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We have collated these into different clinical specialties and graded them for level of user and quality olanzapine 5 mg for sale medications mexico; they can be accessed through the OpenMed website at openmed buy 20mg olanzapine amex symptoms 11dpo. For each specialty area we have grouped resources into a useful learning pathway or curriculum. Many of our tutors will be adding and rating resources in their specialty areas and will point you in the direction of any useful additional resources. Anyone interested in contributing to the website should contact Dr Eleri Williams. Library facilities and e-textbooks Library facilities will be provided electronically through the University of Edinburgh Library Online. Students will also have access to the physical library buildings if they do wish to access these in Edinburgh. The University library will allow access to most journals and online e-textbooks related to the course. Computer requirements Computer and broadband A computer and internet access (preferably broadband) are required to participate in the course. A webcam is very useful for full participation in tutorials but a microphone and headphones will allow ‘voice-only’ participation. Software / computer configurations We will ask you to download some free software and to run configurations to ensure your computer is set up to run some of the e-learning resources (e. You will be given full details of this prior to commencing the course—see below for further details: Flash player Check you have the latest Flash Player (Version 9 or above) How do I know what version of Flash Player I have? Two ways of doing this, either: a) Right-click any flash object in a web browser b) Click on Start> Control Panel >Add/Remove Programs. A dialogue appears that tells you the version of Flash Player currently installed. Wimba Classroom Ensure that your computer is configured to run Wimba (the online tutorial software) before starting the course. Please use the ‘wizard’ to check that your computer and headset are set up for Wimba: edlive. The following are links to demos/videos showing how Wimba Classroom works: Wimba basics: www. Email When you join the University you will get a University of Edinburgh email account and address which will be used for a variety of essential communications. You must access and manage this account regularly as important information from the University will be sent to this address. If you already have a web-based email account and think you are unlikely to check your University email account, it is your responsibility to set up a forward on your University email. Change of details It is vital that you inform Registry Services of any change to details. You are given the opportunity to check and amend your details annually via your Registration Forms, but details can be changed at any time using the online form found here: www. Transkills training Transkills run a range of personal and professional development training courses for students across the University. Course organisers Eleri Williams (Lecturer in Internal Medicine) has responsibility for the day-to- day running of the course, and should be the first point of contact for all students. Associate tutors Associate tutors with specialist expertise will be invited to contribute/run modules in their specialty areas. The programme director is also there to facilitate your orientation and smooth progression through the degree, from initial induction to subsequent course choice, and the transition into the dissertation stage and to the successful completion of the degree. It is your responsibility to inform the programme director immediately of any problems that are interfering with your coursework or progress through the programme, including any religious or medical requirements that might affect your participation in any aspect of the programme. The style of assessment has been chosen to best complement the taught material and learning outcomes.

The reader should be aware that pitfalls in the inter- pretations of study conclusions include the use of biased language and incorrect interpretation of results not supported by the data olanzapine 5 mg otc medications valium. Studies sponsored by drug companies or written by authors with other conflicts of interest may be more prone to these biases and should be regarded with caution 5mg olanzapine with visa medications you can take while pregnant. All sources of con- flict of interest should be listed either at the start or at the end of the article. Bibliography The references/bibliography section demonstrates how much work from other writers the author has acknowledged. This includes a comprehensive reference list including all important studies of the same or similar problem. You will be better at interpreting the completeness of the bibliography when you have immersed yourself in a specialty area for some time and are able to evaluate this author’s use of the literature. Be wary if there are multiple citations of works by just one or two authors, especially if by the author(s) of the current study. The New England Journal of Medicine is a great place for medical students to start. It publishes important and high quality studies and includes a lot of correlation with basic sciences. There are also excellent case discussions, review articles, and basic-science articles. Remember, that what you read in the abstract should not be used to apply the results of the study to a clinical scenario. Initially, we will focus on learning how to criti- cally evaluate the most common clinical studies. These skills will help you to grade the quality of the studies using a schema outlined in Appendix 1. Later the book will focus on studies of diagnostic tests, clinical decision making, cost analyses, prognosis, and meta-analyses or systematic reviews. But as for certain truth, no man has known it, for all is but a woven web of guesses. This requires one to develop an effective search strategy for a clinical question. By the end of this chapter you will understand how to write a clinical question and formulate a search of the literature. Once an answerable clinical question is written and the best study design that could answer the ques- tion is decided upon, the next task is to search the literature to find the best avail- able evidence. This might appear an easy task, but, unless one is sure of which database to use and has good searching skills, it can be time-consuming, frus- trating, and wholly unproductive. This chapter will go through some common databases and provide the information to make the search for evidence both effi- cient and rewarding. Introduction Finding all relevant studies that have addressed a single question is not an easy task. The exponential growth of medical literature necessitates a systematic 33 34 Essential Evidence-Based Medicine searching approach in order to identify the best evidence available to answer a clinical question. While many people have a favorite database or website, it is important to consult more than one resource to ensure that all relevant informa- tion is retrieved. Developed by the National Library of Medicine at the National Institutes of Health in the United States, it is the world’s largest gen- eral biomedical database and indexes approximately one-third of all biomedi- cal articles. Since it was the first medical literature database available for elec- tronic searching, most clinicians are familiar with its use.

Witnesses reported that shortly after take-of discount 20mg olanzapine free shipping treatment jones fracture, the aircraft’s engine began misfring before cutting out and starting again generic olanzapine 2.5mg with mastercard walmart 9 medications. Shortly after, the aircraft commenced a right turn and the engine was again heard to misfre. Part way through the turn the engine again cut out and the aircraft descended rapidly and hit the ground. A severe post-impact fre engulfed the aircraft fuselage, fatally injuring all six occupants. A subsequent investigation into this accident found nothing to suggest that fuel contamination, the amount of fuel carried, structural failure, engine fault, or meteorological conditions were factors in the accident. Pidd, K, Berry, J, Harrison, J, Roche, A, Driscoll, The report into this accident concluded that there T & Newson, R 2006, Alcohol and work: patterns of was insufcient evidence to defnitively link the pilot’s use, workplace culture and safety, Injury Research and alcohol and/or cannabis consumption to the accident. Statistics Series Number 28, Australian Institute of However, evidence concerning the pilot’s activities Health and Welfare, Canberra. WorkCover Tasmania 2010, Drugs and alcohol – medication that could have been consistent with A guide for employers and workers, Hobart. National Centre for Education and Training on performance of post-alcohol impairment, recent Addiction 2006, Fact sheet 1: Alcohol and Work, Adelaide, cannabis use and fatigue could not be discounted as available from www. The researcher must give sound scientific reasons for their use,and explain why there are no realistic alternatives. Animal experiments must use the simplest possible,or least sentient, species of animal. Experiments should use the smallest number of animals that can answer the question posed,and take every practical step to avoid distress or suffering. All staff involved in animal research,and in the breeding, housing and care of animals, must be properly trained and supervised. By law, all research must be scrutinised by a local ethical review, and by the Home Office Inspectorate before work begins. Animal experiments are an integral part of understanding how basic systems of the body work,and what goes wrong with them to cause disease. They are also a necessary, and in some cases legally required, method of testing that proposed treatments are effective and safe. Scientific advances have resulted in the use of animals in research halving over the past thirty years. Research in genetics and molecular biology has clarified similarities and differences between species, allowing a higher proportion of research to be done on the mouse and lower organisms such as fruitflies and nematode worms, and a lower proportion on larger animals. Opponents argue about the validity of data obtained from animals – but the results speak for themselves. Many of the best known and most useful medical treatments of the last century, including antibiotics, vaccines, heart surgery and kidney transplants, have been discovered or tested through the use of animals. It is not a process that can be abandoned because of the advent of cell cultures or genetic decoding. Every researcher has to provide sound scientific reasons for using animals, explaining why no realistic alternative exists. For the future, we expect that the rapid pace of change in medical research will continue to change the sorts of animal studies we do. As we turn to genetics more and more for clues to understand disease, the importance of research on mice will continue to grow.

For small or moderate Blood enters the pulmonary vasculature and thus there emboli subcutaneous low molecular weight heparin is is congestion proximal to the blockage generic olanzapine 7.5mg with amex treatment lichen sclerosis. Therapy is converted to warfarin after 48 hours (for 3 Repair results in the formation of a white scar 2.5 mg olanzapine for sale medicine clipart. Lifelong war- farin may be indicated depending on the underlying Microscopy cause, or in recurrent embolism. Typical features include haemorrhage (due to extravasa- 3 If anti-coagulants are unsuccessful or contraindicated tion of blood), loss of cell architecture, cellular infiltra- a filter may be inserted into the inferior vena cava to tion and occasionally necrosis. Atelectasis and areas of hypoperfusion may be seen, and large emboli may cause Pulmonary hypertension an elevated hemidiaphragm and enlarged proximal pul- Definition monary arteries. A ventilation perfusion (V/Q) scan is Aetiology usually diagnostic, but is less helpful if the chest X-ray Pulmonary hypertension may be secondary to a variety is abnormal. This in turn raises r Right ventricular ‘strain’ pattern – T wave inversion the pulmonary capillary and arterial pressures (left in leads V1–V4. A similar syndrome is associated with Management sytemic lupus erythematosus, scleroderma and Ray- Treatment is aimed at the underlying cause. The result is a de- disease may benefit from oxygen therapy to reduce crease in the lumen of the vessels and hence an increased the vasoconstrictor effect of hypoxia. Progressive fail- r Long-term intravenous infusion of epoprostenol ure of the right side of the heart occurs which is called (prostacyclin) improves the outcome of patients with ‘cor pulmonale’. The administra- tion of bosentan (a nonselective endothelin receptor Clinical features antagonist) may also be beneficial in patients with Dyspnoea, syncope and fatigue are common. Symptoms primarypulmonaryhypertensionalthoughlong-term of the underlying cause and of right ventricular failure follow-up data are not yet available. Occupational lung disease Right heart failure leads to peripheral oedema and hep- atomegaly. A pulmonary mid systolic ejection murmur and an Introduction to occupational early diastolic murmur of pulmonary regurgitation may lung disease be heard (Graham–Steel murmur). Mostpatientswithoccupationallungdisease are entitled to compensation according to their degree Microscopy of disability. If pulmonary hypertension is long-standing, micro- scopy reveals hypertrophy of the media of the vessels with an increase in the amount of smooth muscle. Investigations Incidence r Achest X-ray may show right ventricular and right The incidence of asbestos related disease increased dra- atrialenlargement. Thecentralpulmonaryarteriesare matically in recent decades but appears to have peaked usually prominent and may be ‘pruned’ peripherally. Itisdebatablewhethertheyarecarcinogenic, Pattern of disease Causative agents but their use has now been banned in new buildings Pulmonary fibrosis Mineral dusts such as coal, silicon in the United Kingdom. They persist in the lung for alveolitis allergic response many years and are very fibrogenic and carcinogenic. Acute bronchitis, Irritant gases such as sulphur pulmonary dioxide, chlorine, ammonia, oedema oxides of nitrogen Bronchial carcinoma Asbestos, polycyclic hydrocarbons, Macroscopy/microscopy radon in mines r Asbestos bodies: These are long thin asbestos fibres in the lung parenchyma coated with haemosiderin and Aetiology/pathophysiology protein to form brown filaments with a beaded or Asbestos is made up of various silicates. Theyaretheresultofmacrophages, rally as a fibre, and has been widely used for its insulative which surround and attempt to engulf the fibres, but properties. It was used in sheets in buildings, sprayed on fail to clear them leading to fibroblast proliferation pipes as lagging, in shipbuilding and for boiler insula- and fibrosis. However, it is easily inhaled and the fibres induce r Pleural plaques are well-circumscribed elevated afibrogenic reaction in the lung. The risk of developing plaques of white hyaline fibrous tissue arranged sym- pathology from asbestos is dependent on the duration metrically on the parietal pleura over the ribs and di- and intensity of exposure, and the type of asbestos (see aphragm.