Medicine

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Medicine
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Statue of Asclepius, the Greek god of medicine, holding the symbolic Rod of Asclepius with its coiled serpent
Specialist Medical specialty
Glossary Glossary of medicine

Medicine is the science and practice of establishing the diagnosis, prognosis, treatment, and prevention of disease. 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. [1]

Science systematic enterprise that builds and organizes knowledge

Science is a systematic enterprise that builds and organizes knowledge in the form of testable explanations and predictions about the universe.

Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engineering and computer science, it is typically used to determine the causes of symptoms, mitigations, and solutions.

Prognosis is a medical term for predicting the likely or expected development of a disease, including whether the signs and symptoms will improve or worsen or remain stable over time; expectations of quality of life, such as the ability to carry out daily activities; the potential for complications and associated health issues; and the likelihood of survival. A prognosis is made on the basis of the normal course of the diagnosed disease, the individual's physical and mental condition, the available treatments, and additional factors. A complete prognosis includes the expected duration, function, and description of the course of the disease, such as progressive decline, intermittent crisis, or sudden, unpredictable crisis.

Contents

Medicine has been around for thousands of years, during most of which it was an art (an area of skill and knowledge) 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 a combination of art and science (both basic and applied, under the umbrella of medical science). While stitching technique for sutures is an art learned through practice, the knowledge of what happens at the cellular and molecular level in the tissues being stitched arises through science.

Religion is a social-cultural system of designated behaviors and practices, morals, worldviews, texts, sanctified places, prophecies, ethics, or organizations, that relates humanity to supernatural, transcendental, or spiritual elements. However, there is no scholarly consensus over what precisely constitutes a religion.

Philosophy The rational investigation of the truths and principles of being, knowledge, or conduct.

Philosophy is the study of general and fundamental questions about existence, knowledge, values, reason, mind, and language. Such questions are often posed as problems to be studied or resolved. The term was probably coined by Pythagoras. Philosophical methods include questioning, critical discussion, rational argument, and systematic presentation. Classic philosophical questions include: Is it possible to know anything and to prove it? What is most real? Philosophers also pose more practical and concrete questions such as: Is there a best way to live? Is it better to be just or unjust? Do humans have free will?

Medicine man Native American traditional healer and spiritual leader

A medicine man or medicine woman is a traditional healer and spiritual leader who serves a community of indigenous people of the Americas. Individual cultures have their own names, in their respective Indigenous languages, for the spiritual healers and ceremonial leaders in their particular cultures.

Prescientific forms of medicine are now known as traditional medicine and folk medicine, though they do not fall within the modern definition of “medicine” which is based in medical science. Traditional medicine and folk medicine remain commonly used with, or instead of, scientific medicine and are thus called alternative medicine (meaning “[something] other than medicine”, from Latin alter, “other”). For example, evidence on the effectiveness of acupuncture is "variable and inconsistent" for any condition, [2] but is generally safe when done by an appropriately trained practitioner. [3] In contrast, alternative treatments outside the bounds not just of scientific medicine, but also outside the bounds of safety and efficacy are termed quackery.

Traditional medicine medicine based on traditional beliefs

Traditional medicine comprises medical aspects of traditional knowledge that developed over generations within various societies before the era of modern medicine. The World Health Organization (WHO) defines traditional medicine as "the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness". Traditional medicine is contrasted with scientific medicine.

Alternative medicine describes any practice that aims to achieve the healing effects of medicine, but which lacks biological plausibility and is untested, untestable or proven ineffective. Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine are among many rebrandings of the same phenomenon. Alternative therapies share in common that they reside outside medical science, and rely on pseudoscience. Traditional practices become "alternative" when used outside their original settings without proper scientific explanation and evidence. Frequently used derogatory terms for the alternative are new-age or pseudo, with little distinction from quackery.

Latin Indo-European language of the Italic family

Latin is a classical language belonging to the Italic branch of the Indo-European languages. The Latin alphabet is derived from the Etruscan and Greek alphabets and ultimately from the Phoenician alphabet.

Quackery can encompass an array of practices and practitioners, irrespective of whether they are prescientific (traditional medicine and folk medicine) or modern pseudo-scientific, including chiropractic which rejects modern scientific germ theory of disease (instead believing without evidence that human diseases are caused by invisible subluxation of the bones, predominately of the spine and less so of other bones), with just over half of chiropractors also rejecting the science of immunization.

Chiropractic form of alternative medicine

Chiropractic is a discipline that is concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. Chiropractors have proposed, especially those in the field's early history, that such disorders affect general health via the nervous system. It is classified as a type of complementary and alternative medicine (CAM). The main chiropractic treatment technique involves manual therapy, especially manipulation of the spine, other joints, and soft tissues, but may also include exercises and health and lifestyle counseling. Chiropractors are not medical doctors.

Germ theory of disease Prevailing theory about diseases

The germ theory of disease is the currently accepted scientific theory for many diseases. It states that microorganisms known as pathogens or "germs" can lead to disease. These small organisms, too small to see without magnification, invade humans, other animals, and other living hosts. Their growth and reproduction within their hosts can cause disease. "Germ" may refer to not just a bacterium but to any type of microorganism or even non-living pathogen that can cause disease, such as protists, fungi, viruses, prions, or viroids. Diseases caused by pathogens are called infectious diseases. Even when a pathogen is the principal cause of a disease, environmental and hereditary factors often influence the severity of the disease, and whether a potential host individual becomes infected when exposed to the pathogen.

In medicine, a subluxation is an incomplete or partial dislocation of a joint or organ.

Etymology

Medicine ( UK: /ˈmɛdsɪn/ ( Loudspeaker.svg listen ), US: /ˈmɛdɪsɪn/ ( Loudspeaker.svg listen )) is the science and practice of the diagnosis, prognosis, treatment, and prevention of disease. [4] [5] The word "medicine" is derived from Latin medicus, meaning "a physician". [6] [7]

British English is the standard dialect of the English language as spoken and written in the United Kingdom. Variations exist in formal, written English in the United Kingdom. For example, the adjective wee is almost exclusively used in parts of Scotland and Ireland, and occasionally Yorkshire, whereas little is predominant elsewhere. Nevertheless, there is a meaningful degree of uniformity in written English within the United Kingdom, and this could be described by the term British English. The forms of spoken English, however, vary considerably more than in most other areas of the world where English is spoken, so a uniform concept of British English is more difficult to apply to the spoken language. According to Tom McArthur in the Oxford Guide to World English, British English shares "all the ambiguities and tensions in the word 'British' and as a result can be used and interpreted in two ways, more broadly or more narrowly, within a range of blurring and ambiguity".

American English Set of dialects of the English language spoken in the United States

American English, sometimes called United States English or U.S. English, is the set of varieties of the English language native to the United States. American English is considered to be the world's most influential form of English.

Therapy medical treatment

A therapy or medicaltreatment is the attempted remediation of a health problem, usually following a diagnosis.

Clinical practice

The Doctor by Sir Luke Fildes (1891) The Doctor Luke Fildes crop.jpg
The Doctor by Sir Luke Fildes (1891)

Medical availability and clinical practice varies 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. [8] In 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. [9]

Western world Countries that identify themselves with an originally European shared culture

The Western world, also known as the West, refers to various regions, nations and states, depending on the context, most often including at least parts of Europe, Australasia, and the Americas. There are many accepted definitions, all closely interrelated. The Western world is also known as the Occident, in contrast to the Orient, or Eastern world. It might mean the Northern half of the North–South divide.

Developing country Nation with a low living standard relative to other countries

A developing country is a country with a less developed industrial base and a low Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreement on which countries fit this category. A nation's GDP per capita compared with other nations can also be a reference point. In general, the United Nations accepts any country's claim of itself being "developing".

Developed country country with a developed industry and infrastructure

A developed country, industrialized country, more developed country, or more economically developed country (MEDC), is a sovereign state that has a developed economy and advanced technological infrastructure relative to other less industrialized nations. Most commonly, the criteria for evaluating the degree of economic development are gross domestic product (GDP), gross national product (GNP), the per capita income, level of industrialization, amount of widespread infrastructure and general standard of living. Which criteria are to be used and which countries can be classified as being developed are subjects of debate.

In modern clinical practice, physicians personally assess patients in order to diagnose, prognose, treat, and prevent disease using clinical judgment. The doctor-patient relationship typically begins an interaction with an examination of the patient's medical history and medical record, followed by a medical interview [10] and a physical examination. Basic diagnostic medical devices (e.g. stethoscope, tongue depressor) are typically used. After examination 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 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. [11] Follow-ups may be shorter but follow the same general procedure, and specialists follow a similar process. The diagnosis and treatment may take only a few minutes or a few weeks depending upon the complexity of the issue.

The components of the medical interview [10] and encounter are:

The physical examination is the examination of the patient for medical signs of disease, which are objective and observable, in contrast to symptoms which are volunteered by the patient and not necessarily objectively observable. [12] The healthcare provider uses the senses of sight, hearing, touch, and sometimes smell (e.g., in infection, uremia, diabetic ketoacidosis). Four actions are 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. [13]

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 a specialist, or watchful observation. 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. [14]

The medical decision-making (MDM) process involves 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 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, and lab or imaging results or specialist consultations.

Institutions

The Hospital of Santa Maria della Scala, fresco by Domenico di Bartolo, 1441-1442 Pellegrinaio Santa Maria della Scala n5.jpg
The Hospital of Santa Maria della Scala, fresco by Domenico di Bartolo, 1441–1442

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 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. [15] Advanced industrial countries (with the exception of the United States) [16] [17] and many developing countries provide medical services through a system of universal health care that aims to guarantee care for all through a single-payer health care system, or compulsory private or co-operative 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 or by state-owned hospitals and clinics, or by charities, most commonly by 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 that can afford to pay for it or have self-insured it (either directly or as part of an employment contract) or who may be covered by care financed by the government or tribe directly.

Modern drug ampoules Drug ampoule JPN.jpg
Modern drug ampoules

Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality, and pricing greatly affects the choice by patients/consumers and, therefore, the incentives of medical professionals. While the US healthcare system has come under fire for lack of openness, [18] 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 the possible exploitation of information for commercial gain on the other.

Delivery

Provision of medical care is classified into primary, secondary, and tertiary care categories.

Nurses in Kokopo, East New Britain, Papua New Guinea Nurses at Butawin Urban Clinic, PNG (10711159465).jpg
Nurses in Kokopo, East New Britain, Papua New Guinea

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 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 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 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 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. [19]

Separation of prescribing and dispensing is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from 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. [20]

Branches

February 1918 drawing by Marguerite Martyn of a visiting nurse in St. Louis, Missouri, with medicine and babies Drawing by Marguerite Martyn of a visiting nurse with medicine and four babies, 1918.jpg
February 1918 drawing by Marguerite Martyn of a visiting nurse in St. Louis, Missouri, with medicine and babies

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, surgeons, surgeon's assistant, surgical technologist.

The scope and sciences underpinning human medicine overlap many other fields. Dentistry, while considered by some a separate discipline from medicine, is a medical field.

A patient admitted to 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:

Basic sciences

Louis Pasteur, as portrayed in his laboratory, 1885 by Albert Edelfelt Albert Edelfelt - Louis Pasteur - 1885.jpg
Louis Pasteur , as portrayed in his laboratory, 1885 by Albert Edelfelt

Specialties

In the broadest meaning of "medicine", there are many different specialties. In the UK, most specialities have their own body or college, which have 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); 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 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 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).

Surgical specialty

Surgeons in an operating room Surgeons at Work.jpg
Surgeons in an operating room

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on 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. Surgery has many sub-specialties, including general surgery, ophthalmic surgery, cardiovascular surgery, colorectal surgery, neurosurgery, oral and maxillofacial surgery, oncologic surgery, orthopedic surgery, otolaryngology, plastic surgery, podiatric surgery, transplant surgery, trauma surgery, urology, vascular surgery, and pediatric surgery. In some centers, anesthesiology is part of the division of surgery (for historical and logistical reasons), although it 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 a decade after medical school. Furthermore, surgical training can be very difficult and time-consuming.

Internal specialty

Internal medicine 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. [21] In North America, specialists in internal medicine are commonly called "internists." Elsewhere, especially in Commonwealth nations, such specialists are often called physicians. [22] These terms, internist or physician (in 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 the gut and the kidneys. [23]

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 the world: see the articles on medical education and physician 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 the UK where all doctors are now required by law to work less than 48 hours per week on average.

Diagnostic specialties

Other major specialties

The following are some major medical specialties that do not directly fit into any of the above-mentioned groups:

  • Anesthesiology (also known as anaesthetics): concerned with the perioperative management of the surgical patient. The anesthesiologist's role during surgery is to prevent derangement in the vital organs' (i.e. brain, heart, kidneys) functions and postoperative pain. Outside of the operating room, the anesthesiology physician also serves the same function in the labor and delivery ward, and some are specialized in critical medicine.
  • Dermatology is concerned with the skin and its diseases. In the UK, dermatology is a subspecialty of general medicine.
  • Emergency medicine is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies.
  • Family medicine , family practice , general practice or primary care is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family physicians often provide services across a broad range of settings including office based practices, emergency department coverage, inpatient care, and nursing home care.
Gynecologist Michel Akotionga of Ouagadougou, Burkina Faso Changing lives for girls and women every week (12330467294).jpg
Gynecologist Michel Akotionga of Ouagadougou, Burkina Faso
  • Obstetrics and gynecology (often abbreviated as OB/GYN (American English) or Obs & Gynae (British English)) are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine are generally practiced by gynecological specialists.
  • Medical genetics is concerned with the diagnosis and management of hereditary disorders.
  • Neurology is concerned with diseases of the nervous system. In the UK, neurology is a subspecialty of general medicine.
  • Ophthalmology is exclusively concerned with the eye and ocular adnexa, combining conservative and surgical therapy.
  • Pediatrics (AE) or paediatrics (BE) is devoted to the care of infants, children, and adolescents. Like internal medicine, there are many pediatric subspecialties for specific age ranges, organ systems, disease classes, and sites of care delivery.
  • Pharmaceutical medicine is the medical scientific discipline concerned with the discovery, development, evaluation, registration, monitoring and medical aspects of marketing of medicines for the benefit of patients and public health.
  • Physical medicine and rehabilitation (or physiatry) is concerned with functional improvement after injury, illness, or congenital disorders.
  • Podiatric medicine is the study of, diagnosis, and medical & surgical treatment of disorders of the foot, ankle, lower limb, hip and lower back.
  • Psychiatry is the branch of medicine concerned with the bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related non-medical fields include psychotherapy and clinical psychology.
  • Preventive medicine is the branch of medicine concerned with preventing disease.

Interdisciplinary fields

Some interdisciplinary sub-specialties of medicine include:

Medical students learning about stitches Medical students learning about stitches (2760577402).jpg
Medical students learning about stitches

Medical education and training varies around the world. It typically involves entry level education at a university medical school, followed by 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 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 the United States, can be searched at http://data.medobjectives.marian.edu/. [25]

Headquarters of the Organizacion Medica Colegial de Espana, which regulates the medical profession in Spain Madrid (RPS 13-07-2010) Organizacion Medica Colegial de Espana, fachada.jpg
Headquarters of the Organización Médica Colegial de España, which regulates the medical profession in Spain

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 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 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.

Doctors who are negligent or intentionally harmful in their care of patients can face charges of medical malpractice and be subject to civil, criminal, or professional sanctions.

Medical ethics

A 12th-century Byzantine manuscript of the Hippocratic Oath HippocraticOath.jpg
A 12th-century Byzantine manuscript of the Hippocratic Oath

Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. Six of the values that commonly apply to medical ethics discussions are:

Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts. When moral values are in conflict, the result may be an ethical dilemma or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. For example, some argue that the principles of autonomy and beneficence clash when patients refuse blood transfusions, considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.

History

Statuette of ancient Egyptian physician Imhotep, the first physician from antiquity known by name. Imhotep-Louvre.JPG
Statuette of ancient Egyptian physician Imhotep, the first physician from antiquity known by name.

Ancient world

Prehistoric medicine incorporated plants (herbalism), animal parts, and minerals. In many cases these materials were used ritually as magical substances by priests, shamans, or medicine men. Well-known spiritual systems include animism (the notion of inanimate objects having spirits), spiritualism (an appeal to gods or communion with ancestor spirits); shamanism (the vesting of an individual with mystic powers); and divination (magically obtaining the truth). The field of medical anthropology examines the ways in which culture and society are organized around or impacted by issues of health, health care and related issues.

Early records on medicine have been discovered from ancient Egyptian medicine, Babylonian Medicine, Ayurvedic medicine (in the Indian subcontinent), classical Chinese medicine (predecessor to the modern traditional Chinese medicine), and ancient Greek medicine and Roman medicine.

In Egypt, Imhotep (3rd millennium BCE) is the first physician in history known by name. The oldest Egyptian medical text is the Kahun Gynaecological Papyrus from around 2000 BCE, which describes gynaecological diseases. The Edwin Smith Papyrus dating back to 1600 BCE is an early work on surgery, while the Ebers Papyrus dating back to 1500 BCE is akin to a textbook on medicine. [26]

In China, archaeological evidence of medicine in Chinese dates back to the Bronze Age Shang Dynasty, based on seeds for herbalism and tools presumed to have been used for surgery. [27] The Huangdi Neijing , the progenitor of Chinese medicine, is a medical text written beginning in the 2nd century BCE and compiled in the 3rd century. [28]

In India, the surgeon Sushruta described numerous surgical operations, including the earliest forms of plastic surgery. [29] [ dubious ] [30] Earliest records of dedicated hospitals come from Mihintale in Sri Lanka where evidence of dedicated medicinal treatment facilities for patients are found. [31] [32]

In Greece, the Greek physician Hippocrates, the "father of modern medicine", [33] [34] laid the foundation for a rational approach to medicine. Hippocrates introduced the Hippocratic Oath for physicians, which is still relevant and in use today, and was the first to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence". [35] [36] The Greek physician Galen was also one of the greatest surgeons of the ancient world and performed many audacious operations, including brain and eye surgeries. After the fall of the Western Roman Empire and the onset of the Early Middle Ages, the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the Eastern Roman (Byzantine) Empire.

Most of our knowledge of ancient Hebrew medicine during the 1st millennium BC comes from the Torah, i.e. the Five Books of Moses, which contain various health related laws and rituals. The Hebrew contribution to the development of modern medicine started in the Byzantine Era, with the physician Asaph the Jew. [37]

Middle Ages

A manuscript of Al-Risalah al-Dhahabiah by Ali al-Ridha, the eighth Imam of Shia Muslims. The text says: "Golden dissertation in medicine which is sent by Imam Ali ibn Musa al-Ridha, peace be upon him, to al-Ma'mun." Al-Risalah al-Dhahabiah.JPG
A manuscript of Al-Risalah al-Dhahabiah by Ali al-Ridha, the eighth Imam of Shia Muslims. The text says: "Golden dissertation in medicine which is sent by Imam Ali ibn Musa al-Ridha, peace be upon him, to al-Ma'mun."

The concept of hospital as institution to offer medical care and possibility of a cure for the patients due to the ideals of Christian charity, rather than just merely a place to die, appeared in the Byzantine Empire. [38]

Although the concept of uroscopy was known to Galen, he did not see the importance of using it to localize the disease. It was under the Byzantines with physicians such of Theophilus Protospatharius that they realized the potential in uroscopy to determine disease in a time when no microscope or stethoscope existed. That practice eventually spread to the rest of Europe. [39]

After 750 CE, the Muslim world had the works of Hippocrates, Galen and Sushruta translated into Arabic, and Islamic physicians engaged in some significant medical research. Notable Islamic medical pioneers include the Persian polymath, Avicenna, who, along with Imhotep and Hippocrates, has also been called the "father of medicine". [40] He wrote The Canon of Medicine which became a standard medical text at many medieval European universities, [41] considered one of the most famous books in the history of medicine. [42] Others include Abulcasis, [43] Avenzoar, [44] Ibn al-Nafis, [45] and Averroes. [46] Persian physician Rhazes [47] was one of the first to question the Greek theory of humorism, which nevertheless remained influential in both medieval Western and medieval Islamic medicine. [48] Some volumes of Rhazes's work Al-Mansuri, namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities. [49] Additionally, he has been described as a doctor's doctor, [50] the father of pediatrics, [51] [52] and a pioneer of ophthalmology. For example, he was the first to recognize the reaction of the eye's pupil to light. [52] Al-Risalah al-Dhahabiah by Ali al-Ridha, the eighth Imam of Shia Muslims, is revered as the most precious Islamic literature in the Science of Medicine. [53] The Persian Bimaristan hospitals were an early example of public hospitals. [54] [55]

In Europe, Charlemagne decreed that a hospital should be attached to each cathedral and monastery and the historian Geoffrey Blainey likened the activities of the Catholic Church in health care during the Middle Ages to an early version of a welfare state: "It conducted hospitals for the old and orphanages for the young; hospices for the sick of all ages; places for the lepers; and hostels or inns where pilgrims could buy a cheap bed and meal". It supplied food to the population during famine and distributed food to the poor. This welfare system the church funded through collecting taxes on a large scale and possessing large farmlands and estates. The Benedictine order was noted for setting up hospitals and infirmaries in their monasteries, growing medical herbs and becoming the chief medical care givers of their districts, as at the great Abbey of Cluny. The Church also established a network of cathedral schools and universities where medicine was studied. The Schola Medica Salernitana in Salerno, looking to the learning of Greek and Arab physicians, grew to be the finest medical school in Medieval Europe. [56]

Panorama of Siena's Santa Maria della Scala Hospital, one of Europe's oldest hospitals. During the Middle Ages, the Catholic Church established universities which revived the study of sciences - drawing on the learning of Greek and Arab physicians in the study of medicine. SantaMariaDellaScalaSienaBack.JPG
Panorama of Siena's Santa Maria della Scala Hospital, one of Europe's oldest hospitals. During the Middle Ages, the Catholic Church established universities which revived the study of sciences – drawing on the learning of Greek and Arab physicians in the study of medicine.

However, the fourteenth and fifteenth century Black Death devastated both the Middle East and Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East. [57] In the early modern period, important early figures in medicine and anatomy emerged in Europe, including Gabriele Falloppio and William Harvey.

The major shift in medical thinking was the gradual rejection, especially during the Black Death in the 14th and 15th centuries, of what may be called the 'traditional authority' approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general – see Copernicus's rejection of Ptolemy's theories on astronomy). Physicians like Vesalius improved upon or disproved some of the theories from the past. The main tomes used both by medicine students and expert physicians were Materia Medica and Pharmacopoeia.

Andreas Vesalius was the author of De humani corporis fabrica , an important book on human anatomy. [58] Bacteria and microorganisms were first observed with a microscope by Antonie van Leeuwenhoek in 1676, initiating the scientific field microbiology. [59] Independently from Ibn al-Nafis, Michael Servetus rediscovered the pulmonary circulation, but this discovery did not reach the public because it was written down for the first time in the "Manuscript of Paris" [60] in 1546, and later published in the theological work for which he paid with his life in 1553. Later this was described by Renaldus Columbus and Andrea Cesalpino. Herman Boerhaave is sometimes referred to as a "father of physiology" due to his exemplary teaching in Leiden and textbook 'Institutiones medicae' (1708). Pierre Fauchard has been called "the father of modern dentistry". [61]

Modern

Paul-Louis Simond injecting a plague vaccine in Karachi, 1898 Paul-Louis Simond injecting plague vaccine June 4th 1898 Karachi.jpg
Paul-Louis Simond injecting a plague vaccine in Karachi, 1898

Veterinary medicine was, for the first time, truly separated from human medicine in 1761, when the French veterinarian Claude Bourgelat founded the world's first veterinary school in Lyon, France. Before this, medical doctors treated both humans and other animals.

Modern scientific biomedical research (where results are testable and reproducible) began to replace early Western traditions based on herbalism, the Greek "four humours" and other such pre-modern notions. The modern era really began with Edward Jenner's discovery of the smallpox vaccine at the end of the 18th century (inspired by the method of inoculation earlier practiced in Asia), Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of antibiotics around 1900.

The post-18th century modernity period brought more groundbreaking researchers from Europe. From Germany and Austria, doctors Rudolf Virchow, Wilhelm Conrad Röntgen, Karl Landsteiner and Otto Loewi made notable contributions. In the United Kingdom, Alexander Fleming, Joseph Lister, Francis Crick and Florence Nightingale are considered important. Spanish doctor Santiago Ramón y Cajal is considered the father of modern neuroscience.

From New Zealand and Australia came Maurice Wilkins, Howard Florey, and Frank Macfarlane Burnet.

Others that did significant work include William Williams Keen, William Coley, James D. Watson (United States); Salvador Luria (Italy); Alexandre Yersin (Switzerland); Kitasato Shibasaburō (Japan); Jean-Martin Charcot, Claude Bernard, Paul Broca (France); Adolfo Lutz (Brazil); Nikolai Korotkov (Russia); Sir William Osler (Canada); and Harvey Cushing (United States).

Alexander Fleming's discovery of penicillin in September 1928 marks the start of modern antibiotics. Alexander Fleming.jpg
Alexander Fleming's discovery of penicillin in September 1928 marks the start of modern antibiotics.

As science and technology developed, medicine became more reliant upon medications. Throughout history and in Europe right until the late 18th century, not only animal and plant products were used as medicine, but also human body parts and fluids. [62] Pharmacology developed in part from herbalism and some drugs are still derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloids, [63] taxol, hyoscine, etc.). [64] Vaccines were discovered by Edward Jenner and Louis Pasteur.

The first antibiotic was arsphenamine (Salvarsan) discovered by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of antibiotics was the sulfa drugs, derived by German chemists originally from azo dyes.

Pharmacology has become increasingly sophisticated; modern biotechnology allows drugs targeted towards specific physiological processes to be developed, sometimes designed for compatibility with the body to reduce side-effects. Genomics and knowledge of human genetics and human evolution is having increasingly significant influence on medicine, as the causative genes of most monogenic genetic disorders have now been identified, and the development of techniques in molecular biology, evolution, and genetics are influencing medical technology, practice and decision-making.

Evidence-based medicine is a contemporary movement to establish the most effective algorithms of practice (ways of doing things) through the use of systematic reviews and meta-analysis. The movement is facilitated by modern global information science, which allows as much of the available evidence as possible to be collected and analyzed according to standard protocols that are then disseminated to healthcare providers. The Cochrane Collaboration leads this movement. A 2001 review of 160 Cochrane systematic reviews revealed that, according to two readers, 21.3% of the reviews concluded insufficient evidence, 20% concluded evidence of no effect, and 22.5% concluded positive effect. [65]

Quality, efficiency, and access

Evidence-based medicine, prevention of medical error (and other "iatrogenesis"), and avoidance of unnecessary health care are a priority in modern medical systems. These topics generate significant political and public policy attention, particularly in the United States where healthcare is regarded as excessively costly but population health metrics lag similar nations. [66]

Globally, many developing countries lack access to care and access to medicines. [67] As of 2015, most wealthy developed countries provide health care to all citizens, with a few exceptions such as the United States where lack of health insurance coverage may limit access. [68]

Traditional medicine

Traditional medicine (also known as indigenous or folk medicine) comprises knowledge systems that developed over generations within various societies before the introduction of modern medicine. The World Health Organization (WHO) defines traditional medicine as "the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness." [69]

In some Asian and African countries, up to 80% of the population relies on traditional medicine for their primary health care needs. When adopted outside of its traditional culture, traditional medicine is often called alternative medicine. [69] Practices known as traditional medicines include Ayurveda, Siddha medicine, Unani, ancient Iranian medicine, Irani, Islamic medicine, traditional Chinese medicine, traditional Korean medicine, acupuncture, Muti, Ifá, and traditional African medicine.

The WHO notes however that "inappropriate use of traditional medicines or practices can have negative or dangerous effects" and that "further research is needed to ascertain the efficacy and safety" of several of the practices and medicinal plants used by traditional medicine systems. [69] The line between alternative medicine and quackery is a contentious subject.

Traditional medicine may include formalized aspects of folk medicine, that is to say longstanding remedies passed on and practised by lay people. Folk medicine consists of the healing practices and ideas of body physiology and health preservation known to some in a culture, transmitted informally as general knowledge, and practiced or applied by anyone in the culture having prior experience. [70] Folk medicine may also be referred to as traditional medicine, alternative medicine, indigenous medicine, or natural medicine. These terms are often considered interchangeable, even though some authors may prefer one or the other because of certain overtones they may be willing to highlight. In fact, out of these terms perhaps only indigenous medicine and traditional medicine have the same meaning as folk medicine, while the others should be understood rather in a modern or modernized context. [71]

See also

Related Research Articles

Neurology Medical specialty dealing with disorders of the nervous system

Neurology is a branch of medicine dealing with disorders of the nervous system. Neurology deals with the diagnosis and treatment of all categories of conditions and disease involving the central and peripheral nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle. Neurological practice relies heavily on the field of neuroscience, the scientific study of the nervous system.

Pediatrics field of medicine dealing with the care of children

Pediatrics is the branch of medicine that involves the medical care of infants, children, and adolescents. The American Academy of Pediatrics recommends people be under pediatric care up to the age of 21, though usually only minors under 18 are required to be under pediatric care. A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean "healer of children"; they derive from two Greek words: παῖς and ἰατρός. Pediatricians work both in hospitals, particularly those working in its subspecialties such as neonatology, and as outpatient primary care physicians.

Urology Subspecialty of surgery

Urology, also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the male and female urinary-tract system and the male reproductive organs. Organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs.

Pathology study and diagnosis of disease

Pathology is the study of the causes and effects of disease or injury. The word pathology also refers to the study of disease in general, incorporating a wide range of bioscience research fields and medical practices. However, when used in the context of modern medical treatment, the term is often used in a more narrow fashion to refer to processes and tests which fall within the contemporary medical field of "general pathology", an area which includes a number of distinct but inter-related medical specialties that diagnose disease, mostly through analysis of tissue, cell, and body fluid samples. Idiomatically, "a pathology" may also refer to the predicted or actual progression of particular diseases, and the affix path is sometimes used to indicate a state of disease in cases of both physical ailment and psychological conditions. A physician practicing pathology is called a pathologist.

Gynaecology science of the treatment of diseases of the female sexual organs and reproductive tract

Gynaecology or gynecology is the medical practice dealing with the health of the female reproductive systems and the breasts. Outside medicine, the term means "the science of women". Its counterpart is andrology, which deals with medical issues specific to the male reproductive system.

Emergency medicine medical specialty concerned with care for patients who require immediate medical attention

Emergency medicine, also known as accident and emergency medicine, is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians care for unscheduled and undifferentiated patients of all ages. As first-line providers, their primary responsibility is to initiate resuscitation and stabilization and to start investigations and interventions to diagnose and treat illnesses in the acute phase. Emergency physicians generally practise in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units, but may also work in primary care settings such as urgent care clinics. Sub-specializations of emergency medicine include disaster medicine, medical toxicology, ultrasonography, critical care medicine, hyperbaric medicine, sports medicine, palliative care, or aerospace medicine.

Ophthalmology Field of medicine treating eye disorders

Ophthalmology is a branch of medicine and surgery which deals with the diagnosis and treatment of eye disorders. An ophthalmologist is a specialist in ophthalmology. The credentials include a degree in medicine, followed by additional four to five years of ophthalmology residency training. Ophthalmology residency training programs may require a one year pre-residency training in internal medicine, pediatrics, or general surgery. Additional specialty training may be sought in a particular aspect of eye pathology. Ophthalmologists are allowed to use medications to treat eye diseases, implement laser therapy, and perform surgery when needed. Ophthalmologists may participate in academic research on the diagnosis and treatment for eye disorders.

Anatomical pathology medical specialty

Anatomical pathology (Commonwealth) or Anatomic pathology (U.S.) is a medical specialty that is concerned with the diagnosis of disease based on the macroscopic, microscopic, biochemical, immunologic and molecular examination of organs and tissues. Over the last century, surgical pathology has evolved tremendously: from historical examination of whole bodies (autopsy) to a more modernized practice, centered on the diagnosis and prognosis of cancer to guide treatment decision-making in oncology. Its modern founder was the Italian scientist Giovan Battista Morgagni from Forlì.

Internal medicine or general medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists, or physicians in Commonwealth nations. Internists are skilled in the management of patients who have undifferentiated or multi-system disease processes. Internists care for hospitalized and ambulatory patients and may play a major role in teaching and research.

A podiatrist, also known as a podiatric physician or foot and ankle surgeon, is a medical professional devoted to the treatment of disorders of the foot, ankle, and lower extremity. The term originated in North America, but has now become the accepted term in the English-speaking world for all practitioners of podiatric medicine.

Podiatry branch of medicine devoted to the study of, diagnosis, and medical treatment of disorders of the foot, ankle, and lower extremity

Podiatry is a branch of medicine devoted to the study, diagnosis, and medical and surgical treatment of disorders of the foot, ankle, and lower extremity. The term podiatry came into use in the early 20th century in the United States and is now used worldwide, including in countries such as the United Kingdom, Australia, and Canada.

Residency (medicine) Postgraduate medical training

Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, podiatrist, dentist, optometrist, veterinarian, or pharmacist who practices medicine, usually in a hospital or clinic, under the direct or indirect supervision of a senior clinician registered in that specialty such as an attending physician or consultant. In many jurisdictions, successful completion of such training is a requirement in order to obtain an unrestricted license to practice medicine, and in particular a license to practice a chosen specialty. An individual engaged in such training may be referred to as a resident, house officer, registrar or trainee depending on the jurisdiction. Residency training may be followed by fellowship or sub-specialty training.

A medical speciality is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include children (pediatrics), cancer (oncology), laboratory medicine (pathology), or primary care. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple-year residency to become a medical specialist.

Howard University Hospital, previously known as Freedmen's Hospital, is a major hospital located in Washington, D.C., built on the site of the previous Griffith Stadium. The hospital has served the African-American community in the area for over 150 years, having been established in 1862 to cater for the medical needs of the thousands of African Americans who came to Washington during the Civil War, seeking their freedom. The first hospital of its kind to provide medical treatment for former slaves, it later became the major hospital for the area's African American community. Following the closure of D.C. General Hospital, as of 2016, the hospital has the highest rate of wrongful death lawsuits of any health facility in Washington D.C. over the previous decade.

Temple University School of Medicine

The Lewis Katz School of Medicine at Temple University (LKSOM), located on the Health Science Campus of Temple University in Philadelphia, PA, is one of 7 schools of medicine in Pennsylvania conferring the M.D. degree. It also confers the Ph.D. and M.S. degrees in biomedical sciences. In addition, LKSOM offers a Narrative Medicine Program.

The following outline is provided as an overview of and topical guide to medicine:

A clinical officer (CO) is a gazetted officer who is qualified and licensed to practice medicine. In Kenya a clinical officer operates under the jurisdiction of the Clinical Officers Council and must study clinical medicine and surgery for three or four years, graduate from an approved medical training institution, complete an internship year at a teaching hospital and register as a clinical officer then apply for a practicing license and complete a final three year period of clinical supervision under a senior clinical officer or a senior medical officer in order to qualify for a practising certificate which allows one to provide general medical services to the public or to go into specialization. Clinical Officer (CO) is a protected title and its use by people who are not registered as such by the Clinical Officers Council is prohibited by law and punishable by upto five years in jail with or without a fine. Globally, the title may not have legal restrictions and can refer to a job grade rather than a medical qualification such as junior assistive clinical staff, licensed medical professionals or high-level corporate officers, directors, and managers.

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry.

In the United States and Canada, there are ten recognized dental specialties in which some dentists choose to train and practice, in addition to or instead of general dentistry. In the United Kingdom and Australia, there are thirteen.

Jiangxi University of Traditional Chinese Medicine University in China for traditional medicine

Jiangxi University of Traditional Chinese Medicine, designated as a Medical University in Nanchang, Jiangxi, is an institution of higher learning under the leadership of Jiangxi Provincial Government. According to the Survey by CUCAS, Jiangxi is ranked 43rd in Chinese Medical Universities, 577th University in China by 4icu ranking.

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