By D. Navaras. Art Institute of Chicago. 2018.

Check you have used: q A clear framework q A logical sequence q Headings 5mg finasteride with amex hair loss cure latisse. Check the content is: q Balanced (no one area is given too much emphasis) q Accurate q Current q Objective purchase 1 mg finasteride with visa hair loss zetia. Check that you have: q Reduced unnecessary repetition q Included all the key points q Summarised the main points in a conclusion q Clearly stated recommendations and actions. Check you have: q Reduced jargon q Reduced complexity 90 WRITING SKILLS IN PRACTICE q Made it easy for the reader to find information q Used non-judgemental language. Once you have finished your edit you are ready to complete your final draft. Remember to ensure that copies of your report go to other relevant professionals or agencies. Initial assessment report – key content ° Name, address and identification details (date of birth, hospital number and so on) of the subject of the report. Discharge report – key content ° Name, address and identification details (date of birth, hospital number and so on) of the subject of the report. Summary Points ° Letters and reports about the care and management of clients are an essential form of communication within the health service. Careful consideration needs to be given to the choice of vocabulary and the way the message is phrased. Providing written material is one way of help­ ing to meet this need and involving clients in decision making. However, both professionals and clients have expressed concern about the quality of some of this information. The following chapter looks at how the writing and presentation of written leaflets may be improved. Getting started Most written material benefits from a team approach to its development, writing and production. Useful members might include: ° clinicians with relevant experience ° researchers or academics with knowledge of current research relevant to the subject matter ° persons with writing experience ° representative(s) from the users (clients, clinicians, administrative staff) ° persons with design experience. Your team will need to: ° establish the aims or objectives of the leaflet ° identify the target audience ° decide on the content, format and presentation of the material ° choose the manner of production and distribution 93 94 WRITING SKILLS IN PRACTICE ° determine how and when the material will be evaluated ° cost the development, production, distribution and evaluation. Planning the content of your leaflet Your choice of content will be determined by your objectives, your target audience and your evidence base. The purpose of written ma­ terial is usually one of the following: ° to increase awareness ° to motivate ° to change attitudes ° to change behaviour ° to teach a new behaviour ° to teach a new skill ° to offer support and advice ° to give information. Your aims will affect the type of information you choose and the way in which you present it. You need to define your target audience so that you can make the informa­ tion in your leaflet relevant and useful to them. They may share an illness or other condition, or they may be linked in some other way, for example attending the same GP practice. Find out about age, gender, ethnic group, and any special needs like low literacy skills or a sensory impairment. Once you are clear about your audience, you can start to identify their information needs. For example, at what point in the care process or stage of their illness would that type of information be useful? It would also be invalu­ able to have their views on other written material they have used. There are various ways of canvassing the views of clients (along with family and carers). These include using: INFORMATION LEAFLETS FOR CLIENTS 95 ° questionnaires ° interviews 1 ° focus groups ° representatives from voluntary organisations or self-help groups ° representatives of local ethnic minorities. Establish your evidence base Look for evidence on: ° need ° best practice ° current theory. Research other publications Find out about written leaflets that have already been produced for your client group. You may find that there is perfectly adequate information al­ ready published but not accessible to your clients. For instance, a lot of very good work is produced at a local level or by other associated agencies like social services. It may be more cost-effective to buy in this material than trying to re-invent the wheel yourself.

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If you are using or plan to use Netscape Composer discount 1mg finasteride with mastercard hair loss cure knee, Netscape provides an excellent step-by-step guide (< http://home order finasteride 5 mg with amex hair loss cure propecia. As with all teaching preparation, you need a clear idea of what you are trying to achieve and for whom you are preparing the material. Assuming the material is for your students you could provide them with a diversity of resources to assist them with their learning, such as links 182 to helpful learning resources, assignments and general feedback, reading material, examples of exemplary student work, and so on. Alternatively, you may be planning to teach interactively via the World Wide Web. In both of these cases, we urge you to review the currently available literature on the topic, some of which is identified in the Guided Reading section. USING TECHNOLOGY IN LEARNING AND TEACHING New technologies are having a significant impact on learning and teaching in higher education and will continue to do so. As we have already seen in this chapter and elsewhere in the book, computer and communication technologies can enhance a wide range of traditional teaching activities from the production and distribution of materials to the ways in which learners and teachers interact with each other. But these are examples of the ways in which technology replicates traditional teaching. It is now clear that the forces of change are combining to move us to different ways of learning and teaching where we will see more of the following developments: students becoming more active and independent in their learning students working collaboratively with each other rather than competitively teachers becoming more designers and managers of learning resources, and guides for their students rather than dispensers and controllers of information rapidly changing curriculum content reflecting free- dom to access a diverse range of ever-expanding resources for learning more effective assessment with a growing emphasis on assessment for learning. How can you respond to these new and challenging demands and where can you learn more? Of course we hope that the material in this book will assist you with the basics of learning, teaching and assessment issues. But how can you learn more about the technologies (if these are new to you) or how can you keep abreast of developments? These matters are well beyond the scope of this book and so we hope the following Guided Reading will be helpful. The first book takes the reader through the fundamentals of using computers and the second book explores ways in which computers can be used to support the teaching of large groups, to deliver learning resources to students, and for communication between students. If you want to go further, and explore more of using the Internet in your teaching, we suggest I. Forsyth, Teaching and Learning Materials and the Internet, Kogan Page, 2000. To maintain your currency in the uses of technology beyond the material in these books we urge you to monitor the literature in books, journals and especially in the electronic resources of the kind available on the World Wide Web. There is rapidly growing number of books, as well as resources on the Web, that can assist you with some of the educational issues of using technology in education. Joosten, Delivering Digitally: Managing the Transition to the Knowledge Media. Phillips, The Developer’s Handbook to Interactive Multimedia, A Practical Guide for Educational Applica- tions. If you are concerned to evaluate materials and educational technologies we suggest M. This is an interesting mixture of useful guidance on planning evaluations, evaluating materials, and the whole notion of formative evaluation. Hartley, Designing Instructional Text (3rd edition), Kogan Page, London, 1994, is highly recommended for preparing text-based materials (books, manuals, handouts, computer- generated or stored text). As a result we have included this new chapter which we hope will help you in three important ways. Provide you with information and resources that will assist you to evaluate your teaching and the learning of your students. Guide you in ways that will assist you to make good use of the information you create through your evaluative activities. Arm you with ideas on how to improve the practice of evaluation in your institution. In our experience, as many difficulties in evaluation are created by the implementation of poor policies and practices as by the processes of collecting and presenting evaluative information.

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For those with SMA 2 and SMA 3 purchase finasteride 1 mg on line hair loss causes in women, the slow rate of change can be complicated by various secondary complications cheap 5mg finasteride mastercard hair loss miracle cure, which then have the effect of dragging function down. Thus, fastidious prospective care can have a major influence on function and life span. In older textbooks, children with SMA 2 are said on average to live to early school years but with modern supportive care many in this group are now doing well in high school and beyond. Special Concerns Regarding Care for Infants with SMA 1 In infants with SMA 1, very complex levels of medical care are mixed with difficult ethical and resource issues. At issue in many of these most severely affected infants is the question of treatment goals. While it is virtually always possible to maintain life with tracheostomy, assisted ventilation and assisted tube feedings, most will never emerge from a state of complete dependence. For some, even yes=no binary forms of communication are difficult or impossible. The burdens of care include 194 Crawford Therapy for Spinal Muscular Atrophy 195 196 Crawford continuous high stress to other family members, limited interest or ability of some medical communities, very high financial costs borne by private and governmental third parties and families, and inevitable patient discomforts associated with the high levels of intervention necessary. For many dedicated and caring parents, these burdens easily surpass the benefit of extending life in the state of complete or near complete immobility for their children. As SMA manifests across a continuous spectrum of severity, and because every family and community will value elements of burden and benefit differently in making decisions about the goals of care, there will inevitably be many difficult cases. In recent years, advancements in ‘‘noninva- sive’’ chronic ventilation have made life somewhat less burdensome for many patients and their families, increasing the number of very weak infants for whom a decision to extend life, rather than enter into a program of palliative care, may be a reasonable choice. Caring physicians have an important role in identifying the probable conse- quences of each choice, and to help shoulder the inevitable guilt that accompanies any choice made. A choice for pure palliative care for infants with type 1 SMA is extraordinarily difficult for parents. This can be made easier by understanding that most or all of the discomforts associated with SMA 1 can be effectively minimized. Many infants develop difficulty with sucking and swallowing, particularly when during respiratory illness. In anticipation of this time, it is reasonable to place G tubes prospectively at a time when anesthesia concerns can be minimized. Local institutions favor endo- scopic or surgical approaches, and general vs. Nissen fundiplication is rarely indicated for patients receiving palliative care. Infants also tolerate thin flexible NG tubes well, which can be placed for days or a few weeks at a time in those infants who cannot tolerate G tube placement. Placement of these artificial means for alimentation do not preclude bottle or even breast feeding for those infants who are able to do so, but alleviate the difficulties with maintaining minimum caloric support that frequently develop over time. This is partially related to an increased risk of aspiration, but is less frequent than might be expected. Oral suctioning is uncomfortable for the infant; with time parents can learn to dis- tinguish noisy breathing from distressed states that are relieved with suctioning by a portable suction machine or bulb syringes. Postural drainage with a small percussive cup, or vibration, placing the most atelectatic lung segments upward can be helpful. Glycopyrrolate (Robinul) is difficult to use well; often the benefit of drying secretions is undermined by increased thickness of secretion that makes the overall situation worse. Infants often benefit from aerosolized bronchodilator treatments during times of increased respiratory distress. Many infants with SMA 1 are more comfortable and breath more slowly and effectively in a Trendelenberg position and on their side or even prone. This position is advantageous given the relative imbalance between chest wall weakness and diaphragmatic strength: in the upright position the increase in thoracic volume created by diaphragmatic contraction is undermined by chest wall collapse, but in the Trendelenberg position the forces to collapse the chest wall are diminished. Finally, the distress of severe dyspnea can be blunted by use of aerosolized nar- cotics. This includes the risk of suppression of respiratory drive, but in my experience there is little evidence that delivered in the following manner that induced respiratory depression is a major concern.

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The government’s focus on issues such as crime and drugs buy finasteride 1mg visa hair loss natural treatment, anti-social behaviour buy finasteride 5mg with amex hair loss herbal treatment, teenage pregnancy and child poverty reflects its preoccupation with problems that appear to be the consequence of the breakdown of the family and of traditional communities and mechanisms for holding society together. All these concerns come together in the concept of ‘social exclusion’ which emerged in parallel with increasing concerns about health inequalities. At the launch of the Social Exclusion Unit, a key New Labour innovation, in December 1997, Tony Blair summed up the significance of the concept for New Labour: ‘It is a very modern problem, and one that is more harmful to the individual, more damaging to self-esteem, more corrosive for society as a whole, more likely to be passed down from generation to generation, than material poverty’ (The Times, 9 91 THE POLITICS OF HEALTH PROMOTION December 1997). The term social exclusion appears to be less pejorative and stigmatising than more familiar notions such as ‘the poor’ or ‘the underclass’. Social exclusion also implies a process rather than a state: people are being squeezed out of society, not just existing in conditions of poverty. It expresses a novel sense of guilt over the failures of society as well as the familiar condescen-sion towards the poor. Above all it expresses anxiety about the consequences of social breakdown as well as fear of crime and delinquency. The concepts of equality and inequality have also undergone a significant re-interpretation. This began with the Commission on Social Justice, a think-tank set up in 1992 in the inter-regnum between Neil Kinnock and Tony Blair, when John Smith was Labour leader; it reported in 1994 after his sudden death (Commission on Social Justice 1994). After Labour’s fourth and most bitter election defeat, this body accelerated the process of ridding the party of its social democratic heritage that had begun under Kinnock and was completed under Blair. It shifted Labour’s goal from social equality to social justice, which it defined as recognition of the ‘equal worth’ of all citizens (CSJ 1994:18). In place of the traditional view of inequality as a question of the distribution of the material resources of society, the commission explained it in cultural and psychological terms. Thus it emphasised that ‘self respect and equal citizenship demand more than the meeting of basic needs; they demand opportunities and life chances’. It concluded that ‘we must recognise that although not all inequalities are unjust…unjust inequalities should be reduced and where possible eliminated’. Once Labour had accepted Mrs Thatcher’s famous dictum ‘Tina’—‘there is no alternative’ to the market— then it had also to accept the inevitability of inequality. Its traditional clarion call to the cause of equality gave way to feeble pleas for fair play. In his emotional speech to Labour’s centenary conference in September 1999, Tony Blair reaffirmed the government’s commitment to tackling inequalities in British society and pledged to ‘end child poverty within a generation’. While this went down well with party traditionalists, Blair was careful to put the distinctive New Labour spin on the concept of equality. Thus he reaffirmed that, for New Labour, ‘true equality’ meant ‘equal worth’, not primarily a question of income, more one of parity of esteem. As Gordon Brown put it, poverty was ‘not just a simple problem of money, to be solved by cash alone’, but a state of wider deprivation, expressed above all in ‘poverty of expectations’. In case there was any 92 THE POLITICS OF HEALTH PROMOTION misunderstanding, Anthony Giddens, chief theoretician of the third way, bluntly explained that there was, ‘no future’ for traditional left- wing egalitarianism and its redistributionist ‘tax and spend’ fiscal and welfare policies (Giddens 1999). Instead ‘modernising social democrats’ needed ‘to find an approach that allows equality to coexist with pluralism and lifestyle diversity’. Giddens’ new egalitarianism meant accepting wide differentials in income, but insisting on ‘equal respect’. New Labour’s message to the poor was: never mind the width of the income gulf—feel the quality of our recognition of your pain. A continuing tension between Old and New Labour approaches to inequality was also apparent in the health inequalities debate. For one group of traditionalists, based in Bristol, ‘poverty really is a problem of the lack of enough money—if you give poor people enough money they stop being poor—it is as simple as that’ (Shaw et al. For Richard Wilkinson at Sussex University, a prominent figure in this debate over two decades, it was not so simple. He maintained that social differentials in health were the result of ‘psychosocial’ rather than material factors, as the ‘chronic stress’ generated by a polarised society takes its toll on the health of those who are relatively worse off (Wilkinson 1996:214–15). Whereas the Bristol group insisted that ‘poverty reduction really is something that can be achieved by “throwing money at the problem”’, Wilkinson argued that the solution lay in strategies to ‘achieve narrower income distribution and better social cohesion’ (Shaw et al. In the harsh world of politics, New Labour’s slavish devotion to Tina, fiscal rectitude and electoral expediency mean that it has no intention, either of raising benefits to the poor, or of doing anything to reduce income differentials. The Bristol group’s repeated demands that such measures ‘should be their top priority’ in face of the unmistakable evidence that government policy is moving in the opposite direction reflect the pathological dependence of Old Labour on New Labour, like that of the battered wife who cannot abandon her abusive partner.

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