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Fortunately there is a solution: write the report for your professional peers order 50 mg imuran mastercard, and use the executive summary as your selling tool for the decision makers. Research All types of writing – not just science writing – will fail if the research is inadequate (see bad writing). Research into writing Even those steeped in the harshest traditions of evidence-based medicine can become remarkably cavalier when it comes to making decisions about their writing. But a wide range of evidence exists, both from psychological experiments into readability and from market research carried out privately for commercial publishers. Here is a short selection of some of the main findings: • Long sentences. For going across an A4 page, for instance, you should have a type size of 12 point. BOOKLIST: research into writing • Designing public documents: a review of research, by Elaine Kempson and Nick Moore, London: Policy Studies Institute, 114 RESEARCH INTO WRITING 1994. Useful advice for those designing forms and other docu- ments, with details of many of the experiments on which this advice is based. This classic ranges over typo- graphy and layout, illustrations and tables, effective writing and evaluating design. Resignation letters These can be wonderfully liberating to do, especially when you are deeply unhappy. We also have systematic reviews, but these are written in the form of scientific papers and the term really refers to a research technique rather than a type of writing. If you are asked to do so, look carefully at other review articles that have already appeared in that journal (see evidence-based writing). Make sure you have in writing what the editor wants you to do – the precise topic, and in what form. You will also need to know such details as length, charts or tables, degree of original statistical analysis required, deadline for the article and other relevant conditions (such as will you get paid?

When car- tivates receptors on the cell membranes of about 80% of body rying out its metabolic functions buy imuran 50 mg line, the overall effect of insulin cells. Liver, muscle, and fat cells have many insulin receptors is to lower blood glucose levels, primarily by the following and are primary tissues for insulin action. After insulin– mechanisms: receptor binding occurs, cell membranes become highly per- 1. In the liver, insulin acts to decrease breakdown of meable to glucose and allow rapid entry of glucose into the glycogen (glycogenolysis), formation of new glucose cells. The cell membranes also become more permeable to from fatty acids and amino acids (gluconeogenesis), amino acids, fatty acids, and electrolytes such as potassium, and formation of ketone bodies (ketogenesis). Cellular metabolism is altered same time, it acts to increase synthesis and storage of by the movement of these substances into the cells, activation glycogen and fatty acids. In adipose tissue, insulin acts to decrease breakdown proteins between intracellular compartments, changes in the of fat (lipolysis) and to increase production of glycerol amounts of proteins produced, and perhaps other mechanisms. In muscle tissue, insulin acts to decrease protein break- effects (eg, utilization and storage of glucose, amino acids, and down and amino acid output and to increase amino fatty acids) and inhibit catabolic processes (eg, breakdown of acid uptake, protein synthesis, and glycogen synthesis. After binding to insulin and enter- ing the cell, receptors may be degraded or recycled back to the cell surface. Regulation of Insulin Secretion Insulin is cleared from circulating blood in 10 to 15 min- utes because of rapid binding to peripheral tissues or meta- Insulin, the only hormone that decreases blood sugar, regu- bolic breakdown. The insulin that does not combine with lates the amount of glucose available for cellular metabolism receptors is metabolized in the liver, kidneys, plasma, and and energy needs, during both fasting and feeding. Insulin Cell membrane Pancreas Insulin Glucose Insulin receptor Figure 27–1 Normal glucose metabolism.

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The drug is most often given subcutaneously (SC) Thyrotropin must be used cautiously in clients with coronary and may be self-administered order imuran 50 mg overnight delivery. The long-acting formulation artery disease, congestive heart failure, or adrenocortical (Sandostatin LAR Depot) must be given intramuscularly insufficiency. Thyrotropin alfa (Thyrogen) is a synthetic (IM) in a gluteal muscle of the hip. Dosage should be reduced formulation of TSH used to treat thyroid cancer. Posterior Pituitary Hormones Anterior Pituitary Hormones Desmopressin (DDAVP, Stimate), lypressin, and vasopressin Corticotropin (ACTH, Acthar), which is obtained from animal (Pitressin) are synthetic equivalents of antidiuretic hormone pituitary glands, is mainly of historical interest. A major clinical use is the treatment of neurogenic di- purposes, it has been replaced by adrenal corticosteroids. It may abetes insipidus, a disorder characterized by a deficiency of be used occasionally as a diagnostic test to differentiate primary ADH and the excretion of large amounts of dilute urine. CHAPTER 23 HYPOTHALAMIC AND PITUITARY HORMONES 329 Drugs at a Glance: Hypothalamic and Pituitary Agents Routes and Dosage Ranges Generic/Trade Names Indications for Use Adults Children Hypothalamic Hormones Gonadorelin (Factrel) Diagnostic test of gonadotropic SC, IV 100 mcg functions of the anterior pituitary Goserelin (Zoladex) Endometriosis SC implant into upper abdominal Metastatic breast cancer wall, 3. The drug is ef- Assessment fective in controlling spontaneous or trauma-induced bleed- Assess for disorders for which hypothalamic and pituitary ing and intraoperative and postoperative bleeding when given hormones are given: 30 minutes before the procedure. Vasopressin is also used in the treatment of bleeding esophageal varices because of its • For children with impaired growth, assess height and vasoconstrictive effects. Desmopressin and lypressin may be weight (actual and compared with growth charts) and di- inhaled intranasally; vasopressin must be injected. Oxytocin (Pitocin) is a synthetic drug that exerts the same • For clients with diabetes insipidus, assess baseline blood physiologic effects as the posterior pituitary hormone. Thus, pressure, weight, ratio of fluid intake to urine output, it promotes uterine contractility and is used clinically to in- urine specific gravity, and laboratory reports of serum duce labor and in the postpartum period to control bleeding. Oxytocin must be used only when clearly indicated and when • For clients with diarrhea, assess number and consistency the recipient can be supervised by well-trained personnel, as of stools per day as well as hydration status. CHAPTER 23 HYPOTHALAMIC AND PITUITARY HORMONES 331 itary gland (hypopituitarism). Conditions resulting from Nursing Diagnoses excessive amounts of pituitary hormones (hyperpitu- • Deficient Knowledge: Drug administration and effects itarism) are more often treated with surgery or irradiation.

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The ages of the patients were 5-6 years old in 65 cases buy 50 mg imuran fast delivery, 7-8 years old in 23 cases, and 9-11 years old in 36 cases. On average, the children wet their beds every other night in seven cases. One hundred ten cases wet their bed 1-3 times per night, and seven cases had enuresis more than three times per night. Twenty-six cases had a history of enure- sis in the family, and 38 cases had an ultrasound of their bladder to determine its capacity. The capacity was 2/3 of normal in six cases, half of normal in nine cases, 1/3 of normal in 13 cases, and normal (i. Twenty-four cases in the treat- ment group received an echocephalography. Of these patients, six Chinese Research on the Treatment of Pediatric Enuresis 115 cases were borderline abnormal, three cases had epilepsy-like changes, and 15 cases were normal. There were 42 patients in the comparison group, 31 males and 11 females. The ages of the patients in this group were 5-6 years old in 19 cases, 7-8 years old in 10 cases, and 9-11 years old in 13 cases. On average, the children wet their beds every other night in three cases and 1-3 times per night in 36 cases. Nine cases had a histo- ry of enuresis in the family, and 16 cases had an ultrasound of their bladder to determine its capacity. The capacity was 2/3 of normal in four cases, half of normal in seven cases, 1/3 of normal in four cases, and normal in one case. Of these patients, one case was borderline abnormal, one case had epilepsy-like changes, and seven cases were normal.