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Carbamazepine and phenytoin are ineffective in preventing further febrile seizures order 100mg kamagra gold with mastercard. There are insufficient data on any of the newer antiepileptic drugs to justify their use in this setting at the present time generic kamagra gold 100mg on-line. Intermittent treatment with benzodiazepines given orally or rectally at time of fever reduces the risk of recurrent febrile seizures order kamagra gold 100 mg fast delivery. It must be given every time the Table 1 Treatment of the Child with Simple and Complex Febrile Seizures Chronic AEDs (phenobarbital and valproate) Not indicated Diazepam (oral or rectal) at the time of fever Not routine for simple febrile seizures Consider for complex or multiple simple febrile seizures Rectal diazepam at the time of seizure First-line therapy for prolonged febrile seizures Rapid proven kamagra gold 100 mg, simple, safe, and effective 76 Shinnar child has an intercurrent illness, which can become an issue given the frequency of febrile illnesses in early childhood. There is also the theoretical concern about seda- tion masking signs of more serious illness such as meningitis. Even when effective, it does not reduce the risk of subsequent epilepsy. Furthermore, children who have a seizure as the first manifestation of their febrile illness are both at higher risk to have another one and least likely to benefit. This treatment does have a limited role in selected cases with frequent recurrences. Data from controlled clinical trials suggest that this treatment is no more effective than placebo in prevent- ing recurrence. While antipyretics are generally benign and may make the child more comfortable, recommendations for their use should recognize their relative lack of efficacy and avoid creating undue anxiety and guilt feelings in the parents. Abortive therapy with rectal diazepam (dose based on weight) at the time of sei- zure does not alter the risk of recurrence but is effective in preventing prolonged feb- rile seizures, which are often the main concern. Children with prolonged febrile sei- zures are good candidates for this form of therapy. Rectal diazepam can also be used in cases with a high risk of recurrence, for families who live far away from medical care and for families where the parents are very anxious. In these cases it avoids the need for chronic or intermittent therapy unless a seizure actually occurs and lasts more than 5 min. In many cases, particularly those with simple febrile seizures, reassurance and education about the benign nature of the condition are all that is needed. The American Academy of Pediatrics 1999 practice parameter recommends no treatment for children with simple febrile seizures. The specific treatment option chosen depends on the goals of therapy and spe- cific features individual to each case. For simple febrile seizures, the American Acad- emy of Pediatrics recommends no treatment except reassurance; a recommendation the author fully agrees with. In parents who live far away from medical care or who are particularly anxious, a prescription for rectal diazepam may be appropriate and further minimize anxiety and risk. However, even in this setting, chronic AED therapy is very, very rarely appropriate. For children with complex febrile seizures, current therapeutic options include no treatment, which is appropriate in many cases, intermittent diazepam at the time of fever, and rectal diazepam should a seizure occur and last longer than 5 min. As treatment does not alter long-term outcome and only very prolonged febrile seizures have been causally associated with subsequent epilepsy, a rational goal of treatment would be to prevent prolonged febrile seizures. Therefore, when treatment is indicated, particularly in those at risk for prolonged or multiple febrile seizures or those who live far away from medical care, rectal diazepam used as an abortive agent at the time of seizure would seem the most logical therapeutic option. The above discussion assumes the child is not actively convulsing at the time of decision making which will be true in the vast majority of cases. If a child arrives in the emergency department in the midst of a seizure, they should be treated using the current pediatric status epilepticus protocol, which is covered in Chapter ___. A child who is in the emergency department for the evaluation of an illness and starts seizing should be managed more conservatively and only needs emergency treatment if the seizure persists beyond 5 min. The morbidity and mortality associated with febrile seizures is extremely low, even in the case of febrile status epilepticus. Several large series of febrile status epilepticus reported no deaths and no new neurological deficits following febrile status.

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For example purchase kamagra gold 100mg visa, blinding is impossible with therapies such as therapeutic massage or chiropractic treatment where there is physical contact between therapist and client (Fitter and Thomas 1997; Nahin and Straus 2001; Walker and Anderson 1999) purchase 100 mg kamagra gold free shipping. Moreover kamagra gold 100mg for sale, trials making use of placebos or shams as a control are problematic because within alternative healing paradigms cheap 100mg kamagra gold visa, placebos are “catalysts of the bioregulatory mechanisms” rather than shams (Birch 1997; Lowenberg 1992; Tonkin 1987:7, emphasis his). For instance, naturopathy, one of the therapeutic approaches used by the people who took part in this research, typically includes several alternative therapies, such as homeopathy, herbal reme- dies, massage, and yoga, as well as nutrition and lifestyle counselling, among other therapeutic modalities (Clarke 1996; Northcott 1994). An additional problem in the positivistic assessment of the efficacy of these forms of health care is that despite claims that allopathic and alternative approaches are beginning to converge, there remain irreconcilable differences between alternative and allopathic paradigms of disease and treatment. Moreover, Murphy (2000) argues that scientific research designs fail to take account of the states of mind of the client and practitioner as a form of treatment modality in and of itself, despite the fact that it is a key component of the model of alternative healing espoused by the people who took part in this research. Another potential barrier to the inclusion of these therapies within mainstream health care provision concerns their safety. Some authors warn 118 | Using Alternative Therapies: A Qualitative Analysis that all alternative and complementary therapies are potentially dangerous to the degree that they detour people away from scientifically proven medical care (Ernst 1997; Feigen and Tiver 1986; Gottlieb 2001, emphasis mine). Similarly, a great deal of the literature on the efficacy of alternative and complementary therapies is concerned with the possible dangers posed by participation in these forms of health care. In particular, there is concern over the iatrogenic potential of acupuncture as well as harmful interactions between medication and herbal remedies or vitamins (Eisenberg et al. Compounding this problem is that there is insufficient funding for such research (Tataryn and Verhoef 2001). In particular, physicians express “concern over loss of professional identity and the potential fiscal and professional impact of sharing the consumer health care market with other professions” (Tataryn and Verhoef 2001:VII. Another effect of this resistance is that physicians, in general, lack information about these therapies and are without a perspective through which to understand them (Achilles et al. While there is some recognition by medical professionals that physicians need to have at least an elementary understanding of the alternative therapies their patients use so they are better able to counsel them (Ernst 2000a), many physicians have little knowledge of these forms of health care (Balon et al. Likewise, authors argue that “the education of many complementary and alternative practitioners includes too little foundation in conventional approaches... Both physician efforts at professional boundary maintenance and their lack of knowledge about these therapies are evidenced by the lack of truly complementary health care experienced by the people I spoke with. Conclusion | 119 Furthermore, continued stigmatization of lay users of alternative therapies, including the people who took part in this research, works against inclusion and is reflective of the persistent marginal status of these forms of health care (Saks 1995). Finally, what might be the single most important factor in mitigating against inclusion of alternative and complementary therapies within Medicare is provincial and federal government concerns over costs, specifically, fears that inclusion of alternative therapies would result in “increased service options translating into escalating reimbursement and operating costs” (Tataryn and Verhoef 2001:99). This is an issue that was noted by some of the people I spoke with, among them Nora: I mean if people were using homeopathy then they’re not, I mean, I don’t and the last time I saw my doctor was two years ago. She said: ‘I wouldn’t see you as a major [cost] factor in the health care system based on the number of times you see me. I pay for them and save the medical system a huge amount of money, so do other people like myself. Putting aside the factors that work against integration of alternative with allopathic approaches, and the inclusion of alternative therapies within Medicare, both integration and inclusion would have a number of positive consequences for Canadians engaged in health-seeking behaviour. For instance, the people I spoke with would welcome inclusion of alternative therapies under public health insurance to the extent that it would help them overcome the barriers they face in accessing these forms of health care. These barriers include a lack of financial resources, a lack of information about alternative and complementary therapies, a lack of support from health care professionals, and stigma. That a lack of financial resources constrains access to these therapies is evidenced by the fact that Canadians spend between 1. A lack of information about what kinds of therapies are available is another significant barrier to access for people who would like to use alternative therapies. While some therapists are members of professional bodies and/or are listed in directories or registers, most of the alternative and complementary therapists consulted by the people who took part in this study are not. Similarly, medical and other health care professionals are unlikely to be able to provide information about these 120 | Using Alternative Therapies: A Qualitative Analysis therapies. In addition, the labelling of people who use alternative therapies as deviant both limits their access to these therapies and mitigates against achieving complementary health care. To the degree that their allopathic health care professionals collude in this labelling process, inclusion of these therapies within Canada’s mainstream health care provision would reduce the stigma associated with participation in alternative therapies and encour- age physicians to be supportive of their use, thus improving access.

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The learning outcome is generic kamagra gold 100mg without prescription, at best buy 100 mg kamagra gold with visa, a memorisation of factual information and perhaps a superficial level of understanding safe 100 mg kamagra gold. In contrast discount 100mg kamagra gold fast delivery, students adopting a deep approach are motivated by an interest in the subject matter and a need to make sense of things and to interpret knowledge. The process of achieving this varies between individual students and between students in different academic disciplines. The operation learner relies on a logical step-by-step approach with a cautious acceptance of generalisations only when based on evidence. There is an appropriate attention to factual and procedural detail which may include memorisation for understanding. On the other hand, the comprehension learner uses a process in which the initial concern is for the broad outlines of ideas and their interconnections with previous knowledge. Such students make use of analogies and attempt to give the material personal meaning. However, another process is that used by the so-called versatile learner for whom the outcome is a deep level of understanding based on a knowledge of broad principles supported by a sound factual basis. Versatile learning does not preclude the use of memorisation when the need arises, as it frequentlydoes in science-based courses, but the students do so with a totally different intent from those using the surface approach. Students demonstrating the strategic approach to learning may be seen to use processes similar to both the deep and surface learner. Such students are motivated by the need to achieve high marks and to compete with others. The outcome is a variable level of understanding that depends on what is required by the course and, particularly, the assessments. The learning outcomes can be broadly described in terms of quantity and quality of learning. The outcomes we would hope from a university or college education are very much those resulting from the deep approach. Disturbingly, the evidence we have suggests that these outcomes may not always be encouraged or achieved by students. Indeed, as we stress repeatedly, there is good reason to believe that many of our teaching approaches, curriculum structures and, particularly, our assessment methods, may be inhibiting the use of the deep approach and supporting and rewarding the use of surface or strategic approaches to learning. This appears to be particularly so for medical students undertaking traditional curricula (see article by Newble and Entwistle). NON-TRADITIONAL STUDENTS AND THEIR LEARNING Medical schools now enrol significant numbers of students who do not come directly from high school. Students from overseas and older students entering without the usual prerequisites are just two examples of what we might call ‘non-traditionalstudents’ in medical education. There has been something of an explosion in the research and writing about such students and their learning. In broad terms, it is showing us that any so-called ‘problems’ with these students are often the result of ill-informed attitudes and educational practices, in short, a result of poor teaching. This confirms the importance of creating a positive learning environment rather than seeking fault with students. Students from different cultural backgrounds One thing we are sure you will have noticed in your institution or from your reading is that stereotypes are attached to students from different cultural backgrounds. One of these stereotypes is that students, particularly those 5 from Asia, are rote learners. Yet many studies have shown that these students score at least as well and sometimes higher than western students on measures of deep learning. You may also have noticed how there seems to be a disproportionate number of these Asian students who receive academic distinctions and prizes! This apparent ‘paradox’ – adopting surface approaches such as rote learning but demonstrating high achievement in academic courses – has been the subject of much investigation. What is emerging is that researchers have assumed that memorisation was equated with mechanical rote learning. It is intertwined with understanding such as when you might rote learn a poem to assist in the processes of interpretation and understanding. Thus the traditional Confucianheritage way of memorisation can have different purposes.

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