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Letters where the clinic address differs from that given on the headed paper are often confusing for the client generic geriforte syrup 100 caps mastercard. LETTERS AND REPORTS 81 Referral letter – key content ° Name geriforte syrup 100caps without prescription, address and identification details (date of birth generic 100 caps geriforte syrup otc, hospital number and so on) of the subject of the referral. Common mistakes in referral letters Letter fails to provide sufficient details to enable the receiver to prioritise the referral. Client contact details are incomplete or out of date so it is difficult to notify the client about appointments. Important information relating to the client is omitted, for example the client requires an interpreter or hospital transport. Letter in reply to a complaint – key content ° Name, address and identification details of complainant. Common mistakes in letters about complaints The letter is written defensively – the clinician attempts to demonstrate his or her expertise using jargon, technical terms and excessive clinical detail. For example, it is not ap­ propriate to include information about a lack of previous complaints about a health worker or a service. Reports Clinicians regularly write clinical reports about specific clients. These are formal written accounts that are functional in nature rather than creative – the writer being required to adhere to certain recognised practices in the organisation and presentation of such material. Format of reports Reports have a basic structure consisting of: ° a title ° an introduction LETTERS AND REPORTS 83 ° the main section ° the conclusion ° actions ° recommendations. Title This tells the reader, at a glance, the subject matter of the report. Introduction The introduction in a report sets the scene for the reader, and makes clear the purpose of the report. It will always include specific information about where, when and why the report writer saw the client. A statement about the source of the information can also be included at this point in the re­ port, for example observations made during direct contacts with the client, information from notes, discussion with the client’s family or liaison with other professionals. These details will help identify for the reader how and at what point the report links in with the total care for that particular client. It is also use­ ful if the report is to be an accurate account for future reference. In some circumstances it may be appropriate to give some background information in the introduction, for instance a brief account of the nature and length of the contact with the client. The emphasis is on brief, with the main points expressed in no more than one or two sentences. A sub­ stantial description is better placed in a separate section under a heading like ‘Background Information’ or ‘Other Relevant Information’. Notes about any limitations on the scope or depth of a report are also placed in the introduction (Inglis and Lewis 1982), for example if an as­ sessment was incomplete due to the late arrival of the client. Main section Most of the information contained within a report is recorded within the main section. The content usually relates to current actions, but may refer to past or future events. It is therefore important to indicate the point in time to which the information relates, for example, ‘in his previous assess­ ment on …’. It is not the place to regurgitate lines from the main body of the text, nor should it contain any new pieces of information. The writer must draw together the key mes­ sages of the report and convey these as concisely as possible.

Some people agree to carry the ambu- lation aid but won’t let it touch the floor buy geriforte syrup 100caps line, defeating the purpose buy 100 caps geriforte syrup mastercard. The phys- ical therapist Gary McNamara finds discount 100caps geriforte syrup with mastercard, Until they’ve taken a first step and realize that it’s going to take change to create change, you can’t do anything. You go to some- one’s home and they say, “Yeah, I’ve fallen and my doctor told you to come. They’re convinced that they’re stuck in this rut and there’s nothing they can do. There’s a lot of preconceived notions in their head about assistive devices and what they mean. The psychologist Rhonda Olkin (1999, 285) argues that acceptance of assistive technologies, such as mobility aids, requires that they “be per- ceived as enablers of activities and functions that would otherwise be diffi- cult or impossible. Since mobility aids are visible, family members often hold strong opin- ions, and long-established familial dynamics come into play. Sometimes “a family might resist the implications of an AT and insist that the family member rely on his or her own limited facilities, despite the drain on per- sonal energy and emotional resources” (Olkin 1999, 291). I heard this from younger women whose husbands became deeply disturbed when their wives used mobility aids. The husbands do not outright forbid it, recogniz- ing their wives’ needs. Nevertheless, the husbands are terrified by the im- plications—presumed permanent debility and inevitable downward spiral. Other times, family members are persistent advocates, and physicians en- list their help to persuade patients. They try to get patients to use the device, but they don’t always succeed. Johnny Baker navigates delicate terrain between his patients and their family members. Although family members want his professional opinion to validate their positions, Dr. Baker simply doesn’t know exactly what is right: after all, little scientific evidence exists to guide decisions about ambulation aids. Frequently there’s a family member who says, “Mom does fine here in your examining room, but she totters around at home and I’m concerned about her. Then I try to redirect things to the patient: “How do you respond to what your daughter’s saying? The family member usually wants more assistance than the patient has accepted—like moving from a cane to a walker—and wants to go home and quote the doc- tor: “The doctor said you have to do this. But whether this person who’s using a cane would be better off with a walker, I don’t know. If I can get the patient and family mem- ber to agree with each other, I’ll assume that’s what’s right. Baker and other clinicians noted, the symbolism of specific am- bulation aids is off-putting. Clinician interviewees suggest that carved or painted canes and colorful walkers are more palatable, ornamental as well as practical. Each person needs to find a way to make equipment less of a barrier with other people. The Halperns’ house was an obstacle course, jumbled boxes and stacked papers strewn among sheet-draped furniture. Esther Halpern doesn’t like that walker, rejecting it immediately after the physical therapist delivered it. Halpern loves her “carriage”—an aluminum walker with four wide gray rubber Ambulation Aids / 191 wheels, brakes on each handlebar, and a stretched cloth seat.

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How- ever generic geriforte syrup 100caps overnight delivery, he needs to think about whether he is going to consider hospitals geriforte syrup 100 caps visa, residential homes discount geriforte syrup 100caps line, or both, and in what areas. Also, is he going to contact people who look after their relatives at home? HOW TO DEFINE YOUR PROJECT / 11 Although, on the surface, this project appears more manageable, this researcher has a major point to con- sider. In the UK all social research which is carried out on health care premises comes under the jurisdic- tion of Research Ethics Committees. These committees were set up to ensure that research does not harm pa- tients in any way and that it is done in their best inter- ests. In the USA a similar function is carried out by Institutional Review Boards. This means that the re- searcher would have to get his project approved by the appropriate committee before he could go ahead with the research, and it is not guaranteed that his pro- ject would be given approval. As he would have to sub- mit a full and detailed proposal to the committee, he could be conducting a lot of preliminary work, only to be turned down. Researchers need to think carefully whether this is a route they wish to take, and if so, ob- tain the appropriate advice before committing them- selves. Statement 3: We want to find out how many of the local residents are interested in a play scheme for children dur- ing the summer holiday. This project put forward by a tenants’ association ap- pears to be straightforward and manageable, although there are still several issues which need addressing. My first question for this topic would be: do you really want to find out how many of the local residents are inter- 12 / PRACTICAL RESEARCH METHODS ested, or do you want to find out the interests of resi- dents with children of the appropriate age who would ac- tually use the scheme? If the latter is the case, this narrows down the research population and makes it more manageable. Finding out whether someone is interested in something is not actually the same as finding out whether someone would use the service. For example, I might think a play scheme is a good idea for other children as it might keep them off the streets, but not for my little darlings who are too occupied with their computer. If I said ‘yes, I am interested’, this could be misleading as I have no in- tention of using the service. However, if the purpose of the research is to obtain funding for the scheme, then the more people who express an interest, the better, although the tenants’ association would have to be careful not to produce misleading information. I would also find out whether the tenants’ association was interested only in the issue of how many people were interested in it and would use the play scheme. If they were doing this research anyway, would it be a va- luable addition to find out what sort of scheme resi- dents would like, and what activities their children would like? HOW TO DEFINE YOUR PROJECT / 13 SUMMARY X You must take time to think about your research as this will save you problems later. X When you’re thinking about your research, ask your- self the five ‘Ws’: – What is my research? X Discuss your sentence with your tutor or boss and re- vise if there is any confusion. The first thing you need to do is to think about your research methodology. This is the philosophy or the general princi- ple which will guide your research. It is the overall ap- proach to studying your topic and includes issues you need to think about such as the constraints, dilemmas and ethical choices within your research. Now that you have read Chapter 1, some of these issues will be fresh in your mind. Your research methodology is different to your research methods – these are the tools you use to gather data, such as questionnaires or interviews, and these will be discussed in Chapter 3. UNDERSTANDING THE DIFFERENCE BETWEEN QUALITATIVE AND QUANTITATIVE RESEARCH When you start to think about your research methodol- ogy, you need to think about the differences between qua- litative and quantitative research.

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Because of asthma and at his physician’s recommendation proven geriforte syrup 100caps, Ash requested that his employer limit his exposure to cigarette smoke and car- bon monoxide; Ash later developed sleep apnea and requested reassignment to daytime shifts buy generic geriforte syrup 100 caps. The Supreme Court ruled that individuals cannot bring lawsuits for money damages against states under the ADA order 100caps geriforte syrup overnight delivery. Rehnquist as- serted that, in passing the ADA, Congress had failed to show a convincing pat- tern of discrimination by states against people with disabilities, as would be re- quired for these persons to meet the “equal protection” assurances of the Fourteenth Amendment. Rehnquist continued,“Thus, the Fourteenth Amend- ment does not require States to make special accommodations for the disabled, so long as their actions toward such individuals are rational. They could quite hardheadedly—and perhaps hardheartedly—hold to job-qualification require- ments which do not make allowance for the disabled. Breyer rejected Rehnquist’s assertion:“The powerful evidence of discriminatory treatment throughout society in general, including discrimination by private persons and local governments, implicates state governments as well, for state agencies form part of that larger society. The Professional Golfers Association appealed a lower court’s decision to the Supreme Court, which ruled 7-to-2 for Martin on 29 May 2001. The Supreme Court majority held that walking 5 miles or so around a golf course Notes to Pages 55–80 / 301 is not fundamental to the game and therefore Martin (given his serious phys- ical impairment) merits that accommodation. In his dissent, Justice Antonine Scalia described the majority’s opinion as a misguided intrusion of compassion into the rule of law (and the rules of golf) rather than as a matter of justice. Section 3 of the ADA defines disability as “(A) a physical or mental im- pairment that substantially limits one or more of the major life activities... The NHIS-D did not ask what people feared when they reported being fearful and anxious. These results come from a multivariable logistic regression using 1994–95 NHIS-D Phase I data with being frequently depressed or anxious as the dichoto- mous outcome (dependent) variable and the following as predictor (independent) variables: mobility level (none, minor, moderate, major); age group; sex; race (white, black, other nonwhite); ethnicity (Hispanic); education (high school or less, college, more than college); marital status (married, divorced, widowed, never married); cannot work because of health condition; currently unemployed; household income (less than $15,000, $15,000–$30,000, $30,000–$50,000, $50,000+); and self-perceived health status (excellent, very good, good, fair, poor). Because employment is an important factor, this analysis considered only people age 18–64. The adjusted odds ratios of reporting being depressed or anx- ious are significantly higher for those who live alone (50 percent higher than for others); are divorced (70 percent), widowed (40 percent), or never married (30 percent); cannot work because of health (140 percent); are currently unemployed (40 percent); have an annual income less than $15,000 (70 percent); or perceive health status to be fair (670 percent) or poor (1,120 percent). Factors that statis- tically significantly reduce the adjusted odds ratio of reporting being depressed or anxious include older age (for example, persons 60–64 have a 50 percent lower adjusted odds ratio than persons 18–25); black race (40 percent lower); other non- white race (30 percent); high school education or less (20 percent); and college ed- ucation (compared to graduate school, 20 percent). Table 6 shows responses among people who answered the NHIS-D themselves as opposed to having a proxy answer the questions. The NHIS-D does not indicate whether proxy-respondents accurately represent the views of the person for whom they are responding. Women, racial minorities, and Hispanic respondents are much less likely to say they are disabled than men and white and non-Hispanic respondents; low-income persons are much more likely to perceive disability than those with high incomes (Iezzoni et al. If people expect to develop mobility problems, impair- ments may seem “normal” or “part of life,” not something “deviant” or “dis- abled. Poor persons may be more likely to perceive themselves as disabled because they need to qualify for financial support and governmental programs (e. These figures (adjusted for age group and sex) come from the 1994–95 NHIS-D Phase I, which asked about six activities of daily living (ADLs: bathing or showering; dressing; eating; getting in and out of bed or chairs; using the toi- let, including getting to the toilet; and getting around inside the home) and four mobility-related instrumental ADLs (IADLs: preparing their own meals; shop- ping for personal items like toiletries or medicine; doing heavy work around the house like scrubbing floors, washing windows, and doing heavy yardwork; and doing light work around the house like doing dishes, light cleaning, or taking out the trash). Among persons with major mobility difficulties, the ADL presenting the least problem is eating (13 percent have problems), while the most troubling ADLs are bathing, dressing, getting in and out of chairs and around inside the home (31 to 34 percent reporting difficulties). Heavy house- work is the most problematic IADL, causing difficulties for 28 and 52 percent of people with mild and moderate mobility problems, respectively. Most existing private properties predate federal and state accessibility laws. The Fair Housing Amendments Act of 1988 added people with disabilities as a group protected from discrimination in private housing, representing the first time antidiscrimination provisions for people with disabilities extended to the private sector (West 1991a, 18–19).

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