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Both case management and & Rasi purchase secnidazole 500 mg free shipping, 1990; Lockhart buy secnidazole 500mg low price, 2000) to nursing homes managed care incorporate multiple disciplines as (Zurakowski purchase secnidazole 500mg on-line, 2000) purchase 500 mg secnidazole overnight delivery, King’s framework and related they work to improve the overall quality and cost theories provide a foundation on which nurses can efﬁciency of the health care provided. Table 16–12 lists cations also address the continuum of care, a prior- applications within a variety of nursing work ity in today’s health-care environment. This use of knowledge across disciplines occurs frequently and can be very ap- Obviously, new nursing knowledge has resulted propriate if both disciplines’ perspectives are simi- from applications of King’s framework and theory. Second, the nursing rules of What is evidence-based practice and how will evidence must include heavier weight for research evidence-based nursing practice evolve? Titler been assimilated and accepted as core beliefs of the (1998), a nurse, deﬁnes evidence-based practice as discipline. In addition, King’s concept of perception (1981) Research conducted with a King theoretical base lends itself well to the deﬁnition of client out- is well positioned for application by nurse care- comes. Johnson and Maas (1997) deﬁne a nursing- givers, nurse administrators (Sieloff, 2003), and sensitive client outcome as “a measurable client or client-consumers (Killeen, 1996) as part of an family caregiver state, behavior, or perception that evolving definition of evidence-based nursing is conceptualized as a variable and is largely inﬂu- practice. For example, King (1971) addressed client enced and sensitive to nursing interventions” preference, a possible part of an evidence-based (p. In an update nursing knowledge requires the use of client out- of the concept of satisfaction, King submits that come measurement. The use of standardized client satisfaction is a subset of her central concept of outcomes as study variables increases the ease with perceptions (Killeen, 1996). The evaluation component of the nursing process con- Both managed care and increasing use of technol- sistently refers back to the original goal state- ogy have challenged existing conceptual frame- ment(s). Standardized terms for diagnoses, inter- that King’s concepts have evolved within this ventions, and outcomes potentially improve com- changing health-care climate. Biegen and Tripp-Reimer (1997) sug- King (1981) has always promoted cooperation and gested middle-range theories be constructed from collaboration among disciplines. Alternatively, King’s terpersonal, and social systems need to include an framework and theory may be used as a theoretical expanded conceptualization of King’s concept of basis for these phenomena and may assist in knowl- goal-setting. Personal and professional goal-setting, edge development in nursing in the future. In addition, the variety of practice ap- able goals; solicit input for client care planning; re- plications evident in the literature clearly vise client care plan, as necessary; discuss progress attest to the complexity of King’s work. As re- toward goals; and provide data to facilitate evalua- searchers continue to integrate King’s theory tion of client care plan” (p. Speciﬁcally, she recom- References mends using her concepts of self, role, power, au- thority, decisions, time, space, communication, and Alligood, M. King’s evaluate the use of King’s concepts, and possibly, interacting systems and empathy. King’s theory for nurs- tions now occur without visual perceptions in the ing: Explication and evaluation. Imogene King’s theory as the foundation An essential component in the analysis of for the set of a teaching-learning process with undergrauation conceptual frameworks and theories is the [sic] students [Portuguese]. Theory-based practice in the characteristics of scope, usefulness, and com- emergency department. Consumer centric advocacy: Its connection to nursing frame- more speciﬁc in terms of the nature and works. The perception and judge- King fully intended her Interacting ment of senior baccalaureate student nurses in clinical deci- Systems Framework for nursing to be useful sion making. Imogene King’s conceptual framework: A proposed model for continuing nursing educa- midrange Theory of Goal Attainment (King, tion. Concept of the month: framework and midrange theory has resulted Implementing King’s conceptual framework at the bedside. Young adults’ perceptions of living with families: Theory/research/education/practice (pp. Health promotion in youth with chronic ill- methodologic framework to study nurse patient communica- ness: Are we on the right track? Advances Journal of Obstetric, Gynecologic, and Neonatal Nursing, in Nursing Science, 12(1), 67–75. Advancing King’s systems plore family health in the families of the young chronically framework and theory of nursing. King’s theory between registered nurses and family members of critically as foundation for an advanced directive decision-making ill patients in intensive care and neonatal intensive care model. Nursing models and community as behaviors: Nurse educators and clinical nurse specialists de- client... Use of King’s theory of goal attainment to systems framework and theory of goal attainment promote adolescents’health behavior. Nursing Science Quarterly, study of a psychotic client with human immunodeﬁciency 4, 14–20. Using King’s interacting systems frame- to professional nursing care: Instrument development. Journal of Multicultural Nursing & oping or revising a baccalaureate nursing program. A theory of goal attainment: Systems, concepts, isfaction with nursing care of patients with ostomies. Effectiveness of nursing care: Use of a goal Academy of Nursing Education, 1(1), 30–31. King’s theory of goal Association of Nephrology Nurses and Technicians Journal, attainment applied in group therapy for inpatient juvenile of- 11(2), 11–17, 60. Philosophy of nursing education: A national Advancing King’s systems framework and theory of nursing survey. New York: Recovering from stroke: A qualitative investigation of the role National League for Nursing. Nursing ory of dynamic interacting systems to the study of child abuse Science Quarterly, 7, 29. Nursing informatics: A universal nursing King’s systems framework and theory of nursing (pp. Revista Latino-Americana de situations in nursing interpreted by concepts from King’s Enfermagem, 10(1), 97–103. A study of nurse patient interaction in a high frameworks and community as client: Bridging the gap dependency unit. Perceived needs of parents of critically ill veloping or revising a baccalaureate nursing program. A pro- personal system concepts within the King’s systems frame- gram plan addressing carpal tunnel syndrome: The utility of work to explore perceived health status during the menopause King’s goal attainment theory. Deﬁning the health of a social system ties of newly employed nurses at the University Hospital, within Imogene King’s framework. Medical and nursing students’ perceptions of the actualized power of a nursing department. Measuring nursing power within organiza- Canadian Operating Room Nursing, 12(2), 15–16, 18–19. The development of a conceptual model for models of nursing: Some mental health care applications. The nurse’s role in giving pre-operative ing perspective: Moving beyond borrowed theory. Archives of information to reduce anxiety in patients admitted to hospi- Psychiatric Nursing, 15(3), 140–147. Theory implementation: A challenging jour- families with high-risk infants: Challenges for the future. Canadian Journal of Nursing Administration, 4(1), Journal of Perinatal and Neonatal Nursing, 4(4), 71–77. Family health as derived from King’s tainment: Resolving ﬁlial caregiver role strain. Strengthening patient- Council for Nursing Research’s 1998 Pre-Convention provider relationships. Lippincott’s Case Management, 7(3), Research Utilization Conference, Evidence-based Practice, 86–102.
Little or no nystatin Amphotericin is invaluable in treating life-threatening sys- is absorbed systemically from the oropharynx or gastrointest- temic fungal infections discount 500 mg secnidazole with visa, but has considerable toxicity buy secnidazole 500 mg on line. Patients often prefer topical amphotericin B mycosis) purchase secnidazole 500 mg fast delivery, Histoplasma capsulatum (which causes histoplasmo- because nystatin has a bitter taste discount secnidazole 500 mg mastercard. Cutaneous infections are sis), Cryptococcus neoformans (which causes cryptococcosis), treated with ointment and vaginitis is treated by suppositories. Coccidioides immitis (which causes coccidioidomycosis) and Sporotrichum schenckii (which causes sporotrichosis). Amphotericin is insoluble in water, but can Nystatin can cause nausea and diarrhoea when large doses be complexed to bile salts to give an unstable colloid which can are administered orally. Amphotericin B is normally given as an intravenous infusion given over four to six hours. Key points Several liposomal or lipid/colloidal complex amphotericin preparations have now been formulated, and are less toxic (par- Polyene antifungal drugs ticularly less nephrotoxic), but more expensive than the stand- • Wide spectrum of antifungal activity, fungicidal; makes ard formulation. Topical amphotericin lozenges or suspension are • Amphotericin is used intravenously for deep-seated and used for oral or pharyngeal candidiasis. Mechanism of action • Intravenous amphotericin is toxic, causing fever, chills, hypotension during infusion, nephrotoxicity, electrolyte Amphotericin is a polyene macrolide with a hydroxylated abnormalities and transient bone marrow suppression. The lipophilic amphotericin is reduced by using the liposomal/ surface has a higher affinity for fungal sterols than for choles- lipid/micellar formulations. They are used topically and are • reversible nephrotoxicity; this is dose dependent and active both against dermatophytes and yeasts (e. It results from vasoconstriction and Some imidazoles are also used systemically, although they tubular damage leading to acute renal impairment have limited efficacy and significant toxicity. Mechanism of action of azoles (imidazoles and • tubular cationic losses, causing hypokalaemia and triazoles) hypomagnesaemia; • normochromic normocytic anaemia due to temporary Imidazoles competitively inhibit lanosterol 14-α-demethylase marrow suppression is common. This disrupts the acyl chains of fungal membrane phos- Poor gastro-intestinal absorption necessitates intravenous pholipids, increasing membrane fluidity and causing administration for systemic infections. Amphotericin distrib- membrane leakage and dysfunction of membrane-bound utes very unevenly throughout the body. The t1/2 is occurs due to mutations in the gene encoding for lanosterol 18–24 hours. Breast milk concentrations are inhibits testosterone and cortisol synthesis) and because it similar to those in plasma and fluconazole should not be used interacts adversely with many drugs. The use and properties of more commonly used imidazoles Pharmacokinetics are listed in Table 45. Fluconazole is well absorbed after oral administration and is widely distributed throughout the body. Triazole drugs fluconazole mean elimination t is 30 hours in patients with 1/2 work by the same mechanism as imidazoles but have a wider normal renal function. However, Aspergillus species nel blockers, ciclosporin, docetaxel and, importantly, war- are resistant and resistant Candida species are problematic in farin. Fluconazole is used clinically will increase during concomitant treatment with fluconazole. It is administered orally or Itraconazole and voriconazole are available as oral and par- intravenously as a once daily dose. Oral bioavailability is good for both Adverse effects agents, but intravenous use is indicated for severe fungal infec- tions. The antifungal spectrum is similar to that of fluconazole Adverse effects include: and is broad. The mean itraconazole t1/2 is 30–40 hours and • hepatitis (rarely, hepatic failure). Induces its own infections metabolism Miconazole Oral Candida (topical therapy for Oral gel, four times daily Nausea and Systemic absorption is ringworm, Candida and pityriasis 2% cream or powder vomiting, rashes. Mechanism of action Key points Echinocandins are non-competitive inhibitors of 1,3-β-D glucan Azole antifungal drugs synthase, an enzyme necessary for synthesis of a glucose poly- mer crucial to the structure and integrity of the cell walls of • Relatively wide spectrum of antifungal activity, fungistatic, but fungicidal with higher concentrations. Fungal cells unable to synthesize this polysaccha- • Impair ergosterol biosynthesis by inhibiting ride cannot maintain their shape and lack adequate rigidity to lanosterol 14-alpha-demethylase (fungal cytochrome resist osmotic pressure, which results in fungal cell lysis. Glucan also appears essential for fungal cell growth and divi- • Available as intravenous, oral and topical formulations. The mechanism of action of echinocandins is unique and • Can be used as therapy for superficial (e. Cryptococcus) fungal drugs of this class are potentially additive or synergistic with infections. It may be Caspofungin and micafungin are not absorbed from the administered orally to treat ringworm (Tinea pedis, T. It is given once Both agents are eliminated by hydrolysis and N-acetylation daily for two to six weeks (longer in infections of the nailbed, as to inactive metabolites. It is elimi- nated by hepatic metabolism with a mean elimination t1/2 of 17 hours. Its major side effects are nausea, abdominal discomfort, Drug interactions anorexia, diarrhoea and rashes (including urticaria). Rifampicin increases terbinafine metabolism, Other agents in this expanding class include anidulafungin. The normal t1/2 is six hours and this is Echinocandin antifungal drugs prolonged in renal failure. Antiviral drug therapy is therefore Griseofulvin is orally active, but its spectrum is limited to der- increasingly important. It is given antibacterial therapy because viruses are intimately incorpo- orally with meals and treatment is recommended for six weeks rated in host cells and the therapeutic targets are often similar for skin infections and up to 12 months for nail infections. To summarize these problems: Mechanism of action • Viral replication is intracellular, so drugs must penetrate Griseofulvin is concentrated in fungi and binds to tubulin, cells in order to be effective. Adverse effects • Although viral replication begins almost immediately after the host cell has been penetrated, the clinical signs These include: and symptoms of infection often appear after peak viral • headaches and mental dullness or inattention; replication is over. Less than which can destroy viruses in this situation remains a 1% of the parent drug is excreted in the urine. Its spectrum is intracellularly; relatively restricted and acquired resistance is a major prob- • viral nucleic acid acts as a template for new strands of lem. It is deaminated to 5-fluorouracil in the components utilizing the host cell’s synthetic mechanisms. Adverse effects include gastro-intestinal upset, leuko- • extracellular release of new viral particles. It is much less effective in secondary than in Aciclovir is relatively contraindicated in pregnancy as it is an primary infection. It does not eliminate vaginal carriage, analogue of guanosine and so potentially teratogenic in the so Caesarean section is indicated to avoid neonatal herpes. Treatment of shingles (herpes zoster) should be started Pharmacokinetics within 72 hours of the onset and is useful for patients with Aciclovir bioavailability is approximately 20% after adminis- severe pain, although it shortens the illness only modestly. The mean elimination t1/2 of aciclovir is three hours meningoencephalitis, aciclovir is given intravenously. Clearance is Mechanism of action largely renal and includes an element of tubular secretion; renal Aciclovir undergoes intracellular metabolic activation to its impairment requires dose/schedule adjustment. Ganciclovir, a guanine analogue, is used to treat sight- or life- • Aciclovir has low oral bioavailability. It also has (an aciclovir prodrug) have much greater bioavailability potent activity against herpes viruses 1 and 2 and is used to treat than aciclovir. A loading dose is administered intra- levels, rashes, hepatitis and gastro-intestinal venously followed by maintenance infusions. Foscarnet is active against several important viruses, notably Valganciclovir is the L-valyl ester prodrug of ganciclovir. Foscarnet is given intravenously as loading dose phate in herpes-infected cells by the virally encoded thymi- followed by infusions. These include: Adverse effects • neutropenia and bone marrow suppression (thrombocytopenia and less often anaemia); cell counts These include the following: usually return to normal within two to five days of • nephrotoxicity: minimized by adequate hydration and discontinuing the drug; dose reduction if the serum creatinine rises; monitoring of • temporary or possibly permanent inhibition of renal function is mandatory; spermatogenesis or oogenesis; • central nervous system effects include irritability, anxiety • phlebitis and pain at intravenous infusion site; and fits; • rashes and fever; • nausea, vomiting and headache; • gastro-intestinal upsets; • thrombophlebitis; • transient increases in liver enzymes and serum creatinine • hypocalcaemia and hypomagnaesemia; in underhydrated patients. Contraindications Pharmacokinetics Ganciclovir is contraindicated in pregnancy (it is teratogenic Foscarnet is poorly absorbed (2–5%) after oral administration. Foscarnet is excreted renally by Pharmacokinetics 1/2 glomerular filtration and tubular excretion.
This type of memory proven 500mg secnidazole, which we experience along with a great deal of emotion cheap secnidazole 500 mg fast delivery, is known as a flashbulb memory—a vivid and emotional memory of  an unusual event that people believe they remember very well generic secnidazole 500 mg without a prescription. People are very certain of their memories of these important events cheap secnidazole 500mg visa, and frequently  overconfident. Talarico and Rubin (2003) tested the accuracy of flashbulb memories by asking students to write down their memory of how they had heard the news about either the September 11, 2001, terrorist attacks or about an everyday event that had occurred to them during the same time frame. Then the participants were asked again, either 1, 6, or 32 weeks later, to recall their memories. The participants became less accurate in their recollections of both the emotional event and the everyday events over time. But the participants‘ confidence in the accuracy of their memory of learning about the attacks did not decline over time. After 32 weeks the participants were overconfident; they were much more certain about the accuracy of their flashbulb memories than  they should have been. Schmolck, Buffalo, and Squire (2000) found similar distortions in memories of news about the verdict in the O. Heuristic Processing: Availability and Representativeness Another way that our information processing may be biased occurs when we use heuristics, which are information-processing strategies that are useful in many cases but may lead to errors when misapplied. Let‘s consider two of the most frequently applied (and misapplied) heuristics: the representativeness heuristic and the availability heuristic. In many cases we base our judgments on information that seems to represent, or match, what we expect will happen, while ignoring other potentially more relevant statistical information. Boy Using the representativeness heuristic may lead us to incorrectly believe that some patterns of observed events are more likely to have occurred than others. In this case, list B seems more random, and thus is judged as more likely to have occurred, but statistically both lists are equally likely. Most people think that list B is more likely, probably because list B looks more random, and thus matches (is “representative of‖) our ideas about randomness. But statisticians know that any pattern of four girls and four boys is mathematically equally likely. The problem is that we have a schema of what randomness should be like, which doesn‘t always match what is mathematically the case. Similarly, people who see a flipped coin come up “heads‖ five times in a row will frequently predict, and perhaps even wager money, that “tails‖ will be next. But mathematically, the gambler‘s fallacy is an error: The likelihood of any single coin flip being “tails‖ is always 50%, regardless of how many times it has come up “heads‖ in the past. The tendency to make judgments of the frequency or likelihood that an event occurs on the basis of the ease with Attributed to Charles Stangor Saylor. Imagine, for instance, that I asked you to indicate whether there are more words in the English language that begin with the letter “R‖ or that have the letter “R‖ as the third letter. You would probably answer this question by trying to think of words that have each of the characteristics, thinking of all the words you know that begin with “R‖ and all that have “R‖ in the third position. Because it is much easier to retrieve words by their first letter than by their third, we may incorrectly guess that there are more words that begin with “R,‖ even though there are in fact more words that have “R‖ as the third letter. We may think that our friends are nice people, because we see and remember them primarily when they are around us (their friends, who they are, of course, nice to). And the traffic might seem worse in our own neighborhood than we think it is in other places, in part because nearby traffic jams are more easily retrieved than are traffic jams that occur somewhere else. Salience and Cognitive Accessibility Still another potential for bias in memory occurs because we are more likely to attend to, and thus make use of and remember, some information more than other information. For one, we tend to attend to and remember things that are highly salient, meaning that they attract our attention. Things that are unique, colorful, bright, moving, and unexpected are more salient  (McArthur & Post, 1977; Taylor & Fiske, 1978). In one relevant study, Loftus, Loftus, and  Messo (1987) showed people images of a customer walking up to a bank teller and pulling out either a pistol or a checkbook. By tracking eye movements, the researchers determined that people were more likely to look at the gun than at the checkbook, and that this reduced their ability to accurately identify the criminal in a lineup that was given later. The salience of the gun drew people‘s attention away from the face of the criminal. The salience of the stimuli in our social worlds has a big influence on our judgment, and in some cases may lead us to behave in ways that we might better not have. You checked Consumer Reports online and found that, although the players differed on many dimensions, including price, battery life, ability to share music, and so forth, the Zune was nevertheless rated significantly higher by owners than was the iPod. You tell her that you were thinking of buying a Zune, and she tells you that you are crazy. She says she knows someone who had one and it had a lot of problems—it didn‘t download music correctly, the battery died right after the warranty expired, and so forth—and that she would never buy one. If you think about this question logically, the information that you just got from your friend isn‘t really all that important. You now know the opinion of one more person, but that can‘t change the overall rating of the two machines very much. On the other hand, the information your friend gives you, and the chance to use her iPod, are highly salient. The information is right there in front of you, in your hand, whereas the statistical information from Consumer Reports is only in the form of a table that you saw on your computer. The outcome in cases such as this is that people frequently ignore the less salient but more important information, such as the likelihood that events occur across a large population (these statistics are known as base rates), in favor of the less important but nevertheless more salient information. People also vary in the schemas that they find important to use when judging others and when thinking about themselves. Cognitive accessibility refers tothe extent to which knowledge is activated in memory, and thus likely to be used in cognition and behavior. For instance, you probably know a person who is a golf nut (or fanatic of another sport). Because he loves golf, it is important to his self-concept, he sets many of his goals in terms of the sport, and he tends to think about things and people in terms of it (“if he plays golf, he must be a good person! Other people have highly accessible schemas about environmental issues, eating healthy food, or drinking really good coffee. When schemas are highly accessible, we are likely to use them to Attributed to Charles Stangor Saylor. Counterfactual Thinking In addition to influencing our judgments about ourselves and others, the ease with which we can retrieve potential experiences from memory can have an important effect on our own emotions. If we can easily imagine an outcome that is better than what actually happened, then we may experience sadness and disappointment; on the other hand, if we can easily imagine that a result might have been worse than what actually happened, we may be more likely to experience happiness and satisfaction. The tendency to think about and experience events according to “what might have been‖ is known ascounterfactual thinking (Kahneman & Miller, 1986; Roese,  2005). Imagine, for instance, that you were participating in an important contest, and you won the silver (second-place) medal. Certainly you would be happy that you won the silver medal, but wouldn‘t you also be thinking about what might have happened if you had been just a little bit better—you might have won the gold medal! If you were thinking about the counterfactuals (the “what might have beens‖) perhaps the idea of not getting any medal at all would have been highly accessible; you‘d be happy that you got the medal that you did get, rather than coming in fourth. They videotaped the athletes both as they learned that they had won a silver or a bronze medal and again as they were awarded the medal. Then the researchers showed these videos, without any sound, to raters who did not know which medal which athlete had won. In a follow-up study, raters watched interviews with many of these same athletes as they talked about their performance. The raters indicated what we would expect on the basis of counterfactual thinking—the silver medalists talked about their disappointments in having finished second rather than first, whereas the bronze medalists focused on how happy they were to have finished third rather than fourth. I really wanted to make it home when I got near the end of my journey; I would have been extremely disappointed if the car broke down only a few miles from my home. Perhaps you have noticed that once you get close to finishing something, you feel like you really need to get it done. Jurors who were asked to award monetary damages to others who had been in an accident offered them substantially more in compensation if they barely avoided injury than they offered if the accident seemed inevitable (Miller, Turnbull, & McFarland,  1988). Psychology in Everyday Life: Cognitive Biases in the Real World Perhaps you are thinking that the kinds of errors that we have been talking about don‘t seem that important.
Most studies B have focused on its effects on hip and knee osteoarthritis discount secnidazole 500mg fast delivery, but it may offer beneﬁts for the back as well purchase 500 mg secnidazole visa. The active component is salicin buy secnidazole 500 mg amex, which is similar to aspirin buy secnidazole 500 mg low cost, only it is better tolerated. To prevent injuries, exercise to increase strength and ﬂexibility, use proper lifting techniques, and use proper form for sitting and standing. While it can be embarrassing and annoying, bad breath is not just a cosmetic problem—it can signify an underlying health problem. Approximately 90 percent of cases of bad breath originate from problems in the mouth. Poor oral hygiene (not brushing or ﬂossing regularly or properly) allows bac- B teria to grow and feed on food particles in the mouth. Bacteria emit sulphur gases, which not only cause bad breath, but also damage the tissues in the mouth, leading to inﬂammation of the gums (periodontitis). If left untreated, the bacteria continue to grow and cause gum recession, tooth decay, and even worse-smelling breath. The ancient Greeks chewed tree resin and the Mayans chewed chicle (sap from sapo- dilla tree) to keep their breath fresh. Curtis made and sold the ﬁrst commercial chewing gum called the State of Maine Pure Spruce Gum. When brushing, don’t forget to brush your tongue as it can trap large amounts of bacteria. If the cause of bad breath is a lung, throat, or mouth infection, an antibiotic may B be prescribed. If it is due to constipation and poor digestion, which can lead to the release of toxins into the breath, a laxative and/or ﬁbre supplement may be recom- mended. Foods to avoid: • Foods that move slowly through your digestive tract are more likely to cause constipation and bad breath, such as red meat, fried foods, and processed foods. Odours are transferred to the lungs and expelled by our breath and continue until the food is eliminated. Lifestyle Suggestions • Brush your teeth after meals to remove food particles, especially after drinking coffee or eating sulphur-containing foods such as milk products, ﬁsh, eggs, and meat. Look for products that con- tain zinc (reduces sulphur compounds in the mouth), or tea tree or eucalyptus oil, which have antibacterial and antiseptic properties. Top Recommended Supplements Chlorophyll: A component of green plants, chlorophyll helps neutralize odour. Coenzyme Q10: A deﬁciency of coenzyme Q10, an antioxidant that is important for gum health, has been linked to gum disease, and studies have found that it can help promote healing of the gums. Probiotics: Friendly bacteria that help to reduce formation of bad bacteria that cause bad breath. Complementary Supplement Vitamin C: Essential for healthy gums and teeth; levels may be deﬁcient in those with gum disease and in smokers. Chew gum with xylitol and/or peppermint and take supplements of chlorophyll, coenzyme Q10, and probiotics for gum health. Normally the urine is sterile and does not contain any bacteria, viruses, or fungi. However, an infection can develop when these bugs en- ter the urethra (the tube that carries urine out of the body) and travel up into the bladder. This leads to inﬂammation of the bladder (cystitis) and unpleasant urinary B symptoms. If a bladder infection is not treated properly, it can spread to the kidneys and become very serious. This is often due to a structural abnormality in the urethra or bladder affecting the ﬂow of urine. Infections of the bladder are the second most common infection in women and the most common complication of pregnancy. When urine is left to stagnate in the bladder, the risk of developing infec- tion increases. While necessary, there are various drawbacks to the use of antibiotics, including side effects such as diarrhea, stomach upset, and yeast overgrowth. Overuse of anti- biotics causes resistance—the bugs become stronger than the drugs, leaving people vulnerable to attack by bacteria. To relieve the pain and burning, a drug called phenazopyridine (Pyridium) may be prescribed. This is given for two to three days; it contains a dye and will cause discolouration of the urine and feces. Dietary Recommendations Foods to include: • Drink eight or more glasses of water daily to help ﬂush bacteria out of your bladder. You can sweeten it with stevia, which is a natural, low-calorie plant-based sweetener. Juice cocktails are an alternative that offer better taste and toler- ability, but contain less juice and have added sugar; drink three 16 oz. Foods to avoid: • Caffeine has diuretic properties, which promote ﬂuid loss, making the urine more concen- trated. Wear cotton un- derwear, which allows the skin to breathe; change clothing promptly after swimming. Top Recommended Supplements Cran-Max: Studies show that it prevents bladder infections and may also be effective in treating early bladder infections if taken at the ﬁrst sign of symptoms. Vitamin C: Acidiﬁes urine, making it more difﬁcult for bacteria to grow; inhibits the growth of E. Complementary Supplements Oil of oregano: Has antibacterial properties, and is available in capsules or liquid. Probiotics: Support immune function, help ﬁght off infections, and are essential for those on antibiotics because they restore the friendly bacteria destroyed by antibiotics. Acute bronchitis most commonly occurs follow- ing a respiratory infection, such as a cold or ﬂu. It can also develop due to exposure to cigarette smoke or pollution, or in those who have gastroesophageal reﬂux disease due to backﬂow of acids into the lungs. Acute bronchitis caused by a viral infection B often clears up on its own in a week or two without lasting effects. Long-term exposure to lung irritants (particularly cigarette smoke) can lead to continual inﬂammation and thickening of the lining of your bronchial tubes, which is called chronic bronchitis. People with chronic bronchitis have a persistent productive cough and shortness of breath. If you have a cold or ﬂu and symptoms persist beyond a few weeks, consult with your doctor. Those with chronic bronchitis who smoke are at increased risk of lung cancer above and beyond the normal risk that a smoker faces. Since most cases of acute bronchitis are caused by a viral infection, antibiotics offer little beneﬁt unless your doctor suspects a bacte- rial infection or you are at risk of this. Taking an antibiotic when not necessary can lead to resistance and secondary infections, such as thrush, yeast, and urinary tract B infections, so it is important to ask your doctor if antibiotics are necessary if one is prescribed. Cough suppressants are not recommended because coughing helps the lungs remove irritants. However, if your cough disrupts your sleep, then you may want to take a cough medicine at bedtime. For severe cases of bronchitis, your doctor may prescribe an inhaler to reduce inﬂammation and help you breathe. Herbal teas, such as Throat Coat, which contains marshmallow and licorice, can help relieve sore throat. Studies have shown that increasing fruit and vegetable consumption may reduce the risk of developing bronchitis. Researchers at Harvard did a study of 2,112 teenagers and found an association between good lung function and levels of dietary intake of fruit and ﬁsh rich in omega-3 fatty acids. Teens who ate less of these foods (two servings of fruit per week and less than 22 mg of omega-3 fatty acids per day) had higher rates of asthma, wheezing, and symptoms of chronic bronchitis such as cough and phlegm (Chest, 2007: 132; 238–245).