The Departmental Chair also receives a copy of all evaluations and uses them for annual faculty review order cheap reminyl line medicine while pregnant. An announcement is made to all faculty members that program improvement suggestions are welcomed order reminyl toronto medications list template. Recommendations from the residents meeting are then taken to the Resident Education Committee. Pathology Resident Manual Page 24 • Ad Hoc Projects and Task Forces – Depending upon need, ad hoc task forces or subcommittees are formed to address specific program improvement questions. The annual review examines and summarizes any needs for improvement in program quality, resident performance, faculty development, or graduate performance. Residents being evaluated will receive an email notification when an evaluation has been completed. Residents are also evaluated by technologists, pathology assistants and autopsy assistants. In addition to rotation evaluations, information from other sources will be considered. These include attendance records for required academic sessions, results of written examinations, and informal reports. Residents are reviewed as to performance by the Residency Director at least twice yearly. Please refer to the Housestaff Policies and Procedure Manual for details of the recommended institutional guidelines pertaining to progress and promotions. A poor grade or unsatisfactory rotation evaluation will result in formal counseling, which may include development of a remediation plan, repetition of the rotation or probation. Very specific guidelines from the School of Medicine govern remediation, probation, and due process/grievance procedures pertaining to any such actions. Please refer to the appropriate section in the Housestaff Policy and Procedure Manual for details. Whenever the Residency Director is informed of significant concern regarding a resident’s performance, the resident involved will be contacted and given the opportunity to provide a response. The resident may provide this response by any or all of the following: in the form of a written document, through verbal communication with the residency director, or by personal appearance before the departmental Residency Review Committee. Questions of capricious, arbitrary, punitive or retaliatory actions or interpretations of the policies governing graduate medical education on the part of any faculty member or officer of the Pathology Residency Program are subject to the grievance process. Complaints of illegal discrimination, including failure to provide reasonable accommodations and sexual harassment, are processed in accordance with the Medical Center policies and procedures that are administered through the Equal Opportunity Office. Should a house officer in the Department of Pathology have a grievance or be dissatisfied with any aspect of the program, he/she is encouraged to initially discuss the issue with his/her attending or the Chief Residents. If this is felt by the resident to be inappropriate or the issue is not satisfactorily resolved, timely discussion with the Program Director is highly recommended. Documentation of the issues and a statement of dissatisfaction by the aggrieved resident may be helpful, and is also encouraged, particularly when making an appeal to the Department’s Resident Education Committee. In general, the resident will first discuss any grievance with the Chief Residents. If this fails to provide adequate closure to the grievance, then he/she is directed to speak with one of the Program Director. Issues can best be resolved at this stage and every effort should be made to achieve a mutually agreeable solution. If the grievance is not resolved to the satisfaction of the resident after discussion with the Program Director, the resident has the option to present the grievance, in writing, to the Office of Graduate Medical Education. In situations where the grievance relates to the Chair or Program Director, or where the resident believes that a fair resolution cannot be attained by presenting the grievance to those individuals, he/she may present the grievance in writing directly to the Office of Graduate Medical Education. The Associate Dean for Graduate Medical Education will meet with the resident, the Program Director, the Chair and one or more of the program’s Chief Residents to determine the cause and validity of the complaint and to determine the means of redress. Should the meeting with the Associate Dean fail to resolve the grievance to the satisfaction of the resident, the resident may request that he/she be heard by the Executive Dean. Any action(s) taken in good faith by the Executive Dean addressing the grievance will be final. An appropriate ratio of education to service is ensured by providing a blend of supervised patient care responsibilities, clinical teaching, and didactic education. The Program provides an educational and working environment in which residents may address concerns in a confidential and protected manner. Residents are integrated and actively participate in interdisciplinary clinical quality improvement and patient safety programs. Appropriate educational resources are provided including medical information access, faculty supervision, and a wide variety and volume of both anatomic and clinical pathology cases. Graded and progressive clinical responsibility within the supportive educational environment assures resident development of sufficient competence to enter practice without direct supervision upon completion of the program. Therefore, the use of protective equipment to prevent parenteral, mucous membrane and non-intact skin exposures to a healthcare provider is recommended; iii. Such opportunities include, but are not limited to, confidential discussion with the chief residents, program director, program chair, core program director, and/or core program chair. Other intradepartmental avenues to confidentially discuss any resident concern or issue occur during the Annual Program Evaluations completed by each resident and/or through discussion with the resident representative during the required Annual Program Review (Annual Program Outcomes Assessment and Action Plan Report); ii. E*Value “On-The-Fly” praise and concern comments can be sent through E*Value directly and confidentially to those program directors that offer this service. All procedures performed in autopsy, surgical pathology and clinical laboratory medicine are performed under either direct or indirect supervision of an attending faculty member. Resident responsibilities and progression of responsibility is described in each rotation description. More Pathology Resident Manual Page 29 advanced residents are given increased responsibility which will include more time on each procedure or task being indirectly supervised (immediate availability) by the faculty member. Supervision of Residents • In the clinical learning environment, each patient must have an identifiable, appropriately- credentialed and privileged attending physician (or licensed independent practitioner as approved by each Review Committee) who is ultimately responsible for that patient’s care. Pathology Resident Manual Page 30 • Indirect Supervision B (with direct supervision available): o This means the supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision. The ultimate responsibility for a patient’s care, however, lies with the attending physician, and cannot belong to a pathology assistant. This must include the opportunity to work as a member of effective inter- professional teams that are appropriate to the delivery of care in the specialty. Intermediate residents and residents in the final years of education may stay on duty or return to the hospital to perform intra-operative consultations, apheresis, emergent autopsies (e. Likewise, on call residents and faculty are posted online and distributed to all residents and faculty each month. Informing patient of resident role: When residents have direct contact with patients (e.
These substances are often classiﬁed as phytoestrogens buy cheap reminyl 4 mg treatment 32 for bad breath, which bind to estrogen receptor sites buy reminyl paypal medicine 911. However, other factors beyond isoﬂavones appear to contribute to soy’s anticancer properties. Researchers at the University of Illinois tested the effects of puriﬁed isoﬂavones against soy protein mixes with and without isoﬂavones in female rats. Although all the compounds studied reduced the incidence of mammary gland tumors, the soy protein mix without isoﬂavones was the most effective in decreasing the number of tumors. Lower levels of estrogen have been associated with a decreased risk of breast cancer. This prevents tumors from obtaining the increased blood supply necessary for their continued growth. Population studies have offered clear evidence that soy offers some protection against breast cancer. Women in Asian countries, such as China and Japan, who traditionally consume more soy products than most women in Western countries, have a lower risk of breast cancer. There are also a growing number of clinical and experimental studies offering support for the contention that soy consumption reduces the risk for breast cancer. When healthy women add soy products to their diets, the change leads to lower levels of estrogen and other hormones in their bodies. Animal studies appear to show that intake of soy before adulthood enhances the maturation (differentiation) of breast cells. Population-based studies seem to support the importance of intake during adolescence. Soy eaten after adolescence appears to have a more signiﬁcant protective effect against premenopausal breast cancer compared with postmenopausal breast cancer. The amount necessary to protect against the development of breast cancer is thought to be 25–100 mg of isoﬂavones per day. We strongly recommend getting this amount from food rather than taking a dietary supplement containing puriﬁed isoﬂavones. As the table below shows, you do not need to consume huge amounts of soy foods to get the recommended levels. Vegetables in the Brassica Family Vegetables in the brassica family, such as broccoli, cauliﬂower, cabbage, and kale, contain anticancer phytochemicals known as glucosinolates. The chief glucosinolate is indole-3-carbinol (I3C), a compound formed whenever cruciferous vegetables are crushed, chewed, or cut. In test tube and animal studies, genistein has been shown to inhibit breast cancer cells that do not have estrogen receptors, but in certain situations it may actually encourage growth of breast cancer cells with estrogen receptors. Exactly how all of this research in test tubes relates to human consumption is not clear, but given the potential for harm, we recommend that until this issue is clariﬁed, women with a history of estrogen-receptor-positive breast cancer should restrict soy intake and definitely avoid soy isoflavone supplements. Soy consumption is also contraindicated for women who are taking the anticancer drug tamoxifen. In test tube studies, when isolated human breast cells are exposed to both genistein and tamoxifen at the same time, genistein can stimulate cell growth and override the growth-inhibition effect of tamoxifen. Until researchers show us what happens when tamoxifen, genistein, and naturally occurring estrogen are all together at the same time in the human body, it is prudent to restrict soy intake while on tamoxifen. Speciﬁcally, the body can break down estrogen into either 16-alpha-hydroxyestrone, a compound that promotes the growth of breast tumors; or 2-hydroxyestrone, which does not stimulate breast cancer cells. Broccoli sprouts have been reported to have the highest levels of these compounds, with 1 lb of broccoli sprouts being equivalent to 40 lbs of fresh broccoli. Glucuronidase One of the key ways in which the body gets rid of estrogen is by attaching glucuronic acid to estrogen in the liver and then excreting this complex in the bile. Glucuronidase is a bacterial enzyme that breaks the bond between estrogen and glucuronic acid, leading to less excretion of estrogen. Thus it is not surprising that excessive glucuronidase activity is associated with an increased cancer risk, particularly for estrogen-dependent breast cancer. The activity of this enzyme is increased when the diet is high in fat and low in ﬁber. The level of glucuronidase activity may be one of the factors explaining why certain dietary factors cause breast cancer and why other dietary factors are preventive. The activity of glucuronidase can be reduced by making sure you have a good balance of health- promoting intestinal bacteria. Eat a diet high in plant foods and supplement it with the “friendly” bacteria Lactobacillus acidophilus and Biﬁdobacterium biﬁdum. Another dietary factor that can dramatically reduce the activity of this enzyme is the consumption of onion, garlic, and foods high in glucaric acid such as apples, brussels sprouts, broccoli, cabbage, and lettuce. Anderson Cancer Center, Memorial Sloan-Kettering Cancer Center, and other major cancer centers have conducted preliminary research with calcium D-glucarate in the prevention and treatment of breast cancer, and the results have been quite encouraging. The explanation given for this link is that exposure to artiﬁcial light at night appears to suppress the normal nighttime production of melatonin, a hormone secreted by the pineal gland (a small pea- sized gland at the base of the brain). Melatonin is critically involved in regulating the natural biorhythm of hormone secretion, and it has signiﬁcant anticancer effects, especially against breast cancer. To offset the increased risk of breast cancer that comes with night shift work, we recommend taking 3 mg melatonin at bedtime for night shift workers (regardless of when that bedtime might be). Green Tea Population studies have shown that increasing green tea (Camellia sinensis) consumption reduces the risk of breast cancer. For example, studies have suggested that breast cancer rates are lower in Japan in part because, per day, people there typically drink about three cups of green tea, which provide roughly 240 to 320 mg polyphenols, substances that have an anticancer effect. To achieve the same degree of protection from supplements containing green tea extract, standardized for 80% total polyphenol content, takes 300 to 400 mg per day. Lifestyle • Follow the recommendations in the chapter “A Health-Promoting Lifestyle. Both acute bronchitis and pneumonia are characterized by the development of a cough with or without the production of mucus. Acute bronchitis often occurs during the course of an acute viral illness such as the common cold or influenza. Although pneumonia may occur in healthy individuals, it is usually seen in those who are immune- compromised, particularly drug and alcohol abusers, individuals with chronic lung diseases, and those on chemotherapy and other drugs that suppress the immune system. Hospital-acquired pneumonia is also a serious problem and carries with it a high mortality rate. Acute pneumonia is still the seventh- leading cause of death in the United States. In individuals who are not taking drugs to suppress their immune system or who are suffering from diseases associated with impaired immunity, pneumonia most often follows a viral infection (especially inﬂuenza) or an insult to the host defense mechanisms: cigarette smoke and other noxious fumes, impairment of consciousness (which depresses the gag reﬂex, allowing aspiration), cancer, or hospitalization (being hospitalized for any purpose increases the risk of developing pneumonia). A chest X-ray clears up the diagnosis, but an X-ray should not be done every time someone has a cough. In patients with an acute cough, the following ﬁndings suggest the need for a chest X-ray: (1) heart rate greater than 100 beats per minute, (2) respiratory rate greater than 24 breaths per minute, (3) body temperature above 100. Typically when a person has pneumonia there are characteristic chest sounds: • Rales (a bubbling or crackling sound) heard on one side of the chest or while the patient is lying down • Rhonchi (abnormal rumblings indicating the presence of thick fluid). Viral Pneumonia Viral pneumonia is most often caused by adenovirus, inﬂuenza virus, parainﬂuenza virus, or respiratory syncytial virus. Viral pneumonia is responsible for about 30% of cases of pneumonia and will often develop as a complication of an upper respiratory infection caused by one of the viruses.
G. Ur-Gosh. Mercy College of Health Sciences.