Making Sense of Spirituality in Nursing and Health Care Practice

An Interactive Approach Second Edition

Author: Wilf McSherry

Publisher: Jessica Kingsley Publishers

ISBN: 9781846425301

Category: Medical

Page: 216

View: 7235

'This is a well-written and useful book, particularly for those healthcare professionals who, with a little more confidence, and perhaps some Chaplaincy support, are well able to support their patients on their spiritual journeys. It would be an excellent tool for learning sessions between Chaplaincy and nursing staff, along with other relevant professional groups.' - Signpost 'This book considers why the spiritual needs of individuals are important. In an attempt to explain, the book uses case studies, which show the relationship of theory to practice. It is an interactive book encouraging reflection to explore the meaning of spirituality to patients and health care professionals. The exercises also attempt to explain the importance of a team approach to spiritual assessment as part of a holistic assessment. The book gives clear explanations of spirituality in the context of Holism and the different sections give plenty of food for thought. There are excellent references and suggestions for further reading. It is not a book for light reading but would be invaluable when encountering difficulties with a spiritual assessment or situation.' - Journal of Community Nursing Caring for the spiritual needs of patients is a highly significant yet often neglected and misunderstood aspect of health care. This results, in part, from a general lack of guidance and instruction given to healthcare professionals on the subject. This new edition of an established introductory guide to spirituality and health care practice draws extensively on case studies illustrating the application of theory to practice. It encourages the exploration, through reflective activities, of what spirituality means, both to patients and to the healthcare professionals caring for them. This book provides a comprehensive introduction to spiritual care for heath care professionals in all areas of practice.
Posted in Medical

Spirituality and Social Work

Author: Margaret Holloway,Bernard Moss

Publisher: Macmillan International Higher Education

ISBN: 0230365205

Category: Social Science

Page: 224

View: 3761

Written by two leading authors in the field, Social Work and Spiritualityprovides a critical engagement with the concept of spirituality and a much needed framework for the integration of spiritual care in mainstream practice. It isfundamental reading for all students of social work theory, ethics and practice.
Posted in Social Science

Theory of Spiritual Care for Nursing Practice

Author: Bonnie Weaver Battey, Ph.D. R.N.

Publisher: Xlibris Corporation

ISBN: 1469103249

Category: Medical

Page: N.A

View: 7586

The author?s purpose is to address the issue of establishing the nursing practice of holistic care in hospitals and similar health care agencies as well as in educational programs. The theory of spiritual care for nursing is offered to provide guidance and structure to this effort. Incorporating spirituality into one?s own nursing practice or for the entire nursing staff at an agency is probably a most pressing and intangible task facing nursing today. This text is not the fi nal answer, but is offered to provide one perspective that may provide direction for an ecumenical approach and serve as a theoretical guide for nurse educators in teaching spiritual care to nursing students as well as for nursing leaders and their nursing staff in developing a plan of implementation appropriate to an individual agency.
Posted in Medical

Psycho-spiritual Care in Health Care Practice

Author: Guy Harrison

Publisher: Jessica Kingsley Publishers

ISBN: 1784502928

Category: Religion

Page: 208

View: 3610

Meeting the psychological and spiritual needs of patients is vital to supporting their wellbeing in health care settings. To develop an effective, holistic and inclusive approach to care within predominantly medical health care models, practitioners across health care disciplines must work collaboratively to understand the complex, significant relationships between their patients' medical, therapeutic and spiritual requirements. Bridging the gap between care disciplines, the book presents an innovative vision of patient wellbeing enriched by a synthesis of psychological, spiritual and medical approaches. Prominent practitioners from a range of disciplines including nursing and psychiatry demonstrate how their psycho-spiritual approaches meet the individual needs of patients, adapting to their emotional, spiritual and religious requirements. Accessible and enlightening, this book offers significant practical insight into the role of psychologically informed spiritual care.
Posted in Religion

Talking About Spirituality in Health Care Practice

A Resource for the Multi-Professional Health Care Team

Author: Gillian White

Publisher: Jessica Kingsley Publishers

ISBN: 9781846424939

Category: Health & Fitness

Page: 176

View: 9610

Health care professionals who endeavour to work holistically face a number of questions about spirituality. What is meant by `spirituality' as opposed to `religion'? What is its specific relevance to health care practice? This accessible book provides answers to these questions and offers a model for personal and professional development. Gillian White sets out a framework within which health care professionals can discuss spirituality and equip themselves to respond appropriately to the spiritual concerns of their patient in daily practice. She draws on her experience of sharing and discussing spirituality and spiritual care with other health care professionals and proposes that multi-professional health care teams should talk about spirituality in challenging but safe environments to develop shared understanding of it, and to increase their confidence about integrating spiritual care into their daily practise. This text is a useful contribution to the multi-disciplinary, whole-person approach in health care and will be of interest to all health care professionals, nursing staff and students in these fields.
Posted in Health & Fitness

Spiritual Dimensions of Nursing Practice

Author: N.A

Publisher: W.B. Saunders Company

ISBN: N.A

Category: Medical

Page: 386

View: 7566

This unique book discusses the spiritual aspects of nursing care, addressing the needs of both nurse and patient. It emphasizes the universality of spirituality and is appropriate for nurses and patients of many religious faiths. The developmental stages of spirituality, how to provide spiritual care in acute and chronic situations, Western and Eastern spiritual beliefs, and burnout as a spiritual issue are just a few of the topics discussed.
Posted in Medical

Spiritualität in den Gesundheitsberufen

Ein praxisorientierter Leitfaden

Author: Harold G. Koenig

Publisher: Kohlhammer Verlag

ISBN: 3170275208

Category: Medical

Page: 234

View: 4207

Ärzte, Pflegekräfte und Psychotherapeuten erheben in Europa bislang im Rahmen ihrer Diagnostik in aller Regel keine spirituelle Anamnese und gehen in der Behandlung nur selten auf die spirituellen Bedürfnisse ihrer Patienten ein. Angehörige der Gesundheitsberufe betrachten Religiosität und Spiritualität entweder nicht als ihren Zuständigkeitsbereich oder sind unsicher im Umgang damit. Dieses Buch gibt Grundlagen zum Thema und bietet allen Berufsgruppen innerhalb des therapeutischen Teams konkrete Hilfestellungen zum Umgang mit den spirituellen Bedürfnissen ihrer Patienten. Auch problematische Aspekte werden beleuchtet. Gesundheitsrelevante Informationen zu verschiedenen Religionen und ein Muster-Curriculum runden das Werk ab.
Posted in Medical

Spirituality, Theology and Mental Health

Multidisciplinary Perspectives

Author: Christopher Cook

Publisher: Hymns Ancient and Modern Ltd

ISBN: 0334046262

Category: Religion

Page: 288

View: 3691

Theology, Spirituality and Mental Health provides reflections from leading international scholars and practitioners in theology, anthropology, philosophy and psychiatry as to the nature of spirituality and its relevance to constructions of mental disorder and mental healthcare. Key issues are explored in depth, including the nature of spirituality and recent debates concerning its importance in contemporary psychiatric practice, relationship between demons and wellbeing in ancient religious texts and contemporary practice, religious conversion, and the nature and importance of myth and theology in shaping human self understanding. These are used as a basis for exploring some of the overarching intellectual and practical issues that arise when different disciplines engage together with an attempt to better understand the relationship between spirituality and mental health and translate their findings into mental healthcare practice.
Posted in Religion

Research in Nursing and Health Care

Evidence for Practice

Author: Beverley Joan Taylor

Publisher: Cengage Learning Australia

ISBN: 9780170123150

Category: Nurses

Page: 594

View: 1367

Posted in Nurses

Nursing Practice

Knowledge and Care

Author: Ian Peate,Karen Wild,Muralitharan Nair

Publisher: John Wiley & Sons

ISBN: 1118496795

Category: Medical

Page: 992

View: 2003

Nursing Practice is the essential, textbook to support you throughout your entire nursing degree, from your first year onwards. It explores all the clinical and professional issues that you need to know in one complete volume. Written in the context of the latest Nursing and Midwifery Council Standards for Pre-Registration Nursing Education and the Essential Skills Clusters, this book covers all fields of nursing: Adult, Child, Mental Health, Learning Disabilities and also Maternity care, in both acute and community settings. With full colour illustrations, and plenty of activities and user-friendly features throughout, this evidence-based text encompasses essential nursing theory and practice, providing students with information to support their success. Learning features in the book include: Hear it from the experts- tips and advice from real life nurses, patients and their carers, and student nurses Red Flags- alerting the student to potential dangers Primary Care Considerations- informs students about care issues in the community setting Fields boxes- giving further insight into other fields of nursing, making the book relevant to all fields of nursing practice Medicines Management boxes provide key information about medicines Self-assessment and activities throughout A companion website to this title is available at www.wileynursingpractice.com Here you’ll find a range of resources for both the student and the lecturer, including: Over 350 interactive multiple choice questions Flashcards Glossary Links to references and further reading Illustrations from the book Worksheets
Posted in Medical

Making Sense of Health, Illness and Disease

Author: Peter Twohig,Vera Kalitzkus

Publisher: Rodopi

ISBN: 9789042011199

Category: History

Page: 316

View: 4396

Health, illness and disease are topics well-suited to interdisciplinary inquiry. This book brings together scholars from around the world who share an interest in and a commitment to bridging the traditional boundaries of inquiry. We hope that this book begins new conversations that will situate health in broader socio-cultural contexts and establish connections between health, illness and disease and other socio-political issues. This book is the outcome of the first global conference on "Making Sense of: Health, Illness and Disease," held at St Catherine's College, Oxford, in June 2002. The selected papers pursue a range of topics from the cultural significance of narratives of health, illness and disease to healing practices in contemporary society as well as patients' illness experiences. Researchers and health care practitioners now live in the age of interdisciplinarity, which has transformed both health care delivery and research on health. The essays in this collection transcend the traditional boundaries of biomedicine and draw attention to the many ways in which health is embedded in socio-cultural norms and how these norms, in turn, shape health practices and health care. This volume is of interest not only to researchers but also to those delivering health care.
Posted in History

Health Assessment for Nursing Practice

Author: Susan F. Wilson,Jean Foret Giddens

Publisher: Elsevier Health Sciences

ISBN: 0323294170

Category: Medical

Page: 635

View: 8022

Using a nursing-oriented, holistic approach, this straightforward text provides you with a visual presentation to conducting physical examinations. This textbook clearly delineates the routine exam techniques from those exams for special circumstances or advanced practice. UNIQUE! Routine exams and exams for advanced practice are identified with a special icon to help you quickly and easily determine essential assessment content. Body system chapters are subdivided into clearly delineated sections to allow easy navigation among these consistent sections within the chapters. UNIQUE! End-of-chapter Documentation Samples demonstrate how to document client data and provide a practice context for client charting. UNIQUE! Special feature boxes outline common, Frequently Asked Questions (FAQs) about health assessment and provide corresponding answers. Ethnic and Cultural Variations boxes present differences to anticipate among today’s multicultural client population and show how to vary the exam for varied populations. Separate sections for special circumstances or special needs show how to vary the exam for clients with special needs. Feature boxes outline Healthy People 2010 objectives to provide you thorough discussions of recommendations for health promotion and reducing risk. Interactive Activity Lists at the end of each chapter outline corresponding exercises, checklists, and lab forms that can be found on the companion CD-ROM. Case Studies with Clinical Reasoning Questions are provided at the end of each chapter to test your application of textbook material. NCLEX® exam-style review questions are included at the end of each chapter. PDA-Downloadable Exam Techniques are included on the Evolve companion website to allow you to easily access important summary exam information. UNIQUE! The 30 Core Assessment Skills identified by research as most commonly performed by nurses are now highlighted with a unique icon. UNIQUE! The companion CD-ROM now provides the Core Assessment Skills Checklists as quick step-by-step summaries for each of the 30 Core Assessment Skills. Two new chapters pull all of the essential exam and assessment content together into cohesive chapters for the infant and child and the older adult. UNIQUE! Clinical Reasoning Exemplars walk you through the thinking process of how an experienced nurse makes decisions. UNIQUE! Concept boxes feature eight concepts in the context of health assessment including pain, sleep, oxygenation, perfusion, tissue integrity, motion, sensory, and intracranial regulation.
Posted in Medical

Health Assessment for Nursing Practice - Pageburst E-Book on VitalSource5

Health Assessment for Nursing Practice - Pageburst E-Book on VitalSource

Author: Susan F Wilson,Jean Foret Giddens

Publisher: Elsevier Health Sciences

ISBN: 0323083722

Category:

Page: N.A

View: 8251

Using a nursing-oriented, holistic approach, this straightforward text provides you with a visual presentation to conducting physical examinations. This textbook clearly delineates the routine exam techniques from those exams for special circumstances or advanced practice.UNIQUE! Routine exams and exams for advanced practice are identified with a special icon to help you quickly and easily determine essential assessment content. Body system chapters are subdivided into clearly delineated sections to allow easy navigation among these consistent sections within the chapters. UNIQUE! End-of-chapter Documentation Samples demonstrate how to document client data and provide a practice context for client charting. UNIQUE! Special feature boxes outline common, Frequently Asked Questions (FAQs) about health assessment and provide corresponding answers. Ethnic and Cultural Variations boxes present differences to anticipate among today s multicultural client population and show how to vary the exam for varied populations. Separate sections for special circumstances or special needs show how to vary the exam for clients with special needs. Feature boxes outline Healthy People 2010 objectives to provide you thorough discussions of recommendations for health promotion and reducing risk. Interactive Activity Lists at the end of each chapter outline corresponding exercises, checklists, and lab forms that can be found on the companion CD-ROM. Case Studies with Clinical Reasoning Questions are provided at the end of each chapter to test your application of textbook material. NCLEX(r) exam-style review questions are included at the end of each chapter. PDA-Downloadable Exam Techniques are included on the Evolve companion website to allow you to easily access important summary exam information. UNIQUE! The 30 Core Assessment Skills identified by research as most commonly performed by nurses are now highlighted with a unique icon.UNIQUE! The companion CD-ROM now provides the Core Assessment Skills Checklists as quick step-by-step summaries for each of the 30 Core Assessment Skills. Two new chapters pull all of the essential exam and assessment content together into cohesive chapters for the infant and child and the older adult. UNIQUE! Clinical Reasoning Exemplars walk you through the thinking process of how an experienced nurse makes decisions. UNIQUE! Concept boxes feature eight concepts in the context of health assessment including pain, sleep, oxygenation, perfusion, tissue integrity, motion, sensory, and intracranial regulation.
Posted in

Religion, Religious Ethics and Nursing

Author: Marsha D. Fowler, PhD, MDiv, MS,,Sheryl Reimer Kirkham, PhD, RN,Rick Sawatzky, PhD, RN,Elizabeth Johnston Taylor, PhD, RN

Publisher: Springer Publishing Company

ISBN: 0826106641

Category: Medical

Page: 432

View: 7490

"[This] is a book that challenges you to step back and broaden your thinking about religion in general and religion in nursing...Nurses at all levels will appreciate the applications to nursing practice, theory, and research."--Journal of Christian Nursing "The Reverend Dr. Marsha Fowler and her colleagues have written a landmark book that will change and enlighten the discourse on religion and spirituality in nursing. The authors address the awkward silence on religion in nursing theory and education and with insightful scholarship move beyond the current level of knowledge and limited discourse on religion in nursing theory, education and practice. This book is path-breaking in that [it] gives many new ways to think about the relationships between ethics, health, caregiving, moral imagination, religion and spirituality." From the Foreword by Patricia Benner, PhD, RN, FAAN Professor Emerita of Nursing Department of Social and Behavioral Sciences and Nursing University of California, San Francisco The past 25 years have witnessed an escalating discussion on the role of spirituality within health care. This scholarly volume is rooted in the belief that not only is religion integral to nursing care, but the religious beliefs of both nurse and patient can significantly influence care and its outcome. It offers an in-depth analysis of the ways in which religion influences the discipline of nursing, its practitioners, and treatment outcomes. Through the contributions of an international cadre of nurse scholars representing the world's major religious traditions, the book explores how theories, history and theologies shape the discipline, bioethical decision making, and the perspective of the nurse or patient who embraces a particular religion. It examines the commonalities between the values and thinking of nursing and religion and identifies basic domains in which additional research is necessary. The authors believe that ultimately, scholarly dialogue on the relationship between religion and nursing will foster and enhance nursing practice that is ethical and respectful of personal values. Key Features: Offers in-depth analysis of how religion influences the discipline of nursing, its practitioners, and treatment outcomes Uses critical theories to explore the intersections of religion, ethics, culture, health, gender, power, and health policy Includes an overview of all major world religions Focuses on the implications of religion for nursing practice rather than nursing interventions Designed for graduate and upper-level undergraduate students, nurse academicians and clinicians
Posted in Medical

Spirituality, Values and Mental Health

Jewels for the Journey

Author: Mary Ellen Coyte,Peter Gilbert,Vicky Nicholls

Publisher: Jessica Kingsley Publishers

ISBN: 1843104563

Category: Medical

Page: 336

View: 8011

This edited work addresses policy and practice for professional working in the mental health field and for carers and people with mental health problems themselves, enabling them to overcome the stigma often associated with mental health problems, and the subject of spirituality.
Posted in Medical

Pediatric Primary Care - E-Book

Author: Catherine E. Burns,Ardys M. Dunn,Margaret A. Brady,Nancy Barber Starr,Catherine G. Blosser,Dawn Lee Garzon Maaks

Publisher: Elsevier Health Sciences

ISBN: 1455742171

Category: Medical

Page: 1288

View: 7598

Covering the full spectrum of health conditions seen in the primary care of children, Pediatric Primary Care, 5th Edition emphasizes both prevention and management from the unique perspective of the Nurse Practitioner. Written by an expert editor/contributor team, it provides in-depth, evidence-based guidance for assessing and managing health problems in children from infancy through adolescence. Other key topics include developmental theory, the health status of children today, issues of daily living, and cultural considerations. Four-part organization includes an introductory unit, plus units on child development, the health management of children, and diseases and disorders common to childhood. UNIQUE! Functional health patterns framework in Unit Three provides a lens for discussing health promotion through the various components of healthy living. UNIQUE! ICD framework in Unit Four addresses the classification used to code diseases in both hospital and outpatient settings. UNIQUE! Practice management chapter provides need-to-know information on managing a private healthcare practice, including issues of productivity, compliance with applicable laws, quality-of-care indicators, and successful business practices. UNIQUE! Environmental health chapter offers evidence-based content on the effects of environmental toxicants, such as tobacco smoke, heavy metals, and air pollutants. An 8-page color insert presents over 40 photos that visually demonstrate key assessment findings for ear, skin, and other conditions. NEW! Pediatric Pain Management chapter addresses the increased recognition of pain as the "fifth vital sign" with expanded coverage of acute and chronic pain management in children. Extensively revised and updated genetics chapter presents a new paradigm for addressing genetic considerations in clinical practice, including an introduction to epigenetics. Increased emphasis on health disparities explores the growing health disparities among children in the U.S and worldwide and provides strategies to help patients and parents gain accessibility to health care resources. NEW! Content on implementing a "medical home" explores the trend toward family-centered coordinated health care and fosters appropriate treatment for children with chronic disease. NEW! Updated coverage takes a more global approach, exploring the health status of children outside the U.S. Expanded imaging content offers valuable guidance on using various imaging modalities, including how to prepare the child for diagnostics.
Posted in Medical

Ethical and Philosophical Aspects of Nursing Children and Young People

Author: Gosia M. Brykczynska,Joan Simons

Publisher: John Wiley & Sons

ISBN: 1444392042

Category: Medical

Page: 288

View: 8069

Nurses and healthcare professionals are constantly faced with ethical and philosophical dilemmas when working with children in everyday practice. Ethical and Philosophical Aspects of Nursing Children and Young People is a comprehensive text on the ethics and philosophy behind paediatric nursing that reflects the contemporary issues encountered while working with children and young people. The title provides a philosophical and historical analysis of the subject, looking at a review of sociological and political theories concerning the nature of childhood, and providing a critical analysis of contemporary notions about childhood. It then goes on to look at moral theories and their application to paediatric nursing practice, ethical issues when caring for children of all ages, from infancy to adolescence. It considers issues of disabled children, confidentiality, mental health issues, children's rights, and pain management. With case studies and activities throughout, this book will enable students and newly qualified nurses both to understand philosophical concepts and issues but also to articulate their own reflections and observations on these subjects. Written by children's nurses for children's nurses With contributions from internationally recognised experts in the field Reflective scenarios, further reading, extensive referencing, case studies, guided questions, and resources throughout Includes appendices on the RCPCH Guidelines on Withdrawal of Treatment, the ICN Ethical Code, the Summary of the UNCRC, and the RCPCH Guidelines for the Conduct of Ethical Research
Posted in Medical

Nursing Knowledge and Practice E-Book

Author: Maggie Mallik,Carol Hall,David Howard

Publisher: Elsevier Health Sciences

ISBN: 0702037524

Category: Medical

Page: 504

View: 6883

Nursing knowledge and practice is a comprehensive textbook which forms an ideal basis for foundation nursing students. The core emphasis in the organisation and presentation of knowledge in this third edition remains focused on the in-depth knowledge required by nurses to deliver care in the practice setting. The chapter contents encompass knowledge that applies to all branches of nursing e.g. Communication, Confusion, Aggression and Rehabilitation Safety and Risk, Infection Control, Medicines etc. The structure of all chapters is unique in integrating knowledge from subject areas often taught separately in the nursing curriculum. This enables the foundation student to integrate this range of knowledge in making decisions about the delivery of nursing care to patients/clients in all fields of nursing. Exercises are included to encourage reflection on practice and develop critical thinking skills. It also promotes the expansion of professional knowledge through the development of portfolio evidence. Building on the outstanding success of previous editions the authors have drawn extensively on current best evidence, including research, policy and substantial internet based resources, reflecting UK and international perspectives. • Each chapter begins with an overview of the content and concludes with a summary to help evaluate learning • Case studies reflect the diverse range of client needs and care settings of the four nursing branches and help relate theory to practice • Reflective exercises and suggestions for portfolio evidence, along with decision-making activities, promote reflection on personal experience and links to nursing practice using a problem-based approach • Current research is highlighted throughout, demonstrating the evidence-base for practice decisions. • Key web sites, annotated further reading and references encourage readers to pursue contemporary evidence that underpins competency-based practice. Full colour throughout Content fully updated in line with developments in clinical practice, teaching requirements and the evidence-base Free electronic ancillaries on Evolve enhance the knowledge provided in each chapter with additional information, exercises and resources An introductory chapter on ‘Nursing Knowledge and Practice’ explores the role and context of nursing, nationally and internationally, providing foundation information on core knowledge areas common to all nursing curricula.
Posted in Medical

Trauma Nursing E-Book

From Resuscitation Through Rehabilitation

Author: Karen A. McQuillan,Mary Beth Flynn Makic,Eileen Whalen

Publisher: Elsevier Health Sciences

ISBN: 1437726577

Category: Medical

Page: 992

View: 8811

Using the unique cycles of trauma framework, the 4th edition of this classic and highly acclaimed resource is thoroughly updated to bring you comprehensive coverage of cutting-edge research findings and current issues, trends, and controversies in trauma nursing. Detailed information guides you through all phases of care – from preventive care and the time of injury to the resuscitative, operative, critical, intermediate, and rehabilitative stages. Timely discussions on emerging topics such as mass casualty and rural trauma/telemedicine keep you up to date with the latest developments in the field. This practical, evidence-based reference is the most complete resource available for both novice and experienced trauma nurses working in a variety of care settings. Comprehensive coverage includes practical, clinically relevant trauma information for nurses at all levels of knowledge and experience working in a variety of settings. Evidence-based content ensures that you are using the latest and most reliable information available to provide state-of-the-art care for trauma patients. A user-friendly format, logical organization, and helpful tables and illustrations help you find information quickly and clarify key concepts and procedures. Detailed information guides you through all phases of care – from preventive care and the time of injury to the resuscitative, operative, critical, intermediate, and rehabilitative stages. Special populations coverage prepares you to meet the unique needs of pregnant, pediatric, and elderly patients, as well as bariatric patients, burn victims, patients with substance abuse issues, and organ and tissue donors. A section on Clinical Management Concepts gives you a solid understanding of key issues affecting all patients regardless of their injury, including mechanism of injury, traumatic shock, patient/family psychosocial responses to trauma, pain management, wound healing, and nutrition. A new Mass Casualty chapter prepares you to act quickly and confidently in the event of a disaster, with guidelines for initial response and sustained response, lessons learned from recent disasters, government involvement, and hazmat, bioterrorism, and nuclear-radiological preparedness. A new chapter on Rural Trauma/Telemedicine focuses on the unique nature of rural trauma care and offers strategies to help you improve healthcare delivery in this challenging environment. A new Trauma in the Bariatric Patient chapter provides the specialized information you need to meet the challenges and needs of this growing patient population.
Posted in Medical