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An exploration of women’s experiences in the treatment of thyroid disease cheap super avana online mastercard erectile dysfunction zyprexa, especially relative to these three points purchase super avana erectile dysfunction medication list, may contribute to better understanding on the part of doctors and thus more effective doctor-patient communication and relationships buy super avana 160 mg with amex impotence at 43. Despite the pervasiveness of thyroid disease in women and the importance of the doctor-patient relationship in positive treatment outcomes cheapest sildigra, there is a gap in the literature regarding the treatment experiences of women diagnosed with thyroid disease purchase online provera, particularly regarding the doctor-patient relationship. Therefore, the purpose of this phenomenological study was to explore female thyroid patients’ experiences of treatment and the doctor-patient relationship. The phenomenological research approach was used, as it is designed to examine the meaning of experiences about a particular phenomenon (e. The theoretical perspectives used to guide data interpretation included feminism and social 3 constructivism. More specifically, the following issues were addressed in regard to their relationship with women’s treatment experiences: (a) the culture of the medical profession (see Kaiser, 2002; Thomas, 2001), (b) diagnostic bias (see Hamberg et al. The following paragraphs provide a review of the literature relevant to the study, followed by the problem statement, the purpose and nature of the study, research questions, conceptual framework, definition of terms, assumptions and limitations, and the significance of the study. Background of the Study The incidence of thyroid disease is higher than previously thought (Canaris et al. Across cultures, the prevalence of thyroid disease is much higher in women than men (Canaris et al. Approximately 1 out of every 7 women develops thyroid disease, and its prevalence increases with age (about 20% in women over age 60; Godfrey, 2007). The two predominant conditions resulting from thyroid disease are hyperthyroidism and hypothyroidism, with Grave’s disease and Hashimoto’s disease, respectively, as the most common causes (Zeitlin et al. In the United States, the most common cause of hyperthyroidism is Grave’s disease, an autoimmune form of thyroid disease (Bunevicius & Prange, 2006). Individuals with hyperthyroidism experience heat intolerance, hot flashes, absent menses, insomnia, decreased libido (Godfrey, 2007), rapid heartbeat, sweating, and tremors (Aslan et al. In the United States, the most common cause of hypothyroidism is Hashimoto’s disease, an autoimmune form of thyroid disease (Erdal et al. Individuals with hypothyroidism experience fatigue (Bono, Fancellu, Blandini, Santoro, & Mauri, 2004), lethargy, apathy, difficulty concentrating (Aslan et al. In extreme cases, the individual may experience slowing of thought processes, progressive cognitive impairment, hallucinations, and delusions (Bono et al. Furthermore, abnormalities in thyroid function present with symptoms similar to those of other disorders and can be mistaken for other conditions (Canaris et al. For example, hyperthyroidism and hypothyroidism are frequently misdiagnosed as anxiety and depressive disorders, respectively (Aslan et al. Postpartum thyroiditis, which affects more than 8% of women, is sometimes mistaken for depression (Fassier et al.
Therefore buy super avana 160mg free shipping erectile dysfunction vacuum pumps reviews, the detection methods for receptors are limited and need to be critically evaluated 160mg super avana mastercard erectile dysfunction natural supplements. Since most tissue samples are highly heterogeneous from a cellular point of view 160 mg super avana with visa erectile dysfunction at 65, it is better to use a morphological method for receptor analysis best 100 mg kamagra soft. It is also preferable to detect the receptor protein itself purchase generic toradol line, and if possible, the receptor-binding sites in these proteins, since the binding sites represent the functional molecular basis for peptide hormones . A “gold standard” example is in vitro quantitative somatostatin receptor autoradiography on frozen tissue sections that combines morphology, binding site detection and receptor quantiﬁcation. Because of limited cellular resolution, receptor autoradiography is optimal for the detection of recep- tors in larger cell groups. An attractive morphological alternative is immunohisto- chemical analysis of the receptors on formalin-ﬁxed tissues [57–59] with the limitations that quantiﬁcation is not possible and that an epitope that may be different from the binding site is identiﬁed. The existence of receptor subtypes for G-protein-coupled receptors has made the evaluation of the receptor proﬁles more complex. Rehfeld In principle, all the mentioned methods are capable of detecting receptor sub- types. Unfortunately, antibodies raised against the known G-protein-coupled recep- tors and their subtypes rarely have the necessary reliability for immunohistochemical detection, i. Nevertheless, adequate antibodies against the somatostatin receptor, the sst2 and possibly also sst5, are now available [59–61], and that is a major progress that eventually may occur also for antibodies to the other hormone receptors [62, 63]. Perspective Gastrointestinal endocrinology has developed from an appendix of general endo- crinology to a biological discipline of its own over the last 40 years. Today it comprises a multitude of more than 100 bioactive peptides expressed in a controlled cell-speciﬁc manner all over the body. The peptides participate in intercellular regulation from local control of growth and cell differentiation to acute systemic effects on metabolism all over the body. Thus, in the early 1970s, a revolution changed the fundamental concepts and opened wide perspectives for gastrointesti- nal hormones in physiology and pathophysiology. Gastrointestinal peptide hormones must be viewed as evolutionarily conserved intercellular messengers of general signiﬁcance. There are no obvious boundaries between their role in food intake and digestion and their function in other bodily regulations. Most regulatory peptides (hormones, neuropeptides, growth factors, and cytokines) are probably expressed in the gut, at least at some stage in the phylogenetic or ontogenetic development. Hence, the development of gastrointes- tinal endocrinology may continue its exponential growth with a broad deﬁnition of regulatory peptides. On the other hand, such extension almost deprives the concept of gastrointestinal endocrinology of its meaning. And that is exactly what this is all about: Gastrointestinal hormones should be viewed not only as local hormones of speciﬁc interest to digestive physiologists and clinical gastroenterologists. They are integrated chemical messengers in the coordination and regulation of many or most bodily functions in mammals.
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The role of the professional interpreter is still new and largely unknown in the medical setting purchase super avana 160 mg free shipping erectile dysfunction qof. For this reason generic super avana 160mg overnight delivery erectile dysfunction medication ratings, it is important for interpreters to set clear expectations of their role at the very start of the triadic (provider-patient-interpreter) encounter generic super avana 160mg without a prescription erectile dysfunction early 20s, stressing in particular the elements of accuracy purchase 20mg female cialis fast delivery, completeness order generic viagra super active from india, and confidentiality. It is also important in the early moments of the triadic encounter for the interpreter to attend to other concerns, such as arranging the spatial configuration of the parties in the encounter, addressing any discomfort a patient or provider may have about the presence of an interpreter, or assessing the linguistic style of the patient, keeping in mind at all times the goal of establishing a direct relationship between the two main parties. The most basic task of the interpreter is to transmit information accurately and completely. Therefore, interpreters must operate under a dual commitment: (1) to understand fully the message in the source language, and 2) to retain the essential elements of the communication in their conversion into the target language. Interpreters whose linguistic proficiency (in terms of breadth and depth) in both languages is very high and who have a solid working knowledge of the subject matter are more likely to be able to make the conversions from one language to another without needing to ask for much clarification Those whose linguistic proficiency is limited can use appropriate strategies to ensure that they themselves understand the message before they make the conversion and that all the pertinent information has been transmitted. In the interest of accuracy and completeness, interpreters must be able to manage the flow of communication so that important information is not lost or miscommunicated. Interpreters may also have to attend to the dynamics of the interpersonal interaction between provider and patient, for example when tension or conflict arises. The introduction of a third party into the medical encounter generates dynamics that are inherent in triadic interactions. A primary characteristic of a triadic, as opposed to a dyadic, relationship is the potential for the formation of an alliance between two of the three parties. Because the interpreter is the party to whom both provider and patient can relate most directly, both have a propensity to want to form an alliance with the interpreter. The provider and patient often exhibit this tendency by directing their remarks to the interpreter rather than to each other, which leads to the ‘tell the patient/doctor’ form of communication. Thus, the interpreter must work at encouraging the parties to address each other directly, both verbally and nonverbally. The natural tendency of both providers and patients is to perceive interpreters as an extension of either their own world or the other, rather than as partners in their own right, with their own role responsibilities and obligations. For patients, the desire to form an alliance with the interpreter is heightened because they are likely to perceive the interpreter as understanding not only their language but also their culture. This perceived cultural affinity often leads patients to act as if the interpreter were there as their friend and advocate. For providers, the danger lies in assuming that the interpreter is part of their world and therefore expecting that the interpreter can and should take on other functions, such as obtaining a medical history. On the other hand, when providers assume that interpreters are extensions of the patient’s world, they tend to dismiss the importance of their role and ascribe inferior status to their work. As professionals in their own right, in the interpreter-mediated encounter interpreters owe their allegiance to the therapeutic relationship and its goals of quality health care. Their commitment is to support the other two parties in their respective domains of expertise – the provider as the technical expert with the knowledge and skills in medicine and health care, and the patient as the expert on his or her symptoms, beliefs, and needs. The provider offers informed opinions and options, while the patient remains the ultimate decision maker in terms of treatment. The role of the interpreter is not to take control of the substance of the messages but rather to manage the process of communication.