By B. Ayitos. Seattle University.

Features such as these have proved invaluable for training in trauma care buy clomid 100 mg amex women's health clinic yonge and eglinton. Airway management Manikin being used for advanced life support practice Manikins dedicated to the teaching of airway management feature a head and neck containing an accurate simulation of the anatomy of the oropharynx and larynx generic clomid 25mg online menstrual 1 day period. These models are It is vital for all personnel involved in the care usually mounted on a rigid baseboard that ensures stability of the acutely ill patient to be able to manage an airway while the head and neck are manoeuvred. A range of airway adjuncts may be used, although not all manikins allow practice of the full repertoire. In addition to the static airway manikins, a recent addition to the market allows the instructor to make dynamic changes to the condition of the airway. Through a complex set of inflatable bladders built into the manikin, it is possible to simulate trismus, laryngospasm, tongue swelling, pharyngeal obstruction, tension pneumothorax, and complete airway obstruction. In this way trainees can experience diverse and changing airway problems within the safe environment of a simulation exercise. Careful choice of a robust airway management trainer is recommended, and a lubricant spray or jelly should always be used. Damage to the mouth, tongue, epiglottis, and larynx is common so it is important to be sure that repair or replacement of these parts is easy and relatively inexpensive. Breathing Most manikins respond to artificial ventilation by symmetrical Ambu airway trainer shows cross-sectional anatomy of the airway chest movement. Incorrect intubation, such as tube placement in the right main bronchus or oesophagus, will result in unilateral chest movement or distension of the stomach, respectively. More complex manikins allow the instructor to control chest movements and can generate a variety of different breath sounds. In addition, some allow the simulation and treatment of a tension pneumothorax by needle thoracocentesis and chest drain insertion. Electrocardiographic monitoring and rhythm recognition The ability to monitor and interpret the cardiac rhythm is crucial to the management of cardiac emergencies. An electronic rhythm generator may be connected to suitably designed manikins to enable arrhythmias to be simulated. The digitised electrocardiographic signal from the device may be monitored through chest electrodes or from the manikin chest studs that are used for defibrillation. Basic models provide the minimum requirements of sinus rhythm and the rhythms responsible for cardiac arrest (ventricular fibrillation, ventricular tachycardia, and asystole). More advanced models provide a wide range of arrhythmias and the heart rate, rhythm, or QRST morphology may be changed instantly by the instructor. These devices may be programmed to change Electrocardiogram simulator 100 Training manikins rhythm after the delivery of a direct current shock so that students are able to monitor the effects of defibrillation in a lifelike way. It should be remembered that energy levels of 50-400J are potentially lethal, and a specially designed manikin defibrillation skin that incorporates an attenuator box must always be used. Greater realism is provided by some manikins that produce a palpable pulse (and some blood pressure) when the electrocardiographic rhythm changes to one that is consistent with a cardiac output. Intravenous access Several models currently available enable practice in peripheral or central venous cannulation. A plastic skin overlies the “veins,” which are simulated by plastic tubes containing coloured liquid. The skin provides a realistic impression of cutaneous resistance while the veins provide further resistance to the needle; once the vein is entered the coloured fluid can be aspirated. Some models allow the placement of intravenous catheters by the Seldinger or catheter-through-cannula technique. Some are available that allow peripheral venous cannulation in several different sites. Manikins for central venous cannulation allow access to the subclavian, jugular, and femoral veins; these feature appropriate anatomical landmarks Laerdal intravenous torso can be used for central venous cannulation and may incorporate a compressible bulb that enables the instructor to simulate adjacent arterial pulsation. Some paediatric manikins allow the practise of intraosseous needle Manufacturers and distributors insertion, peripheral cannulation, scalp vein cannulation, and ● Adam Rouilly (London) Ltd umbilical cord catheterisation. Crown Road Eurolink Business Park Sittingbourne Patient simulators Kent ME10 3AG Telephone: 01795 471378 Patient simulators are a natural progression from advanced life Fax: 01795 479787 support training manikins.

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Glossary Distance learning E-conferencing—Use of online presentations and discussion forums (in real time or stored as downloadable files on a website) to avoid the Two of the main developments in web based learning have been need for participants to travel the adaptation of communication technology to support E-learning—Learning through electronic means buy clomid 50mg line women's health center in lansdale, such as via the web learning and the changes in distance learning strategies (see world wide web) generic clomid 50mg with visa menstrual pads, an intranet, or other multimedia materials necessary for delivering online courses. Both aspects should be HTML (hypertext markup language)—The language used to create web considered when designing or delivering web based learning pages. Lessons can be learned by considering how including wordprocessed files, spreadsheets, presentation slides, and other web pages distance education evolved. Hyperlinks—Links in web pages that enable the user to access another Distance and open learning began with correspondence web page (either on the same or a different site) with just one courses. The Open University in Britain is one of the best mouse click known examples of how university level education became Internet—A global network of computers divided into subsets (for accessible, through effective distance learning, to people who example, the web or email systems). Computers are linked to the had neither the traditional qualifications nor the time to enter internet via host computers, which link to other computers via dial up (for example, via a modem) and network connections full time higher education. Internet service provider (ISP)—Home users usually access the internet The secret of the Open University’s success lies in clearly through an internet service provider (such as AOL), which identifying students’ needs; providing effective, local support; maintains a network of PCs permanently connected to the internet and combining conventionally taught components with the use Intranet—A network of computers that share information, usually of up to date multimedia resources, including books, course within an organisation. Access normally requires a password and is guides, videotapes, audiotapes, television, e-conferencing, and limited to a defined range of users Managed learning environment (MLE)—Usually has an integrated discussion groups. Search engines (such as Lycos,Google)—Can be used to help to find information Web based learning is often called online learning or e-learning Videostreaming—The process by which video images are able to be because it includes online course content. These might be in real time (such as a conference) or used asynchronously email, videoconferencing, and live lectures (videostreaming) are Virtual learning environment (VLE)—A set of electronic teaching and all possible through the web. Principal components include systems that can map provide static pages such as printed course materials. All such programmes use HTML A “virtual” learning environment (VLE) or managed learning environment (MLE) is an all in one teaching and learning For additional information see www. A VLE typically combines functions such as 42 Web based learning discussion boards, chat rooms, online assessment, tracking of “Newer technologies such as computers students’ use of the web, and course administration. VLEs act as and video conferencing are not any other learning environment in that they distribute necessarily better (or worse) for teaching information to learners. VLEs can, for example, enable learners or learning than older technologies. The choice of focus of web based courses must always be on the technology should be driven by the needs learner—technology is not the issue, nor necessarily the answer. Technology, open learning and Models of web based learning distance education. London: Routledge, Several approaches can be used to develop and deliver web 1995 based learning. At one end is “pure” distance learning (in which course material, assessment, and support is all delivered online, with no face to face contact between students and teachers). At the other end is an organisational intranet, which replicates printed course Features of a typical web based course materials online to support what is essentially a traditional face x Course information, notice board, timetable to face course. However, websites that are just repositories of x Curriculum map knowledge, without links to learning, communication, and x Teaching materials such as slides, handouts, articles x Communication via email and discussion boards assessment activities, are not learner centred and cannot be x Formative and summative assessments considered true web based learning courses. The individual learner The first step in designing a web based course is to identify the Design of curriculum (taught course, directed learning, self learning) learners’ needs and whether the learners are to be considered as part of a group or as individual learners. The web can be a useful tool for bringing isolated learners together in “virtual” groups—for example, through a discussion forum. There are Feedback and modification Pedagogy several online resources on how to design web based learning to curriculum (delivery of teaching) programmes (for example, at www. Evaluation Assessment Questions to ask before starting a web based learning project (of learning process) (of student learning) x What is the educational purpose of the web based learning project? The learning cycle: useful to bear in mind when planning a web based x What resources and expertise on web based learning exist in the course institution? If not, the e-learning starter guides on the LTSN website are a good resource (www. This is normally done via an organisations and government agencies intranet, which is usually “password protected” and accessible x One subject centre covers medicine, dentistry, and veterinary only to registered users.

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It means bouncing back after setbacks (flare-ups purchase clomid 100 mg on-line women's health clinic dandenong, a medication that doesn’t work order 25 mg clomid menopause zest, another doctor who doesn’t know what’s wrong) and losses (a job opportu- nity, a relationship, the ability to do something with your child) and still believing that your physical ailment is intended to help you find your pur- pose. I will never forget a quotation from an unidentified author that often gave me the courage to try just one more thing in the darkest days of my mys- terious pain: “Why not go out on a limb? Unfortunately for many, their faith has been shattered by their mystery malady. Some of you may ask, “If there is a God or some higher Being, why am I suffering? To me, faith is believing in what we cannot see, what we cannot prove, but what we somehow know at the deep- est level of our being. Based on my own experience, it is a continuous know- ing that once I have done all that I can do, some power greater than I—call it God, Christ, Buddha, the Light, or the Universe—will step in and carry me the rest of the way. And there must be something to it, because study after study reveals that patients with faith survive longer and better than those without. If you think you don’t have any faith, consider the ancient proverb: “When you breathe, you hope. Frankly, if you are reading this book, I’d say you still have some faith, even if it is in tatters. Finding Meaning and Purpose Through the Three Gs Most people want to know their life has meaning and purpose. Those of us with mystery maladies are being given a unique opportunity to find ours. For mystery malady patients who are physically limited in some way, we need to focus on finding purpose in things that do not require large 236 Living with Your Mystery Malady amounts of strength and physical energy. Here are my three Gs for finding meaning and purpose: Giving It is so easy to become wrapped up in yourself when you are ill. There are so many small ways to give that don’t require much except to come out of your preoccupied self-focus and be aware of others. Pay a compliment, give a smile, utter words of encour- agement, make someone a cup of tea, or laugh at someone’s joke. It is not as altruistic as it seems, because giving usually recirculates. Someone smiles back at you, returns the favor, gives you a hug, expresses their admiration. The gift of caring is the greatest gift that can be offered, and if you decide to give it, you will boost your own spirit. In so many ways, giving is putting our love into action, especially when the giving is done without expecting something in return. Somehow we find that when we give with loving intent, we actually gain self-esteem by doing something of value. Loving others becomes part of loving ourselves, and we can delight in ourselves and our relationships even though we are not feeling well physically. Even when our gifts are small because they are limited by our health, they are gifts nonetheless, and the return can be sur- prisingly big. Gratitude Sometimes it takes deprivation to really make you appreciate things—like the lyrics from an old Joni Mitchell song: “You don’t know what you got ’til it’s gone. How many people have so much and yet always have a sense of deprivation? I love how Albert Einstein put it: “There are only two ways to live your life. There is no doubt that gratitude made the difference in a study of con- centration camp prisoners. Those who stayed the healthiest had a coping style the researchers termed “the differential focus on the good. Make a list of the wonderful people, places, and things you are grateful for in your life—even your illness! Even if you are completely bedridden, you can still feel the coolness of the air conditioning in your bedroom when it is hot outside or the warmth of the central heating or fireplace when it is freezing cold beyond your walls. You can appreciate the light that streams in through your window at mid- day, the nurturing you receive from a caregiver, the music that soothes your spirit, or the television show that makes you laugh and distracts you from your illness. Enjoy the silence and stillness of the room, the comfort of the clock ticking.

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