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Higher order x To list x To enjoy x To compare x To believe thinking depression symptoms test nhs buy discount bupron sr 150 mg on-line, problem solving anxiety 6 weeks after quitting smoking discount bupron sr 150 mg mastercard, and processes for acquiring values x To contrast x To have faith in may be excluded because they cannot be simply stated in behavioural terms depression mentality definition order genuine bupron sr on-line. The importance of being clear about the purpose of the curriculum is well accepted. More recently, another prescriptive model of curriculum design has emerged. Curriculum design standard” in curriculum design proceeds by working “backwards” from outcomes to the other elements (content; teaching and learning experiences; assessment; and evaluation). The use of outcomes is becoming more popular in medical education, and this has the important effect of focusing curriculum designers on what the students will do rather than Desired what the staff do. Care should be taken, however, to focus only outcomes (students Content • Teaching Assessment Evaluation on “significant and enduring” outcomes. An exclusive concern • Learning will be with specific competencies or precisely defined knowledge and able to ... Although debate may continue about the precise form of these statements of intent (as they are known), they constitute Outcomes based curriculum (defining a curriculum “backwards”—that is, an important element of curriculum design. It is now well from the starting point of desired outcomes) accepted that curriculum designers will include statements of intent in the form of both broad curriculum aims and more specific objectives in their plans. Alternatively, intent may be Example of statements of intent expressed in terms of broad and specific curriculum outcomes. Aim The essential function of these statements is to require x To produce graduates with knowledge and skills for treating curriculum designers to consider clearly the purposes of what common medical conditions they do in terms of the effects and impact on students. Objectives x To identify the mechanisms underlying common diseases of the circulatory system Descriptive models x To develop skills in history taking for diseases of the circulatory system An enduring example of a descriptive model is the situational Broad outcome model advocated by Malcolm Skilbeck, which emphasises the x Graduates will attain knowledge and skills for treating common importance of situation or context in curriculum design. In this medical conditions x Students will identify the mechanisms underlying common diseases model, curriculum designers thoroughly and systematically of the circulatory system analyse the situation in which they work for its effect on what x Students will acquire skills in history taking for diseases of the they do in the curriculum. The impact of both external and circulatory system internal factors is assessed and the implications for the curriculum are determined. Although all steps in the situational model (including situational analysis) need to be completed, they do not need to Situational analysis* be followed in any particular order. Curriculum design could begin with a thorough analysis of the situation of the External factors Internal factors x Societal expectations and x Students curriculum or the aims, objectives, or outcomes to be achieved, changes x Teachers but it could also start from, or be motivated by, a review of x Expectations of employers x Institutional ethos and content, a revision of assessment, or a thorough consideration x Community assumptions structure of evaluation data. What is possible in curriculum design and values x Existing resources depends heavily on the context in which the process takes x Nature of subject x Problems and place. They are x Nature of support systems curriculum x Expected flow of resources not separate steps. Content should follow from clear statements of intent and must be derived from considering external and *From Reynolds J, Skilbeck M. But equally, content must be delivered by 6 Curriculum design appropriate teaching and learning methods and assessed by relevant tools. No one element—for example, assessment— Situational should be decided without considering the other elements. They also display the essential features of the curriculum in a clear and succinct Organisation and Programme building manner. They provide a structure for the systematic implementation (content) organisation of the curriculum, which can be represented diagrammatically and can provide the basis for organising the curriculum into computer databases. Programme building Programme building The starting point for the maps may differ depending on (assessment) (teaching and learning) the audience.

An initial double-blind randomized study revealed a decrease in seizure frequency of >50% in 33% of children with target doses of approximately 6mg=kg=day vs mood disorder or bipolar discount bupron sr 150 mg. A follow-up open label study after adjustment of mean anticonvulsant doses to 10 mg=kg=day demonstrated a reduction in seizures of! Another multicenter study found seizure reduction of >50% in 40% of patients with a mean dose of 4 depression of 1873 order bupron sr 150mg on-line. A more recent open depression unspecified buy bupron sr 150 mg otc, multicen- ter study, however, recorded a response rate as defined above of only 25%, although this is discrepant with other reports of topiramate efficacy as add-on therapy in LGS. These three anticonvulsant agents have been shown to decrease seizure fre- quency including drop attacks by about half in as much as one-half of children when used as adjunctive agents. Because seizures remain intractable, other options are often considered. A small sub- group of patients with LGS in a study of zonisamide as an adjunctive agent in pedia- tric epilepsy had a ‘‘response’’ of 25–50%, although effectiveness is not clearly defined. Levetiracetam is also used, although there is limited data regarding efficacy. Benzodiazepines, especially clobazam and nitrazepam, are used with some suc- cess. A small study recently suggested that nitrazepam may be at least as efficacious as other anticonvulsant drugs, decreasing seizure frequency by $50% in more than 60% of patients. Use of these drugs is limited by the development of tolerance and physiologic dependence. The ketogenic diet has also been used with some success in many centers although there are no well-documented studies of this therapy specifically for LGS. Prospective studies show a modest reduc- tion in seizure frequency after vagal nerve stimulator implantation. This therapy may be helpful in limiting drop attacks and therefore may lead to improvement in quality of life. Corpus callosotomy has also been used to reduce tonic seizures that result in injury secondary to falling, with some moderate success. The recognition of episodes of nonconvulsive status, which may occur fre- quently in these patients, is important. The use of steroids in this situation has been occasionally used when more conventional therapies have failed. Very few patients have complete seizure control and none of these therapies appears to have altered the progress of intellectual decline. Anticonvulsant manage- ment should aim to minimize polypharmacotherapy and accumulated toxicity. When possible, AEDs should be limited to one or two agents (unless switching medications where the child would be on three AEDs during transition). Treatment of LGS has therefore remained inherently frustrating for both physicians and families. Lennox–Gastaut Syndrome 83 PROGNOSIS Prognosis in children with LGS is defined mainly by neurodevelopmental outcome and refractory seizures. Other important considerations, such as the mortality due to status epi- lepticus, are not particular to this seizure syndrome. Seizure types evolve as the child matures, most typically into more complex partial, and generalized tonic–clonic sei- zures, although the nocturnal seizures persist into adolescence.

However mood disorder unspecified dsm v buy bupron sr on line, once this has been done the analysis is quick and efficient geriatric depression definition discount bupron sr master card, with most software packages producing well presented graphs anxiety yawning buy discount bupron sr 150 mg on line, pie charts and tables which can be used for the final report. QUALITATIVE DATA ANALYSIS To help you with the analysis of qualitative data, it is use- ful to produce an interview summary form or a focus group summary form which you complete as soon as possible after each interview or focus group has taken place. This includes practical details about the time and place, the participants, the duration of the interview or focus group, and details about the content and emerging themes (see Figures 2 and 3). It is useful to complete these forms as 112 / PRACTICAL RESEARCH METHODS soon as possible after the interview and attach them to your transcripts. The forms help to remind you about the contact and are useful when you come to analyse the data. The method you use will depend on your research topic, your personal preferences and the time, equipment and fi- nances available to you. Also, qualitative data analysis is a very personal process, with few rigid rules and procedures. It is for this reason that each type of analysis is best illu- strated through examples (see Examples 8–11 below). Formats for analysis However, to be able to analyse your data you must first of all produce it in a format that can be easily analysed. This might be a transcript from an interview or focus group, a series of written answers on an open-ended questionnaire, or field notes or memos written by the researcher. It is useful to write memos and notes as soon as you begin to collect data as these help to focus your mind and alert you to significant points which may be coming from the data. These memos and notes can be analysed along with your transcripts or questionnaires. You can think of the different types of qualitative data analysis as positioned on a continuum (see Fig. HOW TO ANALYSE YOUR DATA/ 113 Interviewee: ________________ D at e o f I n t erview:________________ P l ac e : ________________________ Time of Interview:________________ Duration of Interview: __________ Where did the interview take place? Did any issues arise which need to be added to the interview schedule for next time? Have I promised to send any information or supply them with the results or a copy of the transcript? Interview summary form 114 / PRACTICAL RESEARCH METHODS D at e : ________________________ Time:_________________________________ Ve n u e : ______________________ D u r at ion: ___________________________ G rou p : ______________________ Diagram of seating plan with participant codes: Where did the focus group take place? Does anything need to be added to the in- terview schedule for the next focus group? Have I promised to send any further informa- tion or the final report to anyone? Qualititative data analysis continuum For those at the highly qualitative end of the continuum, data analysis tends to be an on-going process, taking place throughout the data collection process. The researcher thinks about and reflects upon the emerging themes, adapt- ing and changing the methods if required. For example, a researcher might conduct three interviews using an inter- view schedule she has developed beforehand. However, during the three interviews she finds that the participants are raising issues that she has not thought about pre- viously. So she refines her interview schedule to include these issues for the next few interviews.

Ambulation aids fall at the low-tech anxiety 4 hereford order 150 mg bupron sr mastercard, higher-functioning end of the mobility device continuum anxiety 6 weeks after quitting smoking cheap bupron sr 150 mg fast delivery. Stuart Hartman major depression definition psychology generic bupron sr 150 mg, 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. But I say to people, “Look, you would walk much better, much farther, more comfort- ably, and you’d walk more places because you’d feel supported and steadier on your feet. They go farther because they’re not as exhausted, they’re not huffing and puffing. Canes augment muscle action and provide stability, especially for people with neurologic conditions. For balance, a sin- gle finger lightly touching fixed objects, like walls, actually improves stabil- ity better than canes (Maeda et al. People often “furniture surf” at home, placing objects strategically to balance themselves, but in open spaces have nothing fixed to grab. Canes can convey tactile information and en- hance balance, as fingers touching walls do (Jeka 1997; Maeda et al. Unfortunately, most people get little instruction in proper use of canes (Kuan, Tsou, and Su 1999), although, as Dr. Hartman notes, “somebody with a balance disturbance should use a cane differently from someone with a bad hip or knee who uses it for weight-bearing. Up to 70 percent of canes are the wrong length, faulty, or damaged (Joyce and Kirby 1991; Kumar, Roe, and Scremin 1995; Alexander 1996). Ambulation Aids / 185 Although canes are the least sophisticated ambulation aid, several vari- ants are available, differing at their handles and bases. Canes come with crook tops, spade tops, and straight tops; they can have a single rubber-capped tip or three or four short legs attached to little platforms at their base. Func- tional differences among these variants are unclear, and studies are limited and contradictory. Depend- ing on users’ upper-body strength, underarm crutches can bear up to 100 percent of their weight, while forearm crutches (i. Cuffs free the hands of forearm crutch users for ac- tions like opening doors. Various styles of crutches offer different benefits for people with weakness in specific arm muscles (Ragnarsson 1998). Again, choosing the most suitable crutch depends on individual circumstances. Walkers provide additional stability for people with poor balance and lower-extremity weakness and come in many styles, from standard rigid models without wheels to collapsible wheeled walkers, with handbrakes, seats, and baskets. As with canes, walkers must be the proper height, and training is essential. Wheeled walkers are dangerous if they roll forward un- expectedly, but they are easy to propel on smooth surfaces (Joyce and Kirby 1991), demand less energy (Foley et al. Rigid walkers appear institutional, symbolizing serious debility—anathema to many people. Colorful rolling walkers with baskets and seats, in contrast, are practical (e. Hartman’s patients generally appreciate their ambulation aids—after all, they still walk. But the decision to try one is often complicated and reflects a conscious trade-off, balancing recognition of practical realities against the symbolism of debility. Interviewees’ prag- matic reasons to use ambulation aids fall into five categories: • to assist postoperative recovery after joint, back, or other lower-extremity surgery • to minimize pain by giving mechanical support 186 mbulation Aids • to compensate for neurologic problems, such as weakness or imbalance • to assuage personal fears, such as fear of falling • to convey something to the outside world, such as alerting strangers to stay clear But almost no one welcomes ambulation aids with open arms.

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