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Others are searching for referral information cheap 250mg biaxin free shipping gastritis diet , answering questions such as order biaxin 250 mg on-line gastritis symptoms in spanish, “Where is the best place for me to go to resolve my problem? However consumers may use it, the advent of the Internet has shifted power in medi- cine from one-on-one relationships controlled by professionals to spontaneous, geographically dispersed networks that may include as many as 100,000 participants. Still shell-shocked from his interaction, this Yale-trained internist related that he had diagnosed a long-time patient with a dread- ful rare, systemic, and fatal autoimmune disease that he had never encountered in his practice and had scheduled a treatment plan- ning session with the now-terrified patient to begin addressing her problem. The patient came to the meeting with a two-inch thick binder of articles she had downloaded via the Internet from national and international medical journals. It also contained a basic science section on the potential genetic and molecular basis of the illness. The patient placed the binder on the internist’s desk and said, “Why don’t we start here? When I related this story at one of my presentations, a physician posed the following rhetorical question about the exchange: “Why should I read it [the binder]? As I have subsequently learned, however, this response from physicians is not an unusual one. The “why should I read it” response reflects at least two kernels of truth wrapped in a thick layer of barely examined and ugly emotions. True enough, many physicians do not feel they have enough time to do their jobs properly; and certainly, a lot of the material in the binder may not have been directly relevant to the treatment 104 Digital Medicine planning task at hand. Remember, however, that the physician in Connecticut was deal- ing with a disease he had not treated before and thus needed to research the matter himself to participate meaningfully in the pro- cess. In business, this process is called “outsourcing to the customer,” which is what Federal Express did when it set up its web site to enable a customer to locate a package without going through its call center. By taking the initiative, the patient, not the doctor, took charge of defining medical reality. In the Connecticut example, the physi- cian did not explicitly delegate this task. Rather, the patient “vol- unteered,” in a desperate effort to begin immediately the task of defining her own medical reality and options.

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Pregnant medical radiation workers may work in a radiation environment as long as there is reasonable assurance that the fetal dose can be kept below 1 mGy during the course of pregnancy discount biaxin 500mg with mastercard gastritis diet . Termination of pregnancy at fetal doses of less than 100 mGy is deemed to be unjustifiable purchase 250 mg biaxin fast delivery gastritis zittern, but at higher fetal doses, informed decisions should be made based upon individual circumstances. Radiological protection in paediatric diagnostic and interventional radiology Diagnostic radiological examinations carry a higher risk per unit of radiation dose for the development of cancer in infants and children compared to adults. The higher risk is due to the longer life expectancy of children, in which radiation effects could manifest, and the fact that developing organs and tissues are more sensitive to radiation. Risk is particularly high in infants and young children compared to older children. Justification of every examination involving ionizing radiation, followed by optimization of radiological protection is particularly important in every paediatric patient, in view of the higher risk of adverse effects per unit of radiation dose compared to adults. According to the justification principle, if a diagnostic imaging examination is indicated and justified, this implies that the risk to the patient of not performing the examination is greater than the risk of potential radiation induced harm to the patient. The implementation of quality criteria and regular audits should be instituted as part of the radiological protection culture in the institution. Imaging techniques that do not employ the use of ionizing radiation should always be considered as a possible alternative. For the purpose of minimizing radiation exposure, the criteria for the image quality necessary to achieve the diagnostic task in paediatric radiology may differ from adults, and noisier images, if sufficient for radiological diagnosis, should be accepted. The advice of medical physicists should be sought, if possible, to assist with installation, setting imaging protocols and optimization. Exposure parameters that control radiation dose should be carefully tailored for children and every examination should be optimized with regard to radiological protection. Apart from image quality, attention should also be paid to optimizing study quality. Acceptable quality also depends on the structure and organ being examined and the clinical indication for the study.

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Recent studies have shown a decreased risk of endome- trial cancer (Barbone et al biaxin 250mg sale gastritis diet x90. Although fiber has the ability to decrease blood estrogen concentra- tions by a variety of different mechanisms (Rose et al buy biaxin 250mg on line gastritis symptoms and prevention. Half of the epidemiological studies attempting to link low dietary fiber intake to breast cancer have failed to show this relationship (Gerber, 1998). The data on cereal intake and breast cancer risk are considerably stronger than overall fiber intake (Rohan et al. Physical Activity Regular exercise, as recommended in this report, has been shown to be negatively correlated with the risk of colon cancer (Colbert et al. This is, in part, due to the reduction in obesity, which is positively related to cancer (Carroll, 1998). In men and women who are physically active, the risk of colon cancer is reduced by 30 to 40 percent compared with those who are sedentary. However, relatively few studies found a consistent association between physical activity and decreased incidence of endome- trial cancer. For prostate cancer, results of about 20 studies were less consistent, with only moderately strong relationships. With regard to the possible effect of exercise on other forms of cancer, such as pancreatic cancer (Michaud et al. The role of diet in the promotion or prevention of heart disease is the subject of considerable research. New studies investigating dietary energy sources and physical activity for their potential to alter some of the risk factors for heart disease are underway (i. The corre- lation between total fat and serum cholesterol concentration is due, in part, to the strong positive association between total fat and saturated fat intake and the weak association between total fat and polyunsaturated fat intake (Masironi, 1970; Stamler, 1979). While lauric, myristic, and palmitic acids increase cholesterol concentration (Mensink et al. Epidemiological studies have generally demonstrated a posi- tive association between trans fatty acid intake and increased risk of heart disease (Ascherio et al. There is wide interindividual variation in serum cholesterol response to dietary cholesterol (Hopkins, 1992), which may be due to genetic factors.

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