Helicopter-based Emergency Medical Services: From 1 Different Sources
see HEMS.
A sudden unexpected onset of illness or injury which requires immediate care.... emergency
The process of systematically identifying, appraising and using the best available research ?ndings, integrated with clinical expertise, as the basis for clinical decisions about individual patients. The aim is to encourage clinicians, health-service managers and consumers of health care to make decisions, taking account of the best available evidence, on the likely consequences of alternative decisions and actions. Evidence-based medicine has been developing internationally for the past 25 years, but since around 1990 its development has accelerated. The International COCHRANE COLLABORATION ?nds and reviews relevant research. Several other centres have been set up to look at the clinical application of research results, including the Centre for Evidence-Based Medicine in Oxford.... evidence-based medicine
A detailed review and evaluation of selected clinical records by qualified professional personnel for the purpose of evaluating the quality of medical care.... medical audit
See DENTAL SURGEON.... general dental services
Under the strict legal de?nition, negligence must involve proving a clearly established duty of care which has been breached in a way that has resulted in injury or harm to the recipient of care. There does not need to be any malicious intention. Whether or not a particular injury can be attributed to medical negligence, or must simply be accepted as a reasonable risk of the particular treatment, depends upon an assessment of whether the doctor has fallen below the standard expected of practitioners in the particular specialty. A defence to such a claim is that a respected body of practitioners would have acted in the same way (even though the majority might not) and in doing so would have acted logically.... medical negligence
A file kept for each patient, maintained by the hospital (medical practitioners also maintain medical records in their own practices), which documents the patient’s problems, diagnostic procedures, treatment and outcome. Related documents, such as written consent for surgery and other procedures, are also included in the record. In addition to facts about a patient’s illness, medical records nearly always contain other information such as clinical, demographic, sociocultural, sociological, economic, administrative and behavioural data. The record may be on paper or computerized.... medical record
A statutory body in the United Kingdom that promotes the balanced development of medical and related biological research and aims to advance knowledge that will lead to improved health care. It employs its own research sta? in more than 40 research establishments. These include the National Institute for Medical Research, the Laboratory of Molecular Biology, and the Clinical Sciences Centre. Grants are provided so that individual scientists can do research which complements the research activities of hospitals and universities. There are several medical charities and foundations – for example, the Imperial Cancer Research Fund, the British Heart Foundation, the Nu?eld Laboratories and the Wellcome Trust which fund and foster medical research.... medical research council
Services provided by government to improve the social welfare of those who need them.... social services
See contraception, emergency.... emergency contraception
See LIVING WILL.... advance statements about medical treatment
A complete system of theory and practices that has evolved independently of, and often prior to, the conventional biological approach. Many are traditional systems of medicine that are practised by individual cultures throughout the world. Traditional Oriental medicine and Ayurveda, India’s traditional system of medicine, are two examples.... alternative medical system
Usually managed by NHS trusts, these are a complex variety of services provided to people outside hospital settings. The key parts are the services delivered by district nurses, health visitors and therapists – for example, physiotherapists and speech therapists.... community health services
The blend of health and social services provided to an individual or family in his/her place of residence for the purpose of promoting, maintaining or restoring health or minimizing the effects of illness and disability. These services are usually designed to help older people remain independent and in their own homes. They can include senior centres, transportation, delivered meals or congregate meals sites, visiting nurses or home health aides, adult day care and homemaker services.... community-based care / community-based services / programmes
Willingness and/or ability to seek, use and, in some settings, pay for services. Sometimes further subdivided into expressed demand (equated with use) and potential demand or need.... demand (for health services)
A system allowing an older person to be linked for up to 24 hours a day to a central service which can offer help in an emergency.... emergency alarm
Service provided in response to the perceived individual need for immediate treatment or care.... emergency service
Transportation for older adults to services and appointments. May use buses, taxis, volunteer drivers, or van services that can accommodate wheelchairs and persons with other special needs.... escort services
The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individuals. This approach must balance the best external evidence with the desires of the individual and the clinical expertise of health care providers.... evidence-based care
In a policy context, evidence-based decision-making is the application of the best available scientific evidence to policy decisions about specific treatments or care, as well as changes in the delivery system.... evidence-based decision-making
Guidelines for doctors on the provision of good medical care laid down by the GENERAL MEDICAL COUNCIL (GMC).... good medical practice
The multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviours affect access to health care, the quality and cost of health care, and ultimately health and well-being. Its research domains are individuals, families, organizations, institutions, communities and populations.... health services research
See “community-based care”.... home and community-based services; home and community care programme
Equipment, such as hospital beds, wheelchairs and prosthetics, provided by an agency and used at home.... home medical equipment
Treatment that is usually considered unable to produce the desired benefit either because it cannot achieve its physiological aim or because the burdens of the treatment are considered to outweigh the benefits for the particular individual. There are necessary value judgements involved in coming to an assessment of futility. These judgements must consider the individual’s, or proxy’s, assessment of worthwhile outcome. They should also take into account the medical practitioner or other provider’s perception of intent in treatment. They may also take into account community and institutional standards, which in turn may have used physiological or functional outcome measures.... futile medical treatment
Health services delivered on an inpatient basis in hospitals, nursing homes or other inpatient institutions. The term may also refer to services delivered on an outpatient basis by departments or other organizational units of such institutions, or sponsored by them.... institutional (care) health services
A network of organizations, usually including hospitals and medical practitioner groups, that provides or arranges to provide a coordinated continuum of services to a defined population and is held both clinically and financially accountable for the outcomes in the populations served.... integrated delivery system / integrated services network (isn)
The provision of assistance with laundry tasks for someone in his or her own home, either through a central facility or by a home help in the home.... laundry services
An executive agency of the Department of Health in the UK. Set up in 1994, it is responsible for regulating and advising on the sale or use of any product, other than a medicine, used in the health-care environment for the diagnosis, prevention, monitoring or treatment of illness or disease. Equipment ranges from pacemakers (see CARDIAC PACEMAKER) to prostheses (see PROSTHESIS), and from syringes to magnetic resonance imaging (see (MRI).... medical devices agency
An error or omission in the medical care provided to an individual. Medical errors can occur in diagnosis, treatment, preventive monitoring or in the failure of a piece of medical equipment or another component of the medical system. Often, but not always, medical errors result in adverse events such as injury or death. See also “malpractice”; and “incidence monitoring and reporting”.... medical error
See INFORMATION TECHNOLOGY IN MEDICINE.... medical informatics
See ONCOLOGY.... medical oncology
These are UK bodies that provide doctors with advice and, where appropriate, ?nancial support in defending claims for medical negligence in their clinical practice. They also advise doctors on all legal aspects of their work, including patients’ complaints, and provide representation for members called to account by the GENERAL MEDICAL COUNCIL (GMC) or other regulatory body. The sharp rise in claims for medical negligence in the NHS in the 1980s persuaded the UK Health Departments to introduce a risk-pooling system called the Clinical Negligence Scheme for Trusts, and the defence societies liaise with this scheme when advising their doctor members on responding to claims of negligence (see MEDICAL LITIGATION; MEDICAL NEGLIGENCE).... medical defence organisations
Comprehensive mental health services, as generally defined under some national (or state) laws and statutes, include: inpatient care, outpatient care, day care and other partial hospitalization and emergency services; specialized services for the mental health of the elderly; consultation and education services and specialized programmes for the prevention, treatment and rehabilitation of alcohol and drug abusers. They generally include a variety of services provided to people of all ages, including counselling, psychotherapy, psychiatric services, crisis intervention and support groups. Issues addressed include depression, grief, anxiety and stress, as well as severe mental illnesses.... mental health services
Planning processes which involve the allocation of resources on the basis of community need.... needs-based planning
Health services concerned with the physical, mental and social well-being of an individual in relation to his/her working environment and with the adjustment of individuals to their work. The term applies to more than the safety of the workplace and includes health and job satisfaction.... occupational health services
See “ambulatory care”.... outpatient services
Health services targeted at populations with specific diseases or disorders.... population-based services
Health services re-orientation is characterized by a more explicit concern for the achievement of population health outcomes in the ways in which the health system is organized and funded.... re-orienting health services
Accommodation and support for people who can no longer live at home.... residential care services
The coordinated, or otherwise explicitly agreed upon, sharing of responsibility for provision of medical or nonmedical services on the part of two or more otherwise independent hospitals or health programmes.... shared services
In the UK, this NHS authority (UKTSSA) provides a 24-hour service for matching, allocating and distributing organs. It is also responsible for keeping the records of all patients awaiting transplants. Established in 1991, the authority allocates donor organs without favour, following protocols set by advisory groups. It also administers the Human Organ Transplant Act on behalf of the Department of Health. (See TRANSPLANTATION.)... transplant support services authority
This term is used to de?ne the process of learning and knowledge-acquisition in the study of medicine. It also encompasses the expertise required to develop education and training for students and learners in all aspects of medical health care. Studies for undergraduate students, postgraduate students and individual health-care practitioners, from the initial stages to the ongoing development of a career in medicine or associated health ?elds, are also included in medical education. The word ‘pedagogy’ is sometimes applied to this process.
A range of research investigations has developed within medical education. These apply to course monitoring, audit, development and validation, assessment methodologies and the application of educationally appropriate principles at undergraduate and postgraduate levels. Research is undertaken by medical educationalists whose backgrounds include teaching, social sciences and medicine and related health-care specialties, and who will hold a medical or general educational diploma, degree or other appropriate postgraduate quali?cation.
Development and validation for all courses are an important part of continuing accreditation processes. The relatively conservative courses at both undergraduate and postgraduate levels, including diplomas and postgraduate quali?cations awarded by the specialist medical royal colleges (responsible for standards of specialist education) and universities, have undergone a range of reassessment and rede?nition driven by the changing needs of the individual practitioner in the last decade. The stimuli to change aspects of medical training have come from the government through the former Chief Medical O?cer, Sir Kenneth Calman, and the introduction of new approaches to specialist training (the Calman programme), from the GENERAL MEDICAL COUNCIL (GMC) and its document Tomorrow’s Doctors, as well as from the profession itself through the activities of the British Medical Association and the medical royal colleges. The evolving expectations of the public in their perception of the requirements of a doctor, and changes in education of other groups of health professionals, have also led to pressures for changes.
Consequently, many new departments and units devoted to medical education within university medical schools, royal colleges and elsewhere within higher education have been established. These developments have built upon practice developed elsewhere in the world, particularly in North America, Australia and some European countries. Undergraduate education has seen application of new educational methods, including Problem-Based Learning (PBL) in Liverpool, Glasgow and Manchester; clinical and communications skills teaching; early patient contact; and the extensive adoption of Internet (World Wide Web) support and Computer-Aided Learning (CAL). In postgraduate education – driven by European directives and practices, changes in specialist training and the needs of community medicine – new courses have developed around the membership and fellowship examinations for the royal colleges. Examples of these changes driven by medical education expertise include the STEP course for the Royal College of Surgeons of England, and distance-learning courses for diplomas in primary care and rheumatology, as well as examples of good practice as adopted by the Royal College of General Practitioners.
Continuing Professional Development (CPD) and Continuing Medical Education (CME) are also important aspects of medical education now being developed in the United Kingdom, and are evolving to meet the needs of individuals at all stages of their careers.
Bodies closely involved in medical educational developments and their review include the General Medical Council, SCOPME (the Standing Committee on Postgraduate Medical Education), all the medical royal colleges and medical schools, and the British Medical Association through its Board of Medical Education. The National Health Service (NHS) is also involved in education and is a key to facilitation of CPD/CME as the major employer of doctors within the United Kingdom.
Several learned societies embrace medical education at all levels. These include ASME (the Association for the Study of Medical Education), MADEN (the Medical and Dental Education Network) and AMEE (the Association for Medical Education in Europe). Specialist journals are devoted to research reports relating to medical educational developments
(e.g. Academic Medicine, Health Care Education, Medical Education). The more general medical journals (e.g. British Medical Journal, New England Journal of Medicine, The Lancet, Annals of the Royal College of Surgeons) also carry articles on educational matters. Finally, the World Wide Web (WWW) is a valuable source of information relating to courses and course development and other aspects of modern medical education.
The UK government, which controls the number of students entering medical training, has recently increased the quota to take account of increasing demands for trained sta? from the NHS. More than 5,700 students – 3,300 women and 2,400 men – are now entering UK medical schools annually with nearly 28,600 at medical school in any one year, and an attrition rate of about 8–10 per cent. This loss may in part be due to the changes in university-funding arrangements. Students now pay all or part of their tuition fees, and this can result in medical graduates owing several thousand pounds when they qualify at the end of their ?ve-year basic quali?cation course. Doctors wishing to specialise need to do up to ?ve years (sometimes more) of salaried ‘hands-on’ training in house or registrar (intern) posts.
Though it may be a commonly held belief that most students enter medicine for humanitarian reasons rather than for the ?nancial rewards of a successful medical career, in developed nations the prospect of status and rewards is probably one incentive. However, the cost to students of medical education along with the widespread publicity in Britain about an under-resourced, seriously overstretched health service, with sta? working long hours and dealing with a rising number of disgruntled patients, may be affecting recruitment, since the number of applicants for medical school has dropped in the past year or so. Although there is still competition for places, planners need to bear this falling trend in mind.
Another factor to be considered for the future is the nature of the medical curriculum. In Britain and western Europe, the age structure of a probably declining population will become top-heavy with senior citizens. In the ?nancial interests of the countries affected, and in the personal interests of an ageing population, it would seem sensible to raise the pro?le of preventive medicine – traditionally rather a Cinderella subject – in medical education, thus enabling people to live healthier as well as longer lives. While learning about treatments is essential, the increasing specialisation and subspecialisation of medicine in order to provide expensive, high-technology care to a population, many of whom are suffering from preventable illnesses originating in part from self-indulgent lifestyles, seems insupportable economically, unsatisfactory for patients awaiting treatment, and not necessarily professionally ful?lling for health-care sta?. To change the mix of medical education would be a di?cult long-term task but should be worthwhile for providers and recipients of medical care.... medical education
See “futile medical treatment”; “advanced directive”.... withholding / withdrawing medical treatment
See ETHICS.... world medical association
Quarterly publication of the National Herbalists Association of Australia. Australian medicinal plants, Government reports, case studies, books, plant abstracts. For subscription details and complimentary copy of the Journal contact: NHAA, PO Box 65, Kingsgrove NSW 2208, Australia. Tel: +61(02) 502 2938. Annual subscription (Aus) $40 (overseas applicants include $15 for air mail, otherwise sent by sea mail). ... australian journal of medical herbalism
Legal guidance sought by the sufferer when making claims against a doctor or health authority is available from: Action for Victims of Medical Accidents (AVMA), Bank Chambers, 1 London Road, Forest Hill, London SE23 3TP. ... medical accidents
Est. 1864. The oldest and only body of professional medical herbalists, now known as phytotherapists, in Europe. Membership by examination after completion of course of training. A stipulated period of clinical practice must be completed before the final examination is taken.
Members are directly involved with patient-care, carrying full responsibility for their recommendations, prescribing medication suitable to the individual biological requirements of each patient. Their role includes patient-counselling, health education and research.
Official recognition of the Institute, indicating its growing importance in the field of medicine came with the historic Grant of Arms by Her Majesty’s College of Heralds. Members regard this as evidence that the Royal Charter of King Henry VIII still stands and that there is no monopoly in healing the sick. See: HENRY VIII, HERBALISTS’ CHARTER.
The Institute played a major role in winning vital concessions for the survival of the herbalist in the passage through Parliament of the Medicine’s Bill. See: MEDICINE’S ACT, 1968.
In connection with the NIMH degree courses in herbal medicine are available at a London University, and Exeter University.
The Institute provides professional indemnity cover for its members, and is engaged in a series of clinical trials to evaluate traditional remedies.
All members are required to adhere to a strict professional Code of Ethics and are entitled to carry after their names the letters of qualification: MNIMH or FNIMH.
Members have a key role in preventative medicine and health promotion in their contribution to improvement of the nation’s health.
Address: 56 Longbrook Street, Exeter EX4 6AH, from which a list of members is obtainable. ... national institute of medical herbalists
Measures to avoid pregnancy following unprotected sexual intercourse. There are 2 main methods: hormonal and physical. In the first, oral contraceptives (the “morning after” pill) are taken in a high dose as soon as possible, but not longer than 72 hours, after unprotected intercourse, with a second dose taken 12 hours later. They may be given as a high-dose progesterone-only pill or as a high-dose combined (oestrogen and progesterone) pill. In the physical method, an IUD is inserted by a doctor within 5 days of unprotected intercourse.... contraception, emergency
accident and emergency medicine: an important specialty dealing with the immediate problems of the acutely ill and injured. See also ED.... accident and emergency medicine
(AMA) a professional organization for US physicians. Its purposes include dissemination of scientific information through journals, a weekly newspaper, and a website; representation of the profession to Congress and state legislatures; keeping members informed of pending health and medical legislation; evaluating prescription and non-prescription drugs; and cooperating with other organizations in setting standards for hospitals and medical schools. The AMA maintains a comprehensive directory of licensed physicians in the US.... american medical association
(BMA) a professional body for doctors and also an independent trade union dedicated to protecting individual members and the collective interests of doctors. It has a complex structure that allows representation both by geographical area of work and through various committees, including the General Practice Committee (GPC), Central Consultants and Specialists Committee, Junior Doctors Committee, and the Medical Students Committee.... british medical association
(CMO) the most senior medical adviser to the UK government, who is responsible for providing expert advice on health issues (including health-related emergencies). The CMO is responsible to the Secretary of State for Health and acts as leader of profession for Directors of Public Health. There are separate CMOs appointed to advise the devolved governments in Scotland, Wales, and Northern Ireland.... chief medical officer
see community health.... clinical medical officer
see domiciliary services.... community services
(HHS) the major US government agency providing health care. The department was created in 1953 and assumed its current name in 1980. HHS administers more than 300 health and health-related programmes and services, including *Medicare and *Medicaid. Other activities include research, immunization services, and providing financial assistance for low-income families. Almost a quarter of federal spending occurs through HHS.... department of health and human services
(in Britain) health and social services that are available in the home and are distinguished from hospital-based services. They include the services of such personnel as community nurses employed by care trusts (see district nurse; community midwife; health visitor) and social workers and care assistants employed by social service departments of local authorities. The term community services is applied to these services.... domiciliary services
(LBC) a technique used for analysing *cervical smears taken for *cervical screening. The specimen is collected using a brush or spatula and then mixed with a liquid preservative fluid. In the laboratory, this fluid is spun and filtered to remove blood and other extraneous material, leaving a thin layer of cells that is spread on a microscope slide and examined. LBC yields specimens that are easier to screen and give more accurate results than those obtained by the traditional Pap test.... liquid-based cytology
(LMC) a group of representatives of the general practitioners working in a defined geographical area. There are separate LMCs for each area, and the members speak on behalf of the local practitioners by whom they are elected. Similar arrangements and responsibilities apply for dentists, pharmacists, and optometrists practising in the NHS outside hospitals.... local medical committee
adj. 1. of or relating to medicine, the diagnosis, treatment and prevention of disease. 2. of or relating to conditions that require the attention of a physician rather than a surgeon. For example, a medical ward of a hospital accommodates patients with such conditions.... medical
1. a health service worker who is not a registered medical practitioner (often in the armed forces) working in association with a doctor to undertake minor treatments and preliminary assessments. In poorer countries, particularly in rural areas where qualified resources are short (e.g. China), agricultural workers receive limited training in health care and continue in a dual role as barefoot doctors; elsewhere, limited training concentrates more on environmental issues: the workers so trained are known as sanitarians. 2. in the USA, a person – licensed or unlicensed, certified or uncertified – who provides administrative and/or clinical assistance in a physician’s office or other health-care facility. Administrative duties typically include filling out insurance forms, billing, and bookkeeping, while clinical duties may include taking medical histories, preparing patients to be examined, and preparing blood and urine specimens.... medical assistant
a certificate stating a doctor’s diagnosis of a patient’s medical condition, disability, or fitness to work (see statement of fitness for work). It is known informally as a ‘fit note’ (formerly a ‘sick note’). See Appendix 8.... medical certificate
see local medical committee.... medical committee
(MET) a team, usually consisting of a group of physicians, anaesthetists, and senior nurses, that can be summoned urgently to attend to patients with deteriorating medical conditions. The aim is to prevent further deterioration and to decide if enhanced levels of care are appropriate (e.g. on the high-dependency or intensive care units). The team will also assume the role of the *cardiac-arrest team.... medical emergency team
the study or practice of the legal aspects of medicine. See forensic medicine.... medical jurisprudence
travelling internationally to undergo surgery or otherwise be treated for an illness or condition. This may be done to save money, to avoid having to wait for treatment, or to receive a treatment not available in the home country.... medical tourism
(NHSPSA) see NHS Business Services Authority.... nhs prescription services authority
see Parliamentary and Health Service Ombudsman.... public services ombudsman