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By P. Mason. The American College.

This situation requires policymak- ers and practitioners to be more aware of emerging trends in drug use and to have mechanisms in place to detect and diagnose a wider range of substances used discount 37.5 mg effexor xr with visa. Furthermore buy 150mg effexor xr with visa, there is a need to develop guidelines that are science-based for pharmacologically assisted treatment and behavioural therapies for treating people suffering from drug use dis- orders as a result of multiple drug use discount effexor xr 150 mg visa. Legislation effexor xr 37.5 mg free shipping, technical assistance and capacity building are key for dealing with the growing importance of the “dark net” Law enforcement and the criminal justice system in many countries are still not in a position to deal effectively with the anonymous online marketplace known as the “dark net”. In the absence of recent survey data on drug use in Africa, experts Overall drug use remains stable in the region also perceive an increase in cannabis use. Although trends in drug use vary across regions, as does trend in the use of amphetamines is stable, although this updated reporting on data, the extent of drug use among may underplay the situation in regions where recent infor- the world population has remained stable over the past mation on the extent of drug use is unavailable. Almost 12 per cent of the total number of particularly the case in Asia, where expert perceptions of people who use drugs, or over 29 million people, are esti- trends and treatment admission reports suggest an increase mated to suffer from drug use disorders. Cannabis remains the world’s most widely used drug, with an estimated 183 million people having used the drug in The global picture of drug use is compounded by the fact 2014, and amphetamines remain the second most widely that many people who use drugs, both occasionally and used drug. With an estimated 33 million users, the use of regularly, tend to be polydrug users,1, 2 meaning that they opiates and prescription opioids may not be as widespread use more than one substance concurrently or sequentially, as the use of cannabis, but opioids remain major drugs of usually with the intention of enhancing, potentiating or potential harm and health consequences. Note: Estimated percentage of adults (ages 15-64) who used drugs in the past year. Con- and problem drug use refect the best available information tinuing to use a drug is considered a conditioned response in 2014, and changes compared with previous years largely refect information updated by 20 countries, mostly in North to the positive reinforcement that the person receives as a result of using the drug. The concept of problem ence, which is characterized by, among other things, the drug use has been used in prior editions of the World Drug desire and compulsion to use drugs despite evidence of Report as a proxy for estimating the number of people with drug use disorders. In 2014, the estimated number of problem harmful consequences, the development of tolerance — drug users increased by 2 million over the previous year, which by increasing the quantity of the drug or drugs to achieve refects an increase in the estimated number of opiate users the same effects and a state of withdrawal — and the nega- in North America and Western and Central Europe, as well tive consequences experienced when the person stops using as in the total number of users of cocaine, amphetamines 9 the drug or drugs. Drugs taken together can have a cumulative or synergistic effect, which increases the overall psychoactive experience; the distinction between users of a particular drug, present- that is one way in which drug users may address the devel- ing an interlinked or cyclical epidemic of drug use and opment of tolerance. Additionally, tolerance” — the pharmacological ability of one drug to such a pattern of drug use presents challenges to health have generally the same effect on the nervous system as professionals responding to emergencies related to drug another drug. The phenomenon of cross-tolerance explains use, as well as to those treating people with disorders in part the frequent substitution of drugs that have a similar related to the use of multiple drugs. Examples of such patterns of drug use include the use of alcohol with benzodiazepines, cannabis or cocaine; Recent trends in polydrug use and concurrent use of heroin, benzodiazepines and antihista- substitution between drugs mines; the use of alcohol or other opioids (methadone, Polydrug use encompasses wide variations in patterns of fentanyl etc. One stimulants such as cocaine and amphetamines is fairly such pattern is “speedballing” — when cocaine is injected common and has been widely reported. Findings from a cohort of regular heroin and methampheta- mine injectors in Melbourne, Australia”, International Journal of 12 Charles P. Bicket, “Poly drug use in heroin 13 Vanderplasschen and others, “Poly substance use and mental health” addicts: a behavioral economic analysis”, Addiction, vol. Landry, Understanding Drugs of Abuse: The Processes of 15 Francesco Leri, Jule Bruneau and Jane Stewart, “Understanding Addiction, Treatment and Recovery (Arlington, Virginia, American polydrug use: review of heroin and cocaine co-use” Addiction, vol. Note: The information presented in the map is for 2014 or the latest year since 2010 for which the information is available. The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. A dispute exists between the Governments of Argentina and the United Kingdom of Great Britain and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas). For example, a study showed that an the high prevalence and associated morbidity and mortal- increase in the price of heroin resulted in an increase in 20 ity of the non-medical use of prescription opioids have benzodiazepine and cocaine purchases. In another study, 22 become a major public health issue, a recent increase in cross-price elasticity analysis showed that in the case of heroin use has triggered a sharp increase in heroin-related heroin there was significant substitution with prescription 23, 24 overdose deaths. Several aspects have driven this 16 Jenny Chalmers, Deborah Bradford and Craig Jones, “The effect of 21 Chalmers and others, “The effect of methamphetamine and heroin methamphetamine and heroin price on polydrug use: a behavioural price on poly drug use” (see footnote 16). Bald- win, “Relationship between nonmedical prescription-opioid use 17 Horyniak and others, “How do drug market changes affect charac- and heroin use”, New England Journal of Medicine, vol. The Cannabis use in the past yearCocaine use in the past year highest rate of past-year heroin use was among cocaine users (91. Nine Cocaine use in the past yearNon-medical use of opioid painkillers in out of 10 people who used heroin self-reported co-use of Cannabis use in the past yearNon-medical use of opioid painkillers inthe past year heroin with at least one other drug, and most used heroin Non-medical use of opioid painkillers inthe past yearNon-medical use of other prescription Cocaine use in the past yearthe past yearNon-medical use of other prescriptiondrugs in the past year 25 Ibid. Non-medical use of other prescriptiondrugs in the past year Source: Christopher M. Jones and others, “Vital signs: demo- 26 Compton and others, “Relationship between nonmedical prescrip- graphic and substance use trends among heroin users – UnitedNon-medical use of opioid painkillers indrugs in the past year tion” (see footnote 22). Non-medical use of other prescription extent of heroin use and are an underestimation. Nevertheless, in drugs in the past year the absence of other trend data, this is used to inform the trends in with at least three other drugs. Jones and others, “Vital signs: demographic and the country (United States, Drug Enforcement Administration, substance use trends among heroin users – United States, 2002- National Drug Threat Assessment Summary (October 2015). Ever injected heroin Ever injected opioid pain relievers In Hungary, in the period 2009-2012 a shortage of heroin and an increase in local availability of synthetic cathinones Source: Christopher M. Those reporting non-medical use of prescription opioids for over 100 days in the past year were 40 nearly eight times more likely to report dependence on heroin than those who reported less frequent non-medical 20 use of prescription opioids. Nevertheless, given the large number Amphetamine of non-medical users of prescription opioids, even a small Heroin proportion who switch to heroin use has translated into a Source: Anna Péterfi and others, “Changes in patterns of injecting much higher number of people using heroin. Analysis suggests that the problem of opioid use is not substance-specific and requires holistic approaches to 34 Compton and others, “Relationship between nonmedical address the interconnected epidemic through prevention prescription opioids use” (see footnote 22). Findings from a cohort of regular In Australia, the heroin market changed considerably after heroin and methamphetamine injectors in Melbourne, Australia”, 2000; heroin went from being highly accessible (cheap, International Journal of Drug Policy, vol. The change resulted in a decrease between November 2008 and March 2010, examined the in the prevalence and frequency of injecting heroin, as well impact that the changing market dynamics might have had as a decline in adverse health consequences related to 42 39 on drug use patterns. Also, a combination of heroin and 38 Horyniak and others, “How do drug market changes affect charac- methamphetamine was more commonly used by current teristics of injecting initiation and subsequent patterns of drug use? This practice has been reported particularly nature, as well as a latent indicator, of trends in drug use among marginalized migrant subpopulations of persons resulting in severe health consequences. In 2013, almost 71 per cent of clients in treat- Opioids stand out as a major drug of concern in North ment reported having used more than one substance, with America, Europe (particularly Eastern and South-Eastern polydrug use being more common among cocaine (80 per Europe) and Asia. Misuse of prescrip- nearly three out of every four people in treatment for drug tion drugs and use of cannabis and cocaine were most use disorders are treated for opioid use. The number of frequently reported among users of opioids, while primary people in treatment for cocaine use disorders remains quite cocaine users more frequently reported use of cannabis high in Latin America and the Caribbean, where nearly and opioids. Treatment related to cannabis use users in the Islamic Republic of Iran disorders is more prominent in Africa and Oceania than in other regions. This may be related to the limited treat- In the Islamic Republic of Iran, where opiates remain the ment options for users of other drugs in Africa, where main drug consumed by problem drug users, metham- nearly half of all admissions to treatment for drug use dis- phetamine use has emerged as another drug of concern in orders are for the use of non-specified substances, which recent years. Methamphetamine use has also been masks the true extent of the use of drugs of concern other described as a new form of polydrug use among opiate than cannabis. For example, a for disorders related to the use of amphetamines has been study at an opioid substitution treatment clinic in Zahedan increasing in Asia, half of the people in treatment for drug Province showed that methamphetamine use among use in the region are treated for opioid use disorders.

Keep your back aligned generic effexor xr 37.5 mg online, your abdominal muscles contracted order 75mg effexor xr amex, buttocks tucked in effexor xr 75mg, and knees aligned over the feet generic effexor xr 150 mg mastercard. When you are starting a new program, have someone else watch you to make sure your position is correct throughout your workout. These call for gradual stretching throughout a muscle’s full range of movement until you feel resistance. Wearing improper or worn-out shoes places added stress on your hips, knees, ankles, and feet, where up to 90 percent of all sports injuries occur. Aerobics instructors suffer injuries to their bodies because of the repetitive, jarring movements of some routines. Substitute the marching or gliding movements of low-impact aerobics for the jolting up-and-down motion of typical aerobics routines. Slowly jog for five minutes, even in place if need be, before your workout to gradually increase your heart rate, and core and muscle temperatures. This is particularly important in hot weather, when you can easily lose more than a quart of water in an hour. Even after you have a well-established exercise program, there will be interruptions. You may be ill, you may be in a setting where it is difficult to exercise, shipboard duties may take precedence over leisure activities, or you may sustain an injury. The general rule is that it will take as long to get back to your previous level of activity as you were out. If you cannot exercise for two weeks, gradually increase your activity over a two-week period to get back to your previous level. After your exercise program is established, make sure that it becomes a habit you want to continue for a long time. In 1980 the United States Department of Agriculture and the United States Department of Health and Human Services first issued Nutrition and Your Health: Dietary Guidelines for Americans to provide practical dietary advice based on current research. In addition, the Dietary Guidelines Advisory Committee was established to incorporate new scientific data, and to update the guidelines. The latest revision of the Dietary Guidelines for Americans provides the basis for all Federal nutrition information and education programs for healthy Americans. They are for healthy people two years of age and over, and are not for people who need special diets because of disease and conditions that interfere with normal nutrition. Generally, these guidelines can be followed for a short period of time by people with chronic diseases until more specific advice can be 6-6 obtained from a Registered Dietitian. If one occasionally eats foods that are higher in fat, sugars, or sodium, balance them during the day with other foods that are lower. These Guidelines offer tips for helping to choose foods for a healthful diet: Eat a variety of foods. The nutrients should come from a variety of foods, not from a few highly fortified foods or supplements. A varied diet is defined below by the Food Guide Pyramid with suggested numbers of servings from vegetables, fruits, grain products, dairy products and meat/meat substitutes. A "healthy" body weight depends on the percentage of body weight as fat, the location of fat deposition, and the existence of any weight-related medical problems. However, using tables with suggested weight-for-height-and-age is a popular method of estimating recommended body weight. A number of studies suggest a possible association between excess body weight and several cancers including breast, uterine, colon, gallbladder, and prostate. Of all the dietary factors thought to affect cancer, fat has been the subject of the most research. Substantial evidence suggests that excessive fat intake increases the risk of developing cancers of the breast, colon, and prostate. The National Cancer Institute and National Cholesterol Education Program recommend reducing total fat intake to 30% or less of total calorie intake. This level of fat intake can be achieved by a change in eating habits and is also an effective way to reduce total calories. Consuming more vegetables, fruits, breads, cereals, potatoes, pasta, rice, and dry beans and peas are emphasized especially for their complex carbohydrates, dietary fiber, and other components linked to good health. Some of the benefits from a high fiber diet may be from the food that provides the fiber, not from fiber alone, so fiber from foods is recommended over fiber obtained from supplements. Limit all sugars table sugar, brown sugar, corn sweeteners, syrups, honey, and molasses. Limit the foods high in sugars, such as prepared baked goods, candies, sweet desserts, soft drinks, and fruit-flavored punches. Eat fresh fruits, unsweetened frozen fruits, or canned fruits packed in water, juice, or light syrup. Limit use of high-sodium condiments (soy sauce, steak sauce, catsup), pickles and relishes, and salty snacks. Use only moderate amounts of cured or processed meats, most canned vegetables and soups. A reduction in salt (and sodium) intake will benefit those people whose blood pressure rises with salt intake. Drinking alcoholic beverages has few, if any, net health benefits and is linked to many health problems and accidents. Therefore, individuals who drink alcoholic beverages are advised to use moderation. Moderate drinking is defined as no more than one drink per day for women and two drinks per day for men. Heavy drinkers are at increased risk for various cancers such as oral cavity, larynx, and esophagus. Pregnant women should completely avoid alcoholic beverages throughout their pregnancy. Coordination and judgment are reduced by alcohol; this can lead to serious falls and on-the-job injuries. Limit caffeinated beverages, alcohol, and other diuretics; however, some data indicate that drinking tea, especially green tea, may have health benefits due to antioxidant properties. A dietary supplement is any product intended for ingestion as a supplement to food intake. Such supplements are vitamins, minerals, herbs, botanicals and other plant-derived substances, amino acids, food concentrates and extracts. For anyone who eats a reasonably balanced diet that emphasizes fruits and vegetables, developing a vitamin deficiency is unlikely. The minerals needed in a healthy diet are mostly metals and salts, such as iron, phosphorus, and calcium.

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National trends have shown decreasing intake of calcium-containing milk effexor xr 150 mg with visa, yogurt and cheese cheap effexor xr 150 mg fast delivery. Sufficient calcium intake is particularly important for women generic 150 mg effexor xr visa, especially those who have relatives with osteoporosis (weakness and 6-8 fractures of the spine and other bones) cheap effexor xr 75mg otc. Weight- bearing exercise is a strong stimulus for your body to absorb more calcium and to develop and maintain stronger bones. Serious side effects and even deaths have occurred in people taking unregulated products. For example, there have been over 800 reported adverse reactions and at least 39 deaths associated with ephedra-containing substances. They encourage eating an assortment of foods that will provide the nutrients needed without contributing too much fat, sugars, and sodium to the total diet. But following these Guidelines helps people obtain nutrients needed and may reduce the risk of certain chronic diseases. The Food Pyramid The Food Guide Pyramid was designed to aid individuals in their selection of appropriate types and amounts of foods that could form the foundation of an adequate diet. The overall message from the Food Guide Pyramid is to select foods that together give all the essential nutrients one needs to maintain health without eating too many calories or too much fat. The size of the food group piece corresponds to the recommended number of daily servings from that food group. For example, the Bread group is the largest in size and it has the greatest number of recommended servings. Many triangles and/or circles in a food group piece mean that many of the foods in that category contain a large amount of naturally occurring or added fat and oil, and/or added sugars. Starting at the bottom of the Pyramid and working up, selections from the food groups should be combined to form a healthful diet. It is recommended that daily choices consist of: Level 1: Choose plenty of grains. Bread, cereal, rice, and pasta form the broad base of the Pyramid and should make up the bulk of the daily diet. Fruits and vegetables are full of the vitamins, minerals, carbohydrates, and fiber needed to stay healthy. Level 3: Add a moderate amount of lower-fat/lean foods from the Milk- Group and the Meat-Group. Dairy products provide calcium that is important for a healthy skeleton in everyone. They should not, however, replace the nutrient-rich food choices found throughout levels 1, 2, and 3. The Food Guide Pyramid lists a range for number of servings in each of the five food groups. It also describes the total grams of fat recommended for each calorie level; the Dietary Guidelines recommend that Americans limit fat in their diets to 30 percent of calories. This includes the fat in the foods selected as well as the fat used in cooking or added at the table How Many Servings Do You Need Each Day? For example, a dinner portion of spaghetti, depending upon amount, could count as 2 or 3 servings. Bread, Cereal, Rice & Vegetable Group Fruit Group Pasta Group ½ cup of chopped raw or 1 piece of fruit or melon 1 slice of bread cooked vegetables wedge ½ cup of cooked rice or 1 cup of leafy raw 3/4 cups of juice pasta vegetables ½ cup of canned fruit ½ cups of cooked cereal 1/4 cup of dried fruit 1 oz of ready to eat cereal Milk, Poultry, Fish, Dry Fats, Oils & Sweets Milk, Yogurt & Cheese Beans, Eggs, & Nut Group Limit calories from these, Group 2 ½ to 3 ozs of cooked lean especially if you need to 1 cup of milk or yogurt meat, poultry or fish lose weight 1 ½ ozs of natural Count ½ cup of cooked cheese beans, or 1 egg, or 2 tbsp. The most effective way to moderate the amount of fat and added sugars in the daily diet is to cut down on "extras" - foods in the sixth food group (fats, oils, and sweets). Bread, Cereal, Rice, and Pasta Group - 6 to 11 servings To get fiber, choose several servings a day of foods made from whole grains. Choose foods made with little fat or sugars, such as bread, English muffins, rice, and pasta. When preparing pasta, stuffing, and sauce from packaged mixes, omit or use only half the butter or margarine suggested; if milk or cream is called for, use skim or low fat milk. Vegetable Group - 3 to 5 servings Different types of vegetables provide different nutrients. Punches and most fruit "drinks" contain only a little juice and lots of added sugars. Milk, Yogurt, and Cheese Group - 2 to 3 servings Choose skim milk and nonfat yogurt. Choose "part skim" or low fat cheeses when available and lower fat milk desserts, like ice milk or low fat frozen yogurt. Meat, Poultry, Fish, Dry Beans, Eggs, & Nuts Group - 2 to 3 servings Choose lean meat (lowest in fat); poultry without skin; fish, dry beans and peas. Prepare meats in low fat ways: trim away all the visible fat; remove skin from poultry; broil, roast, or boil these foods instead of frying them. Fats, Oils, and Sweets - Use sparingly Go easy on fats and sugars added to foods in cooking or at the table; butter, margarine, gravy, salad dressing, sugar, and jelly. Food provides the energy needed daily; and, this energy is in the form of calories. There are three calorie sources that the body needs every day: carbohydrate, fat, and protein. They each play a different role in the body and people need different amounts of each. The calories not used will be converted into body fat whether from carbohydrate, fat, or protein. By improving the food choices made daily, improvements in health are possible by understanding calories and the forms they take. Fat: Foods: Butter, margarine, salad dressing, fatty meats, oils, pastries, cookies, crackers, whole milk, hot dogs, french fries, chocolate, nuts, and ice cream. In the body: Fat provides energy and is easily converted to body fat if one eats too much. Notice that if one eats the same amounts (by weight) of carbohydrate, protein and fat, the fat will provide over twice as many calories. A low fat diet means essentially being able to eat more food and be more satisfied with fewer calories. Foods provide a range of nutrients in addition to fats, carbohydrates and proteins. Fiber, the building block of fruits, vegetables and whole grains, aides digestion and other functions. Vitamins are substances needed in minute (but essential) quantities to facilitate all the body processes. For example, vitamin A, found in yellow and orange vegetables, is needed for vision, but too much can be toxic. Minerals, such as iron, zinc, and copper, are also needed in minute amounts – but are poisonous in large quantities. Too little vitamin C can cause scurvy, an illness that historically killed thousands of mariners when fresh fruits and vegetables were not available at sea.

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The medical Widening partcipaton school will consider this informaton when deciding whether to call a candidate for interview buy generic effexor xr 37.5 mg on-line. Subjects at Internatonal Baccalaureate Higher Level to include no more than one science and exclude Chemistry buy 37.5mg effexor xr amex. To include three subjects at Standard Level with an average of grade 6 Personal statement Not scored trusted effexor xr 150mg. Up to six places are being made available per year for local applicants who have not achieved highly enough to gain entry to Standard Entry Medicine Widening partcipaton course and have verifable evidence of signifcant educatonal disadvantage or personal adverse circumstances cheap 37.5mg effexor xr fast delivery. Applicants must not have studied Chemistry post 16 and should not have studied more than one science subject. A minimum of 35 points from six academic subjects, not including Internatonal Baccalaureate Chemistry. Applicants are required to complete a post-applicaton roles Personal statement and responsibilites form. This may involve work with customers or clients requiring support, assistance Work experience or service. Experience in caring role preferred if applicant has had opportunites to undertake this. Internatonal Baccalaureate Higher level subjects should include either three rigorous arts/humanites subjects or two rigorous arts/humanites subjects and one science subject. Not scored but assessed against a set of published non-academic Personal statement requirements. The courses can take this into account in diferent ways, for instance by using ‘adjusted criteria’ to change the entry requirements for applicants from low- partcipaton areas. Applicants with predicted or Internatonal Baccalaureate achieved grades of 33 overall and 16 or above at Higher Level are not eligible. Realistc interest in medicine; life skills; wide range of interests; acts of Personal statement altruism and voluntary work; communicaton and interacton skills. Good refecton on relevant work experience will assist students during the interview process. Work experience As part of the frst year of the programme all students will take part in work experience placements. Applicants with predicted or Internatonal Baccalaureate achieved grades of 33 overall and 16 or above at Higher Level are not eligible. Work experience – Entry onto the Clinical Sciences course, either directly or via a foundaton year, allows students a unique and excitng opportunity to study science and health studies, and which can lead to a career in medicine, the healthcare sciences and other healthcare professions. Subjects at Higher level should Internatonal Baccalaureate include no more than one science and exclude Chemistry. Up to six places are made available per year for local applicants who have not achieved highly enough to gain entry to Standard Entry Medicine Widening partcipaton course and have verifable evidence of signifcant educatonal disadvantage or personal adverse circumstances. Personal statement Reviewed during selecton for interview process, but not formally assessed. Applicants expected to have taken steps to gain an understanding of Work experience medicine as a career, and personal suitability for that career, but no specifc work experience requirements specifed. This is a specifc widening partcipaton programme that is looking at applicants’ potental. It may be that the applicants’ family circumstances or educatonal opportunites have not given them a fair chance to realise their academic potental. For a proporton of applicants, inital contact is made Widening partcipaton by the school’s residental programme which is run in the Spring half term. Applicants from local widening partcipaton schools are invited to apply to this programme to get an experience of what it is like to come to university and to study medicine. It is not essental to have work experience in a clinical setng, however, Work experience candidates must be able to demonstrate commitment to the community through voluntary work, preferably in a caring environment. The programme is open to students studying A levels or an Access to Medicine courses at a non-selectve state schools in Greater London, and to partcipants of Realising Opportunites across England. Foundaton Year for Medicine and Surgery (A900) 1 year (allows progression onto A100 Medicine programme) Home/European Economic Area Internatonal Number of applicants per interview 1. Insight is more important than the specifc work and voluntary experience undertaken. Placements in Work experience hospices, nursing and residental homes etc, where there is interacton with vulnerable people, is just as valuable as shadowing doctors. The Foundaton year for Medicine and Surgery is designed for students who are not eligible to apply directly to the A100, Medicine and Surgery, programme. On successful completon of the Foundaton year, you will Widening partcipaton progress automatcally onto the 5 year Medicine and Surgery programme. At the end of the Foundaton year, you will also be awarded a Certfcate in Higher Educaton. Three Higher Level subjects including Chemistry and Internatonal Baccalaureate each subject at a minimum of 5. Candidates are expected to Work experience refect on whatever paid or unpaid work experience they have undertaken. This programme is only open to East Midlands Widening Partcipaton Widening partcipaton students only. Internatonal Baccalaureate 28 points to include 5,5,5 at Higher level including Biology and Chemistry. Assessment is based Personal statement on motvaton, experience of helping others, commitment, voluntary experience, extracurricular actvites, school/college contributon and supportng evidence in reference. All applicants for this course must meet widening partcipaton criteria at Widening partcipaton inital assessment to be considered further. Internatonal Baccalaureate To be updated - please visit medical school website for more informaton. Personal statement is assessed against the following non-academic criteria: student is self-motvated and has initatve, is literate and artculate and has the ability to demonstrate a commitment to becoming a doctor. Personal statement Statements are assessed on whether candidates have fully, partally or not met each criteria. Scores are then compiled with the highest scoring candidates being invited to atend a selecton day. However, applicants are expected to demonstrate what they have learned Work experience from their life experiences (this may include work experience, paid employment and personal experiences both in and outside health and social care setngs). All candidates must Widening partcipaton meet the eligibility criteria for the programme as well as the academic criteria. Internatonal Baccalaureate N/A Applicants must demonstrate a clear interest and commitment to pursuing Personal statement a career in medicine. O lay inka F asany a M edicalinform ation -Inform ation com pliance and consistency Anagency of theEuropeanUnion Table of contentof this presentation 1. E ssentialinform ation forthe use of the m edicine (1/2) The therapeutic indication(s)of the m edicine is g iven in section 4. E ssentialinform ation forthe use of the m edicine (2/2) The situations w here the m edicine m ustnotbe used forsafety reasons are outlined in section 4.

The Council’s quality assurance and enhancement activity is undertaken under the provisions of the Act order effexor xr 37.5mg otc, an act “for the [purpose of better protecting…the public … buy cheap effexor xr 37.5mg line. Approved bodies have an obligation to support the approving body – Council – in the fulflment of this key part of its remit discount 37.5mg effexor xr mastercard. Action plan drawn up Relevant individuals consider the student’s Plan developed specifying expected Student referred following unsuccessful measurable outcomes generic 150mg effexor xr free shipping, expected timescale potential professional defcits informal advice and support (Section 11 of Guidelines) (Section 11 of Guidelines) 6. However, when students do not (because they will not or cannot) demonstrate professionalism, they should not be allowed to graduate with a medical degree even if they demonstrate satisfactory academic outcomes. However, the career aspirations of an individual cannot be allowed to outweigh the interests of patients. The Council’s statutory duty to better ensure the education and training of medical practitioners is specifcally linked to the protection of the public; it is “for that purpose”. The conferral of a medical degree is a de facto assurance from the medical school to the Medical Council that the graduate has demonstrated to the required level the competencies required to be a doctor. If a student has been advised, supported and remediated in line with the Guidelines contained in this document, yet continues to display major defcits in professionalism, or if they commit a gross breach of professionalism, it is not appropriate for them to be conferred with a medical degree which enables them to register and practise. Developing and maintaining high standards through education, training, and professional competence plays a key role in protecting the public. This is particularly important in an environment of rapidly changing scientifc knowledge, high patient expectations and increasingly sophisticated health care delivery systems. Patients and the public rely on education and training to produce the high quality doctors that they need and deserve. The responsibility to ensure these high standards of medical education and training is a shared one: The Medical Council as the regulator has the statutory authority to set standards and monitor their delivery, and to make the accreditation decisions appropriate to its fndings Medical schools as the deliverers have a duty to ensure that professionalism is fostered and embedded, and that defcits in professional behaviour are appropriately dealt with Doctors – irrespective of whether they have formal teaching commitments or not- have a duty to encourage students to achieve their potential and to provide role models that can be admired and emulated Managers of clinical sites have a responsibility to facilitate the education and training of medical students Last but not least, students themselves have a responsibility to be active participants in their own professional development and to be professional. Criminality (caution or conviction) f) Controlled drug offences (including cultivation or manufacture, possession for sale or supply, possession) g) Criminal damage h) Public order offences i) Road and traffc offences a) Inappropriate examinations of patients b) Other breach of apprpriate boundaries in patient interaction c) Poor communication skills, including rudeness or lack of respect 2. Professional defcit in attitudes d) Breaching patient confdentiality or behaviour towards patients e) Deceiving patients about their care or treatment f) Deceiving a patient about one’s student status, including the inappropriate provision of medical advice a) Verbal abuse b) Intimidation c) Bullying d) Persistent harassment (including sexual 3. Abuse, aggression, threat of harassment) violence, use of violence e) Assault f) Incitement to violence (all irrespective of whether legal proceedings are involved) 42 Medical Council A Foundation For The Future Areas of concern Indicative examples a) Poor communication skills b) Persistent rudeness or lack of respect 4. Poor interaction (including c) Disruption of teaching and learning with other students, staff members, the public, and the d) Persistent failure to work as a member of a clinical team) clinical team or other group or team e) Unfair or unlawful discrimination on the grounds of gender, race or other factors a) Persistent poor attendance b) Cheating in examinations, logbooks or portfolios or other assignments (including plagiarism) c) Passing off others’ work as one’s own 5. Academic professional defcit d) Forging a teacher’s or supervisor’s signature on assessments e) Falsifying research undertaken or research results a) Financial fraud b) Producing fraudulent documentation c) Misrepresentation of academic attainments or 6. Other dishonesty or fraud qualifcations d) Misrepresentation of medical student status in the clinical environment 43 Medical Council A Foundation For The Future Areas of concern Indicative examples a) Misuse of controlled drugs or substances (including cultivation or manufacture, possession for sale or supply, possessing or misusing illegal drugs) b) Alchohol or substance consumption impacting on the health of patients, the student, or those 7. Alcohol or substance misuse working in the academic or clinical environment c) Driving under the infuence of alcohol or drugs (all irrespective of whether legal proceedings are involved) Use of information technology to support potentially unprofessional activity in oneself or others including: a) Criminal activity 8. Professional defcit in use b) Substance abuse of information technology (including the internet and c) Threatening, abusive, rude or lewd behaviour social media) d) Falsifcation and dishonesty e) Breaches of patient confdentiality or dignity a) Not declaring health or disability issue b) Demonstrable lack of insight into health concerns and their potential impact 9. Poor management of one’s own c) Failure to seek necessary medical treatment or health other support d) Refusal to follow medical advice or care plan in relation to maintaining/regaining ftness to proceed 44 Medical Council A Foundation For The Future Documents referenced 1. Guidelines for Medical Schools on Ethical Standards and Behaviour Appropriate for Medical Students. Guide to Professional Conduct and Ethics for Registered Medical Practitioners (7th Edition). Talking about Good Professional Practice: views on what it means to be a good doctor. Procedures + Calcs Vasopressors: a quick reference for use of common vasopressor agents. This helps you stratify your patient with Acute Decompensated Heart Failure and tailor therapy based on where in Quick Links the disease spectrum they are. Step 3 Thorough Eval for Other Causes of Exacerbation • Drugs Intensive Care Topics Patients to consider double coverage (Clinicians should be • Arrhythmias (Afib) selective in application! For patients receiving > 5 days of vancomycin Mechanical Ventilation should have least one steady-state trough concentration obtained. Frequent monitoring (more than single trough concentration before 4th Procedures + Calcs dose) for < 5 days or for lower intensity dosing (target trough vancomycin concentration < 15 mcg/mL) is not recommended. For hemodynamically unstable patients when goal trough concentration is 15 - 20 mcg/mL, more frequent than once weekly vancomycin trough concentration is recommended. Hypoglycemia), stroke, structural, trauma, neoplastic, iatrogenic, delirium tremens Labs: accucheck; clin chem. Your secondary concern, once you initiate efforts to improve hemodynamics, is to find out where the volume has been lost. Third spacing fluid loss can occur, but acute anemia of blood loss should always be assessed for. Obtain Hgb levels, evaluate the patient for possible Gi bleed or intra-abdominal bleeding. What do you think might happen to you if you decide to accept (or not accept) the recommended Home tx? What do we, as your medical team, think might happen if you decide to accept (or not accept) the recommended tx? What are the alternatives available and what are the consequences of accepting each? Document that the pt has decision-making capacity for the following reasons: Mechanical Ventilation * Pt understand his present medical condition and the tx that is being recommended. Review chart for other med/family issues In the Room: Explain the purpose of the pronouncement to family. Ask if family wishes to be present, Also, ask if family would like the chaplain to be present Home Address any questions from family. Note no breathing or lung sounds or heart beat/pulse Vasopressors **when to call coroner: if pt was in hospital <24hrs, death w/ unusual circumstances, or if death was assoc w/ trauma regardless of cause of death** Orders to be done. Additional patient initiated breaths are not vent supported, but the patient must overcome resistance of vent circuit during spontaneous breaths. A partial vent support sometimes used to evaluate for weaning • Continuous positive airway pressure: patient breathes spontaneously while vent maintains constant airway pressure Home Volume targeted vs. Pressure targeted • Volume-targeted: vent delivers a set tidal volume, pressure depends on airway resistance and compliance. Inspiratory time: Normal I:E ratio is ~1:2, but can be controlled on ventilator, use for management of obstructive diseases 4. Inspiratory flow rates: usually 60, increased inspiratory flow rates achieve set volume or pressure in a shorter amount of time, and decrease inspiratory time and allowing for a longer expiratory time before next breath. Plateau pressure: pressure at end of inspiration when flow has ceased, dependent on compliance. Intensive Care Topics A Airway resistance® check endotracheal tube; is it obstructed or too small?

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Your doctor may also advise that you take calcium and vitamin D supplements or drugs called bisphosphonates alongside the steroids to help protect your bones Steroids can be given: against osteoporosis discount effexor xr 150mg on line. It can be dangerous (intramuscular) or vein (intravenous) – to stop steroids suddenly generic 150mg effexor xr with mastercard. Exercise is an important part of this 75mg effexor xr free shipping, • interference with the menstrual cycle and a physiotherapist can suggest • changes in mood discount effexor xr 37.5 mg amex, although this is more diferent exercises that may help ease common in people with a history of your symptoms, strengthen muscles mood disturbances. They can Steroid tablets tend to have more side- also teach you about joint protection efects, particularly when they’re used and can refer you to other healthcare in high doses. They can advise • weight gain you on how to reduce pain when you’re standing or walking and can suggest • thinning of the bones (osteoporosis) suitable footwear for both daily life • muscle weakness and sport. Physiotherapy and arthritis; Splints for The occupational therapist will watch the arthritis of the wrist and hand. They can also give Surgery is occasionally needed for you information on splints if you need rheumatoid arthritis. Hydrotherapy Badly damaged joints can be replaced involves doing special exercises in with man-made (artifcial) joints, which a warm-water pool. It can help reduce will greatly reduce pain and help to the pain in your joints, improve joint restore the function of the joint. Hip, mobility and strengthen your muscles, knee, shoulder and elbow replacements and you may also fnd it soothing are highly successful. You can ask your doctor or physiotherapist if they think hydrotherapy would be suitable for you. But overdoing it on Hand and wrist surgery; Hip replacement the good days can cause a fare-up the surgery; Knee replacement surgery; next day. Make it clear to your family and friends that not all days are the Self-help and daily living same. It’s important they realise that activities you enjoy on a good day may be The symptoms of rheumatoid arthritis impossible on a bad one. The efects of any condition can be Sometimes fare-ups have an obvious mental as well as physical, and people cause, such as another illness or stress, with rheumatoid arthritis are more likely but usually there’s no obvious trigger. How you feel This unpredictability is frustrating and mentally can also afect how you feel makes it difcult to plan ahead. Don’t be embarrassed to talk about this with your doctor if you’re feeling low – managing how you feel is as important as managing the physical symptoms. There are also support groups available if you want to meet other people who have rheumatoid arthritis, and you might fnd that information on pain management helps you to stay positive. Managing a fare-up Over time, you may get better at noticing the early signs of a fare-up. Sometimes a few days rest are all you need, though it’s important to do gentle exercise to help ease stifness. Some of the following tips will also help you to cope with a fare-up and to manage your symptoms in general. Figure 6 Recommended exercises for If you’re having regular fare-ups, people with rheumatoid arthritis you should mention this to your doctor. Recommended Not recommended It may be that you need to review Low-impact sports: Contact sports: your treatment. Rest will make infamed joints feel more comfortable, but without Swimming is a particularly good way movement your joints will stifen and of exercising for people with rheumatoid muscles will become weaker. It exercises the whole body to exercise the muscles without even but puts minimal strain on your joints moving the joint by doing isometric because the water supports your exercises. Contact sports and vigorous in static positions so the joint angle types of exercise should be avoided. Whichever sport or exercise you do, make Many yoga positions are isometric sure you warm up properly. A physiotherapist may be able If you go to a gym or health club, tell the to suggest some of this type of exercise. Your physiotherapist can advise Exercise is good for your general health, you about this too. Good shoes with shock-absorbing If a particular activity causes one or soles are essential. A podiatrist will be more of your joints to become warm able to advise you on suitable footwear and swollen, or if it causes severe pain, if necessary. Because of the way the joints work, the force put through your knees when you walk, run or go up and down stairs can be up to fve or six times your body weight, so keeping your weight down will help reduce the strain on your joints. Diet and nutrition Occasionally some people with arthritis You might see stories in the media about fnd that a specifc type of food upsets diets that claim to cure rheumatoid them, but this is quite unusual. If you do have a food The diets most likely to help are low in intolerance you’ll notice a fare-up in your saturated fats and high in unsaturated arthritis within a few days. We Complementary medicine recommend taking pure fsh body oil Many people with rheumatoid arthritis rather than fsh liver oil. Increasing your try diferent types of complementary intake of vitamin C may also help. Most types haven’t been There’s some evidence that a very proven to be efective in the treatment strict vegetarian diet can help to ease of rheumatoid arthritis, but there are the symptoms of rheumatoid arthritis, a couple that have some scientifc although the reasons for this aren’t evidence to support their use, including clear. It’s important to go to a legally often soothing and relaxing, although registered therapist or one who’s fully there’s little evidence that specifc oils insured and has a set ethical code. Homeopathy If you decide to try therapies or hasn’t been proven to ease the symptoms supplements, you should be critical of rheumatoid arthritis. There are are stif or painful, try experimenting with diferent ways of carrying out many diferent pillows. An occupational therapist can give Avoid eating, smoking and drinking tea, you detailed advice about changing the cofee and alcohol close to bedtime. A huge variety of gadgets is available Discuss your sleep problems with your to help with daily tasks, whether at doctor or rheumatology nurse specialist. Although doctors advise against using Help of this sort can often allow you to sleeping tablets in the long term, they can continue many activities. You can buy be useful for short spells when a lack gadgets from specialist shops as well as of sleep is a serious problem. Hold the other leg straight and lift infammation, you may fnd that you the foot just of the bed. Pull each knee to disturbed sleep than those who don’t your chest in turn, keeping the other have arthritis. If you’re able to, lie on your back, the frst thing to do is to work out why: hands behind your head (or by your side if your shoulders are painful). You may fnd that symptoms are likely to return once the some positions are more comfortable, baby is born.

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