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It is knowledge that provides the capacity for patients to understand their own conditions actonel 35mg line, recognize what constitutes relevant information actonel 35 mg, and contribute to the decision making process both in regard to primary and secondary care. There is also a need in healthcare organizations to ensure that staff are provided not only with the information and knowledge that enables them to effectively perform their tasks, but that they are also included within the organizational processes that enables them to become motivated and participate in organizational improvement. This human resource management approach is normal to techniques of Organization Development (Yolles, 1999). In healthcare organizations the nature of the knowledge processes that are undertaken can be expressed in terms of organizational quality. Stahr (2001), in a study on quality in UK healthcare establishments, uses the definition by Joss, Kogan, & Henkel (1994) to identify three levels of quality: technical, generic and systemic. While the word technical is often used to mean “control and predication”, for Joss et al. The word generic is expressed in terms of normative organizational healthcare standards. The word systemic is concerned with making sure that the whole organization works as an integrated whole in order to ensure long term success. For Stahr (2001), if quality approaches are to be useful they need to affect the culture of an organization, and to do this they need to be systemic. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Knowledge Cycles and Sharing 99 The systems approach to quality is more than just “joined up governance”, intended to convey the impression of organizational cohesion through policy and processes of coherent group behavior. Rather, it is characterized by full integration of all aspects of its activities into focused action on continuous improvement and patient needs (though Stahr does not consider whether these needs should be considered from an objectivistic or subjectivistic perspective). Systemic approaches are more likely to be successful, it is reasoned, than generic and technical approaches, because they impact on everything that managers and clinicians do. Stahr also suggests that systemic approaches become the culture of the organization. However, they should instead be seen to be distinct but intimately connected with that culture (Yolles & Guo, 2003). While knowledge is important to healthcare organizations, there is also a current tendency to explore it in terms of knowledge management (KM). It is an amalgamation of concepts borrowed from the artificial intelligence/knowledge-based systems, software engineering, business process re-engineering (BPR), human re- sources management, and organizational behavior (Liebowitz, 1999). In essence then, knowledge management not only involves the production of information, but also the capture of data at the source, the transmission and analysis of this data, as well as the communication of information based on, or derived from, the data, to those who can act on it (Davenport & Prusak, 1998). The conceptualization of knowledge in the IS view limits ones understanding of knowledge processes, and dilutes the understanding that KM is about knowledge and human understanding rather than about information technology (IT). It is clear from Wickramasinghe (2003) that the subjective dimension of KM is recognized, but the IS approach tends to diminish the barriers to appreciating KM and its implementation. What is the objective nature of knowledge referred to here, and how does it differ from subjective knowledge? Unsurprisingly, by exploring a number of case studies Wickramasinghe (2003) found that knowledge based systems did not support the subjective aspect of knowledge, and by not doing so, their function is reduced to that of an explicated organizational memory. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. If organizational learning is viewed this way then it is both tacit/ informal and explicit/ formal. This type of learning is non-directive since its purpose is not to transmit information through a trainer. All human learning requires the ability to name, classify, construct and communicate cognitive imagery conveying both spatial and temporal charac- teristics (Bateson, 1979). Mental maps can be considered as tacit, in the head methods, for making sense of and for performing tasks. Such methods are acquired by individuals either through contextually-tied trial-and-error techniques, or through imaginative thinking that is essentially abstract and not tied to an immediate context. By contrast, it is possible to argue that organizations create mental maps through methods that formally articulate rules and procedures to guide the activities of their members. Learning in organizations can be said to require the development of both systems and processes in order that changes in the external (and internal) environments filter through to attitudes, procedures and practices in a way that facilitates constant review of operating norms at a variety of levels throughout the organization.

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Organisms that usually live in the human respi- ratory system without causing disease can pass through Older children are more frequently infected by bac- openings caused by such fractures buy actonel 35mg with visa, reach the meninges safe actonel 35 mg, teria, including Haemophilus influenzae, Neisseria and cause infection. For instance, cases have been along a nerve, and using that nerve as a sort of ladder reported when a child in a crowded day care situation or into the skull, where the organism can multiply and a military recruit in a crowded training camp has fallen cause meningitis. There have been case reports in recent years of The classic symptoms of meningitis (particularly of meningitis caused by Streptococcus bovis, an organism bacterial meningitis) include fever, headache, vomiting, GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1327 sensitivity to light (photophobia), irritability, severe fa- then be identified more easily. Special immunologic and tigue (lethargy), stiff neck, and a reddish purple rash on serologic tests may also be used to help identify the in- the skin. In rare instances, CSF from a lumbar puncture can- A very young infant may not show the classic signs not be examined because the amount of swelling within of meningitis. Some infants with meningitis have drawn because doing so could cause herniation of the seizures as their only identifiable symptom. Herniation of the brain stem occurs when the debilitated elderly patients may not have fever or other part of the brain connecting to the spinal cord is thrust identifiable symptoms of meningitis. Such herniation will cause compression of Damage due to meningitis occurs from a variety of those structures within the brain stem that control the phenomena. The action of infectious agents on the brain most vital functions of the body (breathing, heart beat, tissue is one direct cause of damage. Death or permanent debilitation follows age may be due to the mechanical effects of swelling and herniation of the brain stem. Swelling of the meninges may interfere with the normal absorption of CSF by blood vessels, causing accu- Treatment mulation of CSF and damage from the resulting pressure Because meningitis is a potentially deadly condi- on the brain. Alternative treatments should be of normally present substances (carbon dioxide, potassi- used only to support the recovery process following ap- um) to accumulate. Inflammation may cause the blood- propriate antibiotic treatments, or used concurrently with brain barrier to become less effective at preventing the antibiotic treatments. General recommendations Diagnosis Patients should be well rested in bed, preferably in A number of techniques are used when examining a a darkened room. They should be given lots of fluids patient suspected of having meningitis to verify the diag- and nutritious foods. Certain manipulations of the head (lowering the foods and those with high fat and sugar content. Fats are head, chin towards chest, for example) are difficult to difficult to digest in severely ill patients; sugar tends to perform and painful for a patient with meningitis. Patients should also take vitamin A (up to The most important test used to diagnose meningitis 10,000 IU per day), B-complex vitamins (up to 1,500 is the lumbar puncture (LP), commonly called a spinal mg per day), and vitamin C (up to 2 g per day) to help tap. Lumbar puncture involves the insertion of a thin keep the body strong and prevent future infections. Ad- needle into a space between the vertebrae in the lower ditionally, the patient may consider taking other antiox- back and the withdrawal of a small amount of CSF. The idants, essential fatty acids (EFAs), and/or participate CSF is then examined under a microscope to look for in therapies, such as massage therapy and movement bacteria or fungi. Normal may help patients regain their health and build up their CSF should contain no infection-fighting cells (white immune systems. The recovering individual, under the blood cells), so the presence of white blood cells in CSF direction of a professional alternative therapist, may opt is another indication of meningitis. Some of the with- to include mushrooms into his or her diet to stimulate drawn CSF is also put into special lab dishes to allow immune function. Contact an experienced herbalist or growth of the suspected infecting organism, which can homeopathic practitioner for specific remedies. In recent years, however, doctors have turned to such newer medications as vancomycin or the fluoro- Blood-brain barrier—An arrangement of cells quinolones to treat bacterial meningitis because strains of within the blood vessels of the brain that prevents S. It the effectiveness of the blood-brain barrier in preventing also makes it difficult for certain medications to the passage of substances into the brain, medications pass into brain tissue. Antiviral drugs (acyclovir) bers within the brain which then flows over the may be helpful in shortening the course of viral meningi- surface of the brain and spinal cord. Pa- nutrition to cells of the nervous system, as well as tients who develop seizures will require medications to providing a cushion for the nervous system struc- halt the seizures and prevent their return. It may accumulate abnormally in some dis- ease processes, causing pressure on and damage Expected results to brain structures. Viral meningitis is the least severe type of meningi- Fluouroquinolones—A group of medications used tis, and patients usually recover with no long-term ef- to treat bacterial infections in many different parts fects from the infection.

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Most of these procedures are properly described as manipulation rather than mobilization discount 35mg actonel mastercard. Mobilization employs the passive introduction of forces within the normal passive range of motion of the joint (Figure 1) generic actonel 35 mg visa. This is defined as beyond the passive range of motion but less than would be necessary to disrupt spinal integrity. Most manipulative techniques carry the joint to the end of the passive range of motion, with subsequent introduction of a rapid but low-amplitude force to move the joint into this paraphysiological range. These manipulative procedures have been termed high- velocity, low-amplitude (HVLA) manipulations. Figure 1 The active, passive and physiological ranges of motion of a joint The manipulative force may be introduced directly to one part of the spine, usually using the transverse or spinous process or the spinal lamina as a contact point. Other manipulative procedures direct the primary manipulative force through an arm or leg. There are several other types of procedure employed by chiropractors under the broad rubric of spinal manipulation or adjustment. The most common of these procedures, called activator technique, utilizes a hand-held, spring-loaded device. The precise technique used by most chiropractors varies on the basis of the particular area treated. Contemporary chiropractors incorporate many physi cal modalities such as heat, cold, 15 ultrasound, electrical stimulation and traction. These are usually utilized in conjunction with, and often in preparation for, the spinal adjustment. Many chiropractors advise on therapeutic exercises as a regular part of their treatment regimen and increasingly incorporate full rehabilitation programs. In addition, chiropractors often counsel their patients on nutrition and at times will provide vitamins and supplements as a regular part of their treatment regimen. THEORETICAL BASIS FOR MANIPULATION Early chiropractic theory suggested that misalignments of spinal vertebrae (which was the initial description of what came to be known as subluxation) interfered directly with nerve function through pressure, resulting in changes in physiological processes. Over the years, however, chiropractic theories have evolved in parallel with the growth in understanding of spinal pathology and spinal mechanics. Today, most chiropractors (and all chiropractic schools) have broadened the original concept to encompass current theories of spinal pathology including concepts of abnormal spinal biomechanics and neurophysiological theories of 25 pain and reflex function. These theories focus on the restoration of joint mobility, relaxation of muscle spasm, modulation of spinal reflexes and the soothing or psychosocial effects of manual therapy. There is a growing body of experimental studies demonstrating at least short-term effects Chiropractic 41 Figure 2 Several types of chiropractic manipulative procedure. The most widely accepted theories are based on the theory that immobility of spinal joints is one factor that may lead to joint inflammation, formation of adhesions and degenerative joint disease, and that manipulation may reverse 28 some of these changes. Spinal manipulation is felt to improve joint mobility and restore normal joint function, especially when associated with an exercise and rehabilitation 29,30 program. The most commonly invoked theory on the nature of the subluxation (manipulable lesion) suggests that a vertebral unit can have restricted mobility or be fixated within the normal, physiological range of motion of a joint or may display abnormal motion. Such fixation is proposed to result in pain and abnormal spinal reflex function, including 31 muscle hypertonicity and responses in the autonomic nervous system. Under this construct, SMT is proposed to have a direct effect on muscles and joints and, through receptors in these tissues, an effect on the nervous system. While this theoretical construct is far from proven, there is growing experimental support for it. Magnetic 32 resonance imaging (MRI) studies have indicated a direct effect on spinal joints that is consistent with reports describing increased spinal range of motion following spinal 28 manipulation. Reflex contraction of paraspinal musculature has been demon-strated to 33 accompany spinal manipulation. These observations, however, have not answered the question of the duration of the observed physiological changes or whether these changes are of therapeutic benefit. Recent neurophysiological research has focused on possible effects of SMT on the 31 central nervous system. Altered pain thresholds have been reported following SMT, 26 possibly related to activation of endogenous pain suppression mechanisms. In addition, abnormal somatosensory evoked potentials from the paraspinal musculature of patients with low back pain have been shown to normalize following manipulation.

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