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  1. Veterinary pharmacy Veterinary pharmacies, sometimes called animal pharmacies, may fall in the category of hospital pharmacy, retail pharmacy or mail-order pharmacy. Veterinary pharmacies stock different varieties and different strengths of medications to fulfill the pharmaceutical needs of animals. Because the needs of animals, as well as the regulations on veterinary medicine, are often very different from those related to people, veterinary pharmacy is often kept separate from regular pharmacies. Nuclear pharmacy Nuclear pharmacy focuses on preparing radioactive materials for diagnostic tests and for treating certain diseases. Nuclear pharmacists undergo additional training specific to handling radioactive materials, and unlike in community and hospital pharmacies, nuclear pharmacists typically do not interact directly with patients. Military pharmacy Military pharmacy is an entirely different working environment due to the fact that technicians perform most duties that in a civilian sector would be illegal. State laws of Technician patient counseling and medication checking by a pharmacist do not apply. Pharmacy informatics Pharmacy informatics is the combination of pharmacy practice science and applied information science. Pharmacy informaticists work in many practice areas of pharmacy, however, they may also work in information technology departments or for healthcare information technology vendor companies. As a practice area and specialist domain, pharmacy informatics is growing quickly to meet the needs of major national and international patient information projects and health system interoperability goals. Pharmacists in this area are trained to participate in medication management system development, deployment and optimization. Specialty pharmacy Specialty pharmacies supply high cost injectable, oral, infused, or inhaled medications that are used for chronic and complex disease states such as cancer, hepatitis, and rheumatoid arthritis. Unlike a traditional community pharmacy where prescriptions for any common medication can be brought in and filled, specialty pharmacies carry novel medications that need to be properly stored, administered, carefully monitored, and clinically managed. In addition to supplying these drugs, specialty pharmacies also provide lab monitoring, adherence counseling, and assist patients with cost-containment strategies needed to obtain their expensive specialty drugs. It is currently the fastest growing sector of the pharmaceutical industry with 19 of 28 newly FDA approved medications in 2013 being specialty drugs. Due to the demand for clinicians who can properly manage these specific patient populations, the Specialty Pharmacy Certification Board has developed a new certification exam to certify specialty pharmacists. Along with the 100 question computerized multiple-choice exam, pharmacists must also complete 3,000 hours of specialty pharmacy practice within the past three years as well as 30 hours of specialty pharmacist continuing education within the past two years.
  2. Internet pharmacy Since about the year 2000, a growing number of Internet pharmacies have been established worldwide. Many of these pharmacies are similar to community pharmacies, and in fact, many of them are actually operated by brick-and-mortar community pharmacies that serve consumers online and those that walk in their door. The primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient and private method rather than traveling to a community drugstore where another customer might overhear about the drugs that they take. Internet pharmacies (also known as online pharmacies) are also recommended to some patients by their physicians if they are homebound. While most Internet pharmacies sell prescription drugs and require a valid prescription, some Internet pharmacies sell prescription drugs without requiring a prescription. Many customers order drugs from such pharmacies to avoid the "inconvenience" of visiting a doctor or to obtain medications which their doctors were unwilling to prescribe. However, this practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and an individual's overall suitability for use of a medication. There also have been reports of such pharmacies dispensing substandard products. Of particular concern with Internet pharmacies is the ease with which people, youth in particular, can obtain controlled substances (e.g., Vicodin, generically known as hydrocodone) via the Internet without a prescription issued by a doctor/practitioner who has an established doctor-patient relationship. There are many instances where a practitioner issues a prescription, brokered by an Internet server, for a controlled substance to a "patient" s/he has never met. In the United States, in order for a prescription for a controlled substance to be valid, it must be issued for a legitimate medical purpose by a licensed practitioner acting in the course of legitimate doctor-patient relationship. The filling pharmacy has a corresponding responsibility to ensure that the prescription is valid. Often, individual state laws outline what defines a valid patient-doctor relationship. Canada is home to dozens of licensed Internet pharmacies, many of which sell their lower-cost prescription drugs to U.S. consumers, who pay one of the world's highest drug prices. In recent years, many consumers in the US and in other countries with high drug costs, have turned to licensed Internet pharmacies in India, Israel and the UK, which often have even lower prices than in Canada. In the United States, there has been a push to legalize importation of medications from Canada and other countries, in order to reduce consumer costs. While in most cases importation of prescription medications violates Food and Drug Administration (FDA) regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers. There is no known case of any U.S. citizens buying Canadian drugs for personal use with a prescription, who has ever been charged by authorities.
  3. Ambulatory care pharmacy Since the emergence of modern clinical pharmacy, ambulatory care pharmacy practice has emerged as a unique pharmacy practice setting. Ambulatory care pharmacy is based primarily on pharmacotherapy services that a pharmacist provides in a clinic. Pharmacists in this setting often do not dispense drugs, but rather see patients in office visits to manage chronic disease states. In the U.S. federal health care system (including the VA, the Indian Health Service, and NIH) ambulatory care pharmacists are given full independent prescribing authority. In some states such North Carolina and New Mexico these pharmacist clinicians are given collaborative prescriptive and diagnostic authority. In 2011 the board of Pharmaceutical Specialties approved ambulatory care pharmacy practice as a separate board certification. The official designation for pharmacists who pass the ambulatory care pharmacy specialty certification exam will be Board Certified Ambulatory Care Pharmacist and these pharmacists will carry the initials BCACP. Compounding pharmacy Compounding is the practice of preparing drugs in new forms. For example, if a drug manufacturer only provides a drug as a tablet, a compounding pharmacist might make a medicated lollipop that contains the drug. Patients who have difficulty swallowing the tablet may prefer to suck the medicated lollipop instead. Another form of compounding is by mixing different strengths (g, mg, mcg) of capsules or tablets to yield the desired amount of medication indicated by the physician, physician assistant, Nurse Practitioner, or clinical pharmacist practitioner. This form of compounding is found at community or hospital pharmacies or in-home administration therapy. Compounding pharmacies specialize in compounding, although many also dispense the same non-compounded drugs that patients can obtain from community pharmacies. Consultant pharmacy Consultant pharmacy practice focuses more on medication regimen review (i.e. "cognitive services") than on actual dispensing of drugs. Consultant pharmacists most typically work in nursing homes, but are increasingly branching into other institutions and non-institutional settings. Traditionally consultant pharmacists were usually independent business owners, though in the United States many now work for several large pharmacy management companies (primarily Omnicare, Kindred Healthcare and PharMerica). This trend may be gradually reversing as consultant pharmacists begin to work directly with patients, primarily because many elderly people are now taking numerous medications but continue to live outside of institutional settings. Some community pharmacies employ consultant pharmacists and/or provide consulting services. The main principle of consultant pharmacy is developed by Hepler and Strand in 1990
  4. Practice areas Pharmacists practice in a variety of areas including community pharmacies, hospitals, clinics, extended care facilities, psychiatric hospitals, and regulatory agencies. Pharmacists themselves may have expertise in a medical specialty. Community pharmacy A pharmacy (commonly the chemist in Australia, New Zealand and the UK; or drugstore in North America; retail pharmacy in industry terminology; or Apothecary, historically) is the place where most pharmacists practice the profession of pharmacy. It is the community pharmacy where the dichotomy of the profession exists—health professionals who are also retailers. Community pharmacies usually consist of a retail storefront with a dispensary where medications are stored and dispensed. According to Sharif Kaf al-Ghazal, the opening of the first drugstores are recorded by Muslim pharmacists in Baghdad in 754. In most countries, the dispensary is subject to pharmacy legislation; with requirements for storage conditions, compulsory texts, equipment, etc., specified in legislation. Where it was once the case that pharmacists stayed within the dispensary compounding/dispensing medications, there has been an increasing trend towards the use of trained pharmacy technicians while the pharmacist spends more time communicating with patients. Pharmacy technicians are now more dependent upon automation to assist them in their new role dealing with patients' prescriptions and patient safety issues. Pharmacies are typically required to have a pharmacist on-duty at all times when open. It is also often a requirement that the owner of a pharmacy must be a registered pharmacist, although this is not the case in all jurisdictions, such that many retailers (including supermarkets and mass merchandisers) now include a pharmacy as a department of their store. Likewise, many pharmacies are now rather grocery store-like in their design. In addition to medicines and prescriptions, many now sell a diverse arrangement of additional items such as cosmetics, shampoo, office supplies, confections, snack foods, durable medical equipment, greeting cards, and provide photo processing services. Hospital pharmacy Pharmacies within hospitals differ considerably from community pharmacies. Some pharmacists in hospital pharmacies may have more complex clinical medication management issues whereas pharmacists in community pharmacies often have more complex business and customer relations issues. Because of the complexity of medications including specific indications, effectiveness of treatment regimens, safety of medications (i.e., drug interactions) and patient compliance issues (in the hospital and at home) many pharmacists practicing in hospitals gain more education and training after pharmacy school through a pharmacy practice residency and sometimes followed by another residency in a specific area. Those pharmacists are often referred to as clinical pharmacists and they often specialize in various disciplines of pharmacy. For example, there are pharmacists who specialize in hematology/oncology, HIV/AIDS, infectious disease, critical care, emergency medicine, toxicology, nuclear pharmacy, pain management, psychiatry, anti-coagulation clinics, herbal medicine, neurology/epilepsy management, pediatrics, neonatal pharmacists and more. Hospital pharmacies can often be found within the premises of the hospital. Hospital pharmacies usually stock a larger range of medications, including more specialized medications, than would be feasible in the community setting. Most hospital medications are unit-dose, or a single dose of medicine. Hospital pharmacists and trained pharmacy technicians compound sterile products for patients including total parenteral nutrition (TPN), and other medications given intravenously. This is a complex process that requires adequate training of personnel, quality assurance of products, and adequate facilities. Several hospital pharmacies have decided to outsource high risk preparations and some other compounding functions to companies who specialize in compounding. The high cost of medications and drug-related technology, combined with the potential impact of medications and pharmacy services on patient-care outcomes and patient safety, make it imperative that hospital pharmacies perform at the highest level possible. Clinical pharmacy Pharmacists provide direct patient care services that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings, but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often collaborate with physicians and other healthcare professionals to improve pharmaceutical care. Clinical pharmacists are now an integral part of the interdisciplinary approach to patient care. They often participate in patient care rounds for drug product selection. The clinical pharmacist's role involves creating a comprehensive drug therapy plan for patient-specific problems, identifying goals of therapy, and reviewing all prescribed medications prior to dispensing and administration to the patient. The review process often involves an evaluation of the appropriateness of the drug therapy (e.g., drug choice, dose, route, frequency, and duration of therapy) and its efficacy. The pharmacist must also monitor for potential drug interactions, adverse drug reactions, and assess patient drug allergies while designing and initiating a drug therapy plan.
  5. The earliest known compilation of medicinal substances was the Sushruta Samhita, an Indian Ayurvedic treatise attributed to Sushruta in the 6th century BC. However, the earliest text as preserved dates to the 3rd or 4th century AD. Many Sumerian (late 6th millennium BC – early 2nd millennium BC) cuneiform clay tablets record prescriptions for medicine. Ancient Egyptian pharmacological knowledge was recorded in various papyri such as the Ebers Papyrus of 1550 BC, and the Edwin Smith Papyrus of the 16th century BC. In Ancient Greece, Diocles of Carystus (4th century BC) was one of several men studying the medicinal properties of plants. He wrote several treatises on the topic. The Greek physician Pedanius Dioscorides is famous for writing a five volume book in his native Greek Περί ύλης ιατρικής in the 1st century AD. The Latin translation De Materia Medica (Concerning medical substances) was used a basis for many medieval texts, and was built upon by many middle eastern scientists during the Islamic Golden Age. Pharmacy in China dates at least to the earliest known Chinese manual, the Shennong Bencao Jing (The Divine Farmer's Herb-Root Classic), dating back to the 1st century AD. It was compiled during the Han dynasty and was attributed to the mythical Shennong. Earlier literature included lists of prescriptions for specific ailments, exemplified by a manuscript "Recipes for 52 Ailments", found in the Mawangdui, sealed in 168 BC. In Japan, at the end of the Asuka period (538–710) and the early Nara period (710–794), the men who fulfilled roles similar to those of modern pharmacists were highly respected. The place of pharmacists in society was expressly defined in the Taihō Code (701) and re-stated in the Yōrō Code (718). Ranked positions in the pre-Heian Imperial court were established; and this organizational structure remained largely intact until the Meiji Restoration (1868). In this highly stable hierarchy, the pharmacists—and even pharmacist assistants—were assigned status superior to all others in health-related fields such as physicians and acupuncturists. In the Imperial household, the pharmacist was even ranked above the two personal physicians of the Emperor. There is a stone sign for a pharmacy with a tripod, a mortar, and a pestle opposite one for a doctor in the Arcadian Way in Ephesus near Kusadasi in Turkey. The current Ephesus dates back to 400 BC and was the site of the Temple of Artemis, one of the seven wonders of the world. In Baghdad the first pharmacies, or drug stores, were established in 754, under the Abbasid Caliphate during the Islamic Golden Age. By the 9th century, these pharmacies were state-regulated. The advances made in the Middle East in botany and chemistry led medicine in medieval Islam substantially to develop pharmacology. Muhammad ibn Zakarīya Rāzi (Rhazes) (865–915), for instance, acted to promote the medical uses of chemical compounds. Abu al-Qasim al-Zahrawi (Abulcasis) (936–1013) pioneered the preparation of medicines by sublimation and distillation. His Liber servitoris is of particular interest, as it provides the reader with recipes and explains how to prepare the `simples’ from which were compounded the complex drugs then generally used. Sabur Ibn Sahl (d 869), was, however, the first physician to initiate pharmacopoedia, describing a large variety of drugs and remedies for ailments. Al-Biruni (973–1050) wrote one of the most valuable Islamic works on pharmacology, entitled Kitab al-Saydalah (The Book of Drugs), in which he detailed the properties of drugs and outlined the role of pharmacy and the functions and duties of the pharmacist. Avicenna, too, described no less than 700 preparations, their properties, modes of action, and their indications. He devoted in fact a whole volume to simple drugs in The Canon of Medicine. Of great impact were also the works by al-Maridini of Baghdad and Cairo, and Ibn al-Wafid (1008–1074), both of which were printed in Latin more than fifty times, appearing as De Medicinis universalibus et particularibus by 'Mesue' the younger, and the Medicamentis simplicibus by 'Abenguefit'. Peter of Abano (1250–1316) translated and added a supplement to the work of al-Maridini under the title De Veneris. Al-Muwaffaq’s contributions in the field are also pioneering. Living in the 10th century, he wrote The foundations of the true properties of Remedies, amongst others describing arsenious oxide, and being acquainted with silicic acid. He made clear distinction between sodium carbonate and potassium carbonate, and drew attention to the poisonous nature of copper compounds, especially copper vitriol, and also lead compounds. He also describes the distillation of sea-water for drinking. In Europe pharmacy-like shops began to appear during the 12th century. In 1240 emperor Frederic II issued a decree by which the physician's and the apothecary's professions were separated. "The first pharmacy in Europe (still working) was opened in 1241 in Trier, Germany." In Europe there are old pharmacies still operating in Dubrovnik, Croatia, located inside the Franciscan monastery, opened in 1317; and in the Town Hall Square of Tallinn, Estonia, dating from at least 1422. The oldest is claimed to have been set up in 1221 in the Church of Santa Maria Novella in Florence, Italy, which now houses a perfume museum. The medieval Esteve Pharmacy, located in Llívia, a Catalan enclave close to Puigcerdà, also now a museum, dates back to the 15th century, keeping albarellos from the 16th and 17th centuries, old prescription books and antique drugs.
  6. Pharmacy is the science and technique of preparing and dispensing drugs. It is a health profession that links health sciences with chemical sciences and aims to ensure the safe and effective use of pharmaceutical drugs. The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are the experts on drug therapy and are the primary health professionals who optimize use of medication for the benefit of the patients. An establishment in which pharmacy (in the first sense) is practiced is called a pharmacy (this term is more common in the United States) or a chemist's (which is more common in Great Britain). In the United States and Canada, drugstores commonly sell medicines, as well as miscellaneous items such as confectionery, cosmetics, office supplies, toys, hair care products and magazines and occasionally refreshments and groceries. In its investigation of herbal and chemical ingredients, the work of the pharma may be regarded as a precursor of the modern sciences of chemistry and pharmacology, prior to the formulation of the scientific method. The field of pharmacy can generally be divided into three primary disciplines: Pharmaceutics Medicinal Chemistry and Pharmacognosy Pharmacy Practice The boundaries between these disciplines and with other sciences, such as biochemistry, are not always clear-cut. Often, collaborative teams from various disciplines (pharmacists and other scientists) work together toward the introduction of new therapeutics and methods for patient care. However, pharmacy is not a basic or biomedical science in its typical form. Medicinal chemistry is also a distinct branch of synthetic chemistry combining pharmacology, organic chemistry, and chemical biology. Pharmacology is sometimes considered as the 4th discipline of pharmacy. Although pharmacology is essential to the study of pharmacy, it is not specific to pharmacy. Both disciplines are distinct. Those who wish to practice both pharmacy (patient oriented) and pharmacology (a biomedical science requiring the scientific method) receive separate training and degrees unique to either discipline. Pharmacoinformatics is considered another new discipline, for systematic drug discovery and development with efficiency and safety. Professionals The World Health Organization estimates that there are at least 2.6 million pharmacists and other pharmaceutical personnel worldwide. Pharmacists Pharmacists are healthcare professionals with specialised education and training who perform various roles to ensure optimal health outcomes for their patients through the quality use of medicines. Pharmacists may also be small-business proprietors, owning the pharmacy in which they practice. Since pharmacists know about the mode of action of a particular drug, and its metabolism and physiological effects on the human body in great detail, they play an important role in optimisation of a drug treatment for an individual. Pharmacists are represented internationally by the International Pharmaceutical Federation (FIP). They are represented at the national level by professional organisations such as the Royal Pharmaceutical Society in the UK, Pharmacy Guild of Australia (PSA), Canadian Pharmacists Association (CPhA), Indian Pharmacist Association (IPA), Pakistan Pharmacists Association (PPA), and the American Pharmacists Association (APhA). (See also: List of pharmacy associations.) In some cases, the representative body is also the registering body, which is responsible for the regulation and ethics of the profession. In the United States, specializations in pharmacy practice recognized by the Board of Pharmacy Specialties include: cardiovascular, infectious disease, oncology, pharmacotherapy, nuclear, nutrition, and psychiatry. The Commission for Certification in Geriatric Pharmacy certifies pharmacists in geriatric pharmacy practice. The American Board of Applied Toxicology certifies pharmacists and other medical professionals in applied toxicology. Pharmacy technicians Pharmacy technicians support the work of pharmacists and other health professionals by performing a variety of pharmacy related functions, including dispensing prescription drugs and other medical devices to patients and instructing on their use. They may also perform administrative duties in pharmaceutical practice, such as reviewing prescription requests with medic's offices and insurance companies to ensure correct medications are provided and payment is received. A Pharmacy Technician in the UK has recently been referred to by some as a professional. Legislation requires the supervision of certain pharmacy technician's activities by a pharmacist. The majority of pharmacy technicians work in community pharmacies. In hospital pharmacies, pharmacy technicians may be managed by other senior pharmacy technicians. In the UK the role of a PhT in hospital pharmacy has grown and responsibility has been passed on to them to manage the pharmacy department and specialised areas in pharmacy practice allowing pharmacists the time to specialise in their expert field as medication consultants spending more time working with patients and in research. Pharmacy technicians are registered with the General Pharmaceutical Council (GPhC). The GPhC is the regulator of pharmacists, pharmacy technicians and pharmacy premises. In the US, pharmacy technicians perform their duties under supervision of pharmacists. Although they may perform, under supervision, most dispensing, compounding and other tasks, they are not generally allowed to perform the role of counseling patients on the proper use of their medications. Education requirements There are different requirements of schooling based on the area of pharmaceuticals a student is seeking. In the United States, the general pharmacist will attain a Doctor of Pharmacy Degree (Pharm.D.). The Pharm.D. can be completed in a minimum of six years, which includes two years of pre-pharmacy classes, and four years of professional studies. After graduating pharmacy school, it is highly suggested that the student go on to complete a one or two year residency, which provides valuable experience for the student before going out independently to be a generalized or specialized pharmacist. The curriculum created for a Pharm.D. is made up of 208-credit hours. Of the 208-credit hours, 68 are transferred-credit hours, and the remaining 140-credit hours are completed in the professional school. There are a series of required standardized tests that students have to pass throughout the process of pharmacy school. The standardized test to get into pharmacy school is called the Pharmacy College Admission Test (PCAT). In a student's third professional year in pharmacy school, it is required to pass the Pharmacy Curriculum Outcomes Assessment (PCOA). Once the Pharm.D. is attained after the fourth year professional school, the student is then eligible to take the North American Pharmacist Licensure Exam (NAPLEX) and the Multistate Pharmacy Jurisprudence Exam (MPJE) to work as a professional pharmacist.
  7. Ireland is one of a small number of countries where the delivery of Health and Social care services comes under the auspices of one government department. The range of services delivered ranges from neurosurgery at one end of the spectrum to child and family welfare services on the other end. Services are usually categorised by acute care, primary care, continuing care and community care services - such as disabilities, mental health, social inclusion and children and family welfare services. The delivery system is mixed with a range of public, voluntary and private providers in the different care settings. Health of the Nation Over the past decade, Ireland has experienced unprecedented gains in health status and this has been paralleled by major investment in the health services. For many years Irish life expectancy lagged behind the EU average. An improvement over the last decade mean that overall life expectancy in Ireland stands at over 79 years, and is now almost one year greater than the average for the EU. It is difficult to measure what proportion of this improvement may be attributable to better health services, but it is at least indicative that much of the gain has been in mortality from conditions particularly amenable to treatment and care such as heart and circulatory system disease. For example there has been a reduction of 38 percent in circulatory system disease between 1997 and 2005. In addition, over the same period, the cancer mortality rate has fallen by 13 percent and it now close to the EU average. In terms of breast cancer, the five-year relative survival rate is about 80 percent for the period 1999-2004 – the highest rate of improvement in the OECD. Infant mortality is also down by 35 percent in the last ten years. Health Policy in Ireland Health Policy is a matter for government, specifically the Minister for Health and Children. The role of the ministry, called the Department of Health and Children, is to advise on the strategic development of the health and social care system including policy and legislation and to evaluate performance of the health and social care system. Delivery of services is the responsibility of a separate government agency, called the Health Service Executive (HSE). Government allocates funding to run the Health and Social Care system each year and agrees a service plan with the Health Service Executive that sets out the quantum and nature of services to be provided. Funding our Healthcare System Compared with other OECD countries, Ireland's health spending per capita ranks in the top half but when expressed as a percentage of GDP (7.6 percent in 2007) ranks at the lower end of the OECD spectrum. In 2009 15.5 billion euro was allocated to fund the public health and social care system in Ireland, including payments to family doctors and community pharmacists. A review group, established by the minister for Health and Children, is due to report in 2010 on how to improve the funding model and the method of allocating resources, including how a population based funding model might lead to greater equity in allocation of funding to different parts of the country. How Services Are Delivered The Health Service Executive (HSE) has recently re-organised into four regional operating units with the intention of moving responsibility for service delivery closer to the populations they serve. Each region provides services to a population of around one million people and services are delivered through a combination of public, voluntary and private providers. Within each region there are a number of hospital networks providing acute care and local health offices that provide a broad range of primary, community and continuing care services. Acute care is provided through hospitals or hospital networks. These are principally state owned and run with the exception of the capital city, Dublin, where most of the hospitals are non-statutory. Continuing care is provided through networks of community hospitals, long stay facilities and private nursing homes. Significant emphasis is now being put on development of primary care teams that bring Family Doctors and Community Health Professionals, such as Public Health Nurses, into multi-disciplinary teams serving populations of between six and ten thousand people. In addition more specialist services in areas such as Child and Family Welfare, Disability and Mental Health services are delivered primarily through HSE providers or contracted to voluntary agencies. Healthcare Reform in Ireland Government made a major change in the organisation and management of services in 2005 that saw the establishment of a single agency with responsibility for delivery of all health and social care services, called the HSE. This replaced the ten former regional health boards. In addition a national body, called the Health and Information Quality Authority (HIQA) was set up to drive quality, safety, accountability and to ensure the best use of resources in our health and social care services, whether delivered by public, voluntary or private bodies. Several very serious patient/client safety incidents resulted in the establishment of a commission on patient safety that has resulted in a number of recommendations for change. This coupled with the need for progress on several existing strategies and a continued focus on ensuring a more integrated service for patients/clients has led to the: Establishment of a Directorate of Quality and Clinical Care to bring renewed focus to define and implement models of care and to ensure our services are delivered to the highest possible standards; Creation of hospital reconfiguration programmes for groups of hospitals to ensure care is being delivered in the most appropriate settings that is resulting in significant changes for many hospitals; Planned rollout of over 500 primary care teams across the country by 2011; Implementation plan for change in Mental Health and other community services; Commencement of a series of integrating programmes that will focus on defining the patient pathways for priority areas such as diabetes and stroke; and Re-organisation of the HSE national directorates to bring our acute hospitals and Primary, Community and Continuing care divisions together under one umbrella. Outlook in Current Economic Downturn Ireland is no different to most other countries in the challenges it faces in the current economic downturn. The challenge will be to deliver accessible, high quality and equitable health services to those who need them, when and where they need them within available resources. This will bring pressures to bear on both health services and on the health of the population. The demographic ageing of the population is a fact of life and will accelerate over the coming years. By 2025, there will be nearly double the number of people over the age of 65 as there are now. Lifestyle risks remain to the fore as major areas of concern with the potential to undo much of the health improvement achieved in recent years. We have seen significant changes in how services are organised and managed in recent years, following thirty years of a relatively stable health and social care service delivery system in Ireland. This has been driven by the need for a safer and more effective system for patients and clients and we are continually trying to improve our system through a series of changes in the areas of funding, performance measurement, organisation and also in how services are accessed and delivered to our patients and clients.
  8. According to the Department of Health (DoH) 1 in 4 people will experience a mental health condition at some point in their life. For hundreds of years, laws and policies have covered mental health. As times and medicine advances, so do these acts and guidelines. Legislation exists to ensure that those who suffer from mental health conditions are cared for adequately in healthcare settings. In addition to this, these laws are also designed to protect those who suffer from mental health conditions from being discriminated against. Finally, there are laws in place that define when an individual can be sectioned, and when they can have their decision making rights withdrawn from them. The Mental Health Act The Mental Health Act was first established in 1983. Under this act, it is possible to detain a person in hospital against their wishes. This is something that only happens on rare occasions, and can only be carried out when a team of appropriate people have agreed that it is in the individual's best interests that they be admitted to hospital. In order for a person to be admitted to hospital under the act, three separate entities must agree that they would benefit from this. This usually means an Approved Mental Health Professional (AMHP), a doctor who has undergone specialist training, and another medical professional. It is preferred that the doctor agreeing to the admission is somebody familiar with the individual's medical history. When this happens, it is usually to protect the person concerned and those around them. While this act permits sectioning, being sectioned is not an absolute order that the mentally ill person must give into. Under the act, each sectioned person has the right to contest their sectioning in an interview. This interview must take place in the person's home, at a safe place, in a police station, or in a hospital. No sectioning is indefinite. Each person who is sectioned will be assessed continuously and their hospital stay will be reviewed periodically. By using a team of medical professionals, it is possible to determine whether the person who has been sectioned is fit to return home. Mental Health and Healthcare While 1 in 4 people in the UK may suffer from a mental health condition at some point in their lifetime, it does not mean that they are unable to care for their own health. The vast majority of those who have a mental health condition can make their own health decisions. Legally, each healthcare professional must approach a mentally unwell individual for consent, just as they would with anybody else. The rule of thumb is that you must assume that a mentally ill individual has the capacity to make their own healthcare decisions, regardless of what is on their medical record. This can always be challenged if it does not appear that the individual has the capacity to care for themselves, but each healthcare professional must follow set legal guidelines to establish whether capacity is present. In addition to this, those who are mentally unwell are protected against discrimination in healthcare settings. You cannot be denied treatments or basic rights as a result of your mental health status. Mental Health in the Workplace and in Education When working and studying, all individuals who have been diagnosed with a mental health condition are entitled to disability rights. In order for these rights to be safeguarded, it is important that your workplace or academic institution is informed of your condition. The legislation protecting those who suffer from mental health conditions ensures that their working needs are met. This may mean regular breaks to reduce stress, or time away when a GP recommends that this is needed. As far as academic institutions are concerned, this means not discriminating against those who find learning challenging as a result of their condition. This means that a teacher or lecturer cannot penalise a student who does not appear to understand what is expected of them academically, just because they suffer from a mental health condition. Legislation also ensures that you are not discriminated against during any application process. If you clearly state that you suffer from a disability in the form of a mental health condition on any application form, you cannot be denied an interview on this basis. Similarly, it is usually illegal for a workplace or academic institution to purposefully ask you about your mental health status during an interview. However, there are exceptions. If these questions are being asked so that the interviewer can broaden access to education and work, or for safety purposes, they are within their legal rights to make an enquiry. Finally, you cannot be suspended or expelled from your studies or workplace as a result of your mental health condition. Doing this is illegal, and can lead to serious consequences. Mental Health Law and Policy Governing Bodies To ensure you remain protected from discrimination, and to safeguard your health, there are several governing bodies and charities in place. One of these is Rethink. Rethink is a mental health charity that focuses on providing support and information to those who suffer from mental health conditions. By making sure you are armed with information, they can help you remain empowered in every aspect of your life. They are also there to provide additional guidance when things do not go well. The Department of Health is also available to provide guidance regarding mental health. This guidance can be accessed by healthcare workers, social workers, and other individuals who work in the public sector. In addition to this, it is available to those who suffer from a mental health condition and would like to know more about how the law protects them. Through the DoH website, it is also possible to see what the latest news and developments are in this area. Mental health law and policy in the UK are extensive. By creating such extensive guidelines, it is possible to make sure that those who have a mental health condition can receive adequate care, free from discrimination.
  9. In the UK, the majority of healthcare is provided by the National Health Service (NHS). However, some people also choose to undergo care in private hospitals. Both NHS and private hospitals are well-regulated to ensure that medical staff are delivering the care that patients deserve. Regardless of whether the hospital is private or NHS operated, each one is regulated by the Care Quality Commission (CQC), Healthcare Inspectorate Wales, Healthcare Improvement Scotland, or the Regulation and Quality Improvement Agency in Northern Ireland . Certain standards are also set on a national level, which vary according to the services that the hospital is able to deliver. How NHS and Private Hospitals are Regulated The body that regulates each hospital will depend on where in the country it is. As can be seen from the introduction, there are different regulating agencies for each of the UK's countries. However, all of them regulate and monitor hospitals in similar ways, following the model of the CQC. In order for a hospital to operate as a hospital in the UK, it needs to be registered with the CQC or the relevant governing body for the country it is in. Once registered with the CQC, that hospital is then liable to be legally pursued by the body if it does not meet the care standards that have been set out. The CQC and other governing bodies want to ensure that all patients are treated with dignity and respect, that they receive adequate nourishment while in hospital, that the environment they are in is clean and safe, and that staffing services are adequate. If these standards are not met, the hospital that is failing to meet them may find that they face harsh penalties from the CQC. In order to ensure that hospitals are meeting the standards that have been set, the CQC will periodically monitor them and produce reports. If there are areas where the hospital is found to be lacking, recommendations for change will be made. Sometimes, the CQC will review a hospital and whether it is fit for purpose if a high profile case arises. For example, the Foster Report released early in 2013 examined whether hospitals in West Staffordshire were meeting the needs of the patients in them. This reports was initiated after it was found that the hospitals were not meeting the needs of patients in terms of dignity. Finally, the CQC and other governing bodies collate data based on the forms filled in by staff when care is delivered and when incidents occur. The data collected can then be used to identify areas where improvements need to be made. What Standards do NHS and Private Hospitals Need to Meet? The UK private and NHS hospital standards clearly state that patients will receive the care that meets their needs. Patients are also entitled to meals that meet their dietary needs; this means religious and ethical dietary choices must be met. Patients are guaranteed the coordination of care services if they are moved from one place of care to another, and they are free from discrimination on the basis of culture, gender, age, sexuality, and disability. The standards outlined are also designed to ensure that patients remain safe. This means they are free from abuse, will receive care in a clean environment, will get medicines when needed and in a safe way, will be cared for in a safe place, and will not be harmed by any equipment that is unsafe or unsuitable. These regulations cover recommendations that focus on daily tasks, such as cleaning and hand washing. This safety is complimented by the recommendation that staff are competent and able to carry out their jobs efficiently enough to maintain patient welfare. To ensure that hospital standards are met, governing bodies recommend that hospital managers monitor how their hospital's services are being delivered periodically. This regulation also includes the assurance that patient records will be stored in a place that protects privacy, but is still accessible when needed. Finally, it is the hospital's duty to ensure that patients have access to a complaints procedure so that they can ensure their grievances are dealt with in a prompt manner. How Those Receiving Care in UK Hospitals can Complain Although rigorous regulations and standards are in place for individuals receiving care in NHS hospitals, there may still come a time when patients need to complain. This may arise if they feel that their needs are not being met, or if they feel that the hospital is failing to meet the requirements of its governing quality agency in some other way. Patients and relatives who are unhappy with the way a hospital is operating should begin the complaints process by lodging a formal complaint with the hospital itself. Hospital staff should provide complaint details to those who request them; this should include an address to write to, as well as phone number to call. All complaints need to be acknowledged by the hospital management team, who will then outline how they will deal with the grievance that has been put forward. By law, all hospitals must have a clearly outlined complaints procedure. If they do not, the governing body responsible for them can penalise them. NHS hospitals are governed by the NHS Constitution. It a patient or the individual making a complaint is not happy with the way their complaint has been handled, they have the right to call the Parliamentary and Health Service Ombudsmen, who will take their complaint further. In addition to this, there is always the option of contacting the governing body who regulates the hospital in the area it is situated in. Although NHS and private hospitals are both regulated by the same governing bodies, they both have the same obligations as far as their patients are concerned. By not meeting them, hospitals risk breaking the law and can face tough penalties from the bodies that govern them. This process is usually enough to ensure that care standards are met, and patients have full access to a complaints procedure.
  10. In the UK, extensive public health laws exist to prevent people from getting ill. While illness is not entirely avoidable, there are laws in place that can prevent the spread of it. From vaccination programs, to disease control, the public health act covers a variety of issues that concern society as a whole. Public Health and Notifiable Diseases Under public health law, there are certain diseases that are notifiable. This means that a medical practitioner who detects them has a duty to disclose the case to a local health board. Some of these diseases are notifiable due to their severe nature, while others are notifiable in order to ensure that illness prevention measures can be put in place. In a few rare cases, a disease is notifiable so that the local farming community can be made aware of its existence. One example of a severe disease that is notifiable is Meningitis C. When caught, this strain of Meningitis has the potential to kill with hours. It is particularly prevalent during the winter, and at universities. By making it notifiable, the Department of Health (DoH) has made it possible to alert doctors and hospitals when there are outbreaks. As such, medical professionals can watch out for cases when examining symptoms in their patients. In terms of illness prevention measures, certain sexually transmitted diseases need to be notified. For example, HIV/AIDS. By making HIV/AIDS notifiable, the government has been able to track outbreaks and initiate responses accordingly. In relation to the farming community, campylo-bacter is an example of a notifiable disease. This is due to it thriving in chickens. While it is hard to detect while a chicken is alive, being alerted to its presence when a human contracts it is a good way for doctors to watch out for strains that farmers may be able to treat in their poultry. Public Health and Immunisation Another way that public health law protects the public is through the immunisation programs that are available. Currently, these programs are not mandatory in childhood. However, it is the law that certain vaccinations must be offered to a child at various stages throughout their life. Parents are not legally obligated to take healthcare professionals up on their offer to immunise their child, however, failure to follow an immunisation program may be recognised as a sign of neglect--when present alongside other factors. The only collective group of individuals who are compelled to respond to immunisation programs is healthcare professionals. Prior to beginning work with the NHS, nurses, doctors, and other medical professionals must undergo an occupational health check. This check determines their immunity to certain conditions. It also established whether they are adequately vaccinated. In the instance that they are not, healthcare professionals must receive certain vaccinations. By doing this, they can prevent the spread of certain diseases to those they are treating. Public Health and Nutrition The UK's public health laws on nutrition stem from domestic and EU sources. These laws penetrate into the world of social work, hospitals, parenting, and the food market. On a commercial level, food companies are not allowed to make outlandish claims about their products. For example, they may not state that a product can absolutely lower cholesterol, but they can advertise it as an aid. In addition to this, formula milk providers are not allowed to advertise products for babies under the age of 6 months. For products that attend to the needs of babies over that age, they must clearly state that breastfeeding is the better option. As far as social work is concerned, public health law makes it clear that social workers can attend to the needs of children who are not being adequately nourished. These laws usually apply to those who are not being fed, but can also be extended to children whose parents only provide them with food that is bad for their health. In hospitals, public health law covers the preparation of food and provides set nutrition guidelines that are set to meet the needs of patients who are hospitalised. The European Union consistently works on improving Europe-wide public health regulations that need to be adopted. The majority of those extend into the food manufacturing process, but some of them apply to labeling as well. Food sold and produced in Europe generally needs to have clear guidelines regarding its content. It is also against public health laws to lie about what the food contains. For example, the 2013 horse meat scandal led to a series of sanctions against the meat manufacturers who claimed that they were selling beef when it was really horse meat. Finally, meat manufacturers need to follow a certain manufacturing process, and the details of this process are available to the public. By doing this, it is possible to make sure that the public are aware of the additives used during the food manufacturing process. Public Responsibility Agreements and Public Health In Britain, there is a public and private sector. While the government can have a direct say in what happens in the public sector, the private sector is governed by a blend of corporate responsibility and the law. There are certain public health measures that the private sector legally has to follow. For example, restaurant and kitchen facilities must be kept clean to a certain standard. Workplaces and other private sector buildings must ensure they have catered to the health needs of those using their services by engaging in practices like garbage disposal. Public Health Law Governing Bodies One of the key governing bodies overseeing public health is the Department of Health (DoH). Alongside other public agencies, the DoH works towards making sure that public health laws and guidelines are followed. For example, they will interact with social services and hospitals to make sure service users are being cared for properly. In addition to this, each NHS local health board assists with governing public health. Public health laws help us ensure we are safe in many ways. From immunisation programs, to how the food we eat is produced, each regulation works towards keeping us safe and healthy.
  11. To the average person, the world of medical law can often be confusing. Typically, those who need medical legal advice will seek it in the areas of criminal law and personal injury. More often than not, those who need legal advice will be seeking advice regarding a personal injury case. Laws exist to protect those who have not been treated as they should by medical professionals, and there are laws in place to ensure that medical professionals themselves remain protected. Laws Protecting Patients A wide range of laws exist protecting patients, their physical well-being, and their freedom as defined by the European Human Rights Act, Article 8. As far as the law is concerned, patients are entitled to protection in the following ways: Medical professionals must respect their right to privacy. This means no disclosing data without consent. The Data Protection Act and the way in which it covers patients can be complex for service users and medical professionals alike. Medical professionals must obtain consent before proceeding with a procedure. This consent must come from a patient of full capacity. Children who have reasonable understanding of procedures are eligible to provide consent, but this will vary on a case-by-case basis. Consent must also be informed, which means a medical professional has the duty to warn of broad risks, but not all risks. Poorly informed consent can lead to negligence and battery cases. Medical professionals have a duty to care for patients in the best way possible. This means they must act with the utmost care, and should not do anything that could harm their patients. The duty of care of each medical professional varies on a case-by-case basis, but is also enshrined in case law. Although the above three means of protection are described as meeting the needs of patients, the laws also meet the requirements of medical professionals. The law in England and Wales is designed to be fair, and serves the best interests of both parties. Governing Bodies Medical professionals are not just protected by the law, they are also protected by governing bodies. Doctors are covered by the General Medical Council (GMC) who outline guidelines for data protection, obtaining consent, and duty to care. While the GMC covers doctors, there are separate bodies covering other forms of medical professionals. For example, the Nursing and Midwifery Council (NMC) provides guidance to nurses and midwives. As well as providing guidance to medical professionals, these governing bodies also have the power to discipline those who have done wrong. If a patient has a complaint relating to medical law, they can seek legal advice and begin proceedings against the person concerned. When this happens, the case will be heard by the GMC, NMC, or another relevant body, as well as in the law courts. If these medical bodies feel as though the person being legally pursued is not fit to practice, they can reprimand them in the form of a suspension or by taking away their registration. As well as the GMC. NMC and other governing bodies, local NHS trusts and managers have the power to take action if a patient complains. For example, if a patient feels that they have been inadequately treated by a GP, they may complain to the practice manager. This could then be resolved within the practice, or it could be heard at a higher point in the NHS trust. With this route, it is still possible for the GMC to respond. This is a route that can easily be accessed by those who do and do not have professional legal representation. Professional Legal Representation and Medical Law Whether it is because of a personal injury or criminal case, professional legal representation is important when it comes to medical law. When patients are seeking justice, they have the option of taking on a solicitor, who may also instruct a barrister for court proceedings. Patients who fall into a certain income bracket will have the option of accessing legal aid; this is a fund that will pay for their solicitor. As far as criminal cases are concerned, legal aid has a higher availability. For those who are pursuing a medical professional while heading down the personal injury route, there is the option of 'no win, no fee' solicitors. These solicitors will take a percentage of the fee, if they are successful. For medical professionals who are facing prosecution, many NHS trusts have a defence team that can act on their behalf. As far as personal injury cases are concerned, it is as much in the trust's interest to win as it is the professional's, as it is the trust that shoulders the financial burden. However, this is not always the case as far as GPs are concerned, as they are self-employed and contracted out by the NHS. Other Modes of Assistance It is not always the case that a patient can access legal advice when they need it. Some cannot afford a solicitor, but still do not fall into the legal aid category. For others, it is simply a case of needing to seek guidance before pushing for official legal proceedings to begin. For those who cannot access legal advice and those who want extra guidance, it is possible to seek help from charities. The Citizens Advice Bureau (CAB) is available to give advice to members of the public. Although it is a voluntary organisation, CAB often has trained legal professionals working for them, as they are looking for extra experience. For those who would rather seek information from a more specialised charity, there are patient charities available. Charities such as the Patients Association can help provide guidance to those who need it. Although medical law may be complex, there is a wealth of advice out there for those who need it. Solicitors and barristers can provide professional services, while medical bodies like the GMC make their guidelines accessible for all. Charities and patient groups are there to help those who struggle to find legal advice, providing them with vital information. With such a wide variety of guidelines and resources in place, both patients and medical professionals are well-protected.
  12. While the UK provides great healthcare through the NHS and the private sector, mistakes sometimes happen. Whether these mistakes arise as a result of malpractice, or due to a failure to follow legal requirements like gaining consent, obtaining advice from a medical lawyer or solicitor is the best way to ensure that a claim is handled properly. Medical solicitors in the UK primarily deal with negligence, but they can also handle criminal cases involving battery. This area of the law is particularly complex and is constantly adapting; as such, adequate training is required before you can practice in the area. Medical Lawyer/Solicitor Training in England and Wales England and Wales share a legal system that is separate to the ones in Northern Ireland and Scotland. As such, the training there is different. First, you must obtain an LLB; this is a law degree that you study at undergraduate level. It covers many aspects of law, and you have the option of choosing modules that focus on medicine and healthcare. After this, you should aim to pursue your Legal Practice Course (LPC) if you want to become a solicitor. If you want to become a barrister, you should pursue the Bar Professional Training Course (BPTC). Each course is quite expensive, and so many students choose to complete this part of their academic training on a part-time basis while subsidising themselves with relevant part-time work. Following the LPC, a training contract is required. When you reach the training contract stage, you will need to seek training with a solicitor's firm that specialises in medical law. This training contract will include a professional skills course. It is carried out over the space of two years. During this period, you will have the opportunity to take on more responsibility with your chosen firm's client database. Upon completion, the majority of trainee solicitors will have a job waiting for them at the firm they trained with. Training contracts can be quite hard to obtain, so it is recommended that you gain work experience prior to your application to prove your dedication to your chosen field. To become a barrister, you will need to obtain a pupilage following your BPTC. This peerage will be undertaken with a trained barrister, but is usually unpaid. Pupilages can be quite difficult to obtain, and so it is recommended that you network during your BPTC to increase your chances of success. Medical Lawyer/Solicitor Training in Scotland Scotland's legal system is governed separately to England and Wales. As such, if you want to practice in Scotland, you must head down the correct educational route. Much like England and Wales, you can undertake an LLB at a Scottish university. This is known as an LLB in Scottish Law. It will cover various legal topics, which will be relevant to the Scottish system. Upon completion of this, you will need to take your education to postgraduate level. This means completing the Diploma in Professional Legal Practice, if you want to be a solicitor who specialises in medical law. The DPLP comes with the opportunity to volunteer and obtain experience. Once you have completed this, you should seek a traineeship. This is a paid position in a solicitor's firm, which leads towards professional registration as a medical solicitor in Scotland. Ensure the firm you undergo your traineeship with specialises in medical law. In order to become an advocate, you should still aim to complete the DPLP. In Scotland, an advocate is equivalent to a barrister. Prospective advocates then need to undergo a 21 month training period in an office specialising in advocacy. This leads to registration with the Scottish bar. Becoming a Medical Lawyer/Solicitor in Northern Ireland Much like the rest of the UK, Northern Ireland requires prospective legal professionals to obtain an undergraduate degree in law. This can then be used to gain access to begin studying a degree in Professional Legal Studies. Upon completion, it is then necessary to seek a 'master' to train under for a set period of time. Again, focusing on obtaining a master who specialises in medical law is necessary to become a medical lawyer/solicitor. Alternative Routes All three legal jurisdictions offer alternative routes of entry. For the majority of positions, this involves working in a solicitor's officer in order to gain the experience necessary to become a paralegal. Eventually, with the right training and some small courses, it is possible to practice as a solicitor. Currently, this route does not exist for those who want to become a barrister in England and Wales. However, there are some opportunities to become a solicitor via an alternative route and obtain a pupilage after. Governing Bodies In each of the legal jurisdictions in the UK, there are governing bodies regulating who can become a solicitor or barrister. These bodies set the standards required to meet your career goals. In England, the Law Society regulates solicitor practice. In Northern Ireland and Scotland, the Law Society of Northern Ireland and the Law Society of Scotland fulfill this role. For barrister's practice in England, the Bar Council regulates training. In Northern Ireland and Scotland, this role is fulfilled by their respective law societies. Once training is complete, you become a member of these bodies. However, if you are found guilty of malpractice in any away, you can be struck off. For example, if you are found to be taking bribes or messing with accounts, you will no longer be a registered member of the society that is relevant to you. It is also these societies that handle claims relating to solicitor, barrister, and advocate conduct. Becoming a solicitor or barrister who specialises in medical law in the UK can be a long process. For many, it involves at least six years training. However, upon successful completion of your training, you will be able to represent those who have experienced negligence or unfair treatment as a result of a medical professional's conduct.
  13. The latest rankings of health care systems of 11 wealthy countries by the Commonwealth Fund puts New Zealand fourth for performance and 8th for equity. The latest International Comparisons report by the Commonwealth Fund, a US-based private foundation , found New Zealand performed well on measures of care process and administrative efficiency, but below the 11-country average on health care outcomes. The top ranked countries overall across the five criteria were the United Kingdom, Australia the Netherlands and then New Zealand. At the tail end was US coming 11th after Canada (9th) and France (10th). New Zealand’s highest ranking was second in administrative efficiency which was measured by looking at barriers to care like availability of medical records and test results and the amount of time and effort clinicians and patients spend on paperwork. Our health system was ranked third for care process which looked at the areas of preventative care (like health promotion and screening), safe care, co-ordinated care and patient-centred care. Where New Zealand did not perform well in the Fund report’s analysis was access where we were ranked seventh – just on the average for the 11 countries – which looked at affordability (including avoiding medical care or dental care because of cost) and timeliness (including after-hour care and access to elective surgery). The lowest ranking for New Zealand’s health care system was in the areas of equity and health care outcomes where it came eighth. The equity measurements compare performance of higher and lower-income individuals and the health care outcomes criteria include looking at population health outcomes (like chronic disease, preventable deaths under 75 and mortality rates after a stroke, heart attack or cancer diagnosis).
  14. Canada has been ranked third-to-last in a detailed new study comparing health-care systems in 11 developed nations, managing to beat out only France and the bottom-ranked United States. The study, published this week by a New York-based private research foundation called the Commonwealth Fund, focuses largely on America’s dismal performance, but also reveals stubborn weaknesses in Canada’s system that keep us lagging behind top-ranked countries like Australia, the United Kingdom and the Netherlands. According to the study, which relies on 72 metrics grouped into five distinct categories (Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes), those weaknesses include Canada’s comparatively higher infant mortality rate, the prevalence of chronic conditions, long wait times in emergency rooms and to see specialists, poor availability of after-hours care, and a lack of reliable coverage for things like dental work and many prescription drugs. The document makes it clear Canadians are not getting value for money, spending the equivalent of 10 per cent of our GDP on health care in 2014. Meanwhile, many higher-ranked countries spent less and still managed to come out on top. It’s certainly not all bad news, however. Canada performed quite well on many metrics. The country has some of the lowest mortality rates for patients who end up in hospital following a heart attack, for example, and survival rates for certain types of cancer are also comparatively high. Unlike their peers abroad, Canadian doctors were unlikely to say that they wasted too much time on administrative tasks. The survey results were drawn from a few sources. First, there are the Commonwealth Fund’s own international surveys of patients and doctors, conducted using widely accepted sampling and survey methods. Data was also drawn from the World Health Organization (WHO) and the Organization for Economic Co-operation and Development (OECD). The Commonwealth Fund’s last review of the health-care systems across the 11 affluent countries, conducted in 2014, saw Canada ranked second-to-last, meaning we have jumped up one spot this time around. Canada ranks among the world’s more overweight countries, this study show why But the authors themselves note that extremely small differences between scores and rankings on various metrics can easily bump a country up or down on the list. Results are often clustered closely together, with only a few percentage points separating Canada from all the countries above it on the list. There were other limitations as well. In spite of improvements in recent years, the report notes, the availability of data on health system performance across nations “remains highly variable,” and the survey does not capture important information drawn directly from things like medical records or administrative data. “Furthermore, patients’ and physicians’ assessments might be affected by their expectations, which could differ by country and culture … in general, the report relies predominantly on patient experience measures.”
  15. Australia’s healthcare system has been ranked as the second best in the developed world by New York-based researchers, who ranked their own United States system as the worst. According to the Commonwealth Fund’s report, Mirror, Mirror 2017, the United Kingdom’s National Health Service (NHS) was the best system overall worldwide. Australia’s public/private system came second, followed by the Netherlands, with Norway and New Zealand sharing fourth place. The report’s authors said a person’s level of income defines the health care they receive far more in the United States than in any of the other developed nations involved. “The US performs relatively poorly on population health outcomes, such as infant mortality and life expectancy at age 60,” they said. “Despite spending nearly twice as much as several other countries, the United States still has the highest rate of mortality amenable to health care and has experienced the smallest reduction in that measure during the past decade.” Australia still not perfect In the study, the 11 countries’ systems were tested through a number of categories including care process, access to healthcare, administrative efficiency, equity, and healthcare outcomes. While Australia did come in second overall, the Australian system is by no means perfect, ranking in 7th in the equity category, which looks at the difference in healthcare available to high income and low-income earners. Dr Lesley Russell, health policy analyst of the Menzies Centre at the University of Sydney, told the ABC that the result that Australia’s system was among the world’s best should be understood in context. “We know that out-of-pocket costs for Australians are continuing to increase, in large part because of the Medicare freeze that the Government has imposed over the last few years,” she said. “So any self-congratulations and praise should be tempered, because Australia ranks very poorly on the equity measure.” Setting an example Despite the equity issue, the authors of the report still thought many of those countries could learn from Australia’s system. “The top performing countries — the UK, Australia and the Netherlands — could offer important lessons to the US and other countries,” they said. World Rankings – Best Healthcare System United Kingdom Australia Netherlands New Zealand Norway Sweden Switzerland Germany Canada France United States
  16. The Department of Health is responsible for health policy. Health and social services are delivered by the Health Service Executive (HSE) through a network of local health offices, health centres and clinics. ENTITLEMENT TO HEALTH SERVICES Entitlement to health services is normally based on residency and means. Any person regardless of nationality who is accepted by the HSE as being ‘ordinarily resident’ in Ireland is entitled to healthcare. The population is divided into two groups for the purposes of entitlement to health services –medical card holders and non-medical card holders. A person may have full or limited eligibility. There are three types of medical cards; a standard medical card, a GP visit card and a Medical card/GP visit card for people over age 70. [A medical card irrespective of how granted gives the same entitlement, entitlement differs for GP visit card holders] MEDICAL CARD HOLDERS A medical card, issued by the Health Service Executive (HSE), entitles the bearer to receive certain health services free of charge subject to certain personal criteria including a means test. Unless you are the holder of a medical card, visits to a family doctor in Ireland are not free. Medical card eligibility is based on an assessment of means. To qualify, your weekly income must be below the income threshold. Any income, savings, investments and property (except for your own home) are taken into account in the means test. Outgoings such as rent, mortgage, childcare costs, travel to work costs are also considered in assessment. It is important that you give as much information as possible with your application including dependants, mortgage payments, medical expenses etc. There are different means test rules for a person who is applying and is aged 70, or over, as the income guidelines are greatly increased. Other exceptional circumstances are always considered where a person or family has personal or social issues causing undue financial hardship. The card may be granted for the whole family, or for individual members of a family on the grounds of undue financial hardship. The same application form is used for both the Medical Card and the GP Visit Card. If you are not eligible for a medical card, you may be eligible for a GP Visit Card or the Long-Term Illness Scheme GP visit Card: A GP Visit Cards allows individuals and families in Ireland to visit their family doctor for free. Only the cost of visits to your family doctor is free; you must pay for prescribed drugs, medicines and other health services similar to others who don't have a Medical Card. If you have a GP Visit Card you should also apply for a Drugs Payment Scheme Card if you don't already have one. The income guidelines for GP Visit Cards are higher than the Medical Card and the allowances for rent, mortgage and childcare bring many people's income within the guidelines. You will get a GP Visit Card if the combined means of you and your spouse/partner is below HSE income guidelines. If your assessed means are still more than the GP Visit Card guidelines you may still qualify for a GP Visit Card on the grounds that your medical costs causes you undue financial hardship. Such an example would be if you had an ongoing medical condition that required exceptional and regular medical treatment, or visits to the doctor or hospital. If you have a medical card you are entitled to:- Doctor Visits - a range of family doctor or GP services free of charge from a chosen doctor contracted to the HSE in your local area; Prescription Medicines: The supply of prescribed approved medicines, aids and appliances like wheelchairs, crutches etc. In some circumstances a deposit may be required for aids and appliances which will be refunded on return of the aid or appliance. A €2.50 prescription charge applies for each item prescribed to all medical card patients; Certain Dental, Ophthalmic (Eye), and Aural (Ear) health services; Hospital Care - all in-patient services in public wards in public hospitals, including public consultant services; Hospital Visits [Outpatient Services] - These include accident and emergency services as well as planned services provided on an outpatient basis. For example person may be referred by GP for specialist assessment by a consultant. All out-patient services in public hospitals, including public consultant services; Medical & Midwifery Care for Mothers, including health care related to pregnancy and the care of the child for six weeks after birth; Some personal and social care services, for example, public health nursing, social work services and other community care services based on client need. You may also be entitled to the following additional benefits if you have a Medical Card: No need to pay the health portion of your social insurance (PRSI); Free transport to school for children who live 3 miles or more from the nearest school; Exemption from state examination fees in public second-level schools; Financial help with buying school books. The benefits above are available from the relevant Government Department. APPLYING FOR A MEDICAL CARD The quickest way to obtain a medical card is to use the online form at www.hse.ie to enter your details. You will need access to a printer to print the application pack. You may also obtain an application form and a list of participating doctors from your local health centre. NON MEDICAL CARD HOLDERS If you don’t have a medical card you are entitled to:- Subsidised prescribed drugs and medicines; In-Patient and Out –Patient public hospital services (but you may be subject to short stay and long stay maintenance charges and out-patient charges); Maternity and Infant care services. HEALTHCARE FOR FRONTIER WORKERS Frontier workers must apply in the usual way and they will be advised of their entitlement. They will have to submit evidence [Eform or S1], or if from the UK, evidence of entitlement under EU regulations with proof of being insured in that State. Northern Ireland Residents working in Ireland: Are entitled to NHS care as they are legally resident in Northern Ireland Ireland Residents working in Northern Ireland: Are entitled to an NHS medical card, however their spouse and dependents are not [except necessary care for dependants on temporary stay] Are eligible for free GP services in Northern Ireland Are eligible to register with an NHS Dentist Are eligible for maternity services from a GP, a midwife and an obstetrician in a hospital in Northern Ireland Are eligible for an Irish Medical card under EU entitlement without a means test for themselves and family member resident with them. This is provided they are not also insured in Ireland. PENSIONERS For those living in Northern Ireland, and are over age 70, and who wish to move permanently to Ireland they will automatically qualify for a medical card if they are transferring a contribution based social security payment from Northern Ireland. It is immaterial whether under or over 70 but the social security payment has to carry healthcare entitlement with it under EU regulations.
  17. Experiences, perceptions and reporting of the NHS Although the NHS has a high level of popular public support within the country, the national press is often highly critical of it and this may have affected perceptions of the service within the country as a whole and outside. An independent survey conducted in 2004 found that users of the NHS often expressed very high levels satisfaction about their personal experience of the medical services they received. Of hospital inpatients, 92% said they were satisfied with their treatment; 87% of GP users were satisfied with their GP, 87% of hospital outpatients were satisfied with the service they received, and 70% of Accident and Emergency department users reported being satisfied. When asked whether they agreed with the question "My local NHS is providing me with a good service" 67% of those surveyed agreed with it, and 51% agreed with the statement "The NHS is providing a good service. The reason for this disparity between personal experience and overall perceptions is not clear. Similarly the survey also showed that net satisfaction with NHS services (the number reporting satisfied less those reporting dissatisfied) was generally higher amongst NHS services users than for all respondents (users as well as non-users). Where more people had no recent experience of that service, the difference in net positive perception reported by users compared to non-users was more likely to diverge. For example, the least used service surveyed was walk-in centres (only 15% of all persons surveyed had actually used an NHS Walk in clinic in the last year) but 85% of walk in clinic users were satisfied with the service they received. Users' net positive satisfaction was 80%. However, for all respondents (including non-recent users) the overall net positive satisfaction was just 25%. The service with the highest rate of use was the GP service (77% having seen their GP in the last year) and the difference in net satisfaction between users and all users was the smallest (76% and 74% net satisfied respectively) It is also apparent from the survey that most people realise that the national press is generally critical of the service (64% reporting it as being critical compared to just 13% saying the national press is favourable), and also that the national press is the least reliable source of information (50% reporting it to be not very or not at all reliable, compared to 36% believing the press was reliable). Newspapers were reported as being less favourable and also less reliable than the broadcast media. The most reliable sources of information were considered to be leaflets from GPs and information from friends (both 77% reported as reliable) and medical professionals (75% considered reliable). Private-sector medical care England also has a private health care sector. Private health care is sometimes funded by employers through medical insurance as part of a benefits package to employees though it is mostly the larger companies that do. Insurers also market policies directly to the public. Most private care is for specialist referrals with most people retaining their NHS GP as point of first contact. The private sector now does some subcontracting work for the NHS. Thus an NHS patient can be treated in the private sector as an NHS patient if the Health Services has subcontracted work to the hospital. Some private hospitals are business enterprises and some are non-profit-making trusts. Some hospital groups provide insurance plans (e.g. Bupa, Benenden), and some insurance companies have deals with particular private hospital groups. Some private sector patients can be treated in NHS hospitals in which case the patient or his/her insurance company is billed. The Care Quality Commission, after inspecting more than 200 private sector hospitals, warned in April 2018 that informality in processes meant that systematic and robust safety procedures were not in place. Hospital consultants are generally not employed by the private hospitals where they have admitting rights and the commission said private companies could be reluctant to challenge them. Safety was viewed as the responsibility of individual clinicians, rather than a corporate responsibility supported by formal governance processes. Furthermore, private hospitals “were not set up to anticipate and handle emergency situations”. There were only 15 critical care services across 206 hospital sites so in an emergency they had to rely on the 999 service. Most people think that the NHS is well run, with 73% of people reporting that they are satisfied with the running of the service and only a little over 10% reporting themselves as dissatisfied. England's healthcare is ranked 14th in Europe in the Euro Health Consumer Index.
  18. Patient experience A patient needing specialist care at a hospital or clinic, will be informed by the GP of the hospitals where they can get their treatment. This choice usually includes public and private hospitals. The NHS will pay for treatment in a private setting if the hospital meets the cost and service criteria that NHS hospitals adhere to. Otherwise opting for a private hospital makes the patient liable for private hospital fees. Because the private sector often has higher costs, most people choose to be treated for free in an NHS hospital. If the GP judges the case to be extremely urgent, the doctor may by-pass the normal booking system and arrange an emergency admission. The median wait time for a consultant led first appointment in English hospitals is a little over 3 weeks. Patients can be seen by the hospital as out-patients or in-patients, with the latter involving overnight stay. The speed of in-patient admission is based on medical need and time waiting with more urgent cases faster though all cases will be dealt with eventually. Only about one third of hospital admissions are from a waiting list. For those not admitted immediately, the median wait time for in-patient treatment in English hospitals is a little under 6 weeks. Trusts are working towards an 18-week guarantee that means that the hospital must complete all tests and start treatment within 18 weeks of the date of the referral from the GP. Some hospitals are introducing just in time workflow analysis borrowed from manufacturing industry to speed up the processes within the system and improve efficiencies. Almost all NHS hospital treatment is free of charge along with drugs administered in hospital, surgical consumables and appliances issued or loaned. However, if a patient has chosen to be treated in an NHS hospital as a private fee paying patient by arrangement with his consultant, the patient (or the insurance company) will be billed. This can happen because at the inception of the NHS, hospital consultants were allowed to continue doing private work in NHS hospitals and can enable private patients to "jump the NHS queue". This arrangement is nowadays quite rare as most consultants and patients choose to have private work done in private hospitals. Emergency Department (traditionally known as Accident and Emergency) treatment is also free of charge. A triage nurse prioritises all patients on arrival. Waiting times can be up to 4 hours if a patient goes to the Emergency Department with a minor problem or may be referred to other agencies (e.g. pharmacy, GP, Walk in clinic). Emergency Departments try to treat patients within 4 hours as part of NHS targets for emergency care.[citation needed] The Emergency Department is always attached to an NHS general hospital. Private hospitals do not provide emergency care services. The NHS also provides end of life palliative care in the form of Palliative Care Specialist Nurses. The NHS can also commission the expertise of organisations in the voluntary sector to compliment palliative care. Such organisations include Marie Curie Cancer Care, Sue Ryder Care and Macmillan Cancer Support. Despite their names, these services are designed for all palliative conditions, not exclusively cancer. All palliative care services provide support for both the patient and their relatives during and after the dying process. Again, these are all free of charge to the patient.
  19. Healthcare in England is mainly provided by England's public health service, the National Health Service, that provides healthcare to all permanent residents of the United Kingdom that is free at the point of use and paid for from general taxation. Since health is a devolved matter, there are differences with the provisions for healthcare elsewhere in the United Kingdom. Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing to pay. National Health Service (NHS) The National Health Service (NHS) is free at the point of use for the patient though there are charges associated with eye tests, dental care, prescriptions, and many aspects of personal care. The NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare, ophthalmology and dentistry. The National Health Service Act 1946 came into effect on 5 July 1948. Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population generally as a top-up to NHS services. Recently there have been some examples where unused private sector capacity has been used to increase NHS capacity and in some cases the NHS has commissioned the private sector to establish and run new facilities on a sub contracted basis. Some new capital programs have been financed through the private finance initiative. The involvement of the private sector remains relatively small yet, according to one survey by the BMA, a large proportion of the public oppose such involvement. Funding and management The NHS is divided conceptually into two parts covering primary and secondary care with trusts given the task of health care delivery. There are two main kinds of trusts in the NHS reflecting purchaser/provider roles: commissioning trusts are responsible for examining local needs and negotiating with providers to provide health care services to the local population, and provider trusts which are NHS bodies delivering health care service. Commissioning trusts negotiate service delivery with providers that may be NHS bodies or private entities. They will be involved in agreeing major capital and other health care spending projects in their region. By far the most known and most important purchases are services including general practice physician services (most of whom are private businesses working under exclusive contract to the NHS), community nursing, local clinics and mental health service. For most people, the majority of health care is delivered in a primary health care setting. Provider trusts are care deliverers, the main examples being the hospital trusts and the ambulance trusts which spend the money allocated to them by the commissioning trusts. Because hospitals tend to provide more complex and specialised care, they receive the lion's share of NHS funding. The hospital trusts own assets (such as hospitals and the equipment in them) purchased for the nation and held in trust for them. Commissioning has also been extended to the very lowest level enabling GPs who identify a need in their community to commission services to meet that need. Primary care is delivered by a wide range of independent contractors such as GPs, dentists, pharmacists and optometrists and is the first point of contact for most people. Secondary care (sometimes termed acute health care) can be either elective care or emergency care and providers may be in the public or private sector, but the majority of secondary care happens in NHS owned facilities. The NHS is the world's largest health service and the world's fourth-largest employer; only the Chinese People's Liberation Army, Indian Railways, and Wal-Mart employ more people directly. NHS Constitution The NHS has recently adopted a formal constitution which for the first time, in one document, lays down the objectives of the NHS, the rights and responsibilities of the various parties (patients, staff, trust boards) and the guiding principles which govern the service.
  20. With Congressional oversight, United States health agencies develop laws designed to protect public well-being. The Department of Health and Human Services (HHS) oversees the general health issues and concerns of all American citizens, spearheading initiatives that improve public health and further medical research. In 2016, the mission of the HHS entailed improving patient outcomes and reducing medical costs. Throughout time, the HHS has worked toward such goals by supporting various new laws. As a result, the following eight acts of legislation have had a significant impact on health in America. Healthcare Quality Improvement Act of 1986 (HCQIA) The Healthcare Quality Improvement Act (HCQIA) provides immunity for medical professionals and institutions during conduct assessments. The law originated partially due to a Supreme Court ruling involving abuse of the physician peer review process. To date, HCQIA continues to evolve as the act arises in courtrooms and justices deliver new rulings. Legislators enacted the law to protect medical professionals from peer review-related lawsuits and to encourage physicians to file official complaints after encountering unprofessional and dangerous peer conduct. Medicare The Medicare program provides insurance coverage for almost 50-million American citizens. In 1945, President Harry Truman rallied Congress for funding to insure all United States citizens. Twenty years later, president John F. Kennedy finally succeeded in providing coverage for U.S. senior citizens. Today, the Congressional Budget Office forecasts that the program will survive indefinitely thanks to sweeping spending reforms. Medicaid President Johnson’s 1965 legislation also included a provision to provide insurance for low-income individuals. [3] Today, Medicaid provides coverage for over 70-million American citizens. In 2014, the program reimbursed hospitals for almost 50-percent of all medical expenses. Medicaid covers various recipients, such as uninsured expectant mothers, temporarily unemployed workers and disabled individuals. Recently, new legislation has lowered the nation’s uninsured rate to under 9-percent, representing the highest coverage rate in U.S. history. Children’s Health Insurance Program (CHIP) Along with the Medicaid, the Children’s Health Insurance Program (CHIP) has created a strong foundation for delivering health coverage to children living in low-income households. The program originated with the Children’s Health Insurance Authorization Act of 2009 (CHIPRA) and has successfully provided services to many previously disqualified clients. The program has an extensive history of providing insurance to underprivileged children and receives funding from respective states and the federal government. Today, the Affordable Care Act (ACA) makes this service accessible to the largest number of low-income children in the country’s history. Hospital Readmissions Reduction Program (HRRP) The Hospital Readmissions Reduction Program (HRRP), an Affordable Care Act initiative, requires the Centers for Medicare and Medicaid Services (CMS) to reduce payouts to care facilities that experience excessive patient readmissions. The program launched in late 2012 and defines readmissions as ‘repeat patient admissions among participating CMS hospitals in a 30-day period; allowing exceptions for specific conditions, such as heart failure and pneumonia, as well as factors such as poor health and multiple illnesses.’ Health Insurance Portability and Accountability Act (HIPAA) of 1996 The Health Insurance Portability and Accountability Act (HIPAA) protects America workers by allowing them to carry health insurance policies from job to job. The program also permits workers to apply to a select group of health insurance plans to replace lost coverage and adjust for family changes such as marriages, births and adoptions. HIPAA bars insurers from discriminating against policy applicants due to health problems. In some instances, if an insurance company denies a worker’s application, the individual may apply for coverage outside of the normal enrollment period. Additionally, the act preserves state laws that protect workers’ insurance rights. Patient Safety and Quality Improvement Act (PSQIA) of 2005 The Patient Safety and Quality Improvement Act (PSQIA) protects health care workers who report unsafe conditions. [6] Legislators created the law to encourage the reporting of medical errors, while maintaining patients’ confidentially rights. To ensure patient privacy, the HHS levies fines for confidentially breaches. The law also authorizes the Agency for Healthcare Research and Quality (AHRQ) to publish a list of patient safety organizations (PSOs) that record and analyze patient safety data. The Office for Civil Rights (OCR) enforces the law among national health care facilities. Affordable Care Act of 2010 In March 2010, president Barak Obama sanctioned the Affordable Care Act (ACA), a somewhat modified version of the all-inclusive coverage imagined by presidents since the early 1900s. The act requires most U.S. citizens to apply for health insurance coverage, levying a penalty for individuals who fail to secure insurance but making exceptions for a few protected groups. Under the law, enterprises that employ more than 200 workers must provide health insurance coverage. The act also established the American Health Benefits Exchange, where citizens can review and compare insurance plans. The Affordable Care Act offers health care professionals the opportunity to participate in shaping the delivery of patient services. The medical field can benefit from input that helps deliver better services to the growing patient population while reducing care expenses. As a current or future decision maker in the health care field, care providers must reflect on how to create these results at their respective workplaces.
  21. Treatment for SLE No cure for SLE exists. The goal of treatment is to ease symptoms. Treatment can vary depending on how severe your symptoms are and which parts of your body SLE affects. The treatments may include: anti-inflammatory medications for joint pain and stiffness, such as these options available online steroid creams for rashes corticosteroids to minimize the immune response antimalarial drugs for skin and joint problems disease modifying drugs or targeted immune system agents for more severe cases Talk with your doctor about your diet and lifestyle habits. Your doctor might recommend eating or avoiding certain foods and minimizing stress to reduce the likelihood of triggering symptoms. You might need to have screenings for osteoporosis since steroids can thin your bones. Your doctor may also recommend preventive care, such as immunizations that are safe for people with autoimmune diseases and cardiac screenings,
  22. How is Systemic Lupus Erythematosus diagnosed? Your doctor will do a physical exam to check for typical signs and symptoms of lupus, including: sun sensitivity rashes, such as a malar or butterfly rash mucous membrane ulcers, which may occur in the mouth or nose arthritis, which is swelling or tenderness of the small joints of the hands, feet, knees, and wrists hair loss hair thinning signs of cardiac or lung involvement, such as murmurs, rubs, or irregular heartbeats No one single test is diagnostic for SLE, but screenings that can help your doctor come to an informed diagnosis include: blood tests, such as antibody tests and a complete blood count a urinalysis a chest X-ray Your doctor might refer you to a rheumatologist, which is a doctor who specializes in treating joint and soft tissue disorders and autoimmune diseases.
  23. Causes of SLE The exact cause of SLE isn’t known, but several factors have been associated with the disease. Genetics The disease isn’t linked to a certain gene, but people with lupus often have family members with other autoimmune conditions. Environment Environmental triggers can include: ultraviolet rays certain medications viruses physical or emotional stress trauma Sex and hormones SLE affects women more than men. Women also may experience more severe symptoms during pregnancy and with their menstrual periods. Both of these observations have led some medical professionals to believe that the female hormone estrogen may play a role in causing SLE. However, more research is still needed to prove this theory.
  24. What is systemic lupus erythematosus? The immune system normally fights off dangerous infections and bacteria to keep the body healthy. An autoimmune disease occurs when the immune system attacks the body because it confuses it for something foreign. There are many autoimmune diseases, including systemic lupus erythematosus (SLE). The term lupus has been used to identify a number of immune diseases that have similar clinical presentations and laboratory features, but SLE is the most common type of lupus. People are often referring to SLE when they say lupus. SLE is a chronic disease that can have phases of worsening symptoms that alternate with periods of mild symptoms. Most people with SLE are able to live a normal life with treatment. According to the Lupus Foundation of America, at least 1.5 million Americans are living with diagnosed lupus. The foundation believes that the number of people who actually have the condition is much higher and that many cases go undiagnosed. Recognizing potential symptoms of SLE Symptoms can vary and can change over time. Common symptoms include: severe fatigue joint pain joint swelling headaches a rash on the cheeks and nose, which is called a “butterfly rash” hair loss anemia blood-clotting problems fingers turning white or blue and tingling when cold, which is known as Raynaud’s phenomenon Other symptoms depend on the part of the body the disease is attacking, such as the digestive tract, the heart, or the skin. Lupus symptoms are also symptoms of many other diseases, which makes diagnosis tricky. If you have any of these symptoms, see your doctor. Your doctor can run tests to gather the information needed to make an accurate diagnosis.
  25. If you are diagnosed with ulcerative colitis, the symptoms and complications of your disease will vary depending on the extent of the disease. It’s important to understand which type of ulcerative colitis you have and how it will affect you. In addition to ulcerative colitis, there are several other types of ulcerative colitis. The following is a description of the different types of ulcerative colitis and descriptions of common symptoms and complications for each: Ulcerative Proctitis For approximately 30% of all patients with ulcerative colitis, the illness begins as ulcerative proctitis. In this form of the disease, bowel inflammation is limited to the rectum. Because of its limited extent (usually less than the six inches of the rectum), ulcerative proctitis tends to be a milder form of ulcerative colitis. It is associated with fewer complications and offers a better outlook than more widespread disease. Proctosigmoiditis Colitis affecting the rectum and the sigmoid colon, the lower segment of colon located right above the rectum. Symptoms include bloody diarrhea, cramps, and a constant feeling of the need to pass stool, known as tenesmus. Moderate pain on the lower left side of the abdomen may occur in active disease. Left-sided Colitis Continuous inflammation that begins at the rectum and extends as far as a bend in the colon near the spleen called the splenic flexure. Symptoms include loss of appetite, weight loss, diarrhea, severe pain on the left side of the abdomen, and bleeding. Pan-ulcerative (total) Colitis Affects the entire colon. Symptoms include diarrhea, severe abdominal pain, cramps, and extensive weight loss. Potentially serious complications include massive bleeding and acute dilation of the colon (toxic megacolon), which may lead to an opening in the bowel wall. Serious complications may require surgery.
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