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If you are consistently going over time purchase 20mg levitra professional with amex, you need to identify ways of speeding up: 190 WRITING SKILLS IN PRACTICE ° Can you be more concise in the way that you express yourself? Work towards analysing the title discount 20 mg levitra professional fast delivery, drafting a plan and writing an answer within the set time period. In the exam Read the paper Take time to read through the questions on your paper at the start of the exam. Failure to comply with these directions is likely to lead to a reduced grade or a fail. For example, a fellow student failed an exam when he an swered all five questions from the paper. He had less time to answer each question and lost the chance to choose the best ones for him. An examiner in this situation will only mark the first three questions on the student’s paper. Write a plan Always make a rough plan on how you will answer the question. In fact a good plan will save you time and will make sure that you: ° understand what the question is asking ° plan your time effectively ° remember to include all the key points ° have a clear structure ° save on thinking time later, allowing you to just write your answer. Demonstrate your knowledge Writing coursework will have helped prepare you for answering essay questions in an exam. You will still be expected to demonstrate to the examiner the extent of your reading about the subject matter. This will partly be apparent from the range of views and theories you are able to discuss. It will also be demonstrated by your reference to other sources in your answer. You are not usually expected to give a reference list at the end of your answer. Write clearly Exams are handwritten and as students are under pressure to complete the answers as quickly as possible, legibility often suffers. Although you should not slow yourself down by trying to write as neatly as possible, it is still important that the marker can decipher your scribbles. Someone marking around 200 papers will not want to spend ten minutes trying to work out individ ual letters and words. Illegible work is likely to be unmarked, meaning you will lose precious points. Astute editing will also help improve the quality and accuracy of your work. Emergency solutions Sometimes plans go astray and you will need to take emergency action: ° Running out of time – jot down, in note form, the points that would have completed your essay. Indicate you know that the information is from another source by using a general reference like ‘researchers have found’. For example, if you have forgotten the side effects of a drug, describe how you would find them out. Summary Points ° Summative assessments are set at the end of a study unit, term or academic year. It is distinguished from other essays submitted as coursework by its length and detailed treatment of its subject. Each student will make their own choice of topic, unlike set essays where all the students answer the same question. The content of the dissertation will represent the student’s independent study of the subject matter, and will extend beyond the theory and practical applications for merly taught on the course. Writing a dissertation provides the student with an opportunity to: ° study in depth one particular aspect of a subject ° learn the process of academic enquiry ° develop his or her thinking about a specific subject ° deal with a large amount of information ° be able to express ideas coherently ° sustain a discourse throughout a lengthy composition. Choosing a title Unlike set essays, where the question is chosen by the examiner, the stu dent decides on the title for his or her dissertation. Although this is often the most challenging part of the task, it is important to get it right as it will shape both the structure and content of the essay. For instance, some courses con tain advanced study units that involve the completion of a dissertation – so if you are studying ethics, your dissertation will be about some aspect of this. If you have more scope in choosing your topic, you may find Chapter 14 ‘Developing an Idea’ useful. You will have to spend an enormous amount of time and effort in preparing your dissertation. By the completion of your project you may be less than en thusiastic about the work, so start with something that really excites you or has some personal significance for you. This will range from access to the appropriate journals and texts to a tutor who can offer you the appropriate supervision in developing your work. Refining the topic Once you have a general idea of your subject matter, you can start to work at determining the focus of your enquiry. Use a brainstorm (see Chapter 5 ‘Letters and Reports’) or a mind map (see Chapter 11 ‘Assessment’) to gen erate ideas about different aspects of the topic. For example a brainstorm of ‘cross-infection’ might produce the keywords Staphylococcus aureus, antibi otics, wound infections, treatment, infection control measures and methicillin resistant Staphylococcus aureus (MRSA). Once you have narrowed your search to a few keywords, you can start to think about the perspective you will take. Use question stems (Polit and Hungler 1995) to help define your enquiry. For example; ‘Infection control measures have reduced the incidence of MRSA. Questioning the 196 WRITING SKILLS IN PRACTICE proposition in this way prompts you to start examining relationships.
The values that underlie the curriculum should enhance health service provision cheap levitra professional 20 mg on line. The curriculum must be responsive to changing values and expectations in education if it is to remain useful buy levitra professional 20mg on line. Students Elements of a curriculum If curriculum is defined more broadly than syllabus or course of Education improves study then it needs to contain more than mere statements of clinical service content to be studied. A curriculum has at least four important Curriculum Health services communities elements: content; teaching and learning strategies; assessment Clinical service processes; and evaluation processes. Curriculum writers have tried to place some order or rationality on the “Symbiosis” necessary for a curriculum. From Bligh J et al (see “Further process of designing a curriculum by advocating models. A consideration of these models assists in Curriculum models understanding two additional key elements in curriculum Prescriptive models design: statements of intent and context. One of the more well known examples is the “objectives model,” which arose from the initial work of Ralph Tyler in 1949. According to this model, four important questions are used in curriculum design. The first question, about the “purposes” to be obtained, is Objectives model—four important questions* the most important one. The statements of purpose have x What educational purposes should the institution seek to attain? This was interpreted very narrowly by some people and led to the specification of verbs that are acceptable and *Based on Tyler R. Chicago: Chicago University Press, 1949 those that are unacceptable when writing the so called 5 ABC of Learning and Teaching in Medicine “behavioural objectives. A more serious criticism is that the model restricts the x To solve x To fully appreciate curriculum to a narrow range of student skills and knowledge x To construct x To grasp the significance of that can be readily expressed in behavioural terms. Higher order x To list x To enjoy x To compare x To believe thinking, problem solving, 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. 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. A map for students will place them at the centre and will have a different focus from a map prepared for teachers, administrators, or accrediting authorities. They all have The situational model, which emphasises the importance of situation or context in curriculum design a common purpose, however, in showing the scope, complexity, and cohesion of the curriculum.
However generic 20mg levitra professional otc, the present study indicated that most hips with stage 3B progressed during the follow-up period order levitra professional 20mg free shipping. The present study indicated that patients with larger lesions, preoperative collapse, and a history of high-dose steroids had poor results. Conclusion The current results show that vascularized ﬁbular grafting is a good procedure for the precollapse stages and a valuable alternative for patients with stage 3A. Dorr LD, Luckett M, Conaty JP (1990) Total hip arthroplasties in patients younger than 45 years: a nine- to ten-year follow-up study. Barrack RL, Mulroy RD Jr, Harris WH (1992) Improved cementing technique and femoral component loosening in young patients with hip arthroplasties: a 12-year radiographic review. Kobayashi S, Eftekhar NS, Terayama K, et al (1997) Comparative study of total hip arthroplasty between younger and older patients. Bozic KJ, Zurakowski D, Thornhill T (1999) Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head. Mont MA, Fairbank AC, Krackow KA, et al (1996) Corrective osteotomy for osteone- crosis of the femoral head. Sugioka Y, Hotokebuchi T, Tsutsui H (1992) Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Buckley PD, Gearen PF, Petty RW (1991) Structural bone-grafting for early atraumatic avascular necrosis of the femoral head. Hori Y, Tamai S, Okuda H, et al (1979) Blood vessel transplantation to bone. Yoo MC, Chung DW, Hahn CS (1992) Free vascularized ﬁbula grafting for the treat- ment of osteonecrosis of the femoral head. Sugano N, Atsumi T, Ohzono K, et al (2002) The 2001 revised criteria for diagnosis, classiﬁcation, and staging of idiopathic osteonecrosis of the femoral head. Ohzono K, Saito M, Takaoka K, et al (1991) Natural history of nontraumatic avascular necrosis of the femoral head. Urbaniak JR, Coogan PG, Gunneson EB, et al (1995) Treatment of osteonecrosis of the femoral head with free vascularized ﬁbular grafting. Takakura Y, Yajima H, Tanaka Y, et al (2000) Treatment of extrinsic ﬂexion deformity of the toes associated with previous removal of a vascularized ﬁbular graft. Marcus ND, Enneking WF, Massam RA (1973) The silent hip in idiopathic aseptic necrosis. Sotereanos DG, Plakseychuk AY, Rubash HE (1997) Free vascularized ﬁbula grafting for the treatment of osteonecrosis of the femoral head. Magnussen RA, Guilak F, Vail TP (2005) Articular cartilage degeneration in post- collapse osteonecrosis of the femoral head. Berend KR, Gunneson EE, Urbaniak JR (2003) Free vascularized ﬁbular grafting for the treatment of postcollapse osteonecrosis of the femoral head. J Bone Joint Surg [Am] 85:987–993 Treatment of Large Osteonecrotic Lesions of the Femoral Head: Comparison of Vascularized Fibular Grafts with Nonvascularized Fibular Grafts Shin-Yoon Kim Summary. To date, it has been recognized that large osteonecrotic lesions of the femoral head are the most difﬁcult to treat effectively, regardless of the technique used. We compared vascular ﬁbular grafting (VFG) with nonvascular ﬁbular grafting (NVFG) in 19 patients (23 hips: 10 stage IIc hips, 2 stage IIIc hips, and 11 stage IVc hips) matched on the basis of stage, extent of lesions, etiology of the lesions, average age, and preoperative Harris hip score (HHS). The mean duration of follow-up was 4 years (minimum, 3 years; range, 3–5 years). Mean HHS of the stage IIc and IVc hips was signiﬁcantly better in the VFG group. The rate of radiographic signs of progres- sion and mean dome depression in all hips was signiﬁcantly less in the VFG group. The conversion rate to total hip replacement (THR) in the VFG group was 13%; in the NVFG group, it was 24%. The Kaplan–Meier survivorship analysis revealed a 3- year survival rate of 91. Osteonecrosis, Femoral head, Comparison, Vascularized ﬁbular grafting, Nonvascularized ﬁbular grafting Introduction Osteonecrosis (ON) of the bone is a disease in which cell death in components of bone occurs as a result of an interrupted blood supply, probably because of restricted per- fusion. Extravascular pressure and sub- sequent tamponade of the arterial vessels or intravascular thrombosis has been involved. Untreated osteonecrosis of the femoral head (ONFH) generally results in a progressive course of subchondral fracture, collapse, and painful disabling arthrosis. The ultimate goal of treatment is to preserve the femoral head because this condition occurs primarily in young adults. The development of successful strate- gies in treating this disease, however, has been difﬁcult because ON is associated with numerous diseases and neither its etiology nor its natural history has been delineated Department of Orthopedic Surgery, Kyungpook National University Hospital, Samduck 2-ga, 50 Jung-gu, Daegu 700-721, Korea 105 106 S. Therefore, the management of ON is primarily palliative, which does not necessarily halt or retard the progression of the disease. Classification and Staging System Several methods have been proposed for staging and classiﬁcation that will assist in the following: help clinicians establish a prognosis; track improvement or progres- sion; compare the effectiveness of different methods of treatment; and determine the best method of management for patients with different stages of osteonecrosis. The University of Pennsylvania staging system (Steinberg system) was the ﬁrst to use magnetic resonance imaging (MRI) as a speciﬁc modality for determining stage; in addition, it was the ﬁrst to include measurement of lesions and surface involvement as an integral part of the system. Mild lesions are characterized as having less than 15% of head involvement or/and depression of less than 2mm; moderate lesions have a 15%–30% head involvement and/or 2–4mm depression; and severe lesions have more than 30% of head involvement and/or a depression of more than 4mm. Koo and Kim used similar angular measurements taken from the midcoronal and midsagittal images as the index of necrosis. The Japanese Investigation Committee (JIC) subdivided only Ficat and Alert classiﬁcation stages II and III according to the type and location of the lesion, as seen on anteroposterior radiographs (types 1A, 1B, 1C, 2, 3A, and 3B). Recently, they revised the classiﬁcation criteria based on the central coronal section of the femoral head on T1-weighted images or anteroposterior radiographs (types A, B, C1, C2). ARCO (Association for Research in Bone Circulation) designed a uniform staging and classiﬁcation system that combined the University of Pennsyl- vania staging system and the JIC classiﬁcation system.
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