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Those people with a high chance of having the disease can then be referred for a definitive assessment (for example buy cheap tamiflu online, a biopsy) and treatment as necessary purchase tamiflu cheap, while those with a low chance can be reassured discount 75 mg tamiflu otc. In order to achieve this, a programme is required to carry out repeated examinations of large numbers of well people (who do not have, or are unaware of, symptoms), using a test that combines accuracy with simplicity, low cost, safety and acceptability. As the newspaper article illustrates, screening programmes are complex operations that have limitations. It emphasises that screening tests are not perfect and that evaluation is very important. There may be little value in developing a screening programme if the condi tion is not important, either in terms of severity, or incidence/prevalence, or both. Natural history of condi It is important to know about the natural development of a disease that is tion is known. If not, in what proportion of people does it progress, from what stage, and what factors determine this progression? Preclinical phase allowing This relates to the natural history, but also to opportunities for treatment. For screening to have any chance of being effective, there must be a phase during which the disease can be detected, but before it has become too advanced to treat successfully. Acceptability and safety of the test must be acceptable (not unduly painful or anxiety provoking) and the screening test. For example, it has been necessary to show that the radiation dose used in mammography (screening for breast cancer by radiography) is safe, and will not of itself cause breast cancer when used repeatedly during a woman’s life. Validity of the screening A number of measures are used to assess how valid the screening test is test. These measures are sensitivity, specificity, predictive value, accuracy and likelihood ratio. Effective management of It would unacceptable to screen a population, detect a possibly serious disease, confirmed cases is avail and then not be able to treat that disease effectively, or not be able to afford able, and resources exist to to treat everyone confirmed as having the disease. Human and financial Screening on a large scale, such as for breast and cervical cancer, is a major resources are available to operation. Carrying out mammography requires expensive equipment, well operate the system for trained radiographers (to take X-rays), and radiologists (to read X-rays), and screening, definitive diag a good system for contacting and recalling women who require treatment or nosis, recall, quality routine re-examination. Cost-benefit ratio is the costs of preventing a case (incidence and/or mortality) should be calcu acceptable. Advice and counselling Advice and support are necessary for people in various stages and categories available. Validity is a measure of accuracy and can be defined as the capacity of a test or question to give the true result. These concepts apply equally to screening tests, which, after all, are measurement tools used to establish whether or not an individual is likely or not to have a disease. We will now introduce an example that will help to illustrate these various measures of validity. Example Blood cholesterol testing is increasingly common, and many self-test machines are available. This is a form of screening (albeit mainly for a self-selected population), and it is of interest to assess how valid the results are. In the following (hypothetical) example, results on 100 people from a self-test machine have been compared (using the same blood sample) with a well-calibrated laboratory analyser, which can be treated as a gold standard.


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Karyotype analysis revealed that 101 fetuses (58 male and 43 female) were chromosomally normal and 157 (72 male buy tamiflu from india, 63 female discount 75 mg tamiflu free shipping, 16 with triploidy generic tamiflu 75mg with visa, and 6 with tetraploidy) were abnormal All potential control subjects underwent vaginal ultrasonography before the interview. If a nonviable intrauterine preg nancy was detected, the woman was recruited as a member of the group with spontaneous abortion (this occurred in 53 of the 562 case patients). Triploidy means that there was an extra chromosome, and tetraploidy that there were two extra chromosomes. A fetus with this type of abnormality is at increased risk of spontaneous abortion. The authors included examination of chromosomal abnormalities, as only one previous study had done so, and it was felt important to distinguish possible effects of caffeine on genetically normal fetuses from those which were abnormal. Selecting the most appropriate groups of controls can be one of the most demanding aspects of a case-control study. We will look first at how this was done in the Swedish study and then consider some general points about control selection. The cases in the Swedish study were women who had experienced a spontaneous abortion in the first trimester, and who attended the Department of Obstetrics and Gynaecology at Uppsala University Hospital. The single most important principle in control selection is that the controls should be repre sentative of the population from which the cases have arisen, but without the disease in question. The answer to this lies at the beginning of the excerpt on ‘Study subjects’ from paper A (above). The research team were dealing with all (or virtually all) spontaneous abortions for which medical care was sought in Uppsala County. The population from which these cases arose was therefore the Uppsala County population, but with the qualification that they were women who attended the hospital when they experienced a spontaneous abortion. Although it can be expected that most women in Sweden having a spontaneous abortion would attend the hospital, not all would. Furthermore, it is likely that those who do not attend would differ in some respects from those who do, so that the group attending the hospital will not be fully representative of the Uppsala County population. Let’s now look at the full description of how controls were selected for the Swedish study. The control subjects were selected primarily from the antenatal care clinics in Uppsala County. They were frequency-matched to the women who had had spontaneous abortions with regard to duration of gestation (in completed weeks) and area of residence (one of the five municipalities in the county). Of the 1037 women who were seeking antenatal care and were asked to participate, 953 (92 percent) agreed to do so. All potential control subjects underwent vaginal ultrasonography before the interview. If a nonviable intrauterine preg nancy was detected, the woman was recruited as a member of the group with spontaneous abortion (this occurred in 53 of the 562 case patients). In Uppsala County, there are approximately 3 legally induced abortions for every 10 completed pregnancies, and some of these terminated pregnancies would have resulted in spontaneous abortion if the pregnancy had continued. To limit bias in the selection of control subjects, women with induced abortions were added to the control group. In total, 310 women who had undergone induced abortions were asked to participate, and 273 (88 percent) agreed to do so.

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Analysis of data: After the data have been collected order tamiflu with a visa, the researcher turns to the task of analysing them tamiflu 75mg lowest price. The analysis of data requires a number of closely related operations such as establishment of categories buy tamiflu with american express, the application of these categories to raw data through coding, tabulation and then drawing statistical inferences. The unwieldy data should necessarily be condensed into a few manageable groups and tables for further analysis. Thus, researcher should classify the raw data into some purposeful and usable categories. Coding operation is usually done at this stage through which the categories of data are transformed into symbols that may be tabulated and counted. Tabulation is a part of the technical procedure wherein the classified data are put in the form of tables. Computers not only save time but also make it possible to study large number of variables affecting a problem simultaneously. Analysis work after tabulation is generally based on the computation of various percentages, coefficients, etc. In the process of analysis, relationships or differences supporting or conflicting with original or new hypotheses should be subjected to tests of significance to determine with what validity data can be said to indicate any conclusion(s). For instance, if there are two samples of weekly wages, each sample being drawn from factories in different parts of the same city, giving two different mean values, then our problem may be whether the two mean values are significantly different or the difference is just a matter of chance. Through the use of statistical tests we can establish whether such a difference is a real one or is the result of random fluctuations. If the difference happens to be real, the inference will be that the two samples Research Methodology: An Introduction 19 come from different universes and if the difference is due to chance, the conclusion would be that the two samples belong to the same universe. Similarly, the technique of analysis of variance can help us in analysing whether three or more varieties of seeds grown on certain fields yield significantly different results or not. In brief, the researcher can analyse the collected data with the help of various statistical measures. Hypothesis-testing: After analysing the data as stated above, the researcher is in a position to test the hypotheses, if any, he had formulated earlier. Various tests, such as Chi square test, t-test, F-test, have been developed by statisticians for the purpose. The hypotheses may be tested through the use of one or more of such tests, depending upon the nature and object of research inquiry. Hypothesis-testing will result in either accepting the hypothesis or in rejecting it. If the researcher had no hypotheses to start with, generalisations established on the basis of data may be stated as hypotheses to be tested by subsequent researches in times to come. Generalisations and interpretation: If a hypothesis is tested and upheld several times, it may be possible for the researcher to arrive at generalisation, i. As a matter of fact, the real value of research lies in its ability to arrive at certain generalisations. If the researcher had no hypothesis to start with, he might seek to explain his findings on the basis of some theory. The process of interpretation may quite often trigger off new questions which in turn may lead to further researches. Preparation of the report or the thesis: Finally, the researcher has to prepare the report of what has been done by him. The layout of the report should be as follows: (i) the preliminary pages; (ii) the main text, and (iii) the end matter. In its preliminary pages the report should carry title and date followed by acknowledgements and foreword. Then there should be a table of contents followed by a list of tables and list of graphs and charts, if any, given in the report.

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It may also be due to surgery cheap 75 mg tamiflu visa, such as gastric resection and ileal bypass order online tamiflu, or antibiotic therapy discount tamiflu 75 mg on line. Obesity may be due to excessive intake of food (exogenous) or metabolic or endocrine abnormalities (endogenous). Morbid obesity is a disease with serious psychological, social, and medical rami f ications and one that threatens necessary body functions such as respiration. After surgery in adults, a stomach tube remains in place and obser osis: abnormal condition; increase vation is maintained for signs of hemorrhage or blockage of the tube. Pathology 123 Diagnostic and Therapeutic Procedures This section introduces procedures used to diagnose and treat digestive system disorders. Descriptions are provided as well as pronunciations and word analyses for selected terms. It is also used to conf irm the presence and extent of varices in the lower esophagus and stomach in patients with liver disease. When polyps are discovered in the colon, they are retrieved and tested for cancer. Colonoscopy (Examination Polyp of entire length End of of colon) sigmoidoscopy (Examination of lower third Sigmoid colon of colon) Anus Figure 6-9. Bilirubin is a breakdown product of hemo globin and is normally excreted from the body as bile. Excessive bilirubin causes yellowing of the skin and mucous membranes, a condition called jaundice. It also helps detect colon cancer and bleeding associated with diges tive disorders. It is used for diagnosing obstructions, tumors, or other abnormalities of the colon. It is also used to diagnose tumors, cysts, inflammation, abscesses, perforation, bleeding, and obstructions. A band is then inserted that restricts food consumption and delays its passage from the pouch, causing a feeling of fullness. Staple lines Small stomach Staple lines Esophagus pouch Pouch Esophagus Duodenum A. Duodenum Arrows show pathway of food Shortened jejunum is now connected to the small stomach pouch Connection B. Stoma Colostomy performed to Colostomy bag attach healthy attached to stoma tissue to abdomen Figure 6-12. Antacids counteract or decrease excessive drugs include agents that relieve “cramping” (anti stomach acid, the cause of heartburn, gastric dis spasmodics) and those that help in the movement comfort, and gastric reflux. Complete each activity and review your answers to evaluate your understanding of the chapter. Learning Activity 6-1 Identifying Digestive Structures Label the illustration on page 109 using the terms listed below. Enhance your study and reinforcement of word elements with the power of DavisPlus. We recommend you complete the flash-card activity before completing Activity 6–3 below. Learning Activities 135 Learning Activity 6-3 Building Medical Words Use esophag/o (esophagus) to build words that mean: 1. Complete the termi nology and analysis sections for each activity to help you recognize and understand terms related to the digestive system. Use a medical dictionary such as Taber’s Cyclopedic Medical Dictionary, the appendices of this book, or other resources to define each term. Then review the pronunciations for each term and practice by reading the medical record aloud.

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