By F. Dan. University of San Diego.
It promises to make healthcare smarter and proactive and it is in line with the Commission’s priorities of supporting cutting edge research buy cefixime 100 mg overnight delivery virus x trip doujinshi, driving innovation and creating new markets and jobs buy cefixime 100 mg without a prescription virus going around schools. It will rely on the ability of participants to integrate data from multiple sources and use this information to improve health without affecting patient confidentiality. He noted that inequalities still exist within healthcare systems at a national level. Personalised medicine is an opportunity to look at new ways of delivering healthcare, assessing healthcare technologies and monitoring regulatory systems to make sure that they are keeping up with innovation. It is an approach to healthcare that presents an opportunity to bring people together to work on big issues of common interest. There are opportunities for industry to develop new business models based on the widespread use of digital technologies. Personalised medicine also goes hand-in-hand with the development of 2 The Council conclusions on personalised medicine for patients can be consulted on the web page: http://eur- lex. While the regulatory aspects of some of the new technologies are being addressed, there remains the issue of the cost of personalised medicine. Roberto Viola, Director-General for Communications Networks, Content and Technology, addressed the issue of data. For example, computing power needs to be increased, with the possibility of creating a European science cloud. The Directorate-General for Communications Networks, Content and Technology plays various roles in the personalised medicine initiative; considering activities in e-Health, Big data and High Performance Computing. The regulatory aspects are equally important: such as data flows, cybersecurity and data exchanges. Using breast cancer as an example, he said molecular analysis has shown that there is not one, but several types of the disease. Yet will these new treatments help a woman with cancer who also lives in a deprived area and may also be suffering from obesity and diabetes? Personalised medicine may be a way of closing the gap between clinical medicine and the other aspects of real life that affect human health. These differences can be captured in data, but patients must consent to provide this data. Another question is whether it will be possible to produce a better quality of care at a reduced cost. This will require a shift from a system that reacts to disease to one that seeks to prevent disease. Patient-reported outcome statistics will make it possible to establish which interventions are necessary and which are not. Anders Olauson, Honorary President of the European Patients’ Forum, ended the session with a call for patient empowerment. This entails giving patients access to information that will enable them to work with doctors in the management of their own healthcare. Personalised medicine puts the patient at the centre of healthcare decision-making. She illustrated this with an example of a woman whose aunt had a gene mutation which was predictive of cancer. After genetic counselling, the woman asked to be tested and discovered that she too was positive and had a risk of developing cancer. This points to a new model for care where the patient is engaged in researching aspects of his or her own health. Diagnosed with lymphoma in 2005, Peter Kapitein is a founder of the patient advocacy group Inspire2Live. Based in the Netherlands, Inspire2Live has about 34 members who are living with cancer. They meet with clinicians, scientists and business people to identify parts of the cancer healthcare system that could be improved. The group supports a fundraising event each year where cyclists bike up and down Alpe d’Huez in the French Alps six times in one day. They are: engage people with different perspectives; search for the root cause of a problem; think on a big scale, and remain independent.
Airway To open the airway of an infant buy discount cefixime 200 mg on-line antibiotics for acne and alcohol, use the same head-tilt/chin-lift technique as you would for an adult or child buy discount cefixime 200mg line antibiotics to treat uti. However, only tilt the head to a neutral position, taking care to avoid any hyperextension or ﬂexion in the neck. Be careful not to place your ﬁngers on the soft tissues under the chin or neck to open the airway. Table 1-4 illustrates airway and ventilation differences for an adult, child and infant. Basic Life Support for Healthcare Providers Handbook 31 Table 1-4 Airway and Ventilation Differences: Adult, Child and Infant Child (Age 1 Through Infant (Birth to Adult Onset of Puberty) Age 1) Airway Head-Tilt/ Chin-Lift Past neutral position Slightly past neutral Neutral position position Ventilations Respiratory Arrest 1 ventilation every 5 to 1 ventilation every 1 ventilation every 6 seconds 3 seconds 3 seconds Compressions Although the rate of compressions is the same for an infant as for an adult or child, the positioning and manner of providing compressions to an infant are different because of the infant’s smaller size. The ﬁrm, ﬂat surface necessary for providing compressions is also appropriate for an infant. However, that surface can be above the ground, such as a stable table or countertop. Often it is easier for the rescuer to provide compressions from a standing position rather than kneeling at the patient’s side. The ﬁngers should be oriented so that they are parallel, not perpendicular to the sternum. Rescuers may use either their index ﬁnger and middle ﬁnger or their middle ﬁnger and fourth ﬁnger to provide compressions. Fingers that are more similar in length tend to make the delivery of compressions easier. The ratio of compressions to ventilations is the same as for an adult or child, that is, 30 compressions to 2 ventilations (30:2). The rescuer performing chest compressions will be positioned at the infant’s feet while the rescuer providing ventilations will be at the infant’s head. To provide compressions using this technique: Place both thumbs on the center of the infant’s chest side-by-side about 1 ﬁnger-width below the nipple line. While positioned at the infant’s head, the rescuer providing ventilations will open the airway using 2 hands and seal the mask using the E-C technique. With two rescuers, the ratio of compressions to ventilations changes to that of a child, that is, 15 compressions to 2 ventilations (15:2). When applying the pads, place one pad in the center of the anterior chest and the second pad in the posterior position centered between the scapulae. You need to be able Ato recognize that a patient who cannot cough, speak, cry or breathe requires immediate care. A conscious person who is clutching the throat is showing what is commonly called the universal sign for choking. Other behaviors that might be seen include running about, ﬂailing arms or trying to get another’s attention. Caring for an Adult and Child For an adult or child, if the patient can cough forcefully, encourage him or her to continue coughing until he or she is able to breathe normally. If the patient can’t breathe or has a weak or ineffective cough, you will need to perform abdominal thrusts to clear the obstruction. To perform abdominal thrusts, stand behind the patient and while maintaining your balance, make a ﬁst with one hand and place it thumb-side against the patient’s abdomen—just above the navel. Continue delivering abdominal thrusts until the object is forced out; the person can cough, speak or breathe; or the patient becomes unconscious. If you cannot reach far enough around the patient to give effective abdominal thrusts or if the patient is obviously pregnant or known to be pregnant, give chest thrusts. To perform chest thrusts: from behind the patient place the thumb side of the ﬁst against the lower half of the sternum and the second hand over the ﬁst. As you open the airway to give ventilations, look in the person’s mouth for any visible object. Basic Life Support for Healthcare Providers Handbook 37 Continuing cycles of 30 compressions and 2 ventilations is the most effective way to provide care. Even if ventilations fail to make the chest rise, compressions may help clear the airway by moving the blockage into the upper airway where it can be seen and removed. Science Note Evidence suggests that it may take more than one technique to relieve an airway obstruction in the conscious patient and that abdominal thrusts, back blows and chest thrusts are all effective. Note: Based upon local protocols or practice, it is permissible to provide a series of back blows and abdominal thrusts to an adult or child who is choking. Caring for an Infant When an infant is choking and awake but unable to cough, cry or breathe, you’ll need to perform a series of 5 back blows and 5 chest thrusts.
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