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Unlike thinkers purchase 0.4mg flomax prostate cancer icd-9, feelers rely on personal cheap flomax 0.2mg amex prostate cancer 6 medium, subjective feelings in their decisions generic 0.4 mg flomax with mastercard prostate 12 needle biopsy. As empathetic discount 0.4mg flomax with visa mens health malaysia, compassionate, and sensitive people, they take the time to consider how their decision might affect others. Those who prefer judgment are seri ous, time-conscious individuals who live by schedules. Judgers work hard, make decisions quickly and decisively, and sometimes can be closed minded. On the other hand, perceivers are much more open minded, relaxed, and nonconforming. Their flexibility and spon taneity, however, can sometimes lead to irresponsibility. Although judgers need to finish projects and settle all issues, perceivers tend to gather infor mation in a leisurely way before making a final decision. Perceivers prefer to experience as much of the world as possible, so they like to keep their op tions open and are most comfortable adapting. It is the interplay between the four poles that ul timately gives us our individual personality and temperament. A complete description of the 16 personality types can be found on the web site of the Center for Applications of Personality Type. Use the expert feedback and interpretation of your results to learn more about the types of people with whom you work best. Then, as you rotate through the different fields of medicine dur ing the junior year, look closely at each specialist and try to discern their per sonality type. The overall goal is to make sure you know yourself well before determin ing which specialty is right for you. Introverts may become more extroverted, or thinkers might become feelers from one year to the next. Students who were sens ing, thinking, and judging types chose obstetrics and gynecology. Students who were intuitive, feeling, and perceiving types undertook careers in psychiatry. Another study looked closely at the association between these two variables for medical students deciding between primary care and non-primary care spe cialties. Introverts and feelers were more likely to choose primary care, a highly service-oriented area of medicine with the rewards of long term patient relationships. For graduates who chose non-primary care fields, ex troverted thinkers preferred surgical specialties, which is to be expected given the nature of surgical practice—high patient volume, less long-term continuity of care, and clinical situations that require rapid decisions based on facts. Recently, researchers at Louisiana State University updated the original lon gitudinal study done by Myers in the 1950s (see Table 4–1) with new data on doc tors graduating between 1988 and 1998. Introverts and feeling types are more likely to choose primary care because of its nurturing, compassionate aspects. Within primary care, feel ing types are more likely to choose family practice over internal medicine (which has a more technological focus). Sensors—who love more technological, direct approaches with well-learned skills—are more common in surgery (general and orthopedic) as well as obstetrics-gynecology. Intuitives pre fer complex diagnostic challenges and problems with subtle nuances, so they are more likely to become psychiatrists. Thinking types prefer caring for patients where impartiality and stamina are required. They also flock to the surgical spe cialties, where rapid decisions are needed based on hard evidence and facts. Remember—the more you un derstand your temperament and motivations, the less likely you will allow other variables (such as those discussed in Chapter 3) to overshadow them. Simply be aware that working with people with the same personality preferences is an im portant variable to consider. Typically, a physician who switches to a new spe cialty chooses one in which his or her own personality type is much more com mon. After all, medicine is a wonderfully broad profession in which there is an appealing specialty for every personality type! Personality profiles and specialty choices of students from two medical school classes. Changes in medical students’ Myers-Briggs “preferences” be tween their first and fourth years of school. New results relating the Myers-Briggs Type Indicator and medical specialty choice. Choosing the ideal field of medicine requires time, research, and a great deal of thought and investigation. Whether you are a first-year or fourth-year medical student, you need to put in the time to research every specialty under consideration. Procrastination will only lead to a more stressful (and ill-informed) decision—one that may end up being the wrong specialty! This chapter addresses the potential opportunities for students to go about researching medical specialties. Use the different resources and options available to immerse yourself fully in a specific area of medicine. By interacting with other clinicians, you will find out whether that specialty makes good use of your inter ests, preferences, talents, and values. The list may seem daunting, but every stu dent has 4 years in which to take advantage of the many sources of information. These are the only means by which doctors-to-be can figure out answers to many questions: What types of patients do you prefer? By pursuing as many of these options as possible, medical students will better determine their needs and preferences regarding each important variable in specialty selection.

In spite of early onset of significantly within years both in the surgery group after the symptoms buy 0.2mg flomax free shipping prostate cancer 20 year survival rate, diagnosis and initiation of treatment is delayed in the surgery and in the medical group order flomax 0.2 mg overnight delivery prostate cancer 78 years old. There was also no statistical majority cheap 0.4mg flomax with mastercard mens health 2014, leading to flomax 0.2 mg online prostate cancer 6 gleason development of bronchiectasis and significant significance for total number of pulmonary exacerbations pulmonary morbidity[6]. Sputums were the most prevalent medical data including age, body weight, body height, Body Mass specimens with 746/772 samples (96. This is a secondary analysis of a randomized, double-blinded, Methods placebo-controlled trial, including unpublished data on wheezing and hospitalizations during the initial 6 months following admission Observational, longitudinal, descriptive study, with prospective data for acute viral bronchiolitis. The study was performed in a tertiary collection, in a cohort of patients aged 0–11 years, hospitalized with University hospital in Southern Brazil. The process of of hospital stay and identification of respiratory viruses, described selection of independent variables was stepwise forward, level of 5%. Ofthesepatients episode in order to identify recurrent wheezing and hospital with comorbidities, 6/58 (10%) had pneumonia complicated by chest readmissions. In bivariate analysis, patients with comorbidities demon 6 months after the initial acute event and responded to a strated higher chance for age> 60 months (p = 0. Kaplan-Meier analysis showed wheezing was Conclusion significantly reduced in the Azithromycin group (P =0. Data this descriptive, retrospective and cross-sectional study was con from the medical register and the vaccination card were analyzed. Descriptive statistics (frequency, percentages, Results mean,medianandstandarddeviation)andcalculationofpvaluebyFischer’s test (p significant <0. A total of 128 children and adolescents were studied, of which 96/128 (75%) were aged less than 10 years. Among those vaccinated, there sampleswerepositive in 13/81(16%)and negativein 68/81(84%); and were 26/44 (50. Themostassociated comorbiditieswere:neuropathiesand With respect to disease presentation, 51/106 (48%) patients had asthma (7/44 each). The predominant age group was ≥ 5 years old A survey was designed following a Global Tracheostomy (4/ 12–33. Collaborative pediatric interest group meeting and distributed the interstitial infiltrates were the most common changes in to all pediatric member hospitals using Typeform. Questions radiography (6/12, 50%), followed by alveolar changes (4/12, covered the clinical management surrounding the entire process 33. Results We found a greater number of hospitalizations among those < 6 months of age who were not vaccinated (p = 0. Those responding performed a mean of that the hospitalization time was higher among those vaccinated 15 new pediatric tracheostomies per year and 69% of centers had (p = 0. However, the predominant interstitial radiological pattern catheter (100%), a water based lubricant (92%) and scissors (92%). There was Equipmentfeltessentialatbedside included all above plus: a lower frequency of hospitalizations among < 6 months vacci resuscitation bag and mask (92%), spare ties (92%) and O2 nated children. Most (92%) used a process to Nevertheless, vaccinated children apparently had more severe regularly document this equipment. Recommended frequency of outpatient tube changes varied under 6 months may be due to the selection of strains not contained in from every two to four weeks. Indications for considering cuffed tracheostomy tubes included mechanical ventila tion (75%), high leak without a cuffed tube (67%) and aspiration (42%); N. Common indications for suctioning were: inability to cough out secretions (100%), respiratory distress (100%), #N36 − Global Tracheostomy Collaborative Survey on suspected blocked tube (100%), secretions in the tube (92%), request Pediatric Tracheostomy Care. Zhu H 1, Randall D 2, Skinner M 3, Watters K 4, Bossley C 5, 6 4 Most respondents (92%) had discharge criteria for children Harrison J, Roberson D. Areas for further develop hospitalizations and there is variation in management practices for ment include decannulation protocols and transition from pediatric to children following insertion of their tracheostomy. Case Presentation A 13-year-old Caucasian boy was admitted to the hospital in January this year with severe vomiting and dehydration. He had decreased sounds on the left hemithorax and scaphoid abdomen with rare sounds. A laparotomy followed by a thoracotomy revealed a typical Bochdalek hernia with the stomach, small intestine, transverse and ascending colon, spleen, cecum and appendix inside the left thoracic cavity. However, cardiovascular, gastrointestinal, renal and central nervous systems can also be affected. Based on the laboratory data (peripheral eosinophilia), associated with severe D asthma and nasal polyposis, the first suspected diagnosis was allergic Images C and D show failure of diaphragm (green arrows), pulmonary bronchopulmonary aspergillosis, but the Aspergillus serological test hypoplasia (red arrow), spleen (a), small intestine (b) and colon (c) was negative. After some weeks, new symptoms were observed: Discussion gastrointestinal signs, skin lesions with characteristic histological finding and facial paresis. It is generally present in neonates Neither cardiac nor renal involvements were found. Diagnosis is often made by chest X-Ray, but is associated with a high risk of misdiagnosis because of the great variability in radiographic appearance. Once diagnosed, early surgical Problems in Young Children within the Southeast Asian intervention is necessary for the prevention of any complication and Region. Conclusion Pediatrics, National University of Singapore − Singapore, Singapore Congenital diaphragmatic hernia present in late childhood is rare and shows nonspecific symptoms. Hence, a child with recurrent gastroin Background and Objectives testinal or respiratory complaints should be assessed thoroughly and the suspicion of this presentation is needed to successfully diagnose Optimal sleeping habits are important for the health and development and manage this condition properly.

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This section focuses on patients with limited metastatic some patients from unnecessary futile surgery buy flomax 0.4 mg otc prostate cancer veterans. T4 with pleural effusion is classified limited disease in the chest may benefit from aggressive local therapy to 0.4mg flomax mastercard mens health questionnaire both the primary chest and metastatic sites buy flomax 0.2mg otc mens health 9 rules. In certain cases brain metastases because of concerns about neurocognitive Version 2 0.2 mg flomax with amex prostate ablation. Options after an R2 resection include: 1) re-resection and chemotherapy; or 2) concurrent chemoradiation. In patients with separate gemcitabine, or vinorelbine; carboplatin combined with paclitaxel) and pulmonary nodules in the same lobe (T3, N0–1) or ipsilateral also added 2 new carboplatin regimens for patients with comorbidities non-primary lobe (T4, N0–1), surgery is recommended. In patients with or those not able to tolerate cisplatin, including 1) N2 disease and negative margins, options include 1) chemotherapy carboplatin/gemcitabine; and 2) carboplatin/pemetrexed (category 1); or 2) sequential chemotherapy with radiation. Details regarding the specific used for positive margins, but sequential is reasonable in frailer Version 2. For patients with endobronchial obstruction, who have residual abnormalities may require more frequent imaging. Information about smoking cessation (eg, advice, counseling, therapy) should be provided for patients Management of distant metastases (eg, localized symptoms; bone, undergoing surveillance to improve their quality of life. These recommendations include guidelines for metastases with localized symptoms, diffuse brain metastases, or bone routine cancer surveillance, immunizations, health monitoring, metastasis (bisphosphonate or denosumab therapy can be counseling for wellness and health promotion, and cancer screening. The number of available targeted agents is with [or without] chemotherapy) (see Therapy for Recurrence and increasing. Similarly, patients with for first-line therapy based on phase 3 randomized trials such as erlotinib, gefitinib, afatinib, alectinib, ceritinib, and crizotinib. It is important to note that 1) several different tests may be in patients with bone metastasis. Minor toxicities (grade 1–2) included infusion reaction, whether patients are candidates for pembrolizumab (see thrombocytopenia and transaminitis; no treatment-related deaths were Pembrolizumab in this Discussion). Patients (n = 18) were mostly women (72%) and the following targeted agents are recommended (category 2A) for nonsmokers, and all had adenocarcinomas. The most common grade 3 adverse events included lipase histology was determined using small biopsy specimens or mixed elevation (4 patients [15%]), increased alanine aminotransferase (2 histology specimens. Patients with squamous cell carcinoma had improved gemcitabine/vinorelbine) are reasonable alternatives, because data survival with the cisplatin/gemcitabine regimen (10. Treatment-related to either 1) bevacizumab in combination with paclitaxel/carboplatin; or deaths were similar for both regimens (cisplatin/pemetrexed, 9 patients 2) paclitaxel/carboplatin alone. Thus, data suggesting that more than 6 cycles of first-line chemotherapy are not appropriate may Number of Cycles of First-Line Systemic Therapy only apply to taxane-based regimens. However, patients may not be able to maintenance therapy for these patients includes pemetrexed (category tolerate more than 4 cycles of chemotherapy, and most of the 703,704,709,710 2A). A phase 3 trial assessed switch erlotinib, gefitinib, or afatinib for these patients; additional therapy may maintenance therapy with docetaxel given either immediately after be added or substituted (eg, local therapy, systemic therapy). After progression on osimertinib, patients may continue to and fewer adverse events when compared with cytotoxic chemotherapy derive benefit from osimertinib; other options are also recommended (see Nivolumab, Pembrolizumab, and Atezolizumab in this Discussion). In contrast, checkpoint inhibitors including nivolumab, pembrolizumab, and the median overall survival was 9. Erlotinib and afatinib are not recommended as second-line therapy for squamous cell carcinoma based on a phase 3 randomized trial showing low response rates; they are less efficacious and safe compared to other available options. Available carcinogens-Part E: tobacco, areca nut, alcohol, coal smoke, and at. Symptom management in patients with lung cancer: Diagnosis and management of lung cancer, 16. The Health Consequences of Involuntary Exposure to Tobacco 3rd ed: American College of Chest Physicians evidence-based clinical Smoke: A Report of the Surgeon General. A review of human first cancer and risk of second smoking-associated cancers among carcinogens-part C: metals, arsenic, dusts, and fibres. Lancet Oncol survivors of bladder, kidney, head and neck, and stage I lung cancers. Am J Ind Med tobacco use in lung cancer: Diagnosis and management of lung cancer, 2005;48:419-431. Available at: 3rd ed: American College of Chest Physicians evidence-based clinical. Cardiovascular safety of varenicline: patient-level meta-analysis of randomized, blinded, 36. Available at: interventions for smoking cessation: an overview and network. Available at: associated with smoking cessation pharmacotherapies: a network. Available at: American College of Chest Physicians evidence-based clinical practice. Conference on Lung Cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up. Cancer screening in the United States, 2013: a review of current American Cancer Society 50. N guidelines, current issues in cancer screening, and new guidance on Engl J Med 2002;346:126-128.

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Tel: +371 6 7039831 Tel: +44 (0) 1707 366000 this leaflet was last revised in Other sources of information Detailed information on this medicine is available on the European Medicines Agency w eb site cheap flomax 0.2 mg otc prostate weight in grams. Baseline Characteristics Pembrolizumab Chemotherapy N = 154 N = 151 Median age (range) discount flomax 0.2mg fast delivery prostate 26, years 64 order flomax 0.2 mg overnight delivery prostate cancer vs colon cancer. In unusual in atomas to discount 0.4mg flomax mastercard man health 9 fair the malignant germ cell tumors capable of stances when germ cell tumors arise in the brain of metastasizing throughout the neuraxis; (2) pineal infants or patients with Down’s syndrome, other lo parenchymal tumors, such as the low-grade pineocy cations may predominate (Chik et al. The peak age rounding structures (meningioma, dermoid, epider at onset lies within the second and third decades of moid). Normally, germinal cells not residing teratomas that are slow growing and noninvasive are in tissues destined to form sex organs become apop the least common variant (5%). The pure germi totic and die; presumably some may occasionally sur nomas are more commonly found in the pineal re vive and over many years transform into a neoplasm. Summary of Pathology in 154 Patients Undergoing Surgery for Pineal Region Tumors at the New York Neurological Institute Mean Age Tumor Pathology No. Germinomas are with intracranial germ cell tumors is very dependent typically composed of two cell types: large, uniform on histology, it is imperative to establish an unequiv polyhedral cells with clear cytoplasm that resemble ocal diagnosis prior to the administration of radio primordial germ cells; and smaller lymphoid cells. This tumor is consid ered to represent a neoplasm whose cells are par tially differentiated into extra-embryonic structures that express yolk sac potential (Gonzalez-Crussi, 1979). Embryonal cell carcinoma is considered the most histogenetically primitive of the germ cell tu mors, with features of anaplastic columnar to cuboidal cells arranged in sheets and cords (Bjorns son et al. This tumor shows a variable pat tern of acinar, papillary tubular, or solid structures. Hematoxylin and eosin, carcinoma may give rise to a multiplicity of tumor ad 200. Choriocarcinomas are examples of differ entiation along extraembryonic pathways and are sary for diagnosis, immunohistochemical studies can composed solely of cytotrophoblastic and syncy help in problem situations when only limited mater tiotrophoblastic cells without true villous formation. No single antigen, however, has been the primary immunohistochemical marker of this tu identified as “specific” for germinoma (Table 7–2). Endodermal sinus are complex mixtures of tissues that occur most fre tumor and choriocarcinoma resemble extra-embry quently in males, in contrast to sacrococcygeal ter onic tissues, and the embryonal carcinoma appears atomas, which occur more often in females. Endodermal sinus teratomas are largely well differentiated or mature, tumors (yolk sac tumor) consist of glomeruloid but immature teratomas with malignant features do structures composed of a space lined by tumor cells occur (Bjornsson et al. If no other malignant elements are de typically performed after a stress or therapeutic dose tectable, this variant can be managed with radical sur of corticosteroids is administered. This strategy also pertains to Patients with primary tumors arising in the pineal other mature teratoid or embryonal tumors, such as region tend to have a much shorter prodrome. These patients usually present with signs and symptoms of raised intracra nial pressure, such as headache, diplopia, and Tumor Markers lethargy due to aqueductal obstruction. During a prior era when surgical approaches to the pineal region were associated with consider able morbidity and mortality, the standard practice Clinical Presentation was to administer a therapeutic/diagnostic course of the clinical presentation of germ cell tumors varies focal radiation therapy to 20 Gy. Initial neurodiag this approach is no longer favored for several rea nostic studies may be noninformative. Visual field or acuity im germ cell tumors in the pineal region reported in two pairments and hydrocephalus occur late in the pro recent operative pediatric series from the Children’s drome, when the tumor is large or disseminated. If a low-grade tumor such as an astrocytoma, dence of pure germinoma in the two pediatric series pineocytoma, or teratoma exists, radical surgical re was 20% (7/35) and 31% (11/36), respectively. Most importantly, tures seen radiographically are not a reliable predic radiographic studies cannot reliably distinguish tor of histology (Tien et al. Surgery not only provides im vances in surgical technique, neuroanesthesia, and portant diagnostic information, but radical resection postoperative management have decreased morbidity of a malignant tumor may confer a therapeutic ben and mortality rates for pineal-region surgery to ac efit. The role of sec 7–2A (saggital) and Figure 7–2B (axial) reveal a ho ond-look surgery is more controversial. Aqueductal ter with subtotally resected disease, rather than at compression caused hydrocephalus. Residual tumor usually consists of benign germ tumor dissemination may be present in 10% to 30% cell elements that have been more resistant to ther of patients with germ cell tumors at diagnosis (Allen, apy, with the malignant portions having been eradi 1987; Hardenbergh et al. For patients who do not re germ cell tumor markers can be used in some cases spond to high-dose corticosteroids, a ventriculostomy to confirm the presence of a specific germ cell com or shunt may be necessary. If detectable, these markers can also be used hydrocephalus is desirable, as it allows a gradual de for tracking response to therapy or tumor recurrence. Several methods are available for controlling hy Surgical Management drocephalus, each with advantages and disadvan tages. Stereo through a burr hole into the ventricles and floor of tactic biopsy can be performed relatively easily at a the third ventricle into the prepontine cistern, the sur medical center where advanced stereotactic equip geon may relieve obstructive hydrocephalus. There are, however, considerable method avoids the risks of tumor seeding and shunt drawbacks to this procedure, the most significant be malfunction. The tumor may also be biopsied with ing the potential for sampling error in a heteroge this instrument. Major drawbacks of this method include the procedures performed by passing a probe through possibility that the ventriculostomy may close and a brain tissue, several anatomic features of pineal tu small risk of catastrophic hemorrhage during fenes mors make them undesirable for sampling by stereo tration (Ferrer et al. For these patients, a ven tumors, and their periventricular location, which al tricular drain can be placed at the time of surgical lows minor bleeding to persist into the ventricle with resection. This drain is left in place for several days out tamponade by the surrounding tissue (Peragut et and removed when tolerated. The endoscopic biopsy procedure is attractive for patients Optimum Methods of Obtaining who will undergo a third ventriculostomy and whose Diagnostic Tissue tumors protrude into the posterior third ventricle. An open procedure, an endoscopic visually guided bi the risks include limited biopsy material and hem opsy, and a stereotactic biopsy are the three methods orrhage. An open pro cedure is nearly always preferred as it reduces the Surgical Approaches to the Pineal Region risk of sampling error.

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Joe engine was running “It can’t be that serious” and Joe didn’t give inspected the brake fuid and the pads again cheap 0.4 mg flomax fast delivery man health check. But buy flomax 0.4mg amex prostate cancer location, a few days later flomax 0.2 mg fast delivery prostate ultrasound procedure, the motor started making a Joe didn’t give it another thought purchase flomax 0.4 mg without a prescription prostate 10x. Joe inspected the oil, the belts Joe checked the brake fuid, looked at the brake pads everything and the battery. A week later, in addition to the lights, an alarm started soun until one day, as Joe was driving home from work, the engine blew, ding, all the time. When Joe tried to stop the car by the abnormal and decided to dismantle the dashboard. Fortunately, Joe was not injured; to disconnect the lights and also cut the wire to the speaker and the but he left the car smoking at the bottom of a ditch. This grotesque tale illustrates the fact that ignoring alarm signals all the We have discussed means for managing the interpersonal rela time can have serious long-term consequences. Hunger, thirst, pain, a tionships, work overloads and stress that are other major risk factors need for sleep and fatigue are all important alarm signals that ensure for the development of chronic pain. Practice a relaxation, meditation or visualization technique on a ment, work tools and the way we work is a good strategy for preventing regular basis, three times per week. Improve your interpersonal relationships by learning to communicate health: proprioception and stabilization. Today, we have the scientifc knowledge we need to perform preventive maintenance on these formidable machines: our bodies. Daily physical activities in chronic lower back sur les conditions de travail (Belgique). Active despite pain: the putative disorders: Evidence-based prevention and rehabilitation (p. This process starts with a search the prescription for physical activities for help. Don’t forget that pain is a subjective symptom, and you are theonly one that is able to evaluate it. In order to develop an action plan for the treatment of taking part means sharing your experiences pain, frst your symptoms must be identifed (and you are taking part, means taking action! This dynamic process evolves through respiration and relaxation your communication with the treatment team: inform them nutrition about your perceptions since this will lead to adjustments in the strategies proposed and tested. These interventions, which are generally multidisciplinary in nature, are enriched as the patients share their experiences. This can serve to encou rage you as well as show you other ways of managing your pain and even stressful situations, such as developing an attitude to “let go” rather than “dramatizing the situation”. After reading this chapter, you will have a small box of “tools” you can use to help you become a participatory patient and improve your condition and your health. Patients do not want to be a around you: how your friends and family behave during your treat passive part of the treatment; they want to take part. This is not a role that requires academic training, but rather one patient behaviour enables them to take control of their pain. At the end of this section, we will play an active role in improving their health; they learn to manage their present multidisciplinary treatment programmes as a group (interactive symptoms better, and they adopt lifestyle habits that lead to sustainable schools), since patients can help one another manage their symptoms change. This participatory behaviour is a key part in the success better through working together. Your participation is important at all stages of the treatment, starting In the following pages, we will help you better understand your role from the search for assistance up until improvements are experienced. This desire to consult and look for help is often motivated by one of the three following wishes. Regardless of the initial goal, any treatment starts with the patient Even without knowing the biochemistry of the pharmacological making the following decision – “I want to consult” – and this desire substance that is prescribed, we are fully aware of our role as a patient. Their If we consider the role of the patient from the point of view of the years of training should enable them to identify the solutions to their participatory patient, the patient is positioned at the heart of his/her patients’ health issues. If the patient does not follow the prescription for medication be skilled at identifying the medications that can relieve the patient’s or physical activity (for example, going for walks), the treatment will pain. Unlike the health professionals, patients have received no formal not have the desired effect. This role has to be learned day by day, starting the patient is the “active principle” in any treatment. The participatory in attitude so as to trigger an improvement in your health condition. Is this the right the success of any treatment depends on the efforts of the prescription? Since several factors must be taken into consideration in order to bypass the complexity of the painful phenomenon, several health professionals must be committed to the patient throughout the treatment. It is important to note that, for this treatment team, which includes doctors, phy siotherapists, psychologists, occupational therapists and pharmacists, the patient is at the heart of the treatment plan. All of the therapeutic strategies and techniques are prescribed in keeping with his/her individual needs. Section 3 | Chapter 25 the patient’s role 213 the patient at the heart of a dynamic process this focus on the patient should not be viewed in a static context. The healing process is far from static, and the prescriptions are not the only element in the solution for the painful condition. Since the patient is at the heart of the treatment plan, let us make an analogy that compares the patient with that very important organ: the heart. Therefore, there is no need for new strategies, medications and therapy if we do not take action.

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