····· lezzter Preis 39.90€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray This manuscript describes a parameter modification to the Radcalc software model such that it would be able to provide a valid check to the predicted radiation doses from the Monte Carlo treatment planning system. Thus the polynomial correction model obtained provides a simple but robust and empirically sound correction to the Radcalc commercial software such that monitor unit calculations from the Monte Carlo TPS may by verified for post mastectomy chest wall irradiation cases. This provides the medical physicist confidence that any persistent differences should be investigated as possibly due to an actual systematic error unassociated with a failure of the predictive model. ····· 1036125760
····· lezzter Preis 44.10€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray Doing two tasks together is a day today activity and is problematic in case of elderly with parkinsonism due to inefficient allocation of attention during performing tasks of daily routine therefore improvement of this via dual task training in different enviornmental context may prove beneficial and is economical in reference to time and money and reduces risk of falls during routine walking, obstacle crossing and many other. ····· 1036125634
····· lezzter Preis 44.10€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray After a detailed study and comparison of my work with other workers, It can be concluded that diagnostic efficacy of sacral index is higher than Kimura s Base Wing Index for sex determination of sacrum, because the readings obtained by sacral index method were relevant and more significant than Kimura s Base Wing Index method . Continued study over a period of time in a defined area will definitely help in establishing the anthropometric standards. ····· 1036125555
····· lezzter Preis 44.10€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray Submental intubation is an interesting alternative to tracheotomy, especially when short term post-operative control of airway is desirable with the presence of undisturbed access to oral as well as nasal airways and a good dental occlusion. Submental intubation with midline incision has been used in ten cases. All patients had fractures of the jaws disturbing the dental occlusion associated with fracture of the base of the skull, or/and a displaced nasal bone fracture. After standard orotracheal intubation, a passage was created by blunt dissection with a hemostat clamp through the floor of the mouth in the submental area. The proximal end of the orotracheal tube was pulled through the submental incision. Surgery was completed without interference from the endotracheal tube. At the end of surgery, the tube was pulled back to the usual oral route. There were no perioperative complications related to the submental intubation procedure. Average duration of procedure was less than 6 mins. Submental intubation is a simple technique associated with a low morbidity. It is an attractive alternative to tracheotomy in the surgical management of selected cases of panfacial trauma. ····· 1036125541
····· lezzter Preis 44.10€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray The aim of this book was to establish the uptake, output and outcome of prevention of Mother to Child Transmission of Human immuno-deficiency virus. A total of 146 antenatal and intranatal mothers were targeted for the study. A descriptive cross sectional study was conducted. Sampling was done using systematic sampling. The method that was used for data collection was exist interview and also data abstraction form was used to collect data from patient`s records. The data was collected and entered into computer packages for analysis and presentation. The SPSS statistical program was used for analysis.Student s t-test was used to compare continuous variables and Chi-square test for categorical variables.The results of this study have shown that uptake of PMTCT services at Kakamega Provincial hospital was good and most clients were satisfied with the PMTCT services offered. However, it was not be easy to tell from this study whether there have been a reduction in mother-to-child transmission of HIV on the program or not. This was because there was no baseline data prior to the initiation of the program and also there was more than 60% dropout rate during follow-up of children. ····· 1036125538
····· lezzter Preis 71.10€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray The book contributes to the enhancement of evidence based knowledge in the area of cancer nursing care by giving voice to those involved in the caring process namely the patient, the nurse and the patient advocate. This book focuses on the holistic exploration of the nursing care provided to patients with cancer by taking into consideration issues such as spirituality, religiosity, respect, values and ethnohistoric background. This is achieved by a turn to Philosophy as a methodology for nursing research. Explicitly, Hermeneutic Phenomenology is applied as it was inspired by the philosophical ideas of Paul Ricoeur. The book offers a step-to-step description of Hermeneutic Phenomenology by unveiling the processes of distanciation, appropriation and the hermeneutic circle to the reader. The utilization of these processes in the lived experiences of the participants assigns new appropriated interpretations. The book opens up a new pathway to quality cancer nursing care by introducing a descriptive theory of the phenomenon. This theory reflects the aspects that are considered important by the users and at the same time promised by the providers of the health care services. ····· 1036125427
····· lezzter Preis 44.91€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray The purpose of the study is to assess the level of knowledge and compliance of mothers in newborn screening towards designing health program in Philippine perspective. A multi-dimensional assessment approach were used, and thus further playing relevant role in formulating specific and generalized health program proposals for newborns and mothers as well as strengthening the curriculum of nursing and allied health sciences schools globally. ····· 1036125124
····· lezzter Preis 61.20€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray Historically systematic reviews have focused on evidence related to effectiveness and as such the aggregation of results of randomised controlled trials. However health care questions are often complex requiring different research approaches to yield appropriate answers. It is acknowledged that not all research questions are amenable to the results of RCTS and as such there is now a shift towards understanding the need to incorporate research findings that acknowledge social and cultural concerns. This shift has resulted in an increased use of qualitative research findings as evidence and more specifically the systematic review of qualitative research findings. While still a relatively new area of research, the methods surrounding qualitative systematic review are fast developing. To date there are many views and debates on how this type of research should be performed. In order to gain a deeper level of understanding of these positions a discursive analysis informed by Foucault was undertaken on contemporary literature. ····· 1036124834
····· lezzter Preis 71.10€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray Autonomy and empowerment are core concerns in the field of geriatric care but the discussion has been mostly based on the health professionals point of view and in the context of long-term care. The aim of this study was to explore the concept of autonomy and the empowerment process in hospitalized older people encompassing the nurses and patients points of view. A qualitative study design was drawn up within a phenomenological approach. Nurses life histories and patients biographic narratives were collected. Hermeneutic analysis was performed. Patients and nurses have different concepts from each other regarding autonomy and empowerment. Patients have a more comprehensive view of these concepts but feel powerless, voiceless and would like to hold more power regarding the dimensions of care that are currently dependent on nurses action. The differentiation of latent and manifest autonomy emerged in this study. In hospital, latent autonomy is significantly higher than manifest autonomy and nurses play a significant role in the extent of the gap between these two dimensions. Empowering interventions might transform patients latent autonomy into one that is vivid and manifest. ····· 1036124760
····· lezzter Preis 44.10€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray Menopause increases the risk for women independent of age. Prior to menopause, the risk of Coronary Artery Disease (CAD) for women lags behind the risk for men. After menopause, women have similar risks of CAD as men of the same age. The functional and morphological alteration in endothelial cells is critical to atherosclerotic process. After menopause, marked decline in Estrogen and Nitric Oxide (NO) levels takes place. Estrogen exerts its various CAD protective actions by arterial endothelium sex steroid receptors. Nitric oxide released from vascular endothelium is one of most known versatile molecules and has a role in almost every biological system. Nitric oxide inhibits various key steps in development of atherosclerosis via inhibition of platelet activity and smooth muscle cell proliferation. Further presence of Endothelial Nitric Oxide Synthase (eNOS) gene polymorphism Glu298Asp may provide additional insult by decreasing NO levels adding to the CAD risk. Hence, postmenopausal women those who presents with eNOS Glu298Asp polymorphic gene may have higher CAD risk. ····· 1036124749
····· lezzter Preis 44.10€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray This book was written as a result of extensive research carried out in Kitui district, Kenya. The focus was to determine the influence of prenatal care on pregnancy outcome. It covers broad topics on knowledge of prenatal care, utilization of prenatal care services and factors contributing to maternal and prenatal complications by women attending prenatal clinics in rural areas. In general women`s perception of prenatal care, knowledge on when to start attending prenatal clinic and it`s effectiveness in preventing pregnancy complications was found to be inadequate. Prenatal care services should be decentralized to communities to enable pregnant mothers access skilled birth attendants while health facilities should be properly equipped and well staffed with skilled birth attendants This book is intended to help policy makers in establishing policies on how prenatal care services in rural areas should be managed. It is presented in simple language and a straightforward manner, easy to be understood by the reader. The author of this book is a former Chief Nurse of Moi Teaching and referral Hospital ····· 1036124536
····· lezzter Preis 33.21€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray The book is divided in seven chapters consisting two parts for each of gastrointestinal organs. The first part of the chapters gives overview on anatomical and physiological data for the organs, symptomatology as well as laboratory and instrumental tests that are used in diagnosis of the diseases. The second part of the chapters refers to the most common diseases of esophagus, stomach, small and large intestine, liver, biliary system and pancreas respectively. The diseases are presented in the way that includes key practice points with essentials of etiopathogenesis, pathological anatomy, clinical picture, diagnosis and treatment. Modern approaches in diagnostic and interventional gastroenterology are highlighted by the thirty years of clinical practice of the author. The author integrates his practical knowledge with most recent scientific inventions in the field of gastroenterology. The book will be an affordable, highly practical handbook and is strongly recommended for gastroenterologists, general internists and general practitioners. ····· 1036124488
····· lezzter Preis 44.10€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray Peptic ulcer disease is commonly complicated by perforation. Mortality and morbidity arising out of these perforations can be high. Factors that influence outcome in patients with peptic ulcer perforation include treatment delay, ASA class of the patient at the time of operation and presence of shock. Of these treatment delay is most important and modifiable. This book reviews delay and how it affected outcome in patients treated for perforated peptic ulcers at the Kenyatta National Hospital, Nairobi, Kenya. In this book Patient s files for the period January 2002 to December 2008 were reviewed. Data sought included patient demographics, clinical presentation, time from symptom onset to presentation at emergency department, time from presentation at emergency to surgical treatment and the treatment outcomes. The data is analyzed, results presented. And conclusions made. This should provide an interesting read for surgeons at various levels of training and practicing alike. ····· 1036124448
····· lezzter Preis 32.31€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray La problemática actual de los altos niveles de glucosa en sangre deriva en hiperinsulinemia y resistencia a la insulina mucho más de lo que se conoce en la literatura médica. Esto nos lleva a una progresión hacia la diabetes tipo 2 de forma acelerada. Este libro es un estudio sobre qué es la glucosa, las alteraciones que se producen en el organismo y las patologías que aparecen como consecuencia de los niveles alterados en sangre. ····· 1036122861
····· lezzter Preis 26.10€ ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray En este trabajo se presenta un meta-análisis con los datos de 6 ensayos clínicos con la vacuna CIMAvaxEGF en pacientes con cáncer avanzado de pulmón de células no pequeñas, con el objetivo de evaluar la seguridad de la misma. El estudio incluyó 221 pacientes de 6 ensayos clínicos: Piloto I (12 pacientes), Piloto II (34 pacientes), Piloto III (25 pacientes), Piloto IV (42 pacientes), Piloto V (28 pacientes) y Fase II (80 pacientes). El mismo se desarrolló durante un periodo prolongado de inmunizaciones hasta la muerte del paciente. Para evaluar la seguridad de la vacuna se analizó el comportamiento de 7 parámetros de laboratorio: 3 hematológicos (Hemoglobina, Leucocitos y Plaquetas) y 4 hemoquímicos (Transaminasa Glutámico Pirúvica, Transaminasa Glutámico Oxalacética, Fosfatasa Alcalina y Creatinina) y la aparición de eventos adversos, así como su grado de intensidad. La mayoría de los eventos adversos encontrados fueron ligeros y moderados y los severos encontrados no estuvieron relacionados con la administración de la vacuna. Otros resultados y conclusiones pueden leerse en el presente trabajo. ····· 1036122708
für 44.10€ kaufen ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray The content of the book is a honest work done with the involvement of good,renowned experienced doctors in a world class reputed hospital.It will help those people who work in a hospital setting particularly in surgical fields with definite satisfactory result.Safety and efficacy of the said drug have been already established in allover the world.Methodology that is how and at what dosage Fentanyl can be used during and after any surgery of any age group has been described .One of the most common symptoms for which a patient seeks medical advice is pain. Relief of pain is by far the most frequent indication of surgical intervention & a large majority, not all, which seek medical attention subsequently, undergoes operation. The surgeon in his mission induces pain, which at times is more severe than the original complaint. So Fentanyl is the answer to above worry. ····· 1036121601
für 53.10€ kaufen ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray Epidural analgesia is an effective strategy in acute postoperative pain management however not without the potential for adverse consequence. Increasing prevalence in hospital-acquired heel pressure ulcers are of growing concern in acute care facilities. Within the author`s hospital, two surgical patients prescribed epidural analgesia displayed signs of heel pressure despite adherence to local pressure prevention guidelines. A research project commenced aimed at preventing recurrence. Data generated from our study identified that both patients` innate characteristics and routine hospital practices were linked to heel injuries in these patients. Multiple Comorbidity, hypotension, and anti-embolic devices were just some of the factors found to be influential. These findings, and the suggested recommendations, are anticipated to assist us as safe clinicians continually striving to improve nursing practice in risk assessment and heel pressure preventive strategies our study found essential for this patient cohort. ····· 1036121441
für 44.10€ kaufen ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray Paired kidneys are reddish bean shaped organs about 10-12cm long, 5-7cm wide, 3cm thick and has a mass of 135-150g.10 The kidneys lie on the posterior abdominal wall, one on each side of vertebral column, behind the peritoneum and below diaphragm. They extend from the level of 12th thoracic vertebrae to 3rd lumbar vertebrae. The main function of kidney can be categorized as Formation of urine, Water & electrolyte balance, Production of hormones & enzymes. In the resting adult, kidney receives 1.2-1.3litres of blood/min. In an adult, the GFR averages 120ml/min. The collecting duct of kidney is an area of fine control of ultrafiltrate composition & volume, where final adjustment in electrolyte composition is made by the action of mineralocortioid & ADH. The hypertonicity of medullary interstitium plays an important role in concentrating the urine. The kidney not only excretes the metabolic substances, but also toxic agents from the body.6 Hence kidney becomes one of the important targets for the toxicity of agents more than other organs in body. ····· 1036121301
für 71.10€ kaufen ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray Despite the lack of successful treatments for people with severe mental disorders, a large number of patients nevertheless recover. What is known today about recovery from severe mental disorders To what can the improvement in these patients condition be attributed And how do these factors impact on the recovery process The aims of the book are twofold: 1. to present what is known today about recovery from severe mental disorders. 2. to present the findings of a study on recovery from severe mental disorders from the perspective of those who have recovered, with respect to the course of the recovery process, which factors according to the interview subjects influenced their recovery and the user s descriptions of how these factors have influenced their recovery. ····· 1036121283
für 44.10€ kaufen ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray Ischaemic preconditioning is a phenomenon where brief periods of ischaemia and reperfusion prior to a prolonged episode of ischaemia have a protective effect on tissue. Ischaemic preconditioning has been demonstrated in every animal species tested and many different tissues, including human myocardium (Yellon et al, 1993), (Hausenloy et al, 2007). Many different patterns of ischaemic preconditioning have been tested (Kloner and Jennings, 2001 a), and this investigation aimed to identify a pattern of ischaemic preconditioning that promoted protective effects in a rat heart strip model, with recovery of contractile function as end-point assessment. Three different patterns of ischaemia and reperfusion were tested and compared to a control group which received no preconditioning ischaemia. After preconditioning, all four groups were exposed to 30 minutes of ischaemia and 30 minutes reperfusion. Results showed some preconditioning effects in group 3 although statistical analysis found the results not to be significant. However, the pattern used in group 4 was found to exacerbate ischaemic damage, which was unexpected. Further testing is suggested. ····· 1036121257
für 44.10€ kaufen ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray Attempts to determine the association between the radiographic and clinical findings of knee pathology have produced conflicting results. It is also not yet known how knee radiographs influence the conservative management of patients with knee pain. The objective of the study is to determine the association between the clinical and radiographic diagnoses of knee pain and to record the suspected clinical diagnoses and management of the patients prior to referral for radiographs of the knee. The study will also determine any change in the clinical diagnoses and management following radiographic reporting of the selected radiographs. Degenerative changes were the most common radiographic findings. The majority of the knee radiographs were requested at the initial consultation and as the length of treatment increased, the frequency of radiograph requests decreased. Knee radiographs were over-utilized at the CDC and the findings on radiography did not have much influence on the diagnosis and the management of the patient presenting with knee pain. The majority of the clinical diagnoses were degenerative causes of knee pain. ····· 1036121216
für 44.10€ kaufen ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray Iodine deficiency disorders (IDD) constitute one of the major health problems of the world. In the Sudan during the last 50 years a number of reports appeared about the prevalence of goiter in different region in Sudan. In this book we concentrated on the central area around the White Nile which lies between Kosti and Khartoum. The book illustrated on the prevalence of ID in schoolchildren aged 6-18 years and estimating the iodine content in local water and iodized salt. ····· 1036120991
für 44.10€ kaufen ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray Acid-base balance is an vital invasive investigative procedure of the respiratory assessment. Any disorders in the normal homeostatic acid-base balance will lead to altered functioning of the body. The two major disorders are, either the acidotic state or the alkalotic state as reflected by the pH of the arterial blood. PaCO2 reflects the functioning of the lungs i.e either hypoventilation or hyperventilation. On the other hand, HCO3 reflects the function of the kidney i.e either absorption or removal of bicarbonate ions to normalize the pH. Either the lung or the kidney will compensate to correct the acid-base disorder. The physical therapist should be able to assess and interpret the disorders of the acid-base balance accurately and guide his treatment based on the findings of arterial blood gases. This book includes the explanation of the cause of these acid-base disorders, their assessment and the correction of the same. ····· 1036120914
für 44.10€ kaufen ···· Rheinberg-Buch.de - Bücher, eBooks, DVD & Blu-ray We performed a randomized, prospective, controlled trial in 54 patients, to compare norepinephrine and phenylephrine in the management of dopamine resistant septic shock. Patients were randomly allocated to receive either norepinephrine or phenylephrine infusion titrated to achieve a predefined haemodynamic and tissue perfusion targets for continuous 6 hrs as per protocol of our study. All the parameters were recorded every 30 min and increment in dose of studied drug was done in the specified dose range if targets were not achieved. Data from pulmonary arterial and hepatic vein catheterization, thermodilution catheter, blood gas analysis, blood lactate levels, invasive blood pressure, and oxygen transport variables were compared with baseline values after achieving the targets of therapy. No difference was observed in any of the investigated parameters except for statistically significant reduction of heart rate (HR) and increase in stroke volume index (SVI) by phenylephrine. We concluded that both drugs are comparable in reversing hemodynamic and metabolic abnormalities of sepsis patients, with an additional benefit of decrease in HR and improvement in SVI by phenylephrine. ····· 1036120541· 1 · ::::: · 16 ·· 17 ·· 18 ·· 19 ·· 20 ·· 21 ·· 22 · ::::: · 23 ·
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