Nightingale Health Journal - Dec 2013

8/13/2019 Nightingale Health Journal - Dec 2013

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sity) ukd rSwfwrf;wifxm;yg w,f/ (Ek dufwifa*;*sme,f trSwf 37)

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versity) jzpf vmcJ h ygw,f/ acwf opf aq;ynmoif wuúok dvf awGtjzpf (1964)ck ES pfu tp jyKNyD; &ef ukef aq;wuú ok dvf wk d Y uk d zGifh vSpfcJh ygw,f/ cktcgrSm awmh rauG;Nrd KUrS m rauG;aq; wuú okdvf? wyfrawmfaq;w uú ok d vf wkd Y xyf rH wk d ;csJ U zG if h vS pf cJ hygw,f/

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Angina (tif*sKdif;em;)ac:

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vl emu&if bwf atmif h w,f ajym&if *½k pd k uf zd k Yvd k w,f/ rd rd ud k pdk ;&d rfwBuD; Munf haewJ h q&m 0efawG&Sd wJh ta&;ay:tcef;xJ rSm vl em[m bmrsm;Nzpf ygvd rfh qdkNyD; tHhtm;oifh aewJh tjzpf

awG &S d wwf w,f/ 'g[mtouf tEÅ &m,f ay;wwfwJ h ES vH k ;aoG ; tvH k tavmuf r&Ncif ; (Ischae-

mic heart disease) a&m*g jzpf aewwf wJ htwG uf jzpfygw,f/

&if bwf atmif h wm (Angina)

eJ Y ESvH k;aoG;ravQmuf wJh a&m*g(Myocardial infarct) wdk Y&J U vu©

PmawG [m tawmf av;qif wl ygw,f/ ESvHk ;ud k axmuf yH hay; aewJh aoG ;aMumawG vHk ;0 ydwf qd k Yjcif;aMumif h jzpf ap? w0uf w ysuf ydwfqd kYjcif ;aMumif h jzpfap aoG ;r&awmh wJ h ES vH k ;<uuf om; awG rS "mwf ypö nf ;awG xG uf ay: vmwJhtwGuf tm½kHaMumawG ud k vI H Uaqmf NyD ; emusif rI cH pm;& jcif ; Nzpfygw,f/

ES vH k;tpm;xd k;xm;wJh vl u awmh &if bwf atmif h wm rcH pm; &ygbl ;/ bmNzpfvdkYvJqdkawmh tm½k H aMumawG rS r&Sd awmh wJ h t wG uf/ 'D vd k yJ aoG ;csdK qD ;csd Ka&m *gonfawGrSmvnf; &ifbwf atmifhwm rod&S dwwf/ 'g aMumifh Silent infarct /

&ifbwfatmif hwm& JU t aMumif ;&if ;awG ud k od &S d zd k Y ta&; BuD ;wJh av;csufuawmh-

- tcsdef b,favmufMum Mum atmif hwmvJ

- b,f ae&mrS m atmif h wm vJ

- b,f vdkrsdK;atmif hwmvJ

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jzpf yG m;apNyD ; yd k qd k ;apwJ h tcsuf awGu bmvJ pwmawGud k ar; jref;avh &S dygw,f/

Angina (&if bwf atmif h ) qd k wJh pum;udk *&daq;ynm&SifHeberden u 1768 ckESpfrSm

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atmif h awmif h awmif h eJ Y rtD rom Nzpf aewwf w,f/ emw,f qd k wJ h pum;vH k ;xuf rtD romjzpf wm u vlemajymwmeJY eD;pyfyg w,f/

Angina qdkwmu atmif h awmifh awmifhNzpfwJ h cHpm;csuf rsd K;/ &if bwf b,f zuf jcrf ;xuf tv,frSmatmifhwm ydkodom w,f/ tv,frSmatmifhwJht wGuf vlemuESvHk;aMumifh r [kwfbl;qdk NyD; xif wwfw,f/ ar;½k d ;awG rSm atmif h wwf w,f/ aemuf vuf armif ;awG yg atmif h vmwwf w,f/ wa,mufeJYw a,muf u atmif h wJ h yrmP rwl Edk ifyg/

Angina [m vI yf&Sm;rI wck ck vkyfaewk ef ;rSm ay:vmwwf w,f/ em;vdkuf&if oufom oG m;a&m/

Angina oHk;rsdK;&Sdw,f/ (1) pHEIef ;jynfh Angina

(2) pHEIef;rjynfh Angina

(3) ES vHk;aMumif h r[kwfwJ h &ifbwfemNcif ;

(1) pH EIef ;jynf h Angina wG if 1/ &i fbwfatmi fh r, f

( Angina vu© PmawG pHkr,f) 2/ vIyfvIyf&Sm;&S m; vk yf &if

jzpf jzpf? pdwfcHpm;rIawGaMumif h jzpfjzpf &if bwfatmif hr,f

3/ tem;,l 'grS r[k wf &if

bwf atmif h ouf omaq; GTN

oH k;pG J&if ouf omoGm;r,f/ (2) pHEIef ;rjynfh Angina

uawmh txufazmfjyxm;wJh oH k;csuf rS m 2 csufyJ&Sdw,f/

(3) ESvHk ;aMumifh r[kwf wJh &if bwf emjcif ;uawmh oH k ;csuf rS 1 csuf avmuf yJ &Sd r,f 'grS r[kwf oHk ;csufpvHk ; rawGYyJ&Sd wwf w,f/

Angina uawmh vI yf &Sm;rI vk yf &if ay:vmwwf w,f qd k ay r,f h em;em;aeaeaewJ h tcsd ef rS m vnf ; jzpfwwfw,f/ aemuf

tdyfae&muae Ekd;avmufwJh txd &if bwf atmif h wwf w,f/ touf½SLoGif; ½SLxkwfwmeJY Angina u odyfrouf qdkif/

vQmatmufr SmiH k&wJh aq;(Sublingual nitrates) oHk;ygu

rdepfydk if ;twGif; oufomapyg w,f/ 'gayr,fh 'Daq;[m vl emtw Gu f Placebo (aq; aMumif h r[kwfbJ pdwf aMumifh oufomapjcif;) jzpfaewwf NyD; tpmrsdK >yef<uufom; t aMumqG JrI Spasm awGudk vnf; oufomapwwfw, f/ 'g aMumif h 'D aq;iH k cd k if ;NyD ; ouf om &if Angina qdk NyD; uHaouHr raNymEd k if/

Acute coronary syndrome

(ES vH k ;MuG uf om; aoG ;ravQmuf awmhwJ ha&m*g Myocardial

infarct 'grSr[kwf ESvHk;udk axmuf yh H ay;wJ h aoG ;vT wf aMum awG rS maoG ;cJ yd wf qd k Yjcif ; Unsta-

ble angina ) uawmh em;aewJ h tcsdefrSm &ifbwfatmifhrSmyJ/ atmifhwm tawmf jyif;xef w,f/ atmif hwJh tcsd efumvu vnf;Mumw,f/ wjcm;quf ET ,f aewJ h vu© PmawG uawmh armr,f? pdk ;&drfylyefr,f? acR; xGufr,f? ysdKUtefr,f? rl;arh owdvpfr,f/

ESvH k;udk axmuf yHh wJh aoG; aMumaw GusOf;vdk Y &ifbwf

atmif hw muawmh Stable

angina / em&D 0uf txuf atmif h r,f qd k &if Stable angina xuf pm&ifacute coronary syndrome jzpf zd k Y

rsm;w,f/ aeYpOf&ufqufqdk ovd k atmifh ae&ifawmh ES pfrsdK; pvH k;rNzpfEdk if/

&ifbwf atmif h wJ h wjcm;t aMumif ;&if ;awGu rsm;w,f/

tou f½S LoG if ;v dkuf&i f atmifhwmydkqdk;&if tqkwft arS;yg;a&mifvdk Y jzpf wm/ Ad kif; &yf pfydk;awG0if wmu yxr t

qkwftarS ;yg;a&mif/ aemuf buf wD ;&D ;,m;aMumifh tqk wf a&mif erd k;eD ;,m;jzpf NyD; tqk wf tarS;yg;a&mifwwfw,f/ t qk wftarS;yg;a&mif vdkY atmifh wmu vI yf vI yf &S m;&S m;vk yf wmeJ Y rqdkif/ atmifhvm&if rwf rwf xdkif 'grSr[kwf udk,fcE´mudk ta&S Uzuf ud k if ;vd k uf wmeJ Y ouf omapw,f/ 'D vd k atmif h wmu a&mif&rf;aewJh tqkwftarS; yg;awGeJY ES vH k ;ywf ywf vnf t arS;awGeJY yG wfwdk ufvdk Yyg/

&if bwfatmifh aemuf xyf taMumif ;&if ;wck u &if bwf eH &HawGemwm/ wae&mwnf ;rSm em? pl;atmifh? touf ½SLoG if; ½S Lxkwf &if atmif h? vuf armif; vI yf&Sm;&if atmif h? puúefYenf; enf ;yJMumr,f/

vnfyif ;t½kd ;ESif h tay:yd k if; ausm½kd;awG a&m*gjzpf&if vI yf &Sm;rIaMumifhemwwfw,f/ t aemuf zufrSm t&ifemNyD ; &if bwf ta&S Uyd k if ; a&mufvmwwf w,f/

aoG ;vT wf aMumrBuD ;azmif ; MuG uG J tuf a&m*gqd k &if awmh &if bwf atmif hwm tawmfqdk ;&Gm; ygw,f/ pjzpf umpqd k &if tem qHk ;Nzpf NyD ; ausmbuf awGyg ysH U ESHY emusifygw,f/ emusifyHk &,f? jref jref qef qef jzpf yG m;vm wm&,f? ausmzufatmifhwm

awG u 'D a&m*g&J Uxl ;Ncm;csuf 3 rsd K;/ aoG ;vT wf aMumrBuD ;tay: yd k if ;rS mNzpf &if ta&S Uzuf &if bwf awGatmifh r,f/ atmufydki f; aoG;vTwfaMumrBuD;rS m Nzpf&if vuf jyif ½k d;ae&mawG rS memr,f/ aoG;wdk;a&m*gonfawGeJ Y t jcm; wGufqufwpf½SL;a&m*g

onfawGrSm 'D a&m*gjzpfEdkifajc rsm;w,f/

tqkwfao G;aMumtwGif; aoG ;qDvH k;rsm;Nzpfvmygu &if bwfcsuf Ncif;atmifhvmr,f? owdvpfvJusr,f? armr,f? jymESrf;r,f/

&if acgif ;twG if ;avatmif ; a&m*gNzpfvmygu emusifNyD; tvG eftrif;armyef;r,f? pl;&S jyif;jywJh emusifrINzpfNyD; &if bwf ae&mtwd tusrS m jzpf yG m; w,f/

tpmrsdK >yefrS tpmtdrft csOf&nf NyefwufNcif;a&m*g aMumif h vnf ; &if bwf atmif h wm eJYwlwJh emusifrI NzpfyGm;w,f/ tpmpm;NyD;aemuf 'grSr[kwf a&yl awG a&at;awG aomuf NyD ; &ifbwfatmifhwmudkvnf; ES vHk ; aoG;ravQmufawmhwJ ha&m *geJ Y rS m;wwf w,f/ 'D a&m*grS m tpmrsdK&cufwmawG &SdwmeJY cGJ Ncm;Ed kif ygw,f/

onf;ajctd wf a&mif &rf;&if vnf; 'Dvd kawG jzp fwwfy g

w,f/ nmzufAdkuftay:ydkif; emusif rI &Sd wmyJ uGmwmyg/ wjc m; tjzpf enf ;wJ ht

aMumi f;&i f;awGvnf; &Sd yg

w,f/ &if bwfatmifh vl emvm&if

q&m0efeJYusef;rma&;vkyfom; awG ar;jref ;pH k prf ;&r,f h ar;cG ef ; rsm;ud k wif Ny&if ; aqmif;yg;ud k tqHk;owfygw,f/

1/ tc katmif haewmu b,fvdkatmifhwmvJ/ atmifh

awmif h awmif h/ zd xm;ovd k usyf awmifh awmif h vm;/

2/ b,f tcsdefu pNzpfwm vJ/ tvdkvd kae&if;Nzpfvmwm vm;/ vIyf&S m;aewJ htcsdefrSm jzpfwmvm;/ tpmpm;NyD; avh usifhcef; vkyfrd&if ydk qdk;vmo vm;/

3/ b,favmuf MumMum atmif hwmvJ/

4/ b,f ae&mrS matmifh wm vJ/

5/ 'D vdkatmifhvm&if vIyf

&Sm;r IawGudk &yfyp fvdkuf&o vm;/ 6/ vI yf &S m;rI awG ud k &yf vd k uf

wJhtcs defrS m oufomoG m;o vm;/

7/ em;ae&if odkYr[kwf enf;enf;vIyfwmeJY atmifhwm vm;/

'Dtcsufuawm h ESvHk;udk axmuf yH h ay;wJ h aoG ;vT wf aMum awGrSm aoG;cJydwfqdk YNcif; (Un-

stable angina) qdk wJh ta&;ay: odkYr[kw f tEÅ&m,f& SdwJ h jy

óemud k od &S dapzd k Y Nzpf ygw,f/ 8/ t&if u atmifhzl;vm;/ 'D vdk rsdK;atmifh wmvm;/

a'guf wmwif haZmfOD ;

q&m0efeJ Y tD ;ayguf wJ h vlemrsm; vlemwa,muf q&m0ef qD vmw,f/]]q&m usaemf}}]]bl}} (vlemtD ;ayguf oH )]]pum;aNymwd kif ; tD ;ayguf aew,f}}

]]bGwfbl;}} (tD;oH )]]uk ay;ygOD ;}}]]'g[m &Suf p&m t&rf;aumif;w,f q&m}}]]bGrf;bl;bl ;}} ( tD ;oH)]]awmf ao;wmu}}]]bl tl tl zGwfzG wf}}(tD ;oH)]]tD;u teHY rxGufvd kY}}]]zl ;zl ;zGwf xG wfbG wf}}(tD ;oH )

q&m0efu pOf;pm;NyD;]]tif; cif Asm;udk txl;ukeJY jyrSNzpfr,f}}

vl emu]]tpmtdrftl vrf;aMumif; txl;ukvm;}}]]zG wf bvG wf vG wf bG wf}}(tD ;oH )

]]cG Jpdwftxl ;uk vm; q&m}}]]r[k wf bl ;/ cif Asm;ud k em;ES macgif ;vnf acsmif ; txl ;uk eJ Y

jyrSm/ cifAsm;tD ;aygufwm reH bl; xif &if cifAsm;ESmacgif;rSm jyóem&S daeNyD As}}]]Asm}}]]bGwf tG wf tG wf &T wf}} (vl em tD ;ayguf oH )





aoG; aZmf 0if ;xG wf

(1) usaemfhtaru tNrJqHk;r

w,f/ aeYwdkif;rS m uk odkvf? Opöm?

ynm wck ck &atmif pk aqmif ;yg wJ h/

[kwfw,f/ usaemf pdwf npf&if tNrJvkyfjzpfwmwck&Sd w,f/ tJ 'gbmvJ qd k aoG;oGm;

vS Lvd k uf wmbJ/ b,f awmhao rSef;rodwJh 'Dudk,fcE¨ mxJu aoG ;eJ Yvlwa,muf &S ifoefyg apqdk wJh pd wfeJ Yyg/

tck Ed k 0if bm (6) &uf aeYrS m usaemfhwlrav; arG;aeY&,f/ usaemfcsp f&wJ h wpH kw&mt wGuf&,f/ 'DaeY aoG;vS LbPf udk a&mufcJhw,f/

(2) twd wf usaemf yxrOD ;qH k ; aoG ;vS L

jzpf wJh umvuawmh awmf awmf MumcJhy gNy D/ usaemfpdwfxi f aq;ausmif ;om;b0jzpfr,f xifw,f/

usaemf h tcspf qH k ;ol i,f csif ; a'guf wmvif;atmif? olYtudk t&if ; usaem fwd kY eJ Ytwlw l abmvHk;upm;azmf upm;zuf udkNidrf; ½kwfw&uf vluD;rD; ,m;jzpfwJ htcsdefaygh/

udkvif;u bD aoG ;vdkw,f qd k awmh raMumufr&G H U vS Ljzpf cJh w,f/

tJ 'D rS m oH a0*vnf ;& w,f/ twlwl abmvHk;uef? pm;aomuf? vlaumif;b0u ae csufcsi f;aooGm;wwfyg vm;qd kwJhtodudk &vd kufw,f/ tck xdvnf ; ud kNid rf ;&JU cyf at; at;rsufES mudk owd&ygw,f/

(3)

Aef;armf? 2007 xdkxdktcsdef Aef;armfc½k dif aq;½Hk BuD;onf aoG;vSL&Sif &S m; yg;NyD ; tvG ef ac:&cuf ygonf/ aoG ;vd konfhv lemrsm ; 'ku © a&mufonfud k 'D ta&;ay: wm 0ef usq&m0efonf awmfawmf pdwfqif;&Jygonf/ rajymvdk aom raumif;w&m;rsm;vnf; rsm;pGm&S donf/

xkdxdktcs def pdw ftv Gef qwf? a'gotvGefBuD;? rSef w,fxif&i f bmrS*½krpdkuf aom 'Doaumifhom;twGuf aeYwdkif; tukodkvfrsm;wJhum vrsm;jzpfygonf/ xdktcsdef & aomvpmonf vnf ; ravmuf icJh yg/

xdkxdk pdwfnpftukodkvf umvrsm;wG if 'D aumif onf ig bmvS LEd k if vJ Munf h vdk uf aomt cg rdrdudk,fxJrSaoG;udk oGm; jrif ygonf/ xd k YaMumif h xd k tcsd ef umvrsm;wG if awmufavQmuf av;vwBud rf aoG ;vSLjzpf&mrS

aoG ;vS Ljcif ;qd k aomtvk yf ud k pG J vmygonf/

usaemfcspf aom q&mBuD; rsm;jzpfaom orm;awmfBuD ; q&mae0if;? t½kd;txl;ukBuD; q&mBu D;pdk ;vSaemifwdk Y ajym ovd k aZmf 0if ;xG wf aoG ;oG if ;&if tdkaubJ? arYaq;ay;p&mrvdk bl ;qd k aom aemuf ajymif aom p

um;rsm;ESifh aoG ;vSLjcif;udk pGJ vmonfh 'Dq&m0ef/

(4) 2009/ vHk ;cif ;? zm;uefY wd kufe,f

vuf axmuf q&m0efb0wG if vnf; 'D q&m0ef onf aoG ;vS L jcif ;udk pG Jonf h tusif h uaysmuf roGm;/

vlemursm;? cGJpdwfwmu rsm;/ q&m0efESpfa,mufwnf; jzpf aomaMumif h Nrd KUe,f q&m0ef usaem fh tcsp fqHk; q&mBuD; a'gufwmausmfxGef;OD;? wdkuf e,f q&m0ef a'guf wmrsKd ;vG if? wdkufe,fq&m0ef a'gufwm atmifud kudk/ olwdk Y wm;onfh Mum ;u udk,fw dki fao G;v SL? udk ,f wd k ifcG J? ud k,fwdk if uk vk yfcJ h ygonf/ iSuf zsm;aygaom a' o? arG ;vl em? zsuf vl em? xd cd k uf 'Pf&maygaoma'oES ifh aoG; vS Ljcif ;ud k pG J aeonf h q&m0ef wd k Y tH0ifcG ifusjzpf cJ hygonf/

usaemf h aoG ;ES if h &S if oef oG m; aom vl emrsm;ud kMunf h NyD; yD wd jzpfcJh&aom umvrsm;jzpfyg onf/

(5) csD azG q&m0ef BuD ;b0/ csD azG Nrd KUa&muf jynf wG if ;ppf

umv 2012 'ku©onfpcef;

wm0efcH umvwGif vnf; pdwf npf p&maygif ;rsm;pG m qH k pnf ;NyD ; usef;rma&;uus/ ydk ufqHur avmuf/

xdkxd ktcsdef wGif vnf; jrpf BuD;em;aq;½HkBuD ;wGif ppfAHk ; aygufvlemrsm;tm; oGm;aoG ; vSLjcif;jyKcJh ygonf/

tJ'gaemufqHk;ygbJ/ 2-

11-12/ aemuf qH k ;qd k wJ h twk d if ; usef ;rma&;usvmwmeJY rvSL jzpf bl;/

(6) Opö m? ynm? ukod kvfwckck

&&rnf qd kwJ h pum;twdk if ; 'D aeY aoG ;vS Lud k vS Lr,f vd k YqH k ;jzwf yg w,f/

[efeD ac: cspfwlrav; arG ;ae Y&, f/ udk,fuHqdk ;ae wm&,f/ tar&d um;vd kEd kif iHrS m awmif 2 puú ef Ywa,muf vd k ae wJh aoG ;twGuf aoG ;vS L&S if rsm; vd k tyf aew,f qd k wm&,f/ rd cif awG aoG ;vGefaoqHk;wwf wm awG ud k ,f awG YBuH Kzl ;wm&,f/ NyD ; wpH kw&mtwG uf &,f/

'D aeY &ef uk ef aoG ;a&m*gXm eodkYa&muf onf/ oyf&yfoefY &Sif;vG ef;aomaq;½HkBuD;/ aoG ; vSLcsifvdk Yygqdk awmY tm;vH k;ysK ysLiS miS mES if h emrnf ar;NyD ; a'guf wmqdkwmeJY t&ifaoG;vS Lzl; vm;wJh/

[kwfuJh/ 11 Bud rfvS Lzl;yg w,f vd k Yqd k awmh/

emrnf rS wf/ q&mb,f tzG J Utpnf ;uvJ

qd k awmh/ usaemf u &,f NyD ; b,f tzG J Y

tpnf ;urS r[k wfao;ygbl;? wudk ,fawmfygAsmqd k awmh &,f ygonf/

[kwfw,fA s/ t0i f0u wnf;u tzGJYtpnf;vdk ufpk NyD; aoG ;vmvS LwmawG awG Y&w,f/ 'gaumif ;aom ajymif ;vJ jcif ;w ckbJ/

vmvS LwJ htxJrS mvnf ; rdef ;uav;i,fi, fav;awG? vl i,fav;awGawGYw,f/

aumif ;vd k uf wm/ jrif &wm MunfEl;w,fAsm/ wu,fyg/

NyD;wmeJY/ aoG;vS L&Sifwdk if; jznf h&wJh

pm&Guf ay:rSmjznf h/ aoG;aygif wdkif;/ aoG;vSL&SifvufaAGudk uGef jyLwmxJxnfh/ oyf&yf oef Y&Sif ;vG ef;aom aoG ;vS Lcef; xJ rSm q&mrrsm;u aoG;wvH k; xk wfay;w,f/

'Dae&mr Sm pdwfraumif; jzpfp&muawmY oyf&yfvGef ; aom qd k zmuk wif trsm;BuD ;ay:

rSm emrnfwck/ usaemfwd kY&JU cspf vS pG maom cGJpdwftxl;ukq&m0efBuD;em rnf/ 'D uk wif taumif ;pm;awG udk oltm;vHk;vS Lxm;wm/ t vSLtwef;&uf a&maom q&m BuD;ud k wd kufcdkuf ½IHUcs a0zefrI awG *,ufxcH&wJ h q&mBuD;/

q&mBuD;a&/ q&mBuD;udk wdkufcdkufc JYaom vlawG? vl awG/ ud k ,f Ytuk od k vf ud k ud k ,f r jrif Ed kifbl;aemfvdk Y pdwfraumif; jzpfrdygw,f/

aoG ;vS LNyD ;wmeJ Ypm;aomuf cef;oGm;ygqd kvkd Y tHhMooGm; w,f/

[k wf w,fAsm/ aoG ;vSL&Sif awG ud k Ed k Yat;xk yf wxk yf? aumf zD wcG uf? udwf rk ef Ywcsyf? Muuf O wvHk;/

tm;yg;yg;/ aumif ;vd k uf wJ h tpDtpOf/ NyD;wmeJ Y oH"mwf yg wJhtm;aq;udk a&rs m;r sm;eJY aomuf qd k nT ef Mum;NyD ; oH "mwf ygwJ h tm;aq;wvpm xnf h ay; vd k uf ygw,f/

aysmf vd k uf wmAsm/ 'D avmuf oef Y&S if;wJh aoG ;XmeuauR;wJ h wdkufwJhtpmxuf ydktm;&SdwJh t&m &S dr,f rxifbl;av/

(7) 'D ydkYpfwifwJh &nf&G,fcsuf

uawmY- (1) tar&d urS m 2 puú ef Yud k

vlemwa,muf aoG;ta&;w BuD ;vd k aeovd k jref rmjynf aq; ½Hk wdkif;rS mvnf; aoG;vdk tyfae ygw,f/ ZGef (14) aoG ;vSL&Sif rsm;aeYwifrS vdktyfwm r[kwf ygbl;/ aeYwkdif;? em&D wdkif;? rd epf wd kif ;? puúef Ywd k if;rSm aoG;vd k aeygw,f/ tvGefrGefjrwfwJh tvS L'gevnf ;jzpf w,f qd k wmud k jynf ol awG ud k od apcsif ygw,f/ tm;usapcsif ygw,f/

(2) aoG;ta&;wBuD;vdkrI

awGjzp fwJh rdcifawGcGJp dwfzdk Y? aoG;vGefvdkY ? tcsi f;rusvdkY? om;td rf ajymif ;jyef vef vd k Y? aoG ; oGefvdk Y? udk,f0e fysufusvdkY ? ud k ,f 0ef zsuf csvd k Y pojzif Y usef ; rma&;0ef BuD ;XmeeJ Yqdk if wJ h rd cif aoqH k ;EI ef ;avQmh csa&; axmif pk ES pf &nf rS ef ;csuf rS mvnf ; 'D aoG ;

[mta&;ygaMumif ; jynf ol rsm; odapvdk ygw,f/

(3) jynf ol awG od wJ h twd k if ; ppfab;? ,mOfawGrsm ;vmwJh umv? ,mOf wd k uf rI awG? rI cif ;eJ Y qd k if wJ h y#d yu© awG wd k if ;rS mvnf ; 'DaoG;[mta&;ygygw,f/

(4) ig;ESpfatmufaoqHk; EIef ; avQmhcsa&;rS mvnf;... ig; ESpf atmufaoqHk;EIef ;&JU oHk;yHk ES pf yH k [m wES pf atmuf .... xd k w ESpfatmuf&JUoHk ;yH kES pf yHk [m arG; uif ;puav;qdkwJhtwd ki f;/

iSufzsm;aygwJh a'oawGrS m jzL zwfjzLavsmf? armaewJh aoG; iwf aewJ h uav;awG? aoG ;a&m *gXmerSm ta&;ay:aoG ;vdkae MuwJh uav;i,f awG/ arG;arG; csif;0gvdk Y aoG ;vJ&efvd ktyfae wJ h uav;awGtwG ufvnf ; 'D aoG;[m ta&;ygygw,f/

(5) usef ;rmoefpGr f;wJ Y? a&m*guif ;&Sif ;wJ YvlawG? usm; r ra&G ; udk ,f huk d ,f uaoG;eJ Y ol rsm;&Sifoe fatmif rGefjrwfwJh pdwfeJY vSL'gef;Ed kifw,fqdkwm

jynf ol od apcsif w,f/ (6) oyf&yfoefY&Sif;aom aoG ;XmeBuD ;? aoG ;vS L&S if awG ud k aEG ;axG;pGmBud Kqdk wJ Yae&m? tzGJ Y tpnf;tvdkufaoG;vS LaeMu aom aumif;aomajymif;vJrI? vl i,fvl&G ,fav;awG aoG ;udk wufwuf<u<u vSL'ge f;ae aom vlrIa&;pd wf"mwf/ Munf El ;rI ud k jynf ol ud k rQa0csif w,f/ rD'D,mtaygif;udkvnf; oGm; vnfapcsifw,f/

(7) aoG;vSL&SifawGudk p epfwusauR;arG ;? tm;aq;ay; NyD; jyef&wJhyDwd? 'gudkvnf; jynfolud krQa0csifw,f/ rD'D ,mawGu dkvnf; od apcs if w,f/

(8) usaemfwdk Y&JU pd wf&if; tvG ef aumif ;wJ h cG J pd wf txl ;uk BuD ; vS L'gef ;xm;wJ h uk wif awG ud k rD'D,mrsm;taeeJ Y pdwf0if pm;&if oGm;a&muf avh vm cGifh awmi f; Ny D; "mwfyH k½ dkuf Ny D; aqmif;yg;wyk'favmufa&;yg vm;vdkY tjyKoabmeJY wdkuf wG ef ;csifw,f/

(9) usaemfh wlrav; [efeD eJ Y wpH k w&mvnf ; usef ;rmygap qkawmif ;ygw,f/

,Of aus;pG mjzif Y a0zef tBuH jyKEd k if ygw,f/

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Ref: Anastasia Stephens,

medical journalist

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Washington Post


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New York Times

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Nightingale Health Journal - Dec 2013