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What you must be aware of discount prednisolone american express allergy forecast cambridge ma, however generic 40 mg prednisolone visa allergy symptoms hay fever symptoms, when deciding upon your methods discount prednisolone 5 mg online allergy medicine mold spores, are the constraints under which you will have to work. There’s no point deciding that a large scale, national post- al survey is the best way to do your research if you only have a budget of £50 and two months in which to com- plete your work. Also, you need to think about the purpose of your re- search as this will help point to the most appropriate methods to use. For example, if you want to describe in detail the experiences of a group of women trying to set up and run a charity, you wouldn’t send them a closed- ended questionnaire. Instead, you might ask to become involved and set up a piece of action research in which you can decide to use interviews and focus groups. Or you might decide to hold two semi-structured interviews with each of the women involved, one at the beginning of their project and one at the end. If your goal is detailed description, you do not need to try to contact as many people as possible. HOW TO CHOOSE YOUR RESEARCH METHODS / 35 Let us return to the three examples in the exercises given in the previous two chapters to ﬁnd out which would be the most appropriate methods for the research. EXAMPLE 3: APPROPRIATE METHODS Revised Statement 1: This research aims to ﬁnd out what primary school teachers think about the educational value of ‘The Teletubbies’ television programme. She thinks about running a series of semi-structured in- terviews with a small sample of primary school tea- chers. However, the researcher is concerned that some of the teachers may not have seen the programme and might be unable to comment, or might comment purely on ‘hearsay’. So she decides to gather together a group of teachers and show them one episode of The Teletub- bies. Then she discusses the programme with the tea- chers in a focus group setting. This method works well and the researcher decides to hold ﬁve more focus groups with other primary school teachers. Revised Statement 2: The aim of this research is to ﬁnd out how many relatives of Alzheimer’s patients use the Maple Day Centre, and to ascertain whether the ser- vice is meeting their needs. This researcher decides to produce a questionnaire with a combination of closed and open-ended ques- tions. The ﬁrst part of the questionnaire is designed to generate statistics and the second part asks people for a more in-depth opinion. He has approached mem- bers of staﬀ at the Maple Day Centre who are happy to 36 / PRACTICAL RESEARCH METHODS distribute his questionnaire over a period of one month. Revised Statement 3: This research aims to ﬁnd out how many people from our estate are interested in, and would use, a children’s play scheme in the school summer holi- day. Members of the tenants’ association approach the local school and ask the head teacher if a questionnaire could be distributed through the school. The head tea- cher feels that it is not appropriate so the tenants’ asso- ciation have to revise their plans. They’re worried that if they distribute a questionnaire through the post they won’t receive back many responses. Eventually, they de- cide to knock on each door on the estate and ask some simple, standard questions. They’re able to conduct this type of door-to-door, structured interview as they are a large group and are able to divide the work amongst everybody on the committee. If, at this stage, you are still unsure of the most appropri- ate methods for your research, read the following chapters as these explain in more detail how to go about using each method. This will give you more of an insight into what would be required of you if you were to choose that meth- od. As I stressed earlier, you need to think about your own personality, your strengths and weaknesses, your likes and dislikes. If you’re a nervous person who ﬁnds it diﬃcult to talk to strangers, face-to-face interviewing might not be the best method for you. If you love working with groups, you might like to ﬁnd out more about focus group re- search.
The volume of urine in the bladder should never be allowed to exceed 500ml because overstretching the detrusor Beware of paralytic ileus: patients should receive intravenous fluids muscle can delay the return of bladder function prednisolone 40 mg otc allergy testing evansville in. If the patient for at least the first 48 hours after injury is transferred to a spinal injuries unit within a few hours after injury it may be possible to defer catheterisation until then purchase prednisolone cheap online allergy shots grand rapids, but if the patient drank a large volume of fluid before injury this is unwise buy online prednisolone allergy treatment er. In these circumstances, and in patients with multiple injuries, the safest course is to pass a small bore (12–14Ch) 10ml balloon silicone Foley catheter. The gastrointestinal tract The patient should receive intravenous fluids for at least the first 48 hours, as paralytic ileus usually accompanies a severe spinal injury. A nasogastric tube is passed and oral fluids are forbidden until normal bowel sounds return. If paralytic ileus becomes prolonged the abdominal distension splints the diaphragm and, particularly in tetraplegic patients, this may precipitate a respiratory crisis if not relieved by nasogastric aspiration. If a tetraplegic patient vomits, gastric contents are easily aspirated because the patient cannot cough effectively. Ileus may also be precipitated by an excessive lumbar lordosis if too bulky a lumbar pillow is used for thoracolumbar injuries. When perforation occurs it often presents a week after injury with referred pain to the shoulder, but during the stage of spinal shock guarding and rigidity will be absent and tachycardia may not develop. A supine decubitus abdominal film usually shows free gas in the peritoneal cavity. Use of steroids and antibiotics (b) An American study (NASCIS 2) suggested that a short course Figure 4. A later study (NASCIS 3) suggested that patients decubitus view showing massive collection of free gas under the anterior abdominal wall. Recently the use of or perforation steroids has been challenged, and their use has not been universally accepted. Policy concerning steroid treatment • Treat with proton pump inhibitor or H2-receptor antagonist should be agreed with the local spinal injuries unit. If treatment is When the patient is transferred from trolley to bed the whole started 3–8 hours after injury, the infusion is continued for of the back must be inspected for bruising, abrasions, or signs 47 hours. The patient should be turned every two 19 ABC of Spinal Cord Injury hours between supine and right and left lateral positions to prevent pressure sores, and the skin should be inspected at each turn. Manual turning can be achieved on a standard hospital bed, by lifting patients to one side (using the method described in chapter 8 on nursing) and then log rolling them into the lateral position. Alternatively, an electrically driven turning and tilting bed can be used. Another convenient solution is the Stryker frame, in which a patient is “sandwiched” between anterior and posterior sections, which can then be turned between the supine and prone positions by the inbuilt circular turning mechanism, but tetraplegic patients may not tolerate the prone position. Nursing care requires the use of pillows to separate the legs, maintain alignment of the spine, and prevent the formation of contractures. In injuries of the cervical spine a neck roll is used to maintain cervical lordosis. Care of the joints and limbs The joints must be passively moved through the full range each day to prevent stiffness and contractures in those joints which may later recover function and to prevent contractures Figure 4. In the lateral position, note the slight tilt on the opposing side to prevent the patient sliding keep the tetraplegic hand in the position of function are out of alignment. Foot drop and equinus contracture are prevented by placing a vertical pillow between the foot of the bed and the soles of the feet. Skeletal traction of lower limb fractures should be avoided, but early internal or external fixation of limb fractures is often indicated to assist nursing, particularly as pressure sores in anaesthetic areas may develop unnoticed in plaster casts. Later analgesia In the ward environment, diamorphine administered as a low-dose subcutaneous constant infusion, once the correct initial dose has been titrated, gives excellent pain relief, especially if combined with a non-steroidal anti-inflammatory Figure 4. Close observation is essential and naloxone must always be available in case of respiratory depression. As a result, some injuries Following spinal cord trauma, occult injuries can easily compromise associated with high morbidity, for example scaphoid fracture, recovery or aggravate disability.
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Those containing printed material should be kept simple and must be clearly visible at the back of the theatre with the lights on purchase prednisolone 40 mg amex allergy shots drowsiness. Care must be taken when reproducing material from books and journals purchase prednisolone discount allergy testing for 1 year old, which often contain far too much information cheap prednisolone 40 mg on-line allergy generator. Coloured slides of relevant material are ideal for illustrating points and for adding variety and interest. When using slides, avoid turning off the lights for more than brief periods. The level of attention will rapidly fall, however interesting your slides happen to be. PowerPoint ) are rapidly taking over the function performed by both the overhead and slide projectors. If you teach in locations where you are confident of the technology then there are many advantages in using this aid including ease and flexibility of preparation and the capacity to generate student notes derived directly from your presentation. You can also incorporate video and sound in your presentation as required. In Chapter 9 we give you more information about preparing and using these systems. A computer presentation is governed by the same principles as those for slides and overheads – clear, legible text and pictures, and use in a room where sufficient lighting can be left on for student note-taking and activities. If you are not confident of the environment in which you are teaching and in case the technology fails, it is still wise to have overhead transparencies or slide backups. Videos, and less often films these days, are best utilised in short segments. Their use requires more careful planning, 32 as it will be necessary to have a technician to set up equipment. However, the effort is well worthwhile for both the impact of the content and the variety it introduces. We use such material to show illustrative examples and practical techniques. They may also be used in attempts to influence attitudes or to explore emotionally charged issues. A short segment (trigger) can be shown illustrating some challenging situation and the class asked to react to this situation. Videos and films for this purpose are commercially available in some disciplines. WHEN THINGS GO WRONG Throughout this book we present the view that things are less likely to go ‘wrong’ if you have carefully prepared yourself for the teaching task. However, unexpected difficulties can and do arise, so strategies to deal with these need to be part of your teaching skills. In our experience problems in teaching large groups are likely to fall into one of the following categories. An equipment failure can be a potential disaster if you have prepared a computer presentation or a series of slides or transparencies for projection. Preventive measures in- clude having a thorough understanding of your equip- ment, back-up equipment on hand, and learning to change blown bulbs or remove jammed slides. If these measures are of no avail, you will have to continue on without the materials and may do so successfully provided that you have taken care to have a clear record in your notes of the content of your material. You may then be able to present some of the information verbally, on a blackboard or whiteboard, or on an overhead transparency if the original problem was with the slide projector. You will not, of course, be able to use this approach with illustrations and you may have to substitute careful description and perhaps blackboard sketches to cover essential material. Whatever you do, do not pass around your materials, which may be damaged and, of course, by the time most of the audience receive them, they are no longer directly relevant to what you are saying! Do not start apologising or communicate your sense of ‘panic’ if this should happen.
For those wishing to delve more deeply into aspects of medical education research there is now a major text entitled An International Handbook for Research in Medical Education by J generic prednisolone 10mg without a prescription allergy treatment diet. Articles relating to medical education appear regularly in most of the major general medical journals order prednisolone with american express allergy medicine that won't make you drowsy. There are also several journals specifically concerned with publishing research and review articles in the field of medical education generic 10mg prednisolone visa allergy medicine during breastfeeding. Medical Education This is the official journal of the Association for the Study of Medical Education (ASME), which is the organisation catering for individuals interested in medical education in the United Kingdom. The Association also produces an excellent series of booklets dealing with various aspects of medical education and has a series on medical education research. As well as containing articles relating to teaching, this journal also deals with the broader issues of the organisation of medical education as it relates to the United States. It also publishes the Proceedings of the Annual Conference on Research in Medical Education which is the world’s premier medical education research meeting. Medical Teacher This journal is now published in collaboration with the Association for Medical Education in Europe. Rather, it has been a journal containing review articles and descriptions of educational activities by medical teachers from around the world. While this focus remains it is increasingly publishing quality research articles. Teaching and Learning in Medicine An American medical education journal gaining a reputation as a major international journal. Advances in Health Sciences Education A relatively new addition to the list of medical education journals. While published in Europe it has a prestigious international editorial board and is a source of high quality educational research and review articles. World Health Organisation The WHO has been very active for many years in the field of medical education. If not, you could write direct to Distribution and Sales, CH-1211 Geneva 27, Switzerland or search the WHO Website. Alternatively, you could elect to attend courses run by other organisations in your area or even overseas. The WHO supports regional teacher training centres which offer short courses for medical teachers and even degree courses in health personnel education. Many universities now have medical education depart- ments or units which run courses of various types and some have well-developed degree or fellowship programmes for local and overseas postgraduate students. OVERSEAS TRAVEL Generally speaking, people concerned with medical education are friendly and helpful. Should you be travelling, do not hesitate to write to any individual or institution you may wish to visit and observe at first hand educational activities or facilities which have interested you during your reading. If you come from a traditional medical school, you should attempt to visit one of the well known less conventional schools such as McMaster University in Canada; Maastricht University in the Nether- lands; Ben Gurion University of the Negev, in Israel; or Newcastle University in Australia. Many other institutions are now experimenting with alternative curricula so opportunities to experience different ways of teaching medical students should be found reasonably close to your home institution. ORGANISATIONS As your interest in medical education grows you may wish to join an association or attend one of the national or international conferences which are held each year. The following is a list of some of the most well know English- speaking organisations which conduct major annual conferences. In addition it provides a regular forum for the meeting of medical school deans from Europe and sometimes from other parts of the world. Further information can be obtained from the Secretary, AMEE, Tay Park House, 484 Perth Road, Dundee, DD2 1LR, Scotland or on