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It is not justified: few doctors do things that others with similar training could not do as well—or better purchase loratadine 10 mg visa. Confidence based on competence and the ability to understand and cope is quite another matter; it is appreciated by patients and colleagues alike. One applicant was getting near the point when she said at interview, "I like people", then paused and continued, "Well, I don’t like them all, but I find them interesting". Patients can of course sometimes seem extremely demanding, difficult, unreasonable, and even hostile, particularly when you are exhausted. If curing is your main interest better perhaps become a research pharmacologist developing new drugs. Also, bear in mind that the cost of attempting to cure, whether by drugs or by knife, is sometimes to make matters worse. A doctor must accept and honestly admit uncertainty and fallibility, inescapable parts of many occupations but harder to bear in matters of life and death. Experience of illness near at hand, in oneself, friends, or family, may reinforce the desire to become a doctor. Having said that, the day to day detail of good care depends more on nurses than doctors and good career opportunities lie there too. In any event, the emotional impact of illness should be taken together with a broader perspective of the realities of the training and the opportunities and obligations of the career. Dr F J Inglefinger, editor of the New England Journal of Medicine wrote, when seriously ill himself: In medical school, students are told about the perplexity, anxiety and misapprehension that may affect the patient … and in the clinical years the fortunate and sensitive student may learn much from talking to those assigned to his supervision. But the effects of lectures and conversations are ephemeral and are no substitute for actual experience. One might suggest, of course, that only those who have been hospitalised during their adolescent or adult years be admitted to medical school. Such a practice would not only increase the number of empathic doctors; it would also permit the whole elaborate system of medical school admissions to be jettisoned. He had his tongue in his cheek, of course, but he also had his heart in his mouth. Personal experience of the work and life of doctors, first and second hand, preferably in more than one of the different settings of general 6 WHY MEDICINE AND WHY NOT?

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In: Cassel CK buy cheap loratadine 10mg line, Cohen HJ, Larson cholecystectomy in the elderly: a longitudinal analysis of EB, et al. Perianesthetic considerations sion of the extracellular water in elderly patients with for the elderly patient. The first national, validated, clinical prediction rule for delirium after elective noncar- outcome-based, risk adjusted, and peer-controlled diac surgery. Long-term derived growth factors, epidermal growth factor, insulin, postoperative cognitive dysfunction in the elderly: transferrin, and dexamethasone. Effect of age on wound Longitudinal assessment of neurocognitive function after healing in healthy human beings. Scand J Plast Recon- The association of intraoperative factors with the devel- str Surg. Regulation of wound life program: a model of care to prevent cognitive and healing angiogensis—effect of oxygen gradients and functional decline in older hospitalized patients. New York: Springer-Verlag; 2000:850– of normal and ischemic incisional skin wounds. Philadelphia: O2 tension on microbial function of leukocytes and Saunders; 2000:131–144. In: Rosenthal RA, Zenilman ME, predicts the risk of wound infection in surgical patients. Aging alters the impairs anastamotic collagen gene expression and synthe- inflammatory and endothelial cell adhesion profiles during sis: a possible role for nitric oxide. Effects of tissue matrix components, and upregulation of angiogenesis and perfusion and oxygenation on the accumulation of colla- an altered inflammatory response in murine incisional gen in healing wounds. Promotion of wound maintenance of normothermia reduces the incidence of repair in old mice by local injection of macrophages. Rosenthal surement of wound and tissue oxygen tension in post- ples and Practice of Geriatric Surgery. Small-bowel disorders and abdominal wall nutritional supplements postoperatively in malnourished hernia in the elderly patient. In: supplement in pre- and postoperative surgical patients: Rosenthal RA, Zenilman ME, Katlic MR, eds.

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ARR = CER - EER 95% confidence interval (CI) An estimate of the precision of a measurement by determining order loratadine 10mg free shipping, with 95% accuracy, that the measurement includes the "true" value for the population. The broader the CI range, the more uncertain is the true value of the measurement; CIs that cross zero do not reach clinical significance. Experimental event rate (EER) Rate of the outcome in the experimental treatment group. Intention-to-treat (ITT) Results that include every individual originally randomized, regardless of whether or not they completed the trial. Likelihood ratio (LR) Positive LR = probability of an abnormal diagnostic or screening test result (including clinical signs or symptoms) in patients with the disorder of interest compared to the probability of the abnormal result in patients without the disorder (Sn/1 - Sp). Negative LR = probability of a normal diagnostic or screening test result (including clinical signs or symptoms) in patients without the disorder of interest compared to the probability of a normal result in patients with the disorder (Sp/1 - Sn). Negative predictive value The proportion of patients testing negative for the disorder who are actually disease free, of all the patients testing negative. Number needed to treat (NNT) The number of patients who must be treated with this intervention (rather than the control) over a specified time period to prevent one additional bad outcome. NNT = 1/ARR (as a decimal) Number needed to harm (NNH) The number of patients who would need to be treated over a specific time period before one adverse side effect of the treatment will occur. Odds ratio (OR) The odds of an experimental patient suffering an adverse event relative to a control patient. Per protocol analysis Results that do not take into account all persons originally randomized, only those participants who followed the study protocol. Positive predictive value The proportion of patients testing positive for the disorder who actually have the disease, of all the patients testing positive. Relative risk reduction (RRR) Percent reduction in "bad" outcome events in the experimentally treated groups relative to the control groups. RRR = (CER - EER) / CER * 100 Sensitivity (Sn) The proportion of diseased patients actually testing positive for the disorder, of all the diseased patients. SnNout: When a test has a high Sensitivity, a Negative test rules OUT the diagnosis.