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Estrogen replacement may have some undesirable side effects and needs caution in use generic 3mg exelon free shipping medications during childbirth. Estrogen replacement therapy is wonder cure that should be administered routinely to menopausal women purchase exelon 6mg visa symptoms 6 days past ovulation. Rank order Questions: Example: Please indicate the priority of your life by putting the number in decreasing order (1 being the first purchase 1.5mg exelon with amex symptoms 6 days after embryo transfer, 2 being the next and so on buy exelon toronto medicine technology. Force Choice questions: Example: Which statement more closely represents your view point? Rating questions: Example: On 0–10 scale, measure your satisfaction level by encircling the number (0 being extremely dissatisfied and 10 being extremely satisfied). It consists of several declarative statements/ items that express the view point on a topic. Topics/ Strongly Agree Not Disagree Strongly Questions agree decided Disagree 1 2 3 4 h. These are more sensitive for subjective experience than rating based categorical adjectives. It helps the investigator to efficiently quantify subtle gradations in the strength or intensity of an individual characteristics. Unbearable Advantages, Disadvantages and Measure to Improve Closed Ended Questions Advantages Disadvantages Measures to improve 1. Develop picture codes answer be exhaustive which can be used for illiterates as well as literates (e. First present the extremes analyze mutually exclusive and then the values in between so that the respondent is straight away aware of the range of answers. Ensure inclusion of follow ents, the interviewer may up questions to elaborate be tempted to read the list on reasons for choosing a of possible answers in the given rating. Comparing responses of different groups, or of the same group over time, becomes easier. Designing the Questionnaire/Interview Tool The questions should be clear, specific, simple (use simple and common words that convey the idea and avoid technical terms) and neutral (avoid jargons, loaded words and stereotypes that suggest that there is most desirable answer). Following steps may be adopted to design the questionnaire/ interview tool: • State objectives and variables of the research study. The questionnaire should be translated in order to standardize the way questions will be asked. After having it translated, it should be retranslated into the original language by a different person. One can then compare the two versions Designing Research Instruments, Interview Guides and Skills 199 for differences and make decisions concerning the final phrasing of difficult questions. Avoid Pitfalls • Double barreled questions: Each question should contain only one concept. It is important that the question matches the options provided for the answer, a task that seems simple but is often done incorrectly. When you Finalize the Questionnaire, be Sure that– A separate, introductory page is attached to each questionnaire, explaining the purpose of the study, requesting the informant’s consent to be interviewed and assuring confidentiality of the data obtained. Each questionnaire has a heading and space to insert the number, date and location of the interview, and, if required, the name of the informant. Sufficient space is provided for answers to open­ended questions, categories such as ‘other’ and for comments on pre-categorized questions. Self-administered (Written) Questionnaires All steps discussed above apply to written questionnaires as well as to guides/questionnaires used in interviews. For written questionnaires, however, clear guidelines will have to be added on how the answers to questions should be filled in. Self-administered questionnaires are most commonly used in large- scale surveys using predominantly pre-categorized answers among literate study populations. As a response rate of 50% or less to written questionnaires is not exceptional, these tools will rarely be used in small­scale studies. In exploratory studies which require intensive interaction with informants in 200 Research Methodology for Health Professionals order to gain better insight in an issue, self­administered questionnaires would be inadequate tools. Steps • Meeting and informing the opinion leaders and key personnel the date and purpose of the study/ interview. Interviewer’s cloths should be culturally acceptable and as simple as possible (no fancy dresses, high heels or tight jeans in rural areas). When interviewer and informant are of opposite sex, more physical distance will usually be required than when they are of the same sex. This includes designing the forms for recording the measurements, choosing the software for data editing, dummy tabulations, etc. Data represent the information that will ultimately allow investigator to describe phenomena, predict events, identify and quantify differences between conditions, and establish the effectiveness of interventions, because of their critical nature. In addition to ensuring the confidentiality, the security of personal data is to be planned. The researcher should carefully plan how the data will be logged, entered, transformed and organized into a database that will facilitate accurate and efficient statistical analysis. Logging and Tracking Data Any study that involves data collection will require some procedure to log the information as it comes in and track it until it is ready to be analyzed. Without a well-established procedure, data can easily become disorganized, un-interpretable, and ultimately unusable. The recruitment log is a comprehensive record of all individuals approached about participation in a study. The log can also serve to record the dates and times that potential participants were approached, whether they met eligibility criteria, and whether they agreed and provided informed consent to participate in the study. Importantly, for ethical reasons, no identifying information should be recorded for individuals who do not consent to participate in the research study. The primary purpose of the recruitment log is to keep track of participant enrollment and to determine how representative the resulting cohort of study participants is of the population that the researcher is attempting to examine. Data Screening Immediately following data collection, but prior to data entry, the researcher should carefully screen all data for accuracy. The promptness of these procedures is very important because research staff may still be able to re- contact study participants to address any omissions, errors, or inaccuracies. In some cases, the research staff may inadvertently have failed to record certain information (e. In such instances, the research staff may be able to correct the data themselves if too much time has not elapsed. Because data collection and data entry are often done by different research staff, it may be more difficult and time consuming to make such clarifications once the information is passed onto data entry staff. One way to simplify the data screening process and make it more time efficient is to collect data using computerized assessment instruments. Computerized assessments can be programmed to accept only responses within certain ranges, to check for blank fields or skipped items, and even to conduct cross-checks between certain items to identify potential inconsistencies between responses.

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However 1.5 mg exelon medicine 93 948, acute cerebral thrombosis buy exelon 1.5 mg otc symptoms 7 days pregnant, hemorrhage purchase exelon toronto symptoms norovirus, or embolism may present with hypoactive reflexes in the involved extremity generic 6 mg exelon with amex medications ok for dogs. Blood lead levels, glucose tolerance tests, and other studies indicated in a neuropathy workup (page 334) may be required. M—Malformation would bring to mind familial intestinal polyposis (Peutz–Jeghers syndrome) and Fabry disease. I—Inflammation would suggest the pigmentation of the buccal mucosa seen in pulmonary tuberculosis of the adrenal gland leading to Addison disease. N—Neoplasm suggests the pigmentation seen in metastatic malignant melanoma and carcinomatosis. T—Toxic helps recall the toxic substances that cause mouth pigmentation such as silver, bismuth, contraceptives, tranquilizers, antimalarials, lead, arsenic, and mercury. S—Systemic diseases associated with mouth pigmentation include Addison disease, hemochromatosis, and porphyria. Approach to the Diagnosis 584 If lead or arsenic poisoning is suspected, hair analysis may be done. If Addison disease is suspected, serum cortisol or a 24-hour urine 17- hydroxysteroids and 17-ketosteroids should be done. Certainly, the low-grade systolic murmurs tend to be functional; if the murmur changes or disappears on position, inspiration, or exercise it is likely to be functional. After the murmur is determined to be organic, one needs to have a working differential diagnosis in mind to proceed efficiently. N—Neoplasm includes atrial myxomas, the most significant disorder to remember here, but leukemic infiltration of the heart and all the neoplasms associated with anemia might be considered. D—Degenerative disease recalls atherosclerotic heart disease, muscular dystrophy, and Friedreich ataxia. Atherosclerotic heart disease should be emphasized because it frequently causes aortic murmurs. I—Intoxication reminds one that there may be no murmur in alcoholic 585 myocardiopathy until failure develops, but it is a condition to consider nevertheless. I—Idiopathic disorders include mitral valve prolapse, although in some cases this is hereditary. A—Autoimmune disease includes rheumatic fever, the best known of these disorders, although it is now a less frequent consideration in murmurs. T—Traumatic disorders recall a ventricular or aortic aneurysm and occasionally a coronary arteriovenous fistula or valvular insufficiency that may result from a stab wound. Hyperthyroidism produces murmurs in some cases because of the rushing blood and rapid rate, causing many eddy currents. Referral to a cardiologist is wise if the cause is obscure or if one is unable to spend the time for a careful workup. Angiocardiography and cardiac catheterization are the only sure ways to determine the location of the valvular disease, and, in many cases, the exact cause. Spinal cord disease When recalling the differential diagnosis of muscular atrophy, think of these seven factors and the causes will unfold. Lack of use of the muscle: In focal or generalized bone or joint disease there is diminished use of the extremity or part involved, so the muscles atrophy. Primary muscle disease: Muscular dystrophy, dermatomyositis, trichinosis, and McArdle syndrome should be considered here. Peripheral nerve disease: Diabetic neuropathy and the neuropathy from lead, arsenic, and other toxins should be considered here. Hereditary neuropathies such as Charcot–Marie–Tooth disease and Dejerine–Sottas hereditary hypertrophic neuritis are also considered here. Nerve root disease: Spinal column disorders that compress the root include fractures, herniated disks, spondylolisthesis, tuberculosis, metastatic tumors, and multiple myelomas. Spinal cord disease: The degenerative diseases such as amyotrophic lateral sclerosis, progressive muscular atrophy, and syringomyelia must be considered here. In addition, poliomyelitis, transverse myelitis of various areas, anterior spinal artery occlusion, infectious polyneuritis, and spinal cord tumors must be recalled. Approach to the Diagnosis Focal atrophy of a muscle often means a damaged peripheral nerve or root. If there are visible fasciculations, a lesion of the spinal cord or root is most likely. Muscle biopsy is valuable in ruling out trichinosis, dermatomyositis, or muscular dystrophy. Genetic testing (amyotrophic lateral sclerosis and many myopathies) 589 Muscular atrophy. Case Presentation #66 A 40-year-old white male factory worker complained of back pain and weakness of his right leg ever since an injury at work 8 months ago. Based on your knowledge of neuroanatomy, what would be your differential diagnosis? Your examination shows diffuse atrophy of the muscles of the right leg along with diffuse hypesthesia and hypalgesia. However, the reflexes are equal and active in both lower extremities, and there are no pathologic reflexes. Considering the arteries will prompt the recall of arteriosclerosis, emboli, Leriche syndrome, and other conditions that interfere with the blood supply to the muscles. Considering the veins will call to mind varicose veins as a frequent cause of muscle cramps. Turning our attention to the nerve supply will help recall the various neurologic conditions that are associated with muscle cramps. Multiple sclerosis, amyotrophic lateral sclerosis, spinal cord injury, and any upper motor neuron lesion may be the cause of muscular cramps. Finally, the muscle itself may be involved by myositis, myotonic dystrophy, traumatic hemorrhage (i. Next, applying physiology to the analysis of possible causes of muscular cramps, we should easily remember the various fluid and electrolyte disorders that may be implicated. Hypocalcemia and hypomagnesemia due to hypoparathyroidism, rickets, malabsorption syndrome, chronic renal failure, and renal tubular acidosis are a prominent cause of muscular cramps. Hyponatremia from pathologic diaphoresis, diuretics, dilutional hyponatremia, inappropriate antidiuretic hormone secretion, and chronic 592 renal failure are also associated with muscle cramps. Finally, hypokalemia or alkalosis due to primary and secondary hyperaldosteronism, intestinal obstruction, milk–alkali syndrome, and hyperventilation may be the cause. A few additional disorders that may not be recalled by the above methods are lead poisoning, certain drugs such as phenytoin and rifampin, hysteria, fever, pregnancy, and strychnine poisoning. Approach to the Diagnosis Clinically, one should look for absent or diminished pulses in the extremity involved, Chvostek and Trousseau signs of tetany, and neurologic signs of an upper motor neuron lesion.

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