By W. Olivier. Florida Institute of Technology.
Finding the optimal camera setup purchase generic kamagra gold online erectile dysfunction drugs and glaucoma, the correct focal point buy kamagra gold with a mastercard impotence mayo clinic, and a depend- able source of lighting takes some research and many sessions of experi- mental trials 100 mg kamagra gold with amex erectile dysfunction ultrasound. Te photographer should exercise patience and remember to record the exposures and f-stops with every trial photograph taken in order to determine the optimal parameters. Tis focus shif moves the focus point of the object being photographedawayfrom the vis- ible focus since the actual infrared focus in patterned injuries in skin is below the surface of the skin. Te second reason is to attempt to record an injury afer a period of time of healing when it is no longer visible to the unaided human eye. Forensic dental photography 231 use occurs because ultraviolet light is strongly absorbed by pigment in the skin. Case reports suggest that it is possible to photograph a healed injury up to several months afer the injury. Such a case, reported by David and Sobel,27 illustrated a fve-month-old injury recaptured using refective ultraviolet photography where no injury pattern was visible to the naked eye. Te infrared band of light is at the opposite end of the Forensic dental photography 233 Figure 11. Because infrared is longer in wavelength transmission, it penetrates up to 3 mm below the surface of the skin (Figure 11. Since the depth of the injury that will be recorded with the infrared tech- nique is below the surface, the infrared focus point will not be the same as the visible focus point, requiring a focus shif. Te feld of digital infrared forensic photography has grown to include documentation of gunshot residue, tattoo enhancement, questioned documents, blood detection, background deletion, wound tracking, and tumor detection. Te injury documented with infrared technique will not appear the same as photographs taken using visible light. In Kodak Publication N-1, Medical Infrared Photography,6 this diference is discussed (pp. Te reason is the lens aberrations have been corrected for panchromatic pho- tography, so the anastigmatism is not as perfect in the infrared. Te majority of biological infrared images are formed from details not on the outside of the subject…. Tis feature accounts for the misty appearance of many infra- red refection records. Rather, it may just mean that the injuries are not such that the incident wavelength of nonvisible light doesn’t “see” the injuries based on the components in the injured skin. It must also be pointed out that even if the techniques work and images are captured, the resultant images may not add to the evidentiary value (Figures 11. The use of multiple photo- graphic modalities failed to increase the forensic/evidentiary value. Sometimes, nonvisible light photography can be used to help determine if the injuries represent human bitemarks or come from another source. In such cases, the use of digital full-spectrum photography benefts the investigator since the resultant images are instantly available for review (Figures 11. Tis chapter has dealt with the photographic techniques that apply to collecting evidence of patterned injuries in skin, primarily human bitemarks. It should be mentioned that these techniques work for other types of injuries in human skin. While this chapter’s authors are forensic odontologists whose area of expertise is bitemark analysis, full-spectrum photographic documen- tation of injuries in skin not made by teeth can also be important and should be pursued by other criminal investigators (Figures 11. The appearance of a bitemark on the back of the left hand of a homicide victim (Figures 11. Te appropriate protocols for evidence management are fully discussed in Chapter 17. Te protocols require accountability as to who had possession of the evidence from the time it was collected until it is marked and introduced into the legal system. It is important to maintain the integrity of the evidence in terms of its original form and reproducibility. Photography is one of the most important tools used in the practice of forensic dentistry. Te demands on the photographer can be great, especially in situations where an injury is the only evidence tying a suspect to the crime. Time, patience, and preparation in forensic photography are requirements for successful pattern injury documentation. Injury to this breast was thought to have been the result of an avulsive bite when viewed in the color photograph (Figure 11. The images show details indicating that a rope had been used to tie the neck of the bound victim to the headrest of an automobile. The details of the rope seen in the photographs indicated that the ligature marks on the neck were not caused by the border of the seat belt, as the defendant had claimed. Developing the skills necessary to competently document these injuries with visible and nonvis- ible light is one of the great challenges in forensic dentistry. Infrared photography, medical and scien- tifc photography: An online resource for doctors, scientists, and students. Tesis for doctor of philosophy, University of London, Oral Pathology, London Hospital Medical College. A theoretical and experimental study of light absorption and scattering by in vivo skin. Recapturing a fve month old bite mark by means of refective ultraviolet photography. Te World Trade Center attack, the Pentagon attack, and the Pennsylvania crash all related to the 9/11 terrorist’s attacks lef the United 245 246 Forensic dentistry States in shock. Te world watched in astonishment as the tsunami of December 26, 2004, wiped out entire cites and islands around the Indian Ocean. Te identifcation process is very important to the family members of the deceased for legal and psychological reasons. Every phase of the identifca- tion process should lead toward an accurate and scientifcally based iden- tifcation. Tose who read this chapter should have the ability to defne a multiple fatality incident and know the types and causes of those incidents. He or she should understand the principles of site management, relationships with other agencies, and the role of the forensic odontologist in the response, including the latest technological advances in imaging and forensic dental identifcation sofware. For instance, a transportation accident in the New York City area with one to two hundred fatalities could be well within the abilities of the local emergency manage- ment system, fre and police departments, and medical examiner. Conversely, in a juris- dictional area in the Midwest with sparse population and limited resources, a multicar accident with twenty fatalities could create a situation that would be beyond the capabilities of the existing system. Tis situation could be termed a mass disaster, and some sort of outside aid would be needed to assist the local responders. Of course, the survivors of a mass disaster are the initial concern of the responders. Once this priority is accomplished, the eforts intensify to locate, identify, and return to their families those victims who did not survive. Te response eforts to multiple fatalities include recovery, autopsy as required, dental identifcation in multiple Fatality incidents 247 identifcation, and release of bodies to families or to their country of origin. Embalming may be a consideration, but in respect to religious concerns, should be done only afer identifcation and legal release.
In one drugs because of the risk of hypoglycaemia: chlorpropamide series of geriatric patients on digoxin 100mg kamagra gold visa strongest erectile dysfunction pills, the drug was withdrawn (half-life 36 hours) can cause prolonged hypoglycaemia and is in 78% of cases without detrimental effects cheap 100mg kamagra gold with amex erectile dysfunction ear. Brisk diuresis in patients with mental impairment or reduced The decline in renal function must be borne in mind when an mobility can result in incontinence buy kamagra gold 100mg visa hard pills erectile dysfunction. For many patients, a thia- antibiotic that is renally excreted is prescribed, especially if it is zide diuretic, such as bendroflumethiazide, is adequate. Appendix 3 diuretics, such as furosemide, should be used in acute heart of the British National Formulary is an invaluable practical guide. Broad-spectrum drugs including uncommon with low doses of diuretics, but plasma potassium cephalosporins and other beta-lactams, and fluoroquinones are should be checked after starting treatment. If clinically important common precursors of Clostridium difficile infection which has a hypokalaemia develops, a thiazide plus potassium-retaining high mortality rate in the elderly. Amoxicillin is the most com- diuretic (amiloride or triamterene) can be considered, but there mon cause of drug rash in the elderly. Flucloxacillin induced is a risk of hyperkalaemia due to renal impairment, especially cholestatic jaundice and hepatitis is more common in the elderly. Thiazide-induced gout and Case history glucose intolerance are important side effects. An 80-year-old retired publican was referred with ‘congest- ive cardiac failure and acute retention of urine’. His other medication included ketoprofen for osteoarthritis and fre- These drugs plays an important part in the treatment of chronic quent magnesium trisilicate mixture for indigestion. He heart failure, as well as hypertension (see Chapters 28 and 31), had been getting up nearly ten times most nights for a year and are effective and usually well tolerated in the elderly. During the day, he frequently passed small However, hypotension, hyperkalaemia and renal failure are amounts of urine. The possibility of atheroma- were due to the fact that he drank two pints of beer each tous renal artery stenosis should be borne in mind and serum day since his retirement seven years previously. On physical examination he was clinically anaemic, but Potassium-retaining diuretics should be co-administered only not cyanosed. Rectal examination revealed an enlarged, symmetrical prostate and black tarry faeces. Initial laboratory results revealed that the patient had acute on chronic renal failure, dangerously high potassium 5. Drugs should seldom be used to treat symptoms without urinary catheterization, furosemide and haemodialysis. Drugs should not be withheld because of old age, but it doxazosin and ranitidine, and paracetamol as required. Do not use a drug if the symptoms it causes are worse Answer Co-amilozide – hyperkalaemia: amiloride, exacerbation of than those it is intended to relieve. It is seldom sensible to treat the side effects of one drug Chlorpromazine – urinary retention by prescribing another. Ketoprofen – gastric ulcer, antagonism of thiazide diuretic, salt retention, possibly interstitial nephritis In the elderly, it is often important to pay attention to mat- Magnesium trisilicate mixture – additional sodium load ters such as the formulation of the drug to be used – many old (6mmol Na /10mL). Supervision of drug taking may be necessary, as Iatrogenic disease due to multiple drug therapy is common in the elderly. The use of amiloride in renal impairment an elderly person with a serious physical or mental disability leads to hyperkalaemia. This patient’s confusion and rest- cannot be expected to comply with any but the simplest drug lessness were most probably related to his renal failure. Containers require especially clear labelling, and Chlorpromazine may mask some of the symptoms/signs and should be easy to open – child-proof containers are often also delay treatment of the reversible organic disease. The sodium content of some antacids can adversely affect cardiac and renal failure. A proton pump inhibitor should be A previously mentally alert and well-orientated 90-year-old woman became acutely confused two nights after hospital considered as prophylaxis against upper gastro-intestinal admission for bronchial asthma which, on the basis of peak complications in those most at risk. Improper prescription of drugs is a common cause of morbid- Answer ity in elderly people. Common-sense rules for prescribing do Prednisolone, cimetidine, digoxin and nitrazepam. Comment not apply only to the elderly, but are especially important in If an H2-antagonist is necessary, ranitidine is preferred in the this vulnerable group. It is likely that the patient no longer requires digoxin (which accumulates in the elderly). Take a full drug history (see Chapter 1), which should not be used for sedation in elderly (or young) asthmatics. The implications of a angiotensin receptor blockers in heart failure and high cardiovas- growing evidence base for drug use in elderly patients. British Journal of Clinical Pharmacology 2006; 61: Vitamin D and bisphosphonates for fractures and osteoporosis. Drugs and Aging ers in heart failure and thrombolytics in acute myocardial infarc- 2000; 17: 353–62. Three further minor cat- egories of adverse drug reaction have been proposed: Adverse drug reactions are unwanted effects caused by nor- mal therapeutic doses. The classification proposed by Rawlins nephropathy); and Thompson (1977) divides reactions into type A and type B 2. They are dose-related and usually treatment with benzodiazepines or β-adrenoceptor mild, although they may be serious or even fatal (e. The term ‘side effects’ is often applied to minor type products available directly or on prescription. Exposure to drugs in the the drug’s main pharmacological action, are not dose-related population is thus substantial, and the incidence of adverse and are severe, with a considerable mortality. Type A reactions are pathophysiology of type B reactions is poorly if at all under- reported to be responsible for 2–3% of consultations in general stood, and often has a genetic or immunological basis. In a recent prospective analysis of 18820 hospital reactions occur infrequently (1:1000–1:10000 treated subjects admissions by Pirmohamed et al. Most reactions were either Chlorpromazine Sedation Cholestatic jaundice definitely or probably avoidable. Adverse drug reactions are most frequent and severe in the elderly, in neonates, women, Naproxen Gastro-intestinal Agranulocytosis patients with hepatic or renal impairment, and individuals haemorrhage with a history of previous adverse drug reactions. Such reac- Phenytoin Ataxia Hepatitis, tions often occur early in therapy (during the first one to ten lymphadenopathy days). Unfortunately, prick and scratch determine which drug is responsible, as patients are often tak- testing is less useful for assessing the systemic reaction to ing multiple drugs. One or more of several possible approaches drugs than it is for the more usual atopic antigens (e. The following diagnosis of contact sensitivity, but does not reflect considerations should be made to assess causality of the systemic reactions and may itself cause allergy. Provocation effect to the drug: did the clinical event and the time- tests should only be undertaken under expert guidance, course of its development fit with the duration of suspected after obtaining informed consent, and with resuscitation drug treatment and known adverse drug effects?
The state- concepts cheap 100mg kamagra gold overnight delivery erectile dysfunction doctors tucson az, language cheap kamagra gold online amex erectile dysfunction with age, and forms of data that reﬂect ments of values and beliefs are expressed in the new ways of thinking and knowing in nursing order 100mg kamagra gold otc erectile dysfunction doctors near me. The philosophies of nursing that are essential under- complex concepts used in nursing scholarship and pinnings of theoretical developments in the disci- practice require language that can be used and un- pline. The language of nursing theory facilitates Systems of Education communication among members of the discipline. Expert knowledge of the discipline is often required Nursing holds the stature and place of a discipline for full understanding of the meaning of special of knowledge and professional practice within in- terms. A distinguishing mark of any disci- This attribute calls attention to the array of books, pline is the education of future and current mem- periodicals, artifacts, and aesthetic expressions, as bers of the community. These indicators in- Closely aligned with attributes of nursing as a dis- clude procedures, tools, and instruments to cipline previously described is consideration of determine the impact of nursing practice and are nursing as a professional practice. Professional essential to research and management of outcomes practice includes clinical scholarship and processes of practice (Jennings & Staggers, 1998). Resulting of nursing persons, groups, and populations who data form the basis for improving quality of nurs- need the special human service that is nursing. Theory-based research is needed in ery and interdisciplinary work demands practice order to explain and predict nursing outcomes es- from a theoretical perspective. Nursing’s discipli- sential to the delivery of nursing care that is both nary focus is essential within an interdisciplinary humane and cost-effective (Gioiella, 1996). Because environment (Allison & McLaughlin-Renpenning, nursing theory exists to improve practice, the test of 1999). Nursing actions reﬂect nursing concepts and nursing theory is a test of its usefulness in profes- thought. Careful, reﬂective, and critical thinking is sional practice (Fitzpatrick, 1997; Colley, 2003). Chapters in and use of nursing theory offer opportunity for the remaining sections of this book highlight use of successful collaboration with related disciplines nursing theories in nursing practice. From the viewpoint of practice, know what they are doing, why they are doing what Gray and Forsstrom (1991) suggest that through they are doing, what may be the range of outcomes use of theory, nurses ﬁnd different ways of looking of nursing, and indicators for measuring nursing’s at and assessing phenomena, have rationale for impact. These nursing theoretical frameworks serve their practice, and have criteria for evaluating out- in powerful ways as guides for articulating, report- comes. Recent studies reported in the literature af- ing, and recording nursing thought and action. Further, these tion and reﬁnement through research, must be re- studies illustrate that nursing theory can stimulate turned to practice (Dickoff, James, & Wiedenbach, creative thinking, facilitate communication, and 1968). Within nursing as a practice discipline, nurs- clarify purposes and relationships of practice. The ing theory is stimulated by questions and curiosi- practicing nurse has an ethical responsibility to use ties arising from nursing practice. Development of the discipline’s theoretical knowledge base, just as it nursing knowledge is a result of theory-based nurs- is the nurse scholar’s ethical responsibility to de- ing inquiry. The circle continues as data, conclu- velop the knowledge base speciﬁc to nursing prac- sions, and recommendations of nursing research tice (Cody, 1997, 2003). Can nursing theories in- form us how to stand with and learn from peoples Nursing Theory and the Future of the world? Can we learn from nursing theory how to come to know those we nurse, how to be Nursing theory in the future will be more fully in- with them, to truly listen and hear? Can these ques- tegrated with all domains of the discipline and tions be recognized as appropriate for scholarly practice of nursing. New, more open and inclusive ways to theo- ways to inform nurses for humane leadership in na- rize about nursing will be developed. Abdellah notes that nurses in with other disciplines such as politics, economics, other countries have often developed their systems and aesthetics. These authors expect a continuing of education, practice, and research based on learn- emphasis on unifying theory and practice that will ing from our mistakes. She further proposes an in- contribute to the validation of the nursing disci- ternational electronic “think tank” for nurses pline. Reed (1995) notes the “ground shifting” with around the globe to dialogue about nursing reforming of philosophies of nursing science and (McAuliffe, 1998). Such opportunities could lead calls for a more open philosophy, grounded in nurses to truly listen, learn, and adapt theoretical nursing’s values, which connects science, philoso- perspectives to accommodate cultural variations. Theorists will work in groups to We must somehow come to appreciate the essence develop knowledge in an area of concern to nurs- and beauty of nursing, just as Nightingale knew it ing, and these phenomena of interest, rather than to be. Perhaps it will be realized that the essence of the name of the author, will deﬁne the theory nursing is universal and that only the ways of ex- (Meleis, 1992). One challenge of nursing theory is the per- Nursing’s philosophies and theories must in- spective that theory is always in the process of creasingly reﬂect nursing’s values for understand- developing and that, at the same time, it is ing, respect, and commitment to health beliefs and useful for the purposes and work of the disci- practices of cultures throughout the world. Continuing students of the discipline are required to study and know It is important to question to what extent the basis for their contributions to nursing theories developed and used in one major and to those we serve, while at the same time culture are appropriate for use in other be open to new ways of thinking, knowing, cultures. Exploring structures of nursing knowledge and understanding the portant to question to what extent theories devel- nature of nursing as a discipline of knowledge oped and used in one major culture are appropriate and professional practice provides a frame of for use in other cultures. Structuring the nursing knowledge system:A ty- A retrospective and prospective on nursing theory. Terminology in structuring and developing Nursing Science Quarterly, 16(3), 225–231. Image: Journal of Nursing Scholarship, 30(3), 275– linguistic journey to nursing practice. This provides ex- vance the discipline and professional practice of cellent opportunity for nurses in practice and in nursing. One of the most urgent issues facing the administration to study, review, and evaluate nurs- ing theories for use in practice. Communicating these reviews with the nursing theorists would be One of the most urgent issues facing the useful as a way to initiate dialogue among nurses discipline of nursing is the artiﬁcial sepa- and to form new bridges between the theory and ration of nursing theory and practice. This chapter discusses evaluating and selecting discipline of nursing is the artiﬁcial separation of nursing theories for use in nursing: practice, educa- nursing theory and practice. The examination and use of nursing theories Although nursing theory is essential for all nursing, are essential for closing the gap between nursing the main focus of theory analysis and evaluation in theory and nursing practice. Nurses in practice this chapter is the use of nursing theories in nursing have a responsibility to study and value nursing practice. The chapter begins with responses to the theories, just as nursing theory scholars must un- questions: Why study nursing theory? What does derstand and appreciate the day-to-day practice of the practicing nurse want from nursing theory? When practicing nurses and nurse scholars work together, the discipline and practice of nursing ben- Reasons for Studying eﬁt, and nursing service to our clients is enhanced.