5/08/2007
Adriana it's all about Adrianus
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Alison 07
Richard Hatchett, the lead author of one of the studies, "because they looked at the variability between cities and concluded that there was some other factor than the interventions that caused the differing outcomes. "When multiple interventions were introduced early, they were very effective in 1918," he said, "and that certainly offers hope that they would be similarly useful in an epidemic today if we didn't have an effective vaccine." The second study, in the same issue of The Proceedings, suggests that in one sense preventive measures can be too effective. The study examined the course of the epidemic in 23 cities: San Francisco, St. Louis, Milwaukee and Kansas City, Mo., had the most effective prevention programs, and time was of the essence.
I knew about his voices, and sometimes knew what his voices told him, but had come to believe that voices and patient coexisted in a delicate yet stable ecosystem. We memorize the characteristics in residency training and recall them in evaluations to figure out how frightened we ought to be. On the opposite side of the screen, there were scrolls of e-mail messages that other MySpace members had sent him: friendly, uncapitalized, hallucination-free greetings. But he had ignored his hallucinations long enough to write of a different yet equally true self here, and he had found friends who identified him not by psychiatric symptoms but by astrological sign.
Doctors in training sometimes confront situations in which they worry that their supervising physicians are making mistakes or bending the truth. Although some senior physicians welcomed feedback from their juniors, others disdained it, either overtly or through intimidation. The student whose resident seemingly lied to the attending physician about the blood test did not speak up either. But when he told the resident, who had seen the patient earlier and more quickly, the resident refused to re-examine the patient. What should a medical student do in such a situation? One possibility is to take the matter up with a more senior doctor.
After all, in each of these examples, patients are at risk of harm, something that physicians must avoid at all costs. Fortunately, medical educators are increasingly recognizing the dilemmas that doctors in training confront when they witness behavior that makes them uncomfortable.
Students and residents are now expected to provide routine feedback positive and negative about their supervising physicians at the close of their rotation. They also found that only Prozac worked better than dummy pills in depressed children younger than 12. Two weeks before Philadelphia officials began to react, doctors in St. Using mathematical models, they reported that such large differences in death rates could be explained by the ways the cities carried out prevention measures, especially in their timing. The director for global migration and quarantine at the federal Centers for Disease Control and Prevention in Atlanta, found reason for optimism in the study results. But an effective prevention program without a vaccine can leave enough people uninfected and still susceptible to the virus to start the epidemic again as soon as the controls are lifted. If restrictions were introduced too late or lifted too early, success rates declined substantially.
But he added that rigid preventive measures like quarantines, mandated mask wearing and widespread business closings would still need to be put in place. When it is your patient who has died, there is a fugitive quality to it: someone has fled, and you were unable to capture or return him alive. By these criteria, my patient could not be found on the map (though psychosis is also a high risk factor).
He could, however, be found on MySpace.com. The messages had this in common: They were all written to a correspondent who led an unquestionably normal life.I had thought of him as struggling under the constant hold of hallucinations. The last dozen messages on the screen were exactly the same. I had gone on the site only a day after his death, but his cyberobituary must have traveled faster. The unquestionably normal person, whose photograph still looked as though it were reading its e-mail messages from the opposite side of the Web page, had already fled to find peace, or reconciliation or relief, I don't know. This new division of labor established hierarchies.
On the top were the senior physicians who made rounds on the wards once or twice daily. Next were the overworked residents, who essentially lived in the hospital while training. Adolescents responded better than children to treatment for depression and anxiety, the researchers found. And in the studies of anxiety disorders, 69 percent improved on antidepressants and 39 percent improved on dummy pills.
Louis persuaded the city to require that influenza cases be registered with the health department. And two days after the first civilian cases, police officers helped the department enforce a shutdown of schools, churches and other gathering places. But he said the suicidal behavior risk, although lower than found by the F.D.A., demanded that doctors and families watch for warning signs. "You can't treat kids with these drugs without taking this information into account," said Dr. Louis were 347 per 100,000 people, less than half the rate in Philadelphia.
"It had been received wisdom that these interventions didn't work" The director for global migration and quarantine at the federal Centers for Disease Control and Prevention in Atlanta, found reason for optimism in the study results.
In an influenza epidemic, a certain number of people survive the illness and are immune to reinfection. The study examined the course of the epidemic in 23 cities: San Francisco, St. Louis, Milwaukee and Kansas City, Mo., had the most effective prevention programs, and time was of the essence. If restrictions were introduced too late or lifted too early, success rates declined substantially. In the studies involving depression, 61 percent of patients improved while on antidepressants. But 50 percent of depressed patients taking dummy pills also improved. But 50 percent of depressed patients taking dummy pills also improved.
"You can't treat kids with these drugs without taking this information into account," said Dr. Early action appeared to have saved thousands of lives. "It had been received wisdom that these interventions didn't work"
"When multiple interventions were introduced early, they were very effective in 1918," he said, "and that certainly offers hope that they would be similarly useful in an epidemic today if we didn't have an effective vaccine." As these numbers increase, the epidemic fades.Louis, carried out early interventions before the first peak, and then reinstituted them when transmission rates began to rise again. I knew about his voices, and sometimes knew what his voices told him, but had come to believe that voices and patient coexisted in a delicate yet stable ecosystem. In our last meeting, before he stopped coming to appointments, he told me that he had joined the site to meet friends. Some voiced hopes of meeting one day, some had comments about other correspondents on the site, some sent good wishes on relevant holidays. Nor, apparently, was that unseen self writing back.
They were an introduction to a man I had not properly known. Doctors in training sometimes confront situations in which they worry that their supervising physicians are making mistakes or bending the truth. Although some senior physicians welcomed feedback from their juniors, others disdained it, either overtly or through intimidation. And, she added sheepishly, both the resident and the attending physician would be grading her.
Even when students do speak up, they may be ignored. March, who was not involved in the study but who does similar research. "You can't say, 'Take these and call me in six weeks. " And two days after the first civilian cases, police officers helped the department enforce a shutdown of schools, churches and other gathering places. "It had been received wisdom that these interventions didn't work"
Richard Hatchett, the lead author of one of the studies, "because they looked at the variability between cities and concluded that there was some other factor than the interventions that caused the differing outcomes. And in the studies of anxiety disorders, 69 percent improved on antidepressants and 39 percent improved on dummy pills.
And two days after the first civilian cases, police officers helped the department enforce a shutdown of schools, churches and other gathering places. Infected people were quarantined in their homes. Cities that instituted quarantine, school closings, bans on public gatherings and other such procedures early in the epidemic had peak death rates 30 percent to 50 percent lower than those that did not. "That we were able to go back and ask the right questions," Hatchett said, "is a function of a lot of modeling work that we did previously." They also found that only Prozac worked better than dummy pills in depressed children younger than 12. "You can't treat kids with these drugs without taking this information into account," said Dr.
"You can't say, 'Take these and call me in six weeks. " Two weeks before Philadelphia officials began to react, doctors in St. But 50 percent of depressed patients taking dummy pills also improved.
"You can't treat kids with these drugs without taking this information into account," said Dr. Two weeks before Philadelphia officials began to react, doctors in St.
