RESUMO
Quinine and its D-isomer quinidine have been used medically in Europe since the 1600s. They were originally found within the bark of the cinchona tree in the jungle of the Andes. They were recognized to have multiple beneficial medical properties, ranging from a combined antipyretic and analgesic effect to the first effective treatment for malaria and later atrial fibrillation. With the development of other medications and the recognition of the potential life-threatening toxic reactions to these drugs, their medical use declined. Quinine is available without a prescription in many countries and is present in tonic water. Quinine has an extensive following of users who believe it is salutary and harmless, considering it a food supplement. In the past, dermatologists were frequently the first to recognize disease caused by these drugs owing to early findings of dermatitis or petechiae. Even though the medical use of these drugs has markedly decreased, drug eruptions may still be due to quinine, and patients may even be unaware they are taking this medication.
Assuntos
Cinchona , Dermatologia , Toxidermias , Humanos , Extratos Vegetais , Quinina/efeitos adversosRESUMO
I believe this article emphasizes how emotionally valuable receiving patients' trust is to the practicing physician. It also gives new insight into understanding the emotional loss a physician may experience when leaving private practice, even if they remain active in medicine. Finally, for those entering medicine, it explains the profound personal satisfaction they can experience from long term trusting relationships with patients.
Assuntos
Médicos , Humanos , Relações Médico-Paciente , ConfiançaAssuntos
COVID-19 , Administração dos Cuidados ao Paciente , Exame Físico , Testes Imediatos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Ecocardiografia/métodos , Necessidades e Demandas de Serviços de Saúde , Auscultação Cardíaca/métodos , Humanos , Controle de Infecções/métodos , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/tendências , Exame Físico/métodos , Exame Físico/normas , Exame Físico/tendências , Testes Imediatos/organização & administração , Testes Imediatos/normas , SARS-CoV-2RESUMO
What most physicians need when performing a physical examination is the ability to be able to recognize normal from abnormal and, if abnormal findings are present, to be able to diagnose or categorize disease in a useful fashion. This manuscript describes a technique that is feasible and acceptable in accomplishing this by changing the learning objectives for teaching cardiac auscultation to focus on recognizing audible decision-making findings and ensuring competency by requiring passing an auscultation-only examination that is limited to such findings. Medical students indicated the program was helpful and increased their confidence in performing cardiac auscultation.
