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Recent research suggests that there may be a difference in the level of collaboration encouraged by male and female physicians purchase 4mg tolterodine fast delivery symptoms narcissistic personality disorder. In a study conducted by Hall buy 2mg tolterodine with amex adhd medications 6 year old, Roter tolterodine 2 mg mastercard medicine cabinet with lights, Blanch, and Frankel (2009), female medical students more accurately interpreted their patients’ non-verbal communication (e. Doctor-patient interactions in which doctors demonstrated sensitivity to their patients’ non-verbal cues resulted in decreased distress, longer visits, and higher engagement among analogue patients. A study conducted by Bloor, Freemantle, and Maynard (2008) found that male medical professionals completed, on average, 160 more medical cases each year than their female counterparts. According to Firth-Cozens (2008b), this disparity may reflect the type of care given by female doctors, in contrast to the care given by male doctors. For example, female physicians may spend more time with each patient, encouraging the patient to speak more and be more active in the decision making process. The increased depth of care and collaboration would result in females completing fewer cases over the same period. Female doctors have indeed been shown to use a more patient-centered approach with their patients than male physicians, as evidenced by longer consultations and a more emotional, psychosocial focus in their discussions (Beach, 2000; Firth 46 Cozens, 2008b; Hall & Roter, 2002; Hall et al. The more patient-centered approach adopted by most female practitioners may have a significant positive impact for the professionals as well as for the patients. According to Firth-Cozens (2008b), this statistic is a direct result of the more sensitive approach taken by female physicians. Better doctor-patient relationships result from female physicians’ greater emotional and communication skills, resulting in a decreased likelihood that the doctors will be involved in disputes or complaints. In contrast to the traditional authoritarian and paternalistic relationship between doctors and patients, a more egalitarian approach to healthcare has been shown to benefit treatment outcomes. Doctors who respect patient autonomy allow patients to participate in decisions about their own health and take patients’ concerns, opinions, and preferences into consideration. They identified patient autonomy as essential to the doctor-patient relationship and indicated that they were motivated by the fundamental principle of beneficence, as well as their own personal 47 interest in avoiding legal liability. Similar results were found in Rogers’ (2002) study of physicians’ attitudes toward patient autonomy in treatment for back pain. The majority of physicians interviewed were in favor of patient autonomy regarding the use of complementary therapies (e. In the case of autoimmune disorders such as those that cause hyper- and hypothyroidism, respect for patient autonomy is particularly important (Chrisler & Parrett, 1995). Because patients can provide important insight into the experience of their own conditions, patients should be seen as experts on their conditions and respected as such. Considering that the majority of physicians wish to respect patient autonomy while avoiding legal liability (McGuire et al. As described by Chin (2002), in the deliberative model, the physician is both a teacher and a friend who assists the patient in evaluating the safety and effectiveness of potential treatment modalities. Chin (2002) posited that such a model is particularly relevant in the “Internet age,” in which patients are “flooded with information”—not all of which is reputable (p. The increased availability of medical information to the public makes patient autonomy a growing concern. Of those individuals who looked for information about a health concern from sources other than a doctor, over half later spoke with a doctor about that same health concern. This indicates that patients exercise their own autonomy and 48 hope to use the information they discover in conjunction with professional consultation. Additionally, those with chronic health concerns are more likely to seek health information from sources other than doctors. According to Fox (2007), among Internet users with disability or chronic illness such as thyroid disease, 86% have searched online for information. Among those without chronic illness, only 79% have searched for medical information online. Individuals with chronic health concerns also reported that their medical decisions are more frequently affected by information found online. Fox and Jones (2009) reported on a 2008 Pew Research Center study related to patient autonomy in seeking health information from various sources. The study found that 61% of adults use the Internet to search for health information, and over half of online health queries are made on behalf of someone other than the Internet user. Therefore, in order to establish effective doctor-patient relationships, physicians need to take patient autonomy and outside sources into consideration. In addition to consulting professionals, a majority of adults consult friends or family members, books, and other reference material for medical assistance. Significant percentages of those interviewed claimed that information found online affected health-related decisions they made for themselves or someone in their care (Fox & Jones, 2009). These results underscore the importance of online information for individuals with chronic illness, suggesting that doctors treating such patients should be particularly aware of and sensitive to patient autonomy and knowledge. As noted above, traditional doctor-patient relationships have tended to marginalize women by virtue of social perceptions of the female role. In addition to 49 being placed in a position of inferiority due to doctors’ medical expertise, female patients in the care of male physicians may conform to traditional, submissive feminine roles (Chrisler, 2001). This undermines female patients’ autonomy and makes doctor-patient collaboration unlikely. Thus, it is important for women to feel that their feminine status does not affect the quality of the care they receive. Despite theoretical and empirical evidence that a more collaborative, less doctor- centered model of healthcare promotes positive healthcare outcomes (Houle et al. Factors that contribute to the persistence of the traditional model include sexism in healthcare, the medical education system, economics, the culture of the medical profession, and women’s communication patterns. Sexism in Health Care Abundant research and theoretical literature indicates that sexism exists in the medical profession and results in a number of problems, including under-treatment and misdiagnosis of women’s medical issues. According to Secker (1999), male-dominated philosophical, theological, literary, and scientific traditions have characterized women (as opposed to men) as emotional, irrational, pathological, unintelligent, incompetent, dishonest, passive, and childlike (p. Applying these traditions in the medical profession has resulted in a diagnostic bias whereby women’s health complaints tend to be viewed as psychosomatic in origin (Hamberg et al. According to Cheney and Ashcraft (2007), in the medical profession, there is “a tendency to privilege the rational over the emotional” (p. Empirical research supports these theoretical arguments, indicating that physicians tend to interpret men’s symptoms as biological and women’s as psychosomatic (Hamberg et al.

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The remainder are caused by non- in vulvovaginal candidiasis generic 4mg tolterodine with amex medicine zebra, the pH of the vaginal albicans species buy cheap tolterodine 2mg on-line translational medicine, including candida glabrata purchase 1 mg tolterodine otc medicine man pharmacy. The role of sexual identify yeast cells and exclude trichomonas and transmission of candidiasis is thought to be limited. It is estimated that 10–20% of clotrimazole pessary; 500 mg as a single dose; women of childbearing age have candidiasis clotrimazole pessary; 200 mg for 3 nights; asymptomatically. In the United Kingdom, miconazole pessary; 100 mg for 14 nights; nystatin incidence at sexual health clinics has doubled over pessary 100 000 units for 14 nights; fluconazole the last ten years and it is the second commonest capsule 150 mg orally stat. Infection in pregnancy topical azoles are recommended and longer courses Manifestations may be required; oral therapy is contraindicated in • Vulval itching and discomfort pregnancy. Less than 5% of healthy women of There is no need for follow up or retesting if childbearing years experience recurrent candidiasis. Specifically: • advise patients that miconazole damages latex and • Follow-up after treatment may be indicated to clotrimazole has an unknown effect on latex ensure it has been effective. Recent trends in infections –An overview of selected curable sexually gonorrhoea - An emerging public health issue? The patient takes responsibility for contacting partners and asking them to come for treatment. The patient might approach partners by: • directly discussing the infection with their partner • asking the partner to attend the clinic without specifying the reason • giving the partner a card asking them to attend the clinic Provider referral The partners of a patient with a sexually transmitted infection are contacted by a member of the health care team and asked to come to the clinic for treatment. Patient referral is less labour intensive, therefore cheaper and there is less risk of perceived threat to the patient’s confidentiality. Module 7, Part I Page 231 Patient referral Provider referral • Explain to the patient the importance of treating Ideally, specially trained outreach staff should partners undertake provider referrals. Provider referral may • Remind the patient to avoid sex till current be offered when: partners are treated • The patient does not wish to refer partners • Help the patient decide how to communicate themselves with partners • The partners have not attended after a given time • If the patient permits, take the names of partners period and the patient has agreed in advance that who may be at risk of the same infection the health care team can contact the partners in these circumstances Patient referral cards • The identity of the patient and their infection These can be given to a patient to hand to a named should remain confidential, unless the patient has partner who in turn brings the card to the health expressly given permission for them to be disclosed. This enables the health centre staff to Details about the patient should never be discussed recognise the code for the patient’s infection and with a partner. The information on the card should not risk breaking either the Treating partners patient or the partners’ confidentiality, in that there • Partners should be treated for the same infection should be no personal details on it (see the example as the original patient, regardless of whether they below). Page 232 Module 7, Part I Appendix 3 Health education Identification of difficulties Health education for someone with a sexually These may include issues related to gender, culture, transmitted infection should include the following religion or poverty. The problems are best addressed issues: if specific to the patient rather than generalised. Discussing costs and benefits of • exploring ways of reducing risks for future sexually changing sexual behaviour may help the patient transmitted infections; decide what they want to achieve and what they • identifying difficulties that the patient may have are able to do in reality. Promotion of condom use Explanation about the infection Condoms are effective in reducing transmission of Find out what the patient understands about their bacterial sexually transmitted infections and blood infection and how to take their treatment and any borne viruses. Assessment of the patients future risk This information may already be available in the An educative discussion promoting the use of patient’s case notes. There should be the facility to demonstrate Exploring ways of reducing risks the use of condoms to the patient, allowing them Clarify with the patient recent past or present risks the chance to practice. Clarify misconceptions, which may include assumptions that only people in particular groups are at risk for sexually transmitted infections, or that washing after sex reduces the risks. Holding the top of the condom, press out the air from the tip and roll the condom on. Roll the condom right to the base of the penis, leaving space at the tip of the condom for semen. After ejaculation, when you start losing erection, hold the condom at the base and carefully slide it off. Page 234 Module 7, Part I Appendix 4 Appendix 4 Nursing care the membranous tissue and put in the bin for Psychological support incineration after use. Gloves should be changed Establish a supportive relationship with the patient between patients and hands washed. See module 1 on Infection Control and the other part of this module on blood borne viruses. Clarify confidentiality Be able to state to the patient that none of his or Administration of drug therapy her personal details will be communicated to • Ensure the treatment has been correctly prescribed anyone outside the immediate care providing team. Exposure only Ensure the patient knows if and when they have when being examined and tests taken-ensure been advised to return to the service. Safety Infection control Sexually transmitted infections are usually passed by direct genital or oral contact and therefore the nurse or midwife in managing patients with sexually acquired infections requires no special precautions. Since there are so many important issues that need to be discussed, the Module is divided into two parts: Part I. Infections spread by blood and body fluids Each part has its own stated learning outcomes and its own learning activities. Many of the most prevalent sexually retrovirus, classified into type 1 and type 2. It is estimated that the Host cell number of infected people rose by over a third in nucleus the remainder of central and Eastern Europe during 1999 reaching a total of 360 000. Practical arrangements for ongoing account counseling and medical follow-up should be • How the patient would react if the test is positive; arranged and recorded. It is important not to be drawn housing and other consequences into giving precise estimates of life expectancy. A plan for follow-up support risk of infecting others - such as partners, health is essential. Further counselling can then be given on avoiding future exposure to Now carry out Learning Activity 3. Patients should be advised to consider repeat testing Methods of treatment should they continue to engage in risk behaviour. In the absence of a cure or effective vaccine, the aim of treatment is to extend and improve the Positive results quality of life. This involves alleviating symptoms, Patients should be allowed time to adjust to their preventing and treating opportunistic infections diagnosis. They may respond with a variety of and when possible, inhibiting disease progression emotions including shock, fear, anxiety, denial, through the use of anti retroviral therapy. Immediate “coping strategies” discussed during pre-test Alleviating symptoms counselling need to be reviewed, for example, what Treatment should be directed towards individual does the patient have planned for the rest of the symptoms always taking into account possible side day, and who can they be with that evening? Early Trials conducted in Thailand during 1998 diagnosis and access to prompt, effective treatment demonstrated that the use of even a short course of opportunistic infections such as candidiasis, of Zidovudine was effective, providing greater herpes and tuberculosis is also important. This reduces transplacental transmission and considerable improvements have occurred in rates by up to 50%. Current knowledge recommends the single dose to the mother at the onset of labour use of combination therapy, using three or more and then to the baby within 72 hours of delivery, antiretrovirals.

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The following “rogues gallery” is far from exhaustive buy discount tolterodine 1mg line treatment plan for depression, but illustrates some of the more notorious pathogens as well as those that are currently in the news due to resurgence or expansion of their boundaries buy tolterodine 1 mg on-line medications given for bipolar disorder. Ch i k u n g u n y A Chikungunya tops this list because of its recent resurgence in places like India discount tolterodine 1mg line medications side effects, Sri Lanka, Mauritius and countries in Europe involved in frequent tourism to these destinations. Concern has recently arisen that it will soon increase its range in Europe due to the spread of Asian Tiger mosquitoes (Aedes albopictus), which can act as signifcant vectors for this infection. Infection with chikungunya can be severe and temporarily debilitating but is generally not life threatening in otherwise healthy people. It is mainly transmitted by day-biting Aedes mosquitoes and can cycle in both urban and rural areas. In its rural incarnation, monkeys serve as maintenance hosts and tree-hole and bromeliad breeding mosquitoes transmit it. No one should travel to an area 8 Vector-Borne Infections – Primary Examples where Yellow Fever remains endemic without being vaccinated. It has become a ubiq- uitous fxture on the summer landscape of North America and continues to make Culex pipiens mosquito incursions into South America. While most people who become infected don’t experience anything more than fu-like symptoms, a small percentage go on to develop a potentially fatal cerebral hem- orrhage and permanent neurological damage. Transmission occurs primarily through urban vectors because the mosquito (Culex pipiens) most responsible for amplifying the virus in bird popula- tions prefers relatively polluted habitats. It causes the most severe disease in children (<15 years old) and older people (>50 years old). Humans can also acquire infections through con- 9 Vector-Borne Infections – Primary Examples tact with the blood of infected animals during slaughter. The overall case fatality rate associated with human infection is prob- ably less than 1%. Although infections can often be mild, permanent or long-lasting neurological damage can occur in about 10-20% of patients. Rodents are the primary maintenance hosts for this infection and hard ticks in the genus Ixodes serve as the primary vectors. Louis Encephalitis, Western Encephalitis, Lacrosse Encephalitis, Powassan Encephalitis, Murray Valley Encephalitis, etc. Many other, highly localized arboviruses exist throughout the world, some of which can be deadly. Companies should help their travelers become familiar with the particular threats they may face. Basic preventive measures that reduce expo- sure to mosquito bites are recommended to avoid infection. Lyme Disease has never killed anyone but can nevertheless be debili- tating if left untreated. Once the spirochete bacteria (Borrelia) that cause it reach the synovial (joint) fuid or penetrate the central nervous system, routine antibiotics can no longer reach it and the pathogen can cause such problems as arthritis, memory loss and other neurological problems. Prevention involves reducing exposure to tick bites with repellents, insecticide-treated clothing and simple awareness of tick habitats and their presence on the body. A vaccine had formerly been available but is no longer on the market because of incomplete efcacy. Where its range overlaps with ma- laria, the fevers this persistent infection causes are often mistaken for malaria. In Africa, this illness some- times kills 30-70% of those who become infected during outbreaks. Relapsing Fever most often occurs where human habitations and nest-dwelling organisms overlap. Unlike hard ticks, which feed only once per life stage, soft ticks can feed multiple times similar to mosquitoes, thus are much more prolifc transmitters of pathogens. Leishmaniasis Leishmaniasis includes a diverse group of protozoan infec- tions that can cause anything from skin sores (in its mild- est form) to severe organ damage. Some forms of leish- maniasis can be found in nearly every part of the tropics and subtropics, but the primary areas of concern include North Africa, the Middle East (it is a big problem in Iraq) and southwest Asia. Infections are difcult to treat and the drugs generally used can be quite toxic to humans and Leishmaniasis skin sore produce many side efects. Sand Flies, a relative of mosquitoes, that breed in caves, animal burrows and manure piles serve as the vectors. Some commercial insecticide-treated bed nets have been found not as efective in preventing sand fy bites as they are in protecting against mosquitoes. Chagas’ Disease “Kissing bugs” often bite near the eye This disease, while limited to Latin America can have a large im- pact on rural communities. A large, home-dwelling insect known as a “kissing bug” (Reduviidae:Tratominae) transmits the protozoon pathogen that causes it (Trypanosoma cruzi) to people while they sleep. This disease mainly threatens those who live in homes with thatched roofs, and can be combated through indoor residual spray- ing or housing improvements (tin roofs). The pathogen causes 11 Vector-Borne Infections – Primary Examples chronic organ damage and can kill by afecting the function of the heart over many years. Although its short-term efects on workers would be minimal, on- the-job exposure can cause many years of declining health. African Trypanosomiasis (Sleeping Sickness) African trypanosomes resemble those found in Latin America but are transmit- ted by Tsetse fies, which are found only in Africa. This pathogen causes “African Sleeping Sickness” which can induce coma by invading the central nervous system. Trypanosoma brucei gambiense ranges mainly through West and Central Africa, while Trypanosoma brucei rhodesiense is found in East and southern Africa. The Rhodesian form produces a more quickly progressing and acute infection, but both can kill people if left untreated. Lymphatic Filariasis (Elephantiasis) Filariasis generally doesn’t kill but it can cause considerable disability. Several forms of this mosquito-borne infection are caused by nematode worms that invade the lymphatic system causing swelling and tissue buildup in various parts of the body, but particularly afecting the legs. In its most serious manifesta- tion, this disease causes grotesque distortion of appendages known as “elephantiasis.

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Identification with the role of doctor at the end of medical school: A nationwide longitudinal study discount tolterodine 4mg visa treatment with cold medical term. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam study buy generic tolterodine 2mg medications you can give your cat. Being in the patient position: Experiences of health care among people with irritable bowel syndrome order 4 mg tolterodine otc symptoms 5 days before missed period. Nonverbal sensitivity in medical students: Implications for clinical interactions. Analogue patients’ satisfaction with male and female physicians’ identical behaviors. Male and female physicians show different patterns of gender bias: A paper-case study of management of irritable bowel syndrome. Still far to go – An investigation of gender perspective in written cases used at a Swedish medical school. 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Clinical and economic effects of unrecognized or inadequately treated bipolar disorder. Negative emotions in cancer care: Do oncologists’ responses depend on severity and type of emotion? Suffering in deference: A focus group study of older cardiac patients’ preferences for treatment and perceptions of risk. Patient-centered performance management enhancing value for patients and health care systems. A literature review of the changing gender composition, structures and occupational cultures in medicine. Role of patient treatment beliefs and provider characteristics in establishing patient–provider relationships. Psychological research online: Report of Board of Scientific Affairs’ Advisory Group on the conduct of research on the internet. The practice orientations of doctors and patients: The effect of doctor– patient congruence on satisfaction. Irritable bowel syndrome and other gastrointestinal disorders: Evaluating self-medication in an Asian community setting. Relationship of resident characteristics, attitudes, prior training and clinical knowledge to communication skills performance. Clues to patients’ explanations and concerns about their illnesses: A call for active listening. Definitions related to the use of pharmaceutical opioids: Extramedical use, diversion, non-adherence and aberrant medication-related behaviours. Striving for control: Cognitive, self-care, and faith strategies employed by vulnerable black and white older adults with multiple chronic conditions. A study of the longitudinal effects of trust and decision making preferences on diabetic patient outcomes. A study of patient clues and physician responses in primary care and surgical settings. Seeing the cage: Stigma and its potential to inform the concept of the difficult patient. Do women seeking care from obstetrician–gynecologists prefer to see a female or a male doctor? Influences of age, gender, smoking, and family history on autoimmune thyroid disease phenotype. 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