The prostate (from Greek προστάτης - prostates, literally "one who stands before", "protector", "guardian"[1]) is a compound tubuloalveolar exocrine gland of the male mammalian reproductive system. Women do not have a prostate gland, although women do have microscopic paraurethral Skene's glands connected to the distal third of the urethra in the prevaginal space that are homologous to the prostate. The main function of the prostate is to store and secrete a clear, slightly alkaline (pH 7.29) fluid that constitutes 10-30% of the volume of the seminal fluid that, along with spermatozoa, constitutes semen. The rest of the seminal fluid is produced by the two seminal vesicles. The alkalinity of seminal fluid helps neutralize the acidity of the vaginal tract, prolonging the lifespan of sperm. The prostatic part of the urethra develops from the pelvic (middle) part of the urogenital sinus (endodermal origin). Endodermal outgrowths arise from the prostatic part of the urethra and grow into the surrounding mesenchyme. The glandular epithelium of the prostate differentiates from these endodermal cells, and the associated mesenchyme differentiates into the dense stroma and the smooth muscle of the prostate. [2]The prostate glands represent the modified wall of the proximal portion of the male urethra and arises by the 9th week of embryonic life in the development of the reproductive system. Condensation of mesenchyme, urethra and Wolffian ducts gives rise to the adult prostate gland, a composite organ made up of several glandular and non-glandular components tightly fused within a common capsule. Within the prostate, the urethra coming from the bladder is called the prostatic urethra and merges with the two ejaculatory ducts. (The male urethra has two functions: to carry urine from the bladder during urination and to carry semen during ejaculation.) The prostate is sheathed in the muscles of the pelvic floor, which contract during the ejaculatory process. Benign prostatic hyperplasia (BPH) occurs in older men;[6] the prostate often enlarges to the point where urination becomes difficult. Symptoms include needing to go to the toilet often (pollakisuria) or taking a while to get started (hesitancy). If the prostate grows too large it may constrict the urethra and impede the flow of urine, making urination difficult and painful and in extreme cases completely impossible. BPH can be treated with medication, a minimally invasive procedure or, in extreme cases, surgery that removes the prostate. Minimally invasive procedures include Transurethral needle ablation of the prostate (TUNA) and Transurethral microwave thermotherapy (TUMT). These outpatient procedures may be followed by the insertion of a temporary Prostatic stent, to allow normal voluntary urination, without exacerbating irritative symptoms[7]. The surgery most often used in such cases is called transurethral resection of the prostate (TURP or TUR). In TURP, an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine. Older men often have corpora amylacea[8] (amyloid), dense accumulations of calcified proteinaceous material, in the ducts of their prostates. The corpora amylacea may obstruct the lumens of the prostatic ducts, and may underlie some cases of BPH. Prostate cancer is one of the most common cancers affecting older men in developed countries and a significant cause of death for elderly men (estimated by some specialists at 3%). Regular rectal exams are recommended for older men to detect prostate cancer early. In 1993, the Journal of the American Medical Association revealed a connection between vasectomy and an increased risk of prostate cancer. Reported studies of 48,000 and 29,000 men who had vasectomies showed 66 percent and 56 percent higher rates of prostate cancer, respectively. The risk increased with age and the number of years since the vasectomy was performed. However, in March of the same year, the National Institute of Child Health and Human Development held a conference cosponsored by the National Cancer Institute and others to review the available data and information on the link between prostate cancer and vasectomies. It was determined that an association between the two was very weak at best, and even if having a vasectomy increased one's risk, the risk was relatively small. Recent scientific breakthroughs have now meant using a Prostatic stent is a viable method of dis-obstructing the prostate. Stents are devices inserted into the urethra to widen it and keep it open. Stents can be temporary or permanent and is mostly done on an outpatient basis under local or spinal anesthesia and usually takes about 30 minutes.
A nurse is responsible—along with other health care professionals—for the treatment, safety, and recovery of acutely or chronically ill or injured people, health maintenance of the healthy, and treatment of life-threatening emergencies in a wide range of health care settings. Nurses may also be involved in medical and nursing research and perform a wide range of non-clinical functions necessary to the delivery of health care. Nurses also provide care at birth and death. Nursing education, regulation, roles, and titles vary in different countries, but in general reflect an increasing level of responsibility and status. The nursing career structure does not vary throughout the world. Typically there are several distinct levels of nursing practitioner distinguished by increasing education, responsibility, and skills. The major distinction is between task-based nursing and professional nursing. Nurses throughout the world are increasingly employed as advanced practice nurses, such as clinical nurse specialists and nurse practitioners, who diagnose health problems and prescribe medications and other therapies. At the top of the educational ladder is the doctoral-prepared nurse. Nurses may gain a PhD or another doctoral degree, specializing in research, clinical nursing, and so forth. These nurses practice nursing, teach nursing, and carry out nursing research. As the science and art of nursing has advanced, so has the demand for doctoral-prepared nurses. In various parts of the world, the educational background for nurses varies widely. In some parts of eastern Europe, nurses are high school graduates with twelve to eighteen months of training. In contrast, Chile requires any registered nurse to have at least a bachelor's degree. Nursing assistants, orderlies, auxiliary nurses, healthcare assistants. These types of healthcare workers work both in acute and primary settings, under the supervision of registered nurses or licensed practical nurses (in the US). They assist nurses by giving basic care, taking vital signs, administering hygienic care, assisting with feeding, giving basic psychosocial care, housekeeping, and similar duties. See also hospital volunteers. Registration as a registered nurse now requires an associate degree at least, considered the foundation for any future specialization within nursing any other type of medical ways. Postgraduate diplomas provide further vocational training for specialist areas. Masters level courses are available in both research and course work streams; a specialist course has been developed to provide preparation for registration as a nurse practitioner. Professional doctorates are also available. Australia has a long tradition of post-basic courses, usually of a six month (minor) or twelve month (major) duration, which included midwifery, maternal and child welfare, psychiatric, peri-operative ("theatre nursing"), intensive care, and coronary care in later years, as well as a myriad of other courses. They are now provided by the university sector as postgraduate diplomas or post graduate certificates, depending on the length and complexity. There are options available for hospital trained nurses to upgrade their qualifications to a Bachelor of Nursing (post registration). However, most opt instead to undertake specialist courses such as a postgraduate diploma or certification in the area of their clinical interest. Enrolled nurses are trained in the "technical and further education" (TAFE) sector of approximately twelve months duration. In some states, this length has been increased to 18 months to result in diploma level qualification rather than certificate 4. All Enrolled nurse training courses now include a module that permits enrolled nurses to dispense oral, topical, enteral medications, and intramuscular and subcutaneous injections. In some areas of Australia NSW in particular Enrolled nurses are also allowed to administer intravenous medications via a peripheral cannula up to a schedule 4d. Most provinces in Canada prefer any registered nurse to have at least a bachelor's degree (preferably a Bachelor of Science in Nursing (BScN)), although Quebec grants RN status to graduates from CEGEP. Many practicing nurses are still college graduates, but those entering nursing now are required or encouraged to enter at the university level. The profession of nursing is regulated at the provincial and territorial level in keeping with the principles of professional regulation endorsed by the International Council of Nurses. The College of Nurses of Ontario regulates both RNs and RPNs in contrast to the other provinces and territories where RNs and LPNs are regulated by separate bodies. In the western provinces, psychiatric nurses are governed by distinct legislation. All registered nurses and nurse practitioners in the province of Alberta are expected to maintain their clinical competence in order receive an annual practice permit from the College and Association of Registered Nurses of Alberta which also sets standards for scope of practice and provides practice support. The Indian Nursing Council is the regulatory body for profession of nursing. A person practising nursing must be registered with the nursing council. For a person to be registered, he or she has to undergo and pass the prescribed course stipulated by the council. In India, diplomas, bachelor degrees (BSc Nursing) postgraduate degrees (MSc Nursing) and Doctorates (PhD) are offered. Nursing is self regulated in Ireland. The regulatory body is An Bord Altranais (The Nursing Board). The board was established under the 1950 Nurses Act and currently operates under the 1985 Nurses Act. a There are currently over 82,000 nurses registered by An Bord Altranais of which over 65,000 are on the active register ABA Statistics 2006. New Zealand originally had nurse education as a part of the hospital system, but, as early as the 1900s, post registration and post graduate programs of study for nurses were in existence. Reforms in the 1970s disestablished the original hospital-based schools and moved these into the tertiary education sector, namely polytechnics and universities. Within the hospital system were an array of titles and levels, which often focused upon clinical specialty rather than generic nursing knowledge. Today all nurses in New Zealand are educated to degree level via a three year, two semesters per annum, program, with an approximate 50/50 mix of theory to practice. All current students graduate as a registered comprehensive nurse. Legislation exists keeping the number of schools to no more than 21, although some schools run courses in more than one geographical location. Recently, attempts were made to reintroduce the title enrolled nurse with this causing some disagreement between trade unions, the registering body, and health providers.[4] Similarly the NCNZ caused minor controversy when they gave the title nurse practitioner trade mark status, thus preventing those with the title from using it. In order to become a nurse practitioner, the nurse must undertake an approved course of study and present a portfolio of evidence to NCNZ for approval. There are now approximately 20 NP's in New Zealand with a smaller number granted prescribing rights. New Zealand has historically provided many nurses for the global market place; the salaries in overseas countries (notably Australia, USA, United Kingdom and the Middle East) have proved attractive to NZ nurses. This has resulted in a drop in the number of NZ-educated nurses practicing within New Zealand; recently the flow has been decreased by a substantial pay award for hospital based nurses. This pay award was given to those employed within district health boards but not other public sector providers which caused a degree of conflict within the profession and a return to hospital practice for many in the primary healthcare sector. There has also been an increase in nurses from the United Kingdom, India, South Africa and Philippines migrating to New Zealand. A Professional Regulatory Nursing Board implements and enforces the Nursing Act. The board is composed of a chairperson and six additional members, all of whom are nurses with at least a master's degree and ten years of nursing experience. The board inspects nursing schools, conducts licensure examinations, issues and monitors certificates of licensure, promulgates a code of ethics, participates in recognizing nursing specialty organizations, and prescribes guidelines and regulations governing the profession under the Nursing Act. The South African Nursing Council (SANC) was created by the Nursing Act of 1957. Currently, it functions under the authority of the Nursing Act of 1978 and subsequent amendments. SANC inspects and approves nursing schools and education programs; examines, registers, and enrolls nurses, midwives, and nursing auxiliaries; licenses nursing agencies; and monitors nursing employers. Nurses and nursing auxiliaries are required to wear "distinguishing devices" consisting of pins and colored epaulettes to identify them as licensed professionals. To become a nurse within the United Kingdom, one must at the very minimum hold a Diploma in Nursing and have trained for three years, or two years on an 'accelerated' course, (or equivalent if from overseas). After training, the opportunities are vast, with many different areas of nursing, from general ward to teaching or management. Also the practise areas can be in hospital, or in the community or both. In addition to this, there are two levels of nurse: first-level nurses trained for three or four years (RGN, RMN, RSCN, RNMH, RNchild, RNadult, RNmental health, RN Learning Disability) whereas second-level nurses are the state enrolled nurses (SENs) who trained for two years. The SEN training has been phased out, with many SENs retiring or converting to level one through further study. Registered Nurses are able to undertake advanced practice training, commonly at advanced degree level to become specialist nurses in various fields, such as Emergency Nurse Practitioner. These nurses will have obtained, in addition to the basic registration with the NMC, an advanced recordable qualification. Nurses in the United Kingdom can also complete an Independent Prescriber course (of which there are various types at present) which legally permits them to prescribe drugs independently of a doctor. State enrolled nurse (SEN) These nurses are expected to perform to a lower level scope of practice, although in reality enrolled nurses often perform to a similar or higher level as staff nurses. Some areas specifically exclude aspects of practice such as the administration of medications. As such enrolled nurses are technically supposed to work under the supervision of an RN. There are various other higher managerial and specialist nurse roles; however these are less well defined on a national scale and very from country-to-country. Note, "sister" is becoming less used as a nurse title, but it was commonly used and preferred as a title in the past. Registered nurses (RNs) are professional nurses who often supervise the tasks performed by LPNs, orderlies, and nursing assistants. They provide direct care and make decisions regarding plans of care for individuals and groups of healthy, ill, and injured people. RNs are the largest healthcare occupation in the U.S. Doctorate of Nursing Practice (DNPs) advanced nursing degree. They focus more on evidence-based practice and systems leadership that has an immediate impact on the quality of healthcare delivery, rather than on developing programs of original research (as the traditional PhD program graduates do). Very few nurses are prepared at the doctoral level with the skills to transform the practice environment in an immediate way, so the professional opportunities for graduates of the DNP program will be extensive.
In professional settings massage involves the client being treated while lying on a massage table, sitting upright in a massage chair, or lying on a pad on the floor. The massage subject may be fully, partly or unclothed and the body covered with towels or sheets. Specialized massage tables and chairs are used to position clients during massages. A typical commercial massage table has an easily cleaned, heavily padded surface, and a horseshoe-shaped head support that allows the client to breathe easily while lying face down and can be stationary or portable. An orthopedic pillow or bolster can be used to correct body positioning. Ergonomic chairs serve a similar function as a massage table. Chairs may be either stationary or portable models. Massage chairs are easier for the practitioner to transport than massage tables, and clients do not need to disrobe to receive a chair massage. Due to these two factors, chair massage is often performed in settings such as corporate offices, outdoor festivals, shopping malls, and other public locations. Many different types of oils can be used including fractionated coconut oil, grape seed oil, macadamia oil, sesame oil, pecan oil, and mustard oil. Arnica, from the flowers or leaves of the Arnica montana, may be added olive oil when used medicinally, or almond oil when used as a massage oil.[13] Aromatherapy oils such as neroli oil and pine oil can also be mixed with carrier oils. Ayurveda is a natural health care system originating in India that incorporates massage, yoga, meditation and herbal remedies. Ayurvedic massage, also known as Abhyanga is usually performed by one or two therapists using a heated blend of herbal oils based on the ayurvedic system of humors. Myofascial release refers to the manual massage technique for stretching the fascia and releasing bonds between fascia, integument, and muscles with the goal of eliminating pain, increasing range of motion and equilibrioception. Myofascial release usually involves applying shear compression or tension in various directions, or by skin rolling. Watsu is the combination of hydrotherapy and shiatsu developed by Harold Dull. The work is done in skin temperature water with both the therapist and practitioner in the water, usually a pool which is between 3.5 ft to 4 ft. (100–120�cm) deep. The work entails much movement in the water and practitioners believe that it incorporates the activation of the energy lines derived from shiatsu. Peer-reviewed medical research has shown that the benefits of massage include pain relief, reduced trait anxiety and depression, and temporarily reduced blood pressure, heart rate, and state anxiety.[19] Theories behind what massage might do include blocking nociception (gate control theory), activating the parasympathetic nervous system which may stimulate the release of endorphins and serotonin, preventing fibrosis or scar tissue, increasing the flow of lymph, and improving sleep[5] but such effects are yet to be supported by well designed clinical studies. In the USA licensure is the highest level of regulation and this restricts anyone without a license from practicing massage therapy or by calling themselves that protected title. Certification allows only those who meet certain educational criteria to use the protected title and registration only requires a listing of therapists who apply and meet an educational requirement. [34] People state that they use massage because they believe that it relieves pain from musculoskeletal injuries and other causes of pain, reduces stress and enhances relaxation, rehabilitates sports injuries, decreases feelings of anxiety and depression, and increases general well being.[5] Heinrich Himmler, commander of the Schutzstaffel (SS) and one of the most powerful men in Nazi Germany might have lost faith in German victory due to his discussions with his masseurs Felix Kersten and Walter Schellenberg.[38] Albert Bedane (1893–1980) who provided shelter to a Jewish woman and others during World War II was a massage/physiotherapist. Athletic training • Audiology • Bioengineering • Biomedical science • Chiropractic • Dental hygiene • Dietetics • Electrocardiographic technicians • Emergency medical services • Hemodialysis technicians • Massage therapy • Medical assistants • Medical physics • Medical technologist • Medical transcription • Music therapy • Nuclear medicine technology • Nutrition • Occupational therapy • Optometry • Phlebotomy • Orthotics/Prosthetics • Physical therapy • Podiatry • Psychology • Radiation therapy • Radiography • Radiologic technologist • Respiratory therapy • Speech therapy • Social work • Ultrasonography
