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By I. Diego. Alcorn State University. 2018.

This summarised evidence can be organised using the standards described above purchase levlen 0.15mg birth control 5 days late. There are several reasons why we advocate the prepara- tion and maintenance of a portfolio purchase 0.15 mg levlen with amex birth control for women -. These reasons are: Self-evaluation: the summary you prepare provides an invaluable record of your teaching which assists you to reflect on your teaching over a particular period (say a semester or year) and to make improvements should these be necessary. So it is very wise to have maintained a portfolio for at least the past two or three years. Evidencein cases where your teaching is challenged: in these days of increasing accountability and staff appraisal there may be occasions where the quality of your work is challenged. Documentary evidence maintained by you in your portfolio may prove invaluable in defending your case. Fosteringdiscussion and review of teaching: keeping a portfolio and encouraging others to do so will help to create an environment where discussion of teaching becomes the norm rather than an unusual practice in your department. Do remember that a teaching portfolio is a summary of your major teaching activities and accomplishments; it is an important adjunct to your curriculum vitae (CV). It is not intended that it include all the material listed in Figure 10. Accordingly, you should initially be comprehensive in your collection of information for your portfolio and then summarise the material when it is to be used for some external audience. Creating, assembling and using your portfolio The most important things to remember are to keep evidence of your teaching activities and to file away a copy of relevant materials, letters received, articles published, evaluations conducted, and so on, and that your portfolio is a summary. The evidence is the basis from which your portfolio is constructed and the source from which any statements you make in your portfolio can be verified. It is suggested that your portfolio might end up being between six and twelve pages long. Keep files of back-up material to follow the structure used in the portfolio. Remember, these materials are not part of the portfolio, but are evidence if required. Prepare brief statements of explanation against each of the criteria selected. You should also add your own brief evaluation of the item and the steps you have taken to modify your teaching in light of (say) feedback received. Finally, remember to constantly review your portfolio and keep it up to date. It is surprising how easy it is to forget the diverse teaching activities we undertake and the feedback we receive. Remember too that your portfolio is an important tool for learning about your teaching. Ensuring a trustworthy system of evaluation The final part of the framework for an evaluation system is ensuring that the system in place is ‘trustworthy’. We cannot go into much detail about this here, but the following quotation from Scholarship Assessed summarizes what we have in mind: “. Appropriate methods would be used and significant results would advance the institution and individual towards their goals. The process would be effectively presented and discussed as openly as possible in public forums. Finally, reflective critique would keep evaluation flexible and open to improvement over time. We do not expect that you will be able to change your institution’s policies and practices overnight. But, by talking about the characteristics of good evaluation with the right people, you will have an influence upon bringing about useful improvements for the advancement of learning and teaching. This book also explores evaluating research and service and so comple- ments Scholarship Assessed which is noted below. On portfolios, the most straightforward advice is contained in the original Canadian work on this subject by B. Another useful introduction to portfolios, which also considers their relationship to scholarship, is The Teaching Portfolio: Capturing the Scholarship of Teaching by R.

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This high-fat generic 0.15 mg levlen free shipping birth control pills kidney disease, adequate-protein buy levlen 0.15mg on-line birth control 5 years, low- carbohydrate therapy requires careful calorie and fluid management. The entire family must be invested in the process and we require the family to take classes in its management. Traditionally, children are admitted for a 48-hr fast, followed by gradual introduction of the ketogenic diet as an eggnog preparation. Even children with intractable epilepsy may show significant seizure reduction. In a large retrospec- tive study at our institution, we found greater than 50% seizure reduction in 50% of patients and greater than 90% in 27%. Well-established side effects include constipation, slowed weight gain and growth, hyperlipidemia (reversible), and kidney stones (6%). A current trial of the Atkins diet, a therapy with less protein and calorie restriction that also induces ketosis, is underway as well. Vagus nerve stimulation has emerged over the past decade as another tool for intractable epilepsy. This therapy has been approved by the FDA since 1997, but is not officially approved for use in children under age 12. More than 25,000 patients have been implanted and more than 7000 of these patients were under age 18 at sur- gery. Standard stimulation settings of 30 sec on and 5 min off are initially programmed, but can be adjusted as needed. The vagus nerve stimulator is theorized to stimulate the nucleus solitarius and locus ceruleus, but its effects on the brain and EEG patterns are less clear. Efficacy is typically a 25–40% seizure reduction, similar to most new anticonvulsants. However, side effects are few and limited generally to voice change and hoarseness. In addition, a small magnet that causes an immediate stimulation to occur can be used to try and abort seizures, allowing the child and family a unique form of acute therapy. Reports of behavioral improvement have also been described in the recent literature. Corpus callosotomy can also be performed for intractable nonfocal epilepsy, commonly atonic seizures. Callosotomies have been used since 1940 and are either partial (anterior two-thirds) or complete in two stages. This therapy specifically ben- efits atonic seizures, but is more palliative than curative according to reports, with an approximate 8% seizure-free rate described. In catastrophic cases where a child is in persistent status epilepticus, the use of intravenous solumedrol or immunoglobulin has been described as a potential immunomodulating therapy. There is little scientific evidence for steroids other than in infantile spasms outside of anecdotal reports. Early devel- opment of intractable epilepsy in children: a prospective study. The efficacy of the ketogenic diet-1998: a prospective evaluation of intervention in 150 children. Vining EPG, Freeman JM, Pillas DJ, Uematsu S, Carson BS, Brandt J, Boatman D, Pulsifer MB, Zuckerberg A. The outcome of 58 chil- dren after hemispherectomy—The Johns Hopkins Experience 1968–1996. INTRODUCTION Infantile spasms is an epilepsy syndrome associated with acquired mental retarda- tion that affects infants usually between the third and eighth month of life. It is a generalized seizure disorder characterized by clusters of sudden flexor or extensor jerks. Spasms are often initially misdiagnosed as colic or gastroe- sophageal reflux before they increase in frequency and severity. West syndrome specifically is the triad of infantile spasms, psychomotor regression, and the electroencephalogram (EEG) pattern of hypsarrhythmia. The incidence of infantile spasms is low, but the disorder is not uncommon, with approximately 1 per 3000 births. DIAGNOSIS AND EVALUATION The etiology of infantile spasms warrants careful investigation, with from 50% to 70% of patients having a defined cause (symptomatic), including metabolic condi- tions, perinatal asphyxia, Down syndrome, cerebral infarction, structural malforma- tions, and tuberous sclerosis. Relatively fewer cases are defined as having a cryptogenic (unclear) etiology.

As with any circle of friends levlen 0.15 mg low price birth control for women -,the newcomer finds it dif- ficult to break into the ring and should not be put off if the first few attempts fail cheap 0.15mg levlen with mastercard birth control and blood clots. The first and most important thing to do when you walk into the operating theatre is to 67 68 What They Didn’t Teach You at Medical School introduce yourself to all present. Make sure that the nursing staff know your name and grade,particularly the scrub nurse. You will find that the scrub nurse can be your best ally during a difficult operation and the trust and friendship that develops between you will be invaluable when you are operating alone or when on-call. I have been saved on more than one occasion by the scrub nurse, who has told me which suture type my consultant prefers for wound closure. This has allowed my consultant to gain confidence in me and prevents embarrassing ticking off sessions on the post- operative ward round. When talking to your registrar or consultant in the first few weeks of your post, before you know them well, keep small talk to appropriate breaks in the surgeon’s concentration and the subject professional at first. Learning Anatomy Theatres are the place to improve your knowledge of anatomy, but not to ‘learn’ it. This may sound strange,but I guarantee that you will find it more productive to learn your anatomy at home before entering the operating theatre. When you are assisting you can then see the anatomy you have learnt come to life and appreciate it in three dimensions as well as see variations between individuals. All theatre operation lists must be submitted a day in advance (except emergency lists), so that it is always possible to find out which operations are to be performed the following day. Your seniors will always question you in theatre on your anatomy and it pays to read up the night before. Do this every time and not only will you impress your boss,but you will accel- erate your anatomical and surgical knowledge. If you feel the timing is not appropriate then wait until after the operation and then ask (I often do this – it shows maturity and an under- standing that the surgeon is concentrating). The Operating Theatre 69 Don’ts 1 Engage in conversation during emergencies. Your seniors are not out to get you and there will be a good reason that you may not understand. You are within your rights to ask for an explanation after the operation. This is actually a good way to improve your surgical understanding as long as you take the correct approach. This contaminates theatre floors and means that the nursing staff will have to clean them again. The purpose of a mask is to prevent droplets from your mouth from being projected forward. If you turn your head to sneeze you will fire your germs straight into the wound. The following are the departments commonly dealt with by all house officers: G haematology G biochemistry G microbiology G transfusion G virology G histopathology All junior doctors should have a list of the daytime and on-call telephone numbers of each of these departments which will save hours on the telephone to the switchboard in the middle of the night. Just like any other department there is a hierarchy of seni- ority in these departments and a consultant who works in conjunction with the chief technician usually heads each one. You can imagine that each patient in hospital has on average one blood test a day and perhaps one body fluid examination every three or four days (for example a mid-stream urine or wound swab). If the hospital has 1000 beds you can imagine how busy these departments are. For run of the mill non-urgent investigations there is no need to discuss requests, unless you are contacted by the laboratory. However, if you need to request an unusual or urgent investigation then telephoning the department is not only courteous, but it will ensure that the test is actually performed. This is particularly important outside normal working hours when samples are often only picked up from the drop box (where the porters or vac- uum chutes leave them) if the technician is telephoned in advance. When speaking to departments always ensure that you are talking to the relevant person at the start of the conversation and then explain your request. There is rarely any problem with requests being accepted unless it is the middle of the night where you will be asked 71 72 What They Didn’t Teach You at Medical School for clinical justification.

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