By F. Aldo. Rivier College.

They explain how such technologies can contribute to streamlining the processes within healthcare enterprises discount toradol 10 mg without prescription pain treatment while on suboxone, telemedicine environments buy cheap toradol 10mg pain medication for shingles treatment, and home healthcare practices. The next chapter by Wang and Feng continues the theme of novel technology and focuses on the fundamental theories of biomedical image registration. The authors explain the fundamental connection between biomedical image registration and clinical KM that could improve the quality and safety of healthcare. The move towards electronic data capture and information retrieval is documented together with cross-organisational working and sharing of clinical records. The authors identify key drivers for change and explain the crucial role that all stakeholders play to bring about effective and efficient patient care. Finally in this section, Raghavan discusses the concept of medical decision support system and the knowledge sharing standards among such systems. The evolution of xv decision support in the healthcare arena is explained together with the need for knowl- edge sharing among medical decision support systems. Section III: Knowledge M anagement in Action: Clinical Cases and Application This section of six chapters builds upon the preceding sections and presents clinical KM cases in action. Clarke, Lehaney and Evans start the section with their chapter on the exchange and sharing of knowledge between the emergency services of a UK county. The highly participative study takes into account technological potential and con- straints, organisational issues, and geographic factors. Lessons learned include the need to adopt a more closely integrate operational and strategic planning in the area and to make more explicit use of known and tested methodologies. The service serves as a critical knowledge broker, synthesizing, and translating infor- mation for clients before, during, and after their interactions with clinical practices; thus enabling health professionals to focus on their unique functions. Golemati, Mougiakakou, Stoitsis, Valavanis and Nikita describe basic principles and applications for clinical decision support systems. The authors discuss how such sys- tems make use of advanced modeling techniques and available patient data to optimize and individualize patient treatment. The chapter concludes by stating that knowledge- oriented decision support systems aim to improve the overall health of the population by improving the quality of healthcare services, as well as by controlling the cost- effectiveness of medical examinations and treatment. Knowledge intensive inter-organizational systems for healthcare are the basis for the chapter by Paavola, Turunen and Vuori. The chapter promulgates recent findings and understanding on how information and knowledge systems can be better adopted to support new ways of work and improve productivity in public funded healthcare. The authors advise that issues related to clinical KM such as the varying information and knowledge processing needs of clinicians from various medical expertise domains should be examined carefully when developing new clinical information systems. The author examines systems in four distinct areas: library-type applications, real-time clinical decision support systems, hybrid sys- tems and finally computable guidelines, all of which combine to provide an effective point of care. The authors highlight the importance of social capital where information and knowledge systems are used in the sharing process. They conclude that the use of social capital to analyse knowledge sharing initiatives will lead to more holistic approaches. I hope that academics, clinical practitioners, managers, and students will value this text on their bookshelves as, in the ensuing pages, there is much food for thought— bon appétit. Quantifying value for physician order-entry systems: A balance of cost and quality. The book has truly been a coming together of academic and practitioner minds, without whom this book would merely have remained a scintilla of an idea quietly percolating away in the deepest recesses of my mind. I thank all contributors of this book for their excellent chapters; many contributors also served as reviewers, and additional thanks are due to these hard-working soles for giving up so much of their valuable time and collective energies. Thanks also to every- body who submitted proposals for giving me that most rare and coveted of headaches: a plethora of high quality and relevant submissions from which to choose. Sincere thanks to Professor Swamy Laxminarayan, chief of biomedical information engi- neering at Idaho State University in the USA for writing such a fine foreword and for his kind words and unstinting support in recent years. Professor Raouf Naguib, head of the Biomedical Computing Research Group (BIOCORE) at Coventry University in the UK was a great source of encouragement and provided me with extensive insights into the crazy world of academia. Virtually his first words to me came in the form of advice: to focus on that which I did best, words which obviously stuck with me. I additionally thank Raouf for encouraging me to form my Knowledge Management for Healthcare (KMH) research subgroup, which generated immediate interest and recognition from international academic and healthcare institutions and which continues to go from strength to strength. Ashish Dwivedi for his seminal work in the area of clinical and healthcare knowledge management and for forming the granite-like founda- tion of the KMH subgroup. I appreciate also the expressions of interest and words of support from my numerous interactions with conference delegates in the USA, Singapore, Mexico and the UK.

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Serious immune-based side effects cheap 10mg toradol fast delivery pain treatment center franklin tennessee, such as pul- concentration monary fibrosis best toradol 10mg pain treatment electrical stimulation, have been reported, and blood dyscrasias, such as agranulocytosis and thrombocytope- Clinical Uses nia, may occur in up to 0. Mexiletine is useful as an antiarrhythmic agent in the management of patients with either acute or chronic Contraindications ventricular arrhythmias. While it is not at present an in- Patients who are hypersensitive to tocainide or to local dication for use, there is interest in using mexiletine to anesthetics of the amide type should not be exposed to treat the congenital long QT syndrome when an abnor- tocainide. The first signs of toxicity manifest as fine tremor of When used with other class IB antiarrhythmic drugs, to- the hands, followed by dizziness and blurred vision. The side effects of oral maintenance therapy include re- Mexiletine versible upper gastrointestinal distress, tremor, light- Mexiletine (Mexitil) is an antiarrhythmic agent with headedness, and coordination difficulties. These effects pharmacological and antiarrhythmic properties similar generally are not serious and can be reduced by down- to those of lidocaine and tocainide. Like tocainide, mex- ward dose adjustment or administering the drug with iletine is available for oral administration. Cardiovascular adverse effects, which are less common, include palpitations, chest pain, and angina or Electrophysiological Actions anginalike pain. As with other members of class IB, mexiletine slows Contraindications the maximal rate of depolarization of the cardiac membrane action potential and exerts a negligible ef- Mexiletine is contraindicated in the presence of cardio- fect on repolarization. Mexiletine demonstrates a rate- genic shock or preexisting second- or third-degree heart dependent blocking action on the sodium channel, with block in the absence of a cardiac pacemaker. Caution rapid onset and recovery kinetics suggesting that it may must be exercised in administration of the drug to pa- be more useful for the control of rapid as opposed to tients with sinus node dysfunction or disturbances of in- slow ventricular tachyarrhythmias. Flecainide inhibits the sodium channel, leading Flecainide is effective in treating most types of atrial ar- to conduction slowing in all parts of the heart, but rhythmias. It is also used for life-threatening ventricular most notably in the His-Purkinje system and ventricu- arrhythmias. Flecainide also inhibits abnormal auto- Flecainide crosses the placenta, with fetal levels reaching maticity. In many centers, it is the second-line drug after digoxin for therapy of fe- Electrophysiological Actions tal arrhythmias. Because of the high incidence of proar- Sinoatrial Node rhythmia, initiation of therapy or significant increases in Flecainide decreases the sinus cycle length but re- dosing should be performed only on inpatients. Adverse Effects Atrium Flecainide decreases the maximal rate of depolar- Most adverse effects occur within a few days of initial ization in atrial tissue and shifts the membrane respon- drug administration. The atrioventricular conduction time, measured as Worsening of heart failure and prolongation of the PR the A–H interval, is prolonged by flecainide as is the His-Purkinje or H–V interval. His-Purkinje System and Ventricular Muscle Contraindications Flecainide slows conduction in the His-Purkinje system and ventricular muscle to a greater degree than Flecainide is contraindicated in patients with preexist- in the atrium. Flecainide may also cause block in acces- ing second- or third-degree heart block or with bundle sory A-V connections, which is the principal mecha- branch block unless a pacemaker is present to maintain nism for its effectiveness in treating A-V reentrant ventricular rhythm. Electrocardiographic Changes Drug Interactions Flecainide increases the PR, QRS, and to a lesser ex- In patients whose condition has been stabilized by fle- tent, QTc intervals. Hemodynamic Effects Propafenone Flecainide produces modest negative inotropic effects that may become significant in the subset of patients Propafenone (Rythmol) exhibits predominantly class with compromised left ventricular function. Additionally, propafenone is a weak Oral bioavailability Nearly complete -receptor and L-type calcium channel blocker. Onset of action 1 hour Peak response 2–3 hours Electrophysiological Actions Duration of action 8–12 hours Plasma half-life 2–10 hours As with all members of its class, propafenone has its ma- Primary route of metabolism Hepatic jor effect on the fast inward sodium current. Inhibition of the sodium channel throughout the cardiac cycle will result in a de- Approved indications for propafenone include treatment crease in the rate of ectopy and trigger ventricular of supraventricular arrhythmias and life-threatening tachycardia. Propafenone has been shown to increase mor- Sinoatrial Node tality in patients with structural heart disease, and so ex- Propafenone causes sinus node slowing that could treme caution must be used in this subset of patients. It may lengthen the sinus node with flecainide, the patient should be hospitalized for recovery time with minimal effects on sinus cycle length. Atrium Adverse Effects and Drug Interactions The action potential duration and ERP of atrial mus- Concurrent administration of propafenone with cle are both prolonged by propafenone. The electrophys- digoxin, warfarin, propranolol, or metoprolol increases iological effects persist beyond removal of the drug from the serum concentrations of the latter four drugs. In patients with atrial flutter, fibrillation, or Cimetidine slightly increases the propafenone serum tachycardia, propafenone can slow the atrial rate, result- concentrations. Additive pharmacological effects can ing in a change from 2:1 or 4:1 A-V block to 1:1 A-V con- occur when lidocaine, procainamide, and quinidine are duction with a subsequent increase in the ventricular rate.

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