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Brainstorming is a technique which can be modified for use in large group teaching cheap ampicillin 500mg on-line antibiotic 3 2. It can be of value at the beginning to stimulate interest in the topic to be discussed 500 mg ampicillin with visa antimicrobial coating. The students are presented with an issue or a problem and asked to contribute as many ideas or solutions as they can. All contributions are accepted without comment or 29 judgement as to their merits and are written on the board or on an overhead transparency. One of us has successfully used this technique with a class of 120 at the beginning of a lecture. The session commenced with a request for the class to put forward their suggestions in response to a question. These suggestions were then categorised and used as a basis for further discussion in an environment where the students had been the initiators of the discussion points. Brainstorming is discussed further in the chapter on small group teaching. Classroom Assessment Techniques (CATs) are a relatively recent innovation that we would encourage you to use with your students. These techniques stimulate active learning but most importantly help teachers gather useful informa- tion on what, how much, and how well their students are learning. In this technique, the teacher stops two or three minutes early and asks students to write anonymous brief response to a question such as: “What was the most important thing you learned in this class? This technique assists in the development of thinking skills by encoura- ging students to go beyond initial reactions to an issue. In response to a suitable prompt or question, students write out a specified number of pros and cons or advantages and disadvantages. These can then be discussed in small groups, analysed in class, or analysed yourself prior to the next class session. We strongly recommend the book by Angelo and Cross on classroom assessment. Student note-taking The research in this area generally supports the view that note taking should be encouraged. The teacher can assist this process by providing a structure for material that is complex. Diagrams and other schematic representations may be more valuable than simple prose. This section will review their use in large group teaching for a variety of purposes including illustrating the structure, providing information and examples, stimulating interest and activity, and providing variety. The aids most likely to be used are handouts, the board, overhead transparencies, slides, videos and, increasingly, on-line Internet sessions. Handouts must serve a clear purpose and be used during the teaching session so that students are familiar with their content and simply do not file them away. Handouts may be valuable as a guide to the structure of your session and in this case may be very similar in content to the teaching plan. You may wish to use the handout to provide detailed information on an area not well covered in standard student texts or not covered in detail in your teaching. Handouts may also be used to guide further study and to provide references for additional reading. Whenever you distribute handouts, it is essential that you use them in some way with your students. Clear, legible and well-planned use of these basic aids is a delight to see and remain valuable allies in assisting you to communicate with your students. They are especially worthwhile for displaying an outline of your session or for recording feedback from students in response to questions you may have raised. The overhead projector is extensively used in teaching and is particularly useful for giving outlines and listing key points. A pen or pencil placed on the transparency itself should be used to direct the students’ attention to the appropriate point rather than using the pointer on the screen.

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I dress myself; I do my own housework; I do everything I can do because that’s exercise order 500 mg ampicillin otc antibiotic 777. As soon as I get on the bike in the morning generic ampicillin 250mg online virus 68 florida, hey, all the stiffness is gone. Certainly, chiropractic has long received professional recognition, but other alternative therapies still remain outside the Western medical mainstream, including herbal thera- pies, acupuncture, homeopathy, megavitamins, energy healing, prayer, massage, and faith healing. Roughly 40 percent of Americans say they use some type of alternative therapy, with numbers of visits exceeding en- counters with primary care physicians (Eisenberg et al. People with physical disabilities are much more likely than others to report using alternative therapies, especially to treat pain, depression, anxiety, insom- nia, and headache (Krauss et al. I asked every person whether they use or have used alternative or com- plementary therapies, such as acupuncture, chiropractic, herbal medicine, or massage. I’ve often wondered about acupuncture, but when I think of needles, I freeze up, and I don’t know many people who’ve used it. Walter Masterson has tried various alternative therapies: I’m getting massage now. A couple of years ago, the thought of seeing an acupuncturist would have been ludicrous to me. But at the end of the session, there was a sense of internal cleanness in my legs which impressed me. But when there’s no cure, it’s really impossible to say that something has no impact. I stopped going when it became apparent to me that it wasn’t going to make this go away. They tasted terrible, but I stuck with it for a couple of months just to see what impact it would have. Monkey arm, quite literally—probably about an inch and a half of monkey arm chopped up into five or six pieces. Lillian Lowell, in her late seventies, has a thick thatch of white hair and alert, inquisitive eyes. Her tiny house is neat as a pin, the living room filled with glass animals—cats, dogs, penguins. I started acupuncture shortly after I started hurting, and that worked beautifully for a year. It was very relaxing, very fun, and that kept me going for at least a year before I really thought of an op- eration. He told me it was os- teoarthritis and the cartilage was degenerating, the bones rubbing against each other—he described it fairly callously. My internist said, ‘Anything that’s good therapy for you is good therapy. She tried sev- Physical and Occupational Therapy / 179 eral practitioners, but “I wasn’t getting the same results from the acupunc- ture—the nice relaxed feeling. At that point, I realized I was starting to take over my own medical care. I was feeling guilty about going to see a chiropractor because it was an alternative medicine. So I didn’t even tell my primary care doctor”—the physician who had referred me to this woman. Some people try techniques, such as massage or prayer, they do not nec- essarily see as formal interventions. Lester Goodall is “still exploring the school where it’s mind over matter. I put my hands like this here,” Lester held both hands out straight in front of him, “and I try to communicate with my immune system. They now say the immune system,” which might affect MS, “is controlled by the brain. Wealthier people can afford to pay out-of-pocket for care, but costs accumulate over time. About 20 percent of people say they do not get physical or occupational therapy because they cannot afford it.

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Bur- dening them with my disease 250mg ampicillin otc antibiotics meat, even by explaining my cane ampicillin 500mg antimicrobial hand sanitizer, seemed presumptuous. When propped in a corner, it in- variably fell, with a clatter, to the tile floor. If placed on the floor in cramped hospital rooms, someone, including me, could trip over it. Girded by these rationalizations, I began stashing—hiding—the cane at the nurse’s station or utility room before entering patients’ rooms, carefully clutching the doorjamb. Unlike Fred Astaire’s glossy, svelte walking stick, real mobility aids clearly aim to 181 182 mbulation Aids support or transport persons. These aids generally do their jobs well, eas- ing pain, enhancing balance, maximizing safety, helping people get around. Mobility aids can restore independence and conserve energy drained by enervating struggles to walk. Users of mobility aids openly admit—both to themselves and the exter- nal world—their lost physical function and consequent need. After in- juries, walking short-term with canes or crutches evokes sympathetic in- quiries about that presumed skiing or other accident. When I fractured my foot and adopted the cane, surgeons regaled me with stories of their own broken bones (but never asked about my injury). Long-term, however, mo- bility aids carry not only weight, quite literally, but also a hefty symbol- ism. One study found that about half of people with great difficulty walking one-quarter mile do not use any assistance; they probably simply avoid walking that far (Ver- brugge, Rennert, and Madans 1997, 386). Using equipment to aid mobility, however, enhances people’s sense of autonomy and self-sufficiency. With increasing technological sophistication, mobility aids can offer efficient al- ternatives to costly personal assistance and institutionalization, even for people with significant physical limitations. Chapters 11 and 12 explore the contradictions surrounding mobility aids, juxtaposing their important advantages with persisting individual and societal unease. Chapter 11 considers ambulation aids (canes, crutches, walkers) but not potentially useful items fabricated for particular needs (special shoes, splints, braces, orthotics, or limb prostheses). As a bottom line, decisions about mobility aids and all assistive tech- nologies (AT) must reflect the user’s needs, circumstances, and preferences. AT choice should include the right to choose or to reject AT” (Olkin 1999, 291). Almost inevitably, others weigh in—family members, physicians, physical and occupational therapists,AT vendors, and health insurers. Decisions about mobility aids can become complicated and emotionally charged. Use of Mobility Aids by People with Major Mobility Difficulties Mobility Aid (%) Difficulty Cane Walker Wheelchair Arthritis 44 26 16 Back problems and sciatica 34 10 5 Heart conditions 30 15 14 Lung conditions 16 11 12 Stroke 48 28 44 Missing lower limb 57 30 23 Diabetes 37 40 35 Multiple sclerosis 36 29 66 million) use canes; 0. After accounting for various personal factors,4 we find that cane users live alone 50 percent more frequently than other people, and walker users 30 percent more often. The survey has no information on whether mobility aids allow people to live alone more independently and safely than without the equipment. Mobility aids have their own hierarchy, from low-tech wooden canes with crook handles, to multifooted canes, to crutches, to walkers, to manual wheelchairs and scooters, to sophisticated power wheelchairs. People gen- erally start with the lowest practical option, then, if impairments progress, they move up the hierarchy, as did Walter Masterson (chapter 3). Over the last two decades the sophistication, design, and diversity of mobility aids have grown dramatically, offering consumers wide-ranging options for most tastes and requirements. Yet little systematic evidence is available about the technical pros and cons of different mobility aids and their safety and biomechanics in routine use. Research including persons with ac- 184 mbulation Aids tual mobility problems is generally conducted in laboratories, with few studies examining how people use mobility aids in daily life or whether these aids save societal costs (e. Choice of mobility aids must consider many factors beyond lower- extremity functioning, including people’s cognitive status and judgment, vision, vestibular function (which affects balance), upper-body strength, and global physical endurance, as well as home and community environ- ments. Ambulation aids fall at the low-tech, higher-functioning end of the mobility device continuum. Stuart Hartman, an orthopedic surgeon, encourages patients to use ambulation aids by emphasizing that they will still walk independently, albeit now with mechanical assistance: People don’t normally want these things—they just don’t want to be seen that way. They feel like everybody is looking at them, like they’re getting old and that’s the final chapter.

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Most survivors from cardiac arrest have developed a shockable rhythm order ampicillin 500mg amex virus removal programs, such as ventricular fibrillation or pulseless ventricular tachycardia generic ampicillin 500mg amex antimicrobial ointment neosporin, and may be successfully shocked before the arrival of the cardiac arrest team. The function of this team is then to A cardiac arrest team training provide advanced life support techniques, such as advanced airway management and drug therapy. The resuscitation committee The resuscitation committee ● Specialists in: Every hospital should have a resuscitation committee as Cardiology or general medicine recommended in the Royal College of Physicians’ report. The committee should ensure that Emergency medicine hospital staff are appropriately and adequately trained, that Paediatrics there is sufficient resuscitation equipment in good working ● Resuscitation officer order throughout the hospital, and that adequate training ● Nursing staff representative ● Pharmacist facilities are available. The minutes of the committee’s ● Administrative and support staff meetings should be sent to the medical director or appropriate representative—for example, porters medical executive or advisory committee of the hospital and ● Telephonists’ representative should highlight any dangerous or deficient areas of practice, such as lack of equipment or properly trained staff. Postgraduate deans or tutors (or both) should be ex-officio members of the committee to facilitate liaison on training matters and to ensure that adequate time and money is set The resuscitation committee should receive a aside to allow junior doctors to receive training in resuscitation. Resuscitation provision and The resuscitation officer performance should be regularly reviewed as part of the clinical governance process The resuscitation officer should be an approved instructor in advanced life support, often also in paediatric advanced life support and sometimes in advanced trauma life support. The background of resuscitation officers is usually that of a nurse with several years’ experience in a critical care unit, an operating department assistant, or a very experienced ambulance paramedic. The resuscitation officer is directly responsible to the chair of the resuscitation committee and receives full backing in carrying out the role as defined by that committee. It is essential that a dedicated resuscitation training room is available and that adequate secretarial help, a computer, telephone, fax machine, and office space are provided to enable the resuscitation officer to work efficiently. As well as conducting the in-hospital audit of resuscitation, he or she should be encouraged to undertake research studies to Chair of the resuscitation committee further their career development. Doctors, nurses, and managers do not always recognise the Committee crucial importance of having a resuscitation officer, especially when funding has been a major issue. Training should be Resuscitation officer mandatory for all staff undertaking general medical care. It is likely that many specialties will require formal training in cardiopulmonary resuscitation before a certificate of Training Administration Training room and equipment Secretarial support accreditation is granted in that specialty. It is advisable that the recommendations of the Royal College of Physicians’ report and the recommendations of the Resuscitation team structure 55 ABC of Resuscitation Resuscitation Council (UK) should be implemented in full in The cardiac arrest team all hospitals. All hospitals should have a unique telephone number to be used in case of suspected cardiac arrest. It would ● Specialist registrar or senior house officer be helpful if hospitals standardised this number (222 or 2222) in medicine ● Specialist registrar or senior house officer so that staff moving from hospital to hospital do not have to in anaesthesia learn a new number each time they move. This emergency ● Junior doctor number should be displayed prominently on every telephone. Because the person instigating the call may not know exactly what location they are calling from, the telephone should indicate this—for example, “cardiac arrest, Jenner Hoskin ward, third floor. The hospital resuscitation committee should determine the composition of the cardiac arrest team. In multistorey hospitals those carrying the cardiac bleep must have an override facility to commandeer the lifts. The resuscitation officer must ensure that after any resuscitation attempt, the necessary documentation is accurately completed in “Utstein format. It is essential that the senior doctor and nurse at the cardiac arrest should debrief the team, whether resuscitation has been Practising in the resuscitation training room successful or not. If any member of staff is especially distressed then a confidential counselling facility should be made available through the occupational health or psychological medicine department. Presence of relatives The resuscitation training room It is now accepted by many resuscitation providers and institutions that the relatives of those who have suffered a This room should be totally dedicated to resuscitation training and fully equipped with cardiac arrest may wish to witness the resuscitation attempt. Clear intubation trainers, and other required guidelines are available from the Resuscitation Council (UK) training aids detailing how relatives should be supported during cardiopulmonary resuscitation procedures. Allowing relatives to witness resuscitation attempts seems, in many cases, to allow them to feel that everything possible has been done for their relative even if the attempt at resuscitation is unsuccessful, and may be a help in the grieving process. Do not attempt resuscitation orders For some patients, attempts at cardiopulmonary resuscitation are not appropriate because of the terminal nature of their DNAR orders illness or the futility of the attempt. Every hospital resuscitation ● Hospital’s policy must be agreed with ethics committee should agree a “do not attempt resuscitation” and medical advisory committees (DNAR) policy with its ethics committee and medical advisory ● Discuss with patients or relatives (or both) committee (see Chapter 21). In many cases it may be when appropriate appropriate to discuss the suitability of attempting ● Advance directive or “living will” views must be respected cardiopulmonary resuscitation with the patient or with his or ● DNAR orders must be documented and her relatives in the light of the patient’s diagnosis, the signed by the doctor responsible probability of success, and the likely quality of subsequent life.

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