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The effectiveness of your written material Evaluate the outcomes of your project cheap prometrium 100mg without a prescription. A first review might be best 12 months after the completion of your project buy prometrium 100 mg otc. This is a fundamental question but not necessarily one that is easy to answer cheap 100 mg prometrium fast delivery. There are a number of different methods you can use to help you evaluate the effectiveness of your written material. Try one or a combination of the following ways: ° User feedback from clients, clinicians and administrative staff. Feedback might be obtained via focus groups, questionnaires or more general sources like the organisation’s information officer. Putting a date for review on material is one way of helping to ensure this happens at the right time. The purpose of these reviews will be: ° to update the information with current knowledge and practice ° to monitor accessibility ° to review the timing of the delivery of the information ° to update the information to reflect changes in legislation ° to update the information to reflect current health and social policies ° to amend any inaccuracies. You will need to decide who has responsibility for carrying out these re­ views and make contingency plans in the event of staff changes. INFORMATION LEAFLETS FOR CLIENTS 117 Summary Points ° Most written material benefits from a team approach to its development, writing and production. PART TWO W riting for T eaching and Learning W riting for Teaching and Learning Teaching and learning is an integral part of the health profes- sional’s working life. All clinicians have to undergo formal training and assessment in order to obtain a qualification. Note-taking, writing essays and completing exams are famil­ iar student activities. Once qualified the clinician is likely to return periodically to the learner role, either by attending continuing education programmes or, more formally, by en­ rolling as a postgraduate student. In addition, many clinicians are now involved as educators themselves and are writing teaching materials, and setting and marking coursework. The main section of this part looks at writing as a learning medium and preparing materials for teaching. It includes ad­ vice on how and where to search for information and the use of effective reading strategies – skills that are of use not only to the student but also to clinicians wishing to review the lit­ erature either for research purposes or to establish an evi­ dence base. The second section of this part gives some specific advice on using written materials in teaching. The final section covers several writing activities from note-taking, essays and assessment through to dissertations and research. Research projects Structure of quantitative and qualitative research papers. Writing an academic piece of work will take the following steps: Read and note-take Plan Read and note-take Write a draft Macro revision – edit on major issues Redraft Micro revision – edit small details, spelling and grammar Final draft 123 124 WRITING SKILLS IN PRACTICE Individual writers may spend longer on certain stages and may repeat steps. For example, one person may do several drafts before they are satis­ fied that the work is finally ready. Another may be continually reading and adding material right up to the point of the final draft. During the writing process you will learn how to: ° search for data ° appraise the quality and validity of material by other writers ° recognise the significance of material both in general terms and for the purposes of your writing ° select relevant information ° collate large amounts of information ° recognise the connections between different sets of information ° organise thoughts into a logical and coherent account ° construct a written argument or opinion ° write using an academic style of writing ° write to a deadline and within a specified word limit ° present written material. Finding information You need to develop a systematic approach to searching for information. Remember material might be in printed form, on microfilm, microfiche, CD-ROM or online. Further clarification of these terms can be gained by using introductory texts and review articles where the words will be used in a meaningful context. WRITING AS AN AID TO LEARNING 125 ° An overview of the topic – use an introductory text, a review or general article in a professional journal. You will find that they frequently appear in the reference list of different articles and books.

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You have to use your discretion about how much you do this as there might be occasions when somebody is unwilling or too nervous to contribute purchase 200 mg prometrium with mastercard. You often find that discount prometrium 100mg with mastercard, even though you have negotiated a time cheap prometrium 200 mg overnight delivery, people enjoy the discussion and want to continue, although at this stage you must make it clear that people can leave, if they wish. Often, some of the most useful and pertinent information is given once the ‘official’ time is over. Also, you will find that people talk to you on an individual basis after the group has finished, especially those who might have been nervous contribut- ing in a group setting. It is useful to take a notepad and jot down these conversations as soon as possible after the contact as the information might be relevant to your re- search. Finishing the focus group When you have finished your focus group, thank the par- ticipants for taking part and leave a contact name and number in case they wish to follow up any of the issues that have been raised during the discussion. It’s good practice to offer a copy of the report to anybody who wants one. However, this might not be practical if the final report is to be an undergraduate dissertation. You could explain this to the participants and hope that they under- stand, or you could offer to produce a summary report which you can send to them. HOW TO CONDUCT FOCUS GROUPS/ 79 TABLE 8: STRATEGIES FOR DEALING WITH AWKWARD SITUATIONS SITUATION STRATEGY Break-away Say: ‘I’m sorry, would you mind rejoining the group as this conversations is really interesting? Dominance First of all stop making eye-contact and look at other people expectantly. If, however, leadership tendencies aren’t immediately obvious, but manifest themselves during the discussion, try to deal with them as with ‘dominance’, above. If this still fails, as a last resort you might have to be blunt: ‘Can you let others express their opinions as I need to get as wide a variety as possible? The other members were happy to do this as they were free to express themselves and their opinions were quite different from those of their self-appointed ‘leader’. Disruption by On rare occasions I have come across individuals whowant participants to disrupt the discussion as much as possible. They will do this in a number of ways, from laughing to getting up and walking around. I try to overcome these from the start by discussing and reaching an agreement on how participants should behave. Usually I will find that if someone does become disruptive, I can ask them to adhere to what we all agreed at the beginning. Sometimes, the other participants will ask them to behave which often has a greater influence. Defensiveness Make sure that nobody has been forced to attend and that they have all come by their own free will. Be empathetic – understand what questions or topics could upset people and make them defensive. Try to avoid these if possible, or leave them until the end of the discussion when people are more relaxed. These facilities can be hired at a price which, unfortunately, tends to be beyond the budgets of most stu- dents and community groups. Your local college or university might have a room which can be set up with video recording equipment and the in- stitution may provide an experienced person to operate the machinery. If your institution doesn’t provide this fa- cility, think about whether you actually need to video your focus group as the more equipment you use, the more po- tential there is for things to go wrong. Most social re- searchers find that a tape recording of the discussion supplemented by a few handwritten notes is adequate (see Chapter 7 for further discussion on different methods of recording). Ideally, it needs to be small and unobtru- sive with an inbuilt microphone and a battery indicator light so that you can check it is still working throughout the discussion, without drawing attention to the machine. A self-turning facility is useful as you get twice as much recording without having to turn over the tape. The recorder should be placed on a non-vibratory surface at equal distance from each participant so that every voice can be heard.

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Cross References Chorea cheap prometrium 200 mg visa, Choreoathetosis; Trombone tongue Bouche de Tapir Patients with facioscapulohumeral (FSH) dystrophy have a peculiar and characteristic facies purchase 200 mg prometrium with visa, with puckering of the lips when attempting to whistle 100mg prometrium for sale. The pouting quality of the mouth, unlike that seen with other types of bilateral (neurogenic) facial weakness, has been likened to the face of the tapir (Tapirus sp. Cross References Facial paresis Bovine Cough A bovine cough lacks the explosive character of a normal voluntary cough. It may result from injury to the distal part of the vagus nerve, particularly the recurrent laryngeal branches which innervate all the muscles of the larynx (with the exception of cricothyroid) with result- ant vocal cord paresis. Because of its longer intrathoracic course, the left recurrent laryngeal nerve is more often involved. A bovine cough may be heard in patients with tumors of the upper lobes of the lung (Pancoast tumor) due to recurrent laryngeal nerve palsy. Bovine cough may also result from any cause of bulbar weakness, such as motor neu- rone disease, Guillain-Barré syndrome, and bulbar myopathies. New England Journal of Medicine 1997; 337: 1370-1376 Cross References Bulbar palsy; Diplophonia; Signe de rideau Bradykinesia Bradykinesia is a slowness in the initiation and performance of voluntary movements, one of the typical signs of parkinsonian - 58 - Broca’s Aphasia B syndromes, in which situation it is often accompanied by difficulty in the initiation of movement (akinesia, hypokinesia) and reduced ampli- tude of movement (hypometria) which may increase with rapid repet- itive movements (fatigue). It may be overcome by reflexive movements or in moments of intense emotion (kinesis paradoxica). Bradykinesia in parkinsonian syndromes reflects dopamine depletion in the basal ganglia. It may be improved by levodopa and dopaminergic agonists, less so by anticholinergic agents. Slowness of voluntary movement may also be seen with psy- chomotor retardation, frontal lobe lesions producing abulia, and in the condition of obsessive slowness. Cross References Abulia; Akinesia; Fatigue; Hypokinesia; Hypometria; Kinesis paradoxica; Parkinsonism; Psychomotor retardation Bradylalia Bradylalia is slowness of speech, typically seen in the frontal-subcorti- cal types of cognitive impairment, with or without extrapyramidal fea- tures, or in depression. Cross References Palilalia; Tachylalia Bradyphrenia Bradyphrenia is a slowness of thought, typically seen in the frontal- subcortical types of cognitive impairment, e. Such patients typically answer questions correctly but with long response times. Cross References Abulia; Dementia Bragard’s Test - see LASÈGUE’S SIGN Broca’s Aphasia Broca’s aphasia is the classic “expressive aphasia,” in distinction to the “receptive aphasia”of Wernicke; however, there are problems with this simple classification, since Broca’s aphasics may show compre- hension problems with complex material, particularly in relation to syntax. Considering each of the features suggested for the clinical classi- fication of aphasias (see Aphasia), Broca’s aphasia is characterized by: ● Fluency: slow, labored, effortful speech (nonfluent) with phonemic paraphasias, agrammatism, and aprosody; the patient knows what s/he wants to say and usually recognizes the paraphasic errors (i. Silent reading may also be impaired (deep dyslexia) as reflected by poor text comprehension. Aphemia was the name originally given by Broca to the language disorder subsequently named “Broca’s aphasia. Broca’s aphasia is sometimes associated with a right hemiparesis, especially affecting the arm and face; there may also be bucco-lingual-facial dyspraxia. Classically Broca’s aphasia is associated with a vascular lesion of the third frontal gyrus in the inferior frontal lobe (Broca’s area), but in practice such a circumscribed lesion is seldom seen. More commonly there is infarction in the perisylvian region affecting the insula and operculum (Brodmann areas 44 and 45), which may include underly- ing white matter and the basal ganglia (territory of the superior branch of the middle cerebral artery). The terms “small Broca’s aphasia,” “mini-Broca’s aphasia,” and “Broca’s area aphasia,” have been reserved for a more circumscribed clinical and neuroanatomical deficit than Broca’s aphasia, wherein the damage is restricted to Broca’s area or its subjacent white matter. There is a mild and transient aphasia or anomia which may share some of the characteristics of aphemia/phonetic disintegration (i. Broca’s area aphasias: apha- sia after lesions including the frontal operculum. Neurology 1990; 40: 353-362 Mohr JP, Pessin MS, Finkelstein S, Funkenstein HH, Duncan GW, Davis KR. London: Imperial College Press, 2003: 84-89 Cross References Agrammatism; Agraphia; Alexia; Aphasia; Aphemia; Aprosodia, Aprosody; Paraphasia; Wernicke’s aphasia Brown-Séquard Syndrome The Brown-Séquard syndrome is the consequence of anatomical or, more usually, functional hemisection of the spinal cord (spinal hemisec- tion syndrome), producing the following pattern of clinical findings: ● Motor: Ipsilateral spastic weakness, due to corticospinal tract involvement - 60 - Bruit B Segmental lower motor neurone signs at the level of the lesion, due to root and/or anterior horn cell involvement. Spinal cord lesions producing this syndrome may be either extramedullary (e. Lancet 2000; 356: 61-63 Cross References Dissociated sensory loss; Myelopathy; Proprioception; Spasticity; Weakness Brudzinski’s (Neck) Sign Brudzinski described a number of signs, but the one most often used in clinical practice is the neck sign, which is sometimes evident in cases of meningeal irritation, for example due to meningitis.

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Lesser known is the Association of Lowland Search & Rescue buy prometrium 200 mg amex, which operates on the same principle as the Mountain Rescue service except in low-lying marshy areas such as Norfolk and Essex buy 100mg prometrium fast delivery. The training is time-consuming purchase prometrium 100mg online, but there are many different organisations that come under the umbrella of the Mountain Rescue Council. See their websites for further information about training and time commitments: http://www. If this is the case then a career in the military seems a sensible alternative to offer you the best of both worlds – excitement, travel and medicine. Excellent careers are available for physicians and surgeons in the Royal Army, Royal Navy and Royal Air Force. There are many non-governmental organisations (NGOs) that are desperate for well-trained but senior doctors. Most of the larger organisations,such as the Red Cross and Médecins Sans Frontières (MSF), prefer to take doctors who have passed their membership examinations or those who are already SpRs. However, it is worth enquiring if you are keen to do this sort of thing. At the very least they will rec- ommend another organisation to turn to. MSF have an excellent website with a section devoted to doctors with their stories (physicians,surgeons and anaesthetists). There is also a good page for medical students to help plan electives under ‘Working for MSF’ then‘Medical Students’: http://www. Like all other organisa- tions they have opportunities as well as a need for all types of doctor. At this relatively junior level those with an interest in general and family medicine or public health will be able to offer more than a surgical SHO who does not have the experience to be able to operate independently. Indeed, if you ask any orthopaedic SpR about it, they will probably tell you that they are the appointed surgeon to their local rugby or football team. This is usually a good starting point, but for those who wish to take things fur- ther and want to become a registered sports doctor read on. The field of sports and exercise medicine (SEM) is growing and currently await- ing approval from the Royal College of Surgeons (RCS) for a Certificate of Surgical Training. This is being organised by the SEM committee and there is growing inter- est in adding this subject into the undergraduate curriculum. The next few years will see new specialities evolving so keep your eyes open! Already there are universities that run postgraduate MSc programmes in SEM. The Royal London Hospital,University College London and the Universities of Bath, Glasgow, Nottingham, Ulster and Wales are to name but a few and this list is likely to grow. If an MSc seems daunting then a diploma can be sat through the RCS of Edinburgh. Some may find that, despite six or so years at medical school, when you graduate and get stuck into your pre-registration house officer (PRHO) year that a career in med- icine is not for you. Firstly,this is not an uncommon feeling and there will be very few individuals who do not experience this emotion at some point, although rarely will you find your friends and colleagues expressing it openly. Sure, you have spent a few years and a lot of money studying hard only to find out that, at the end of it, you do not like what you are doing. It is far better to discover that early on in your potential career than when you are 30 something and a registrar. Opportunities abound for qualified doctors in fields that do not involve patients. However, a word of warning: try and finish your PRHO/FY1 year at all costs, as the opportunities are far greater if you are a registered doctor and the door is left open should you wish to return. Complications from Medications and Supplements Patients who are taking harmful combinations of drugs can easily be over- looked. Pharmacists should be alert to such combinations, but it can’t be tracked if patients don’t pay for their prescriptions with insurance. If patients take over-the-counter medications or nutritional supplements that are not in the pharmacist’s database or if they fail to report the use of such products to their pharmacist, the patients themselves may be facilitating serious drug interactions, which may in turn bring about undiagnosable symptoms. Another medication-related problem that contributes to the diagnosis dilemma is drug dosages.

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