BAZELE MEDICINEI DE FAMILIE RESTIAN PDF

Editura Restian A. Bazele Medicinei de Familie. Medicina de Familie Restian. Bazele medicinei de familie. The exact time of the invention of the first wheelchair is uncertain, however the earliest depictions of a wheelchair-like construction can be seen on a 5 th century BCE vase in China.

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Wheelchairs are used by people for whom walking is difficult or impossible, due to illness, injury, or disability.

Obviously it allows them to move around and improves their quality of life, but it has also negative effects. Some suffer chronic pain due to over exertion; it contributes to depression, and causes a great deal of embarrassment and social anxiety. Some patients prefer to remain at home rather than go outside.

Getting in and out of the wheelchair is difficult, and they sometimes need assistance going to the toilet. Wheelchair bound patients have also extra expenses;the home has to be adapted to the wheelchair, zero-step entries and door widths adequate for wheelchairs to pass through, and sometimes, especially the elderly, have to hire a live-in caregiver.

The exact time of the invention of the first wheelchair is uncertain, however the earliest depictions of a wheelchair-like construction can be seen on a 5 th century BCE vase in China. These early wheelchairs were not much different from wheelbarrows. It would take another years before a vehicle that was powered by hand cranks would be invented by Stephan Farffler, a German watchmaker who was also paraplegic [1], Figure 1.

Though this helped many millions of people to gain their mobility, there was still the matter of those who had upper body disabilities, or other cardiovascular issues, who were unable to use self-powered wheelchairs. There has been relatively little advancement in technology since, with mostly minor improvements in size, noise, comfort, portability, accessibility, and control. The commercial version is called the ReWalk TM , and is well tolerated by patients [5].

The most frequently adverse effects cited were falls caused by wheelchair related characteristics, transfer activities, impaired seated balance and environmental factors [6]. Pain is a major concern for wheelchair users. Upper limb shoulder, elbow and hand pain is often caused by overuse of the muscles and joints from doing transfers and pressure relief maneuvers and from pushing a wheelchair [7].

Carpal tunnel syndrome and other reports of pain in the wrist are due to extremes in wrist flexion and extension [8]. Pressure ulcers are from the prolonged sitting [9]. Daily exercises with the intention of preventing pressure ulcers is highly recommended and working with a physiotherapist to increase or preserve mobility is also to be encouraged.

Apart from the physiological risk factors associated with wheelchair use, there are a number of real and perceived psychological issues. Users of wheelchairs often feel stigmatized.

These behaviors include less eye contact, gaze avoidance, greater personal distance, and briefer social interactions [12]. All of the above contribute to the possibility of developing an especially debilitating psychological state which is encountered in the context of the chronically ill; the loss of self-identity [14].

This further leads to non-compliance with medical treatment. In a meta-analysis, the relationship between depression and noncompliance, was substantial, with an odds ratio of 3. Therefore wheelchair bound patients should be referred to psychological evaluation and treatment if needed. Its aim is to secure equal opportunities and equal rights for people with disabilities.

Effective civil rights legislation is sought in order to secure these opportunities and rights [17]. In most countries there are legislations promoting wheelchairs accessibility, still there are many inaccessible public and private places all around the world.

This should be managed as soon as possible as even one stair is an obstacle for the wheelchair bound person it causes loss of his independence and dignity. Some countries have financial programs to help wheelchair bound persons. The NHS spends roughly million pounds yearly on purchasing the wheelchairs themselves, as well as the staff salaries within wheelchair service. There is wide local variation in waiting times for assessment and provision of wheelchairs, especially powered ones. For instance in 40 per cent of centers, the average time taken to deliver a standard wheelchair ranged from 11 to over 20 days, yet, in the case of powered wheelchairs 40 per cent of centers took an average of between nine weeks to a year from referral to delivery [20].

After receiving their wheelchair, and despite the high cost of administration, user satisfaction remains quite low, and users report a multitude of concerns with regards to their issued wheelchair Figure 2.

An update from the Director of NHS Commissioning has claimed progress in three main areas: the establishment of first national dataset for wheelchair services, new models of personalizing wheelchair services and production of guides to support CCGs Clinical Commissioning Groups [22]. Watson N , and Woods B. Social History of Medicine ;18 3 , Investigating neck pain in wheelchair users. Am J Phys Med Rehabil ;82 3 Aceste scaune rulante timpurii nu erau cu mult diferite de roabe.

Acest lucru conduce la nerespectarea tratamentului medical. One should however not disregard potential risks entailed by the use of these technologies [2]. However, we suppose that the informations gathered by some apps are purely medical, because these are possibly based for example on the SCORE score, as consequence of the Framingham Study. Despite this, if we replace the involvement of the medical profession with other profession without any medical connotations, the project of new apps could to be identically ruled.

The GP has in oversight all the time rather healthy people than sick ones, and therefore the health surveillance is for the GP, unlike other specialists, at least as important as the function of the care of the sick ones. The true GP should not be a dispatcher, but the one who resolves the current medical problems of his patients and not to send them to different specialists, before trying to solve these problems by himself.

The pressures of the IT companies on European health policy in the domain of mHealth data should not become the subject of a program of intensive support from medical organizations. The same kind of pressure will reconvene from governments that seek to reduce health expenditures and those health funds used for prevention should be increased and not only filled out by IT systems.

No data can prove that the doctor-patient relationship and its effectiveness can be replaced by an informatics system. The doctors are not opposed to technological progress, but should not encourage the attempts of pan-european governamental savings.

The wheelchair development The exact time of the invention of the first wheelchair is uncertain, however the earliest depictions of a wheelchair-like construction can be seen on a 5 th century BCE vase in China. Specific adverse effects associated with Wheelchairs use The most frequently adverse effects cited were falls caused by wheelchair related characteristics, transfer activities, impaired seated balance and environmental factors [6].

References 1. Collapsible Wheel Chair. No wheelchairs beyond this point: a historical examination of wheelchair access in the twentieth century in Britain and America.

Social Policy and Society ;4 01 , Davies A. Disability and Rehabilitation ;25 6 , Esquenazi A. The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury. A systematic review of risk factors associated with accidental falls, outcome measures and interventions to manage fall risk in non-ambulatory adults.

Disability and Rehabilitation ;37 19 JNPT ;39 4 Wrist kinematic characterization of wheelchair propulsion in various seating positions: implication to wrist pain. Clinical Biomechanics ;18 6 :SS Pressure ulcer risk assessment and prevention: a systematic comparative effectiveness review.

Annals of Internal Medicine ; 1 The safety of wheelchair occupants in road passenger vehicles. The effects of service dogs on social acknowledgments of people in wheelchairs. The Journal of Psychology ; 1 Living stigma: The impact of labeling, stereotyping, separation, status loss, and discrimination in the lives of individuals with disabilities and their families.

Sociological Inquiry ;75 2 Charmaz K. Loss of self: a fundamental form of suffering in the chronically ill. Sociol Health Illn ;5 2 Exploring the effect of depression on physical disability: longitudinal evidence from the established populations for epidemiologic studies of the elderly. Am J Public Health ;89 9 Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence.

Archives of Internal Medicine ; 14 Bagenstos, Samuel Law and the Contradictions of the Disability Rights Movement. New Haven : Yale University Press. Journal of Legal Medicine ;31 2 National Health Service.

Promotion and provision of the health service in England. Act Pickup B. NHS wheelchair reforms are taking too long, say campaigners. Wheelchair Service Improvement ProgramUpdate. Several comments of principle: The Family Physician is the physician who provides primary health care, personalized and with continuity for the individual, family or community, regardless of age, sex or disease.

To return to the basis for a certain specialty, namely functions that compose the domain for that specialty — what ensures the specialty? What unresolved problems by other specialties solves it? By a simple enumeration of the functions of Family Medicine [4] we can find arguments against the replacing her through any IT applications; these functions are deeply affected by these initiatives for promoting of the mHealth from 14, at least 11 : the function of ensuring accessibility to healthcare; the surveillance of the health; primary prevention , secondary and tertiary prevention; the making of specific prevention; health promotion function; the current medical care ; to facilitate the entry and the patient orientation in healthcare system; the diagnostic and therapeutic synthesis ; the coordination of healthcare services based on patient needs; continued health surveillance ; the family and community care ; function of recovery and rehabilitation ; the terminal and palliative care; the scientific research.

Of curse, the administrative intentions to replace general practitioners with apps or even with personnel with lower calification, are not only rumours; the justification of these intentions through the lack of personnel is not satisfactory enough. Some arguments: at first glance you might think that the family doctor has as a first function to provide current medical assistance to the population, either by solving by himself the medical problems, or by sending the case to the specialist for specific field.

Others believe that the GP has rather the function to oversee the health status of the population and to prevent diseases. A clear regulatory framework should be in place at European level, in order to delimitate mHealth services which have a medical purpose from those services having a sole wellbeing purpose.

Certification processes involving doctors and including a scientific review process should be in place for these apps, to ensure an acceptable level of quality and reliability.

Doctors and patients would expect that the medical service they provide and receive through mHealth is legally viable.

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Wheelchairs are used by people for whom walking is difficult or impossible, due to illness, injury, or disability. Obviously it allows them to move around and improves their quality of life, but it has also negative effects. Some suffer chronic pain due to over exertion; it contributes to depression, and causes a great deal of embarrassment and social anxiety. Some patients prefer to remain at home rather than go outside. Getting in and out of the wheelchair is difficult, and they sometimes need assistance going to the toilet. Wheelchair bound patients have also extra expenses;the home has to be adapted to the wheelchair, zero-step entries and door widths adequate for wheelchairs to pass through, and sometimes, especially the elderly, have to hire a live-in caregiver.

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