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By Q. Arokkh. Tougaloo College. 2018.

ESSAYS 173 Use your outline to help in organising the information you collect through reading generic 200mg floxin overnight delivery antibiotic resistance of streptococcus pyogenes, seminars and lectures generic 400 mg floxin amex ebv past infection, for example filing notes under confidenti­ ality, use of information, Data Protection Act (1998) and so on. This will help when you start to write your essay as all the information for each sec­ tion will already be collated. You will find that your outline will change as you find out more about the subject and develop your ideas. Try out different outlines until you find the best structure for your essay. Start at an early stage to think about the allocation of words within your essay. Some sections might need to be longer as the points are more important or relate to a broader issue. Planning in this way will keep you on track and help you balance out the essay content. Remember that without a clear plan your essay is likely to: ° lack structure ° contain irrelevant material ° omit important facts ° have an imbalance in the content ° fall short of or exceed the word limit. Once the title has been analysed and the outline drawn up you will have important clues about: ° what topics to research ° what type of information: ° knowledge ° skills ° statistics ° principles ° policies ° legislation ° clinical guidelines ° clinical experience ° clinical roles and responsibilities 174 WRITING SKILLS IN PRACTICE ° what information is relevant to the essay ° how to structure the essay ° how to present the information. Research Always take time to constantly refer back to your analysis of the title and your outline when researching your essay. See Chapter 7 ‘Writing As an Aid to Learning’ for more information on how to search for information. The introduction All essays need some form of introduction to set the scene for the reader. It will briefly state: ° what you are about to tell the reader ° why you are going to tell this to the reader ° how you will tell it. In other words, the introduction lets your reader know the (a) content, (b) rationale and (c) structure of your essay. They will then have a framework that will help them to organise and make sense of the information as they read through the rest of the essay. By being able to select the important details, you will also show the examiner that you have understood the question. Some topics may necessitate a brief overview of the background or history of the subject in order to place your discussion in context. Remem­ ber to keep this to a short summary that contains only the essential points, otherwise you may get sidetracked into giving an overlong account of something that is minor to your overall argument. This will result in an ESSAYS 175 unbalanced account and may mean you are unable to cover the relevant material in enough detail. This will help set the tone of your essay by indicating that you have thoroughly researched your topic. However, do not be tempted to write a paragraph that merely contains a series of quotes. The examiner will want to read your thoughts and opin­ ions on the subject. For instance, you may need to describe x in order to understand how y relates to z. They will then understand when you start with a de­ scription of x before discussing the relationship between y and z. The introduction forms approximately 12 per cent of your essay – so in a 2000 word composition you would plan to have an introduction of about 250 words. Pitfalls to avoid: ° Writing an overlong introduction so that the essay becomes unbalanced. This is very boring for the marker and not the best way to impress him or her! The main section The main or middle part will come after your introduction and will form the bulk of your essay. It is here that you will demonstrate to the marker your knowledge and understanding of the subject matter. Structure There are different ways to organise the information in your essay.

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Established medicine came late to rehabilitation (Berkowitz and Fox 1989 cheap 400mg floxin fast delivery antimicrobial agents and chemotherapy, 146) buy floxin 400mg with amex bacteria growth temperature. Treating wounded World War I soldiers gave orthopedics credibility and catalyzed initial medical rehabili- tation efforts—designing prosthetics and orthotics to improve mobility of injured veterans. Between world wars, improving function for polio sur- vivors gained attention, although the greatest advances involved non- physicians in Warm Springs, Georgia: Franklin Delano Roosevelt and the physical therapist Helena Mahoney. In the mid 1920s Roosevelt requested endorsement from the American Orthopedic Association (AOA), but the AOA refused to allow Roosevelt even to address their annual convention in Atlanta: “He was told he was a man without standing. Some disability rights ac- tivists argue that rehabilitation specialists further the medicalization of disability, exhorting people to “fit in or cope with ‘normal’ life and expec- tations so that they did not become a burden on the rest of society” (Barnes, Mercer, and Shakespeare 1999, 20). Leading PM&R specialists, however, assert their aims of assisting people to find and fulfill their own “desires and life plans. Patients, their families, and their rehabilitation teams work together to determine realistic goals.... Rehabilitation is a concept that should permeate the entire health-care system” (DeLisa, Cur- rie, and Martin 1998, 3). If patients can’t walk, the physiatrist’s job is to help find alternatives. If what’s causing [the mobility problem] is not easily reversible, then you’ve got to face up to the fact: “I’ve got an irreversible condition here, and I’ve got to compensate for it. So trouble with mobility is a very 162 / Physicians Talking to Their Patients complicated psychological and physical problem. Despite that, early on in my rehabilitation training, we often said that mobility prob- lems were the easiest things to rehabilitate. Fundamentally, the per- son still has their mind, they are a human being with their social re- lationships. It’s this nasty problem with physically moving their body from point A to point B. But at least there are ways to compensate that don’t mean staying immo- bile at home, surfing the Internet, or talking on the phone. Magaziner often wonders what physicians can re- ally do to help people with limited mobility: “I bump up fairly quickly against what feels like the borderline between what’s medical and what’s social. What’s difficult is when you’re done with the medical evalua- tion and you find that this person has rotten social supports, is lucky to have any apartment (never mind the third floor walk-up), and has no fi- nancial resources to make things any better. Magaziner asks a nurse to visit the home, to gather essential information, then feels powerless to af- fect change even at the most basic level. He hits that “borderline between what’s medical and what’s social” and can’t make the leap. Firmly rooted on the medical side, he recognizes that walking difficulties raise complex issues— physical, psychological, social, environmental—that he is poorly equipped to address. Magaziner nonetheless calls on physical or occupational therapists (PTs or OTs). These two health professions have roots not only in medicine but also in social perspectives, including the effect of environmental factors on peo- ple’s daily functioning. Their approach thus “melds two significantly dif- ferent models of health, illness, and medical care. This duality can lead to significant confusion for traditionally trained physicians” (Hoenig 1993, 884). Physicians’ referrals to physical and occupational therapy are often idiosyncratic and highly variable. Despite this, physicians generally control people’s access to physical and occupational therapy. Unless people pay out-of-pocket, health insurers demand physicians’ orders to cover therapy, then typically set strict limits on the amount of therapy covered, regardless of patients’ feelings about its benefits (chapter 13). Today, physical and occupational therapy are vibrant professions, ad- justing—as is medicine—to new financial realities and insights about the causation and course of diseases and physical impairments. Home-based services are expanding rapidly for both professions, prompting concerns about local labor shortages and the certification of lesser-trained aides (Feldman 1997). Most acknowledge that more scientific proof is needed of the effectiveness of physical and occupational therapy, especially to con- vince health insurers to cover these services. Perhaps because of its stronger medical origins and traditions, physical therapy has generated more research, although occupational therapy studies are now appearing.

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In cases of febrile status epilepticus (seizures lasting longer than 30 min) neuroima- ging is usually indicated as part of the evaluation of status epilepticus 200 mg floxin sale antibiotics insomnia. An MRI within a few days of the episode of febrile status epilepticus is being used to identify whether or not hippocampal damage has occurred in the research setting order 400 mg floxin visa virus your computer has been locked, but at the moment there is insufficient data to use the results to guide clinical care. While genetic factors are important, there are no specific tests beyond taking a good family history. The known genetic mutations are mostly in sodium channels and account for less than one percent of cases. While this is a rapidly evolving field, formal genetic testing is not part of the routine clinical evaluation of children who exclusively have febrile seizures at this time. THERAPY The approach to the treatment of febrile seizures has changed over the last few dec- ades. First, the recognition that the vast majority of febrile seizures are benign has occurred. Second, there has been an increasing recognition that chronic therapy with antiepileptic drug (AED) therapy is associated with a variety of cognitive and behavioral side effects. Lastly, we have rea- lized that chronic and intermittent AED therapy, while effective to some degree in preventing recurrent febrile seizures, do not alter the risk of subsequent epilepsy. For this reason, especially in children with simple febrile seizures, reassurance and counseling rather than drugs are the preferred treatment options. In this section, we will first review the available treatment options and then present an approach to the management of the child with both simple and complex febrile seizures (Table 1). Chronic prophylaxis with phenobarbital or valproate will reduce the risk of recurrent febrile seizures. However, it does not reduce the risk of subsequent epilepsy and is associated with significant morbidity and is therefore no longer recommended. Carbamazepine and phenytoin are ineffective in preventing further febrile seizures. There are insufficient data on any of the newer antiepileptic drugs to justify their use in this setting at the present time. Intermittent treatment with benzodiazepines given orally or rectally at time of fever reduces the risk of recurrent febrile seizures. It must be given every time the Table 1 Treatment of the Child with Simple and Complex Febrile Seizures Chronic AEDs (phenobarbital and valproate) Not indicated Diazepam (oral or rectal) at the time of fever Not routine for simple febrile seizures Consider for complex or multiple simple febrile seizures Rectal diazepam at the time of seizure First-line therapy for prolonged febrile seizures Rapid, simple, safe, and effective 76 Shinnar child has an intercurrent illness, which can become an issue given the frequency of febrile illnesses in early childhood. There is also the theoretical concern about seda- tion masking signs of more serious illness such as meningitis. Even when effective, it does not reduce the risk of subsequent epilepsy. Furthermore, children who have a seizure as the first manifestation of their febrile illness are both at higher risk to have another one and least likely to benefit. This treatment does have a limited role in selected cases with frequent recurrences. Data from controlled clinical trials suggest that this treatment is no more effective than placebo in prevent- ing recurrence. While antipyretics are generally benign and may make the child more comfortable, recommendations for their use should recognize their relative lack of efficacy and avoid creating undue anxiety and guilt feelings in the parents. Abortive therapy with rectal diazepam (dose based on weight) at the time of sei- zure does not alter the risk of recurrence but is effective in preventing prolonged feb- rile seizures, which are often the main concern. Children with prolonged febrile sei- zures are good candidates for this form of therapy. Rectal diazepam can also be used in cases with a high risk of recurrence, for families who live far away from medical care and for families where the parents are very anxious. In these cases it avoids the need for chronic or intermittent therapy unless a seizure actually occurs and lasts more than 5 min. In many cases, particularly those with simple febrile seizures, reassurance and education about the benign nature of the condition are all that is needed. The American Academy of Pediatrics 1999 practice parameter recommends no treatment for children with simple febrile seizures. The specific treatment option chosen depends on the goals of therapy and spe- cific features individual to each case. For simple febrile seizures, the American Acad- emy of Pediatrics recommends no treatment except reassurance; a recommendation the author fully agrees with.

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You do not have to be a member of the British Medical Association to use the ser- vice buy 400mg floxin with amex virus removal programs, which is a bonus buy floxin 400mg without a prescription virus file scanner. It also contains sections on medical news, training and an on-line library. At the time of writing this site does not have as many advertisements as the British Medical Journal, but it is growing in popularity and will become more useful as time marches on. Often the recruitment officer will know about impending post availabilities long before they are advertised. Applying for a Post Once you have found a post or posts that tickle your fancy you must apply. There is no limit to the number of posts you may apply for, but you will find that each appli- cation takes a lot of time and energy so you become selective pretty quickly! All advertisements have a reference code, which is different for every job. Most adver- tisements will also list a 24-hour answerphone number or e-mail address. All you have to do is leave your name and address along with the job reference on the answer- phone and the hospital will send you an application pack (application form, occupa- tional health questionnaire, police check form, details about the hospital, trust and the post). Some advertisements instruct the applicant to simply send a number of curricula vitae (CVs) with a covering letter. Over the last few years medical human resources departments have become digitally aware and allow on-line applications where the forms can be downloaded, filled in and e-mailed back. This is the way for- ward, but if you file an application this way then telephone to confirm that your application has been received as e-mail is not infallible! Regardless of what the advertisement specifies, when you send off your applica- tion always send a copy of your CV with a covering letter, which should be typed in a standard business format. If possible speak to the PRHO or SHO who is currently Applying for Pre-registration House Officer Posts 11 doing that job to find out the inside word. It is usually not possible to speak with or meet the consultant organising the interviews until the short-listing is done. You will be among the 15–20 candidates short-listed from several hundred others and should be proud to make it this far. You should spend at least a few days doing a bit of research for the big day. It can be a useful piece of conversation during or at the end of an interview. When asked if you have any questions you can ask about cur- rent research in the department and act interested. These are to test your pattern of thinking rather than your knowledge, so do not be alarmed. Finally, there is one golden rule: never attend an interview for a post which you would not be happy to accept if offered on the day. If you have several interviews on the go it is not unrea- sonable to state this when offered a job. However, you must give a time frame as to when you will give them an answer. However, it should also be a fun and stimulat- ing year as you finally get to put into practice all the things you have learnt at med- ical school. There is nothing quite like your first pay cheque to put a smile on your face and a load on your liver. There will be good and bad times ahead,but I hope the sections in this chapter may make it easier for you to look after your patients and do what is required of you. Do not forget that, if you get into difficulties, there are always others around whom you can ask for help. Prioritising the Working Day This is a topic that newly qualified doctors find particularly difficult. After the often busy and chaotic morning ward round with your consultant or specialist registrar (SpR), how do you know what to do next and in what order.

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