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Do not forget to include those post-submission tasks like reading proofs cardura 2 mg on-line. Once you have some idea of the overall sequence of events you can start to identify the main goals related to each stage. Now you need to list the tasks you need to perform in order to reach your goals. For the above goal your tasks might include: ° browsing books, articles and other information sources ° identifying seminal texts ° reading recent research ° reviewing notes from conferences/courses ° making notes. For instance, you might decide to carry out a database search to help in reading current research on feeding diffi­ culties. This will help you in carry­ ing out your search and in selecting the appropriate databases. When you have answered these questions you should have a more pre­ cise description of the task. The above example could be phrased as ‘to complete a search on European re­ search into refusal of food by infants between two and five years of age, us­ ing CINAHL, ClinPSYC and PsychLit from 1990 to current time’. Precise targets are easier to measure, and therefore more useful in indicating whether or not you have achieved your goals. MANAGING YOUR TIME EFFECTIVELY 235 At first it will be difficult to break down your project into a very de­ tailed analysis. However, you need to have a clear idea of your overall goals before you can start thinking about the timeframe, so aim to identify as much detail as possible. It may be helpful to make a few copies of the planner so that you can redraft your plan as needed. Although there will be a natural sequence, some things will need to be done very early on. For ex­ ample, obtaining copyright to reproduce a table or diagram can take some time. If you can identify this at the outset, you can apply for permission in plenty of time.

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A promising direction for treatment is DBS discount 4mg cardura fast delivery, where electrodes are placed in specific nuclei in the extrapyramidal motor circuit including the globus pallidus and subthalamic nucleus. While some initial reports of improvement in dystonia are favorable, there are concerns about mechanical pro- blems including electrode movement and breaks. To date, DBS has been infrequently employed in children with hyperkinetic movement disorders. Children with extrapyramidal cerebral palsy are more likely than those with severe spasticity to have normal intelligence. However, this group may have difficul- ties with dysarthria or inability to speak. In this situation, assistive technology is an important component of therapy. Sophisticated devices can be designed to give children control of their environment from communication to mobility. Referral to specialized centers or teams is recommended to provide the optimum equipment, given the rapid advances in this area. MEDICATION MANAGEMENT While the possible range of side effects to oral medications is beyond the scope of this chapter, several generalizations can be made. Some medications have recogniz- able side effects, such as sedation from diazepam and seizures from acute baclofen withdrawal. Others become evident with repeated use, such as personality changes with trihexyphenidyl. As many of the medications used have not been thoroughly studied in childhood, clinicians should listen carefully to parental=caregiver concerns about any changes in their children after medication initiation. Parents=caregivers will continue to administer medications if they see positive benefits, which should be an important determinant in clinician decision making with regard to use and dosing. A helpful additional aid is to keep community therapists masked as to onset and dosing of medications, utilizing their opinions as to changes in motor function with medication use=adjustments. ASSOCIATED PROBLEMS While this chapter is primarily directed toward medical management, it is important to recognize that affected children and their families may have a wide range of med- ical, financial, psychosocial, educational, and vocational needs, which may change over time.

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All aspirations for social progress through transcending the capitalist order generic 1mg cardura mastercard, which had sustained generations of radicals from 1848 to 1968 and beyond, were now in abeyance. Indeed, not only were all prospects of social change through collective action now ruled out, the scope for individual initiative was also put in question. Doctors could now play a role in society, not in alliance with mass democratic social movements, but only as agents of the state. This fundamental change in social context gives Virchow’s slogan an entirely different meaning. In the absence of a forceful movement from below, medical intervention in society becomes a vehicle of government policy, not politics ‘writ large’, but politics on a small scale, petty, intrusive and moralising. Radical doctors may still project their desires for the redistribution of wealth to remove the social causes of health inequalities but, as the government’s response confirms, its only interest is in improving social cohesion and stability. Hence doctors who take on a wider social role find themselves implementing policies which, far from offering greater liberty and democracy, have an inherently coercive character. What a bitter irony that Virchow, the great libertarian, now provides an aura of radical legitimacy for an authoritarian government health policy. The pre-eminent role of health in Western society since the early 1990s is linked to a significant shift in the boundaries between the spheres of public and personal life, and to changes in the relationship between the state and the medical profession. Challenging the tyranny of health in the context of the wider social changes we have discussed, involves redefining these boundaries. This means, on the one hand, defending the autonomy of the medical profession and, on the other, upholding the autonomy of the patient. He further argued that professional autonomy was ‘the critical outcome of the interaction between political and economic power and occupational representation, interaction sometimes facilitated by educational institutions and other devices which successfully persuade the state that the occupation’s work is reliable and valuable’ (Freidson 1970:82–3). The licensing system introduced in Britain by the 1858 Medical Act sought to guarantee the public that a registered doctor was a ‘safe general practitioner’ and the GMC policed both the conduct of doctors with their patients and in their relations with other practitioners. It also allowed a unified profession to project an ethical orientation which put public service before self interest. As Freidson put it, ‘the profession’s service orientation is a public imputation it has successfully won in a process by which its leaders have persuaded society to grant and support its autonomy’ (Freidson 1970:82).

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