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Mobile technologies and smartphones have transformed the cultural landscape and the opportunities for information delivery chronic gastritis/lymphoid hyperplasia allopurinol 300 mg buy lowest price. A recent survey in Time magazine reported that 9 of 10 Americans carry a mobile device and access it regularly atrophische gastritis definition allopurinol 300 mg generic with mastercard. Thirty-three percent of Americans feel anxious if they are separated from their phones for even short periods of time gastritis diet 3-1-2-1 allopurinol 300 mg buy. Seventy-five percent of Americans age 25 to 29 years sleep with their phones, and twice as many people would pick their phones over their lunch if forced to choose. Just-in-time education can potentially provide patient-specific answers to clinical questions at the moment the provider needs to know. The opportunities for clinically relevant learning at highly "teachable moments" are obvious. Text-based applications running on the web, such as UpToDate, ClinicalKey, mobile manuals, Epocrates, and many others, offer mobile access to specific clinical information on mobile devices. Increasing levels of integration with electronic medical health records for specific patient allows the possibility for both alerts and instruction relevant to specific patient care situations to be offered in real time. Such integration of electronic medical health records with just-in-time education is still in its infancy. As a particular example, the rapidly expanding fields of cardiovascular genetics and genomics are producing new knowledge at a rapid rate, and this information will not be widely familiar to many practicing physicians. Similarly, physicians will often be uncertain as to when such information is even relevant for a particular patient or disease state. Thus cardiovascular genetic data might be examples of "chunks of knowledge" that could provide "just-in-time" education to practicing cardiologists caring for patients with certain cardiomyopathies. Limitations Web-based learning is still in an early phase in subspecialty medical education, and many challenges face the organizations and groups that develop learning materials for interventional cardiologists. The rapid expansion of learning platforms, mobile devices, and technology standards has offered both opportunities and challenges. One of the greatest challenges relates to the rapid evolution of knowledge and clinical information. Case studies, guidelines, and clinical trial results can rapidly become obsolete as new science is developed. When clinical information is embedded in enduring materials, its relevancy is quickly dated and it requires significant financial resources and effort to keep clinical information up to date, especially when it is in noneditable formats such as video or web-based packages. Clearly, the current significant use of web-based learning sites would seem to confirm that physicians desire to use online resources in education, but objective demonstration of improved physician performance or patient outcomes from these learning interactions is still lacking, especially for online educational methods that teach cognitive or procedural skills. Whereas medical journals have formal peer-review processes that have been developed over many years,5,6 online content can appear on the web from any number of sources. Much of the web-based learning in interventional cardiology comes from major cardiology societies such as the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, the American Heart Association, or the European Society of Cardiology. However, medical educational content can also be usergenerated or even crowd-sourced from comment fields, blogs, or wikis, methods where the quality and source of information may be unclear. Selected Glossary of E-Learning Terms Apps are small computer programs, or "applications," that typically run on mobile devices such as smartphones or tablets (such as iPad or Google Nexus) but also on a computer or laptop. Blended learning refers to using web-based teaching methods together with more traditional classroom-based methods. This is sometimes referred to as hybrid learning, or "flipping the classroom," since the latter allows lectures to be given asynchronously via the web while classroom time is reserved for higher level, integrative learning. Blog, derived from the word "weblog," is an e-learning or social media tool that allows the ongoing discussion of a particular topic or theme, often in response to a prompt. Blogs allow social interaction and engagement with a wider audience of blog readers or members. Topics are often maintained and archived in reverse chronological order for ongoing review.
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The patient may not actuall y need all the drugs present in a combination: he is subjected to additional side effects and expense (often du e to ignorance of the ph ys ician about the exact composition of the combined formulations) gastritis y probioticos cheap allopurinol 300 mg with amex. When a combined formulation is used diet plan for gastritis sufferers order 300 mg allopurinol amex, this cannot be done wi thout a lteri ng the dose of the other component(s) gastritis kaj je allopurinol 300 mg on line. The time course of action of the compo nents may be different: administering them at the same intervals may be inappropriate. Altered rena l or hepatic function or the patient may differently affect the pharmacokinetics of the components. Contraindication 10 one componen t (alle rgy, other conditions) contraindicates the whole product. Confusio n of therapeutic a ims and fa lse sense of superiority of two drugs over one is fostered, specially in case of antimicrobials whose combinations should be avoided. One or more of the fol lowing categories of differences among individuals are responsible for the variations in drug response: (I) Individuals differ in pharmacokinetic handling of drugs: attain varying plasma/target site concentration of the drug. They fall in two categories viz generic and nongenetic including all environmental. Though indi vidual variation cannot be totall y accounted for by these factors, their understanding can guide the choice of appropriate drug and dose for an ind ividual patient. The factors modify drug action either: (a) Quantitatively the plasma concentration and/or the action of the drug is inc reased or decreased. Most of the factors introduce this type of c hange an d ca n be dea lt with by adjustment of drug dosage. This is less common but often prec ludes furt her use of that drug in the affected patient. The various factors a re discussed below- It infl uences the concentra tion of the drug allained at the site of action. Some age based formulae for calculating child dose from the adult dose have been framed, but arc not in use now. Solid dosage forms and metered dose inhalers are difficult to administer to young children. Glomerular filtration reaches adult rates by 5 month of age and tubular ecretion takes about 7 months to mature. Similarly, hepatic drug metaboliz ing system is inadequate in newborns -<:hloramphenicol can produce gray baby syndrome (see Ch. Blood-brain barrier is more permeable-drugs attain higher concentration in the C S (easy entry of unconjugated bilirubin in brain cau cs kernicterus). Drug absorptio n may also be altered in infants because of lower gastric acidi ty and s lower intestinal Lransit. Transdermal absorption however, is faster because infant skin is thin and more permeable. Taking advantage of this fact, diazepam solution is given rectally to control febrile seizures in children < 5 years. Also, higher per kg dose is needed in children for drugs which are pri marily excreted un changed by Elderly In the elderly, renal function progressi vcly declines (intact nephron loss) so that g. There is also a reduction in the hepatic microsomal drug metabolizing activity and liver blood flow: oral bioavailability of drugs with high hepatic extraction is generall y increased, bu t the overall e ffects on drug metabolism are no t uniform. Due to lower renal as well as metabolic clea rance, the e lde rly are prone to develop cumulati ve toxicity whi le receiving prolonged medication. The responsiveness of adrenergic receptors to both agonists and antagonists is reduced in the elderly and sensiti vity to other drugs also may be a ltered. Due to prostati sm in elderly males, even mi ld anticholinergic activity of the drug can accentuate bladder voiding difficulty. Elderly are also like ly to be on multiple drug therapy for hypertension, ischaemic heart d isease, diabetes, arthritis, etc. They are more prone to develop postural instabi lity, giddiness and mental confusion.
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