What does DM stand for in medical contexts. How is DM used as an abbreviation in healthcare settings. What are the different meanings of DM in medicine and related fields.

The Primary Medical Meanings of DM

In the medical field, DM is a versatile abbreviation with multiple meanings. Understanding these various interpretations is crucial for healthcare professionals and patients alike.

Diabetes Mellitus: The Most Common Medical Usage

The most prevalent use of DM in medicine stands for Diabetes Mellitus. This chronic condition affects millions worldwide, characterized by elevated blood sugar levels due to insufficient insulin production or ineffective insulin use by the body.

• Type 1 DM: An autoimmune condition where the pancreas produces little to no insulin
• Type 2 DM: The most common form, where the body becomes resistant to insulin
• Gestational DM: Occurs during pregnancy and usually resolves after childbirth

How is DM (Diabetes Mellitus) diagnosed? The diagnosis typically involves blood tests to measure fasting blood sugar levels, HbA1c, and sometimes an oral glucose tolerance test. A fasting blood sugar level of 126 mg/dL or higher on two separate tests indicates diabetes.

Dextromethorphan: A Common Cough Suppressant

In pharmacology, DM often refers to Dextromethorphan, an active ingredient found in many over-the-counter cough medications. It works by affecting signals in the brain that trigger the cough reflex.

Is DM (Dextromethorphan) safe for everyone? While generally safe when used as directed, it can interact with certain medications and should be used with caution in individuals with specific medical conditions. Always consult a healthcare provider before use, especially for children, pregnant women, or those with chronic health issues.

Lesser-Known Medical Meanings of DM

While Diabetes Mellitus and Dextromethorphan are the most common interpretations, DM has several other meanings in specialized medical contexts.

Dermatomyositis: A Rare Autoimmune Condition

In rheumatology and dermatology, DM can stand for Dermatomyositis. This inflammatory condition affects both skin and muscles, causing characteristic rashes and muscle weakness.

Can DM (Dermatomyositis) be cured? While there is no cure for dermatomyositis, treatment aims to manage symptoms and improve quality of life. This often involves a combination of medications, physical therapy, and lifestyle modifications.

Diastolic Murmur: A Cardiovascular Finding

In cardiology, DM might refer to Diastolic Murmur. This is an abnormal heart sound heard during the diastolic phase of the cardiac cycle, often indicating issues with heart valves or blood flow.

1. Mitral stenosis
2. Aortic regurgitation
3. Tricuspid stenosis

How is a DM (Diastolic Murmur) detected? Healthcare providers typically use a stethoscope to listen for heart sounds during a physical examination. Further diagnostic tests like echocardiograms may be used to determine the cause and severity of the murmur.

DM in Healthcare Management and Research

Beyond direct medical conditions, DM has important meanings in healthcare administration and research settings.

Data Management: Crucial for Medical Research

In medical research and clinical trials, DM often stands for Data Management. This involves the collection, storage, and analysis of medical data to support scientific studies and improve patient care.

Why is DM (Data Management) important in healthcare? Effective data management ensures the accuracy and integrity of medical information, facilitates research, and supports evidence-based decision-making in patient care. It also plays a crucial role in maintaining patient privacy and complying with healthcare regulations.

Disease Management: A Holistic Approach to Care

In healthcare administration, DM can refer to Disease Management. This comprehensive approach aims to improve outcomes for patients with chronic conditions through coordinated healthcare interventions and communications.

• Patient education and self-management skills
• Regular monitoring and follow-up
• Evidence-based treatment protocols
• Coordination among healthcare providers

How does DM (Disease Management) benefit patients? By providing a structured, proactive approach to managing chronic conditions, disease management programs can improve patient outcomes, reduce hospitalizations, and enhance overall quality of life.

DM in Specialized Medical Fields

Various medical specialties use DM as an abbreviation for specific terms relevant to their field.

Distant Metastasis: A Critical Oncology Term

In oncology, DM may stand for Distant Metastasis. This refers to the spread of cancer cells from the primary tumor site to distant organs or lymph nodes.

What impact does DM (Distant Metastasis) have on cancer prognosis? The presence of distant metastases often indicates a more advanced stage of cancer, which can significantly affect treatment options and overall prognosis. Early detection and intervention are crucial in managing metastatic disease.

Dry Matter: Important in Veterinary Medicine

In veterinary medicine and animal nutrition, DM often refers to Dry Matter. This term is used when discussing the nutrient content of animal feed after removing all moisture.

Why is DM (Dry Matter) content important in animal nutrition? Understanding the dry matter content of feed allows for more accurate comparison of nutrient densities between different feed types, ensuring animals receive balanced and appropriate nutrition.

DM in Medical Education and Qualifications

The abbreviation DM also has significance in medical education and professional qualifications.

Doctorate of Medicine: An Advanced Medical Degree

In academic contexts, DM can stand for Doctorate of Medicine. This is an advanced postgraduate degree offered in some countries, typically focusing on a specific medical specialty.

How does a DM (Doctorate of Medicine) differ from an MD? While an MD (Doctor of Medicine) is the standard medical degree in many countries, a DM is an additional, specialized qualification that represents advanced training and expertise in a particular area of medicine.

Doctor of Management: A Related Healthcare Degree

Although not strictly medical, the Doctor of Management (DM) degree can be relevant in healthcare settings, particularly for those in leadership and administrative roles.

• Healthcare administration
• Hospital management
• Health policy and strategy

Can individuals with a DM (Doctor of Management) work in healthcare? Yes, those with a DM degree focusing on healthcare management can play crucial roles in hospital administration, health policy development, and healthcare system improvement.

The Importance of Context in Interpreting DM

Given the multitude of meanings for DM in medical contexts, it’s crucial to consider the specific field and situation when interpreting this abbreviation.

Potential for Confusion and Misinterpretation

The diverse meanings of DM highlight the potential for confusion in medical communication. Healthcare professionals must be aware of these various interpretations to ensure accurate understanding and prevent errors.

How can misinterpretation of DM be avoided in medical settings? Clear communication, specifying the full term when first used, and considering the context are essential strategies to prevent misunderstandings related to the DM abbreviation.

Evolving Meanings in Modern Medicine

As medical science advances, new meanings for DM may emerge. Staying informed about current terminology and abbreviations is crucial for healthcare professionals and researchers.

Will the meanings of DM in medicine continue to evolve? It’s likely that as new medical discoveries are made and healthcare practices change, additional meanings for DM may develop, underscoring the importance of ongoing education and clear communication in the medical field.

Conclusion: The Multifaceted Nature of DM in Medicine

The abbreviation DM in medicine encompasses a wide range of meanings, from common conditions like Diabetes Mellitus to specialized terms in various medical fields. This diversity highlights the complexity of medical terminology and the importance of clear communication in healthcare settings.

Understanding the various interpretations of DM is crucial for healthcare professionals, students, and patients alike. It enables more effective communication, reduces the risk of misunderstandings, and contributes to better patient care and medical research outcomes.

As medicine continues to evolve, so too will the meanings and applications of abbreviations like DM. Staying informed about these changes and maintaining clear, context-specific communication will remain essential in the dynamic field of healthcare.

DM Medical Abbreviation Meaning

What does DM mean? What is the full form of DM? » English Abbreviations&Acronyms » YThi

1, The full form of DM is Direct Message. It’s used on Computing ,Internet in Worldwide

Direct Message (DM) is a messaging function in many social media applications that allow private messages between users of a social network. DM is only visible to the sender and recipient(s). The term is popular on social media networks like Twitter, Facebook, and Instagram.

2, The full form of DM is Diabetes Mellitus. It’s used on Medical ,Diseases & Conditions in Worldwide

Diabetes Mellitus (DM), commonly known as diabetes is a medical disorder in which blood sugar levels are abnormally high because the body does not produce enough insulin to meet its needs.

3, The full form of DM is Dry Matter. It’s used on Academic & Science ,Units in Worldwide

Dry Matter (DM) is a measurement of the mass of something when all its water content was removed or completely dried.

4, The full form of DM is Disaster Management. It’s used on Medical ,Hospitals in Worldwide

Disaster Management (DM) is the organization and management of resources and responsibilities for dealing with all humanitarian aspects of emergencies, in particular, preparedness, response, and recovery in order to lessen the impact of disasters.

5, The full form of DM is Deutsche Mark. It’s used on Regional ,Currencies in Germany

The Deutsche Mark (DM) was the official currency of Germany until the adoption of the euro in 2002. Deutsche Mark is commonly called the “Deutschmark” in English but not in German. Germans often say “Mark” or “D-Mark”.

6, The full form of DM is Doctorate of Medicine. It’s used on Academic & Science ,Academic Degrees in Worldwide

Doctorate of Medicine (DM) is a postgraduate super specialty degree awarded for a course or program in the field of medicine.

7, The full form of DM is DeathMatch. It’s used on Computing ,Games & Entertainment in Worldwide

DeathMatch (DM) is a type of gameplay mode found in many shooter games. Normally, the goal of deathmatch game is to kill the characters controlled by other players.

8, The full form of DM is Dystrophia Myotonica. It’s used on Medical ,Diseases & Conditions in Worldwide

Dystrophia Myotonica (DM) or Myotonic dystrophy, is a neuromuscular disease that affects muscle function.

9, The full form of DM is Doctor of Management. It’s used on Academic & Science ,Academic Degrees in Worldwide

Doctor of Management (DM) is a doctoral degree awarded on the basis of advanced study and research in management.

10, The full form of DM is District Magistrate. It’s used on Governmental ,Titles in India

The District Collector also known as the District Magistrate (DM) is the district head of administration of the bureaucracy in a state of India. He is also responsible for the maintenance of law and order in his district. Magistrate derives from the Middle English word magistrat, denoting a “civil officer in charge of administrating laws”.

11, The full form of DM is Disease Management. It’s used on Medical ,Diseases & Conditions in Worldwide

Disease Management (DM) is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant.

Appendix B: Some Common Abbreviations: MedlinePlus

This is a list of some common abbreviations and acronyms.

Abbreviation	Stands for	More information
ABG	Arterial blood gases	You may have an ABG test to detect lung diseases.
ACE	Angiotensin converting enzyme	Drugs called ACE inhibitors are used to treat high blood pressure, heart failure, diabetes and kidney diseases.
ACL	Anterior cruciate ligament	Commonly injured part of the knee
ADHD	Attention deficit hyperactivity disorder	A behavior disorder
AFIB	Atrial fibrillation	A disturbance of the rhythm of the heart
AIDS	Acquired immunodeficiency syndrome	Infection caused by human immunodeficiency virus
ALP	Alkaline phosphatase	You may have a blood test for ALP to detect liver or bone disease.
ALS	Amyotrophic lateral sclerosis.	Also known as Lou Gehrig’s Disease
ALT	Alanine aminotransferase	You may have a blood test for ALP to detect liver disease.
AMD	Age-related macular degeneration	An eye problem
AMI	Acute myocardial infarction	Heart attack
AODM	Adult onset diabetes mellitus	Type 2 diabetes
AST	Aspartate aminotransferase	You may have a blood test for ALP to detect liver disease.
AVM	Arteriovenous malformation	A defect in the circulatory system.
BID	Twice a day	Your doctor may write this on your prescription.
BMI	Body mass index	A measure of how much you should weigh based on your height
BP	Blood pressure	The force of your blood pushing against the walls of your arteries
BPH	Benign prostatic hypertrophy	Enlargement of the prostate gland
BRCA	Breast Cancer Gene	People with the gene may be at increased risk for breast or ovarian cancer.
BUN	Blood urea nitrogen	You may have a blood test for BUN to detect kidney disease problems.
CA	Cancer OR Calcium
CA-125	Cancer antigen 125	You may have a blood test for CA-125 A to measure cancer activity.
CABG	Coronary artery bypass graft	A type of heart surgery
CAD	Coronary artery disease	A common type of heart disease
CAT	Computerized axial tomography	A type of x-ray
CBC	Complete blood count	A blood test that measures many properties of the cells in your blood
CHD	Congenital heart disease	Heart disease you were born with
CHF	Congestive heart failure	Also called heart failure. A condition in which the heart can’t pump enough blood throughout the body.
CMV	Cytomegalovirus	A common virus
CNS	Central nervous system	The brain and spinal cord
COPD	Chronic obstructive pulmonary disease	A lung disease that makes it hard to breathe
CPK	Creatine phosphokinase	You may have a blood test for CPK to see if you’ve had a heart attack.
CPR	Cardiopulmonary resuscitation	An emergency procedure whose heart has stopper or is no longer breathing
CRF	Chronic renal failure	Failure of the kidneys
CRP	C-reactive protein	You may have a blood test for CRP to see if you have   inflammation or heart problems.
CSF	Cerebrospinal fluid	A fluid that surrounds the brain and spinal cord
CVA	Cerebrovascular accident	A stroke or “brain attack”
CXR	Chest x-ray	A diagnostic test that uses radiation to make images of your lungs
D&C	Dilatation and curettage	A surgical procedure on the uterus (womb)
DJD	Degenerative joint disease	Another name for arthritis
DM	Diabetes mellitus
DTP	Diphtheria, tetanus, pertussis	A vaccine for three diseases
DVT	Deep-vein thrombosis	A blood clot
DX	Diagnosis
ECG, EKG	Electrocardiogram	A test that measures electrical impulses of the heart
ECHO	Echocardiogram	A test that uses sound waves to look at the heart
EEG	Electroencephalogram	A test that measures electrical impulses of the brain
EMG	Electromyography	A test that measures electrical impulses of muscles
ENT	Ear, nose and throat
ERCP	Endoscopic retrograde cholangiopancreatography	A way to diagnose problems in the liver, gallbladder, bile ducts and pancreas
ESR	Erythrocyte sedimentation rate	A blood test for inflammation
ESRD	End-stage renal (kidney) disease
FSH	Follicle stimulating hormone	If you are a woman, you may have a blood test for FSH to evaluate fertility.
GERD	Gastroesophageal reflux disease	A problem that happens when stomach contents leak back into your gullet
GI	Gastrointestinal	Another term for your digestive system
GFR	Glomerular filtration rate	A test of kidney damage
GU	Genitourinary	The urinary and sex organs
HAV	Hepatitis A virus	A virus that causes one type of liver disease
HBV	Hepatitis B virus	A virus that causes one type of liver disease
HCT	Hematocrit	A blood test measurement
HCV	Hepatitis C virus	A virus that causes one type of liver disease
HDL	High density lipoprotein	A type of cholesterol, also known as “good” cholesterol
HGB	Hemoglobin	A blood test measurement
HIV	Human immunodeficiency virus	The virus that causes AIDS
HPV	Human papilloma virus	A virus that causes cervical cancer
HRT	Hormone replacement therapy	Hormones supplements that women may take
HTN	Hypertension	High blood pressure
IBD	Inflammatory bowel disease	A name for two digestive disorders– ulcerative colitis and Crohn’s disease
IBS	Irritable bowel syndrome	A problem with the large intestine
ICD	Implantable cardioverter defibrillator	A device that monitors heart rhythm problems
ICU	Intensive care unit	Special hospital unit
IDDM	Insulin-dependent diabetes mellitus	Type 1 diabetes
IM	Intramuscular	A type of injection
IUD	Intrauterine device	A type of birth control for women
IV	Intravenous	A type of injection
IVP	Intravenous pyelogram	An x-ray test of the  urinary system
LDL	Low density lipoprotein	A type of cholesterol, also known as “bad” cholesterol
LFT	Liver function tests
MI	Myocardial infarction	Heart attack
MMR	Measles, mumps, and rubella	A vaccine for three diseases
MRI	Magnetic resonance imaging	A  type of imaging test
MRSA	Methicillin-resistant Staphylococcus aureus	A type of infection
MS	Multiple sclerosis	A disease of the nervous system
NG	Nasogastric	You may need an NG tube to empty the contents of your stomach.
NIDDM	Non-insulin dependent diabetes mellitus	Type 2 diabetes
NKDA	No known drug allergies
NSAID	Non-steroidal anti-inflammatory drug	Drugs like ibuprofen
OCD	Obsessive-compulsive disorder	A type of anxiety disorder
PAD	Peripheral arterial disease	Diseases of the arteries outside the heart
PAP	Papanicolau	You may need a PAP test to detect cervical cancer.
PAT	Paroxysmal atrial tachycardia	A disturbance of the rhythm of the heart
PET	Positron emission tomography	A type of x-ray test
PFT	Pulmonary function test	You may need PFTs to find out how your lungs are working.
PID	Pelvic inflammatory disease	Infection and inflammation of the female reproductive organs
PMS	Premenstrual syndrome	A group of symptoms that may happen before a woman’s period
PPD	Purified protein derivative	You may have a PPD skin test for tuberculosis.
PRN	As needed	Your doctor may write this on your prescription.
PSA	Prostate specific antigen	You may have a blood test for PSA to detect prostate disease.
PT	Prothrombin time	A measure of blood clotting
PTH	Parathyroid hormone	You may have a blood test for PTH to detect    parathyroid disease.
PTSD	Post-traumatic stress syndrome	An illness caused by traumatic events
PTT	Partial thromboplastin time	A measure of blood clotting
PUD	Peptic ulcer disease	A disease of the stomach
PVC	Premature ventricular contraction	A disturbance of the rhythm of the heart
QID	Four times a day	Your doctor may write this on your prescription.
RA	Rheumatoid arthritis	A type of joint disease
RBC	Red blood cell	A type of blood cell
RSV	Respiratory syncytial virus	A virus that causes infections in children
Rx	Prescription
SAD	Seasonal affective disorder	Depression during seasons with little light
SIDS	Sudden infant death syndrome
SLE	Systemic lupus erythematosus	Lupus for short
SOB	Shortness of Breath
STD	Sexually transmitted disease
T3	Triiodothyronine	You may have a blood test for T3 to detect thyroid disease.
T4	Thyroxine	You may have a blood test for T4 to detect thyroid disease.
TB	Tuberculosis	An infection of the lungs
TAH	Total abdominal hysterectomy	Surgery to remove a woman’s uterus (womb)
TIA	Transient ischemic attack	A  small stroke
TIBC	Total iron binding capacity	A test that measures the amount of iron in your blood
TID	Three times a day	Your doctor may write this on your prescription.
TMJ	Temporomandibular joint	The joint that connects your jaw to the side of your head
TORCH	Stands for a group of infections that may cause birth defects	A newborn will have this test to check for infections. Sometimes the mother also needs the test.
TSH	Thyroid stimulating hormone	You may have a blood test for TSH to detect thyroid disease.
TURP	Transurethral resection of prostate gland	An operation to remove parts of the prostate gland
URI	Upper respiratory infection	Another name for the common cold
UTI	Urinary tract infection	Infection of the bladder and kidneys
XRT	Radiotherapy	Therapy that uses radiation, usually for cancer
WBC	White blood cell	A type of blood cell

Medical abbreviations and acronyms (D) | Radiology Reference Article

This article contains a list of commonly used medical abbreviations and acronyms that start with the letter D and may be encountered in medicine and radiology (please keep both the main list and any sublists in alphabetic order).

A – B – C – D – E – F – G – H – I – J – K – L -M – N – O – P – Q – R – S – T – U – V – W – X – Y – Z – misc

• D
  • aspartic acid (single letter amino acid code)
  • day
  • diarrhea
  • distal
  • dorsal 
• D1, D2, D3, D4: 1^st – 4^th parts of the duodenum
• D1, D2, etc. : day one post op, day two post op, etc.
• D1-D12 (dorsal vertebrae: alternative to T1-T12)
• D&C: dilation and curettage
• DA: dopamine
• Da: dalton
• DAD: diffuse alveolar damage
• DAH: diffuse alveolar hemorrhage
• DAI: diffuse axonal injury
• DAMA: discharge against medical advice
• DAPLD: domestically acquired particulate lung disease
• DAPT: dual antiplatelet therapy
• DAT: dopamine active transporter (DaTSCAN)
• DAVF: dural arteriovenous fistula
• dB: decibel
• DBP: diastolic blood pressure
• DBS: deep brain stimulation
• DBT: distal biceps tendon
• DC
• D&C: dilation and curettage
• D/C: discharge
• DCCV: direct current cardioversion
• DCD: donation before cardiac death
• DCDA: dichorionic diamniotic
• DCE: dynamic contrast enhancement
• DCG: dacrocystogram
• DCI: delayed cerebral ischemia
• DCIA: deep circumflex iliac artery
• DCIS: ductal carcinoma in situ
• DCM: dilated cardiomyopathy
• DCR
• DD
• DDD
• DDK: dysdiadochokinesia
• DDLPS: dedifferentiated liposarcoma
• DDMFR: Diploma in Dental and Maxillofacial Radiology (UK)
• DDx: differential diagnosis
• DEB: drug-eluting balloon
• DEB-TACE: drug-eluting bead transcatheter arterial chemoembolisation
• DECT: dual-energy CT
• defib: defibrillator
• DENV: dengue viruses
• deoxyHb: deoxygenated hemoglobin
• DES
• DESS: double echo steady state sequence
• DEXA: dual energy x-ray absorptiometry
• DF118: dihydrocodeine (common name in the UK)
• DFI: diabetic foot infection
• DFR: distal femoral replacement
• DFU: diabetic foot ulcer
• DFV: domestic and family violence
• dGEMRIC: delayed gadolinium-enhanced MRI of cartilage
• DGH: district general hospital (UK)
• DHEA: dihydroepiandrosterone
• DI: diabetes insipidus
• DIC: disseminated intravascular coagulation
• DICOM: digital imaging and communications in medicine
• DIEP: deep inferior epigastric perforators
• DIH: direct inguinal hernia
• DILI: drug-induced liver injury
• DIOS: distal intestinal obstruction syndrome
• DIP: desquamative interstitial pneumonia
• DIPI: direct intraperitoneal insemination
• DIPJ: distal interphalangeal joint
• DIPNECH: diffuse idiopathic neuroendocrine cell hyperplasia
• DIR: double inversion recovery
• DISH: diffuse idiopathic skeletal hyperostosis
• DISI: dorsal intercalated segment instability
• DJBL: duodenal–jejunal bypass liner
• DJD: degenerative joint disease
• DJF: duodenojejunal flexure
• DKA: diabetic ketoacidosis
• DLBCL: diffuse large B cell lymphoma
• DLB: dementia with Lewy bodies
• DLC: discoligamentous complex
• DLCO: diffusing capacity of the lungs for carbon monoxide
• DLP
• DM: diabetes mellitus
• DMBSG: diffuse midline brainstem glioma
• DMD: Duchenne muscular dystrophy
• DMRD: Diploma in Medical Radiodiagnosis
• DMRE: Diploma in Medical Radiology and Electrology
• DMS: diagnostic medical sonography
• DMSA: dimercaptosuccinic acid
• DNA
• DNAR: do not attempt resuscitation
• DNB: Diplomate of National Board
• DNC: dilation and curettage
• DNET: dysembryoplastic neuroepithelial tumor
• DNR: do not resuscitate
• DNS: deviated nasal septum
• DOA: dead on arrival
• DOAC: direct oral anticoagulant
• DOB: date of birth
• DOE: dyspnea on exertion
• DOI: digital object identifier
• DORV: double outlet right ventricle
• DOT: directly observed therapy
• DOTA: 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid
• DP: distal phalanx
• DPA: dorsalis pedis artery
• DPH: diffuse pulmonary hemorrhage
• DPT: diphtheria, pertussis, tetanus (vaccine)
• DR: distal radius
• DR: delayed ratio
• DRESS: drug reaction with eosinophilia and systemic symptoms
• DRG
• DRR: digitally reconstructed radiographs
• DRUJ: distal radioulnar joint
• DS
• DSA: digital subtraction angiography
• DSM
• DSM-V: Diagnostic and Statistical Manual of Mental Disorders
• DSPA: digital subtraction pulmonary angiography
• DT: delirium tremens
• DTaP: diphtheria, tetanus, and pertussis (vaccine)
• DTI: diffusion tensor imaging
• DTP: diphtheria, tetanus, pertussis (vaccine)
• DTPA: diethylenetriaminepentaacetic acid
• DTR: deep tendon reflexes
• DTS: double tissue sampling
• DTT: diffusion tensor tractography
• DU: duodenal ulcer
• DV: domestic violence
• DVD: digital versatile disc
• DVT: deep vein thrombosis
• D/W: discussion with
• DWI: diffusion weighted imaging
• DWM: Dandy-Walker malformation
• Dx: diagnosis
• DXA: dual energy x-ray absorptiometry
• DXT: deep x-ray therapy
• Dy: dysprosium
• DZ: dizygote

Related Radiopaedia articles

Medical abbreviations and acronyms

A – B – C – D – E – F – G – H – I – J – K – L – M – N – O – P – Q – R – S – T – U – V – W – X – Y – Z – misc

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What Do These Letters Mean?

What’s the difference between MD and DO?

Let’s start at the top. As far as MDs (allopathic physicians) and DOs (osteopathic physicians), both kinds of doctors are board-certified and licensed in all 50 states to practice medicine and surgery, as well as prescribe medication. Both attend four years of medical school, plus a residency program, and both can be primary care physicians or specialize in areas like cardiology, orthopedics, or dermatology. 

Here’s how they differ:

What’s an MD? A medical doctor (MD, or allopathic physician) attends an allopathic (or traditional) medical school that focuses on teaching sciences like anatomy and physiology, the diagnosis and treatment of diseases, and providing preventative care. All MDs treat disorders and injuries by using methods aimed at counteracting the problem.

What’s a DO? A doctor of osteopathic medicine (DO) attends an osteopathic medical school, which focuses on a holistic view of medicine. An osteopathic medical school emphasizes a whole-person approach to care, such as the environment, nutrition, and all the body systems for diagnosis and treatment — in addition to focusing on the sciences, diagnosis, and treatment. As part of their training, DOs must take additional hours to learn about the musculoskeletal system.

What do other initials in healthcare mean?

Here’s a rundown of a few other initials you might find after the name of a healthcare professional.

What’s an NP or a PA? A nurse practitioner (NP) and a physician assistant (PA) both diagnose and treat illnesses, develop treatment plans, prescribe medications, and serve as a patient’s main healthcare provider. Most PAs have a master’s degree and practice with physicians and other providers. NPs will have either a master’s or doctorate degree, more education hours than PAs, and they can have a private practice in some states. PAs and NPs are also known as advanced practice clinicians (APCs).

What’s an RN or an LPN? A registered nurse (RN) and a licensed practical nurse (LPN) have very different roles, but both care for patients. An RN will have an associate’s degree (and most times a bachelor’s degree) in nursing and may specialize in one area, such as women and newborn or cardiac care. You’ll find RNs administering medication, monitoring patients, documenting care, and consulting with other healthcare providers. An LPN will have about a year of nursing education and perform less technical tasks, like taking vital signs and observing patients.

What’s a CNA or patient care tech? A certified nursing assistant (CNA) and patient care tech may refer to the same role at Intermountain. This licensed professional provides basic care and clinical support to patients. They collaborate with RNs and others, and help with patient and family requests.

What’s a DPM? A podiatrist is a doctor or surgeon of foot medicine (DPM) that specializes in the foot, ankle, and structures of the leg. A podiatrist treats lower extremity disorders, diseases, and injuries. They may have a private or group practice and will have completed four years at a podiatric medical school and at least two years of postgraduate residence training. It’s important to know that a podiatrist is different from a medical doctor (MD) who is an orthopedic foot and ankle surgeon. An orthopedic surgeon will have a significantly higher amount of medical training.

To find a doctor near you, search Intermountain here.

Early Diagnosis of Diabetes Mellitus Type 2 (DM2) – Full Text View

Rationale: The global prevalence of diabetes, along with its devastating effects on life expectancy and quality of life, continues to increase. Worldwide, the total number of people with diabetes is projected to rise from about 171 million in 2000 to 336 million in the year 2030. Type 2 diabetes accounts for about 85 percent to 95 percent of all diagnosed cases of diabetes and is associated with a number of serious long-term complications, which are a major cause of morbidity, hospitalization and mortality in diabetic patients. More evidence is becoming available that both lifestyle and clinical intervention in the pre-diabetic condition are effective in slowing down progression of pre-diabetes to overt diabetes.

Over many centuries, several forms of traditional medicine have developed which are often based on fundamental principles that differ from those of “Western” medicine. One of the most prominent characteristics of Traditional Chinese Medicine (TCM), is a more holistic approach to the functioning and disfunctioning of living organisms. Every healthy organism is in a Yin Yang balance and is considered to be a complex interplay between body and mind. Western medicine relies on detailed classification of diseases, empirical investigations and treatments targeting those disorders. However, “Western medicine” is showing an increased interest in traditional forms of medicine.

The progress in research, especially metabolomics, as the ultimate phenotyping, has been shown to enable the efficacy study of complex mixtures such as Traditional Chinese Medicine (TCM) in complex biological systems, bridging it with molecular pharmacology. The present study is especially designed to explore biomarkers and tools for early diagnosis of diabetes mellitus type 2 with objective Western markers and TCM.

Objectives: The primary objective of the present study is to determine consistency in classification of DM type 2 in three categories as defined by Traditional Chinese Medicine (TCM) in pre-diabetic subjects.

Secondary objectives are to find relationships between diagnosis according to TCM and risk profile according to Western approach (fasting glucose and HbA1c in plasma, age, BMI, waist circumference). Another objective is to find relationships between classification of risk for DM type 2 according to TCM and objective parameters.

Study design: This study is designed as an explorative study. Study population: In the study 50 pre-diabetic male volunteers, with a fasting blood glucose ≥ 6.1 and ≤ 6.9 mmol/L, 30-70 years old, and having a BMI ≥ 26 and ≤ 35 kg/m2 will participate.

Intervention: No administration of a study substance will take place.

Main study parameters/endpoints:

TCM Diagnosis:Identification of DM type 2 based on TCM, diagnosed independently by 3 physicians and classified in Upper Xiao, Middle Xiao and Lower Xiao.

General measurements as BMI, waist circumference, blood pressure and heart rate variability will be conducted.

Next to these measurements also the following parameters will be established. Biophoton emission: a recording of the energy field and balance based on analysis of intensity and quantum stochastic nature of light from both hands (ventral and dorsum), in combination with both right-left and dorsal-ventral symmetry of both hands.

Performance Meridian Measurements (MERID measurements): The ‘MERID’ meridian method is based on the change of skin impedance after a given IR (infrared) stimulus to a Biological Active Point (BAP) which gives a reliable and reproducible measure for the energy status of that particular meridian and consequently of the related organ or organ system.

Heart rate variability:

Heart rate is affected by both sympathetic and parasympathetic input. These two branches of the autonomic control system affect both heart rate and changes in heart rate. Cardiac autonomic balance, also called sympatho-vagal balance, is the combined effect of parasympathetic (inhibitory) and sympathetic (excitatory) innervation of the heart and can be considered the main determinant of the regulation of heart rate and can be quantified by means of electrocardiography (ECG) measurements and spectral analysis.

Metabolomics:

Metabolomics to be applied in this study consists of a number of methods based on LC-MS and GC-MS technology to determine (relative) concentrations of endogenous metabolites in biological samples (blood and urine).

Nature and extent of the burden and risks associated with participation, benefit and group relatedness:

This study is set up as a study with an explorative character. No administration of substances will take place. All subjects will be subjected to seven non-invasive measurements, filling in a number of questionnaires and subjected to three physical examinations. Blood sampling, in the fasting state, will be done at two determined time points (pre-study and in study) and will not exceed 30 mL. Furthermore, one (spot) urine sample will be collected in the study.

Based on the above mentioned assessments and the fact that no administration of substances will take place, the discomfort for the subjects in the study is minimal and the risk for participating subjects is negligible.

What Do Those Letters and Degrees Mean?

M.D.

Doctor of Medicine (M.D. or MD, from the Latin Medicinae Doctor meaning “Teacher of Medicine,”) is an academic degree for medical doctors.

In the United States, the M.D. degree is the oldest and most common medical degree held by physicians and surgeons. The M.D. degree is typically earned in four years.

Admissions to medical schools in the United States is competitive, with less than one half of the approximately 35,000 applicants matriculating to a medical school. Before graduating from a medical school and achieving the degree of Medical Doctor, students have to pass the United States Medical Licensing Examination (USMLE) Step 1 and both the Clinical Knowledge and Clinical Skills parts of Step 2.

Following the awarding of the M.D., physicians who wish to practice in the United States are required to complete at least one internship year (PGY-1) and pass the USMLE Step 3.

Most, in order to receive Board Eligible or Board Accredited status in a specialty of medicine such as general surgery or internal medicine, then undergo additional specialized training in the form of a residency. The length of residency can vary from 3 years for fields such as family practice, pediatrics or internal medicine to 7 or more years for fields such as plastic surgery and neurosurgery.

Those who wish to further specialize in areas such as cardiology, interventional radiology, or microsurgery then complete an additional fellowship which lasts from 1 to 3 more years.

M.P.H.

The Master of Public Health (M.P.H.) is a professional master’s degree awarded for studies in areas related to public health. In the United States the Council on Education for Public Health (CEPH) accredit schools of public health through a formal review process.

MPH is usually a one or two year program, with many students already possessing an advanced degree. In some countries the MPH program is only available for medical graduates (MBBS or equivalent), those without the medical degree can join the Master of Medical Science in Public Health program.

Dr. Granzow’s M.P.H. degree has an additional specialization in Health Systems Management.

F.A.C.S.

Members of the American College of Surgeons are referred to as “Fellows.” The letters FACS (Fellow, American College of Surgeons) after a surgeon’s name mean that the surgeon’s education and training, professional qualifications, surgical competence, and ethical conduct have passed a rigorous evaluation, and have been found to be consistent with the high standards established and demanded by the College.

The American College of Surgeons is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. It is the largest organization of surgeons in the world.

The American College of Surgeons admits to its Fellowship only those surgeons whose professional activity is devoted to surgical practice and who agree without compromise to practice by the professional and ethical standards of the College.

In evaluating the eligibility of applicants for Fellowship, the College investigates each applicant’s entire surgical practice. Requirements for Fellowship include certification by an American Surgical Specialty Board which is a member of the American Board of Medical Specialties and which is appropriate to the applicant’s specialty practice, a current appointment on the surgical staff of the applicant’s primary hospital with no reportable action pending, a current practice that establishes the applicant as a specialist in surgery, interest in pursuing professional excellence both as an individual surgeon and a member of the surgical community, and ethical fitness as well as professional proficiency as determined by an appropriate College Credentials Committee.

A.O.A.

Alpha Omega Alpha, commonly referred to as AΩA, can be thought of as the “Phi Beta Kappa for medical schools.” As the only national honor medical society, its mission, developed over the past one hundred years, has been to recognize and enhance professionalism, academic excellence, service, and leadership within the profession.

Criteria for and restrictions upon election to AΩA are detailed in the Constitution. These elections occur each year in the 124 chapters within the United States, Canada, Puerto Rico, and the American University of Beirut. In 2006, as in other recent years, close to 3100 medical students and a much smaller number of faculty, resident, and alumni members were elected. Since its founding in 1902, more than 100,000 members have been added to the rolls.

Membership in Alpha Omega Alpha is reserved for the top students in a given medical school class year at graduation..

Dr. Granzow is a member of Alpha Omega Alpha and graduated in the top 10% of his medical school class.

The history of the emergence of evidence-based medicine – Basics of evidence-based medicine. Biomedical statistics. – Vnauke.by

Evidence-based medicine is a complex system of methods and approaches to conducting clinical medical research, evaluating and applying the results.

In the narrowest sense, “evidence-based medicine” is a method (type) of medical clinical practice when a medical practitioner applies to a patient only those methods of prevention, diagnosis and treatment, the usefulness and effectiveness of which has been proven in studies performed at a high methodological level, and provides extremely low probability of getting “random results”.

The term “evidence-based medicine” itself was proposed in the 90s by clinical epidemiologists from McMaster University in Toronto.

The Scientific Revolution, which broke out during the Renaissance, affected astronomy, mathematics and physics. In medicine, such pioneers were the founder of human anatomy, Andreas Vesalius (1514-1564). It was he who gave a scientific description of the structure of human organs and tissues, and the father of modern physiology and embryology, William Harvey (1578-1657), who opened two circles of blood circulation, expounded the knowledge of blood circulation as a whole, and who was the first to express the idea that “all living things arise from an egg “.

But, despite this, medical thinking was still based on the old foundations. Until the 19th century, many doctors believed in the truthfulness of the “humoral” explanation of the existence of the body, according to which human health directly depends on the interaction between certain body fluids – mucus, blood, black and yellow bile.

In the medical world, unfortunately, the pre-scientific period lasted many times longer than we would like. The benefits of using many methods of diagnosis and treatment during that dark era were very dubious, and often even a real threat to the life of the unfortunate patient.For example, it was generally accepted to treat gunshot wounds with cauterization with hot iron and hot boiling resin and oil. During the hostilities in Italy in 1536, when the oil ran out, the Frenchman A. Paré suggested using wound dressings, as he saw it, with useless ointment-based components. And in his personal diary, he noted that he spent a long sleepless night worrying about the unfortunate cavalrymen, whom he treated in such an incomprehensible way, and how amazed he was in the morning, making sure that the victims “were satisfied like meadow larks”, and those, who had previously been treated traditionally, continued to suffer agonizingly from painful sensations and fever.

Another example. Bloodletting and the use of leeches are a separate chapter in the annals of medicine. From ancient times until the 19th century, bloodletting was achieved in various ways and served as the main method for curing major ailments. Professor F. Brousset, later called the bloodthirsty doctor in history, in 1832, during the cholera epidemic, tried to treat the unfortunate with a debilitating diet (a total ban on food and drink) and bloodletting using phlebotomy. It is known that only in 1800more than 85 thousand liters of blood were released in the hospitals of Paris, and in 1824 more than 33 million leeches were imported to France alone.

By the beginning of the 19th century. the old faith in outdated theories and many methods of treatment was largely lost. The pessimistic mood that was present among the doctors is best reflected in an excerpt from the notes published in one of the journals of those times: , Capable of bringing into developing medicine what physics took from mathematics, and chemistry – on the scales of laboratory scales.Medicine remains what these two sciences were a hundred years ago – a set of inferences that are poorly correlated with each other. ” The time has come for the birth of a new and highly critical attitude to medicine. Physicians P. Louis (1787–1872) and J. Gavard (1809–1890) pioneered the quantitative method for assessing the effectiveness of prevention, diagnosis and treatment.

P. Louis was one of the first to doubt the effectiveness of bloodletting as a method of treatment, questioning the dogma that it must be performed as quickly as possible.He compared the results of treatment of patients for whom bloodletting was performed at the first symptoms of the disease and at a much later date, and found that they did not depend in any way on the timing of phlebotomy. On the basis of his research in 1835, P. Louis concluded that with pneumonia, erysipelas of tissues and diphtheria, bloodletting had no effect. Gradually, the intensive application of this technique, which had been used for centuries, ceased.

By this time, the basic laws of statistics as an applied tool were already being developed.Zh Gavar was one of the first to introduce them into medical practice. He said that conclusions about the superiority of some methods over others should not be based on empirical concepts, but should follow from those results that were obtained in the process of careful observation of rather large samples of patients who were prescribed treatment according to the compared methods. Gavar postulated: “In order to give preference to one of the interventions, it must not only demonstrate” much “better results than the compared treatments, but also the differences in their effectiveness must exceed some threshold value, which is associated with the number of observations.If the difference is below the accepted threshold, then it should most likely be ignored and not considered significant. ” In other words, it was J. Gavard who developed a direct statistical approach, on which all evidence-based medicine is based.

The emergence of controlled trials in medicine was due to I. Fibiger, who in 1898 described the results of a clinical study that compared the results of treatment of patients with diphtheria, divided into groups that received and did not receive the corresponding serum.But the study did not catch the eye of conservative medical professionals. It was only in 1948 that the results of measuring the effect of streptomycin in patients with tuberculosis were published. It is this study that is considered the first controlled study that followed the methodological rules of randomization and the implementation of statistical norms and analysis

In the 50s, many new methods of treating diseases appeared. As a rule, the supporters of the new method based their opinion only on what follows from the known facts of the pathogenesis of the disease.But after it was indicated that a significant proportion of them are completely useless. Thus, the determination of the level of HCl in the stomach, which has become widely practiced, has led to the conclusion that a decrease in acid production with the help of anticholinergic substances should lead to a good effect. But the test showed no noticeable expected results. In a 1970 editorial in the renowned Lancet, anticholinergic drugs were labeled “psychological placebos.”

The English clinical epidemiologist Archie Cochran is considered to be a pioneer, because in the 70s it was he who proposed revising the medical knowledge accumulated by that time and separating the methods and methods of exposure with efficiency, the reliability of which was obtained in randomized trials, from methods, the reliability of which was not confirmed by this method …He developed a technique for performing such a meta-analysis. In the 90s, after that, students and followers created the “Cochrane Cooperation” association. The main goal of the organization is to help practitioners around the world in an objectively and scientifically grounded choice of a clinically proven drug or treatment method. This is achieved through a thorough search and analysis of the information from the performed randomized controlled trials.

Statistics have become the main tool of evidence-based medicine and clinical epidemiology.Statistics is a science that studies the methods of systematic study of mass processes by compiling their quantitative characteristics and their scientific description. It is with the help of biomedical statistics that the conclusions of any biological and medical tests are described and discussed in quantitative form.

1. In your definition “Evidence-based medicine (eng.Evidence-based medicine) is a complex system of methods and approaches to conducting clinical medical research, evaluating and applying the results. “- emphasis on” a complex system of methods and approaches to conducting … research. ” medical practice of methods with proven effectiveness.This is the difference and your incorrectness.

2. About the blonde amused, although more on rudeness pulls. This is in a soft definition.

We look at the date of the quote you cited – 2001.(by the way, it would be nice to attach a link). More “fresh” definition of Vlasov 2009 (http://lib.komarovskiy.net/dokazatelnaya-medicina-kak-sredstvo-prodvizheniya-lekarstvennyx-sredstv-vlasov-v-v.html):

“According to the simplest and most correct definition, DM is a type of medical practice, characterized by the conscious and consistent use of only those interventions in patient management that have been proven to be effective in benign studies.” Focus on the patient.

BMJ definition here – http://library.med.nyu.edu/library/instruction/handouts/pdf/ebmdefinitions.pdf. Emphasis on the patient.

And finally, the definition on the Cochrane community website – http://www.cochrane.org/about-us/evidence-based-health-care:

Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Again, focus on the patient.

Although yes, I have an error. The above quote is not Vlasov’s definition, but a translation of the Evidence Based Medicine Working Group, 1993.

Are you going to argue further?

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Vasily Vlasov – Time of Evidence-Based Medicine – Domestic Notes

Evidence-Based Medicine (EBM) was formed in the eighties of the twentieth century.The words “Evidence-based medicine” were translated into Russian 10 years ago into English “Evidence based medicine” (EBM, there are other versions of the translation: evidence-based medicine; medicine based on evidence).

DM is a form of medical practice that applies only to the treatment of an individual patient interventions that have been proven useful in benign scientific studies.

Features Approaching

There are two components to the scientific approach to medicine: deductive and empirical.They are both scientific, because in different ways they give generalized knowledge, that is, knowledge that is transferred to other situations, to other patients, of a different age and in other countries.

Traditionally, the deductive component of knowledge was considered the main thing in medicine – understanding the causes of diseases, the mechanisms of their development, the mechanisms of action of drugs (drugs) and surgical operations. Unfortunately, medicine and science generally have insufficient knowledge about many diseases, some diseases remain mysterious – neither the cause nor the mechanisms of development are known.Sometimes it only seems that the cause of the disease is known. So, before the discovery of a microorganism that causes peptic ulcer disease, it was treated with soda, sleep, gastric resection and many other methods. Each method of treatment had its own explanations and rationales, its own theory of peptic ulcer: nervous, self-digestion of the gastric mucosa, etc. For this reason, an intellectually attractive deductive approach cannot be effective, i.e., with a certain probability, bringing the expected result: if an idea does not correspond to the truth, usually the conclusions from this idea are false.History, of course, knows many cases when correct practical conclusions were drawn on the basis of false theoretical premises, but these are still rare exceptions.

In medicine, at the same time, there has always been a different approach, empirical (pragmatic): the method of treatment is better, which better helps patients. It doesn’t matter whether we know how this method works or not ^[1] . For example, it is not known exactly why a single injection of the hormonal drug dexamethasone in a woman who is in preterm labor significantly reduces the likelihood of death of an immature newborn and maternal complications.But it is known that this intervention works, which means that it must be applied.

Of course, it is interesting to know why, how effective intervention helps to prevent unwanted outcomes. This knowledge is especially useful for scientists developing new drugs based on knowledge about the mechanisms of disease development and knowledge about the action of drugs. This knowledge is useful for doctors as well. Sometimes deduction – the conclusion about the correct course of action based on existing knowledge – can successfully treat patients in a situation where there is no empirical evidence of the effectiveness of treatment.For example, many drugs are not tested on children. Accordingly, pediatricians have to rely on ideas about the mechanism of drug action and apply it based on knowledge of the effect in adults or not use it. On the other hand, it is sometimes possible to use a proven, effective drug more effectively if the mechanisms of its action are known; it is possible to assume possible side effects of treatment, interaction with other drugs that the patient is taking.

In an ideal world, the knowledge of a professional is complete, and everything he does has a certain effectiveness.Alas, in the real world, knowledge of many diseases is incomplete, and the cure available may be untested. Moreover, this situation can persist for a long time. For example, the alleged therapeutic effect of thick chicken broth for “colds” ^[2] has not been tested in an experiment, despite the fact that this remedy has been used since biblical times. Likewise, drinking plenty of fluids for a “cold,” recommended by doctors for at least 100 years, may not provide relief and may even make you feel unwell.

Knowledge of the mechanism of action of drugs suggests that some intervention is beneficial, but does not prove the usefulness of drugs for the treatment of a particular disease. For example, a significant proportion of patients with damage to the heart muscle from a lack of blood flow (myocardial infarction) die from cardiac arrhythmias. There are drugs that successfully help against arrhythmias, but do not reduce, but even increase mortality from a heart attack. Another example. In older people, bone density often decreases and fractures are more frequent.There are drugs that successfully increase bone density, but do not prevent fractures. There are many examples of how a medicine makes the desired changes in the body, but does not help in the treatment of a disease.

Therefore, to justify the treatment of a particular patient, it is better to have not so much scientific considerations about how the disease develops, but scientific evidence that in such patients such an intervention helps to achieve such results (desired, beneficial for the patient).

The era of “enlightened skepticism”

The distinction between “pre-scientific” and “scientific” theories is not as simple as it seems.It is clear that from the observation made in ancient Egypt, how the sacred bird ibis supposedly inserts its beak into the anus and sends water there, it does not follow that washing the large intestine with water is beneficial for health. However, even more bizarre constructions continue to live in the modern world. An example is homeopathy. This relatively recently appeared system of treatment is based on the assumption that with a decrease in the dose of a substance, its effect on the body does not disappear, but changes to the opposite: a substance that, in usual doses, causes phenomena similar to diseases (edema of the mucous membranes), in small doses will eliminate such edema …This assumption contradicts the body of knowledge of scientific medicine, and the creator of homeopathy, Samuel Hahnemann, explicitly stated that his system was opposed to medicine (the latter he called allopathy). However, homeopathy is thriving in some modern medical settings.

The empirical component is what we call evidence of effectiveness. Regardless of whether there are theories and how correct they are, experience provides knowledge about whether the interference is working or not. Experience should not be idealized.It is necessary to distinguish between experience as a set of repeated actions in certain situations and experience as a technologically more or less complex practice of studying the consequences of certain actions (research, synonymous with experiment). If you do not make a distinction, do not feel the difference, then bizarre phenomena such as the “experience” of the times of Trofim Lysenko appear ^[3] . Then, thousands of methodically unprepared Soviet people, mainly peasants, were involved in haphazard manipulations with plants for noble purposes, but without a chance of getting an interesting result for anyone.Since Lysenko, Lepeshinskaya, Boshyan and many other nominees of the Stalinist era did not have sufficient education, they did not understand the criticism of their results from “normal” scientists.

What is needed is scientific evidence, that is, the results of benign clinical studies. Clinical research in this sense is opposed to laboratory research: they are primarily focused not on finding explanations for the disease, but on testing the means of treatment or prevention, the accuracy of diagnostic methods and the accuracy of predicting the course of the disease.

The first mentions of proposals to rely on data on outcomes of diseases in assessing the work of a doctor or the effectiveness of drugs date back to the 18th century. However, these attempts were rare exceptions, and until the end of the 19th century, treatment was assessed based on reference to authoritative opinion and on the basis of agreement with generally accepted theory. Ignacy Semmelweis, who successfully prevented childbirth fever, was not recognized by his contemporaries and died in the yellow house. The reason is simple – he assumed the incredible: the cause of fever (infection) is in the hands of obstetricians, and hands must be washed.

In order to move into the current “evidence-based” phase by the end of the twentieth century, medicine had to go through periods of changing hobbies with different theories of diseases. The most important stage was the refusal of scientific medicine to search for a universal theory for all diseases. Perhaps the last burst of this ancient aspiration was the so-called. the theory of nervousism, which the communist party imposed in the USSR under the name of “Pavlovian theory”. This theory claimed to explain all or almost all disease phenomena by processes in the nervous system ^[4] .

In the 19th century, medicine experienced an important period of disillusionment and “therapeutic nihilism” as physicians learned of the limited effectiveness and even uselessness of the most common treatments (phlebotomy, enemas, and laxatives). Medicine emerged from this state thanks to fundamental research on diseases, which proposed truly effective interventions, for example, sulfonamides in the treatment of infections instead of bloodletting and cupping, vaccines for the prevention of infections.Actually, the understanding that in the arsenal of medicine, along with highly effective methods of treatment (antibiotics for pneumonia), are preserved ancient remedies with unknown effectiveness (blood-sucking cups on the back for pneumonia), and led to the emergence of DM.

The “Founding Fathers” of evidence-based medicine saw its essence in “enlightened skepticism.” Indeed, the “evidence-based” physician should be skeptical about proposals to use any means and accept them only when evidence of its effectiveness is presented.The “evidence-based” physician must also critically consider the existing practice. It is thanks to the emergence of benign data proving the uselessness of blood-sucking cans and mustard plasters that they have ceased to be used for pneumonia ^[5] .

Medicine has always been a science, but ideas about what “science”, scientific evidence, have changed over time. Relatively late, only in the second half of the twentieth century, an idea was formed about what methods of “scientific experience” (experiment) should be used in order to assess the clinical effectiveness of diagnostic and treatment methods.Medicine becomes “evidence-based” only in the sense of the basis of the doctor’s actions by direct evidence of the correctness of actions.

Good evidence

Knowledge about the effect of drugs on the concentration of sodium in the blood or the nature of cell damage in this disease can be obtained in the laboratory, in animals, in cell culture. Knowledge about the effect of drugs on the course of the disease can be obtained only in the clinic. Therefore, for a doctor, for medical practice in general, fundamental research is not so important as clinical research.Physicians intuitively know this and read clinical journals, not theoretical (fundamental) ones. True, reputable doctors, especially those teaching students, like to talk about the mechanisms of action of drugs and the mechanisms of diseases. This makes an impression on others and may seem very convincing, but it does not prove the correctness of the actions arising from the reasoning.

Clinical trials vary. The main difference between studies is not the intervention being studied or the disease, but the structure of the study (its architecture, design).Different diseases and different interventions can be studied in studies of the same structure.

The simplest study is a description of a case of a disease or several cases (a series of cases). Such research usually points to an interesting rare variant of a disease or a combination of diseases, tells the doctor about possible outcomes, but says almost nothing about how such patients should be managed.

A more complex study of the type “description of current practice”. The doctor not only describes how he treated his patients, but also indicates the usual outcomes, the timing of discharge from the hospital (calculates the average severity of symptoms, the average length of hospital stay, etc.).and the frequency of disability. Such research is also not conclusive. If no one has died from acute bronchitis, this does not at all prove that the described treatment is the best. They don’t die from bronchitis even without treatment. Only in rare cases, when it comes to an incurable disease, the description of some practice, as a result of which a significant proportion, for example ¹ / ₄ patients, recover, is remarkable. Such research is enough to believe that patients should be treated in this way.

If a doctor describes not just a hospital practice, but the results of treatment in some way, for example, the outcome of a new version of surgery for urinary incontinence, then this study is called a clinical trial.The doctor created a new method, applied it to a group of patients (tested) and reports the results. Such a clinical trial is of great interest to the readers of the journal. It’s not just work experience. This is the data for evaluating the effectiveness of the invention.

The trouble is, the invention of highly effective treatments is rare. More often, the new, more effective method of treatment is only 10-15% better than the old one. What does it mean? This means that the new method reduces the hospital stay from 15 days to 12, the frequency of exacerbations from annually to four in five years.

Obviously, the patient cannot notice such a difference in the frequency of exacerbations, and the doctor cannot notice a decrease in the number of bed-days by such an amount, since in practice the hospitalization terms do not change due to holidays or slow laboratory work. That is why special research structures have been created to reliably identify relatively small advantages or disadvantages of new and old treatments.

The most reliable trial design for treatment is the controlled trial (CT).Its main difference is that the result of the application of the studied method is compared with the result in the control group. If the compared groups differ from each other only in how they were treated, then there is every reason to believe that the difference in outcomes is due to different treatment. This is strong evidence of the advantages or disadvantages of the new treatment. This evidence is used by the DM.

Of particular importance is a variant of the CI called a randomized controlled blinded clinical trial.This option was first implemented only in 1946. Its difference lies in the fact that to create identical groups of patients, the randomization method is used (from the English random – random). With this study design, patients are randomly assigned to a new treatment group and a comparison group (receiving standard treatment or nothing at all). “Random” means not randomly, as you like, but in an unpredictable order, for example, as a coin tossed heads or tails.As a result, the groups, of course, are not exactly the same, but it is important that in all respects they differ only slightly, in a random way.

Randomization also facilitates “blinding” (sometimes understandably called “masking”). “Blinding” is the conduct of CT in such a way that the patients of the compared groups do not know what kind of treatment they are receiving – new or old. This is necessary in order for patients with equal zeal to accept the prescribed treatment and with equal interest in the use of additional means, for example, “folk”.In order for the medical staff to treat the patients of the compared groups equally, in the CI, which are called “double-blind”, the test is carried out in such a way that medical workers do not know who they are treating and whose condition they are assessing – patients receiving new treatment or the old one. This is necessary so that a doctor who evaluates, for example, changes in an X-ray image, is equally critical of him, regardless of how the patient was treated.

This complex design of testing the efficacy of medical interventions makes trials expensive and complex, but the complexity comes at the expense of obtaining reliable evidence of the superiority of one treatment method over another.Therefore, sometimes, with an unacceptable degree of simplification, they say that DM is about treating patients based on the results of double-blind randomized CTs. This, of course, is not the case, because in the absence of results of double-blind randomized CTs, the “evidence-based” doctor uses the existing data, the results of simpler studies, and even if there are results of randomized CTs, he does not ignore the results of simpler studies, but only gives them the corresponding, smaller weight.

Application limits

The situation with the use of evidence of the effectiveness of the intervention is complicated by the fact that medicine is not limited to “science”. It has two terms reflecting its properties, due to the interaction of people – doctors and patients.

1. Empathic component: characteristics of relationships and actions arising from the understanding of the patient as a friendly human being.

2. Ethical component: limitations and duties of a doctor arising from ethical standards.

The role of EBM in solving ethical problems and building relationships with the patient is still small. The point is that the impulses given by the “inner ethical sense” of a person may be alien to other people, and aspirations are not necessarily rational. Therefore, in modern medical practice, DM norms are combined with ethical rules, the effectiveness of which has not been experimentally proven. The irrational behavior of patients and doctors is clearly manifested, for example, in the case of suffering, in which medicine cannot effectively help the patient.Many people, including doctors, feel the need to do something. It is dangerous to be led by this desire: interventions that are not beneficial are necessarily harmful. Because all interventions are harmful. The only rational course of action, and in this case, is to use only interventions that are useful, and in the absence of such, non-intervention. Naturally, this approach does not exclude the use of symptomatic remedies, palliative operations, pain therapy.These interventions are effective, however, not in treatment, but in reducing the patient’s suffering, at least temporarily. It is usually difficult for people to accept that non-interference is the best course of action, but this is often the case.

It follows that evidence-based practice is the greatest good a doctor can do for a patient. Therefore, we can say that EBM lies at the foundation of the moral choice of the doctor. As for psychological and social problems, the same scientific principles operate in this area as in medicine.

DM

does not override anything. It only draws the doctor’s attention to direct evidence of the usefulness or futility of interventions. Already because there is no reliable evidence on the effectiveness of many interventions, for many situations, the doctor inevitably in such cases will have to make decisions based on his knowledge of the mechanisms of development of the disease and the mechanisms of action of drugs.

Of course, all the components of a medical decision are united by the doctor’s experience, including his store of knowledge and skills (see.diagram). Scientific evidence is only relevant if it is in an area that is acceptable to the patient and appropriate to the particular case. The doctor is required not only to know the scientific evidence, but also to master the methods of examining the patient to identify the main features of a particular case of the disease and to be able to inform the patient and identify his preferences.

DM calls on the doctor to refuse questions: What is this? How is this explained? Why is this happening? The answers to these questions may be interesting, but they are remotely related to the management of a particular patient.

DM indicates the correct question – what should be done? More specifically, is intervention A better for condition B to achieve outcome C? This method of questioning applies not only to therapeutic interventions (therapeutic, surgical), but also to diagnosis and prevention. Only when looking for an answer to such a question can we rely on the results of scientific research, which prove the correctness of the decision to use or not use the intervention in a particular patient.

New information environment

DM reflects the new state of medical science.This progress is based on the development of several branches of medicine. This is, first of all, the development of epidemiology as a science not of the spread of infectious diseases, but of the science of the patterns of development and spread of all diseases, the science of research methods for medical reality ^[6] . It is epidemiology that provides answers to questions about whether a new disease exists and to what extent, for example, exposure to poisonous gas in the workplace can influence the development of the disease.In the clinic, epidemiology provides the research doctor with research methods.

The second is the development of medical information. Until the end of the twentieth century, a doctor, just like another specialist, in order to keep abreast of new discoveries, technologies, knowledge, had to study and read a lot. A system of postgraduate (postgraduate) training has been created for doctors and other specialists in all developed countries. In the USSR and now in Russia, it exists in the form of a periodic “improvement”. In the world, the main direction of its development is the transition to continuous postgraduate education.It is believed, not without reason, that listening to lectures every five years is not enough for a doctor to be constantly ready for the correct use of more and more new methods of diagnosis, treatment and prevention. In order to be a modern doctor, to own today’s knowledge, and not yesterday’s, a doctor must systematically follow new scientific advances. This means that you need to follow the medical literature. A great many medical journals and books are published in the world. They are simply impossible to read and assimilate.

Information technology of the late twentieth century and the concept of DM solved this problem. Electronic media and the Internet have given physicians quick access to the latest journal issues. Moreover, electronic means made it possible to quickly search for the necessary information in databases. For example, with funding from the US government, the MEDLINE database is available worldwide. It contains the titles and abstracts of articles from the best medical journals in the world. Each entry is supplied with a set of keywords.Therefore, if a doctor needs to find publications on the methods of endoscopic plastic surgery for an inguinal hernia, then using these keywords he will easily find everything published in the world, more precisely, in the best journals in the world.

DM provided additional search tools: it is possible to select from all publications on the issue only those that are directly related to clinical practice and are evidence-based. For example, select only those articles in which, during a clinical trial, outcomes were compared in patients operated on by conventional means and through an endoscope.The analysis of such articles can quickly answer the question: are there any advantages of endoscopic surgery for a given patient.

Another important problem was solved in the twentieth century. This is the problem of multiplicity of studies. As you know, scientific problems are studied by many scientists at the same time, and the more important the problem, the more research is carried out. Accordingly, a situation often arises when a doctor finds not one, but several articles with test results on a clinical question, and these results may not coincide.How to be in such a situation? Previously, the problem was solved by “voting”: three studies “for”, one “against”. But it has always been obvious that research can have different methodological quality. This means that one cannot approach them according to the principle of “one study – one vote.”

The current methodology for synthesizing scientific evidence consists of systematic review and meta-analysis. A systematic review is a literature review that: 1) includes all the world’s literature on a problem, and 2) rejects substandard (unproven) studies.All world literature became possible to include only after the advent of electronic search tools. Before that, doctors could not carry out such a search simply because the collections of magazines and books in the libraries available to them were poor, and the doctor did not have enough time to spend several days in library searches to solve the problem of an individual patient. In old dissertations and journal articles, expressions such as “in the literature available to us, we did not find …” are not uncommon. Today it is no longer possible to write such a thing.

It became possible to discard non-evidence-based studies as the quality of studies improved. This has been proven by analyzes of the content of medical literature at the end of the twentieth century. The researcher who prepares the systematic review sets the criteria for including studies. Studies that do not meet the criteria are discarded. Conclusions are drawn from benign studies. For example, in the countries of the former USSR, the use of low-energy laser radiation for the treatment of various diseases is widespread.Does it help? There are thousands of publications on studies of various structures in various diseases. However, discarding case reports and current practice, and trials that did not involve blinding and randomization, it turns out that there are very few studies of acceptable quality. For many diseases for which lasers are used, there is no benign evidence at all.

If several benign studies are found, then the systematic reviewer has an additional challenge: the results of these studies should be summarized so as to give the doctor one final assessment.This assessment cannot be just qualitative: the drug helps. The estimate should be quantitative, that is, indicate the size of the effect. For example, with influenza type A, the antiviral drug rimantadine helps. But how much? Provided that treatment is started on the first day of the manifestations of the disease, regular intake of the drug leads to a reduction in the disease by one day. In order to obtain such a quantitative estimate by summarizing the results of several tests, statistical (mathematical) procedures are used, called “meta-analysis”, i.e.That is, analysis beyond the usual analysis of a single study.

Of course, it would be good for a doctor not to read thousands of articles, but to have access to generalizations of the results of individual studies, that is, to systematic reviews. As recently as 20 years ago, systematic reviews were rare. 10 years ago, a large group of medical professionals from different countries created the Cochrane Collaboration (www.cochrane.org), an organization named after the English epidemiologist Archie Cochrane, who first called for evaluating the effectiveness of all therapeutic interventions by summarizing (systematic review) the results of all clinical trials.The organization is committed to creating systematic reviews, keeping them up to date (fresh) and making the results of these reviews available to doctors around the world. Anyone can find the most reliable information on the effectiveness of individual interventions on the organization’s website. All reviews follow the principle mentioned above, answering the question of whether intervention A is better for condition B to achieve outcome C than another intervention or non-intervention.

The idea of ​​generalization turned out to be fruitful.The Campbell Collaboration (http://www.campbellcollab-oration.org) has recently been created in the likeness of the Cochrane Campbell Collaboration. This organization prepares systematic reviews of the effects of social interventions (pedagogy, criminology, etc.).

In other words, DM as a modern phenomenon is based on the use of intellectual achievements of the second half of the twentieth century. The evidence-based physician today has excellent, reliable sources of information, primarily Cochrane reviews. A new type of reference book has also appeared, in which the recommendations are based on an analysis close to the analysis in Cochrane reviews (Evidence-Based Medicine reference book, http: // www.mediasphera.ru/books.htm).

Evidence-based medicine could not have arisen before the 1980s, simply because there were no means to find better information, and doctors did not really know what practical information was. Now, with some special knowledge of EBM, each doctor can quickly and efficiently search, critically evaluate information and apply it in their work.

Enthusiasts believe, not without reason, that the development of evidence-based medicine will contribute to the progress of health care to a much greater extent than large scientific projects proper, such as, for example, the Human Genome project.Practice has so far justified these hopes.

^[1] We use the term “effectiveness” – the equivalent of the English. “efficacy” to denote the effectiveness of an intervention, such as a treatment, in an experimental setting. Otherwise, this way of measuring and expressing efficiency is called “ideal efficiency” or “efficiency under controlled conditions.” In real conditions of medical practice, the effectiveness is usually lower for various reasons. It is sometimes referred to as “real efficiency”.

^[2] The popular name “cold”, based on the assumption that illness arises from cooling, corresponds to different illnesses. A hundred years ago, doctors called this set of diseases “catarrh of the upper respiratory tract”, in the middle of the twentieth century – “acute respiratory diseases”, then “acute respiratory viral infections”, and now “flu and flu-like diseases.” Such uncertainty exists because these diseases caused by different microorganisms are similar in their course, and their treatment is mainly reduced to symptomatic, i.e.e. to alleviate the manifestations of the disease.

^[3] Soifer V. N. Power and science: the history of the defeat of genetics in the USSR. Tenafly, NJ: Hermitage, 1989.

^[4] Yaroshevsky M. G. How Ivan Pavlov was betrayed. Repressed science. SPb .: Nauka, 1994.S. 76-82.

^[5] Vlasov V. V. Introduction to evidence-based medicine. M: Mediasfera, 2001.

90,000 If an ultrasound examination finds a hyperechoic focus in the ventricle of the heart

What is a hyperechoic focus in the fetal heart?

Hyperechoic focus is a term that refers to the increased echogenicity (brightness) of a small area of ​​the heart muscle in an ultrasound image.The detection of a hyperechoic focus in the heart is NOT a malformation of the heart , but simply reflects the nature of its ultrasound image. A hyperechoic focus occurs in the place of increased deposition of calcium salts on one of the muscles of the heart, which does not interfere with the normal functioning of the fetal heart and does not require any treatment.

Why may a fetus have a hyperechoic focus in the heart?

Possible causes of hyperechoic focus in the heart:

• Sometimes a hyperechoic focus in the heart is detected in absolutely normal fetuses, and with ultrasound in dynamics this symptom may disappear.
• The presence of a hyperechoic focus in the fetal heart can be a manifestation of chromosomal diseases of the fetus , in particular, Down’s syndrome. In this regard, when a hyperechoic focus is detected, a thorough assessment of the fetal anatomy is carried out. However, this marker belongs to the “small” markers of Down syndrome, therefore, the detection of only a hyperechoic focus in the heart does not increase the risk of having Down syndrome and is not an indication for other diagnostic procedures.

What to do if a hyperechoic focus is detected in the fetal heart?

When hyperechoic focus occurs:

• if the fetus has ONLY a hyperechoic focus in the heart, then no additional examinations are required. The risk of Down’s disease does not increase.
• for a planned ultrasound scan at 32-34 weeks, the fetal heart will be examined again. In most cases, the hyperechoic focus in the heart disappears by this time of pregnancy, but even if it continues to remain in the heart, this does not in any way affect the health of the fetus and the tactics of pregnancy management.

Doppler during pregnancy in Minsk

Doppler (synonym, Doppler) of feto-placental blood flow is a study of the state of blood flow in the mother-placenta-fetus system, which is performed during an ultrasound examination during pregnancy.

The results of Doppler ultrasound allow us to judge the state of the uterine-placental-fetal blood flow and indirectly indicate the intrauterine state of the child.

The physical effect used in modern medicine to measure blood flow velocity was discovered in 1842 by Christian Johann Doppler, professor of mathematics and geometry.Dopplerometry has become widespread in obstetrics since the mid-80s of the 20th century. The most commonly used Doppler techniques for scanning during pregnancy are as follows: pulse, color (color), power doppler.

Pulse Doppler.

The essence of the Doppler effect is that when ultrasonic waves are reflected from moving objects (in our case, such objects are blood cells moving through the vessels), the physical properties of the wave change.The difference between the frequency of the reflected and emitted ultrasonic pulses is called the Doppler shift. Blood flow velocity is calculated using a mathematical formula based on the Doppler shift and then marked with a luminous dot on the monitor. The combination of these points forms a pattern on the screen of the ultrasound machine, which is called the blood flow velocity curve. In addition, during Doppler measurements, audible signals are heard to help the doctor distinguish whether the measurement is in the desired vessel.The doctor evaluates the blood flow velocity curve visually, and also, marking certain areas, calculates special indices. These indices are called vascular resistance indices and characterize the state of blood flow in the studied vessel. In general, there can be many indicators characterizing blood flow in a vessel, but the most popular indices in obstetric ultrasound are IR (resistance index), PI (pulsation index) and SDO (systalo-diastolic ratio). The values ​​of the obtained resistance indices are compared with the normative ones and, based on this, a conclusion on the state of blood flow in the vessel is formulated.

Color Doppler.

This technique is based on the application of the same frequency shift, only after signal conversion, an image of blood vessels, usually red and blue, appears on the monitor screen. Using this technique, it is impossible to determine the calculated indices, but it is possible to characterize the features of the blood flow in the organ, to trace the course of the vessels.

Colored and pulsed Doppler are often used in combination – colored to locate the vessel, pulsed to assess the blood flow velocity in it.

Color Doppler is used very often during pregnancy ultrasound. So such dangerous conditions as placental previa to the cervix, true umbilical cord knot, repeated entanglement of the umbilical cord around the fetal neck, cervical cancer can be diagnosed using this technique. In addition, color Doppler is used for every examination of the fetal heart and helps to detect heart defects.

Power Doppler.

Another method for assessing the blood supply to the object under study.Changes in the amplitude characteristics of the wave are transformed in the apparatus, and usually orange vessels are visible on the monitor. This technique is not often used in obstetrics.

Indications for Doppler.

The main indications for assessing blood flow in the mother-placenta-fetus system are:

1. Maternal diseases:

• gestosis, arterial hypertension,
• kidney disease,
• collagenoses,
• antiphospholipid syndrome and other autoimmune conditions
• congenital thrombophilia
• diabetes mellitus

2.Diseases of the fetus, placenta, umbilical cord:

• size gap
• oligohydramnios, polyhydramnios
• multiple pregnancy
• Disturbance of maturation of the placenta
• hydrocephalus, fetal malformations, umbilical cord abnormalities, fetal chromosomal abnormalities
• pathological types of CTG
• malformations and suspected chromosomal abnormalities

3. Complicated obstetric history (GVRP, preeclampsia, stillbirth in previous pregnancies).

Assessment of blood flow in the placenta basin.

Assessment of placental blood flow includes the measurement of resistance indices in the umbilical artery and in both uterine arteries. Violation of blood flow in the umbilical cord indicates a malfunction in the fetal part of the placenta. Violation of blood flow in the uterine arteries indicates a malfunction in the uterine part of the placenta. You need to know that normal blood flow rates are a fairly reliable sign of the normal intrauterine state of the fetus, but do not completely exclude the development of certain complications; the presence of blood flow disorders in different parts of the uterine-placental-fetal system requires strict dynamic control and treatment, including in a hospital setting.

Assessment of fetal circulation.

Hemodynamics of the baby is usually assessed by examining the blood flow in the cerebral vessels (middle cerebral artery), aorta, venous duct, heart.

Classification of disorders of uteroplacental-fetal blood flow.

The most commonly used, simple and convenient classification of placental blood flow disorders is set out below.

1st stage

A. Disruption of the uteroplacental blood flow while maintaining the fetal-placental (increased resistance indices in the uterine arteries)

B.Violation of the fetal-placental blood flow while maintaining the uteroplacental blood flow (increased resistance indices in the umbilical artery)

2nd stage

Simultaneous disturbance of uteroplacental and fetal-placental blood flow (increased resistance indices in the umbilical cord artery and in the uterine arteries)

3rd degree

Critical impairment of fetal-placental blood flow (impaired blood flow in the umbilical cord) – there is no diastolic blood flow in the umbilical artery, or even reverse (reverse) blood flow appears.

After assessing the blood flow in the vessels of the placenta and the fetus, the doctor draws appropriate conclusions and formulates a conclusion. Based on this conclusion and the results of other examination methods, the tactics of pregnancy management are selected.

Points to remember:

* Doppler is an additional technique that is used after an ultrasound examination.

* Indications for dopplerometry are determined by the doctor.Such a study should not be carried out without evidence.

* The frequency of Doppler measurements is determined by the doctor. Sometimes daily monitoring of the mother-fetus blood flow is required

* Normal Doppler results do not override the results of other tests and do not guarantee the absence of intrauterine fetal distress.

Change of information and development of science

I am old enough now to see healthcare evolve and change dramatically.From treating heart attacks, changing treatments for low back pain, and treating HIV infection, medicine continues to adapt and change as we learn more and use evidence to guide treatment.

Evidence? I can recall many conversations with patients who felt that the mere mention of “evidence-based medicine” or EBM was a prelude to being told that they would not get what they wanted.

What has changed in my career is the movement to justify how we treat different conditions, from peer opinion, which means the experts’ best guess, to using studies (randomized controlled trials, if possible) to actually compare treatment A to B.

Task: change. What we know is constantly changing. Science continues to evolve and we continue to learn daily.

So now we are with COVID-19.

A study is soon investigating all aspects of this infectious disease. This includes everything from how we treat an advanced infection in the intensive care unit to how to properly prevent people from getting this highly contagious virus in the first place. We also try to understand what influences someone’s risk for worse outcomes.Patterns appear and more information appears.

One area that has received due attention is the production of antibodies by the body. There are two main ways to generate antibodies to the virus. We either receive them after being infected (provided that we have not died of the disease), or we receive vaccines, which are usually “weakened” versions of the virus. This is a process in which the action of the virus is weakened (“weakened”), but the antibody response still occurs.

This is where all the action is … right now.

At this point, we know that COVID-19 does induce an antibody response, but as published in the Journal Blood on October 1, these antibodies remain in effect or begin to disappear approximately three to four months after infection. It also appears that the more severe the infection, the more antibodies are produced.

We are now hearing about the possibility of a vaccine that acts through the RNA of a cell that appears to provide protection about seven days after the second dose.This can be a game changer. Another caveat is that the data must be corroborated by other scientists and more people need to be studied to evaluate side effects. Even if it works, it can take months for the general population to be available. If and when a vaccine becomes available, we will need to prioritize frontline workers and those who are medically vulnerable.

What does this mean to me as a primary healthcare provider? The jury has yet to be decided, but I suspect COVID-19 could very well look like the flu and may require an annual vaccination.This also means that other preventative measures such as washing your hands, masks, keeping your hands out of your face, and staying at home when you are sick will continue to be important. While that would be nice, I don’t think it will ever be a one-and-all situation. Both COVID-19 and the flu can transmit the virus to other people before they develop any symptoms. People can spread COVID-19 about two days before signs or symptoms appear and remain infectious for at least 10 days after the signs or symptoms first appear.(People with the flu are usually infectious the day before symptoms appear and remain infectious for about seven days.)

Another important point, according to the researchers, is that to end the ongoing COVID-19 pandemic, the vaccine must be at least 80% effective, and 75% of people must receive it. Since such high vaccination coverage is unlikely to occur anytime soon, other measures such as social distancing and wearing masks are likely to be important preventive measures for the foreseeable future.(Source: Bartsch SM, O’Shea KJ, Ferguson MC, et al. Vaccine efficacy required for the COVID-19 coronavirus vaccine to prevent or stop an epidemic as the only intervention. Am J Prev Med . 2020; 59 (4) : 493-503.)

Also, as soon as we have the vaccine, as with the flu, it will prioritize who gets the vaccine and in what order. The National Academies of Science, Engineering, and Medicine have outlined guidelines for the distribution of COVID-19 vaccines, urging high-risk healthcare workers and first aiders to receive first doses, and then to older residents of institutions such as nursing homes and adults with pre-existing vaccines.conditions that put them at increased risk. The group urged states and cities to focus on providing access in minority communities, and the US on supporting access in low-income countries.

As a family medicine physician, I always try to remember what my mentor told me many years ago, “A plan is the best guess for today.” We must act in accordance with what we know now and be ready (and open) to new information and learning.One thing is for sure, change will be permanent.

Dictionary of medical abbreviations / Technical, economic, legal dictionaries on perfekt.ru

Book Direct Marketing vs Purchasing Center

Direct Marketing vs Purchasing Center
Sergey Potapov

Sergey Potapov

Direct marketing versus the purchasing center

Despite the fact that “direct” means “direct”, not all messages get to whoever we would like.In this article, we will look at the reasons for this.

What does DM mean as an operation?

Consider the classic “SMCR” model based on Shannon and Weaver information theory.

Let us assume that the sender is a company interested in direct marketing services. A message is information on and inside an envelope, or perhaps a postcard. The channel is not the DM itself (for this is given by the research topic). A channel is a company that provides a direct marketing service (or a database if we operate on our own).And finally, the recipient, these are the people to whom the letter can reach.

Problematic “places”!

Naturally, failures can occur at any link in the above chain. The sending company may be mistaken in the very intention to turn to DM as a way to promote, have the wrong idea about its consumer and reach the wrong audience. Its brand may be poorly compatible with DM, or the DM strategy may not be consistently thought out, but one-time, based on fashion, on a kind of promotional “coin” (and let’s try as we do .