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This report focuses on the Veterans Health Administration (VHA). The VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans through the nation's largest integrated health care system.
This paper reports the Tunisian experience of medical abortion. The project started in 1998 with a small introductory study at the obstetric and gynaecology department of a university hospital and was later extended step by step to other family planning and public health centres that provided abortion services. The study was first conducted on 264 women using the modified regimen of 200mg mifepristone, followed 48 hours later by 400µg misoprostol in women seeking pregnancy of maximum 56 days of amenorrhoea. This gave a success rate of 91.1%. Results from further studies in other locations showed increasing success rates of 94.4% and 95.6%, with high acceptability and satisfaction among users and providers. The registration and effective introduction of medical abortion was quite rapid. Following successful conduct of the pilot study, i...
Scintillating materials are used in a variety of medical imaging devices. This paper presents a description of four medical imaging modalities that make extensive use of scintillators: planar x-ray imaging, x-ray computed tomography (x-ray CT), SPECT (single photon emission computed tomography) and PET (positron emission tomography). The discussion concentrates on a description of the underlying physical principles by which the four modalities operate. The scintillator requirements for these systems are enumerated and the compromises that are made in order to maximize imaging performance utilizing existing scintillating materials are discussed, as is the potential for improving imaging performance by improving scintillator properties.
Tests to identify individuals who are likely to develop serious diseases are being rapidly developed. Some of these tests are directed at diseases for which there are presently no known therapies, thereby raising questions over the social consequences of identifying susceptible persons. This assessment examines existing and developing medical tests and their current and potential uses by health insurers and employers.
Advances in wireless technologies in the last ten years have created considerable opportunities as well as challenges for wireless body medical systems. The foremost challenge is how to build a reliable system connecting heterogeneous body sensors and actuators in an open system environment. In this dissertation, we present our work towards this goal. The system addresses four design issues: the underlying network architecture, the network scheduling disciplines, the location determination and tracking methods, and the embedded application execution architecture. We first present the design of an adaptive wireless protocol (MBStarPlus) to provide the basic wireless platform WBAN (Wireless Body Area Network). MBStarPlus is a real-time, secure, robust and flexible wireless network architecture. It is designed to utilize any low-power wir...
This report discusses the medical malpractice system that has frequently been cited as a contributor to increasing health care costs and has been targeted in many health care reform proposals as a potential source of savings. The report first examines the nature of defensive medicine, adopting a working definition of defensive medicine that embraces the complexity of the problem from both the physician and broader public policy perspectives. Finally, it comments on the potential impact of a variety of medical malpractice reforms on the practice of defensive medicine.
Although adolescence cannot be said to be a medical condition, and although most adolescents are healthy, some do become ill. But the adolescent is not a patient like any other...Today, the age of majority is set in most jurisdictions at the age of 18 years, but in the context of medical treatment, many countries do recognise a certain level of autonomy (to a greater or lesser extent) of adolescents who are deemed to be mature. However, the extent of this autonomy raises many questions. Is the consent of the adolescent required, along with that of the parents, before any intervention may take place? Do they have a right of veto? Is their consent alone enough? Are they recognised as having the right to take part in medical trials, the right to refuse necessary treatment...? These and many other questions are at the heart of this multidi...
Intelligent Tutoring Systems (ITS) are increasingly breaking free of the lab and entering the classroom. These practice-based software systems promise significant learning gains over more traditional e-learning approaches. However, their widespread uptake is still hampered by the difficulty in building them. Over the past ten years we have developed ITS authoring tools that have evolved to the point that it is now feasible for teachers to build their own systems. We report on one such system, an ITS for medical imaging, built by the head of the Medical Imaging Department of a polytechnic institution using VIPER, an ITS authoring system we have developed. Despite requiring no specialist skills (other than domain knowledge) to build, an initial study provides evidence that the resulting ITS is effective at teaching the important concepts...
Platonic Craft and Medical Ethics examines the Platonic theory of craft and shows its application to different ethical problems in medicine, both ancient and modern. I begin by elucidating the Platonic use of the term “craft” or “technē”, using especially the paradigmatic craft of medicine, and explicate a number of important principles inherent in his use of the term. I then show how Plato’s framework of crafts can be applied to two ancient debates. First, I show how Plato’s understanding of crafts is used in discussing the definition of medicine, and how he deals with the issue of “bivalence”, that medicine seems to be capable of generating disease as well as curing it. I follow this discussion into Aristotle, who, though he has a different interpretation of bivalence, has a solution in many ways similar to Plato’s. Second, I di...
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