Post-acute care Health Dictionary

A type of disease or disorder having a sudden onset with severe symptoms, and generally a short or self-limited duration (such as a head cold or sprain). The opposite of CHRONIC.... acute

A short period of intensive rehabilitation and treatment to enable people to return home following hospitalization or to prevent admission to hospital or residential care.... intermediate care

Basic or general health care focused on the point at which a patient ideally first seeks assistance from the medical care system. It is the basis for referrals to secondary and tertiary level care.... primary care

The provision of barrier-free access to the necessary range of health care services over any given period of time, with the level of care varying according to individual needs.... continuity of care

Specialist care provided on an ambulatory or inpatient basis, usually following a referral from primary care.... secondary care

The provision of highly specialized services in ambulatory and hospital settings.... tertiary care

See ABDOMEN, DISEASES OF.... abdomen, acute

The protocol which doctors and midwives follow to ensure that the pregnant mother and her FETUS are kept in good health, and that the pregnancy and birth have a satisfactory outcome. The pregnant mother is seen regularly at a clinic where, for example, her blood pressure is checked, the growth and development of her child-to-be are carefully assessed, and any problem or potential problems dealt with. Most antenatal care deals with normal pregnancies and is supervised by general practitioners and midwives in primary-care clinics. If any serious problems are identi?ed, the mother can be referred to specialists’ clinics in hospitals. (See PREGNANCY AND LABOUR.)... antenatal care

Services and support to help people with care needs to live as independently as possible in their communities.... community care

Care of older persons who are dying.... end-of-life care

Services provided to individuals or communities by health service providers for the purpose of promoting, maintaining, monitoring or restoring health.... health care

Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in a specially equipped unit of a health care facility. It can also be administered at home under certain circumstances (dialysis, respirators, etc.).... intensive care

A health care delivery system which entails interventions to control the price, volume, delivery site and intensity of health services provided, the goal of which is to maximize the value of health benefits and the coordination of health care management for a covered population.... managed care

The active total care offered to a person and that person’s family when it is recognized that the illness is no longer curable, in order to concentrate on the person’s quality of life and the alleviation of distressing symptoms. The focus of palliative care is neither to hasten nor postpone death. It provides relief from pain and other distressing symptoms and integrates the psychological and spiritual aspects of care. It offers a support system to help relatives and friends cope during an individual’s illness and with their bereavement.... palliative care

A pre?x signifying after or behind.... post

See MYALGIC ENCEPHALOMYELITIS (ME).... post-viral fatigue syndrome

See GENERAL PRACTITIONER (GP)... primary care trust

Medical and nursing care of persons in the terminal stage of an illness. See also “palliative care”.... terminal care

A specialist ward for the care of acutely ill patients who may be suffering, or who have suffered, a myocardial infarction (heart attack) or another serious cardiovascular disorder.... coronary care unit

A form of anxiety that develops after a stressful or frightening event.

Common causes include natural disasters, violence, rape, torture, serious physical injury, and military combat.

Symptoms, which may develop many months after the event, include recurring memories or dreams of the event, a sense of personal isolation, and disturbed sleep and concentration.

There may be a deadening of feelings, or irritability and feelings of guilt, sometimes building up to depression.

Most people recover, in time, with emotional support and counselling.... post-traumatic stress disorder

Inflammatory condition of the bronchial tubes caused by cold and damp or by a sudden change from a heated to a cold atmosphere. Other causes: viral or bacterial infection, irritating dust and fumes, colds which ‘go down to the chest’.

Symptoms: short dry cough, catarrh, wheezing, sensation of soreness in chest; temperature may be raised. Most cases run to a favourable conclusion but care is necessary with young children and the elderly. Repeated attacks may lead to a chronic condition.

Alternatives. Teas – Angelica, Holy Thistle, Elecampane leaves, Fenugreek seeds (decoction), Hyssop, Iceland Moss, Mouse Ear, Mullein, Nasturtium, Plantain, Wild Violet, Thyme, White Horehound, Wild Cherry bark (decoction), Lobelia, Liquorice, Boneset. With fever, add Elderflowers.

Tea. Formula. Equal parts: Wild Cherry bark, Mullein, Thyme. Mix. 1 heaped teaspoon to cup water simmered 5 minutes in closed vessel. 1 cup 2-3 times daily. A pinch of Cayenne assists action.

Irish Moss (Carragheen) – 1 teaspoon to cup water gently simmered 20 minutes. It gels into a viscous mass. Cannot be strained. Add honey and eat with a spoon, as desired.

Tablets/capsules. Iceland Moss. Lobelia. Garlic. Slippery Elm.

Prescription No 1. Morning and evening and when necessary. Thyme 2; Lungwort 2; Lobelia 1. OR Prescription No 2. Morning and evening and when necessary. Iceland Moss 2; Wild Cherry bark 1; Thyme 2.

Doses:– Powders: one-third teaspoon (500mg) or two 00 capsules. Liquid Extracts: 30-60 drops. Tinctures: 1-2 teaspoons.

Practitioner. Alternatives:–

(1) Tincture Ipecacuanha BP (1973). Dose, 0.25-1ml.

(2) Tincture Grindelia BPC (1949). Dose, 0.6-1.2ml.

(3) Tincture Belladonna BP (1980). Dose, 0.5-2ml.

Black Forest Tea (traditional). Equal parts: White Horehound, Elderflowers and Vervain. One teaspoon to each cup boiling water; infuse 5-15 minutes; drink freely.

Topical. Chest rub: Olbas oil, Camphorated oil. Aromatherapy oils:– Angelica, Elecampane, Mullein, Cajeput, Lemon, Eucalyptus, Lavender, Mint, Onion, Pine, Thyme.

Aromatherapy inhalants: Oils of Pine, Peppermint and Hyssop. 5 drops of each to bowl of hot water.

Inhale: head covered with a towel to trap steam.

Diet: Low salt, low fat, high fibre. Halibut liver oil. Wholefoods. Avoid all dairy products. Supplements. Vitamins A, C, D, E. ... bronchitis, acute

Care that is generally provided for a short period of time to treat a new illness or a flare-up of an existing condition. This type of care may include treatment at home, short-term hospital stays, professional care, surgery, X-rays and scans, as well as emergency medical services.... acute care / acute health care

A disease which is characterized by a single or repeated episode of relatively rapid onset and short duration from which the patient usually returns to his/her normal or previous state or level of activity. An acute episode of a chronic disease (for example, an episode of diabetic coma in a patient with diabetes) is often treated as an acute disease.... acute disease / illness

See ALTE.... acute life-threatening event (alte)

Formerly known as adult respiratory distress syndrome. A form of acute respiratory failure in which a variety of di?erent disorders give rise to lung injury by what is thought to be a common pathway. The condition has a high mortality rate (about 70 per cent); it is a complex clinical problem in which a disproportionate immunological response plays a major role. (See IMMUNITY.)

The exact trigger is unknown, but it is thought that, whatever the stimulus, chemical mediators produced by cells of the immune system or elsewhere in the body spread and sustain an in?ammatory reaction. Cascade mechanisms with multiple interactions are provoked. CYTOTOXIC substances (which damage or kill cells) such as oxygen-free radicals and PROTEASE damage the alveolar capillary membranes (see ALVEOLUS). Once this happens, protein-rich ?uid leaks into the alveoli and interstitial spaces. SURFACTANT is also lost. This impairs the exchange of oxygen and carbon dioxide in the lungs and gives rise to the clinical and pathological picture of acute respiratory failure.

The typical patient with ARDS has rapidly worsening hypoxaemia (lack of oxygen in the blood), often requiring mechanical ventilation. There are all the signs of respiratory failure (see TACHYPNOEA; TACHYCARDIA; CYANOSIS), although the chest may be clear apart from a few crackles. Radiographs show bilateral, patchy, peripheral shadowing. Blood gases will show a low PaO2 (concentration of oxygen in arterial blood) and usually a high PaCO2 (concentration of carbon dioxide in arterial blood). The lungs are ‘sti?’ – they are less e?ective because of the loss of surfactant and the PULMONARY OEDEMA.

Causes The causes of ARDS may be broadly divided into the following:... acute respiratory distress syndrome (ards)

A residence which offers housing and personal care services to a number of residents. Services (such as meals, supervision and transportation) are usually provided by the owner or manager. Usually 24-hour professional health care is not provided on site. See also “assisted living facility”.... adult care home / residential facility

See “day care centre”.... adult day care

Planning in advance for decisions that may have to be made prior to incapability or at the end of life. People may choose to do this planning formally, by means of advance directives, or informally, through discussions with family members, friends and health care and social service providers, or a combination of both methods.... advance care planning

Care provided to individuals after their release from institutional care.... after-care

Services provided to people deemed to be aged or elderly.... aged care

Multidisciplinary team of health professionals that is responsible for comprehensive assessments of the needs of older persons, including their suitability for hospital, home or institutional care.... aged care assessment team

Health care practices that are not currently an integral part of conventional medicine. The list of these practices changes over time as the practices and therapies are proven safe and effective and become accepted as mainstream health care practices. These unorthodox approaches to health care are not based on biomedical explanations for their effectiveness. Examples include homeopathy, herbal formulas, and use of other natural products as preventive and treatment agents.... alternative and complementary health care / medicine / therapies

Health services provided on an outpatient basis in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies the patient travels to a location to receive services and no overnight stay in hospital is required. Many surgeries and treatments are now provided on an outpatient basis, while previously they were considered reason for inpatient hospitalization.... ambulatory care

Establishment which provides accommodation and care for older or disabled persons who cannot live independently but do not need nursing care. Residents are also provided with domestic assistance (meals, laundry, personal care).... assisted living facility / assisted care living facility

Personal care for people with disabilities in non-institutionalized settings generally by paid, non-family carers.... attendant care

See “adult care home”.... board and care home

The application of knowledge to the benefit of a community or individual. There are various levels of care:... care

1 A well planned entity of inter- and intra-organizational care processes to solve the complexity of problems of an individual, and accompanied by systematic follow-up actions. Care chains are integrated to the extent that there are no gaps, barriers or breaks in the process leaving the older person without proper care. 2 A description of the different parts of care.... care chain / chain of care

A residential facility that provides accommodation and offers a range of care and support services. Care homes may provide a limited number of services to support low dependency or may provide a wide range of services to cater for the continuum from low to high dependency care. See “assisted living facility”; “high dependency care facility”.... care home

See COMMUNITY CARE.... care in community

See “case management”.... care management

Some state of deficiency decreasing quality of life and affecting a demand for certain goods and services. For the older population, lowered functional and mental abilities are decisive factors that lead to the need for external help.... care need

A combination of services designed to meet a person’s assessed needs.... care package

An agreed and explicit route an individual takes through health and social care services. Agreements between the various providers involved will typically cover the type of care and treatment, which professional will be involved and their level of skills, and where treatment or care will take place. See also “care plan”; “care programme”.... care pathway

A dynamic document based on an assessment which outlines the types and frequency of care services that a client receives. It may include strategies, interventions, continued evaluation and actions intended to help an older person to achieve or maintain goals.... care plan

A documented arrangement of integrated care, based on the analysed needs of a specific group of people, from intake to supply of care and services, as well as the intended outcomes, and including a description of the way the arrangement should be applied in order to match the needs of individual persons.... care programme

Legislation (approved by the UK parliament in 2001) that sets up a new, independent regulatory body for social care and private and voluntary health-care services. The new body is called the National Care Standards Commission and covers England and Wales, but in the latter the National Assembly is the regulatory body. Independent councils register social-care workers, set social-care work standards and regulate the education and training of social workers in England and Wales. The Act also gives the Secretary of State for Health the authority to keep a list of individuals considered unsuitable to work with vulnerable adults. In addition, the legislation reforms the regulation of childminders and day-care provision for young children, responsibility for overseeing these services having been transferred from local authorities to the Chief Inspector of Schools. Services covered by the Act range from residential care homes and nursing homes, children’s homes, domiciliary-care agencies, fostering agencies and voluntary adoption agencies through to private and voluntary health-care services. This includes private hospitals and clinics and private primary-care premises. For the ?rst time, local authorities will have to meet the same standards as independent-sector providers.... care standards act

The types and volumes of services available.... care supply

Persons with chronic illnesses and/or impairments which lead to long-lasting disabilities in functioning and reliance on care (personal care, domestic life, mobility, self direction).... care-dependent

A person who provides support and assistance, formal or informal, with various activities to persons with disabilities or long-term conditions, or persons who are elderly. This person may provide emotional or financial support, as well as hands-on help with different tasks. Caregiving may also be done from long distance. See also “formal assistance”; “informal assistance”.... caregiver

The emotional, physical and financial demands and responsibilities of an individual’s illness that are placed on family members, friends or other individuals involved with the individual outside the health care system.... caregiver burden

A severe reaction to the caregiving burden, requiring intervention to enable care to continue.... caregiver burnout

See “caregiver”; “formal assistance”; “informal assistance”.... carer

(French) A woman with a tender touch

Caress, Caressa, Carressa... caresse

(Latin) One who rides a chariot Carewe, Crewe, Crew... carew

The ongoing provision of medical, functional, psychological, social, environmental and spiritual care services that enable people with serious and persistent health and/or mental conditions to optimize their functional independence and well-being, from the time of condition onset until problem resolution or death. Chronic care conditions are multidimensional, interdependent, complex and ongoing.... chronic care

Roxb.

Family: Barringtoniaceae.

Habitat: Sub-Himalayan tract, from Jammu eastwards to West Bengal, Madhya Pradesh and Tamil Nadu.

English: Kumbi, Slow-Match tree.

Ayurvedic: Katabhi, Kumbhi- ka, Kumbhi, Kumbi, Kaitrya, Kumudikaa.

Siddha/Tamil: Kumbi, Ayma.

Action: Bark—demulcent (in coughs and colds), antipyretic and antipruritic (in eruptive fevers), anthelmintic, antidiarrhoeal. An infusion of flowers is given after child birth.

Seeds contain triterpenoid sapo- genols, sterols; leaves contain a tri- terpene ester, beta-amyrin, hexaco- sanol, taraxerol, beta-sitosterol, quer- cetin and taraxeryl acetate.

Careya herbacea Roxb., a related species, is known as Kumbhaadu-lataa in Bengal.

Dosage: Bark—50-100 ml decoction. (CCRAS.)... careya arborea

Professional specialized or therapeutic care that requires ongoing assessment, planning, intervention and evaluation by health care professionals.... clinical care

Assistance provided free of charge or at reduced rates to members of a group or society. Other members of the group or society generally provide care on a voluntary basis.... communal care

Includes health services and integrates social care. It promotes self care, independence and family support networks.... community health care

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

Provision of a complete range of health services, from diagnosis to rehabilitation.... comprehensive health care

The provision of one or more elements of care (nursing, medical, health-related services, protection or supervision, or assistance with personal daily living activities) to an older person for the rest of his or her life.... continuing care

A facility which provides continuing care.... continuing care facility

A community which provides several levels of housing and services for older people, ranging from independent living units to nursing homes, on one site but generally in separate buildings.... continuing care retirement community

The entire spectrum of specialized health, rehabilitative and residential services available to the frail and chronically ill. The services focus on the social, residential, rehabilitative and supportive needs of individuals, as well as needs that are essentially medical in nature.... continuum of care

A collaborative process that promotes quality care, continuity of care and cost-effective outcomes which enhance the physical, psychosocial and vocational health of individuals. It includes assessing, planning, implementing, coordinating, monitoring and evaluating health-related service options. It may also include advocating for the older person.... coordinated care

A specialised hospital unit equipped and sta?ed to provide intensive care (see INTENSIVE THERAPY UNIT (ITU)) for patients who have had severe heart attacks or undergone surgery on the heart.... coronary care unit (ccu)

Medical treatment and care that cures a disease or relieves pain and promotes recovery.... curative care

Board, room and other personal assistance services generally provided on a long-term basis. It excludes regular medical care.... custodial care

A facility, operated by a local authority, voluntary organization, geriatric centre or acute hospital, providing activities for older people. These activities, usually during the day for a determined period, are intended to promote independence and enhance living skills, and can include the provision of personal care and preparation of meals.... day care centre

Any activities by a health professional involving direct interaction, treatment, administration of medications or other therapy or involvement with a patient.... direct patient care

Care provided in an individual’s own home.... domiciliary care

A legal requirement that a person act towards others and the public with the watchfulness, attention, caution and prudence that a reasonable person would use in the circumstance. If a person’s actions do not meet this standard of care, then the acts are considered negligent, and any damages resulting may be claimed in a lawsuit for negligence.... duty of care

Costs are the measure of the economic function of care. Total costs and unit costs are the basic indicators.... economy of care

See “aged care”.... elder care

The description and measurement of the various health care services and encounters rendered in connection with an identified injury or period of illness.... episode of care

Fair treatment of needs, regarding both the distribution of services and allocation of resources.... equity of care

The basic evaluative principles which (should) guide “good” care. Principles typically refer to respect for, and the dignity of, human beings. Basic dimensions are “autonomy” (respect for self determination), “well-being” (respect for happiness, health and mental integrity) and “social justice” (justifiable distribution of scarce goods and services). More specifically, ethics of care refer to ethical standards developed for the care professions which are designed to implement ethical principles in the practice of care provision.... ethics (of care)

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

A facility that offers sub-acute care, providing treatment services for people requiring inpatient care who do not currently require continuous acute care services, and admitting people who require convalescent or restorative services or rehabilitative services or people with terminal disease requiring maximal nursing care.... extended care facility (ecf)

Housing where there is additional support (such as the provision of meals and extra communal facilities) to that usually found in sheltered housing. Sometimes called ‘very sheltered housing’.... extra care sheltered housing

See “formal assistance”.... formal care

A form of assisted housing, usually provided in private homes owned and occupied by individuals or families, offering a place of residence, meals, housekeeping services, minimum supervision, and personal care for a fee to non-family members who do not require supervision by skilled medical personnel.... foster care

Care of older persons that encompasses a wide range of treatments from intensive care to palliative care.... geriatric care

See “health system”.... health care delivery system

Any establishment that is engaged in direct patient care on site.... health care institution / facility

A group comprising a variety of professionals (medical practitioners, nurses, physical and occupational therapists, social workers, pharmacists, spiritual counsellors), as well as family members, who are involved in providing coordinated and comprehensive care. There are three types of health care team, defined by the degree of interaction among members and the sharing of responsibility for care:... health care team

The systematic evaluation of properties, effects and/or impacts of health care technology. It may address the direct, intended consequences of technologies as well as their indirect, unintended consequences.... health care technology assessment (hcta)

An establishment primarily engaged in providing inpatient nursing and rehabilitative services to individuals requiring nursing care.... high dependency care facility

See “community-based care”.... home and community-based services; home and community care programme

A public or private organization that provides home health services supervised by a licensed health professional in a person’s home, either directly or through arrangements with other organizations.... home health agency (hha) / home health care agency

See “domiciliary care”.... home health care / home care

Schemes providing nursing care, personal care or practical help for older people who have returned home after a stay in hospital.... home-from-hospital / hospital after-care schemes

A cluster of comprehensive services that address the needs of dying persons and their families, including medical, spiritual, legal, financial and family support services.... hospice care

A range of housing schemes providing high levels of care.... housing with care

See “informal assistance”.... informal care

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

As the needs and demands of patients, and the costs of health care of populations, have risen sharply in recent years, governments and health-care providers – whether tax-funded, insurance-based, employer-provided or a mix of these – have had increasingly to face the dilemma of what services a country or a community can a?ord to provide. As a result, various techniques for deciding priorities of care and treatment are evolving. In the United Kingdom, priorities were for many years based on the decisions of individual clinicians who had wide freedom to prescribe the most appropriate care. Increasingly, this clinical freedom is being circumscribed by managerial, community and political decisions driven in part by the availability of resources and by what people want. Rationing services, however, is not popular and as yet no broadly agreed consensus has emerged, either in western Europe or in North America, as to how priorities can be decided that have broad community support and which can be a?orded. (See CLINICAL GOVERNANCE; EVIDENCE-BASED MEDICINE.)... health-care priorities

The methods and strategies for linking and coordinating the various aspects of care delivered by different care systems, such as the work of general practitioners, primary and specialty care, preventive and curative services, and acute and long-term care, as well as physical and mental health services and social care, to meet the multiple needs/problems of an individual client or category of persons with similar needs/problems.... integrated care

The origin of this important branch of medicine lies in the e?ective use of positive-pressure VENTILATION of the lungs to treat respiratory breathing failure in patients affected by POLIOMYELITIS in an outbreak of this potentially fatal disease in Denmark in 1952. Doctors reduced to 40 per cent, the 90 per cent mortality in patients receiving respiratory support with the traditional cuirass ventilator by using the new technique. They achieved this with a combination of manual positive-pressure ventilation provided through a TRACHEOSTOMY by medical students, and by looking after the patients in a speci?c area of the hospital, allowing the necessary sta?ng and equipment resources to be concentrated in one place.

The principle of one-to-one, 24-hours-a-day care for seriously ill patients has been widely adopted and developed for the initial treatment of many patients with life-threatening conditions. Thus, severely injured patients – those with serious medical conditions such as coronary thrombosis or who have undergone major surgery, and individuals suffering from potentially lethal toxic affects of poisons – are treated in an INTENSIVE THERAPY UNIT (ITU). Patients whose respiratory or circulatory systems have failed bene?t especially by being intensively treated. Most patients, especially post-operative ones, leave intensive care when their condition has been stabilised, usually after 24 or 48 hours. Some, however, need support for several weeks or even months. Since 1952, intensive medicine has become a valued specialty and a demanding one because of the range of skills needed by the doctors and nurses manning the ITUs.... intensive care medicine

Care provided in geriatric centres and acute hospitals to older persons who are in need of limited medical care and who are awaiting nursing home placement.... interim nursing home care

An institution which is licensed to provide, on a regular basis, health-related care and services to individuals who do not require the degree of care or treatment which a hospital or skilled nursing facility is designed to provide.... intermediate care facility (icf)

A classification of diseases, conditions and other reasons for attendance for primary care. This classification is an adaptation of the ICD but makes allowance for the diagnostic uncertainty that prevails in primary care.... international classification of health problems in primary care (ichppc)

The official classification of the World Organisation of Family Doctors. It includes three elements of the doctor-patient encounter: the reason for the encounter; the diagnosis; and the treatment or other action or intervention.... international classification of primary care (icpc)

A range of health care, personal care and social services provided to individuals who, due to frailty or level of physical or intellectual disability, are no longer able to live independently. Services may be for varying periods of time and may be provided in a person’s home, in the community or in residential facilities (e.g. nursing homes or assisted living facilities). These people have relatively stable medical conditions and are unlikely to greatly improve their level of functioning through medical intervention.... long-term care (ltc) / long-term aged care

See “high dependency care facility”.... long-term care facility

Insurance policies which pay for long-term care services (such as nursing home and home care) that are generally not covered by other health insurance.... long-term care insurance

A health plan that uses managed care arrangements and has a defined system of selected providers who contract with the plan. Those enrolled have a financial incentive to use participating providers who agree to furnish a broad range of services to them. Providers may be paid on a pre-negotiated basis.... managed care plan

This process aims to reduce the costs of health care while maintaining its quality. The concept originated in the United States but has attracted interest in the United Kingdom and Europe, where the spiralling costs of health care have been causing widespread concern. Managed care works through changing clinical practice, but it is not a discrete entity: the American I. J. Iglehart has de?ned it as ‘a variety of methods of ?nancing and organising the delivery of comprehensive health care in which an attempt is made to control costs by controlling the provision of services’. Managed care has three facets: health policy; how that policy is managed; and how individuals needing health care are dealt with. The process and its applications are still evolving and it is likely that di?erent health-care systems will adapt it to suit their own particular circumstances.... managed health care

This was set up under the CARE STANDARDS ACT 2000 as an independent regulator in respect of homes for the elderly, the disabled and children in the state and private sectors in the UK.... national care standards commission

The provision of a dedicated unit with special facilities, including one-to-one nursing and appropriate technology, for caring for premature and seriously ill newborn babies. Paediatricians and neonatologists are involved in the running of such units. Not every maternity unit can provide intensive care: for example, the provision of arti?cial ventilation, other than as a holding procedure until a baby can be transferred to a better-equipped and better-serviced unit. Such hospitals tend to have special-care baby units, which are capable of looking after the needs of most, but not all, premature or ill babies.... neonatal intensive care

See “care plan”.... patient care planning

An approach to care that consciously adopts a patient’s perspective. This perspective can be characterized around dimensions such as respect for patients’ values, preferences and expressed needs; coordination and integration of care; information, communication and education; physical comfort, emotional support and alleviation of fear and anxiety; involvement of family and friends; or transition and continuity.... patient-centred care

Assistance with those functions and activities normally associated with body hygiene, nutrition, elimination, rest and ambulation, which enables an individual to live at home or in the community.... personal care

See “care plan”.... personal care plan

See “care plan”.... plan of care

Action taken to prevent CONCEPTION after sexual intercourse. The type of contraception may be hormonal, or it may be an intrauterine device (see below, and under CONTRACEPTION). Pregnancy after intercourse without contraception – or where contraception has failed as a result, for example, of a leaking condom – may be avoided with a course of ‘morning-after’ contraceptive pills. Such preparations usually contain an oestrogen (see OESTROGENS) and a PROGESTOGEN. Two doses should be taken within 72 hours of ‘unprotected’ intercourse. An alternative for the woman is to take a high dose of oestrogen on its own. The aim is to postpone OVULATION and to affect the lining of the UTERUS so that the egg is unable to implant itself.

Intrauterine contraceptive device (IUCD) This, in e?ect, is a form of post-coital contraception. The IUCD is a plastic shape up to 3 cm long around which copper wire is wound, carrying plastic thread from its tail. Colloquially known as a coil, it acts by inhibiting implantation and may also impair migration of sperm. Devices need changing every 3–5 years. Coils have generally replaced the larger, non-copper-bearing ‘inert’ types of IUCD, which caused more complications but did not need changing (so are sometimes still found in situ). They tend to be chosen as a method of contraception (6 per cent) by older, parous women in stable relationships, with a generally low problem rate.

Nevertheless, certain problems do occur with IUCDs, the following being the most common:

They tend to be expelled by the uterus in women who have never conceived, or by a uterus distorted by, say, ?broids.

ECTOPIC PREGNANCY is more likely.

They are associated with pelvic infection and INFERTILITY, following SEXUALLY TRANSMITTED DISEASES (STDS) – or possibly introduced during insertion.

They often produce heavy, painful periods (see MENSTRUATION), and women at high risk of these problems (e.g. women who are HIV positive [see AIDS/HIV], or with WILSON’S DISEASE or cardiac lesions) should generally be excluded – unless the IUCD is inserted under antibiotic cover.... post-coital contraception

A test for INFERTILITY. A specimen of cervical mucus, taken up to 24 hours after coitus (during the post-ovulatory phase of the menstrual cycle), is examined microscopically to assess the motility of the sperms. If motility is above a certain level, then sperms and mucus are not interacting abnormally – thus eliminating one cause of sterility.... post-coital test

Also called an autopsy (and less commonly, necropsy), this is an examination of a body to discover the causes of death. Such an examination is sometimes required by law. An unnatural death; a death occurring in suspicious circumstances; or a death when a doctor feels unable to complete a certi?cate about the cause – all must be reported to the CORONER (in Scotland, to the procurator ?scal). He or she may order an autopsy to be carried out as part of the inquiry into cause of death. Sometimes doctors may request the permission of relatives to perform a post-mortem so that they may discover something of value for the improvement of medical care. Relatives may refuse consent. (See also DEATH, CAUSES OF.)... post-mortem examination

The period after an operation, the patient’s condition after operation, or any investigations or treatment during this time.... post-operative

The term applied to anything happening immediately after childbirth: for example, postpartum haemorrhage. (See also PREGNANCY AND LABOUR.)... post-partum

A term introduced to PSYCHIATRY in 1980 after the Vietnam War. It is one of several psychiatric disorders that can develop in people exposed to severe trauma, such as a major physical injury, participation in warfare, assault or rape, or any event in which there is major loss of life or a threat of loss of life. Most people exposed to trauma do not develop psychiatric disorder; however, some develop immediate distress and, occasionally, the reaction can be delayed for many months. Someone with PTSD has regular recurrences of memories or images of the stressful event (‘?ashbacks’), especially when reminded of it. Insomnia, feelings of guilt and isolation, an inability to concentrate and irritability may result. DEPRESSION is very common. Support from friends and family is probably the best management, but those who do not recover quickly can be helped by antidepressants and psychological treatments such as COGNITIVE BEHAVIOUR THERAPY. Over the past few years, PTSD has featured increasingly in compensation litigation.... post-traumatic stress disorder (ptsd)

Care that has the aim of preventing disease or its consequences. It includes health care programmes aimed at warding off illnesses, early detection of disease, and inhibiting further deterioration of the body.... preventive care

Sometimes called primary medical care, this is the care provided by a GENERAL PRACTITIONER (GP) – traditionally entitled the family doctor – or other health professionals who have ?rst contact with a patient needing or wanting medical attention. In the NHS, the primary health-care services include those provided by the general, dental, ophthalmic and pharmaceutical services as well as the family doctor service. Community health services provided outside the hospitals also o?er some primary health care.... primary health care

The provision of medical and dental care to patients who pay for the care either directly, through private medical insurance, or through employer-funded private insurance. In the UK, most patients are treated and cared for by the community- or hospital-based NHS. Although not forbidden to do so, few NHS general practitioners see private patients. NHS consultants are – within certain prescribed circumstances – allowed to treat private patients and many, especially surgeons, do so; but consultations and treatment are usually done on private-health premises. Some NHS hospitals have private facilities attached, but most private care is carried out in separate, privately run clinics and hospitals.

Certain specialties – for example, orthopaedic and reconstructive/cosmetic surgery and mental health – attract more private patients than others, such as paediatrics or medicine for the elderly. The standards of clinical care are generally the same in the two systems, but private patients can see the specialist of their choice at a time convenient to them. Waiting times for consultations and treatment are short and, when in hospital, private patients usually have their own room, telephone, TV, open visiting hours, etc.

A substantial proportion of private medical-care services are those provided for elderly people requiring regular nursing care and some medical supervision. The distinction between residential care and nursing care for the elderly is often blurred, but the government policy of providing means-tested state funding only for people genuinely needing regular nursing care – a system operated by local-authority social-service departments in England and Wales – has necessitated clearer de?nitions of the facilities provided for the elderly by private organisations. The strict criteria for state support (especially in England), the budget-conscious approach of local authorities when negotiating fees with private nursing homes, and the fact that NHS hospital trusts also have to pay for some patients discharged to such homes (to free-up hospital beds for new admissions) have led to intense ?nancial pressures on private facilities for the elderly. This has caused the closure of many homes, which, in turn, is worsening the level of BED-BLOCKING by elderly patients who do not require hospital-intensity nursing but who lack family support in the community and cannot a?ord private care.... private health care

The degree to which delivered health services meet established professional standards and are judged to be of value to the consumer. Quality may also be seen as the degree to which actions taken or not taken maximize the probability of beneficial health outcomes and minimize risk and other outcomes, given the existing state of medical science and art.... quality of care

Inefficient functioning of the kidney, leading to death unless acute medical attention is available. Envenomation (especially snake bite) is a common cause, as well as a range of medical conditions, including infection..... renal failure (acute)

See “residential care”; “assisted living facility”.... residential aged care facility

Provides accommodation and other care, such as domestic services (laundry, cleaning), help with performing daily tasks (moving around, dressing, personal hygiene, eating) and medical care (various levels of nursing care and therapy services). Residential care is for older people with physical, medical, psychological or social care needs which cannot be met in the community.... residential care

Accommodation and support for people who can no longer live at home.... residential care services

Services provided in the home, at a day care centre or by temporary placement in a nursing home or residential home to functionally disabled or frail individuals to provide occasional or systematic relief to informal caregivers.... respite care

Services provided to older people on a short-term basis to restore their physical condition to a level which would allow them to return home with appropriate support. See “rehabilitation”.... restorative care

Health activities, including promotion, maintenance, treatment, care and health related decision-making, carried out by individuals and families.... self care

See SARS.... severe acute respiratory syndrome (sars)

Involves care designed to improve the physical wellbeing and restore the health of older people to an optimum level following a serious illness.... short-term aged care

“Higher level” of care (such as injections, catheterization and dressing changes) provided by trained health professionals, including nurses, doctors and therapists.... skilled care

Daily nursing and rehabilitative care that can only be performed by, or under the supervision of, skilled nursing personnel.... skilled nursing care

Assistance with the activities of daily life (personal care, domestic maintenance, self-direction) delivered by a personal care helper, home helper or social worker and aimed at supporting older people who experience disabilities in functioning.... social care service

See “informal care”.... social network care

A long-term care facility unit with services specifically for persons with particular diseases, disorders or injuries.... special care unit

Nursing care needs that require the advanced and specialized clinical skills and knowledge of a registered nurse.... specialized nursing care needs

People or groups who have an involvement or interest in the aged care system, including beneficiaries, providers and funders.... stakeholders (in aged care)

Major government schemes to ensure adequate health services to substantial sectors of the community through direct provision of services.... state medicine (health care systems)

Sub-acute care is a bridge between acute care and home care. It is medical and skilled nursing services provided to persons who are not in the acute phase of an illness but who require a level of care higher than that provided in a long-term care setting.... sub-acute care

A type of short-term care provided by some long-term care facilities and hospitals, which may include rehabilitation services, specialized care for certain conditions (such as stroke and diabetes) and/or post-surgical care and other services associated with the transition between hospital and home.... transitional care

Necrosis. Fatal disease in which the substance of the liver is destroyed. Incidence is rare since the public has been alerted to the dangers of certain chemical toxins, fumes from synthetic glues, solvents, and poisonous fungi.

Symptoms: jaundice, delirium and convulsions.

As it is the work of the liver to neutralise incoming poisons it may suffer unfair wear and tear, alcohol and caffeine being common offenders.

Treatment for relief of symptoms only: same as for abscess of the liver.

Treatment by or in liaison with a general medical practitioner. ... liver – acute yellow atrophy

Care of the mother after childbirth until about 6 weeks later.... postnatal care

Glomerulonephritis. Recognised by slight puffiness of the eyes and a dropsical accumulation of fluid in body cavities. Blood pressure rises. Appetite disappears. Digestion is deranged, urine may be blood-stained and a variety of symptoms present as dizziness, headache, nausea. Commonly caused by post streptococcal throat infection circulating in the blood, yet it is now known that the condition may arise from exposure to common garden insecticides and toxic substances of commercial importance that alter the body’s immune system and affect kidney function.

Acute toxic nephritis is possible in the convalescent stage of scarlet and other infectious fevers, even influenza. Causes are legion, including septic conditions in the ear, nose, throat, tonsils, teeth or elsewhere. Resistance to other infections will be low because of accumulation of toxins awaiting elimination. When protein escapes from the body through faulty kidneys general health suffers.

This condition should be treated by or in liaison with a qualified medical practitioner.

Treatment. Bedrest essential, with electric blanket or hot water bottle. Attention to bowels; a timely laxative also assists elimination of excessive fluid. Diuretics. Diaphoretics. Abundant drinks of bottled water or herb teas (3-5 pints daily). Alkaline drinks have a healing effect upon the kidneys. Juniper is never given for active inflammation.

Useful teas. Buchu, Cornsilk, Couchgrass, Clivers, Bearberry, Elderflowers, Marshmallow, Mullein, Marigold flowers, Wild Carrot, Yarrow.

Greece: traditional tea: equal parts, Agrimony, Bearberry, Couchgrass, Pellitory.

Powders. Equal parts: Dandelion, Cornsilk, Mullein. Dose: 750mg (three 00 capsules or half teaspoon) every 2 hours. In water or cup of Cornsilk tea.

Tinctures. Equal parts: Buchu, Elderflowers, Yarrow. Mix. Dose: 1-2 teaspoons in water or cup of Cornsilk tea, every two hours.

Topical. Hot poultices to small of the back; flannel or other suitable material saturated with an infusion of Elderflowers, Goldenrod, Horsetail or Yarrow. Herbal treatment offers a supportive role. ... bright’s disease (acute)

Extreme anguish after birth of a child. Mental illness: “sinking into gloom”. Baby blues. Bursting into tears; every small problem seems magnified; agoraphobic tendency. Etiology. Some mothers have a genetic predisposition to the condition. Death of a close relative, stressful pregnancy, redundancy, moving house, or sheer physical and mental exhaustion.

Treatment. Conventional medicine advises strong anti-depressants. Alternatives, until “hormones settle down”: Agnus Castus, Helonias, Milk Thistle. Raspberry leaf tea (tablets/capsules/liquid extracts/tinctures). Special attention to the thyroid gland.

Diet. See: GENERAL DIET.

Supplements. Vitamins: B group, E. Minerals: Calcium, Iodine, Magnesium, Zinc. Tyrosine. Supportives: Astute GP, helpful health visitor, thoughtful husband. ... depression – post-natal

See oral hygiene.... teeth, care of

A set of symptoms, usually affecting women, that are very similar to cystitis but which occur in the absence of infection.... urethral syndrome, acute

the sudden uncontrolled development of severe abdominal symptoms secondary to disease or injury. Failure to establish a prompt diagnosis may lead to rapid clinical decline. Perforation of a peptic ulcer, an inflamed appendix or colonic diverticulum, or rupture of the liver or spleen following a crush injury all produce an acute abdomen requiring urgent treatment.... acute abdomen

a combination of angina (unstable or stable), non-S–T elevation *myocardial infarction (NSTEMI), and S–T elevation myocardial infarction (STEMI). It implies the presence of coronary artery disease.... acute coronary syndrome

a rare and life-threatening complication of pregnancy that usually presents in the third trimester with symptoms of nausea, vomiting, malaise, and abdominal pain. Liver function tests are abnormal and the features of *pre-eclampsia and often *HELLP syndrome are present. *Hepatic encephalopathy, *disseminated intravascular coagulation, and renal failure may develop, and the condition is associated with a high maternal and fetal mortality. Treatment involves a multidisciplinary approach, usually in an intensive care unit.... acute fatty liver of pregnancy

Hair, like nails and skin, is a protein material built up on amino acids. It is rich in minerals, especially sulphur. A sebaceous gland at the base of the hair follicle secretes sebum, an oily substance, which acts as a lubricant. When vital minerals and vitamins are lacking in the blood the quality of fibre and sebum deteriorates resulting in lustreless hair and change of texture. Healthy hair depends upon good personal hygiene, brushing, and washing with gentle-acting materials instead of harsh detergent shampoos which remove natural oils from the scalp and spoils its condition.

An adequate daily intake of essential fatty acids is assured by the golden oils (Sunflower, Corn, etc) which can be well supported by Evening Primrose oil capsules.

Internal: Bamboo gum. Nettle tea, Alfalfa, Horsetail, Soya.

Topical. Shampoo. Soapwort or Yucca. Chop 2 tablespoons (dry) or 1 tablespoon (fresh) leaves or root. Place in cup of warm water. Stir until a froth is produced. Decant and massage liquor into scalp.

Aloe Vera gel is noted for its moisturising effect and to provide nutrients. It may be used as a shampoo, hair set and conditioner. Jojoba oil has been used for centuries by the Mexican Indians for a healthy scalp; today, it is combined with Evening Primrose and Vitamin E with good effect. Olive oil stimulates strong growth.

One of several herbs may be used as a rinse, including Nettles, Rosemary, Southernwood, Fennel, Chamomile, Yellow Dock and Quassia. Hair should be washed not more than once weekly with warm water and simple vegetable soap; rinse four times with warm rinse, finishing off with cold. Brunettes should add a little vinegar; blondes, lemon juice. Selenium once had a reputation as a hair conditioner; recent research confirms. Selenium shampoos are available.

Supplements: Vitamins B (complex), B6, Choline, C and E. Copper, Zinc, Selenium, Vitamin B12 (50mg thrice daily).

Aromatherapy. 2 drops each: Sage, Nettles, Thyme; to 2 teaspoons Gin or Vodka, and massage into the scalp daily. ... hair care

 Inflammation of the vocal cords. May be associated with the common cold, influenza, and other viral or bacterial infections.

Causes: smoking, mis-use of the voice in talking or singing (Ginseng).

Symptoms: voice husky or absent (aphonia). Talking causes pain. Self-limiting.

Treatment. Stop talking for 2 days. Care is necessary: neglect or ineffective treatment may rouse infection and invade the windpipe and bronchi resulting in croup.

Differential: croup is alerted by high fever and characteristic cough, requiring hospital treatment. Alternatives. Teas: Red Sage. Garden Sage. Thyme, wild or garden.

Effective combination: equal parts, Sage and Raspberry leaves. Used also as a gargle.

Tablets/capsules. Poke root. Lobelia. Iceland Moss.

Cinnamon. Tincture, essence or oil of: 3-5 drops in teaspoon honey.

Horseradish. 1oz freshly scraped root to steep in cold water for two hours. Add 2 teaspoons runny honey. Dose: 2-3 teaspoons every two hours.

Topical. Equal parts water/cider vinegar cold pack round throat. Renew when dry.

Traditional: “Rub soles of the feet with Garlic and lard well-beaten together, overnight. Hoarseness gone in the morning.” (John Wesley) Friar’s balsam.

Aromatherapy. Steam inhalations. Oils: Bergamot, Eucalyptus, Niaouli, Geranium, Lavender, Sandalwood.

Diet. Three-day fruit fast.

Supplements. Daily. Vitamin A (7500iu). Vitamin C (1 gram thrice daily). Beta carotene 200,000iu. Zinc 25mg. ... laryngitis, acute

Inflammation of the liver from virus infection. As the commonest form of liver disorder, it is often without jaundice or marked liver symptoms apart from general malaise and abdominal discomfort, ‘Gippy tummy’, ‘chill on the liver’. For feverishness, add a diaphoretic.

Treatment. Bitter herbs keep the bile fluid and flowing.

Alternatives. Teas. Agrimony, Lemon Balm, Boldo, Bogbean, Centuary, Dandelion, Hyssop, Motherwort, Wormwood, Yarrow.

Maria Treben. Equal parts: Bedstraw, Agrimony, Woodruff. 2 teaspoons to cup boiling water.

Cold tea: 2 teaspoons Barberry bark to each cup cold water. Infuse overnight. Half-1 cup freely. Tablets/capsules: Blue Flag. Dandelion. Wild Yam. Liquorice.

Formula. Equal parts: Turkey Rhubarb, Dandelion, Meadowsweet. Dose: Liquid Extracts: 1-2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). 3-4 times daily. Alfred Vogel. Dandelion, Devil’s Claw, Artichoke.

Antonius Musa, physician to Emperor Augustus Caesar records: “Wood Betony preserves the liver and bodies of men from infectious diseases”.

Preventative: Garlic. (Old Chinese)

Milk Thistle: good responses observed.

General. Bedrest until motions are normal. Enema with any one of above herb teas.

Diet. Fat-free. Fasting period from 1-3 days on fruit juices and herb teas only. Artichokes. Dandelion coffee. Lecithin.

See: COCKROACH, The.

Treatment by or in liaison with a general medical practitioner. ... liver – acute infectious hepatitis

(toxic pustuloderma) a reaction to a medication, resulting in the appearance of fine sterile *pustules on inflamed skin; the pustules may easily be overlooked. Common causes include penicillins, and pustular psoriasis must be excluded from the diagnosis.... acute generalized exanthematous pustulosis

see AKI.... acute kidney injury

acute kidney injury (see AKI).... acute renal failure

see adult respiratory distress syndrome.... acute respiratory distress syndrome

(ARF) a primary disorder of gaseous exchange (as distinct from failure of the mechanical process of breathing). The prototype of ARF is *adult respiratory distress syndrome, but the term sometimes also refers to disruption of any other part of the respiratory system, including the respiratory control centre in the brain with its *efferent and *afferent pathways.... acute respiratory failure

(ARN) severe inflammation and necrosis of the retina associated with inflammation and blockage of retinal blood vessels, haemorrhage and death of retinal tissue, and retinal detachment. It may affect both eyes (bilateral acute retinal necrosis, BARN), and visual prognosis is poor. ARN is thought to be due to viral infection.... acute retinal necrosis

Physical and psychological care with the aim of making the final period of a dying person’s life as free from pain, discomfort, and emotional distress as possible. Carers may include doctors, nurses, other medical professionals, counsellors, social workers, clergy, family, and friends.

Pain can be relieved by regular low doses of analgesic drugs. Opioid analgesics, such as morphine, may be given if pain is severe. Other methods of pain relief include nerve blocks, cordotomy, and TENS. Nausea and vomiting may be controlled by drugs. Constipation can be treated with laxatives. Breathlessness is another common problem in the dying and may be relieved by morphine.

Towards the end, the dying person may be restless and may suffer from breathing difficulty due to heart failure or pneumonia. These symptoms can be relieved by drugs and by placing the patient in a more comfortable position.

Emotional care is as important as the relief of physical symptoms.

Many dying people feel angry or depressed and feelings of guilt or regret are common responses.

Loving, caring support from family, friends, and others is important.

Many terminally ill people prefer to die at home.

Few terminally ill patients require complicated nursing for a prolonged period.

Care in a hospice may be offered.

Hospices are small units that have been established specifically to care for the dying and their families.... dying, care of the

Painful infection and ulceration of the gums due to abnormal growth of bacteria that usually exist harmlessly in small numbers in gum crevices. Predisposing factors include poor oral hygiene, smoking, throat infections, and emotional stress. In many cases the disorder is preceded by gingivitis or periodontitis. The condition is uncommon, primarily affecting people aged 15–35.

The gums become sore and bleed at the slightest pressure. Crater-like ulcers develop on the gum tips between teeth, and there may be a foul taste in the mouth, bad breath, and swollen lymph nodes. Sometimes, the infection spreads to the lips and cheek lining (see noma).

A hydrogen peroxide mouthwash can relieve the inflammation.

Scaling is then performed to remove plaque.

In severe cases, the antibacterial drug metronidazole may be given to control infection.... gingivitis, acute ulcerative

Short-term inflammation of the liver, which usually recovers in 1–2 months. In some cases, acute hepatitis may progress to chronic hepatitis (see hepatitis, chronic), but it rarely leads to acute liver failure.

Acute hepatitis is fairly common.

The most frequent cause is infection with one of the hepatitis viruses (see hepatitis, viral), but it can arise as a result of other infections such as cytomegalovirus infection or Legionnaires’ disease.

It may also occur as a result of overdose of halothane or paracetamol or exposure to toxic chemicals including alcohol (see liver disease, alcoholic).

Symptoms range from few and mild to severe with pain, fever, and jaundice.

Blood tests, including liver function tests, may be used for diagnosis.

In most cases of acute viral hepatitis, natural recovery occurs within a few weeks.

If the disorder is caused by exposure to a chemical or drug, detoxification using an antidote may be possible.

Intensive care may be required if the liver is badly damaged.

Rarely, a liver transplant is the only way of saving life.

In all cases, alcohol should be avoided.... hepatitis, acute

A type of leukaemia in which excessive numbers of immature white blood cells called blasts are produced in the bone marrow. If untreated, acute leukaemia can be fatal within a few weeks or months. The abnormal cells may be of 2 types: lymphoblasts (immature lymphocytes) in acute lymphoblastic leukaemia, and myeloblasts (immature forms of other types of white cell) in acute myeloblastic leukaemia.

Exposure to certain chemicals (such as benzene and some anticancer drugs) or high levels of radiation may be a cause in some cases. Inherited factors may also play a part; there is increased incidence in people with certain genetic disorders (such as Fanconi’s anaemia) and chromosomal abnormalities (such as Down’s syndrome). People with blood disorders such as chronic myeloid leukaemia (see leukaemia, chronic myeloid) and primary polycythaemia are at increased risk, as their bone marrow is already abnormal.

The symptoms and signs of acute leukaemia include bleeding gums, easy bruising, headache, bone pain, enlarged lymph nodes, and symptoms of anaemia, such as tiredness, pallor, and breathlessness on exertion. There may also be repeated chest or throat infections. The diagnosis is based on a bone marrow biopsy. Treatment includes transfusions of blood and platelets, the use of anticancer drugs, and possibly radiotherapy. A bone marrow transplant may also be required. The outlook depends on the type of leukaemia and the age of the patient. Chemotherapy has increased success rates and 6 in 10 children with the disease can now be cured, although treatment is less likely to be completely successful in adults.... leukaemia, acute

see rheumatic fever.... acute rheumatism

(ATN) a condition caused by acute renal injury from either ischaemia or toxins and associated with tubular damage that is usually reversible. The earliest feature is *isosthenuria, which may occur while there is still a high urine flow rate. This is followed by a reduction in *glomerular filtration rate. *Oliguria is common and dialysis often needed for survival. If the cause of the initial damage can be removed, recovery of renal function within six weeks can be expected in most cases.... acute tubular necrosis

(ACA)... affordable care act 2010

a person who helps with the general care of a patient, usually assisting a nurse or social worker with care of the vulnerable elderly in the community. Care assistants include home helps.... care assistant

(HSCIC) formerly, an executive nondepartmental public body set up in April 2013 to collect, analyse, and publish UK national health data and supply IT systems and services to health-care providers nationwide. It was rebranded as *NHS Digital in August 2016.... health and social care information centre

(CQC) a publicly funded independent organization established in 2009 and responsible for regulation of health and social care in England; it replaced the Healthcare Commission, the Commission for Social Care Inspection, and the Mental Health Act Commission. The responsibilities of the commission include publication of national health-care standards; annual assessment of the performance of NHS and social-care organizations; reviewing other (i.e. private and voluntary) health- and social-care organizations; reviewing complaints about the services when it has not been possible to resolve them locally; and investigating serious service failures.... care quality commission

any of several professionals supporting a dentist, formerly referred to as dental auxiliaries and professionals complementary to dentistry. A dental hygienist performs scaling and instruction in oral hygiene. A dental nurse helps the dentist at the chairside by preparing materials, passing instruments, and aspirating fluids from the patient’s mouth. A dental technician constructs dentures, crowns, and orthodontic appliances in the laboratory for the dentist. A clinical dental technician provides dentures directly to patients. A dental therapist performs non-complex treatment under the prescription of a dentist. In the UK dental care professionals are required to be statutorily registered with the General Dental Council (GDC).... dental care professional

(DHSC) (in Britain) a department of central government that supports the Secretary of State for Health and Social Care in meeting his or her obligations, which include the *National Health Service, the promotion and protection of the health of the nation, and social care, including some oversight of personal social services provided by local authorities. The department is staffed by civil servants, including some health professionals. Following the reforms of the Health and Social Care Act 2012, the Department no longer has direct control of the NHS, which has passed to *NHS England. The name of the department was expanded from ‘Department of Health’ in 2018. Equivalent departments support the ministers responsible for health services in Scotland, Wales, and Northern Ireland.

DHSC section of the website: provides information on a wide range of public health issues... department of health and social care

identifying services required to meet population health-care needs and obtaining such services from an appropriate service provider via allocation of resources and contracting arrangements. Commissioners monitor the quality of commissioned services, including adherence to any appropriate national standards. Most NHS commissioning is undertaken by *clinical commissioning groups or *NHS England.... health-care commissioning

a multidisciplinary plan for delivering health and social care to patients with a specific condition or set of symptoms. Such plans are often used for the management of common conditions and are intended to improve patient care by reducing unnecessary deviation from best practice. See clinical governance.... integrated care pathway

an ironic ‘law’ stating that where good health care is most needed, it is usually least available. It was first stated by the Welsh GP Tudor Hart to underline the great difficulty in bringing areas of health-care poverty up to acceptable levels. See health inequalities; justice; need; rationing.... inverse care law

acute kidney injury caused by myoglobin that is released from damaged skeletal muscle (*rhabdomyolysis). This is usually the result of trauma and the condition was first recognized in victims trapped and crushed during the London Blitz. Muscle injury can also occur with pressure necrosis, particularly in the unconscious or immobile patient, or with a *compartment syndrome. Rarely it may complicate intensive muscular exercise or extensive viral myositis and it is a recognized complication of modest overexertion in some inherited disorders of muscle metabolism, such as *McArdle’s disease.... myoglobinuric acute renal failure

see NICE.... national institute for health and care excellence

(PPACA) see Affordable Care Act 2010.... patient protection and affordable care act

an approach to health care that focuses on the needs of the individual care user, rather than providing a standardized response to their condition. The patient is encouraged to take an active role in discussing a health-care plan that reflects their own needs, circumstances, and values.... person-centred care

Latin: after death. See autopsy.... post mortem

insidious numbness in muscles that develops 15–20 years after an attack of *poliomyelitis; the muscles may or may not have been previously affected. It may be caused by loss of nerve cells that have been under greater strain than normal as a result of the polio; there is no evidence of reactivation of the poliovirus. The syndrome also includes other symptoms, such as fatigue and pain, which may be due to secondary mechanical causes.... post-polio syndrome

n. (in radiology) the electronic manipulation of digitally acquired images (see digitization) following an examination in order to improve diagnostic accuracy or to improve and optimize visualization.... post-processing

medical care given to an individual who has survived a *cardiac arrest. This will usually consist of a 12-lead electrocardiogram (see lead2), a chest X-ray, a number of venous and arterial blood tests, and transfer to a high-dependency or coronary care unit for further intensive monitoring and drug administration.... postresuscitation care

a pregnancy that has gone beyond 42 weeks gestation or 294 days from the first date of the last menstrual period.... post-term pregnancy

see PICU.... psychiatric intensive care unit

Acne (M,S,F,B,I,N):

Bergamot, camphor (white), cananga, cedarwood (Atlas, Texas & Virginian), chamomile (German & Roman), clove bud, galbanum, geranium, grapefruit, immortelle, juniper, lavandin, lavender (spike & true), lemon, lemongrass, lime, linaloe, litsea cubeba, mandarin, mint (peppermint & spearmint), myrtle, niaouli, palmarosa, patchouli, petitgrain, rosemary, rosewood, sage (clary & Spanish), sandalwood, tea tree, thyme, vetiver, violet, yarrow, ylang ylang.

Allergies (M,S,F,B,I):

Melissa, chamomile (German & Roman), immortelle, true lavender, spikenard.

Athlete’s foot (S):

Clove bud, eucalyptus, lavender (true &spike), lemon, lemongrass, myrrh, patchouli, tea tree.

Baldness & hair care (S,H):

West Indian bay, white birch, cedarwood (Atlas, Texas & Virginian), chamomile (German & Roman), grapefruit, juniper, patchouli, rosemary, sage (clary & Spanish), yarrow, ylang ylang.

Boils, abscesses & blisters (S,C,B):

Bergamot, chamomile (German & Roman), eucalyptus blue gum, galbanum, immortelle, lavandin, lavender (spike & true), lemon, mastic, niaouli, clary sage, tea tree, thyme, turpentine.

Bruises (S,C):

Arnica (cream), borneol, clove bud, fennel, geranium, hyssop, sweet marjoram, lavender, thyme.

Burns (C,N):

Canadian balsam, chamomile (German & Roman), clove bud, eucalyptus blue gum, geranium, immortelle, lavandin, lavender (spike & true), marigold, niaouli, tea tree, yarrow.

Chapped & cracked skin (S,F,B):

Peru balsam, Tofu balsam, benzoin, myrrh, patchouli, sandalwood.

Chilblains (S,N):

Chamomile (German & Roman), lemon, lime, sweet marjoram, black pepper.

Cold sores/herpes (S):

Bergamot, eucalyptus blue gum, lemon, tea tree.

Congested & dull skin (M,S,F,B,I):

Angelica, white birch, sweet fennel, geranium, grapefruit, lavandin, lavender (spike & true), lemon, lime, mandarin, mint (peppermint & spearmint), myrtle, niaouli, orange (bitter & sweet), palmarosa, rose (cabbage & damask), rosemary, rosewood, ylang ylang.

Cuts/sores (S,C):

Canadian balsam, benzoin, borneol, cabreuva, cade, chamomile (German & Roman), clove bud, elemi, eucalyptus (blue gum, lemon & peppermint), galbanum, geranium, hyssop, immortelle, lavender (spike & true), lavandin, lemon, lime, linaloe, marigold, mastic, myrrh, niaouli, Scotch pine, Spanish sage, Levant styrax, tea tree, thyme, turpentine, vetiver, yarrow.

Dandruff (S,H):

West Indian bay, cade, cedarwood (Atlas, Texas & Virginian), eucalyptus, spike lavender, lemon, patchouli, rosemary, sage (clary & Spanish), tea tree.

Dermatitis (M,S,C,F,B):

White birch, cade, cananga, carrot seed, cedarwood (Atlas, Texas & Virginian), chamomile (German & Roman), geranium, immortelle, hops, hyssop, juniper, true lavender, linaloe, litsea cubeba, mint (peppermint & spearmint), palmarosa, patchouli, rosemary, sage (clary & Spanish), thyme.

Dry & sensitive skin (M,S,F,B):

Peru balsam, Tolu balsam, cassie, chamomile (German & Roman), frankincense, jasmine, lavandin, lavender (spike & true), rosewood, sandalwood, violet.

Eczema (M,S,F,B):

Melissa, Peru balsam, Tolu balsam, bergamot, white birch, cade, carrot seed, cedarwood (Atlas, Texas & Virginian), chamomile (German & Roman), geranium, immortelle, hyssop, juniper, lavandin, lavender (spike & true), marigold, myrrh, patchouli, rose (cabbage & damask), rosemary, Spanish sage, thyme, violet, yarrow.

Excessive perspiration (S,B):

Citronella, cypress, lemongrass, litsea cubeba, petitgrain, Scotch pine, Spanish sage.

Greasy or oily skin/scalp (M,S,H,F,B):

West Indian bay, bergamot, cajeput, camphor (white), cananga, carrot seed, citronella, cypress, sweet fennel, geranium, jasmine, juniper, lavender, lemon, lemongrass, !itsea cubeba, mandarin, marigold, mimosa, myrtle, niaouli, palmarosa, patchouli, petitgrain, rosemary, rosewood, sandalwood, clary sage, tea tree, thyme, vetiver, ylang ylang.

Haemorrhoids/piles (S,C,B):

Canadian balsam, Copaiba balsam, coriander, cubebs, cypress, geranium, juniper, myrrh, myrtle, parsley, yarrow.

Insect bites (S,N):

French basil, bergamot, cajeput, cananga, chamomile (German & Roman), cinnamon leaf, eucalyptus blue gum, lavandin, lavender (spike & true), lemon, marigold, melissa, niaouli, tea tree, thyme, ylang ylang.

Insect repellent (S,V):

French basil, bergamot, borneol, camphor (white), Virginian cedarwood, citronella, clove bud, cypress, eucalyptus (blue gum & lemon), geranium, lavender, lemongrass, litsea cubeba, mastic, melissa, patchouli, rosemary, turpentine.

Irritated & inflamed skin (S,C,F,B):

Angelica, benzoin, camphor (white), Atlas cedarwood, chamomile (German & Roman), elemi, immortelle, hyssop, jasmine, lavandin, true lavender, marigold, myrrh, patchouli, rose (cabbage & damask), clary sage, spikenard, tea tree, yarrow.

Lice (S,H):

Cinnamon leaf, eucalyptus blue gum, galbanum, geranium, lavandin, spike lavender, parsley, Scotch pine, rosemary, thyme, turpentine.

Mouth & gum infections/ulcers (S,C):

Bergamot, cinnamon leaf, cypress, sweet fennel, lemon, mastic, myrrh, orange (bitter & sweet), sage (clary & Spanish), thyme.

Psoriasis (M,S,F,B):

Angelica, bergamot, white birch, carrot seed, chamomile (German & Roman), true lavender.

Rashes (M,S,C,F,B):

Peru balsam, Tofu balsam, carrot seed, chamomile (German & Roman), hops, true lavender, marigold, sandalwood, spikenard, tea tree, yarrow.

Ringworm (S,H):

Geranium, spike lavender, mastic, mint (peppermint & spearmint), myrrh, Levant styrax, tea tree, turpentine.

Scabies (S):

Tolu balsam, bergamot, cinnamon leaf, lavandin, lavender (spike & true), lemongrass, mastic, mint (peppermint & spearmint), Scotch pine, rosemary, Levant styrax, thyme, turpentine.

Scars & stretch marks (M,S):

Cabreuva, elemi, frankincense, galbanum, true lavender, mandarin, neroli, palmarosa, patchouli, rosewood, sandalwood, spikenard, violet, arrow.

Slack tissue (M,S,B):

Geranium, grapefruit, juniper, lemongrass, lime, mandarin, sweet marjoram, orange blossom, black pepper, petitgrain, rosemary, yarrow.

Spots (S,N):

Bergamot, cade, cajeput, camphor (white), eucalyptus (lemon), immortelle, lavandin, lavender (spike & true), lemon, lime, litsea cubeba, mandarin, niaouli, tea tree.

Ticks (S,N):

Sweet marjoram.

Toothache & teething pain (S,C,N):

Chamomile (German & Roman), clove bud, mastic, mint (peppermint & spearmint), myrrh.

Varicose veins (S,C):

Cypress, lemon, lime, neroli, yarrow.

Verrucae (S,N):

Tagetes, tea tree.

Warts & corns (S,N):

Cinnamon leaf, lemon, lime, tagetes, tea tree.

Wounds (S,C,B):

Canadian balsam, Peru balsam, Tolu balsam, bergamot, cabreuva, chamomile (German & Roman), clove bud, cypress, elemi, eucalyptus (blue gum & lemon), frankincense, galbanum, geranium, immortelle, hyssop, juniper, lavandin, lavender (spike & true), linaloe, marigold, mastic, myrrh, niaouli, patchouli, rosewood, Levant styrax, tea tree, turpentine, vetiver, yarrow.

Wrinkles & mature skin (M,S,F,B):

Carrot seed, elemi, sweet fennel, frankincense, galbanum, geranium, jasmine, labdanum, true lavender, mandarin, mimosa, myrrh, neroli, palmarosa, patchouli, rose (cabbage & damask), rosewood, clary sage, sandalwood, spikenard, ylang ylang.... skin care