Clinical Director, University of Illinois College of Medicine
A family physician finds physical symptoms in a patient that indicate alcohol dependence and suggests treatment erectile dysfunction medication canada cheapest generic malegra dxt uk. In each of these situations impotence antonym discount malegra dxt 130mg on line, those with an important relationship to the substance users have stated that the substance use is risky erectile dysfunction drugs not working buy malegra dxt 130 mg on line, dangerous erectile dysfunction japan order malegra dxt 130 mg online, aberrant, or harmful to self or others. They will be better motivated to moderate their substance use or to abstain (either solely through their own efforts or with the help of a treatment program), if these key persons offer relevant information in a supportive and empathic manner, rather than being judgmental, dismissive, or confrontational. Substance users often respond to overt persuasion with some form of resistance (Rollnick et al. This chapter discusses a variety of proven techniques and gentle tactics that you, the clinician in a treatment facility, can use to raise the topic with people not thinking of change, to create client doubt about the commonly held belief that substance abuse is "harmless" and to lead to client conviction that substance-abuse is having, or will in the future have, significant negative results. Many clinicians have succeeded in helping significant others act as mediators and use appropriate motivational strategies for intervening with close relations who are substance users. Constructive means of encouraging those clients mandated to enter treatment are described in this chapter as well. A variety of other laboratory and collateral information further supports a history of years of heavy alcohol consumption. Or he may be fearful that if he examines his alcohol use too closely and shares his history he may not be considered for transplantation at all. He may even have already been told that if he is actively drinking he will not be listed for transplantation. The simple fact is that he has never connected his health problems with his use of alcohol. As the patient asks questions, he begins to paint a new picture of addictive disease that allows him to see himself in that picture. By tailoring the presentation to each patient and encouraging questions throughout, I provide him and his family, if present, with important information about the biological factors supporting alcohol dependence. This psychoeducational reframing gives the client a different perspective on his relationship with alcohol, taking away some of the guilt and shame that was based on a more moralistic understanding of the disease. The very act of self-diagnosis is a movement from precontemplation to contemplation. It can be accomplished by a simple cognitive reframe within the context of a thorough and caring assessment completed in a professional, yet genuinely compassionate manner. The new client could be at any point in the severity continuum (from mild problem use to more severe dependence), could have few or many associated health or social problems, and could be at any stage of readiness to change. In opening sessions it is important to Establish rapport and trust Explore events that precipitated treatment entry Commend clients for coming these recommendations are discussed further below. Establish Rapport and Trust Before you raise the topic of change with people who are not thinking about it, establish rapport and trust. Next, tell the client something about how you or your program operates and how you and the client could work together. This is the time to state how long the session will last and what you expect to accomplish both now and over a specified time. If there are confidentiality issues (discussed in more detail later in this chapter), these should be introduced early in the session. It is critical that you inform the client which information will be kept private, which can be released with permission, and which must be sent back to a referring agency. Rather, you will be asking the client to do most of the talking-giving her perspective about both what is happening and how she feels about it. If the client seems particularly hesitant or defensive, one strategy is to choose a topic of likely interest to the client that can be linked to substance use. Many programs administer breath tests for alcohol or urine tests for drugs and reschedule counseling sessions if substances are detected at a specified level or if a client appears to be under the influence (Miller et al. Strong emotions can block change if you, the counselor, do not acknowledge them through reflective listening. The pregnant woman wants a healthy child; the neglectful mother probably wants to regain custody of her children; and the concerned husband needs specific guidance on convincing his wife to enter treatment.
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Received November 05 erectile dysfunction doctor in bhopal discount 130mg malegra dxt overnight delivery, 2010 Revised April 25 erectile dysfunction drugs and high blood pressure cheap malegra dxt 130mg overnight delivery, 2011 Accepted May 27 erectile dysfunction johannesburg buy cheap malegra dxt 130 mg on line, 2011 Published online June 25 erectile dysfunction medications online generic malegra dxt 130mg without a prescription, 2011 than by physicians or physicians-in-training. A majority of respondents view these online interactions as ethically problematic. Over the past several years, the rise in popularity of these networks has been dramatic. Facebook, the most popular online social network, boasts over 500 million users since its inception in 2004,2 and it recently surpassed Google as the most popular site on the internet. Additionally, we wanted to capture the attitudes of both users and nonusers of online technologies. Based upon previously published data regarding physician response rates to surveys,12 the expected response rate was 25%. It was felt that this would provide sufficient data for reasonable estimates of proportions, based on the survey responses. Participants were asked to describe the extent of their agreement with statements describing attitudes toward the ethical acceptability of visiting patient profiles, interacting with patients as part of patient care, and interacting with patients for social reasons. Data Collection the survey questionnaire was sent to study subjects along with an addressed, stamped envelope in three sequential mailings. Statistical Methods All demographic variables and questionnaire responses were summarized by professional status (medical student, resident physician, or practicing physician) using descriptive statistics (mean and standard deviation for continuous measures; count and percent for categorical measures). Survey the survey was designed by the study team based on the existing literature13 and guided by research questions. The survey instrument was then piloted among ten resident and practicing physicians, and underwent iterative revision by members of the study team. The survey instrument examined four content areas: attitudes toward online social networks, personal utilization patterns of online social networks, patient interaction experiences within online social networks, and demographic data (the full survey is available as an appendix online). Demographic data collected included age, year of medical school graduation (or anticipated medical school graduation), medical specialty, self-reported practice type (academic, private practice, mixed), self-reported practice setting (urban, rural, suburban), and gender. Usage Patterns of Online Social Networks Medical students (%) Has respondent ever used social networking sites? Strongly agree/ agree Neutral Strongly disagree/ disagree My online social networking profile contains only information that I would be willing to share with patients. Data for patient-initiated friend requests categorized by specialty is reported in Figure 2. There were no statistically significant differences among the three groups for any of the responses. Of those who had received friend requests, 58% of practicing physicians reported that they always replied "no" to the request, and 42% replied that they accepted them on a caseby-case basis. For those resident physicians who had received friend requests, 57% reported that they never accepted friend requests from patients or their families, and 43% reported that they accepted them on a case-by-case basis. Among medical students who reported having received friend requests from patients or family members of patients, all reported accepting Table 3. Physician-patient Interactions within Online Social Networks Medical students (%) Ever visited the profile of a patient or family member? Attitudes Toward Online Social Networks Medical Students (%) Resident Physicians (%) n=131 25 (19. Strongly agree/agree Neutral Strongly disagree/disagree It is ethically acceptable for physicians to interact. Strongly agree/agree Neutral Strongly disagree/disagree It is ethically acceptable for physicians to interact with patients within online social networking sites as part of patient care. Strongly agree/agree Neutral Strongly disagree/disagree Online social networking sites have potential for improving doctor-patient communication. Strongly agree/agree Neutral Strongly disagree/disagree Communication with patients within online social networking sites can be safely accomplished without compromising patient confidentiality.
In the past few years outcome-based education policy has begun to limit instructors to only using those techniques that have been shown to be effective impotence and high blood pressure buy malegra dxt with visa. In the United States for instance benadryl causes erectile dysfunction 130 mg malegra dxt mastercard, the No Child Left Behind Act requires those developing instruction to show evidence of its "effectiveness impotence causes and treatment discount malegra dxt 130 mg otc. Richard Hake (1998) reviewed data from over 6000 physics students in 62 introductory physics courses and found that students in classes that utilized active learning and 222 interactive engagement techniques improved 25 percent points impotence workup malegra dxt 130mg without prescription, achieving an average gain of 48% on a standard test of physics conceptual knowledge, the Force Concept Inventory, compared to a gain of 23% for students in traditional, lecture-based courses. Similarly, Hoellwarth & Moelter (2011) showed that when instructors switched their physics classes from traditional instruction to active learning, student learning improved 38 percent points, from around 12% to over 50%, as measured by the Force Concept Inventory, which has become the standard measure of student learning in physics courses. A Review of the Research," Prince (2004) found that "there is broad but uneven support for the core elements of active, collaborative, cooperative and problem-based learning" in engineeri ng education. Michael (2006), in reviewing the applicability of active learning to physiology education, found a "growing body of research within specific scientific teaching communities that supports and validates the new approaches to teaching that have been adopted. One study described in the report found that students in traditional lecture courses were twice as likely to leave engineering and three times as likely to drop out of college entirely compared with students taught using active learning techniques. In another cited study, students in a physics class that used active learning methods learned twice as much as those taught in a traditional class, as measured by test results. The didactic method of instruction is often contrasted with dialectics and the Socratic method; the term can also be used to refer to a specific didactic method, as for instance constructivist didactics. Didactics is a theory of teaching, and in a wider sense, a theory and practical application of teaching and learning. In demarcation from "Mathetics" (the science of learning), didactics refers only to the science of teaching. This theory might be contrasted with open learning, also known as experiential learning, in which people can learn by themselves, in an unstructured manner, on topics of interest. Didactical methodology being practicsed in Ancient India the theory of Didactic Learni ng methods focuses on the baseline knowledge students possess and seeks to improve upon and convey this information. It also refers to the foundation or starting point in a lesson plan, where the overall goal is knowledge. A teacher or educator functions in this role as an authoritative figure, but also as both a guide and a resource for students. Didactics or the didactic method have different connotations in continental Europe and English speaking countries. For the Anglo-Saxon tradition, the didactic method still carries the origi nal meaning of teaching moral contents, and is therefore associated with unfavourable views opposed to the teachi ngs of a true art or science. The Oxford dictionary merely defines didactics as a particularly moral instruction. Didacticism was indeed the 224 cultural origin of the didactic method but refers within its narrow context usually pejoratively to the use of language to a doctrinal end. The interpretation of these opposing views are theorised to be the result of a differential cultural development in the 19th century when Great Britain and its former colonies went through a renewal and increased cultural distancing from continental Europe. It was particularly the later appearance of Romanticism and Aestheticism in the Anglo-Saxon world which offered these negative and limiting views of the didactic method. In continental Europe those moralising aspects of didactics were removed earlier by cultural representatives of the age of enlightenment, such as Voltaire, Rousseau, and later specifically related to teaching by Johann Heinrich Pestalozzi. The consequences of these cultural differences then created two main didactic traditions: the Anglo-Saxon tradition of curriculum studies on one side and the Continental and North European tradition of didactics on the other. And still today, the science of didactics is carrying much less weight in much of the English speaking world. With the advent of globalisation at the beginning of the 20th century, however, the arguments for such relative philosophical aspects in the methods of teaching started to diminish somewhat. Therefore, it not only enhances social inclusion, active citizenship, and personal development, but also self-sustainability, rather than competitiveness and employability. Allen Tough (1979), Canadian educator and researcher, asserts that almost 70% of learning projects are self-planned. There is no age lim it for Lifelong Learning During the last fifty years, constant scientific and technological innovation and change has had a profound effect on learning needs and styles.
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To help State Government in production and supply of breeder seeds for multiplication of foundation and certified seeds top erectile dysfunction pills order genuine malegra dxt on-line. To serve as a repository of national and international scientific information on various aspects of agricultural and animal production erectile dysfunction frequency age purchase malegra dxt 130mg with amex. To collaborate with relevant national and international agencies for all round development of agriculture in the State erectile dysfunction uk purchase malegra dxt online, in particular and the country as a whole; and also to undertake such other activities doctor for erectile dysfunction in gurgaon order cheap malegra dxt on-line, as it may deem fit, from time-to- time. It continues the work started by these ancient centres, as a pathfinder for the current and future spiritual awakening of people, in the spheres of Yoga, Vedanta, Tantra and other allied subjects. Normally an educational institution focuses solely on academic goals, whereas a gurukul environment combines both intellectual and experiential learning, aiming towards the holistic growth of the student. Sri Swami Sivananda originally had the vision of a yoga institute when he established the Yoga Vedanta Forest Academy in Rishikesh in 1950. This inspiration was carried forward by Sri Swami Satyananda, who established Bihar School of Yoga in Munger in 1963, followed by the Ganga Darshan complex. Swami Niranjanananda, with the blessings of his predecessors, founded Bihar Yoga Bharati in 1994 as an Institute for Advanced Studies in Yogic Sciences. Sri Swami Satyananda founded Bihar School of Yoga i n order to carry out the mission given to him by his guru to spread the message of yoga from door to door and from shore to shore. Under his guidance, the ancient science of yoga was taught on a scientific basis with clarity and vision. Thousands of people were and continue to be trained and educated in yogic subjects. This gurukul based institute is the first of its kind in the world to impart a comprehensive yogic education. The main objective of instituting the University was to ensure a high quality of students coming out of the technical colleges through a common curriculum and uniform evaluation. Today, the University has 110 colleges, both constituent and affiliated, with around 58,000 students. The disciplines include engineering and architecture, business management and hotel management, computer studies and pharmacy. The university is functioning in its new campus located at Kalinga Vihar Rourkela, Odisha, India. When Biju Patnaik University of Technology was established, only five colleges existed Veer Surendra Sai University of Technology, Burla founded in 1956, College of Engineering a nd Technology, Bhubaneswar founded in 1981, Odisha School of Mining Engineering, Keonjhar founded in 1956, Central Institute of Plastic Engineering and Technology, Bhubaneswar founded in 1968 and Indira Gandhi Institute of Technology, Sarang founded in 1982 were there, under the state government of Odisha and a few other private engineering and management institutes which were under Sambalpur University, in Odisha. Latter in 2009 three new government colleges were added Parala Maharaja Engineering College, Berhampur, International Institute of Information Technology, Bhubaneswar and Government College of Engineering, Kalahandi. Bilaspur University (Viswavidyalaya) is State University which has been established by the Gazette notification on 03. The jurisdiction of Bilaspur University is extended to 05 Districts namely:- revenue Districts of Bilaspur, Mungeli, Korba, Janjgir Champa and Raigarh. The University is situated on Old High Court Building, Near Gandhi Chowk Bilaspur city. The colleges carry out undergraduate and postgraduate studies in different streams of Science, Arts, Commerce, Law and Education and Centres of research. The University plans to develop strategy for enhancing the range of pedagogic approaches and the use of technology. As a part of this approach, the University plans to start classrooms into state of the art ones, enabling teachers to teach using wide variety of media. Aspire to translate collective dream of the Community of the region in to reality. Create, disseminate and advance knowledge, through instructional and Inter disciplinary and collaborative researches. Educate and train the Human Resource persons for the development of the State of Chhattisgarh. Advancement of intellectual, academic, cultural and natural resource development for Socio- economic development of the region. To develop innovative and professional instructional programmes to cater the needs of students of the State of Chhattisgarh. To create an ambience for quality teaching-learning and skill development and its upgradation.
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