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Practical Neurology 2002; 2: 221-224 Bruxism Bruxism is forcible grinding or gnashing of the teeth 20mg levitra professional erectile dysfunction getting pregnant. This is common in children order levitra professional amex erectile dysfunction medication online pharmacy, and as a parasomnia generic 20 mg levitra professional with visa erectile dysfunction drug warnings, said to occur in 5-20% of the popu- lation during nonREM sleep purchase discount levitra professional erectile dysfunction icd 10. Dysfunction of efferent and/or afferent thalamic and stri- atopallidal tracts has been suggested as the neural substrate. If necessary, a rubber device or bite may be worn in the mouth to protect the teeth. Psychological Bulletin 1977; 84: 767-781 Cross References Encephalopathy; Masseter hypertrophy Buccofacial Dyspraxia - see OROFACIAL DYSPRAXIA Bulbar Palsy Bulbar palsy is weakness of bulbar musculature of lower motor neu- rone origin. This may be differentiated clinically from bulbar weakness of upper motor neurone origin (pseudobulbar palsy). Clinical features of bulbar palsy include: Dysarthria of flaccid/nasal type Dysphonia Dysphagia, often with nasal regurgitation Weak (“bovine”) cough; risk of aspiration +/− Wasted, fasciculating tongue +/− absent jaw jerk +/− absent gag reflex. Recognized causes include: ● Brainstem disorders affecting cranial nerve motor nuclei (intrin- sic): motor neurone disease (which may also cause a pseudobul- bar palsy) poliomyelitis glioma syringobulbia - 62 - Butt-First Maneuver B ● Cranial nerve lesions outside the brainstem (there may be associ- ated sensory signs): Infiltration by carcinoma, granuloma ● Neuromuscular junction transmission defect: myasthenia gravis. A myogenic bulbar palsy may be seen in oculopharyngeal muscular dystrophy, inclusion body myositis, or polymyositis. Cross References Bovine cough; Dysarthria; Dysphagia; Dysphonia; Fasciculation; Gag reflex; Jaw jerk; Lower motor neurone (LMN) syndrome; Pseudobulbar palsy; Upper motor neurone (UMN) syndrome Bulbocavernosus Reflex A test of the integrity of the S2, S3 and S4 spinal roots, looking for contraction of the anal sphincter (may be felt with a gloved finger in the rectum) when squeezing the glans penis or clitoris. Cross References Cauda equina syndrome; Reflexes Buphthalmos Buphthalmos, or ox-eye, consists of a large and bulging eye caused by raised intraocular pressure due to congenital or secondary glaucoma. Cacosmia - see PAROSMIA Calf Hypertrophy Calf enlargement has many causes; it may reflect true hypertrophy (enlargement of muscle fibers) or, more commonly, pseudohypertro- phy, due to infiltration with tissue elements other than muscle. Hypertrophy may be due to neuromuscular disorders producing: ● Chronic partial denervation, for example: radiculopathy peripheral neuropathy spinal muscular atrophy following paralytic poliomyelitis. Pseudohypertrophy may be due to: ● Dystrophinopathies (Duchenne muscular dystrophy, Becker dys- trophy), due to excess connective tissue. Journal of Neurology, Neurosurgery and Psychiatry 2004; 75: 1606 Wilson H, Kidd D, Howard RS, Williams AJ, Spencer GT. Postgraduate Medical Journal 2000; 76: 179-181 Cross References Gowers’ sign; Muscle hypertrophy; Myokymia; Myotonia; Neuro- myotonia Caloric Testing Caloric tests examine the vestibulo-ocular reflexes (VOR). They are mainly used in two circumstances: to identify vestibular pathology in the assessment of dizziness/vertigo when clinical tests of VOR are unhelpful and to assess brainstem integrity in coma. Each labyrinth may be sepa- rately assessed by irrigating each outer ear. Head flexion to 30˚ above the - 64 - Camptocormia C horizontal allows maximum stimulation of the horizontal semicircular canals, whereas 60˚ below horizontal maximally stimulates the lateral semicircular canals. Induced nystagmus is then timed both with and without visual fixation (in the dark, Frenzel glasses). Normally, the eyes show conjugate deviation toward the ear irri- gated with cold water, with corrective nystagmus in the opposite direction; with warm water the opposite pattern is seen. A reduced duration of induced nystag- mus is seen with canal paresis; enhancement of the nystagmus with removal of visual fixation suggests this is peripheral in origin (labyrinthine, vestibulocochlear nerve), whereas no enhancement suggests a central lesion. In coma the deviation may be present but without corrective sac- cades, even at a time when the oculocephalic responses elicited by the doll’s head maneuver are lost. As coma deepens even the caloric reflexes are lost as brainstem involvement progresses. London: BMJ Publishing, 1997: 283-314 Cross References Coma; Nystagmus; Oculocephalic response; Vertigo; Vestibulo-ocular reflexes Camptocormia Camptocormia, or “bent spine syndrome,”was first described as a psy- chiatric phenomenon in men facing armed conflict (a “war neurosis”). It has subsequently been realized that reducible lumbar kyphosis may also result from neurological disorders, including muscle disease (par- avertebral myopathy, nemaline myopathy), Parkinson’s disease, dysto- nia, motor neurone disease, and, possibly, as a paraneoplastic phenomenon. Cases with associated lenticular (putaminal) lesions have also been described. Camptocormia (bent spine) in patients with Parkinson’s disease: char- acterization and possible pathogenesis of an unusual phenomenon. Dropped head syndrome and bent spine syndrome: two separate entities or different manifestations of axial myopathy? Journal of Neurology, Neurosurgery and Psychiatry 1998; 65: 258-259 Cross References Dropped head syndrome; Dystonia - 65 - C Camptodactyly Camptodactyly Camptodactyly, literally “bent finger,” is a flexion deformity at the proximal interphalangeal joint, especially affecting the little fingers. A distinction is sometimes drawn between camptodactyly and stre- blodactyly: in the latter, several fingers are affected by flexion con- tractures (streblo = twisted, crooked), but it is not clear whether the two conditions overlap or are separate. The term streblomicrodactyly has sometimes been used to designate isolated crooked little fingers. Although some papers report camptodactyly to be usually unilateral, of 27 cases seen by the author in general neurology outpatient clin- ics over a 5 year period (2000-2004), most (24) referred for reasons other than finger deformity, 20 had bilateral changes, albeit asym- metric in some. The condition may be familial: in the author’s series, other family members were affected by report or by examination in 11 out of 26 families represented. X-linked dominant transmission has been sug- gested but there are occasional reports of father-to-child transmis- sion. Camptodactyly may occur as part of a developmental disorder with other dysmorphic features or, as in all the cases observed by the author, in isolation. It is important to differentiate camptodactyly, a nonneurogenic cause of clawing, from neurological diagnoses, such as: Ulnar neuropathy C8/T1 radiculopathy Cervical rib Syringomyelia Awareness of the condition is important to avoid unnecessary neu- rological investigation. International Journal of Clinical Practice 2001; 55: 592-595 Cross References Claw hand Capgras Syndrome - see DELUSION Carphologia Carphologia, or floccillation, is an aimless plucking at clothing, as if picking off pieces of thread. This may sometimes be seen in psychiatric illness, delirium, Alzheimer’s disease, or vascular dementia particularly affecting the frontal lobe. Cross References Delirium; Dementia Carpopedal Spasm - see MAIN D’ACCOUCHEUR - 66 - Catatonia C Catalepsy This term has been used to describe increased muscle tone, leading to the assumption of fixed postures which may be held for long periods with- out fatigue. Clearly this term is cognate with or overlaps with waxy flex- ibility which is a feature of catatonic syndromes. The term should not be confused with cataplexy, a syndrome in which muscle tone is lost. Cross References Cataplexy; Catatonia Cataplexy Cataplexy is a sudden loss of limb tone which may lead to falls (drop attacks) without loss of consciousness, usually lasting less than 1 minute. Attacks may be precipitated by strong emotion (laughter, anger, embarrassment, surprise). Sagging of the jaw and face may occur, as may twitching around the face or eyelids. During an attack there is elec- trical silence in antigravity muscles, which are consequently hypotonic, and transient areflexia. Rarely status cataplecticus may develop, partic- ularly after withdrawal of tricyclic antidepressant medication. Cataplexy may occur as part of the narcoleptic syndrome of exces- sive and inappropriate daytime somnolence, hypnagogic hallucinations and sleep paralysis (Gélineau’s original description of narcolepsy in 1877 included an account of “astasia” which corresponds to cata- plexy). Symptomatic cataplexy occurs in certain neurological diseases including brainstem lesions, von Economo’s disease (postencephalitic parkinsonism), Niemann-Pick disease type C, and Norrie’s disease. Therapeutic options for cataplexy include: tricyclic antidepres- sants, such as protriptyline, imipramine and clomipramine; serotonin reuptake inhibitors, such as fluoxetine; and noradrenaline and sero- tonin reuptake inhibitors, such as venlafaxine.

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But 20 mg levitra professional otc erectile dysfunction treatment with viagra, the drug may be used as a preventative sequences of nucleotides that are specifically synthesized to be agent in those people whose immune system will be compro- complimentary with a target sequence of viral ribonucleic acid cost of levitra professional erectile dysfunction onset. By binding to the viral RNA generic 20mg levitra professional fast delivery erectile dysfunction ugly wife, the oligonucleotide blocks the Another category of antiviral drugs is known as the anti- RNA from being used as a template to manufacture protein generic levitra professional 20 mg visa impotence homeopathy treatment. These drugs target those viruses of clinical The use of antiviral drugs is not without risk. Host cell significance called retroviruses that use the mechanism of damage and other adverse host reactions can occur. Thus, the reverse transcription to manufacture the genetic material use of antiviral drugs is routinely accompanied by close clini- needed for their replication. The See also Immunodeficiency diseases; Viruses and responses to development of antiviral drugs has been stimulated by the viral infection efforts to combat HIV. Some anti-HIV drugs have shown promise against hepatitis B virus, herpes simplex virus, and varicella-zoster virus. The various antiviral agents are designed to thwart the AAppert, Nicolas FrançoisPPERT, NICOLAS FRANÇOIS (1750-1841) replication of whatever virus they are directed against. One French chef means to achieve this is by blocking the virus from comman- Nicolas Appert gave rise to the food canning industry. Born in deering the host cell’s nuclear replication machinery in order Châlons-sur-Marne, France, around 1750, young Appert to have its genetic material replicated along with the host’s worked at his father’s inn and for a noble family as a chef and genetic material. By 1780 he had set up a confectionery shop in vention of replication will prevent the numbers of viruses from increasing, giving the host’s immune system time to deal Paris, France. Appert became interested in food preservation when the The incorporation of the nucleotide building blocks into French government offered a 12,000-franc prize in 1795 to the deoxyribonucleic acid (DNA) can be blocked using the drug person who could find a way to keep provisions for idoxuridine or trifluridine. Both drugs replace the nucleoside Napoleon’s armies from spoiling in transit and storage. After thymidine, and its incorporation produces a nonfunctional years of experimentation Appert devised a method of putting DNA. So, food in glass bottles that were then loosely corked and this antiviral drug is also an anti-host drug. Vidarabine is immersed in boiling water for lengths of time that varied with another drug that acts in a similar fashion. The drug is incor- the particular food; after boiling, the corks were sealed down porated into DNA in place of adenine. In an age before bacteriology, Appert did not other DNA building blocks. But, because the virus utilizes known as appertization—preserved the food. Appert later set the host’s genetic machinery, stopping the viral replication up his first bottling plant at Massy, south of Paris, in 1804. The French navy successfully used Appert’s products in Another tact for antiviral drugs is to block a viral 1807, and in 1809 Appert was awarded the 12,000-franc prize. This approach has been successfully covery, which he did in his 1810 work The Art of Preserving exploited by the drug acyclovir. The drug is converted in the Animal and Vegetable Substances for Several Years, which host cell to a compound that can out compete another com- gave specific directions for canning over fifty different foods. Appert, who also invented Arenaviruses contain ribonucleic acid (RNA) as their the bouillon cube, was financially ruined in 1814 when his genetic material. The viral genome consists of two strands of plant was destroyed during the Napoleonic wars. Little is known about the actual replication of new viral components or about the assembly of these components to produce the new virus ARCHAEA particles. It is known that the new virus exits the host by “bud- Archaea ding” off from the surface of the host cell. When the budding Genes that code for vital cellular functions are highly con- occurs some of the lipid constituent from the membrane of the served through evolutionary time, and because even these host forms the envelope that surrounds the virus. American microbiologist Carl Woese and his col- only known exception is an arenavirus called the Tacaribe leagues obtained sequences of the genes coding for RNA in the virus, which is resident in Artibeus bats. The association subunit of the ribosome from different organisms to argue that between an arenavirus type and a particular species of rodent life on Earth is comprised of three primary groups, or is specific. These domains are the Eukarya (which include one species of mouse or rat. A hallmark of arenaviruses is that While Archae are microorganisms, they are no more the infections in these rodent hosts tend not to adversely related to bacteria than to eukaryotes. In contrast to the rodent hosts, the human illness organization of their genetic material bears more similarity to can be compromising. Most arenavirus infections produce relatively mild The three domains are thought to have diverged from symptoms that are reminiscent of the flu, or produce no symp- one another from an extinct or as yet undiscovered ancestral toms whatsoever. The archae and eukarya may have branched off from a phocytic choriomeningitis virus, usually produces symptoms common ancestral line more recently than the divergence of that are mild and are often mistaken for gastrointestinal upset. However, this view remains However, some infections with the same virus produce a controversial and provisional. They inhabit environments which are too the different outcomes of an infection with the virus is yet to harsh for other microbes. These viruses include the Lassa virus (the furous springs of Yellowstone National Park. Very recently, it cause of Lassa fever), Junin virus (the cause of Argentine has been shown that two specific archael groups, pelagic eur- hemorrhagic fever), Machupo virus (the cause of Bolivian yarchaeota and pelagic crenarchaeota are one of the ocean’s hemorrhagic fever), and Guanarito virus (the cause of dominant cell types. Hemorrhagic fevers are char- a fundamentally important function in that ecosystem. The death rate in an outbreak of these hemorrhagic fevers can See also Bacterial kingdoms; Evolution and evolutionary be extremely high. The urine or feces may con- taminate food or water, may accidentally contact a cut on the ARENAVIRUS skin, or the virus may be inhaled from dried feces. In addi- Arenavirus tion, some arenaviruses can also be transmitted from one Arenavirus is a virus that belongs in a viral family known as infected person to another person. The name arenavirus derives from the appear- are the Lassa virus and the Machupo virus. Person-to-person ance of the spherical virus particles when cut into thin sections transmission can involve direct contact or contact of an 34 WORLD OF MICROBIOLOGY AND IMMUNOLOGY Asexual generation and reproduction infected person with food implements or medical equipment, The bulk of the gigantic fungus is some three feet as examples. The only surface evidence of the fungus are As with other hemorrhagic fevers, treatment consists of periodic displays of golden mushrooms that are present in stabilizing the patient. The results of another Armillaria ostoyae found in Washington state is even these tests have been encouraging. Estimates put the area covered by the Washington state Lassa virus, consists of a protein component of the viral enve- fungus at over 11000 acres. Tests of this vaccine in primates have also been encour- aging to researchers. See also Fungi Currently, the human illnesses caused by arenaviruses are best dealt with by the implementation of a rodent control program in those regions that are known to be sites of out- ASEXUAL GENERATION AND breaks of arenavirus illness. Because the elimination of rodents in the wild is virtually impossible, such a program is Asexual generation and reproductionREPRODUCTION best directed at keeping the immediate vicinity of dwellings clean and rodent-free.

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He contributed two sections buy levitra professional from india drugs for erectile dysfunction in nigeria, a small Missouri school whose interests were one on “Idiopathic Bone Fragility (Osteopsathy- directed mainly toward the education of under- rosis)” and the other “Fractures and Dislocations privileged children cheap 20 mg levitra professional visa erectile dysfunction doctors san francisco. Key endowed of the Extremities” as part of Graham’s Surgical a likely scholar with a fellowship purchase 20 mg levitra professional with amex impotence forum. Immersed though he was in serious work buy 20mg levitra professional mastercard erectile dysfunction quotes, his The integrity of his publications, as of all his love and zest for sports always managed to shine work, is and will remain beyond question. I shall never forget the fishing trips fessionally and socially, Albert believed in and we took together in California, Idaho, Oregon, lived the truth. There was never a dull 1928, he made an English translation of Normal moment, due to his unfailing good humor, his and Pathological Physiology of Bone, from the ready wit, and his joy in seeing others catch more original French by Leriche and Policard. His ability to start a conversation mount the difficulties of a foreign language. He had as broad a his flair for absolute truth, Albert replied, “Avec knowledge of orthopedic surgery and of general le dictionnaire. He was extremely He became associated with the Washington kind and modest to the point where, when asked University School of Medicine in 1926 as associ- to give a paper or make some other presentation, ate in clinical orthopedics; in 1927, he was he willingly shared his honor with one of his col- appointed assistant professor of clinical orthope- leagues; in fact, he often turned the whole matter dics and, in 1931, head of the division of to the other man’s credit. He had a prodigious memory, arduous, often when they were finished, some- especially for the minutiae in orthopedic litera- times as late as five in the afternoon, his terrific ture. His presence at any function, social or drive compelled him to begin work on some medical, was practically a guarantee of its project of his own. He was an active member of Theta Nu cal and analytical mind had full scope. He was Epsilon, Gamma Alpha, Alpha Omega Alpha fra- full of intellectual curiosity. His original ideas were never-ending, Clinical Orthopedics at Washington University in and he pursued not one, but many simultaneously. Louis and head of the Division of Orthopedics, Once he stated that he had decided long before a position he held until his death. Among them was the excellent book one, a person might be slowed down and thus The Management of Fractures, Dislocations, and spend years to finish it. In Cowdry’s Special His own drive was a great stimulus to those Cytology he described synovial membranes, with whom he worked. He found time to contribute to advance his younger men and associates into to The Practitioners Library of Medicine and positions at the school and toward membership in Surgery, Military Surgical Manual of the orthopedic societies. Several times he said that he National Research Council, Clinics, Instructional hoped some day his younger men would be Course Lectures of The American Academy of among the leaders in orthopedic surgery. He was Orthopedic Surgeons, Lewis’Practice of Surgery, totally unselfish, both with his time and his A Textbook of Surgery by American Authors, money. He made private loans to those who Bancroft and Murray’s Surgical Treatment of the needed them, and it is known that he paid the Motor-Skeletal System, Ghormlley’s Orthopedic 173 Who’s Who in Orthopedics Surgery, Cirzrrgia de L’rgezzcia, Cole’s Opera- These meetings were held at the time of those tive Technic and Clinical Orthopedics. Among his of the Congress of the American College of many articles that have appeared in scientific Surgeons. This article contains and clinical observation of the effects of com- what I would consider fair and just criticism of pression in arthrodesis, lesions of the interverte- the National Board of Orthopedic Surgery. He voiced his objection Committee for Investigation of the Kenny Treat- to the regimentation of orthopedic surgeons and ment of Poliomyelitis appointed by the American to a self-perpetuating board, which existed at that Orthopedic Association, the American Academy time. In his analysis of the group comprising the of Orthopedic Surgeons, and the Section on American Orthopedic Association, he found that Orthopedic Surgery of the American Medical their qualifications for this specialty varied and Association. His constructive criticism of the that their success had been obtained by a variety Kenny method of treatment in infantile paralysis of routes. He objected to a uniform, prescribed and his evaluation and report on this method of method of training and, as he stated in the final treatment remain a masterpiece. At the meetings of the American of demanding that a candidate follow a rigidly outlined Academy of Orthopedic Surgeons, his contribu- course of orthopedic training and that they recognize tions to discussion were eagerly sought. His the incontrovertible fact that satisfactory orthopedic knowledge of orthopedic surgery was so profound surgeons have been and can be developed in many dif- ferent ways. Their standards of excellence should not that, in discussing papers, he could seize on the be lowered and they can demand more time devoted salient points and illuminate them as nobody else to practice, but they should not close the door of our could. He was a member of the American Medical specialty in the face of men who are well qualified, but Association, American Surgical Association, whose education has not been along the lines which American College of Surgeons, American they have laid down. They are not omniscient but with Radium Society, Missouri Medical Association, the best of intentions they are becoming omnipotent Orthopedic Research Society (of which he was and this is not to the best interests of orthopedic surgery president at the time of his death), Clinical Ortho- of the future. Finally it is to be reiterated that the func- pedic Society, Southern Medical Association, tion of the Board is to establish minimum standards; Southern Surgical Association, and the Robert for the practice of and not to dictate the future devel- opment of orthopedic surgery. Key, and he had the This presidential address should be read and fullest cooperation from his confreres; although re-read by all aspirants to the field of orthopedic he was most grateful, he suffered from “an embar- surgery, as well as by those who have already rassment of riches”—everyone wanted to speak arrived, for stripped of all unnecessary verbiage on his program. Needless to say, the meeting was as it is, it contains the outline of basic training, a great success. Adding to that success, he invited educational requirements, and necessary qualifi- all the members of the Club for dinner at his home cations for a true orthopedic surgeon. John Albert Key died at his country home Some of us were fortunate enough to spend a near Steelville in the Ozarks on August 6, 1955. Key presided at the first Orthopedic Section of the Forum on Fundamental Surgical Problems, of the American College of Surgeons in 1951. He organized this section of the forum and all suc- ceeding meetings of this section until his death. Kidner contributed extensively to orthope- dic literature throughout his active life. His pub- lications covered a wide range of subjects and added greatly to orthopedic knowledge and tech- niques. Probably the outstanding characteristics of his writings were their conservatism and soundness; he was not one to be carried away by new ideas just because they were new, but was always ready to accept new proposals that had been thoroughly tested by time and experience. He was a member of the American Orthopedic Association, serving as its president in 1937–1938, and a member of the Clinical Ortho- pedic Society. He was a fellow of the American Academy of Orthopedic Surgeons and the Frederick Clinton KIDNER American College of Surgeons. He was associate professor of orthopedic surgery, emeritus, Wayne 1879–1950 University School of Medicine; surgeon-in-chief, emeritus, of Orthopedics at the Children’s Hospi- Dr. Frederick Clinton Kidner was born on April tal of Michigan; retired chief surgeon of the 13, 1879, at Ipswich, Massachusetts. He received Department of Orthopedics at Harper Hospital; his preliminary education in Boston and at St. He was graduated from Harvard pital and Wyandotte General Hospital; consultant University, receiving his AB degree in 1900 and in orthopedic surgery at the Woman’s and Receiv- his degree of MD in 1904. Kidner early manifested an interest in his friends and the love that came to him from orthopedic surgery and after his internship those, especially the crippled children of his state, pursued special courses in this branch of medi- who through his skill and devotion were restored cine in Boston. Kidner was invited to become a Kidner died in Detroit on October 20, 1950. Kidner, in addition to his active medical career in Detroit, played a large part in the development of a state-wide Crippled Children’s Service in Michigan, one of the first in this country.

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How­ ever buy levitra professional online now erectile dysfunction quitting smoking, some decline to do this generic 20mg levitra professional with amex erectile dysfunction 32 years old, and all will refuse to engage in any on-going debates buy generic levitra professional erectile dysfunction doterra. Depending on the feedback buy levitra professional line erectile dysfunction medication new zealand, you may want to submit your article to another journal. Writing your journal article Your choice of topic will be affected by your interests and expertise. It is easier to write on a subject about which you are very knowledgeable and JOURNAL ARTICLES 279 that arouses your keen interest. You may also want to take the advice of the editor who may have a particular theme in mind for future editions. Planning your article Consider your aims The first step in planning your article is to decide on your overall aim. Aim: Outcome: To teach a skill Reader learns a skill How will your article help your reader learn a skill? You might want to give a sequence of instructions, explanations and practical examples. To share innovative or best prac- Reader is able to apply principles or tice model to own practice Check that your approach is innovative by researching information about cur­ rent practices. Have you proof that your model benefits your clients, service or organisation? To explain or provide an Reader increases knowledge and un- update on theory derstanding Engage your reader with the material by suggesting ways of following up the­ ory through independent study, real life experiences and by providing self-assessment exercises. Most journals will prefer that the theoretical aspects of your article are related to clinical practice. To challenge or stimulate debate Reader thinks, reflects or challenges back! Choose a controversial issue, challenge a traditional belief or take an unusual perspective on a topic. However, remember to support your arguments with facts, figures and examples. To disseminate research Reader increases knowledge of evi­ dence base and applies findings to practice Journals will be particularly interested in the results of your research and their implications for clinical practice. For example, you might want to write about the implications of a new piece of legislation for clinical practice. To entertain Reader enjoys Some journals accept items that are purely for the entertainment of the reader rather than for any academic or professional reason. A humorous piece, a collec­ tion of anecdotes or a historical piece, are just some examples. Once you are sure of this yourself it will be much easier to communicate it to your reader. Redraft it until you think you have a clear and succinct statement, for example, ‘to explain the signs and symptoms of depression, its causes, traditional classifications and manage­ ment options’. Answering these questions is particularly important if you are writing an article for members of another discipline. For example, an occupational therapist writing an article on poor hand–eye co-ordination for teachers will need to think carefully about the knowledge base of his or her readers. Add your target audience to your statement of purpose, for example, ‘explain to district nurses the signs and symptoms of depression, its causes, traditional classifications and management options’. Decide on the content Your statement of purpose or your objective forms the starting point for drafting the content of your article. Brainstorming using the keywords from your objective is a useful way of developing ideas. It may help this JOURNAL ARTICLES 281 process if you set yourself a series of questions. In the above example, you might want to ask some of the following questions. The key areas or concepts identified through this process will form your section headings. Even if these are not used as titles in the final article, they can act as markers for how you will organise your material. Creating a structure Forming a structure early on in your planning will help in refining your search for information. Here are some examples of different formats for presenting material in articles. Research papers Research articles or research papers are always written using the traditional scientific approach discussed in Chapter 13 ‘Research Projects’. An abstract consists of a short paragraph that summarises the research paper for the reader. Most are 200 to 250 words in length, although some journals may accept longer ones. A reader can use the abstract to quickly make a decision about whether the research findings are of relevance to him or her and therefore worth reading. On a database, an abstract may be the only information available to the searcher on the contents of a paper. Abstracts contain: ° a statement about the purpose of your research ° your hypothesis or your research question ° a description of your research design ° your rationale for choosing that design ° a statement about your methods and procedures that includes details of any special equipment and the selection and number of subjects ° a description of your data analysis ° your major findings ° your conclusions 282 WRITING SKILLS IN PRACTICE ° implications for further research or applications to practice. The organisation of the abstract very much reflects the structure of the re­ search paper, the standard format being: ° Introduction (this contains information about relevant literature, the purpose and rationale for your research and your hypothesis) ° Methods ° Results ° Discussion of results ° Conclusion. Other formats Example of a literature review: ° Introduction (reason for or objectives in conducting the review) ° Rationale for literature selection ° Critical analysis of the literature ° Results of your review ° Conclusions ° Implications for further research ° Applications to clinical practice. Example of a clinical update on skin diseases: ° Incidence of skin diseases ° Description of skin ° Effect on client (psychological aspects, physical factors, quality of life) ° Assessment (including a description of different skin diseases) ° Treatment ° Summary (a position statement). Example of a debate on clinical supervision: ° Introduction (definition of clinical supervision, statement on the purpose and terms of reference of the article) JOURNAL ARTICLES 283 ° Overview of the models of supervision ° Comparison of models of delivery ° Discussion of the benefits of supervision (supported by references to research). Example of a continuing professional development article on ‘depression’: ° Statement about the aims and intended learning outcomes for the reader, for example: ° describe the signs and symptoms of depression ° list common causes of depression ° differentiate between the four classifications of depression ° describe four treatments for depression ° Introduction ° Definition of depression ° Common causes ° Signs and symptoms ° Classification of depression ° Treatments ° Conclusion (applications to practice). A teaching article of this sort might suggest other complementary forms of study. In the above example, the reader might be asked to reflect on his or her own experience of depression, complete a self-assessment question­ naire on the basic facts, and make a list of symptoms noted in a client diag­ nosed with depression. A well-structured article will be organised and logical, and will only include information that is necessary to meet your aims. Researching your article Your next step is to carry out a thorough literature review of your intended subject area. See Chapter 7 ‘Writing As an Aid to Learning’ for information on searches.

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