126 resultados para gynecological examination


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In this study, we investigate an adaptive decomposition and ordering strategy that automatically divides examinations into difficult and easy sets for constructing an examination timetable. The examinations in the difficult set are considered to be hard to place and hence are listed before the ones in the easy set in the construction process. Moreover, the examinations within each set are ordered using different strategies based on graph colouring heuristics. Initially, the examinations are placed into the easy set. During the construction process, examinations that cannot be scheduled are identified as the ones causing infeasibility and are moved forward in the difficult set to ensure earlier assignment in subsequent attempts. On the other hand, the examinations that can be scheduled remain in the easy set.

Within the easy set, a new subset called the boundary set is introduced to accommodate shuffling strategies to change the given ordering of examinations. The proposed approach, which incorporates different ordering and shuffling strategies, is explored on the Carter benchmark problems. The empirical results show that the performance of our algorithm is broadly comparable to existing constructive approaches.

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Practice based learning in Northern Ireland is a core element of social work education and comprising 50% of the degree programme for undergraduate and postgraduate students. This article presents evidence about the perceptions of practice learning from voluntary sector/non-government organisation (NGO) placement providers and final year social work students on social work degree programmes in Northern Ireland in 2011. It draws on data from 121 respondents from189 final year students and focus group interviews with voluntary sector providers offering 16% (85) of the total placements available to students. The agencies who participated in the research study provide a total of 55 PLOs to social work students, and are therefore fairly representative in terms of voluntary sector (NGO) provision. The article locates these data in the context of practice learning pedagogy and the changes introduced by the Regional Strategy for Practice Learning Provision in Northern Ireland 2010–2015. Several themes emerged including; induction, support and guidance, practice educator/student relationship, professional identity and confidence in risk assessment and decision-making. Social work educators, placement providers and employers must be cognisant of newly qualified social workers’ needs in terms of consolidating knowledge within the formative stages of their professional development.

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Summary
Background
The ability to carry out a neurological examination and make an appropriate differential diagnosis is one of the mainstays of our final Bachelor of Medicine (MB) exam; however, with the introduction of objective structured clinical examinations (OSCEs) it has become impossible to arrange for adequate numbers of suitable real patients to participate in the exam.

Context
It is vital that newly qualified doctors can perform a basic neurological examination, interpret the physical signs and formulate a differential diagnosis.

It is vital that newly qualified doctors can perform a basic neurological examination

Innovation
Since 2010 we have introduced an objective structured video examination (OSVE) of a neurological examination of a real patient as part of our final MB OSCE exam. The students view clips of parts of the examination process. They answer questions on the signs that are demonstrated and formulate a differential diagnosis.

Implications
This type of station is logistically a lot easier to organise than a large number of real patients at different examination sites. The featured patients have clearly demonstrated signs and, as every student sees the same patient, are perfectly standardised. It is highly acceptable to examiners and performed well as an assessment tool. There are, however, certain drawbacks in that we are not examining the student's examination technique or their interaction with the patient. Also, certain signs, in particular the assessment of muscle tone and power, are more difficult for a student to estimate in this situation

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PURPOSE: We studied the effects on intraocular pressure (IOP) of anesthesia administered during examination under anesthesia (EUA) in children. DESIGN: Randomized clinical trial. METHODS: This randomized trial compared IOP after inhaled sevoflurane gas to that after intramuscular ketamine hydrochloride in children undergoing EUA. IOP was measured in 30 eyes with TonoPen XL (Mentor, Inc, Norwell, Massachusetts, USA) as soon as possible after anesthesia induction (T1) and two, four, six, and eight minutes thereafter. At the same times, we recorded systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR). RESULTS: Compared with the mean IOP at T1, IOP in the sevoflurane group was significantly lower for all measurements from two to eight minutes thereafter (mean decrease in IOP: two minutes = 12%, four minutes = 19%; six minutes = 19%; eight minutes = 17%, all P < or = .01). In the ketamine group, mean IOP was not significantly changed from T1 through six minutes, whereas at eight minutes, it was 7% lower (P = .03). SBP and DBP were significantly lower for sevoflurane than for ketamine at all measurements from two minutes onward, and HR was lower for sevoflurane than for ketamine at two, four, and six minutes. CONCLUSIONS: IOP measured after ketamine sedation is more likely to represent the awake IOP than that after sevoflurane anesthesia. Changes in SBP, DBP, and HR caused by sevoflurane suggest that hemodynamic alterations may underlie its effects on IOP.

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This multimethod case study of a Greek vocational school explored teachers’ culture (including beliefs about education, teachers’ role, and students’ nature) using the concept of Pupil Control Ideology to explain problems of disengagement and low morale among staff and students, as well as tensions in relationships. A prominent custodial culture was identified in the school using a functional/apolitical pedagogy to transmit ‘legitimate’ knowledge to students whose working-class background did not produce desired outcomes. This generated deficit views of students, teachers’ sympathy, and a seemingly caring school ethos which was, nevertheless, oppressive. Students’ failings were naturalised and vocational education misinterpreted as merely a streaming device in a system honouring academic achievement and middle-class ways. Teachers were blind to these cultural subtleties, believing they acted ‘rationally’ and altruistically. A humanistic subculture emphasising student empowerment and social transformation consisted of a minority of teachers and was rather marginalised. This disallowed meaningful dialogue and the identification of an alternative rationale for the sector, generating strong feelings of futility. Positive change in this school necessitated the deconstruction and (subsequent) reconstruction of custodial teachers’ worldview as embedded in their practice.