This is an accepted version of this page
63-466: The Bristol stool scale is a diagnostic medical tool designed to classify the form of human faeces into seven categories. It is used in both clinical and experimental fields. It was developed at the Bristol Royal Infirmary as a clinical assessment tool in 1997, and is widely used as a research tool to evaluate the effectiveness of treatments for various diseases of the bowel, as well as
126-505: A specialist , or watchful observation. A follow-up may be advised. Depending upon the health insurance plan and the managed care system, various forms of " utilization review ", such as prior authorization of tests, may place barriers on accessing expensive services. The medical decision-making (MDM) process includes the analysis and synthesis of all the above data to come up with a list of possible diagnoses (the differential diagnoses), along with an idea of what needs to be done to obtain
189-441: A clinical communication aid; including being part of the diagnostic triad for irritable bowel syndrome . The seven types of stool are: Types 1 and 2 indicate constipation , with 3 and 4 being the ideal stools as they are easy to defecate while not containing excess liquid, and 6 and 7 indicate diarrhea. In the initial study, in the population examined in this scale, the type 1 and 2 stools were more prevalent in females, while
252-407: A combination of all three. Most tribal societies provide no guarantee of healthcare for the population as a whole. In such societies, healthcare is available to those who can afford to pay for it, have self-insured it (either directly or as part of an employment contract), or may be covered by care financed directly by the government or tribe. Transparency of information is another factor defining
315-429: A combination of art and science (both basic and applied , under the umbrella of medical science ). For example, while stitching technique for sutures is an art learned through practice, knowledge of what happens at the cellular and molecular level in the tissues being stitched arises through science. Prescientific forms of medicine, now known as traditional medicine or folk medicine , remain commonly used in
378-500: A decade after medical school. Furthermore, surgical training can be very difficult and time-consuming. Surgical subspecialties include those a physician may specialize in after undergoing general surgery residency training as well as several surgical fields with separate residency training. Surgical subspecialties that one may pursue following general surgery residency training: Other surgical specialties within medicine with their own individual residency training: Internal medicine
441-553: A definitive diagnosis that would explain the patient's problem. On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, lab or imaging results, or specialist consultations . Contemporary medicine is, in general, conducted within health care systems . Legal, credentialing , and financing frameworks are established by individual governments, augmented on occasion by international organizations, such as churches. The characteristics of any given health care system have
504-491: A delivery system. Access to information on conditions, treatments, quality, and pricing greatly affects the choice of patients/consumers and, therefore, the incentives of medical professionals. While the US healthcare system has come under fire for its lack of openness, new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and
567-513: A few minutes or a few weeks, depending on the complexity of the issue. The components of the medical interview and encounter are: The physical examination is the examination of the patient for medical signs of disease that are objective and observable, in contrast to symptoms that are volunteered by the patient and are not necessarily objectively observable. The healthcare provider uses sight, hearing, touch, and sometimes smell (e.g., in infection, uremia , diabetic ketoacidosis ). Four actions are
630-402: A modified version of the scale was validated using a criterion of self-assessment for ages six–eight years of age. A version of the scale was developed into a chart suitable for use on US television by Gary Kahan of NewYork–Presbyterian Hospital . Medicine This is an accepted version of this page Medicine is the science and practice of caring for patients, managing
693-448: A patient to investigate or treat a pathological condition such as disease or injury , to help improve bodily function or appearance or to repair unwanted ruptured areas (for example, a perforated ear drum ). Surgeons must also manage pre-operative, post-operative, and potential surgical candidates on the hospital wards. In some centers, anesthesiology is part of the division of surgery (for historical and logistical reasons), although it
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#1732876861217756-473: A period of supervised practice or internship , or residency . This can be followed by postgraduate vocational training. A variety of teaching methods have been employed in medical education, still itself a focus of active research. In Canada and the United States of America, a Doctor of Medicine degree, often abbreviated M.D., or a Doctor of Osteopathic Medicine degree, often abbreviated as D.O. and unique to
819-399: A physician before taking Questran Light because that product contains phenylalanine . Interactions with these drugs have been noted: Most interactions are due to the risk of decreased absorption of these drugs. The duration of treatment is not limited, but the prescribing physician should reassess at regular intervals if continued treatment is still necessary. The principal overdose risk
882-517: A piece of epidemiological research conducted on a population of 4,196 people living in Olmsted County Minnesota , in which participants were asked to complete a questionnaire based on the Bristol stool scale . The research results (see table) indicate that about 1 in 5 people have a slow transit (type 1 and 2 stools), while 1 in 12 has an accelerated transit (type 5 and 6 stools). Moreover,
945-587: A secondary care setting. Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include trauma centers , burn treatment centers, advanced neonatology unit services, organ transplants , high-risk pregnancy, radiation oncology , etc. Modern medical care also depends on information – still delivered in many health care settings on paper records, but increasingly nowadays by electronic means . In low-income countries, modern healthcare
1008-547: A significant impact on the way medical care is provided. From ancient times, Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals, and the Catholic Church today remains the largest non-government provider of medical services in the world. Advanced industrial countries (with the exception of the United States ) and many developing countries provide medical services through
1071-410: A system of universal health care that aims to guarantee care for all through a single-payer health care system or compulsory private or cooperative health insurance. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices, state-owned hospitals and clinics, or charities, most commonly
1134-483: Is a bile acid sequestrant , which binds bile in the gastrointestinal tract to prevent its reabsorption. It is a strong ion exchange resin , which means it can exchange its chloride anions with anionic bile acids in the gastrointestinal tract and bind them strongly in the resin matrix. The functional group of the anion exchange resin is a quaternary ammonium group attached to an inert styrene - divinylbenzene copolymer . Colestyramine removes bile acids from
1197-466: Is a common cause of chronic functional diarrhea, often misdiagnosed as diarrhea-predominant irritable bowel syndrome (IBS-D), and most of these patients respond to colestyramine. It is beneficial in the treatment of postcholecystectomy syndrome chronic diarrhea. Colestyramine is also useful in treating post-vagotomy diarrhea . Colestyramine can be helpful in the treatment of Clostridioides difficile infections, to absorb toxins A and B, and reduce
1260-450: Is classified into primary, secondary, and tertiary care categories. Primary care medical services are provided by physicians , physician assistants , nurse practitioners , or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, clinics , nursing homes , schools, home visits, and other places close to patients. About 90% of medical visits can be treated by
1323-525: Is derived from Latin medicus , meaning "a physician". Medical availability and clinical practice vary across the world due to regional differences in culture and technology . Modern scientific medicine is highly developed in the Western world , while in developing countries such as parts of Africa or Asia, the population may rely more heavily on traditional medicine with limited evidence and efficacy and no required formal training for practitioners. In
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#17328768612171386-438: Is interspersed with brief episodes of diarrhoea ; while a minority of patients with IBS have only diarrhoea. The presentation of symptoms is usually months or years and commonly patients consult different doctors, without great success, and doing various specialized investigations. It notices a strong correlation of the reported symptoms with stress ; indeed diarrhoeal discharges are associated with emotional phenomena . IBS blood
1449-595: Is not a surgical discipline. Other medical specialties may employ surgical procedures, such as ophthalmology and dermatology , but are not considered surgical sub-specialties per se. Surgical training in the U.S. requires a minimum of five years of residency after medical school. Sub-specialties of surgery often require seven or more years. In addition, fellowships can last an additional one to three years. Because post-residency fellowships can be competitive, many trainees devote two additional years to research. Thus in some cases surgical training will not finish until more than
1512-400: Is often too expensive for the average person. International healthcare policy researchers have advocated that "user fees" be removed in these areas to ensure access, although even after removal, significant costs and barriers remain. Separation of prescribing and dispensing is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from
1575-534: Is present only if the disease is associated with haemorrhoids . Research conducted on irritable bowel syndrome in the 2000s, faecal incontinence and the gastrointestinal complications of HIV have used the Bristol scale as a diagnostic tool easy to use, even in research which lasted for 77 months. Historically, this scale of assessment of the faeces has been recommended by the consensus group of Kaiser Permanente Medical Care Program ( San Diego , California, US) for
1638-456: Is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. According to some sources, an emphasis on internal structures is implied. In North America, specialists in internal medicine are commonly called "internists". Elsewhere, especially in Commonwealth nations, such specialists are often called physicians . These terms, internist or physician (in
1701-517: The developed world , evidence-based medicine is not universally used in clinical practice; for example, a 2007 survey of literature reviews found that about 49% of the interventions lacked sufficient evidence to support either benefit or harm. In modern clinical practice, physicians and physician assistants personally assess patients to diagnose , prognose, treat, and prevent disease using clinical judgment. The doctor-patient relationship typically begins with an interaction with an examination of
1764-747: The diagnosis , prognosis , prevention , treatment , palliation of their injury or disease , and promoting their health . Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness . Contemporary medicine applies biomedical sciences , biomedical research , genetics , and medical technology to diagnose , treat, and prevent injury and disease, typically through pharmaceuticals or surgery , but also through therapies as diverse as psychotherapy , external splints and traction , medical devices , biologics , and ionizing radiation , amongst others. Medicine has been practiced since prehistoric times , and for most of this time it
1827-913: The pharmacist who provides the prescription drug . In the Western world there are centuries of tradition for separating pharmacists from physicians. In Asian countries, it is traditional for physicians to also provide drugs. Working together as an interdisciplinary team , many highly trained health professionals besides medical practitioners are involved in the delivery of modern health care. Examples include: nurses , emergency medical technicians and paramedics , laboratory scientists, pharmacists , podiatrists , physiotherapists , respiratory therapists , speech therapists , occupational therapists , radiographers, dietitians , and bioengineers , medical physicists , surgeons , surgeon's assistant , surgical technologist . The scope and sciences underpinning human medicine overlap many other fields. A patient admitted to
1890-494: The small bowel (ileum) is where bile acids are reabsorbed. When this section is removed, the bile acids pass into the large bowel and cause diarrhea due to stimulation of chloride/fluid secretion by the colonocytes resulting in a secretory diarrhea. Colestyramine prevents this increase in water by making the bile acids insoluble and osmotically inactive. Colestyramine is also used in the control of other types of bile acid diarrhea . The primary, idiopathic form of bile acid diarrhea
1953-410: The Bristol stool scale in response to medications or therapies, in fact, in one study was also used to titrate the dose more finely than one drug ( colestyramine ) in subjects with diarrhoea and faecal incontinence. In a randomised controlled study , the scale is used to study the response to two laxatives: Macrogol ( polyethylene glycol ) and psyllium ( Plantago psyllium and other species of
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2016-707: The European Union, the profession of doctor of medicine is regulated. A profession is said to be regulated when access and exercise is subject to the possession of a specific professional qualification. The regulated professions database contains a list of regulated professions for doctor of medicine in the EU member states, EEA countries and Switzerland. This list is covered by the Directive 2005/36/EC . Colestyramine Colestyramine ( INN ) or cholestyramine ( USAN ) (trade names Questran , Questran Light , Cholybar , Olestyr )
2079-1090: The GI tract, ultimately reducing urine oxalate and calcium oxalate stone formation. Colestyramine is available as powder form, in 4-g packets, or in larger canisters. In the United States , it can be purchased either as a generic medicine, or as Questran or Questran Light ( Bristol-Myers Squibb ). A typical dose is 4 to 8 g once or twice daily, with a maximum dose of 24 g/d. These side effects have been noted: Intestinal obstruction has been reported in patients with previous bowel surgery who should use colestyramine cautiously. Cholestyramine-induced hyperchloremic metabolic acidosis has also been reported rarely. Patients with hypothyroidism , diabetes , nephrotic syndrome , dysproteinemia, obstructive liver disease, kidney disease , or alcoholism should consult their doctor before taking this medication. Other drugs should be taken at least one hour before or four to six hours after colestyramine to reduce possible interference with absorption. Patients with phenylketonuria should consult with
2142-467: The UK where all doctors are now required by law to work less than 48 hours per week on average. The following are some major medical specialties that do not directly fit into any of the above-mentioned groups: Some interdisciplinary sub-specialties of medicine include: Medical education and training varies around the world. It typically involves entry level education at a university medical school , followed by
2205-480: The United States, can be searched at http://data.medobjectives.marian.edu/ Archived 4 October 2018 at the Wayback Machine . In most countries, it is a legal requirement for a medical doctor to be licensed or registered. In general, this entails a medical degree from a university and accreditation by a medical board or an equivalent national organization, which may ask the applicant to pass exams. This restricts
2268-473: The United States, must be completed in and delivered from a recognized university. Since knowledge, techniques, and medical technology continue to evolve at a rapid rate, many regulatory authorities require continuing medical education . Medical practitioners upgrade their knowledge in various ways, including medical journals , seminars, conferences, and online programs. A database of objectives covering medical knowledge, as suggested by national societies across
2331-545: The University Department of Medicine, Bristol Royal Infirmary , it was suggested by the authors as a clinical assessment tool in 1997 in the Scandinavian Journal of Gastroenterology after a previous prospective study , conducted in 1992 on a sample of the population (838 men and 1,059 women), had shown an unexpected prevalence of defecation disorders related to the shape and type of stool. The authors of
2394-446: The absence of scientific medicine and are thus called alternative medicine . Alternative treatments outside of scientific medicine with ethical, safety and efficacy concerns are termed quackery . Medicine ( UK : / ˈ m ɛ d s ɪ n / , US : / ˈ m ɛ d ɪ s ɪ n / ) is the science and practice of the diagnosis , prognosis , treatment , and prevention of disease . The word "medicine"
2457-589: The basis of physical examination: inspection , palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (listen), generally in that order, although auscultation occurs prior to percussion and palpation for abdominal assessments. The clinical examination involves the study of: It is to likely focus on areas of interest highlighted in the medical history and may not include everything listed above. The treatment plan may include ordering additional medical laboratory tests and medical imaging studies, starting therapy, referral to
2520-438: The body by forming insoluble complexes with bile acids in the intestine , which are then excreted in the feces . As a result of this loss of bile acids, more plasma cholesterol is converted to bile acids in the liver to normalise levels. This conversion of cholesterol into bile acids lowers plasma cholesterol levels . Bile acid sequestrants such as colestyramine were first used to treat hypercholesterolemia , but since
2583-502: The broadest meaning of "medicine", there are many different specialties. In the UK, most specialities have their own body or college, which has its own entrance examination. These are collectively known as the Royal Colleges, although not all currently use the term "Royal". The development of a speciality is often driven by new technology (such as the development of effective anaesthetics) or ways of working (such as emergency departments);
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2646-591: The collection of data on functional bowel disease (FBD). More recently, according to the latest revision of the Rome III Criteria , six clinical manifestations of IBS can be identified: These four identified subtypes correlate with the consistency of the stool, which can be determined by the Bristol stool scale. In 2007, the Mayo Clinic College of Medicine in Rochester, Minnesota , United States, reported
2709-459: The considerable legal authority of the medical profession to physicians that are trained and qualified by national standards. It is also intended as an assurance to patients and as a safeguard against charlatans that practice inadequate medicine for personal gain. While the laws generally require medical doctors to be trained in "evidence based", Western, or Hippocratic Medicine, they are not intended to discourage different paradigms of health. In
2772-667: The diarrhea and the other symptoms these toxins cause. However, because it is not an anti-infective, it is used in concert with vancomycin . It is also used in the "wash out" procedure in patients taking leflunomide or teriflunomide to aid drug elimination in the case of drug discontinuation due to severe side effects caused by leflunomide or teriflunomide. A case report suggests that colestyramine may be useful for cyanobacterial ( microcystin ) poisoning in dogs. Ointments containing colestyramine compounded with Aquaphor have been used in topical treatment of diaper rash in infants and toddlers. Cholestyramine also binds with oxalate in
2835-763: The examination for the Membership of the Royal College of Physicians (MRCP) or the equivalent college in Scotland or Ireland. "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in General Surgery, which in the UK leads to membership of the Royal College of Surgeons of England (MRCS). At present, some specialties of medicine do not fit easily into either of these categories, such as radiology, pathology, or anesthesia. Most of these have branched from one or other of
2898-417: The expertise or procedures performed by specialists. These include both ambulatory care and inpatient services, emergency departments , intensive care medicine , surgery services, physical therapy , labor and delivery , endoscopy units, diagnostic laboratory and medical imaging services, hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in
2961-655: The former paper concluded that the form of the stool is a useful surrogate measure of colon transit time. That conclusion has since been challenged as having limited validity for Types 1 and 2; however, it remains in use as a research tool to evaluate the effectiveness of treatments for various diseases of the bowel, as well as a clinical communication aid. The same scale has been validated in Spanish , Brazilian Portuguese , and Polish versions. A version has also been designed and validated for children. More recently, in September 2011,
3024-640: The gut and the kidneys. In the Commonwealth of Nations and some other countries, specialist pediatricians and geriatricians are also described as specialist physicians (or internists) who have subspecialized by age of patient rather than by organ system. Elsewhere, especially in North America, general pediatrics is often a form of primary care . There are many subspecialities (or subdisciplines) of internal medicine : Training in internal medicine (as opposed to surgical training), varies considerably across
3087-553: The hospital is usually under the care of a specific team based on their main presenting problem, e.g., the cardiology team, who then may interact with other specialties, e.g., surgical, radiology, to help diagnose or treat the main problem or any subsequent complications/developments. Physicians have many specializations and subspecializations into certain branches of medicine, which are listed below. There are variations from country to country regarding which specialties certain subspecialties are in. The main branches of medicine are: In
3150-434: The information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions. Follow-ups may be shorter but follow the same general procedure, and specialists follow a similar process. The diagnosis and treatment may take only
3213-527: The introduction of statins , now have only a minor role for this indication. They can also be used to treat the pruritus , or itching, that often occurs during liver failure and other types of cholestasis where the ability to eliminate bile acids is reduced. Colestyramine is commonly used to treat diarrhea resulting from bile acid malabsorption . It was first used for this in Crohn's disease patients who had undergone ileal resection. The terminal portion of
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#17328768612173276-773: The narrow sense, common outside North America), generally exclude practitioners of gynecology and obstetrics, pathology, psychiatry, and especially surgery and its subspecialities. Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized; such general physicians would see any complex nonsurgical problem; this style of practice has become much less common. In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, gastroenterologists and nephrologists specialize respectively in diseases of
3339-416: The nature of the stool is affected by age, sex, body mass index , whether or not they had cholecystectomy and possible psychosomatic components ( somatisation ); there were no effects from factors such as smoking , alcohol , the level of education, a history of appendectomy or familiarity with gastrointestinal diseases, civil state, or the use of oral contraceptives . Several investigations correlate
3402-496: The new specialty leads to the formation of a unifying body of doctors and the prestige of administering their own examination. Within medical circles, specialities usually fit into one of two broad categories: "Medicine" and "Surgery". "Medicine" refers to the practice of non-operative medicine, and most of its subspecialties require preliminary training in Internal Medicine. In the UK, this was traditionally evidenced by passing
3465-477: The patient's medical history and medical record , followed by a medical interview and a physical examination . Basic diagnostic medical devices (e.g., stethoscope , tongue depressor ) are typically used. After examining for signs and interviewing for symptoms , the doctor may order medical tests (e.g., blood tests ), take a biopsy , or prescribe pharmaceutical drugs or other therapies. Differential diagnosis methods help to rule out conditions based on
3528-440: The possible exploitation of information for commercial gain on the other. The health professionals who provide care in medicine comprise multiple professions , such as medics , nurses , physiotherapists , and psychologists . These professions will have their own ethical standards , professional education, and bodies. The medical profession has been conceptualized from a sociological perspective . Provision of medical care
3591-432: The primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sexes. Secondary care medical services are provided by medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required
3654-485: The same genus ) of 126 male and female patients for a period of 2 weeks of treatment; failing to show the most rapid response and increased efficiency of the former over the latter. In the study, they were measured as primary outcomes : the number weekly bowel movements, stool consistency according to the types of the Bristol stool scale , time to defecation, the overall effectiveness, the difficulty in defecating and stool consistency. From 2010, several studies have used
3717-502: The scale as a diagnostic tool validated for recognition and evaluation of response to various treatments, such as probiotics , moxicombustion , laxatives in the elderly, preparing Ayurvedic poly-phytotherapy filed TLPL/AY, psyllium, mesalazine , methylnaltrexone , and oxycodone / naloxone , or to assess the response to physical activity in athletes. Developed and proposed for the first time in England by Stephen Lewis and Ken Heaton at
3780-555: The two camps above; for example anaesthesia developed first as a faculty of the Royal College of Surgeons (for which MRCS/FRCS would have been required) before becoming the Royal College of Anaesthetists and membership of the college is attained by sitting for the examination of the Fellowship of the Royal College of Anesthetists (FRCA). Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on
3843-685: The type 5 and 6 stools were more prevalent in males; furthermore, 80% of subjects who reported rectal tenesmus (sensation of incomplete defecation) had type 7. These and other data have allowed the scale to be validated. The initial research did not include a pictorial chart with this being developed at a later point. The Bristol stool scale is also very sensitive to changes in intestinal transit time caused by medications, such as antidiarrhoeal loperamide , senna , or anthraquinone with laxative effect. People with irritable bowel syndrome (IBS) typically report that they suffer with abdominal cramps and constipation . In some patients, chronic constipation
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#17328768612173906-418: The world: see the articles on medical education for more details. In North America, it requires at least three years of residency training after medical school, which can then be followed by a one- to three-year fellowship in the subspecialties listed above. In general, resident work hours in medicine are less than those in surgery, averaging about 60 hours per week in the US. This difference does not apply in
3969-419: Was an art (an area of creativity and skill), frequently having connections to the religious and philosophical beliefs of local culture. For example, a medicine man would apply herbs and say prayers for healing, or an ancient philosopher and physician would apply bloodletting according to the theories of humorism . In recent centuries, since the advent of modern science , most medicine has become
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