1. History of integrated Mx of illness Integrated management of childhood illness ( IMCI)-1992 Integrated management of pregnancy and child birth . (IMPAC ) integrated management of adolescent and adult illness ( IMAAI) integrated management of geriatric illness (IMGI) WE NEED GENERALISED INTEGRATION—i.e. Integrated management of human illness (IMHI) PHILOSOPHY OF FAMILY MEDICINE/ FAMILY PHYSICIAN ( MDGP) COURSE.

2. Family medicine Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity.

3. Quality healthcare in family medicine Quality healthcare in family medicine is the achievement of optimal physical and mental health through accessible, safe, cost-effective care that is based on best evidence, responsive to the needs and preferences of patients and populations, and respectful of patients’ families, personal values, and beliefs.

4. Family Medicine, Scope and Philosophical Statement Family medicine is the natural evolution of historical medical practice. The first physicians were generalists. For thousands of years, generalists provided all of the medical care available. They diagnosed and treated illnesses, performed surgery, and delivered babies. As medical knowledge expanded and technology advanced, many physicians chose to limit their practices to specific, defined areas of medicine.

5. Family Medicine, Scope and Philosophical Statement Family medicine is a three-dimensional specialty, incorporating (1) knowledge, (2) skill and (3) process. Although knowledge and skill may be shared with other specialties, the family medicine process is unique. At the center of this process is the patient-physician relationship with the patient viewed in the context of the family.

6. IN SUMMARY The family physician of today is rooted in the historical generalist tradition. The specialty is three dimensional, combining knowledge and skill with a unique process. The patient-physician relationship in the context of the family is central to this process and distinguishes family medicine from other specialties. Above all, the scope of family medicine is dynamic, expanding, and evolutionary.

7. PHILOSOPHY Philosophy :-is the way of looking or understanding of universe and its contents. It may be idealistic, metaphysics and dialectical materialistic philosophy. It depends upon the answer of the question to the existence of matter in this universe is primary(dialectical materialism)or secondary to consciousness(idealism) or undecided one( metaphysical philosophy).

8. X↑A ←----------DIALECTICS----------->B ↓Y Dialectics is a method of thinking and interpreting the world of both nature and society. It is a way of looking at the universe, which sets out from the axiom that everything is in change and motion. But not only that. Dialectics explains that change and motion involve contradiction and can only take place through contradictions.

9. Dialectical logic The dialectics is a science of the forms of our thinking Dialectics is the method of reasoning which aims to understand things concretely in all their movement, change and interconnection, with their opposite and contradictory sides in unity.

10. FORMAL /DIALECTICAL CONCEPT (A=A ) , (A≠ A ) It is definitely true that the right Philosophy or right scientific thought, which is more scientific and more practical, can have more clear and true concept regarding a particular subject or system. According to the theory of dialectics, there is nothing stable except change and development. So our present medical concept in our society, should be changed towards more scientific and practical form, from which we can solve the problem regarding health as far as possible by present existing concept( formal logic) we are not able to solve health problem in our practice mostly.

11. INTEGRATION This is a process of making association of a subject or event or a system with others. According to the theory of dialectical materialism, every matter/subject/system/ event has some kind of similarities and associated each other in somewhat. For example, every thing of this universe is material, which is made up of atoms, again atoms made up of electron, protons & neutrons, further more, these from atomic particles i.e quantum particles. This means, there is nothing in this universe, purely isolated and not associated Hence every thing is associated with each other in some how and somewhat, and thus making association (synthesis) of similarities of matter/subject/event is very important. From which we can find out some physical laws, which govern that system or event or subject

12. CONCEPT Concept is a reflection of individual/society to some thing, which is depended on most available scientific knowledge and practice of an individual or society. Hence concept can be variable according to thought, Philosophy and level of scientific knowledge and practice of people and society. Any concept, regarding any thing, is an unstable matter, which is Continuously changing and developing towards more clear & higher level, which is depended on the looking angle, Consciousness of the people of society with various thoughts, Knowledge, types of Philosophy & practice.

13. Understanding Understanding is the level of consciousness or knowledge of an object/event/ system for given specific time and space of the people or society. This means, the understanding of any people or society is variable regarding something, according to the level of scientific and practical knowledge and philosophical basic concept for given time period and given place.

14. Management The verb manage comes from the Italianmaneggiare (to handle — especially tools), which in turn derives from the Latinmanus (hand). The French word mesnagement (later ménagement) influenced the development in meaning of the English word management in the 17th and 18th centuries It may be defined as conceptualized art of worth-full handling of events, systems, organizations or any kind of tasks or the acts of getting people together to accomplish desired goals and objectives.

15. Management of health and illness In case of health and disease management, it has broad role and spheres of scientific as well as philosophic understanding on its theoretical and practical aspects. It comprises, data collection, analysis, interpretation, understanding the problems, try to find out the cause of problems, prediction of the way of solution, decision making about the plan of action in systematic and coordinated form, coutinuos evaluation on effectiveness of action and achievements of goals.

16. Dialectical view of Health and disease(it’s a new way) Dialectics is a method of thinking and interpreting the world of both nature and society. It is a way of looking at the universe, which sets out from the axiom that everything is in a constant state of change and unrest. But not only that. Dialectics explains that change and motion involve contradiction and can only take place through contradictions. So instead of a smooth, uninterrupted line of progress, we have a line which is interrupted by sudden and explosive periods in which slow, accumulated changes (quantitative change) undergoes a rapid acceleration, in which quantity is transformed into quality. Dialectics is the logic of contradiction. Dialectics studies both subjective and objective phenomena together rather than separately, hence its result will be obviously more close approximate to essence of any phenomena.

17. RK Dhaugoda’s basic law of dialectics(it’s a new comprehensive law of dialectics) Any event, system or unit contains opposite phenomena which are also connected relatively by means dynamic reciprocal association with other one or more sets of opposite phenomena again. (It is a new law explored by Dr. R.K.Dhaugoda in the field of dialectics, called RK Dhaugoda’s basic law of dialectics) i.e. opposite phenomena within opposite phenomena, systems, which are interdepended,interchangable each other as four dimensional certain reciprocal associations primarily. in short-dialectics is law of dynamic unity of opposites within opposites-according to R.K.Dhaugoda-this law is applied practically in many instances in this book e.g. The health and disease are opposite phenomena, are connected with another opposite phenomena i.e. stress factors (cytokines) and antistress factor . likewise day and night are opposites related with other sets of opposite phenomena, rotation of earth from west to east in its own axis, and sun arise from east / sets from west.

18. R.K.Dhaugoda’sGENERAL THEORY OF VASCULITIS This theory is made from the various conclusions of various literature reviews, discussions, and various studies and finding, which are presented many chapters of the book rkdhaugoda’s GENERAL THEORY OF VASCULITIS PART-1. It is hypothesized to build the general theory of vasculitis, with the help of guide line theory that is dialectical materialism, to express the objective reality of the physiological and pathological laws within the human body and to solve many problems in the field of management of health and disease in the huge proportional of population, in terms of effective, preventive, curative with least costs and simple techniques and coordinating with other various scientific approaches. THIS WORK IS STARTED SINCE-2004 TO TILL DATE.

19. R.K.Dhaugoda’sGENERAL THEORY OF VASCULITIS According to this theory: (1) Any inflammatory (infectious or non infectious & endogenous or exogenous originated disease is associated with varying degree of vaculitis in relation to time, space, motion and matter (antigen specific/strss factors/antistress factors). It means the main / key pathology of any inflammation is the vaculits (primary or secondary vaculitis). Vaculitis is the inflammation of vascular system,and associated with inflammation of any types of cells of the body. (2) All the inflammatory originated diseases having the common pathology vasculitis are principally mediated by the major factor TNF- alpha). It means TNF- alpha is the principle cytokine, and principle pathogenic mediator for all types’ vasculitis diseases (from boils to cancer pathology). (3) All these vasculitis pathology have relatively high level of TNF- alpha in the circulation, which are associated with relative hypo-ANTISTRESS AGENT(Relative low level of intracellular ANTI-STRESS FACTOR). Because in any hypo-ANTI-STRESS AGENT-condition, there is increased synthesis of TNF- alpha and they’re appearance of inflammatory response, and then various degree of vasculitis process is developed.

20. WHOWorld Health Organization WHO (World Health Organization)- is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

21. WRONG-WHO definition of Health The wrong WHO definition of Health Health is a state of completephysical, mental and social well-being and not merely the absence of disease or infirmity. This Definition has not been modified since 1948. Health is not a absolute phenomena, so the lack of operational value and the problem created by use of the word "complete”- according to dialectical law ,Nature is a state of motion and change According to Angels, “All nature from the smallest thing to the biggest, from grains of sand to sun, from the primary living cell (protista) to man, has its existence in internal coming into being and going out of being, in a ceaseless flux, in unresting motion and change. So health can not be a complete or absolute thing.

22. WRONG-WHO definition of Health ." “The phrase absence of disease or infirmity” is also a great fundamental problem in the definition of health by WHO .this last phrase says that concept of absolute health and health is taken as isolated form from disease side , which is opposite to reality. Health never can be isolated from disease. if there is no disease in a man there shouldn’t be existence of health simultaneously , it is possible the detachment of health and disease only after death of a person. According to dialectical law (Contradictions inherent in Nature) every thing or system in the universe and its contents there should be opposite system or things simultaneously and they are interchangeable, contradicted in nature. In the 21st century, health is a shared responsibility, involving equitable access to essential care and collective defense against transnational threats.

23. The new definition of HEALTH, according toRkdhaugoda’s new concept of heath and disease Health is defined as “the relative dynamically balance STATE of optimum level of dialectic materialistic thought and practice in relation to idealistic thought of an individual; and relative reciprocal association of intracellular level of ANTI-STRESS ELEMENT in relation to stress factors(TNF-alpha) in the body of an individual”. ---By DR. RKD

24. DEFINITION OF DISEASE DISEASE is just opposite of health, hence disease is defined as “the relative low level of dialectical materialistic thought and practice, as compare to idealistic thought and practice; and the relative unbalanced intracellular ANTISTRESS ELEMENT in comparison to stress factors(TNF-alpha) in the body of an individual”. --By DR. RKD

25. Scientific And Revolutionary Definition of Immunity WHO is the co-coordinator or contractor or organizer or monitor or authority of world health, hasn’t define immunity and disease officially yet. That’s why there are a lot of problems in the management of world health effectively. WHO has defined health in 1948, and has not updated up to now, This WHO definition of health also a non realistic , impracticable and unscientific one.

26. Scientific And Revolutionary Definition of Immunity According to R.K.Dhaugoda :- “Immunityis defined as relatively physiologic balance of anti-stress factor (antibodies ) in comparison to outer and inner stress factors( microbes, pollutants, radiation,virus,,oxydising agents, mechanical forces, altered bio-mechanical, HORMONE ENZYMES CELL GROWTH , mental tortures, fear ,anxiety as outer and prime cytokine TNF- alpha as inner stress factor of body ); and increased awareness on natural/body laws ( dialectical - materialistically ) as well as mental laws ( psychologically -positive self steam)”. ---BY DR. RKD Before this, no one has been defined immunity in molecular level as well as natural, philosophical and psychological level yet.

27. APPLICATION OF SYSTEM OFIMHIINTEGTETED MANAGEMENT OF HUMAN ILLNESS IMHI is the systemof relative integration of philosophical-Psycho-social-bio-mechanical, multi-concepts, multisystem, holistic, Multi-approach, cost effective and simple way of management of human illness and assessment of well-being uniquely,scientificallyand humanly. - AUTHOR :- DR. RKDHAUGODA ------------------------------------------------------------RESTRUCTURING OF HEALTH CARE SYSTEM FOR :- Bridging Rural and Urban health by General Practice

28. OBJECTIVES OF IMHI Understand the basic philosophy( dialectics ), principles, spheres, broad integrative comprehensive guidelines and methods of IMHI. Describe the rationale for the evidence-based syndromic approach to case management as described in the IMHI. List the clinical illnesses included in the IMHI concept and their relevance insituations associated with TIME, PLACE , PERSON and motion. ASSESS THE LEVEL OF OPTIMUM HEALTH STATUS OF A PERSON IN GIVEN TIME PLACE , AND MOTION. TO DETECT ANY ONGOING SUBCLINICAL PATHOGENESIS. AND TO PLAN FOR PREVENTING ATIONS. Clinically, Assess the and classify the condition of a SICK PERSON as well , to determine its severity and establish the relationship between thisclassification and the subsequentmanagement. List the danger signs and aggravating and risk factors that should beroutinely checked in all patients. Look for environmental, cultural, economical, educational level, concepts and psychological status of patient and family member and of particular society. Look for other existing alternative medical system which patients have accepted and their spheres and try to correlate them logically.

29. THE FUNDAMENTAL APPROACHES OF IMHI MEASURING OF HUMAN OPTIMUM HEALTH LEVEL ( MEASUREMENT OF SUBCLINICAL SUSCEPTIBLE PATHOLOGY/ DISODERS (PRE-DIABETES CODN ) Are syndromic, diagnostic or combined or empirical for unspecified conditions. e.g APPROCH IS BASICALLY DEPENDED ON STAGING AND QUANTIFYING THE MOST OF THE HUMAN DISORDERS FOR EXAMPLE SIRS , SEPSIS , SEPTIC SHOCK, MOD : ACUTENESS, CHRONICITY, VISIBLE OR INVISIBLE DIASBILITY OR DISORDERS. EMOTIONAL UPSET, DEGREE OF MENTAL DISFUNCTION,ENVIROMENTAL,PERSONAL,FAMILIAL, PHILOSOPHICO-SOCIO-ECHONOMICAL, AND GLOBAL INTEGRATED ASSESSMENT FOR MULTI-ENFLUNCING FACTORS.

30. METHOD OF APPROACH OF IMHI Shortly –method of approach of IMHI , is holistic ,comprehensive and integrated form that is philosophico-psycho-physiological-biomechanical-emotional-educational-realizational- environmental-socio- global ranges. The IMHI clinical interventions ensure that every person receives the benefits of preventive measures, as well as appropriate care for their illnesses, based on strong evidence and updated technical Knowledge.

31. IM HI-COVERS IMHI – covers the following subjects relatively and broadly as integrated concepts, knowledge and practices for better and easy management of human illness in view of personal- socio-economical and environmental background.

32. INTRODUCTION OF IMHI It is a system of co-ordination relatively and related all motions of nature, society and mind. It is basically integrated with fundamental and scientific philosophical view of world and its contents that is dialectical materialistic view. It is related to holistic approach of various useful concepts, systems, practices and methods in the management of whole human and social illness in relation to human and his environment, from the beginning of history of human society up to-now. It is a dynamic, continuously changing, developing integrated concepts and practice of management of human health globally, in its accessibility, accessibility, affordability with simplicity.

33. CONT.-INTRODUCTION OF IMHI It is the unification of all the modalities or systems of human illness managements in our societies in scientific bases with effectiveness of their efficacy. It really coordinates the fundamental human social factors, like human thought process, human practices up on nature or environments and societies. And feedback of society and environments to human thought, attitude and practices. It shows that nothing is complete and isolated things, concepts, system and methods, practices. And needs integration for more worth-full achievement in the field of any human thought and practices and for understanding of laws of nature and human body and their relation with other various natural, social and human psycho- biological phenomena.

34. CONT.-INTRODUCTION OF IMHI It explains that the simplicity of working mechanism of universe and its contents with complexity of their manifold inter relation. Like every human disease is differentiated and has specific as well vague manifestations. but all most all human disease have some basic and fundamental pathologic processes in nature ,that is vasculitis , there are fundamental role of prime cytokine ,TNF-alpha IN THE HUMAN DISESE PATHOGENESIS THERE ARE FUNDAMENTAL ROLE OF MASTER CHEMICAL (anti-stress agent ), MASTER light therapy, UVBI,MASTER ANEROBIC EXERCISE ( YOGA ), VACCINATION PRINCIPLE ( LIKE KILLS LIKE ), OTHER VARIOUS NATUROTHAERAPIES,PSYCHOTHERAPY, HEALTH EDUCATION PROMOTIONS, PHILOSOPHICO-SOCIAL THERAPY.THESE ALL ARE ALL ROUNDER METHODS OF MANAGEMENT OF HUMAN ILLNESS.

35. CONT.-INTRODUCTION OF IMHI PHILOSOPICALLY – ITS BASIC PRINCIPLE IS THE KEY LAW OF DIALECTICS. UNITY AND STRUGGLE OF ONTRADICTIONS. THE KRDHAUGODA,S BASIC LAW OF DIALECTICS THAT IS Any event, system or unit contains opposite phenomena which are also connected relatively by means varying degree of reciprocal association dynamically with other sets of opposite phenomena again. FOR EXAMPLE. The health and disease are opposite phenomena, are connected dynamically with another opposite phenomena i.e. stress factors(cytokines-TNF-alpha) and antistress factor of an individual.

36. CONT.-INTRODUCTION OF IMHI LOGICALLY THIS NEW CONCEPT OF IMHI COVERS THE WIDE VERIETIS OF SUBJECTS IN CO-ORDINATED FORM. IT RELATES THE IILNESS OF HUMAN FROM HEAD TO TOE, ILLNESS DUE TO DISBALANCE OF EXTERNAL ENVIROMENT AND INTERNAL ENVIROMENT OF BODY. IMMUNITY AND STRESS FACTORS LINKED WITH HEALTH AND HUMAN DISEASES.PRODUCTIVE. MIND OF HUAMN LINKED WITH ECONOMICAL PROSPERITY. THERE BY RELAEASE FROM MOST OF HUMAN DISEASE INCLUDING PROVERTY, HUNGER SOCIAL UNPEACE. According to guideline of this IMHI- it makes easy and simple assessment of human diseases and provides quick and quality management as early as possible in preventive as well as palliative and curative cost effective heath care provision.

37. CONT.-INTRODUCTION OF IMHI LOGICALLY THIS NEW CONCEPT OF IMHI COVERS THE WIDE VERIETIS OF SUBJECTS IN CO-ORDINATED FORM. IT RELATES THE IILNESS OF HUMAN FROM HEAD TO TOE, ILLNESS DUE TO DISBALANCE OF EXTERNAL ENVIROMENT AND INTERNAL ENVIROMENT OF BODY. IMMUNITY AND STRESS FACTORS LINKED WITH HEALTH AND HUMAN DISEASES.PRODUCTIVE. MIND OF HUAMN LINKED WITH ECONOMICAL PROSPERITY. THERE BY RELAEASE FROM MOST OF HUMAN DISEASE INCLUDING PROVERTY, HUNGER SOCIAL UNPEACE. According to guideline of this IMHI- it makes easy and simple assessment of human diseases and provides quick and quality management as early as possible in preventive as well as palliative and curative cost effective heath care provision.

38. STRATEGY OF IMHI The strategy includes following main components: 1) Improving case management skills, concepts, practice of health-care staff in Integrated scientific way. 2) Improving overall health systems in new holistic integrated way 3) Improving family and community health practices. 4) improving integration of main modern medical heath care system with other alternative health care system like ayurvedic system like YOGA , homeopathic system ( vaccination principle , like cure like ) , light therapy ( UV, LLLT ),PHYSIOHERAPY , HOT SPRING DEAD SEA THERAPY etc. as far as possible in the course of monument of various human illness in appropriate ways. 5) Improving world wide world view of dialectical materialistic educational promotion as well establishment and development of this new integrated health care education system globally. 6) In health facilities, this IMHI promotes the quick and quality diagnosis and management of most of the human illnesses in grass root level as well as tertiary level in integrated way with various systems of health care management easily and cost effectively.

39. Contn-STRATEGY OF IMHI To establish world wide this new IMHI concept and practice in correlation with WHO and national health programmer and policy makers of particular countries. 17) Background theories of this new concept of IMHI are the R.K.Dhaugoda’s basic law of dialectics (Any event, system or unit contains opposite phenomena which are also connected relatively by means varying degree of reciprocal association dynamically with other sets of opposite phenomena again) , R.K.Dhaugoda’s general theory/equation of vasculitis ( vasculitis = TNF- ALPHA : ASA) and R.K.Dhaugoda’s general ratio of health and disease ( HEALTH : DISEASE = 4:1 )

40. Contn--STRATEGY OF IMHI This newly designed concept and practice of IMHI reviews the concepts and definition of health given by WHO and the existing world health concepts and practices in various isolated form rather than interrelated form .It helps in the development and easy approach of world heath care system in a very comprehensive , integrated multi-healthcare systems , simple and cost effective world wide management of human illness and related problems. In other words, this is not only a one of the great revolutionary, scientific, dialectical-materialistic concept of health and disease, but also which is basically quite opposite to the old existing concept of health and disease.

41. METHODS OF IMPLEMENTATION OF IMHI The implementation of the IMHI strategy in a country is a phased process that requires a great deal of coordination among existing health care systems, concepts, interest, programme, policies and services. It involves working closely with local governments and ministries of health, ministry of education, ministry of environment to plan and adapt the principles of the approach to local circumstances. The main steps are:

42. METHODS OF IMPLEMENTATION OF IMHI Adopting an integrated approach to human health and development in the national health policy. Adapting the standard IMHI clinical guidelines to the country’s needs, available drugs, available health care systems, understandings, policies, and to the local foods, rituals, environment and language and practice used by the population. Upgrading care in local clinics by training health workers in new methods and in new concepts to examine and treat infant, children, adult, women, and elders, and to effectively counsel family members or parents. Making upgraded care possible by ensuring that enough of the right low-cost medicines and simple equipment or techniques are available. Strengthening care in hospitals for those persons mild to moderate sick to be treated in an outpatient clinic. And severe one in hospital setup. Developing support mechanisms within communities for preventing disease, for health and educational promotion, for helping families to care for sick any family member, and for getting person to clinics or hospitals when needed. Adopting new general educational system and new health training curriculum that is compulsory inclusion of dialectical materialism education in curriculum of all systems of education of the country.

43. PRINCIPLE GUIDELINES OF IMHI Simple approach and problem identification in integrated form eg. Syndromic or diagnostic or combined – first action is the detection of severity and dangerousness sign of any illness or person in relation to psychological, physical, biomechanical, spiritual/emotional, economical, traumatic ,infectious ,noninfectious ,environmental ,nutritional maladjustments,acutenss,cronicity,genetic,oncogenic,traumatic,disastes,te-rrorism related, physiologic distresses, hormone,enzymes,electrolite disbalances.etc. Prompt use of information technology that is Quality networking or communications for updated self information , to patients , family members , health resource persons , and society members or, authorities regarding problem approach, problem identification process , staging of illness and system involvements ,prompt possible diagnosis, multi-way communication ,for data collection, and there by making appropriate impression and person’s economic ,social, educational ,cultural status etc. Assessment of sick PATIENTS:- The assessment procedure for child and adult age group includes a number of important steps that must be taken by the health care provider: (1) Take a history and talkwith family member or patient itself or with the caregiver about the child’s problem; (2) check for general danger signs; (3) assess major symptoms; (4) evaluate nutritional, emotional ,behavioral, psychological drug or substance abuse status; (5) assess for child the child’s feeding; and for adult appetite (6) check immunization status; and (7) assess for philosophico-psycho-socio-economic-familial -environmental status.( 9) check for other related problems.

44. PRINCIPLE GUIDELINES OF IMHI IDENTIFICATION OF VERY SEVERE AND CRITICAL ILLNESSSES AND ASSESSMENT OF TIMELY REFERAL TO RIGHT PLACE FOR EARLY PROMPT MANAGEMENT OF SEVERE ILLNESSES AFTER PRIMARY SUPPORTIVE MANAGEMENT AS FAR AS POSSIBLE. SELF AND LOCAL MANAGEMENT OF HUGELY .At Home- self or family members ,Grass root level clinics private or government ,health posts, health centers, regional health centers , district hospitals ( primary or secondary health facility ) providers are- axillaries health workers , local clinicians , drug retailers, widwifes,nurses health assistants, MBBS, BDS, FAMILY PHYSICIANS ( ALL WORKS AS VITALLY AND MULTI- APPROACH AND IN INTEGRATED WAY WITH NEED OF MINIMAL REFERAL TO HIGHER OR TERTIARY CENTRES).

45. PRINCIPLE GUIDELINES OF IMHI Non- specific management of any problem has great value( treatment of person rather than disease )., should behave person as a human, humanly understand emotions and support this appropriately, assures and communicates to patents and family member. Understand any physical illness generally associated with psychological upsets and vice versa. Make a inter-personal relation as a friend with patient and parents for friendly, familial environment or attachment, for more effective. The combination of individual signs leads to a patient’s classification rather than a diagnosis. This classification indicates the severity of the condition and calls for specific actions based on whether the patient (a) should be urgently referred to a higher level of care, (b) requires specifictreatments, or (c) can be safely managed at home. The classification is stage-coded: stage –IV- NEEDS REFERAL TO SUPER TERTIARY LEVEL HOSPITAL, stage –III requires hospital referral or admission; stage-II indicates the need to initiate treatment; and stage-I indicateshome management.

46. METHODS OF SPECIFIC MANAGEMENT: -depends on acute severe vs. chronic illness. –NON-SPECIFIC-SPECIFIC- use of general anti-stress factors ( magnesium in appropriate way), act to decrease aggravating, factors or outer stress factors, arrange for stabilizing basic vital factors – for very severe and unconscious patients should follow emergency management protocols like MAINTAINANCE OF ABCDE ( 5 TUBES – O2 LINE, ECG LINE, IV LINE, BP MONITORING LINE,SPO2 NONITORING LINE , IF NECESSARY- INSERT OTHER TUBES LIKE:- NG,FOLLEYS,S ,CHEST TUBES, CVP LINE ,ENTUBATION TUBE). ,(BP,PULSE,TEMPERATURE, SPO2,PAIN,POSITION,SEIZURES,RESPIRATION ,DEHYDRATION.BLEEDING ) and other various supporting management like, nutritional support.. Management of timely appropriate referral system to right place where can be available specific prompt management of very critical and specific patients. SPECIFIC- SPECIFIC – as far as possible according to causative agent or illness specific final treatment (like antibiotics, antidaibetics,hormonal , surgery, reduction and plaster, chemotherapy, antidepressants, etc) with coordination of non-specific-specific treatment and non-specific treatment. Review of effectiveness of management; quick re-evaluate the impression, diagnosis, action and outcome, if necessary modified treatment. POST-SPECIFIC -TREATMENT - management of post illness situations- rest ,physiotherapy, socio-economic, rehabilitation and counseling for emotional , psychological, disability, change of suitable profession ,sexual disorders and dissatisfaction and alternatives etc.and preventive educations to family and social members.; and follow up . METHODS MOF SPECIFIC MANAGEMENT:METHODSMMEEEEEE OMEF SPECIFIC MANAGEMENT:

47. Danger signs of human illness 1) Signs of severe SIRS, SEPSIS, SEPTIC SHOCK, MOD 2) Seizures during the current illness. Seizures may result from fever. Febrile seizures do little harm beyond frightening the parents. But seizures may also be associated with meningitis, cerebral malaria, or other life-threatening conditions 3) Unconsciousness or lethargy or GCS level. An unconscious patient is likely to be seriously ill. These signs can be associated with many conditions, includingsevere dehydration, severe hypoxia, sepsis, or meningitis. cerebral edema, tumors .etc.4) Inability to drink or breastfeed or intake of food. 5) Persistent Vomiting/diahoerreait may be a sign of serious illness. This symptom may also prevent the child from taking medications or fluids for rehydration. 6) Persistent Inability to pass urine, stool, flatus with or without distention of abdomen. Signs of obstructions- distension of body parts or disorders of lumens of organs. Distal ischemia, not passing urine, baby, fluids, bloods, bile, CSF, stool, flatus, ovum, semen, lymph or body

48. Danger signs of human illness 7) Persistent crying of child or persistent/ intractable pain 8) Persistent dyspnoea/ dysphasia, cough, hemetemeis, hemoptysis, edema. 9) Persistent discharges from body and heavy bleedings and signs of sudden internal blood loss – sock, dypsnea, anemia, tachycardia 10) Persistent ECG, pulse, BP-abnormality. 11) PERSISTENT SEVERE EMOTIONAL UPSETS, ABNORMAL THOUGHT AND ABNORMAL BEHAVIOURAL DISORDERS. 12) SUDDEN SYNCOPE, LOC, CHEST PAIN, LOSS OF VISOIN, HEARING SPEECH, SWALLOING. 13) HX OF INGESTION OF SUSPECTED POISON, OR BITE FROM SUSPECTED SNAKE, ANIMAL-ETC. Severe wt. loss, anemia, passing of black stool, rashes, jaundice. Enlarged lymph nodes. Persistent and severe dizziness, vertigo, abnormal movement or tremors, weakness or paralysis of limb. Others known and unknown signs can be mentioned as long lists.