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The absurdities of old physic are patent to all generic zyloprim 100mg visa symptoms jaw pain, a matter of every-day experience; we want to learn a better way generic zyloprim 300 mg amex medicine plies, if there is one generic 100 mg zyloprim amex medicine hat tigers. The first phase of Specific Medication is so plain discount zyloprim online amex symptoms renal failure, “that he who runs may read;” it appeals directly to every man’s experience and better judgment; and it needs but a clear presentation to obtain the assent of every man, not governed by prejudice. This unit of life that constitutes a living man is clearly divisible, and is divided by physiologists into several parts, which may be studied separately, and for each of which we have a standard of healthy life. Thus, we study the circulation of the blood, respiration, digestion and blood-making, nutrition, waste and excretion, as well as the structure of the blood, and the solids, and the essential conditions of life - heat and electricity. And as we study these separately in health, that we may fix in our mind a healthy standard of life, so we study them separately in disease that we may know its exact character. We see that the departure from health must be in one of three directions - above, below, from - or according to the classification of Dr. The first lesson in specific diagnosis is to recognize the separate lesions which compose a disease, and classify them as named above. We say, that at once a rational treatment is suggested, but this is only so, to one who has given the subject some thought; the old therapeutics shed but little light upon it. Now, it is but a simple application of common sense to say, that if we desire to influence the circulation of the blood, we shall select a remedy that acts upon the circulatory system, and not one that acts upon the bowels, skin, kidneys, brain, or other parts. And it is only one step farther to say, that the remedy should be selected with regard to the character of the lesion - if in excess, that it will bring it down - if defective, that it will bring it up - if perverted, that it will correct it. This, the reader will see, is but the application of logic to the practice of medicine. We want precision of observation, and thus applying the unvarying rules of logic, we reason to correct conclusions; and a practice thus based must be right. You can’t call this theorizing - it is plain matter-of-fact - clearly demonstrable in its premises and conclusions - and as absolutely true at the bedside as in the lecture-room. The second lesson in specific diagnosis is to determine the relative importance of these lesions. We want to know which stands first, and serves as a basis - we might properly call this the basic lesion - and then the relative importance of others which have grown upon it. When we come to study the “second phase” of specific medication we will find this to be a principal feature. We can best illustrate this lesson, by reference to cases: - For instance, many simple fevers and inflammations have as a basic lesion, the disturbance of the circulation, and the increase of temperature; arrest of secretion, loss of appetite, digestion and nutrition, depravation of the blood, and derangement of innervation, are based upon them. The disease may really be a very active and severe one, and yet rest so wholly upon the lesion of circulation, that if this is corrected, they all fade away, and the patient rapidly convalesces. But again, we find cases in which the lesions of circulation and temperature are quite as marked, and yet the sedative is not curative; in some cases, indeed, it is not sedative even. Let us take two very common cases illustrative of this: A typical malarial fever gives us quite as frequent a pulse and exalted a temperature, as in the case where the sedative alone was curative - but now we find it only preparative - the lesion of the blood is the basic lesion. We prepare the patient for the use of Quinine, or in some cases give it alone, and the Quinine is curative. Again, a patient is suffering with acute fever or inflammation, the pulse quite as frequent, the temperature as high, and yet the sedative has no more influence than so much water, unless it be to irritate the stomach. Supposing we examine the tongue and find it pallid with white coat, we say at once here is a lesion of the blood, a salt of soda is required. We give it, and now the sedative acts kindly, or indeed it may not be necessary, simple bicarbonate of soda lessening the frequency of the pulse more markedly than Veratrum. We find the same is the case where the symptoms point to the Alkaline Sulphites, Muriatic Acid, Sulphurous Acid, Chlorate of Potash, Phosphorus, Iron, Copper, or even Cod Oil, or food. If for instance, in an endemic of typhoid fever, we find deep redness of mucous membranes, this being characteristic of the basic lesion - a want of acid - we find that Muriatic Acid becomes sedative, stimulant, restorative, increases secretion, checks diarrhœa, stops delirium, indeed does all for the patient that we can wish. Most times we supplement it with other remedies acting in these directions - but occasionally it is safest to trust to the acid alone. For instance, the face is flushed, eyes bright, pupils contracted, increased heat of scalp, restless and sleepless, determination of blood to the brain - Gelseminum becomes our best sedative. Because it quiets the irritation of the brain, and removes this, which is the basic lesion. So it is in the opposite condition- enfeebled capillary circulation, and tendency to congestion of the cerebro-spinal centers. The pulse may be quite as frequent, the temperature as high, secretions arrested, blood poisoning rapid, and yet sedatives are not sedative. We must influence the vegetative system of nerves first, to restore capillary circulation - and then our other remedies act kindly. I have sat by the bedside and seen the pulse fall from 140 beats per minute to 100, and the temperature from 107° to 101°, in four hours, under the influence of Belladonna alone - and yet Belladonna is not sedative? I do not propose, in doing this, to occupy much of your time in details, but rather to present the principles upon which specific or direct medication rests. It means that we never oppose remedies directly to processes of disease, but on the contrary, influence diseased action in a roundabout, indirect, and uncertain manner. As examples - We violently excite the intestinal canal with cathartics to arrest disease of the brain, the lungs, the kidneys, or other distant parts. Or it is possible that we confine our ministration first, to the gastric sac, then follow with potent cathartics. Whatever may be said in favor of such a practice, and how fine-so-ever the theories with reference to it may be spun, it is based upon the idea that two diseases can not exist in the body at the same time, and if the medicines are sufficiently potent, their action will surely be the strongest - and the disease will stop - leaving the patient to recover slowly from the influence of the medicines. I have, many a time, and have in this way, myself, been a wonderful dispensation of Providence. In the olden time men would not believe that the Doctors aided large numbers of people out of the world. The doctors, God bless them, pulled the sick through; they would all have died if it had not been for the Faculty. It is wonderful how statistics take the conceit out of some people and some things. When we find hundreds of cases of severe disease tabulated - such as typhoid fever and pneumonia - with a mortality of but one to three per cent. This brings the matter home, and one doesn’t like to confess his own sins, as a rule. Now I am glad to know that you, and Eclectics as a rule, have a very much better practice than theory. Whilst they occasionally wander off after these phantasms, it is the exception and not the rule. As a body of physicians we recognize the fact that disease in all its forms is an impairment of life. And we recognise the necessity of conserving this life, and of employing such means as will increase it, and enable it to resist and throw off disease, and restore normal structure and function. We recognize the importance of the functions of circulation, innervation, excretion, etc. And all experience shows, that just in proportion as we get this normal performance, disease is arrested. From its inception Eclecticism has been, to a very considerable extent, Specific Medication.
Hepatocytes show accumulation of glycogen granules with single glucose residues remaining at the branch points near the periphery of the granule cheap zyloprim 100mg line symptoms low blood pressure. When fatty acid ~-oxidation predominates in the liver purchase generic zyloprim pills medications 73, mitochondrial pyruvate is most likely to be A cheap zyloprim 100mg mastercard treatment zona. The peripheral blood smear reveals a nonspherocytic buy generic zyloprim treatment centers for drug addiction, normocytic anemia, and Heinz bodies are seen in some of his erythrocytes. Which of the following genetic deficiencies is most likely related to his hemolytic episode? Which of the following sets of laboratory test results would most likely have been obtained for this patient? This activity of the debranching enzyme removes 1,6-linked glucose residues from the branch points during glycogenolysis. Only option E is consistent with the constellation of clinical findings pre- sented. Only option C is characteristic of hemolytic jaundice; indirect hyperbilirubi- nemia with no spillover of the water-insoluble unconjugated form into the urine. The carboxyl carbon is number 1, and carbon num- Cardioprotective Effects of ber 2 is referred to as the a carbon. When designating a fatty acid, the number of carbons is given Omega-3 Fatty Acids along with the number of double bonds (carbons:double bonds). Omega-3 fatty acids in the diet are correlated Palmitic C16:0 or 16:0 with a decreased risk of cardiovascular disease. Unsaturated Fatty Acids These appear to replace Unsaturated fatty acids have one or more double bonds. Humans can synthesize only a few of some of the arachidonic the unsaturated fatty acids; the rest come from essential fatty acids in the diet that are trans- acid (an omega-6 fatty acid) ported as triglycerides from the intestine in chylomicrons. Two important essential fatty acids in platelet membranes and are linolenic acid and linoleic acid. These polyunsaturated fatty acids, as well as other acids may lower the production formed from them, are important in membrane phospholipids to maintain normal fluidity of of thromboxane and the cell membranes essential for many functions. A diet high The omega (co) numbering system is also used for unsaturated fatty acids. The co-family describes the position of the last double bond relative to the end of the chain. The omega des- in omega-3 fatty acids ignation identifies the major precursor fatty acid, e. Arachidonic acid is itself an important precursor for prostaglandins, throrn- with a decrease in serum boxanes, and leukotrienes. Trans- double bonds are unnatural and predominate in fatty acids found in margarine and other foods where partial hydrogenation of vegetable oils is used in their preparation. Compared with liquid oils, these partial hydrogenated fatty acids are conveniently solid at cool temperatures. When incorporated into phospholipids that constitute membranes, trans- fatty acids decrease membrane fluidity, similar to saturated fatty acids that are found in butter fat and other foods. Trans- fatty acids, as well as saturated fatty acids, are associated with increased risk of atherosclerosis. Activation of Fatty Acids When fatty acids are used in metabolism, they are first activated by attaching coenzyme A (CoA); fatty acyl CoA synthetase catalyzes this activation step. The product is generically referred to as a fatty acyl CoA or sometimes just acyl CoA. Specific examples would be acetyl CoA with a 2-carbon acyl group, or palmitoyl CoA with a 16-carbon acyl group. Upon entry into the intestinal lumen, bile is secreted by the liver to emulsify the lipid contents. The pancreas secretes pancreatic lipase, colipase, and cho- lesterol esterase that degrade the lipids to 2-monoglyceride, fatty acids, and cholesterol. These lipids are absorbed and re-esterified to tryglycerides and cholesterol esters and packaged, along with apoprotein B-48 and otherlipids (e. Defects in lipid digestion result in steatorrhea, in which there is an excessive amount oflipids in stool (fatty stools). Acetyl CoA combines with oxaloacetate in the mitochondria to form citrate, but rather than continuing in the citric acid cycle, citrate is transported into the cytoplasm. Factors that indirectly promote this process include insulin and high-energy status. In the cytoplasm, citrate lyase splits citrate back into acetyl CoA and oxaloacetate. The oxaloac- etate returns to the mitochondria to transport additional acetyl CoA. Synthesis of Palmitate From Glucose Acetyl CoA Carboxylase Acetyl CoA is activated in the cytoplasm for incorporation into fatty acids by acetyl CoA car- boxylase, the rate-limiting enzyme of fatty acid biosynthesis. Fatty Acid Synthase Fatty acid synthase is more appropriately called palmitate synthase because palmitate is the only fatty acid that humans can synthesize de novo. This enzyme is a large, multienzyme complex in the cytoplasm that is rapidly induced in the liver after a meal by high carbohydrate and con- comitantly rising insulin levels. Although malonyl CoA is the substrate used by fatty acid synthase, only the carbons from the acetyl CoA portion are actually incorporated into the fatty acid produced. Triglyceride formation from fatty acids and glycerol3-phosphate occurs primarily in liver and adipose tissue. Accumulation of significant triglyceride in tissues other than adipose tissue usually indicates a pathologic state. During fasting (glucagon), this same enzyme allows the liver to trap glycerol released into the blood from lipolysis in adipose tissue for subsequent conversion to glucose. The roles of glycerol kinase and glycerol 3-P dehydrogenase during triglyceride synthesis and storage are shown in Figure 1-15-2. In cell membranes, they also serve as a reservoir of second messengers such as diacylglycerol, inositol 1,4,5-triphosphate, and arachidonic acid. Their structure is similar to triglycerides, except that the last fatty acid is replaced by phosphate and a water-soluble group such as choline (phosphatidylcholine, lecithin) or inositol (phosphatidyl- inositol). Lipoproteins are named according to their density, which increases with the percentage of protein in the particle. This enzyme is induced by insulin and transported to the luminal surface of capillary endothelium, where it is in direct contact with the blood. The core lipid is surrounded by phospholipids similar to those found in cell membranes, which increase the solubility of chylomicrons in lymph and blood. ApoB-48 is attached and required for release from the epithelial cells into the lymphatics. Chylomicrons leave the lymph and enter the peripheral blood, where the thoracic duct joins the left subclavian vein, thus initially bypassing the liver. The chylomicron remnant is picked up by hepatocytes through the apoE receptor; thus, dietary cholesterol, as well as any remaining triglyceride, is released in the hepatocyte. When a cell is repairing membrane or dividing, the cholesterol is required for membrane synthesis.
But you can still try to let go of the shame that leads nowhere and does nothing to help you order 100mg zyloprim free shipping medicine 93 3109. Robin reviews her Rating Responsibility Exercise (see Worksheet 5-17) and notices that she owns partial responsibility for some of the problems that led to her divorce cheap zyloprim 300mg overnight delivery symptoms norovirus. She lists those contributions and then plans steps for productive action on the Action Strategy Worksheet shown in Worksheet 5-19 discount 100 mg zyloprim with mastercard symptoms 6 weeks pregnant. Chapter 5: Untangling Twisted Thinking 75 Worksheet 5-19 Robin’s Action Strategy Worksheet The problem: My divorce generic 100 mg zyloprim medications given to newborns. My Speciﬁc Contributions to the Problem Speciﬁc Actions I Can Take I am ten pounds overweight. It won’t help this divorce, but my counselor said exer- cise will lift my spirits, and I’ll be healthier. I’m not the most attractive I can’t do a lot about my appearance other woman in the world. I ignored our lack of When I ﬁnd another relationship, I need to communication in the marriage. After completing your Rating Responsibility Exercise in Worksheet 5-18, the next step is to create an action strategy to determine how you can begin solving your problem. By identify- ing productive actions to address the problem, you’re able to move forward and stop berating yourself. Name the problem you’re blaming yourself for and write it at the top of the worksheet. In the left-hand column, list the speciﬁc contributions you’ve identiﬁed that you have some control over. In other words, record anything you did that may have led to the problem or made it worse. In the right-hand column, list any steps you can take now or in the future that may be useful in solving this problem. Worksheet 5-21 My Reﬂections Chapter 6 Indicting and Rehabilitating Thoughts In This Chapter Investigating and charging thoughts Putting thoughts on trial Repairing thoughts ost people simply assume that thoughts they have about themselves and the world Mare true. But thoughts don’t always reﬂect reality, just as funhouse mirrors don’t reﬂect the way you really look. In Chapter 5, we help you uncover the distortions (also known as reality scramblers) in your thoughts. We show you how to take your distorted thoughts to court and charge them with the crime of inﬂicting misery on yourself. If you ﬁnd them guilty (and we think you will), you see how to rehabilitate those criminal thoughts so that they can contribute to your well-being. From Arraignment to Conviction: Thought Court We base our technique called Thought Court on the principles of cognitive therapy. Beck, who discovered that changing the way people think changes the way they feel. Many studies attest to the fact that cognitive therapy works very well to alleviate anxiety and depression. We give you examples of Thought Trackers in this section, but for more information, ﬂip to Chapter 4. Thought Court is a process of indicting the accused thought (the one you pinpoint in your Thought Tracker) and then bringing it to trial. As the defense attorney, you present the evidence that supports the validity or accuracy of the thought. In other words, the defense claims that your thought is true and isn’t culpable for your anguish. On the other side, you, as the prosecutor, lay out a case demonstrating that the thought is actually guilty of distortion and therefore has caused you unnecessary emotional distress. If you ﬁnd the thought guilty, we give you ways to replace or rehabilitate your thought. Most people learn better through stories and examples than through laborious explana- tions. With that in mind, we help you master the process of Thought Court by presenting a case example in the next section. Then we give you the chance to put your thoughts on trial, and in case you need more help, we follow up your practice with more case examples. Examining a sample case in Thought Court Jeremy is a good looking 23-year-old personal trainer who takes pride in his healthy lifestyle. He’s known at the gym for the colorful, long-sleeved T-shirts that he always wears. Jeremy gets more than his share of attention from women, but he never gets involved because he has a secret: He was seriously burned as a child, and his chest and arms are deeply scarred. Jeremy has never had a serious rela- tionship; he believes any woman seeing his body would recoil in disgust. Rather than face rejection and ridicule, he locks himself away in solitary conﬁnement. His com- bination of fear and yearning motivates him to see a therapist, and he manages to tell his therapist about his lifelong secret. Jeremy’s therapist suggests that he start examining his thoughts with a Thought Tracker (see Worksheet 6-1) and then take his thoughts to Thought Court. Worksheet 6-1 Jeremy’s Thought Tracker Feelings & Sensations Corresponding Events Thoughts/Interpretations (Rated 1–100) Anxiety (85), fear Chelsea asks me out for I can’t possibly go out with her. Anxiety (75), The guys asked me to go The shame would overwhelm shame (85), bitter into the hot tub with them me. Chapter 6: Indicting and Rehabilitating Thoughts 79 Jeremy’s most malicious thoughts: 1. Next, his therapist suggests that Jeremy put the ﬁrst of these thoughts on trial using a worksheet (later on, they address his other malicious thought). As you can see in Worksheet 6-2, Jeremy writes down the malicious thought ﬁrst and then in one column defends the thought by listing all the reasons, logic, and evidence he can muster to support the case that the thought is true. In the other column, Jeremy attempts to prosecute the thought by demonstrating that it’s false. Worksheet 6-2 Jeremy’s Thought on Trial Worksheet Accused thought: I couldn’t stand to see the look of repulsion on her face. I’ve seen the look of shock on people’s My family seems to have gotten faces before. After one surgery, a physical therapist made a comment that my burns were permanently deforming and I’d just have to learn to live with them. So far, this case is going very well for the defense and very poorly for the prosecution. Thus, Jeremy remains quite convinced that his thought is a true reﬂection of reality; it’s just the way things are. The therapist tells him he’s made a good start but asks him to consider the Prosecutor’s Investigative Questions in Worksheet 6-3 and write down his reﬂections on those questions (see Worksheet 6-4). Do I know of friends or acquaintances who have experienced similar events but for whom this thought wouldn’t apply? Worksheet 6-4 Jeremy’s Reﬂections These questions are a little difﬁcult to contemplate.
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This surgical threshold may change with the evo- lution of endovascular stent grafting generic zyloprim 100 mg with visa treatment uti infection. There is very little evidence zyloprim 300mg mastercard medications in pregnancy, however cheap zyloprim 300mg on-line treatment dvt, that aggressive preoperative cardiac risk assessment signiﬁcantly has lowered operative mortality order zyloprim on line amex symptoms 3 dpo. The primary improvements in surgical outcome more likely can be attributed to improved surgical and anesthetic techniques. Standard open surgical repair remains a signiﬁcant operative intervention, with an operative mortality rate of between 3% and 5% at the best surgical centers. The majority of these complications can be avoided with proper preopera- tive planning, proper intraoperative technique, and superb postopera- tive care. Abdominal Masses: Vascular 431 resulted in promising short- and medium-term results. The obvious appeal of an endovascular approach is that it is minimally invasive and obviates the signiﬁcant incisional discomfort and recovery of the standard operation. The overall cost-effectiveness and utility of this procedure await further testing and development. Case Discussion With regard to the case presented at the beginning of this chapter, several important points can be made. Obviously, if the patient were having severe abdominal pain after the procedure, then a more urgent radiologic exam, if not emer- gent surgery, would be indicated. This allows the vascular surgeon to evaluate optimally the extent of an aneurysm and to make an accurate assessment as to the best and safest way to repair the aneurysm. If the aneurysm is greater than 5cm in transverse diameter, it should be repaired electively, assuming that the patient is a reasonable operative risk. Summary The diagnosis, workup, and treatment of vascular abdominal masses have been presented in this chapter. A basic understanding of ab- dominal anatomy and physiology greatly assists in the evaluation of a patient with a vascular abdominal mass. Classifying the mass anatom- ically, based on etiology and clinical course, greatly helps in the under- standing of the problem and type of intervention necessary to facilitate proper therapy. The diagnosis and treatment of vascular abdominal masses frequently requires input from several medical and surgical specialists. In addition to primary care specialists, gastroenterologists, oncologists, general surgeons, surgical oncologists, gynecologists, radiologists, infectious disease specialists, urologists, and vascular sur- geons often contribute in the management of a patient with a vascular abdominal mass. Ciocca abdominal mass depends on the nature of the mass, the timing of the diagnosis, and the overall condition of the patient. Elective interven- tion, whether medical or surgical, generally is better than delayed or emergent intervention. Collagenase activity of the human aorta: a comparison of patients with and without abdominal aneurysms. Selective evaluation and management of coronary artery disease in patients undergoing repair of abdominal aortic aneurysms: a 16-year experience. To understand bilirubin metabolism and classify jaundice as nonobstructive or obstructive. To describe the usefulness and limitations of blood tests and hepatobiliary imaging in the eval- uation of a jaundiced patient. Cases Case 1 A 43-year-old woman has had intermittent episodes of right upper quadrant pain, usually associated with eating fatty foods. That pain radiates to her right shoulder, but it spontaneously resolves after several hours. She now presents to the emergency room with a deeper, more persistent pain in the right upper quadrant. She noticed yellow- ing of her eyes and darkening of her urine for the past 36 hours. Case 2 A 63-year-old man complains to his physician about yellow dis- coloration of his eyes. Examination reveals a nontender mass in the right upper quadrant, indicating an enlarged gallbladder (Courvoisier’s 433 434 T. Case 3 A 23-year-old man presents to the emergency room with fatigue and jaundice. Introduction The appearance of jaundice in a patient is a visually dramatic event. It invariably is associated with signiﬁcant illness, although long-term outcome is dependent on the underlying cause of the jaundice. Jaun- dice is a physical ﬁnding associated with a disturbance of bilirubin metabolism. It often is accompanied by other abnormal physical ﬁnd- ings and usually is associated with speciﬁc symptoms. The student should be able to classify jaundice broadly as obstructive or nonob- structive based on history and physical examination. The appropri- ate use of blood tests and imaging allows further reﬁnement of the differential diagnosis. In general, nonobstructive jaundice does not require surgical inter- vention, whereas obstructive jaundice usually requires a surgical or other interventional procedure for treatment. Greater emphasis is placed on surgical jaundice than on medical jaundice in this chapter. Bilirubin Metabolism and the Classiﬁcation of Jaundice Bilirubin is a normal body product that results from the breakdown of heme primarily from red blood cells but also from other body con- stituents. This bilirubin, known as unconjugated or indirect bilirubin, is bound to albumin and is not water-soluble. Conjugated bilirubin is soluble in water and also is referred to as direct bilirubin. The conjugated bilirubin then is released into the biliary tree and from there into the intestinal tract. In the colon, the bilirubin undergoes further conversion into several prod- ucts, including urobilinogen. A portion of the urobilinogen is reabsorbed, while the remainder passes in the stools. The brown color of normal stool is due to these breakdown products of bilirubin metabolism. An interruption in any portion of the metabolic pathway can result in an excess of bilirubin and the clinical syndrome of jaundice. The sclerae usually are the ﬁrst site of color abnormality, typically becom- ing yellow with a bilirubin level of about 2. Skin yellowing is evident at levels of 4 to 5mg/dL, depending on skin pigmentation. Jaundice 435 The urine usually is dark, since the kidneys excrete the excess biliru- bin.
Anaesthesia record system on handheld computers--pilot experience and uses for quality control and clinical guidelines discount zyloprim 100 mg otc medicine 773. Early experiences with e-Health services (1999-2002): Promise zyloprim 300mg without prescription treatment head lice, reality buy cheap zyloprim treatment yellow jacket sting, and implications order cheap zyloprim on-line treatment with chemicals or drugs. Supply of injectable drugs for individual patients using the prescription entry system. Challenge for preventing medication errors-learn from errors: What is the most effective label display to prevent medication error for injectable drug? Computer assisted satellite pharmacy consultative service in a primary care clinic. Would artificial neural networks implemented in clinical wards help nephrologists in predicting epoetin responsiveness? Developing high-specificity anti-hypertensive alerts by therapeutic state analysis of electronic prescribing records. Evaluation of accuracy of drug interaction alerts triggered by two electronic medical record systems in primary healthcare. Computerized physician order entry of medications and clinical decision support can improve problem list documentation compliance. Introduction of computer assisted control of oral anticoagulation in general practice. Healthcare informatics : the business magazine for information and communication systems 2009;26(9):30-3. The push to share data electronically--both inside and outside of the hospital walls--is forcing patient identification to the forefront. Primary care clinician attitudes towards ambulatory computerized physician order entry. The concordance of self-report with other measures of medication adherence: a summary of the literature. A meta-model of chemotherapy planning in the multi hospital/multi-trial-center-environment of pediatric oncology. Critical pathway for the management of acute heart failure at the veterans affairs san diego healthcare system: Transforming performance measures into cardiac care. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. Implementation of a computerized physician order entry system at a 500 bed community hospital: case for pharmacist involvement. Clinical pharmacy in a geriatric unit: Impacts of clinical pharmacy interventions prior to medical order. The effects of computerized medical records on provider efficiency and quality of care. Massachusetts Technology Collaborative and New England Healthcare Institute; 2006. Collaborative improvement in the order and delivery process of intravenous infusion medications in the neonatal intensive care unit to decrease errors and utilize technology. Centralized information system for general practitioners and out-patient medical services: Conception of realization. Building man-man-machine synergies: experiences from the Vanderbilt and Geneva clinical information systems. The impact of computerised physician order entry systems on pathology services: A systematic review. Computer-supported weight-based drug infusion concentrations in the neonatal intensive care unit. Home infusion therapy trial of a multitherapy remotely programmable ambulatory pump. Multi-tasking in practice: coordinated activities in the computer supported doctor-patient consultation. Methods, architecture, evaluation and usability of a case- based antibiotics advisor. Computerized community cholesterol control (4C): meeting the challenge of secondary prevention. Identifying medication-use system variances associated with computerized provider order entry. Healthcare financial management : journal of the Healthcare Financial Management Association 2009;63(11):38-41. Improving recognition of drug interactions: benefits and barriers to using automated drug alerts. The utility of adding retrospective medication profiling to computerized provider order entry in an ambulatory care population. Online prospective drug utilization review in community practice: Clinical and economic impact. Is health information technology associated with patient safety in the United States? The evolution and implementation of a pediatric computerized order entry system: a case study. Development of a mini computer program to identify medication orders requiring modification based on patient-specific renal function. Using an Internet comanagement module to improve the quality of chronic disease care. A continuous-improvement approach for reducing the number of chemotherapy-related medication errors. Translating research into practice: Organizational issues in implementing automated decision support for hypertension in three medical centers. Integration of an automated dispensing device into a computerized unit dose hospital pharmacy. Development of a guideline-based decision support system with explanation facilities for outpatient therapy. Pharmacy-based automated medication records: methods, application, and a survey of use. Project of an expert system supporting risk stratification and therapeutic decision making in acute coronary syndromes. Development and implementation of an automated proactive approach toward improving pneumoccal vaccination rates in an in-patient acute care hospital setting. Frequency, relevance, causes of and strategies for prevention of medication errors. The gap between actual and mandated use of an electronic medication record three years after deployment. Implementing new ways of working: Interventions and their effect on the use of an electronic medication record. Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: patient gateway for diabetes collaborative care.