K. Mazin. Saint Thomas Aquinas College. 2019.
These activities include the pathologist’s role in the development and implementation of integrated medical informatics that optimize patient care generic 20mg apcalis sx overnight delivery erectile dysfunction treatment devices. A core program provides training that will lead to basic competence in general pathology generic apcalis sx 20 mg fast delivery erectile dysfunction over 65. Elective opportunities are offered to permit the development of specialty excellence in particular subspecialty fields within Pathology such as Surgical Pathology and Hematopathology best apcalis sx 20 mg erectile dysfunction treatment mumbai. We encourage a strong and collegial relationship between faculty residents and all members of the department. We believe when our residents finish this program they should have outstanding skills and knowledge and we will help them obtain the fellowship, faculty or hospital position that they choose. Competencies that are specific to individual rotations are included with each sub-discipline. Residents will be given graduated responsibilities and will be evaluated at two general skill levels. Specific goals and learning objectives (Skill Levels) are described under each sub-discipline. Objectives: Learning Evaluation Activities Activities Demonstrate the ability to critically assess the scientific literature. In addition, there are 1-3 cytopathology fellows, 1-2 Surgical Pathology Fellows, and 1-3 post-sophomore fellows. The faculty works with the residents to design an elective program that will provide a sound educational experience in the resident’s chosen area of concentration, as well as to flexibly adapt to the resident’s level of expertise and career goals. During the elective time residents are encouraged to spend time carrying out basic or applied research and/or time pursuing subspecialty training. In addition, the following list of year-specific goals defines specific goals either in skills, knowledge, or professionalism that are appropriate for each year of training. Residents must strive to achieve these goals as well as the overall educational goals described in the previous pages. Goals may vary somewhat between levels depending on individual rotation schedules. The resident must demonstrate a prioritization of educational mission, with the willingness and appreciation of teaching from attending staff, fellows and senior residents and other para-health professionals. They should demonstrate understanding in what is told to them by appropriate and timely follow-up on assigned duties. Attendance is required for all residents, except for those residents on vacation or on a rotation outside of Kansas City. Depending upon the conference, attendance is required at 80% of the conferences depending upon the resident rotation. Residents must be present prior to or within 10 minutes after the beginning of each conference or lecture in order to fulfill the attendance requirement. Conference attendance will be recorded by the Chief Residents and reviewed on a quarterly basis by the Program Director. Failure to achieve the required attendance level will result in disciplinary action including loss of educational funds for the next academic year. Publishing a peer-reviewed article is considered as important educational experience and all residents are expected to publish a minimum of one manuscript during their training or present at least one abstract at a national meeting. Pathology Resident Manual Page 17 Resident Travel Funds Each resident may apply for funding to attend up to two regional/national scientific meetings during the four-year residency program contingent upon availability of funds as determined by the Chair of the Department of Pathology. Funding will be contingent upon the resident being in good standing by the Program Director. If the resident is on a rotation that requires resident service, it is the responsibility of the resident to find coverage for the service (as approved by the Chief Residents and Program Director). In such cases, the strength of the scientific project will be reviewed by the Department of Pathology Research Committee or Resident Education Committee and final approval will be determined by the Department Chair based upon availability of funds. Resident Educational Funds Each academic year each resident will be allocated $750 for educational development. Additionally, these funds may be applied to cover expenses related to attending pre- approved medical conferences and workshops. American Board of Pathology application fees and permanent license fees are not covered. Funding will be contingent upon the resident being in good standing (including adequate conference attendance) as deemed by the Program Director. During the year that a resident serves as Chief Resident, the allocation is increased to $1,250. Funding will also be provided for travel expense, lodging, food, and meeting registration, not to exceed $1,200 (receipts are required for reimbursement) for each resident to attend a board review course during either the third or fourth year of the residency program. Such residents may petition the residency education committee for consideration of extension of contract to allow them time to take the examination again. Initial Application Screening The initial screening of applicants is done by the residency program coordinator or program directors. If greater than 10 years, the type of work the candidate has been engaged in since graduation from medical school is noted. Experience, either by education or work experience, in the field of pathology is noted. The program directors read the applicant’s personal statement and evaluate it based on the following: • Command of the English language • Stated genuine interest in Pathology • Overall quality of the statement • Dean’s Letter • Medical Transcripts • Letters of reference • Any potential items for concern Additional Screening If the program director is unable after the secondary screening to make a decision on whether or not to invite a candidate, the application will be sent to one of the other program director or another member of the Resident Education Committee for their review. After receiving feedback from the committee reviewer, the program director will decide whether or not to extend an invitation to the candidate. Each candidate that is selected for interview will be invited via email by the residency program coordinator. Once the applicant is schedule, they will be sent an email with an interview confirmation and instructions for the interview day. Interview Process Six to 8 interview dates are selected and up to 8 candidates may be interviewed per interview day. At the beginning of each interview day an overview of the institution and program is presented. Five faculty members, including the two program directors and one chief resident interview the applicants. Each interviewer is given all application materials for each applicant to be interviewed in their scheduled day. Each interviewer is asked to complete a resident candidate evaluation form and also an individual ranking Pathology Resident Manual Page 20 form for each candidate they interview. Interviewers are asked to assign them a quartile based on every applicant they have ever interviewed. In February an annual ranking meeting is held with all faculty and resident interviewers and any other faculty who wish to attend. After initial grouping into ‘Upper, Middle, or Lower Thirds’, the final rank list determined by the committee. A list of faculty members who will evaluate residents on each rotation has been developed and a tracking mechanism is used to insure that all evaluations have been obtained.
At the end of the 38-day trial buy line apcalis sx erectile dysfunction red 7, more than 67% of the women had a 50% or greater reduction in menopausal symptoms buy discount apcalis sx 20mg diabetes and erectile dysfunction health. No signiﬁcant side effects have been produced in experimental and clinical studies discount apcalis sx 20mg overnight delivery gas station erectile dysfunction pills. In addition to being helpful in improving the symptoms of menopause, gamma-oryzanol has also been shown to be quite effective in lowering blood cholesterol and triglyceride levels. In the late 1940s, several clinical studies found vitamin E to be effective in relieving hot ﬂashes and menopausal vaginal complaints compared with a placebo. In one study, vitamin E supplementation was shown to improve not only those symptoms but also the blood supply to the vaginal wall when taken for at least four weeks. Vitamin E may be effective in relieving the dryness and irritation of atrophic vaginitis as well as other forms of vaginitis. Rather than exerting a drug-like effect, these substances are thought to nourish and tone the female hormonal system and reproductive organs. Much of their effect is thought to be a result of phytoestrogens in the plants as well as the plants’ ability to improve blood ﬂow to the reproductive organs. This nonspecific mode of action makes many of these botanicals useful in a broad range of conditions. Phytoestrogen-containing herbs offer signiﬁcant advantages over the use of estrogens in the treatment of menopausal symptoms. Although both synthetic and natural estrogens may pose signiﬁcant health risks, phytoestrogens have not been associated with these side effects. In fact, epidemiological data and experimental studies have demonstrated that phytoestrogens are extremely effective in inhibiting breast tumors, not only because they occupy estrogen receptors but also through other, unrelated anticancer mechanisms (see the chapter “Breast Cancer [Prevention]”). In the last 30 years, black cohosh (Cimicifuga racemosa) has emerged as the most frequently studied of the herbal alternatives to hormone replacement therapy for menopausal symptoms. The collective ﬁndings of studies involving black cohosh and long-term clinical anecdotal evidence indicate that it is most effective for hot ﬂashes (both during the day and at night), mood swings, sleep disorders and body aches. In perhaps the most detailed double-blind study to date, black cohosh extract was evaluated for its effect on menopausal symptoms, bone metabolism, and the lining of the uterus (endometrium). Results indicated that the black cohosh extract was equal to the conjugated estrogens and superior to the placebo in reducing menopausal complaints. Both black cohosh extract and the conjugated estrogens produced beneﬁcial effects on bone metabolism, but the black cohosh extract had no effect on endometrial thickness, which was signiﬁcantly increased by the conjugated estrogens (increased endometrial thickness is associated with a higher rate of uterine cancer). Vaginal superﬁcial cells were increased with both black cohosh and conjugated estrogens. These results seem to conﬁrm that black cohosh extracts contain substances with selective estrogen-receptor-modifying activity—that is, it shows positive effects in the brain/hypothalamus, bone, and vagina, but has no cancer-causing effects on the uterus. Some recent studies have used black cohosh extract in combination with other botanical extracts. A clinical trial involving 125 menopausal women showed that a combination of 40 mg black cohosh extract, 12 mg isoﬂavones from red clover, 60 mg isoﬂavones from soy, 30 mg chasteberry extract, 250 mg valerian extract, and 121 mg vitamin E resulted in a signiﬁcant lowering of menopausal symptoms after four and six months. Maca (Lepidium meyenii) is an herbal remedy from Peru most often thought of as enhancing male sexuality, but it also has effects on women. Thus maca tends to work on all of a woman’s menopausal symptoms instead of on any one specific symptom alone, such as hot flashes. The maca also had a small effect on increasing bone density and alleviated numerous menopausal symptoms including hot ﬂashes, insomnia, depression, nervousness, and diminished concentration. There were no changes in hormone levels, but there was a signiﬁcant reduction in anxiety, depression, and sexual dysfunction with maca consumption compared with the baseline and the placebo. Red clover (Trifolium praetense), a member of the legume family, has been used worldwide as a source of hay for cattle, horses, and sheep and by humans as a source of protein (leaves and young sprouts). Historically, it has also been recognized as a medicinal plant for humans and, more recently, as a menopausal herb. At least six clinical trials have been conducted on the effect of red clover isoﬂavones on vasomotor symptoms; about half show beneﬁt and the others do not. The ﬁrst two published studies on red clover and hot ﬂashes showed no statistically signiﬁcant difference between the red clover standardized extract and a placebo during a three-month period, although both groups did improve. In the ﬁrst study red clover extract produced a 75% reduction in hot ﬂashes after 16 weeks in 30 women. In the ﬁrst study, 80 mg isoﬂavones per day resulted in a signiﬁcant reduction in hot ﬂashes as compared with baseline. Dong quai (Angelica sinensis) is one of the most famous herbal remedies in China, where it is often referred to as “female ginseng. Although a double-blind, placebo-controlled study in women showed no signiﬁcant beneﬁt, the preparation used (a dried aqueous extract) was clearly lacking some of the important volatile compounds, though it was standardized for ferulic acid content. Also, in a double-blind study, the combination of 100 mg dong quai extract, 60 mg soy isoﬂavones, and 50 mg black cohosh extract signiﬁcantly reduced menstrual migraines. Saint-John’s-wort ( Hypericum perforatum) extract research has focused on the area of mild to moderate depression. A recent randomized, double-blind, placebo-controlled clinical trial studied Saint-John’s- wort in perimenopausal/menopausal hot ﬂashes. Clinical exams and interviews were performed at baseline, four weeks, and eight weeks. In women taking Saint-John’s-wort, the frequency of hot ﬂashes began to decline during the ﬁrst month and showed more improvement during the second month. The decline in duration and severity of hot ﬂashes was statistically signiﬁcant at week eight and the decline was much more evident in the Saint-John’s-wort group. Another double-blind randomized clinical trial studied the effect of Saint-John’s-wort extract on the symptoms and quality of life of 47 symptomatic perimenopausal women age 40 to 65 with three or more hot ﬂashes per day. After 12 weeks of treatment, a nonsigniﬁcant difference in favor of the Saint-John’s-wort group was observed in daily hot ﬂash frequency and hot ﬂash score. After three months of treatment, women in the Saint-John’s-wort group reported signiﬁcantly better quality-of-life scores and significantly fewer sleep problems compared with the placebo group. One study of women with menopause symptoms using 900 mg Saint-John’s-wort extract for 12 weeks found that about three-quarters of the women experienced improvement in both psychological and psychosomatic menopausal symptoms as well as a feeling of sexual well-being. For information on possible drug interactions with Saint-John’s-wort, see the chapter “Depression. EstroG is an herbal product containing a mixture of standardized extracts of Cynanchum wilfordii, Phlomis umbrosa, and Angelica gigas that has shown favorable results in clinical studies. In the most detailed double-blind study, 64 pre-, peri-, and postmenopausal women were randomly assigned to take either EstroG (517 mg per day) or a placebo for 12 weeks. Statistically signiﬁcant improvement in vaginal dryness in the EstroG group was also observed. However, premature menopause, surgical menopause, or medication- induced menopause is not normal, and the beneﬁts and risks should be addressed individually under the guidance of a physician.