Jeffrey A Brinker, M.D.
- Professor of Medicine
- Joint Appointment in Radiology and Radiological Science
Back to Top Date Sent: 3/24/2020 333 these criteria do not imply or guarantee approval buy genuine probalan online treatment programs. Criteria | Codes | Revision History the use of discography in the treatment of lower back pain does not meet the Kaiser Permanente Medical Technology Assessment Criteria order probalan 500mg otc symptoms xylene poisoning. Back to Top Date Sent: 3/24/2020 334 these criteria do not imply or guarantee approval purchase probalan overnight treatment xdr tb guidelines. Back to Top Date Sent: 3/24/2020 335 these criteria do not imply or guarantee approval. Replaces all or part of the function of a permanently inoperative or malfunctioning internal body organ. Equipment using miscellaneous code ****99, K0108, or L4205 in the absence of specific equipment/prosthetic codes 3. Duplicate items of equipment are being requested 2004 Kaiser Foundation Health Plan of Washington. Back to Top Date Sent: 3/24/2020 336 these criteria do not imply or guarantee approval. Criteria | Codes | Revision History Testicular prosthesis is considered medically necessary for replacement of congenitally absent testes, or testes lost due to disease, injury or surgery. Testicular prosthesis may be covered when associated with transgender services when clinical criteria is met. Back to Top Date Sent: 3/24/2020 337 these criteria do not imply or guarantee approval. Back to Top Date Sent: 3/24/2020 338 these criteria do not imply or guarantee approval. Back to Top Date Sent: 3/24/2020 339 these criteria do not imply or guarantee approval. These are highly localized, hyperirritable spots in a palpable taut band of skeletal muscle fibers. They can also contribute to impaired range of motion and increased sensitivity to stretch. Trigger points may develop anywhere in the body in response to sudden injury, muscle overload, or repetitive microtrauma. Frequently affected sites include trapezius, supraspinatus, infraspinatus, teres muscle, lumbar paraspinals, gluteus, and pectoralis muscles. It is postulated that the injured muscle fibers shorten forming taut bands in response to the excessive amounts of calcium released from the damaged fibers or to the excessive amounts of acetyl choline released from the corresponding motor end plate. Back to Top Date Sent: 3/24/2020 340 these criteria do not imply or guarantee approval. Several treatment modalities have been used to alleviate the chronic myofascial pain, but no single strategy proved to be universally successful. The needle is not left in situ but is removed after the muscle has finished twitching and the trigger point inactivated. This should be followed by exercises, usually stretching or ergonomic adjustments, in order to establish a painless full range of motion. Some investigators explain that the localized twitch response that often occurs may interrupt the motor end-plate noise, producing an analgesic effect, while others suggest that eliciting a localized twitch response and stretching exercises relax the actin-myosin bonds in the tight bands. It is also postulated that the mechanical damage of the muscle fibers and nerve terminations leads to an increase of extracellular potassium, depolarization of nerve fibers, inhibition of central feedback mechanisms, local dilution of nerve-sensitizing substances, increasing vasodilatation, and formation of necrosis in trigger point area. Dry needling techniques include superficial or deep needling and needling with or without paraspinal needling. In the technique that involved paraspinal needling, needles are inserted at the trigger point as well as in the paraspinal muscle of the same segment that innervates the painful muscles. The states allowing the procedure to have to follow guidelines for education and competency standards for performing it. The majority of trials were unblinded, had methodological limitations, and none was designed as an equivalence trial. Improvements were observed when the comparisons were made between pre-and post-treatment within each of the study groups. Many of the authors interpreted the lack of difference between the study groups as equal effects. As indicated earlier, none of the trials were designed as equivalence study, and a lack of significant differences between study groups cannot be interpreted as equal effects as it might be due to the small sample sizes and insufficient power of the trials. Back to Top Date Sent: 3/24/2020 341 these criteria do not imply or guarantee approval. The results of the two meta-analyses have to be interpreted with caution due to the small number and size of the trials as well as their methodological limitations, and significant heterogeneity between studies. There is insufficient published evidence to determine the appropriate number of points to be injected. There is insufficient published evidence to determine the duration of pain relief after the injection. There is insufficient evidence to determine whether the patients would need to undergo another needling procedure, and the most appropriate interval between re-injections if needed. Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Effectiveness of dry needling for the treatment of temporomandibular myofascial pain: a double-blind, randomized, placebo-controlled study. Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial. Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-analysis. Comparison of dry needling and physiotherapy in treatment of myofascial pain syndrome.
The responsibility of the state to take action to enable adults to live healthy lives order 500 mg probalan with visa 20 medications that cause memory loss, and to protect them where possible from avoidable harms order probalan visa treatment zone tonbridge, is even stronger with respect to the protection of children and young people buy probalan 500 mg overnight delivery medications osteoarthritis pain. While there is an increasing focus on the importance of children and young people participating in healthcare decision-making, this is premised on the assumption that the proposed treatment is recommended by a health professional, and is in the child?s best interests. Similarly, parental discretion with respect to the decisions parents take on behalf of children is not boundless. The fact that a parent consents to a cosmetic procedure on behalf of their child, or even initiates consideration of that procedure, does not necessarily mean that it is ethically acceptable for a professional to provide it. For pragmatic reasons, both law and policy frequently need to draw ?bright line? distinctions based on age, including determining the age at which in law, childhood and the associated parental responsibility comes to an end. We suggest that there are strong justifications for limiting access to cosmetic procedures to people over the age of 18, other than in exceptional cases. Some of the ethical challenges that arise in connection with the provision and use of cosmetic procedures fall outside the sphere of influence of individual practitioners. Nor are they responsible for the inadequate and patchwork nature of regulation in this field or for the failures of some parts of the industry to demonstrate corporate social responsibility. An ethical approach would include: Acting first and foremost in the best interests of their users / patients, and not taking on the role of a salesperson. The fact that cosmetic procedures constitute a physical intervention whose hoped-for benefits are primarily psychological highlights the importance of practitioners, at the very least, having access to psychological expertise, through multidisciplinary working or other forms of professional and peer support. Practitioners should not hesitate to probe in some depth what users hope to achieve, and be frank about the evidence as to how likely these aims are to be realised. This includes discussing alternative interventions where the evidence suggests that these are more likely to be effective. While ethical engagement between practitioner and user of cosmetic procedures cannot be reduced simply to the question of informed consent, nevertheless the approach taken to consent is a key element in that encounter. We suggest that in this context shared decision making where users or patients play an active role in decisions about their treatment or care may prove a better model than the traditional consent process, where patients are asked only to accept or refuse a treatment offered by their doctor. In genuinely shared decision-making, consultations should be partnerships between practitioner and user, in contrast both with the traditional understandings of the doctor / patient relationship and with models of consumer choice and high-pressure sales. Changes to promote more ethical practice are needed both on the ?demand? and on the ?supply? side, and two issues have emerged repeatedly throughout this inquiry that are significant in considering practical ways forward: the absence of high quality data with respect to many of the issues touched upon by this report; and the delays and failures of successive governments in responding to the series of major reports over the past decade that have laid bare the inadequate state of regulation of the cosmetic procedures industry. We therefore highlight where further work is urgently required to improve the information and research base. We also distinguish what, in our view, would be ideal and should be achieved in the long-term, and what may be more immediately achievable in the current regulatory environment. The ?stewardship? role of the state includes positive public action to enable people to flourish with respect to both their physical and their mental health. Such public action is justified to counteract both the specific claims made about the positive effects of cosmetic procedures, and more generally to counter the effects of broader visual and media cultures in which choices about cosmetic procedures are embedded. It also justifies action in response to inequality and discrimination: the development and marketing of cosmetic procedures has the scope to contribute to discriminatory attitudes by endorsing particular appearance ideals and offering technical ?fixes? to achieve them. Such responsibilities go wider than state actors, and we identify specific action that could be taken by industry both in the images and claims promulgated through advertising and in the wider role played by social and traditional media. In 2016, Transport for London (TfL) amended its advertising policy in order to refuse advertising that ?could reasonably be seen as likely to cause pressure to conform to an unrealistic or unhealthy body shape, or as likely to create body confidence issues particularly among young people?. Recommendation 3: We further recommend that the Advertising Standards Authority works proactively to monitor compliance with such standards, in line with its recent commitments to devote more resources to proactive review of advertisements and its ongoing work on body image. We welcome the fact that social media companies such as Facebook / Instagram are beginning to include concerns about body image in the campaigning and educational work they undertake among adolescents. In the light of the increasing concerns emerging with respect to correlations between social media use and such body image issues, we suggest that collaborative work across the sector to tackle these issues falls squarely within the remit of their corporate social responsibilities. Similarly, we suggest that marketing apps designed for children as young as nine that encourage them to ?play? at having cosmetic surgery makeovers, is clearly inappropriate and irresponsible. We endorse the campaign by Endangered Bodies which has established a petition to Apple, Google and Amazon requesting them to exclude xxvii C o s m e t i c p r o c e d u r e s : e t h i c a l i s s u e s from their app stores any cosmetic surgery games targeted at children. Broadcast media have also played a part in influencing how cosmetic procedures are perceived, particularly through the growth and popularity of cosmetic surgery makeover shows. While there is considerable diversity within the genre with respect to attitudes to body image and appearance ideals, a common feature conveyed by many is the idea that surgical ?fixes? to problems are always available. Recommendation 4: We recommend that the social media industry (including Facebook / Instagram, Snapchat, Twitter and YouTube) collaborate to establish and fund an independent programme of work, in order to understand better how social media contributes to appearance anxiety, and how this can be minimised; and to take action accordingly. Recommendation 5: We recommend that Ofcom review the available evidence and consider whether specific guidance to accompany its Broadcasting Code is warranted with respect to the tacit messages about body image and appearance ideals that may be conveyed by makeover shows involving invasive cosmetic procedures. Contemporary concerns about exclusion and discrimination in connection with appearance exist alongside significant momentum towards more inclusive attitudes towards diversity. The Face Equality Campaign, the BeReal campaign, and Models of Diversity, for example, all aim to promote acceptance of greater diversity of appearance in various sectors, including in business and employment. Discrimination on the grounds of appearance often coincides with, or contributes to, discrimination on other grounds, such as age, race and disability, that are already prohibited under the Equality Act 2010. Full use of existing powers, not only of enforcement, but also through advice and guidance, should be made to challenge discrimination based on appearance. Recommendation 6: We recommend that the Equality and Human Rights Commission: develop and publish specific guidance on disfigurement and appearance-related discrimination, founded on the requirements of existing equality legislation; and take discrimination related to appearance into account when monitoring discrimination relating to areas such as age, race, gender and disability. The stewardship role of the state is particularly strong in relation to its responsibilities to protect the welfare, including the mental health and well-being, of children.
The level of conditioning and 500mg probalan with amex treatment yeast uti, consequently generic 500mg probalan fast delivery medications prescribed for pain are termed, the effectiveness of the training performed by crewmembers are also determined in long-duration flight according to the parameters of the treadmill test with gradually increasing locomotor loads on the treadmill discount probalan 500mg line medicine 93 7338. The length of the test is 11 minutes, and the energy expended during the experiment is approximately 100 kcal. A distinctive feature of the test is the standardization of the sequence and length of each of the five load levels (Fig. The mean speed limits of slow, moderate, and fast running, which constitute the basis of the test, are shown in the crew procedures. However, during flight training the crew receives instructions to use these speeds as general guidelines only, and is instructed to select exact running speeds within each level based on how they feel. Conditioning indices are the intensity of work performed, the running speed within each level, and the heart rate. During a 360-day flight the intensity of work and, consequently, the volume of work increased, but the heart rate recorded while performing maximum running somewhat decreased, stabilizing at 170 bpm. A similar dynamic of test parameters was also noted for the commander of an 11-month space flight. Along with this, test indices of the flight engineer of the same mission from the third month of flight later showed a different decrease in tolerance to locomotor loads: the running speed within the levels was unusually low and in a number of cases the cosmonaut did not follow the structure of the test, abruptly stopping the run or changing to a cool-down walk, passing the maximum run phase. The principles outlined above were the basis for generating exercise countermeasures for long-duration space flights 62,74 aboard Russian space stations. Analysis of flight results and data from postflight examinations of crewmembers allows us to conclude that the requirements of the onboard training system for time, volume, and intensity meet the two primary objectives. Specifically, they a) successfully maintain the physiological systems at a level necessary and sufficient to support health and high performance during all stages of flight, including readaptation to Earth gravity and b) do not require special professional qualifications. After appropriate ground training, these protocols are accessible to crewmembers of various ages and body types. A decrease in orthostatic tolerance may result from many factors peculiar to space flight. However, the main etiological factor that has a negative influence on the homeostatic mechanism of the circulatory system is the length of time in microgravity. Data obtained in ground experiments with simulations of hypokinesis contributed significantly to the study of this area. The results of numerous short-term and long-duration model studies of the unique physiological effects of microgravity, in which various countermeasures for orthostatic intolerance were developed, showed that the 19 V4 Ch 8 Countermeasures to Short-Term and Long-Term Space Flight Grigoriev et al. The first day training consisted of two microcycles with a total length of 60 74 minutes. Instead of five days, a two-stage training program was used beginning 18 days prior to the end of the flight and consisted of preliminary and basic training (Fig. The issue concerning the usefulness of the Bracelet occlusion cuffs throughout long-duration space flights still remains open. The prophylactic effect of occlusion cuffs in space flights is based on the pooling of a certain volume of blood in vessels of the lower extremities. This pooling is caused by an occlusion of the superficial veins of the calf and consequently leads to a decrease in blood volume that is shifted towards the head. When using pneumatic occlusion cuffs in experiments with simulated microgravity conditions (head-down tilt bed rest), the subjects developed the illusion of shifting from an actual antiorthostatic position to an orthostatic position with the head raised in relation to the horizontal. Meanwhile, the unpleasant feelings of heaviness in the head and edema of the soft tissues of the face and neck decreased; the cardiac output and the cranial and pulmonary blood flow indices 41 decreased; and the sensitivity of the vestibular apparatus to linear accelerations changed. Direct research methods (probing the femoral artery and vein) have shown that during short-duration use of mechanical occlusion cuffs, the pressure in the vein on the upper surface of the foot markedly increased, the pressure in the femoral vein showed a tendency to decrease, and the arterial pressure in the vessels of the lower 77 extremities did not change. During a seven-day head-down tilt bed rest (-15º) the use of occlusion cuffs, with pressure in them ranging from 30 to 50 mm Hg, was accompanied by artificial pooling of blood in the lower extremities (about 250 ml) and the normalization of central hemodynamic indicators. The most pronounced effect 78 was observed with a pressure in the cuffs of 50 mm Hg. Similar data have also been obtained in longer experiments with 30-day head-down tilt bed rest (-8º) in which Bracelet-type mechanical cuffs were used daily for 12–15 hours per day. The research results also revealed the training effect of a systematic pooling of blood in the 79 lower extremities on the bodys antigravitational functions. Extended wearing of the occlusion cuffs may mitigate the development of such complications as fainting and increased distensibility of the veins of lower extremities, although with the degree of occlusion recommended for flights, these occurrences, as a rule, are not observed. With extended wearing of the cuffs, it is possible to exclude the possibility that the distensibility of the veins in the lower extremities may increase which, in turn, may have a 41 80 negative effect on the tolerance to orthostatic loads during landing. Authors believe that the results of research 20 V4 Ch 8 Countermeasures to Short-Term and Long-Term Space Flight Grigoriev et al. In the experiments conducted by the same authors with 18 hours of water immersion, the training that included wearing occlusion cuffs on the upper third of the hip for eight hours with a pressure in them of 60–70 mm Hg (with a cycle of 1 minute of pressure, 1 minute of rest) aided the maintenance of orthostatic tolerance. Use of the cuffs during short-term flights was accompanied by insufficient pulse engorgement in the chest and head and in several cosmonauts—a disappearance of feelings of heaviness in the head and unpleasant sensory and autonomic symptoms. The occlusion cuffs during long-term flight were subjectively assessed as useful by the crews of Mir expeditions 4, 5, and 6. However, objective studies of their impact on the cardiovascular system, conducted with three crewmembers during months 1, 2, 4, and 6 of the Mir-9 and Mir-10 expeditions, were inconclusive. The following are observed during the test: a decrease in the volume of circulating blood, an increased heart rate, a decrease in the stroke volume and cardiac output, a decrease in the systolic and pulse pressure, an increase in the diastolic pressure, and activation of the neuroendocrine regulation of fluid-electrolyte 42,85–93 metabolism with subsequent retention of fluid and electrolytes. If the test tolerance is good the feelings are pleasant; if the tolerance is bad, the feelings are accompanied by a tingling sensation and heaviness in the legs due to the overfilling with blood. This is accompanied by sweating, dizziness, and, in some cases, severe visual and auditory disturbances, general weakness, and nausea.
- Coughing up blood
- Pectus excavatum
- Swelling and pain in the joints of the shoulders, knees and ankles
- Complete blood count (CBC) to monitor for anemia
- Hiatal hernia occurs in the upper part of the stomach. Part of the upper stomach pushes into the chest.
- General ill feeling (malaise)
Allows client to feel hopeful and begin to unaffected side and learn to control affected side order probalan mastercard treatment plant. Provides opportunity to use behaviors previously effective 500mg probalan amex medicine expiration dates, Determine presence and quality of support systems purchase probalan 500 mg online medications used for adhd. Emphasize and provide positive I-messages for small gains Consolidates gains, helps reduce feelings of anger and help either in recovery of function or independence. Support behaviors or efforts such as increased interest and Suggests possible adaptation to changes and understanding participation in rehabilitation activities. Monitor for sleep disturbance, increased difficulty concentrating, May indicate onset of depression (common aftereffect of stroke), statements of inability to cope, lethargy, and withdrawal. Collaborative Refer for neuropsychological evaluation and counseling, if May facilitate adaptation to role changes that are necessary indicated. Note: Depression is common in stroke survivors and may be a direct result of the brain damage or an emotional reaction to sudden-onset disability. Have suction equipment available at bedside, especially during Timely intervention may limit amount and untoward effect of early feeding efforts. Promote effective swallowing using methods such as the following: Schedule activities and medications to provide a minimum Promotes optimal muscle function and helps to limit fatigue. Assist client with head control or support, and position based Counteracts hyperextension, aiding in prevention of aspiration on specific dysfunction. Optimal positioning can facilitate intake and reduce risk of aspiration—head back for decreased posterior propulsion of tongue, head turned to weak side for unilateral pharyngeal paralysis, and lying down on either side for reduced pharyngeal contraction. Place client in upright position during and after feeding, as Uses gravity to facilitate swallowing and reduces risk of appropriate. Clients with dry mouth require a moisturizing agent, such as ar tificial saliva or alcohol-free mouthwash, before and after eating; clients with excess saliva will benefit from use of a drying agent, such as lemon or glycerin swabs, before meal and a moisturizing agent afterward. Season food with herbs, spices, and lemon juice according to Increases salivation, improving bolus formation and swallowing clients preference, within dietary restrictions. Stimulate lips to close or manually open mouth by light Aids in sensory retraining and promotes muscular control. Place food of appropriate consistency in unaffected side Provides sensory stimulation (including taste), which may in of mouth. For example: Clients with decreased range of tongue mo tion require thick liquids initially, progressing to thin liquids, whereas clients with delayed pharyngeal swallow will han dle thick liquids and thicker foods better. Note: Pureed food is not recommended because client may not be able to rec ognize what is being eaten. Most milk products, peanut but ter, syrup, and bananas are avoided because they produce mucus and are sticky. Touch parts of the cheek with tongue blade or apply ice Can improve tongue movement and control necessary for to weak tongue. Feeling rushed can increase stress and level of frustration, may increase risk of aspiration, and may result in clients termi nating meal early. In general, liquids should be offered only after client has finished eating solids. Although use may strengthen facial and swallowing muscles, if client lacks tight lip closure to accommodate straw or if liquid is deposited too far back in mouth, risk of aspiration may be increased. Maintain accurate record of food and fluid intake; record If swallowing efforts are not sufficient to meet fluid and nutri calorie count if indicated. May increase release of endorphins in the brain, promoting a sense of general well-being and increasing appetite. Collaborative Review results of radiographic studies, such as video Aids in determining phase of swallowing difficulties—oral fluoroscopy. Coordinate multidisciplinary approach to develop treatment Inclusion of dietitian and speech and occupational therapists plan that meets individual needs. Encourage client to turn head and eyes to scan the Helps client compensate for visual field loss, increasing environment. Discuss affected side while touching, manipulating, and Focuses clients attention, and limb activation treatment stroking affected side; provide items of varied size, provides tactile stimuli to promote use of affected limb in weight, and texture for client to hold. Have client look at and handle affected side, bring across Encourages client to accept affected limb or side as part of self midline during care activities. Assist client to position affected extremity carefully and to Promotes safety awareness, reducing risk of injury. Discuss environmental safety concerns and assist in developing Client may continue to have some ongoing degree of func plan to correct risk factors. Reinforce continuation of prescribed rehabilitation activities Maximizes recovery and enhances independence. Deficits affect the choice of teaching methods and content and complexity of instruction. These individuals will be providing support and care and have great impact on clients quality of life. Aids in establishing realistic expectations and promotes understanding of current situation and needs. Identify signs and symptoms requiring further follow-up, such Prompt evaluation and intervention reduces risk of complica as changes or decline in visual, motor, sensory functions; tions and further loss of function. Review current restrictions or limitations and discuss planned Promotes understanding, provides hope for future, and creates or potential resumption of activities, including sexual expectation of resumption of more normal life. Follow-through is essential to similar-acting drug, such as ticlopidine (Ticlid) and warfarin progression of recovery and prevention of complications. Identify ways of continuing program Note: Long-term anticoagulation may be beneficial for after discharge. Provide written instructions and schedules for activity, medica Provides visual reinforcement and reference source after tion, and important facts. Encourage client to refer to lists, written communications or Provides aids to support memory and promotes improvement notes, and memory book.
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Resident has to develop these attributes through different mechanism of interaction buy cheap probalan 500 mg online medicine runny nose. Degree course is expected to perform major and minor surgical procedures independently as well as under supervision of a faculty member/a senior resident purchase 500 mg probalan medicine 2015. She/he should be able to do many major operations independently such as: (Few examples only given): • Tracheostomy order probalan 500 mg line treatment wetlands, • Tonsillectomy • Adenoidectomy/grommet insertion, • Nasal Polypectomy • Incision/drainage of quinsy/other abscesses, • S. Be able to manage common emergies like, fracure nasal bone, stridor requiring a tracheostomy, epistaxis, Subperiosteal abscess, and Peritonsillar abscess. Research methology/ Reporting on research Learns the basics in research methodology and make the thesis protocol with the 4 months of admission. Selection of thesis Topic Subject of thesis will be selected by the candidate under guidance of Faculty which will be approved by the departmental guide and other faculty. The Candidate will be asked to submit the protocol within 4 (Four) month of admission after it is scrutinized by departmental Faculty. It is to be approved by the Central thesis committee of the Institute/College if such committee does exist, and the ethical considerations are also discussed in such Research Programme committee. Once the thesis protocol is approved the candidate starts his research work under direct supervision of guide and coguides. Three/six monthly progress of the thesis will be checked to know the outcomes/or difficulties faced by the Candidate. At the discretion of director/rector/thesis committee one month extension may be given to a candidate for submission of the protocol and the final thesis for any valid reason for the delay. Journal club: 2 hrs duration Paper presentation/discussion once per week (Afternoon. Lecture/discussion : Lectures on newer topics by Faculty, in place of seminar/as per need. Case presentation in the ward and the afternoon Special clinics (such as vertigo / otology Tumour clinics. Resident will present a clinical case for discussion before a faculty and discussion made pertaining to its management and decision to be recorded in case files. Surgicopathological Conference: Special emphasis is made on the surgical pathology and the radiological aspect of the case in the pathology deptt. Combined Round/Grand Round: these exercises are to be done for the hospital once/wk or twice/ month involving presentation of unusual or difficult patients. Presentations of cases in clinical combined Round and a clinical series/research data on clinical materials for benefit of all clinicians/ Pathologists/other related disciplines once in week or forthrightly in the Grand round. Community camps: For rural exposure and also for experiences in preventive aspect in Rural situation/ hospital/school, Patient care camps are to be arranged 2-3/year, involving Residents/junior faculty. The ear cases are thoroughly investigated and are discussed by the Junior Residents with the faculty for their management/discussions are made after each case is presented. Bedside clinical training for patient care care management and for bedside manners: Daily for ½ to one hours duration during ward round with faculty and 1-2 hours in the evening by senior resident/ Faculty on emergency duty, bedside patient care discussions are to be made. Once a week one Faculty should take a one hour Teaching Round by Rotation of Faculty (4/5 such rounds per semester of 6 months. Death Cases: Once a month/ once in 3 months the records of such cases are presented by the Senior Residents. This programme helps to take corrective measures as well as to maintain accountability in patient management. Clinical interaction with audiologists/speech therapist: Clinical interaction with audiologist/ speech therapist pertaining to management of the patients with 1audiological/speech problems are to be made/discussion arranged. Audiologic methods and therapy strategies are to be made known to Resident doctors. Research Methodology : Courses and Lectures are to be arranged for the residents for language proficiency by humanity teachers besides few lectures on human values and ethical issues in patient care. Writing Thesis: Thesis progress is presented once in 3 months and discussion made in the dept. Guides/co-guides are to hear the problems of the candidate; can provide assistance to the student. Progress made or any failure of the candidate may be brought to the notice of college Dean/ Principal. Final Examination & Examiners the Oral, Clinical and Practical Examination: One or 2 centres depending on local university rules. Results of the examination will be declared as pass/failed/pass with distinction (Grades/marks may also be given if necessary as per University Rules. Assessment Formative: 25% (6 monthly, each with 5% weightage) Based on day to day/semester Tests, jointly or individually assessed by different faculty members & computed and a final aggregrate will be considered together and that will considerate a 2. Both Formative assessment and Summative assessment will be added together at the time of final examination, and results prepared accordingly. Clinical Patient presentation/discussion: (i) One long case: the long case will be structured, comprising history taking, clinical examination, investigations, decision making, proposed treatment modalities, ethical justification and personal attributes. One of the internal examiner will be the Head of the Deptt and he /she shall be Chairman/Convener. The second internal examiner shall be next senior most member of Faculty of the deptt provided he/she is eligible for such duty. Hony teacher with previous full time experience ( of 10 years standing) may only be made examiners if there does not exist any a full time qualified faculty under the same university/college. The external examiners will be asked to send two sets of question papers for the theory examination. The Chief internal examiner or Chairman/Convener will moderate it and finally make two sets of question paper, – continuing 8-10 shorts questions.