By C. Esiel. Bluffton University. 2018.

Through careful thought you should stop yourself wasting time and energy on inappropriate methods as your research progresses purchase rosuvastatin 5mg with amex. Consider the follow- ing example: EXAMPLE 1: JAMES James wanted to find out about students’ experiences of housing in his university town cheap rosuvastatin 5mg online. When the replies started to come in generic rosuvastatin 5 mg without a prescription, he realised that the questionnaires weren’t generating the type of information in which he was interested generic rosuvastatin 5mg line. When he talked through his concerns 4 / PRACTICAL RESEARCH METHODS with his tutor, it emerged that James was really inter- ested in attitudes towards, and experiences of, rented accommodation. His questionnaire had been poorly de- signed and was not generating this type of information. He had to scrap the questionnaire and construct an- other which he combined with a number of one-to- one interviews to get more in-depth information. He had spent three months designing and administering a questionnaire which had not produced the type of infor- mation he required. If he had spent more time thinking about the research, especially coming to terms with the difference between qualitative and quantitative research, he would have saved himself a lot of time and energy (see Chapter 2). THE FIVE ‘WS’ When you start to think about your research project, a useful way of remembering the important questions to ask is to think of the five ‘Ws’: X What? Once you have thought about these five ‘Ws’ you can move on to think about how you are going to collect your data. One of the hardest parts in the early stages is to be able to define your project, so much research fails because the researcher has been un- able to do this. If you are unable to do this, the chances are your research topic is too broad, ill thought out or too obscure. Okay, you might have been told to do some research by your tutor or by your boss, but there should be another reason why you have chosen your particular subject. It might be solely to do with the fact that you are interested in the topic. This is a good start as you need to be inter- ested in your research if you are to keep up your enthu- siasm and remain motivated. Or you might have identified a gap in the research literature – this is good as it shows you have carried out careful background re- search. Or perhaps you want to try to obtain funding for a particular service or enterprise and you need to do some research first to find out if there is demand for what you are proposing. Whatever your reason, think very carefully about why you are doing the research as this will affect your topic, the way you conduct the research and the way in which you report the results. If you’re doing it for a university dis- sertation or project, does your proposed research provide the opportunity to reach the required intellectual stan- 6 / PRACTICAL RESEARCH METHODS dard? Will your research generate enough material to write a dissertation of the required length? Or will your research generate too much data that would be impossible to summarise into a report of the required length? If you’re conducting research for funding purposes, have you found out whether your proposed funding body re- quires the information to be presented in a specific for- mat? If so, you need to plan your research in a way which will meet that format. However, you should think about the type of people with whom you will need to get in touch with and whether it will be possible for you to contact them. If you have to conduct your research within a par- ticular time scale, there’s little point choosing a topic which would include people who are difficult or expensive to contact. Also, bear in mind that the Internet now pro- vides opportunities for contacting people cheaply, espe- cially if you’re a student with free internet access. Thinking about this question in geographical terms will help you to narrow down your research topic. Also, you need to think about the resources in terms of budget and time that are HOW TO DEFINE YOUR PROJECT / 7 available to you. If you’re a student who will not receive travel expenses or any other out of pocket expenses, choose a location close to home, college or university. If you’re a member of a community group on a limited bud- get, only work in areas within walking distance which will cut down on travel expenses. Also, you need to think about where you’ll be carrying out your research in terms of venue.

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A promising direction for treatment is DBS buy 5mg rosuvastatin otc, where electrodes are placed in specific nuclei in the extrapyramidal motor circuit including the globus pallidus and subthalamic nucleus rosuvastatin 10mg discount. While some initial reports of improvement in dystonia are favorable cheap 20 mg rosuvastatin visa, there are concerns about mechanical pro- blems including electrode movement and breaks rosuvastatin 5 mg sale. To date, DBS has been infrequently employed in children with hyperkinetic movement disorders. Children with extrapyramidal cerebral palsy are more likely than those with severe spasticity to have normal intelligence. However, this group may have difficul- ties with dysarthria or inability to speak. In this situation, assistive technology is an important component of therapy. Sophisticated devices can be designed to give children control of their environment from communication to mobility. Referral to specialized centers or teams is recommended to provide the optimum equipment, given the rapid advances in this area. MEDICATION MANAGEMENT While the possible range of side effects to oral medications is beyond the scope of this chapter, several generalizations can be made. Some medications have recogniz- able side effects, such as sedation from diazepam and seizures from acute baclofen withdrawal. Others become evident with repeated use, such as personality changes with trihexyphenidyl. As many of the medications used have not been thoroughly studied in childhood, clinicians should listen carefully to parental=caregiver concerns about any changes in their children after medication initiation. Parents=caregivers will continue to administer medications if they see positive benefits, which should be an important determinant in clinician decision making with regard to use and dosing. A helpful additional aid is to keep community therapists masked as to onset and dosing of medications, utilizing their opinions as to changes in motor function with medication use=adjustments. ASSOCIATED PROBLEMS While this chapter is primarily directed toward medical management, it is important to recognize that affected children and their families may have a wide range of med- ical, financial, psychosocial, educational, and vocational needs, which may change over time. The identification of a person who can coordinate various aspects of care is of great benefit in overall management. Furthermore, housing accessibility is critical for those children with more severe forms of cerebral palsy, both to optimize independence of the affected child, as well as to limit other impairments such as herniated disks from repeated lifting by caregivers. A practical recommendation is to find a dwelling on one floor, such as a ranch-style home. COMPLEMENTARY ALTERNATIVE MEDICINE (CAM) Families may use complementary alternative medicine, including acupuncture, cra- niosacral therapy, myofascial release, therapeutic taping, diet and herbal remedies, 22 Puscavage and Hoon electrical stimulation, constraint-induced training, chiropractic treatments, massage and hyperbaric oxygen. While there are individual reports of improvements with various alternative therapies, some carry substantial risks. Furthermore, rigorous studies have not been conducted to assess efficacy. Prior to utilizing these therapies, cost, efficacy, and potential side effects should be carefully considered. CONCLUSIONS Despite the wide range of available interventions with demonstrated benefits in individual children, there is currently no clear consensus regarding the nature of optimal therapy(ies), as well as timing and duration of specific interventions (8–11). Further advances in treatment will require controlled trials, matched on etio- logical antecedents and using reliable, valid quantitative measurement systems to assess effectiveness. Singer and Kossoff, the authors acknowledge the thoughtful comments of numerous Kennedy Krieger Institute physicians, clinicians, and thera- pists, including Drs. Michael Johnston, Charles Silberstein, Frank Pidcock, Bruce Shapiro, Eric Levey, and Elaine Stashinko; Ms. This WE MOVE web site offers informa- tion and support for healthcare professionals and others whose lives are affected by pediatric movement disorders. United cerebral palsy (UCP) is the leading source of information on cerebral palsy and is a pivotal advocate for the rights of persons with any disability. As one of the largest health charities in America, UCP’s mission is to advance the independence, productivity, and full citizenship of people with cerebral palsy and other disabilities. The Children’s Hemiplegia and Stroke Association, a non profit organization, offering support and information to families of infants, children, and young adults who have hemiplegia, hemiparesis, hemiple- gic cerebral palsy, childhood stroke, infant stroke, or in utero stroke.

Reliability is sensitive to the length of the test 20mg rosuvastatin for sale, the station or item discrimination purchase rosuvastatin 5mg mastercard, and the heterogeneity of the cohort of candidates 20 mg rosuvastatin mastercard. Standardised patients’ portrayals order rosuvastatin 20mg with mastercard, patients’ behaviour, examiners’ behaviour, and administrative variables also affect reliability. Questions to ensure validity The validity of a test is a measure of the degree to which the test actually measures what it is supposed to measure. Validity is x Are the patient problems relevant and important to the curriculum? The most basic evidence of validity comes x Have content experts (generalists and specialists) reviewed the from documenting the links between the content of the stations? The validity of a standard depends on the judges’ qualifications and the Judges (n≥12) must first imagine the minimally competent or borderline trainee reasonableness of the procedure they use to set it. When pass-fail decisions are being made, a skill based assessment should be “criterion referenced” (that is, trainees should be For each item in each checklist, judges record what they believe assessed relative to performance standards rather than to each the chances are that their imaginary trainee will be successful other or to a reference group). Although the use of OSCEs for skill based assessment is increasingly widespread, modifying more For each item in each checklist, traditional formats may be appropriate when they are judges revise (or not) their initial predictions combined with other forms of assessment or are used to screen trainees. The success of any skill based assessment depends on finding a suitable balance between validity and reliability and Item score = average of revised judgements Station pass mark = average of the item scores between the ideal and the practical. OSCE pass mark = average of the station pass marks Further reading A modified Angoff procedure for an OSCE x Gorter S, Rethans JJ, Scherpbier A, van der Heijde D, Houben H, van der Linden S, et al. Developing case-specific checklists for standardized-patient-based assessments in internal medicine: a review of the literature. The second picture and the picture showing an oral examination are from OSCE checklists do not capture increasing levels of expertise. A comparison of standard-setting procedures for an OSCE in undergraduate medical education. Guidelines for estimating the real cost of an objective structured clinical examination. At the lowest level of the pyramid This article explains what is meant by work based assessment and presents a is knowledge (knows), followed by competence (knows how), classification scheme for current methods performance (shows how), and action (does). In this framework, Miller distinguished between “action” and the lower levels. Work based methods of assessment target this highest level of the pyramid and collect information about doctors’ performance in their normal Does practice. Other common methods of assessment, such as multiple choice questions, simulation tests, and objective Shows how structured clinical examinations (OSCEs) target the lower levels of the pyramid. Underlying this distinction is the sensible but Knows how still unproved assumption that assessments of actual practice are a much better reflection of routine performance than Knows assessments done under test conditions. Miller’s pyramid for assessing clinical competence Methods Although the focus of this article is on practising doctors, work based assessment methods apply to medical students and trainees as well. These methods can be classified in many ways, Methods of collecting data but this article classifies them in two dimensions. The first Clinical records dimension describes the basis for making judgments about the quality of performance. The second dimension is concerned Basis for judgment with how data are collected. Administrative data • Outcomes of care • Process of care Basis for judgment • Practice volume Diaries Outcomes In judgments about the outcomes of their patients, the quality Observation of a cardiologist, for example, might be judged by the mortality of his or her patients within 30 days of acute myocardial infarction. Historically, outcomes have been limited to mortality Classification for work based assessment methods and morbidity, but in recent years the number of clinical end points has been expanded. Patients’ satisfaction, functional status, cost effectiveness, and intermediate outcomes—for Three aspects of doctors’ performance example, HbA1c and lipid concentrations for diabetic can be assessed—patients’ outcomes, patients—have gained acceptance. For the public, outcomes assessment is a measure of accountability that provides reassurance that the doctor is performing well in practice. For individual patients, it supplies a basis for deciding which doctor to see.

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Suitably modified cheap 10 mg rosuvastatin free shipping, it is used today as a standard He was its surgeon-in-chief for 17 years cheap rosuvastatin 10 mg without prescription, respon- procedure cheap rosuvastatin 5mg with visa. Painful feet and lame backs were two sible for the professional care of its children buy rosuvastatin 5 mg on-line, most clinical problems that challenged his resourceful of whom were suffering from skeletal tuberculo- mind and to which he brought new insight. Ober’s originality of concept and care in mornings, at the Home, members of the staff and execution of his newly devised surgical proce- many regular visitors were encouraged to discuss dures gained them early acceptance even by his freely the problems of each patient. All those professional rivals in a day when clinical rivalry attending rounds quickly developed an apprecia- was intense and sometimes bitter. Under his The residents and younger associates whom he conscientious supervision, the Peabody Home trained adopted and championed his techniques. For the last 14 years of his life he was a Although his clinical work was his vocation, member of the Peabody Home Board of Trustees. He enjoyed teaching His active private practice continued until his and was an effective teacher. It could be said of him that the reward for writing and was the man who made the second work well done was the ability to do more work. He was working on the third lished by his Yankee dislike of sham and by his edition at the time of his death. O’Connor organized and directed many teaching courses on the subject of arthroscopy, the attendance at which was always capacity. He found time to write several papers, a monograph, and two books on arthroscopy. He demonstrated unusual courage, particularly during the difficult terminal period of his illness, and never gave up hope. O’Connor, a pioneer in the devel- opment of arthroscopic surgery, died on Novem- ber 29, 1980, in Bandon, Oregon, where he spent his last days, following a fight against cancer of the lung. O’CONNOR 1933–1980 Born in Chicago, Illinois, and educated at De Pauw University, Indiana, and Northwestern Medical School, Illinois, Dr. O’Connor began his medical career as a general practitioner in Telluride, Colorado. Later, returning to Louisville, Kentucky, he completed his orthope- dic training in 1968 under the supervision of Pro- fessor James Harkess, and settled in West Covina, California. O’Connor traveled to Tokyo, Japan, where he studied the arthroscopic techniques of Dr. Masaki Watanabe, and returned to the United States with a Watanabe arthroscope. Perceiving quickly the great potential of this instrument, he became its prime advocate in southern California. Overcoming the natural Hiram Winnett ORR resistance to new techniques, he persisted in his attempts to teach other orthopedists its value as a 1877–1956 diagnostic tool as well as its potential for intra- articular surgery. In the process he helped to Hiram Winnett Orr (the Hiram was replaced by develop the first operating arthroscope and the enigmatic initial H as soon as he learned to became the first to employ the instrument in sign his name) was born in West Newton, PA, meniscal surgery. After graduating est in intra-articular photography, including from the local high school at the age of 15 years, movies, 35-millimeter slides, and videotapes. In Lincoln, 249 Who’s Who in Orthopedics he lived with his maternal uncle, Dr. It remains, however, a viable option Winnett, a busy general practitioner. He gave his collection of more than 2,600 general practitioner, and in 1904 went to Chicago items to the American College of Surgeons, and where he fell under the spell of Dr. John Ridlon, it is now on permanent loan to the University of the Professor of Orthopedic Surgery at North- Nebraska College of Medicine. After spending a summer in tion of books on Anne of Brittany and her era was Chicago working with Dr. Ridlon, Orr returned given to the Love Library at the University of to Lincoln filled with enthusiasm for his new Nebraska. Orr had extensive experience as an editor, He then joined a group of individuals already including a short stint as editor of the progenitor lobbying for a crippled children’s hospital. In of The Journal of Bone and Joint Surgery, and as 1905 the legislature provided funds to open the an author of numerous papers and several books.

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Many such efforts have achieved little more than increasing complexity and confusion for students discount 20 mg rosuvastatin with mastercard. However cheap 5mg rosuvastatin with amex, the extended matching question (EMQ) is becoming increasingly popular order 5 mg rosuvastatin amex. The main technical advantage is the reduced impact of cueing by increasing the number of distractors best rosuvastatin 5mg. Other advantages include ease of construction and flexibility as they work equally well for basic science as for clinical areas. However, they are particularly well suited for testing diagnostic and management skills. The EMQ is typically made up of four parts: a theme of related concepts; a list of options; a lead-in statement to direct students; and two or more item sterns. The item shown includes two stems that illustrate how this EMQ might test at different levels. The first stem requires problem solving in order to determine a diagnosis; the second stem tests only recall. More stems could, of course, be added to this example to increase the content coverage of the test item and the range of levels tested. In some respects, EMQs share similarities with the context- dependent MCQ we described earlier. It is not enough simply to select 100 questions from the item bank or from among those recently prepared by your colleagues. The selection must be done with great care and must be based on the objectives of the course. A blueprint, or table of test specifications, should be prepared which identifies the key topics of the course which must be tested. The number of questions to be allocated to each topic should then be determined according to its relative importance. Sort out the items into the topics and select those which cover as many areas within the topic as possible. It is advisable to have a small working group at this stage to check the quality of the questions and to avoid your personal bias in the selection process. You may find that there are some topics for which there is an inadequate number or variety of questions. You should then commission the writing of additional items from 146 appropriate colleagues or, if time is short, your committee may have to undertake this task. This process of blue- printing will establish the content validity of the test. It is less confusing to students if the items for each topic are kept together. Check to see that the correct answers are randomly distributed throughout the paper and if not, reorder accordingly. Organise for the paper to be word- processed, with suitable instructions about the format required and the need for security. At the same time make sure that the ‘Instructions to Students’ section at the beginning of the paper is clear and accurate. Check and recheck the copy as errors are almost invariably discovered during the examination, a cause of much consternation. Finally, have the paper printed and arrange for secure storage until the time of the examination. Scoring and analysing an objective test The main advantage of the objective type tests is the rapidity with which scoring can be done. This requires some attention to the manner in which the students are to answer the questions. It is usually inappropriate to have the students mark their answers on the paper itself. When large numbers are involved a separate structured sheet should be used.

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