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By: Po Gin Kwa, MD Clinical Assistant Professor, Faculty of Medicine, Memorial University of Newfoundland; Pediatrician, Eastern Health, St. John’s, Newfoundland and Labrador, Canada

Thus when a message is delivered on inner meanings such as emotions buy 100mg kamagra polo amex erectile dysfunction doctor chicago, impulses and the radio cheap kamagra polo 100 mg erectile dysfunction doctors in maine, only auditory sensation is involved discount kamagra polo 100mg mastercard impotence cures. The use of senses of touch 40mg levitra super active sale, smell and taste order antabuse overnight, wherever Education and Training applicable, would further improve communication. Methodology Communication should be two-way: Unilateral communication from the sender to the receiver is not Every doctor has to act as an educator and trainer, whe- fully effective. It does not allow for any feedback from ther as a faculty member in a Medical College, Trainer the receiver of the communication and hence it is not in a Training Institution, Lecturer in front of a group of possible for the communicator to improve and modify laymen, Administrator responsible for Human Resource his message and technique of communication according Development of his subordinates, Physician to his to the needs of the receiver. Hence education and training, communication is complete only it is essential for a doctor to have elementary knowledge when feedback received by the communicator confirms of education and training methodology. Systems Approach Direct communication is more effective: Communi- The training process is a system in itself, comprising the cation is most effective when it is face to face. Before undertaking a training program, the trainer The efficacy of communication decreases as the must find out what the trainees need to learn. He may even discover Form al Presentation M ethods that the training program was not relevant to the job Lecture: This is the traditional method of teaching. Sometimes, they may even be taught, the next step is to state the objectives of the speak on similar topics. First, the overall general objective of the training to the audience in comparison to the monotony of a is stated. It is important to remember that “a good training program should have its specific objectives in behavioral Panel discussion: This is an extension of the dialog terms. Here a small group of experts get in front of be so stated that they pertain to an observable and the audience and discuss amongst themselves various measureable change in behaviour. It is better expressed in Group Methods behavioral terms as follows: These methods offer large scope for discussion and free “At the end of the training the trainee will be able exchange of views among the learners themselves and to list five reasons why growth of population must be among the learners and teachers, thereby facilitating checked. In the conventional method, a group of 5 to 15 persons discusses, a particular subject. In sequence in the curriculum, proceeding from simple to informal settings, as in a roadside, street or village difficult topics; (c) Sufficient time is given to trainees to gathering, or in a group of patients and their relatives, practise the skills taught. Besides the above, there are other group methods Teaching Methods of education described below. These methods have limited scope for discus- from project, (iv) To learn and develop vocabulary for sion and interaction. In group methods, the teachers education program, (v) To formulate questions for the and learners share the same platform and are thus able formal interview questionnaire/schedules and (vi) To to indulge in free discussion. Thus there are advisers, experts rapport, with general non-controversial subjects of and specialist speakers who guide the whole group.

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The liver is grossly damaged and fails to the cecum and producing the double gallbladder cheap kamagra polo 100mg without a prescription erectile dysfunction medication with no side effects. Section 17 „ Viva Voce in Surgery See the long case ‘chronic cholecystitis’ Pancreatogram and cholangiogram is then 6 discount kamagra polo online erectile dysfunction houston. Tis is the noninvasive imag- the biliary and pancreatic system through are seen as negative shadows purchase kamagra polo online now erectile dysfunction ugly wife. It can show stricture of the pancre- The X-ray plate is the T – tube cholangio- atic duct silagra 100 mg online. Biopsy or brushings can be obtained if The air bubble buy zenegra 100mg mastercard, entering through the tube ‹‰Ǥ ͳͲ͵Ǥͳ͸ ǣ there is obstruction due to tumor. How will you diferentiate between air cytological and microbiological bubble and residual stone? The air bubble shadow changes its Terapeutic indications position; with change of position of the 1. Nasobiliary drainage for temporary changes direction opposite to the air drainage of the bile duct. Endoscopic sphincterotomy and the remaining contrast agent is injected extraction of the stone. Contact dissolution by infusing monoo- at 5, 10, 15 and 30 minutes and the ctanoin or methyl terbutyl either via delayed flms. Burhenne’s technique-Patient is dis- diatrizoate (urografn) – 76 percent charged home with T – tube in situ and and meglumine iothalmate. What are the prerequisites of using the the mature T – tube tract with the contrast agents? Estimation of blood urea and cre- removal of the tube at 7th to 10th choledochoscope. Intrahepatic biliary radical entered and ing this period, it may lead to a false contrast injected. Hypernephroma-spider leg de- formity of the calices (splaying of the calices) usually at one pole. Polycystic kidney disease-Tere is spider leg deformity of the calices in both the kidneys as the disease is bilateral. Diagnosis of congenital abnormal- ity producing prolonged urinary tract infection, e. What are the disadvantages of ultra- See ‘head injury’ in the chapter 53 on sec- ized, the kidney is normally functioning. Retrograde pyelography-It is the con- the entire body can be studied in a series of radiation. It can produce images in various planes – trast agent is injected into the renal cal- c.

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Sarah and Katie were using their lunch break to stop by their elderly landlord’s house to drop off the rent generic 100mg kamagra polo with amex erectile dysfunction penile injections. When they got there order cheap kamagra polo on line vyvanse erectile dysfunction treatment, the landlord was prostrate in his flower garden order kamagra polo 100mg online impotence of organic origin meaning, semiconscious buy discount viagra jelly 100 mg on line, his rototiller still idling buy cialis black 800mg amex. He responded weakly, and in a confused state, no sweat evident on his pale dry scalp and arms. At the emergency room, Sarah and Katie learned that their landlord had suffered heatstroke. The physician congratulated them on their quick action, saying their intervention probably saved the old man’s life. He assured the two that after intravenous fluid and electrolyte administration and an overnight observation in the hospital, Mr. Explain why elderly individuals would have a greater risk of suffering or heatstroke. When attempting to lower body temperature in response to hyperthermia, one should avoid treatments that induce shivering or vasoconstriction. Dehydration can lead to heat exhaustion, which is characterized by high heart rate, dizziness, headache, loss of endurance/skill/confusion, and nausea. The skin may still be cool/sweating, but there are clear signs of developing vasoconstriction, for example, pale color. Heat-exhausted individuals have little or no urine production, and that which is produced is highly concentrated. Cramps may be associated with dehydration and rectal temperature may be up to 40°C and the victim may collapse on stopping activity. Heatstroke may arise in an individual who has not been identified as suffering from heat exhaustion and has persisted in further activity in the heat. Heat tolerance and the sensitivity of the sweating response are significantly reduced in the elderly. Normal mechanisms for temperature regulation function by causing vasodilation of cutaneous blood vessels when the body temperature rises above the thermoregulatory set point. This increases blood flow near the surface of the body and allows the heat from the core of the body that is carried by the blood to leave the body via radiation, convection, and evaporation. As the water on the skin evaporates, it removes heat by endothermic process of evaporative heat loss. These are responses no longer at work in the subject, thus impairing his ability to deal with work in the hot environment. Shivering is an effective homeostatic mechanism that generates heat and raises the body temperature. Peripheral vasoconstriction also occurs as a result of this mechanism and functions to decrease heat loss across the skin thereby keeping warm blood in the core of the body.

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Crude death rate in a colony of retired people The calculation is given in Table 25 discount kamagra polo 100 mg reasons erectile dysfunction young age. It should be pointed out that these __________________________________________________ Index rate = methods of standardisation are not unique to death Population of the study area rates and can also be used for comparing other events order discount kamagra polo online erectile dysfunction johannesburg, • Calculation of the standardizing factor such as morbidity rates kamagra polo 100mg sale erectile dysfunction treatment perth. The < 1 2400 reference population is usually the population of the 1-4 9600 whole country order zudena canada. This enables comparison of rates in two 5-14 19000 communities within the country purchase malegra fxt line. However, an inter- 15-19 9000 20-24 8000 national standard population has to be used for compa- 25-34 14000 rison of rates within countries. For comparison, the age structure of 55-64 8000 65 + 7000 population in India is given in Table 25. Sex ratio in developed countries is more Vital Statistics as Indicators of Health than one, i. The The indices of health used commonly are related to ratio in many developing countries, including India, is mortality and morbidity. As per 2011 census, It is the proportion of the total number of deaths in persons sex ratio in India is adverse towards women and India aged 50 years and above to the total deaths. There are was the lowest amongst 10 most populous countries in more old people in developed countries and a large the world. Russia tops the list in sex ratio (1140) followed number of deaths occur at age 50 years and above. Most alarming is decrease in child sex countries with poor health conditions and inadequate ratio, which was 945 in 1991 census and 927 health services, mortality before 50 years is comparatively in 2001. Such mortality method applied to compare the mortality related to is particularly higher in young children and women (due two places, periods, professions or groups. High proportional mortality • To find the rate of survival after treatment in diseases obviously reflects better health conditions in a community. For comparison postneonatal, infant and maternal mortality, discussed between two population, it is essential to use age adjusted already. Death rates for communicable diseases such as or standardized death rates as described already. Total death rate in the age Longevity, worked out by the Life Table Method group 1 to 5 years is also a useful indicator. Morbidity (described below), is also a comprehensive measure of data collected in specific surveys can serve as indicators community health. It is not affected by age and sex status, and physical growth of children from 1 to 4 years distribution. It is obtainable at 10 yearly intervals as per may also help in assessment of community health. It is a very good index to compare the level of health References in different countries. However, by the very nature of its derivation, it is not suitable for quantifying the change 1.