We sell nutritional supplements in our viagra cialis online pharmacy pharmacy health store and from time to time I get questions about how big the tablets are. This sort of query comes from someone who has difficulty taking tablets.
Of course, it is possible to cut most tablets in half, but that’s a bit laborious and you can end up with bits of tablet flying all over your kitchen.
A different approach is looking at it from a psychological angle. Most people who say they cannot swallow big tablets can swallow a large piece of pizza crust (for example), so I tell them to think about that when they are attempting to swallow a tablet – to tell themselves it is no different from swallowing a large piece of food. Some people find this trick really helps.
Tuesday, 1 November 2011
Saturday, 29 October 2011
Medicine, science, and humanities: what is their role in medical education?
Medicine, science, and humanities: what is their role in medical education?
.
How much of the practice of online pharmacy viagra is “science”? How much science, as in “how many science courses” should be required of students applying to medical school? How much science must be taught to students once they are in medical school? To what degree does this require the memorization of mountains of facts as opposed to learning to and practicing the scientific approach to thinking and problem solving and analyzing data? What about other material that might help in being an effective physician…the social sciences of psychology, anthropology, sociology, or the broader content of a “liberal” education such as literature, history, philosophy, foreign languages? Is there a place for these in medicine? Is there a need for these in medicine? If there is, what is the best way to ensure that students acquire the knowledge, both temporally (prerequisites or in medical school) and pedagogically?
These questions are important to medical educators, and to students planning to apply to medical school, as well as “pre-med” advisors in colleges. Most medical school faculty are physicians or “basic scientists” (physiologist, biochemists, anatomists, pharmacologists, neuroscientist and those straddling the disciplines or creating new ones). There are usually a few social scientists, especially epidemiologists and psychologists, based in departments of preventive medicine, community medicine, and public health, and psychiatry. There are also likely to be a small number of people with degrees in education (largely in the office of medical education), and in humanities (frequently involved in teaching ethics, the branch of humanities most commonly taught in medical school). In general, the basic science faculty believe that the material they teach is crucial to the creation of competent physicians, while clinicians range from agreement (perhaps less passionate) to a belief that they don’t use or remember much of the biological sciences that they had to learn, and the main thing students need to do is to get through it, pass “Part I” (of the US Medical Licensing Examination, USMLE, which emphasizes basic science and is usually taken after the first two years of medical school), and get on to the “important stuff”, their clinical education and training.
Occasionally, the faculty even engage in in-depth discussion and analysis of how the material is taught; whether intensive study of sciences in the first two years of medical school tested by recall of facts on examinations is the best way to learn – and retain so that it can be used years later in clinical work – the content. Many, if not most, schools, have gone to some form of “integrated” curriculum in the first two years, most often based on organ systems, teaching the aspects of each of the basic sciences relevant to that system, mixed in with clinical perspectives, epidemiology, ethics, and social determinants of health. Most have decreased the number of hours of lecture and increased small-group learning, including Problem-Based Learning (PBL) in which groups of students review a patient case, with a facilitator, with the goal of learning how to approach thinking about a patient and their problems and how to work with not only their disease but with them, in all of complexities of life that they face. Some schools, such as the new Paul L. Foster Texas Tech medical school at El Paso, spent over a year with educators, clinicians, and basic scientists poring over every piece of the curriculum and how it would be delivered and reinforced, before admitting their first class.
I have often written about who does, or should, get into medical school, particularly in the context of predicting specialty choice for primary care (e.g., Medical Student Selection, December 14, 2008; Are we training physicians to be empathic? Apparently not., September 12 2009). A recent article in Academic Medicine, “Challenging Traditional Premedical Requirements as Predictors of Success in Medical School: The Mount Sinai School of Medicine Humanities and Medicine Program”[1] by David Muller and Nathan Kase, looked at the performance of students who were taken in a special program that did not have science requirements with that of “traditionally prepared” students. Their conclusion is that “Students without the traditional premedical preparation performed at a level equivalent to their premedical classmates.” Of course, there were some differences; they performed a little worse (statistically significantly, but still well) on the USMLE Part I. They performed better on their psychiatry clinical clerkship, and not significantly better or worse on their other clerkships. The success of the students in this program (“HuMed”) was great enough that more students who were not science (or “pre-med”) majors were accepted by Mt. Sinai outside the program; nationally, 18% of students matriculating in medical school in 2009 were humanities and social science majors while at Mt. Sinai it was 25% without HuMed students and 43% counting them. There are a lot of caveats: the HuMed program offered (voluntary) pre-matriculation introductions to organic and biochemistry, and the HuMed students were all very high performers in their areas of college study. Perhaps it means that if you are a very smart – and skilled, for being a successful student is a skill – student you can make it in medical school even without lots of premedical science, but if you are not, the science helps.
This article does not answer this question, but it did receive significant national coverage. The New York Times article by Anemona Hartocollis on July 29, 2010, “Getting into med school without hard science”, generated many blog comments and letters. One, by a Mills College professor of chemistry and physics, David Keeports, notes that “Many people have great personalities, but medicine is a science. A person who has avoided fundamental scientific and mathematical knowledge and the scientific approach to problem solving isn’t the person I want to see when I have a medical problem.” Well, he is a physical science professor, and maybe not representative of the entire population, most of whom really value the ability of a doctor to successfully communicate with him. More important, however, is his comment, that “I see no place in medical school for anyone who hasn’t demonstrated an ability to easily learn, assimilate and analyze technical information.” I agree with that completely; I have frequently written about the need to understand the scientific approach and thought process. I believe that the most important of these is epidemiology (listed above as a social science). It is critical that physicians are able to understand and interpret the data coming from scientific studies, and be able to explain it effectively to their patients. This is, however, different from being required to memorize huge numbers of facts that you will forget soon after the exam, and not miss later.
Because the amount of scientific information continues to increase, and because much of it renders what we used to “know” incorrect, medical school faculties should be able to identify what pieces of factual information a student really needs to know to become a doctor and to be able to think scientifically, identify how to effectively teach it and measure learning, and tie that to the skills that a practicing physician will need. The concept of “competency based education”, rather than an education devoted to learning and regurgitating content, has been around for a long time. One of the best publications on competency-based medical education was published by the World Health Organization (WHO) in 1978, and examine such education from an international perspective. Competency-Based Curriculum Development in Medical Education. An Introduction. Public Health Papers No. 68., by WC McGaghie, GE Miller, AW Sajid and TV Telder provides guidelines for effective teaching and learning in medicine that are as valuable, and as needed, today as they were more than 30 years ago when it was written. They argue against teaching a course (say, in the first year of medical school) and expecting that the material learned will be remembered and usable in future years. They note that only a small portion of what is learned in a course is remembered only a few years later if it is not used. I would add that the material that is remembered is less likely to be that which the student will need in the future than that which was so counter-intuitive that it took many hours of rote memorization. They argue for a curriculum that teaches relevant material, and effective ways of thinking, in the context in which it will be used, and teaching and measuring competency rather than memory.
Too much of medical education is driven by inertia and vested interest, e.g., these are the kind of students we’ve always taken, this is the material we’ve always taught, this is the way we’ve always taught it, this is the way we’ve always measured it, and (surprise!) the kind of students we’ve always taken are those who do best on the tests that we give which measure retention of what we’ve taught the way we taught it. Rather, we should start from the other end: what kinds of doctors do we want and need, what set of skills and knowledge do we want them to have? Then we need to figure out what characteristics of incoming students (personality, knowledge, and life experience) are most likely to make them become those kind of doctors (input variables), and what content and educational methods will me most effective in helping them to learn the skills they will need (process variables). This makes a lot of sense, but it can challenge existing models of who teaches, how they are reimbursed, and who gets in to school.
Maybe models such as those of Mt. Sinai and Paul L. Foster schools of medicine will help lead the way. But we all need all medical schools to move into the modern era, of identifying societal needs, what their graduates need to look like to meet those needs, and measuring the degree to which these outcomes are achieved.
[1] Muller D, Kase N, “Challenging Traditional Premedical Requirements as Predictors of Success in Medical School: The Mount Sinai School of Medicine Humanities and Medicine Program”, Acad Med Aug 2010;85(8):1378-83.
.
.
How much of the practice of online pharmacy viagra is “science”? How much science, as in “how many science courses” should be required of students applying to medical school? How much science must be taught to students once they are in medical school? To what degree does this require the memorization of mountains of facts as opposed to learning to and practicing the scientific approach to thinking and problem solving and analyzing data? What about other material that might help in being an effective physician…the social sciences of psychology, anthropology, sociology, or the broader content of a “liberal” education such as literature, history, philosophy, foreign languages? Is there a place for these in medicine? Is there a need for these in medicine? If there is, what is the best way to ensure that students acquire the knowledge, both temporally (prerequisites or in medical school) and pedagogically?
These questions are important to medical educators, and to students planning to apply to medical school, as well as “pre-med” advisors in colleges. Most medical school faculty are physicians or “basic scientists” (physiologist, biochemists, anatomists, pharmacologists, neuroscientist and those straddling the disciplines or creating new ones). There are usually a few social scientists, especially epidemiologists and psychologists, based in departments of preventive medicine, community medicine, and public health, and psychiatry. There are also likely to be a small number of people with degrees in education (largely in the office of medical education), and in humanities (frequently involved in teaching ethics, the branch of humanities most commonly taught in medical school). In general, the basic science faculty believe that the material they teach is crucial to the creation of competent physicians, while clinicians range from agreement (perhaps less passionate) to a belief that they don’t use or remember much of the biological sciences that they had to learn, and the main thing students need to do is to get through it, pass “Part I” (of the US Medical Licensing Examination, USMLE, which emphasizes basic science and is usually taken after the first two years of medical school), and get on to the “important stuff”, their clinical education and training.
Occasionally, the faculty even engage in in-depth discussion and analysis of how the material is taught; whether intensive study of sciences in the first two years of medical school tested by recall of facts on examinations is the best way to learn – and retain so that it can be used years later in clinical work – the content. Many, if not most, schools, have gone to some form of “integrated” curriculum in the first two years, most often based on organ systems, teaching the aspects of each of the basic sciences relevant to that system, mixed in with clinical perspectives, epidemiology, ethics, and social determinants of health. Most have decreased the number of hours of lecture and increased small-group learning, including Problem-Based Learning (PBL) in which groups of students review a patient case, with a facilitator, with the goal of learning how to approach thinking about a patient and their problems and how to work with not only their disease but with them, in all of complexities of life that they face. Some schools, such as the new Paul L. Foster Texas Tech medical school at El Paso, spent over a year with educators, clinicians, and basic scientists poring over every piece of the curriculum and how it would be delivered and reinforced, before admitting their first class.
I have often written about who does, or should, get into medical school, particularly in the context of predicting specialty choice for primary care (e.g., Medical Student Selection, December 14, 2008; Are we training physicians to be empathic? Apparently not., September 12 2009). A recent article in Academic Medicine, “Challenging Traditional Premedical Requirements as Predictors of Success in Medical School: The Mount Sinai School of Medicine Humanities and Medicine Program”[1] by David Muller and Nathan Kase, looked at the performance of students who were taken in a special program that did not have science requirements with that of “traditionally prepared” students. Their conclusion is that “Students without the traditional premedical preparation performed at a level equivalent to their premedical classmates.” Of course, there were some differences; they performed a little worse (statistically significantly, but still well) on the USMLE Part I. They performed better on their psychiatry clinical clerkship, and not significantly better or worse on their other clerkships. The success of the students in this program (“HuMed”) was great enough that more students who were not science (or “pre-med”) majors were accepted by Mt. Sinai outside the program; nationally, 18% of students matriculating in medical school in 2009 were humanities and social science majors while at Mt. Sinai it was 25% without HuMed students and 43% counting them. There are a lot of caveats: the HuMed program offered (voluntary) pre-matriculation introductions to organic and biochemistry, and the HuMed students were all very high performers in their areas of college study. Perhaps it means that if you are a very smart – and skilled, for being a successful student is a skill – student you can make it in medical school even without lots of premedical science, but if you are not, the science helps.
This article does not answer this question, but it did receive significant national coverage. The New York Times article by Anemona Hartocollis on July 29, 2010, “Getting into med school without hard science”, generated many blog comments and letters. One, by a Mills College professor of chemistry and physics, David Keeports, notes that “Many people have great personalities, but medicine is a science. A person who has avoided fundamental scientific and mathematical knowledge and the scientific approach to problem solving isn’t the person I want to see when I have a medical problem.” Well, he is a physical science professor, and maybe not representative of the entire population, most of whom really value the ability of a doctor to successfully communicate with him. More important, however, is his comment, that “I see no place in medical school for anyone who hasn’t demonstrated an ability to easily learn, assimilate and analyze technical information.” I agree with that completely; I have frequently written about the need to understand the scientific approach and thought process. I believe that the most important of these is epidemiology (listed above as a social science). It is critical that physicians are able to understand and interpret the data coming from scientific studies, and be able to explain it effectively to their patients. This is, however, different from being required to memorize huge numbers of facts that you will forget soon after the exam, and not miss later.
Because the amount of scientific information continues to increase, and because much of it renders what we used to “know” incorrect, medical school faculties should be able to identify what pieces of factual information a student really needs to know to become a doctor and to be able to think scientifically, identify how to effectively teach it and measure learning, and tie that to the skills that a practicing physician will need. The concept of “competency based education”, rather than an education devoted to learning and regurgitating content, has been around for a long time. One of the best publications on competency-based medical education was published by the World Health Organization (WHO) in 1978, and examine such education from an international perspective. Competency-Based Curriculum Development in Medical Education. An Introduction. Public Health Papers No. 68., by WC McGaghie, GE Miller, AW Sajid and TV Telder provides guidelines for effective teaching and learning in medicine that are as valuable, and as needed, today as they were more than 30 years ago when it was written. They argue against teaching a course (say, in the first year of medical school) and expecting that the material learned will be remembered and usable in future years. They note that only a small portion of what is learned in a course is remembered only a few years later if it is not used. I would add that the material that is remembered is less likely to be that which the student will need in the future than that which was so counter-intuitive that it took many hours of rote memorization. They argue for a curriculum that teaches relevant material, and effective ways of thinking, in the context in which it will be used, and teaching and measuring competency rather than memory.
Too much of medical education is driven by inertia and vested interest, e.g., these are the kind of students we’ve always taken, this is the material we’ve always taught, this is the way we’ve always taught it, this is the way we’ve always measured it, and (surprise!) the kind of students we’ve always taken are those who do best on the tests that we give which measure retention of what we’ve taught the way we taught it. Rather, we should start from the other end: what kinds of doctors do we want and need, what set of skills and knowledge do we want them to have? Then we need to figure out what characteristics of incoming students (personality, knowledge, and life experience) are most likely to make them become those kind of doctors (input variables), and what content and educational methods will me most effective in helping them to learn the skills they will need (process variables). This makes a lot of sense, but it can challenge existing models of who teaches, how they are reimbursed, and who gets in to school.
Maybe models such as those of Mt. Sinai and Paul L. Foster schools of medicine will help lead the way. But we all need all medical schools to move into the modern era, of identifying societal needs, what their graduates need to look like to meet those needs, and measuring the degree to which these outcomes are achieved.
[1] Muller D, Kase N, “Challenging Traditional Premedical Requirements as Predictors of Success in Medical School: The Mount Sinai School of Medicine Humanities and Medicine Program”, Acad Med Aug 2010;85(8):1378-83.
.
Tuesday, 3 May 2011
Finding the right depression medication
by free.article
Photo: ehow.com
Always feeling under the weather? Always not in the mood to be around others and have a good time? If you’re suffering from prolonged sadness for quite some time now, you should face these bouts of depression and get yourself diagnosed by a psychiatrist, they’re doctors who can actually help you out with your problem. Not to mention the various depression treatments, as well as all sorts of depression purchase cialis that doctors prescribe to their depression patients.
Fortunately depression can now be cured, especially when diagnosed early, depressed individuals can actually be treated through therapy and depression cheap cialis, although it may be a bit costly, a person’s good mental health is something that shouldn’t be scrimped on. Cognitive behavioral talk or interpersonal talk are incredibly healthy depression treatments that are just some of the available psychosocial depression treatments that cognitive behavior therapists can offer to their patients, both actually prove to be able to produce fruitful and positive results even for just short-term sessions, around ten to twenty weeks are almost always, already enough to get a depression patient slowly begin their recovery towards a sound mental health.
Before getting started with depression medication, the depression patient must first get him or herself to a reputable doctor, get a diagnosis of which type of depression the patient is actually suffering from, may it be clinical depression, manic depression or what-have-you. It’s best that you’re sure what you’re actually dealing with since there are various depression medications that are available in the market, you should make sure that you get the most appropriate one, the one that’ll actually cure your depression illness.
There’s actually a wide variety of anti-depressant depression medications available to help treat those who are suffering from depressive disorders. The more popular ones are those that are of the selective serotonin reuptake inhibitors or SSRIs variant then there are the tricyclics while the other popular variant is the monoamine oxidase inhibitors or MAOIs. These depression medications (the SSRIs variant as well as the other newer depression medication available in the market) actually to be a much safer alternative than the tricyclics, since they have fewer side-effects as opposed to the tricyclics depression medication variant.
Sometimes, doctors actually find it more effective to mix up these depression medications, depending on the needs of the individual, the doctor might actually prescribed a variety of depression medication to help cure one’s depression illness. Also the dosages of depression medication can actually be increased or lowered depending on what the doctor finds to be the most effective. However, when it comes to taking these depression medications, patients are highly advised to never mix up depression medications as well as pick out which dosages to take without consulting their doctors first.
Anti-anxiety or sedatives however, should never be mistaken as depression medication. Even though these anti-anxiety drugs are often prescribed along with depression medication, they don’t actually help cure one’s depression illness. Their mere purpose is to help calm one’s nerves which is why depression medications are still needed to be taken by the depression patient.
There are actually some common side-effects from depression medication, usually coming from the tricyclic variety. Some people tend to not mind these side-effects from depression medication, however if it does become to much of a bother and may end up ruining one’s ability to function properly, it’s best to go immediately to your doctor and report the side-effects. Quite common side-effects from depression medication are the following:
Dry mouth: always having the irritating feeling of being hydrated, it’s best to always have some (clean, drinking) water nearby so as to have something to drink whenever dry mouth occurs, chewing sugar free gum as well as brushing your teeth after every meal is also a good idea.
Constipation: cure such discomfort by eating and taking in a lot of fiber to help aid your digestion.
Blurry vision: another temporary side-effect, this one’s quite easy to pass but if it proves to be too much of a bother, consult your doctor immediately.
Headaches: quite common with the newer kinds of depression medication, it’s really not a big deal and will actually go away easily.
Insomnia: first-time users may actually experience this depression medication side-effect but it usually just happens during the first few weeks of taking the depression medication, asking your doctor to lower the dosage of the depression medication may actually help you with this side-effect, as well as the time of day wherein you take your depression medication can actually have something to do with your sleeping problem.
Source: ArticleTrader.com
Photo: ehow.com
Always feeling under the weather? Always not in the mood to be around others and have a good time? If you’re suffering from prolonged sadness for quite some time now, you should face these bouts of depression and get yourself diagnosed by a psychiatrist, they’re doctors who can actually help you out with your problem. Not to mention the various depression treatments, as well as all sorts of depression purchase cialis that doctors prescribe to their depression patients.
Fortunately depression can now be cured, especially when diagnosed early, depressed individuals can actually be treated through therapy and depression cheap cialis, although it may be a bit costly, a person’s good mental health is something that shouldn’t be scrimped on. Cognitive behavioral talk or interpersonal talk are incredibly healthy depression treatments that are just some of the available psychosocial depression treatments that cognitive behavior therapists can offer to their patients, both actually prove to be able to produce fruitful and positive results even for just short-term sessions, around ten to twenty weeks are almost always, already enough to get a depression patient slowly begin their recovery towards a sound mental health.
Before getting started with depression medication, the depression patient must first get him or herself to a reputable doctor, get a diagnosis of which type of depression the patient is actually suffering from, may it be clinical depression, manic depression or what-have-you. It’s best that you’re sure what you’re actually dealing with since there are various depression medications that are available in the market, you should make sure that you get the most appropriate one, the one that’ll actually cure your depression illness.
There’s actually a wide variety of anti-depressant depression medications available to help treat those who are suffering from depressive disorders. The more popular ones are those that are of the selective serotonin reuptake inhibitors or SSRIs variant then there are the tricyclics while the other popular variant is the monoamine oxidase inhibitors or MAOIs. These depression medications (the SSRIs variant as well as the other newer depression medication available in the market) actually to be a much safer alternative than the tricyclics, since they have fewer side-effects as opposed to the tricyclics depression medication variant.
Sometimes, doctors actually find it more effective to mix up these depression medications, depending on the needs of the individual, the doctor might actually prescribed a variety of depression medication to help cure one’s depression illness. Also the dosages of depression medication can actually be increased or lowered depending on what the doctor finds to be the most effective. However, when it comes to taking these depression medications, patients are highly advised to never mix up depression medications as well as pick out which dosages to take without consulting their doctors first.
Anti-anxiety or sedatives however, should never be mistaken as depression medication. Even though these anti-anxiety drugs are often prescribed along with depression medication, they don’t actually help cure one’s depression illness. Their mere purpose is to help calm one’s nerves which is why depression medications are still needed to be taken by the depression patient.
There are actually some common side-effects from depression medication, usually coming from the tricyclic variety. Some people tend to not mind these side-effects from depression medication, however if it does become to much of a bother and may end up ruining one’s ability to function properly, it’s best to go immediately to your doctor and report the side-effects. Quite common side-effects from depression medication are the following:
Dry mouth: always having the irritating feeling of being hydrated, it’s best to always have some (clean, drinking) water nearby so as to have something to drink whenever dry mouth occurs, chewing sugar free gum as well as brushing your teeth after every meal is also a good idea.
Constipation: cure such discomfort by eating and taking in a lot of fiber to help aid your digestion.
Blurry vision: another temporary side-effect, this one’s quite easy to pass but if it proves to be too much of a bother, consult your doctor immediately.
Headaches: quite common with the newer kinds of depression medication, it’s really not a big deal and will actually go away easily.
Insomnia: first-time users may actually experience this depression medication side-effect but it usually just happens during the first few weeks of taking the depression medication, asking your doctor to lower the dosage of the depression medication may actually help you with this side-effect, as well as the time of day wherein you take your depression medication can actually have something to do with your sleeping problem.
We provide free articles and information. Check us out at Free Articles
Source: ArticleTrader.com
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قرص تاخیری وگادول ، تادالاÙیل Ùˆ سیلدناÙیل (ویاگرا)
اÙزایش هنده میل جنسی وبرقرارکننده سخت ترین Ùˆ مداومترین Øالت نعوظ Ú©Ù‡ لذت جنسی را به Øداکثر مقدار ممکن میرساند .
قرص تاخیری وگادول ، تادالاÙیل Ùˆ سیلدناÙیل (ویاگرا)
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قرص ترکیبی وگادول (سيلدناÙيل Ùˆ ترامادول) Øاوی 100 میلی گرم سيلدناÙيل Ùˆ 50 میلی گرم ترامادول
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تاخیری قوی و جلوگیری از انزال زودرس
اÙزایش هنده میل جنسی وبرقرارکننده سخت ترین Ùˆ مداومترین Øالت نعوظ Ú©Ù‡ لذت جنسی را به Øداکثر مقدار ممکن میرساند .
در Øالت Ú©Ù„ÛŒ در هر سه قرص، یک قرص 100 ميلي گرم Ùˆ يك ساعت قبل از نزديكي بايد مصر٠شود.
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