By R. Rozhov. University of North Carolina at Asheville.

The question is everything As in other forms of clinical research purchase pepcid 40mg line, there are several different ways in which one could carry out a study into the potential or real diagnostic usefulness of a physical sign or laboratory test generic pepcid 20mg on line, and each of them is appropriate to one sort of question and inappropriate for others. Among the questions one might pose about the relation between a putative diagnostic test (say, BNP) and a target disorder (say, LVD), four are most relevant: q Phase I questions: Do patients with the target disorder have different test results from normal individuals? At first glance the first three questions may appear indistinguishable or even identical. They are not, because the strategies and tactics employed in answering them are crucially different, and so are the conclusions that can be drawn from their answers. The first two differ in the “direction” in which their results are analysed and interpreted, and the third differs from the first two as well in the fashion in which study patients are assembled. The fourth question gets at what we and our patients would most like to know: are they better off for having undergone it? The conclusions that can (and, more importantly, cannot) be drawn from the answers to these questions are crucially different, and there are plenty of examples of the price paid by patients and providers when the answers to Phase I or II questions are 24 ARCHITECTURE OF DIAGNOSTIC RESEARCH interpreted as if they were answering a Phase III (or even a Phase IV) question. These questions also nicely describe an orderly and efficient progression of research into the potential usefulness of a clinical sign, symptom, or laboratory result, and we will use the BNP story to show this sequence. Phase I questions: Do patients with the target disorder have different test results from normal individuals? Question 1 often can be answered with a minimum of effort, time, and expense, and its architecture is displayed in Table 2. For example, a group of investigators at a British university hospital measured BNP precursor in convenience samples of “normal controls” and in patients who had various combinations of hypertension, ventricular hypertrophy, and LVD. It was not surprising, therefore, that they concluded that BNP was “a useful diagnostic aid for LVD”. Note, however, that the direction of interpretation here is from known diagnosis back to diagnostic test.

Body Organization and © The McGraw−Hill Anatomy buy discount pepcid 40mg online, Sixth Edition Organization cheap pepcid 20mg with visa, and the Anatomical Nomenclature Companies, 2001 Human Organism 38 Unit 2 Terminology, Organization, and the Human Organism Right Epigastric Left hypochondriac region hypochondriac region region Right Umbilical Left lateral region lateral abdominal abdominal region region Right Hypogastric Left inguinal region inguinal region region FIGURE 2. The upper vertical planes are positioned lateral to the rectus abdo- minis muscles, the upper horizontal plane is positioned at the level of the rib cage, and the lower horizontal plane is even with the upper border of the hipbones. The cubital fossa is the depressed anterior portion of the cubital region. The shoulder is the region be- The manus has three principal divisions: the carpus, con- tween the pectoral girdle and the brachium that contains the taining the carpal bones (see fig. The shoulder is also referred to as the omos, or ing the metacarpal bones; and the five digits (commonly called deltoid region. The cubital region is the area between the arm fingers), containing the phalanges. The front of the hand is re- ferred to as the palmar region (palm) and the back of the hand is cubital: L. Body Organization and © The McGraw−Hill Anatomy, Sixth Edition Organization, and the Anatomical Nomenclature Companies, 2001 Human Organism Chapter 2 Body Organization and Anatomical Nomenclature 39 Right upper quadrant Left upper quadrant Right lower quadrant Left lower quadrant FIGURE 2. The perineal region can be divided into a urogenital triangle (anteriorly) and an anal triangle (posteriorly). Body Organization and © The McGraw−Hill Anatomy, Sixth Edition Organization, and the Anatomical Nomenclature Companies, 2001 Human Organism 40 Unit 2 Terminology, Organization, and the Human Organism Cranial cavity (contains brain) Vertebral cavity (contains spinal cord) Thoracic cavity (contains heart, lungs, Diaphragm and esophagus) (respiratory muscle) Abdominal cavity (contains stomach, liver, spleen, pancreas, and intestines) Pelvic cavity (contains certain reproductive organs, especially in female) Paras FIGURE 2. The lower extremity consists of the hip, thigh, knee, leg, and pes (foot). The thigh is commonly called the upper leg, or Knowledge Check femoral region. The knee has two surfaces: the front surface is the patellar region, or kneecap; the back of the knee is called the 12. The shin is a prominent bony ridge face landmarks that help distinguish their boundaries?

Consequently buy pepcid 20mg on line, the type toms or exacerbations of the condition of medication prescribed varies with the (Hansell generic 20 mg pepcid with mastercard, 1995). Medications are commonly Some individuals experience cognitive used for bladder management, control of changes as a result of multiple sclerosis, spasticity, or emotional symptoms. Some individuals, however, ple sclerosis never experience urinary may experience impairment in perform- problems, for those who do, anticholiner- ing tasks that require conceptualization, gic medications, which inhibit the actions memory, or new learning, as well as diffi- of the parasympathetic nervous system, culty with tasks that require either rapid are sometimes helpful in relieving bladder or precise motor responses. Depression is com- stimulate the actions of the parasympa- mon, although the degree to which it is a thetic nervous system, may be helpful in reaction to the disease or a manifestation relieving urinary retention. Bladder training may be helpful in reducing bladder problems Treatment and Management of and in helping the individual to manage Multiple Sclerosis bladder control. Use of a catheter or san- itary pads may also decrease the embar- The diagnosis of multiple sclerosis is rassment of possible leakage of urine. There is no specific ids are ingested and ensuring a ready treatment for multiple sclerosis, nor is availability of restrooms to minimize the there a cure. If individuals have ed toward controlling individual symp- problems with urinary retention, they toms and preventing exacerbations and may be taught to insert a catheter into complications. Relaxants or antispasmod- toms, but it can have risks that must be ics may be prescribed for muscle spasm or carefully weighed by each individual. There is no steroids taken over extended periods of formula for estimating the general out- time, they are usually prescribed only on come for all individuals. Symptoms often a temporary basis to decrease exacerba- fluctuate with periods of remission (when tions, and not as ongoing therapy. Al- or anxiety may have antianxiety agents or though the symptoms may partly resolve antidepressants prescribed. Since suicide when the disease is in remission, exacerba- rates are relatively high among individu- tions can leave permanent residual defects. The general prognosis for individuals In general, individuals with multiple with multiple sclerosis is unpredictable, sclerosis should remain as active as they with varying rates of progression and can without developing excessive fatigue. For some indi- Physical therapy may be prescribed to help viduals (about 20 percent) the condition with problems of mobility or with the use remains relatively stable with only mild of assistive devices, such as walkers, if symptoms, such as slight weakness, needed.