By U. Darmok. Lincoln University of Pennsylvania. 2018.

One of the most effective interventions involved using prompts on a computer when ordering tests or drugs duphaston 10 mg mastercard. These resulted in improved drug-ordering practices and long-term changes in physician behav- ior duphaston 10mg. Less effective were audits of patient care charts and distributed educational materials buy duphaston 10 mg visa. In some cases, these very short presentations actually produced negative results leading to lower use of high quality evidence in physician practices. The construct called Pathman’s Pipeline demonstrating the barriers to uptake of validated evidence was discussed in Chapter 17. Practice guidelines should be developed using a preset process called the evidence- and outcomes-based approach. Separate the main steps of the policy- making process, the outcome and desirability. First estimate the specific out- comes and probability of each one of the proposed interventions. Explicitly estimate the effect of the intervention on all outcomes that are important to patients. Estimate how the outcomes will likely vary with different patient characteristics and based on estimates of outcomes from the highest-quality experimental evidence avail- able. Use formal methods such as systematic reviews or formal critical appraisal of the component studies to analyze the evidence and estimate the outcomes. To accurately understand patient preferences, use actual assessments of patients’ preferences to determine the desirability of the outcomes. Critical appraisal of clinical practice guidelines2 (1) Are the recommendations valid? These must be con- sidered from the perspective of the patient as well as the physician. All rea- sonable physician options should be considered including comments on those options not evidence-based but in common practice. This must be reproducible by anyone reading the paper outlining how the guideline was developed. The different outcomes should be described explicitly and the reasons why each outcome was chosen should be given. The guideline developers must balance the need to have experts create a guideline with the potential conflicts of interest of those experts. It should be tested in various settings to determine if physicians are willing to use it and to ensure that it accomplishes its stated goals. The guidelines should be simple enough and make enough sense for most clinicians to use them. The evidence for the guideline should be explicitly listed and graded using a commonly used grading scheme. The results of the studies should be compelling with large effect sizes to back up the use of the evidence. It should be clear from the presentation of the evidence how uncertainty in the evidence has been handled. The guide- lines ought to meet your needs for improving the care of the patient you are seeing. Patient prefer- ences must be considered after a thorough discussion of all the options. It must be reasonable for any physician to provide the needed follow-up and support for patients who require the recommended health care. Clinical prediction rules Physicians are constantly looking for sets of rules to assist them in the diagnos- tic process. The definition of clinical prediction rules is that they are a decision- making support tool that can help physicians to make a diagnosis. They are derived from original research and incorporate three or more variables into the decision process. Their development is an excellent model for how prediction rules should be created. The main reason for developing this rule was to attempt to decrease the number of ankle x-rays ordered for relatively minor trauma. The rule has been successfully applied in various settings and resulted in decreased use of ankle x-rays. The first step in the development of these rules was to determine the underly- ing processes in making a particular diagnosis and initiating treatment modali- ties. In the case of the Ottawa ankle rules, this involved defining the components of the ankle examination, determining whether physicians could accurately assess them, and attempting to duplicate the results in a variety of settings. In the case of the ankle rules, it was found that only a few physical examination findings could be reliably and reproducibly assessed.

There are numerous ways and methods of cheating and they include:  Copying from others during a test or an examination duphaston 10 mg low cost. Tampering with marks /grades after the work has been returned buy duphaston 10mg otc, then re-submitting them for re-marking/re-grading cheap 10 mg duphaston mastercard. Plagiarism means to produce, present or copy others’ work without authorization and acknowledgment as the primary source in the form of articles, opinions, thesis, books, unpublished works, research data, conference and seminar papers, reports, paper work, website data, lecture notes, design, creative products, scientific products, music, music node, artefacts, computer source codes, ideas, recorded conversations and others materials. In short, it is the use, in part or whole, of others’ words or ideas and then claiming them as yours without proper attribution to the original author. It includes:  Copying and pasting information, graphics or media from the Internet into your work without citing the source. The non-acknowledgment of an invention or findings of an assignment or academic work, alteration, falsification or misleading use of data, information or citation in any academic work constitute fabrication. Some examples of collusion include:  Paying, bribing or allowing someone else to do an assignment, test/examination, project or research for self-interest. Examples of unfair advantage are:  Gaining access to reproduce or circulate test or examination materials prior to its authorised time. If under any circumstances a student comes to know of any incident that denotes a violation of academic integrity, the student must report it to the relevant lecturer. The lecturer is then responsible for investigating and verifying the violation and then reporting the matter to the Dean of the School. If the investigation reveals that a violation has been committed, the student will be referred to the University Student Disciplinary Committee (Academic Cases). This programme manages psychosocial issues in a more effective manner and finally could improve the well-being of individuals in order to achieve life of better quality. Ideally, students are encouraged to participate in the exchange programme within their third to fifth semester (3 year degree programme) and within the third to seventh semester (4 year degree programme). However, as a condition for the conferment of a degree the student gives this right unconditionally, directly but not exclusively, and free of royalties to the university to use the contents of the work/thesis for teaching, research and promotion purposes. In addition, the student gives non-exclusive rights to the University to keep, use, reproduce, display and distribute copies of the original thesis with the rights to publish for future research and the archives. Students from the School of Medical Sciences and School of Dentistry are required to register for two (2) units of Co- Curriculum course in year Two. Students from the School of Health Sciences are required to register for one (1) unit of Co-Curriculum course. Students may obtain advice from the School of Languages, Literacies and Translation if they have different Bahasa Malaysia qualifications from the above. International students in this category are required to take and pass three Intensive Malay Language courses before they commence their Bachelor’s degree programmes. Note: • Students are required to accumulate four (4) units of English for graduation. They can also take foreign language courses to replace their English language units but they must first obtain written consent from the Dean of the School of Languages, Literacies and Translation. With academic exposure to cultural issues and civilization in Malaysia, it is hoped that students will be more aware of issues that can contribute to the cultivation of the culture of respect and harmony among the plural society of Malaysia. Among the topics in this course are Interaction among Various Civilizations, Islamic Civilization, Malay Civilization, Contemporary Challenges faced by the Islamic and Asian Civilizations and Islamic Hadhari Principles. This course is designed with 3 main objectives: (1) to introduce students to the basic concept and the practices of social accord in Malaysia, (2) to reinforce basic understanding of challenges and problems in a multi-ethnic society, and (3) to provide an understanding and awareness in managing the complexity of ethnic relations in Malaysia. At the end of this course, it is hoped that students will be able to identify and apply the skills to issues associated with ethnic relations in Malaysia. The mode of teaching is through interactive lectures, practical, business plan proposals, execution of entrepreneurial projects and report presentations. Practical experiences through hands-on participation of students in business project management will generate interest and provide a clearer picture of the world of entrepreneurship. The main learning outcome is the assimilation of culture and entrepreneurship work ethics in their everyday life. This initiative is made to open the minds and arouse the spirit of entrepreneurship among target groups that possess the potential to become successful entrepreneurs. By exposing entrepreneurial knowledge to all students, it is hoped that it will accelerate the effort to increase the number of middle-class entrepreneurs in the country. Emphasis will be given both to current issues in Malaysian politics and the historical and economic developments and trends of the country. An analysis of the formation and workings of the major institutions of government – parliament, judiciary, bureaucracy, and the electoral and party systems will follow this. The scope and extent of Malaysian democracy will be considered, especially in the light of current changes and developments in Malaysian politics. The second part of the course focuses on specific issues: ethnic relations, national unity and the national ideology; development and political change; federal-state relations; the role of religion in Malaysian politics; politics and business; Malaysia in the modern world system; civil society; law, justice and order; and directions for the future. It is compulsory for students from the School of Education to choose a uniformed body co-curriculum package from the list below (excluding Seni Silat Cekak). Students who do not enrol for any co-curriculum courses or who enrol for only a portion of the 3 units need to replace these units with skill/option courses.

Using illegal drugs can also get you into trouble with the law or cause money problems duphaston 10 mg cheap. Myth “All illegal drugs are equally harmful” Fact Different drugs can harm you in different ways purchase 10mg duphaston with visa. Some drugs buy duphaston 10 mg lowest price, such as heroin, are regarded as more dangerous because they have a higher risk of addiction and overdose, or because they are injected. Myth “My teenager is moody and losing interest in school – they must be on drugs” Fact Parents often ask how they can tell if their child is using drugs. Many of the possible signs, such as mood swings or loss of interest in hobbies or study, are also normal behaviour for teenagers. Find out the details of their drug taking – what they have taken, for how long and why. You can help your child develop a sensible attitude towards drugs, by showing a sensible attitude to your own use of drugs – particularly legal drugs such as alcohol and medication. Myth “Young people are tempted to try drugs by pushers” Fact Most young people are introduced to illegal drugs by a friend or someone they know. In many cases drugs are ‘pulled’ rather than ‘pushed’ – the person asks for it themselves, often out of curiosity. You may feel uncomfortable talking about drugs because you don’t know enough about the subject. If someone you know is taking drugs or you think they are taking drugs: • Listen to them – it is important to understand and respect how they feel; • Keep the lines of communication open; and • Look for more information before you do anything. A number of voluntary agencies also provide education, counselling and treatment throughout the country. To get information on your local services: Freephone: Drugs helpline 1800 459 459 (Monday – Friday, 9am to 5pm) Web: www. They are known as ‘controlled drugs’ and are listed in different groups called schedules. The schedules group drugs according to how useful they are and what is needed to control their use. They have the same general effects as depressants but they cause addiction in a different way. Depressants and sedatives are sometimes called ‘downers’ and stimulant drugs are sometimes called ‘uppers’. For example, cannabis can have depressant effects as well as causing euphoria and ecstasy has both stimulant and hallucinogenic effects. The most common type is called resin, which comes as solid dark-coloured lumps or blocks. Cannabis is usually rolled with tobacco into a ‘joint’ or ‘spliff’ and smoked, but it can also be cooked and eaten. Effects – Getting ‘stoned’ on cannabis makes you feel relaxed, talkative and happy. Some people feel time slows down and they also report a greater appreciation of colours, sounds and tastes. Side-effects – Cannabis can affect your memory and concentration and can leave you tired and lacking motivation. If you are not used to cannabis or you use a stronger type than you are used to you can feel anxiety, panic or confusion. But research shows that long-term users can find it hard to control their use of the drug and may become addicted. Smoking cannabis increases your risk of heart disease and cancers such as lung cancer and may also affect your fertility. In people who have underlying mental health problems, cannabis use may trigger schizophrenia. In Ireland it is the second most common drug found in the systems of drink drivers, after alcohol. Effects – Ecstasy can make you feel more alert and in tune with your surroundings. Other physical effects include muscle pain, nausea, jaw stiffness and teeth grinding. Risks – Most legal drugs are tested on animals first, but ecstasy users are human guinea pigs. Research already shows that regular weekend users experience a mid-week ‘crash’ that can leave them feeling tired and depressed, often for days. It could be years before we know the long-term effects but some users may be at risk of developing mental health problems later in life.

Statistically it states that for a precise measurement generic 10 mg duphaston fast delivery, there is only a small amount of variation around the true value of the variable being measured cheap duphaston 10mg mastercard. In statistical terminology this is equivalent to a small standard deviation or range around the central value of multiple measurements buy duphaston 10 mg online. For example, if each time a physician takes a blood pressure, the same measurement is obtained, then we can say that the measure- ment is precise. The same measurement can become imprecise if not repeated the same way, for example if different blood-pressure cuffs are used. Reliability has been used loosely as a synonym of precision but it also incor- porates durability or reproducibility of the measurement in its definition. It tells you that no matter how often you repeat the measurement you will get the same or similar result. It can be precise, in which case the results of repeated measure- ments are almost exactly the same. We are looking for instruments that will give precise, consistent, reproducible, and dependable data. Statistically, it is equivalent to saying that the mean or arithmetic average of all measurements taken is the actual and true value of the thing being measured. For example, if indirect blood-pressure measurements use a manometer and blood-pressure cuff that correlate closely to direct intra-arterial measurements in healthy, young volunteers using a pres- sure transducer, it means that the blood pressure measured using the manome- ter and blood-pressure cuff is accurate. The measurement will be inaccurate if the manometer is not calibrated properly or if an incorrect cuff size is used. It is possible for a measurement to be accurate but not precise if the average measured result is the true value of the thing being measured but the spread around that measure is very great. Precision and accuracy are direct functions of the instruments chosen to make a particular measurement. Validity tells us that the measurement actually rep- resents what we want to measure. For example, weight is a less valid measure for obe- sity than skin fold thickness or body mass index. Blood pressure measured with a standard blood-pressure cuff is a valid measure of the intra-arterial pressure. However, a single blood-sugar measurement is not a valid measure of overall diabetic control. The first set of definitions defines validity by the process with which it is determined. The second definition defines where validity is found in a clinical study and includes internal and external validity. This means that there is a study show- ing that the measurement of interest agrees with other accepted measures of the same thing. Similarly, blood-pressure cuff readings correlate with intra-arterial blood pressure as recorded by an electrical pressure transducer. Predictive validity is a type of criterion-based validity that describes how well the measurement predicts an outcome event. This could be the result of another measurement or the presence or absence of a particular outcome. For example, lack of fever in an elderly patient with pneumonia predicts a higher mortality than in the same group of patients with fever. This was determined from studies of factors related to the specific outcome of mortality in elderly patients with pneumonia. We would say that lack of fever in elderly pneumonia patients gives predictive validity to the outcome of increased mortality. It is a statement of the fact that the instrument measures the phenomenon of interest and that it makes sense. For example, the measured performance of a student on one multiple-choice examination should predict that student’s performance on another multiple-choice examination. Performance on an observed exam- ination of a standardized patient accurately measures the student’s ability to accurately perform a history and physical examination on any patient. However, having face validity doesn’t mean that the measure can be accepted without ver- ification. In this example, it must be validated because the testing situation may cause some students to freeze up, which they wouldn’t do when face-to-face with a real patient, thus decreasing its face validity. Validity can also be classified by the potential effect of bias or error on the results of a study. Internal and external validity are the terms used to describe this and are the most common ways to classify validity. Internal validity exists when preci- sion and accuracy are not distorted by bias introduced into a study.