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By K. Grobock. Sarah Lawrence College. 2018.

On Treatments for Women  in it buy generic erectafil 20mg, place it in the vagina two or three times a day buy cheap erectafil 20 mg line. And note that prior to this the vagina ought to be washed well with the same warm water with which these things were mixed discount erectafil 20 mg free shipping. Having ground it, dis- solve it with rainwater, and with a linen or cotton cloth place it in the vagina in the above-mentioned manner. Let the woman sit in water where there have been cooked marsh mallows and pennyroyal, and she will be freed. For Swelling of the Face [] For sudden swelling of the face, a fumigation of hot water alone suffices. Ad hoc facimusb ma- turatiuum de malua et maluauisco, absinthio, arthimesia, et auxungia, et cum caputc apparuerit,d contere nucleose et appone. Et sif non rumpitur cum flebo- tomo aperiatur, et exprimeg parum in principio ne subita euacuatione malum fiat, et inpone licinium singulis diebus bis uel ter, illinitum cum uitello oui. Istis facimus pannum in uino intinctum in quob bullierint folia mirtilli, uelc ipsa herba ueld ipsi mirtilli. On Treatments for Women  On Pain of the Breasts [] For pain of the breasts caused by milk, we should mix clay with vinegar and make a plaster; this diminishes the pain and constricts the milk. On Lesions of the Breasts [] There are some women who have lesions in the breasts. For this we make a maturative from marsh mallow and mayweed, wormwood, mugwort, and animal grease, and when the head [of the lesion] appears, grind together nuts and apply them. And if it does not rupture let it be opened with a lancet, and press out a little in the beginning lest by a sudden evacuation it becomes bad, and each day apply a piece of lint twice or three times smeared with egg yolk. For this cleans every fistula and makes it become necrotic, as long as it is not between any bones. On Foul-Smelling Sweat [] There are some women who have sweat that stinks beyond measure. For these we prepare a cloth dipped in wine in which there have been boiled leaves of bilberry, or the herb itself or the bilberries themselves. Accipe pulegium, policariam, quatuor frondes lauri, et bullianta in aqua, et facias eam sedere in aqua ista, et postb fac de omni- bus fumigium. On Treatments for Women  On Swelling of the Vagina [] For swelling of the vagina. Take pennyroyal, fleabane, and four fronds of laurel, and boil them in water, and you should make her sit in this water, and afterward make a fumigation from all these [herbs]. For Antlike Itching and Itch-Mites [] For antlike itches and itch-mites wherever they might be in the body, especially in the face and on the forehead, we mix grain with wine, and with a powder of frankincense applied in the manner of a plaster, we place it on the [afflicted] spot. On Pain of the Eyes [] For pain of the eyes, take marsh mallow, the herb of violets, tips of bramble, dried roses, vervain, and sermountain. OnW eboftheEye [] If there is a web in the eye, take conch and frankincense and burn them. Take two parts of aloe, and as much frank- incense and plaster of Paris as of the aloe; pulverize them finely and prepare them with fresh animal grease and anoint the place. On Cancer of the Nose [] For cancer of the nose, take lungwort, sage, Greek tar, wild garlic, and ‘‘blacking,’’ that is, earth of the countryside,45 and pulverize them all equally. Et cum exierit de balneo, pista maluam,e arthimesiam, camphoram, et eas pistatas in olla calefacias, et informa magdaleones cum oleo laurino uelf pulegino pauco, et suppone. Tunc accipe tribu- los marinos et coque in aqua marina uelb salsa, et [vb] fumiga pedes sepe, et post fumigium cum fomentumc erit tepidum, lauabis pedes. Postea accipe semen urtice et cornu cerui, et da puluerem inde factum ad bibendum cum uino. Afterward, grind root of delicate willow and root of madder, and give the juice to the patient with wine. Cook all these herbs in water thoroughly, and make the patient sit in it up to her breasts. And when she exits from the bath, pound marsh mal- low, mugwort, and camphor, and warm these pounded things in a pot, and make lozenges with laurel oil or a little pennyroyal oil, and insert them as a suppository. On Swelling of the Feet [] Sometimes it happens that the feet are swollen due to pain of the womb. Then take sea brambles and cook them in sea- or saltwater, and fumigate the feet often. And after the fumigation, when the mixture has become lukewarm, you will wash the feet. Afterward, take nettle seed and buck’s-horn plantain, and give a powder made of this to drink with wine. Accipe paleam auenea et combure in cineres, post apponatur aqua calida quantum patiens sustinere poterit, et intus teneat pedes quous- que infrigidentur. Accipe pinguedinem anguillarum recentium que apparet post decoctionem illarum, et [rb] succum caprifolii, et barbe Iouis, et ouorum formicarum plenam palmam, tere et cola,b et hec omnia simulc cum oleo misceanturd et decoquantur. On Treatments for Women  [On Cutting the Umbilical Cord] [] When the umbilical cord of the child is cut, you should say as follows, holding the stump extended: ‘‘Jesus Christ is dead, he was pierced by the lance, and he took no thought of any ointment or of his pain or of any unguent.

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Though typical office visits are short discount erectafil 20 mg visa, taking time to understand the patient’s perspective may help avoid cultural assumptions purchase erectafil 20mg without prescription. For example discount 20 mg erectafil free shipping, when seeing a patient who is culturally different from you, one might assume that the patient’s values are different as well. On the other hand, it is easy to make false assumptions of shared values based on misperceived similarities of backgrounds between the provider and the patient. Understanding the patient’s perspective comes from active questioning of the patient to determine their values and per- spectives and avoids assumptions about similarities and differences. Patients have varying levels of understanding of health-care issues, some with vast and others with limited previous health-care experience and levels of under- standing. The patient’s level of health literacy clearly affects her perspective on the question and how she will interpret any discussion of results and recom- mendations. During the initial phases of the discussion about her question, it is important to understand her health literacy and general literacy level. Asking the patient what she knows about the problem can provide an impression of health literacy. This may be adequate, but asking a question such as: “How comfortable are you with the way you read? For example, if a patient wishes to avoid taking a medication because he or she is more con- cerned about the side effects of treatment than the benefits of treatment, focus the discussion on the evidence in this area. Also, many studies report major morbidity and mortality of treatment, yet, patients may be more concerned about the quality-of-life effects of treatment over many years. In other studies, the use of composite outcomes can make it difficult to directly answer a patient’s question since some of these are more important to the patient than others. The patient in our example wishes to know whether aspirin reduces the risk of heart attack. Although one may find a study that shows a statistically significant reduction of myocardial infarction, if the result is only reported as a composite outcome along with other outcomes such as reduced incidence of angina and heart failure, the result will not directly address your patient’s ques- tion. Since this type of presentation of data is used by authors when an individ- ual outcome is not itself statistically significant, the combination of outcomes is used to achieve statistical significance and get the study published. But, the composite is often made up of various outcomes not all of which have the same value to the patient. The goal of a discussion with the patient is to explain the results of each of the composite components so that she can make up her mind about which of the outcomes are important to her. Recommendations for understanding the patient’s experience and expectations The patient’s perspective on the problem as well as the available evidence deter- mines the true need to proceed with further steps to communicate evidence. It is possible that the patient’s questions relate only to background information, which is clearly defined in the science of medicine and not dependent on your interpretation of the most recent research evidence for an answer. Then, if evi- dence is needed to answer a patient’s question, first check to see whether it truly addresses the patients query about her desired outcomes rather than outcomes that are not important to the patient. Step 2: Build partnerships Taking time for this step is a way to build rapport with the patient. After dis- cussing the patient’s perspective, an impression will have developed of whether one generally agrees or disagrees with the patient. At this point in the discussion, Communicating evidence to patients 203 it should be clear what, if any, existing evidence may be of interest to the patient. The physician will also have a good understanding of whether to spend a major- ity of their time discussing basic or more advanced information. Using phrases such as “Let me summarize what you told me so far” or “It sounds like you are not sure what to do next” can help to build partnership that will allow a transition to the third step in the process of communicating evidence. In the example, the patient who is interested in aspirin for prevention of strokes and heart attacks is frustrated by her lack of reduction of weight or cholesterol after implementing some lifestyle changes. Expressing empathy for her struggles will likely help the patient see you as partner in her care. Step 3: Provide evidence As health-care providers, numbers are an important consideration in our decision-making process. While some may want the results this way, many patients do not want results to be that specific or in numerical form. As a general rule, patients tend to want few specific numbers, although patients’ preferences range from not wanting to know more than a brief statement or the “bottom line” of what the evidence shows to wanting to know as much as is available about the actual study results. Check the patient’s preference for information by ask- ing: “Do you want to hear specific numbers or only general information? Another way to start is by giving minimal information and allowing the patient to ask for more, or follow this basic information by asking the patient whether more specific infor- mation is desired. Previous experiences with the patient can also assist in deter- mining how much information to discuss. Presenting the information There are a number of ways to communicate information to patients and under- standing the patient’s desires can help determine the best way to do this. The first approach is to use conceptual terms, such as “most patients” or “almost every patient” or “very few patients. A second approach is to use general numerical terms, such as “half the patients” or “1 in 100 patients. While these are the most common verbal approaches, both conceptual and numerical rep- resentations can be graphed, either with rough sketches or stick figures.

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All of these new challenges should be part of the optimization process and should be included in clinical and technical protocols cheap 20mg erectafil fast delivery. Local diagnostic reference levels should be re-evaluated for digital imaging buy erectafil 20 mg fast delivery, and patient dose parameters should be displayed at the operator console 20mg erectafil for sale. Training in the management of image quality and patient dose in digital radiology is necessary. Digital radiology will involve new regulations and invoke new challenges for practitioners. As digital images are easier to obtain and transmit, the justification criteria should be reinforced. Commissioning of digital systems should involve clinical specialists, medical physicists and radiographers to ensure that imaging capability and radiation dose management are integrated. The doses can often approach or exceed levels known with certainty to increase the probability of cancer. Proper justification of examinations, use of the appropriate technical parameters during examinations, proper quality control and application of diagnostic reference levels of dose, as appropriate, would all contribute to this end. All of these issues should be addressed for providing assistance in the successful management of patient dose. If the image quality is appropriately specified by the user, and suited to the clinical task, there will be a reduction in patient dose for most patients. Pregnancy and medical radiation Thousands of pregnant patients are exposed to radiation each year as a result of obstetrics procedures. Lack of knowledge is responsible for great anxiety and probably unnecessary termination of many pregnancies. Dealing with these problems continues to be a challenge primarily for physicians, but also for medical and health physicists, nurses, technologists and administrators. Medical professionals using radiation should be familiar with the effects of radiation on the embryo and foetus, including the risk of childhood cancer, at most diagnostic levels. Doses in excess of 100 ± 200 mGy risk nervous system abnormalities, malformations, growth retardation and fetal death. Justification of medical exposure of pregnant women poses a different benefit/risk situation to most other medical exposures, because in in utero medical exposures there are two different entities (the mother and the foetus) that must be considered. Prior to radiation exposure, female patients of childbearing age should be evaluated and an attempt made to determine who is or could be pregnant. For pregnant patients, the medical procedures should be tailored to reduce fetal dose. After medical procedures involving high doses of radiation have been performed on pregnant patients, fetal dose and potential fetal risk should be estimated. Pregnant medical radiation workers may work in a radiation environment as long as there is reasonable assurance that the fetal dose can be kept below 1 mGy during the course of pregnancy. Termination of pregnancy at fetal doses of less than 100 mGy is deemed to be unjustifiable, but at higher fetal doses, informed decisions should be made based upon individual circumstances. Radiological protection in paediatric diagnostic and interventional radiology Diagnostic radiological examinations carry a higher risk per unit of radiation dose for the development of cancer in infants and children compared to adults. The higher risk is due to the longer life expectancy of children, in which radiation effects could manifest, and the fact that developing organs and tissues are more sensitive to radiation. Risk is particularly high in infants and young children compared to older children. Justification of every examination involving ionizing radiation, followed by optimization of radiological protection is particularly important in every paediatric patient, in view of the higher risk of adverse effects per unit of radiation dose compared to adults. According to the justification principle, if a diagnostic imaging examination is indicated and justified, this implies that the risk to the patient of not performing the examination is greater than the risk of potential radiation induced harm to the patient. The implementation of quality criteria and regular audits should be instituted as part of the radiological protection culture in the institution. Imaging techniques that do not employ the use of ionizing radiation should always be considered as a possible alternative. For the purpose of minimizing radiation exposure, the criteria for the image quality necessary to achieve the diagnostic task in paediatric radiology may differ from adults, and noisier images, if sufficient for radiological diagnosis, should be accepted. The advice of medical physicists should be sought, if possible, to assist with installation, setting imaging protocols and optimization. Exposure parameters that control radiation dose should be carefully tailored for children and every examination should be optimized with regard to radiological protection. Apart from image quality, attention should also be paid to optimizing study quality. Acceptable quality also depends on the structure and organ being examined and the clinical indication for the study. Additional training in radiation protection is recommended for paediatric interventional procedures, which should be performed by experienced paediatric interventional staff due to the potential for high patient radiation dose exposure. Public protection: Release of patients after therapy with unsealed radionuclides A major concern for public protection related to medicine is the release of patients after therapy with unsealed radionuclides.

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