Phlegm is a liquid secreted by the mucous membranes of mammals. Its definition is limited to the mucus produced by the respiratory system, excluding that from the nasal passages, that, expelled by coughing. Phlegm is in essence a water-based gel consisting of glycoproteins, immunoglobulins and other substances, its composition varies depending on climate and state of the immune system. Its color can vary from transparent to pale or dark yellow and green, from light to dark brown, to dark grey depending on the constituents. Contrary to popular misconception and misuse and phlegm are not always the same. Mucus is a normal protective layering around the airway, nasal turbinate, urogenital tract. Mucus is an adhesive viscoelastic gel produced in the airway by submucosal glands and goblet cells and is principally water, it contains high-molecular weight mucous glycoproteins that form linear polymers. Phlegm is more related to disease than is mucus and can be troublesome for the individual to excrete from the body.
Phlegm is a juicy secretion in the airway during inflammation. Phlegm contains mucus with virus, other debris, sloughed-off inflammatory cells. Once phlegm has been expectorated by a cough it becomes sputum. There are multiple factors that can contribute to an excess of phlegm in the larynx. Vocal abuse: Vocal abuse is the misuse or overuse of the voice in an unhealthy fashion such as clearing the throat, screaming, talking loudly, or singing incorrectly. Clearing the throat: Clearing the throat removes or loosens phlegm but the vocal cords hit together causing inflammation and therefore more phlegm. Yelling/screaming: Yelling and screaming both cause the vocal cords to hit against each other causing inflammation and phlegm. Nodules: Excessive yelling and incorrect singing as well as other vocal abusive habits can cause vocal nodules. See vocal fold nodule for more information on nodules. Smoking: Smoke is hot, polluted air which dries out the vocal cords. With each breath in of smoke, the larynx is polluted with toxins that inhibit it from rehydrating for about 3 hours.
The vocal cords need a fair amount of lubrication and swell from inflammation when they do not have enough of it. When the vocal folds swell and are inflamed, phlegm is created to attempt to ease the dryness. Experiment on smoking correlations: In 2002, an experiment was done and published by the American College of Chest Physicians to find if there was a correlation of smokers with coughing and phlegm. In the study, 117 participants were studied, a mix of current smokers, ex-smokers, non-smokers, a positive control of participants with a disease, COPD At the end of the experiment, experimenters found that there was a high correlation between phlegm and cough with smoking of 0.49 Illness: During illness like the flu and pneumonia, phlegm becomes more excessive as an attempt to get rid of the bacteria or viral particles within the body. A major illness associated with excess phlegm is acute bronchitis. A major symptom of acute bronchitis is an excess amount of phlegm and is caused by a viral infection, only bacterial infections, which are rare, are to be treated with an antibiotic.
Hay fever, asthma: In hay fever and asthma, inner lining in bronchioles become inflamed and create an excess amount of phlegm that can clog up air pathways. Air pollution: In studies of children, air pollutants have been found to increase phlegm by drying out and irritating parts of the throat. Humourism is an ancient theory that the human body is filled with four basic substances, called the four humours, which are held in balance when a person is healthy, it is related to the ancient theory of the four elements and states that all diseases and disabilities result from an excess or deficit in black bile, yellow bile and blood. Hippocrates, an ancient Greek medical doctor, is credited for this theory, about 400 BC, it influenced medical thinking for more than 2,000 years, until discredited in the 1800s. Phlegm was thought to be associated with apathetic behaviour; this adjective always refers to behaviour, is pronounced differently, giving full weight to the "g": not /ˈflɛmatɪk/ but /flɛgˈmatɪk/.
To have "phlegm" traditionally meant to have stamina and to be unswayed by emotion. Sir William Osler’s 1889 Aequanimitas discusses the imperturbability or calmness in a storm required of physicians. "'Imperturbability means coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril, impassiveness, or, to use an old and expressive word, phlegm." This was his farewell speech at the University of Pennsylvania in 1889 before becoming Physician-in-Chief at the founded Johns Hopkins Hospital in Baltimore, Maryland. This is from "Celebrating the Contributions of William Osler" in the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions." The phlegm of Humourism is far from the same thing as phlegm. Nobel laureate Charles Richet MD, when describing humorism's "phlegm or pituitary secretion" in 1910 asked rhetorically, "this strange liquid, the cause of tumours, of chlorosis, of rheumatism, cacochymia - where is it?
Who will see it? Who has seen it? What can we say of this fanciful classification of humours into four groups, of which two are imaginary?" Phlegm may be a carrier of larvae of intestinal parasites. Bloody sputum can be a symptom of serious disease, but can be a rela
Universal precautions refers to the practice, in medicine, of avoiding contact with patients' bodily fluids, by means of the wearing of nonporous articles such as medical gloves and face shields. The practice was introduced in 1985–88. In 1987, the practice of universal precautions was adjusted by a set of rules known as body substance isolation. In 1996, both practices were replaced by the latest approach known as standard precautions. Use of personal protective equipment is now recommended in all health settings. Under universal precautions all patients were considered to be possible carriers of blood-borne pathogens; the guideline recommended wearing gloves when collecting or handling blood and body fluids contaminated with blood, wearing face shields when there was danger of blood splashing on mucous membranes and disposing of all needles and sharp objects in puncture-resistant containers. Universal precautions were designed for doctors, nurses and health care support workers who were required to come into contact with patients or bodily fluids.
This included staff and others. Pathogens fall into two broad categories and airborne. Universal precautions were practiced in any environment where workers were exposed to bodily fluids, such as: Blood Semen Vaginal secretions Synovial fluid Amniotic fluid Cerebrospinal fluid Pleural fluid Peritoneal fluid Pericardial fluid Feces UrineBodily fluids that did not require such precautions included: Nasal secretions Vomitus Perspiration Sputum SalivaUniversal precautions were the infection control techniques that were recommended following the AIDS outbreak in the 1980s; every patient was treated as if infected and therefore precautions were taken to minimize risk. Universal precautions were good hygiene habits, such as hand washing and the use of gloves and other barriers, correct handling of hypodermic needles and scalpels, aseptic techniques. Protective clothing included but was not limited to: Barrier gowns barrier contraception Gloves mask Eyewear Face shields Additional precautions were used in addition to universal precautions for patients who were known or suspected to have an infectious condition, varied depending on the infection control needed of that patient.
Additional precautions were not needed for blood-borne infections, unless there were complicating factors. Conditions indicating additional precautions: Prion diseases Diseases with air-borne transmission Diseases with droplet transmission Transmission by direct or indirect contact with dried skin or contaminated surfaces or any combination of the above. Research around stigma and discrimination in health-related settings has implicated universal precautions as a means by which health care workers discriminate against patients; the employment of universal precautions when working with people with HIV and/or hepatitis C has been demonstrated to be inconsistent and implicated with feelings of stigmatization reported by those populations. Health-cased social research reveals that by not applying universal precautions universally, as is the purpose, health professionals are instead making judgements based on an individual's health status, it is speculated that this differential approach to care stems from stigma towards HIV and hepatitis C, rooted in fears and misconceptions around transmission and assumptions about patient lifestyle and risk.
Barrier nursing Body substance isolation Viral hemorrhagic fever Hepatitis B Recommendations for Prevention of HIV Transmission in Health-Care Settings
Emergency medical services
Emergency medical services known as ambulance services or paramedic services, are emergency services which treat illnesses and injuries that require an urgent medical response, providing out-of-hospital treatment and transport to definitive care. They may be known as a first aid squad, FAST squad, emergency squad, rescue squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS. In most places, the EMS can be summoned by members of the public via an emergency telephone number which puts them in contact with a control facility, which will dispatch a suitable resource to deal with the situation. Ambulances are the primary vehicles for delivering EMS, though some use cars, aircraft or boats. EMS agencies may operate the non-emergency patient transport service, some have units for technical rescue operations such as extrication, water rescue, search and rescue; as a first resort, the EMS provide treatment on the scene to those in need of urgent medical care.
If it is deemed necessary, they are tasked with transferring the patient to the next point of care. This is most an emergency department of a hospital. Ambulances only transported patients to care, this remains the case in parts of the developing world; the term "emergency medical service" was popularised when these services began to emphasise diagnosis and treatment at the scene. In some countries, a substantial portion of EMS calls do not result in a patient being taken to hospital. Training and qualification levels for members and employees of emergency medical services vary throughout the world. In some systems, members may be present who are qualified only to drive ambulances, with no medical training. In contrast, most systems have personnel who retain at least basic first aid certifications, such as basic life support. In English-speaking countries, they are known as emergency medical technicians and paramedics, with the latter having additional training such as advanced life support skills.
Physicians and nurses provide pre-hospital care to varying degrees in different countries. Emergency care in the field has been rendered in different forms since the beginning of recorded history; the New Testament contains the parable of the Good Samaritan, in which a man, beaten is cared for by a passing Samaritan. Luke 10:34 – "He went to him and bandaged his wounds, pouring on oil and wine, he put the man on his own donkey, took him to an inn and took care of him." During the Middle Ages, the Knights Hospitaller were known for rendering assistance to wounded soldiers in the battlefield. The first use of the ambulance as a specialized vehicle, in battle came about with the ambulances volantes designed by Dominique Jean Larrey, Napoleon Bonaparte's chief surgeon. Larrey was present at the battle of Spires, between the French and Prussians, was distressed by the fact that wounded soldiers were not picked up by the numerous ambulances until after hostilities had ceased, set about developing a new ambulance system.
Having decided against using the Norman system of horse litters, he settled on two- or four-wheeled horse-drawn wagons, which were used to transport fallen soldiers from the battlefield after they had received early treatment in the field. Larrey's projects for'flying ambulances' were first approved by the Committee of Public Safety in 1794. Larrey subsequently entered Napoleon's service during the Italian campaigns in 1796, where his ambulances were used for the first time at Udine and Milan, he adapted his ambulances to the conditions developing a litter which could be carried by a camel for a campaign in Egypt. A major advance was made with the introduction of a transport carriage for cholera patients in London during 1832; the statement on the carriage, as printed in The Times, said "The curative process commences the instant the patient is put in to the carriage. This tenet of ambulances providing instant care, allowing hospitals to be spaced further apart, displays itself in modern emergency medical planning.
The first known hospital-based ambulance service operated out of Commercial Hospital, Ohio by 1865. This was soon followed by other services, notably the New York service provided out of Bellevue Hospital which started in 1869 with ambulances carrying medical equipment, such as splints, a stomach pump and brandy, reflecting contemporary medicine. Another early ambulance service was founded by Jaromir V. Mundy, Count J. N. Wilczek, Eduard Lamezan-Salins in Vienna after the disastrous fire at the Vienna Ringtheater in 1881. Named the "Vienna Voluntary Rescue Society," it served as a model for similar societies worldwide. In June 1887 the St John Ambulance Brigade was established to provide first aid and ambulance services at public events in London, it was modelled on a military-style discipline structure. In the late 19th century, the automobile was being developed, in addition to horse-drawn models, early 20th century ambulances were powered by steam and electricity, reflecting the competing automotive technologies in existence.
However, the first motorized ambulance was brought into service in the last year of the 19th century, with the Michael Reese Hospital, Ch
Health policy can be defined as the "decisions and actions that are undertaken to achieve specific healthcare goals within a society". According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future. There are many categories of health policies, including global health policy, public health policy, mental health policy, health care services policy, insurance policy, personal healthcare policy, pharmaceutical policy, policies related to public health such as vaccination policy, tobacco control policy or breastfeeding promotion policy, they may cover topics of financing and delivery of healthcare, access to care, quality of care, health equity. Health-related policy and its implementation is complex. Conceptual models can help show the flow from health-related policy development to health-related policy and program implementation and to health systems and health outcomes. Policy should be understood as more than a national law or health policy that supports a program or intervention.
Operational policies are the rules, regulations and administrative norms that governments use to translate national laws and policies into programs and services. The policy process encompasses decisions made at a national or decentralized level that affect whether and how services are delivered. Thus, attention must be paid to policies at multiple levels of the health system and over time to ensure sustainable scale-up. A supportive policy environment will facilitate the scale-up of health interventions. There are many topics in the politics and evidence that can influence the decision of a government, private sector business or other group to adopt a specific policy. Evidence-based policy relies on the use of science and rigorous studies such as randomized controlled trials to identify programs and practices capable of improving policy relevant outcomes. Most political debates surround personal health care policies those that seek to reform healthcare delivery, can be categorized as either philosophical or economic.
Philosophical debates center around questions about individual rights and government authority, while economic topics include how to maximize the efficiency of health care delivery and minimize costs. The modern concept of healthcare involves access to medical professionals from various fields as well as medical technology, such as medications and surgical equipment, it involves access to the latest information and evidence from research, including medical research and health services research. In many countries it is left to the individual to gain access to healthcare goods and services by paying for them directly as out-of-pocket expenses, to private sector players in the medical and pharmaceutical industries to develop research. Planning and production of health human resources is distributed among labour market participants. Other countries have an explicit policy to ensure and support access for all of its citizens, to fund health research, to plan for adequate numbers and quality of health workers to meet healthcare goals.
Many governments around the world have established universal health care, which takes the burden of healthcare expenses off of private businesses or individuals through pooling of financial risk. There are a variety of arguments against universal healthcare and related health policies. Healthcare is an important part of health systems and therefore it accounts for one of the largest areas of spending for both governments and individuals all over the world. Many countries and jurisdictions integrate a human rights philosophy in directing their healthcare policies; the World Health Organization reports that every country in the world is party to at least one human rights treaty that addresses health-related rights, including the right to health as well as other rights that relate to conditions necessary for good health. The United Nations' Universal Declaration of Human Rights asserts that medical care is a right of all people: UDHR Article 25: "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing and medical care and necessary social services, the right to security in the event of unemployment, disability, old age or other lack of livelihood in circumstances beyond his control."In some jurisdictions and among different faith-based organizations, health policies are influenced by the perceived obligation shaped by religious beliefs to care for those in less favorable circumstances, including the sick.
Other jurisdictions and non-governmental organizations draw on the principles of humanism in defining their health policies, asserting the same perceived obligation and enshrined right to health. In recent years, the worldwide human rights organization Amnesty International has focused on health as a human right, addressing inadequate access to HIV drugs and women's sexual and reproductive rights including wide disparities in maternal mortality within and across countries; such increasing attention to health as a basic human right has been welcomed by the leading medical journal The Lancet. There remains considerable controversy regarding policies on who would be paying the costs of medical care for all people and under what circumstances. For example, government spending on healthcare is sometimes used as a global indicator of a government's commitment to the health of its people. On the other hand, one school of thought emerging from the United States rejects the notion of health care financing through taxpayer funding as incompatible with the
A medical device is any device intended to be used for medical purposes. Thus what differentiates. Medical devices benefit patients by helping health care providers diagnose and treat patients and helping patients overcome sickness or disease, improving their quality of life. Significant potential for hazards are inherent when using a device for medical purposes and thus medical devices must be proved safe and effective with reasonable assurance before regulating governments allow marketing of the device in their country; as a general rule, as the associated risk of the device increases the amount of testing required to establish safety and efficacy increases. Further, as associated risk increases the potential benefit to the patient must increase. Discovery of what would be considered a medical device by modern standards dates as far back as c. 7000 BC in Baluchistan where Neolithic dentists used flint-tipped drills and bowstrings. Study of archeology and Roman medical literature indicate that many types of medical devices were in widespread use during the time of ancient Rome.
In the United States it wasn't until the Federal Food and Cosmetic Act in 1938 that medical devices were regulated. In 1976, the Medical Device Amendments to the FD&C Act established medical device regulation and oversight as we know it today in the United States. Medical device regulation in Europe as we know it today came into effect in the 1993 by what is collectively known as the Medical Device Directive. On May 26th, 2017 the Medical Device Regulation replaced the MDD. Medical devices vary in both indications for use. Examples range from simple, low-risk devices such as tongue depressors, medical thermometers, disposable gloves, bedpans to complex, high-risk devices that are implanted and sustain life. One example of high-risk devices are those with Embedded software such as pacemakers, which assist in the conduct of medical testing and prostheses. Items as intricate as housings for cochlear implants are manufactured through the deep drawn and shallow drawn manufacturing processes; the design of medical devices constitutes a major segment of the field of biomedical engineering.
The global medical device market reached $209 billion USD in 2006 and was estimated to be between $220 and $250 billion USD in 2013. The United States controls ~40% of the global market followed by Europe and the rest of the world. Although collectively Europe has a larger share, Japan has the second largest country market share; the largest market shares in Europe belong to Germany, Italy and the United Kingdom. The rest of the world comprises regions like Australia, China and Iran; this article discusses what constitutes a medical device in these different regions and throughout the article these regions will be discussed in order of their global market share. A global definition for medical device is difficult to establish because there are numerous regulatory bodies worldwide overseeing the marketing of medical devices. Although these bodies collaborate and discuss the definition in general, there are subtle differences in wording that prevent a global harmonization of the definition of a medical device, thus the appropriate definition of a medical device depends on the region.
A portion of the definition of a medical device is intended to differentiate between medical devices and drugs, as the regulatory requirements of the two are different. Definitions often recognize In vitro diagnostics as a subclass of medical devices and establish accessories as medical devices. Section 201 of the Federal Food Drug & Cosmetic Act defines a device as an "instrument, implement, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is: recognized in the official National Formulary, or the United States Pharmacopoeia, or any supplement to them Intended for use in the diagnosis of disease or other conditions, or in the cure, treatment, or prevention of disease, in man or other animals, or Intended to affect the structure or any function of the body of man or other animals, andwhich does not achieve its primary intended purposes through chemical action within or on the body of man or other animals and, not dependent upon being metabolized for the achievement of its primary intended purposes.
The term'device' does not include software functions excluded pursuant to section 520." According to Article 1 of Council Directive 93/42/EEC, ‘medical device’ means any "instrument, appliance, material or other article, whether used alone or in combination, including the software intended by its manufacturer to be used for diagnostic and/or therapeutic purposes and necessary for its proper application, intended by the manufacturer to be used for human beings for the purpose of: diagnosis, monitoring, treatment or alleviation of disease, monitoring, alleviation of or compensation for an injury or handicap, replacement or modification of the anatomy or of a physiological process, control of conception,and which does not achieve its principal intended action in or on the human body by pharmacological, immunological or metabolic means, but which may be assisted in its function by such means. The New Approach, defined in a European Council Resolution of May 1985, represents an innovative way of technical harmonisation.
It aims to remo
Philosophy of healthcare
The philosophy of healthcare is the study of the ethics and people which constitute the maintenance of health for human beings. For the most part, the philosophy of healthcare is best approached as an indelible component of human social structures; that is, the societal institution of healthcare can be seen as a necessary phenomenon of human civilization whereby an individual continually seeks to improve and alter the overall nature and quality of their life. This perennial concern is prominent in modern political liberalism, wherein health has been understood as the foundational good necessary for public life; the philosophy of healthcare is concerned with the following elemental questions: Who requires and/or deserves healthcare? Is healthcare a fundamental right of all people? What should be the basis for calculating the cost of treatments, hospital stays, etc.? How can healthcare best be administered to the greatest number of people? What are the necessary parameters for clinical trials and quality assurance?
Who, if anybody, can decide when a patient is in need of "comfort measures"? However, the most important question of all is'what is health?'. Unless this question is addressed any debate about healthcare will be vague and unbounded. For example, what is a health care intervention? What differentiates healthcare from engineering or teaching, for example? Is health care about'creating autonomy' or acting in people's best interests? Or is it always both? A'philosophy' of anything requires baseline philosophical questions, as asked, for example, by philosopher David Seedhouse; the purpose and meaning of healthcare philosophy is to consolidate the abundance of information regarding the ever-changing fields of biotechnology and nursing. And seeing that healthcare ranks as one of the largest spending areas of governmental budgets, it becomes important to gain a greater understanding of healthcare as not only a social institution, but as a political one. In addition, healthcare philosophy attempts to highlight the primary movers of healthcare systems.
The ethical and/or moral premises of healthcare are intricate. To consolidate such a large segment of moral philosophy, it becomes important to focus on what separates healthcare ethics from other forms of morality, and on the whole, it can be said that healthcare. With that said, healthcare ought to "be treated differently from other social goods" in a society, it is an institution. At some point in every person's life, a decision has to be made regarding one's healthcare. Can they afford it? Do they deserve it? Do they need it? Where should they go to get it? Do they want it? And it is this last question. After weighing all of the costs and benefits of her healthcare situation, the person has to decide if the costs of healthcare outweigh the benefits. More than basic economic issues are at stake in this conundrum. In fact, a person must decide whether or not their life if it is worth salvaging. Of course, in instances where the patient is unable to decide due to medical complications, like a coma the decision must come from elsewhere.
And defining that "elsewhere" has proven to be a difficult endeavor in healthcare philosophy. Whereas bioethics tends to deal with more broadly-based issues like the consecrated nature of the human body and the roles of science and technology in healthcare, medical ethics is focused on applying ethical principles to the field of medicine. Medical ethics has its roots in the writings of Hippocrates, the practice of medicine was used as an example in ethical discussions by Plato and Aristotle; as a systematic field, however, it is a large and new area of study in ethics. One of the major premises of medical ethics surrounds "the development of valuational measures of outcomes of health care treatments and programs. Terms like beneficence and non-maleficence are vital to the overall understanding of medical ethics. Therefore, it becomes important to acquire a basic grasp of the varying dynamics that go into a doctor-patient relationship. Like medical ethics, nursing ethics is narrow in its focus when compared to the expansive field of bioethics.
For the most part, "nursing ethics can be defined as having a two-pronged meaning," whereby it is "the examination of all kinds of ethical and bioethical issues from the perspective of nursing theory and practice." This definition, although quite vague, centers on the practical and theoretical approaches to nursing. The American Nurses Association endorses an ethical code that emphasizes "values" and "evaluative judgments" in all areas of the nursing profession; the importance of values is being recognized in all aspects of healthcare and health research. And since moral issues are prevalent throughout nursing, it is important to be able to recognize and critically respond to situations that warrant and/or necessitate an ethical decision. Balancing the cost of care with the q