Neglected patients

Complementaiy medicine particularly charges that conventional medicine seriously neglects patients as whole integrated human beings (body, mind, spirit) and treats them too much as machines. Conventional practitioners may well feel uneasily... 

Florence AT. Neglected diseases, neglected devices, neglected patients Int J Hiarm 2008 350 1-2. 

This strict adherence to time windows has come under attack in recent years because it neglects patient physiology [18,19], Common sense dismisses the idea that a patient instantly changes from a good treatment candidate to a bad one when the clock moves beyond the window. From clinical experience alone, we know this to be incorrect as there are patients who have large infarcts despite early presentation (Fig. 12.7). Moreover, multiple studies have demonstrated that there can be substantial volumes of viable penumbral tissue between 12 and 24 h from stroke onset [99-101],... 

Medicines are made available as authorised medicines, pharmacy preparations, or investigational medicinal products. For many diseases active substances are available, and yet groups of neglected patients or special patient groups will not receive the medicines they need. If a patient needs a medicine, which is not on the national market, it may be imported from abroad or prepared in a pharmacy. The complicated rules, which are nationally determined, for reimbursement (in some Countries) and Iraig procedures render importation a laborious way to make medicines available for the patient To be reimbursed some Countries require that medicines are to be shown to be efficacious, appropriate and economic. 

Whereas agreements on patents and authorised production can be negotiated in cases of shortages (see section on shortages), this has so far not yet been possible in cases of national versus pharmaceutical industry interests on behalf of neglected patients. Patented medicines block the production of more affordable generic versions while more and more patients become sick or die because the medicines they need to stay alive are simply too expensive. Recently, much attention has been attracted by India s efforts to increase access to medicines and implement a patent system... 

DNDi (Drugs for neglected diseases initiative). DNDi backs WHO Neglected Patients R D Treaty, http //www.ip-watch.org/2012/ 05/11/dndi-policy-brief-backs-who-neglected-patients-rd-treaty/. Accessed 3 May 2013... 

Legislation does not always lead to adequate safety management and proper patient protection. Li fact, the certification process may be dominated by economic interests while neglecting patient safety, as the following example will illustrate. 

Why is it worth the effort Because the patients and employees for whom we are responsible are intrinsically valuable, and this fact alone demands such effort on our part. The effort we make—or fail to make—shapes the values and culture of the organization. We cannot be effective in creating a culture that values safety unless we value and respect the intrinsic worth of the individuals in our charge. Our values play out in the culture. If a leader relentlessly and exclusively pursues extrinsic values (e.g., cost efficiency), or if that is how others perceive him, this sense begins to pervade an organizational culture in which motivation is directed away from safety toward these extrinsic values. Staff may then cut corners in the name of necessity, unconsciously neglecting patient safety. 

Locally advanced cancer breast cancer generally refers to breast carcinomas with significant primary tumor and nodal disease but in which distant metastases cannot be documented. A wide variety of clinical scenarios can be seen within this group of patients, including neglected tumors that have spread locally and inflammatory breast cancers that are a unique clinical entity. Many locally advanced breast cancers are diagnosed in patients who have had symptoms for months to years and have neglected to seek medical attention. Patients with inflammatory breast cancer often are treated inappropriately for cellulitis with antibiotics for several weeks to months. 

I cannot close the eyes to admit a very patient, silent and supportive co-operation of my compassionate wife, Dr. Hemlata Srivastava and two considerate sons, Abhijit Srivastav and Arpit Srivastava, who suffered seclusion and neglect due to my invariable involvement with the book for about 1 year. Last, but not the least my gratitude to all my friends and well wishers, who through their admiration or criticism added directly or indirectly to my strength and inspired vigorously to complete the task in the form as it is today. 

Combinations of active ingredients, specific pharmaceutical formulations, specific use, and company names can be included in the product name. Examples of this are shown in Table 8.2. This combinations and mixes of names can be very complicated and disturbing for the health-care and for the patients, especially for the elderly. It not easy to know what is important. Is ZOC a company or a pharmaceutical formulation changing the dosing schedule Patient safety in the reconciliation of medicines as described in Chapter 10 is very important and must not be neglected. 

When is medication indicated in the treatment of psychiatric illness There is no short answer to this question. At one end of the continuum, patients with schizophrenia and other psychotic disorders, bipolar disorder, and severe major depressive disorder should always be considered candidates for pharmacotherapy, and neglecting to use medication, or at least discuss the use of medication with these patients, fails to adhere to the current standard of mental health care. Less severe depressive disorders, many anxiety disorders, and binge eating disorders can respond to psychotherapy and/or pharmacotherapy, and different therapies can target distinct symptom complexes in these situations. Finally, at the opposite end of the spectrum, adjustment disorders, specific phobias, or grief reactions should generally be treated with psychotherapy alone. 

When switching between a MAOl and other antidepressants that affects serotonin activity, the first medication must be allowed to wash out of the patient s system before the new antidepressant is started. The duration of this washout period is determined by the half-life of the antidepressant that is being discontinued. If a washout is neglected, then a potentially dangerous serotonin syndrome may result. 

Although evaluation of obesity is important, the elucidation of patterns of eating behavior is the critical component in the assessment of eating-disordered obese patients. Unfortunately, it is just this aspect of the evaluation that is most often neglected in treatment programs that too narrowly focus on weight reduction. If a careful history is obtained, then BED is not difficult to diagnose. 

Before the late 1980s there were very limited options in terms of pharmaceuticals for the psychiatric patient. With the advent of fluoxetine (Prozac), which was first launched in Belgium in 1986, the whole area of neuroscience became of much greater interest, especially given the fact that it was an area which had been relatively neglected up until that point. Options for treatment are now much more varied and offer the psychiatrist and patient far more choice. This has come at a price though several drugs have had to be taken off the market while some remain available but with restricted use. In this... 

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