From 30d3f75c6159b312ecd08596457e70d4cdd5c7a0 Mon Sep 17 00:00:00 2001 From: turtle89431 Date: Tue, 5 May 2026 00:32:53 -0700 Subject: [PATCH] Scrape wikipedia-science: 917 new, 2599 updated, 3599 total (kb-cron) --- _index.db | Bin 51396608 -> 51515392 bytes .../wiki/Internal_environment-0.md | 32 ++ .../wiki/Internal_environment-1.md | 20 ++ .../wiki/Internal_environment-2.md | 19 ++ .../List_of_nerves_of_the_human_body-0.md | 290 ++++++++++++++++++ .../wiki/Lists_of_medical_eponyms-0.md | 41 +++ .../wiki/Localized_disease-0.md | 22 ++ .../en.wikipedia.org/wiki/Long-term_care-0.md | 19 ++ .../en.wikipedia.org/wiki/Long-term_care-1.md | 25 ++ .../en.wikipedia.org/wiki/Long-term_care-2.md | 22 ++ .../en.wikipedia.org/wiki/Long-term_care-3.md | 25 ++ .../en.wikipedia.org/wiki/Long-term_care-4.md | 34 ++ data/en.wikipedia.org/wiki/MHealth-0.md | 39 +++ data/en.wikipedia.org/wiki/MHealth-1.md | 21 ++ data/en.wikipedia.org/wiki/MHealth-2.md | 32 ++ data/en.wikipedia.org/wiki/MHealth-3.md | 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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 == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Ocular_prosthesis-0.md b/data/en.wikipedia.org/wiki/Ocular_prosthesis-0.md new file mode 100644 index 000000000..c9344ee9a --- /dev/null +++ b/data/en.wikipedia.org/wiki/Ocular_prosthesis-0.md @@ -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. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Ocular_prosthesis-1.md b/data/en.wikipedia.org/wiki/Ocular_prosthesis-1.md new file mode 100644 index 000000000..dd7209fc9 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Ocular_prosthesis-1.md @@ -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%). \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Ocular_prosthesis-2.md b/data/en.wikipedia.org/wiki/Ocular_prosthesis-2.md new file mode 100644 index 000000000..dbb3570cf --- /dev/null +++ b/data/en.wikipedia.org/wiki/Ocular_prosthesis-2.md @@ -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: \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Ocular_prosthesis-3.md b/data/en.wikipedia.org/wiki/Ocular_prosthesis-3.md new file mode 100644 index 000000000..d0cea19d3 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Ocular_prosthesis-3.md @@ -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.: \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Ocular_prosthesis-4.md b/data/en.wikipedia.org/wiki/Ocular_prosthesis-4.md new file mode 100644 index 000000000..cd0db9401 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Ocular_prosthesis-4.md @@ -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. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Ocular_prosthesis-5.md b/data/en.wikipedia.org/wiki/Ocular_prosthesis-5.md new file mode 100644 index 000000000..38680ab90 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Ocular_prosthesis-5.md @@ -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 \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/OpenGALEN-0.md b/data/en.wikipedia.org/wiki/OpenGALEN-0.md new file mode 100644 index 000000000..9d4798e7d --- /dev/null +++ b/data/en.wikipedia.org/wiki/OpenGALEN-0.md @@ -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 \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Ophthalmic_drug_administration-0.md b/data/en.wikipedia.org/wiki/Ophthalmic_drug_administration-0.md new file mode 100644 index 000000000..6ec9ebdea --- /dev/null +++ b/data/en.wikipedia.org/wiki/Ophthalmic_drug_administration-0.md @@ -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. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Ophthalmic_drug_administration-1.md b/data/en.wikipedia.org/wiki/Ophthalmic_drug_administration-1.md new file mode 100644 index 000000000..e4c149f88 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Ophthalmic_drug_administration-1.md @@ -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. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Ophthalmic_drug_administration-2.md b/data/en.wikipedia.org/wiki/Ophthalmic_drug_administration-2.md new file mode 100644 index 000000000..ce166f82c --- /dev/null +++ b/data/en.wikipedia.org/wiki/Ophthalmic_drug_administration-2.md @@ -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 == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Opioid_rotation-0.md b/data/en.wikipedia.org/wiki/Opioid_rotation-0.md new file mode 100644 index 000000000..addcea3bc --- /dev/null +++ b/data/en.wikipedia.org/wiki/Opioid_rotation-0.md @@ -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. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Oral_administration-0.md b/data/en.wikipedia.org/wiki/Oral_administration-0.md new file mode 100644 index 000000000..f3438083a --- /dev/null +++ b/data/en.wikipedia.org/wiki/Oral_administration-0.md @@ -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 == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Oral_myology-0.md b/data/en.wikipedia.org/wiki/Oral_myology-0.md new file mode 100644 index 000000000..80c88a975 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Oral_myology-0.md @@ -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. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Orphan_patient-0.md b/data/en.wikipedia.org/wiki/Orphan_patient-0.md new file mode 100644 index 000000000..514c47353 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Orphan_patient-0.md @@ -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. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Overdiagnosis-0.md b/data/en.wikipedia.org/wiki/Overdiagnosis-0.md new file mode 100644 index 000000000..e06ad9453 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Overdiagnosis-0.md @@ -0,0 +1,25 @@ +--- +title: "Overdiagnosis" +chunk: 1/3 +source: "https://en.wikipedia.org/wiki/Overdiagnosis" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:30.416283+00:00" +instance: "kb-cron" +--- + +Overdiagnosis is the diagnosis of disease that will never cause symptoms or death during a patient's ordinarily expected lifetime and thus presents no practical threat regardless of being pathologic. Overdiagnosis is a side effect of screening for early forms of disease. Although screening saves lives in some cases, in others it may turn people into patients unnecessarily and may lead to treatments that do no good and perhaps do harm. Given the tremendous variability that is normal in biology, it is inherent that the more one screens, the more incidental findings will generally be found. For a large percentage of them, the most appropriate medical response is to recognize them as something that does not require intervention; but determining which action a particular finding warrants ("ignoring", watchful waiting, or intervention) can be very difficult, whether because the differential diagnosis is uncertain or because the risk ratio is uncertain (risks posed by intervention, namely, adverse events, versus risks posed by not intervening). +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. Some people contend that the term "overdiagnosis" is inappropriate, and that "overtreatment" is more representative of the phenomenon. +Because most people who are diagnosed are also treated, it is difficult to assess whether overdiagnosis has occurred in an individual. Overdiagnosis in an individual cannot be determined during life. Overdiagnosis is only certain when an individual remains untreated, never develops symptoms of the disease and dies of something else. The distinction of "died with disease" versus "died of disease" is then important and relevant. Thus most of the inferences about overdiagnosis comes from the study of populations. Rapidly rising rates of testing and disease diagnosis in the setting of stable rates of the feared outcome of the disease (e.g. death) are highly suggestive of overdiagnosis. Most compelling, however, is evidence from a randomized trial of a screening test intended to detect pre-clinical disease. A persistent excess of detected disease in the tested group years after the trial is completed constitutes the best evidence that overdiagnosis has occurred. +Although overdiagnosis is potentially applicable to the diagnosis of any disease, the concept was first recognized and studied in cancer screening—the systematic evaluation of asymptomatic patients to detect early forms of cancer. The central harm of cancer screening is overdiagnosis—the detection of abnormalities that meet the pathologic definition of cancer (under the microscope) but will never progress to cause symptoms or death during a patient's ordinarily expected lifetime. +In advanced age, such as 65 years or older, the concept of overdiagnosis takes on increasing importance as life expectancy decreases. There are various cancer types for which a standard contraindication to screening is life expectancy of less than 10 years, for the simple and logical reason that a person who already has medically complex health status (e.g., multiple comorbidities) and realistically can probably expect to live for less than 10 years is less likely to get a net benefit (balance of benefit versus harms) from diagnosing and treating that cancer, especially if it may be indolent anyway. Prostate cancer is a classic example, but the concept can apply to breast cancer and other types as well. + +== Overdiagnosis and the variability of cancer progression == +Cancer screening is the effort to detect cancer early, during its pre-clinical phase—the time period that begins with an abnormal cell and ends when the patient notices symptoms from the cancer. It has long been known that some people have cancers with short pre-clinical phases (fast-growing, aggressive cancers), while others have cancers with long pre-clinical phases (slow-growing cancers). And this heterogeneity has an unfortunate implication: namely, screening tends to disproportionately detect slow-growing cancers (because they are accessible to be detected for a long period of time) and disproportionately miss the fast-growing cancers (because they are only accessible to be detected for a short period of time)—the very cancers we would most like to catch. For more information, see Screening (medicine)#Length time bias. +This long-standing model has a hidden assumption: namely, that all cancers inevitably progress. But some pre-clinical cancers will not progress to cause problems for patients. And if screening (or testing for some other reason) detects these cancers, overdiagnosis has occurred. +The figure below depicts the heterogeneity of cancer progression using 4 arrows to represent 4 categories of cancer progression. + +The arrow labeled "Fast" represents a fast-growing cancer, one that quickly leads to symptoms and to death. These are the worst forms of cancer and unfortunately often appear in the interval between screening tests. The arrow labeled "Slow" represents a slow-growing cancer, one that leads to symptoms and death but only after many years. These are the cancers for which screening has arguably the greatest beneficial impact. +The arrow labeled "Very Slow" represents a cancer that never causes problems because it is growing very slowly. If a cancer grows slowly enough, then patients will die of some other cause before the cancer gets big enough to produce symptoms. +The arrow labeled "Non-progressive" represents a cancer that never causes problems because it is not growing at all. In other words, there are cellular abnormalities that meet the pathologic definition of cancer but never grow to cause symptoms—alternatively, they may grow and then regress. Although the concept of non-progressive cancers may seem implausible, basic scientists have begun to uncover biologic mechanisms that halt the progression of cancer. Some cancers outgrow their blood supply (and are starved), others are recognized by the host's immune system (and are successfully contained), and some are not that aggressive in the first place. +Cancer that grows too slowly to be likely to harm the patient is usually referred to as a benign tumor. Although some types of benign tumor may require intervention, they are often simply monitored for malignant transformation. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Overdiagnosis-1.md b/data/en.wikipedia.org/wiki/Overdiagnosis-1.md new file mode 100644 index 000000000..c981e7bf0 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Overdiagnosis-1.md @@ -0,0 +1,33 @@ +--- +title: "Overdiagnosis" +chunk: 2/3 +source: "https://en.wikipedia.org/wiki/Overdiagnosis" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:30.416283+00:00" +instance: "kb-cron" +--- + +== Evidence for overdiagnosis in cancer == +The phenomenon of overdiagnosis is most widely understood in prostate cancer. A dramatic increase in the number of new cases of prostate cancer was observed following the introduction of the PSA (prostate specific antigen) screening test. Because of the problem of overdiagnosis, most organizations recommend against prostate cancer screening in men with limited life expectancy—generally defined as less than 10 years (see also prostate cancer screening). +Overdiagnosis has been identified in mammographic screening for breast cancer. Long-term follow-up of the Malmo randomized trial of mammography found a persistent excess of 115 breast cancers in the screened group 15 years after the trial was completed (a 10% rate of overdiagnosis). In a letter to the editor, authors not associated with the original study of the data from the randomized clinical trial argued that one-quarter of mammographically detected breast cancers represent overdiagnosis. A systematic review of mammography screening programs reported an overdiagnosis rate of around 50%, which is the same of saying that a third of diagnosed cases of breast cancer are overdiagnosed. +Overdiagnosis has also been identified in chest x-ray screening for lung cancer. Long-term follow-up of the Mayo Clinic randomized trial of screening with chest x-rays and sputum cytology found a persistent excess of 46 lung cancer cases in the screened group 13 years after the trial was completed, suggesting that 20–40% of lung cancers detected by conventional x-ray screening represent overdiagnosis. There is considerable evidence that the problem of overdiagnosis is much greater for lung cancer screening using spiral CT scans. +Overdiagnosis has also been associated with early detection in a variety of other cancers, including neuroblastoma, melanoma, and thyroid cancer. In fact, some degree of overdiagnosis in cancer early detection is probably the rule, not the exception. + +== Evidence for overdiagnosis of infectious diseases == +Issues with overdiagnosis of infectious diseases, such as malaria or typhoid fever, persist in many regions around the world. For example, malaria overdiagnosis is well-documented in African countries. and results in over-inflation of actual malaria rates reported at the local and national levels. Health facilities tend to over-diagnose malaria in patients presenting with symptoms such as fever, due to traditional perceptions (for example any fever being equivalent to malaria) and issues related to laboratory testing (see Diagnosis of malaria). Therefore, malaria overdiagnosis leads to under-management of other fever-inducing conditions, but also to over-prescription of antimalarial drugs. + +== Harms of overdiagnosis == +Overdiagnosed patients cannot benefit from the detection and treatment of their "cancer" because the cancer was never destined to cause symptoms or death. They can only be harmed. There are three categories of harm associated with overdiagnosis: + +Physical effects of unnecessary diagnosis and treatment: All medical interventions have side effects. This is particularly true of cancer treatments. Surgery, radiation and chemotherapy all pose varying morbidity and mortality risks. +Psychological effects: there is a burden for an individual simply being labeled as "diseased" (e.g. the burden of being labeled a "cancer patient") and an associated increased sense of vulnerability. +Economic burden: Not only the associated cost of treatment (from which the patient cannot benefit, because the disease posed no threat), but also—at least, in the current health care system in the United States—a potential increase in the cost of health insurance or even an inability to procure it (e.g. the diagnosis creates a pre-existing condition that affects health insurance). Similar issues may arise with life insurance. Unlike health insurance, life insurance does not fall under the scope of the Affordable Care Act, thus insurers have even more leeway in denying or reducing coverage or inflating premiums due to the patient's condition. +While many identify false positive results as the major downside to cancer screening, there are data to suggest that—when patients are informed about overdiagnosis—they are much more concerned about overdiagnosis than false positive results. + +== Distinction among overdiagnosis, misdiagnosis, and false positive results == +Overdiagnosis is often confused with the term "false positive" test results and with misdiagnosis, but they are three distinct concepts. A false positive test result refers to a test that suggests the presence of disease, but is ultimately proved to be in error (usually by a second, more precise test). Patients with false positive test results may be told that they have a disease and erroneously treated; overdiagnosed patients are told they have disease and generally receive treatment. Misdiagnosed patients do not have the condition at all, or have a totally different condition, but are treated anyway. +Overdiagnosis is also distinct from overtesting. Overtesting is the phenomenon where patients receive a medical test that they don't need; it will not benefit them. For instance, a patient that receives a lumbar spine x-ray when they have low back pain without any sinister signs or symptoms (weight loss, fever, lower limb paresthesia, etc.) and symptoms have been present for less than 4 weeks. Most tests are subject to overtesting, but echocardiograms (ultrasounds of the heart) have been shown to be particularly prone to overtesting. The detection of overtesting is difficult; recently, many population-level estimates have emerged to try to detect potential overtesting. The most common of these estimates is geographical variation in test use. These estimates detect regions, hospitals or general practices that order many more tests, compared to their peers, irrespective of differences in patient demographics between regions. Further methods that have been used include identifying general practices that order a higher proportion of tests that return a normal result, and the identification of tests with large temporal increases in their use, without a justifiable reason. + +== Solutions to overdiagnosis == +The concept of undiagnosing is a strategy to review diagnostic labels and remove those that are unnecessary or no longer beneficial. It is important that the medical record is updated to reflect the removal of the diagnosis. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Overdiagnosis-2.md b/data/en.wikipedia.org/wiki/Overdiagnosis-2.md new file mode 100644 index 000000000..cde06de35 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Overdiagnosis-2.md @@ -0,0 +1,29 @@ +--- +title: "Overdiagnosis" +chunk: 3/3 +source: "https://en.wikipedia.org/wiki/Overdiagnosis" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:30.416283+00:00" +instance: "kb-cron" +--- + +=== Removing cancer from names of low-risk diagnoses === +It has been proposed that some conditions that are indolent (i.e., unlikely to cause appreciable harm during the patient's lifetime) should have the words "cancer" or "carcinoma" removed from their accepted/preferred medical name. Such a proposal is to name conditions as indolent lesions of epithelial origin or IDLE. + +== Medical complexity == +If a person is medically complex (multiple comorbidities) and may expect to live for less than ten years, then there may be a net harm (benefit less harm) in diagnosing and treating one or more of their morbidities, eg prostate cancer. The principal, however, can apply to all cancers and other illnesses. + +== See also == +Disease mongering – Pejorative term for expanding a disease's market for treatment +False positive – Types of error in data reportingPages displaying short descriptions of redirect targets +Medicalization – Categorization of human problems as medical +Interventionism (medicine) +Patient education – Teaching or training of patients concerning their own health needs +Schooliosis – Misdiagnosis of scoliosis +Screening (medicine) – Brief medical evaluation to detect unnoticed health problems + +== References == + +== Further reading == +Welch, H. Gilbert, Schwartz, Lisa. Overdiagnosed: Making People Sick in the Pursuit of Health. Beacon Press; 2011-01-18. ISBN 9780807022009. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Oxygen_saturation_(medicine)-0.md b/data/en.wikipedia.org/wiki/Oxygen_saturation_(medicine)-0.md new file mode 100644 index 000000000..b301a7757 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Oxygen_saturation_(medicine)-0.md @@ -0,0 +1,45 @@ +--- +title: "Oxygen saturation (medicine)" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Oxygen_saturation_(medicine)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:31.562690+00:00" +instance: "kb-cron" +--- + +Oxygen saturation is the fraction of oxygen-saturated hemoglobin relative to total hemoglobin (unsaturated + saturated) in the blood. The human body requires and regulates a very precise and specific balance of oxygen in the blood. Normal arterial blood oxygen saturation levels in humans are 96–100 percent. If the level is below 90 percent, it is considered low and called hypoxemia. Arterial blood oxygen levels below 80 percent may compromise organ function, such as the brain and heart, and should be promptly addressed. Continued low oxygen levels may lead to respiratory or cardiac arrest. Oxygen therapy may be used to assist in raising blood oxygen levels. Oxygenation occurs when oxygen molecules (O2) enter the tissues of the body. For example, blood is oxygenated in the lungs, where oxygen molecules travel from the air and into the blood. Oxygenation is commonly used to refer to medical oxygen saturation. + + +== Definition == + +In medicine, oxygen saturation, commonly referred to as "sats", measures the percentage of hemoglobin binding sites in the bloodstream occupied by oxygen. At low partial pressures of oxygen, most hemoglobin is deoxygenated. At around 90% (the value varies according to the clinical context) oxygen saturation increases according to an oxygen-hemoglobin dissociation curve and approaches 100% at partial oxygen pressures of >11 kPa. A pulse oximeter relies on the light absorption characteristics of saturated hemoglobin to give an indication of oxygen saturation. + + +== Physiology == +The body maintains a stable level of oxygen saturation for the most part by chemical processes of aerobic metabolism associated with breathing. Using the respiratory system, red blood cells, specifically the hemoglobin, gather oxygen in the lungs and distribute it to the rest of the body. The needs of the body's blood oxygen may fluctuate such as during exercise when more oxygen is required or when living at higher altitudes. A blood cell is said to be "saturated" when carrying a normal amount of oxygen. Both too high and too low levels can have adverse effects on the body. + + +== Measurement == +An SaO2 (arterial oxygen saturation, as determined by an arterial blood gas test) value below 90% indicates hypoxemia (which can also be caused by anemia). Hypoxemia due to low SaO2 is indicated by cyanosis. Oxygen saturation can be measured in different tissues: + + +== Pulse oximetry == + +Pulse oximetry is a method used to estimate the percentage of oxygen bound to hemoglobin in the blood. This approximation to SaO2 is designated SpO2 (peripheral oxygen saturation). The pulse oximeter is a small device that clips to the body (typically a finger, an earlobe or an infant's foot) and displays its reading, or transfers it to another device. Oxygenated and deoxygenated hemoglobin differ in absorption of light of different wavelengths. The oximeter uses light-emitting diodes of different wavelengths in conjunction with a light-sensitive sensor to measure the absorption of red and infrared wavelengths in the extremity, and estimates the SpO2 from the absorption spectrum. + + +== Medical significance == +Healthy individuals at sea level usually exhibit oxygen saturation values between 96% and 99%, and should be above 94%. At 1,600 meters' altitude (about one mile high) oxygen saturation should be above 92%. +An SaO2 (arterial oxygen saturation) value below 90% causes hypoxia (which can also be caused by anemia). Hypoxia due to low SaO2 is indicated by cyanosis, but oxygen saturation does not directly reflect tissue oxygenation. The affinity of hemoglobin to oxygen may impair or enhance oxygen release at the tissue level. Oxygen is more readily released to the tissues (i.e., hemoglobin has a lower affinity for oxygen) when pH is decreased, body temperature is increased, arterial partial pressure of carbon dioxide (PaCO2) is increased, and 2,3-DPG levels (a byproduct of glucose metabolism also found in stored blood products) are increased. When the hemoglobin has greater affinity for oxygen, less is available to the tissues. Conditions such as increased pH, decreased temperature, decreased PaCO2, and decreased 2,3-DPG will increase oxygen binding to the hemoglobin and limit its release to the tissue. + + +== See also == +Arteriovenous oxygen difference + + +== References == + + +== External links == +Interactive hemoglobin saturation graph \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pain_out_of_proportion-0.md b/data/en.wikipedia.org/wiki/Pain_out_of_proportion-0.md new file mode 100644 index 000000000..11387fa97 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pain_out_of_proportion-0.md @@ -0,0 +1,20 @@ +--- +title: "Pain out of proportion" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Pain_out_of_proportion" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:32.847967+00:00" +instance: "kb-cron" +--- + +Pain out of proportion or pain out of proportion to physical examination is a medical sign where apparent pain in the individual does not correspond to other signs. It is found in a number of conditions, including: + +Necrotizing fasciitis +Compartment syndrome +Mesenteric ischemia +Mueller-Weiss disease +Also used in reference to the medical diagnosis of Malingering ICD-10 Z76.5 as in "Pain out of proportion to symptoms". + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Palsy-0.md b/data/en.wikipedia.org/wiki/Palsy-0.md new file mode 100644 index 000000000..e3ec770c0 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Palsy-0.md @@ -0,0 +1,32 @@ +--- +title: "Palsy" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Palsy" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:34.180713+00:00" +instance: "kb-cron" +--- + +Palsy is a medical term which refers to various types of paralysis or paresis, often accompanied by weakness and the loss of feeling and uncontrolled body movements such as shaking. The word originates from the Anglo-Norman paralisie, parleisie et al., from the accusative form of Latin paralysis, from Ancient Greek παράλυσις (parálusis), from παραλύειν (paralúein, "to disable on one side"), from παρά (pará, "beside") + λύειν (lúein, "loosen"). The word is longstanding in the English language, having appeared in the play Grim the Collier of Croydon, reported to have been written as early as 1599: + +Rob. I'll have thee come, I say. Why tremblest thou? +Grim. No sir, not I; 'tis a palsy I have still. +In some editions, the Bible passage of Luke 5:18 is translated to refer to "a man which was taken with a palsy". More modern editions simply refer to a man who is paralysed. Although the term has historically been associated with paralysis generally, it "is now almost always used in connection to the word cerebral—meaning the brain". +Specific kinds of palsy include: + +Bell's palsy, partial facial paralysis +Bulbar palsy, impairment of cranial nerves +Cerebral palsy, a neural disorder caused by intracranial lesions +Conjugate gaze palsy, a disorder affecting the ability to move the eyes +Erb's palsy, also known as brachial palsy, involving paralysis of an arm +Spinal muscular atrophy, also known as wasting palsy +Progressive supranuclear palsy, a degenerative disease +Squatter's palsy, a common name for bilateral peroneal nerve palsy that may be triggered by sustained squatting +Third nerve palsy, involving cranial nerve III + + +== References == + + +== External links == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pannus-0.md b/data/en.wikipedia.org/wiki/Pannus-0.md new file mode 100644 index 000000000..cff826c73 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pannus-0.md @@ -0,0 +1,24 @@ +--- +title: "Pannus" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Pannus" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:35.450829+00:00" +instance: "kb-cron" +--- + +Pannus is an abnormal layer of fibrovascular tissue or granulation tissue. Common sites for pannus formation include over the cornea, over a joint surface (as seen in rheumatoid arthritis), or on a prosthetic heart valve. Pannus may grow in a tumor-like fashion, as in joints where it may erode articular cartilage and bone. +In common usage, the term pannus is often used to refer to a panniculus (a hanging flap of tissue). + + +== Pannus in rheumatoid arthritis == +The term "pannus" is derived from the Latin for "tablecloth". Chronic inflammation and exuberant proliferation of the synovium leads to formation of pannus and destruction of cartilage, bone, tendons, ligaments, and blood vessels. Pannus tissue is composed of aggressive macrophage- and fibroblast-like mesenchymal cells, macrophage-like cells and other inflammatory cells that release collagenolytic enzymes. +In people suffering from rheumatoid arthritis, pannus tissue eventually forms in the joint affected by the disease, causing bony erosion and cartilage loss via release of IL-1, prostaglandins, and substance P by macrophages. + + +== Pannus in ophthalmology == +In ophthalmology, pannus refers to the growth of blood vessels into the peripheral cornea. In normal individuals, the cornea is avascular. Chronic local hypoxia (such as that occurring with overuse of contact lenses) or inflammation may lead to peripheral corneal vascularization, or pannus. Pannus may also develop in diseases of the corneal stem cells, such as aniridia. It is often resolved by peritomy. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Paresis-0.md b/data/en.wikipedia.org/wiki/Paresis-0.md new file mode 100644 index 000000000..569a17293 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Paresis-0.md @@ -0,0 +1,45 @@ +--- +title: "Paresis" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Paresis" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:36.779117+00:00" +instance: "kb-cron" +--- + +In medicine, paresis () is a condition typified by a weakness of voluntary movement, or by partial loss of voluntary movement or by impaired movement. When used without qualifiers, it usually refers to the limbs, but it can also be used to describe the muscles of the eyes (ophthalmoparesis), the stomach (gastroparesis), and also the vocal cords (vocal cord paresis). +Neurologists use the term paresis to describe weakness, and plegia to describe paralysis in which all voluntary movement is lost. The term paresis comes from the Ancient Greek: πάρεσις 'letting go' from παρίημι 'to let go, to let fall'. + + +== Types == + + +=== Limbs === +Monoparesis – One leg or one arm +Paraparesis – Both legs +Hemiparesis – The loss of function to only one side of the body +Triparesis – Three limbs. This can either mean both legs and one arm, both arms and a leg, or a combination of one arm, one leg, and face +Double hemiparesis – All four limbs are involved, but one side of the body is more affected than the other +Tetraparesis – All four limbs +Quadriparesis – All four limbs, equally affected +These terms frequently refer to the impairment of motion in multiple sclerosis and cerebral palsy + + +=== Other === +Gastroparesis – impaired stomach emptying +A form of ophthalmoplegia +Spastic paresis – exaggerated tendon reflexes and muscle hypertonia +In the past, the term was most commonly used to refer to "general paresis", which was a symptom of untreated syphilis. However, due to improvements in treatment of syphilis, it is now rarely used in this context. + + +== See also == + + +== References == + + +== External links == + +Overview +Hind Limb Paresis and Paralysis in Rabbits \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Past_medical_history-0.md b/data/en.wikipedia.org/wiki/Past_medical_history-0.md new file mode 100644 index 000000000..f2d1f8aa5 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Past_medical_history-0.md @@ -0,0 +1,87 @@ +--- +title: "Past medical history" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Past_medical_history" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:37.940913+00:00" +instance: "kb-cron" +--- + +In a medical encounter, a past medical history (abbreviated PMH) is the total sum of a patient's health status prior to the presenting problem. + + +== Questions to include == +Different sources include different questions to be asked while conducting a PMH, but in general, they include the following: + +General state of health: e.g. excellent, good, fair, poor. Note any significant change from previous state. +Past illnesses: e.g. cancer, heart disease, hypertension, diabetes. +Hospitalizations: including all medical, surgical, and psychiatric hospitalizations. Note the date, reason, duration for the hospitalization. +Injuries, or accidents: note the type and date of injury. +Surgeries: note the type of procedure, date, hospital, surgeon, and any complications. +Current medications: note name, dosage, frequency of any medication, including any over-the-counter medications and herbal remedies. Note whether patient is taking the medications according to the prescribed instructions. +Allergies: note any environmental, food, or drug allergies, as well as the specific type of reaction, e.g. anaphylaxis, rash, itching. +Immunizations: take a careful record of all immunizations, including tetanus, diphtheria, pertussis, polio, Hepatitis B, measles, mumps, rubella, Haemophilus influenzae type B, influenza. +Substance abuse: note any alcohol, tobacco, and illicit drug use, include type, amount, and duration, as well as any past treatment or drug rehabilitation. +Diet: ask about everything the patient has eaten the day before and for the past week. Note the type of food consumed and do a nutritional status assessment. Medically, however, this is considered to be a part of social history. Dietary supplements would also be under PMH. +Sleep: a useful mnemonic for sleep patterns is BEARS, for Bedtime problems (e.g. snoring, sleep apnea, or nightmares), Excessive daytime sleepiness, Awakenings at night, Regularity and duration of sleep, Snoring. +Alternative therapies: e.g. acupuncture, massage, herbal medicine, vitamins, chiropractice. +Obstetric/Gynecologic history (if female): include total number of pregnancies, whether they are full term, preterm, miscarriages, abortions, living, as well as any complications. Include menopause and date. Include sexual history and any history of sexually transmitted infection. +Birth history: details of labor and delivery of patient, admission to NICU, maternal fever, duration of rupture of membranes, Apgar scores (particularly import in first three months of life) +Growth and development: plots of height, weight, and head circumference are standard content for pediatric records, any change in trajectory (e.g. growth plots which cross percentile lines rather than running parallel), developmental mile stones, any IQ or other developmental testing + + +== Acronyms == +Several acronyms have been developed to categorize the appropriate questions to include: + +"MMASH", for Medical Illnesses, Medications, Allergies, Surgeries, Hospitalizations. +"PAM HUGS FOSS", for +Previous presence of the symptom (same chief complaint) +Allergies (drugs, foods, chemicals, dust, etc.) +Medicines (any drugs the patient used) +Hospitalization for any illness in the past +Urinary changes (especially if diabetic or elderly) +Gastrointestinal complaints (diet changes, bowel movements, etc.) +Sleep pattern (waking up/going to sleep, etc.) +Family history (similar chief complaints/serious illness) +OB/GYN history (LMP, abortions, etc.) +Sexual habits (active/preferences/STD, etc.) +Social life (job/house/smoking/alcohol, etc.) +In prehospital medicine, namely EMS, the acronyms SAMPLE or CHAMPS are used. + +Signs/Symptoms +Allergies +Medicines (Prescriptions) +Past Pertinent History +Last bowel movement/oral intake +Events leading to the current complaint + +Chief Complaint +History +Allergies +Medicines (Prescriptions) +Previous activity +Signs/Symptoms + + +== Medicare definitions == +The Centers for Medicare and Medicaid Services has published criteria for what constitutes a reimbursable PMH. A PMH is considered one of three elements of the "Past, Family, and Social History" (abbreviated as PFSH): + +Past medical history: "the patient's past experiences with illnesses, operations, injuries and treatments"; +Family history: "a review of medical events in the patient's family, including diseases which may be hereditary or place the patient at risk"; +Social history: "an age-appropriate review of past and current activities". +A pertinent PFSH consists of at least one of the three components; a full PFSH consists of two or three components for an established patient, or all three components for a new patient visit. + + +== See also == +History of present illness +Medical history +Medical record + + +== References == + + +== External links == +Overview at medinfo.ufl.edu +An example of Past Medical History Questionnaire \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pathognomonic-0.md b/data/en.wikipedia.org/wiki/Pathognomonic-0.md new file mode 100644 index 000000000..ba2671adc --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pathognomonic-0.md @@ -0,0 +1,36 @@ +--- +title: "Pathognomonic" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Pathognomonic" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:39.255891+00:00" +instance: "kb-cron" +--- + +Pathognomonic (synonym pathognomic) is a term, often used in medicine, that means "characteristic for a particular disease". A pathognomonic sign is a particular sign whose presence means that a particular disease is present beyond any doubt. The absence of a pathognomonic sign does not rule out the disease. Labelling a sign or symptom "pathognomonic" represents a marked intensification of a "diagnostic" sign or symptom. +The word is an adjective of Greek origin derived from πάθος pathos 'disease' and γνώμων gnomon 'indicator' (from γιγνώσκω gignosko 'I know, I recognize'). + + +== Practical use == +While some findings may be classic, typical or highly suggestive in a certain condition, they may not occur uniquely in this condition and therefore may not directly imply a specific diagnosis. A pathognomonic sign or symptom has very high positive predictive value and high specificity but does not need to have high sensitivity: for example it can sometimes be absent in a certain disease, since the term only implies that, when it is present, the doctor instantly knows the patient's illness. The presence of a pathognomonic finding allows immediate diagnosis, since there are no other conditions in the differential diagnosis. +Singular pathognomonic signs are relatively uncommon. Examples of pathognomonic findings include Koplik's spots inside the mouth in measles, the palmar xanthomata seen on the hands of people suffering from hyperlipoproteinemia, Negri bodies within brain tissue infected with rabies, or a tetrad of rash, arthralgia, abdominal pain and kidney disease in a child with Henoch–Schönlein purpura, or succinylacetone for Tyrosinemia Type I. +As opposed to symptoms (reported subjectively by the patient and not measured) and signs (observed by the physician at the bedside on physical exam, without need for a report) a larger number of medical test results are pathognomonic. An example is the hypersegmented neutrophil, which is seen only in megaloblastic anemias (not a single disease, but a set of closely related disease states). More often a test result is "pathognomonic" only because there has been a consensus to define the disease state in terms of the test result (such as diabetes mellitus being defined in terms of chronic fasting blood glucose levels). +In contrast, a test with very high sensitivity rarely misses a condition, so a negative result should be reassuring (the disease tested for is absent). A sign or symptom with very high sensitivity is often termed sine qua non. An example of such test is a genetic test to find an underlying mutation in certain types of hereditary colon cancer. + + +== Examples == + + +== See also == +AIDS-defining clinical condition +List of eponymous medical signs +Medical sign + + +== References == + + +== External links == + +Slide show with audio summary of 122 pathognomonic signs \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Patient-0.md b/data/en.wikipedia.org/wiki/Patient-0.md new file mode 100644 index 000000000..cd9786a8d --- /dev/null +++ b/data/en.wikipedia.org/wiki/Patient-0.md @@ -0,0 +1,55 @@ +--- +title: "Patient" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Patient" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:40.560918+00:00" +instance: "kb-cron" +--- + +A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a medical doctor, nurse, optometrist, dentist, veterinarian, or other health care provider. + + +== Etymology == +The word patient originally meant 'one who suffers'. This English noun comes from the Latin word patiens, the present participle of the deponent verb, patior, meaning 'I am suffering', and akin to the Greek verb πάσχειν (paskhein 'to suffer') and its cognate noun πάθος (pathos). +This language has been construed as meaning that the role of patients is to passively accept and tolerate the suffering and treatments prescribed by the healthcare providers, without engaging in shared decision-making about their care. + + +== Outpatients and inpatients == + +An outpatient (or out-patient) is a patient who attends an outpatient clinic with no plan to stay beyond the duration of the visit. Even if the patient will not be formally admitted with a note as an outpatient, their attendance is still registered, and the provider will usually give a note explaining the reason for the visit, tests, or procedure/surgery, which should include the names and titles of the participating personnel, the patient's name and date of birth, signature of informed consent, estimated pre-and post-service time for history and exam (before and after), any anesthesia, medications or future treatment plans needed, and estimated time of discharge absent any (further) complications. Treatment provided in this fashion is called ambulatory care. Sometimes surgery is performed without the need for a formal hospital admission or an overnight stay, and this is called outpatient surgery or day surgery, which has many benefits including lowered healthcare cost, reducing the amount of medication prescribed, and using the physician's or surgeon's time more efficiently. Outpatient surgery is suited best for more healthy patients undergoing minor or intermediate procedures (limited urinary-tract, eye, or ear, nose, and throat procedures and procedures involving superficial skin and the extremities). More procedures are being performed in a surgeon's office, termed office-based surgery, rather than in a hospital-based operating room. + +An inpatient (or in-patient), on the other hand, is "admitted" to stay in a hospital overnight or for an indeterminate time, usually, several days or weeks, though in some extreme cases, such as with coma or persistent vegetative state, patients can stay in hospitals for years, sometimes until death. Treatment provided in this fashion is called inpatient care. The admission to the hospital involves the production of an admission note. The leaving of the hospital is officially termed discharge, and involves a corresponding discharge note, and sometimes an assessment process to consider ongoing needs. In the English National Health Service this may take the form of "Discharge to Assess" - where the assessment takes place after the patient has gone home. +Misdiagnosis is the leading cause of medical error in outpatient facilities. When the U.S. Institute of Medicine's groundbreaking 1999 report, To Err Is Human, found up to 98,000 hospital patients die from preventable medical errors in the U.S. each year, early efforts focused on inpatient safety. While patient safety efforts have focused on inpatient hospital settings for more than a decade, medical errors are even more likely to happen in a doctor's office or outpatient clinic or center. + + +== Day patient == +A day patient (or day-patient) is a patient who is using the full range of services of a hospital or clinic but is not expected to stay the night. The term was originally used by psychiatric hospital services using of this patient type to care for people needing support to make the transition from in-patient to out-patient care. However, the term is now also heavily used for people attending hospitals for day surgery. + + +== Alternative terminology == +Because of concerns such as dignity, human rights and political correctness, the term "patient" is not always used to refer to a person receiving health care. Other terms that are sometimes used include health consumer, healthcare consumer, customer or client. However, such terminology may be offensive to those receiving public health care, as it implies a business relationship. +In veterinary medicine, the client is the owner or guardian of the patient. These may be used by governmental agencies, insurance companies, patient groups, or health care facilities. Individuals who use or have used psychiatric services may alternatively refer to themselves as consumers, users, or survivors. +In nursing homes and assisted living facilities, the term resident is generally used in lieu of patient. Similarly, those receiving home health care are called clients. + + +== Patient-centered healthcare == + +The doctor–patient relationship has sometimes been characterized as silencing the voice of patients. It is now widely agreed that putting patients at the centre of healthcare by trying to provide a consistent, informative and respectful service to patients will improve both outcomes and patient satisfaction. +When patients are not at the centre of healthcare, when institutional procedures and targets eclipse local concerns, then patient neglect is possible. Incidents, such as the Stafford Hospital scandal, Winterbourne View hospital abuse scandal and the Veterans Health Administration controversy of 2014 have shown the dangers of prioritizing cost control over the patient experience. Investigations into these and other scandals have recommended that healthcare systems put patient experience at the center, and especially that patients themselves are heard loud and clear within health services. +There are many reasons for why health services should listen more to patients. Patients spend more time in healthcare services than regulators or quality controllers, and can recognize problems such as service delays, poor hygiene, and poor conduct. Patients are particularly good at identifying soft problems, such as attitudes, communication, and 'caring neglect', that are difficult to capture with institutional monitoring. +One important way in which patients can be placed at the centre of healthcare is for health services to be more open about patient complaints. Each year many hundreds of thousands of patients complain about the care they have received, and these complaints contain valuable information for any health services which want to learn about and improve patient experience. + + +== See also == + + +== References == + + +== External links == + +Jadad AR, Rizo CA, Enkin MW (June 2003). "I am a good patient, believe it or not". BMJ. 326 (7402): 1293–5. doi:10.1136/bmj.326.7402.1293. PMC 1126181. PMID 12805157.a peer-reviewed article published in the British Medical Journal's (BMJ) first issue dedicated to patients in its 160-year history +Sokol DK (21 February 2004). "How (not) to be a good patient". BMJ. 328 (7437): 471. doi:10.1136/bmj.328.7437.471. PMC 344286.review article with views on the meaning of the words "good doctor" vs. "good patient" +"Time Magazine's Dr. Scott Haig Proves that Patients Need to Be Googlers!" – Mary Shomons response Archived 2015-04-26 at the Wayback Machine to the Time Magazine article "When the Patient is a Googler" \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pay_for_performance_(healthcare)-0.md b/data/en.wikipedia.org/wiki/Pay_for_performance_(healthcare)-0.md new file mode 100644 index 000000000..20c4c8d0c --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pay_for_performance_(healthcare)-0.md @@ -0,0 +1,32 @@ +--- +title: "Pay for performance (healthcare)" +chunk: 1/4 +source: "https://en.wikipedia.org/wiki/Pay_for_performance_(healthcare)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:42.788886+00:00" +instance: "kb-cron" +--- + +In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. This model also penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care. +Professional societies in the United States have given qualified approval to incentive programs, but express concern with the validity of quality indicators, patient and physician autonomy and privacy, and increased administrative burdens. + +== Studies and trends == +Pay for performance systems link compensation to measures of work quality or goals. Current methods of healthcare payment may actually reward less-safe care, since some insurance companies will not pay for new practices to reduce errors, while physicians and hospitals can bill for additional services that are needed when patients are injured by mistakes. However, early studies showed little gain in quality for the money spent, as well as evidence suggesting unintended consequences, like the avoidance of high-risk patients, when payment was linked to outcome improvements. +The 2006 Institute of Medicine report Preventing Medication Errors recommended "incentives...so that profitability of hospitals, clinics, pharmacies, insurance companies, and manufacturers (are) aligned with patient safety goals;...(to) strengthen the business case for quality and safety." A second Institute of Medicine report Rewarding Provider Performance: Aligning Incentives in Medicare (September 2006) stated "The existing systems do not reflect the relative value of health care services in important aspects of quality, such as clinical quality, patient-centeredness, and efficiency...nor recognize or reward care coordination...(in) prevention and the treatment of chronic conditions." The report recommends pay for performance programs as an "immediate opportunity" to align incentives for performance improvement. However, significant limitations exist in current clinical information systems in use by hospitals and health care providers, which are often not designed to collect data valid for quality assessment. +After reviewing the medical literature in 2014, pediatrician Aaron E. Carroll wrote in The New York Times that pay for performance in the US and UK has brought "disappointingly mixed results". These disappointing results were confirmed in 2018 by health economist Igna Bonfrer and co-authors in The BMJ, based on an observational study among 1,371,364 US patients aged 65 years and older. Sometimes even large incentives do not change the way doctors practice medicine. When incentives do change practice, clinical outcomes do not improve. Critics say that pay for performance is a technique borrowed from corporate management, where the main outcome of concern is profit. In medical practice, many important outcomes and processes, such as spending time with patients, cannot be quantified. + +== Commentary by physician organizations == +In the United States, most professional medical societies have been nominally supportive of incentive programs to increase the quality of health care. However, these organizations also express concern over the choice and validity of measurements of improvement, which may include process measures that do not directly tie to outcomes. The American Medical Association (AMA) has published principles for pay for performance programs, with emphasis on voluntary participation, data accuracy, positive incentives and fostering the doctor-patient relationship, and detailed guidelines for designing and implementing these programs. +Positions by other physician organizations question the validity of performance measures, and whether it will preserve an individual physician's clinical judgement, a patient's preferences, autonomy and privacy. They question whether it will lower costs, although it will increase administrative costs. + +American Academy of Family Physicians: "there are a multitude of organizational, technical, legal and ethical challenges to designing and implementing pay for performance programs" +American College of Physicians: "adoption of appropriate quality improvement strategies, if done right, will result in higher quality patient care leading to increased physician and patient satisfaction. But the College is also concerned that these changes could lead to more paperwork, more expense, and less revenue; detract from the time that internists spend with patients, and have unintended adverse consequences for sicker and non-compliant patients." "... concerned about using a limited set of clinical practice parameters to assess quality, especially if payment for good performance is grafted onto the current payment system, which does not reward robust comprehensive care." +American Geriatrics Society: "quality measures (must) target not only care for specific diseases, but also care that addresses multiple, concurrent illnesses and (are) tested among vulnerable older adults. Using indicators that have been developed for a commercially insured population...may not be relevant" +American Academy of Neurology (AAN): "An unintended consequence is that current relative payments are distorted and represent a misaligned incentive system, encouraging diagnostic tests over thoughtful and skilled patient care. The AAN recommends addressing these underlying inequities before a P4P program is adopted. +The Endocrine Society: "it is difficult to develop standardized measure across medical specialties...variations must be allowed to meet the unique needs of the individual patient...P4P programs should not place financial or administrative burdens on practices that care for underserved patient populations" + +== Implementation == + +=== Germany === +As of 2015, Germany was typically not a value-based system, but value measurements were coming more common; notable examples include required quality systems introduced in 2000, coinciding with a diagnostic reimbursement group payment scheme in 2000, followed a biannual reports mandate in 2005, and outcomes in 2007. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pay_for_performance_(healthcare)-1.md b/data/en.wikipedia.org/wiki/Pay_for_performance_(healthcare)-1.md new file mode 100644 index 000000000..469f7d741 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pay_for_performance_(healthcare)-1.md @@ -0,0 +1,29 @@ +--- +title: "Pay for performance (healthcare)" +chunk: 2/4 +source: "https://en.wikipedia.org/wiki/Pay_for_performance_(healthcare)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:42.788886+00:00" +instance: "kb-cron" +--- + +=== France === +In France, P4P in ambulatory care was introduced as individual contracts between physicians and statutory health insurance in 2009 and termed CAPI (Contrat d'Amélioration des Pratiques Individuelles). Fourteen months later, 14,800 contracts were signed, representing one third of eligible GPs. They were signed on a voluntary basis for a three-year period and could be broken at any time on the GP's demand. The additional payment took into account the size of the population and the achievements for a number of indicators (clinical care, prevention, generic prescription), for which final as well as intermediate targets were defined. Depending on the baseline measures for the GP's practice, either final or intermediate targets were considered in determining the level of remuneration. There were no penalties for GPs who did not achieve the targets. With effect in 2012, CAPI were renamed ROSP (Rémunération sur Objectifs de Santé Publique) and incorporated into the collective agreements between doctors and statutory health insurance, with an expanded list of objectives and an extension to specialties such as cardiology. + +=== United Kingdom === +In the United Kingdom, the National Health Service (NHS) began a major pay for performance initiative in 2004, known as the Quality and Outcomes Framework (QOF). General practitioners agreed to increases in existing income according to performance with respect to 146 quality indicators covering clinical care for 10 chronic diseases, organization of care, and patient experience. For example, family practitioners got points for clinically reviewing patients with asthma every 15 months. Unlike proposed quality incentive programs in the United States, funding for primary care was increased 20% over previous levels. This allowed practices to invest in extra staff and technology; 90% of general practitioners use the NHS Electronic Prescription Service. +A 2006 study found that most of the doctors actually did get most of the points, although some practices seemed to have gotten high scores by excluding patients with high-risk factors from their percentage targets. The 8,000 family practitioners included in the study had an increase in revenue by $40,000 by collecting nearly 97% of the points available. +A 2014 study examined 1.8 million hospital charts, and found that the mortality in control hospitals fell more than mortality in the pay-for-performance hospitals. Short-term improvements were not maintained. At the end of the 42 month period, the reduction in mortality for the 3 conditions covered by the program at the participating pay-for-performance hospital was no longer significant; however, there was a significantly larger reduction in mortality at participating hospitals for the 5 conditions not covered or incentivized by the program. This indicates a possible "spill-over" effect. +A 2015 population based study investigated the relationship between mortality and performance on the scheme across the whole of England. Although all-cause and cause-specific mortality rates declined over time, there was no significant relationship between practice performance on quality indicators and all-cause or cause-specific mortality rates in the practice locality. Higher mortality was associated with other well-known predictors: greater area deprivation, urban location, and higher proportion of a non-white population. + +=== United States === + +==== New York State Model GBUACO ==== +The Greater Buffalo United Accountable Care Organization (GBUACO), New York State's first Medicaid accountable care organization (ACO), is the state's first value-based payment (VBP) pilot. The Greater Buffalo United Accountable Care Organization was the 1st Medicaid and Commercial ACO in New York State. It received 1 of 5 NCQA ACO recognitions in the country. The model of integrated health care and high-level results displayed by Greater Buffalo United Accountable Care Organization (GBUACO) have been set as the building ground for other ACOs in the state. The pilot agreement was between GBUACO & the YourCare Health Plan. Under VBP, GBUACO's network of health care professionals will be compensated based on the quality, and not the quantity, of care delivered. An ACO is a patient-centered care model that aims to raise patient care quality, reduce costs and streamline health care delivery. A total of 15 organizations are taking part in this VBP feasibility study. +Under the VBP system, doctors and health care providers have to meet clearly defined quality metrics that focus on prevention and managing chronic diseases. Through care coordination, providers are incentivized for keeping their patients in the ACO healthy, minimizing expensive emergency room visits, hospital stays and costly duplicative medical tests. Under VBP shared savings, total spending is compared with a target: if the organization's spending is below the target, it can share some of the difference as a bonus. +"GBUACO is proud to once again be leading the way in health care reform," said Raul Vazquez, M.D., GBUACO president and chief executive officer (CEO). "We are honored to have been approved for this pilot, and we are excited to play a pivotal role as an early adopter of the VBP program. GBUACO stands ready to be an active participant in providing lessons learned and sharing best practices for statewide VBP implementation." +The New York State Department of Health's Delivery System Reform Incentive Payment Program (DSRIP) is overseeing the two-year pilot VBP program. The effectiveness of the program is measured by how well each ACO performs within the predetermined metrics. +Through this agreement, GBUACO Outperformed both State and National Averages. +The ACO did better than the Nation in all 12 measurable Metrics in 2018. +The ACO also did better than the State in 9 of 15 Metrics in 2018. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pay_for_performance_(healthcare)-2.md b/data/en.wikipedia.org/wiki/Pay_for_performance_(healthcare)-2.md new file mode 100644 index 000000000..c975a6a8c --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pay_for_performance_(healthcare)-2.md @@ -0,0 +1,47 @@ +--- +title: "Pay for performance (healthcare)" +chunk: 3/4 +source: "https://en.wikipedia.org/wiki/Pay_for_performance_(healthcare)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:42.788886+00:00" +instance: "kb-cron" +--- + +==== VBP and VBP Levels ==== +Value-Based Purchasing (VBP) Linking provider payments to improved performance by health care providers. This form of payment holds health care providers accountable for both the cost and quality of care they provide. It attempts to reduce inappropriate care and to identify and reward the best-performing providers. +VBP Levels 1, 2, and 3 describe the level of risk providers choose to share with the MCO. GBUACO is a level 2 VBP. +VBP risk levels allow providers to gradually increase the level of risk in their contracts. Levels of risk offer a flexible approach for providers in moving to VBP. +Level 1 VBP: +FFS with upside-only shared savings +available when outcome scores are sufficient. +Has only an upside. +Receives FFS Payments. +Level 2 VBP: +FFS with risk sharing (upside +available when outcome scores are sufficient). +Has upside and downside risk. +Receives FFS Payments. +Level 3 VBP: (feasible after experience with Level 2; requires mature contractors) +Prospective capitation PMPM or Bundle +(with outcome-based component). +Has upside and downside risk. +Prospective total budget payments. + +==== California ==== +Responding to public backlash to managed care in the 1990s, California health care plans and physician groups developed a set of quality performance measures and public "report cards", emerging in 2001 as the California Pay for Performance Program, now the largest pay-for-performance program in the country. Financial incentives based on utilization management were changed to those based on quality measures. Provider participation is voluntary, and physician organizations are accountable through public scorecards, and provided financial incentives by participating health plans based on their performance. + +==== Medicare ==== +In the United States, Medicare has various pay-for-performance ("P4P") initiatives in offices, clinics and hospitals, seeking to improve quality and avoid unnecessary health care costs. The Centers for Medicare and Medicaid Services (CMS) has several demonstration projects underway offering compensation for improvements: + +Five original statutorily mandated value-based programs, including the Hospital Value-Based Purchasing (HVBP) Program, Hospital Readmission Reduction Program (HRRP), Hospital Acquired Conditions (HAC) Reduction Program, End-Stage Renal Disease Quality Incentive Program (ESRD QIP), and the Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM). The VM was replaced by the MIPS QPP track in 2019. +Other value-based programs for different settings include the Skilled Nursing Facility Value-Based Purchasing (SNFVBP) and Home Health Value Based Purchasing (HHVBP). +Dozens of ongoing and concluded Innovation Center models incorporating value-based incentives in their model designs as part of the center's statutory requirement to improve quality without increasing health care costs or reduce health care costs without reducing healthcare quality. +Payments for better care coordination between home, hospital and offices for patients with chronic illnesses. In April 2005, CMS launched its first value-based purchasing pilot or "demonstration" project- the three-year Medicare Physician Group Practice (PGP) Demonstration. The project involves ten large, multi-specialty physician practices caring for more than 200,000 Medicare fee-for-service beneficiaries. Participating practices will phase in quality standards for preventive care and the management of common chronic illnesses such as diabetes. Practices meeting these standards will be eligible for rewards from savings due to resulting improvements in patient management. The First Evaluation Report to Congress in 2006 showed that the model rewarded high quality, efficient provision of health care, but the lack of up-front payment for the investment in new systems of case management "have made for an uncertain future with respect for any payments under the demonstration." +A set of 10 hospital quality measures which, if reported to CMS, will increase the payments that hospitals receive for each discharge. By the third year of the demonstration, those hospitals that do not meet a threshold on quality will be subject to reductions in payment. Preliminary data from the second year of the study indicates that pay for performance was associated with a roughly 2.5% to 4.0% improvement in compliance with quality measures, compared with the control hospitals. Dr. Arnold Epstein of the Harvard School of Public Health commented in an accompanying editorial that pay-for-performance "is fundamentally a social experiment likely to have only modest incremental value." +Rewards to physicians for improving health outcomes by the use of health information technology in the care of chronically ill Medicare patients. +Reputational incentives through traditional pay-for-reporting programs, such as nationwide hospital quality data collected under the Hospital Inpatient Quality Reporting (IQR) Program and publicly displayed by CMS through its Care Compare website and Star Ratings methodology, also creates indirect financial incentives to improve quality as C-suite pays close attention to this publicly displayed data and how it influences patient decisions about where they decide to seek care. +In 2019, CMS filed to remove several quality measurements from its Hospital Inpatient Quality Reporting (IQR) Program, although they were retained in the value-based purchasing programs (Hospital Value-Based Purchasing, Hospital Readmissions Reduction, and Hospital-Acquired Condition Reduction Programs). + +==== Negative incentives ==== +As a disincentive, CMS has proposed eliminating payments for negative consequences of care that results in injury, illness or death. This rule, effective October 2008, would reduce payments for medical complications such as "never events" as defined by the National Quality Forum, including hospital infections. Section 1886(p) of the Social Security Act established the HAC Reduction Program, criticized by some stakeholders as a "penalty program", which reduces overall Medicare payments for hospitals that rank in the worst-performing quartile of all hospitals on measures of hospital-acquired conditions or "never events". Other private health payers are considering similar actions; the Leapfrog Group is exploring how to provide support to its members who are interested in ensuring that their employees do not get billed for such an event, and who do not wish to reimburse for these events themselves. Physician groups involved in the management of complications, such as the Infectious Diseases Society of America, have voiced objections to these proposals, observing that "some patients develop infections despite application of all evidence-based practices known to avoid infection", and that a punitive response may discourage further study and slow the dramatic improvements that have already been made. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pay_for_performance_(healthcare)-3.md b/data/en.wikipedia.org/wiki/Pay_for_performance_(healthcare)-3.md new file mode 100644 index 000000000..56a97b193 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pay_for_performance_(healthcare)-3.md @@ -0,0 +1,36 @@ +--- +title: "Pay for performance (healthcare)" +chunk: 4/4 +source: "https://en.wikipedia.org/wiki/Pay_for_performance_(healthcare)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:42.788886+00:00" +instance: "kb-cron" +--- + +==== Multiple providers for complex disorders ==== +Pay for performance programs often target patients with serious and complex illnesses; such patients commonly interact with multiple healthcare providers and facilities. However, pilot programs now underway focus on simple indicators such as improvement in lab values or use of emergency services, avoiding areas of complexity such as multiple complications or several treating specialists. A 2007 study analyzing Medicare beneficiaries' healthcare visits showed that a median of two primary care physicians and five specialists provide care for a single patient. The authors doubt that pay-for-performance systems can accurately attribute responsibility for the outcome of care for such patients. The American College of Physicians Ethics has expressed concern: Pay-for-performance initiatives that provide incentives for good performance on a few specific elements of a single disease or condition may lead to neglect of other, potentially more important elements of care for that condition or a comorbid condition. The elderly patient with multiple chronic conditions is especially vulnerable to this unwanted effect of powerful incentives. + +==== Deselection, ethical issues ==== +Present pay-for-performance systems measure performance based on specified clinical measurements, such as reductions in glycohemoglobin (HbA1c) for patients with diabetes. Healthcare providers who are monitored by such limited criteria have a powerful incentive to deselect (dismiss or refuse to accept) patients whose outcome measures fall below the quality standard and therefore worsen the provider's assessment. Patients with low health literacy, inadequate financial resources to afford expensive medications or treatments, and ethnic groups traditionally subject to healthcare inequities may also be deselected by providers seeking improved performance measures. + +==== Public reporting ==== +In Minnesota, Minnesota Community Measurement ranks providers on multiple categories such as patient experience and total cost of care and provides public reporting online to inform consumers. The service is designed to help purchasers make better decisions when seeking care and to provide feedback to providers for areas that need improvement. + +== See also == +Advance market commitments +Bundled payment +Capitation +Evidence-based medicine +Fee-for-service +Guideline (medical) +Health maintenance organization +Patient safety +Social impact bonds +Value based health care +Value-based insurance design + +== References == + +== External links == +p4presearch.org from the University of Minnesota Department of Family Medicine and Community Health \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Perinatal_mortality-0.md b/data/en.wikipedia.org/wiki/Perinatal_mortality-0.md new file mode 100644 index 000000000..e9768152f --- /dev/null +++ b/data/en.wikipedia.org/wiki/Perinatal_mortality-0.md @@ -0,0 +1,65 @@ +--- +title: "Perinatal mortality" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Perinatal_mortality" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:44.093784+00:00" +instance: "kb-cron" +--- + +Perinatal mortality (PNM) is the death of a fetus or neonate and is the basis for calculation of the perinatal mortality rate. Perinatal means "relating to the period starting a few weeks before birth and including the birth and a few weeks after birth." +Variations in the precise definition of the perinatal mortality exist, specifically concerning the issue of inclusion or exclusion of early fetal and late neonatal fatalities. The World Health Organization defines perinatal mortality as the "number of stillbirths and deaths in the first week of life per 1,000 total births, the perinatal period commences at 22 completed weeks (154 days) of gestation, and ends seven completed days after birth", but other definitions have been used. +The UK figure is about 8 per 1,000 and varies markedly by social class, with the highest rates seen in Asian women. Globally, an estimated 2.6 million neonates died in 2013 before the first month of age, down from 4.5 million in 1990. + + +== Causes == + +Preterm birth is the most common cause of perinatal mortality, causing almost 30 percent of neonatal deaths. Infant respiratory distress syndrome, in turn, is the leading cause of death in preterm infants, affecting about 1% of newborn infants. Birth defects cause about 21 percent of neonatal death. +Some major causes of perinatal mortality rate are: + +Maternal diseases +Pelvic diseases: endometriosis, ovarian tumor +Anatomical defects: Uterine, cervical anomalies +Endocrine imbalance +Blood incompatibilities +Malnutrition +Toxemias of pregnancy +APH +Congenital defects +Advanced maternal age + + +== Fetal mortality == +Fetal mortality refers to stillbirths or fetal death. It encompasses any death of a fetus after 20 weeks of gestation or 500 gm. In some definitions of the PNM, early fetal mortality (week 20–27 gestation) is not included, and the PNM may only include late fetal death and neonatal death. Fetal death can also be divided into death before labor, antenatal (antepartum) death, and death during labor, intranatal (intrapartum) death. + + +== Neonatal mortality == +Neonatal mortality refers to the death of a live-born baby within the first 28 days of life. Early neonatal mortality refers to the death of a live-born baby within the first seven days of life, while late neonatal mortality refers to death after 7 days until before 28 days. Some definitions of the PNM include only the early neonatal mortality. Neonatal mortality is affected by the quality of in-hospital care for the neonate. Neonatal mortality and postneonatal mortality (covering the remaining 11 months of the first year of life) are reflected in the infant mortality rate. + + +== Perinatal mortality rate == + +The PNMR refers to the number of perinatal deaths per 1,000 total births. It is usually reported annually. It is a major marker to assess the quality of health care delivery. Varying definitions, registration bias, and differences in the underlying risks of the populations may hamper comparisons between different rates. +PNMRs vary widely and may be below 10 for certain developed countries and more than 10 times higher in developing countries. The WHO has not published contemporary data. + + +== Effects of neonatal nutrition on neonatal mortality == +Probiotic supplementation of preterm and low birthweight babies during their first month of life can reduce the risk of blood infections, bowel sickness, and death in low- and middle-income settings. However, supplementing with Vitamin A does not reduce the risk of death and increases the risk of bulging fontanelle, which may cause brain damage. + + +== See also == +Maternal death +Miscarriage +Neonatal intensive care unit +Neonaticide +Stillbirth + + +== References == + + +== External links == + +WHO 2005 report +European Perinatal Health Report 2010 Archived 2022-01-19 at the Wayback Machine \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Periodic_breathing-0.md b/data/en.wikipedia.org/wiki/Periodic_breathing-0.md new file mode 100644 index 000000000..818493480 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Periodic_breathing-0.md @@ -0,0 +1,22 @@ +--- +title: "Periodic breathing" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Periodic_breathing" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:45.426022+00:00" +instance: "kb-cron" +--- + +Periodic breathing is clusters of breaths separated by intervals of apnea or near-apnea. As opposed to normal breathing, which is usually regular, periodic breathing is defined as three or more episodes of central apnea lasting at least 4 seconds, separated by no more than 30 seconds of normal breathing. +Periodic breathing was originally thought to arise from serious neurologic or cardiovascular disease and therefore to carry a poor outlook. It is now known that periodic breathing also tends to occur during sleep, it can occur in healthy persons, and the apnea in periodic breathing is usually central sleep apnea rather than obstructive sleep apnea. +Periodic breathing during sleep occurs typically in adult patients with congestive heart failure. +Periodic breathing is also a normal variation of breathing found in premature and full term infants. It occurs when the infant has pauses in breathing for no more than 10 seconds at a time followed by a series of rapid, shallow breaths. Then the breathing returns to normal without any stimulation or intervention. These pauses in breathing may be accompanied by minor oxygen desaturation and bradycardia. It usually occurs when the infant is sleeping deeply, but may occur with light sleep or even when awake. Studies have shown that 78% of healthy full-term infants experience episodes of periodic breathing in the first two weeks of life, which typically resolves in the first six months of life. + + +== Types == +1. Cheyne-Stokes respiration +2. Biot's respiration + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Permissive_hypotension-0.md b/data/en.wikipedia.org/wiki/Permissive_hypotension-0.md new file mode 100644 index 000000000..45400e0c5 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Permissive_hypotension-0.md @@ -0,0 +1,12 @@ +--- +title: "Permissive hypotension" +chunk: 1/2 +source: "https://en.wikipedia.org/wiki/Permissive_hypotension" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:46.615676+00:00" +instance: "kb-cron" +--- + +Permissive hypotension or hypotensive resuscitation is the use of restrictive fluid therapy, specifically in the trauma patient, that increases systemic blood pressure without reaching normotension (normal blood pressures). The goal blood pressure for these patients is a mean arterial pressure of 40-50 mmHg or systolic blood pressure of less than or equal to 80. This goes along with certain clinical criteria. Following traumatic injury, some patients experience hypotension (low blood pressure) that is usually due to blood loss (hemorrhage) but can be due to other causes as well (for example, blood leaking around an abdominal aortic aneurysm). In the past, physicians were very aggressive with fluid resuscitation (giving fluids such as normal saline or lactated Ringer's through the vein) to try to bring the blood pressure to normal values. Recent studies have found that there is some benefit to allowing specific patients to experience some degree of hypotension in certain settings. This concept does not exclude therapy by means of i.v. fluid, inotropes or vasopressors, the only restriction is to avoid completely normalizing blood pressure in a context where blood loss may be enhanced. When a person starts to bleed (big or small) the body starts a natural coagulation process that eventually stops the bleed. Issues with fluid resuscitation without control of bleeding are thought to be secondary to dislodgement of the thrombus (blood clot) that is helping to control further bleeding. Thrombus dislodgement was found to occur at a systolic pressure greater than 80mm Hg. In addition, fluid resuscitation will dilute coagulation factors that help form and stabilize a clot, hence making it harder for the body to use its natural mechanisms to stop the bleeding. These factors are aggravated by hypothermia (if fluids are administered without being warmed first it will cause body temperature to drop). +It is becoming common in hemorrhaging patients without traumatic brain injury. Due to the lack of controlled clinical trials in this field, the growing evidence that hypotensive resuscitation results in improved long-term survival mainly stems from experimental studies in animals. Numerous animal models of uncontrolled hemorrhagic shock have demonstrated improved outcomes when a lower than normal blood pressure (mean arterial pressure of 60 to 70 mmHg) is taken as the target for fluid administration during active hemorrhage. The first published study in humans, in people with penetrating torso trauma, has demonstrated a significant reduction in mortality when fluid resuscitation was restricted in the prehospital period. However, the objective of that study was the comparison between standard prehospital and trauma center fluid resuscitation versus delayed onset of fluid resuscitation (fluid not administered until patients reached the operating room). A more recent study (2011) performed by the Baylor Group on patients who required emergency surgery secondary to hemorrhagic shock was randomized to a mean arterial pressure (MAP) of 50mmHg versus 65mm Hg. The lower MAP group was found to need less total IV fluids, used fewer blood products, had lower early mortality (within the first 24 hours - which accounts for a large portion of mortality in trauma patients) and trended towards lower 30-day mortality and less postoperative coagulation, concluding that permissive hypotension is safe. Two large human trials of this technique have been conducted, which demonstrated the safety of this approach relative to the conventional target (greater than 100 mmHg), and suggested various benefits, including shorter duration of hemorrhage and reduced mortality. Johns Hopkins group performed a retrospective cohort review from National Trauma Data Bank that found a statistically significant difference in mortality for patients treated with pre-hospital intravenous fluids. Clinical data from well-controlled, prospective trials applying the concept of permissive hypotension in trauma patients are still missing. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Permissive_hypotension-1.md b/data/en.wikipedia.org/wiki/Permissive_hypotension-1.md new file mode 100644 index 000000000..8e2ac51d4 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Permissive_hypotension-1.md @@ -0,0 +1,28 @@ +--- +title: "Permissive hypotension" +chunk: 2/2 +source: "https://en.wikipedia.org/wiki/Permissive_hypotension" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:46.615676+00:00" +instance: "kb-cron" +--- + +== Pathophysiology == +Following injury, the otherwise healthy individual has a natural ability to clot off bleeding. The higher the pressure in your vessels, the harder it is for the bleeding to stop, since the fluid essentially "pushes" the clot out and consequently the bleeding resumes. In more technical terms: hypotension facilitates in vivo coagulation. This is especially true in patients who still have active bleeding. Attempts to normalize blood pressure in case of uncontrolled bleeding as in patients with penetrating trauma, may result in increased blood loss and worse outcomes. In this context, restriction of fluid resuscitation may actually improve outcomes. This concept has been supported by animal studies that have demonstrated aggressive fluid resuscitation increases the volume of hemorrhaging fluid to a significant level as well as increased mortality. +Another issue with aggressive fluid resuscitation is the potential for hypothermia if fluids that are stored at room temperature are used. If these fluids are not warmed prior to infusion (which sometimes time does not permit), this can result in a significant drop in core body temperature. Hypothermia is associated with many problems including a bleeding disorder, organ failure, and hypotension, and is one of the three components in the "Triad of Death" that is feared by all trauma specialists. +The crystalloid fluid used in initial resuscitative efforts does not contain any clotting factors or erythrocytes (red blood cells). Its use may result in a dilution of clotting factors and erythrocytes, and therefore poorer control of bleeding and impaired oxygen transport to tissues causing further ischemic damage. Additionally, crystalloids have an acidic pH, and the administration of large quantities of isotonic or slightly hypertonic crystalloid solutions such as 0.9% normal saline or Lactated Ringer's can cause or aggravate metabolic acidosis, another component of the "Triad of Death" leading to a decrease in myocardial (heart muscle) function. +Permissive hypotension is a temporary measure to improve outcomes until the source of bleeding is controlled. There are issues associated with prolonged permissive hypotension (> 90 min considered prolonged where detrimental effects outweigh benefits according to most recent animal studies - no human data available to date) that must be taken to account. Prolonged permissive hypotension can lead to aggravated post-injury coagulopathy (coagulation dysfunction), ischemic damage secondary to poor tissue perfusion including the brain, mitochondrial dysfunction, and lactic acidosis among others. It is also possible that other substances, such as estrogen (17 beta-estradiol) could allow for longer models of permissive hypotension. In a rat model of hemorrhagic shock, estrogen was able to reduce some of the negative effects of prolonged permissive hypotension as well as prolong long-term survival. + +== Contraindications == +Patients with preexisting hypertension are at higher risk of death and morbidity during permissive hypotension. This is due to the shift in the autoregulatory curve to the right for hypertensive patients. +Permissive hypotension relies on the heart's ability to pump fluid through the body efficiently. Less intravascular fluid results in less fluid filling the heart (lower end diastolic volume) which results in a lower amount of volume pumped out of the heart (stroke volume). This is based on the Frank-Starling law of the heart. Healthy patients should be able to compensate for lower volumes to some extent, but patients with pre-existing cardiovascular disease limiting myocardial function (such as angina pectoris) may not. Applying permissive hypotension to the latter patient category may result in decreased coronary perfusion and result in ischemic damage to the heart and potentially myocardial infarction (heart attack). +Permissive hypotension may also be contraindicated in patients with cerebrovascular disease, carotid artery stenosis, and compromised renal (kidney) function, where hypotension may induce sludge (thickening of the blood) and lead to occlusion of the vessel lumen. It is also recommended that fluid loading should be used, instead of permissive hypotension, for those with crush syndrome. +A high percentage of polytraumatized patients have traumatic brain injury. The results from the Traumatic Coma Data Bank show the influence of the presence or absence of hypotension (defined as one or more recordings of a systolic blood pressure ≤90 mm Hg) or hypoxia (PaO2 <60 mm Hg) at the time of admission) on the outcome of patients with traumatic brain injury and hypotension at admission to the hospital showed twice the mortality and a significant increase in morbidity when compared with patients who were normotensive. The concomitant presence of hypoxia and hypotension upon admission resulted in a 75% mortality. Evidence strongly suggests that the avoidance or minimization of hypotension during the acute and postinjury period following traumatic brain injury had the highest likelihood of improving outcomes of any one single therapeutic maneuver. Therefore, managing a patient with traumatic brain injury and continuing bleeding elsewhere becomes a balance between meeting the demands of the brain versus the demands of the body, which should be addressed by the experienced anesthesiologist, surgeon and emergency physician. + +== Current Recommendations == +UK - Resuscitation to maintain a palpable radial pulse (indicative of systolic blood pressure 80-90mm Hg) in ongoing hemorrhage in soldiers and to maintain only a palpable central pulse (ex. carotid), indicative of systolic blood pressure of 60mm Hg with penetrating torso trauma. +United States - US Military follows permissive hypotension. Any patient that experiences altered mental status or becomes unconscious (systolic blood pressure less than or equal to 50mmHg) is resuscitated to restore mentation or systolic blood pressure of 70mmHg. +Israel - Israeli Military also follows permissive hypotension and follows similar guidelines as the United States. + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Phonagnosia-0.md b/data/en.wikipedia.org/wiki/Phonagnosia-0.md new file mode 100644 index 000000000..8d3ade7d7 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Phonagnosia-0.md @@ -0,0 +1,35 @@ +--- +title: "Phonagnosia" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Phonagnosia" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:47.797123+00:00" +instance: "kb-cron" +--- + +Phonagnosia (from Ancient Greek φωνή phone, "voice" and γνῶσις gnosis, "knowledge") or voice blindness is a type of agnosia, or loss of knowledge, that involves a disturbance in the recognition of familiar voices and the impairment of voice discrimination abilities in which the affected individual does not suffer from comprehension deficits. Phonagnosia is an auditory agnosia, an acquired auditory processing disorder resulting from brain damage. Other auditory agnosias include cortical deafness and auditory verbal agnosia also known as pure word deafness. +Since people suffering from phonagnosia do not suffer from aphasia, it is suggested that the structures of linguistic comprehension are functionally separate from those of the perception of the identity of the speaker who produced it. + + +== History == +Phonagnosia is the auditory equivalent of prosopagnosia. Unlike prosopagnosia, investigations of phonagnosia have not been extensively pursued. Phonagnosia was first described by a study by Van Lancker and Cantor in 1982. The subjects in this study were asked to identify which of four names or faces matched a specific famous voice. The subjects could not complete the task. Since then, there have been a couple studies done on patients with phonagnosia. The clinical and radiologic findings with computerized tomographic scans (CAT scans) in these cases suggest that recognition of familiar voices is impaired by damage to the inferior and parietal regions of the right hemisphere while voice discrimination is impaired by temporal lobe damage of either hemisphere. These studies have also shown evidence for a double dissociation between voice recognition and voice discrimination. Some patients will perform normally on the discrimination tasks but poorly on the recognition tasks; whereas the other patients will perform normally on the recognition tasks but poorly on the discrimination tasks. Patients did not perform poorly on both tasks. +Associative phonagnosia is a form of phonagnosia that develops with dementia or other focal neurodegenerative disorders. Some research has led to questions of other impairments in phonagnosics. Recently, studies have shown that phonagnosics also have trouble in recognizing the sounds of familiar instruments. As it is with voices, they also show deficiency in distinguishing between sounds from different instruments. Although the disability is shown, phonagnosics are much less affected in this area of sound discrimination. In distinguishing voices, it is a complete agnosia, but this is not the case for musical instrument sounds, as they can correctly identify some of them. Controversy arises in that not all phonagnosics exhibit these symptoms, and so not all researchers agree that it should be attributed to the damage suffered that causes phonagnosia. Much debate has arisen over the fact that it seems that separate areas of the brain are utilized to handle information from language and music. This has led some researchers to skeptically consider this impairment as a clear symptom of the disorder. Again, more research is needed to create a clearer conclusion. +An interesting attribute that phonagnosics possess is that they can correctly detect emotions in voices when someone talks to them. They can also correctly match an emotion with a facial expression. Although surprising, this finding is sensible because it is known and well agreed upon that the limbic system, involved in expressing emotions and detecting emotions of others, is a separate system within the brain. The limbic system is made up of several brain structures including the hippocampus, amygdala, anterior thalamic nuclei, septum, limbic cortex and fornix. +Presently, there is no therapy or treatment for phonagnosia. Clearly, more research is needed to accomplish the feat of developing treatment for the disorder. The lack of treatment stems from the lack of knowledge about the disorder. Increased research will reveal vital information needed to formulate effective treatments and therapies. + + +== Case studies == +It is progressive and gets worse as the disorder worsens. QR and KL participated in a study done of auditory and visual tasks accompanied by a brain MRI. QR suffered a deficit in voice recognition only, while KL had an associative form of prosoagnosia. The auditory and visual deficits could then be compared with an MRI of each patient's brain. The MRI of QR, a patient with a behavioural variant frontotemporal dementia, shows bilateral fronto-temporal atrophy mostly in the right anterior temporal lobe but extending back within the temporal lobe and including the superior temporal sulcus. The MRI of KL showed bilateral anterior temporal lobe atrophy, with more damage on the right side and in the inferior temporal cortices. The clinical diagnosis of KL was temporal variant frontotemporal lobar degeneration with progressive right temporal lobe atrophy. +More recently, there has been a study of developmental phonagnosia. KH, a 60-year-old woman who exhibits all the symptoms of impairments in vocal recognition, but does not have any of the brain damage associated with such impairment. Additionally, KH has suffered from this inability to recognize voices for her whole life, making her the first known case of developmental phonagnosia. The study of KH has turned the research world of phonagnosia on its head because it was thought that phonagnosia resulted only after damage to the parietal and temporal lobes had been sustained. The discovery that phonagnosia can exist without structural damage shows that the disorder can be the result of cognitive abnormalities. Given the recency of this study, little research has been conducted on the cognitive based theories. Areas of interest lie in the neural connections between the various areas in the parietal lobe, as well as those within the temporal lobe. Developmental phonagnosia suggests in the name itself that the disorder develops when the brain is developing in the womb and throughout childhood. Researchers have suggested that neurons are not making the connections needed for the correct identification of voices, familiar or unfamiliar. Still, no solid theories have been formed and research studies to test these individuals in its developmental stage. + + +== Pop Culture == +The protagonist in the Tollywood film Prasanna Vadanam is afflicted with this disorder due to brain injury. + + +== See also == +Auditory processing disorder + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Phoniatrics-0.md b/data/en.wikipedia.org/wiki/Phoniatrics-0.md new file mode 100644 index 000000000..a44256e2d --- /dev/null +++ b/data/en.wikipedia.org/wiki/Phoniatrics-0.md @@ -0,0 +1,19 @@ +--- +title: "Phoniatrics" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Phoniatrics" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:49.015177+00:00" +instance: "kb-cron" +--- + +Phoniatrics or phoniatry is the study and treatment of organs involved in speech production, mainly the mouth, throat (larynx), vocal cords, and lungs. Problems treated in phoniatrics include dysfunction of the vocal cords, cancer of the vocal cords or larynx, inability to control the speech organs properly (speech disorders), and vocal loading problems. +According to the Union of European Phoniatricians, phoniatrics is "the medical specialty dealing with voice, speech, language, hearing and swallowing disorders". + + +== References == + + +== External links == +"Logbook Phoniatrics UEMS 2010" (PDF). Union of the European Phoniatricians. 1 October 2010. Archived from the original (PDF) on 30 October 2016. Retrieved 30 October 2016. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Physical_disorder-0.md b/data/en.wikipedia.org/wiki/Physical_disorder-0.md new file mode 100644 index 000000000..d2719aa85 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Physical_disorder-0.md @@ -0,0 +1,16 @@ +--- +title: "Physical disorder" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Physical_disorder" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:50.252559+00:00" +instance: "kb-cron" +--- + +Physical disorder, as a medical term, is poorly defined, and typically used in contrast to a mental disorder or a genetic disorder. The term mental disorder is heavily used in psychiatric medicine, and is defined in some psychiatric medicine texts, most notably the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, the more generic term of medical disorder is poorly defined, and is not mentioned in the World Health Organization's International Classification of Diseases, nor many common medical textbooks. Attempts have been made to adopt a more universal definition, but there is no widely agreed upon definition. +A physical disorder is not easily defined as the term "disorder" itself has not yet been defined by any authoritative medical body. The term "disorder" bears no special clinical relevance, and could be used interchangeably with disease. The use of the term "disorder" likely rests on historical precedent as well as the preference of the field. For example, it is common to find examples of diseases named "disorders" in psychiatry and genetics, such as autosomal dominant disorders, but uncommon in cardiology. In general, diseases called "disorders" have a relatively well understood, narrow pathophysiology, such as bipolar disorder, compared to something more generic, such as heart disease. Similarly, disorders are typically not acquired, or the result of environmental factors, such as lung disease. +A disease or illness described as a physical disorder likely impacts the musculoskeletal system and lacks an inciting injury. Examples may include webbed toes, peau deficit disorder, arthritis, or ataxia, though the latter two may also reasonably be called an immune disorder and a neurological disorder, respectively. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Physical_inactivity-0.md b/data/en.wikipedia.org/wiki/Physical_inactivity-0.md new file mode 100644 index 000000000..2eb609589 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Physical_inactivity-0.md @@ -0,0 +1,33 @@ +--- +title: "Physical inactivity" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Physical_inactivity" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:51.505258+00:00" +instance: "kb-cron" +--- + +Physical inactivity refers to the lack of moderate-to-vigorous physical activity in a person's lifestyle. It is distinct from sedentary behavior. + + +== Health effects == +The World Health Organization (WHO) has defined physical inactivity as a global public health problem. Each year, approximately 3.2 million people die from causes related to physical inactivity. + + +== Prevalence == + +Globally, 28% of adults and 80% of adolescents are estimated to be insufficiently active. +As of 2008, the WHO identified the Americas and the Eastern Mediterranean as regions with the greatest prevalence of physical inactivity. Nearly half of all women in both of these regions have physical inactivity, as well as 40% of men in the Americas and 36% of men in the Eastern Mediterranean. In contrast, the region with the lowest prevalence of physical inactivity is Southeast Asia. There, 19% of women and 15% of men are physically inactive. +In the US, physical inactivity prevalence varies by state and ethnicity. All states and territories had prevalence rates of more than 15% of adults. Colorado, Utah, Oregon, and Washington were the only states with physical inactivity prevalence less than 20%. Seven states and two territories had prevalence greater than 30%: Tennessee, Oklahoma, Louisiana, Alabama, Kentucky, Arkansas, and Mississippi, Guam, and Puerto Rico. Hispanics have the highest rate of physical inactivity (31.7%), followed by African-Americans (30.3%), and then non-Hispanic whites (23.4%). + + +== Causes == +Several factors have been identified as part of the rising prevalence of physical inactivity. People are participating less in physical activity during leisure time. Additionally, they are increasingly likely to use sedentary behaviors during work and domestic activities. Also, instead of walking or cycling, many now use passive transportation. Urbanization may also increase physical inactivity: factors such as violence, lack of greenspace, poor air quality, and dense traffic may discourage physical activity. The rise of technology has shifted physical activity patterns, lessening the demand for manual tasks. Modern devices like computers, smartphones, and digital entertainment options have made inactive leisure more appealing. + + +== References == + + +== External links == +WHO fact sheet on physical activity \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Physiological_agonism_and_antagonism-0.md b/data/en.wikipedia.org/wiki/Physiological_agonism_and_antagonism-0.md new file mode 100644 index 000000000..14f20afde --- /dev/null +++ b/data/en.wikipedia.org/wiki/Physiological_agonism_and_antagonism-0.md @@ -0,0 +1,25 @@ +--- +title: "Physiological agonism and antagonism" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Physiological_agonism_and_antagonism" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:52.749554+00:00" +instance: "kb-cron" +--- + +Physiological agonism describes the action of a substance which ultimately produces the same effects in the body as another substance—as if they were both agonists at the same receptor—without actually binding to the same receptor. Physiological antagonism describes the behavior of a substance that produces effects counteracting those of another substance (a result similar to that produced by an antagonist blocking the action of an agonist at the same receptor) using a mechanism that does not involve binding to the same receptor. + + +== Examples == + + +=== Physiological agonists === +Epinephrine induces platelet aggregation, and so does hepatocyte growth factor (HGF). Thus, they are physiological agonists to each other. + + +=== Physiological antagonists === +There are several substances that have antihistaminergic action despite not being ligands for the histamine receptor. For instance, epinephrine raises arterial pressure through vasoconstriction mediated by A1-adrenergic receptor activation, in contrast to histamine, which lowers arterial pressure. Thus, despite not being true antihistamines because they do not bind to and block the histamine receptor, epinephrine and other such substances are physiological antagonists to histamine. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pilon_fracture-0.md b/data/en.wikipedia.org/wiki/Pilon_fracture-0.md new file mode 100644 index 000000000..3fed9d783 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pilon_fracture-0.md @@ -0,0 +1,30 @@ +--- +title: "Pilon fracture" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Pilon_fracture" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:54.213164+00:00" +instance: "kb-cron" +--- + +A pilon fracture is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accidents. Pilon fractures are rare, comprising 3 to 10 percent of all fractures of the tibia and 1 percent of all lower extremity fractures, but they involve a large part of the weight-bearing surface of the tibia in the ankle joint. Because of this, they may be difficult to fixate and are historically associated with high rates of complications and poor outcome. +Pilon is the French word for "pestle" and was introduced into orthopedic literature in 1911 by pioneer French radiologist Étienne Destot. + + +== Classification == +Pilon fractures are categorized by two main X-ray schemes, Ruedi-Allgower classification system. and Müller AO Classification of fractures. + + +== Treatment == +The treatment of pilon fractures depends on the extent of the injury. This includes the involvement of other bones such as the fibula and the talus, involvement of soft tissue, and the fracture pattern. Treatment strategies and fixation methods used include internal and external fixation, as well as staged approaches, with the aim of reducing the fracture, reconstructing the involved bones and restoration of articular surface congruence, with minimal insult to soft tissues. Appropriate wound management is important to reduce the high rate of infectious complications and secondary wound healing problems associated with open pilon fractures. Vacuum-assisted wound closure therapy and using a staged protocol (awaiting soft-tissue recovery before extensive reconstructive efforts) may play a positive role. + + +== See also == +Ankle fracture + + +== References == + + +== External links == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Point-of-care_testing-0.md b/data/en.wikipedia.org/wiki/Point-of-care_testing-0.md new file mode 100644 index 000000000..96d292c28 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Point-of-care_testing-0.md @@ -0,0 +1,20 @@ +--- +title: "Point-of-care testing" +chunk: 1/2 +source: "https://en.wikipedia.org/wiki/Point-of-care_testing" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:55.414574+00:00" +instance: "kb-cron" +--- + +Point-of-care testing (POCT), also called near-patient testing or bedside testing, is defined as medical diagnostic testing at or near the point of care—that is, at the time and place of patient care. This contrasts with the historical pattern in which testing was wholly or mostly confined to the medical laboratory, which entailed sending off specimens away from the point of care and then waiting hours or days to learn the results, during which time care must continue without the desired information. + +== Technology overview == +Point-of-care tests are simple medical tests that can be performed at the bedside. In many cases, the simplicity was not achievable until technology developed not only to make a test possible at all but then also to mask its complexity. For example, various kinds of urine test strips have been available for decades, but portable ultrasonography did not reach the stage of being advanced, affordable, and widespread until the 2000s and 2010s. Today, portable ultrasonography is often viewed as a "simple" test, but there was nothing simple about it until the more complex technology was available. Similarly, pulse oximetry can test arterial oxygen saturation in a quick, simple, noninvasive, affordable way today, but in earlier eras this required an intra-arterial needle puncture and a laboratory test; and rapid diagnostic tests such as malaria antigen detection tests or COVID-19 rapid tests that rely on a state of the art in immunology that did not exist until recent decades. Thus, over decades, testing continues to move toward the point of care more than it formerly had been. A recent survey in five countries (Australia, Belgium, the Netherlands, the UK and the US) indicates that general practitioners / family doctors would like to use more POCTs. +The driving notion behind POCT is to bring the test conveniently and immediately to the patient. This increases the likelihood that the patient, physician, and care team will receive the results quicker, which allows for better immediate clinical management decisions to be made. In addition, this technology enables remote communities as First Nations people, to have access to laboratory testing, thereby allowing for more assertive health care. POCT includes: blood glucose testing, blood gas and electrolytes analysis, rapid coagulation testing, rapid cardiac markers diagnostics, drugs of abuse screening, urine strips testing, pregnancy testing, fecal occult blood analysis, food pathogens screening, hemoglobin diagnostics, infectious disease testing (such as COVID-19 rapid tests), cholesterol screening and emerging technologies in micronutrient deficiency screening and diagnosis of acute febrile illness. +Lab-on-a-chip technologies are one of the main drivers of point-of-care testing, especially in the field of infectious disease diagnosis. These technologies enable different bioassays such as microbiological culture, PCR, ELISA to be used at the point of care. +POCT is often accomplished through the use of transportable, portable, and handheld instruments (e.g., blood glucose meter, nerve conduction study device) and test kits (e.g., CRP, HBA1C, Homocystein, HIV salivary assay, etc.). Small bench analyzers or fixed equipment can also be used when a handheld device is not available—the goal is to collect the specimen and obtain the results in a very short period of time at or near the location of the patient so that the treatment plan can be adjusted as necessary before the patient leaves. Cheaper, faster, and smarter POCT devices have increased the use of POCT approaches by making it cost-effective for many diseases, such as diabetes, carpal tunnel syndrome (CTS) and acute coronary syndrome. Additionally, it is very desirable to measure various analytes simultaneously in the same specimen, allowing a rapid, low-cost, and reliable quantification. Therefore, multiplexed point-of-care testing (xPOCT) has become more important for medical diagnostics in the last decade. +Many point-of-care test systems are realized as easy-to-use membrane-based test strips, often enclosed by a plastic test cassette. This concept often is realized in test systems for detecting pathogens, the most common being COVID-19 rapid tests. Very recently such test systems for rheumatology diagnostics have been developed, too. These tests require only a single drop of whole blood, urine or saliva, and they can be performed and interpreted by any general physician within minutes. Recently, a portable medical diagnostic device called "BioPoC" has been reported which employs free-standing enzyme-modified responsive polymer membrane-based biosensors and a newly devised low-cost transduction principle for the detection of H. pylori and urea. +During the COVID-19 pandemic, rapid development of POCT occurred, aiming to improve the turnaround time and ease of use compared to the gold standard lab-based PCR test. These have included rapid antigen tests, alternate nucleic acid amplification methods, and novel sensors. A range of test have been developed including smartphone based platforms, and tests targeting blood, saliva, faecal matter, urine, and tears have been proposed. Saliva in particular may offer sufficiently high detection rates in tandem with a non-invasive and user friendly procedure, although reliability requires improvement. +Emerging technology at the point of care setting is being developed to allow for rapid assessment of micronutrient deficiency. The Cornell NutriPhone is a promising technology for determining nutritional status at the point of care. This technology allows assessment of iron, vitamin A, vitamin D, and vitamin B12 from a single drop of blood in around 15 minutes. Building on this same platform, there are proof-of-concept studies for fever and cancer. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Point-of-care_testing-1.md b/data/en.wikipedia.org/wiki/Point-of-care_testing-1.md new file mode 100644 index 000000000..dc6deaf6b --- /dev/null +++ b/data/en.wikipedia.org/wiki/Point-of-care_testing-1.md @@ -0,0 +1,41 @@ +--- +title: "Point-of-care testing" +chunk: 2/2 +source: "https://en.wikipedia.org/wiki/Point-of-care_testing" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:55.414574+00:00" +instance: "kb-cron" +--- + +== Benefits == +The coupling of POCT devices and electronic medical records enable test results to be shared instantly with care providers. The use of mobile devices in the health care setting also enable the health care provider to quickly access patient test results sent from a POCT device. A reduction in morbidity and mortality has been associated with such rapid turn around times from a study using the i-STAT to analyze blood lactate levels after congenital heart surgery. +POCT has become established worldwide and finds vital roles in public health. Many researchers emphasize POCT as the normal standard of care in disaster situations. +Potential operational benefits include more rapid decision making and triage, reduced operating times, high-dependency, postoperative care time, emergency room time, number of outpatient clinic visits, number of hospital beds required, ensuring optimal use of professional time and reduced of antimicrobial medication. +At home or POCT tests, providing results within minutes of being administered, would allow for appropriate measures and rapid decisions about dental patients' care process. Characteristics and detection rate of SARS-CoV-2 in alternative sites and specimens related to dentistry has been extensively reviewed. + +== Regulatory in the U.S. == +The Clinical Laboratory Improvement Amendments (CLIA) regulate any laboratory testing and require laboratories to obtain certificates to do any testing on human specimens for health assessment or to diagnose, prevent, or treat disease. Three federal agencies partner together to cover the responsibilities put forward in the regulations: the Food and Drug Administration (FDA), Centers for Medicare & Medicaid Services (CMS), and the Centers for Disease Control and Prevention (CDC). In addition, accreditation standards developed by Joint Commission and College of American Pathologists have been developed to improve quality. + +=== Food and Drug Administration (FDA) === +In vitro diagnostic (IVD) products use the same categorization as medical devices (Class I, II, and III) to assure safety and effectiveness. Regulatory controls and premarket approval process are determined by this classification, with Class I being the lowest risk (least regulated) and Class III being the highest risk (most regulated). +Under the CLIA, it is the role of the FDA to assess the complexity of the in vitro laboratory diagnostic tests. Tests are only scored after the FDA has cleared or approved a premarketing request, or upon request. Manufacturers can apply for CLIA waivers during this premarket approval/clearance process. Tests that are already cleared or approved for home use or are waived by 42 CRF 293.15(c), are classified as waived. Otherwise, the tests are either classified as moderate or high complexity based on seven categorization criteria listed in 42 CFR 493.17. If the test is classified as moderate, the manufacturer may request the test be waived through the CLIA Waiver by Application. The application must show that the test meets the criteria in 42 U.S.C. § 263a(d)(3), that the test is simple and will not cause harm to the patient if performed incorrectly. +These test classifications determine the certifications needed for laboratories to perform said tests. Waived tests require the least regulation, while moderate to high complexity tests require higher regulation and standards within the laboratory. + +=== Center for Medicaid Services (CMS) === +Under CLIA, it is the role of CMS to issue laboratory certificates and monitor, inspect, and enforce laboratory regulatory compliance based on the tests being performed. In total, CMS covers 260,000 laboratories. + +=== Centers for Disease Control and Prevention (CDC) === +The CDC focuses on the analysis, research, and technical assistance within the CLIA partnership. In particular, the CDC establishes technical standards and guidelines, conducting studies, monitoring practices, and developing resources. In addition, the CDC manages the Clinical Laboratory Improvement Advisory Committee (CLIAC). CLIAC is made up of experts in many specialties throughout clinical and anatomic pathology that provide guidance and advice on general issues within laboratory science. +The CDC specifically acknowledges that point-of-care testing simply describes the location at which the testing is performed and not the complexity of the test itself. With technological innovation, more complex tests will be able to be performed at the bedside that may not be CLIA-waived like some other at-home point of care tests that the FDA has waived such as urine dipsticks. + +== Funding == +In the United Kingdom the GP contract leaves the cost of point-of-care testing, which may be substantial, with the individual GP practice, which the cost of medication is met by the +clinical commissioning group, which, as the House of Commons Health and Social Care Committee noted in October 2018, creates perverse incentives. + +== See also == +COVID-19 rapid test +Rapid diagnostic test +Multiplexed point-of-care testing + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Posterior_cortex-0.md b/data/en.wikipedia.org/wiki/Posterior_cortex-0.md new file mode 100644 index 000000000..2e0bdb3e1 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Posterior_cortex-0.md @@ -0,0 +1,19 @@ +--- +title: "Posterior cortex" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Posterior_cortex" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:56.639705+00:00" +instance: "kb-cron" +--- + +Posterior cortex usually means the posterior (back) part of the complete cerebral cortex and includes the occipital, parietal, and temporal cortices. In other words, the posterior cortex includes all the cerebral cortex without the frontal cortex. +In combination with specific cortical areas, 'posterior cortex' usually refers to the posterior (back) part of that cortical area. For example: the posterior parietal cortex is the posterior part of the parietal cortex and the posterior cingulate cortex is the posterior part of the cingulate cortex. + + +== Function of the posterior cortex == +The posterior cortex is the “sensory” cortex, much as the frontal cortex is the “action” cortex. The posterior cortex is responsible for encoding the sensory content (visual, auditory, and tactile) of any experience (both real and imaginary experience). The posterior cortex with the exception of the primary sensory areas (Primary visual cortex (V1), primary auditory cortex, and somatosensory cortex) was called by Christof Koch and colleagues the posterior cortical hot zone for its close association with the minimal neural substrate essential for conscious perception. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Postictal_state-0.md b/data/en.wikipedia.org/wiki/Postictal_state-0.md new file mode 100644 index 000000000..aba22ab27 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Postictal_state-0.md @@ -0,0 +1,32 @@ +--- +title: "Postictal state" +chunk: 1/2 +source: "https://en.wikipedia.org/wiki/Postictal_state" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:57.970186+00:00" +instance: "kb-cron" +--- + +The postictal state is the altered state of consciousness after an epileptic seizure. It usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures, and is characterized by drowsiness, confusion, nausea, hypertension, headache or migraine, and other disorienting symptoms. +The ictal period is the seizure itself; the interictal period is the time between seizures, when brain activity is more normal; and the preictal period is the time leading up to a seizure: + +Ictal period refers to a physiologic state or event such as a seizure, stroke, or headache. The word originates from the Latin word ictus, meaning a blow or a stroke. In electroencephalography (EEG), the recording during a seizure is said to be "ictal". The following definitions refer to the temporal relation with seizures. +Pre-ictal refers to the state immediately before the actual seizure, stroke, or headache. +Post-ictal refers to the state shortly after the event. +Interictal refers to the period between seizures, or convulsions, that are characteristic of an epilepsy disorder. For most people with epilepsy, the interictal state corresponds to more than 99% of their life. The interictal period is often used by neurologists when diagnosing epilepsy since an EEG trace will often show small interictal spiking and other abnormalities known by neurologists as subclinical seizures. Interictal EEG discharges are those abnormal waveforms not associated with seizure symptoms. + +== Signs and symptoms == +Jerome Engel defines the postictal state as "manifestations of seizure-induced reversible alterations in neuronal function but not structure." Commonly after a seizure, a person feels mentally and physically exhausted for up to one or two days. The most common complaint is an inability to think clearly, specifically "poor attention and concentration, poor short term memory, decreased verbal and interactive skills, and a variety of cognitive defects specific to individuals." +Postictal migraine headaches are a major complaint among persons with epilepsy, and can have a variety of etiologies. One possible cause of these migraines is high intracranial pressure resulting from postictal cerebral edema. At times, a person may be unaware of having had a seizure, and the characteristic migraine is their only clue. +Other symptoms associated with the postictal state are less common. Todd's paresis is a temporary regional loss of function in whatever region just experienced the seizure, and its manifestation depends on where the seizure was located. Loss of motor function is most common and can range from weakness to full paralysis. About 6% of patients who had tonic–clonic seizures experienced Todd's paresis afterward, with loss of motor function sometimes accompanied with temporary numbness, blindness, or deafness. Todd's paresis can also cause anterograde amnesia if the seizure included the bilateral hippocampi, and aphasia if the seizures began in the language-dominant hemisphere. Symptoms typically last about 15 hours, but can continue for 36 hours. +Postictal psychosis is a neuropsychiatric sequel to seizures of chronic epilepsy in adults. Tending to occur with bilateral seizure types, it is characterized by auditory and visual hallucinations, delusions, paranoia, affective change, and aggression. Following the typical postictal confusion and lethargy, the person gradually recovers to a normal lucid state. In persons who experience postictal psychosis, this "lucid phase" usually continues at least 6 hours (and up to a week), followed by the psychosis lasting as little as one hour to more than 3 months (the mean is 9–10 days). The psychosis is typically treated medically using atypical antipsychotics and benzodiazepines, and successful epilepsy surgery can resolve the psychotic episodes. +Postictal bliss or euphoria is also reported following seizures. This has been described as a highly blissful feeling associated with the emergence from amnesia. Feelings of depression before a seizure may lead to postictal euphoria. +Some of postictal symptoms are almost always present for a period of a few hours up to a day or two. Absence seizures do not produce a postictal state and some seizure types may have very brief postictal states. Otherwise, the lack of typical postictal symptoms, such as confusion and lethargy following convulsive seizures, may be a sign of non-epileptic seizures. Usually such seizures are instead related to syncope or have a psychogenic origin ("pseudoseizures"). +The postictal state can also be useful for determining the focus of the seizure. Decreased verbal memory (short term) tends to result from a seizure in the dominant hemisphere, whereas seizures in the non-dominant hemisphere tend to manifest with decreased visual memory. Inability to read suggests seizure foci in the language areas of the left hemisphere, and "after a seizure semivoluntary events as mundane as nose wiping tend to be done with the hand ipsilateral to (that is on the same side as) the seizure focus." + +== Mechanism == +While it might seem that the neurons become “exhausted” after the near-constant firing involved in a seizure, the ability of the neuron to carry an action potential following a seizure is not decreased. Neurons of the brain fire normally when stimulated, even after long periods of status epilepticus. + +=== Neurotransmitters === +Neurotransmitters must be present in the axon terminal and then exocytosed into the synaptic cleft in order to propagate the signal to the next neuron. While neurotransmitters are not typically a limiting factor in neuronal signaling rates, it is possible that with extensive firing during seizures neurotransmitters could be used up faster than new ones could be synthesized in the cell and transported down the axon. There is currently no direct evidence for neurotransmitter depletion following seizures. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Postictal_state-1.md b/data/en.wikipedia.org/wiki/Postictal_state-1.md new file mode 100644 index 000000000..f37e46db0 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Postictal_state-1.md @@ -0,0 +1,25 @@ +--- +title: "Postictal state" +chunk: 2/2 +source: "https://en.wikipedia.org/wiki/Postictal_state" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:57.970186+00:00" +instance: "kb-cron" +--- + +=== Receptor concentration === +In studies that stimulate seizures by subjecting rats to electroshock, seizures are followed by unconsciousness and slow waves on an electroencephalogram (EEG), signs of postictal catalepsy. Administering the opiate antagonist naloxone immediately reverses this state, providing evidence that increased responsiveness or concentration of the opiate receptors may be occurring during seizures and may be partially responsible for the weariness humans experience following a seizure. When humans were given naloxone in-between seizures, researchers observed increased activity on their EEGs, suggesting that opioid receptors may also be upregulated during human seizures. To provide direct evidence for this, Hammers et al. did positron emission tomography (PET) scanning of radiolabelled ligands before, during, and after spontaneous seizures in humans. They found that opioid receptors were upregulated in the regions near the focus of the seizure during the ictal phase, gradually returning to baseline availability during the postictal phase. Hammers notes that cerebral bloodflow after a seizure cannot account for the increase in PET activity observed. Regional bloodflow can increase by as much as 70–80% after seizures but normalizes after 30 minutes. The shortest postictal interval in their study was 90 minutes and none of the patients had seizures during the scanning. It has been predicted that a decrease in opioid activity following a seizure could cause withdrawal symptoms, contributing to postictal depression. The opioid receptor connection with mitigating seizures has been disputed, and opioids have been found to have different functions in different regions of the brain, having both proconvulsive and anticonvulsive effects. + +=== Active inhibition === +It is possible that seizures cease spontaneously, but it is much more probable that some changes in the brain create inhibitory signals that serve to tamp down the overactive neurons and effectively end the seizure. Opioid peptides have been shown to be involved in the postictal state and are at times anticonvulsive, and adenosine has also been implicated as a molecule potentially involved in terminating seizures. Evidence for the theory of active inhibition lies in the postictal refractory period, a period of weeks or even months following a series of seizures in which seizures cannot be induced (using animal models and a technique called kindling, in which seizures are induced with repeated electrical stimulation). +Leftover inhibitory signals are the most likely explanation for why there would be a period in which the threshold for provoking a second seizure is high, and lowered excitability may also explain some of the postictal symptoms. Inhibitory signals could be through GABA receptors (both fast and slow IPSPs), calcium-activated potassium receptors (which give rise to afterhyperpolarization), hyperpolarizing pumps, or other changes in ion channels or signal receptors. +While not an example of active inhibition, acidosis of the blood could aid in ending the seizure and also depress neuron firing following its conclusion. As muscles contract during tonic-clonic seizures they outpace oxygen supplies and go into anaerobic metabolism. With continued contractions under anaerobic conditions, the cells undergo lactic acidosis, or the production of lactic acid as a metabolic byproduct. This acidifies the blood (higher H+ concentration, lower pH), which has many impacts on the brain. For one, “hydrogen ions compete with other ions at the ion channel associated with N-methyl-d-aspartate (NMDA). This competition may partially attenuate NMDA receptor and channel mediated hyperexcitability after seizures.” + +=== Cerebral bloodflow === +Cerebral autoregulation typically ensures that the correct amount of blood reaches the various regions of the brain to match the activity of the cells in that region. In other words, perfusion typically matches metabolism in all organs; especially in the brain, which gets the highest priority. However, following a seizure it has been shown that sometimes cerebral blood flow is not proportionate to metabolism. While cerebral blood flow didn't change in the mouse hippocampus (the foci of seizures in this model) during or after seizures, increases in relative glucose uptake were observed in the region during the ictal and early postictal periods. Animal models are difficult for this type of study because each type of seizure model produces a unique pattern of perfusion and metabolism. Thus, in different models of epilepsy, researchers have had differing results as to whether or not metabolism and perfusion become uncoupled. Hosokawa's model used EL mice, in which seizures begin in the hippocampus and present similarly to the behaviors observed in human epileptic patients. If humans show similar uncoupling of perfusion and metabolism, this would result in hypoperfusion in the affected area, a possible explanation for the confusion and 'fog' patients experience following a seizure. + +== See also == +Ictal headache + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Precancerous_condition-0.md b/data/en.wikipedia.org/wiki/Precancerous_condition-0.md new file mode 100644 index 000000000..6eceb2f9f --- /dev/null +++ b/data/en.wikipedia.org/wiki/Precancerous_condition-0.md @@ -0,0 +1,91 @@ +--- +title: "Precancerous condition" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Precancerous_condition" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:31:59.257697+00:00" +instance: "kb-cron" +--- + +A precancerous condition is a condition, tumor or lesion involving abnormal cells which are associated with an increased risk of developing into cancer. Clinically, precancerous conditions encompass a variety of abnormal tissues with an increased risk of developing into cancer. Some of the most common precancerous conditions include certain colon polyps, which can progress into colon cancer, monoclonal gammopathy of undetermined significance, which can progress into multiple myeloma or myelodysplastic syndrome, and cervical dysplasia, which can progress into cervical cancer. Bronchial premalignant lesions can progress to squamous cell carcinoma of the lung. +Pathologically, precancerous tissue can range from benign neoplasias, which are tumors which don't invade neighboring normal tissues or spread to distant organs, to dysplasia, a collection of highly abnormal cells which, in some cases, has an increased risk of progressing to anaplasia and invasive cancer which is life-threatening. Sometimes, the term "precancer" is also used for carcinoma in situ, which is a noninvasive cancer that has not grown and spread to nearby tissue, unlike the invasive stage. As with other precancerous conditions, not all carcinoma in situ will become an invasive disease but is at risk of doing so. + + +== Classification == +The term precancerous or premalignant condition may refer to certain conditions, such as monoclonal gammopathy of unknown significance, or to certain lesions, such as colorectal adenoma (colon polyps), which have the potential to progress into cancer (see: Malignant transformation). Premalignant lesions are morphologically atypical tissue which appear abnormal when viewed under the microscope, and which are more likely to progress to cancer than normal tissue. Precancerous conditions and lesions affect a variety of organ systems, including the skin, oral cavity, stomach, colon, lung, and hematological system. Some authorities also refer to hereditary genetic conditions which predispose to developing cancer, such as hereditary nonpolyposis colorectal cancer, as a precancerous condition, as individuals with these conditions have a much higher risk of developing cancer in certain organs. + + +== Signs and symptoms == +The signs and symptoms of precancerous conditions differ based on the organ affected. In many cases, individuals with precancerous conditions do not notice any symptoms. Precancerous conditions of the skin or oral cavity can appear as visible lesions without associated pain or discomfort, while precancerous conditions of the hematological system are typically asymptomatic, and in the case of monoclonal gammopathy of unknown significance, it may only rarely cause numbness and tingling in the hands and feet or difficulty with balance (see: peripheral neuropathy). + + +== Causes == + +In most cases, many risk factors for precancerous conditions and lesions are the same risk factors that determines individuals vulnerable to a specific cancer. For example, individuals with cervical or anal infection with oncogenic, or cancer causing, strains of the human papilloma virus (HPV) are at higher risk for cervical and anal cancers, as well as for cervical and anal dysplasia. Similarly, sun or especially UV exposure is an important risk factor for both actinic keratosis which can progress into melanomas as well as skin cancer. Smoking is a risk factor for premalignant (as well as malignant) lung lesions. Hereditary conditions that are risk factors to cancer can also be risk factors to premalignant lesions. However, in many cases, precancerous conditions or lesions can be sporadic and idiopathic in nature, meaning that they are not associated with a hereditary genetic risk factor to the particular cancer, nor with a direct causative agent or other identifiable cause. + + +== Pathophysiology == + +The pathophysiology of precancerous lesions is thought to be similar to that of cancer, and also varies depending on the disease site and type of lesion. It is thought that cancer is always preceded by a clinically silent premalignant phase during which many oncogenic genetic and epigenetic alterations accumulate before it is truly malignant. The duration of this premalignant phase can vary from cancer to cancer, disease site to site and from individual to individual. Increasing evidence suggests that the evasion of the immune system occurs in premalignant lesions, and that the nature of the first immune response to these lesions may determine if they progress to cancer or regress to normal tissue. + + +== Examples == + + +=== Skin === +actinic keratosis +Bowen's disease (intraepidermal carcinoma/squamous carcinoma in situ) +dyskeratosis congenita + + +=== Breast === +ductal carcinoma in situ +lobular carcinoma in situ +Sclerosing adenosis +Small duct papilloma + + +=== Head and neck/oral === +oral submucous fibrosis +erythroplakia +lichen planus (oral) +leukoplakia +proliferative verrucous leukoplakia +stomatitis nicotina + + +=== Gastrointestinal === +Barrett's esophagus +atrophic gastritis +colon polyp +Plummer-Vinson syndrome (sideropenic dysphagia) +hereditary nonpolyposis colorectal cancer +Ulcerative colitis +Crohn's disease +Respiratory + +Bronchial premalignant lesions + + +=== Gynecological === +cervical dysplasia (cervical intraepithelial neoplasm, CIN) +vaginal intraepithelial neoplasm (VAIN) +anal dysplasia (also see: anal cancer) +lichen sclerosus +Bowen's disease (penile or vulvar) +erythroplasia of Queyrat + + +=== Urological === +bladder carcinoma in situ + + +=== Hematological === +monoclonal gammopathy of unknown significance + + +== References == + + +== External links == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Presentation_(medical)-0.md b/data/en.wikipedia.org/wiki/Presentation_(medical)-0.md new file mode 100644 index 000000000..661c7eb1c --- /dev/null +++ b/data/en.wikipedia.org/wiki/Presentation_(medical)-0.md @@ -0,0 +1,27 @@ +--- +title: "Presentation (medical)" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Presentation_(medical)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:00.373100+00:00" +instance: "kb-cron" +--- + +In medicine, a presentation is the appearance in a patient of illness or disease—or signs or symptoms thereof—before a medical professional. In practice, one usually speaks of a patient as presenting with this or that. Examples include: + +"...Many depressed patients present with medical rather than psychiatric complaints, and those who present with medical complaints are twice as likely to be misdiagnosed as those who present with psychiatric complaints." +"...In contrast, poisonings from heavy metal can be subtle and present with a slowly progressive course." +"...Some patients present with small unobstructed kidneys, when the diagnosis is easy to miss." +"...A total of 7,870,266 patients presented to a public hospital ED from 1 July 2017 to 30 June 2018." + + +== See also == +Presentation (obstetrics) + + +== References == + + +== External links == +Search the Merriam Webster Medical Dictionary for presenting and related terms \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Prevention_paradox-0.md b/data/en.wikipedia.org/wiki/Prevention_paradox-0.md new file mode 100644 index 000000000..cf386c014 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Prevention_paradox-0.md @@ -0,0 +1,31 @@ +--- +title: "Prevention paradox" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Prevention_paradox" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:01.559023+00:00" +instance: "kb-cron" +--- + +The prevention paradox describes the situation where the majority of cases of a disease come from a population at low or moderate risk of that disease, and only a minority of cases come from the high risk population (of the same disease). This is because the number of people at high risk is small. The prevention paradox was first formally described in 1981 by the epidemiologist Geoffrey Rose. +Especially in the context of the COVID-19 pandemic, the term "prevention paradox" was also used to describe the apparent paradox of people questioning steps to prevent the spread of the pandemic because the prophesied spread did not occur. This however is instead an example of a self-defeating prophecy or a preparedness paradox. + + +== Hypothetical case study == +For example, Rose describes the case of Down syndrome where maternal age is a risk factor. Yet, most cases of Down syndrome will be born to younger, low risk mothers (this is true at least in populations where most women have children at a younger age). This situation is paradoxical because it is common and logical to equate high-risk populations with making up the majority of the burden of disease. +Another example could be seen in terms of reducing overall alcohol misuse problems in a population. Although less serious, most alcohol problems are not found among dependent drinkers. Greater societal gain will be obtained by achieving a small reduction in alcohol misuse within a far larger group of "risky" drinkers with less serious problems than by trying to reduce problems among a smaller number of alcoholic drinkers with serious addiction issues. + + +== See also == +False positive paradox +Preparedness paradox + + +== Notes and references == + + +== External links == +"Sick individuals and sick populations", G. Rose, Int J Epidem 1985; vol. 14, no. 1: pp. 32-38. +"Commentary: The prevention paradox in lay epidemiology—Rose revisited", Kate Hunt and Carol Emslie, Int J Epidem 2001; vol. 30, no. 3: pp. 442-446. +The Prevention Paradox Applies to Alcohol Use and Problems among Adolescents \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Preventive_healthcare-0.md b/data/en.wikipedia.org/wiki/Preventive_healthcare-0.md new file mode 100644 index 000000000..d18b8efbc --- /dev/null +++ b/data/en.wikipedia.org/wiki/Preventive_healthcare-0.md @@ -0,0 +1,29 @@ +--- +title: "Preventive healthcare" +chunk: 1/10 +source: "https://en.wikipedia.org/wiki/Preventive_healthcare" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:02.881779+00:00" +instance: "kb-cron" +--- + +Preventive healthcare or prophylaxis is the application of healthcare measures to prevent diseases. Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices, and are dynamic processes that begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention. Preventative care can include services such as, screening tests to check for diseases, services like vaccines, dental cleanings, and education and counseling to help one make informed health related decisions. +Each year, millions of people die of preventable causes. A 2004 study showed that about half of all deaths in the United States in 2000 were due to preventable behaviors and exposures. Leading causes included cardiovascular disease, chronic respiratory disease, unintentional injuries, diabetes, and certain infectious diseases. The study also estimated that 400,000 people die each year in the United States due to poor diet and a sedentary lifestyle. According to estimates made by the World Health Organization (WHO), about 55 million people died worldwide in 2011, and two-thirds of these died from non-communicable diseases, including cancer, diabetes, and chronic cardiovascular and lung diseases. This is an increase from the year 2000, during which 60% of deaths were attributed to these diseases.) +Preventive healthcare is especially important given the worldwide rise in the prevalence of chronic diseases and deaths from these diseases. There are many methods for prevention of disease. One of them is prevention of teenage smoking through information giving. It is recommended that adults and children aim to visit their doctor for regular check-ups, even if they feel healthy, to perform disease screening, identify risk factors for disease, discuss tips for a healthy and balanced lifestyle, stay up to date with immunizations and boosters, and maintain a good relationship with a healthcare provider. In pediatrics, some common examples of primary prevention are encouraging parents to turn down the temperature of their home water heater in order to avoid scalding burns, encouraging children to wear bicycle helmets, and suggesting that people use the air quality index (AQI) to check the level of pollution in the outside air before engaging in sporting activities. +Some common disease screenings include checking for hypertension (high blood pressure), hyperglycemia (high blood sugar, a risk factor for diabetes mellitus), hypercholesterolemia (high blood cholesterol), screening for colon cancer, depression, HIV and other common types of sexually transmitted disease such as chlamydia, syphilis, and gonorrhea, mammography (to screen for breast cancer), colorectal cancer screening, a Pap test (to check for cervical cancer), and screening for osteoporosis. Genetic testing can also be performed to screen for mutations that cause genetic disorders or predisposition to certain diseases such as breast or ovarian cancer. However, these measures are not affordable for every individual and the cost effectiveness of preventive healthcare is still a topic of debate. + +== Overview == +Preventive healthcare strategies are described as taking place at the primal, primary, secondary, and tertiary prevention levels. +Although advocated as preventive medicine in the early twentieth century by Sara Josephine Baker, in the 1940s, Hugh R. Leavell and E. Gurney Clark coined the term primary prevention. They worked at the Harvard and Columbia University Schools of Public Health, respectively, and later expanded the levels to include secondary and tertiary prevention. Goldston (1987) notes that these levels might be better described as "prevention, treatment, and rehabilitation", although the terms primary, secondary, and tertiary prevention are still in use today. The concept of primal prevention has been created much more recently, in relation to the new developments in molecular biology over the last fifty years, more particularly in epigenetics, which point to the paramount importance of environmental conditions, both physical and affective, on the organism during its fetal and newborn life, or so-called primal period of life. + +=== Primal and primordial preventions === + +Primal prevention is health promotion par excellence. New knowledge in molecular biology, in particular epigenetics, points to how much affective as well as physical environment during fetal and newborn life may determine adult health. This way of promoting health consists mainly in providing future parents with pertinent, unbiased information on primal health and supporting them during their child's primal period of life (i.e., "from conception to first anniversary" according to definition by the Primal Health Research Centre, London). This includes adequate parental leave, ideally for both parents, with kin caregiving and financial help where needed. +Primordial prevention refers to all measures designed to prevent the development of risk factors in the first place, early in life, and even preconception, as Ruth A. Etzel has described it "all population-level actions and measures that inhibit the emergence and establishment of adverse environmental, economic, and social conditions". This could be reducing air pollution or prohibiting endocrine-disrupting chemicals in food-handling equipment and food contact materials. + +=== Primary prevention === +Primary prevention consists of traditional health promotion and "specific protection". Health promotion activities include prevention strategies such as health education and lifestyle medicine, and are current, non-clinical life choices such as eating nutritious meals and exercising often, that prevent lifestyle-related medical conditions, improve the quality of life, and create a sense of overall well-being. Preventing disease and creating overall well-being prolongs life expectancy. Health-promotional activities do not target a specific disease or condition but rather promote health and well-being on a very general level. On the other hand, specific protection targets a type or group of diseases and complements the goals of health promotion. + +==== Food ==== +Food is the most basic tool in preventive health care. Poor nutrition is linked to various chronic illnesses. Because of this, having a healthy diet and proper nutrition can be used to prevent illnesses. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Preventive_healthcare-1.md b/data/en.wikipedia.org/wiki/Preventive_healthcare-1.md new file mode 100644 index 000000000..efb135f91 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Preventive_healthcare-1.md @@ -0,0 +1,43 @@ +--- +title: "Preventive healthcare" +chunk: 2/10 +source: "https://en.wikipedia.org/wiki/Preventive_healthcare" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:02.881779+00:00" +instance: "kb-cron" +--- + +===== Access ===== +Some groups are at a disadvantage when it comes to health, not because of qualities they're born with but because of socioeconomic factors they experience in life. The 2011 National Health Interview Survey performed by the Centers for Disease Control was the first national survey to include questions about ability to pay for food. Difficulty with paying for food, medicine, or both is a problem facing 1 out of 3 Americans. If better food options were available through food banks, soup kitchens, and other resources for low-income people, obesity and the chronic conditions that come along with it would be better controlled. A food desert is an area with restricted access to healthy foods due to a lack of supermarkets within a reasonable distance. These are often low-income neighborhoods with the majority of residents lacking transportation. There have been several grassroots movements since 1995 to encourage urban gardening, using vacant lots to grow food cultivated by local residents. Mobile fresh markets are another resource for residents in a "food desert", which are specially outfitted buses bringing affordable fresh fruits and vegetables to low-income neighborhoods. + +===== Food education and guidance ===== +It has been proposed that healthy longevity diets are included in standard healthcare as switching from a "typical Western diet" could often extend life by a decade. + +==== Protective measures ==== + +Specific protective measures such as water purification, sewage treatment, and the development of personal hygienic routines, such as regular hand-washing, safe sex to prevent sexually transmitted infections, became mainstream upon the discovery of infectious disease agents and have decreased the rates of communicable diseases which are spread in unsanitary conditions. +Scientific advancements in genetics have contributed to the knowledge of hereditary diseases and have facilitated progress in specific protective measures in individuals who are carriers of a disease gene or have an increased predisposition to a specific disease. Genetic testing has allowed physicians to make quicker and more accurate diagnoses and has allowed for tailored treatments or personalized medicine. +Food safety has a significant impact on human health and food quality monitoring has increased. +Water, including drinking water, is also monitored in many cases for securing health. There also is some monitoring of air pollution. In many cases, environmental standards such as via maximum pollution levels, regulation of chemicals, occupational hygiene requirements or consumer protection regulations establish some protection in combination with the monitoring. +Preventive measures like vaccines and medical screenings are also important. Using PPE properly and getting the recommended vaccines and screenings can help decrease the spread of respiratory diseases, protecting the healthcare workers as well as their patients. + +=== Secondary prevention === +Secondary prevention is about identifying early stages of diseases, e.g. by using screening tests. It deals with latent diseases and attempts to prevent an asymptomatic disease from progressing to symptomatic disease. Certain diseases can be classified as primary or secondary. This depends on definitions of what constitutes a disease, though, in general, primary prevention addresses the root cause of a disease or injury whereas secondary prevention aims to detect and treat a disease early on. Secondary prevention consists of "early diagnosis and prompt treatment" to contain the disease and prevent its spread to other individuals, and "disability limitation" to prevent potential future complications and disabilities from the disease. Early diagnosis and prompt treatment for a syphilis patient would include a course of antibiotics to destroy the pathogen and screening and treatment of any infants born to syphilitic mothers. Disability limitation for syphilitic patients includes continued check-ups on the heart, cerebrospinal fluid, and central nervous system of patients to curb any damaging effects such as blindness or paralysis. + +=== Tertiary prevention === +Tertiary prevention attempts to reduce the damage caused by symptomatic disease by focusing on mental, physical, and social rehabilitation. It aims to maximize the remaining capabilities and functions of an already disabled individual. Goals of tertiary prevention include: preventing pain and damage, halting progression and complications from disease, and restoring the health and functions of the individuals affected by disease. For syphilitic patients, rehabilitation includes measures to prevent complete disability from the disease, such as implementing work-place adjustments for the blind and paralyzed or providing counseling to restore normal daily functions to the greatest extent possible. + +=== Quaternary prevention === +Quaternary prevention means avoiding unnecessary medical interventions or overmedicalization. + +== Leading causes of preventable death == + +=== Worldwide === +The leading causes of preventable death worldwide share similar trends to the United States. There are a few differences between the two, such as malnutrition, pollution, and unsafe sanitation, that reflect health disparities between the developing and developed world. + +However, several of the leading causes of death – or underlying contributors to earlier death – may not be included as "preventable" causes of death. A study concluded that pollution was "responsible for approximately 9 million deaths per year" in 2019. And another study concluded that the global mean loss of life expectancy (a measure similar to years of potential life lost) from air pollution in 2015 was 2.9 years, substantially more than, for example, 0.3 years from all forms of direct violence, albeit a significant fraction of the LLE is considered to be unavoidable (such as pollution from some natural wildfires). +A 2021 landmark study by the World Health Organization and the International Labour Organization found that exposure to long working hours is the occupational risk factor with the largest attributable burden of disease, i.e. an estimated 745,000 fatalities from ischemic heart disease and stroke events in 2016. With this study, prevention of exposure to long working hours has emerged as a priority for prevention healthcare in workplace settings. + +=== United States === +The leading preventable cause of death in the United States is tobacco; however, poor diet and lack of exercise may soon surpass tobacco as a leading cause of death. These behaviors are modifiable and public health and prevention efforts could make a difference to reduce these deaths. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Preventive_healthcare-2.md b/data/en.wikipedia.org/wiki/Preventive_healthcare-2.md new file mode 100644 index 000000000..8e6fbc405 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Preventive_healthcare-2.md @@ -0,0 +1,38 @@ +--- +title: "Preventive healthcare" +chunk: 3/10 +source: "https://en.wikipedia.org/wiki/Preventive_healthcare" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:02.881779+00:00" +instance: "kb-cron" +--- + +== Child mortality == +In 2010, 7.6 million children died before reaching the age of 5. While this is a decrease from 9.6 million in 2000, it was still far from the fourth Millennium Development Goal to decrease child mortality by two-thirds by 2015. Of these deaths, about 64% were due to infection including diarrhea, pneumonia, and malaria. About 40% of these deaths occurred in neonates (children ages 1–28 days) due to pre-term birth complications. The highest number of child deaths occurred in Africa and Southeast Asia. As of 2015 in Africa, almost no progress has been made in reducing neonatal death since 1990. In 2010, India, Nigeria, Democratic Republic of the Congo, Pakistan, and China contributed to almost 50% of global child deaths. Targeting efforts in these countries is essential to reducing the global child death rate. +Child mortality is caused by factors including poverty, environmental hazards, and lack of maternal education. In 2003, the World Health Organization created a list of interventions in the following table that were judged economically and operationally "feasible," based on the healthcare resources and infrastructure in 42 nations that contribute to 90% of all infant and child deaths. The table indicates how many infant and child deaths could have been prevented in 2000, assuming universal healthcare coverage. + +== Preventive methods == + +=== Smoking === +For primary smoking prevention, education, warning about the dangers of tobacco and counseling is employed. Tobacco control may include a ban on tobacco advertising and sponsorship, see MPOWER tobacco control. Secondary prevention includes protecting people from smoke with bans in public buildings for example, offering cessation. + +=== Obesity === +Obesity is a major risk factor for a wide variety of conditions including cardiovascular diseases, hypertension, certain cancers, and type 2 diabetes. In order to prevent obesity, it is recommended that individuals adhere to a consistent exercise regimen as well as a nutritious and balanced diet. A healthy individual should aim for acquiring 10% of their energy from proteins, 15-20% from fat, and over 50% from complex carbohydrates, while avoiding alcohol as well as foods high in fat, salt, and sugar. Sedentary adults should aim for at least half an hour of moderate-level daily physical activity and eventually increase to include at least 20 minutes of intense exercise, three times a week. Preventive health care offers many benefits to those that chose to participate in taking an active role in the culture. The medical system in our society is geared toward curing acute symptoms of disease after the fact that they have brought us into the emergency room. An ongoing epidemic within American culture is the prevalence of obesity. Healthy eating and regular exercise play a significant role in reducing an individual's risk for type 2 diabetes. A 2008 study concluded that about 23.6 million people in the United States had diabetes, including 5.7 million that had not been diagnosed. 90 to 95 percent of people with diabetes have type 2 diabetes. Diabetes is the main cause of kidney failure, limb amputation, and new-onset blindness in American adults. + +=== Sexually transmitted infections === + +Sexually transmitted infections (STIs), such as syphilis and HIV, are common but preventable with safe-sex practices. STIs can be asymptomatic, or cause a range of symptoms. Preventive measures for STIs are called prophylactics. The term especially applies to the use of condoms, which are highly effective at preventing disease, but also to other devices meant to prevent STIs, such as dental dams and latex gloves. Other means for preventing STIs include education on how to use condoms or other such barrier devices, testing partners before having unprotected sex, receiving regular STI screenings, to both receive treatment and prevent spreading STIs to partners, and, specifically for HIV, regularly taking prophylactic antiretroviral drugs, such as Truvada. Post-exposure prophylaxis, started within 72 hours (optimally less than 1 hour) after exposure to high-risk fluids, can also protect against HIV transmission. + +=== Malaria prevention using genetic modification === +Genetically modified mosquitoes are being used in developing countries to control malaria. This approach has been subject to objections and controversy. + +=== Thrombosis === + +Thrombosis is a serious circulatory disease affecting thousands, usually older persons undergoing surgical procedures, women taking oral contraceptives and travelers. The consequences of thrombosis can be heart attacks and strokes. Prevention can include exercise, anti-embolism stockings, pneumatic devices, and pharmacological treatments. + +=== Cancer === + +In recent years, cancer has become a global problem. Low and middle income countries share a majority of the cancer burden largely due to exposure to carcinogens resulting from industrialization and globalization. However, primary prevention of cancer and knowledge of cancer risk factors can reduce over one third of all cancer cases. Primary prevention of cancer can also prevent other diseases, both communicable and non-communicable, that share common risk factors with cancer. + +==== Lung cancer ==== \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Preventive_healthcare-3.md b/data/en.wikipedia.org/wiki/Preventive_healthcare-3.md new file mode 100644 index 000000000..465dceb52 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Preventive_healthcare-3.md @@ -0,0 +1,26 @@ +--- +title: "Preventive healthcare" +chunk: 4/10 +source: "https://en.wikipedia.org/wiki/Preventive_healthcare" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:02.881779+00:00" +instance: "kb-cron" +--- + +Lung cancer is the leading cause of cancer-related deaths in the United States and Europe and is a major cause of death in other countries. Tobacco is an environmental carcinogen and the major underlying cause of lung cancer. Between 25% and 40% of all cancer deaths and about 90% of lung cancer cases are associated with tobacco use. Other carcinogens include asbestos and radioactive materials. Both smoking and second-hand exposure from other smokers can lead to lung cancer and eventually death. +Prevention of tobacco use is paramount to prevention of lung cancer. Individual, community, and statewide interventions can prevent or cease tobacco use. 90% of adults in the U.S. who have ever smoked did so prior to the age of 20. In-school prevention/educational programs, as well as counseling resources, can help prevent and cease adolescent smoking. Other cessation techniques include group support programs, nicotine replacement therapy (NRT), hypnosis, and self-motivated behavioral change. Studies have shown long term success rates (>1 year) of 20% for hypnosis and 10%-20% for group therapy. +Cancer screening programs serve as effective sources of secondary prevention. The Mayo Clinic, Johns Hopkins, and Memorial Sloan-Kettering hospitals conducted annual x-ray screenings and sputum cytology tests and found that lung cancer was detected at higher rates, earlier stages, and had more favorable treatment outcomes, which supports widespread investment in such programs. +Legislation can also affect smoking prevention and cessation. In 1992, Massachusetts (United States) voters passed a bill adding an extra 25 cent tax to each pack of cigarettes, despite intense lobbying and $7.3 million spent by the tobacco industry to oppose this bill. Tax revenue goes toward tobacco education and control programs and has led to a decline of tobacco use in the state. +Lung cancer and tobacco smoking are increasing worldwide, especially in China. China is responsible for about one-third of the global consumption and production of tobacco products. Tobacco control policies have been ineffective as China is home to 350 million regular smokers and 750 million passive smokers and the annual death toll is over 1 million. Recommended actions to reduce tobacco use include decreasing tobacco supply, increasing tobacco taxes, widespread educational campaigns, decreasing advertising from the tobacco industry, and increasing tobacco cessation support resources. In Wuhan, China, a 1998 school-based program implemented an anti-tobacco curriculum for adolescents and reduced the number of regular smokers, though it did not significantly decrease the number of adolescents who initiated smoking. This program was therefore effective in secondary but not primary prevention and shows that school-based programs have the potential to reduce tobacco use. + +==== Skin cancer ==== + +Skin cancer is the most common cancer in the United States. The most lethal form of skin cancer, melanoma, leads to over 50,000 annual deaths in the United States. Childhood prevention is particularly important because a significant portion of ultraviolet radiation exposure from the sun occurs during childhood and adolescence and can subsequently lead to skin cancer in adulthood. Furthermore, childhood prevention can lead to the development of healthy habits that continue to prevent cancer for a lifetime. +The Centers for Disease Control and Prevention (CDC) recommends several primary prevention methods including: limiting sun exposure between 10 AM and 4 PM, when the sun is strongest, wearing tighter-weave natural cotton clothing, wide-brim hats, and sunglasses as protective covers, using sunscreens that protect against both UV-A and UV-B rays, and avoiding tanning salons. Sunscreen should be reapplied after sweating, exposure to water (through swimming for example) or after several hours of sun exposure. Since skin cancer is very preventable, the CDC recommends school-level prevention programs including preventive curricula, family involvement, participation and support from the school's health services, and partnership with community, state, and national agencies and organizations to keep children away from excessive UV radiation exposure. +Most skin cancer and sun protection data comes from Australia and the United States. An international study reported that Australians tended to demonstrate higher knowledge of sun protection and skin cancer knowledge, compared to other countries. Of children, adolescents, and adults, sunscreen was the most commonly used skin protection. However, many adolescents purposely used sunscreen with a low sun protection factor (SPF) in order to get a tan. Various Australian studies have shown that many adults failed to use sunscreen correctly; many applied sunscreen well after their initial sun exposure and/or failed to reapply when necessary. A 2002 case-control study in Brazil showed that only 3% of case participants and 11% of control participants used sunscreen with SPF >15. + +==== Cervical cancer ==== + +Cervical cancer ranks among the top three most common cancers among women in Latin America, sub-Saharan Africa, and parts of Asia. Cervical cytology screening aims to detect abnormal lesions in the cervix so that women can undergo treatment prior to the development of cancer. Given that high quality screening and follow-up care has been shown to reduce cervical cancer rates by up to 80%, most developed countries now encourage sexually active women to undergo a Pap test every 3–5 years. Finland and Iceland have developed effective organized programs with routine monitoring and have managed to significantly reduce cervical cancer mortality while using fewer resources than unorganized, opportunistic programs such as those in the United States or Canada. +In developing nations in Latin America, such as Chile, Colombia, Costa Rica, and Cuba, both public and privately organized programs have offered women routine cytological screening since the 1970s. However, these efforts have not resulted in a significant change in cervical cancer incidence or mortality in these nations. This is likely due to low quality, inefficient testing. However, Puerto Rico, which has offered early screening since the 1960s, has witnessed almost a 50% decline in cervical cancer incidence and almost a four-fold decrease in mortality between 1950 and 1990. Brazil, Peru, India, and several high-risk nations in sub-Saharan Africa which lack organized screening programs, have a high incidence of cervical cancer. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Preventive_healthcare-4.md b/data/en.wikipedia.org/wiki/Preventive_healthcare-4.md new file mode 100644 index 000000000..d69b35d85 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Preventive_healthcare-4.md @@ -0,0 +1,25 @@ +--- +title: "Preventive healthcare" +chunk: 5/10 +source: "https://en.wikipedia.org/wiki/Preventive_healthcare" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:02.881779+00:00" +instance: "kb-cron" +--- + +==== Colorectal cancer ==== +Colorectal cancer is globally the second most common cancer in women and the third-most common in men, and the fourth most common cause of cancer death after lung, stomach, and liver cancer, having caused 715,000 deaths in 2010. +It is also highly preventable; about 80 percent of colorectal cancers begin as benign growths, commonly called polyps, which can be easily detected and removed during a colonoscopy. Other methods of screening for polyps and cancers include fecal occult blood testing. Lifestyle changes that may reduce the risk of colorectal cancer include increasing consumption of whole grains, fruits and vegetables, and reducing consumption of red meat. + +=== Dementia === + +== Health disparities and barriers to accessing care == +Access to healthcare and preventive health services is unequal, as is the quality of care received. A study conducted by the Agency for Healthcare Research and Quality (AHRQ) revealed health disparities in the United States. In the United States, elderly adults (>65 years old) received worse care and had less access to care than their younger counterparts. The same trends are seen when comparing all racial minorities (black, Hispanic, Asian) to white patients, and low-income people to high-income people. Common barriers to accessing and utilizing healthcare resources included lack of income and education, language barriers, and lack of health insurance. Minorities were less likely than whites to possess health insurance, as were individuals who completed less education. These disparities made it more difficult for the disadvantaged groups to have regular access to a primary care provider, receive immunizations, or receive other types of medical care. Additionally, uninsured people tend to not seek care until their diseases progress to chronic and serious states and they are also more likely to forgo necessary tests, treatments, and filling prescription medications. +These sorts of disparities and barriers exist worldwide as well. Often, there are decades of gaps in life expectancy between developing and developed countries. For example, Japan has an average life expectancy that is 36 years greater than that in Malawi. Low-income countries also tend to have fewer physicians than high-income countries. In Nigeria and Myanmar, there are fewer than 4 physicians per 100,000 people while Norway and Switzerland have a ratio that is ten-fold higher. Common barriers worldwide include lack of availability of health services and healthcare providers in the region, great physical distance between the home and health service facilities, high transportation costs, high treatment costs, and social norms and stigma toward accessing certain health services. + +== Economics of lifestyle-based prevention == +With lifestyle factors such as diet and exercise rising to the top of preventable death statistics, the economics of healthy lifestyle is a growing concern. There is little question that positive lifestyle choices provide an investment in health throughout life. To gauge success, traditional measures such as the quality years of life method (QALY), show great value. However, that method does not account for the cost of chronic conditions or future lost earnings because of poor health. +Developing future economic models that would guide both private and public investments as well as drive future policy to evaluate the efficacy of positive lifestyle choices on health is a major topic for economists globally. Americans spend over three trillion a year on health care but have a higher rate of infant mortality, shorter life expectancies, and a higher rate of diabetes than other high-income nations because of negative lifestyle choices. Despite these large costs, very little is spent on prevention for lifestyle-caused conditions in comparison. In 2016, the Journal of the American Medical Association estimated that $101 billion was spent in 2013 on the preventable disease of diabetes, and another $88 billion was spent on heart disease. In an effort to encourage healthy lifestyle choices, as of 2010 workplace wellness programs were on the rise but the economics and effectiveness data were continuing to evolve and develop. +Health insurance coverage impacts lifestyle choices, even intermittent loss of coverage had negative effects on healthy choices in the U.S. The repeal of the Affordable Care Act (ACA) could significantly impact coverage for many Americans as well as "The Prevention and Public Health Fund" which is the U.S. first and only mandatory funding stream dedicated to improving public health including counseling on lifestyle prevention issues, such as weight management, alcohol use, and treatment for depression. +Because in the U.S. chronic illnesses predominate as a cause of death and pathways for treating chronic illnesses are complex and multifaceted, prevention is a best practice approach to chronic disease when possible. In many cases, prevention requires mapping complex pathways to determine the ideal point for intervention. Cost-effectiveness of prevention is achievable, but impacted by the length of time it takes to see effects/outcomes of intervention. This makes prevention efforts difficult to fund—particularly in strained financial contexts. Prevention potentially creates other costs as well, due to extending the lifespan and thereby increasing opportunities for illness. In order to assess the cost-effectiveness of prevention, the cost of the preventive measure, savings from avoiding morbidity, and the cost from extending the lifespan need to be considered. Life extension costs become smaller when accounting for savings from postponing the last year of life, which makes up a large fraction of lifetime medical expenditures and becomes cheaper with age. Prevention leads to savings only if the cost of the preventive measure is less than the savings from avoiding morbidity net of the cost of extending the life span. In order to establish reliable economics of prevention for illnesses that are complicated in origin, knowing how best to assess prevention efforts, i.e. developing useful measures and appropriate scope, is required. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Preventive_healthcare-5.md b/data/en.wikipedia.org/wiki/Preventive_healthcare-5.md new file mode 100644 index 000000000..e99ead1c9 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Preventive_healthcare-5.md @@ -0,0 +1,24 @@ +--- +title: "Preventive healthcare" +chunk: 6/10 +source: "https://en.wikipedia.org/wiki/Preventive_healthcare" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:02.881779+00:00" +instance: "kb-cron" +--- + +== Effectiveness == +Preventive healthcare measures increase the quality of life. There are varying views on what constitutes a "good investment." Some argue that preventive health measures should save more money than they cost, when factoring in treatment costs in the absence of such measures. Others have argued in favor of "good value" or conferring significant health benefits even if the measures do not save money. Preventive health services comprise a myriad of different services, each of which can individually lead to net costs, savings, or neither. +A 2010 study reported that in the United States, vaccinating children, cessation of smoking, daily prophylactic use of aspirin, and screening of breast and colorectal cancers had the most potential to prevent premature death. Preventive health measures that resulted in savings included vaccinating children and adults, smoking cessation, daily use of aspirin, and screening for issues with alcoholism, obesity, and vision failure. These authors estimated that if usage of these services in the United States increased to 90% of the population, there would be net savings of $3.7 billion, which comprised only about -0.2% of the total 2006 United States healthcare expenditure. Despite the potential for decreasing healthcare spending, utilization of healthcare resources in the United States still remains low, especially among Latinos and African-Americans. Overall, preventive services are difficult to implement because healthcare providers have limited time with patients and must integrate a variety of preventive health measures from different sources. +While these specific services bring about small net savings, not every preventive health measure saves more than it costs. A 1970s study showed that preventing heart attacks by treating hypertension early on with drugs did not save money in the long run. The money saved by evading treatment from heart attack and stroke only amounted to about a quarter of the cost of the drugs. Similarly, it was found that the cost of drugs or dietary changes to decrease high blood cholesterol exceeded the cost of subsequent heart disease treatment. Due to these findings, some argue that rather than focusing healthcare reform efforts exclusively on preventive care, the interventions that bring about the highest level of health should be prioritized. +In 2008, Cohen et al. outlined a few arguments made by skeptics of preventive healthcare, for example that preventive measures only cost less than future treatment when the proportion of the population that would become ill in the absence of prevention is fairly large. The Diabetes Prevention Program Research Group conducted a 2012 study evaluating the costs and benefits in quality-adjusted life-years or QALYs of lifestyle changes versus taking the drug metformin. They found that neither method brought about financial savings, but were cost-effective nonetheless because they brought about an increase in QALYs. Preventive healthcare skeptics also argue that while many treatments of existing diseases involve use of advanced equipment and technology, in some cases, this would be a more efficient use of resources than attempts to prevent the disease. Cohen suggested that the preventive measures most worth exploring and investing in are those that could benefit a large portion of the population to bring about cumulative and widespread health benefits at a reasonable cost. + +=== Cost-effectiveness of childhood obesity interventions === +As of 2015 there were at least four nationally implemented childhood obesity interventions in the United States: the Sugar-Sweetened Beverage excise tax (SSB), the TV AD program, active physical education (Active PE) policies, and early care and education (ECE) policies. They each have similar goals of reducing childhood obesity. The effects of these interventions on BMI have been studied, and the cost-effectiveness analysis has led to a better understanding of projected cost reductions and improved health outcomes. The Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) was conducted to evaluate and compare the CEA of these four interventions. +Gortmaker, S.L. et al. (2015) stated: "The four initial interventions were selected by the investigators to represent a broad range of nationally scalable strategies to reduce childhood obesity using a mix of both policy and programmatic strategies... 1. an excise tax of $0.01 per ounce of sweetened beverages, applied nationally and administered at the state level (SSB), 2. elimination of the tax deductibility of advertising costs of TV advertisements for "nutritionally poor" foods and beverages seen by children and adolescents (TV AD), 3. state policy requiring all public elementary schools in which physical education (PE) is currently provided to devote ≥50% of PE class time to moderate and vigorous physical activity (Active PE), and 4. state policy to make early child educational settings healthier by increasing physical activity, improving nutrition, and reducing screen time (ECE)." The CHOICES found that SSB, TV AD, and ECE led to net cost savings. Both SSB and TV AD increased quality adjusted life years and produced yearly tax revenue of 12.5 billion U.S. dollars and 80 million U.S. dollars, respectively. +Some challenges with evaluating the effectiveness of child obesity interventions include: + +The economic consequences of childhood obesity are both short and long term. In the short term, obesity impairs cognitive achievement and academic performance. Some believe this is secondary to negative effects on mood or energy, but others suggest there may be physiological factors involved. Furthermore, obese children have increased health care expenses (e.g. medications, acute care visits). In the long term, obese children tend to become obese adults with associated increased risk for a chronic condition such as diabetes or hypertension. Any effect on their cognitive development may also affect their contributions to society and socioeconomic status. +In the CHOICES, it was noted that translating the effects of these interventions may in fact differ among communities throughout the nation. In addition it was suggested that limited outcomes are studied and these interventions may have an additional effect that is not fully appreciated. +Modeling outcomes in such interventions in children over the long term is challenging because advances in medicine and medical technology are unpredictable. The projections from cost-effective analysis may need to be reassessed more frequently. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Preventive_healthcare-6.md b/data/en.wikipedia.org/wiki/Preventive_healthcare-6.md new file mode 100644 index 000000000..38f0ef0f6 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Preventive_healthcare-6.md @@ -0,0 +1,23 @@ +--- +title: "Preventive healthcare" +chunk: 7/10 +source: "https://en.wikipedia.org/wiki/Preventive_healthcare" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:02.881779+00:00" +instance: "kb-cron" +--- + +=== Economics of U.S. preventive care === +As of 2009, the cost-effectiveness of preventive care was a highly debated topic. While some economists argue that preventive care is valuable and potentially cost saving, others believe it is a waste of resources. Preventive care is composed of a variety of clinical services and programs including annual doctor's check-ups, annual immunizations, and wellness programs; recent models show that these simple interventions can have significant economic impacts. + +=== Clinical preventive services and programs === +Research on preventive care addresses the question of whether it is cost saving or cost effective and whether there is an economics evidence base for health promotion and disease prevention. The need for and interest in preventive care is driven by the imperative to reduce health care costs while improving quality of care and the patient experience. Preventive care can lead to improved health outcomes and cost savings potential. Services such as health assessments/screenings, prenatal care, and telehealth and telemedicine can reduce morbidity or mortality with low cost or cost savings. Specifically, health assessments/screenings have cost savings potential, with varied cost-effectiveness based on screening and assessment type. Inadequate prenatal care can lead to an increased risk of prematurity, stillbirth, and infant death. Time is the ultimate resource and preventive care can help mitigate the time costs. Telehealth and telemedicine is one option that has gained consumer interest, acceptance, and confidence and can improve quality of care and patient satisfaction. + +=== Economics for investment === +There are benefits and trade-offs when considering investment in preventive care versus other types of clinical services. Preventive care can be a good investment as supported by the evidence base and can drive population health management objectives. The concepts of cost saving and cost-effectiveness are different and both are relevant to preventive care. Preventive care that may not save money may still provide health benefits; thus, there is a need to compare interventions relative to impact on health and cost. +Preventive care transcends demographics and is applicable to people of every age. The Health Capital Theory underpins the importance of preventive care across the lifecycle and provides a framework for understanding the variances in health and health care that are experienced. It treats health as a stock that provides direct utility. Health depreciates with age and the aging process can be countered through health investments. The theory further supports that individuals demand good health, that the demand for health investment is a derived demand (i.e. investment is health is due to the underlying demand for good health), and the efficiency of the health investment process increases with knowledge (i.e. it is assumed that the more educated are more efficient consumers and producers of health). +The prevalence elasticity of demand for prevention can also provide insights into the economics. Demand for preventive care can alter the prevalence rate of a given disease and further reduce or even reverse any further growth of prevalence. Reduction in prevalence subsequently leads to reduction in costs. There are a number of organizations and policy actions that are relevant when discussing the economics of preventive care services. The evidence base, viewpoints, and policy briefs from the Organisation for Economic Co-operation and Development (OECD),the Robert Wood Johnson Foundation, and efforts by the U.S. Preventive Services Task Force (USPSTF) all provide examples that improve the health and well-being of populations (e.g. preventive health assessments/screenings, prenatal care, and telehealth/telemedicine). The Affordable Care Act (ACA) has major influence on the provision of preventive care services. As of 2016 it came under heavy scrutiny and review by the new administration. According to the Centers for Disease Control and Prevention (CDC), the ACA makes preventive care affordable and accessible through mandatory coverage of preventive services without a deductible, copayment, coinsurance, or other cost sharing. +The U.S. Preventive Services Task Force (USPSTF), a panel of national experts in prevention and evidence-based medicine, works to improve health of Americans by making evidence-based recommendations about clinical preventive services. They do not consider the cost of a preventive service when determining a recommendation. Each year, the organization delivers a report to Congress that identifies critical evidence gaps in research and recommends priority areas for further review. +The National Network of Perinatal Quality Collaboratives (NNPQC), sponsored by the CDC, supports state-based perinatal quality collaboratives (PQCs) in measuring and improving upon health care and health outcomes for mothers and babies. These PQCs have contributed to improvements such as reduction in deliveries before 39 weeks, reductions in healthcare associated bloodstream infections, and improvements in the utilization of antenatal corticosteroids. +Telehealth and telemedicine has realized significant growth and development. The Center for Connected Health Policy (The National Telehealth Policy Resource Center) has produced multiple reports and policy briefs on the topic of Telehealth and Telemedicine and how they contribute to preventive services. Policy actions and provision of preventive services do not guarantee utilization. Reimbursement has remained a significant barrier to adoption due to variances in payer and state level reimbursement policies and guidelines through government and commercial payers. Americans use preventive services at about half the recommended rate and cost-sharing, such as deductibles, co-insurance, or copayments, also reduce the likelihood that preventive services will be used. Despite the ACA's enhancement of Medicare benefits and preventive services, there were no effects on preventive service utilization, calling out the fact that other fundamental barriers exist. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Preventive_healthcare-7.md b/data/en.wikipedia.org/wiki/Preventive_healthcare-7.md new file mode 100644 index 000000000..83c55c1b1 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Preventive_healthcare-7.md @@ -0,0 +1,27 @@ +--- +title: "Preventive healthcare" +chunk: 8/10 +source: "https://en.wikipedia.org/wiki/Preventive_healthcare" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:02.881779+00:00" +instance: "kb-cron" +--- + +==== Affordable Care Act and preventive healthcare ==== +The Patient Protection and Affordable Care Act, also known as just the Affordable Care Act or Obamacare, was passed and became law in the United States on March 23, 2010. The finalized and newly ratified law was to address many issues in the U.S. healthcare system, which included expansion of coverage, insurance market reforms, better quality, and the forecast of efficiency and costs. Under the insurance market reforms the act required that insurance companies no longer exclude people with pre-existing conditions, allow for children to be covered on their parents' plan until the age of 26, and expand appeals that dealt with reimbursement denials. The Affordable Care Act also banned the limited coverage imposed by health insurances, and insurance companies were to include coverage for preventive health care services. The U.S. Preventive Services Task Force has categorized and rated preventive health services as either A or B, as to which insurance companies must comply and present full coverage. Not only has the U.S. Preventive Services Task Force provided graded preventive health services that are appropriate for coverage, they have also provided many recommendations to clinicians and insurers to promote better preventive care to ultimately provide better quality of care and lower the burden of costs. + +=== Health insurance === +Healthcare insurance companies are willing to pay for preventive care despite the fact that patients are not acutely sick in hope that it will prevent them from developing a chronic disease later on in life. Today, health insurance plans offered through the Marketplace, mandated by the Affordable Care Act are required to provide certain preventive care services free of charge to patients. Section 2713 of the Affordable Care Act, specifies that all private Marketplace and all employer-sponsored private plans (except those grandfathered in) are required to cover preventive care services that are ranked A or B by the U.S. Preventive Services Task Force free of charge to patients. UnitedHealthcare insurance company has published patient guidelines at the beginning of the year explaining their preventive care coverage. + +=== Evaluating incremental benefits === +Evaluating the incremental benefits of preventive care requires a longer period of time when compared to acutely ill patients. Inputs into the model such as discounting rate and time horizon can have significant effects on the results. One controversial subject is use of a 10-year time frame to assess cost effectiveness of diabetes preventive services by the US Congressional Budget Office. +Preventive care services mainly focus on chronic disease. The Congressional Budget Office has provided guidance that further research is needed in the area of the economic impacts of obesity in the U.S. before the CBO can estimate budgetary consequences. A bipartisan report published in May 2015 recognizes the potential of preventive care to improve patients' health at individual and population levels while decreasing the healthcare expenditure. + +=== Economic case === + +==== Mortality from modifiable risk factors ==== +Chronic diseases such as heart disease, stroke, diabetes, obesity and cancer have become the most common and costly health problems in the United States. In 2014, it was projected that by 2023 the number of chronic disease cases would increase by 42%, resulting in $4.2 trillion in treatment and lost economic output. They are also among the top ten leading causes of mortality. Chronic diseases are driven by risk factors that are largely preventable. Sub-analysis performed on all deaths in the United States in 2000 revealed that almost half were attributed to preventable behaviors including tobacco use, poor diet, physical inactivity and alcohol consumption. More recent analysis reveals that heart disease and cancer alone accounted for nearly 46% of all deaths. Modifiable risk factors are also responsible for a large morbidity burden, resulting in poor quality of life in the present and loss of future life earning years. It is further estimated that by 2023, focused efforts on the prevention and treatment of chronic disease may result in 40 million fewer chronic disease cases, potentially reducing treatment costs by $220 billion. + +==== Childhood vaccinations ==== +Childhood immunizations are largely responsible for the increase in life expectancy in the 20th century. From an economic standpoint, childhood vaccines demonstrate a very high return on investment. According to Healthy People 2020, for every birth cohort that receives the routine childhood vaccination schedule, direct health care costs are reduced by $9.9 billion and society saves $33.4 billion in indirect costs. The economic benefits of childhood vaccination extend beyond individual patients to insurance plans and vaccine manufacturers, all while improving the health of the population. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Preventive_healthcare-8.md b/data/en.wikipedia.org/wiki/Preventive_healthcare-8.md new file mode 100644 index 000000000..0bea95880 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Preventive_healthcare-8.md @@ -0,0 +1,28 @@ +--- +title: "Preventive healthcare" +chunk: 9/10 +source: "https://en.wikipedia.org/wiki/Preventive_healthcare" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:02.881779+00:00" +instance: "kb-cron" +--- + +==== Health capital theory ==== +The burden of preventable illness extends beyond the healthcare sector, incurring costs related to lost productivity among workers in the workforce. Indirect costs related to poor health behaviors and associated chronic disease costs U.S. employers billions of dollars each year. +According to the American Diabetes Association (ADA), medical costs for employees with diabetes are twice as high as for workers without diabetes and are caused by work-related absenteeism ($5 billion), reduced productivity at work ($20.8 billion), inability to work due to illness-related disability ($21.6 billion), and premature mortality ($18.5 billion). Reported estimates of the cost burden due to increasingly high levels of overweight and obese members in the workforce vary, with best estimates suggesting 450 million more missed work days, resulting in $153 billion each year in lost productivity, according to the CDC Healthy Workforce. +The health capital model explains how individual investments in health can increase earnings by "increasing the number of healthy days available to work and to earn income." In this context, health can be treated both as a consumption good, wherein individuals desire health because it improves quality of life in the present, and as an investment good because of its potential to increase attendance and workplace productivity over time. Preventive health behaviors such as healthful diet, regular exercise, access to and use of well-care, avoiding tobacco, and limiting alcohol can be viewed as health inputs that result in both a healthier workforce and substantial cost savings. + +==== Quality-adjusted life years ==== +Health benefits of preventive care measures can be described in terms of quality-adjusted life-years (QALYs) saved. A QALY takes into account length and quality of life, and is used to evaluate the cost-effectiveness of medical and preventive interventions. Classically, one year of perfect health is defined as 1 QALY and a year with any degree of less than perfect health is assigned a value between 0 and 1 QALY. As an economic weighting system, the QALY can be used to inform personal decisions, to evaluate preventive interventions and to set priorities for future preventive efforts. +Cost-saving and cost-effective benefits of preventive care measures are well established. The Robert Wood Johnson Foundation evaluated the prevention cost-effectiveness literature, and found that many preventive measures meet the benchmark of <$100,000 per QALY and are considered to be favorably cost-effective. These include screenings for HIV and chlamydia, cancers of the colon, breast and cervix, vision screening, and screening for abdominal aortic aneurysms in men >60 in certain populations. Alcohol and tobacco screening were found to be cost-saving in some reviews and cost-effective in others. According to the RWJF analysis, two preventive interventions were found to save costs in all reviews: childhood immunizations and counseling adults on the use of aspirin. + +==== Minority populations ==== +Health disparities are increasing in the United States for chronic diseases such as obesity, diabetes, cancer, and cardiovascular disease. Populations at heightened risk for health inequities are the growing proportion of racial and ethnic minorities, including African Americans, American Indians, Hispanics/Latinos, Asian Americans, Alaska Natives and Pacific Islanders. +According to the Racial and Ethnic Approaches to Community Health (REACH), a national CDC program, non-Hispanic blacks currently have the highest rates of obesity (48%), and risk of newly diagnosed diabetes is 77% higher among non-Hispanic blacks, 66% higher among Hispanics/Latinos and 18% higher among Asian Americans compared to non-Hispanic whites. Current U.S. population projections predict that more than half of Americans will belong to a minority group by 2044. Without targeted preventive interventions, medical costs from chronic disease inequities will become unsustainable. Broadening health policies designed to improve delivery of preventive services for minority populations may help reduce substantial medical costs caused by inequities in health care, resulting in a return on investment. + +==== Policies ==== + +Chronic disease is a population-level issue that requires population-level efforts and national- and state-level public policy to effectively prevent, rather than individual-level efforts. The United States currently employs many public health policy efforts aligned with the preventive health efforts discussed above. The Centers for Disease Control and Prevention support initiatives such as Health in All Policies and HI-5 (Health Impact in 5 Years), and collaborative efforts that aim to consider prevention across sectors and address social determinants of health as a method of primary prevention for chronic disease. + +==== Obesity ==== \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Preventive_healthcare-9.md b/data/en.wikipedia.org/wiki/Preventive_healthcare-9.md new file mode 100644 index 000000000..34cd5fe9a --- /dev/null +++ b/data/en.wikipedia.org/wiki/Preventive_healthcare-9.md @@ -0,0 +1,28 @@ +--- +title: "Preventive healthcare" +chunk: 10/10 +source: "https://en.wikipedia.org/wiki/Preventive_healthcare" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:02.881779+00:00" +instance: "kb-cron" +--- + +Policies that address the obesity epidemic should be proactive and far-reaching, including a variety of stakeholders both in healthcare and in other sectors. Recommendations from the Institute of Medicine in 2012 suggest that "concerted action be taken across and within five environments (physical activity (PA), food and beverage, marketing and messaging, healthcare and worksites, and schools) and all sectors of society (including government, business and industry, schools, child care, urban planning, recreation, transportation, media, public health, agriculture, communities, and home) in order for obesity prevention efforts to truly be successful." +There are dozens of current policies acting at either (or all of) the federal, state, local and school levels. Most states employ a physical education requirement of 150 minutes of physical education per week at school, a policy of the National Association of Sport and Physical Education. In some cities, including Philadelphia, a sugary food tax is employed. This is a part of an amendment to Title 19 of the Philadelphia Code, "Finance, Taxes and Collections", Chapter 19-4100, Sugar-Sweetened Beverage Tax that was approved 2016, which establishes an excise tax of $0.015 per fluid ounce on distributors of beverages sweetened with both caloric and non-caloric sweeteners. Distributors are required to file a return with the department, and the department can collect taxes, among other responsibilities. These policies can be a source of tax credits. Under the Philadelphia policy, businesses can apply for tax credits with the revenue department on a first-come, first-served basis. This applies until the total amount of credits for a particular year reaches one million dollars. +Recently, advertisements for food and beverages directed at children have received much attention. The Children's Food and Beverage Advertising Initiative (CFBAI) is a self-regulatory program of the food industry. Each participating company makes a public pledge that details its commitment to advertise only foods that meet certain nutritional criteria to children under 12 years old. This is a self-regulated program with policies written by the Council of Better Business Bureaus. The Robert Wood Johnson Foundation funded research to test the efficacy of the CFBAI. The results showed progress in terms of decreased advertising of food products that target children and adolescents. + +==== Childhood immunization policies ==== + +Despite nationwide controversies over childhood vaccination and immunization, there are policies and programs at the federal, state, local and school levels outlining vaccination requirements. All states require children to be vaccinated against certain communicable diseases as a condition for school attendance. However, only 18 states allow exemptions for "philosophical or moral reasons." Diseases for which vaccinations form part of the standard ACIP vaccination schedule are diphtheria tetanus pertussis (whooping cough), poliomyelitis (polio), measles, mumps, rubella, haemophilus influenzae type b, hepatitis B, influenza, and pneumococcal infections. The CDC website maintains such schedules. +The CDC website describes a federally funded program, Vaccines for Children (VFC), which provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay. Additionally, the Advisory Committee on Immunization Practices (ACIP) is an expert vaccination advisory board that informs vaccination policy and guides on-going recommendations to the CDC, incorporating the most up-to-date cost-effectiveness and risk-benefit evidence in its recommendations. + +== See also == + +== References == + +== External links == +United States Preventive Services Task Force (USPSTF) +Canadian Task Force on Preventive Health Care (CTFPHC) +European Centre for Disease Prevention and Control (ECDC) +Hu, Frank; Cheung, Lilian; Otis, Brett; Oliveira, Nancy; Musicus, Aviva, eds. (19 January 2021). "The Nutrition Source – Healthy Living Guide 2020/2021: A Digest on Healthy Eating and Healthy Living". www.hsph.harvard.edu. Boston: Department of Nutrition at the Harvard T.H. Chan School of Public Health. Archived from the original on 5 October 2021. Retrieved 11 October 2021. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Preventive_nutrition-0.md b/data/en.wikipedia.org/wiki/Preventive_nutrition-0.md new file mode 100644 index 000000000..3fbb1214c --- /dev/null +++ b/data/en.wikipedia.org/wiki/Preventive_nutrition-0.md @@ -0,0 +1,22 @@ +--- +title: "Preventive nutrition" +chunk: 1/2 +source: "https://en.wikipedia.org/wiki/Preventive_nutrition" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:04.138297+00:00" +instance: "kb-cron" +--- + +Preventive nutrition is a branch of nutrition science with the goal of preventing, delaying, and/or reducing the impacts of disease and disease-related complications. It is concerned with a high level of personal well-being, disease prevention, and diagnosis of recurring health problems or symptoms of discomfort which are often precursors to health issues. The overweight and obese population numbers have increased over the last 40 years and numerous chronic diseases are associated with obesity. Preventive nutrition may assist in prolonging the onset of non-communicable diseases and may allow adults to experience more "healthy living years." There are various ways of educating the public about preventive nutrition. Information regarding preventive nutrition is often communicated through public health forums, government programs and policies, or nutritional education. For example, in the United States, preventive nutrition is taught to the public through the use of the food pyramid or MyPlate initiatives. + +== History == +Preventive nutrition has been known about for a long time. The philosopher Hippocrates (460-377 BC) believed that nutrition had a significant impact on maintaining health and that the best way to prevent diseases was to "let food be your medicine and medicine be your food." Meyer-Abich (2005) also believed that nutrition was foundational to a healthy life. He took a holistic approach to health and discussed the essential role of nutrition in his paper, "Human health in nature - towards a holistic philosophy of nutrition." +Since the early 1980s, food trends have changed. The introduction of processed foods gained fast popularization. During the commercialization and industrialization of food, the demand for processed, prepackaged, convenient food such as beef in fast food increased. Farmers began to industrially farm livestock to produce more meat due to industry demand. As a result, livestock feed is often corn, soy, and grain. Compared to grass-fed beef, grain-fed beef is higher in saturated fatty acids along with a less favorable omega fatty acids profile. Processed, prepackaged, and convenient food options often contain high amounts of sugar, sodium, and fat, and are associated with the development of poor health outcomes. + +== Disease prevention == +Although life expectancy has increased over the years, the number of "healthy years" has not. There is a rising prevalence of nutrition related diseases in the world today. Chronic disease epidemics associated with nutrition including obesity, type 2 diabetes, osteoporosis, cardiovascular disease, and cancers are increasing. According to the World Health Organization, the proportion of people with obesity has almost tripled since 1975. A survey conducted in China among the hypertensive population highlights that obesity contributes to the development of hypertension. Only about half the participants were aware of their hypertension diagnosis and only 20.3% had controlled hypertension. The article also showed a correlation between poor hypertension control and obesity. Preventive nutrition may be a helpful strategy to help control obesity and chronic non-communicable diseases. In those with obesity, a weight reduction of 10% has been demonstrated to prevent non-communicable diseases and increase life expectancy. The Mediterranean diet has been investigated in many studies as a tool for weight loss. Results show that adhering to a Mediterranean diet causes weight loss and decreases fat mass which prevents or reduces the risk of non-communicable disease, including type 2 diabetes and cardiovascular disease. It is also associated with a reduced risk of mortality in certain populations, including those with obesity, hypertension, type 2 diabetes, and cardiovascular disease. + +== Implementation == +Diets with low nutrient dense products (e.g. highly processed foods) have increased, and in Western countries, approximately 2/3 of adults are obese. The risk of developing a chronic disease such as type 2 diabetes, hypertension, cardiovascular disease, non-alcoholic fatty liver disease, cancer, depression, and osteoarthritis is higher in those with obesity (i.e. BMI over 30) and increases healthcare costs. Several diets have been studied to analyze their effect on weight loss and prevention of chronic diseases. These include, the ketogenic diet, low fat diets, low carbohydrate diets, the Mediterranean diet, and many more. The ketogenic diet has been scientifically validated for its effectiveness in enhancing glycemic control among individuals with type 2 diabetes and those who are at risk of developing the disease. This dietary approach helps individuals improve insulin resistance and blood glucose control. +The Mediterranean diet was first examined in the 1950s with the Seven Countries Study in Greece and Italy after World War II. Compared to Western countries, a low incidence of heart disease and cancer was observed. Although it is not the only diet shown to help with weight loss and improve health outcomes, it has been studied extensively and has the most available evidence supporting its use to prevent non-communicable diseases. In general, the Mediterranean diet consists of high intakes of fruit, vegetables, seeds, nuts, whole grains, fish and other seafood, and extra virgin olive oil as the fat source when cooking. It has a moderate intake of legumes, poultry, eggs, dairy products, and red wine, and a low intake of red or processed meat, animal fat, and high sugar foods. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Preventive_nutrition-1.md b/data/en.wikipedia.org/wiki/Preventive_nutrition-1.md new file mode 100644 index 000000000..8b3237511 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Preventive_nutrition-1.md @@ -0,0 +1,38 @@ +--- +title: "Preventive nutrition" +chunk: 2/2 +source: "https://en.wikipedia.org/wiki/Preventive_nutrition" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:04.138297+00:00" +instance: "kb-cron" +--- + +== Education == +Extreme diets, such as the ketogenic diet, may potentially have adverse effects and lack data on long-term outcomes. Therefore, it should be used as a tool, rather than a long term solution. An alternative to strict diets or to complement dietary approaches, is cultivating nutritional awareness and making proactive food choices. This is a sustainable method for maintaining good health and contributes to preventive nutrition. Being familiar with nutritional labels can inform dietary choices. Reading these labels increases awareness of the food content and our consumption habits, including quantities and macronutrients. In a four-week randomized control trial assessing the impact of three types of nutrition labels on consumer food purchases, the results indicated that "products for which participants viewed the label and subsequently purchased the product during the same shopping episode were significantly healthier than products where labels were viewed but the product was not subsequently purchased." The objective of preventive nutrition is to continually enhance one's awareness of food quantities, ingredients, and how specific foods impact the body. + +== Athletics == +Athletes are held to a higher standard of nutrition and preventive nutrition contributes to injury prevention in athletes. According to a study done by the National Collegiate Athletic Association, most athletes and coaches do not fully understand or focus on the importance of nutrition. Nutrition contributes to injury prevention as well as exercise capacity. To demonstrate this, a group of high-performance runners completed a fat adaptation carbohydrate restoration (FACR) dietary intervention (five days' carbohydrate < 20% and fat > 60% energy, plus one-day carbohydrate ≥ 70% energy), and a control high-carbohydrate (HCHO) diet for six days (carbohydrate > 60% energy; fat < 20% energy). It was found that, compared to the HCHO diet, the FACR diet improved running economy, which is the efficiency the athlete's body uses energy while running, leading to a faster run time. Although this is a very specific diet, it shows that diet can quickly improve athletic performance. However, there is limited evidence on how diet or nutritional awareness influences athletic performance. Therefore, more research must be done to confirm which diets have a positive or negative impact on exercise performance and injury prevention. + +== Limitations == +Most people are aware that nutrition has an impact on health, but the recommended dietary guidelines are not always followed. According to Kovacs, "one solution to address health concerns is to shift current dietary patterns to diets that are both nutritious and sustainable." Financial limitations, lack of time, and accessibility contribute to poor eating habits and are difficult barriers to overcome. "The poorest who face disproportionate barriers to accessing healthy food have an increased risk of malnutrition". A study was conducted on barriers to healthy eating and showed the correlation between poverty in urban settings, food security, food access, and nutrition. Although it has been suggested that living in urban settings increases access to food, the study concluded that there is a financial limitation to achieving food security that must be addressed. Solutions to these barriers have been suggested, yet it remains a significant limitation to preventive nutrition. + +== Future research == +Although there is evidence that nutrition plays a role in obesity and developing chronic disease, there are many other factors to consider. Unmodifiable risk factors and lifestyle choices may put certain individuals at higher risk, outcomes may differ depending on the chronic disease, and exercise may have contributed to the weight loss observed in studies. For example, the effect of a Mediterranean diet on cardiovascular disease outcomes is uncertain and more research should be carried out to assess its role. A holistic approach to weight loss and chronic disease prevention is important, including preventive nutrition. There is insufficient evidence on which diet will provide the most benefit to individuals. However, there is evidence that a healthy diet is important to maintain or improve overall quality of life. + +== See also == +Preventive healthcare +Dietitian specializes in human nutrition. +Animal nutritionist specializes in animal nutrition. +Physical activity +Hippocrates +The Food Pyramid +Mediterranean Diet and Mediterranean Diet Pyramid +Non-communicable diseases + +== References == + +== External links == +Preventive Nutrition and Food Science +Biomedicine & Preventive Nutrition +MyPlate \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Proarrhythmia-0.md b/data/en.wikipedia.org/wiki/Proarrhythmia-0.md new file mode 100644 index 000000000..589007b96 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Proarrhythmia-0.md @@ -0,0 +1,65 @@ +--- +title: "Proarrhythmia" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Proarrhythmia" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:05.273346+00:00" +instance: "kb-cron" +--- + +Proarrhythmia is a new or more frequent occurrence of pre-existing arrhythmias, paradoxically precipitated by antiarrhythmic therapy, which means it is a side effect associated with the administration of some existing antiarrhythmic drugs, as well as drugs for other indications. In other words, it is a tendency of antiarrhythmic drugs to facilitate emergence of new arrhythmias. + + +== Types of proarrhythmia == +According to the Vaughan Williams classification (VW) of antiarrhythmic drugs, there are 3 main types of Proarrhythmia during treatment with various antiarrhythmic drugs for Atrial Fibrillation or Atrial flutter: + + +=== Ventricular proarrhythmia === +Torsades de pointes (VW type IA and type III drugs) +Sustained monomorphic ventricular tachycardia (usually VW type IC drugs) +Sustained polymorphic ventricular tachycardia/ventricular fibrillation without long QT (VW types IA, IC, and III drugs) + + +=== Atrial proarrhythmia === +Conversion of atrial fibrillation to flutter (usually VW type IC drugs or amiodarone). May be a desired effect. +Increase of defibrillation threshold (a potential problem with VW type IC drugs) +Provocation of recurrence (probably VW types IA, IC and III drugs). It is rare. + + +=== Abnormalities of conduction or impulse formation === +Sinus node dysfunction, atrioventricular block (almost all drugs) +Accelerate conduction over accessory pathway (digoxin, intravenous verapamil, or diltiazem) +Acceleration of ventricular rate during atrial fibrillation (VW type IA and type IC drugs). + + +== Increased risk == +Presence of structural heart disease, especially LV systolic dysfunction. +Class IC agents. +Increased age. +Females. + + +== Clinical pointers == + + +=== Class IA drugs === +Dose independent, occurring at normal levels. +Follow QT interval, keep ms. + + +=== Class IC drugs === +May be provoked by increased heart rate. +Exercise stress tests after loading. + + +=== Class III drugs === +Dose dependent. +Follow bradycardia, prolonged QT closely. + + +== References == + + +== External links == +Roden DM (August 1998). "Mechanisms and management of proarrhythmia". Am. J. Cardiol. 82 (4A): 49I–57I. doi:10.1016/S0002-9149(98)00472-X. PMID 9737654. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Procidentia-0.md b/data/en.wikipedia.org/wiki/Procidentia-0.md new file mode 100644 index 000000000..5e8276ec2 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Procidentia-0.md @@ -0,0 +1,20 @@ +--- +title: "Procidentia" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Procidentia" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:06.525615+00:00" +instance: "kb-cron" +--- + +Procidentia is a severe prolapse, the falling down of an organ from its normal anatomical position, usually referring to uterine prolapse. + + +== See also == +Uterine prolapse (and Female genital prolapse) +Rectal prolapse +Prolapse + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Prodromus-0.md b/data/en.wikipedia.org/wiki/Prodromus-0.md index d7dde6a15..4b9653cea 100644 --- a/data/en.wikipedia.org/wiki/Prodromus-0.md +++ b/data/en.wikipedia.org/wiki/Prodromus-0.md @@ -4,7 +4,7 @@ chunk: 1/1 source: "https://en.wikipedia.org/wiki/Prodromus" category: "reference" tags: "science, encyclopedia" -date_saved: "2026-05-05T06:38:38.830660+00:00" +date_saved: "2026-05-05T07:32:07.883218+00:00" instance: "kb-cron" --- diff --git a/data/en.wikipedia.org/wiki/Prognosis-0.md b/data/en.wikipedia.org/wiki/Prognosis-0.md new file mode 100644 index 000000000..f23a66c39 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Prognosis-0.md @@ -0,0 +1,61 @@ +--- +title: "Prognosis" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Prognosis" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:09.032566+00:00" +instance: "kb-cron" +--- + +Prognosis (Ancient Greek: πρόγνωσις 'fore-knowing, foreseeing'; pl.: prognoses) is a medical term for predicting the likelihood or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) or remain stable over time; expectations of quality of life, such as the ability to carry out daily activities; the potential for complications and associated health issues; and the likelihood of survival (including life expectancy). A prognosis is made on the basis of the normal course of the diagnosed disease, the individual's physical and mental condition, the available treatments, and additional factors. A complete prognosis includes the expected duration, function, and description of the course of the disease, such as progressive decline, intermittent crisis, or sudden, unpredictable crisis. +When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because previous research found that this proportion of patients died. This statistical information does not apply to the prognosis for each individual patient, because patient-specific factors can substantially change the expected course of the disease: additional information is needed to determine whether a patient belongs to the 45% who will die, or to the 55% who survive. + + +== Methodology == + + +=== Disease and prognostic indicators === +Prognostic scoring is also used for cancer outcome predictions. A Manchester score is an indicator of prognosis for small-cell lung cancer. For non-Hodgkin lymphoma, physicians have developed the International Prognostic Index to predict patient outcome. Other medical areas where prognostic indicators are used include drug-induced liver injury (DILI) (Hy's law), the use of an exercise stress test after myocardial infarction, and to predict survival in people with multiple myeloma. + + +=== End of life === +Studies have found that most doctors are overly optimistic when making a prognosis; they tend to overstate how long a patient might live. For patients who are critically ill, particularly those in an intensive care unit, there are numerical prognostic scoring systems that are more accurate. The most famous of these is the APACHE II scale, which is most accurate when applied in the seven days prior to a patient's predicted death. +Knowing the prognosis helps determine whether it makes more sense to attempt or withhold certain treatments, and thus plays an important role in end-of-life decisions and advance care planning. + + +== Estimator == +Estimators that are commonly used to describe prognoses include: + +Progression-free survival – the length of time during and after medication or treatment during which the disease being treated (usually cancer) does not get worse. +Survival rate – indicating the percentage of people in a study or treatment group who are alive for a given period of time after diagnosis. +Survival time – the remaining duration of life. If not otherwise specified, it generally starts from the time of diagnosis. + + +== History == +One of the earliest written works of medicine is the Book of Prognostics of Hippocrates, written around 400 BC. This work opens with the following statement: "It appears to me a most excellent thing for the physician to cultivate Prognosis; for by foreseeing and foretelling, in the presence of the sick, the present, the past, and the future, and explaining the omissions which patients have been guilty of, he will be the more readily believed to be acquainted with the circumstances of the sick; so that men will have confidence to intrust themselves to such a physician." +For 19th-century physicians, particularly those following the French school of medicine, the main aim of medicine was not to cure disease, but rather to give a medical diagnosis and achieve a satisfying prognosis of the patient's chances. Only several decades later did the focus of efforts in Western medicine shift to curing disease. + + +== See also == +Cure – Substance or procedure that ends a medical condition +Medical diagnosis – Process to identify a disease or disorder +Nocebo – Harmful effect from negative belief +Optimism bias – Type of cognitive bias +Placebo (origins of technical term) – Substance or treatment of no therapeutic valuePages displaying short descriptions of redirect targets +Prediction – Statement about a future event +Reference class forecasting – Method of predicting the future +Relative survival – Calculation in epidemiology +Sign (medicine) – Indications of a specific illness, including psychiatricPages displaying short descriptions of redirect targets +Signs and symptoms – Indications of a specific illness, including psychiatric +Survival analysis – Branch of statistics +Survival rate – Medical analysis of disease +Symptom – Indications of a specific illness, including psychiatricPages displaying short descriptions of redirect targets + + +== References == + + +== External links == + +Computer models at prognosis.org \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Progression-free_survival-0.md b/data/en.wikipedia.org/wiki/Progression-free_survival-0.md new file mode 100644 index 000000000..f80633bd3 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Progression-free_survival-0.md @@ -0,0 +1,31 @@ +--- +title: "Progression-free survival" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Progression-free_survival" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:10.257154+00:00" +instance: "kb-cron" +--- + +Progression-free survival (PFS) is "the length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse". In oncology, PFS usually refers to situations in which a tumor is present, as demonstrated by laboratory testing, radiologic testing, or clinically. Similarly, "disease-free survival" is the length of time after patients have received treatment and have no detectable disease. +Time to progression (TTP) does not count patients who die from other causes but is otherwise a close equivalent to PFS (unless there are many such events). The FDA gives separate definitions and prefers PFS. + + +== Background == +PFS is widely used as a surrogate endpoint in oncology. The definition of "progression" generally involves imaging techniques (plain radiograms, CT scans, MRI, PET scans, ultrasounds) or other aspects: biochemical progression may be defined on the basis of an increase in a tumor marker (such as CA125 for epithelial ovarian cancer or PSA for prostate cancer). In clinical trials, what precisely constitutes an "event" in PFS (an event being either disease progression or death) may vary depending on the specific disease and/or the toxicological characteristics of the treatments in the trial; however, this is generally defined in the trial protocol prior to the trial enrolling patients. +As of 2019, change in the radiological aspects of a lesion is defined according to RECIST criteria. Progression may also be due to the appearance of a new lesion or to unequivocal progression in other lesions, such as an increase in size or the lesions spreading to nearby tissues. +Progression-free survival is commonly used as an alternative to overall survival (OS). In some cancers, PFS and OS are strictly related, but in others they are not. In a time trade off study in renal cancer, physicians rated PFS the most important aspect of treatment, while for patients it fell below fatigue, hand foot syndrome, and other toxicities. + + +== Special aspects == +By definition, PFS refers to the date on which progression is detected. An advantage of measuring PFS over measuring OS is that PFS appears sooner than deaths, allowing faster trials. PFS also allows for greater insight into consequences of diseases and treatments that fall below the threshold of mortality, such as pain, organ dysfunction, interference in daily life, and other effects that progressive disease may have on the patient while they are still alive. +The use of PFS for proof of effectiveness and regulatory approval is controversial. It is often used as a clinical endpoint in randomized controlled trials for cancer therapies. It is a metric frequently used by the UK National Institute for Health and Clinical Excellence and the U.S. Food and Drug Administration to evaluate the effectiveness of a cancer treatment. Studies find that new cancer drugs approved by the U.S. Food and Drug Administration improve progression-free survival by a median of 2 to 3 months depending on the sample and analyzed time period: 2.5 months, 2.70 months, 3.30 months. +PFS improvements do not always result in corresponding improvements in overall survival, and the control of the disease may come at the biological expense of side effects from the treatment itself. This has been described as an example of the McNamara fallacy. + + +== See also == +Survival rate + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Progressive_disease-0.md b/data/en.wikipedia.org/wiki/Progressive_disease-0.md new file mode 100644 index 000000000..d9aa3f826 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Progressive_disease-0.md @@ -0,0 +1,31 @@ +--- +title: "Progressive disease" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Progressive_disease" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:11.479868+00:00" +instance: "kb-cron" +--- + +Progressive disease or progressive illness is a disease or physical ailment whose course in most cases is the worsening, growth, or spread of the disease. This may happen until death, serious debility, or organ failure occurs. Some progressive diseases can be halted and reversed by treatment (surgical, dietary, or lifestyle interventions). Many can be slowed by medical therapy. Some cannot be altered by current treatments. +Though the time distinctions are imprecise, diseases can be rapidly progressive (typically days to weeks) or slowly progressive (months to years). The time course of a disease affects whether it is considered acute or chronic. By definition, virtually all slowly progressive diseases are also chronic diseases. Biologically, many of these are also referred to as degenerative diseases due to the cellular changes. +Not all chronic diseases are progressive: a chronic, non-progressive disease may be referred to as a static condition. +Progressive disease can also be a clinical endpoint i.e. an endpoint in a clinical trial. A progressive disease should not be confused with a terminal disease, the difference being that a terminal disease invariably leads to death. + + +== Examples == + +There are examples of slowly and rapidly progressive diseases affecting all organ systems and parts of the body. The following are some examples of rapidly and slowly progressive diseases affecting various organ systems: + +Brain: Creutzfeldt–Jakob disease progresses rapidly compared to Alzheimer's disease. +Eyes: Cataracts can be static or slowly progressive. Macular degeneration is slowly progressive, while retinal detachment is rapidly progressive. +Lungs: Emphysema due to alpha-1 antitrypsin deficiency is a slowly progressive pulmonary disease. +Kidneys: Goodpasture's syndrome is a rapidly progressive glomerulonephritis, while diabetic glomerulosclerosis is slowly progressive. +Pancreas: Type 1 diabetes mellitus involves rapidly progressive loss of insulin secretory capacity compared to type 2 diabetes mellitus, in which the loss of insulin secretion is slowly progressive over many years. MODY 2, due to GCK mutation, is a relatively static form of reduced insulin secretion. +Joints: Both osteoarthritis and rheumatoid arthritis are slowly progressive forms of arthritis. +Nerves: Essential tremor is a slowly progressive neurological disorder which is usually genetically passed down. +Cancer: the abnormal growth of body cells + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Protocol_system-0.md b/data/en.wikipedia.org/wiki/Protocol_system-0.md new file mode 100644 index 000000000..3c4b1a5fb --- /dev/null +++ b/data/en.wikipedia.org/wiki/Protocol_system-0.md @@ -0,0 +1,23 @@ +--- +title: "Protocol system" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Protocol_system" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:12.693353+00:00" +instance: "kb-cron" +--- + +A computer-based protocol system is a paradigm providing a set of tools which allow health care providers access to current guidelines which they can apply in practice. Studies have shown that protocols can aid in optimising patient care. There are two types of protocol systems: passive and active. +In a healthcare setting, a protocol, also called a medical guideline, is a set of instructions which describe a process to be followed to investigate a particular set of findings in a patient, or the method which should be followed to control a certain disease. + + +== Protocol systems == +Passive +Passive protocol systems are a source of information which health care providers have the freedom to choose to consult or not; they are not intrinsically incorporated into the healthcare process. The purpose of a passive protocol system is to give healthcare providers access to information which may remind healthcare providers of steps during patient care which may otherwise be forgotten or changed. + +Active +Active protocol systems are specific guidelines for healthcare providers to follow. They are a central way which healthcare is delivered. Examples of active protocol systems include trigger-automated order entry systems and appointment scheduling. Active protocol systems may provide an explanation function which offers background information, definitions, risks, and the rationale that supports specific recommendations. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Proximodistal_trend-0.md b/data/en.wikipedia.org/wiki/Proximodistal_trend-0.md new file mode 100644 index 000000000..1d0b4932b --- /dev/null +++ b/data/en.wikipedia.org/wiki/Proximodistal_trend-0.md @@ -0,0 +1,14 @@ +--- +title: "Proximodistal trend" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Proximodistal_trend" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:14.007881+00:00" +instance: "kb-cron" +--- + +The proximodistal trend is the tendency for more general functions of limbs to develop before more specific or fine motor skills. It comes from the Latin words proxim- which means "close" and "-dis-" meaning "away from", because the trend essentially describes a path from the center outward. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pulmonary_consolidation-0.md b/data/en.wikipedia.org/wiki/Pulmonary_consolidation-0.md new file mode 100644 index 000000000..3cf340c80 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pulmonary_consolidation-0.md @@ -0,0 +1,41 @@ +--- +title: "Pulmonary consolidation" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Pulmonary_consolidation" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:15.280779+00:00" +instance: "kb-cron" +--- + +A pulmonary consolidation is a region of normally compressible lung tissue that has been filled with liquid instead of air. The condition is marked by induration (swelling or hardening of normally soft tissue) of a normally aerated lung. It is considered a radiologic sign. Consolidation occurs through accumulation of inflammatory cellular exudate in the alveoli and adjoining ducts. The liquid can be pulmonary edema, inflammatory exudate, pus, inhaled water, or blood (from bronchial tree or hemorrhage from a pulmonary artery). Consolidation must be present to diagnose pneumonia: the signs of lobar pneumonia are characteristic and clinically referred to as consolidation. + + +== Signs == +Signs that consolidation may have occurred include: + +Expansion of the thorax on inspiration is reduced on the affected side +Vocal fremitus is increased on the affected side +Percussion note is impaired in the affected area +Breath sounds are bronchial +Possible medium, late, or pan-inspiratory crackles +Vocal resonance is increased. Here, the patient's voice (or whisper, as in whispered pectoriloquy) can be heard more clearly when there is consolidation, as opposed to the healthy lung where speech sounds muffled. +A pleural rub may be present. +A lower PAO2 than calculated in the alveolar gas equation + + +== Diagnosis == + + +=== Radiology === +Typically, an area of white lung is seen on a standard X-ray. Consolidated tissue is more radio-opaque than normally aerated lung parenchyma, so that it is clearly demonstrable in radiography and on CT scans. Consolidation is often a middle-to-late stage feature/complication in pulmonary infections. + + +== See also == +Pulmonary infiltrate + + +== References == + + +== External links == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pulmonary_drug_delivery-0.md b/data/en.wikipedia.org/wiki/Pulmonary_drug_delivery-0.md new file mode 100644 index 000000000..3d8bf9017 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pulmonary_drug_delivery-0.md @@ -0,0 +1,97 @@ +--- +title: "Pulmonary drug delivery" +chunk: 1/2 +source: "https://en.wikipedia.org/wiki/Pulmonary_drug_delivery" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:16.581186+00:00" +instance: "kb-cron" +--- + +Pulmonary drug delivery is a route of administration in which patients use an inhaler to inhale their medications and drugs are absorbed into the bloodstream via the lung mucous membrane. This technique is most commonly used in the treatment of lung diseases, for example, asthma and chronic obstructive pulmonary disease (COPD). Different types of inhalers include metered-dose inhalers (MDI), dry powder inhalers (DPI), soft mist inhalers (SMI) and nebulizers. The rate and efficacy of pulmonary drug delivery are affected by drug particle properties, breathing patterns and respiratory tract geometry. +Pulmonary drug delivery minimizes systemic side effects and increases bioavailability owing to the localised absorption through the lung. The disadvantages include possible drug irritation to the lung, limited drug dissolution, relatively high drug clearance, and the drug effectiveness depends on the inhaler techniques and patients' compliance. Drug formulation can be challenging since the drug has to bypass the defence mechanisms in the respiratory tract. Pharmacokinetics and pharmacodynamics of the drug in elderly patients can also be particularly difficult to predict due to age-related changes in body composition. +Ongoing developments in inhaler device engineering, technology and drug formulations may improve the efficacy and overcome the challenges of pulmonary drug delivery. Recent advancements involve the utilization of the pulmonary route as an entry to systemic circulation for treating different diseases, as well as the development of pulmonary drug formulation and particle engineering technology to increase the efficacy of pulmonary delivery. + +== Application / Clinical use == +Pulmonary drug delivery is mainly utilized for topical applications in the lungs, such as the use of inhaled beta-agonists, corticosteroids and anticholinergic agents for the treatment of asthma and COPD, the use of inhaled mucolytics and antibiotics for the treatment of cystic fibrosis (CT) and respiratory viral infections, and the use of inhaled prostacyclin analogs for the treatment of pulmonary arterial hypertension (PAH). +In addition, this technique is employed for systemic application, for example the use of inhaled insulin for diabetes management, the use of inhaled loxapine for treatment of psychiatric disorders. Vaccines, such as the measles-rubella vaccines, can also be delivered via inhalation. + +== Examples of inhalers == + +=== Metered-dose inhalers (MDIs) === +Metered-dose inhalers include pressurized metered-dose inhalers (pMDIs) and breath-actuated metered-dose inhalers (BAMDIs). pMDIs are the most commonly used inhalers for treating lung diseases. It requires coordination of patients' inhalation and inhaler actuation. BAMDIs are triggered by patients' inspiratory flow instead of hand actuation, solving the coordination issue. MDIs with spacers have similar effectiveness in drug delivery compared to nebulizers, with additional benefits in convenience and cost-effectiveness. The use of MDIs together with spacers, valved holding chambers (VHCs) or masks improve the efficacy of drug delivery into the lungs. + +==== Advantages ==== +High portability +Fixed dose is delivered +Efficient aerosolized delivery of drug particles +Inexpensive +Convenient usage +Quiet administration + +==== Disadvantages ==== +Require coordination between inhalation and inhaler actuation + +==== Examples ==== +Pressurized metered-dose inhalers (pMDIs) +Breath-actuated metered-dose inhalers (BAMDIs) + +=== Dry powder inhalers (DPIs) === +The solid drug powders in DPIs are released by the force of the patient's inspiratory flow. Turbulent airflow generated inside the inhaler by the inhalation force is associated with the movement of airflow and the resistance inside the inhaler. Patients should inhale with adequate inspiratory flow to overcome the resistance of DPIs, leading to drug particle deaggregation for successful pulmonary delivery. + +==== Advantages ==== +High portability +Fixed dose is delivered +Require minimal coordination between inhalation and inhaler actuation + +==== Disadvantages ==== +Require adequate inspiratory flow from patients +Moisture sensitive + +==== Examples ==== +Turbuhaler +Accuhaler +Handihaler +Genuair +Ellipta +Breexhaler + +=== Soft-mist inhalers (SMIs) === +Soft-mist inhaler aerosolized a fixed dose of liquid drug formulation into inhalable tiny particles through an extremely fine nozzle system using the energy generated by the lever-compressed spring, without the use of propellants. The slow and prolonged duration of aerosolization facilitates the patient's coordination between inhaler actuation and inhalation. + +==== Advantages ==== +High portability +Require minimal patient's coordination between inhalation and inhaler actuation +High drug deposition in lungs + +==== Disadvantages ==== +Low availability in markets +Relatively expensive + +==== Example ==== +Respimat + +=== Nebulizers === +Nebulizer is mainly used in emergencies, or by patients with poor compliance to other handy inhalers. Nebulizer delivers medication into the lungs by converting water-based liquid drug formulations into inhalable droplets mechanically, such as the use of an ultrasonic system, or thermally. Major types of nebulizers include vibrating mesh nebulizers (VMN), jet nebulizers (JN) and ultrasonic nebulizers. + +==== Advantages ==== +Patients' education and coordination are not required. +Suitable for older patients and children +Better patient satisfaction due to the visible aerosols +Easily employed with tidal breathing + +==== Disadvantages ==== +Long time of drug delivery +Inaccurate drug dosages +Bulky device +Expensive +Require regular maintenance +Low drug delivery efficiency to the lungs + +==== Examples ==== +Vibrating mesh nebulizers (VMN) +Jet nebulizers (JN) +Ultrasound nebulizers + +== Factors affecting pulmonary drug delivery == +To achieve successful pulmonary drug delivery, a fraction of the inhaled particles should not deposit on the upper respiratory tract since they will be swallowed or expectorated without reaching the lungs, leading to the loss of pharmacological effect or provoking unwanted systemic side effects. Factors affecting the deposition of drug particles in lungs include drug particle properties, breathing patterns and respiratory tract geometry. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pulmonary_drug_delivery-1.md b/data/en.wikipedia.org/wiki/Pulmonary_drug_delivery-1.md new file mode 100644 index 000000000..5d52da85f --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pulmonary_drug_delivery-1.md @@ -0,0 +1,43 @@ +--- +title: "Pulmonary drug delivery" +chunk: 2/2 +source: "https://en.wikipedia.org/wiki/Pulmonary_drug_delivery" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:16.581186+00:00" +instance: "kb-cron" +--- + +=== Drug particle properties === +Particle diameter and particle density significantly affect the drug deposition pattern in the respiratory tract, and are the most common considerations for formulation of pulmonary drugs. Drug particles with diameter larger than 5 μm, predominantly deposit on the upper respiratory tract, limiting the amount of drug particles reaching the lung. Moderate-size drug particles with diameter between 2 μm to 5 μm, primarily deposit on the central and small airways. Small drug particles with diameter smaller than 2 μm, predominantly deposit on the alveolar sacs. Other factors affecting deposition of drugs include particle electrostatic charge, particle shape and particle volatility. Electrostatic charge of the drug particles enhances deposition due to the formation of electrostatic force on the wall of the respiratory tract. Non-spherical particle shape has a different entry pathway compared to that of the spherical particles, causing a change in deposition pattern. Particle volatility affects particle diameter due to the change of particle diameter during condensation and evaporation. + +=== Breathing patterns === +Drug particle deposition is associated with mean residence time and tidal volume. An increase in mean residence time or tidal volume enhances drug deposition in lungs, while an increase in air flow decreases the mean residence time, resulting in the decrease of total deposition of drug particles. + +=== Respiratory tract geometry === +The bifurcation of trachea into bronchi with smaller diameter increases turbulent flow, leading to an increase in deposition in the large respiratory tract by impaction. + +== Advantages == +Several advantages are associated with the pulmonary route of administration. For respiratory diseases, drug can be delivered directly to the disease site to perform topical relief, thus rapid onset of action can be achieved and there is less systemic side effects. Less dosage of drug can also achieve similar therapeutic effect compared to other routes of administration. For drugs designed to exert systemic effect through the lung as a drug target, the drug can reach the circulation bypassing poor gastrointestinal absorption and hepatic first pass metabolism which improve drug bioavailability. The large absorptive surface area, highly permeable membrane with rich blood supply also enable rapid onset of action and increase bioavailability of the drug. + +== Disadvantages and challenges == +Despite a number of advantages in the pulmonary route compared to other routes of administration, numerous disadvantages are associated with the pulmonary route. As the drug needs to be delivered through the respiratory tract to the lungs, drug formulation can be challenging due to the defense mechanisms which intend to remove or inactivate the exogenous chemicals. Airway constriction and mucus secretion with ciliary movement prevent drugs from reaching the lungs, while enzymes, macrophages and surfactant in the lungs may also inactivate the drugs leading to less drug being absorbed. Studies show that only around 20% of drug reaches the lung for each inhalation and drug loss is mainly due to the accumulation in the oropharynx in terms of pMDIs and DPIs and drug retention in the device for nebulisers. +Some irritating drug particles may also cause local side effects at the respiratory tract, for example inhaled corticosteroid accumulating in the oropharynx can result in dysphonia and oral thrush. Besides, drug dosing may be inaccurate due to the variations of breathing patterns between individuals and the presence of numerous factors affecting the deposition and absorption of drug particles in the lungs. In particular, elder patients may not have enough strength to generate sufficient inspiratory flow, resulting in less drug inhalation and hence low drug bioavailability. Finally, inhalers, especially nebulizers, require regular maintenance and cleaning. The inhaler devices are relatively expensive compared to oral tablets, which may not be affordable to low income patients. +The effectiveness of drug delivery highly depends on the patient's compliance and proper inhaler technique with no significant error in using the inhalers. Poor compliance may lead to uncontrolled or poorly controlled disease status. For instance, a patient may feel recovered and discontinue the treatment, or a patient may forget to take the medication, resulting in suboptimal disease management. Reducing the amount of puffs by combination inhalers delivering two or more drugs in one breath or the use of electronic data loggers can improve compliance. +Incorrect inhaler techniques, such as poor coordination, no exhalation before inhaling the drug aerosol or not holding breath for a few seconds after inhalation may lead to medication depositing inside the respiratory tract instead of the lungs, resulting in inefficient and inadequate treatment. Practical demonstration instead of verbal instruction, education and rechecking on the inhaler technique after a period of time can reduce error and enhance true compliance. + +== Ongoing development == +The use of the pulmonary route as an entry into the systemic circulation is constantly developing due to the additional benefits of bypassing the hepatic first pass metabolism, rapid systemic absorption, higher patients compliance and its non-invasive nature. Potent drugs with the ability to penetrate the lung mucosa into the blood circulation may be available for treating diseases requiring systemic drug delivery. The ongoing researches include the use of inhaled nicotine for smoking cessation, the use of inhaled levodopa for the treatment of Parkinson's disease, and the pulmonary delivery of various biologics. +In addition to the development of new pulmonary drugs, the drug formulation and particle engineering technology is advancing, such as the use of Ultrasound Mediated Amorphous to Crystalline transition (UMAX) process to micronize drug into inhalable drug particles with better performance, the use of drug nanoparticles to minimize unwanted drug adverse effects and increase drug bioavailability at the target site, and the use of porous drug particles to improve pulmonary delivery efficacy. + +== See also == +Route of administration +Inhaler +Metered-dose inhaler +Dry powder inhaler +Nebulizer +Respiratory tract +Respiratory system +Lung + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pulmonary_wedge_pressure-0.md b/data/en.wikipedia.org/wiki/Pulmonary_wedge_pressure-0.md new file mode 100644 index 000000000..20b7a22d7 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pulmonary_wedge_pressure-0.md @@ -0,0 +1,30 @@ +--- +title: "Pulmonary wedge pressure" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Pulmonary_wedge_pressure" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:17.755342+00:00" +instance: "kb-cron" +--- + +The pulmonary wedge pressure, also called pulmonary arterial wedge pressure, pulmonary capillary wedge pressure, pulmonary artery occlusion pressure, or cross-sectional pressure, is the pressure measured by wedging a pulmonary artery catheter with an inflated balloon into a small pulmonary arterial branch. It estimates the left atrial pressure. +Pulmonary venous wedge pressure is not synonymous with the above; it has been shown to correlate with pulmonary artery pressures in studies, albeit unreliably. +Physiologically, distinctions can be drawn among pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary venous pressure and left atrial pressure, but not all of these can be measured in a clinical context. +Noninvasive estimation techniques have been proposed. + + +== Clinical significance == + +Because of the large compliance of pulmonary circulation, it provides an indirect measure of the left atrial pressure. +For example, it is considered the gold standard for determining the cause of acute pulmonary edema; this is likely to be present at a pulmonary wedge pressure of greater than 20mmHg. It has also been used to diagnose severity of left ventricular failure and mitral stenosis, given that elevated pulmonary capillary wedge pressure strongly suggests failure of left ventricular output. +Traditionally, it was believed that pulmonary edema with normal pulmonary wedge pressure suggested a diagnosis of acute respiratory distress syndrome or non cardiogenic pulmonary edema (as in opiate poisoning). However, since capillary hydrostatic pressure exceeds wedge pressure once the balloon is deflated (to promote a gradient for forward flow), a normal wedge pressure cannot conclusively differentiate between hydrostatic pulmonary edema and acute respiratory distress syndrome. +Physiological pulmonary wedge pressure is 6–12 mm Hg. + + +== References == + + +== External links == +Overview at cvphysiology.com +Pulmonary+wedge+pressure at the U.S. National Library of Medicine Medical Subject Headings (MeSH) \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pursed-lip_breathing-0.md b/data/en.wikipedia.org/wiki/Pursed-lip_breathing-0.md new file mode 100644 index 000000000..e7fc43c39 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pursed-lip_breathing-0.md @@ -0,0 +1,25 @@ +--- +title: "Pursed-lip breathing" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Pursed-lip_breathing" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:19.004998+00:00" +instance: "kb-cron" +--- + +Pursed-lip breathing (PLB) is a breathing technique that consists of exhaling through tightly pressed (pursed) lips and inhaling through the nose with the mouth closed. + + +== Uses == +Pursed-lip breathing can help to ease shortness of breath in people with a variety of lung problems. It can be used effectively during asthma attacks to slow breathing and reduce the work of breathing. +Physicians, nurses, physical therapists, occupational therapists, and respiratory therapists teach this technique to their patients to ease shortness of breath and to promote deep breathing, also referred to as abdominal or diaphragmatic breathing. The purpose of PLB is to create back-pressure inside airways to splint them open; moving air thus takes less work. +Breathing through pursed lips on both exhalation and inhalation is one of the signs that health workers use to detect possible chronic obstructive pulmonary disease (COPD) in patients. COPD Canada suggests that using PLB has positive effects in treating stress- and anxiety-related disorders. + + +== Mechanism of action == +Pursed-lip breathing increases positive pressure generated in the conducting branches of the lungs. This can hold open bronchioles in patients with high lung compliance, such as those with emphysema. +Pursed-lip breathing also accesses the parasympathetic nervous system, which reduces stress during episodes of shortness of breath. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pus-0.md b/data/en.wikipedia.org/wiki/Pus-0.md new file mode 100644 index 000000000..842dd0c45 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pus-0.md @@ -0,0 +1,70 @@ +--- +title: "Pus" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Pus" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:20.218358+00:00" +instance: "kb-cron" +--- + +Pus is an exudate, typically white-yellow, yellow, or yellow-brown, formed at the site of inflammation during infections, regardless of cause. An accumulation of pus in an enclosed tissue space is known as an abscess, a visible collection of pus within or beneath the epidermis is known as a pustule, pimple or spot, and a similar collection of pus around a hair follicle, is known as a boil. + + +== Terminology == +Suppuration is the formation or discharge of pus or may refer to pus itself. The adjectives purulent and suppurative describe the characteristic of containing, relating to, consisting of, or being pus or being related to suppuration. For example, purulent discharge is synonymous with pus while mucopurulent discharge refers to exudate containing both mucus and pus. Seropurulent fluid or discharge contains both serum and pus. A wound or lesion may be described as suppurative or purulent if contains or expresses pus. Pyogenic means producing, generating, or characterized by the expression of pus. The term is often used to describe pyogenic bacteria, organisms whose infections frequently result in pus formation. A pyogenic infection is an infection that is characterized by severe local inflammation, usually with pus formation, generally caused by one of the pyogenic bacteria. The adjective pussy (pronounced ; comparative: pussier, superlative: pussiest) can also refer to pus. This usage is uncommon relative to the common meanings of the homograph pussy. + + +== Description == +Pus consists of a thin, protein-rich fluid (historically known as liquor puris) and dead leukocytes (white blood cells) from the body's immune response (mostly neutrophils). During infection, T helper cells release cytokines, which trigger neutrophils to seek the site of infection by chemotaxis. There, the neutrophils release granules, which destroy the bacteria. The bacteria resist the immune response by releasing toxins called leukocidins. As the neutrophils die off from toxins and old age, they are destroyed by macrophages, forming the viscous pus. Bacteria that cause pus are called pyogenic. +Although pus is normally of a whitish-yellow hue, changes in the color can be observed under certain circumstances. Pus is sometimes green because of the presence of myeloperoxidase, an intensely green antibacterial protein produced by some types of white blood cells. Green, foul-smelling pus is found in certain infections of Pseudomonas aeruginosa. The greenish color is a result of the bacterial pigment pyocyanin that it produces. Amoebic abscesses of the liver produce brownish pus, which is described as looking like "anchovy paste". Pus from anaerobic infections can more often have a foul odor. +In almost all cases when there is a collection of pus in the body, a clinician will try to create an opening to drain it. This principle has been distilled into the famous Latin aphorism "Ubi pus, ibi evacua" ("Where there is pus, evacuate it"). +Some disease processes caused by pyogenic infections are impetigo, osteomyelitis, septic arthritis and necrotizing fasciitis. + + +== Pyogenic bacteria == +Many species of bacteria may be involved in the production of pus. The most commonly found include: + +Staphylococcus aureus +Staphylococcus epidermidis +Streptococcus pyogenes +Escherichia coli (Bacillus coli communis) +Streptococcus pneumoniae (Fraenkel's pneumococcus) +Klebsiella pneumoniae (Friedländer's bacillus) +Salmonella typhi (Bacillus typhosus) +Pseudomonas aeruginosa +Neisseria gonorrhoeae +Actinomyces +Burkholderia mallei (Glanders bacillus) +Mycobacterium tuberculosis (tubercle bacillus) +Staphylococcus aureus bacteria is the most common cause of boils. + + +== Historical terminology == + +In the pre-asepsis era, surgeon Frederick Treves (1853–1923) wrote, +"Practically all major wounds suppurated. Pus was the most common subject of converse [among surgeons], because it was the most prominent feature in the surgeon's work. It was classified according to degrees of vileness."  +But pus of the right kind was considered desirable. +"If a patient was lucky ... a thick cream-colored odorless fluid would appear within five or six days"; +such "laudable" pus was considered "a sure sign that the wound would heal"  +because it meant "Nature has put up a bold fight against the invader". +"On the other hand, if the pus gradually became watery, blood tinged and foul smelling, it was designated 'sanious'  +[or 'ill-conditioned' ]  +and the wound condition was considered unfavorable". +It later came to be understood that "laudable" pus generally implied an invasion of relatively benign staphylococcus, while "ill-conditioned" pus usually meant the more dangerous streptococcus was present. + + +== See also == +Pyoderma +Serous fluid +Carbuncle +Phlegmon +Empyema + + +== References == + + +== External links == + + Media related to Pus at Wikimedia Commons \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pyonephrosis-0.md b/data/en.wikipedia.org/wiki/Pyonephrosis-0.md new file mode 100644 index 000000000..ab1c8485d --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pyonephrosis-0.md @@ -0,0 +1,44 @@ +--- +title: "Pyonephrosis" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Pyonephrosis" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:21.494633+00:00" +instance: "kb-cron" +--- + +Pyonephrosis (from Greek pyon 'pus' and nephros 'kidney') is a dangerous kidney infection that is characterized by pus accumulation in the renal collecting system. It is linked to renal collecting system blockage and suppurative renal parenchymal destruction, which result in complete or nearly complete kidney failure. + + +== Signs and symptoms == +Clinical symptoms in patients with pyonephrosis can range from frank sepsis (15%) to asymptomatic bacteriuria. Upon physical examination, the hydronephrotic kidney may be linked to a palpable abdominal mass. On rare occasions, the hydronephrotic kidney infection may burst spontaneously into the peritoneal cavity, resulting in diffuse peritonitis and sepsis in certain patients. + + +== Cause == +Pyonephrosis can result from an upper urinary tract infection combined with blockage and hydronephrosis. + + +== Diagnosis == +When a patient has suspected pyonephrosis, the initial workup should consist of a complete blood count, serum chemistry with blood urea nitrogen (BUN) and creatinine, blood cultures, and urinalysis with culture +It is generally not recommended to perform routine radiographic imaging on patients who have simple urinary tract infections. When patients do not improve quickly with appropriate antibiotics, however, appropriate radiographic studies help diagnose pyonephrosis, emphysematous pyelonephritis, and renal and/or perirenal abscesses. + + +== Treatment == +Together with intravenous antibiotics, drainage—either percutaneous or retrograde with a ureteral stent—has become the cornerstone of treatment since the development of ultrasonography and computed tomography (CT) scanning. Drainage offers a great outcome with low rates of morbidity and mortality. A CT scan or ultrasound-guided drainage greatly reduces the need for a nephrectomy. + + +== See also == +Pyelonephritis +Nephrotic syndrome + + +== References == + + +== Further reading == +Pappas, Diane E.; Hendley, J. Owen; Meissner, H. Cody; Nayak, Jennifer Lynn; Caserta, Mary T.; Arvin, Ann M.; Ross, Shannon A.; Kimberlin, David W.; Prober, Charles G. (January 1, 2023). "Urinary Tract Infections, Renal Abscess, and Other Complex Renal Infections". Principles and Practice of Pediatric Infectious Diseases. Elsevier. pp. 352–358.e4. doi:10.1016/B978-0-323-75608-2.00048-3. ISBN 9780323756082. Retrieved December 28, 2023. +Yu, Mei-Hong; Tu, Yue-Xing; Wityk, Paweł; Rak, Janusz; Fandilolu, Prayagraj M.; Sonawane, Kailas D.; Zhang, Zao; Hayashi, Rick; Mostofi, Keyvan; Daryabin, Mathieu; Kuljanin, Miljan; Lajoie, Gilles A. (January 1, 2012). "Renal Abscess and Other Complex Renal Infections". Principles and Practice of Pediatric Infectious Diseases. Elsevier. pp. 343–345.e1. doi:10.1016/B978-1-4377-2702-9.00050-7. ISBN 9781437727029. Retrieved December 28, 2023. + + +== External links == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Pyramidalis–anterior_pubic_ligament–adductor_longus_complex-0.md b/data/en.wikipedia.org/wiki/Pyramidalis–anterior_pubic_ligament–adductor_longus_complex-0.md new file mode 100644 index 000000000..f5b352674 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Pyramidalis–anterior_pubic_ligament–adductor_longus_complex-0.md @@ -0,0 +1,81 @@ +--- +title: "Pyramidalis–anterior pubic ligament–adductor longus complex" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Pyramidalis–anterior_pubic_ligament–adductor_longus_complex" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:22.613323+00:00" +instance: "kb-cron" +--- + +The Pyramidalis–anterior pubic ligament–adductor longus complex, or the PLAC, is an anatomical concept in Sports medicine. The PLAC concept is used as a basis to classify type of adductor longus avulsions. +The PLAC concept was developed in order to provide consistency in the diagnose of different injury patterns seen with adductor longus avulsions in athletes. The PLAC injury classification explains the symptoms and clinical presentation seen with acute adductor avulsions. The PLAC classification doesn't determine whether surgery should be performed, but it informs the surgical repair strategy if operative treatment is chosen. It is a tool for future research comparing surgical and conservative management outcomes through consistent anatomical classification. +For MRI imaging the PLAC classification captures the structural complexity of adductor longus avulsions and provides a standardised anatomical framework for describing the related injuries. The MRI imaging protocol was developed to consistently and accurately define the injury patterns seen with adductor longus avlusions, replacing the outdated grading system. +PLAC injuries are most often seen in professional athletes, in sports such as association football, rugby, martial arts and ice hockey, and often the sole cause of pubalgia in athletes, and/or associated with sports hernias. +The PLAC concept was defined by Belgian Orthopaedic Surgeon Ernest Schilders in 2017. + + +== Structure == + +The PLAC is composed of muscles and ligaments of the lower abdomen and groin: + +Pyramidalis muscle (P) +Anterior pubic ligament +Adductor longus muscle and tendon +PLAC injuries may also affect: + +Pectineus muscle (Pect) +Rectus abdominis +Inguinal ligament +Due to the size and location of the pyramidalis muscle, it can be mistaken for the rectus abdominis. The pyramidalis muscle is the only abdominal muscle anterior to the pubis (as displayed in the sagittal view of the PLAC). This is important for MRI imaging, as in professional athletes, due to a significantly reduction, or absence, of fat planes (adipose tissue layers) between muscles, it can be difficult to distinguish the pyramidalis from the rectus abdominis in imaging–contributing to possible over-diagnosis of rectus abdominis injuries. + +P – Pyramidalis +L – Ligament +A – Adductor +C – Complex +As an acronym "PLAC" can be used as a checklist in the imaging of adductor longus avulsions to systematically assess possible damage to associated structures in the injuries. + + +== PLAC Injury: Symptoms and Signs == +In professional athletes signs of a possible PLAC injury (adductor avulsion) are as follows: + +Sudden ‘pop’ sensation in the groin or adductor region during a kick, forced abduction, or reaching movement +Inability for the athlete to continue playing immediately after the injury +Difficulty walking post-injury +Pain in the lower abdominal region +Unable to perform long-lever adduction (e.g., resisted straight-leg adduction) +Palpable gap may be present on clinical examination by a physician, but not in all cases +Early imaging in cases with professional athletes is crucial for the most accurate diagnosis to ensure swift treatment and return to play. + + +== PLAC Classification == +There are six types of injury patterns seen with PLAC Injuries: + +Injury types 1,2, and 3 were most common in professional athletes. + + +== Imaging Protocol and Assessment == +Adductor avulsion do not benefit from a grading system because isolated avulsion account only for 1/3rd of avulsions, as more commonly other parts of the PLAC and pectineus are injured. +Step One: Adductor longus fibrocartilage assessment + +Normal +Complete Tear +Partial Tear (Type 6) +Step Two: Assessment pyramidalis-adductor longus connection + +Normal +Complete Tear +Partial Tear +Step Three: Partial pectineus avulsion + +Yes +No + + +== See also == +Pyramidalis muscle +Sports medicine +Athletic pubalgia + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Quality_of_life_(healthcare)-0.md b/data/en.wikipedia.org/wiki/Quality_of_life_(healthcare)-0.md new file mode 100644 index 000000000..5b49f9850 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Quality_of_life_(healthcare)-0.md @@ -0,0 +1,33 @@ +--- +title: "Quality of life (healthcare)" +chunk: 1/3 +source: "https://en.wikipedia.org/wiki/Quality_of_life_(healthcare)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:23.761946+00:00" +instance: "kb-cron" +--- + +In healthcare, quality of life is an assessment of how the individual's well-being may be affected over time by a disease, disability or disorder. + +== Measurement == +Early versions of healthcare-related quality of life measures referred to simple assessments of physical abilities by an external rater (for example, the patient is able to get up, eat and drink, and take care of personal hygiene without any help from others) or even to a single measurement (for example, the angle to which a limb could be flexed). +The current concept of health-related quality of life acknowledges that subjects put their actual situation in relation to their personal expectation. The latter can vary over time, and react to external influences such as length and severity of illness, family support, etc. As with any situation involving multiple perspectives, patients' and physicians' rating of the same objective situation have been found to differ significantly. Consequently, health-related quality of life is now usually assessed using patient questionnaires. These are often multidimensional and cover physical, social, emotional, cognitive, work- or role-related, and possibly spiritual aspects as well as a wide variety of disease related symptoms, therapy induced side effects, and even the financial impact of medical conditions. Although often used interchangeably with the measurement of health status, both health-related quality of life and health status measure different concepts. + +=== Activities of daily living === + +Activities of Daily Living (ADLs) are activities that are oriented toward taking care of one's own body and are completed daily. These include bathing/showering, toileting and toilet hygiene, dressing, eating, functional mobility, personal hygiene and grooming, and sexual activity. Many studies demonstrate the connection between ADLs and health-related quality of life (HRQOL). Mostly, findings show that difficulties in performing ADLs are directly or indirectly associated with decreased HRQOL. Furthermore, some studies found a graded relationship between ADL difficulties/disabilities and HRQOL- the less independent people are at ADLs- the lower their HRQOL is. While ADLs are an excellent tool to objectively measure quality of life, it is important to remember that Quality of life goes beyond these activities. For more information about the complex concept of quality of life, see information regarding the disability paradox. +In addition to ADLs, instrumental activities of daily living (IADLs) can be used as a relatively objective measure of health-related quality of life. IADLs, as defined by the American Occupational Therapy Association (AOTA), are "Activities to support daily life within the home and community that often require more complex interactions than those used in ADLs". IADLs include tasks such as: care for others, communication management, community mobility, financial management, health management, and home management. Activities of IADLS includes: grocery shopping, preparing food, housekeeping, using the phone, laundry, managing transportation/finances. Research has found that an individual's ability to engage in IADLs can directly impact their quality of life. + +==== Pharmacology for older adults ==== +Elderly patients taking more than five medications increases risk of cognitive impairment, and is one consideration when assessing what factors impact QoL, ADLs, and IADLs of older adults. Due to multiple chronic conditions, managing medications in this group of people is particular challenging and complex. Recent studies showed that polypharmacy is associated with ADL disability due to malnutrition, and is a risk factor for hospital admission due to falls, which can have severe consequences on a person's quality of life moving forward. Thus, when assessing an elderly person's quality of life, it is important to consider the medications an older patient is taking, and whether they are adhering to their current prescription taking schedule. +Occupational Therapy's Role +Occupational therapists (OTs) are global healthcare professionals who treat individuals to achieve their highest level of quality of life and independence through participation in everyday activities. OTs are trained to complete a person-centered evaluation of an individual's interests and needs, and tailor their treatment to specifically address ADLs and IADLs that their patient values. In the AOTAs most recent vision statement (2025) they explicitly state that OT as an inclusive profession works to maximize quality of life through the effective solution of participation in everyday living. To learn more about occupational therapy, see the Wikipedia page dedicated to the profession. + +=== Special Considerations in Palliative Care === +HRQoL in patients with serious, progressive, life-threatening illness should be given special considerations in both the measurement and analysis of HRQoL. Oftentimes, as level of functioning deteriorates, more emphasis is put on caregiver and proxy questionnaires or abbreviated questionnaires. Additionally, as diseases progress, patients and families often shift their priorities throughout the disease course. This can affect the measurement of HRQoL as, oftentimes, patients change the way they respond to questionnaires which results in HRQoL staying the same or even improving as their physical condition worsens. To address this issue, researchers have developed new instruments for measuring end-of-life HRQoL that incorporate factors such as sense of completion, relations with the healthcare system, preparation, symptom severity, and affective social support. Additionally, research is being conducted on the impact of existential QoL on palliative care patients as terminal illness awareness and symptom burden may be associated with lower existential QoL. + +=== Examples === + +Similar to other psychometric assessment tools, health-related quality of life questionnaires should meet certain quality criteria, most importantly with regard to their reliability and validity. Hundreds of validated health-related quality of life questionnaires have been developed, some of which are specific to various illnesses. The questionnaires can be generalized into two categories: +Generic instruments \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Quality_of_life_(healthcare)-1.md b/data/en.wikipedia.org/wiki/Quality_of_life_(healthcare)-1.md new file mode 100644 index 000000000..64ab9c3c3 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Quality_of_life_(healthcare)-1.md @@ -0,0 +1,35 @@ +--- +title: "Quality of life (healthcare)" +chunk: 2/3 +source: "https://en.wikipedia.org/wiki/Quality_of_life_(healthcare)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:23.761946+00:00" +instance: "kb-cron" +--- + +CDC HRQOL–14 "Healthy Days Measure": A questionnaire with four base questions and ten optional questions used by the Centers for Disease Control and Prevention (CDC) (https://www.cdc.gov/hrqol/hrqol14_measure.htm). +Short-Form Health Survey (SF-36, SF-12, SF-8): One example of a widely used questionnaire assessing physical and mental health-related quality of life. Used in clinical trials and population health assessments. Suitable for pharmacoeconomic analysis, benefiting healthcare rationing. +EQ-5D a simple quality of life questionnaire (https://euroqol.org). +AQoL-8D a comprehensive questionnaire that assesses HR-QoL over 8 domains - independent living, happiness, mental health, coping, relationships, self-worth, pain, senses (https://www.aqol.com.au). +Disease, disorder or condition specific instruments + +King's Health Questionnaire (KHQ) +International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) in urinary incontinence, the LC -13 Lung Cancer module from the EORTC Quality of Life questionnaire library, or the Hospital Anxiety and Depression Scale (HADS) ). +Manchester Short Assessment of Quality of Life: 16-item questionnaire for use in psychiatric populations. +ECOG, most commonly used to evaluate the impact of cancer on people. +NYHA scale, most commonly used to evaluate the impact of heart disease on individuals. +EORTC measurement system for use in clinical trials in oncology. These tools are robustly tested and validated and translated. A large amount of reference data is now available. The field of HRQOL has grown significantly in the last decade, with hundreds of new studies and better reporting of clinical trials. HRQOL appears to be prognostic for survival in some diseases and patients. +WHO-Quality of life-BREF (WHOQOL-BREF): A general Quality of life survey validated for several countries. +The Stroke Specific Quality Of Life scale SS-QOL: It is a patient-centered outcome measure intended to provide an assessment of health-related quality of life (HRQOL) specific to patients with stroke only. It measures energy, family roles, language, mobility, mood, personality, self care, social roles, thinking, upper extremity function, vision and work productivity. +In rheumatology, condition specific instruments have been developed such as RAQoL for rheumatoid arthritis, OAQoL for osteoarthritis, ASQoL for ankylosing spondylitis, SScQoL for systemic sclerosis and PsAQoL for people with psoriatic arthritis. +MOS-HIV(Medical Outcome Survey-HIV) was developed specifically for people living with HIV/AIDS. + +== Utility == +A variety of validated surveys exist for healthcare providers to use for measuring a patient's health-related quality of life. The results are then used to help determine treatment options for the patient based on past results from other patients, and to measure intra-individual improvements in QoL pre- and post-treatment. +When it is used as a longitudinal study device that surveys patients before, during, and after treatment, it can help health care providers determine which treatment plan is the best option, thereby improving healthcare through an evolutionary process. + +=== Importance === +There is a growing field of research concerned with developing, evaluating, and applying quality of life measures within health related research (e.g. within randomized controlled studies), especially in relation to Health Services Research. Well-executed health-related quality of life research informs those tasked with health rationing or anyone involved in the decision-making process of agencies such as the Food and Drug Administration, European Medicines Agency or National Institute for Clinical Excellence. Additionally, health-related quality of life research may be used as the final step in clinical trials of experimental therapies. +The understanding of Quality of Life is recognized as an increasingly important healthcare topic because the relationship between cost and value raises complex problems, often with high emotional attachment because of the potential impact on human life. For instance, healthcare providers must refer to cost-benefit analysis to make economic decisions about access to expensive drugs that may prolong life by a short amount of time and/or provide a minimal increase to quality of life. Additionally, these treatment drugs must be weighed against the cost of alternative treatments or preventative medicine. In the case of chronic and/or terminal illness where no effective cure is available, an emphasis is placed on improving health-related quality of life through interventions such as symptom management, adaptive technology, and palliative care. Another example of why understanding quality of life is important is during a randomized study of 151 patients with metastatic non-small-cell lung cancer who were split into obtaining early palliative and standardized care group. The earlier palliative group not only had better quality of life based on the Functional assessment of Cancer Therapy-Lung scale and the Hospital Anxiety and Depression Scale, but the palliative care group also had less depressive symptoms (16% vs. 38%, P=0.01) despite having received less aggressive end-of-life care (33% vs. 54%, P=0.05) and longer median overall survival than the standard group (11.6 months vs. 8.9 months, P=0.02). By having a quality of life measure, we are able to evaluate early palliative care and see its value in terms of improving quality of care, reduced aggressive treatment and consequently costs, and also greater quality/quantity of life. +In the realm of elder care, research indicates that improvements in quality of life ratings may also improve resident outcomes, which can lead to substantial cost savings over time. Research has shown that evaluating an elderly person's functional status, in addition to other aspects of their health, helps improve geriatric quality of life and decrease caregiver burden. Research has also shown that quality of life ratings can be successfully used as a key-performance metric when designing and implementing organizational change initiatives in nursing homes. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Quality_of_life_(healthcare)-2.md b/data/en.wikipedia.org/wiki/Quality_of_life_(healthcare)-2.md new file mode 100644 index 000000000..f59746e3d --- /dev/null +++ b/data/en.wikipedia.org/wiki/Quality_of_life_(healthcare)-2.md @@ -0,0 +1,50 @@ +--- +title: "Quality of life (healthcare)" +chunk: 3/3 +source: "https://en.wikipedia.org/wiki/Quality_of_life_(healthcare)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:23.761946+00:00" +instance: "kb-cron" +--- + +=== Research === +Research revolving around Health Related Quality of Life is extremely important because of the implications that it can have on current and future treatments and health protocols. Thereby, validated health-related quality of life questionnaires can become an integral part of clinical trials in determining the trial drugs' value in a cost-benefit analysis. For example, the Centers for Disease Control and Prevention (CDC) is using their health-related quality of life survey, Healthy Day Measure, as part of research to identify health disparities, track population trends, and build broad coalitions around a measure of population health. This information can then be used by multiple levels of government or other officials to "increase quality and years of life" and to "eliminate health disparities" for equal opportunity. + +Within the field of childhood cancer, quality of life is often measured both during and after treatment. International comparisons of both outcomes and predictors are hindered by the use of a large number of different measurements. Recently, a first step for a joint international consensus statement for measuring quality of survival for patients with childhood cancer has been established. + +=== Ethics === +The quality of life ethic refers to an ethical principle that uses assessments of the quality of life that a person could potentially experience as a foundation for making decisions about the continuation or termination of life. It is often used in contrast to or in opposition to the sanctity of life ethic. +While measuring tools can be a way to scientifically quantify quality of life in an objective manner on a broad range of topics and circumstances, there are limitations and potential negative consequences with its utilization. Firstly, it makes the assumption that an assessment can be able to quantify domains such as physical, emotional, social, well-being, etc. with a single quantitative score. Furthermore, how are these domains weighted? Will they be measured the same or equally for each person? Or will it take into account how important these specific domains are for each person when creating the final score? Each person has their own specific set of experiences and values and a point of argument is that this needs to be taken into account. However, this would be a difficult task for the person to rank these quality of life domains. Another point to keep in mind is that people's values and experiences change over time and their quality of life domain rankings may differ. This caveat must be added or the dynamics of this could be taken into account when interpreting and understanding the results from a quality of life measuring tool. Quality of life measuring tools can also promote a negative and pessimistic view for clinicians, patients, and families, especially when used at baseline during the time of diagnosis. Quality of life measuring tools can fail to account for effective therapeutic strategies that can alleviate health burdens, and thus can promote a self-fulfilling prophecy for patients. On a societal level, the concept of low quality of life can also perpetuate negative prejudices experienced by people with disabilities or chronic illnesses. + +== Analysis == + +=== Statistical biases === +It is not considered uncommon for there to be some statistical anomalies during data analysis. Some of the more frequently seen in health-related quality of life analysis are the ceiling effect, the floor effect, and response shift bias. +The ceiling effect refers to how patients who start with a higher quality of life than the average patient do not have much room for improvement when treated. The opposite of this is the floor effect, where patients with a lower quality of life average have much more room for improvement. Consequentially, if the spectrum of quality of life before treatment is too unbalanced, there is a greater potential for skewing the end results, creating the possibility for incorrectly portraying a treatment's effectiveness or lack thereof. + +==== Response shift bias ==== +Response shift bias is an increasing problem within longitudinal studies that rely on patient reported outcomes. It refers to the potential of a subject's views, values, or expectations changing over the course of a study, thereby adding another factor of change on the end results. Clinicians and healthcare providers must recalibrate surveys over the course of a study to account for Response Shift Bias. The degree of recalibration varies due to factors based on the individual area of investigation and length of study. + +=== Statistical variation === + +In a study by Norman et al. about health-related quality of life surveys, it was found that most survey results were within a half standard deviation. Norman et al. theorized that this is due to the limited human discrimination ability as identified by George A. Miller in 1956. Utilizing the Magic Number of 7 ± 2, Miller theorized that when the scale on a survey extends beyond 7 ± 2, humans fail to be consistent and lose ability to differentiate individual steps on the scale because of channel capacity. +Norman et al. proposed health-related quality of life surveys use a half standard deviation as the statistically significant benefit of a treatment instead of calculating survey-specific "minimally important differences", which are the supposed real-life improvements reported by the subjects. In other words, Norman et al. proposed all health-related quality of life survey scales be set to a half standard deviation instead of calculating a scale for each survey validation study where the steps are referred to as "minimally important differences". + +== See also == +Medical ethics +Medical law +Patient-reported outcome +Pharmacoeconomics +Quality-adjusted life year (QALY) + +== References == + +== External links == +ProQolid (Patient-Reported Outcome & Quality of Life Instruments Database) +Mapi Research Trust ("Non-profit organization involved in Patient-Centered Outcomes") +PROLabels(Database on Patient-Reported Outcome claims in marketing authorizations) Archived 2016-03-14 at the Wayback Machine +Quality-of-Life-Recorder (Project to bring QoL measurement to routine practice. Platform & library of electronic questionnaires, Shareware/Freeware) +The International Society for Quality of Life +Health and Quality of Life Outcomes +The Healthcare Center. Better Health for Everyone \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Quaternary_prevention-0.md b/data/en.wikipedia.org/wiki/Quaternary_prevention-0.md new file mode 100644 index 000000000..a78abb09c --- /dev/null +++ b/data/en.wikipedia.org/wiki/Quaternary_prevention-0.md @@ -0,0 +1,45 @@ +--- +title: "Quaternary prevention" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Quaternary_prevention" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:25.016088+00:00" +instance: "kb-cron" +--- + +Quaternary prevention means avoiding unnecessary medical interventions. They are the actions taken to identify an individual at risk of overmedicalisation, to protect them from new medical invasion, and to suggest interventions which are ethically acceptable. The term was coined by the Belgian general practitioner Marc Jamoulle, +Quaternary prevention is the set of activities to mitigate or avoid the consequences of unnecessary or excessive intervention of the health system, i.e.iatrogenic damage. + + +== Definition == +The Wonca International Dictionary for General/Family Practice defines it as "action taken to identify patient at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable". +Alternatively, quaternary prevention has been defined as an "action taken to protect individuals from medical interventions that are likely to cause more harm than good." + + +== Per Jamoulle == +Jamoulle divided medical situations into four quadrants based on if the patient was experiencing illness (i.e. if the patient experienced subjective poor health) and if a health care provider had identified disease (constructed based on diagnostic criteria), with a different type of prevention happening in each: + +Primary prevention when both illness and disease are absent +Secondary prevention when illness is absent but disease is present +Tertiary prevention when both illness and disease are present +Quaternary prevention when the patient is experiencing illness but there is no identified disease +Jamoulle noted that when the patient was experiencing illness but no specific disease had been identified that patient was particularly vulnerable to their condition being made worse by invasive or harmful diagnostic medical intervention. + + +== See also == + + +== References == + + +== Further reading == +Gofrit ON, Shemer J, Leibovici D, Modan B, Shapira SC. Quaternary prevention: a new look at an old challenge. Isr Med Assoc J. 2000;2(7):498-500. +Ortún V. Gestión clínica y sanitaria. De la práctica diaria a la academia, ida y vuelta. Barcelona: Elsevier/Masson; 2003. p.245 +UEMO, European Union of General Practitioners / Family Physicians, Santiago LM. Quaternary prevention. Document 2008/040, October 2008. +Gérvas J, Starfield B, Heath I. Is clinical prevention better than cure? Lancet. 2008;372:1997-99. +Marc Jamoulle. Paradigm shift in Primary Care working fields. 11th congress of SBMFC, Brazilia, June 2011. Archived 2012-03-17 at the Wayback Machine +Marc Jamoulle. la prévention quaternaire, une tâche explicite du médecin généraliste. Prospective Jeunesse. 2012; 7–11. +Julien Nève, Marc Jamoulle. Quaternary prevention, an explicit task of the physician. Oct 25, 2012. +Gérvas J. Prevención cuaternaria en ancianos. Rev Esp Geriatr Gerontol. 2012; 47(6):266-9. +Quaternary Prevention (P4). Revista Brasileira de Medicina de Família e Comunidade. 2015; 10(35). \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Radiofrequency_ablation-0.md b/data/en.wikipedia.org/wiki/Radiofrequency_ablation-0.md new file mode 100644 index 000000000..cdae47aa5 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Radiofrequency_ablation-0.md @@ -0,0 +1,29 @@ +--- +title: "Radiofrequency ablation" +chunk: 1/3 +source: "https://en.wikipedia.org/wiki/Radiofrequency_ablation" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:26.338818+00:00" +instance: "kb-cron" +--- + +Radiofrequency ablation (RFA) is a medical procedure in which heat generated from medium frequency alternating current (in the range of 350–500 kHz) is used to selectively destroy dysfunctional tissue such as malfunctioning parts in the electrical conduction system of the heart, tumors, and sensory nerves. RFA is generally conducted in the outpatient setting, using either a local anesthetic or twilight anesthesia. When it is delivered via catheter, it is called radiofrequency catheter ablation. RFA also forms the basis behind electrosurgery. +Two advantages of medium frequency current (over previously used low frequency AC or pulses of DC) are that it does not directly stimulate nerves or heart muscle, and therefore can often be used without the need for general anesthesia, and that it is specific for treating the desired tissue without significant collateral damage. Due to this, RFA is an alternative for eligible patients who have comorbidities or do not want to undergo surgery. +Documented benefits have led to RFA becoming widely used during the 21st century. RFA procedures are performed under image guidance (such as X-ray screening, CT scan or ultrasound) by an interventional pain specialist (such as an anesthesiologist), interventional radiologist, otolaryngologists, a gastrointestinal or surgical endoscopist, or a cardiac electrophysiologist, a subspecialty of cardiologists. + +== Tumors == + +RFA may be performed to treat tumors in the lung, liver, kidney, and bone, as well as other body organs less commonly. Once the diagnosis of tumor is confirmed, a needle-like RFA probe is placed inside the tumor. The radiofrequency waves passing through the probe increase the temperature within tumor tissue, which results in destruction of the tumor. RFA can be used with small tumors, whether these arose within the organ (primary tumors) or spread to the organ (metastases). The suitability of RFA for a particular tumor depends on multiple factors. +RFA can usually be administered as an outpatient procedure, though may at times require a brief hospital stay. RFA may be combined with locally delivered chemotherapy to treat hepatocellular carcinoma (primary liver cancer). A method currently in phase III trials uses the low-level heat (hyperthermia) created by the RFA probe to trigger release of concentrated chemotherapeutic drugs from heat-sensitive liposomes in the margins around the ablated tissue as a treatment for hepatocellular carcinoma (HCC). +Radiofrequency ablation is also used in pancreatic cancer and bile duct cancer. +RFA has become increasingly important in the care of benign bone tumors, most notably osteoid osteomas. Since the procedure was first introduced for the treatment of osteoid osteomas in the 1990s, it has been shown in numerous studies to be less invasive and expensive, to result in less bone destruction and to have equivalent safety and efficacy to surgical techniques, with 66 to 95% of people reporting freedom from symptoms. While initial success rates with RFA are high, symptom recurrence after RFA treatment has been reported, with some studies demonstrating a recurrence rate similar to that of surgical treatment. RFA is also increasingly used in the palliative treatment of painful metastatic bone disease in people who are not eligible or do not respond to traditional therapies ( i.e. radiation therapy, chemotherapy, palliative surgery, bisphosphonates or analgesic medications). + +== Cardiology == + +Radiofrequency energy is used in heart tissue or normal parts to destroy abnormal electrical pathways that are contributing to a cardiac arrhythmia. It is used in recurrent atrial flutter (Afl), atrial fibrillation (AF), supraventricular tachycardia (SVT), atrial tachycardia, Multifocal Atrial Tachycardia (MAT) and some types of ventricular arrhythmia. The energy-emitting probe (electrode) is at the tip of a catheter which is placed into the heart, usually through a vein. This catheter is called the ablator. The practitioner first "maps" an area of the heart to locate the abnormal electrical activity (electrophysiology study) before the responsible tissue is eliminated. Radiofrequency ablation technique can be used in AF, either to block the atrioventricular node after implantation of a pacemaker or to block conduction within the left atrium, especially around the pulmonary veins. Radiofrequency ablation for AF can be unipolar (one electrode) or bipolar (two electrodes). Although bipolar can be more successful, it is technically more difficult, resulting in unipolar being used more often. But bipolar is more effective in preventing recurrent atrial arrhythmias. +Ablation is now the standard treatment for SVT and typical atrial flutter. In some conditions, especially forms of intra-nodal re-entry (the most common type of SVT), also called atrioventricular nodal reentrant tachycardia or AVNRT, ablation can also be accomplished by cryoablation (tissue freezing using a coolant which flows through the catheter); this avoids the risk of complete heart block, a potential complication of radiofrequency ablation in this condition. Recurrence rates with cryoablation are higher though. Microwave ablation, where tissue is ablated by the microwave energy "cooking" the adjacent tissue, and ultrasonic ablation, creating a heating effect by mechanical vibration, and laser ablation have also been developed but are not in widespread use. + +=== Renal sympathetic denervation === + +A new indication for the use of radiofrequency technology has made news in the last few years. Hypertension is a very common condition, with about 1 billion people over the world, nearly 75 million in the US alone. Complications of inadequately controlled hypertension are many and have both individual and global impact. Treatment options include medications, diet, exercise, weight reduction and meditation. Inhibition of the neural impulses that are believed to cause or worsen hypertension has been tried for a few decades. Surgical sympathectomy has helped but not without significant side effects. Therefore, the introduction of non-surgical means of renal denervation using a radiofrequency ablation catheter was enthusiastically welcomed. Although the initial use of radiofrequency-generated heat to ablate nerve endings in the renal arteries to aid in management of 'resistant hypertension' were encouraging, the most recent phase 3 studying looking at catheter-based renal denervation for the treatment of resistant hypertension failed to show any significant reduction in systolic blood pressure. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Radiofrequency_ablation-1.md b/data/en.wikipedia.org/wiki/Radiofrequency_ablation-1.md new file mode 100644 index 000000000..777b8f1c4 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Radiofrequency_ablation-1.md @@ -0,0 +1,38 @@ +--- +title: "Radiofrequency ablation" +chunk: 2/3 +source: "https://en.wikipedia.org/wiki/Radiofrequency_ablation" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:26.338818+00:00" +instance: "kb-cron" +--- + +== Aesthetics dermatology == +Radiofrequency ablation is also used in dermatosurgical applications in the form of electrosurgery. Depending on the output waveform used, different modes of ablation can be achieved, including are electrosection (cutting), electrocoagulation, electrodessication and fulguration. The use of radiofrequency ablation has obtained importance as it can be used to treat most of the skin lesions with minimal side effects and complications. + +== Varicose veins == +Radiofrequency ablation is a minimally invasive procedure used in the treatment of varicose veins. It is an alternative to the traditional stripping operation. Under ultrasound guidance, a radiofrequency catheter is inserted into the abnormal vein and the vessel treated with radio-energy, resulting in closure of the involved vein. Radiofrequency ablation is used to treat the great saphenous vein, the small saphenous vein, and the perforator veins. The latter are connecting veins that transport blood from the superficial veins to the deep veins. Branch varicose veins are then usually treated with other minimally invasive procedures, such as ambulatory phlebectomy, sclerotherapy, or foam sclerotherapy. Currently, the VNUS ClosureRFS stylet is the only device specifically cleared by FDA for endovenous ablation of perforator veins. +The possibility of skin burn during the procedure is very small, because the large volumes (500 cc) of dilute Lidocaine (0.1%) tumescent anesthesia injected along the entire vein prior to the application of radiofrequency provide a heat sink that absorbs the heat created by the device. Early studies have shown a high success rate with low rates of complications. + +== Obstructive sleep apnea == + +RFA was first studied in obstructive sleep apnea (OSA) in a pig model. RFA has been recognized as a somnoplasty treatment option in selected situations by the American Academy of Otolaryngology but was not endorsed for general use in the American College of Physicians guidelines. +The clinical application of RFA in obstructive sleep apnea is reviewed in that main article, including controversies and potential advantages in selected medical situations. +Unlike other electrosurgical devices, RFA allows very specific treatment targeting of the desired tissue with a precise line of demarcation that avoids collateral damage, which is crucial in the head and neck region due to its high density of major nerves and blood vessels. RFA also does not require high temperatures. However, overheating from misapplication of RFA can cause harmful effects such as coagulation on the surface of the electrode, boiling within tissue that can leave "a gaping hole", tears, or even charring. + +== Pain management == + +=== Back === +RFA, or rhizotomy, was developed by Nikolai Bogduk to treat chronic pain arising from the facet joints in the lower (lumbar) back. Radiofrequency waves are used to produce heat on specifically identified nerves surrounding the facet joints called the lumbar medial branches of the dorsal ramus of the spinal nerves. By generating heat around the nerve, the nerve is ablated, thus destroying its ability to transmit signals to the brain. +The nerves to be ablated are identified through injections of local anesthesia (such as lidocaine) around the medial branches prior to the RFA procedure to first confirm the diagnosis. If the local anesthesia injections provide temporary pain relief, the injection is repeated a second time to confirm the diagnosis. Then RFA is performed on the nerve(s) that responded well to the injections. +RFA is a minimally invasive procedure which can usually be done in day-surgery clinics, going home shortly after completion of the procedure. The person is awake during the procedure, so risks associated with general anesthesia are avoided. Whether for back or knee pain, a drawback for this procedure is that nerves recover function over time, so the pain relief achieved lasts only temporarily (3–15 months) in most people. + +=== Knees === + +Radiofrequency ablation of sensory nerves in the knee, also called genicular neurotomy or genicular RFA, is clinically preceded by confirming pain reduction upon anesthetizing the main knee sensory nerves in a test procedure called genicular nerve block. Genicular nerve block is a short (10–30 minutes), outpatient procedure usually performed weeks before genicular RFA. The extent of pain reduction by injecting a local anesthetic, such as bupivacaine, at specific locations of the target genicular nerves, is self-assessed by the person for hours after the procedure, leading to confirmation with the physician of the need for RFA. +In the procedure for genicular RFA, a guide cannula is first directed under local anesthesia and imaging (ultrasound or fluoroscopy) to each target genicular nerve, then the radiofrequency electrode is passed through the cannula, and the electrode tip is heated to about 80 °C (176 °F) for one minute to cauterize a small segment of the nerve. The heat destroys that segment of the nerve, which is prevented from sending pain signals to the brain. +As of 2019, several hundred publications showed promise for substantial, long-term (6 months or longer) reduction of knee pain following genicular RFA. +The US Food and Drug Administration had approved in 2017 a commercial device using cooled RFA, with effects lasting for up to a year of pain relief from knee arthritis. As of 2023, reviews of clinical outcomes indicated that efficacy for reducing knee pain was achieved by ablating three or more branches of the genicular nerve (one of the articular branches of the tibial nerve). Other sources indicate 4-5 genicular nerve targets may be justified for ablation to optimize pain relief, while a 2022 analysis indicated that as many as 10 genicular nerve targets for RFA would produce better long-term relief of knee pain. +Knee pain relief of 50% or more following genicular RFA may last from several months to two years, and can be repeated by the same outpatient procedure when pain recurs. +An anatomical study of cadaver knees indicated that ultrasound-guided bony landmarks could be used to effectively target the superior medial geniculate nerve, superior lateral geniculate nerve, and inferior medial geniculate nerve – the three nerves commonly targeted for knee RFA – with average nerve-to-needle distances of 1.7, 3.2, and 1.8 mm, respectively. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Radiofrequency_ablation-2.md b/data/en.wikipedia.org/wiki/Radiofrequency_ablation-2.md new file mode 100644 index 000000000..8150b2bbc --- /dev/null +++ b/data/en.wikipedia.org/wiki/Radiofrequency_ablation-2.md @@ -0,0 +1,38 @@ +--- +title: "Radiofrequency ablation" +chunk: 3/3 +source: "https://en.wikipedia.org/wiki/Radiofrequency_ablation" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:26.338818+00:00" +instance: "kb-cron" +--- + +== Barrett's esophagus == +Radiofrequency ablation has been shown to be a safe and effective treatment for Barrett's esophagus. The balloon-based radiofrequency procedure was invented by Robert A. Ganz, Roger Stern and Brian Zelickson in 1999 (System and Method for Treating Abnormal Tissue in the Human Esophagus). While the person is sedated, a catheter is inserted into the esophagus and radiofrequency energy is delivered to the diseased tissue. This outpatient procedure typically lasts from fifteen to thirty minutes. Two months after the procedure, the physician performs an upper endoscopic examination to assess the esophagus for residual Barrett's esophagus. If any Barrett's esophagus is found, the disease can be treated with a focal RFA device. Between 80 and 90% or greater of people in numerous clinical trials have shown complete eradication of Barrett's esophagus in approximately two to three treatments with a favorable safety profile. The treatment of Barrett's esophagus by RFA is durable for up to 5 years. + +== Thyroid nodules == +Radiofrequency ablation has been used successfully on benign thyroid nodules for decades, most notably in Europe, South America and Korea. In the United States, the FDA approved the use of RFA techniques for thyroid nodules in 2018. Since then, professional guidelines reflect its use as a viable treatment modality for thyroid nodules, and the procedure is increasingly applied. + +=== Timeline in the United States === +- 2023: the American Thyroid Association issued the position statement "Thyroid ablative procedures provide valid alternative treatment strategies to conventional surgical management for a subset of patients with symptomatic benign thyroid nodules. +- 2022: the American Association of Clinical Endocrinologists published an update in Endocrine Practice, stating that the "new image-guided minimally invasive approaches appear safe and effective alternatives when used appropriately and by trained professionals to treat symptomatic or enlarging thyroid masses". +- 2018: FDA approved the RFA procedure for treatment of benign thyroid nodules. + +=== Procedure === +The procedure is similar to a thyroid biopsy, although instead of using a needle to remove cells from the nodule, a probe delivers heat to the interior of the nodule that effectively cauterizes the tissue. Over the course of 3–6 months, the nodule will continue to shrink, typically achieving a 50-80% reduction total size. +In order to qualify for an RFA procedure, a person must have a clearly benign thyroid nodule, usually proven by two fine needle aspiration biopsies. +As of 2020, RFA is not recommended for the treatment of malignant thyroid nodules, although research into this topic is ongoing. + +== Other uses == +RFA is also used in radiofrequency lesioning for vein closure in areas where intrusive surgery is contraindicated by trauma, and in liver resection to control bleeding (hemostasis) and facilitate the transection process. +This process has also been used to treat TRAP sequence in multiple gestation pregnancies. This has an acceptable success rate for saving the 'pump' twin in recent studies compared to previous methods including laser photocoagulation. +RFA is used to treat uterine fibroids using the heat energy of radio frequency waves to ablate the fibroid tissue. The Acessa device obtained FDA approval in 2012. The device is inserted via a laparoscopic probe and guided inside the fibroid tissue using an ultrasound probe. The heat shrinks the fibroids. Clinical data on the procedure show an average of 45% shrinkage. +RFA is also used in the treatment of Morton's neuroma where the outcome appears to be more reliable than alcohol injections. + +== See also == +Interventional radiology +Radio frequency +Heart arrhythmia + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Rapid_antigen_test-0.md b/data/en.wikipedia.org/wiki/Rapid_antigen_test-0.md new file mode 100644 index 000000000..9dbb58a1e --- /dev/null +++ b/data/en.wikipedia.org/wiki/Rapid_antigen_test-0.md @@ -0,0 +1,38 @@ +--- +title: "Rapid antigen test" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Rapid_antigen_test" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:27.654819+00:00" +instance: "kb-cron" +--- + +A rapid antigen test (RAT), sometimes called a rapid antigen detection test (RADT), antigen rapid test (ART), or loosely just a rapid test, is a rapid diagnostic test suitable for point-of-care testing that directly detects the presence or absence of an antigen. RATs are a type of lateral flow test detecting antigens, rather than antibodies (antibody tests) or nucleic acid (nucleic acid tests). Rapid tests generally give a result in 5 to 30 minutes, require minimal training or infrastructure, and have significant cost advantages. Rapid antigen tests for the detection of SARS-CoV-2, the virus that causes COVID-19, have been commonly used since the COVID-19 pandemic. +For many years, an early and major class of RATs—the rapid strep tests for streptococci—were so often the referent when RATs or RADTs were mentioned that the two latter terms were often loosely treated as synonymous with those. Since the COVID-19 pandemic, awareness of RATs is no longer limited to health professionals and COVID-19 has become the expected referent, so more precise usage is required in other circumstances. +RATs are based on the principle of antigen-antibody interaction. They detect antigens (generally a protein on the surface of a virus). A linear chromatography substrate (a porous piece of material) bears an indicator line, onto which antibodies directed against the target antigen are fixed. Antibodies are also fixed to a visualisation marker (generally a dye, though sometimes these antibodies are modified to fluoresce), to which the sample is added. Any virus particles present will bind to these markers. This mix then travels through the substrate through capillarity. When it reaches the indicator line, virus particles are immobilised by the antibodies fixed there, along with the visualisation marker, allowing concentration and thus visual detection of significant levels of virus in a sample. +A positive result with an antigen test should generally be confirmed by RT-qPCR or some other test with higher sensitivity and specificity. + + +== Uses == +Common examples of RATs or RADTs include: + +COVID-19 testing-related rapid tests +Rapid strep tests (for streptococcal antigens) +Rapid influenza diagnostic tests (RIDTs) (for influenza virus antigens) +Malaria antigen detection tests (for Plasmodium antigens) + + +=== COVID-19 rapid antigen tests === + +Rapid antigen tests for COVID-19 are one of the most useful applications of these tests. Often called lateral flow tests, they have provided global governments with several benefits. They are quick to implement with minimal training, offered significant cost advantages, costing a fraction of existing forms of PCR testing and give users a result within 5–30 minutes. Rapid antigen tests have found their best use as part of mass testing or population-wide screening approaches. They are successful in these approaches because in addition to the aforementioned benefits, they identify individuals who are the most infectious and could potentially spread the virus to a large number of other people. This differs slightly from other forms of COVID-19 tests such as PCR that are generally seen to be a useful test for individuals. +As early as February 2021, the US Department of State considered the antigen test suitable for entry to the country. In Canada, although the antigen test appeared to be no route to entry in January 2021, Health Canada in August 2021 made available subsidized at no cost rapid antigen tests "to more small and medium-sized organizations through new pharmacy partners". + + +== Scientific basis and underlying biology == +RATs are immunochromatographic assays which give results that can be seen with the naked eye (with or without special illumination, such as a UV lamp). They are qualitative in nature, although within a certain range it is possible to make rough order of magnitude estimates of viral load from the results. RATs are generally screening tests, with relatively low sensitivity and specificity, thus results should be evaluated on the basis of confirmatory tests like PCR testing or western blot. +One inherent advantage of an antigen test over an antibody test (such as antibody-detecting rapid HIV tests) is that it can take time for the immune system to develop antibodies after infection begins, but the foreign antigen is present right away. Although any diagnostic test may have false negatives, this latency period can open an especially wide avenue for false negatives in antibody tests, although the particulars depend on which disease and which test are involved. A rapid antigen test typically costs around US$5 to manufacture. +For both typhoid and HIV, the antigen test is able to detect the infection earlier than the antibody test can. As the infection progresses, however, the antigen test becomes less sensitive than the antibody test. In HIV, this is because blood levels of immunoreactive p24 antigen diminish as the infection progresses. There are several rapid combination antigen/antibody tests for HIV. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Rapid_diagnostic_test-0.md b/data/en.wikipedia.org/wiki/Rapid_diagnostic_test-0.md new file mode 100644 index 000000000..7a443bb4f --- /dev/null +++ b/data/en.wikipedia.org/wiki/Rapid_diagnostic_test-0.md @@ -0,0 +1,39 @@ +--- +title: "Rapid diagnostic test" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Rapid_diagnostic_test" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:28.836706+00:00" +instance: "kb-cron" +--- + +A rapid diagnostic test (RDT) is a medical diagnostic test that is quick and easy to perform. RDTs are suitable for preliminary or emergency medical screening and for use in medical facilities with limited resources. They also allow point-of-care testing in primary care for things that formerly only a laboratory test could measure. They provide same-day results within two hours, typically in approximately 20 minutes. + +The European Union defines that a rapid test means qualitative or semi-quantitative in vitro-diagnostic medical devices, used singly or in a small series, which involve non-automated procedures and have been designed to give a fast result. +Lateral flow tests are probably the most known type of rapid diagnostic tests, similar to pregnancy tests, but there exist other systems as dipsticks, vertical flow, etc. Anything that can be used at bedside (point-of-care) of the patient. Emerging lateral flow technology, the Cornell FeverPhone, has been validated to differentiate causes of acute febrile illness such as Dengue Virus, Chikugunya Virus and Malaria using a single drop of blood in about 15 minutes. + + +== Examples == +Some examples of RDTs are listed below: + +Rapid antibody tests +Rapid HIV test +Rapid plasma reagin +Rapid antigen tests +Rapid COVID-19 test +Rapid influenza diagnostic test +Malaria antigen detection tests +Rapid strep test +Rapid urease test +NEMIS Rapid pathogen screening test +Rapid combination test +Fourth generation HIV rapid diagnostic test (p24+antibody) + + +== See also == +Point-of-care testing +Lateral flow tests + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Rapid_strep_test-0.md b/data/en.wikipedia.org/wiki/Rapid_strep_test-0.md new file mode 100644 index 000000000..0f0b9a98a --- /dev/null +++ b/data/en.wikipedia.org/wiki/Rapid_strep_test-0.md @@ -0,0 +1,35 @@ +--- +title: "Rapid strep test" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Rapid_strep_test" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:30.077360+00:00" +instance: "kb-cron" +--- + +The rapid strep test (RST) is a rapid antigen detection test (RADT) that is widely used in clinics to assist in the diagnosis of bacterial pharyngitis caused by group A streptococci (GAS), sometimes termed strep throat. There are currently several types of rapid strep test in use, each employing a distinct technology. However, they all work by detecting the presence of GAS in the throat of a person by responding to GAS-specific antigens on a throat swab. + + +== Medical use == +A rapid strep test may assist a clinician in deciding whether to prescribe an antibiotic to a person with pharyngitis, a common infection of the throat. Viral infections are responsible for the majority of pharyngitis, but a significant proportion (20% to 40% in children and 5% to 15% in adults) is caused by bacterial infection. The symptoms of viral and bacterial infection may be indistinguishable, but only bacterial pharyngitis can be effectively treated by antibiotics. Since the major cause of bacterial pharyngitis is GAS, the presence of this organism in a person's throat may be seen as a necessary condition for prescribing antibiotics. GAS pharyngitis is a self-limiting infection that will usually resolve within a week without medication. However, antibiotics may reduce the length and severity of the illness and reduce the risk of certain rare but serious complications, including rheumatic heart disease. +RSTs may also have a public health benefit. In addition to undesirable side-effects in individuals, inappropriate antibiotic use is thought to contribute to the development of drug-resistant strains of bacteria. By helping to identify bacterial infection, RSTs may help to limit the use of antibiotics in viral illnesses, where they are not beneficial. +Some clinical guidelines recommend the use of RSTs in people with pharyngitis, but others do not. US guidelines are more consistently in favor of their use than their European equivalents. The use of RSTs may be most beneficial in the third world, where the complications of streptococcal infection are most prevalent, but their use in these regions has not been well studied. +Microbial culture from a throat swab is a reliable and affordable alternative to an RST which has high sensitivity and specificity. However, a culture requires special facilities and usually takes 48 hours to give a result, whereas an RST can give a result within several minutes. + + +== Procedure == +The person’s throat is first swabbed to collect a sample of mucus. In most RSTs, this mucus sample is then exposed to a reagent containing antibodies that will bind specifically to a GAS antigen. A positive result is signified by a certain visible reaction. There are three major types of RST: First, a latex fixation test, which was developed in the 1980s and is largely obsolete. It employs latex beads covered with antigens that will visibly agglutinate around GAS antibodies if these are present. Second, a lateral flow test, which is currently the most widely used RST. The sample is applied to a strip of nitrocellulose film and, if GAS antigens are present, these will migrate along the film to form a visible line of antigen bound to labeled antibodies. Third, optical immunoassay is the newest and more expensive test. It involves mixing the sample with labeled antibodies and then with a special substrate on a film which changes colour to signal the presence or absence of GAS antigen. + + +== Interpretation == +The specificity of RSTs for the presence of GAS is at least 95%, with some studies finding close to 100% specificity. Therefore, if the test result is positive, the presence of GAS is highly likely. However, 5% to 20% of individuals carry GAS in their throats without symptomatic infection, so the presence of GAS in an individual with pharyngitis does not prove that this organism is responsible for the infection. The sensitivity of lateral flow RSTs is somewhat low at 65% to 80%. Therefore, a negative result from such a test cannot be used to exclude GAS pharyngitis, a considerable disadvantage compared with microbial culture, which has a sensitivity of 90% to 95%. However, optical immunoassay RSTs have been found to have a much higher sensitivity of 94%. +Although an RST cannot distinguish GAS infection from asymptomatic carriage of the organism, most authorities recommend antibiotic treatment in the event of a positive RST result from a person with a sore throat. US guidelines recommend following up a negative result with a microbial culture, whereas European guidelines suggest relying on the negative RST. + + +== See also == +Screening (medicine) +Diagnostic test + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Regression_(medicine)-0.md b/data/en.wikipedia.org/wiki/Regression_(medicine)-0.md new file mode 100644 index 000000000..c21513fbc --- /dev/null +++ b/data/en.wikipedia.org/wiki/Regression_(medicine)-0.md @@ -0,0 +1,18 @@ +--- +title: "Regression (medicine)" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Regression_(medicine)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:31.331934+00:00" +instance: "kb-cron" +--- + +Regression in medicine is the partial or complete reversal of a disease's signs and symptoms. + +Clinically, regression generally refers to a decrease in severity of symptoms without completely disappearing. At a later point, symptoms may return. These symptoms are then called recidive. + +In cancer, regression refers to a specific decrease in the size or extent of a tumour. In histopathology, histological regression is one or more areas within a tumor in which neoplastic cells have disappeared or decreased in number. In melanomas, this means complete or partial disappearance from areas of the dermis (and occasionally from the epidermis), which have been replaced by fibrosis, accompanied by melanophages, new blood vessels, and a variable degree of inflammation. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Relapsing–remitting-0.md b/data/en.wikipedia.org/wiki/Relapsing–remitting-0.md new file mode 100644 index 000000000..2b9e51777 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Relapsing–remitting-0.md @@ -0,0 +1,15 @@ +--- +title: "Relapsing–remitting" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Relapsing–remitting" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:32.477854+00:00" +instance: "kb-cron" +--- + +Relapsing–remitting is a medical term referring to a presentation of disease symptoms that become worse over time (relapsing), followed by periods of less severe symptoms that do not completely cease (partial remitting). The term is used to describe a type of multiple sclerosis called relapsing–remitting multiple sclerosis, where unpredictable relapses are followed by remission for months to years. +The term is also used to describe palindromic rheumatism in the context of rheumatoid arthritis, catatonia, lupus, mental disorders, and experimental autoimmune encephalomyelitis. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Remission_(medicine)-0.md b/data/en.wikipedia.org/wiki/Remission_(medicine)-0.md new file mode 100644 index 000000000..8b923a114 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Remission_(medicine)-0.md @@ -0,0 +1,22 @@ +--- +title: "Remission (medicine)" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Remission_(medicine)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:33.706636+00:00" +instance: "kb-cron" +--- + +Remission is either the reduction or disappearance of the signs and symptoms of a disease. The term may also be used to refer to the period during which this reduction occurs. A remission may be considered a partial remission or a complete remission. Each disease, type of disorder, or clinical trial can have its own definition of a partial remission. For example, a partial remission for cancer may be defined as a 50% or greater reduction in the measurable parameters of tumor growth as may be found on physical examination, radiologic study, or by biomarker levels from a blood or urine test. +A complete remission, also called a full remission, is a total disappearance of the signs and symptoms of a disease. A person whose condition is in complete remission may be considered cured or recovered. Relapse is a term to describe returning symptoms of the disease after a period of remission. In cancer-treatment, doctors usually avoid the term "cured" and instead prefer the term "no evidence of disease" (NED) to refer to a complete remission of cancer, which does not rule out the possibility of relapse. +In mental disorders, there is generally no distinction between partial remission and complete remission. For example, a person diagnosed with a personality disorder must initially fit a set or subset of criteria from a predefined list, and remission in this context is defined as no longer meeting the criteria required for diagnosis. In this case it is still possible for the person to be demonstrating some symptoms, but they are at a subclinical severity or frequency that does not merit re-diagnosis. +For some diseases featuring remission, especially for those with no known cure such as multiple sclerosis, remission is implied to always be partial. + + +== See also == +Relapsing-remitting +Spontaneous remission + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Responsible_drug_use-0.md b/data/en.wikipedia.org/wiki/Responsible_drug_use-0.md new file mode 100644 index 000000000..235cd6636 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Responsible_drug_use-0.md @@ -0,0 +1,31 @@ +--- +title: "Responsible drug use" +chunk: 1/3 +source: "https://en.wikipedia.org/wiki/Responsible_drug_use" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:34.912036+00:00" +instance: "kb-cron" +--- + +Responsible drug use seeks to maximize the benefits and minimize the risks associated with psychoactive drug use. For illegal psychoactive drugs that are not diverted prescription controlled substances, some critics believe that illegal recreational drug use is inherently irresponsible, due to the unpredictable and unmonitored strength and purity of the drugs and the risks of addiction, infection, and other side effects. +Nevertheless, harm reduction advocates claim that the user can be responsible by employing the same general principles applicable to the use of alcohol: avoiding hazardous situations, excessive doses, and hazardous combinations of drugs; avoiding injection; and not using drugs at the same time as activities that may be unsafe without a sober state. Drug use can be thought of as an activity that is potentially beneficial but also potentially risky. Similar to other risky activities such as skydiving or mountain climbing, the varied risks of drug use can be minimized by using harm-reduction strategies such as education, caution, and common sense. These advocates also point out that government action (or inaction) makes responsible drug use more difficult by artificially increasing risks, such as by making drugs of known purity and strength unavailable due to prohibition. + +== Harm reduction == + +Responsible drug use is emphasized as a primary prevention technique in harm-reduction drug policies. Harm-reduction policies were popularized in the late 1980s although they began in the 1970s counter-culture where cartoons were distributed to users explaining responsible drug use and consequences of irresponsible drug use. +Harm reduction as applied to drug use began as a philosophy in the 1980s aiming to minimize HIV transmission between intravenous drug users. It also focused on condom usage to prevent the transmission of HIV through sexual contact. Harm reduction worked so effectively that researchers and community policy makers adapted the theory to other diseases to which drug users were susceptible, such as Hepatitis C. +Professor Graham Foster, of St Mary's Hospital, London, said: "Sharing banknotes or straws is a significant risk factor that people need to be more aware of. Although the risk of contracting hepatitis C through snorting is lower than through sharing a needle, it is still there." +Harm reduction seeks to minimize the harms that can occur through the use of various drugs, whether legal (e.g. ethanol (alcohol), caffeine and nicotine), or illegal (e.g. heroin and cocaine). For example, people who inject drugs can minimize harm to both themselves and members of the community through proper injecting technique, using new sterile needles and syringes each time, utilizing sterile water, employing sterile micron filters to purify solutions, using antiseptic pads to prepare injection sites and clean drug mixing vials/containers, testing for contaminants, and through proper disposal of all injecting equipment. +Other harm reduction methods have been implemented with drugs such as crack cocaine. In some cities, peer health advocates (Weeks, 2006) have participated in passing out clean crack pipe mouthpiece tips to minimize the risk of Hepatitis A, B and C and HIV due to sharing pipes while lips and mouth contain open sores. Also, a study by Bonkovsky and Mehta reported that, just like shared needles, the sharing of straws used to "snort" cocaine can spread blood diseases such as Hepatitis C. +The responsible user therefore acts to minimize the spread of blood-borne viruses such as hepatitis C and HIV in the wider community and reduce their own risk exposure to drug-related harms. + +=== Supervised injection sites (SiS) === + +The provision of supervised injection sites, also referred to as safe injection sites, operates under the premise of harm reduction by providing the injection drug user with a clean space and clean materials such as needles, sterile water, alcohol swabs, and other items used for safe injection. +Vancouver, British Columbia opened a SiS called Insite in its poorest neighbourhood, the Downtown Eastside. Insite was opened in 2003 and has dramatically reduced many harms associated with injection drug use. The research arm of the site, run by The Centre of Excellence for HIV/AIDS has found that SiS leads to increases in people entering detox and addiction treatment without increasing drug-related crime. As well, it reduces the littering of drug paraphernalia (e.g., used needles) on the street and reduces the number of people injecting in public areas. The program is attracting the highest-risk users, which has led to less needle-sharing in the Downtown Eastside community, and in the 453 overdoses which occurred at the facility, health care staff have saved every person. +Since the drug policy of the Netherlands considers substance use a social and health-related issue and not a legal one, the government has opened clinics where drug users may consume their substances in a safe, clean environment. Users are given access to clean needles and other paraphernalia, monitored by health officials and are given the ability to seek help from drug addiction. +Due to the project's initial success in reducing mortality ratios and viral spread amongst injection drug users, other projects have been started in Switzerland, Germany, Spain, Australia, Canada and Norway. France, Denmark and Portugal also opened multiple drug consumption facilities. + +== Principles == +Duncan and Gold argue that to use controlled and other drugs responsibly, a person must adhere to a list of principles. They and others argue that drug users ought to proceed by: \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Responsible_drug_use-1.md b/data/en.wikipedia.org/wiki/Responsible_drug_use-1.md new file mode 100644 index 000000000..b413c5840 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Responsible_drug_use-1.md @@ -0,0 +1,52 @@ +--- +title: "Responsible drug use" +chunk: 2/3 +source: "https://en.wikipedia.org/wiki/Responsible_drug_use" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:34.912036+00:00" +instance: "kb-cron" +--- + +understanding and educating oneself on the effects, risks, side effects and legal status of the drug they are taking +measuring accurate dosages, and take other precautions to reduce the risk of overdose when taking drugs where an overdose is possible +if possible, drug checking all substances before use to determine their purity and strength +attempting to gain the most pure and high-quality drugs, laced with no cutting agent at best such as by buying on darknet markets +using drugs only in relaxed and responsible social situations as altered consciousness can be inappropriate in potentially dangerous or unknown settings +avoiding driving, operating heavy machinery, or otherwise situate themselves directly or indirectly responsible for the safety or care of another person while intoxicated and discouraging persons from operating a motor vehicle while intoxicated +having a trip sitter (or "copilot") when taking hallucinogenic drugs +taking a small dose first when taking a new drug ("start low and go slow") +taking the smallest dose of a recreational drug that will produce the desired effects +using recreational drugs in moderation, setting reasonable limits on the consumption and not allowing drug use to overshadow other aspects of their life (i.e. financial and social responsibilities) +avoiding mixing or combining drugs, especially unknown drugs and drugs with known dangerous interactions +not trusting someone else with the responsibility for your health and safety +knowing basic first-aid techniques and taking responsibility for applying them appropriately in cases of drug emergencies +avoiding the injection of drugs; if injection cannot be avoided, then by using proper supplies like sterile needles, micron filters, and sterile water +recognizing that one's own drug-taking behavior and attitudes in the presence of others will influence others, especially children +abstaining from drug use when inappropriate for reasons of health and physical fitness such as during pregnancy +respecting an individual's decision concerning drug use +providing alternatives of acceptable social-recreational behaviors within a group for others and avoiding drug use to become the only motivation or focus of the social situation +understanding the individuality of response +being aware of the complex influences of set and setting on psychoactive drug experiences and acting accordingly +Some proposed ethical guidelines include: + +never tricking or trying to persuade anyone to use a drug +being morally conscious of the source of the drugs that a person is using +Duncan and Gold suggested that responsible drug use involves three areas of responsibility: + +Situation: concerns over the possible situations in which drugs might be used legally, such as the avoidance of hazardous situations; not using when alone; nor using due to coercion or when the use of drugs itself is the sole reason for use. +Health: the avoidance of excessive doses or hazardous combinations of drugs; awareness of possible health consequences of drug use; avoiding drug-using behaviors that can potentially lead to addiction; and not using a drug recreationally during periods of excessive stress. +Safety: using the smallest dose necessary to achieve the desired effects; using only in relaxed settings with supportive companions; avoiding the use of drugs by injection; and not using drugs while performing complex tasks or those where the drug might impair one's ability to function safely. + +== Criticism and counterarguments == + +=== Health and social consequences === +Drug use and users are often not considered socially acceptable; they are often marginalized socially and economically. +Drug use may affect work performance; however, drug testing should not be necessary if this is so, as a user's work performance would be observably deficient, and be grounds in itself for dismissal. In the case of discriminate use of substituted amphetamines and other stimulants, work capacity actually increases, which in itself raises additional ethical considerations. + +=== Illegality === +Illegality causes supply problems, and artificially raises prices far above the production and transportation costs. Purity and potency of many drugs is difficult to assess, as the drugs are illegal. Unscrupulous and unregulated middlemen are drawn by profit into the industry of these valuable commodities, directly affecting the users ability to obtain and use the drugs safely and forcing the user to take avoidable risks. Drug dosing with varying purity is problematic. Profit motivation rewards illegal sellers who dilute substances with a cutting agent; when a user, expecting a low dose, procures "uncut" drugs, an overdose can result. +The morality of buying certain illegal drugs is also questioned given that the trade in cocaine, for instance, has been estimated to cause 20,000 deaths a year in Colombia alone. Increasing Western demand for cocaine causes several hundred thousand people to be displaced from their homes every year, indigenous people are enslaved to produce cocaine and people are killed by the land mines drug cartels place to protect their coca crops. However, the majority of deaths currently caused by the illegal drug trade can only take place in a situation in which the drugs are illegal and some critics blame prohibition of drugs and not their consumption for the violence surrounding them. The illegality of drugs in itself may also cause social and economic consequences for those using them, and legal regulation of drug production and distribution could alleviate these and other dangers of illegal drug use. + +=== At festivals === +As drugs are very prevalent in festival culture more and more consider taking measures for responsible usage there. Some music festival organizers have chosen to provide services meant to inform about responsible drug use and drug checking for the disposal of dangerously laced ones. As a result, some have reported a significant reduction of the workload of festival's medics, welfare team and police officers. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Responsible_drug_use-2.md b/data/en.wikipedia.org/wiki/Responsible_drug_use-2.md new file mode 100644 index 000000000..95d34a11e --- /dev/null +++ b/data/en.wikipedia.org/wiki/Responsible_drug_use-2.md @@ -0,0 +1,35 @@ +--- +title: "Responsible drug use" +chunk: 3/3 +source: "https://en.wikipedia.org/wiki/Responsible_drug_use" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:34.912036+00:00" +instance: "kb-cron" +--- + +== Organizations == +Many organizations exist to promote responsible drug use and harm reduction throughout the world. +Some, such as Students for Sensible Drug Policy or Drug Policy Alliance, are primarily activist groups concerned with drug policy reform, promoting scientific research on drugs, and opposing stigma and misinformation about drug use and drug users. Others exist primarily as drug testing services for drug users (e.g. Energy Control or DrugsData), or as supervised injection services (e.g. Insite), or as informational sources (e.g. Bluelight or Erowid). Governments have begun to address responsible drug use within their respective jurisdictions. The U.S. Department of Health and Human Services addresses harm reduction through the Substance Abuse and Mental Health Services Administration as a part of the department's Overdose Prevention Strategy. + +== See also == + +== References == + +== Further reading == +Zinberg, N. E. (1984) Drug, Set, And Setting: The Basis for Controlled Intoxicant Use (New Haven: Yale University Press) ISBN 0-300-03110-6 + +== External links == +Fact sheets on responsible recreational drug use +Towards a Culture of Responsible Psychoactive Drug Use +Fundamentals of Responsible Psychoactive Use, Erowid + +=== Harm reduction === +The History of Harm Reduction +SOM.NIT // Risk reduction associated with recreational drug consumption +Harm Reduction & Drug info (and resources in Canada) + +=== Responsible drug use websites === +ConsumeResponsibly, Cannabis +RollSafe, MDMA +TripSafe, Psychedelics \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Review_of_systems-0.md b/data/en.wikipedia.org/wiki/Review_of_systems-0.md new file mode 100644 index 000000000..b4133bd18 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Review_of_systems-0.md @@ -0,0 +1,26 @@ +--- +title: "Review of systems" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Review_of_systems" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:36.064738+00:00" +instance: "kb-cron" +--- + +A review of systems (ROS), also called a systems enquiry or systems review, is a technique used by healthcare providers for eliciting a medical history from a patient. It is often structured as a component of an admission note covering the organ systems, with a focus upon the subjective symptoms perceived by the patient (as opposed to the objective signs perceived by the clinician). Along with the physical examination, it can be particularly useful in identifying conditions that do not have precise diagnostic tests. + + +== Examples == +Whatever system a specific condition may seem restricted to, it may be reasonable to review all the other systems in a comprehensive history. Different sources describe slightly different systems of organizing the organ systems. However, the following are examples of what can be included. Unspecified and other symptoms can't consider for both HPI and ROS: +There are 14 systems recognized by the Centers for Medicare and Medicaid Services: + +The questions may be asked of the patient in a "head to toe" manner. + + +== Relationship to history == + +For CMS, a "problem pertinent" ROS is limited to the problem(s) identified in the HPI; an "extended" ROS covers an additional 2 to 9 systems, and a "complete" ROS covers at least 10 additional systems. The chances of double dipping should be avoided while taking ROS from History. There are many rules and guidelines a coder must be aware of when it comes to appropriately selecting an Evaluation and Management (EM) code and avoiding doubling dipping is one of them.This established patient has had a fever with sore/scratchy throat and severe headache for the past three days. He has had a little nausea but no vomiting. He said his pain is relieved with cold drinks and ibuprofen.In the above example if you take throat as location in HPI, you cannot take sore/scratchy throat in ROS as ENT element. Most of the double dipping will happen in the ENT section since it is a combined system. There are some crossovers within the system, such as how the statement of "No known allergies" could also be calculated as part of the review of systems (ROS). The statement suggests the patient is not allergic to any medications, which is commonly part of the "past medical history" element.The patient was brought up by an aunt; Patient having nasal problems for last 4 days, symptoms including runny nose / rhinorrhea. Denies cough, no fever, pneumonia, severe headache for the past three days.In the above example, if you take Nose as location, you cannot take runny nose/rhinorrhea in ROS as an ENT element. Double dipping is against the rules. The common double dipping example (above) uses the elements of HPI (location and associated signs and symptoms) for both the HPI and the ROS. Double dipping may increase revenue by making it possible to qualify for a higher level of history and as such be considered fraud or abuse. There is a fine line between the signs and symptoms that a patient shares in the HPI and those obtained via the ROS. The ROS is a distinct review of systems. For example: if the documentation reads "'patient states that her hip has been painful' credit is not given in both the HPI 'location' and to the MSK (musculoskeletal) review of systems." It goes on to explain that if the patient's complaint is followed by "no other MSK issues", then it can be counted in the ROS as well as the HPI. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Right-to-left_shunt-0.md b/data/en.wikipedia.org/wiki/Right-to-left_shunt-0.md new file mode 100644 index 000000000..94f26b915 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Right-to-left_shunt-0.md @@ -0,0 +1,141 @@ +--- +title: "Right-to-left shunt" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Right-to-left_shunt" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:38.670025+00:00" +instance: "kb-cron" +--- + +A right-to-left shunt is a cardiac shunt which allows blood to flow from the right heart to the left heart. This terminology is used both for the abnormal state in humans and for normal physiological shunts in reptiles. + + +== Clinical Significance == +A right-to-left shunt occurs when: + +there is an opening or passage between the atria, ventricles, and/or great vessels; and, +right heart pressure is higher than left heart pressure and/or the shunt has a one-way valvular opening. +Small physiological, or "normal", shunts are seen due to the return of bronchial artery blood and coronary blood through the Thebesian veins, which are deoxygenated, to the left side of the heart. + + +=== Causes === +Congenital defects can lead to right-to-left shunting immediately after birth: + +Persistent truncus arteriosus (minimal cyanosis) +Transposition of great vessels +Tricuspid atresia +Tetralogy of Fallot +Total anomalous pulmonary venous return +A mnemonic to remember the conditions associated with right-to-left shunting involves the numbers 1-5, as follows: + +1 Combination Vessel: Persistent truncus arteriosus (minimal cyanosis) +2 Vessels involved: Transposition of great vessels +3 Leaflets: Tricuspid atresia +4 Tetra- prefix: Tetralogy of Fallot +5 Words: Total anomalous pulmonary venous return +A mainstem intubation with an endotracheal tube can lead to right-to-left shunting. This occurs when the tip of the endotracheal tube is placed beyond the carina. In this way only one lung is oxygenated and oxygen-poor blood from the non-ventilated lung dilutes the oxygen level of blood returning from the lungs in the left ventricle. + + +==== Eisenmenger syndrome ==== +An uncorrected left-to-right shunt can progress to a right-to-left shunt; this process is termed Eisenmenger syndrome. This is seen in Ventricular septal defect, Atrial septal defect, and patent ductus arteriosus, and can manifest as late as adult life. This switch in blood flow direction is precipitated by pulmonary hypertension due to increased pulmonary blood flow in a left-to-right shunt. The right ventricle hypertrophies to compensate for this pulmonary hypertension, so the right ventricular pressure becomes higher than the pressure in the left ventricle. Because of this switch in the pressure gradient, blood starts flowing right to left, forming a right-to-left shunt. As with any right-to-left shunt, there is decreased blood flow to the lungs, resulting in decreased oxygenation of blood and cyanosis. + + +==== Tetralogy of Fallot ==== +The most common cause of right-to-left shunt is the Tetralogy of Fallot, a congenital cardiac anomaly characterized by four co-existing heart defects. + +Pulmonary stenosis (narrowing of the pulmonary valve and outflow tract, obstructing blood flow from the right ventricle to the pulmonary artery) +Overriding aorta (aortic valve is enlarged and appears to arise from both the left and right ventricles instead of the left ventricle, as occurs in normal hearts) +Right ventricular hypertrophy (thickening of the muscular walls of the right ventricle, this is a result of the increased amount of work the heart has to do) +Ventricular septal defect (a hole exists in the septum that divides the left and right ventricles) + +Outside of heart-related conditions, right-to-left shunts of the heart can be seen with Pulmonary Arteriovenous Malformations (PAVMs). + + +=== Symptoms === +Early cyanosis is a symptom of a right-to-left shunt. A right-to-left shunt results in decreased blood flow through the pulmonary system, leading to decreased blood oxygen levels (hypoxemia). Hypoxemia manifests as cyanosis, causing "blue babies." + + +=== Diagnosis === +Differentiation between a right-to-left shunt and pulmonary disease is often aided clinically by the results of a hyperoxia test. Using high levels of inspired oxygen should have little effect on the dissolved O2 in the blood because highly oxygenated blood is diluted by shunted (low oxygenation) blood. + + +=== Shunt equation === + + + + + + Q + + p + + + + / + + + Q + + s + + + = + ( + C + c + + O + + 2 + + + − + C + a + + O + + 2 + + + ) + + / + + ( + C + c + + O + + 2 + + + − + C + v + + O + + 2 + + + ) + + + {\displaystyle Q_{p}/Q_{s}=(CcO_{2}-CaO_{2})/(CcO_{2}-CvO_{2})} + + +Qp/Qs is the shunt fraction +CcO2 is the end-capillary oxygen content +CaO2 is the arterial oxygen content +CvO2 is the mixed venous oxygen content. + + +== Reptiles == + +Because most reptiles have a single ventricle and all reptiles have both a right aortic arch and a left aortic arch, all reptiles have the capacity for right-to-left shunt. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Right_atrial_pressure-0.md b/data/en.wikipedia.org/wiki/Right_atrial_pressure-0.md new file mode 100644 index 000000000..be4eeadcb --- /dev/null +++ b/data/en.wikipedia.org/wiki/Right_atrial_pressure-0.md @@ -0,0 +1,47 @@ +--- +title: "Right atrial pressure" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Right_atrial_pressure" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:37.358360+00:00" +instance: "kb-cron" +--- + +Right atrial pressure (RAP) is the blood pressure in the right atrium of the heart. RAP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. RAP is often nearly identical to central venous pressure (CVP), although the two terms are not identical, as a pressure differential can sometimes exist between the venae cavae and the right atrium. CVP and RAP can differ when venous tone (i.e the degree of venous constriction) is altered. This can be graphically depicted as changes in the slope of the venous return (VR) plotted against right atrial pressure (where central venous pressure (CVP) increases, but right atrial pressure (RAP) stays the same; VR = CVP − RAP). + + +== Factors affecting RAP == +Factors that increase RAP include: + +Hypervolemia +Forced exhalation +Tension pneumothorax +Heart failure +Pleural effusion +Decreased cardiac output +Cardiac tamponade +Mechanical ventilation and the application of positive end-expiratory pressure (PEEP) +Pulmonary Hypertension +Pulmonary Embolism +Left to right shunted Atrial Septal Defect +Factors that decrease RAP include: + +Hypovolemia +Deep inhalation +Distributive shock + + +== See also == +Pulmonary capillary wedge pressure +Jugular venous pressure +Central venous pressure + + +== References == + + +== External links == +Cardiovascular Physiology Concepts +Cardiovascular Physiology +Right+Atrial+Pressure at the U.S. National Library of Medicine Medical Subject Headings (MeSH) \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Risk_of_infection-0.md b/data/en.wikipedia.org/wiki/Risk_of_infection-0.md new file mode 100644 index 000000000..a49497e47 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Risk_of_infection-0.md @@ -0,0 +1,30 @@ +--- +title: "Risk of infection" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Risk_of_infection" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:39.833246+00:00" +instance: "kb-cron" +--- + +Risk of infection is a nursing diagnosis which is defined as the state in which an individual is at risk to be infected by an opportunistic or pathogenic agent (e.g., viruses, fungi, bacteria, protozoa, or other parasites) from endogenous or exogenous sources. The diagnosis was approved by NANDA in 1986. Although anyone can become infected by a pathogen, patients with this diagnosis are at an elevated risk and extra infection controls should be considered. + + +== Endogenous sources == +The risk of infection depends on a number of endogenous sources. +Chronic blood loss leads to iron and nutrient deficiencies essential for immune cell production and function, thereby decreasing the body’s resistance to infection and placing the patient at increased risk for infection. + + +== Assessment == +The patient should be asked about a history of repeated infections, symptoms of infection, recent travel to high-risk areas, and their immunization history. They should also be assessed for objective signs such as the presence of wounds, fever, or signs of nutritional deficiency + + +== Intervention == +The specific nursing interventions will depend on the nature and severity of the risk. Patients should be taught how to recognize the signs of infection and how to reduce their risk. Surgery is a frequent risk factor for infection and a physician may prescribe antibiotics prophylactically. Immunization is another common medical intervention for those who are at high risk for infection. +Hand washing is the best way to break the chain of infection. + + +== References == + +Carpenito, L J, ed. (2024). Nursing diagnosis: application to clinical practice (9th ed.). Philadelphia, PA: Lippincott. ISBN 0-7817-3319-7. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Risk_of_mortality-0.md b/data/en.wikipedia.org/wiki/Risk_of_mortality-0.md new file mode 100644 index 000000000..752b5854f --- /dev/null +++ b/data/en.wikipedia.org/wiki/Risk_of_mortality-0.md @@ -0,0 +1,23 @@ +--- +title: "Risk of mortality" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Risk_of_mortality" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:41.068791+00:00" +instance: "kb-cron" +--- + +The risk of mortality (ROM) provides a medical classification to estimate the likelihood of in-hospital death for a patient. The ROM classes are minor, moderate, major, and extreme. The ROM class is used for the evaluation of patient mortality. + + +== See also == +Case mix index +Diagnosis codes +Severity of illness + + +== References == +Alemi, F., J. Rice, and R. Hankins. 1990. "Predicting In-Hospital Survival of Myocardial Infarction." Medical Care 28 (9): 762–75. +Averill, R. F., J. H. Muldoon, J. C. Vertrees, N. I. Goldfield, R. L. Mullin, E. C. Fineran, M. Z. Zhang, B. Steinbeck, and T. Grant, The Evolution of Casemix Measurement Using Diagnosis Related Groups (DRGs) 3M HIS Working Paper. Wallinford, CT: 3M Health Information Systems, 1997 +Iezzoni, L. I., M. Shwartz, A. S. Ash, J. S. Hughes, J. Daley, and Y. D. Mackiernan, Severity Measurement Methods and Judging Hospital Death Rates for Pneumonia, Medical Care 34 (1): 11–28, 1996 \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Risky_sexual_behavior-0.md b/data/en.wikipedia.org/wiki/Risky_sexual_behavior-0.md new file mode 100644 index 000000000..a6871a5ac --- /dev/null +++ b/data/en.wikipedia.org/wiki/Risky_sexual_behavior-0.md @@ -0,0 +1,56 @@ +--- +title: "Risky sexual behavior" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Risky_sexual_behavior" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:42.273338+00:00" +instance: "kb-cron" +--- + +Risky sexual behavior is the description of the activity that will increase the probability that a person engaging in sexual activity with another person infected with a sexually transmitted infection will be infected, become unintentionally pregnant, or make a partner pregnant. It can mean two similar things: the behavior itself, and the description of the partner's behavior. +The behavior could be unprotected vaginal, oral, anal, or non-penetrative manual intercourse. The partner could be a non-exclusive sexual partner, HIV-positive, and/or an intravenous drug user. + + +== Factors == + +Risky sexual behaviors can include: + +Sex and drugs such as alcohol or methamphetamine. +Barebacking, i.e. sex without using condoms. +Mouth-to-genital contact. +Starting sexual activity at a young age. +Having multiple sexual partners. +Having a high-risk partner, someone who has multiple sexual partners and/or infections. +Anal sex without using condoms and proper lubrication. +Sex with a partner who has ever injected drugs. +Engaging in sex work. +Consumption of pornographic materials (which can encourage other risky sexual behaviors) +Risky sexual behavior includes unprotected intercourse, multiple sexual partners, and illicit drug use. The use of alcoholic drinks and illicit drugs greatly increases the risk of gonorrhea, chlamydia, trichomoniasis, hepatitis B, and HIV/AIDS. Trauma from penile-anal sex has been identified as a risky sexual behavior. +Risky sexual behaviors can lead to serious consequences both for person and their partner(s). This sometimes includes cervical cancer, ectopic pregnancy, and infertility. An association exists between those with a higher incidence of body modifications (such as body piercings and tattoos) and risky sexual behaviors. + + +== Epidemiology == +According to the National Youth Behavior Risk Survey, 19% of all sexually active adolescents in the US consumed alcohol or used other drugs before their last sexual intercourse. In contrast, adolescents who reported no substance use were found to be the least likely to engage in sexual risk-taking. +Most Canadian and American adolescents aged 15 to 19 years describe having had sexual intercourse at least one time. In the same population, 23.9% and 45.5% of young, adolescent females describe having sex with two or more sexual partners during the previous year. Of the males in the same population, 32.1% of Canadian males had two or more partners and 50.8% of American males also describe a similar experience. +Alcohol is the most commonly used substance among youth aged 18–25 years. 10% of young adults had an alcohol use disorder in 2018, which is greater than the prevalence among all other age cohorts. Research indicates that alcohol can lead to risky sexual behavior including lack of condom use, sexual intercourse with a non-primary partner, as well as lower likelihood of using contraception in general. +Among older age cohorts, a similar positive trend can be observed in risky sexual behavior when combined with alcohol use. For instance, research on older men who have sex with men (MSM) showed that the likelihood of engaging in risky sexual activities increased with the use of alcohol and other drugs. + + +== Treatment and interventions == + +There are several factors linked to risky sexual behaviors. These include inconsistent condom use, alcohol use, polysubstance abuse, depression, lack of social support, recent incarceration, residing with a partner, and exposure to intimate partner violence and childhood sexual abuse. Further research is needed to establish the exact causal relationship between these factors and risky sexual behaviors. Sexual health risk reduction can include motivational exercises, assertiveness skills, educational and behavioral interventions. Counseling has been developed and implemented for people with severe mental illness, may improve participants' knowledge, attitudes, beliefs, behaviors or practices (including assertiveness skills) and could lead to a reduction in risky sexual behavior. +There are several studies on the management of risky sexual behavior among youth, with most focusing on the prevention of sexually transmitted infections (STIs) such as HIV. A meta-analysis evaluating prevention interventions among adolescents offers support for these programs in contributing to successful outcomes such as decreased incident STIs, increased condom use, and decreased or delayed penetrative sex. The findings showed that most interventions were administered in a group format and involved psychoeducation on HIV/AIDS, active interpersonal skills-training with some additionally focusing on self-management skills-training and condom information/ demonstrations. Some evidence suggests that family interventions may be beneficial in preventing long-term risky sexual behavior in early adulthood. + + +== See also == +Date rape +Drug-facilitated sexual assault +Non-consensual condom removal + + +== References == + + +== External links == +Drug Use and Sexual Behaviors Reported by Adults: United States, 1999–2002 \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/SARI_Screening_Tool-0.md b/data/en.wikipedia.org/wiki/SARI_Screening_Tool-0.md new file mode 100644 index 000000000..99fd69768 --- /dev/null +++ b/data/en.wikipedia.org/wiki/SARI_Screening_Tool-0.md @@ -0,0 +1,14 @@ +--- +title: "SARI Screening Tool" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/SARI_Screening_Tool" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:43.480584+00:00" +instance: "kb-cron" +--- + +SARI Screening Tool also known as the SARI score is a tool developed by the Ministry of Health in the Kingdom of Saudi Arabia. It is a visual triage used to identify those with the potential to have COVID-19. The tools was also used to screen for MERS. It has been modified multiple times and the weights of each symptom have been changed over time as well. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Sclerosis_(medicine)-0.md b/data/en.wikipedia.org/wiki/Sclerosis_(medicine)-0.md new file mode 100644 index 000000000..fa388ce3b --- /dev/null +++ b/data/en.wikipedia.org/wiki/Sclerosis_(medicine)-0.md @@ -0,0 +1,31 @@ +--- +title: "Sclerosis (medicine)" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Sclerosis_(medicine)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:44.831503+00:00" +instance: "kb-cron" +--- + +Sclerosis (from Ancient Greek σκληρός (sklērós) 'hard') is the stiffening of a tissue or anatomical feature, usually caused by a replacement of the normal organ-specific tissue with connective tissue. The structure may be said to have undergone sclerotic changes or display sclerotic lesions, which refers to the process of sclerosis. +Common medical conditions whose pathology involves sclerosis include: + +Amyotrophic lateral sclerosis—also known as Lou Gehrig's disease or motor neurone disease—a progressive, incurable, usually fatal disease of motor neurons. +Atherosclerosis, a deposit of fatty materials, such as cholesterol, in the arteries which causes hardening. +Focal segmental glomerulosclerosis is a disease that attacks the kidney's filtering system (glomeruli) causing serious scarring and thus a cause of nephrotic syndrome in children and adolescents, as well as an important cause of kidney failure in adults. +Hippocampal sclerosis, a brain damage often seen in individuals with temporal lobe epilepsy. +Lichen sclerosus, an inflammatory skin disease that most often affects the vulva and the penis. +Multiple sclerosis, or focal sclerosis, is a central nervous system disease which affects coordination. +Osteosclerosis, a condition where the bone density is significantly increased, resulting in decreased lucency on radiographs. +Otosclerosis, a disease of the ears. +Primary lateral sclerosis, progressive muscle weakness in the voluntary muscles. +Primary sclerosing cholangitis, a hardening of the bile duct by scarring and repeated inflammation. +Systemic sclerosis (progressive systemic scleroderma), a rare, chronic disease which affects the skin, and in some cases also blood vessels and internal organs. +Tuberous sclerosis, a rare genetic disease which affects multiple systems. + + +== References == + + +== External links == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Screen_time-0.md b/data/en.wikipedia.org/wiki/Screen_time-0.md new file mode 100644 index 000000000..857773f81 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Screen_time-0.md @@ -0,0 +1,30 @@ +--- +title: "Screen time" +chunk: 1/4 +source: "https://en.wikipedia.org/wiki/Screen_time" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:46.015001+00:00" +instance: "kb-cron" +--- + +Screen time is the amount of time spent using an electronic device with a display screen such as a smartphone, computer, television, video game console, or tablet. The concept is under significant research with related concepts in digital media use and mental health. Screen time is correlated with mental and physical harm in child development. The positive or negative health effects of screen time on a particular individual are influenced by levels and content of exposure. Screen time increases dopamine. To prevent harmful excesses of screen time, some governments have placed regulations on usage. + +== History == + +=== Statistics === +The first electronic screen was the cathode ray tube (CRT), which was invented in 1922. CRTs were the most popular choice for display screens until the rise of liquid crystal displays (LCDs) in the early 2000s. Screens are now an essential part of entertainment, advertising, and information technologies. +Since their popularization in 2007, smartphones have become ubiquitous in daily life. In 2023, 85% of American adults reported owning a smartphone. An American survey in 2016 found a median of 3.7 minutes per hour screen use per citizen. All forms of screens are frequently used by children and teens. Nationally representative data of children and teens in the United States show that the daily average of screen time increases with age. TV and video games were once largest contributors to children's screen time, but the past decade has seen a shift towards smart phones and tablets. Specifically, a 2011 nationally representative survey of American parents of children from birth to age 8 suggests that TV accounted for 51% of children's total daily screen time, while mobile devices only accounted for 4%. However, in 2017, TV dropped down to 42% of children's total daily screen time, and mobile media devices jumped up to 35%. + +==== Race, socioeconomic class, and screen time ==== +Research has shown that race and socioeconomic class are associated with overall screen time. Younger demographics and individuals who self-identified as Black and "Other" were associated with above average screen use. Additionally, Black and Latino Americans had longer screen times because of less access to desktop computers, which thus leads to more time on phones. In children, the divide is much larger. On average in 2011, White children spent 8.5 hours a day with digital media, and Black and Latino children spent about 13 hours a day on screens. Black and Latino children were also more likely to have TVs in their rooms, which contributed to their increased use of screen time. +The discrepancy in the amount of screen time can also be attributed to a difference in income. In more affluent private schools, there has been a larger push to remove screens from education in order to limit the negative impacts that have been found from screen time. However, in public schools there is more push for the use of technology with some public schools advertising free iPads and laptops to students. Additionally, affluent families are able to afford nannies and extracurriculars that can limit the need for entertainment from screens. + +=== Effects of COVID-19 pandemic === +The COVID-19 pandemic in 2020 increased screen time as people stayed indoors, adding to concerns about the effects of excessive screen time. Specialists called for limiting screen time and for living a more active lifestyle. +Studies have shown that even after children returned to school following a period of online schooling, which significantly increased daily screen time, their level of physical activity has remained low, while screen time has increased. Due to the increase of screen time, many children gained weight during this time. + +== Physical health effects == + +=== Sleep === +More screen-time has been linked with shorter sleep duration, decreased sleep efficiency, and longer sleep onset delay. When using any screen before bedtime, the blue light emitted disrupts the body's natural melatonin hormone production. Melatonin is produced by the brain's pineal gland and controls the body's internal clock. This clock is what is referred to as the body's circadian rhythm and it naturally is responsive to light. Melatonin levels increase as the sun sets and remain at that increased state for the remainder of the night. As the sun rises, melatonin levels start to drop. This hormone reduction is what helps the body's natural rhythm wake up due to the bursts of natural sunlight. The light screens emit are in a similar spectrum of sunlight, but the blue light emission is what human circadian rhythms are most sensitive to. Studies have shown that the blue wavelengths are closely correlated to those from sunlight, which is what helps the body keep in sync with the sunrise and sunset. Therefore, using any screen prior to bedtime disrupts the body's production of natural bedtime hormones which can trick the brain to believe it is still daytime making it harder to fall asleep. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Screen_time-1.md b/data/en.wikipedia.org/wiki/Screen_time-1.md new file mode 100644 index 000000000..c4dfb95a6 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Screen_time-1.md @@ -0,0 +1,22 @@ +--- +title: "Screen time" +chunk: 2/4 +source: "https://en.wikipedia.org/wiki/Screen_time" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:46.015001+00:00" +instance: "kb-cron" +--- + +Increased use of screens in children has also been shown to have an association with adverse effects on the quality of sleep in children. A 2010 review concluded that "the use of electronic media by children and adolescents does have a negative impact on their sleep, although the precise effects and mechanisms remain unclear", with the most consistent results associating excessive media use with shorter sleep duration and delayed bed times. A 2016 meta-analysis found that "Bedtime access and use of media devices was significantly associated with inadequate sleep quantity; poor sleep quality; and excessive daytime sleepiness". This relationship is because much of the time spent on screens for children is at night, which can cause them to go to sleep later in addition to the blue light from the screens making it more difficult to sleep. However, the relationship between screen use and sleep may not be the same across neurotypical and neurodivergent children. There are reasons to believe that autistic children, for example, may be more interested in screens than their neurotypical peers, and less able to disengage from them. A 2025 systematic review found that a causal link between screen-time use and sleep in autistic children could not be established based on available research findings at the time. +Night-time use of screens is common for Americans ages 12–18: A 2018 nationally representative survey found that 70% use their mobile device within 30 minutes of going to sleep. Data suggests those who had spent more time on their screens were more likely to wake in the night from notifications on their phone, or experience disruptive sleep. In a series of nationally representative surveys, 36% of Americans age 12–18 and 35% of Mexican teens age 13–18 woke up during the night before to check their mobile device. For American children and teens, 54% of those did so because of getting a notification and 51% did so because of the desire to check social media. Content that stirs emotions has been linked with a delay in the onset of sleep. +Many apps promise to improve sleep by filtering out blue light produced by media devices; there have been no large studies to assess whether such apps work. Some users express dissatisfaction with the resultant orange tint of screens. Some people use blue-blocking glasses, for the purpose of attempting to block out blue light both from electronic media and from other artificial light sources. The American Academy of Pediatrics recommends that the screen time of children be limited for multiple reasons, including that "Too much screen time can also harm the amount and quality of sleep". + +=== Effects on physical health === +As well as negatively impacting the adult sleep cycle, using screens can also affect one's physical health. Obesity is commonly correlated with big screen times. Studies have suggested that if the amount of screen time adolescents spend was limited, the likelihood of obesity can be reduced. However, the associations between discretionary screen time and adverse health outcomes were strongest in those with low grip strength, fitness and physical activity and markedly attenuated in those with the highest levels of grip strength, fitness and physical activity. +This sedentary behavior is largely due to the nature of most electronic activities. Sitting to watch television, playing computer games or surfing the Internet takes time away from physical activities which leads to an increased risk of weight gain. It has been found that children (kindergarten and 1st graders) who watch 1–2 hours of television a day are more likely to be overweight or obese than children who watch less than one hour a day. Additionally, one study showed that the increased use of video games and other forms of media consumption led to more back pain among Norwegian teens. +It has been reported that screen time negatively affects health in children independently of their physical activity and eating habits. One possible explanation for the link between TV and obesity is the number of commercials for sugary and unhealthy foods. This advertising can have an effect on what gets purchased and consumed in a household. The effect of advertising was demonstrated in a study where children were shown cartoons with and without food commercials. The children who watched the food commercials along with the cartoons ate 45% more unhealthy snacks than the group who watched the cartoons without food ads. + +== Mental health effects == + +As previously discussed, sleep and screen time are heavily impacted by the other and can lead to affecting one's behavior as well. If someone does not get an adequate amount of sleep, it can affect their behavior and performance for the day. High amounts of screen time also can significantly affect a person's mental health, although some have called these findings into question. Excessive screen usages is linked with many mental health effects in children. A systematic review by Santos et al. pointed out that social media use was linked with depressive symptoms among mostly girls and that recreational screen time was linked to negative psychological effects on these children and teens. With screen usage increasing as time progresses, adults have begun spending more and more time focusing their attention on screens and not their own kids. This time spent sitting and viewing a screen has been linked to mental health effects such as anxiety and depression. Adults with screen times of six hours or greater are more likely to suffer from moderate to severe depression. This increased screen time has been shown to be directly correlated with an increased chance of depression in adults. With this added risk, lack of sleep plays a major role in a healthy mindset, and without proper rest, mental health can degrade at a higher rate. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Screen_time-2.md b/data/en.wikipedia.org/wiki/Screen_time-2.md new file mode 100644 index 000000000..512187ef8 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Screen_time-2.md @@ -0,0 +1,23 @@ +--- +title: "Screen time" +chunk: 3/4 +source: "https://en.wikipedia.org/wiki/Screen_time" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:46.015001+00:00" +instance: "kb-cron" +--- + +=== Brain development === +An increase in screen time has been associated with negative cognitive outcomes for children between 0 and 4. A study on Korean children aged 24–30 months old found that toddlers with 3 hours of TV viewing per day were three times as likely to experience a language delay. Toddlers with higher TV time also scored lower on school readiness tests, which measured vocabulary, number knowledge, and classroom engagement. The same outcomes are not present in children older than 4. Children who watched more TV were found to have less brain connectivity between language, visual and cognitive control regions of the brain than their peers who watched less TV. +An ongoing study reported from the National Institutes of Health concluded that preteens who spent over 7 hours on screens a day and children who spend less than 7 hours a day had noticeably different development of their cerebral cortex. This part of the brain usually thins as people mature but the accelerated decrease could potentially be linked to amounts spent on screens. +The American Academy of Pediatrics recommends a screen time no longer than 1 hour per day for children aged 3–5. According to a study published in November 2019, children who have a longer screen time have slower brain development and reduced "skills like imagery, mental control and self-regulation". The scientists add that: "This is important because the brain is developing the most rapidly in the first five years," "That's when brains are very plastic and soaking up everything, forming these strong connections that last for life." They also stated that screens rapidly changed childhood. The over-exposure also negatively affects literacy, cognition and language skills. + +=== Behavioral impact === +Screen use has been implicated with a slew of behavioral effects, especially in children. The primary effect is an increase in sedentary activity. Approximately 47% of American children spend 2 or more hours per day on screen-based sedentary activities. Research results indicated children who had high amounts of screen time had delayed white matter development, decreased ability to rapidly name objects, and poorer literacy skills. It has been proven that there is a negative relationship between an increase in screen time and behavioral problems in young children. Preschool aged children (between the ages of 0 and 5 years old) with over four hours of screen usages a day were shown to be 1.76 times more likely to have behavioral and conduct problems. This is in contrast with the 25.5% who reported at least 20 minutes of physical activity per day for a week. Additionally, the likelihood of a child participating in physical activity has been shown to decrease with increasing screen use. Screen use can also affect interpersonal skills. UCLA researchers reported that sixth-graders who went five days without screen use were significantly better at reading human emotions than sixth-graders with average screen use. In a study done by Muppalla et al. excessive use of screen time in adolescents is linked with triggering dopamine, which is a neurotransmitter that acts as a reward system in the brain. Leading to these children developing attention deficits, like ADHD (attention deficit hyperactivity disorder) and developing addictive tendencies on these young children. In a literature review done by Anderson et al. (2017), children who have extensive exposure to particularly violent media are at risk of developing aggressive behaviors and a desensitization towards violence. Researchers reviewed longitudinal studies, meta-analysis, experimental and cross sectional studies from the past 60 years, focusing on video game violence. + +=== Language development === +Children that spend an increased amount of time on screens have less opportunities to interact with adults and caregivers which reduces their language development. Language skills is an essential part of early childhood development, and human interaction is the best way for these children to develop those skills. When children are spending most of their time using tablets and screens there are less chances for them to interact with adults, like their parents, to expand their language skill set. It has been shown that younger, preschool-aged children and the amount of screen time they are exposed to has a negative effect on their language development. When these children are spending 2 or more hours on their screens, tablets, TVs it is more likely for them to have a poor vocabulary and shows delays in when they are starting to speak. In the Journal of Psychiatric Research a research study was performed to show the correlation between screen time and developmental and behavioral issues. This research showed that out of the 28,484 preschool aged children in the study it was concluded that children with two or more hours of screen time a day were found to have 1.54 to 2.38 times the odds of having a speech disorder and had 1.96 times more likely to have a type of learning disability, than those children who had an hour or less of screen time per day. + +=== Academic performance === +Academic performance can be improved by screen time depending on the length and content of exposure. Toddlers after the age of 18 months can be exposed to high-quality programming such as Sesame Street or PBS that provide educational television. The right content can prove beneficial, but too much screen time distracts students from studying. It is important for parents to establish a limit to how much screen time their children can use per day. Limiting and monitoring children's screen usage can increase cognitive development, but further research is required to get a better understanding of how screen time positively affects academic performance. On the other hand, increased screen use has been associated with missing school assignments. Students who used screens for more than two hours a day are twice as likely to not turn in homework on a regular basis. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Screen_time-3.md b/data/en.wikipedia.org/wiki/Screen_time-3.md new file mode 100644 index 000000000..5dcd1c010 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Screen_time-3.md @@ -0,0 +1,55 @@ +--- +title: "Screen time" +chunk: 4/4 +source: "https://en.wikipedia.org/wiki/Screen_time" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:46.015001+00:00" +instance: "kb-cron" +--- + +Research shows that children who lack guidance from their mothers are more likely to overuse screen time and also to struggle academically. Those with more prevalent maternal interference in their online activities tend to have more controlled screen time. These children also watched more educational content when online versus their counterparts with less parental control. Educational content consumed during time allotted for digital use is shown to be positively associated with academic achievement. On the other hand, those who only consumed violent media or leisurely video games on school nights, showed a negative associated with academic achievement. Their lower academic performances were marked by decreases in grade averages and in their ability to adjust to a school or academic environment. Inability to adjust to these situations resulted in a negative effect on school performance. + +== Environmental effects == +More screen time generally leads to less time spent in nature and therefore a weaker connection to it. Studies show nature-inspired activities simultaneously decrease for youth in financially stabilized countries with mental health issues increasing, drawing a connection to higher screen time levels. However, the higher the count in activities spent experiencing the outdoors produced positive results in mental health among adolescents. +Digital technologies emitted approximately 4% of world greenhouse-gas emissions in the year 2019 and the number could be two times larger by the year 2025. For comparison, the paper pulp and print industries emitted together about 1% in 2010 and about 0.9% in 2012. + +== Effects on infants and young children == +Recent research shows that excessive screen time in children under age three is associated with delayed language development, reduced sleep duration, and lower levels of physical activity. Public health guidelines recommend limiting screen exposure in early childhood and encouraging interactive, caregiver-child activities instead. Some researchers also highlight potential long-term cognitive and behavioral risks linked to early and frequent digital media use. + +== Limitations on screen time == + +=== Adults === + +There is no consensus on the safe amount of screen time for adults. Many adults spend up to 11 hours a day looking at a screen. Adults many times work jobs that require viewing screens which leads to the high screen time usage. Adults obligated to view screens for a means of work may not be able to use screen time less than two hours, but there are other recommendations that help mitigate negative health effects. For example, breaking up continuous blocks of screen time usage by stretching, maintaining good posture, and intermittently focusing on a distant object for 20 seconds. Furthermore, to mitigate the behavioral effects, adults are encouraged not to eat in front of a screen to avoid habit formation and to keep track of their screen use every day. Specialists also recommend that adults analyze their daily screen time usage and replace some of the unnecessary usage with a physical activity or social event. + +=== Children === +In 2019, the World Health Organization came out with guidelines about media use for children under 5: + +Birth to age 1: No sedentary screen time +Ages 2–4: No more than 60 minutes of sedentary screen time +More extensive guidelines have been put forth by the American Academy of Pediatrics (AAP) in 2016 for children up to age 5, which include screen time, the quality of content used, and how parents are using screens with their children. The screen time limits are as follows: + +Birth up to 18–24 months: No screen time (with the exception of video chatting) +18–24 months: Limit screen time as much as possible +Ages 2–5: Limit screen time to about an hour a day +Ages 5-18: No more than 5 hours a day +In addition to these screen time guidelines, the AAP recommends that when screen time does occur, the content should be high-quality, educational, slower-paced, and free of violence. Caregivers should avoid giving apps to children that have highly distracting content. +They also recommend that families try to use media with their child so that they can help explain what content is on the screen and how it applies to their own lives. They recommend to turn off devices (including TVs) when the child is not actively using them and to keep bedrooms as screen-free zones. Additionally, they recommend that screens should be put away at least 1 hour before bedtime. +For children from ages 5 to 18, the AAP came out with recommendations in 2016 that focus less on the amount of screen time and more on how media is being used. They recommend children and teens should keep devices (including TVs) out of the bedroom during bedtime, and screens should be put away at least 1 hour before bedtime. They recommend that caregivers discourage children and teens to use screens during homework for entertainment purposes. Additionally, they recommend that families come up with a "Family Use Plan" that aligns with their family's needs, values, and goals. This plan should have consistent guidelines and limits for each family member, and families should consider having designated times of the day and areas in the house that are screen-free. + +== See also == +Dark therapy +Delayed sleep phase disorder +f.lux +Gaming disorder +Light effects on circadian rhythm +Night Shift (software) +Problematic smartphone use +Red Moon (software) +Social aspects of television + +== References == + +== Further reading == +Anya Kamenetz (2018). The Art of Screen Time: How Your Family Can Balance Digital Media and Real Life. PublicAffairs. ISBN 978-1-61039-672-1. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Screening_(medicine)-0.md b/data/en.wikipedia.org/wiki/Screening_(medicine)-0.md new file mode 100644 index 000000000..5a7857494 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Screening_(medicine)-0.md @@ -0,0 +1,76 @@ +--- +title: "Screening (medicine)" +chunk: 1/4 +source: "https://en.wikipedia.org/wiki/Screening_(medicine)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:47.287610+00:00" +instance: "kb-cron" +--- + +In medicine, screening is a strategy used to look for as-yet-unrecognised conditions or risk markers. This testing can be applied to individuals or to a whole population without symptoms or signs of the disease being screened. +Screening interventions are designed to identify conditions which could at some future point turn into disease, thus enabling earlier intervention and management in the hope to reduce mortality and suffering from a disease. Although screening may lead to an earlier diagnosis, not all screening tests have been shown to benefit the person being screened- overdiagnosis, misdiagnosis, and creating a false sense of security are some potential adverse effects of screening. Additionally, some screening tests can be inappropriately overused. For these reasons, a test used in a screening program, especially for a disease with low incidence, must have good sensitivity in addition to acceptable specificity. +Several types of screening exist: universal (population-based) screening involves testing of all individuals in a certain category (for example, all children of a certain age). Case finding involves testing a smaller group of people based on the presence of risk factors (for example, because a family member has been diagnosed with a hereditary disease). When delivered to large numbers of people at the population level rather than by individual clinicians, testing asymptomatic people for disease because they have one or more risk factors is sometimes referred to as targeted or stratified screening. Screening interventions are not designed to be diagnostic, and often have significant rates of both false positive and false negative results. +In the US, frequently updated recommendations for screening are provided by the independent panel of experts, the United States Preventive Services Task Force. In the UK, recommendations are provided by the UK National Screening Committee. + +== Principles == +In 1968, the World Health Organization published guidelines on the Principles and practice of screening for disease, which is often referred to as the Wilson and Jungner criteria. The principles are still broadly applicable today: + +The condition should be an important health problem. +There should be a treatment for the condition. +Facilities for diagnosis and treatment should be available. +There should be a latent stage of the disease. +There should be a test or examination for the condition. +The test should be acceptable to the population. +The natural history of the disease should be adequately understood. +There should be an agreed policy on whom to treat. +The total cost of finding a case should be economically balanced in relation to medical expenditure as a whole. +Case-finding should be a continuous process, not just a "once and for all" project. +In 2008, with the emergence of new genomic technologies, the WHO synthesised and modified these with the new understanding as follows: +Synthesis of emerging screening criteria proposed over the past 40 years + +The screening programme should respond to a recognized need. +The objectives of screening should be defined at the outset. +There should be a defined target population. +There should be scientific evidence of screening programme effectiveness. +The programme should integrate education, testing, clinical services and programme management. +There should be quality assurance, with mechanisms to minimize potential risks of screening. +The programme should ensure informed consent, confidentiality and respect for personal, bodily autonomy. +The programme should promote equity and access to screening for the entire target population. +Programme evaluation should be planned from the outset. +The overall benefits of screening should outweigh the harm. +In summation, "when it comes to the allocation of scarce resources, economic considerations must be considered alongside 'notions of justice, equity, personal freedom, political feasibility, and the constraints of current law'." + +== Types == + +Mass screening (sometimes termed population-based screening): The screening of a whole population or subgroup. It is offered to all, irrespective of the risk status of the individual. +High risk or targeted screening or selective screening: High risk screening is conducted only among high-risk people. +Multiphasic screening: The application of two or more screening tests to a large population at one time, instead of carrying out separate screening tests for single diseases. +When done thoughtfully and based on research, identification of risk factors can be a strategy for medical screening. + +== Examples == + +=== Common programs === +In many countries there are population-based screening programmes. In some countries, such as the UK, policy is made nationally and programmes are delivered nationwide to uniform quality standards. Common screening programmes include: + +Cancer screening +Pap smear or liquid-based cytology to detect potentially precancerous lesions and prevent cervical cancer +Mammography to detect breast cancer +Colonoscopy and fecal occult blood test to detect colorectal cancer +Dermatological check to detect melanoma +PSA to detect prostate cancer +PPD test to screen for exposure to tuberculosis +Beck Depression Inventory to screen for depression +SPAI-B, the Liebowitz Social Anxiety Scale and Social Phobia Inventory to screen for social anxiety disorder +Alpha-fetoprotein, blood tests and ultrasound scans for pregnant women to detect fetal abnormalities +Bitewing radiographs to screen for interproximal dental caries +Ophthalmoscopy or digital photography and image grading for diabetic retinopathy +Ultrasound scan for abdominal aortic aneurysm +SARI Screening Tool for COVID-19 and MERS +Screening of potential sperm bank donors +Screening for metabolic syndrome +Screening for potential hearing loss in newborns +Hearing screening at occupational health programs + +=== School-based === +Most public school systems in the United States screen students periodically for hearing and vision deficiencies and dental problems. Screening for spinal and posture issues such as scoliosis is sometimes carried out, but is controversial as scoliosis (unlike vision or dental issues) is found in only a very small segment of the general population and because students must remove their shirts for screening. Many states no longer mandate scoliosis screenings, or allow them to be waived with parental notification. There are currently bills being introduced in various U.S. states to mandate mental health screenings for students attending public schools in hopes to prevent self-harm as well as the harming of peers. Those proposing these bills hope to diagnose and treat mental illnesses such as depression and anxiety. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Screening_(medicine)-1.md b/data/en.wikipedia.org/wiki/Screening_(medicine)-1.md new file mode 100644 index 000000000..4964cde89 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Screening_(medicine)-1.md @@ -0,0 +1,38 @@ +--- +title: "Screening (medicine)" +chunk: 2/4 +source: "https://en.wikipedia.org/wiki/Screening_(medicine)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:47.287610+00:00" +instance: "kb-cron" +--- + +=== Screening for social determinants of health === +The social determinants of health are the economic and social conditions that influence individual and group differences in health status. Those conditions may have adverse effects on their health and well-being. To mitigate those adverse effects, certain health policies like the United States Affordable Care Act (2010) gave increased traction to preventive programs, such as those that routinely screen for social determinants of health. Screening is believed to a valuable tool in identifying patients' basic needs in a social determinants of health framework so that they can be better served. + +==== Policy background in the United States ==== +When established in the United States, the Affordable Care Act was able to bridge the gap between community-based health and healthcare as a medical treatment, leading to programs that screened for social determinants of health. The Affordable Care Act established several services with an eye for social determinants or an openness to more diverse clientele, such as Community Transformation Grants, which were delegated to the community in order to establish "preventive community health activities" and "address health disparities". + +==== Clinical programs ==== +Social determinants of health include social status, gender, ethnicity, economic status, education level, access to services, education, immigrant status, upbringing, and much, much more. Several clinics across the United States have employed a system in which they screen patients for certain risk factors related to social determinants of health. In such cases, it is done as a preventive measure in order to mitigate any detrimental effects of prolonged exposure to certain risk factors, or to simply begin remedying the adverse effects already faced by certain individuals. They can be structured in different ways, for example, online or in person, and yield different outcomes based on the patient's responses. Some programs, like the FIND Desk at UCSF Benioff Children's Hospital, employ screening for social determinants of health in order to connect their patients with social services and community resources that may provide patients greater autonomy and mobility. + +== Medical equipment used == +Medical equipment used in screening tests is usually different from equipment used in diagnostic tests as screening tests are used to indicate the likely presence or absence of a disease or condition in people not presenting symptoms; while diagnostic medical equipment is used to make quantitative physiological measurements to confirm and determine the progress of a suspected disease or condition. Medical screening equipment must be capable of fast processing of many cases, but may not need to be as precise as diagnostic equipment. + +== Limitations == +Screening can detect medical conditions at an early stage before symptoms present while treatment is more effective than for later detection. In the best of cases lives are saved. Like any medical test, the tests used in screening are not perfect. The test result may incorrectly show positive for those without disease (false positive), or negative for people who have the condition (false negative). Limitations of screening programmes can include: + +Screening can involve cost and use of medical resources on a majority of people who do not need treatment. +Adverse effects of screening procedure (e.g. stress and anxiety, discomfort, radiation exposure, chemical exposure). +Stress and anxiety caused by prolonging knowledge of an illness without any improvement in outcome. This problem is referred to as overdiagnosis (see also below). +Stress and anxiety caused by a false positive screening result. +Unnecessary investigation and treatment of false positive results (namely misdiagnosis with Type I error). +A false sense of security caused by false negatives, which may delay final diagnosis (namely misdiagnosis with Type II error). +Screening for dementia in the English NHS is controversial because it could cause undue anxiety in patients and support services would be stretched. A GP reported "The main issue really seems to be centred around what the consequences of a such a diagnosis is and what is actually available to help patients." + +== Analysis == +To many people, screening instinctively seems like an appropriate thing to do, because catching something earlier seems better. However, no screening test is perfect. There will always be the problems with incorrect results and other issues listed above. It is an ethical requirement for balanced and accurate information to be given to participants at the point when screening is offered, in order that they can make a fully informed choice about whether or not to accept. +Before a screening program is implemented, it should be looked at to ensure that putting it in place would do more good than harm. The best studies for assessing whether a screening test will increase a population's health are rigorous randomized controlled trials.When studying a screening program using case-control or, more usually, cohort studies, various factors can cause the screening test to appear more successful than it really is. A number of different biases, inherent in the study method, will skew results. + +=== Overdiagnosis === \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Screening_(medicine)-2.md b/data/en.wikipedia.org/wiki/Screening_(medicine)-2.md new file mode 100644 index 000000000..04709f69e --- /dev/null +++ b/data/en.wikipedia.org/wiki/Screening_(medicine)-2.md @@ -0,0 +1,30 @@ +--- +title: "Screening (medicine)" +chunk: 3/4 +source: "https://en.wikipedia.org/wiki/Screening_(medicine)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:47.287610+00:00" +instance: "kb-cron" +--- + +Screening may identify abnormalities that would never cause a problem in a person's lifetime. +An example of this is prostate cancer screening; it has been said that "more men die with prostate cancer than of it". Autopsy studies have shown that between 14 and 77% of elderly men who have died of other causes are found to have had prostate cancer. +Aside from issues with unnecessary treatment (prostate cancer treatment is by no means without risk), overdiagnosis makes a study look good at picking up abnormalities, even though they are sometimes harmless. +Overdiagnosis occurs when all of these people with harmless abnormalities are counted as "lives saved" by the screening, rather than as "healthy people needlessly harmed by overdiagnosis". So it might lead to an endless cycle: the greater the overdiagnosis, the more people will think screening is more effective than it is, which can reinforce people to do more screening tests, leading to even more overdiagnosis. Raffle, Mackie and Gray call this the popularity paradox of screening: "The greater the harm +through overdiagnosis and overtreatment from screening, the more people there are who believe they owe their health, or even their life, to the programme"(p56 Box 3.4) +The screening for neuroblastoma, the most common malignant solid tumor in children, in Japan is a very good example of why a screening program must be evaluated rigorously before it is implemented. In 1981, Japan started a program of screening for neuroblastoma by measuring homovanillic acid and vanilmandelic acid in urine samples of six-month-old infants. In 2003, a special committee was organized to evaluate the motivation for the neuroblastoma screening program. In the same year, the committee concluded that there was sufficient evidence that screening method used in the time led to overdiagnosis, but there was no enough evidence that the program reduced neuroblastoma deaths. As such, the committee recommended against screening and the Ministry of Health, Labor and Welfare decided to stop the screening program. +Another example of overdiagnosis happened with thyroid cancer: its incidence tripled in United States between 1975 and 2009, while mortality was constant. In South Korea, the situation was even worse with 15-fold increase in the incidence from 1993 to 2011 (the world's greatest increase of thyroid cancer incidence), while the mortality remained stable. The increase in incidence was associated with the introduction of ultrasonography screening. +The problem of overdiagnosis in cancer screening is that at the time of diagnosis it not possible to differentiate between a harmless lesion and lethal one, unless the patient is not treated and dies from other causes. So almost all patients tend to be treated, leading to what is called overtreatment. As researchers Welch and Black put it, "Overdiagnosis—along with the subsequent unneeded treatment with its attendant risks—is arguably the most important harm associated with early cancer detection." + +=== Lead time bias === + +If screening works, it must diagnose the target disease earlier than it would be without screening (when symptoms appear). +Even if in both cases (with screening vs without screening) patients die at the same time, just because the disease was diagnosed earlier by screening, the survival time since diagnosis is longer in screened people than in persons who was not screened. This happens even when life span has not been prolonged. As the diagnosis was made earlier without life being prolonged, the patient might be more anxious as he must live with knowledge of his diagnosis for longer. +If screening works, it must introduce a lead time. So statistics of survival time since diagnosis tends to increase with screening because of the lead time introduced, even when screening offers no benefits. If we do not think about what survival time actually means in this context, we might attribute success to a screening test that does nothing but advance diagnosis. As survival statistics suffers from this and other biases, comparing the disease mortality (or even all-cause mortality) between screened and unscreened population gives more meaningful information. + +=== Length time bias === + +Many screening tests involve the detection of cancers. Screening is more likely to detect slower-growing tumors (due to longer pre-clinical sojourn time) that are less likely to cause harm. Also, those aggressive cancers tend to produce symptoms in the gap between scheduled screening, being less likely to be detected by screening. So, the cases screening often detects automatically have better prognosis than symptomatic cases. The consequence is those more slow progressive cases are now classified as cancers, which increases the incidence, and due to its better prognosis, the survival rates of screened people will be better than non-screened people even if screening makes no difference. + +=== Selection bias === \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Screening_(medicine)-3.md b/data/en.wikipedia.org/wiki/Screening_(medicine)-3.md new file mode 100644 index 000000000..d7f39a121 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Screening_(medicine)-3.md @@ -0,0 +1,29 @@ +--- +title: "Screening (medicine)" +chunk: 4/4 +source: "https://en.wikipedia.org/wiki/Screening_(medicine)" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:47.287610+00:00" +instance: "kb-cron" +--- + +Not everyone will partake in a screening program. There are factors that differ between those willing to get tested and those who are not. +If people with a higher risk of a disease are more likely to be screened, for instance women with a family history of breast cancer are more likely than other women to join a mammography program, then a screening test will look worse than it really is: negative outcomes among the screened population will be higher than for a random sample. +Selection bias may also make a test look better than it really is. If a test is more available to young and healthy people (for instance if people have to travel a long distance to get checked) then fewer people in the screening population will have negative outcomes than for a random sample, and the test will seem to make a positive difference. +Studies have shown that people who attend screening tend to be healthier than those who do not. This has been called the healthy screenee effect, which is a form of selection bias. The reason seems to be that people who are healthy, affluent, physically fit, non-smokers with long-lived parents are more likely to come and get screened than those on low-income, who have existing health and social problems. One example of selection bias occurred in Edinbourg trial of mammography screening, which used cluster randomisation. The trial found reduced cardiovascular mortality in those who were screened for breast cancer. That happened because baseline differences regarding socio-economic status in the groups: 26% of the women in the control group and 53% in the study group belonged to the highest socioeconomic level. Cardiovascular risk screening is a vital tool in reducing the global incidence of cardiovascular diseases. + +=== Study Design for the Research of Screening Programs === +The best way to minimize selection bias is to use a randomized controlled trial, though observational, naturalistic, or retrospective studies can be of some value and are typically easier to conduct. Any study must be sufficiently large (include many patients) and sufficiently long (follow patients for many years) to have the statistical power to assess the true value of a screening program. For rare diseases, hundreds of thousands of patients may be needed to realize the value of screening (find enough treatable disease), and to assess the effect of the screening program on mortality a study may have to follow the cohort for decades. Such studies take a long time and are expensive, but can provide the most useful data with which to evaluate the screening program and practice evidence-based medicine. + +==== All-cause mortality vs disease-specific mortality ==== +The main outcome of cancer screening studies is usually the number of deaths caused by the disease being screened for - this is called disease-specific mortality. To give an example: in trials of mammography screening for breast cancer, the main outcome reported is often breast cancer mortality. However, disease-specific mortality might be biased in favor of screening. In the example of breast cancer screening, women overdiagnosed with breast cancer might receive radiotherapy, which increases mortality due to lung cancer and heart disease. The problem is those deaths are often classified as other causes and might even be larger than the number of breast cancer deaths avoided by screening. So the non-biased outcome is all-cause mortality. The problem is that much larger trials are needed to detect a significant reduction in all-cause mortality. In 2016, researcher Vinay Prasad and colleagues published an article in BMJ titled "Why cancer screening has never been shown to save lives", as cancer screening trials did not show all-cause mortality reduction. + +== See also == + +== References == + +== Further reading == +UK National Screening Committee Criteria for appraising the viability, appropriateness and effectiveness of a screening programme [accessed October 2019] and Oxford Medicine Online +Raffle, Mackie, Gray Screening: evidence and practice. Oxford University Press 2019 ISBN 9780198805984 +Health Knowledge Interactive Learning Module on Screening by Angela Raffle. Last accessed October 2019. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Secondary_malignant_neoplasm-0.md b/data/en.wikipedia.org/wiki/Secondary_malignant_neoplasm-0.md new file mode 100644 index 000000000..d1d44fa40 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Secondary_malignant_neoplasm-0.md @@ -0,0 +1,14 @@ +--- +title: "Secondary malignant neoplasm" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Secondary_malignant_neoplasm" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:48.442724+00:00" +instance: "kb-cron" +--- + +Secondary malignant neoplasm is a malignant tumor whose cause is the treatment (usually radiation or chemotherapy) which was used for a prior tumor. It must be distinguished from Metastasis from the prior tumor or a relapse from it since a secondary malignant neoplasm is a different tumor. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Secretomotor-0.md b/data/en.wikipedia.org/wiki/Secretomotor-0.md new file mode 100644 index 000000000..a2a221dc1 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Secretomotor-0.md @@ -0,0 +1,16 @@ +--- +title: "Secretomotor" +chunk: 1/1 +source: "https://en.wikipedia.org/wiki/Secretomotor" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:49.703071+00:00" +instance: "kb-cron" +--- + +The adjective secretomotor refers to the capacity of a structure (often a nerve) to induce a gland to secrete a substance (usually mucus or serous fluid). +Secretomotor nerve endings are frequently contrasted with sensory neuron endings and motor nerve endings. An example of secretomotor activity can be seen with the lacrimal gland, which secretes the aqueous layer of the tear film. The lacrimal branch of the ophthalmic nerve (itself a branch of trigeminal nerve V1) supplies secretomotor innervation to the lacrimal gland, stimulating its secretion of the aqueous layer. However, these nerves fibers originate from the facial nerve (VII) and only travel briefly with fibers from the trigeminal nerve. +Secretomotor neurons in the intestines and gall bladder control the movement of fluid and electrolytes. + + +== References == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Sedentary_lifestyle-0.md b/data/en.wikipedia.org/wiki/Sedentary_lifestyle-0.md new file mode 100644 index 000000000..6fac1a074 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Sedentary_lifestyle-0.md @@ -0,0 +1,49 @@ +--- +title: "Sedentary lifestyle" +chunk: 1/2 +source: "https://en.wikipedia.org/wiki/Sedentary_lifestyle" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:51.056809+00:00" +instance: "kb-cron" +--- + +Sedentary lifestyle is a lifestyle type, in which one is physically inactive and does little or no physical movement and/or exercise. A person living a sedentary lifestyle is often sitting or lying down while engaged in an activity like socializing, watching TV, playing video games, reading or using a mobile phone or computer for much of the day. A sedentary lifestyle contributes to poor health quality, diseases as well as many preventable causes of death. +Sitting time is a common measure of a sedentary lifestyle. A global review representing 47% of the global adult population found that the average person sits down for 4.7 to 6.5 hours a day with the average going up every year. +Screen time is a term for the amount of time a person spends looking at a screen such as a television, computer monitor, or mobile device. Excessive screen time is linked to negative health consequences. + +== Definition == + +Sedentary behavior is not the same as physical inactivity: sedentary behavior is defined as "any waking behavior characterized by an energy expenditure less than or equal to 1.5 metabolic equivalents (METs), while in a sitting, reclining or lying posture". Spending most waking hours sitting does not necessarily mean that an individual is sedentary, though sitting and lying down most frequently are sedentary behaviors. Esmonde-White defines a sedentary lifestyle as a lifestyle that involves "longer than six hours a day" of sedentary behavior. + +== Health effects == + +Effects of a sedentary work life or lifestyle can be either direct or indirect. One of the most prominent direct effect of a sedentary lifestyle is an increased body mass index (BMI) leading to obesity. In 2006, Lawrence D. Frank co-authored a highly-cited (over 1,900 citations) article: Many Pathways from Land Use to Health. They determined that a 5% increase in a community's walkability index was associated with a 32.1% increase in time spent walking or biking and a .23-point reduction in BMI. +A country-level study examining the global cost of disease and its associated risk factors identified obesity as a top-seven risk factor associated with attributable death and a top-eight risk factor associated with attributable disease burden. Obesity was a top-three risk factor for high-income countries. +At least 300,000 premature deaths, and $90 billion in direct healthcare costs are caused by obesity and sedentary lifestyle per year in the US alone. The risk is higher among those that sit still more than five hours per day. It is shown to be a risk factor on its own independent of hard exercise and BMI. People that sit still more than four hours per day have a 40 percent higher risk than those that sit fewer than four hours per day. However, those that exercise at least four hours per week are as healthy as those that sit fewer than four hours per day. +Indirectly, an increased BMI due to a sedentary lifestyle can lead to decreased productivity and increased absenteeism from necessary activities like work. + +A sedentary lifestyle contributes to or can be a risk factor for: + +=== Brain function === +Extended periods of sitting reduce overall blood circulation. This diminished blood flow leads to reduced oxygen delivery to the brain (cerebral hypoxia), impairing cognitive functions such as concentration and alertness. The brain relies heavily on a continuous supply of oxygen and glucose for optimal performance; decreased circulation hampers this supply, resulting in cognitive sluggishness and decreased mental sharpness. + +=== Neck and shoulders === +Sitting, particularly with poor posture, often involves craning the neck forward to look at screens or documents. Such forward head posture puts excessive strain on the cervical vertebrae, leading to muscle tension and pain in the neck and shoulders. Over time, this can cause the cervical vertebrae to become misaligned permanently, leading to chronic neck pain and potential nerve impingement. + +=== Upper body and back === + +The intervertebral discs, which act as cushions between the vertebrae, are subjected to constant pressure when sitting for prolonged periods. This compression can lead to disc degeneration and herniation. Additionally, collagen, a primary structural protein in tendons and ligaments, tends to harden when not regularly stretched and mobilized, which leads to decreased flexibility and increased risk of injury in the back. + +=== Heart disease === + +Physical inactivity reduces the efficiency of the cardiovascular system. Sluggish blood flow allows for the accumulation of fatty acids and lipids in the blood vessels. These deposits can adhere to the vessel walls, forming plaques (atherosclerosis), which eventually narrow the arteries and restrict blood flow. This condition increases the risk of coronary artery disease and heart attacks as the heart struggles to receive adequate oxygen and nutrients. +One study found that interrupting sitting with 20 minutes of light-intensity walking each hour significantly reduced systolic and diastolic blood pressure in healthy participants or 3 minutes of light intensity walking every 30 minutes. + +=== Overproductive pancreas === +A sedentary lifestyle contributes to decreased muscle activity, which affects glucose metabolism. Reduced muscle activity leads to lower insulin sensitivity, prompting the pancreas to produce more insulin to maintain normal blood glucose levels (metabolic syndrome). Chronic overproduction of insulin can exhaust the pancreas and contribute to insulin resistance, a precursor to type 2 diabetes. + +=== Leg problems === +Prolonged sitting impedes venous return from the legs to the heart, leading to venous stasis (slow blood flow in the veins). This can cause fluid to pool in the lower extremities, resulting in swelling (edema) and varicose veins. Also, sluggish blood flow increases the risk of clot formation, potentially leading to deep vein thrombosis (DVT), a condition where blood clots form in the deep veins, which can travel to the lungs and cause a life-threatening pulmonary embolism. + +== Mitigation == \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Sedentary_lifestyle-1.md b/data/en.wikipedia.org/wiki/Sedentary_lifestyle-1.md new file mode 100644 index 000000000..34c6e36bc --- /dev/null +++ b/data/en.wikipedia.org/wiki/Sedentary_lifestyle-1.md @@ -0,0 +1,41 @@ +--- +title: "Sedentary lifestyle" +chunk: 2/2 +source: "https://en.wikipedia.org/wiki/Sedentary_lifestyle" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:51.056809+00:00" +instance: "kb-cron" +--- + +Adults and children spend long amounts of time sitting in a workplace or at a school, which is why interventions have been focused in these two areas. Mass media campaigns might also be able to reduce the amount of time spent sitting or lying down and positively affect the intention to be active physically. +Recent innovations in AI technology have led to the development of exercise prescription systems designed to reduce sedentary behavior. These systems deliver personalized exercise plans by analyzing individual health metrics, potentially decreasing the prevalence of a sedentary lifestyle and its associated health risks. + +=== In urban spaces === +Some evidence has been found of a negative association between exposure to an existing urban motorway and moderate to vigorous physical activity. The proportion of physically active individuals was higher in high- versus low-walkability neighborhoods. Rising rates of being overweight, obesity, and physical inactivity in China's rapidly growing cities and urban populations have been due to urban development practices and policies. + +=== In a work environment === +Occupational sedentary behaviour accounts for a significant proportion of sitting time for many adults. Some workplaces have implemented exercise classes at lunch, walking challenges among coworkers, or allowing employees to stand rather than sit at their desks during work. Workplace interventions such as alternative activity workstations, sit-stand desks, and promotion of stair use are among measures implemented to counter the harms of a sedentary workplace. + +==== Research ==== +A 2018 Cochrane review concluded that "At present there is low‐quality evidence that sit‐stand desks may reduce sitting at work in the first year of their use. However, the effects are likely to reduce with time. There is generally insufficient evidence to draw conclusions about such effects for other types of interventions and for the effectiveness of reducing workplace sitting over periods longer than one year." +An intervention to encourage office workers to stand and move reduced their sitting time by 22 minutes after 1 year; the effect was 3-times greater when the intervention included a sit-to-stand desk. The intervention also led to small improvements in stress, wellbeing and vigor. + +=== In education === +The majority of time children are in a classroom, they are seated (60% of the time). Children who regularly engage in physical activity are more likely to become healthy adults; children benefit both physically and mentally when they replace sedentary behavior with active behavior. Despite this knowledge and due in part to an increase in sedentary behaviors, as of 2018 children have 8 fewer hours of free play each week than they did 20 years before. +Several studies have examined the effects of adding height-adjustable standing desks to classrooms, which have reduced the time spent sitting. However, associating the reduction in sitting with health effects is challenging. In one study conducted on Australian school children, known as the Transform-Us! study, interventions reduced the amount of time children spent sitting in the classroom, which was associated with lower body mass index and waist circumference. The interventions used in the study included stand-up desks and easels, the use of timers, and sport and circus equipment in the classroom. Teachers also made lessons more active, and added breaks to lessons to promote active time. In the US, another intervention for children is promoting the use of active transportation to and from school, such as through the Safe Routes to School program. + +== History == + +Over the last hundred years, there has been a large shift from manual labor jobs (e.g. farming, manufacturing, building) to office jobs which is due to many contributing factors including globalization, outsourcing of jobs and technological advances (specifically internet and computers). In 1960, there was a decline of jobs requiring moderate physical activity from 50% to 20%, and one in two Americans had a physically demanding job, while in 2011 this ratio was one in five. From 1990 to 2016, there was a decrease of about one third in manual labor jobs/employment. In 2008, the United States American National Health Interview Survey found that 36% of adults were inactive, and 59% of adult respondents never participated in vigorous physical activity lasting more than 10 minutes per week. +According to a 2018 study, office based workers typically spend 70–85% sitting. In the US population, prevalence of sitting watching television or videos at least 2 h/d was high in 2015–2016 (ranging from 59% to 65%); the estimated prevalence of computer use outside school or work for at least 1 h/d increased from 2001 to 2016 (from 43% to 56% for children, from 53% to 57% among adolescents, and from 29% to 50% for adults); and estimated total sitting time increased from 2007 to 2016 (from 7.0 to 8.2 h/d among adolescents and from 5.5 to 6.4 h/d among adults). + +== See also == + +== References == + +== Further reading == + +== External links == + +WHO fact sheet on physical activity \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Self-diagnosis-0.md b/data/en.wikipedia.org/wiki/Self-diagnosis-0.md new file mode 100644 index 000000000..a7412cbb0 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Self-diagnosis-0.md @@ -0,0 +1,33 @@ +--- +title: "Self-diagnosis" +chunk: 1/4 +source: "https://en.wikipedia.org/wiki/Self-diagnosis" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:52.335800+00:00" +instance: "kb-cron" +--- + +Self-diagnosis is the process of diagnosing, or identifying, medical conditions in oneself. It may be assisted by medical dictionaries, books, resources on the Internet, past personal experiences, or recognizing symptoms or medical signs of a condition that a family member previously had or currently has. +Depending on the nature of an individual's condition and the accuracy of the information they access, self-diagnoses can vary greatly in their safety. Due to self-diagnoses' varied accuracy, public attitudes toward self-diagnosis include denials of its legitimacy and applause of its ability to promote healthcare access and allow for individuals to find solidarity and support. Furthermore, external influences such as marketing, social media trends, societal stigma around disease, and to which demographic population one belongs greatly affect the use of self-diagnosis. + +== Appropriate use == +Self-diagnosis is prone to error and may be potentially dangerous if inappropriate decisions are made, which can stem from broad or inaccurately applied symptoms as well as confirmation bias. Because of the risks, self-diagnosis is officially discouraged by physicians and patient care organizations. Physicians are also discouraged from engaging in self-diagnosis due to potential lack of objectivity. An inaccurate self-diagnosis—a misdiagnosis—can result in improper health care, including using the wrong treatment or not seeking care for a serious condition that was under-diagnosed. Further concerns include undermining physician authority, lacking an unbiased view of oneself, overestimating one's symptoms, or adopting a state of denial about these symptoms. +However, self-diagnosis may be appropriate under certain circumstances. The use of over-the-counter (non-prescription) medications is often involved in self-diagnosis for conditions that are unlikely to be serious and have a low risk of harm by incorrect medication. Some conditions are more likely to be self-diagnosed, especially simple conditions such as head lice and skin abrasions or familiar conditions such as menstrual cramps, headache or the common cold. During the COVID-19 pandemic, self-diagnosis through the use of self-testing kits became commonplace and endorsed by governments, the Centers for Disease Control and Prevention (CDC) providing guidelines by which the American public should go about self-testing. +Complex conditions, including conditions like ADHD in adults and autism spectrum disorder (ASD), are more difficult to self-diagnose accurately. Such self-diagnoses are complicated by multiple factors, such as direct-to-consumer marketing of medications, which is widely criticized for promoting inappropriate self-diagnosis. Additionally, especially among younger generations, access to social media and the Internet has increased the ease with which individuals can access symptom lists and self-diagnose themselves with these complex conditions, potentially inaccurately. + +== Influencing factors == + +=== Marketing === + +==== Direct-to-consumer advertising ==== +Pharmaceutical and medical companies consider self-diagnosis in their marketing strategies as a means of connecting with their consumer base. Pharmaceutical companies have put a considerable amount of funding into marketing campaigns, which a 2007 study linked to an increase in seemingly healthy patients seeking out more diagnostic screenings. Specific marketing campaigns, termed disease awareness campaigns, disseminate information about a certain condition to consumers, rather than specific patients already diagnosed, and promote specific drugs developed by a pharmaceutical company as a remedy for said condition. +Often, these campaigns are proliferated through the creation of unbranded websites with checklists of ambiguous and broad symptoms that are stated to be representative of a specific disease, which has caused the American Medical Association (AMA) to warn doctors of this form of direct-to-consumer advertising. The AMA's concern was that the symptom checklists state that a widely applicable set of symptoms are indicative of a specific condition, improperly educating consumers about the disease and convincing them to adopt that diagnosis for a condition they may not have. Ebling assesses that naming the disease gives it an increased authenticity that merits a medical solution, which the websites present to be a specific, branded drug, all without appearing to be obviously sponsored. Medical professionals have taken concern with this promotion of a medical solution, accusing it to be a means of profiting off of consumers who are attempting to treat a condition they may not have. Doctors further criticize these campaigns for being misleading because they also often use language that celebrates the agency a patient is assuming over themselves by gaining this knowledge and seeking out a solution. +These ambiguous symptom checklists have been mirrored by advertisements by medical brands on TikTok that present their content as traditional influencer posts, then asking users if they exhibit any symptoms that could be applied to various conditions, such as "Are you nervous?" From this point, like the websites, these advertisements encourage users to empower themselves to address a specific condition they might have by using the company's services, which may include consultations or specific medications. +However, there is no consensus among studies as to whether exposure to direct-to-consumer advertising leads to a higher rate of requesting brand-name drugs. + +==== Premenstrual dysphoric disorder (PMDD) ==== +The pharmaceutical industry has also played a role in promoting drugs that treat premenstrual dysphoric disorder (PMDD). Sarafem, a differently-branded version of Prozac, which is used to treat depression, was created during the time when Prozac's patent was soon to expire. United States patent law required Eli Lilly and Company, Prozac's developer, to present a new use for the drug to extend their patent. Ebling states that Eli Lilly sought out doctors who would support the designation of PMDD as its own disease, resulting in FDA recognition of the condition and approval of Sarafem to serve as a treatment for it. The company succeeded in avoiding the competition that would have been generated by the production of a generic version of Prozac. +Since then, PMDD has become more commonly recognized, now having its own category in the DSM-V. However, it is still not consistently recognized among healthcare professionals due to some doctors still considering it a contested condition. + +==== Self-diagnosis kits ==== \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Self-diagnosis-1.md b/data/en.wikipedia.org/wiki/Self-diagnosis-1.md new file mode 100644 index 000000000..cfc7c7447 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Self-diagnosis-1.md @@ -0,0 +1,33 @@ +--- +title: "Self-diagnosis" +chunk: 2/4 +source: "https://en.wikipedia.org/wiki/Self-diagnosis" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:52.335800+00:00" +instance: "kb-cron" +--- + +Self-diagnosis itself is becoming a more lucrative industry given the popularity of self-testing kits. While these are most commonly associated with COVID-19, self-testing kits exist for a wide range of conditions, such as prostate cancer, Alzheimers, and menopause. Though healthcare professionals warn of their potential to be unreliable, these kits appeal to the public due to their easy use, convenience, and inexpensiveness. Despite the fact that doctors warn that they cannot necessarily conclusively diagnose a condition nor encapsulate a disease's full complexity, the industry creating these tests is growing in profitability. + +==== Smartphone applications ==== +Developers of medical diagnosis applications can also be fueled by commercial interests. A number of applications receive monetary returns for acting as referrals to health insurance companies, doctor's offices, and pharmacies. These forms of monetary compensation are often not mentioned in the app's contents or general overview. + +=== The role of stigma === + +==== Public stigma ==== +Though self-diagnosis may work to counter the stigma associated with disease, it faces its own share of public disapproval. Those who publish posts encouraging self-diagnosis do not always have verified medical credentials even though they often present their posts as providing expert advice. As a result, self-diagnoses are not always accepted by the public because they can be seen as misleading (see later section on Use of Social Media and Webpages). +Medical experts are concerned that self-diagnosis can overemphasize and enforce stereotypical perceptions of a disorder, positing that social media posting can ignore the medical complexity of physical and mental health disorders. + +==== Support ==== +Self-diagnosis can provide a reprieve from societal stigma surrounding mental illness. An individual who diagnoses themselves with a condition is able to seek out online communities of others with the same condition, providing them with a sense of recognition and belonging. On TikTok, those who deem themselves to exhibit traits of conditions such as obsessive-compulsive disorder, dissociative identity disorder, and ASD have found communities of support. Similarly, specific online communities exist for autistic people, which autistic adults report as assisting with combatting feelings of not fitting in prior to being able to identify with the disorder. Communities for health problems not necessarily recognized by the medical establishment also exist online with the same purpose of providing support and understanding. +Relatedly, self-diagnosis can foster a sense of self-understanding that promotes self-acceptance in the face of harsh social norms. This has been particularly influential for autistic people. Autistic people may display different behaviors than non-autistic individuals, prompting autistic people to feel "othered." Without an explanation as to why they may feel different than others, they have a higher likelihood of feeling confused and having low self-esteem, studies linking delayed diagnosis in autistic individuals with higher rates of anxiety, depression, and suicidal tendencies. Autistic adults also often face barriers and deterrents to receiving a formal diagnosis, especially if they are from a marginalized community. However, advocates for self-diagnosis posit that with an explanation, autistic people can understand why they may feel different, alleviating this burden. This understanding can also promote a greater comprehension of their strengths, weaknesses, and symptoms, allowing them to better navigate everyday life. +Additionally, social media users argue that the prevalence of self-diagnosis has promoted an open discussion surrounding mental health, working to remove the stigmas from various diseases and conditions. Online discussion of self-diagnosis has also been espoused as a tool to provide the benefits of a diagnosis to those who face financial or geographic boundaries to receiving a professional diagnosis. + +=== Prevalence of the internet === +The Internet and other connected resources have become popular places to start the self-diagnosis process. The availability of medical information online allows patients to have greater access to medical knowledge. + +==== Smartphone applications ==== +There are a multitude of medical and health apps available on both the Apple App Store and Google Play Store that can be used for self-diagnosing purposes. Approximately 20% of smartphone users have a health-related application downloaded onto their device. +Experts have criticized the creators of such medical apps as promoting a false sense of credibility in order to increase the number of downloads. For example, these apps will often use widely recognized medical symbols such as the red cross or a stethoscope on their thumbnails and diagnostic pages, as well as emphasize terms such as "algorithm", "sensors", and "computer" in the diagnosis process to convey a sense of scientific objectivity. Lupton and Jutel, in their analysis of 35 self-diagnosis apps, argue that these techniques portray self-diagnosis apps as having an augmented authority in determining diagnoses. +In relation to the amount of power that health-related smartphone apps have in determining a diagnosis, researchers have emphasized the importance of using such apps judiciously. In order to maintain a balance between patient agency and professional medical authority, many self-diagnosis applications remind users of the incomplete medical certainty of the diagnosis provided and to encourage them to obtain secondary professional medical advice from a doctor or specialist. Additionally, the sources of application diagnosis information can often be difficult to determine or verify. There have been cases where certain health-related applications made claims to receiving significant contributions of content from prestigious educational institutions to increase downloads, but little information was provided as to the extent and verifiability of such contributions. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Self-diagnosis-2.md b/data/en.wikipedia.org/wiki/Self-diagnosis-2.md new file mode 100644 index 000000000..a69ee8f80 --- /dev/null +++ b/data/en.wikipedia.org/wiki/Self-diagnosis-2.md @@ -0,0 +1,29 @@ +--- +title: "Self-diagnosis" +chunk: 3/4 +source: "https://en.wikipedia.org/wiki/Self-diagnosis" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:52.335800+00:00" +instance: "kb-cron" +--- + +==== Use of chatbots ==== +A recent technology that has started to take hold in the realm of self-diagnosis is the utilization of chatbot-based symptom checker (CSC) applications. CSCs were designed to combat the problem of extended wait times to see a doctor and the unavailability of punctual medical advice. Patients have also utilized chatbots to determine severity of their potential diagnosis before going through the process of seeing a doctor and incurring the financial strain that can come with it. Chatbots utilize artificial intelligence (AI) in order to assist patients in their medical concerns during all hours of the day. The operational mechanism of CSCs is a text-to-text system, where the chatbot asks a series of health-related questions in order to determine a diagnosis. The effectiveness of chatbots in the process of self-diagnosis is still highly debated among researchers. +Studies have found that users have varying opinions on the required input for chatbot websites and applications. In some cases, chatbots offer limited space to input multiple symptoms and locations of symptoms for diagnosis determination. Interfaces have presented users with a "pre-structured symptom selection list" which has forced users to be more general with their responses than they would prefer. Other users have felt that questions asked by self-diagnosing chatbots require too much detail, leaving them confused or overwhelmed. +People are also using AI chatbots for self-diagnosis. + +==== Social media ==== +Social media has started to take on a particularly important role in the process of self-diagnosis, especially the diagnosis of mental health disorders. Social media users seeking answers often self-diagnose after resonating with a particular trait of a disorder that has been mentioned in a social media post. Self-diagnosis through social media is generally more prevalent in individuals who have obsessive–compulsive disorder (OCD), anxiety, depression, or other complex trauma. +Increased access to the ability to self-diagnose via the Internet can have benefits for patient-doctor communication. By assessing a patient's self-diagnosis, a medical professional can see with which specific traits of a disease the patient identified and can work with them to create a potentially more effective diagnosis and treatment. +Self-diagnosis through social media may have some drawbacks associated with it. Some social media postings can simplify a diagnosis, leading to a spread of misinformation about the emphasized disease. Some online self-diagnosis tests state that common, broad symptoms, like anxiety and mood swings, are definite indicators of specific disorders, causing social media users to report such posts for inaccuracy. People who publish health-related posts on the self-diagnosis of health issues may not have verified medical credentials even though they have posed their post as providing expert advice. Journalist and author Doreen Dodgen-Magee considers self-diagnosis tests to work due to confirmation bias, which was witnessed when there was a statistical increase in the number of teenage girls approaching their doctors with a concern they had Tourette syndrome after multiple videos naming broad symptoms as signs of Tourettes went viral on TikTok. + +== Impact on varying demographics == + +=== Ethnic and socio-economic backgrounds === + +==== Vulnerable demographics ==== +Ani and Bazargan from the Department of Family Medicine and Research Centers in Minority Institutions found that accessibility, affordability, continuity of medical care, and financial strains are the primary factors that determine whether patients choose to use self-diagnose or formal diagnoses. By utilizing the Behavioral Model for Vulnerable Populations, the study sampled over 1,394 African American and Latino households. Apart from their minority ethnic status, the households also had the following intersectional identities: 89% were female, 50% were single-parent households, 60% had less than a high school education, 73% were unemployed, and 33% were non-English speakers. Throughout the research process, 43% of the participants reported that a physician had never diagnosed at least one of their illnesses. The study's results note the significant influence of socio-economic backgrounds on using self-diagnosis as a more efficient and accessible medical solution. The study, however, also raised a concern regarding self-diagnosis in minority communities. Results show that the possibility of seeking self-diagnosis was far more likely when there were noticeable symptoms than when the symptoms were non-noticeable. If regular health checks were not offered to these demographics, they most likely would not realize their health conditions until they become irreversible. Commenting on this unrepairable outcome, Pete Wharmby, author of two books about autism, expressed frustration for non-white autistic people: "Autism is often undiagnosed, especially in demographics that are not young white males. This means self-diagnosis is often a requirement to get an official diagnosis. Some cannot get this dx, but still, deserve to be heard." + +==== COVID-19 pandemic ==== +COVID-19 also contributed to the increase in self-diagnosis among minority populations. Samantha Artiga from the Kaiser Family Foundation reports that when statistics were corrected to account for differences in age by race and ethnicity, it became clear that Black, Hispanic, AIAN, and NHOPI persons had the highest rates of COVID-19 cases and deaths in compared to white people. These demographics had a correlated surge in self-diagnosed COVID-19 cases. The Conversation highlights how using internet resources to evaluate COVID-19 symptoms and self-triage was promoted during the pandemic, exhibiting how online health information gained new significance. \ No newline at end of file diff --git a/data/en.wikipedia.org/wiki/Self-diagnosis-3.md b/data/en.wikipedia.org/wiki/Self-diagnosis-3.md new file mode 100644 index 000000000..73b154d5c --- /dev/null +++ b/data/en.wikipedia.org/wiki/Self-diagnosis-3.md @@ -0,0 +1,29 @@ +--- +title: "Self-diagnosis" +chunk: 4/4 +source: "https://en.wikipedia.org/wiki/Self-diagnosis" +category: "reference" +tags: "science, encyclopedia" +date_saved: "2026-05-05T07:32:52.335800+00:00" +instance: "kb-cron" +--- + +==== The benefits and costs for vulnerable demographics ==== +This trend of turning to self-diagnosis among minorities can be potentially dangerous, given the unfiltered and unauthorized information online. A report from Psychreg criticizes self-diagnosis for its potentially hazardous nature, reporting that 61% of the advice on social media (specifically, TikTok) is incorrect. The Camber Mental Health Organization also notes the potential danger of online self-diagnosis, indicating that influencers without proper license offer public advice that can further jeopardize the vulnerable demographics. +Other studies present non-dangerous aspects of self-diagnosis for these populations. A new study published by the Department of Public Health and Primary Care at Leiden University Medical Centre explains that patients use the internet to find reliable medical information about minor ailments and thus prevent symptoms from worsening if immediate health care cannot be provided. After surveying 1,372 participants, the study finds that most patients utilize this symptom-based approach. Suppose the patients expect the potential diagnosis to be more lethal. In that case, they tend to conduct further research on the internet to verify their suspicions about their condition. + +=== Age === +Younger generations are more likely to perform self-diagnosis. Kwakernaak explains their findings of a positive correlation between self-diagnosing accuracy and the age variable. There was an inverse relationship between age and accuracy; the younger the patient was, the more likely they would find high-quality websites for information. Kunst from Statista conducts a survey that presents the frequency data of each age group using apps for self-diagnosis. The group aged 18–19 years old were almost two times more likely to use the Internet regularly or occasionally compared to all the other age groups. The data showed that 10% of those in that age group used self-diagnosis regularly compared to 4% of respondents older than 61. The study posits that this frequent usage may explain why the younger population had more experience searching for high-quality websites and receiving accurate diagnoses. However, Kunst notes that this conclusion may be biased as the survey was conducted online and thereby only targeted respondents who had frequent access to the Internet. + +== See also == +Cure +Cyberchondria +Home remedy +Related mental disorders: +Delusional parasitosis +Hypochondria +Medical students' disease +Morgellons +Therapy + +== References == \ No newline at end of file