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The first stem requires problem solving in order to determine a diagnosis; the second stem tests only recall discount female viagra 50mg with visa menopause nutrition. More stems could buy female viagra 100 mg low cost women's health center queens, 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. Where facilities are available it is convenient to use answer sheets that can be directly scored by computer or for responses to be entered directly into a computer by students. An overlay is produced by cutting out the positions of the correct responses. This can then be placed over the student’s answer sheet and the correct responses are easily and rapidly counted. Before doing so ensure that the student has not marked more than one answer correct! In most major medical examinations a computer will be used to score and analyse objective-type examinations. You must therefore be familiar with the process and be able to interpret the subsequent results. The computer programme will generally provide statistical data about the examination including a reliability coefficient for internal consistency, a mean and standard deviation for the class and analyses of individual items. Should you be 147 the person responsible for the examination you will need to know how to interpret this information in order to process the examination results and to help improve subsequent examinations.

Manikins are vital for learning practical cardiopulmonary resuscitation skills The most important question to ask initially is: which skills need to be acquired? This will obviously depend on the class under instruction; the requirements of a lay class will be quite different from those of professional hospital staff learning advanced life support skills discount female viagra 50 mg amex women's health fitness magazine uk. For large classes it may be better to maximise the practical hands-on exposure by investing in several cheaper With all manikins female viagra 100 mg without prescription menstruation with blood clots, realistic appearance, manikins rather than rely on one or two expensive, more accurate anatomical landmarks, and an appropriate response to any attempted complex models. Models vary greatly in sophistication, but most provide some qualitative indication that technique is adequate, such as audible clicks when the depth of chest compression is correct. Some manikins incorporate sensors that recognise the correct hand position and the rescuer’s attempts at shaking, opening the airway, and Resuscitation skills that can be practised palpation of a pulse. The depths of ventilation and chest on manikins compression may also be recorded. An objective assessment of Basic life support performance may be communicated to the student or ● Manual airway control with or without instructor by means of flashing lights, meters, audible signals, simple airway adjuncts or graphical display on a screen. A permanent record may be ● Pulse detection obtained for subsequent study or certification. A score, indicating the number of correct ● Precordial thump manoeuvres, may form the basis of a test of competence. A minimum score of 70% correct ● Defibrillation and cardioversion ● Intravenous and intraosseous access cardiac compressions and ventilations may be taken to (with or withoutadministration of drugs) represent effective life support. This score on a Skillmeter Related skills Resusci Anne manikin is acceptable to the Royal College of ● Management of haemorrhage, fractures, etc. General Practitioners of the United Kingdom as part of the ● Treatment of pneumothorax MRCGP examination. Some care is required, however, and the “skin” should not be permanently marked by lipstick or pens or allowed to become stained with extensive use. Many currently available manikins have replacements available for those components subject to extensive wear and tear. This is particularly true for the face, which bears the brunt of damage and where discoloration or wear will make the manikin aesthetically unattractive. A carrying case (preferably rigid and fitted with castors for heavier manikins) is essential for safe storage and transport. Cross infection and safety To minimise the risk of infection occurring during the conduct of simulated mouth-to-mouth ventilation the numbers of Manikins can be students using each manikin should be kept low and careful used for a attention should be paid to hygiene. Students should be free of variety of communicable infection, particularly of the face, mouth, or training exercises respiratory tract. Faceshields or other barrier devices (see Chapter 18) should be used when appropriate. Manikins should be disinfected during and after each training session according to the manufacturer’s instructions. Preparations incorporating 70% alcohol and chlorhexidine are often used. Hypochlorite solutions containing 500ppm chlorine (prepared by adding 20ml of domestic bleach to 1l of water) are effective but unpleasant to use. They are best reserved for the thorough cleaning of manikins between classes. Moulded hair has now replaced stranded or artificial hair and is much easier to keep clean. Many modern manikins feature a disposable lower airway consisting of plastic lungs and connecting tubes. Expired air passes through a non-return valve in the side of the manikin during expiration. All disposable parts should be replaced in accordance with the manufacturer’s recommendations. Other manikins use a clean mouthpiece and disposable plastic bag insert for each student.

Archaebacteria are now However best 50 mg female viagra menstruation medicine, for a period of time from a few days to several known to be a very ancient form of life discount female viagra 50mg mastercard pregnancy kicks, and may even consti- weeks, infected animals may continue to excrete brucella into tute a separate kingdom of life. Under warm, moist conditions, the bac- aquaticus is thus, one of the fundamental milestones of micro- teria may survive for months in soil, milk, and even seawater. Because the bacteria are so hardy, humans may become Brock’s discovery has also had a significant impact in infected with Brucella by direct contact with the bacteria. The enzymes of the bacterium are Handling or cleaning up after infected animals may put a per- designed to work at high temperatures. Brucella are extremely effi- merase is the basis of the polymerase chain reaction that is cient in crossing the human skin barrier through cuts or breaks used to artificially amplify the amount of deoxyribonucleic in the skin. The use of PCR has spawned a multi-billion dollar The incubation period of Brucella, the time from expo- biotechnology industry. The primary complaints are weakness and Bacteriology at the University of Wisconsin-Madison. The course of the disease reflects the location of the Brock has also been a prolific writer and scientific his- Brucella bacteria within the human host. His numerous books include volumes on the biology of Brucella are introduced into the bloodstream, the bacteria seek microorganisms, the principles of microbial ecology, the mile- out the nearest lymph nodes and invade the lymph node cells. Even Diagnosing brucellosis involves culturing the blood, though they lack genetic material, they are infectious. A positive culture Both BSE and CJD are characterised by a loss of coor- alone does not signify brucellosis, since persons who have been dination and the control over functions such as grasping and treated for the disease may continue to harbor Brucella bacteria holding, dementia, paralysis, eventually leading to death. Confirmation of brucellosis, therefore, is no cure for either disease, and no are vaccines available. Progressive dence of the characteristic symptoms and a history of possible and ultimately fatal dementia that was accompanied by other contact with infected milk or other animal products. Brucellosis is treated with administration of an antibiotic become accepted by the medical community. The average incidence rate for CJD over time is about Since the invention of an animal vaccine for brucellosis one person per million. The most in the 1970s, the disease has become somewhat rare in the recent example is the 48 confirmed cases that were diagnosed United States. Yet the vaccine cannot prevent all incidence of in Britain between 1996 and 2001. The Centers for Disease Control usually reports predilection for a gender, any ethnic group, or for geographi- fewer than 100 total cases per year in the United States. However, the incidence in those over 55 years of of these were reported in persons who worked in the meat pro- age is far higher (over 30 times) than for those under 55 years. Brucellosis remains a risk for those who Three means of acquiring CJD have been identified. Secondly, the disease can appear Brucellosis also remains a risk when animal products with no exact origin being known. About 85% of CJD cases from foreign countries are imported into the United States. Lastly, the disease can be Outbreaks of brucellosis have been linked to unpasteurized acquired during surgery. This so-called iatrogenic form is typ- feta and goat cheeses from the Mediterranean region and ically a result of CJD-contaminated equipment or tissue (brain Europe. In the 1960s, brucellosis was linked to bongo drums and corneal grafts are two examples). Treatment consists of man- can harbor Brucella bacteria, which can be transmitted to aging the patient so that his/her increasingly impaired men- humans through cuts and scrapes in the human skin surface. On an individual level, people can BSE causes a progressive neurological deterioration in avoid the disease by not eating animal products imported from cattle that is similar to the course of CJD in humans. Cattle with countries where brucellosis is frequent, and by avoiding foods BSE are more temperamental, have problems with their posture made with unpasteurized milk. The so-called incubation period, the time from when the animal is first infected until symptoms appear, ranges from two to eight years.

Finishing the focus group When you have finished your focus group buy generic female viagra 50mg online pregnancy test, thank the par- ticipants for taking part and leave a contact name and number in case they wish to follow up any of the issues that have been raised during the discussion buy female viagra 100 mg lowest price menstrual gas relief. It’s good practice to offer a copy of the report to anybody who wants one. However, this might not be practical if the final report is to be an undergraduate dissertation. You could explain this to the participants and hope that they under- stand, or you could offer to produce a summary report which you can send to them. HOW TO CONDUCT FOCUS GROUPS/ 79 TABLE 8: STRATEGIES FOR DEALING WITH AWKWARD SITUATIONS SITUATION STRATEGY Break-away Say: ‘I’m sorry, would you mind rejoining the group as this conversations is really interesting? Dominance First of all stop making eye-contact and look at other people expectantly. If, however, leadership tendencies aren’t immediately obvious, but manifest themselves during the discussion, try to deal with them as with ‘dominance’, above. If this still fails, as a last resort you might have to be blunt: ‘Can you let others express their opinions as I need to get as wide a variety as possible? The other members were happy to do this as they were free to express themselves and their opinions were quite different from those of their self-appointed ‘leader’. Disruption by On rare occasions I have come across individuals whowant participants to disrupt the discussion as much as possible. They will do this in a number of ways, from laughing to getting up and walking around. I try to overcome these from the start by discussing and reaching an agreement on how participants should behave. Usually I will find that if someone does become disruptive, I can ask them to adhere to what we all agreed at the beginning. Sometimes, the other participants will ask them to behave which often has a greater influence. Defensiveness Make sure that nobody has been forced to attend and that they have all come by their own free will. Be empathetic – understand what questions or topics could upset people and make them defensive. Try to avoid these if possible, or leave them until the end of the discussion when people are more relaxed. These facilities can be hired at a price which, unfortunately, tends to be beyond the budgets of most stu- dents and community groups. Your local college or university might have a room which can be set up with video recording equipment and the in- stitution may provide an experienced person to operate the machinery. If your institution doesn’t provide this fa- cility, think about whether you actually need to video your focus group as the more equipment you use, the more po- tential there is for things to go wrong. Most social re- searchers find that a tape recording of the discussion supplemented by a few handwritten notes is adequate (see Chapter 7 for further discussion on different methods of recording). Ideally, it needs to be small and unobtru- sive with an inbuilt microphone and a battery indicator light so that you can check it is still working throughout the discussion, without drawing attention to the machine. A self-turning facility is useful as you get twice as much recording without having to turn over the tape. The recorder should be placed on a non-vibratory surface at equal distance from each participant so that every voice can be heard. Before the participants arrive, place it in the HOW TO CONDUCT FOCUS GROUPS/ 81 centre of the room and test your voice from each seat, varying your pitch and tone. Participants in focus groups tend to speak quietly at the beginning, but once they be- gin to relax, they tend to raise their voices. Be aware of any noise which could disrupt the recorder, such as tick- ing clocks or traffic outside. CHOOSING A VENUE It is extremely important to make sure you choose the right venue for your focus group as this will affect parti- cipation levels, the level of discussion and the standard of recording. You should ask yourself the following ques- tions when considering a venue: X Is the venue accessible in terms of physical access for those with mobility difficulties? X Is it accessible in terms of ‘mental’ access, that is, would the type of people you intend to recruit feel comfortable entering that building? X Is the room big enough to accommodate the number of people you intend to recruit?