed an average of 44 sex partners over their lifetime.
|
||||
In a 2019 survey, data showed that the average number of partners varies, with men and women reporting different averages (6.4 for men, 7 for women).
|
||||
The average "body count" for adults aged 30–44 is approximately 8 for both men and women, with over half (56–58%) having more than five partners. While averages vary by region—around 10–11 in the U.S.. Turkey leads in some reports, with an average of 14.5 to 18.5, followed by Australia (13.3), New Zealand (13.2), and Iceland (13.0). Other countries with high averages include Finland (12.4), Norway (12.1), and Italy/Sweden (11.8).
|
||||
An analysis of the National Family Health Survey-5 (NFHS-5) conducted between 2019 and 2021 by the International Institute for Population Sciences, Indian men were found to have the highest mean number of lifetime sexual partners in India.
|
||||
In Jamaica, a 2004 Behavioral Surveillance Survey demonstrated that 89 percent of males and 78 percent of females aged 15 to 24 had sex with a nonmarital or noncohabitating partner in the preceding 12 months. Fifty-six percent of males and 16 percent of females had multiple sex partners in the preceding 12 months.
|
||||
According to some unidentified poll results reported by the Steve Harvey Radio Show in January 2026, Gen Z adults (typically defined as those born between 1997 to 2012), who were the youngest group surveyed in the poll, prefer partners with one to two previous partners. Millennials between the ages of 30 and 45 are more flexible and say three to five past partners is fine. Of course the number of sexual partners that a person has had in their lifetime cannot decrease as a person gets older, so lower numbers would naturally be associated with younger people.
|
||||
MSP is increasing due to shifting social norms, greater sexual liberty, and the rise of hookup culture. Increased opportunities via dating apps, reduced stigma and a greater emphasis on personal exploration.
|
||||
|
||||
== Health risks ==
|
||||
The likelihood of developing substance abuse or dependence increases linearly with the number of sex partners, an effect more pronounced for women. People who have a higher number of sex partners do not have higher rates of anxiety or depression.
|
||||
MSP is statistically associated with an increased risk of contracting sexually transmitted infections including HIV, syphilis, HPV and, in some studies, a higher risk of developing cancer. Key health risks include unprotected exposure, physical injury, and psychological impacts such as anxiety.
|
||||
MSP increases the risk of developing bacterial vaginosis. MSP can result in pregnant women with a greater risk of contracting HIV. HIV is strongly associated with having MSP. Having multiple sex partners is associated with higher incidences of STIs.
|
||||
Prevention of disease strategies include intensive counseling of those who have met the definition of multiple sex partners.
|
||||
In Sub-Saharan Africa, travel and wealth is a risk factor in engaging in sexual activities with multiple sex partners.
|
||||
|
||||
== See also ==
|
||||
|
||||
Cruising for sex
|
||||
Hookup culture
|
||||
Polyamory
|
||||
Sexual ethics
|
||||
|
||||
== References ==
|
||||
@ -0,0 +1,56 @@
|
||||
---
|
||||
title: "Multiplexed point-of-care testing"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Multiplexed_point-of-care_testing"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:30:59.380296+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Multiplexed point-of-care testing (xPOCT) is a more complex form of point-of-care testing (POCT), or bedside testing. Point-of-care testing is designed to provide diagnostic tests at or near the time and place that the patient is admitted. POCT uses the concentrations of analytes to provide the user with information on the physiological state of the patient. An analyte is a substance, chemical or biological, that is being analyzed using a certain instrument. While point-of-care testing is the quantification of one analyte from one in vitro (e.g., blood, plasma or urine) sample, multiplexed point-of-care testing is the simultaneous on-site quantification of various analytes from a single sample.
|
||||
Processing of one biological sample to yield multiple biomarker results allows for POCT testing to be done for patients who may have conditions that require the confirmation of multiple biomarkers and tests before diagnosis (e.g., many types of cancers). xPOCT has important emerging applications in resource-limited settings (e.g., in the developing countries, in doctor's practices, or at home by non experts) and has recently become more important for in vitro diagnostics.
|
||||
|
||||
|
||||
== Background ==
|
||||
Historically, medical testing has been a tedious, long, and expensive process in a clinical setting. It usually involves taking a large sample from the patient (e.g., urine, blood, saliva, tissue swab) and processing it in a separate laboratory, which takes hours or sometimes days to complete. In that time frame, the patient needs to be provided with care, which is not favorable to do without the desired information from the laboratory test. As far back as the 1950s, radioimmunoassays were first demonstrated for the sensitive detection of insulin and thyroxine levels in human plasma. In the 1990s, research that was being conducted in the microelectronics industry was applied to the design of immunoassays, and since then the applications for immunoassays have expanded.
|
||||
There has been a movement towards quicker, more simplistic and cost effective technologies that require small amounts of biological substances to yield results. This movement has been dubbed as microfluidic and lab-on-a-chip technology and aims to bring the results of a test accurately, quickly, and conveniently back to the patient with low cost and complexity to ensure the best patient care. Multiplexed point-of-care testing aims to do all of these things, but with multiple biomarkers at once. Microfluidics refers to the study and control of very small amounts of liquids, and lab-on-a-chip is an electronic chip that is usually about 3 square millimeters that has the ability to perform various laboratory like capillary electrophoresis and PCR.
|
||||
|
||||
|
||||
== xPOCT technology characteristics ==
|
||||
An ideal device for multiplexed point-of-care testing should offer high sensitivity and the capability to process one sample using multiple types of tests. It should be capable of testing various kinds of substances at the same time, including proteins, drugs, RNAs and cells. A high sensor performance that requires small samples, short turnaround times, low system complexity for non experts, and low cost are some characteristics of xPOCT technology. Especially for the resource-limited settings (developing countries, doctors offices, directly at home), equipment-free or smartphone-based devices are very advantageous.
|
||||
xPOCT devices has to fulfill the following:
|
||||
|
||||
Low sample consumption (e.g., blood from a finger prick) or the ability to measure in noninvasive samples (e.g., saliva, urine or exhaled breath condensate)
|
||||
Fast sample-to-result times enabling an immediate treatment
|
||||
Long shelf life with extended reagent storage
|
||||
Ease of storage
|
||||
Comparable test results with central laboratory findings ensuring international quality standards (ISO 15189)
|
||||
Automatic or facile system operation with minimized user intervention
|
||||
Cheap and portable readout systems (e.g., handheld readers) along with disposable test strips or cartridges fulfilling the in vitro diagnostics guideline (EU Directives or FDA regulations).
|
||||
|
||||
|
||||
== Technologies ==
|
||||
Multianalyte detection is mostly achieved through three different approaches, but the technology mainly aims to use a single or small set of biological samples to split or separate them to be read by various types of assays:
|
||||
|
||||
Regional separation employing distinct sections of a channel network or array of electrodes
|
||||
Spatial separation of detection sites with the help of various wells or spots
|
||||
Application of multiple labels such as enzymes, redox molecules, beads, and dyes
|
||||
Other xPOCT devices use mass spectrometry (MS) to directly identify biomarkers. For example, matrix-assisted laser desorption/ionization (MALDI)-MS is used to rapidly identify pathogens, but devices that use this technology tend to be bulky and difficult to use. For the signal readout, optical and electrochemical detection methods are mainly employed.
|
||||
Current types of diagnostic devices being used:
|
||||
|
||||
Paper-based systems - Lateral flow assays like pregnancy tests, which use samples that react with colored particles and require the device to read the color signature
|
||||
Array-based systems - Devices with electrodes or fluorescent molecules in them that are sensitive to certain analytes
|
||||
Bead-based systems - Systems that use beads as a material for the analytes to bind specifically to, and those complexes are subsequently filtered or separated by size or color, as in bead based flow cytometry
|
||||
|
||||
|
||||
== Benefits and challenges ==
|
||||
xPOCT has incredible benefits and applications for the healthcare and technology. It allows for a more cost effective, more rapid, portable, less painful, less complex yet accurate technology that can be used to test for indicators of conditions that previously required multiple samples and several hours or days to do. In addition to its implications in the clinical setting, the low complexity and portability of many multiplexed point-of-care test devices allows for its use by non experts at home both for those who require at home health monitoring systems and for other personalized medicinal uses. The incidence of false positives or false negatives seem to be low.
|
||||
Reaching the optimal space of high performance and low complexity, cost, and size has some challenges. Scientists, hospitals, manufacturers, and policy makers must ensure that the data gathered from these devices would be secure, and that the devices and the materials used in conjunction with it remain affordable and safe. In addition to these things, the devices themselves should be functional for long periods of time and should find ways to deal with their sensitivity to patient to patient variations, and the environment (humidity, temperature etc.).
|
||||
|
||||
|
||||
== Future research ==
|
||||
Current research that is being done regarding xPOCT is focusing on making the requirements for something to be considered a xPOCT easier and cheaper to obtain. Scientists are working to make multiplexed point-of-care devices smaller, more portable, and affordable. Research is also being done on the maximum number of analytes that can be tested at once, if smartphones are a good device to use to present the results of a test, and could there be a device that allows a patient to wear a xPOC device that continuously monitors biomarkers of interest.
|
||||
|
||||
|
||||
== References ==
|
||||
91
data/en.wikipedia.org/wiki/NPU_terminology-0.md
Normal file
91
data/en.wikipedia.org/wiki/NPU_terminology-0.md
Normal file
@ -0,0 +1,91 @@
|
||||
---
|
||||
title: "NPU terminology"
|
||||
chunk: 1/2
|
||||
source: "https://en.wikipedia.org/wiki/NPU_terminology"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:19.220321+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
NPU terminology (NPU; Nomenclature for Properties and Units) is a patient-centered clinical laboratory terminology for use in the clinical laboratory sciences. Its function is to enable results of clinical laboratory examinations to be used safely across technology, time and geography. To achieve this, the NPU terminology supplies:
|
||||
|
||||
Unique identifiers for types of examined properties of the patient, supporting structured communication and storage of laboratory data in e.g. clinical laboratory reports or electronic health records
|
||||
Stable and unambiguous definitions of the types of examined properties, expressed using international nomenclatures, and in accordance with international standards
|
||||
Specification of measurement units where relevant
|
||||
A structure allowing for secure translation of the definitions into other languages
|
||||
|
||||
== Purpose ==
|
||||
The purpose of the NPU terminology is to enable patient examination data to be safely transmitted between laboratory information systems, recognized, compared, reused in calculations, extracted for research or statistics, and stored for documentation, without loss of meaning. It does not cover sampling procedures or methodologies used for determining these data, which may both vary over time.
|
||||
The terminology adheres to international standards of metrology, terminology, and health informatics, in particular the International System of Quantities (ISQ) and the International Systems of Units (SI units). It currently includes over 17 000 entries widely covering multiple disciplines in the field of clinical laboratory science including:
|
||||
|
||||
Clinical Allergology
|
||||
Clinical Chemistry
|
||||
Clinical Haematology
|
||||
Clinical Immunology and Blood Banking
|
||||
Clinical Microbiology
|
||||
Clinical Pharmacology
|
||||
Molecular Biology and Genetics
|
||||
Reproduction and Fertility
|
||||
Thrombosis and Haemostasis
|
||||
Toxicology
|
||||
The NPU terminology is supported by a joint committee (C-SC-NPU) of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and a subcommittee of the International Union of Pure and Applied Chemistry (IUPAC).
|
||||
The terminology is freely available for download in its generic version (in English [3]) and various language versions. The specific syntax and the references to international terminologies, classifications and nomenclatures make the terminology definitions language-independent.
|
||||
|
||||
== Utility and benefits ==
|
||||
Most countries currently strive to implement eHealth systems for electronic management and communication of healthcare information. The primary drivers for adoption of Electronic Health Records (EHR) and supporting infrastructure include:
|
||||
|
||||
Drive to improve quality of patient care
|
||||
Need to contain burgeoning healthcare costs
|
||||
Improve accessibility and portability of patient records
|
||||
Better source data for epidemiological studies
|
||||
Before health records can be successfully communicated and stored there must be a fundamental agreement on the definition for each individual piece of information. Terminology solutions for describing such "concepts" currently include (but are not limited to) SNOMED CT, LOINC and the NPU. Key benefits conferred by the NPU terminology include:
|
||||
|
||||
Patient-centric definitions, generally independent of changes in technology
|
||||
Concepts with references to established international definitions
|
||||
Definitions specifying measurement units (with preference for SI) and measured properties
|
||||
Consistent with the principles outlined in the International Vocabulary of Metrology (VIM) and Vocabulary for Nominal Properties and Nominal Examinations (VIN)
|
||||
Broad membership of guiding NPU committee with extensive expertise in the biological and chemical sciences and the principles of nomenclature.
|
||||
|
||||
== Governance ==
|
||||
The NPU Terminology is owned by both the IFCC and IUPAC. It is governed by the NPU Steering Committee, which consists of representatives from key NPU stakeholders including IFCC, IUPAC, C-SC-NPU, and countries with recognized national release centers.
|
||||
|
||||
== Terminology structure ==
|
||||
Each NPU entry holds a structured definition of the 'result type' it identifies.
|
||||
The definitions are expressed using well established concepts and terms from the field of laboratory medicine. References to internationally acknowledged classifications, nomenclatures and terminologies are filed where possible. This ensures that the definitions are unambiguous, and that the meaning of each concept will remain stable and accessible over time.
|
||||
The definition structure is based on the scientific concept of 'examination' – an examination studies one or more properties of a system (a delimited part of the universe). In a clinical laboratory terminology such as the NPU terminology the system of interest is assumed to be (part of) the patient or the environment, and the NPU definition structure states:
|
||||
|
||||
The system studied – the part of the patient that is the object of the examination (blood plasma, pituitary gland, skin, kidney, whole body)
|
||||
The component – the specific part or process that is of interest in the system studied (glucose, hormone secretion, bacteria, urine excretion)
|
||||
The kind-of-property - (amount-of-substance concentration, secretion rate, number, volume)
|
||||
An SI unit or WHO where relevant – (for measurable properties, i.e. differential or rational [not ordinal] quantities).
|
||||
These statements are ordered in a fixed syntax:
|
||||
|
||||
System—Component; kind of property
|
||||
(a unit is added where relevant, and specifications to each statement may also be added as needed)
|
||||
|
||||
=== Examples ===
|
||||
Body temperature of a patient
|
||||
NPU08676 Patient—Body; Celsius temperature = ? degree Celsius
|
||||
|
||||
Erythrocyte cell count in patient blood
|
||||
NPU01960 Blood—Erythrocytes; number concentration = ? × 1012 per litre
|
||||
|
||||
Concentration of 'Glycoprotein hormones alpha chain' in patient blood plasma
|
||||
NPU28109 Plasma—Glycoprotein hormones alpha chain; mass concentration = ? microgram per litre
|
||||
|
||||
The identifying NPU codes may be used as identifiers with local terms, but a systematically shortened form of the NPU definition is available and is frequently used as a "name" in laboratory reports, for example:
|
||||
|
||||
Pt—Body; temp. = ? °C (Code: NPU08676)
|
||||
|
||||
B—Erythrocytes; num.c. = ? × 1012/L (Code: NPU01960)
|
||||
|
||||
P—Glycoprotein hormones alpha chain; mass c. = ? μg/L (Code: NPU28109)
|
||||
|
||||
== External referencing for NPU concepts ==
|
||||
A key benefit of the NPU terminology is clear definition of terms. Codes are generally only applied where a clear external database reference is available for unequivocal definition of terms.
|
||||
|
||||
Example 1: In the items listed above, the reference for 'Blood' is 'Medical Subject Headings database (MESH), ID D001769' which gives the definition:
|
||||
"The body fluid that circulates in the vascular system (BLOOD VESSELS). Whole blood includes PLASMA and BLOOD CELLS."
|
||||
|
||||
Example 2: The reference for 'Glycoprotein hormones alpha chain' is UniProt Protein Knowledgebase, ID P01215, which besides a set of synonyms and a reference to the corresponding gene gives the full sequence of the protein.
|
||||
30
data/en.wikipedia.org/wiki/NPU_terminology-1.md
Normal file
30
data/en.wikipedia.org/wiki/NPU_terminology-1.md
Normal file
@ -0,0 +1,30 @@
|
||||
---
|
||||
title: "NPU terminology"
|
||||
chunk: 2/2
|
||||
source: "https://en.wikipedia.org/wiki/NPU_terminology"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:19.220321+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
== Translation of NPU definitions ==
|
||||
The English NPU definition structure allows for easy and reliable translation of the NPU definitions into other languages; translating each term in the structured NPU definition into another language will produce a valid definition in that language. The concept behind each term in the definition can be determined and agreed on by accessing the international code assigned to that term. The place of the concept in the syntax assigns the specific meaning of the concept in relation to the examination result.
|
||||
Translations of the NPU terminology are directly available in Danish and Swedish. The terminology has been structured such that translations into other languages is straightforward.
|
||||
|
||||
== NPU foundations ==
|
||||
C-NPU has been managing the development of structured definitions for laboratory result information for the IFCC and IUPAC and making recommendations through papers, recommendations, and technical reports. These mostly joint documents are available from the old IUPAC website [Y].
|
||||
|
||||
While these documents formed the foundation for NPU entries applying to each scientific discipline, subsequent additions in the last decade have consisted primarily of "User driven" requests. The day-to-day administration of the NPU Terminology has for many years been carried out by representatives from the Danish Board of Health with input from the advising NPU committee. The NPU terminology is in nationwide use in laboratories, messages and national registers in Denmark and Sweden (which were also heavily involved in the initial development of the terminology), and in sporadic use in several other European countries. In 2014, Norway declared the NPU terminology mandatory on a national scale for most clinical laboratory fields.
|
||||
|
||||
== See also ==
|
||||
|
||||
IHTSDO
|
||||
SNOMED CT
|
||||
LOINC
|
||||
|
||||
== References ==
|
||||
Nordin G, Dybkaer R. Recommendation for term and measurement unit for "HbA1c". Clin Chem Lab Med 2007; 45(8):1081-2.
|
||||
Summary of NPU definition publications
|
||||
René Dybkær: "An Ontology on Property for Physical, Chemical and Biological Systems"
|
||||
Berzell M., "Electronic Healthcare Ontologies: Philosophy, the real world and IT structures"
|
||||
33
data/en.wikipedia.org/wiki/Narrative_medicine-0.md
Normal file
33
data/en.wikipedia.org/wiki/Narrative_medicine-0.md
Normal file
@ -0,0 +1,33 @@
|
||||
---
|
||||
title: "Narrative medicine"
|
||||
chunk: 1/2
|
||||
source: "https://en.wikipedia.org/wiki/Narrative_medicine"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:00.701624+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Narrative medicine is the discipline of applying the skills used in analyzing literature to interviewing patients. The premise of narrative medicine is that how a patient speaks about his or her illness or complaint is analogous to how literature offers a plot (an interconnected series of events) with characters (the patient and others) and is filled with metaphors (picturesque, emotional, and symbolic ways of speaking), and that becoming conversant with the elements of literature facilitates understanding the stories that patients bring. Narrative Medicine is a diagnostic and comprehensive approach that utilizes patients' narratives in clinical practice, research, and education to promote healing. Beyond attempts to reach accurate diagnoses, it aims to address the relational and psychological dimensions that occur in tandem with physical illness. Narrative medicine aims not only to validate the experience of the patient, it also encourages creativity and self-reflection in the physician.
|
||||
|
||||
== History and development ==
|
||||
In 1910, the Carnegie Foundation for the Advancement of Teaching created the Flexner Report, which set out to redefine medical educational practices. The report argues that the goal of medicine is "an attempt to fight the battle against disease most advantageously to the patient." Flexner wrote that "the practitioner deals with facts of two categories. Chemistry, physics, biology enable him to apprehend one set; he needs a different apperceptive and appreciative apparatus to deal with other more subtle elements. Specific preparation is in this direction much more difficult; one must rely for the requisite insight and sympathy on a varied and enlarging cultural experience." In the late 20th century, narrative medicine came to emphasize an aspect of wider cultural elements in medicine.
|
||||
From the 1990s, physicians such as Rachel Naomi Remen and Rita Charon, who also holds a doctorate in English literature, argued that medical practice should be structured around the narratives of patients. In 2000, Rita Charon first used the term 'Narrative Medicine' to describe a method of using what she calls "narrative competence," which is "the capacity to recognize, absorb, metabolize, interpret, and be moved by stories of illness."
|
||||
|
||||
== Methodology ==
|
||||
The teaching of narrative medicine involves close reading of texts, writing assignments of personal reflection about the text, and discussion of the personal reflections. With the development of 'narrative competence' comes greater understanding and empathy that facilitate the patient and clinician working together.
|
||||
Close reading
|
||||
Close reading is a technique in teaching literature wherein the formal aspects of a text are studied. Students are directed to the read a text "for its information, ambiguity, complexity, texture, and mood as well as for its plot." These methods can be adapted to film, art, and music in the form of 'slow looking' and 'close listening.'
|
||||
Creative Writing
|
||||
Following a close reading of a text, students write about their personal encounter with the text, which "unleashes the curiosity and imagination of the writer."
|
||||
Discussion
|
||||
In turn, Narrative Medicine teachers apply "close reading" to the students' reflective writing.
|
||||
|
||||
== Allied use of narrative ==
|
||||
The term 'Narrative Medicine' refers to training in interpreting literature and applying that skill to understanding the accounts of patients. Associated fields also use 'Narrative-based Medicine', a main proponent of which is the English General Practice physician John Launer, who holds a degree in English literature. His approach comes from an orientation of Family therapy, wherein patients are invited to expand on and explore new directions in the accounts of their illnesses.
|
||||
|
||||
=== Narrative in Medicine ===
|
||||
A broader field is the use of narrative in general in helping doctors and patients deepen understanding of the ways of relating to illness and healing. In the 1990s and early 21st century, this approach is exemplified by the American physician Lewis Mehl-Madrona and the British physician Trisha Greenhalgh.
|
||||
|
||||
== Educational programs ==
|
||||
A number of schools in the United States offer advanced classes in narrative medicine.
|
||||
43
data/en.wikipedia.org/wiki/Narrative_medicine-1.md
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43
data/en.wikipedia.org/wiki/Narrative_medicine-1.md
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@ -0,0 +1,43 @@
|
||||
---
|
||||
title: "Narrative medicine"
|
||||
chunk: 2/2
|
||||
source: "https://en.wikipedia.org/wiki/Narrative_medicine"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:00.701624+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Columbia University has developed educational programs in the field of narrative medicine.
|
||||
Interprofessional Education: The Division of Narrative Medicine at Columbia University Irving Medical Center collaborates with all clinical programs at the medical center, in addition to leading the Interprofessional Education programming.
|
||||
Rounds and Workshops: The division hosts events and trainings, including "monthly rounds and weekend intensive workshops" for the public.
|
||||
Master of Science: Columbia University created the "Master of Science in Narrative Medicine" program in 2009, making it the first graduate program devoted to narrative medicine.
|
||||
Textbook: In 2016, the first textbook in narrative medicine was published: "The Principles and Practice of Narrative Medicine."
|
||||
Certification Program: In 2017, an asynchronous online "Certification program in Narrative Medicine" began.
|
||||
In 2016, the Lewis Katz School of Medicine launched a Narrative Medicine Program run by Mike Vitez, a Pulitzer Prize-winning journalist, and Naomi Rosenberg, an Emergency Medicine physician. The program's goal is to protect, support, and nourish the humanism that brings physicians into the profession, and to teach the skills of narrative that help at the bedside and beyond. The program has curricular and extracurricular components. Reflective writing forms a significant component of the Professional Identity Formation thread in the MD curriculum. Electives in medical humanities range from exploration of narrative medicine to photo storytelling to improvisational acting. Students also conceive and complete individual or group projects for elective credit under the guidance of the faculty. Extracurricular activities include a wide array of writing and narrative medicine workshops—some led by students—for students, residents, and hospital staff. "Narrative Medicine Talks" is a regular speaker series, and the program hosts fall and spring Story Slams for the Lewis Katz School of Medicine and Temple Hospital Community. On December 7, 2019, LKSOM hosted its inaugural Narrative Medicine Conference.
|
||||
Montefiore Medical Center created a program in Narrative Medicine within its Department of Family and Social Medicine. Residents learn how to use personal narrative to enhance empathy, as well addressing stress, loss, and balance.
|
||||
The Ohio State University Humanities Institute supports the multidisciplinary initiative of narrative medicine. The program runs concurrently with their other undergraduate and graduate programs, where students "strive to develop narrative competence that enables them to deliver care that is not only more empathetic and compassionate, but also more effective."
|
||||
In 2020, the University of Southern California Keck School of Medicine began a Master of Science program in Narrative Medicine.
|
||||
In 2011, Western University created the Narrative Medicine Initiative (NMI) and has incorporated narrative medicine into its undergraduate, postgraduate, and continuing medical education departments. They work to answer questions such as "How does the art of storytelling improve health care education and the experience of patient care?" Western holds regular (at least annual) narrative medicine rounds during which local patients and physicians share their stories of disease and illness, with a focus on how the stories will improve physician's ability to handle future stories.
|
||||
Lenoir-Rhyne University has established the Thomas Wolfe Center for Narrative, with the slogan "Heeding the call for narrative in a fragmented world." The program offers graduate-level and certification courses in several narrative training disciplines, one of which is narrative medicine.
|
||||
Saybrook University takes a broad approach to narrative medicine through its mind-body medicine program, which follows the mind-body approach to health and wellness as a way to improve quality of life for patients.
|
||||
Misericordia University requires a course in narrative medicine for all students in its Medical and Health Humanities major.
|
||||
The growing field of narrative medicine extends beyond the United States:
|
||||
|
||||
The British Medical Journal began writing seminars to promote this type of narrative among emerging physicians.
|
||||
At University of Southern Denmark narrative medicine is a required course for all undergraduate medical students.
|
||||
In Italy, the Healthcare Area of ISTUD (Institute of Management Studies) offers a Master in Applied Narrative Medicine that is designed for health care professionals
|
||||
|
||||
== See also ==
|
||||
|
||||
== References ==
|
||||
|
||||
== Further reading ==
|
||||
|
||||
== External links ==
|
||||
|
||||
Intima: A Journal of Narrative Medicine
|
||||
Columbia | Narrative Medicine
|
||||
Northwest Narrative Medicine Collaborative - community of narrative medicine, medical humanities, and health humanities practitioners in the U.S. Pacific Northwest
|
||||
English language articles at Italian Narrative Medicine website
|
||||
Website of Dr. John Launer (Narrative-based Medicine)
|
||||
19
data/en.wikipedia.org/wiki/Neo-Hippocratism-0.md
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19
data/en.wikipedia.org/wiki/Neo-Hippocratism-0.md
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@ -0,0 +1,19 @@
|
||||
---
|
||||
title: "Neo-Hippocratism"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Neo-Hippocratism"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:01.854843+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Neo-Hippocratism was an influential movement and was the subject of numerous conversations and theorizations between the seventeenth and mid-nineteenth centuries. The movement saw a revival in popularity with physicians after the First World War. It sought to reappraise the role of Hippocrates and Hippocratic medicine and was closely associated with the idea of the holistic treatment of the patient.
|
||||
The popularity of neo-Hippocratism has been seen as a reaction to the growing systematisation and professionalism of medicine which some physicians saw as reductionist and failing to treat the whole person. Neo-Hippocratism is described as a rational and methodical method of seeing the body as a whole. Of examining a human in their entirety and “considers all medical and or internistic therapeutic agents- psychical, dietetic, chemical, biological, and physical- and applies them according to the indications of the individual patient under severe control of the continuous diagnosis of the person.
|
||||
|
||||
|
||||
== History ==
|
||||
The expression, neo-hippocratism is said to been first coined by Arturo Castiglioni in 1926. One of the movement's principal promoters was Alexander Polycleitos Cawadias (1884–1971).
|
||||
|
||||
|
||||
== References ==
|
||||
14
data/en.wikipedia.org/wiki/Neointima-0.md
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14
data/en.wikipedia.org/wiki/Neointima-0.md
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@ -0,0 +1,14 @@
|
||||
---
|
||||
title: "Neointima"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Neointima"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:03.124624+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Neointima typically refers to scar tissue that forms within tubular anatomical structures such as blood vessels, as the intima is the innermost lining of these structures. Neointima can form as a result of vascular surgery such as angioplasty or stent placement. Formation of neointima occurs due to proliferation of smooth muscle cells as well as macrophages.
|
||||
|
||||
|
||||
== References ==
|
||||
59
data/en.wikipedia.org/wiki/Neuroangiogenesis-0.md
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59
data/en.wikipedia.org/wiki/Neuroangiogenesis-0.md
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@ -0,0 +1,59 @@
|
||||
---
|
||||
title: "Neuroangiogenesis"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Neuroangiogenesis"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:06.848068+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Neuroangiogenesis is the coordinated growth of nerves and blood vessels. The nervous and blood vessel systems share guidance cues and cell-surface receptors allowing for this synchronised growth. The term neuroangiogenesis only came into use in 2002 and the process was previously known as neurovascular patterning. The combination of neurogenesis and angiogenesis is an essential part of embryonic development and early life. It is thought to have a role in pathologies such as endometriosis, brain tumors, and Alzheimer's disease.
|
||||
|
||||
|
||||
== Physiology ==
|
||||
|
||||
|
||||
=== Neurovascular patterning ===
|
||||
Neurovascular development is the parallel emergence and patterning of the nervous system and the vascular system during embryogenesis and early life. Neurovascular congruency appears to be determined by shared molecular patterning mechanism involving axon guidance that involves axonal guidance molecules such as sema3A (semaphorin 3A) and (neuropilin).
|
||||
|
||||
|
||||
=== Mechanisms ===
|
||||
Neuroangiogenic and axonal guidance molecules act on both neuronal growth cones and endothelial tip cells in order to guide growth.
|
||||
Neuronal growth cones are situated on the tips of nerve cells and are responsive to different factors, both positive and negative. Growth of the neuron occurs by an extension of the actin (red in image) and microtubule (green in image) cytoskeleton.
|
||||
|
||||
Tip cells found at the extremity of the developing blood vessel control adjacent endothelial cells to direct growth. Tip cells have receptors and ligands via which they respond to local neuroangiogenic factors.
|
||||
|
||||
|
||||
== Neurogenic factors ==
|
||||
There are many neuroangiogenic factors, some of which act to promote neuronal growth and vice versa. The table shows examples
|
||||
|
||||
|
||||
== Pathology ==
|
||||
Neuroangiogenesis is implicated in a number of pathologies, including endometriosis, brain tumors, and senile dementias, such as Alzheimer's disease. Each of these incurs a significant cost for the healthcare industry, meaning that complete understanding of processes involved – including neuroangiogenesis – is necessary to enable development of functional treatments.
|
||||
|
||||
|
||||
=== Endometriosis ===
|
||||
Endometriosis is a common gynaecological disease caused by endometrial tissue implanting outside the uterus, a symptom of which is chronic pelvic pain. The formation, growth and persistence of these implants are dependent upon angiogenesis to increase the supply of blood vessels. The resulting increase in blood flow may correlate directly with pain symptoms. One possible explanation for this is the simultaneous growth of neurons into these areas alongside blood vessels through neuroangiogenesis.
|
||||
|
||||
|
||||
=== Brain tumors ===
|
||||
Brain tumors, such as glioblastoma multiforme, are characterized by dense vascularity associated with high expression of the proangiogenic factors, VEGF and interleukin 8.
|
||||
|
||||
|
||||
=== Brain injury ===
|
||||
Following ischemic stroke or traumatic brain injury, angiogenesis supports oxygen and nutrient re-supply to injured tissue, and stimulates neurogenesis and synaptogenesis, particularly in the ischemic penumbra. Neuroangiogenesis is finely regulated and sequential, involving proliferation and migration of endothelial cells to restore blood–brain barrier function, recruitment of pericytes, and stabilization new blood vessels, a process dependent on upregulation of proangiogenic factors, such as VEGF and angiopoietin-1.
|
||||
|
||||
|
||||
=== Alzheimer’s disease ===
|
||||
A condition possibly resulting from a reduction in neuroangiogenic factors is Alzheimer’s disease. Without continued neuroangiogenesis during aging, areas of the brain may no longer have the full complement of functional capillaries and hence, by inference, cerebral blood flow and cognitive ability decline. This condition of reduced neuroangiogenesis and lower capillary density during senescence, possibly involving impaired regulation of angiogenic factors by hypoxia, could be a vascular basis for Alzheimer's disease.
|
||||
|
||||
|
||||
== See also ==
|
||||
Neurogenesis
|
||||
Angiogenesis
|
||||
Endometriosis
|
||||
Alzheimer's disease
|
||||
|
||||
|
||||
== References ==
|
||||
18
data/en.wikipedia.org/wiki/Neurocristopathy-0.md
Normal file
18
data/en.wikipedia.org/wiki/Neurocristopathy-0.md
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@ -0,0 +1,18 @@
|
||||
---
|
||||
title: "Neurocristopathy"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Neurocristopathy"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:08.133460+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Neurocristopathy is a diverse class of pathologies that may arise from defects in the development of tissues containing cells commonly derived from the embryonic neural crest cell lineage. The term was coined by Robert P. Bolande in 1974.
|
||||
After the induction of the neural crest, the newly formed neural crest cells (NCC) delaminate from their tissue of origin and migrate from the entire neural axis of the vertebrate embryo to specific locations where they will give rise to different cell derivatives. The formation of this cell population therefore requires a timely and spatially controlled interplay of inter- and intra-cellular signals. An alteration in the occurrence and timing of these signals leads to a set of syndromes called Neurocristopathies (NCP), which comprises a broad spectrum of congenital malformations affecting an appreciable percentage of newborns. Moreover, since NCC migrate along the embryo, they are susceptible to subtle changes in the environment both during their migration and upon arrival at their destination. This means that even little modifications, either genetically or environmentally caused, in the external cues that modulate NCC migration have a deep effect on the normal migration and differentiation of these cells, thus becoming a causative factor for the development of NCP.
|
||||
Recently, a new classification for this group of diseases has been proposed. This new criteria takes into account the axial origin of the NC population that contributes to the derived tissue affected in a particular NCP. According to this, some diseases have a single axial origin, i.e., they arise from an alteration in the development of only one NC population (e.g. cranial NCP, such as Auriculo Condylar Syndrome). However, other NCP arise from a defect in two or more NC populations (such as the CHARGE syndrome).
|
||||
Accepted examples of NCP are piebaldism, Waardenburg syndrome, Hirschsprung disease, Ondine's curse (congenital central hypoventilation syndrome), pheochromocytoma, paraganglioma, Merkel cell carcinoma, multiple endocrine neoplasia, neurofibromatosis type I, CHARGE syndrome, familial dysautonomia, DiGeorge syndrome, Axenfeld-Rieger syndrome, Goldenhar syndrome (a.k.a. hemifacial microsomia), craniofrontonasal syndrome, congenital melanocytic nevus, melanoma, and certain congenital heart defects of the outflow tract. Recently, many diseases have been incorporated as NCP, mainly based on the finding of new NC derivatives. In particular, Multiple sclerosis has been suggested as being neurocristopathic in origin.
|
||||
The usefulness of the definition resides in its ability to refer to a potentially common etiological factor for certain neoplasms and/or congenital malformation associations that are otherwise difficult to group with other means of nosology. Moreover, the classification of NCP is intended to help physicians understand the causal mechanism that drives the formation of a certain NCP, and therefore the selection of the correct diagnostic test and therapies.
|
||||
|
||||
|
||||
== References ==
|
||||
24
data/en.wikipedia.org/wiki/Neuron-0.md
Normal file
24
data/en.wikipedia.org/wiki/Neuron-0.md
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@ -0,0 +1,24 @@
|
||||
---
|
||||
title: "Neuron"
|
||||
chunk: 1/8
|
||||
source: "https://en.wikipedia.org/wiki/Neuron"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:09.374333+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
A neuron (American English), neurone (British English), or nerve cell, is a cell that is excitable, firing electric signals called action potentials across a neural network in the nervous system, mainly in the central nervous system, and helps to receive and conduct impulses. Neurons communicate with other cells via synapses, which are specialized connections that commonly use minute amounts of chemical neurotransmitters to pass the electric signal from the presynaptic neuron to the target cell through the synaptic gap.
|
||||
Neurons are the main components of nervous tissue in all animals except sponges and placozoans. Plants and fungi do not have nerve cells. Molecular evidence suggests that the ability to generate electric signals first appeared in evolution some 700 to 800 million years ago, during the Tonian period. Predecessors of neurons were the peptidergic secretory cells. They eventually gained new gene modules which enabled cells to create post-synaptic scaffolds and ion channels that generate fast electrical signals. The ability to generate electric signals was a key innovation in the evolution of the nervous system.
|
||||
Neurons are typically classified into three types based on their function. Sensory neurons respond to stimuli such as touch, sound, or light that affect the cells of the sensory organs, and they send signals to the spinal cord and then to the sensorial area in the brain. Motor neurons receive signals from the brain and spinal cord to control everything from muscle contractions to glandular output. Interneurons connect neurons to other neurons within the same region of the brain or spinal cord. When multiple neurons are functionally connected together, they form what is called a neural circuit.
|
||||
A neuron contains all the structures of other cells such as a nucleus, mitochondria, and Golgi bodies, but has additional unique structures such as an axon, and dendrites. The soma or cell body, is a compact structure, and the axon and dendrites are filaments extruding from the soma. Dendrites typically branch profusely and extend a few hundred micrometers from the soma. The axon leaves the soma at a swelling called the axon hillock and travels for as far as 1 meter in humans or more in other species. It branches but usually maintains a constant diameter. At the farthest tip of the axon's branches are axon terminals, where the neuron can transmit a signal across the synapse to another cell. Neurons may lack dendrites or have no axons. The term neurite is used to describe either a dendrite or an axon, particularly when the cell is undifferentiated.
|
||||
Most neurons receive signals via the dendrites and soma and send out signals down the axon. At the majority of synapses, signals cross from the axon of one neuron to the dendrite of another. However, synapses can connect an axon to another axon or a dendrite to another dendrite. The signaling process is partly electrical and partly chemical. Neurons are electrically excitable, due to the maintenance of voltage gradients across their membranes. If the voltage changes by a large enough amount over a short interval, the neuron generates an all-or-nothing electrochemical pulse called an action potential. This potential travels rapidly along the axon and activates synaptic connections as it reaches them. Synaptic signals may be excitatory or inhibitory, increasing or reducing the net voltage that reaches the soma.
|
||||
In most cases, neurons are generated by neural stem cells during brain development and childhood. Neurogenesis largely ceases during adulthood in most areas of the brain.
|
||||
|
||||
== Nervous system ==
|
||||
Neurons are the primary components of the nervous system, along with the glial cells that give them structural and metabolic support. The nervous system is made up of the central nervous system, which includes the brain and spinal cord, and the peripheral nervous system, which includes the autonomic, enteric and somatic nervous systems. In vertebrates, the majority of neurons belong to the central nervous system, but some reside in peripheral ganglia, and many sensory neurons are situated in sensory organs such as the retina and cochlea.
|
||||
Axons may bundle into nerve fascicles that make up the nerves in the peripheral nervous system (like strands of wire that make up a cable). In the central nervous system bundles of axons are called nerve tracts.
|
||||
|
||||
== Anatomy and histology ==
|
||||
|
||||
Neurons are highly specialized for the processing and transmission of cellular signals. Given the diversity of functions performed in different parts of the nervous system, there is a wide variety in their shape, size, and electrochemical properties. For instance, the soma of a neuron can vary from 4 to 100 micrometers in diameter.
|
||||
30
data/en.wikipedia.org/wiki/Neuron-1.md
Normal file
30
data/en.wikipedia.org/wiki/Neuron-1.md
Normal file
@ -0,0 +1,30 @@
|
||||
---
|
||||
title: "Neuron"
|
||||
chunk: 2/8
|
||||
source: "https://en.wikipedia.org/wiki/Neuron"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:09.374333+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
The soma is the body of the neuron. As it contains the nucleus, most protein synthesis occurs here. The nucleus can range from 3 to 18 micrometers in diameter.
|
||||
The dendrites of a neuron are cellular extensions with many branches. This overall shape and structure are referred to metaphorically as a dendritic tree. The branches form fractal patterns that repeat at multiple size scales. This fractal tree is where the majority of input to the neuron occurs via the dendritic spine.
|
||||
The axon is a finer, cable-like projection that can extend tens, hundreds, or even tens of thousands of times the diameter of the soma in length. The axon primarily carries nerve signals away from the soma and carries some types of information back to it. Many neurons have only one axon, but this axon may—and usually will—undergo extensive branching, enabling communication with many target cells. The part of the axon where it emerges from the soma is called the axon hillock. Besides being an anatomical structure, the axon hillock also has the greatest density of voltage-dependent sodium channels. This makes it the most easily excited part of the neuron and the spike initiation zone for the axon. In electrophysiological terms, it has the most negative threshold potential.
|
||||
While the axon and axon hillock are generally involved in information outflow, this region can also receive input from other neurons.
|
||||
The axon terminal is found at the end of the axon farthest from the soma and contains synapses. Synaptic boutons are specialized structures where neurotransmitter chemicals are released to communicate with target neurons. In addition to synaptic boutons at the axon terminal, a neuron may have en passant boutons, which are located along the length of the axon.
|
||||
The accepted view of the neuron attributes dedicated functions to its various anatomical components; however, dendrites and axons often act in ways contrary to their so-called main function.
|
||||
Axons and dendrites in the central nervous system are typically only about one micrometer thick, while some in the peripheral nervous system are much thicker. The soma is usually about 10–25 micrometers in diameter and often is not much larger than the cell nucleus it contains. The longest axon of a human motor neuron can be over a meter long, reaching from the base of the spine to the toes.
|
||||
Sensory neurons can have axons that run from the toes to the posterior column of the spinal cord, over 1.5 meters in adults. Giraffes have single axons several meters in length running along the entire length of their necks. Much of what is known about axonal function comes from studying the squid giant axon, an ideal experimental preparation because of its relatively immense size (0.5–1 millimeter thick, several centimeters long).
|
||||
Fully differentiated neurons are permanently postmitotic however, stem cells present in the adult brain may regenerate functional neurons throughout the life of an organism (see neurogenesis). Astrocytes are star-shaped glial cells that have been observed to turn into neurons by virtue of their stem cell-like characteristic of pluripotency.
|
||||
|
||||
=== Membrane ===
|
||||
Like all animal cells, the cell body of every neuron is enclosed by a plasma membrane, a bilayer of lipid molecules with many types of embedded protein structures. A lipid bilayer is a powerful electrical insulator, but in neurons, many of the protein structures embedded in the membrane are electrically active. These include ion channels that permit electrically charged ions to flow across the membrane and ion pumps that chemically transport ions from one side of the membrane to the other. Most ion channels are gated, permeable only to specific types of ions. Some ion channels are voltage gated, meaning that they can be switched between open and closed states by altering the voltage difference across the membrane. Others are chemically gated, meaning that they can be switched between open and closed states by interactions with chemicals that diffuse through the extracellular fluid. The ions include sodium, potassium, chloride, and calcium. The interactions between ion channels and ion pumps produce a voltage difference across the membrane, typically a little less than 1/10 of a volt at baseline. This voltage has two functions: first, it provides a power source for an assortment of voltage-dependent protein machineries that are embedded in the membrane; second, it provides a basis for electrical signal transmission between different parts of the membrane.
|
||||
|
||||
=== Histology and internal structure ===
|
||||
|
||||
Numerous microscopic clumps called Nissl bodies (or Nissl substance) are seen when nerve cell bodies are stained with a basophilic ("base-loving") dye. These structures consist of rough endoplasmic reticulum and associated ribosomal RNA. Named after German psychiatrist and neuropathologist Franz Nissl (1860–1919), they are involved in protein synthesis and their prominence can be explained by the fact that nerve cells are very metabolically active. Basophilic dyes such as aniline or (weakly) hematoxylin highlight negatively charged components, and so bind to the phosphate backbone of the ribosomal RNA.
|
||||
The cell body of a neuron is supported by a complex mesh of structural proteins called neurofilaments, which together with neurotubules (neuronal microtubules) are assembled into larger neurofibrils. Some neurons also contain pigment granules, such as neuromelanin (a brownish-black pigment that is byproduct of synthesis of catecholamines), and lipofuscin (a yellowish-brown pigment), both of which accumulate with age. Other structural proteins that are important for neuronal function are actin and the tubulin of microtubules. Class III β-tubulin is found almost exclusively in neurons. Actin is predominately found at the tips of axons and dendrites during neuronal development. There the actin dynamics can be modulated via an interplay with microtubule.
|
||||
There are different internal structural characteristics between axons and dendrites. Typical axons seldom contain ribosomes, except some in the initial segment. Dendrites contain granular endoplasmic reticulum or ribosomes, in diminishing amounts as the distance from the cell body increases.
|
||||
|
||||
== Classification ==
|
||||
64
data/en.wikipedia.org/wiki/Neuron-2.md
Normal file
64
data/en.wikipedia.org/wiki/Neuron-2.md
Normal file
@ -0,0 +1,64 @@
|
||||
---
|
||||
title: "Neuron"
|
||||
chunk: 3/8
|
||||
source: "https://en.wikipedia.org/wiki/Neuron"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:09.374333+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Neurons vary in shape and size and can be classified by their morphology and function. The anatomist Camillo Golgi grouped neurons into two types; type I with long axons used to move signals over long distances and type II with short axons, which can often be confused with dendrites. Type I cells can be further classified by the location of the soma. The basic morphology of type I neurons, represented by spinal motor neurons, consists of a cell body called the soma and a long thin axon covered by a myelin sheath. The dendritic tree wraps around the cell body and receives signals from other neurons. The end of the axon has branching axon terminals that release neurotransmitters into a gap called the synaptic cleft between the terminals and the dendrites of the next neuron.
|
||||
|
||||
=== Structural classification ===
|
||||
|
||||
==== Polarity ====
|
||||
|
||||
Most neurons can be anatomically characterized as:
|
||||
|
||||
Unipolar: single process. Unipolar cells are exclusively sensory neurons. Their dendrites receive sensory information, sometimes directly from the stimulus itself. The cell bodies of unipolar neurons are always found in ganglia. Sensory reception is a peripheral function, so the cell body is in the periphery, though closer to the CNS in a ganglion. The axon projects from the dendrite endings, past the cell body in a ganglion, and into the central nervous system.
|
||||
Bipolar: 1 axon and 1 dendrite. They are found mainly in the olfactory epithelium, and as part of the retina.
|
||||
Multipolar: 1 axon and 2 or more dendrites
|
||||
Golgi I: neurons with long-projecting axonal processes; examples are pyramidal cells, Purkinje cells, and anterior horn cells
|
||||
Golgi II: neurons whose axonal process projects locally; the best example is the granule cell
|
||||
Anaxonic: where the axon cannot be distinguished from the dendrite(s)
|
||||
Pseudounipolar: 1 process which then serves as both an axon and a dendrite
|
||||
|
||||
==== Other ====
|
||||
Some unique neuronal types can be identified according to their location in the nervous system and distinct shape. Some examples are:
|
||||
|
||||
Basket cells, interneurons that form a dense plexus of terminals around the soma of target cells, found in the cortex and cerebellum
|
||||
Betz cells, large motor neurons in primary motor cortex
|
||||
Lugaro cells, interneurons of the cerebellum
|
||||
Medium spiny neurons, most neurons in the corpus striatum
|
||||
Purkinje cells, huge neurons in the cerebellum, a type of Golgi I multipolar neuron
|
||||
Pyramidal cells, neurons with triangular soma, a type of Golgi I
|
||||
Rosehip cells, unique human inhibitory neurons that interconnect with Pyramidal cells
|
||||
Renshaw cells, neurons with both ends linked to alpha motor neurons
|
||||
Unipolar brush cells, interneurons with unique dendrite ending in a brush-like tuft
|
||||
Granule cells, a type of Golgi II neuron
|
||||
Anterior horn cells, motoneurons located in the spinal cord
|
||||
Spindle cells, interneurons that connect widely separated areas of the brain
|
||||
|
||||
=== Functional classification ===
|
||||
|
||||
==== Direction ====
|
||||
Afferent neurons convey information from tissues and organs into the central nervous system and are also called sensory neurons.
|
||||
Efferent neurons (motor neurons) transmit signals from the central nervous system to the effector cells.
|
||||
Interneurons connect neurons within specific regions of the central nervous system.
|
||||
Afferent and efferent also refer generally to neurons that, respectively, bring information to or send information from the brain.
|
||||
|
||||
==== Action on other neurons ====
|
||||
A neuron affects other neurons by releasing a neurotransmitter that binds to chemical receptors. The effect on the postsynaptic neuron is determined by the type of receptor that is activated, not by the presynaptic neuron or by the neurotransmitter. Receptors are classified broadly as excitatory (causing an increase in firing rate), inhibitory (causing a decrease in firing rate), or modulatory (causing long-lasting effects not directly related to firing rate).
|
||||
The two most common (90%+) neurotransmitters in the brain, glutamate and GABA, have largely consistent actions. Glutamate acts on several types of receptors and has effects that are excitatory at ionotropic receptors and a modulatory effect at metabotropic receptors. Similarly, GABA acts on several types of receptors, but all of them have inhibitory effects (in adult animals, at least). Because of this consistency, it is common for neuroscientists to refer to cells that release glutamate as "excitatory neurons", and cells that release GABA as "inhibitory neurons". Some other types of neurons have consistent effects, for example, "excitatory" motor neurons in the spinal cord that release acetylcholine, and "inhibitory" spinal neurons that release glycine.
|
||||
The distinction between excitatory and inhibitory neurotransmitters is not absolute. Rather, it depends on the class of chemical receptors present on the postsynaptic neuron. In principle, a single neuron, releasing a single neurotransmitter, can have excitatory effects on some targets, inhibitory effects on others, and modulatory effects on others still. For example, photoreceptor cells in the retina constantly release the neurotransmitter glutamate in the absence of light. So-called OFF bipolar cells are, like most neurons, excited by the released glutamate. However, neighboring target neurons called ON bipolar cells are instead inhibited by glutamate, because they lack typical ionotropic glutamate receptors and instead express a class of inhibitory metabotropic glutamate receptors. When light is present, the photoreceptors cease releasing glutamate, which relieves the ON bipolar cells from inhibition, activating them; this simultaneously removes the excitation from the OFF bipolar cells, silencing them.
|
||||
It is possible to identify the type of inhibitory effect a presynaptic neuron will have on a postsynaptic neuron, based on the proteins the presynaptic neuron expresses. Parvalbumin-expressing neurons typically dampen the output signal of the postsynaptic neuron in the visual cortex, whereas somatostatin-expressing neurons typically block dendritic inputs to the postsynaptic neuron.
|
||||
|
||||
==== Discharge patterns ====
|
||||
Neurons have intrinsic electroresponsive properties like intrinsic transmembrane voltage oscillatory patterns. So neurons can be classified according to their electrophysiological characteristics:
|
||||
|
||||
Tonic or regular spiking. Some neurons are typically constantly (tonically) active, typically firing at a constant frequency. Example: interneurons in neurostriatum.
|
||||
Phasic or bursting. Neurons that fire in bursts are called phasic.
|
||||
Fast-spiking. Some neurons are notable for their high firing rates, for example, some types of cortical inhibitory interneurons, cells in globus pallidus, retinal ganglion cells.
|
||||
|
||||
==== Neurotransmitter ====
|
||||
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|
||||
title: "Neuron"
|
||||
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category: "reference"
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|
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date_saved: "2026-05-05T07:31:09.374333+00:00"
|
||||
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|
||||
---
|
||||
|
||||
Neurotransmitters are chemical messengers passed from one neuron to another neuron or to a muscle cell or gland cell.
|
||||
|
||||
Cholinergic neurons – acetylcholine. Acetylcholine is released from presynaptic neurons into the synaptic cleft. It acts as a ligand for both ligand-gated ion channels and metabotropic (GPCRs) muscarinic receptors. Nicotinic receptors are pentameric ligand-gated ion channels composed of alpha and beta subunits that bind nicotine. Ligand binding opens the channel causing the influx of Na+ depolarization and increases the probability of presynaptic neurotransmitter release. Acetylcholine is synthesized from choline and acetyl coenzyme A.
|
||||
Adrenergic neurons – noradrenaline. Noradrenaline (norepinephrine) is released from most postganglionic neurons in the sympathetic nervous system onto two sets of GPCRs: alpha adrenoceptors and beta adrenoceptors. Noradrenaline is one of the three common catecholamine neurotransmitters, and the most prevalent of them in the peripheral nervous system; as with other catecholamines, it is synthesized from tyrosine.
|
||||
GABAergic neurons – gamma aminobutyric acid. GABA is one of two neuroinhibitors in the central nervous system (CNS), along with glycine. GABA has a homologous function to ACh, gating anion channels that allow Cl− ions to enter the post synaptic neuron. Cl− causes hyperpolarization within the neuron, decreasing the probability of an action potential firing as the voltage becomes more negative (for an action potential to fire, a positive voltage threshold must be reached). GABA is synthesized from glutamate neurotransmitters by the enzyme glutamate decarboxylase.
|
||||
Glutamatergic neurons – glutamate. Glutamate is one of two primary excitatory amino acid neurotransmitters, along with aspartate. Glutamate receptors are one of four categories, three of which are ligand-gated ion channels and one of which is a G-protein coupled receptor (often referred to as GPCR).
|
||||
AMPA and Kainate receptors function as cation channels permeable to Na+ cation channels mediating fast excitatory synaptic transmission.
|
||||
NMDA receptors are another cation channel that is more permeable to Ca2+. The function of NMDA receptors depends on glycine receptor binding as a co-agonist within the channel pore. NMDA receptors do not function without both ligands present.
|
||||
Metabotropic receptors, GPCRs modulate synaptic transmission and postsynaptic excitability.
|
||||
Glutamate can cause excitotoxicity when blood flow to the brain is interrupted, resulting in brain damage. When blood flow is suppressed, glutamate is released from presynaptic neurons, causing greater NMDA and AMPA receptor activation than normal outside of stress conditions, leading to elevated Ca2+ and Na+ entering the post synaptic neuron and cell damage. Glutamate is synthesized from the amino acid glutamine by the enzyme glutamate synthase.
|
||||
Dopaminergic neurons—dopamine. Dopamine is a neurotransmitter that acts on D1 type (D1 and D5) Gs-coupled receptors, which increase cAMP and PKA, and D2 type (D2, D3, and D4) receptors, which activate Gi-coupled receptors that decrease cAMP and PKA. Dopamine is connected to mood and behavior and modulates both pre- and post-synaptic neurotransmission. Loss of dopamine neurons in the substantia nigra has been linked to Parkinson's disease. Dopamine is synthesized from the amino acid tyrosine. Tyrosine is catalyzed into levodopa (or L-DOPA) by tyrosine hydroxylase, and levodopa is then converted into dopamine by the aromatic amino acid decarboxylase.
|
||||
Serotonergic neurons—serotonin. Serotonin (5-Hydroxytryptamine, 5-HT) can act as excitatory or inhibitory. Of its four 5-HT receptor classes, 3 are GPCR and 1 is a ligand-gated cation channel. Serotonin is synthesized from tryptophan by tryptophan hydroxylase, and then further by decarboxylase. A lack of 5-HT at postsynaptic neurons has been linked to depression. Drugs that block the presynaptic serotonin transporter are used for treatment, such as Prozac and Zoloft.
|
||||
Purinergic neurons—ATP. ATP is a neurotransmitter acting at both ligand-gated ion channels (P2X receptors) and GPCRs (P2Y) receptors. ATP is, however, best known as a cotransmitter. Such purinergic signaling can also be mediated by other purines like adenosine, which particularly acts at P2Y receptors.
|
||||
Histaminergic neurons—histamine. Histamine is a monoamine neurotransmitter and neuromodulator. Histamine-producing neurons are found in the tuberomammillary nucleus of the hypothalamus. Histamine is involved in arousal and regulating sleep/wake behaviors.
|
||||
|
||||
==== Multimodel classification ====
|
||||
Since 2012 there has been a push from the cellular and computational neuroscience community to come up with a universal classification of neurons that will apply to all neurons in the brain as well as across species. This is done by considering the three essential qualities of all neurons: electrophysiology, morphology, and the individual transcriptome of the cells. Besides being universal this classification has the advantage of being able to classify astrocytes as well. A method called patch-sequencing in which all three qualities can be measured at once is used extensively by the Allen Institute for Brain Science. In 2023, a comprehensive cell atlas of the adult, and developing human brain at the transcriptional, epigenetic, and functional levels was created through an international collaboration of researchers using the most cutting-edge molecular biology approaches.
|
||||
|
||||
== Connectivity ==
|
||||
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||||
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|
||||
title: "Neuron"
|
||||
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|
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||||
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|
||||
---
|
||||
|
||||
Neurons communicate with each other via synapses, where either the axon terminal of one cell contacts another neuron's dendrite, soma, or, less commonly, axon. Neurons such as Purkinje cells in the cerebellum can have over 1000 dendritic branches, making connections with tens of thousands of other cells; other neurons, such as the magnocellular neurons of the supraoptic nucleus, have only one or two dendrites, each of which receives thousands of synapses.
|
||||
Synapses can be excitatory or inhibitory, either increasing or decreasing activity in the target neuron, respectively. Some neurons also communicate via electrical synapses, which are direct, electrically conductive junctions between cells.
|
||||
When an action potential reaches the axon terminal, it opens voltage-gated calcium channels, allowing calcium ions to enter the terminal. Calcium causes synaptic vesicles filled with neurotransmitter molecules to fuse with the membrane, releasing their contents into the synaptic cleft. The neurotransmitters diffuse across the synaptic cleft and activate receptors on the postsynaptic neuron. High cytosolic calcium in the axon terminal triggers mitochondrial calcium uptake, which, in turn, activates mitochondrial energy metabolism to produce ATP to support continuous neurotransmission.
|
||||
An autapse is a synapse in which a neuron's axon connects to its dendrites.
|
||||
The human brain has some 8.6 × 1010 (eighty six billion) neurons. Each neuron has on average 7,000 synaptic connections to other neurons. It has been estimated that the brain of a three-year-old child has about 1015 synapses (1 quadrillion). This number declines with age, stabilizing by adulthood. Estimates vary for an adult, ranging from 1014 to 5 × 1014 synapses (100 to 500 trillion).
|
||||
|
||||
=== Nonelectrochemical signaling ===
|
||||
Beyond electrical and chemical signaling, studies suggest neurons in healthy human brains can also communicate through:
|
||||
|
||||
force generated by the enlargement of dendritic spines
|
||||
the transfer of proteins – transneuronally transported proteins (TNTPs)
|
||||
They can also get modulated by input from the environment and hormones released from other parts of the organism, which could be influenced more or less directly by neurons. This also applies to neurotrophins such as BDNF. The gut microbiome is also connected with the brain.
|
||||
Neurons also communicate with microglia, the brain's main immune cells via specialized contact sites, called "somatic junctions". These connections enable microglia to constantly monitor and regulate neuronal functions, and exert neuroprotection when needed.
|
||||
|
||||
== Mechanisms for propagating action potentials ==
|
||||
|
||||
In 1937 John Zachary Young suggested that the squid giant axon could be used to study neuronal electrical properties. It is larger than but similar to human neurons, making it easier to study. By inserting electrodes into the squid giant axons, accurate measurements were made of the membrane potential.
|
||||
The cell membrane of the axon and soma contain voltage-gated ion channels that allow the neuron to generate and propagate an electrical signal (an action potential). Some neurons also generate subthreshold membrane potential oscillations. These signals are generated and propagated by charge-carrying ions including sodium (Na+), potassium (K+), chloride (Cl−), and calcium (Ca2+).
|
||||
Several stimuli can activate a neuron leading to electrical activity, including pressure, stretch, chemical transmitters, and changes in the electric potential across the cell membrane. Stimuli cause specific ion-channels within the cell membrane to open, leading to a flow of ions through the cell membrane, changing the membrane potential. Neurons must maintain the specific electrical properties that define their neuron type.
|
||||
Thin neurons and axons require less metabolic expense to produce and carry action potentials, but thicker axons convey impulses more rapidly. To minimize metabolic expense while maintaining rapid conduction, many neurons have insulating sheaths of myelin around their axons. The sheaths are formed by glial cells: oligodendrocytes in the central nervous system and Schwann cells in the peripheral nervous system. The sheath enables action potentials to travel faster than in unmyelinated axons of the same diameter, whilst using less energy. The myelin sheath in peripheral nerves normally runs along the axon in sections about 1 mm long, punctuated by unsheathed nodes of Ranvier, which contain a high density of voltage-gated ion channels. Multiple sclerosis is a neurological disorder that results from the demyelination of axons in the central nervous system.
|
||||
Some neurons do not generate action potentials but instead generate a graded electrical signal, which in turn causes graded neurotransmitter release. Such non-spiking neurons tend to be sensory neurons or interneurons, because they cannot carry signals long distances.
|
||||
|
||||
== Neural coding ==
|
||||
Neural coding is concerned with how sensory and other information is represented in the brain by neurons. The main goal of studying neural coding is to characterize the relationship between the stimulus and the individual or ensemble neuronal responses and the relationships among the electrical activities of the neurons within the ensemble. It is thought that neurons can encode both digital and analog information.
|
||||
|
||||
== All-or-none principle ==
|
||||
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||||
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|
||||
title: "Neuron"
|
||||
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|
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category: "reference"
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|
||||
date_saved: "2026-05-05T07:31:09.374333+00:00"
|
||||
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|
||||
---
|
||||
|
||||
The conduction of nerve impulses is an example of an all-or-none response. In other words, if a neuron responds at all, then it must respond completely. Greater intensity of stimulation, like brighter image/louder sound, does not produce a stronger signal but can increase firing frequency. Receptors respond in different ways to stimuli. Slowly adapting or tonic receptors respond to a steady stimulus and produce a steady rate of firing. Tonic receptors most often respond to increased stimulus intensity by increasing their firing frequency, usually as a power function of stimulus plotted against impulses per second. This can be likened to an intrinsic property of light where greater intensity of a specific frequency (color) requires more photons, as the photons cannot become "stronger" for a specific frequency.
|
||||
Other receptor types include quickly adapting or phasic receptors, where firing decreases or stops with a steady stimulus; examples include skin which, when touched causes neurons to fire, but if the object maintains even pressure, the neurons stop firing. The neurons of the skin and muscles that are responsive to pressure and vibration have filtering accessory structures that aid their function.
|
||||
The pacinian corpuscle is one such structure. It has concentric layers like an onion, which form around the axon terminal. When pressure is applied and the corpuscle is deformed, mechanical stimulus is transferred to the axon, which fires. If the pressure is steady, the stimulus ends; thus, these neurons typically respond with a transient depolarization during the initial deformation and again when the pressure is removed, which causes the corpuscle to change shape again. Other types of adaptation are important in extending the function of several other neurons.
|
||||
Although neurons have long been assumed to always give a stereotyped maximal response or none at all, there is a body of research that argues that this is only partially correct, and that while it is true that Neurons either fire an Action Potential or do not, the amplitude and duration of the Action Potentials that a Neuron fires can vary greatly, allowing the Neuron to encode information in at least the strength of the Action Potential. Additionally, the analog information carried in the Action Potential has been shown to be able to survive and travel distances originally not thought to be possible. This has been proposed to be a highly effective way to encode information compared to the usual rate and temporal coding theories commonly seen in the literature, with the ability to transfer around 4 times more information than current wisdom would suggest.
|
||||
|
||||
== Etymology and spelling ==
|
||||
The German anatomist Heinrich Wilhelm Waldeyer introduced the term neuron in 1891, based on the ancient Greek νεῦρον neuron 'sinew, cord, nerve'.
|
||||
The word was adopted in French with the spelling neurone. That spelling was also used by many writers in English, but has now become rare in American usage and uncommon in British usage.
|
||||
Some previous works used nerve cell (cellule nervose), as adopted in Camillo Golgi's 1873 paper on the discovery of the silver staining technique used to visualize nervous tissue under light microscopy.
|
||||
|
||||
== History ==
|
||||
|
||||
The neuron's place as the primary functional unit of the nervous system was first recognized in the late 19th century through the work of the Spanish anatomist Santiago Ramón y Cajal.
|
||||
To make the structure of individual neurons visible, Ramón y Cajal improved a silver staining process that had been developed by Camillo Golgi. The improved process involves a technique called "double impregnation" and is still in use.
|
||||
In 1888 Ramón y Cajal published a paper about the bird cerebellum. In this paper, he stated that he could not find evidence for anastomosis between axons and dendrites and called each nervous element "an autonomous canton." This became known as the neuron doctrine, one of the central tenets of modern neuroscience.
|
||||
In 1891, the German anatomist Heinrich Wilhelm Waldeyer wrote a highly influential review of the neuron doctrine in which he introduced the term neuron to describe the anatomical and physiological unit of the nervous system.
|
||||
The silver impregnation stains are a useful method for neuroanatomical investigations because, for reasons unknown, it stains only a small percentage of cells in a tissue, exposing the complete micro structure of individual neurons without much overlap from other cells.
|
||||
|
||||
=== Neuron doctrine ===
|
||||
|
||||
The neuron doctrine is the now fundamental idea that neurons are the basic structural and functional units of the nervous system. The theory was put forward by Santiago Ramón y Cajal in the late 19th century. It held that neurons are discrete cells (not connected in a meshwork), acting as metabolically distinct units.
|
||||
Later discoveries yielded refinements to the doctrine. For example, glial cells, which are non-neuronal, play an essential role in information processing. Also, electrical synapses are more common than previously thought, comprising direct, cytoplasmic connections between neurons; In fact, neurons can form even tighter couplings: the squid giant axon arises from the fusion of multiple axons.
|
||||
Ramón y Cajal also postulated the Law of Dynamic Polarization, which states that a neuron receives signals at its dendrites and cell body and transmits them, as action potentials, along the axon in one direction: away from the cell body. The Law of Dynamic Polarization has important exceptions; dendrites can serve as synaptic output sites of neurons and axons can receive synaptic inputs.
|
||||
|
||||
=== Compartmental modelling of neurons ===
|
||||
Although neurons are often described as "fundamental units" of the brain, they perform internal computations. Neurons integrate input within dendrites, and this complexity is lost in models that assume neurons to be a fundamental unit. Dendritic branches can be modeled as spatial compartments, whose activity is related to passive membrane properties, but may also be different depending on input from synapses. Compartmental modelling of dendrites is especially helpful for understanding the behavior of neurons that are too small to record with electrodes, as is the case for Drosophila melanogaster.
|
||||
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|
||||
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|
||||
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|
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|
||||
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||||
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|
||||
date_saved: "2026-05-05T07:31:09.374333+00:00"
|
||||
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|
||||
---
|
||||
|
||||
== Neurons in the brain ==
|
||||
The number of neurons in the brain varies dramatically from species to species. In a human, there are an estimated 10–20 billion neurons in the cerebral cortex and 55–70 billion neurons in the cerebellum. By contrast, the nematode worm Caenorhabditis elegans has just 302 neurons, making it an ideal model organism as scientists have been able to map all of its neurons. The fruit fly Drosophila melanogaster, a common subject in biological experiments, has around 100,000 neurons and exhibits many complex behaviors. Many properties of neurons, from the type of neurotransmitters used to ion channel composition, are maintained across species, allowing scientists to study processes occurring in more complex organisms in much simpler experimental systems.
|
||||
|
||||
== Neurological disorders ==
|
||||
|
||||
Charcot–Marie–Tooth disease (CMT) is a heterogeneous inherited disorder of nerves (neuropathy) that is characterized by loss of muscle tissue and touch sensation, predominantly in the feet and legs extending to the hands and arms in advanced stages. Presently incurable, this disease is one of the most common inherited neurological disorders, affecting 36 in 100,000 people.
|
||||
Alzheimer's disease (AD), also known simply as Alzheimer's, is a neurodegenerative disease characterized by progressive cognitive deterioration, together with declining activities of daily living and neuropsychiatric symptoms or behavioral changes. The most striking early symptom is loss of short-term memory (amnesia), which usually manifests as minor forgetfulness that becomes steadily more pronounced with illness progression, with relative preservation of older memories. As the disorder progresses, cognitive (intellectual) impairment extends to the domains of language (aphasia), skilled movements (apraxia), and recognition (agnosia), and functions such as decision-making and planning become impaired.
|
||||
Parkinson's disease (PD), also known as Parkinson's, is a degenerative disorder of the central nervous system that often impairs motor skills and speech. Parkinson's disease belongs to a group of conditions called movement disorders. It is characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia), and in extreme cases, a loss of physical movement (akinesia). The primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of dopamine, which is produced in the dopaminergic neurons of the brain. Secondary symptoms may include high-level cognitive dysfunction and subtle language problems. PD is both chronic and progressive.
|
||||
Myasthenia gravis is a neuromuscular disease leading to fluctuating muscle weakness and fatigability during simple activities. Weakness is typically caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction, inhibiting the stimulative effect of the neurotransmitter acetylcholine. Myasthenia is treated with immunosuppressants, cholinesterase inhibitors and, in selected cases, thymectomy.
|
||||
|
||||
=== Demyelination ===
|
||||
|
||||
Demyelination is a process characterized by the gradual loss of the myelin sheath enveloping nerve fibers. When myelin deteriorates, signal conduction along nerves can be significantly impaired or lost, and the nerve eventually withers. Demyelination may affect both central and peripheral nervous systems, contributing to various neurological disorders such as multiple sclerosis, Guillain-Barré syndrome, and chronic inflammatory demyelinating polyneuropathy. Although demyelination is often caused by an autoimmune reaction, it may also be caused by viral infections, metabolic disorders, trauma, and some medications.
|
||||
|
||||
=== Axonal degeneration ===
|
||||
Although most injury responses include a calcium influx signaling to promote resealing of severed parts, axonal injuries initially lead to acute axonal degeneration, which is the rapid separation of the proximal and distal ends, occurring within 30 minutes of injury. Degeneration follows with swelling of the axolemma, and eventually leads to bead-like formation. Granular disintegration of the axonal cytoskeleton and inner organelles occurs after axolemma degradation. Early changes include accumulation of mitochondria in the paranodal regions at the site of injury. The endoplasmic reticulum degrades and mitochondria swell up and eventually disintegrate. The disintegration is dependent on ubiquitin and calpain proteases (caused by the influx of calcium ions), suggesting that axonal degeneration is an active process that produces complete fragmentation. The process takes about roughly 24 hours in the PNS and longer in the CNS. The signaling pathways leading to axolemma degeneration are unknown.
|
||||
|
||||
== Development ==
|
||||
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|
||||
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||||
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|
||||
---
|
||||
|
||||
Neurons develop through the process of neurogenesis, in which neural stem cells divide to produce differentiated neurons. Once fully differentiated they are no longer capable of undergoing mitosis. Neurogenesis primarily occurs during embryonic development.
|
||||
Neurons initially develop from the neural tube in the embryo. The neural tube has three layers – a ventricular zone, an intermediate zone, and a marginal zone. The ventricular zone surrounds the tube's central canal and becomes the ependyma. Dividing cells of the ventricular zone form the intermediate zone which stretches to the outermost layer of the neural tube called the pial layer. The gray matter of the brain is derived from the intermediate zone. The extensions of the neurons in the intermediate zone make up the marginal zone when myelinated becomes the brain's white matter.
|
||||
Differentiation of the neurons is ordered by their size. Large motor neurons are first. Smaller sensory neurons together with glial cell differentiate at birth.
|
||||
Adult neurogenesis can occur and studies of the age of human neurons suggest that this process occurs only for a minority of cells and that the vast majority of neurons in the neocortex form before birth and persist without replacement. The extent to which adult neurogenesis exists in humans, and its contribution to cognition are controversial, with conflicting reports published in 2018.
|
||||
The body contains a variety of stem cell types that can differentiate into neurons. Researchers found a way to transform human skin cells into nerve cells using transdifferentiation, in which "cells are forced to adopt new identities".
|
||||
During neurogenesis in the mammalian brain, progenitor and stem cells progress from proliferative divisions to differentiative divisions. This progression leads to the neurons and glia that populate cortical layers. Epigenetic modifications play a key role in regulating gene expression in differentiating neural stem cells, and are critical for cell fate determination in the developing and adult mammalian brain. Epigenetic modifications include DNA cytosine methylation to form 5-methylcytosine and 5-methylcytosine demethylation. DNA cytosine methylation is catalyzed by DNA methyltransferases (DNMTs). Methylcytosine demethylation is catalyzed in several stages by TET enzymes that carry out oxidative reactions (e.g. 5-methylcytosine to 5-hydroxymethylcytosine) and enzymes of the DNA base excision repair (BER) pathway.
|
||||
At different stages of mammalian nervous system development, two DNA repair processes are employed in the repair of DNA double-strand breaks. These pathways are homologous recombinational repair used in proliferating neural precursor cells, and non-homologous end joining used mainly at later developmental stages
|
||||
Intercellular communication between developing neurons and microglia is also indispensable for proper neurogenesis and brain development.
|
||||
|
||||
== Nerve regeneration ==
|
||||
|
||||
Peripheral axons can regrow if they are severed, but one neuron cannot be functionally replaced by one of another type (Llinás' law).
|
||||
|
||||
== See also ==
|
||||
|
||||
== References ==
|
||||
|
||||
== Further reading ==
|
||||
|
||||
== External links ==
|
||||
|
||||
IBRO (International Brain Research Organization). Fostering neuroscience research especially in less well-funded countries.
|
||||
NeuronBank Archived 2021-04-13 at the Wayback Machine an online neuromics tool for cataloging neuronal types and synaptic connectivity.
|
||||
High Resolution Neuroanatomical Images of Primate and Non-Primate Brains.
|
||||
The Department of Neuroscience at Wikiversity, which presently offers two courses: Fundamentals of Neuroscience and Comparative Neuroscience.
|
||||
NIF Search – Neuron Archived 2015-01-22 at the Wayback Machine via the Neuroscience Information Framework
|
||||
Cell Centered Database – Neuron
|
||||
Complete list of neuron types according to the Petilla convention, at NeuroLex.
|
||||
NeuroMorpho.Org an online database of digital reconstructions of neuronal morphology.
|
||||
Immunohistochemistry Image Gallery: Neuron
|
||||
Khan Academy: Anatomy of a neuron
|
||||
Neuron images
|
||||
80
data/en.wikipedia.org/wiki/Never_event-0.md
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80
data/en.wikipedia.org/wiki/Never_event-0.md
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@ -0,0 +1,80 @@
|
||||
---
|
||||
title: "Never event"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Never_event"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:10.544218+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
In medicine, a never event is the "kind of mistake (medical error) that should never happen".
|
||||
According to the Leapfrog Group never events are defined as "adverse events that are serious, largely preventable, and of concern to both the public and health care providers for the purpose of public accountability."
|
||||
A 2012 study reported there may be as many as 1,500 instances of one never event, a retained foreign object, per year in the United States. The same study suggests an estimated total of surgical mistakes at just over 4,000 per year in the United States, but these statistics are extrapolations from small samples rather than actual event counts.
|
||||
|
||||
|
||||
== United States ==
|
||||
A list of events was compiled by the National Quality Forum and updated in 2012.
|
||||
The NQF’s report recommends a national state-based event reporting system to improve the quality of patient care.
|
||||
|
||||
Artificial insemination with the wrong donor sperm or donor egg
|
||||
Unintended retention of a foreign body in a patient after surgery or other procedure
|
||||
Patient death or serious disability associated with patient elopement (disappearance)
|
||||
Patient death or serious disability associated with a medication error (e.g., errors involving the wrong drug, dose, patient, time, rate, preparation or route of administration)
|
||||
Patient death or serious disability associated with a hemolytic reaction due to the administration of ABO/HLA-incompatible blood or blood products
|
||||
Patient death or serious disability associated with an electric shock or elective cardioversion while being cared for in a healthcare facility
|
||||
Patient death or serious disability associated with a fall while being cared for in a healthcare facility
|
||||
Surgery performed on the wrong body part
|
||||
Surgery performed on the wrong patient
|
||||
Wrong surgical procedure performed on a patient
|
||||
Intraoperative or immediately postoperative death in an ASA Class I patient
|
||||
Patient death or serious disability associated with the use of contaminated drugs, devices, or biologics provided by the healthcare facility
|
||||
Patient death or serious disability associated with the use or function of a device in patient care, in which the device is used or functions other than as intended
|
||||
Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a healthcare facility
|
||||
Infant discharged to the wrong person
|
||||
Patient suicide, or attempted suicide resulting in serious disability, while being cared for in a healthcare facility
|
||||
Maternal death or serious disability associated with labor or delivery in a low-risk pregnancy while being cared for in a health care facility
|
||||
Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility
|
||||
Death or serious disability (kernicterus) associated with failure to identify and treat hyperbilirubinemia in neonates
|
||||
Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility
|
||||
Patient death or serious disability due to spinal manipulative therapy
|
||||
Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances
|
||||
Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility
|
||||
Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility
|
||||
Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider
|
||||
Abduction of a patient of any age
|
||||
Sexual assault on a patient within or on the grounds of the healthcare facility
|
||||
Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of the healthcare facility
|
||||
As of 2019, 11 states have mandated reporting for never events, and an additional 16 states have mandated reporting for serious adverse events including never events.
|
||||
|
||||
|
||||
== United Kingdom ==
|
||||
The National Patient Safety Agency produced a list of eight core never events in March 2009:
|
||||
|
||||
Wrong site surgery
|
||||
Retained instrument postoperation
|
||||
Wrong route administration of chemotherapy
|
||||
Misplaced nasogastric or orogastric tube not detected before use
|
||||
Inpatient suicide using non-collapsible rails
|
||||
Escape from within the secure perimeter of medium or high security mental health services by patients who are transferred prisoners
|
||||
In-hospital maternal death from post-partum haemorrhage after elective caesarean section
|
||||
Intravenous administration of mis-selected concentrated potassium chloride
|
||||
NHS England produced a report on 148 reported never events in the period from April to September 2013 highlighting particular hospitals with more than one such event. In 2021 there were still about 500 never events each year in the English NHS. According to Jeremy Hunt a hospital can get as many as 108 safety related instructions in a year.
|
||||
NHS Improvement has produced monthly and cumulative annual reports since 2015, when the definition of what constitutes a Never Event in the NHS also changed to require not only actual patient harm but also the potential for significant actual harm. Annual counts have therefore increased, and comparing recent with older data is misleading. The definition continues to undergo more minor change. A provisional report for the 10 month period 1 April 2017 to 31 January 2018 acknowledged 393 never events within NHS England, including 172 wrong site surgeries, 97 retained foreign body post procedures, 60 wrong implants/prostheses and 31 medication administration errors.
|
||||
|
||||
|
||||
== Recommended actions following a never event ==
|
||||
The Leapfrog Group suggested four actions to be taken following a never event:
|
||||
|
||||
Apologize to the patient
|
||||
Report the event
|
||||
Perform a root cause analysis
|
||||
Waive costs directly related to the event
|
||||
|
||||
|
||||
== See also ==
|
||||
Hospital-acquired condition
|
||||
Sentinel event
|
||||
|
||||
|
||||
== References ==
|
||||
35
data/en.wikipedia.org/wiki/Nocebo-0.md
Normal file
35
data/en.wikipedia.org/wiki/Nocebo-0.md
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@ -0,0 +1,35 @@
|
||||
---
|
||||
title: "Nocebo"
|
||||
chunk: 1/2
|
||||
source: "https://en.wikipedia.org/wiki/Nocebo"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:12.972595+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
A nocebo effect is said to occur when a patient's expectations for a treatment cause the treatment to have a worse effect than it otherwise would have. For example, when a patient anticipates a side effect of a medication, they can experience that effect even if the "medication" is actually an inert substance. The complementary concept, the placebo effect, is said to occur when expectations improve an outcome.
|
||||
More generally, the nocebo effect is falling ill simply by consciously or subconsciously anticipating a harmful event. This definition includes anticipated events other than medical treatment. It has been applied to Havana syndrome, where purported victims were anticipating attacks by foreign adversaries. This definition also applies to cases of electromagnetic hypersensitivity.
|
||||
Both placebo and nocebo effects are presumably psychogenic but can induce measurable changes in the body. One article that reviewed 31 studies on nocebo effects reported a wide range of symptoms that could manifest as nocebo effects, including nausea, stomach pains, itching, bloating, depression, sleep problems, loss of appetite, sexual dysfunction, and severe hypotension.
|
||||
|
||||
== Etymology and usage ==
|
||||
Walter Kennedy coined the term nocebo (Latin nocēbō, "I shall harm", from noceō, "I harm") in 1961 to denote the counterpart of placebo (Latin placēbō, "I shall please", from placeō, "I please"), a substance that may produce a beneficial, healthful, pleasant, or desirable effect. Kennedy emphasized that his use of the term nocebo refers strictly to a subject-centered response, a quality "inherent in the patient rather than in the remedy". That is, he rejected the use of the term for pharmacologically induced negative side effects such as the ringing in the ears caused by quinine. That is not to say that the patient's psychologically induced response may not include physiological effects. For example, an expectation of pain may induce anxiety, which in turn causes the release of cholecystokinin, which facilitates pain transmission.
|
||||
|
||||
== Response ==
|
||||
In the narrowest sense, a nocebo response occurs when a drug-trial subject's symptoms are worsened by the administration of an inert, sham, or dummy (simulator) treatment, called a placebo. Placebos contain no chemicals (or any other agents) that could cause any of the observed worsening in the subject's symptoms, so any change for the worse must be due to some subjective factor. Adverse expectations can also cause anesthetic medications' analgesic effects to disappear.
|
||||
The worsening of the subject's symptoms or reduction of beneficial effects is a direct consequence of their exposure to the placebo, but the placebo has not chemically generated those symptoms. Because this generation of symptoms entails a complex of "subject-internal" activities, we can never speak in the strictest sense in terms of simulator-centered "nocebo effects", but only in terms of subject-centered "nocebo responses". Some observers attribute nocebo responses (or placebo responses) to a subject's gullibility, but there is no evidence that someone who manifests a nocebo/placebo response to one treatment will manifest a nocebo/placebo response to any other treatment; i.e., there is no fixed nocebo/placebo-responding trait or propensity.
|
||||
Based on a biosemiotic model (2022), Goli explains how harm and/or healing expectations lead to a multimodal image and form transient allostatic or homeostatic interoceptive feelings, demonstrating how repetitive experiences of a potential body induce epigenetic changes and form new attractors, such as nocebos and placeboes, in the actual body.
|
||||
|
||||
== Effects ==
|
||||
|
||||
=== Side effects of drugs ===
|
||||
It has been shown that, due to the nocebo effect, warning patients about drugs' side effects can contribute to the causation of such effects, whether the drug is real or not. This effect has been observed in clinical trials: according to a 2013 review, the dropout rate among placebo-treated patients in a meta-analysis of 41 clinical trials of Parkinson's disease treatments was 8.8%. A 2013 review found that nearly 1 out of 20 patients receiving a placebo in clinical trials for depression dropped out due to adverse events, which were believed to have been caused by the nocebo effect.
|
||||
In January 2022, a systematic review and meta-analysis concluded that nocebo responses accounted for 72% of adverse effects after the first COVID-19 vaccine dose and 52% after the second dose.
|
||||
Many studies show that the formation of nocebo responses are influenced by inappropriate health education, media work, and other discourse makers who induce health anxiety and negative expectations.
|
||||
Researchers studying the side effects of statins in UK determined that a large proportion of reported side effects were related not to any pharmacological cause but to the nocebo effect. In the UK, publicity in 2013 about the apparent side effects caused hundreds of thousands of patients to stop taking statins, leading to an estimated 2,000 additional cardiovascular events in the subsequent years.
|
||||
|
||||
=== Electromagnetic hypersensitivity ===
|
||||
Evidence suggests that the symptoms of electromagnetic hypersensitivity are caused by the nocebo effect.
|
||||
|
||||
=== Pain ===
|
||||
Verbal suggestion can cause hyperalgesia (increased sensitivity to pain) and allodynia (perception of a tactile stimulus as painful) as a result of the nocebo effect. Nocebo hyperalgesia is believed to involve the activation of cholecystokinin receptors.
|
||||
45
data/en.wikipedia.org/wiki/Nocebo-1.md
Normal file
45
data/en.wikipedia.org/wiki/Nocebo-1.md
Normal file
@ -0,0 +1,45 @@
|
||||
---
|
||||
title: "Nocebo"
|
||||
chunk: 2/2
|
||||
source: "https://en.wikipedia.org/wiki/Nocebo"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:12.972595+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
== Ambiguity of medical usage ==
|
||||
Stewart-Williams and Podd argue that using the contrasting terms "placebo" and "nocebo" for inert agents that produce pleasant, health-improving, or desirable outcomes and unpleasant, health-diminishing, or undesirable outcomes (respectively) is extremely counterproductive. For example, precisely the same inert agents can produce analgesia and hyperalgesia, the first of which, on this definition, would be a placebo, and the second a nocebo.
|
||||
A second problem is that the same effect, such as immunosuppression, may be desirable for a subject with an autoimmune disorder, but undesirable for most other subjects. Thus, in the first case, the effect would be a placebo, and in the second a nocebo. A third problem is that the prescriber does not know whether the relevant subjects consider the effects they experience desirable or undesirable until some time after the drugs have been administered. A fourth is that the same phenomena are generated in all the subjects, and generated by the same drug, which is acting in all of the subjects through the same mechanism. Yet because the phenomena in question have been subjectively considered desirable to one group but not the other, the phenomena are now being labeled in two mutually exclusive ways (i.e., placebo and nocebo), giving the false impression that the drug in question has produced two different phenomena.
|
||||
|
||||
== Ambiguity of anthropological usage ==
|
||||
Some people maintain that belief can kill (e.g., voodoo death: Cannon in 1942 describes a number of instances from a variety of different cultures) and or heal (e.g., faith healing). A self-willed death (due to voodoo hex, evil eye, pointing the bone procedure, etc.) is an extreme form of a culture-specific syndrome or mass psychogenic illness that produces a particular form of psychosomatic or psychophysiological disorder resulting in psychogenic death. Rubel in 1964 spoke of "culture-bound" syndromes, those "from which members of a particular group claim to suffer and for which their culture provides an etiology, diagnosis, preventive measures, and regimens of healing".
|
||||
Certain anthropologists, such as Robert Hahn and Arthur Kleinman, have extended the placebo/nocebo distinction into this realm to allow a distinction to be made between rituals, such as faith healing, performed to heal, cure, or bring benefit (placebo rituals) and others, such as "pointing the bone", performed to kill, injure or bring harm (nocebo rituals). As the meaning of the two interrelated and opposing terms has extended, we now find anthropologists speaking, in various contexts, of nocebo or placebo (harmful or helpful) rituals:
|
||||
|
||||
that might entail nocebo or placebo (unpleasant or pleasant) procedures;
|
||||
about which subjects might have nocebo or placebo (harmful or beneficial) beliefs;
|
||||
that are delivered by operators that might have nocebo or placebo (pathogenic, disease-generating or salutogenic, health-promoting) expectations;
|
||||
that are delivered to subjects that might have nocebo or placebo (negative, fearful, despairing or positive, hopeful, confident) expectations about the ritual;
|
||||
that are delivered by operators who might have nocebo or placebo (malevolent or benevolent) intentions, in the hope that the rituals will generate nocebo or placebo (lethal, injurious, harmful or restorative, curative, healthy) outcomes; and, that all of this depends upon the operator's overall beliefs in the nocebo ritual's harmful nature or the placebo ritual's beneficial nature.
|
||||
Yet it may become even more terminologically complex, for as Hahn and Kleinman indicate, there can also be cases of paradoxical nocebo outcomes from placebo rituals and placebo outcomes from nocebo rituals (see also unintended consequences). In 1973, writing from his extensive experience of treating cancer (including more than 1,000 melanoma cases) at Sydney Hospital, Milton warned of the impact of the delivery of a prognosis, and how many of his patients, upon receiving their prognosis, gave up hope and died a premature death: "there is a small group of patients in whom the realization of impending death is a blow so terrible that they are quite unable to adjust to it, and they die rapidly before the malignancy seems to have developed enough to cause death. This problem of self-willed death is in some ways analogous to the death produced in primitive peoples by witchcraft ('pointing the bone')".
|
||||
|
||||
== Ethics ==
|
||||
Some researchers have pointed out that the harm caused by communicating with patients about potential treatment adverse events raises an ethical issue. To respect their autonomy, one must inform a patient about harms a treatment may cause. Yet the way in which potential harms are communicated could cause additional harm, which may violate the ethical principle of non-maleficence. It is possible that nocebo effects can be reduced while respecting autonomy using different models of informed consent, including the use of a framing effect and the authorized concealment.
|
||||
|
||||
== See also ==
|
||||
|
||||
== Notes ==
|
||||
|
||||
== References ==
|
||||
|
||||
== External links ==
|
||||
|
||||
Nocebo and nocebo effect
|
||||
The nocebo response
|
||||
The Nocebo Effect: Placebo's Evil Twin
|
||||
What modifies a healing response
|
||||
The science of voodoo: When mind attacks body, New Scientist
|
||||
The Effect of Treatment Expectation on Drug Efficacy: Imaging the Analgesic Benefit of the Opioid Remifentanil
|
||||
This Video Will Hurt (The Nocebo Effect), via YouTube
|
||||
BBC Discovery program on the nocebo effect
|
||||
What is the Nocebo effect?
|
||||
@ -0,0 +1,34 @@
|
||||
---
|
||||
title: "Non-pharmacological intervention"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Non-pharmacological_intervention"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:14.294367+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
A non-pharmacological intervention (NPI) is any type of healthcare intervention which is not primarily based on medication. Some examples include exercise, sleep improvement, and dietary habits.
|
||||
Non-pharmacological interventions may be intended to prevent or treat (ameliorate or cure) diseases or other health-related conditions, or to improve public health. They can be educational and may involve a variety of lifestyle or environmental changes. Complex or multicomponent interventions use multiple strategies, and they often involve the participation of several types of care providers.
|
||||
Non-pharmacological interventions can call on various fields of expertise, such as surgery, medical devices, rehabilitation, psychotherapy, and behavioral interventions.
|
||||
|
||||
|
||||
== Examples ==
|
||||
|
||||
|
||||
=== Hypertension ===
|
||||
The first line of treatment for hypertension is lifestyle changes, including dietary changes, physical exercise, and weight loss. Although these have all been recommended in scientific advisories, a Cochrane systematic review of available relevant studies found that although weight-loss diets did reduce body weight and blood pressure, beneficial effects of those changes could not be demonstrated, owing to the small number of participants and studies, and that therefore the impact of weight loss on mortality and morbidity is unknown. Their potential effectiveness is similar to and at times exceeds a single medication. If the blood pressure is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction. Dietary changes shown to reduce blood pressure include diets containing low amounts of sodium, the DASH diet (Dietary Approaches to Stop Hypertension), vegetarian diets, and green tea consumption. Physical exercise regimens that reduce blood pressure include isometric resistance exercise, aerobic exercise, resistance exercise, and device-guided breathing.
|
||||
|
||||
|
||||
== See also ==
|
||||
|
||||
|
||||
== References ==
|
||||
|
||||
|
||||
== Further reading ==
|
||||
Boutron I, Ravaud P, Moher D, eds. (2012). Randomized clinical trials of nonpharmacological treatments. Boca Raton: CRC Press. ISBN 978-1-4200-8802-1.
|
||||
|
||||
|
||||
== External links ==
|
||||
Checklist for reporting of non-pharmacologic treatment interventions (an extension of the CONSORT statement for Consolidated Standards of Reporting Trials).
|
||||
33
data/en.wikipedia.org/wiki/Nosokinetics-0.md
Normal file
33
data/en.wikipedia.org/wiki/Nosokinetics-0.md
Normal file
@ -0,0 +1,33 @@
|
||||
---
|
||||
title: "Nosokinetics"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Nosokinetics"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:15.487225+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Nosokinetics is the science/subject of measuring and modelling the process of care in health and social care systems. Nosokinetics brings together the Greek words for noso: disease and kinetics: movement.
|
||||
Black box models are currently used to plan changes in health and social care systems. These input-output models overlook the process of inpatient care, as a result suboptimal decisions are made. Nosokinetics, (analogous to Pharmacokinetics), seeks to develop dynamic methods which measure and model the process of inpatient care. The aim is to develop a scientific base to underpin the planning of sustainable health and social care systems.
|
||||
|
||||
|
||||
== Establishment ==
|
||||
Nosokinetics is a new science that was established in the UK in the early 1990s by Prof Peter H Millard after publishing his PhD thesis. In 2004 Nosokinetics group newsletter was established.
|
||||
|
||||
|
||||
== Origin ==
|
||||
Prof Peter H Millard writes about Nosokinetics : "If the random forces of wind and tide can make such a beautiful statue (referring to an iceberg), how much better could mankind do if a new science was developed which explains the complex processes of health and social care. Until new methods of planning health and social care services to meet the needs of an ageing population are introduced, service delivery will stumble on from crisis to crisis. The world population is ageing and sustainable systems of health care need to be developed."
|
||||
He has established the nosokinetics group of interested researchers. The group collaborates to organize conferences and disseminates news of nosokinetics and other researchers' research and practical use of modelling to enhance decision making in health and social care systems.
|
||||
|
||||
|
||||
== Network ==
|
||||
The Nosokinetics Group has succeeded in attracting a lot of researchers. Nosokinetics interested people are present in many countries including Australia, UK & Egypt. They are from different disciplines ranging from health care providers to management scientists. The news related to nosokinetics is shared to the network through the bimonthly newsletter Nosokinetics News which helps to communicate papers, conferences and events of interest to the Nosokinetics network.
|
||||
|
||||
|
||||
== See also ==
|
||||
Health administration
|
||||
Association of University Programs in Health Administration
|
||||
|
||||
|
||||
== References ==
|
||||
69
data/en.wikipedia.org/wiki/Nosology-0.md
Normal file
69
data/en.wikipedia.org/wiki/Nosology-0.md
Normal file
@ -0,0 +1,69 @@
|
||||
---
|
||||
title: "Nosology"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Nosology"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:16.804017+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Nosology (from Ancient Greek νόσος (nosos) 'disease' and -λογία (-logia) 'study of') is the branch of medical science that deals with the classification of diseases. Fully classifying a medical condition requires knowing its cause (and that there is only one cause), the effects it has on the body, the symptoms that are produced, and other factors. For example, influenza is classified as an infectious disease because it is caused by a virus, and it is classified as a respiratory infection because the virus infects and damages certain tissues in the respiratory tract. The more that is known about the disease, the more ways the disease can be classified nosologically.
|
||||
Nosography is a description whose primary purpose is enabling a diagnostic label to be put on the situation. As such, a nosographical entity need not have a single cause. For example, inability to speak due to advanced dementia and an inability to speak due to a stroke could be nosologically different but nosographically the same.
|
||||
|
||||
|
||||
== Types of classification ==
|
||||
Diseases may be classified by cause, pathogenesis (mechanism by which the disease progresses), or by symptom(s).
|
||||
Alternatively, diseases may be classified according to the organ system involved, though this is often complicated since many diseases affect more than one organ.
|
||||
Traditionally diseases were defined as syndromes by their symptoms. When more information is available, they are also defined by the damage they produce. When cause is known, they are better defined by their cause, though still important are their characteristics. This leads to a branching differentiation in which a clinical syndrome (pattern of signs and symptoms) can come to be understood as a nonspecific finding shared by a group of disease entities or endotypes. For example, concepts such as murrain and the grippe that were formerly undifferentiable to humans and thus understood as a single disease later can be logically unraveled as separate diseases with similar clinical presentations. Thus, nosology is dynamic, reclassifying as science advances.
|
||||
The advent of molecular biology brought a further reclassification potential with the concept of molecularly defined diseases, defined by their molecular characteristics. This concept was introduced in 1949, with the seminal paper, "Sickle Cell Anemia, a Molecular Disease", in Science magazine, Linus Pauling, Harvey Itano and their collaborators laid the groundwork for establishing the field of molecular medicine. Molecular medicine, in concert with genetics and genomics as aspects of molecular biology, provided new instances of the theme that clinical presentations that humans formerly interpreted as a single disease can be subclassified into a group of disease entities or endotypes. For example, many OMIM database entries show the pattern of disease name XYZ with types identified as XYZ1 (involving sequence variants in gene A), XYZ2 (involving sequence variants in gene B), XYZ3 (involving sequence variants in gene C), XYZ4 (involving sequence variants in both genes B and C), and so on.
|
||||
|
||||
|
||||
== Coding systems ==
|
||||
Several classifications of diseases have been historically proposed, and normally all of them assign a code to every supported disease. Some of them codify diseases following the path of the classification tree, and others like SNOMED use a multifactor classification system.
|
||||
The most known coding system is the World Health Organization ICD-Series, but there are other accepted classifications like DOCLE, NANDA or SNOMED. Historically there were others like the Berkson Coding System that are not maintained anymore.
|
||||
There are also coding systems for symptoms present in the diseases and biological findings. They are normally included in medical dictionaries, also with a codification system. Some of them are MeSH (Medical Subject Headings), COSTART (Coding Symbols for Thesaurus of Adverse Reaction Terms) or MedDRA (Medical Dictionary for Regulatory Activities) Other systems like Current Procedural Terminology do not deal directly with diseases but with the related procedures.
|
||||
|
||||
|
||||
== Extended nosology and general medical conditions ==
|
||||
In a wide sense, nosology deals not only with diseases, but with any kind of medical condition, like injuries, lesions or disorders.
|
||||
Medical conditions, like diseases, can be defined by cause, pathogenesis (mechanism by which the disease is caused), or by a collection of symptoms, medical signs and biomarkers, particularly when the other two definitions are not available (idiopathic diseases).
|
||||
|
||||
From a nosological point of view, medical conditions can be divided in disorders, diseases, syndromes, lesions and injuries, each one with some specific meaning, as listed at Disease § Terminology.
|
||||
|
||||
|
||||
== History ==
|
||||
Ancient medical treatises had a variety of different ways of classifying and grouping illnesses. Chinese texts like the Huangdi Neijing categorized diseases by which of the atmospheric influences was believed to be responsible for them. Many ancient Greek, Mesopotamian, Roman, and Egyptian authors categorized diseases by the body parts they affected, while others divided diseases into acute or chronic illnesses. Mental disorders were classified into categories like mania and paranoia by Hippocrates, and this system was utilized by later authors like Najib ad-Din Samarqandi.
|
||||
Many popular ancient disease classification systems largely relied upon humorism, which carried over into medieval times. Early attempts to develop more comprehensive approaches to the classification of diseases were made by Jean Fernel in the 16th century. Early modern nosological efforts grouped diseases by their symptoms, whereas modern systems focus on grouping diseases by the anatomy and cause involved.
|
||||
In the 17th century, the English physician Thomas Sydenham was the first to propose a syndrome-based classification of diseases. For Sydenham a disease and a syndrome were equivalent concepts.
|
||||
In the 18th century, the taxonomist Carl Linnaeus, Francois Boissier de Sauvages, and psychiatrist Philippe Pinel developed an early classification of physical illnesses. In the late 19th century, Emil Kraepelin and then Jacques Bertillon developed their own nosologies. Bertillon's work, classifying causes of death, was a precursor of the modern code system, the International Classification of Diseases.
|
||||
|
||||
|
||||
== Applications ==
|
||||
Nosology is used extensively in public health, to allow epidemiological studies of public health issues. Analysis of death certificates requires nosological coding of causes of death.
|
||||
Nosological classifications are used in medical administration, such as filing of health insurance claims, and patient records.
|
||||
|
||||
|
||||
== See also ==
|
||||
Clinical coder
|
||||
Diagnosis code
|
||||
Differential diagnosis
|
||||
International Statistical Classification of Diseases and Related Health Problems (ICD)
|
||||
ICD-10 (ICD 10th Revision)
|
||||
Medical classification
|
||||
Pathology (study of disease)
|
||||
Category:Diseases and disorders (Wikipedia's categorization of diseases)
|
||||
Symptomatology – study of individual symptoms
|
||||
|
||||
|
||||
== References ==
|
||||
|
||||
|
||||
== Further reading ==
|
||||
Snider, G. L. (2003). "Nosology for Our Day". American Journal of Respiratory and Critical Care Medicine. 167 (5): 678–683. doi:10.1164/rccm.200203-204PP. PMID 12598211.
|
||||
C. S. Herrman, "The Bipolar Spectrum", SSRN (Social Science Research Network, 5 August 2010)
|
||||
|
||||
|
||||
== External links ==
|
||||
|
||||
International Classification of Diseases (ICD-10) by the World Health Organization
|
||||
40
data/en.wikipedia.org/wiki/Not_otherwise_specified-0.md
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40
data/en.wikipedia.org/wiki/Not_otherwise_specified-0.md
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|
||||
---
|
||||
title: "Not otherwise specified"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Not_otherwise_specified"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:18.001904+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
In medicine, not otherwise specified (NOS) is a subcategory in systems of disease/disorder classification such as ICD-9, ICD-10, or DSM-IV. It is generally used to note the presence of an illness where the symptoms presented were sufficient to make a general diagnosis, but where a specific diagnosis was not made. The DSM-IV, for example, "applies the term not otherwise specified (NOS) to a disorder or disturbance that does not meet the criteria for the specific disorders already discussed". The term was introduced because "it is sometimes impossible for the practitioner completing the diagnostic assessment to categorize all the symptoms that a client is experiencing into one diagnostic category". In the context of mental health diagnoses, four situations have been outlined for which such a diagnosis may be considered appropriate:
|
||||
|
||||
Client meets the general guidelines for a disorder, yet not all of the criteria are met, or the ones present are not considered clinically significant.
|
||||
Significant behaviors are noted affecting social and occupational functioning, but are not considered part of the usual presentation for a disorder.
|
||||
Uncertainty about etiology or the cause of the disorder exists. This is especially important when it is suspected that the disorder may be related to a general medical condition.
|
||||
Insufficient information exists to fully support assigning behaviors to a particular mental disorder in the category, but the general criteria for the category of disorders are evident.
|
||||
It is noted, however, that the use of an NOS classification invites scrutiny when billing or seeking reimbursement for practitioners.
|
||||
|
||||
|
||||
== Examples ==
|
||||
This classification is commonly used in psychiatric diagnoses, such as in:
|
||||
|
||||
DD-NOS, depressive disorder
|
||||
ED-NOS, eating disorder
|
||||
MD-NOS, mood disorder
|
||||
PD-NOS, personality disorder
|
||||
PDD-NOS, pervasive developmental disorder
|
||||
Psychotic disorder not otherwise specified, psychotic disorder
|
||||
Dissociative disorder not otherwise specified, dissociative disorder
|
||||
It is also used in the conditions:
|
||||
|
||||
PTCL-NOS, peripheral T-cell lymphoma not otherwise specified
|
||||
Adenocarcinoma not otherwise specified
|
||||
The ICD-10 also uses this phrase for various things, such as:
|
||||
|
||||
Fall from, out of or through building, not otherwise specified (W13.9)
|
||||
The phrase is also used within the List of UN numbers, where it refers to a generic entry, e.g. "UN 1993: Flammable liquid, N.O.S.".
|
||||
|
||||
|
||||
== References ==
|
||||
36
data/en.wikipedia.org/wiki/Nothing_by_mouth-0.md
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36
data/en.wikipedia.org/wiki/Nothing_by_mouth-0.md
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|
||||
---
|
||||
title: "Nothing by mouth"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Nothing_by_mouth"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:11.785494+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Nothing by mouth is an American medical instruction meaning to withhold food and fluids. It is also known as nil per os (npo or NPO), a Latin phrase that translates to English as "nothing through the mouth". Nil by mouth is the term used in the UK (NBM), nihil/non/nulla per os, or complete bowel rest. A liquid-only diet may also be referred to as bowel rest.
|
||||
NPO is one of the abbreviations that is not used in AMA style; "nothing by mouth" is spelled out instead.
|
||||
|
||||
|
||||
== Purpose ==
|
||||
The typical reason for NPO instructions is the prevention of aspiration pneumonia, e.g. in those who will undergo general anesthesia, or those with weak swallowing musculature, or in case of gastrointestinal bleeding, gastrointestinal blockage, or acute pancreatitis. Alcohol overdoses that result in vomiting or severe external bleeding also warrant NPO instructions for a period.
|
||||
|
||||
|
||||
== Duration ==
|
||||
Pre-surgery NPO orders are typically between 6 and 12 hours prior to surgery, through recovery suite discharge, but may be longer if long acting medications or oral post-meds were administered. It is not uncommon for the food NPO period to be longer than that for liquid, as the American Board of Anesthesiology advises against liquid NPO periods greater than eight hours. The NPO periods for illness tend to be much longer, although exceptions are made for small scheduled amounts of water consumption if an IV drip is not in use. With sufficient IV fluids, NPO periods of several days have been utilized successfully in non-diabetic patients (although short NPO periods in patients with diabetes are possible with IV fluids, insulin, and dextrose. Extended periods (greater than 12 hours) are still contraindicated).
|
||||
The American Board of Anesthesiology recommends that patients should not eat solid food for at least 8 hours prior to a procedure, and should not drink even clear liquids for at least 2 hours prior. Clear liquid fasting includes water, juices without pulp, carbonated beverages, clear tea, and black coffee. Ingestion of water 2 hours prior to a procedure results in smaller gastric volumes and higher gastric pH when compared with those who ingested > 4 hours prior. The volume of liquid is less important than the type of liquid ingested. Non-emergency surgical cases should be delayed for NPO status.
|
||||
When nothing by mouth or a liquid-only diet is indicated for an extended period, enteral feeding or total parenteral nutrition may be recommended.
|
||||
|
||||
|
||||
== Unrestricted clear fluids ==
|
||||
Fasting guidelines often restrict the intake of any oral fluid after two to six hours preoperatively. However, it has been demonstrated in a large retrospective analysis in Torbay Hospital that unrestricted clear oral fluids right up until transfer to theatre could significantly reduce the incidence of postoperative nausea and vomiting without an increased risk in the adverse outcomes for which such conservative guidance exists.
|
||||
|
||||
|
||||
== See also ==
|
||||
List of abbreviations used in medical prescriptions
|
||||
List of Latin phrases
|
||||
Per os
|
||||
Preoperative fasting
|
||||
|
||||
|
||||
== References ==
|
||||
32
data/en.wikipedia.org/wiki/Ocular_prosthesis-0.md
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32
data/en.wikipedia.org/wiki/Ocular_prosthesis-0.md
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@ -0,0 +1,32 @@
|
||||
---
|
||||
title: "Ocular prosthesis"
|
||||
chunk: 1/6
|
||||
source: "https://en.wikipedia.org/wiki/Ocular_prosthesis"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:20.544903+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
An ocular prosthesis, artificial eye or glass eye is a type of craniofacial prosthesis that replaces an absent natural eye following an enucleation, evisceration, or orbital exenteration. Someone with an ocular prosthesis is altogether blind on the affected side and has monocular (one sided) vision.
|
||||
The prosthesis fits over an orbital implant and under the eyelids. The ocular prosthesis roughly takes the shape of a convex shell and is made of medical grade acrylic plastic. A few ocular prostheses today are made of cryolite glass. A variant of the ocular prosthesis is a very thin hard shell known as a scleral shell which can be worn over a damaged or eviscerated eye. Makers of ocular prosthetics are known as ocularists. Ocularists are surprisingly rare: as of 2025, there were fewer than 200 certified practitioners in the United States, and only around three dozen in India.
|
||||
Visual prosthesis are currently in research which could provide vision to the artificial eye.
|
||||
|
||||
== History ==
|
||||
|
||||
The earliest known evidence of the use of ocular prosthesis is that of a woman found in Shahr-I Sokhta, Iran dating back to 2900–2800 BC. It has a hemispherical form and a diameter of just over 2.5 cm (1 inch). It consists of very light material, probably bitumen paste. The surface of the artificial eye is covered with a thin layer of gold, engraved with a central circle (representing the iris) and gold lines patterned like sun rays. On both sides of the eye are drilled tiny holes, through which a golden thread could hold the eyeball in place. Since microscopic research has shown that the eye socket showed clear imprints of the golden thread, the eyeball must have been worn during her lifetime. In addition to this, an early Hebrew text references a woman who wore an artificial eye made of gold. Roman and Egyptian priests are known to have produced artificial eyes as early as the fifth century BC constructed from painted clay attached to cloth and worn outside the socket.
|
||||
The first in-socket artificial eyes were made of gold with colored enamel, later evolving into the use of glass by the Venetians in the later part of the sixteenth century. These were crude, uncomfortable, and fragile and the production methodology remained known only to Venetians until the end of the 18th century, when Paris took over as the center for artificial eye-making. But the center shifted again, this time to Germany because of their superior glass blowing techniques. Shortly following the introduction of the art of glass eye-making to the United States, German goods became unavailable because of World War II. As a result, the US instead made artificial eyes from the plastic polymethyl methacrylate (PMMA), commonly known as acrylic.
|
||||
Production of modern ocular prosthetics has expanded from simply using glass into many different types of materials. In the United States, most custom ocular prostheses are fabricated from acrylic. In some countries, Germany especially, prostheses are still most commonly made from glass.
|
||||
|
||||
=== Limits of realism ===
|
||||
Ocularist surgeons have always worked together to make artificial eyes look more realistic. For decades, all efforts and investments to improve the appearance of artificial eyes have been dampened by the immobility of the pupil. One solution to this problem has been demonstrated recently in a device based on an LCD which simulates the pupil size as a function of the ambient light.
|
||||
|
||||
== Implant types and chemical construction ==
|
||||
There are many different types of implants, classification ranging from shape (spherical vs egg (oval) shaped), stock vs custom, porous vs nonporous, specific chemical make-up, and the presence of a peg or motility post. The most basic simplification can be to divide implant types into two main groups: non-integrated (non-porous) and integrated (porous).
|
||||
|
||||
=== Nonintegrated implants ===
|
||||
Though there is evidence that ocular implants have been around for thousands of years, modern nonintegrated spherical intraconal implants came into existence around 1976 . Nonintegrated implants contain no unique apparatus for attachments to the extraocular muscles and do not allow in-growth of organic tissue into their inorganic substance. Such implants have no direct attachment to the ocular prosthesis. Usually, these implants are covered with a material that permits fixation of the extraocular recti muscles, such as donor sclera or polyester gauze which improves implant motility, but does not allow for direct mechanical coupling between the implant and the artificial eye. Non-integrated implants include acrylic, glass, and silicone spheres.
|
||||
|
||||
==== Polymethyl methacrylate (PMMA) (acrylic) ====
|
||||
Polymethyl methacrylate (PMMA), commonly known as acrylic, is a transparent thermoplastic available for use as ocular prosthesis, replacement intraocular lenses when the original lens has been removed in the treatment of cataracts and has historically been used as hard contact lenses.
|
||||
PMMA has a good degree of compatibility with human tissue, much more so than glass. Although various materials have been used to make nonintegrated implants in the past, polymethyl methacrylate is one of the implants of choice.
|
||||
28
data/en.wikipedia.org/wiki/Ocular_prosthesis-1.md
Normal file
28
data/en.wikipedia.org/wiki/Ocular_prosthesis-1.md
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@ -0,0 +1,28 @@
|
||||
---
|
||||
title: "Ocular prosthesis"
|
||||
chunk: 2/6
|
||||
source: "https://en.wikipedia.org/wiki/Ocular_prosthesis"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:20.544903+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
=== Integrated implants (porous) ===
|
||||
The porous nature of integrated implants allows fibrovascular ingrowth throughout the implant and thus also insertion of pegs or posts. Because direct mechanical coupling is thought to improve artificial eye motility, attempts have been made to develop so-called 'integrated implants' that are directly connected to the artificial eye. Historically, implants that directly attached to the prosthesis were unsuccessful because of chronic inflammation or infection arising from the exposed nonporous implant material. This led to the development of quasi-integrated implants with a specially designed anterior surface that allegedly better transferred implant motility to the artificial eye through the closed conjunctiva and Tenon's capsule. In 1985, the problems associated with integrated implants were thought to be largely solved with the introduction of spherical implants made of porous calcium hydroxyapatite. This material allows for fibrovascular ingrowth within several months. Porous enucleation implants currently are fabricated from a variety of materials including natural and synthetic hydroxyapatite, aluminium oxide, and polyethylene.
|
||||
The surgeon can alter the contour of porous implants before insertion, and it is also possible to modify the contour in situ, although this is sometimes difficult.
|
||||
|
||||
==== Hydroxyapatite (HA) ====
|
||||
Hydroxyapatite implants are spherical and made in a variety of sizes and different materials (coralline/synthetic).
|
||||
Since their approval by the Food and Drug Administration in 1989, spherical hydroxyapatite implants have gained widespread popularity as an enucleation implant and was at one point the most commonly used orbital implant in the United States. The porous nature of this material allows fibrovascular ingrowth throughout the implant and permits insertion of a coupling device (PEG) with reduced risk of inflammation or infection associated with earlier types of exposed integrated implants.
|
||||
Hydroxyapatite is limited to preformed (stock) spheres (for enucleation) or granules (for building up defects).
|
||||
One main disadvantage of HA is that it needs to be covered with exogenous material, such as sclera, polyethylene terephthalate, or vicryl mesh (which has the disadvantage of creating a rough implant tissue interface that can lead to technical difficulties in implantation and subsequent erosion of overlying tissue with the end stage being extrusion), as direct suturing is not possible for muscle attachment. Scleral covering carries with it the risk of transmission of infection, inflammation, and rejection.
|
||||
A 2008 study showed that HA has a more rapid rate of fibrovascularization than MEDPOR, a high-density porous polyethylene implant manufactured from linear high-density polyethylene.
|
||||
|
||||
==== Porous polyethylene (PP) ====
|
||||
Development in polymer chemistry has allowed introduction of newer biocompatible material such as porous polyethylene (PP) to be introduced into the field of orbital implant surgery. Porous polyethylene enucleation implants have been used since at least 1989. It is available in dozens of prefabricated spherical and non-spherical shapes and in different sizes or plain blocks for individualized intraoperative customizing. The material is firm but malleable and allows direct suturing of muscles to implant without wrapping or extra steps. Additionally, the smooth surface is less abrasive and irritating than other materials used for similar purposes. Polyethylene also becomes vascularized, allowing placement of a titanium motility post that joins the implant to the prosthesis in the same way that the peg is used for hydroxyapatite implants.
|
||||
PP has been shown to have a good outcome, and in 2004, it was the most commonly used orbital implant in the United States. Porous polyethylene fulfills several criteria for a successful implant, including little propensity to migrate and restoration of defect in an anatomic fashion; it is readily available, cost-effective, and can be easily modified or custom-fit for each defect. The PP implant does not require to be covered and therefore avoids some of the problems associated with hydroxyapatite implants.
|
||||
|
||||
==== Bioceramic ====
|
||||
Bioceramic prosthetics are made of aluminium oxide (Al2O3). Aluminium oxide is a ceramic biomaterial that has been used for more than 35 years in the orthopedic and dental fields for a variety of prosthetic applications because of its low friction, durability, stability, and inertness. Aluminium oxide ocular implants can be obtained in spherical and non-spherical (egg-shaped) shapes and in different sizes for use in the anophthalmic socket. It received US Food and Drug Administration approval in April 2000 and was approved by Health and Welfare, Canada, in February 2001.
|
||||
Aluminium oxide has previously been shown to be more biocompatible than HA in cell culture studies and has been suggested as the standard reference material when biocompatibility studies are required to investigate new products. The rate of exposure previously associated with the bioceramic implant (2%) was less than most reports on the HA or porous polyethylene implant (0% to 50%).
|
||||
22
data/en.wikipedia.org/wiki/Ocular_prosthesis-2.md
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22
data/en.wikipedia.org/wiki/Ocular_prosthesis-2.md
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@ -0,0 +1,22 @@
|
||||
---
|
||||
title: "Ocular prosthesis"
|
||||
chunk: 3/6
|
||||
source: "https://en.wikipedia.org/wiki/Ocular_prosthesis"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:20.544903+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
==== Conical orbital implant (COI) and multipurpose conical orbital implant (MCOI) ====
|
||||
The safe and effective sphere (still popular and easy to use) was supplemented with the pyramid or COI implant. The COI has unique design elements that have been incorporated into an overall conical shape, including a flat anterior surface, superior projection and preformed channels for the rectus muscles. 5-0 Vicryl suture needles can be passed with slight difficulty straight through the implant to be tied on the anterior surface. In addition, this implant features a slightly recessed slot for the superior rectus and a protrusion to fill the superior fornix.
|
||||
As of 2005 the newest model is the multipurpose conical orbital implant (MCOI), which was designed to address the issues of the postoperative anophthalmic orbit being at risk for the development of socket abnormalities including enophthalmos, retraction of the upper eyelid, deepening of the superior sulcus, backward tilt of the prothesis, and stretching of the lower eyelid after evisceration or enucleation. These problems are generally thought to be secondary to orbital volume deficiencies which is also addressed by MCOIs. The conical shape of the MCOI more closely matches the anatomic shape of the orbit than a spherical implant. The wider anterior portion, combined with the narrower and longer posterior portion, allows for a more complete and natural replacement of the lost orbital volume. This shape reduces the risk of superior sulcus deformity and puts more volume within the muscle cone. Muscles can be placed at any location the surgeon desires with these implants. This is advantageous for cases of damaged or lost muscles after trauma, and the remaining muscles are transposed to improve postoperative motility. In anticipation of future peg placement there is a 6 mm (0.24 in) diameter flattened surface, which eliminates the need to shave a flat anterior surface prior to peg placement.
|
||||
Both implants (COI and MCOI) are composed of interconnecting channels that allow ingrowth of host connective tissue. Complete implant vascularization reduces the risk of infection, extrusion, and other complications associated with nonintegrated implants. Additionally, both implants produce superior motility and postoperative cosmesis.
|
||||
|
||||
==== Pegged (motility post) implants ====
|
||||
In hydroxyapatite implants, a secondary procedure can insert an externalized, round-headed peg or screw into the implant. The prosthesis is modified to accommodate the peg, creating a ball-and-socket joint. After fibrovascular ingrowth is completed, a small hole can be drilled into the anterior surface of the implant. After conjunctivalization of this hole, it can be fitted with a peg with a rounded top that fits into a corresponding dimple at the posterior surface of the artificial eye. This peg thus directly transfers implant motility to the artificial eye. However, the motility peg is mounted in a minority of patients. This may partially be due to problems associated with peg placement, whereas hydroxyapatite implants are assumed to yield superior artificial eye motility even without the peg.
|
||||
Polyethylene also becomes vascularized, allowing placement of a titanium motility post that joins the implant to the prosthesis in the same way that the peg is used for hydroxyapatite implants.
|
||||
|
||||
== Implant movement ==
|
||||
Implant and prosthesis movement are important aspects of the overall cosmetic appearance after enucleation, and are essential to the objective of crafting a lifelike eye similar in all aspects to the normal fellow eye. There are several theories of improved eye movement, such as using integrating prosthetic material, pegging the implant, covering the implant (e.g. with scleral tissue), or suturing the eye muscles directly to the prosthetic implant. The efficiency of transmitting movement from the implant to the prosthesis determines the degree of prosthetic motility. Movement is transmitted from traditional nonporous spherical implants through the surface tension at the conjunctival–prosthetic interface and movement of the fornices. Quasi-integrated implants have irregularly shaped surfaces that create an indirect coupling mechanism between the implant and prosthesis that imparts greater movement to the prosthesis. Directly integrating the implant to the prosthesis through an externalized coupling mechanism would be expected to improve motility further.
|
||||
Despite the reasoning stating that hydroxyapatite orbital implants without a motility peg would yield a superior artificial eye motility, when similar surgical techniques are used, unpegged porous (hydroxyapatite) enucleation implants and donor sclera-covered nonporous (acrylic) spherical enucleation implants yield comparable artificial eye motility. In two studies, there were no differences in maximum amplitude between hydroxyapatite and acrylic or silicone spherical enucleation implants, thus indicating that the implant material itself may not have a bearing on implant movement as long as the muscles are attached directly or indirectly to the implant and the implant is not pegged. The motility of a nonintegrated artificial eye may be caused by at least two forces:
|
||||
46
data/en.wikipedia.org/wiki/Ocular_prosthesis-3.md
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46
data/en.wikipedia.org/wiki/Ocular_prosthesis-3.md
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@ -0,0 +1,46 @@
|
||||
---
|
||||
title: "Ocular prosthesis"
|
||||
chunk: 4/6
|
||||
source: "https://en.wikipedia.org/wiki/Ocular_prosthesis"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:20.544903+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
The rubbing force between the posterior surface of the artificial eye and the conjunctiva that covers the implant may cause the artificial eye to move. Because this force is likely to be approximately equal in all directions, it would cause comparable horizontal and vertical artificial eye amplitudes.
|
||||
An artificial eye usually fits snugly in the conjunctival space (possibly not in the superior fornix). Therefore, any movement of the conjunctival fornices will cause a similar movement of the artificial eye, whereas lack of movement of the fornices will restrict its motility.
|
||||
Imbrication of the rectus muscles over a nonintegrated implant traditionally was thought to impart movement to the implant and prosthesis. Like a ball-and-socket joint, when the implant moves, the prosthesis moves. However, because the so-called ball and socket are separated by layers of Tenon's capsule, imbricated muscles, and conjunctiva, the mechanical efficiency of transmission of movement from the implant to the prosthesis is suboptimal. Moreover, the concern is that imbrication of the recti over nonintegrated implants actually can result in implant migration. The recent myoconjuctival technique of enucleation is an alternative to muscle imbrication.
|
||||
Although it is generally accepted that integrating the prosthesis to a porous implant with peg insertion enhances prosthetic movement, there is little available evidence in the literature that documents the degree of improvement. In addition to this, although the porous implants have been reported to offer improved implant movement, these are more expensive and intrusive, require wrapping and subsequent imaging to determine vascularization and pegging to provide for better transmission of implant movement to the prosthesis, and are prone to implant exposure.
|
||||
Age and size of the implant may also affect the motility, since in a study comparing patients with hydroxyapatite implants and patients with nonporous implants, the implant movement appeared to decrease with age in both groups. This study also demonstrated improved movement of larger implants irrespective of material.
|
||||
|
||||
== Surgical procedure ==
|
||||
Enucleation and orbital implantation surgery follows these steps:
|
||||
|
||||
Anesthesia
|
||||
Conjunctival peritomy
|
||||
Separation of the anterior Tenon's fascia from the sclera
|
||||
Pass sutures through rectus muscles
|
||||
Rectus muscles disinserted from the globe
|
||||
Rotate and elevate the globe
|
||||
Open Tenon's capsule to visualize optic nerve
|
||||
Cauterize necessary blood vessels
|
||||
Divide the nerve
|
||||
Remove the eye
|
||||
Hemostasis is achieved with either cautery or digital pressure
|
||||
Insert orbital implant.
|
||||
If necessary (hydroxyapatite) cover the implant with wrapping material before
|
||||
Attach the muscle (if possible) either directly (PP) or indirectly (HA) to implant.
|
||||
Create fenestrations in wrapping material if necessary
|
||||
For HA implants drill 1 mm holes as muscle insertion site
|
||||
Draw Tenon's fascia over implant
|
||||
Close Tenon's facia in one or two layers
|
||||
Suture conjunctiva
|
||||
Insert temporary ocular conformer until prosthesis is received (4–8 weeks later)
|
||||
After implant vascularization, an optional secondary procedure can be done to place a couple peg or post.
|
||||
Also under anesthesia:
|
||||
|
||||
Create conjunctival incision at the peg insertion site
|
||||
Create hole into implant to insert peg or post
|
||||
Modify prosthesis to receive peg/post.
|
||||
The surgery is done under general anesthesia with the addition of extra subconjunctival and/or retrobulbar anesthetics injected locally in some cases. The following is a description of the surgical procedure performed by Custer et al.:
|
||||
22
data/en.wikipedia.org/wiki/Ocular_prosthesis-4.md
Normal file
22
data/en.wikipedia.org/wiki/Ocular_prosthesis-4.md
Normal file
@ -0,0 +1,22 @@
|
||||
---
|
||||
title: "Ocular prosthesis"
|
||||
chunk: 5/6
|
||||
source: "https://en.wikipedia.org/wiki/Ocular_prosthesis"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:20.544903+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
The conjunctival peritomy is performed at the corneal limbus, preserving as much healthy tissue as possible. Anterior Tenon's fascia is separated from the sclera. Blunt dissection in the four quadrants between the rectus muscles separates deep Tenon's fascia.
|
||||
Sutures may be passed through the rectus muscles before their disinsertion from the globe. Some surgeons also suture one or both oblique muscles. Traction sutures or clamps may be applied to the horizontal rectus muscle insertions to assist in rotating and elevating the globe during the ensuing dissection. Tenon's capsule may be opened posteriorly to allow visualization of the optic nerve. The vortex veins and posterior ciliary vessels may be cauterized before dividing the nerve and removing the eye. Alternatively, the optic nerve may be localized with a clamp before transection. Hemostasis is achieved with either cautery or digital pressure.
|
||||
The orbital implant is inserted at the time of enucleation. An appropriately sized implant should replace the volume of the globe and leave sufficient room for the ocular prosthesis. Enucleation implants are available in a variety of sizes that may be determined by using sizing implants or calculated by measuring globe volume or axial length of the contralateral eye.
|
||||
In the past, spherical nonporous implants were placed in the intraconal space and the extraocular muscles were either left unattached or were tied over the implant. Wrapping these implants allows attachment of the muscles to the covering material, a technique that seems to improve implant movement and reduce the incidence of implant migration. Porous implants may be saturated with antibiotic solution before insertion. Because the brittle nature of hydroxyapatite prevents direct suturing of the muscles to the implant, these implants are usually covered with some form of wrapping material. The muscles are attached to the implant in a technique similar to that used for spherical non-porous implants. The muscles may be directly sutured to porous polyethylene implants either by passing the suture through the implant material or by using an implant with fabricated suture tunnels. Some surgeons also wrap porous polyethylene implants either to facilitate muscle attachment or to reduce the risk of implant exposure. A variety of wrapping materials have been used to cover porous implants, including polyglactin or polyglycolic acid mesh, heterologous tissue (bovine pericardium), homologous donor tissue (sclera, dermis), and autogenous tissue (fascia lata, temporalis fascia, posterior auricular muscle, rectus abdominis sheath).
|
||||
Fenestrations in the wrapping material are created at the insertion sites of the extraocular muscles, allowing the attached muscles to be in contact with the implant and improving implant vascularization. Drilling 1 mm holes into the implant at the muscle insertion sites is performed to facilitate vascularization of hydroxyapatite implants. Tenon's fascia is drawn over the implant and closed in one or two layers. The conjunctiva is then sutured.
|
||||
A temporary ocular conformer is inserted at the completion of the pro- cedure and is worn until the patient receives a prosthesis 4 to 8 weeks after surgery.
|
||||
|
||||
An elective secondary procedure is required to place the coupling peg or post in those patients who desire improved prosthetic motility. That procedure is usually delayed for at least 6 months after enucleation to allow time for implant vascularization. Technetium bone or gadolinium-enhanced magnetic resonance imaging scans are not now universally used, but they have been used to confirm vascularization before peg insertion. Under local anesthesia, a conjunctival incision is created at the peg insertion site. A hole is created into the porous implant to allow insertion of the peg or post. The prosthesis is then modified to receive the peg or post. Some surgeons have preplaced coupling posts in porous polyethylene implants at the time of enucleation. The post may spontaneously expose or is externalized in a later procedure via a conjunctival incision.
|
||||
|
||||
== Aftermath of surgical procedures ==
|
||||
Regardless of the procedure, a type of ocular prosthesis is always needed afterwards. The surgeon will insert a temporary prosthesis at the end of the surgery, known as a stock eye, and refer the patient to an ocularist, who is not a medical doctor, but board certified ocularist by the American Society of Ocularists. The process of making an ocular prosthesis, or a custom eye, will begin, usually six weeks after the surgical procedure, and it typically will take up to three visits before the final fitting of the prosthesis. In most cases, the patient will be fitted during the first visit, return for the hand-painting of the prosthesis, and finally come back for the final fitting. The methods used to fit, shape, and paint the prosthesis often vary to suit both ocularist and patient needs.
|
||||
Living with an ocular prosthesis requires care, but oftentimes patients who have had incurable eye disorders, such as micropthalmia, anophtalmia or retinoblastoma, achieve a better quality of life with their prostheses. It is generally recommended to leave the prosthesis in the socket as much as possible, though it may require some cleaning and lubrication, as well as regular polishing and check-ups with ocularists.
|
||||
45
data/en.wikipedia.org/wiki/Ocular_prosthesis-5.md
Normal file
45
data/en.wikipedia.org/wiki/Ocular_prosthesis-5.md
Normal file
@ -0,0 +1,45 @@
|
||||
---
|
||||
title: "Ocular prosthesis"
|
||||
chunk: 6/6
|
||||
source: "https://en.wikipedia.org/wiki/Ocular_prosthesis"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:20.544903+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
== Notable people with prosthetic eyes ==
|
||||
Bhumibol Adulyadej – King of Thailand; lost his eye in a 1948 car crash (right eye)
|
||||
Baz Bastien – Canadian ice hockey player, coach (right eye)
|
||||
Mokhtar Belmokhtar – Algerian smuggler, kidnapper, weapons dealer, and terrorist; lost his eye mishandling explosives (left eye)
|
||||
Sammy Davis Jr. – American entertainer (left eye)
|
||||
Peter Falk – American actor (right eye)
|
||||
Tex Avery – American animation director (left eye)
|
||||
Ry Cooder – American musician best known for his slide guitar work (left eye)
|
||||
Nick Griffin – British National Party leader (left eye)
|
||||
Jay Horwitz (born 1945), American executive for the New York Mets baseball team (right eye)
|
||||
Leo McKern – Actor (left eye)
|
||||
Carl Ouellet – Canadian professional wrestler (right eye)
|
||||
Claus Schenk Graf von Stauffenberg – German career army officer and resistance leader (left eye)
|
||||
Robert Thurman – Writer (left eye)
|
||||
Mo Udall – American politician (right eye)
|
||||
Fetty Wap - American rapper (left eye)
|
||||
Gordon Brown - Former Prime Minister of the United Kingdom (left eye)
|
||||
Helmut Marko - Formula 1 racing driver (left eye)
|
||||
Leo Fender - Inventor (left eye)
|
||||
Jeff Healey - Guitarist (both eyes)
|
||||
|
||||
== References ==
|
||||
|
||||
== External links ==
|
||||
|
||||
Mind Map: Adjusting and Adapting to Eye Loss
|
||||
Personal stories about having an artificial eye
|
||||
Fabricating Ocular Prostheses
|
||||
History of Artificial Eyes
|
||||
Ocular Prosthetics
|
||||
Eyeform Opticians Ocular Prosthesis information
|
||||
A FourDoc (short on-line documentary) about last glass eye maker in England.
|
||||
How Prosthetic Eyes are made
|
||||
American Academy of Maxillofacial Prosthetics Archived 2009-04-25 at the Wayback Machine
|
||||
Introduction to the Self-Lubricating Prosthesis
|
||||
54
data/en.wikipedia.org/wiki/OpenGALEN-0.md
Normal file
54
data/en.wikipedia.org/wiki/OpenGALEN-0.md
Normal file
@ -0,0 +1,54 @@
|
||||
---
|
||||
title: "OpenGALEN"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/OpenGALEN"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:21.712290+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
OpenGALEN is a not-for-profit organisation that provides an open source medical terminology. This terminology is written in a formal language called GRAIL (GALEN Representation And Integration Language) and also distributed in OWL.
|
||||
|
||||
|
||||
== Background ==
|
||||
The GALEN technologies were developed with research funding provided by the European Community Framework III (GALEN Project) and Framework IV (GALEN-In-Use Project) programmes.
|
||||
Early phases of the GALEN Programme developed the GRAIL concept modelling language, experimented with different structures for the GALEN Common Reference Model, and, in parallel, tested the usefulness of the approach with a series of clinical demonstrator projects.
|
||||
Later phases of the GALEN Programme, during the late 1990s, have concentrated on robust implementations of GRAIL and the Terminology Server, development of the GALEN Common Reference Model in both scope and detail, and development of tools and techniques to enable the further development, scaling-up and maintenance of the model. An important additional focus has been in developing tools and techniques with which we can map the information found in existing coding and Medical classification schemes to the GALEN Common Reference Model.
|
||||
OpenGALEN has been set up as a not-for-profit Dutch Foundation by the universities of Manchester and Nijmegen to make the results of the GALEN projects available to the world.
|
||||
|
||||
|
||||
== GALEN Common Reference Model ==
|
||||
The GALEN Common Reference Model is the model of medical concepts (or clinical terminology) being built in GRAIL. This model forms the underlying structural foundation for the services provided by a GALEN Terminology Server.
|
||||
The GALEN Common Reference Model is written in the formal language GRAIL (see below). The GRAIL statements in the model are equivalent with sentences like these:
|
||||
|
||||
Ulcer is a kind of inflammatory lesion
|
||||
The process whose outcome is an ulcer is called ulceration
|
||||
The stomach is a part of the GI tract
|
||||
It is sensible to talk about ulcers located in the stomach
|
||||
Ulcers located in the stomach are called Gastric Ulcers
|
||||
Ulcers located in the stomach are actually located on the mucosa of the wall of the stomach
|
||||
The GALEN Common Reference Model is available from the OpenGALEN Foundation as open source.
|
||||
|
||||
|
||||
== Projects ==
|
||||
The GALEN tools and technologies were used in France for the development of the French classification of procedures Classification Commune des Actes Médicaux (CCAM).
|
||||
|
||||
|
||||
== References ==
|
||||
|
||||
Rector, A.; Rogers, J.; Zanstra, P.; Van Der Haring, E. (2003). "OpenGALEN: Open source medical terminology and tools". AMIA Annual Symposium Proceedings. 2003: 982. PMC 1480228. PMID 14728486.
|
||||
Rector, A.; Solomon, W.; Nowlan, W.; Rush, T.; Zanstra, P.; Claassen, W. (1995). "A Terminology Server for medical language and medical information systems". Methods of Information in Medicine. 34 (1–2): 147–157. doi:10.1055/s-0038-1634569. hdl:2066/21859. PMID 9082124. S2CID 7978610.
|
||||
Rector, A.; Zanstra, P.; Solomon, W.; Rogers, J.; Baud, R.; Ceusters, W.; Claassen, W.; Kirby, J.; Rodrigues, J.; Rossi Mori, A. R.; Van Der Haring, E. J.; Wagner, J. (1998). "Reconciling users' needs and formal requirements: Issues in developing a reusable ontology for medicine". IEEE Transactions on Information Technology in Biomedicine. 2 (4): 229–242. doi:10.1109/4233.737578. PMID 10719533. S2CID 10702025.
|
||||
Rogers, J.; Roberts, A.; Solomon, D.; Van Der Haring, E.; Wroe, C.; Zanstra, P.; Rector, A. (2001). "GALEN ten years on: Tasks and supporting tools". Studies in Health Technology and Informatics. 84 (Pt 1): 256–260. PMID 11604744.
|
||||
Ten Napel, H.; Rogers, J. (2001). "Assessment of the GALEN methodology on holistic classifications for professions allied to medicine". Studies in Health Technology and Informatics. 84 (Pt 2): 1369–1373. PMID 11604951.
|
||||
Rogers, J.; Rector, A. (2000). "GALEN's model of parts and wholes: Experience and comparisons". AMIA Annual Symposium Proceedings: 714–718. PMC 2243933. PMID 11079977.
|
||||
Solomon, W.; Roberts, A.; Rogers, J.; Wroe, C.; Rector, A. (2000). "Having our cake and eating it too: How the GALEN Intermediate Representation reconciles internal complexity with users' requirements for appropriateness and simplicity". AMIA Annual Symposium Proceedings: 819–823. PMC 2244105. PMID 11079998.
|
||||
Rogers, J. (2006). "Quality assurance of medical ontologies". Methods of Information in Medicine. 45 (3): 267–274. doi:10.1055/s-0038-1634078. PMID 16685334. S2CID 9398450.
|
||||
|
||||
|
||||
== External links ==
|
||||
OpenGALEN Web site
|
||||
CCAM, Classification Commune des Actes Médicaux
|
||||
University of Manchester, Bio-Health Informatics Group
|
||||
University of Nijmegen, Medical Informatics
|
||||
@ -0,0 +1,34 @@
|
||||
---
|
||||
title: "Ophthalmic drug administration"
|
||||
chunk: 1/3
|
||||
source: "https://en.wikipedia.org/wiki/Ophthalmic_drug_administration"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:22.890768+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Ophthalmic drug administration is the administration of a drug to the eyes, most typically as an eye drop formulation. Topical formulations are used to combat a multitude of diseased states of the eye. These states may include bacterial infections, eye injury, glaucoma, and dry eye. However, there are many challenges associated with topical delivery of drugs to the cornea of the eye.
|
||||
|
||||
== Eye drop formulations ==
|
||||
Two of the largest challenges faced when using topicals to treat pathological states of the eye include patient compliance and ineffective absorbance of drugs into the cornea due to short contact times, solution drainage, tears turnover, and dilution or lacrimation. In fact, researchers in this field of drug delivery agree that less than 7% of drugs delivered to the eye reach and penetrate the corneal barrier, therefore, increasing the frequency of dosing used for topicals. This is one of the fundamental problem associated with using topicals to deliver drugs to the cornea and therefore leads to the increased demand for patient compliance. Together, these two factors drive a need in the field of scientific research and engineering for a way to better deliver drugs to the cornea of the eye while decreasing dosing frequency and demand for patient compliance. Strategies to achieve a prolonged residence time of drug delivery systems on ocular surface include mucoadhesive and in situ gelling polymers and thiolated cyclodextrins (see thiomers). Besides the logistical problems associated with using topicals, there are also systemic side effects which result from the administration of some drugs used to combat the pathological states of the eye. With the increased concentration of drugs in topicals and the frequent application to the eye, a majority of the drug is drained from the eye via nasolacrimal drainage. This drainage is thought to be the reason that systemic side effects exist from such administration.
|
||||
|
||||
== Contact lenses as delivery devices ==
|
||||
|
||||
The U.S. Centers for Disease Control and Prevention (CDC) claims that there were "about 41 million contact lens wearers greater than 18 years old in the United States" in 2018. Of all of these wearers, nearly 90% of them wear contact lenses known as 'soft contact lenses' (SCLs). Contact lenses are regulated by the United States Food and Drug Administration (FDA).
|
||||
The main approaches that researchers in this field are using today are: molecular imprinting, supercritical soaking, solvent impregnation, and nanoparticle loading. Each of these techniques assists by hoping to deliver drugs at a lower, more sustained, rate that does not require a demand for increased patient compliance nor the systemic side effects from topical drug delivery systems. However, each of these different types of loading techniques results in contact lenses that all have separate physical and chemical challenges when it comes to the sustained release and penetration of specific drugs at the molecular level in regards to the cornea of the eye.
|
||||
|
||||
=== Molecular imprinting ===
|
||||
Molecular imprinting is a process by which polymerization of a polymer around template result in the polymer matrix with embedded templates. After the template is removed, a cavity results with the functionalized monomers within the polymer cavity. This cavity is the idealized position for drug loading since this process can be designed specifically to recruit and hold onto drugs due to chemical specificity. This technique can be better visualized by referring to Figure 3.0. This type of drug loading can be used as a way to create a pH responsive system, which releases drug(s) as the pH of the biological system changes. Some drugs that have been successfully loaded via this method are: timolol, norfloxacin, ketotifen, polyvinlypyrrolidone, and hyaluronic acid. The molecular structures of each of these drugs are shown below in the index of important scientific terminology.
|
||||
|
||||
=== Supercritical soaking/solvent impregnation ===
|
||||
The supercritical soaking method is commonly used in hydrogel-based contact lenses and is the most common of all types of molecular drug loading techniques. Since this technique requires no special equipment or advanced knowledge of polymer-based hydrogels it is the least complex of all loading types. In order to load the hydrogel matrix with a certain drug, contact lenses are simply placed in a solution of the drug and the drug diffuses into the matrix. Since this loading technique is driven solely by the gradient of the drug concentration surrounding the lens relative to the hydrogel matrix, the diffusion rate and amount of drug that is loaded can be controlled solely by the concentration of the drug solution. Since this process allows for specific amounts of a certain drug to be loaded to the hydrogel matrix, this method of loading has become important for patient-specific (personalized) medicine and treatments.
|
||||
|
||||
=== Nanoparticle loading ===
|
||||
The nanoparticle loading technique includes two major parts. The first part of this process is the creation and conjugation of a specific drug into or onto a nanoparticle or other colloidal particle. Next, the nanoparticle is loaded into the hydrogel matrix of the contact lens. In this case, before the drug can diffuse out of the hydrogel matrix to reach the cornea, it must also diffuse or be released out of the nanoparticle.
|
||||
|
||||
== Physical and chemical challenges of loading ==
|
||||
It is important to recognize the positives and negatives associated with each type of drug loading for using contact lenses as drug delivery devices. In order to seriously address the possibility of clinical translation of these devices, it is important to recognize the physical and chemical barriers. By understanding this better, the mechanism of drug loading and the controlled and sustained release of drugs to a patient's eye can be optimized.
|
||||
|
||||
=== Lens transparency ===
|
||||
Since contact lenses are used on a part of the body that is important for normal daily functioning (sight) it is critical that scientists take into account the transparency of the lens. As larger and more drugs/objects are loaded to a contact lens it begins to physically crowd the space available, making it more difficult for light to penetrate and reach the eye.
|
||||
@ -0,0 +1,23 @@
|
||||
---
|
||||
title: "Ophthalmic drug administration"
|
||||
chunk: 2/3
|
||||
source: "https://en.wikipedia.org/wiki/Ophthalmic_drug_administration"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:22.890768+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Fundamental Concept Understanding: A simple analogy to this is a crowded versus an uncrowded area while it is raining outside. When individuals are packed tightly the rain falls and lands on people, making its way to the ground slowly but surely in a scattered way. In an uncrowded area, the rain can fall and land on the ground easily and without interference from the people. In this analogy, the rain is analogous to light and the people are analogous to drugs being loaded in a contact lens. The more drugs added to the contact lens, the less light that can penetrate without being randomly scattered. Random scattering of the light can result in unclear and unfocused sight.
|
||||
|
||||
Researchers have noted that by using the nanoparticle loading technique, the transparency decreases by nearly 10%. Conversely, researchers have confirmed that by using the molecular imprinting and supercritical soaking methods of drug loading, the lens transparency of the contact lenses has stayed at or above the lens transparency of the contact lenses currently approved by the FDA.
|
||||
|
||||
=== Oxygen permeability ===
|
||||
Oxygen permeability is another important feature of all contact lenses and much be optimized to the largest degree possible when creating drug delivery devices for the eye. The contact lens adheres to the external cornea of the eye which is made up of a layer of cells. Cells, being the basic component of living organisms, require sustained and constant access to oxygen in order to survive. The cornea of the eye is not supplied with blood as are most other cells in the body, making this a challenging part of the body to which to deliver drugs. Decreasing oxygenation to the eye can result in undesirable side effects. Researchers in this field have noted that different types of contact lenses have varying degrees of oxygen permeability. For example, it has been shown that SCLs have limited oxygen permeability while silicon-based contact lenses have much better oxygen permeability. Silicon-base contact lenses have also been shown to have some other very important physical parameters.
|
||||
Researchers have attempted to make the thickness of the contact lenses in order to increase the drug loading capacity of the contact lens. However, for silicon-based lenses this parameter is inversely proportion to oxygen permeability (i.e. as thickness of the contact lens increases the oxygen permeability decreases). Moreover, it has been shown that as water content increases in silicon-based lenses, the oxygen permeability decreases, another relationship that is inversely proportional. Surprisingly, as SCLs increase with water content the oxygen permeability also increases (a directly proportional relationship).
|
||||
In regards to whether silicon-based lenses or SCLs are a better candidate as an ophthalmic drug delivery device is a question that remains unanswered and is not uniformly agreed upon in the scientific community. For example, Ciolino et al. claim that silicon-based contact lenses are better candidates for patients that are long-term contact lens wearer. Conversely, Kim et al. suggest that SCLs are better candidates because they show the possibility to be able to overcome the difficult of oxygen permeability as well as mechanical integrity of the lens. Kim et al. have shown that the mechanical strength can be increased for SCLs by incorporating a nanodiamond (ND) infrastructure into contact lens matrix.
|
||||
Additionally, many researchers have investigated the implications of loading vitamin E into the contact lens matrix of SCLs. Although vitamin E incorporation into the matrix has been shown to slow the release of drugs into the eye and onto cornea (a desirable trait of an ophthalmic delivery system), it has also been shown to decrease oxygen permeability. Oxygen permeability continues to be an extremely important factor in the development of these devices and is one of the main reason that much research is beginning to focus on this area of drug delivery.
|
||||
|
||||
=== Water content ===
|
||||
The amount of water content that a particular contact lens can retain is another extremely important factor that must be taken into account when these devices are designed. Research in this specific area of design suggests that contact lens wearers find it more comfortable to wear lenses that retain water more than those that deter water. For SCLs, as the water content of a lens increases so does the oxygen permeability. Conversely, as the water content increases in silicon-based contact lenses, the oxygen permeability decreases. In reference to SCLs, higher water content in contact lenses allows for easier loading using the supercritical soaking method. This could be due to the water acting as a lubricant to some drugs and allowing the drug to be more easily facilitated into the matrix. This would essentially allow for more drug to be loaded into contact lenses of this type. This increase in drug loading capacity is an important advancement and would allow for patients wince it may allow for a longer period of drug release time and would hopefully be more sustained.
|
||||
Furthermore, Guzman-Aranguez et al. has shown that when using the molecular imprinting method for loading drugs such as ketotifen and norfloxacin into the contact lens, the water content is not largely impacted. Additionally, it has been predicted by Peng et al. by using Fickian release kinetic models that although water content changes once contact lenses are inserted onto the cornea of the eye, this will not pose significant challenges when it comes to the release of rugs from SCLs.
|
||||
@ -0,0 +1,33 @@
|
||||
---
|
||||
title: "Ophthalmic drug administration"
|
||||
chunk: 3/3
|
||||
source: "https://en.wikipedia.org/wiki/Ophthalmic_drug_administration"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:22.890768+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
=== Drug release kinetics ===
|
||||
The most important factor that must be taken into account when designing any type of drug delivery device, and specifically ocular devices, is the release rate of a drug. As discussed previously, the deliver rate and kinetics associated with drugs to the eye can reach levels that are toxic to the eye or could even cause undesirable side effects. The rate of release of a drug is also important because too slow of a release could have no beneficial outcome for the patient and a release that is too quick could result in negative side effects. Thus, it is important to balance the factors that govern the release of drugs from contact lenses as potential drug delivery devices. Researchers such as C. Alvarez-Lorenzo have tested (with animal models) and have data which supports that molecularly imprinted contact lenses release drugs in a sustained and long period of time. It has also been supported by researchers that the rate of drug release can be controlled by incorporating vitamin E within the hydrogen matrix.
|
||||
|
||||
=== Systemic side effects ===
|
||||
Over time, it has been reported that many of the same drugs and eye drops used to treat particular eye diseases do, in fact, result in systemic side effects that could possibly be minimized or limited due to a slower, more sustained release of the drug. The systemic side effects of glaucoma medications such as latanoprost increased heart rate resulting in cardiac arrhythmias, bronchoconstriction, and hypotension. These complications could be life-threatening. Some other drugs that help to reduce the effects of glaucoma in the eye result in vomiting, diarrhea, tachycardia and bronchospasm. It has been found that some drugs delivered in the form of eye drops are highly toxic to children since their total body volume and tissue volumes are much lower than that of an adult for which the drugs are intended for use. In this case, some parents are not aware of these implications and could use the same drug they would use to help treat their children's bacterial infections in the eye. Moreover, some drugs administered to the eye have been shown to result in cardiac depression and propagation of some disorders such as asthma. With continued research in this area, it has become known that skin irritation, itching or rash are commonly associated with drugs used to treat ocular bacterial infections.
|
||||
|
||||
== Ocular disorders ==
|
||||
There are currently four main ocular disorders that have been heavily investigated and have shown success with using contact lenses as possible devices for molecular drug delivery.
|
||||
|
||||
=== Bacterial infection ===
|
||||
|
||||
The drug release rate is extremely important in treating many diseased states of the eye, bacterial infections being one of them. Ciprofloxacin and norfloxacin are drugs that are normally used to treat bacterial infections of the eye. It is of utmost importance that these drugs stay in the therapeutic window for an extended period of time in order to be fully effective and kill bacteria. To keep the specific drug in the therapeutic window using eye drops the topical must be applied approximately every 30 minutes in order to be fully effective. Having to apply eye drops every 30 minutes would be nearly impossible for anyone and is not the ideal mechanism by which to deliver such drugs to the eye. Researchers have gathered data to support the idea that silicon-based contact lenses with ciprofloxacin could release the drug in the therapeutic window for approximately one month. Ana Guzman-Aranguez et al. also confirmed that the contact lens used also retained important properties such as transparency, oxygen permeability, mechanical strength, and zero-order release pharmacokinetics.
|
||||
|
||||
=== Corneal injury ===
|
||||
Many factors can result in corneal injury and cause the deterioration or death of cells that make up the cornea of the eye. The epithelial cells that make up the cornea are important in order for normal vision. These cells play a role in creating a physical environment that can correctly bend light rays to help project images to the retina of the eye. There have been successful human clinical trials with using SCLs infused with epidermal growth factor (EGF) that showed increased rate of healing of the epithelial cell layer of the cornea.
|
||||
|
||||
=== Glaucoma ===
|
||||
Glaucoma is the leading cause of blindness in the world and is a progressive and irreversible disease of the eye. A poly(lactic-co-glycolic acid)-based contact lens was shown to release latanoprost at a sustained release rate of up to a month in animal models by Ciolino et al. at Harvard Medical School and Massachusetts Institute of Technology. Latanoprost is one of the drug interventions used to treat patients with glaucoma, generally in the form of topicals such as eye drops.
|
||||
|
||||
=== Dry eye ===
|
||||
More than 50% of all contact lens wearers report that they experience dry eye. In order to help combat this issue and be assured that this does not occur in people that will one day be using drug eluting contact lenses, it is important to make sure that this complication is highly investigated. However, these investigations will not only be beneficial for contact lenses as drug delivery devices, but it will also have positive implications on contact lens wearers who use lenses for vision correction and appearance.
|
||||
|
||||
== References ==
|
||||
39
data/en.wikipedia.org/wiki/Opioid_rotation-0.md
Normal file
39
data/en.wikipedia.org/wiki/Opioid_rotation-0.md
Normal file
@ -0,0 +1,39 @@
|
||||
---
|
||||
title: "Opioid rotation"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Opioid_rotation"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:24.152953+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Opioid rotation or opioid switching is the process of changing one opioid to another to improve pain control or reduce unwanted side effects. This technique was introduced in the 1990s to help manage severe chronic pain and improve the opioid response in cancer patients and non-cancer patients. In order to obtain adequate levels of pain relief, patients requiring chronic opioid therapy may require an increase in the original prescribed dose for a number of reasons, including increased pain or a worsening disease state. Over the course of long-term treatment, an increase in dosage cannot be continued indefinitely as unwanted side effects of treatment often become intolerable once a certain dose is reached, even though the pain may still not be properly managed. One strategy used to address this is to switch the patient between different opioid drugs over time, usually every few months. Opioid rotation requires strict monitoring in patients with ongoing levels of high opioid doses for extended periods of time, since long term opioid use can lead to a patient developing tolerance to the analgesic effects of the drug. Patients may also not respond to the first opioid prescribed to them at all, therefore needing to try another opioid to help manage their pain. A patient's specific response and sensitivity to opioids include many factors that include physiology, genetics and pharmacodynamic parameters, which together determine the amount of pain control and tolerance of a particular opioid.
|
||||
|
||||
|
||||
== Mechanism ==
|
||||
Opioid analgesic drugs tend to exhibit incomplete cross-tolerance, so that even when a patient has developed a high level of tolerance to one drug from this class, they may find that a different opioid drug will still be effective. The reasons for this are still not completely understood, but are thought to result from variations in opioid receptor affinity and occupancy levels at equianalgesic doses, as well as additional mechanisms of action possessed by some drugs such as the NMDA antagonist action of methadone or levorphanol, or the SNRI activity of tramadol or tapentadol.
|
||||
|
||||
|
||||
== Indications ==
|
||||
There are no clinical guidelines outlining the use and implementation of opioid rotation. However, this strategy is commonly used for these various situations: pain not controlled by current opioid, pain controlled but in the presence of intolerable adverse events, pain not controlled despite rapid increase in opioid dose, switching to utilize different alternative routes of administration, or switching due to high cost of current opioid (or other patient-specific cost considerations).
|
||||
|
||||
|
||||
== Potential issues ==
|
||||
While there is good evidence for the efficacy of opioid rotation as a treatment approach in general, there is less evidence for what particular opioid analgesics are most suitable, and in practice the choice of opioid drugs used depends on many factors such as patient characteristics, prescriber preferences and safety. One issue with opioid rotation is that an opioid therapy failure poorly predicts whether other opioids would be effective. In certain situations, multiple switches may be required before pain therapy is optimized. In addition, recent studies explore which opioid drugs are most effective in implementing in an opioid rotation, but have so far found no difference in efficacy between opioid drugs like methadone and fentanyl in cancer patients.
|
||||
Diversion of prescribed opioid drugs for illicit recreational use is also a particular concern in this field, as the drugs which are most effective for relieving suffering in palliative care also tend to be those most sought after by drug abusers. The choice of what opioid drug to use in which patient thus tends to be a balance between many different factors that must be considered, and the need for opioid rotation in chronic pain patients makes it advantageous for a wide range of different opioid drugs to be available, even though they may be broadly equivalent in action when used in shorter term treatment. Additionally, newer studies may explore which patient populations can benefit the most from opioid rotation and which populations can have their pain managed by other means.
|
||||
|
||||
|
||||
== See also ==
|
||||
Opioid-induced hyperalgesia
|
||||
|
||||
|
||||
== References ==
|
||||
|
||||
|
||||
== External links ==
|
||||
Equianalgesic Charts
|
||||
American Pain Society Guidelines
|
||||
Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain
|
||||
Online opioid equianalgesia calculator Electronic calculator that includes logic for bidirectional and dose-dependent conversions
|
||||
Shaheen, PE; Walsh, D; Lasheen, W; Davis, MP; Lagman, RL (2009). "Opioid equianalgesic tables: are they all equally dangerous?". J Pain Symptom Manage. 38 (3): 409–17. doi:10.1016/j.jpainsymman.2009.06.004. PMID 19735901.
|
||||
49
data/en.wikipedia.org/wiki/Oral_administration-0.md
Normal file
49
data/en.wikipedia.org/wiki/Oral_administration-0.md
Normal file
@ -0,0 +1,49 @@
|
||||
---
|
||||
title: "Oral administration"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Oral_administration"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:25.383618+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Oral administration is a route of administration whereby a substance is taken through the mouth, swallowed, and then processed via the digestive system. This is a common route of administration for many medications.
|
||||
Oral administration can be easier and less painful than other routes of administration, such as injection. However, the onset of action is relatively low, and the effectiveness is reduced if it is not absorbed properly in the digestive system, or if it is broken down by digestive enzymes before it can reach the bloodstream. Some medications may cause gastrointestinal side effects, such as nausea or vomiting, when taken orally. Oral administration can also only be applied to conscious patients, and patients able to swallow.
|
||||
|
||||
|
||||
== Terminology ==
|
||||
Per os (; P.O.) is an adverbial phrase meaning literally from Latin "through the mouth" or "by mouth". The expression is used in medicine to describe a treatment that is taken orally (but not used in the mouth such as, caries prophylaxis). The abbreviation P.O. is often used on medical prescriptions.
|
||||
|
||||
|
||||
== Scope ==
|
||||
Enteral administration includes:
|
||||
|
||||
Buccal, dissolved inside the cheek
|
||||
Sublabial, dissolved under the lip
|
||||
Sublingual administration (SL), dissolved under the tongue, but due to rapid absorption many consider SL a parenteral route
|
||||
Oral (PO), swallowed tablet, capsule or liquid
|
||||
Enteral medications come in various forms, including oral solid dosage (OSD) forms:
|
||||
|
||||
Tablets to swallow, chew or dissolve in water or under the tongue
|
||||
Capsules and chewable capsules (with a coating that dissolves in the stomach or bowel to release the medication there)
|
||||
Time-release or sustained-release tablets and capsules (which release the medication gradually)
|
||||
Powders or granules and oral liquid dosage forms:
|
||||
Teas
|
||||
Drops
|
||||
Liquid medications or syrups
|
||||
|
||||
|
||||
== Facilitating methods ==
|
||||
Concomitant ingestion of water facilitates in swallowing tablets and capsules. If the substance has disagreeable taste, addition of a flavor may facilitate ingestion. Substances that are harmful to the teeth are preferably given through a straw.
|
||||
|
||||
|
||||
== See also ==
|
||||
Nothing by mouth
|
||||
List of abbreviations used in medical prescriptions
|
||||
List of Latin phrases
|
||||
Medical prescription
|
||||
Thin-film drug delivery
|
||||
|
||||
|
||||
== References ==
|
||||
46
data/en.wikipedia.org/wiki/Oral_myology-0.md
Normal file
46
data/en.wikipedia.org/wiki/Oral_myology-0.md
Normal file
@ -0,0 +1,46 @@
|
||||
---
|
||||
title: "Oral myology"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Oral_myology"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:26.614785+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
Oral myology (also known as "orofacial myology") is the field of study that involves the evaluation and treatment (known as "orofacial myofunctional therapy") of the oral and facial musculature, including the muscles of the tongue, lips, cheeks, and jaw.
|
||||
|
||||
|
||||
== Use ==
|
||||
Orofacial myofunctional therapy treatment is most commonly used to retrain oral rest posture, swallowing patterns in the oral phase, and speech.
|
||||
|
||||
|
||||
=== Tongue thrust and thumb sucking ===
|
||||
A major focus of the field of oral myology and treatment of orofacial myofunctional disorders include tongue posture and establishing equilibrium between the tongue, lips and the cheek muscles. Tongue exercise proved to be successful in treating tongue thrust. Tongue exercise alone was reported to be successful in cessation of thumb sucking and treatment of anterior open bite malocclusion. When the tongue rests against the palate it begins to expand the maxilla by applying a slow and consistent force to the lingual (tongue side) surfaces of the teeth. This may aid in the treatment of crooked teeth and under-developed face.
|
||||
|
||||
|
||||
=== Sleep apnea and snoring ===
|
||||
Oral myology plays also an important role in the management of patients with sleep breathing disorders and snoring where oropharyngeal exercises were found to reduce the severity and primary symptoms of obstructive sleep apnea. Poor positioning of the tongue affects breathing and allows a series of events to occur that can affect the orofacial complex. Patients with sleep apnea and other breathing difficulties usually have decreased tone and mobility in the cheek, tongue, lip, and soft palate, and sensory alterations due to a tendency to engage in mouth breathing rather than nasal breathing. In treatment of sleep apnea, oral myology therapy involves a series of exercises designed to improve tongue position and tongue function for a better control of the extrinsic tongue muscles and place the tongue in a ‘‘proper posture during function and at rest.’’
|
||||
|
||||
|
||||
=== Dysphagia ===
|
||||
Disruption of normal swallowing, referred to as dysphagia, has a variety of reasons, among which is tongue muscles weakness and fatigue. The tongue is a critical organ in swallowing, providing the driving forces that transport food and liquid through the mouth and pharynx. Fatigue in the tongue muscles may contribute to incomplete food clearance (residue), prolonged time to complete a meal and reduced intake. Tongue exercise to increase the muscle tone is therefore an important part of the oral myology therapy of dysphagia.
|
||||
|
||||
|
||||
=== Speech disorders ===
|
||||
Dentofacial and functional malocclusions can also affect normal speech. Non-physiologic function of the tongue has been considered an important aetiological factor of malocclusions. The tongue is an important organ contributing to deglutition, speech, growth and development of the jaws, and alignment of the teeth in occlusion. The effect of the tongue on growth of the jaws and development of the occlusion is a result of its pressure on the teeth and other areas during rest and function. The number of tongue movements and the contact point of the tongue with the palate are different in the pronunciation of consonants and words. These can be affected by tongue malfunction such as tongue thrust. Accordingly, treatment of tongue thrust is essential for treatment of speech disorders, and oral myology therapy aiming at tongue muscles training is an important part of speech therapy.
|
||||
|
||||
|
||||
== Intra-oral adhesive pads in oral myology ==
|
||||
The use of intra-oral adhesive pads as part of oral myology therapy is a new technique to induce and assist in tongue exercise. One study suggests the use of adhesive pads was efficient in treatment of anterior open bite malocclusion and thumb sucking in children.
|
||||
|
||||
|
||||
== See also ==
|
||||
Facial toning
|
||||
|
||||
|
||||
== References ==
|
||||
|
||||
|
||||
== Further reading ==
|
||||
Nestor, James (2020). Breath: The New Science of a Lost Art. Riverhead Books. ISBN 978-0735213616.
|
||||
49
data/en.wikipedia.org/wiki/Orphan_patient-0.md
Normal file
49
data/en.wikipedia.org/wiki/Orphan_patient-0.md
Normal file
@ -0,0 +1,49 @@
|
||||
---
|
||||
title: "Orphan patient"
|
||||
chunk: 1/1
|
||||
source: "https://en.wikipedia.org/wiki/Orphan_patient"
|
||||
category: "reference"
|
||||
tags: "science, encyclopedia"
|
||||
date_saved: "2026-05-05T07:31:27.839139+00:00"
|
||||
instance: "kb-cron"
|
||||
---
|
||||
|
||||
In health care, an orphan patient is a patient who has been "lost" within the system or has no primary provider overseeing their care.
|
||||
Usually, the primary provider is a general practitioner who takes care of some of the basic health needs and then refers to a specialist for complicated medical problems. Thus, orphan patients are sometimes referred to as "no-family-doctor" patients. The view from insiders and health care providers is that orphan patients tend to receive inferior care compared to those who have a "gatekeeper" coordinating the medicine.
|
||||
The Wordspy entry for this phrase is as follows [1]:
|
||||
|
||||
A hospital patient who doesn't have a family doctor. Also known as an unattached patient.
|
||||
Example Citation:
|
||||
Dr. Tom Dickson, chief of staff at the William Osler Health Centre in Brampton, Ont., said the FP [family physician] shortage is so severe in the ring of suburbs surrounding Toronto — the '905 belt' — that dozens of orphan patients are arriving at local community hospitals every day.
|
||||
—Patrick Sullivan, "Enter the hospitalist: new type of patient creating a new type of specialist," Canadian Medical Association Journal, May 2, 2000
|
||||
Earliest Citation:
|
||||
Recent media reports have identified a growing problem in Ontario's health care system — the care of "orphan patients." These are patients who rely on walk-in clinics and emergency departments because they do not have their own family doctor.
|
||||
|
||||
—Jan Kasperski, "Orphan patients," The Record (Kitchener-Waterloo), October 13, 1999
|
||||
|
||||
|
||||
== Contributing factors ==
|
||||
There are multiple factors that are contributing to the orphan patient problem in North America. Some of them include:
|
||||
|
||||
problems maintaining a supply of qualified health practitioners
|
||||
providing access to them where and when they are needed most
|
||||
a growing population of patients
|
||||
an aging population of patients
|
||||
a sicker population of patients (particularly with diabetes and obesity being rampant in North America)
|
||||
a more "medicalized" population of patients (expectations for medical care are higher than ever, and we have more defined diseases to treat)
|
||||
increasing complexity of treatments for the diseases we have always known about (standard-of-care treatment for heart attack is much more labour-intensive now than it was even a decade ago)
|
||||
The orphan patient problem has only been recognized in the media recently.
|
||||
Older medical references mention the term 'orphan patient' using a different definition, specifically patients with an orphan disease. For example, New England Journal of Medicine mentioned patients with orphan diseases as orphan patients in 1988:
|
||||
N Engl J Med. 1988 Mar 10;318(10):646.
|
||||
The orphan patient.
|
||||
Shelley WB, Shelley ED.
|
||||
Publication Types: Letter
|
||||
PMID 3344016
|
||||
|
||||
|
||||
== Solutions ==
|
||||
Solutions to the orphan patient problem are complex, as expected due to its multifactorial origins. It is not possible to decrease the population. It is not easy to increase the number of physicians and other health care providers available, as the time to train them tends to be long. Some of the temporary solutions have involved changing the way that health care is provided by:
|
||||
|
||||
making greater use of alternative health care providers such as nurse practitioners, hospitalists and Telehealth-style public information services.
|
||||
using technological assists such as electronic medical records and telemedicine to make the existing health care providers more efficient.
|
||||
implementing wider and more effective public health initiatives such as smoking cessation and fitness programs in order to decrease the burden of illness on a community. Community smoking bans and seatbelt regulations are political interventions that are sometimes spearheaded by medical professionals but can be implemented without their involvement.
|
||||
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