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Tears are routinely repaired with the scope in the ipsilateral portal and the cannula coming in from the contralateral portal (Fig purchase raloxifene 60 mg online. Although accessory portals are not routinely needed buy generic raloxifene 60mg line, they may be used to assist with positioning of the cannulae order raloxifene 60 mg with mastercard. Sutures may be placed in either a horizontal fashion or a vertical orientation. The sutures may be placed at 4- to 5-mm inter- vals alternating between the upper and the lower meniscal surfaces Figure 6. The loop vertical suture placed under the meniscus with the hor- izontal loop placed above the meniscus. If ACL reconstruction is done, the sutures are tightened so that the repair can be verified. The sutures are usually tied after the completion of the meniscal repair and are then tied sequentially over the knee capsule. Cannon believes that the risk-benefit ratio should discourage the placement of sutures posterior to 1cm from the posterocentral insertion of the posterior horn of the menisci. He believes that the suturing ante- rior to this point should provide enough strength to reduce and hold the meniscus. Working posterior to this places undue difficulty on the pro- cedure and unnecessary risk to the neurovascular bundle. This has become the major benefit of the hybrid repair, using the sutures for the easy to access mid-portion and the bioabsorbable fixators for the diffi- cult to access posterior region. Results of Zone-Specific Repair Rosenberg and his colleagues have evaluated the type of suture used for repair. This group found that the use of nonabsorbable sutures did not abrade or damage the articular cartilage on second look arthroscopy. Hamstring Graft Reconstruction Techniques sutures broke several months after repair. Because of these findings, Rosenberg does not recommend the use of absorbable sutures for routine meniscal tears. Capsular tears that heal quickly may be amenable to the use of absorbable sutures. Several other studies have also reported good success with this technique. The gold standard for results can be identified by a series that uses second-look arthroscopy as an outcome measure. The cannula is placed in the contralateral portal, while viewing from the ipsilateral portal. In the latter group 4 out of 5 of the knees were ACL deficient at the time of repair and second-look arthroscopy. The Technique of the BioStinger Insertion The appropriate length of BioStinger (Linvatec, Largo, FL) selected, is usually 13mm, and loaded on the cannulated wire of the delivery unit (Fig. The cannula is placed against the meniscus and 2mm of cannulated wire is delivered into the torn fragment (Fig. When the torn fragment is reduced, the cannulated wire is advanced into the rim using the slider bar on the side of the device (Fig. The BioStinger is inserted into the meniscus by depressing the handle on the end. To prevent the cannulated wire from bending, firm pressure must be exerted on the cannula to keep this against the meniscus. The cannula is backed up 5mm, and the head of the BioStinger inspected to be sure 84 6. The BioStinger is driven across the tear by depressing the handle of the delivery device. The appearance of the completed meniscal repair using sutures in the middle segment and BioStinger posterior is shown in Figure 6. The use of the fibrin clot was shown by Henning and later Jackson to improve the results of isolated meniscal repairs.

The individual learner The first step in designing a web based course is to identify the Design of curriculum (taught course safe 60mg raloxifene, directed learning buy 60 mg raloxifene otc, self learning) learners’ needs and whether the learners are to be considered as part of a group or as individual learners purchase raloxifene 60mg amex. The web can be a useful tool for bringing isolated learners together in “virtual” groups—for example, through a discussion forum. There are Feedback and modification Pedagogy several online resources on how to design web based learning to curriculum (delivery of teaching) programmes (for example, at www. Evaluation Assessment Questions to ask before starting a web based learning project (of learning process) (of student learning) x What is the educational purpose of the web based learning project? The learning cycle: useful to bear in mind when planning a web based x What resources and expertise on web based learning exist in the course institution? If not, the e-learning starter guides on the LTSN website are a good resource (www. This is normally done via an organisations and government agencies intranet, which is usually “password protected” and accessible x One subject centre covers medicine, dentistry, and veterinary only to registered users. Thus it is possible to protect the science (LTSN 01) intellectual property of online material and to support x Although not strictly web based learning, LTSN 01 uses a confidential exchange of communication between students. As students are usually in medical, dental, and veterinary education large groups for basic science teaching, web based learning can 43 ABC of Learning and Teaching in Medicine be used to provide learning materials to complement conventional programmes and to enable self assessment—for example, access to anatomical sites and image banks for the With web based learning, the material can be linked to teaching of pathology courses. Web based learning can be libraries (for example, for ordering books or journals), useful to support clinical teaching when learners are online databases, and electronic journals. These functions are particularly useful for research and clinical activities geographically dispersed—for example, to learn clinical skills through video demonstrations. Advantages and disadvantages of online assessment Assessment Advantages With all types of learning, including web based learning, it is x Students can receive quick feedback on their performance useful for students to receive constructive, timely, and relevant x Useful for self assessments—for example, multiple choice questions feedback on their progress. Online assessment is sometimes x A convenient way for students to submit assessment from remote sites constrained by the medium in which it is operating. Computer x Computer marking is an efficient use of staff time marked assessments alone are not appropriate for marking or Disadvantages giving feedback on assignments such as essays or projects that x Most online assessment is limited to objective questions require more than the mere reproduction of knowledge. If knowledge reproduction is x Computer marked assessments tend to be knowledge based and being tested, objective questions (such as multiple choice or measure surface learning “true or false” questions) with instant or model answers can provide excellent feedback. Assessment of higher cognitive functions, such as analysis and synthesis, will require more complex tests. Automated marking may be difficult for such assessments, and the teacher is likely to have to do a substantial Advantages and disadvantages of web based learning amount of work before he can add his or her comments to the Advantages student’s record. Further guidance on how to design web based x Ability to link resources in many different formats assessments for online courses can be found at www. Appropriate technology and reasonable computer x Learners find it frustrating if they cannot access graphics, images, skills are needed to get the best out of web based or online and video clips because of poor equipment learning. Programmes and web pages can be designed to x The necessary infrastructure must be available and affordable x Information can vary in quality and accuracy, so guidance and accommodate different technical specifications and versions of signposting is needed software. It is frustrating for learners, however, if they are trying x Students can feel isolated to work on the internet with slow access or cannot download images and videos they need. On the other hand, web based programmes may, for example, encourage more independent and active learning and are often an efficient means of delivering course materials. Effective web teaching and learning Course designers need to remember that younger students are more likely to be familiar with using the internet than older learners, who may feel less comfortable with a web based course. To get the best out of their learning experience, learners need basic computer skills, support, and guidance. Teachers must design their courses to encourage effective web based learning rather than aimless “surfing. This change means that doctors are becoming more adept at using computers and online resources to support their daily work and continuing professional development. Electronic media can facilitate access to evidence based 44 Web based learning resources such as the Cochrane Library. These web based Further reading clinical support sites are excellent resources for postgraduate “on the job” learning. The online learning handbook:developing awareness of good practice, and standards should be set in and using web based learning. The role of teachers is to ensure that the learning environment provided takes account of learners’ needs and ensures that they are effectively prepared and supported. Online learning has advantages, but web based learning should not always be viewed as the method of choice because barriers (such as inadequate equipment) can easily detract from student learning.

Writing drafts Views are mixed about whether writing several drafts is a good idea or not quality raloxifene 60 mg. Some advise writing coursework essays under exam conditions as practice for timed examinations generic raloxifene 60mg without prescription. This may help in preparing you for your exams raloxifene 60mg lowest price, however it is unlikely to help you in producing your best piece of work. I would recommend that, like any other written task, you take the opportu­ nity to draft your essay and revise it as necessary before you submit it. Use the checklist in the ‘Action Points’ at the end of this chapter to help edit your draft. Assessment criteria There is no set marking scheme that is used as a standard by all tutors for assessing essays. The way in which this type of written work is assessed 180 WRITING SKILLS IN PRACTICE varies between markers and between institutions. Some tutors work out a system where a set amount of marks is awarded to each main point covered in the essay. The accumulated figure is then converted into a percentage, which in turn may be used to place the stu­ dent within a band or grade. This tends to work well with descriptive questions, but is less useful for essays where a greater depth of understand­ ing needs to be demonstrated by the student. Analytical questions benefit from an approach where assessment is based on a variety of criteria that reflect several subsets of skills. The marker will be looking for evidence of the student’s performance in each of these skill areas. Knowledge of the subject ° Evidence – ° Able to recall facts and figures accurately. Understanding of the subject ° Ability to analyse information Evidence – ° Able to identify key components of an idea or concept. Essay skills ° Interpretation Evidence – ° Identified key elements of the title. Marking schemes are devised in a way that helps the tutor allocate marks according to the degree that the student has met the criteria. For example: ESSAYS 183 Knowledge detailed 5 4 3 2 1 sketchy in-depth 5 4 3 2 1 shallow thorough 5 4 3 2 1 superficial Tutors may use a weighting system so that certain skill subsets receive a higher percentage of the marks. Submitting your essay Ask your tutor or refer to your institutional guidelines about presentation and submission of your essay. It is vital that you comply with these other­ wise you may lose marks or have your essay rejected. In general essays must be: ° Typed – most institutions require essays to be either typed or word-processed on one side of good quality A4 paper. Leave space at the end or add a blank sheet for the marker to put your grade and sum up his or her views. The structure of your essay q Your introduction is brief and states the what, why and how? The content of your essay q There is a balance in what you have presented. You have indicated the sources for your essay q Your sources are cited in the text. You have complied with the terms of reference q Length is within the word limit. Summary Points ° Essays are a means for tutors to gauge the level of individual students’ performance. These will tell you both the topic and the approach you need to take in writing the essay. Although students will know the structure of the assessment, the specific content of the exam pa­ per is unseen. Unlike coursework these assessments are sat under exam conditions within a specified time period and invigilators are present to ensure that the regulations are met. An identical exam paper is used to as­ sess students who are at the same point in their studies as parity in assess­ ment is imperative.

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