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By K. Zakosh. Art Institute of Chicago. 2018.

In medical schools in many countries woman are forming an increasingly high proportion of student intakes phenergan 25 mg otc. However generic 25 mg phenergan, as the proportion of women in senior clinical and academic positions remains a minority the propensity for bias remains order phenergan 25 mg online. In course planning you should ensure: the elimination of sexist language in course materials and in teaching quality 25 mg phenergan. Adult (mature-age) students Most medical schools aim to recruit a proportion of mature age students buy discount phenergan 25mg line, often from diverse backgrounds. There is also a growing trend towards graduate entry medical schools (outside North America where this has been the norm for many years). Older students usually approach higher education with a greater intensity of purpose than their younger peers because so much more, in terms of sacrifices and ambitions, rests on their study and achievements. They also expect staff to be more flexible and adaptive in their teaching and assessment methods. These students often experience greater anxiety over assessment arrange- ments. Vagueness on your part, or in the course plan, can only contribute to this concern. Students with a disability You will encounter students with physical impairments, who have medical, psychiatric or psychological problems, or who have a learning disability. Most universities have policies and support arrangements relating to students who have disabilities of these kinds, and we urge you to understand the resources that are available to help you when teaching and assessing such students. The sensitive use of small group work (see Chapter 3) can be a means of dealing with some matters, but not all. The selection of content – taking care to induct students into the language and peculiarities of the subject and to the assessment methods – and above all, the clarity of your expectations can all contribute to a smooth and successful transition. International students International students, especially those in their first year of studies, require special consideration. These considera- tions relate most closely to matters of your personal preparation for teaching. Two important aspects are your own level of cultural awareness and the way in which you teach. Cultural awareness can be developed through training programmes, but a more realistic approach for the busy teacher is to develop out-of-class contact with relevant overseas student groups and through reading. The usual principles of good teaching apply as much for this group as for others but particular care should be given to your use of language – especially your speed, pronunciation and use of unnecessarily complex sentence constructions. As you review these considerations for each group of students you will realise that almost all are worthwhile principles for planning and teaching all students and should therefore be taken into account in routine course planning. In summary, we offer the following general suggestion: be aware of your own attitudes and behaviour, be available and helpful to all students and, particularly be willing to learn, to adapt and to adjust. But elsewhere in this book you will find suggestions on ways of developing these qualities. Nowhere is this more evident than in the process of linking the many content and student considera- tions we have been discussing to the particulars of preparing a course plan. We suggest that you generate a simple checklist of content and student matters to be taken into account during the next step of planning – writing course objectives. AIMS AND OBJECTIVES The intentions of the course are usually expressed in the form of aims and objectives. Objectives are rather more specific statements of what students should be able to do as a result of a course of study. We are convinced that clear outcome objectives are a fundamental tool in course planning because they enable the rational choice of content and teaching and learning activities and are important in planning a valid assessment. Objectives provide a guide to teachers and to students, but should not be so restrictive as to prevent the spontaneity that is so essential to the higher education of students. The relationship between objectives, teaching and learning activities, and assessment is best set out in a course- planning chart such as that seen in Figure 6. Each defined objective is matched with appropriate teaching and learning activities and with a valid form of assessment. For instance, in the example, you would not expect the students to learn to be able to ‘take a comprehensive history at the completion of the course’ on the basis of lectures, nor would you expect that this could be validly assessed by a paper-and-pencil test. The course designer has provided a relevant teaching and learning activity and a suitable form of assessment, WRITING OBJECTIVES Before you start writing objectives it might help to know what they look like.

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We hope our per- sonal experiences and the many case studies we present throughout the book will inspire you to work proactively with your doctors to find your diag- nostic solutions buy phenergan 25 mg with mastercard. We have dubbed the medical conditions that lead to a diagnosis dilemma “mystery maladies buy phenergan 25mg without prescription. Definition of Mystery Maladies • Conditions generic phenergan 25mg without prescription, syndromes discount phenergan 25 mg with amex, or symptoms that cannot be diagnosed easily or neatly despite advances in medical technology • Misdiagnosed chronic conditions • Symptoms that have no known cause or origin • Conditions or syndromes that are now identifiable but until recently were considered “mysteries” and may still be unfamiliar to many physicians 21 Copyright © 2005 by Lynn Dannheisser and Jerry Rosenbaum buy 25 mg phenergan with amex. Say, for exam- ple, that you have a persistent cough following what appears to have been a cold. You make an appointment with your primary care physician and tell her your symptoms. She peers in your throat and ears, feels your glands, and listens to your chest. After asking some additional questions, she decides on a treatment plan based on an established protocol. She may prescribe a course of antibiotics, rest, and plenty of fluids, and she might advise you to avoid milk products that can cause mucus. Unfortunately, you don’t get better—and so your mystery mal- ady begins. The following scenario is not atypical for many mystery malady sufferers. You call your physician again; she is somewhat perplexed but suggests a different antibiotic and perhaps an expectorant. Out of concern and in an abundance of caution, she refers you to a specialist, perhaps a pulmonolo- gist, an allergist, or both, and you make the rounds. These physicians, in turn, may send you for x-rays, blood tests, and other medical tests. The end result is a laundry list of possible diagnoses, a fistful of medical bills, and a medicine cabinet full of prescriptions that offer you no relief. Perhaps you’re now among the 65 percent of people who take prescribed allergy medica- tions but don’t actually have allergies. At this point, you’re confused, worried, and even slightly depressed because you’re still coughing and you can’t seem to get well. Now you may be thinking the real reason behind your medical problem must be “stress” or, depending on how fearful you’ve become, some undetected form of lung cancer. Soon your upbeat and generally good-natured physicians and their staff start to sound annoyed when you call yet again because they’ve been unable to help you. Either you’ve given up entirely on doctors or you may still be search- ing for the right one who will have the answers. Your friends and relatives encourage you to visit a renowned diagnos- tic clinic for yet another opinion. Although you are still coughing, at least you feel a temporary reprieve from your anxieties because surely these doc- tors will be able to make a definitive diagnosis. The day of your appoint- ment arrives and so do you, along with all your records, a list of questions, All About Mystery Maladies: A New Mind-Set 23 and renewed confidence that your mysterious symptoms will finally be iden- tified and treated. The clinic physicians review your records, perform their own physical exams, administer new tests, and repeat others. After this visit, the doctors are absolutely certain of what you don’t have, but they don’t seem to know exactly what you do have. You diligently try to follow their treatment suggestions and obtain some relief, but your symp- toms still don’t go away completely. The following table lists some examples of mystery maladies, and following that are some statistics of how many people suffer from them. We’ll discuss many of these mystery maladies in case studies throughout the book. Examples of Mystery Maladies Adrenal fatigue Fluid retention Anxiety/somatization Food allergies/sensitivities disorders* Headaches* Autoimmune disorders Heavy metal poisoning Biomechanical pain* Hemorrhoids Blurred vision Inflammatory bowel disease Breathing difficulties Interstitial cystitis Burning hands Lupus* Chest pain Mold allergies Childhood diseases Mood swings Chronic fatigue syndrome* Multiple chemical sensitivities* Constipation Multiple sclerosis* Depression Nausea Diarrhea Parasites Digestive disturbances Pelvic pain* Dizziness or loss of balance Reflex sympathetic dystrophy* Fibromyalgia* Sleep disturbances* (continued) *Statistics for these selected mystery maladies are presented in the following list. All About Mystery Maladies: A New Mind-Set 25 • Five percent of patients who experience trauma to an extremity are esti- mated to have reflex sympathetic dystrophy,10 but because of confusion over the diagnosis the true incidence is unknown.

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Hatt for his innovative except the severe visual impairment buy 25mg phenergan with mastercard, which was a ideas phenergan 25 mg for sale. Eicher attained the rank of Major before great setback because of his insatiable reading being discharged discount phenergan 25 mg with visa, in 1945 buy phenergan 25 mg without a prescription. In addition to his wife 25mg phenergan overnight delivery, his oldest son, 1948, strong Hoosier ties brought Dr. A son, Dan, and a his family to Indianapolis, where he practiced daughter, Julie, survive. Eicher’s primary interest, and he became a pioneer in the develop- ment of the intramedullary stemmed femoral prosthesis. Müller in Saint Gallen, Switzerland, he became interested in the double-cup type of 94 Who’s Who in Orthopedics strengthened by his knowledge of medicine in general, of medical administration, of public affairs and by his ability to assess the characters of other men. Ellis was, above all, a wise man and he possessed the urbanity and detachment that would have made him a good judge or colonial governor. Yet these qualities were not such as to attract the attention of the crowd or even of the profession at large. He was not a brilliant inno- vator or a popular orator, and his talents were con- cealed by a natural reserve that could be a little forbidding. Those who knew him well instinctively sought his opinion, and even his verdict, not only on clini- cal problems but on difficult matters of adminis- tration. It was natural that he found himself on the governing bodies of both of his teaching hospitals and he was chairman of the Medical Committee Valentine Herbert ELLIS of the Royal National Orthopedic Hospital and of 1901–1953 the Academic Board of the Institute of Orthope- dics. His colleagues in the Institute had particular Valentine Herbert Ellis was born in India on reason to be grateful to him; a young postgradu- February 24, 1901, and was the son of Major- ate school is very vulnerable to the influence of General Philip Ellis of the Army Medical Service. He gradu- the great weight of his authority to keep the ated in 1925, became a Fellow of the Royal course steady and the pace even. When he spoke College of Surgeons of England in 1928 and at as treasurer of the British Orthopedic Association, about that time turned his attention to orthope- he was no tame book-keeper but a maker of dics. He would have been one of the associa- National Orthopedic Hospital, was appointed tion’s greatest presidents. He had already served assistant surgeon in 1931 and served the hospital with distinction as president of the Orthopedic faithfully until he died. Ellis was wholly free from self-importance and No happier choice could have been made. He was it seems never to have occurred to him to seek no narrow-minded specialist, and it was fitting his own advancement; his thoughts were for that the first and moving tribute paid to his the benefit of his patients and of any organiza- memory came from his friend and colleague, tion with which he was connected. It life was distinguished by simplicity and content- was the breadth of his interests that made Ellis ment. Few orthopedic sur- dren and there was a quiet elegance about their geons nowadays can claim to have a proper charming house in a pleasant backwater of knowledge of every aspect of their work, but Ellis Paddington. It was furnished with perfect taste; could and this invested his opinions with unusual there were even tapestries that Ellis himself value. He was very well read and by means of had worked in his odd moments of leisure. The other appointments, as at Lord Mayor Treloar’s garden was his particular delight and he would Hospital, Alton, and at the Heatherwood Hospi- invite the visitor to inspect his 15 varieties of lily, tal, Ascot, he accumulated a vast and varied expe- though his descriptions of their characteristics rience. His versatility was reflected in the papers were always punctuated by powerful impreca- he wrote; they were not numerous, just over 20, tions against his only enemies—the stray cats of but each dealt with some important aspect of a Paddington. This Three of his activities as a surgeon are partic- all-round competence in orthopedics was ularly noteworthy. Burns, 95 Who’s Who in Orthopedics his closest friend since they were undergraduates together, wrote Recent Advances in Orthopedic Surgery, an exceptionally valuable book that should have gone into further editions; it revealed the breadth of the authors’ interests. During the war, Ellis was posted to the emergency hospital at Park Prewett in Hampshire, where he worked with unremitting devotion. In 1945, he and Innes published a short but significant paper on “Battle Casualties Treated by Penicillin,” based on a study of no less than 15,000 cases. A quotation from this paper reveals his sanity at a time when there was much uncritical enthusiasm: “Penicillin has made no difference to the paramount impor- tance of early and adequate surgery; it has, in addition, produced new difficulties in that the effect of penicillin on contaminated wounds obscures the extent of the infection of the tissues, and makes it difficult to judge how radical surgery R. Elmslie spent the whole of his professional immense value in the elucidation of injuries of life as student and surgeon at St.

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Theoretically buy phenergan 25 mg free shipping, agnosias can occur in any sensory modality cheap 25 mg phenergan with mastercard, but some authorities believe that the only unequivocal examples are in the visual and auditory domains (e cheap phenergan 25 mg visa. Nonetheless order phenergan 25mg with mastercard, many other “agnosias” have been described phenergan 25mg amex, although their clinical definition may lie outwith some operational criteria for agnosia. With the passage of time, agnosic defects merge into anterograde amnesia (failure to learn new information). Anatomically, agnosias generally reflect dysfunction at the level of the association cortex, although they can on occasion result from thal- amic pathology. The neuropsycho- logical mechanisms underpinning these phenomena are often poorly understood. Visual agnosia: disorders of object recognition and what they tell us about normal vision. Advances in Clinical Neuroscience & Rehabilitation 2004; 4(5): 18-20 Cross References Agraphognosia; Alexia; Amnesia; Anosognosia; Aprosodia, Aprosody; Asomatognosia; Astereognosis; Auditory Agnosia; Autotopagnosia; Dysmorphopsia; Finger agnosia; Phonagnosia; Prosopagnosia; Pure word deafness; Simultanagnosia; Tactile agnosia; Visual agnosia; Visual form agnosia Agrammatism Agrammatism is a reduction in, or loss of, the production or com- prehension of the syntactic elements of language, for example articles, prepositions, conjunctions, verb endings (i. Despite this impoverishment of language, or “telegraphic speech,” meaning is often still conveyed because of the high information content of verbs and nouns. Agrammatism is encountered in Broca’s type of nonfluent aphasia, associated with lesions of the posterior inferior part of the frontal lobe of the - 9 - A Agraphesthesia dominant hemisphere (Broca’s area). Cross References Aphasia; Aprosodia, Aprosody Agraphesthesia Agraphesthesia, dysgraphesthesia, or graphanesthesia, is a loss or impairment of the ability to recognize letters or numbers traced on the skin (i. Whether this is a perceptual deficit or a tactile agnosia (“agraphognosia”) remains a subject of debate. Cross References Agnosia; Tactile agnosia Agraphia Agraphia or dysgraphia is a loss or disturbance of the ability to write or spell. Since writing depends not only on language function but also on motor, visuospatial, and kinesthetic function, many factors may lead to dysfunction. Agraphias may be classified as follows: ● Central, aphasic, or linguistic dysgraphias: These are usually associated with aphasia and alexia, and the deficits mirror those seen in the Broca/anterior and Wernicke/posterior types of aphasia; oral spelling is impaired. From the linguistic viewpoint, two types of para- graphia may be distinguished, viz. A syndrome of agraphia, alexia, acalculia, finger agnosia, right-left disorientation and difficulty spelling words (Gerstmann syndrome) may be seen with dominant parietal lobe pathologies. Oxford: OUP, 2003: 126-145 Cross References Alexia; Allographia; Aphasia; Apraxia; Broca’s aphasia; Fast micro- graphia; Gerstmann syndrome; Hypergraphia; Macrographia; Micrographia; Neglect; Wernicke’s aphasia Agraphognosia - see AGRAPHESTHESIA Agrypnia Agrypnia is severe, total insomnia of long duration. Recognized causes include trauma to the brainstem and/or thalamus, prion disease (fatal familial and sporadic fatal insomnia), Morvan’s syndrome, von Economo’s disease, trypanosomiasis, and a relapsing-remitting disor- der of possible autoimmune pathogenesis responding to plasma exchange. Annals of Neurology 2001; 50: 668-671 Akathisia Akathisia is a feeling of inner restlessness, often associated with restless movements of a continuous and often purposeless nature, such as rocking to and fro, repeatedly crossing and uncross- ing the legs, standing up and sitting down, pacing up and down. Voluntary suppression of the movements may exacerbate inner tension or anxiety. Recognized associations of akathisia include Parkinson’s disease and neuroleptic medication (acute or tardive side effect), suggesting that dopamine depletion may contribute to the pathophysiology; dopamine depleting agents (e. Treatment by reduction or cessation of neuroleptic therapy may help, but can exacerbate coexistent psychosis. Centrally acting β-blockers, such as propranolol, may also help, as may anticholinergic agents, amantadine, clonazepam, and clonidine. Cambridge: CUP, 1995 Cross References Parkinsonism; Tic - 11 - A Akinesia Akinesia Akinesia is an inability to initiate voluntary movements. More usually in clinical practice there is a difficulty (reduction, delay), rather than complete inability, in the initiation of voluntary movement, perhaps better termed bradykinesia, reduced amplitude of movement, or hypokinesia. These difficulties cannot be attributed to motor unit or pyramidal system dysfunction. Akinesia may coexist with any of the other clinical features of extrapyramidal system disease, partic- ularly rigidity, but the presence of akinesia is regarded as an absolute requirement for the diagnosis of parkinsonism. Hemiakinesia may be a feature of motor neglect of one side of the body (possibly a motor equivalent of sensory extinction).

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