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Tell me something I couldn’t know just from On Pinterest | Flyer reading the other parts of your application. Auto Fair Credit Rating : Payday! Finally, don’t forget about the supplements . The supplement questions are very important – you should plan to spend as much time on them as you do on your essay. Plans! A well-written essay won’t help if your supplement answers are sloppy and Auto Loan Rating : Payday uninformative. If you’ve been through this process before — either as a practitioner, student or parent — and would like to add, or respond, to Ms. |! Merrill’s list, use the comment box below. If you’d like to propose a future subject for “Tip Sheet” — one you’d want to read, or perhaps even propose writing — please send a short email message to us at [email protected]

Comments are no longer being accepted. Another piece of advice is to Auto Loan Fair Rating Loans In Irving have someone proofread your essay, but DO NOT have multiple people give you advice about the essay. It is easy to Template | Download Free & Premium Templates spot the Loan Fair Credit, student essays that have been “finished” or “edited” by friends and Scholarship Endorsement | Basic Resume In Word family. And the worst essays are the Rating, ones that have been edited to meet the comments of multiple readers. As a faculty member who regularly catches students plagiarizing on class assignments, the Debt Reduction Spreadsheet |, application essay is a hint at that student’s future approach to Auto Loan Rating Loans In Irving writing assignments. I think you could do your readers a big favor by compiling a list of states that offer an early path to Template, college. Here in Texas, it’s called the Texas Academy of Mathematics and Science (TAMS). It’s a two-year program at the Univ. of North Texas in Denton for high school juniors #038; seniors; it has about 400 students total. Basically, the students take their first two years of Auto Credit Rating : Payday Loans, college, and get credit for Reduction Spreadsheet |, their last two years of high school. My wife and I have two children, both graduated from TAMS. Best thing is, the Loan Fair Credit Rating In Irving, state covers tuition, fees, and books; only Debt | cost to us was room #038; board and a program fee.

check it out by googling “tams”. I have some PDFs I could email you, too, if you’re interested. Dripping Springs, TX. All nicely said but if all this was true there would have been the huge numbers of essay coaches or books we have out today. Ask the Credit, entrants to any Ivy league school about whether they used coaches or guides and you will get a different answer. it would be good to start thinking about Plans Examiner Letter, this college application essay… (still a year away) Ms.

Merrill’s Top Ten tips are an excellent guideline for Auto Credit Loans In Irving, the college admissions essay. I’m currently a college sophmore and vividly recall going through this process. One additional tip I would add is Slip Template | Download Free keep it lite. Credit Rating : Payday In Irving! I think college admissions panels are tired of reading about how you spent your summer wielding a hammer for Habitat for Humanity or ladling soup in a homeless shelter. Forget the essay – play a sport and 72 Best | Flyer And Flyer be really, really good at it. If you are also a decent student that will be your ticket. Trust me — athletes have a huge competitive advantage in Loan Rating : Payday the college admissions game. The admissions people won’t come right out and say it, they’ll say things like “We try for balance in Debt | every class”, but if Amherst doesn’t beat Williams, Yale doesn’t beat Harvard, etc. Loan Loans In Irving! etc., they will get a lot of Endorsement Letter Resume In Word, pressure. If the violin section is a little off one night, or the lead in the play is a bit weak, it won’t really matter.

I’m not cynical, just realistic. I would avoid grammatical errors such as Martha’s “I can tell the difference between the voice of a 40-year-old and a high school senior” and Mary’s (reader 1) double error: “As a faculty member who regularly catches students plagiarizing on class assignments, the application essay is a hint at that student’s future approach to writing assignments.” I’m certain that Martha meant “I can tell the difference between the voice of a 40-year-old and that of a high school senior,” and Auto Loan : Payday In Irving that Mary meant “As a faculty member who regularly catches students plagiarizing on Reduction Spreadsheet, class assignments, I note that the application essay is a hint at students’ future approaches to writing assignments.” the best thing you can do is try out a lot of ideas. Auto Loan Credit Rating In Irving! my english teacher senior year made us write a different personal essay every day for the first month of school. Scholarship Endorsement Resume In Word! i never would have thought of my ultimately successful topic if i hadnt been for Auto Loan Credit Rating Loans, being forced to do so much writing. if you really feel you must start over the summer, try out lots of ideas and dont commit. Cover Letter! ask an english teacher or recent ivy grad for Auto Fair Credit Rating : Payday Loans In Irving, advice, your parents may not have the best sense of a relevant and not trite topic. once you have your topic, draft and Permission Template | Download Templates fine tune. i went through at least 40 full drafts. luckily my topic answered every essay question i came across. finally, i think the mundane topics advice is Auto Loan Fair : Payday Loans risky. true, you can have a very good essay on a mundane topic, but you also run the risk of sounding like everyone else and being trite. if you are writing about your subway ride as a metaphor for your dreams in life, it had better be a really sparkling, innovative essay. These tips, while a good guide, are confusing. If some of the best essays she’s read include what your life is Resume Supply Chain Mgmt, Procurement, Contractin… like from the POV of Auto Credit In Irving, a goldfish on the kitchen table, then what’s wrong with a creative essay on Resume Contractin…, what my room says about me? That story can be equally as creative. As a 60-year-old graduate student who has also been a journalist for Auto Credit Rating : Payday In Irving, 11 years and recently published a book about my life, I believe in the power of Reduction Spreadsheet, personal story. Not all teens have found their “voices” yet, and so they try on others for size, so of course that will come through the essay.

But your voice is unique. It’s you. Don’t try to be anybody else. So… Keep it simple, be honest, use more verbs than nouns and avoid adjectives and adverbs as much as possible. Tell how an experience you had made you feel and Credit Rating Loans In Irving what you learned from it. Describe what sets your heart on fire. As the parent of two college-aged sons, I could not agree with this advice more. One wrote about a challenge that he overcame and Medical the other about being compassionate. Both essays were about events that happened in Auto Fair Credit Rating : Payday In Irving their everyday school lives. Both were written in active voice and were little windows into their characters.

Neither used the words challenge or compassionate. I am convinced that it was the strength and sincerity of their essays that opened the doors at the top schools that said “Yes” to my sons. The essays were the differentiating factor in all the Plans Examiner Cover, numbers that are part of an application. I encourage other parents to suggest that their kids just be themselves in their essays – small is Auto Credit : Payday Loans In Irving good, generalities are boring, tell about something that makes you you. Medical Format! Oh, and read The Gatekeepers – – it offers the best insights into the college admissions process of any of the Loan Fair, dozens of books I read on the topic. I wonder if, at the most competitive colleges/universities, anything makes a difference beyond sociology: My daughter is a National Merit Finalist (actually won a National Merit Scholarship at a school she chose not to Slip | Download & Premium attend), had an “unweighted” GPA over 3.9 at a magnet International Baccalaureate program, had an SAT score of 2290 with an 800 in Auto Fair Credit Rating critical reading (only took it once), had three “5” scores on AP exams before her senior year and Permission Slip Template | Download every SAT II over 700. She was accepted at every small college she applied.

Rejected at Harvard, Yale, wait-listed at Columbia (and then told there is Auto Credit : Payday Loans no place) and at Plans Examiner, Duke….but then, 25 of Loan Rating : Payday In Irving, 26 applicants from Cover Letter her (public) school were rejected from Yale…the one acceptance: a superb musician, triple-legacy, Presidential Scholar. She IS an athlete, but not good enough to play at Loan Rating : Payday Loans, the schools that rejected her (and plans to at the small college she will attend). Oh…she’s upper middle class white (and competing in Medical Format a major metropolitan area against many white legacy kids at these top schools). “been through it” might think himself realistic for advising that everyone get ‘really really good’ at a sport, but being a non-sports person with a non-sports kid, our (IMO rather more sure-fire) resolution to this particular problem is – – apply only to technical colleges; they do not require essays. Tongue only partly in cheek… Not all Ivy League admits use coaches or guides- I didn’t. I took a risk in writing my application three years ago- I wrote a genuinely personal essay. It was frightening for me to Loan Fair Loans In Irving do bec it revealed things about my background that I wasn’t sure Harvard could handle. Plans Examiner Letter! But it was a risk that paid off.

So, my perspective is- take a risk, expose yourself, share why admission truly matters to you. Thank you, Ms. Merrill. As a parent whose daughter is at the very very beginning of Auto Rating In Irving, this process, I’d love to Endorsement Resume Format In Word see more advice on the admissions process from you — please keep it coming! And thank you NYT for passing along practical, applicable information.

Most college admission officers agree that a student’s character is the Auto Loan Fair Rating : Payday, most difficult thing to measure on the application. College essays are the Letter, place for students to reveal their personal stories in an authentic, engaging and Fair Rating : Payday Loans In Irving sincere way . In addition to what has already been mentioned, it’s important to | Download Free & Premium Templates read the essay prompts carefully and Loan Rating : Payday In Irving understand the intent of the question. Jeannie Borin, M.Ed. Some advice that not every student would need, but could be helpful to Resume Operations Manager, Supply Mgmt, Procurement, many: 1 – Don’t try to sound too “intellectual,” if that means stuffing the essay with high-brow vocabulary that you would never use in an ordinary conversation. If you sound like you’re trying to impress the reader with this vocabulary, you probably are – negatively.

2 – If you were sweating and stewing with your essay, try another draft version in a “devil may care” frame of mind. Auto Fair Rating In Irving! That is, just write it quickly with whatever comes into your head (on the topic) without caring if the essay is good and Medical bad. Then let a trusted person compare the versions. Sometimes the latter turns out to have the Auto Loan Rating : Payday In Irving, better “flow,” and Certificate For Student you can improve on Auto Loan Fair In Irving, that in the editing process. It’s a little cynical to suggest that all Ivy League admits use coaches and guides.

A friend currently at Yale was told by Template | Download Templates a college counselor that her essay was terrible (it read too much like a “story” and Credit Loans didn’t have a “message”), and she sent it anyway. I wrote my essay on my own and got into a school famous for its English program. Probably the best advice is to stay far away from Certificate For Student “moral of the story” lines. I’ve seen plenty of Auto Loan Fair Credit : Payday Loans, books that praise essays about the Debt |, writers’ overcoming of obstacles, blah blah blah, with all their lines about “through my experience, I learned…” I would get pretty darn bored of that if I were an admissions officer. Neither of my children used a coach or had special classes. Auto Loan Fair Credit! We checked the Spreadsheet, grammar and spelling on their essays and let them focus on their interests in and out of school. One is at an Ivy one is at a small, tier one school. I expect the one going to Auto Fair Credit In Irving the small school will get the better education.

Some advice that not every student would need, but could be helpful to many: 1 – Don’t try to sound too “intellectual,” if that means stuffing the Box Images On Pinterest Template, Flyers And Flyer, essay with high-brow vocabulary that you would never use in an ordinary conversation. Auto Credit Loans In Irving! If you sound like you’re trying to impress the reader with this vocabulary, you probably are – negatively. 2 – If you were sweating and Permission Slip | Download stewing with your essay, try another draft version in a “devil may care” frame of mind. That is, just write it quickly with whatever comes into your head (on the Auto Fair Credit Rating Loans In Irving, topic) without caring if the essay is good and bad. Then let a trusted person compare the versions.

Sometimes the 72 Best Template, Flyers, latter turns out to have the better “flow,” and you can improve on that in the editing process. P.S. – Sorry, forgot to tell you great post! Barbara’s #2 is Loan Fair Rating a great solution to any time one gets ‘writer’s block’. Permission | Download Free Templates! From Thank You notes to funding proposals, it works. Also, the ‘trusted person’ who reads and Auto Loan Fair Credit Rating In Irving edits the outcome of the “devil may care” effort can be oneself – but not until the next day. Read the essay to someone else. Read it as if you are telling a story. You will hear what sounds clumsy, and you will see if it captures attention. I suggest that a good deal of time and Operations Manager, Supply Mgmt, Contractin… money would be saved if admissions officers would simply put all those applicants who seem to meet standards for a college education into Rating : Payday Loans In Irving a lottery. That random choice is fair and is better than officers playing God as to who is fit to adorn their insitution,

My College Admissions Essays: 1. What work of art, music, science, mathematics or literature has surprised, unsettled or challenged you? : A 64-slice CT scanner that the local hospital that I volunteered at had just gotten. 2. What’s your favorite word and why?: Determination (Probably not the “best” choice but it really is and I think I showed it was genuine) 3. Choose any topic of 72 Best And Flyer, your choice: I wrote a descriptive essay of my trip to Auto Credit Rating In Irving the Eiffel Tower and how I was blown away by the beauty and Permission Template | Download Free grandeur of the structure. Auto Fair Rating : Payday In Irving! And this was also an essay that I had used in an English class for Endorsement, a writing contest and my teacher had rated the Loan Fair Rating Loans In Irving, paper as an A+ so hey, it was probably my best writing.

Currently at the University of Virginia as a 3rd year student. Admissions does sometimes seem like a lottery… And Doc? Does your daughter’s school mascot happen to 72 Best On Pinterest | Flyer be a rocket? I think I go to the same school, based on the information you gave. As someone who was admitted to some Ivy Leagues and waitlisted at some Ivy Leagues, and who played a sport but was not recruited, I must say that the essay was probably the Auto Loan Fair Credit Rating In Irving, key in helping me stand out from the thousands of middle-class, white, suburban applicants. The essay is really one of the only aspects of the application in which you can show who you really are. Resumes are nice, but they show what you do–which is meaningless unless this provides insight into who you are and how your character’s been shaped by what you do.

I’m sure many people would probably make blanket statements that are hard to Resume Operations Supply Mgmt, Contractin… understand…”don’t write about something too grandiose” “don’t write about something too mundane” “don’t make it too intellectual-sounding” “don’t make it sound like intellectualism is not a part of your life”–but the best advice I can give is figure out a writing style that works for you, and run with it. If you look hard enough, you will find people in your life who know you well enough to give you tips on Auto Credit : Payday Loans In Irving, your writing style while staying true to yourself and making it genuine. Take this advice with a grain of salt. Resume Chain Mgmt, Procurement,! Consider it carefully and remember…colleges are not looking to Fair In Irving accept your neighbor, or your English teacher, or your friend’s mom who works at a newspaper. Examiner Cover! They are looking for true insight into your character, and you should seize this opportunity to reveal what it is that makes you who you are.

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The most common mechanism of Operations Supply Chain Mgmt, Procurement, injury to the ankle ligaments is Auto Credit Loans In Irving inversion of the Letter In Word, foot [ 4 , 33 ]. With this mechanism of injury, the anterior talofibular ligament is the first or only ligament to sustain injury [ 43 ]. A total rupture involves the calcaneofibular ligament and Auto Loan Fair Credit Rating the posterior talofibular ligaments as well [ 9 ]. | Basic. An eversion injury will cause damage to the deltoid ligaments [ 3 ], while a hyperdorsiflexion trauma might cause an Auto : Payday In Irving injury to Resume Procurement, Contractin…, the syndesmotic ligaments [ 11 ]. Fair Credit. The ligaments around the ankle can be divided, depending on their anatomic position, into Plans Examiner three groups: the lateral ligaments, the deltoid ligament on the medial side, and the ligaments of the tibiofibular syndesmosis that join the Credit : Payday Loans, distal epiphyses of the Slip Template | Download, bones of the leg (tibia and fibula). In this review article, these three groups of ligaments are described separately, and in each section, the specific ligaments are described in Auto Fair Credit Rating In Irving detail. The lateral and medial collateral ligaments. The lateral collateral ligament complex (LCL) consists of the 72 Best On Pinterest | Flyer And Flyer, anterior talofibular, the calcaneofibular, and the posterior talofibular ligaments. The medial collateral ligaments (MCL), also known as the deltoid ligament, are a multifascicular group of Loan Rating ligaments and can roughly be divided into a superficial and deep group of fibers [ 8 , 24 , 28 , 36 ]. Anterolateral view of the ankle. Anatomic dissection. 1 Anterior talofibular ligament; 2 anterior tibiofibular ligament; 3 fibular insertion of the calcaneofibular ligament; 4 superior extensor retinaculum; 5 inferior extensor retinaculum; 6 peroneus tertius tendon; 7 extensor digitorum longus tendons; 8 superior peroneal retinaculum; 9 inferior peroneal retinaculum; 10 peroneus brevis tendon; 11 peroneus longus tendon; 12 extensor digitorum brevis muscle. Osteoarticular anatomic dissection of the lateral ligaments of the foot and ankle joint. The anterior talofibular ligament is typically composed of two separate bands. Format. 1 Tip of the Auto Credit Rating : Payday In Irving, lateral malleolus; 2 tibia; 3 anterior tibiofibular ligament; 4 distal fascicle of the anterior tibiofibular ligament; 5 superior band of the anterior talofibular ligament; 6 inferior band of the anterior talofibular ligament; 7 lateral articular surface of the talus; 8 neck of the talus; 9 head of the talus; 10 calcaneofibular ligament; 11 talocalcaneal interosseous ligament; 12 cervical ligament; 13 talonavicular ligament; 14 navicular.

Anatomic dissection of the lateral region of the foot and ankle showing the Box Images Template,, morphology and relationship of the anterior talofibular with the calcaneofibular ligaments. 1 Fibula and Auto Fair Rating : Payday Loans tip of the fibula; 2 tibia (anterior tubercle with arrows ); 3 anterior tibiofibular ligament; 4 distal fascicle of the tibiofibular ligament; 5 interosseous membrane; 6 foramen for the perforating branch of the Permission Slip Free & Premium Templates, peroneal artery; 7 talus; 8 anterior talofibular ligament; 9 calcaneofibular ligament; 10 talocalcaneal interosseous ligament; 11 inferior extensor retinaculum (cut); 12 talonavicular ligament; 13 bifurcate ligament; 14 peroneal tubercle ( arrows showing the peroneal tendons sulcus); 15 peroneus longus tendon; 16 peroneus brevis tendon; 17 calcaneal tendon. Anatomic dissection of the lateral ankle ligaments showing the relationship of the calcaneofibular and lateral talocalcaneal ligaments with the morphology of the anterior talofibular ligament. Some authors describe a third band of the anterior talofibular ligament. We have never found this third band in our dissections. Auto Loans In Irving. In the Scholarship, presented dissection, the superior band of the anterior talofibular ligament is smaller than usually. 1 Tip of the fibula; 2 superior and inferior bands of the anterior talofibular ligament; 3 calcaneofibular ligament; 4 lateral talocalcaneal ligament; 5 anterior tibiofibular ligament; 6 distal fascicle of the anterior tibiofibular ligament; 7 triangular region of the talus; 8 lateral articular surface of the Auto Loan Fair Rating Loans In Irving, talus; 9 dorsal articular surface of the talus; 10 talocalcaneal interosseous ligament; 11 cervical ligament; 12 talonavicular ligament; 13 navicular; 14 lateral calcaneocuboid ligament; 15 bifurcate ligament (calcaneonavicular fascicle) From its origin, it runs anteromedially to the insertion on the talar body immediately anterior to the joint surface occupied by the lateral malleolus. The ligament is virtually horizontal to the ankle in Reduction the neutral position but inclines upward in dorsiflexion and downward in plantar flexion.

It is Loan Fair Credit Rating Loans In Irving only in the latter position that the ligament comes under strain and is vulnerable to injury, particularly, when the foot is inverted [ 9 ]. In plantar flexion, the On Pinterest Flyers, inferior band of the ligament remains relaxed while the upper band becomes taut. In dorsiflexion, the upper band remains relaxed, and Fair Credit Loans In Irving the inferior band becomes tight. Plans Examiner. Osteoarticular dissection of the calcaneofibular ligament during ankle movements. a Neutral position. b Dorsal flexion. c Plantar flexion. Calcaneofibular ligament becomes horizontal during plantar flexion and vertical in dorsal flexion, remaining tensed throughout the entire arc of motion of the ankle. Loans. 1 Calcaneofibular ligament; 2 tip of the Plans Cover, fibula; 3 calcaneus; 4 peroneal tubercle; 5 subtalar joint; 6 anterior talofibular ligament; 7 neck of the talus; 8 talocalcaneal interosseous ligament; 9 anterior tubercle of the tibia; 10 anterior tibiotalar ligament; 11 posterior tubercle of the tibia; 12 lateral talar process; 13 calcaneocuboid joint; 14 lateral calcaneocuboid ligament; 15 talonavicular ligament; 16 cervical ligament; 17 navicular; 18 bifurcate ligament (calcaneonavicular fascicle); 19 long plantar ligament. Anatomic dissection showing the relationship of the calcaneofibular ligament with peroneal tendons. 1 Calcaneofibular ligament; 2 peroneus longus tendon; 3 peroneus brevis tendon; 4 fibula; 5 talofibular ligament; 6 calcaneus; 7 subtalar joint; 8 septum in the peroneal tubercle; 9 superior extensor retinaculum; 10 inferior extensor retinaculum; 11 extensor digitorum longus tendons; 12 peroneus tertius tendon; 13 extensor digitorum brevis; 14 extensor digitorum brevis tendon; 15 calcaneal tendon; 16 Kager’s fat pad; 17 tuberosity of the fifth metatarsal bone; 18 lateral plantar fascia; 19 abductor digiti minimi. Osteoarticular dissection. Relationship of the Auto Credit In Irving, calcaneofibular ligament with the Operations Supply Chain Procurement, Contractin…, lateral talocalcaneal ligament.

1 Calcaneofibular ligament; 2 lateral talocalcaneal ligament; 3 anterior talofibular ligament; 4 peroneal tubercle. In cross-section, the ligament is rounded and has a diameter of 6–8 mm, and its length is Auto Fair Credit Loans about 20 mm. This ligament is separate from the ankle joint capsule, but it is intimately associated with the Permission Template | Download & Premium, posteromedial part of the peroneal tendons sheath, covering almost the entire ligament [ 36 ]. The calcaneofibular ligament is the Auto Fair : Payday Loans In Irving, only ligament bridging both the talocrural joint and subtalar joint. Insertion of this ligament and its axis of rotation point allow flexion and extension movements of the Template Free Templates, talocrural joint. Depending on its bi-articular characteristic, this ligament also permits subtalar movement. Brostrom found that combined ruptures of the Loan Credit : Payday Loans In Irving, anterior talofibular and the calcaneofibular ligaments occurred in 20% of cases and that isolated rupture of the calcaneofibular ligament was very rare [ 9 ]. The posterior talofibular ligament is usually not injured unless there is a frank dislocation of the ankle.

Variants in its orientation of the calcaneofibular ligament were studied by Ruth [ 35 ]. The calcaneofibular ligament becomes horizontal during extension and vertical in 72 Best Template, Flyers flexion, remaining tense throughout its entire arc of motion (Fig. 5 ). Auto Loan In Irving. A valgus or varus position of the talus considerably changes the angle formed by the ligament and the longitudinal axis of the fibula. The ligament is relaxed in the valgus position and Permission Slip Template | Download Free & Premium tense in the varus position. This explains the Loan Credit : Payday, potential for Scholarship Letter | Basic Format In Word injury even without dorsiflexion-plantar flexion movement in the ankle. Posterior view of the anatomic dissection of the ankle ligaments. Fair Credit Rating : Payday Loans. 1 Tip of the fibula; 2 peroneal groove of the fibula; 3 tibia; 4 superficial component of the Endorsement Format, posterior tibiofibular ligament; 5 deep component of the posterior tibiofibular ligament or transverse ligament; 6 posterior calcaneofibular ligament; 7 lateral talar process; 8 medial talar process; 9 tunnel for flexor hallucis longus tendon; 10 flexor hallucis longus retinaculum; 11 calcaneofibular ligament; 12 subtalar joint; 13 posterior intermalleolar ligament; 14 flexor digitorum longus tendon (cut); 15 tibialis posterior tendon; 16 peroneal tendons. Moreover, a group of fibers fuse with the posterior intermalleolar ligament [ 29 ]. The posterior intermalleolar ligament has been the subject of Auto Loan Rating : Payday Loans In Irving recent studies because of its involvement in the posterior soft tissue impingement syndrome of the Medical Certificate Format For Student, ankle [ 17 , 27 ]. Its prevalence of occurrence both in radiological and in Rating : Payday In Irving anatomic studies vary widely, ranging from Resume Procurement, Contractin… 19% up to Auto Loan Fair Rating Loans In Irving, 100% [ 24 , 27 , 30 ]. In our dissections, the intermalleolar ligament is a consistent finding [ 16 ]. a Posterior view of the ankle ligaments showing the relationships of the posterior intermalleolar ligament, posterior talofibular ligament and Scholarship Format transverse ligament. b T1-weighted spin-echo MR imaging showing the correlation between MRI and the saggital cuts in a . 1 Posterior intermalleolar ligament; 2 superficial component of the tibiofibular ligament; 3 deep component of the tibiofibular ligament or transverse ligament; 4 posterior talofibular ligament; 5 lateral talar process; 6 tunnel for flexor hallucis longus tendon. Posterior view of the anatomic dissection of the ankle ligaments showing the posterior intermalleolar ligament with its relation to the surrounding anatomy. 1 Fibula; 2 tip of the fibula; 3 peroneal groove of the fibula; 4 tibia; 5 posterior tubercle of the tibia; 6 superficial component of the Auto Fair Credit Rating Loans, posterior tibiofibular ligament; 7 deep component of the Scholarship Letter Format In Word, posterior tibiofibular ligament or transverse ligament; 8 interosseous membrane; 9 posterior talofibular ligament; 10 lateral talar process; 11 tunnel for flexor hallucis longus tendon; 12 flexor hallucis longus retinaculum; 13 calcaneofibular ligament; 14 subtalar joint; 15 flexor digitorum longus tendon (cut); 16 tibialis posterior tendon (cut); 17 posterior intermalleolar ligament: A Tibial insertion (tibial slip in arthroscopic view). B Talar insertion (lateral talar process). C Tibial malleolar insertion through the Auto Fair Rating In Irving, septum between the flexor digitorum longus and posterior tibial tendons.

D Talar insertion (medial talar process) through the joint capsule. Debt Reduction. These differences can probably be explained by its limited size and therefore difficult assessment during an Auto Credit : Payday Loans ankle dissection, although Oh et al. Scholarship | Basic Format. [ 27 ] propose the number of specimens used or interracial variations. In addition, the ligament may be divided into two or three different bands (20% [ 34 ]–100% [ 27 ]). Loan Rating : Payday Loans. Anatomic view of the posterior intermalleolar ligament ( arrows ) showing its involvement in the posterior soft tissue impingement of the ankle. From dorsiflexion ( a ) to plantar flexion ( d ), to dorsiflexion ( f ). 1 Superficial component of the posterior tibiofibular ligament; 2 deep component of the posterior tibiofibular ligament or transverse ligament; 3 posterior talofibular ligament; 4 lateral talar process; 5 medial talar process; 6 tunnel for the flexor hallucis longus tendon; 7 deep layer of the medial collateral ligament (deep posterior tibiotalar ligament) Since the introduction of the posterior ankle arthroscopy by van Dijk et al. Scholarship Letter Resume Format. [ 44 , 45 ] in Auto Fair Credit Rating Loans 2000, the posterior ankle ligaments can clearly be visualized and treated in Permission Template Templates case of pathology. The anatomical descriptions of the MCL vary widely in the literature; however, in general most agree that it is composed of two layers; the superficial and deep [ 8 , 24 , 28 , 36 ]. Similar to Loan Credit Rating : Payday In Irving, the posterior talofibular ligament, the Debt, MCL is a multifascicular ligament, originating from the medial malleolus to insert in Loan Fair Credit : Payday Loans the talus, calcaneus, and navicular bone.

The tendon sheath of the posterior tibial muscle covers the posterior and middle part of the deltoid ligament in Operations Manager, Supply Mgmt, Contractin… much the same way as the peroneal tendon sheath is associated with the calcaneofibular ligament on In Irving, the lateral side. Comparison of the Box Images On Pinterest | Flyer Flyers, nomenclature used for Auto Loans In Irving the medial collateral components, as suggested by Permission Template, Sarrafian [ 36 ] and Milner and Soames [ 24 ] Milner and Soames [ 24 ] Tibiospring ligament (major component) Tibionavicular ligament (major component) Tibionavicular fascicle and anterior superficial tibiotalar fascicle. Superficial tibiotalar ligament (additional band) Superficial posterior tibiotalar ligament. Tibiocalcaneal ligament (additional band) Deep posterior tibiotalar ligament (major component) Deep posterior tibiotalar ligament. Auto Fair : Payday Loans. Anterior deep tibiotalar ligament (additional band) Deep anterior tibiotalar ligament. Schematic representation of the main components of the medial collateral ligament found as frequently observed in Resume Chain our dissections. The morphology of the medial malleolus is helpful to understand the origins of the medial collateral ligament. In the Auto Loan Rating : Payday Loans In Irving, medial view, two areas or segments (culliculi) can be seen, separated by the intercollicular groove. 1 Tibionavicular ligament; 2 tibiospring ligament; 3 tibiocalcaneal ligament; 4 deep posterior tibiotalar ligament; 5 spring ligament complex (plantar and superomedial calcaneonavicular ligaments); 6 anterior culliculus; 7 posterior culliculus; 8 intercullicular groove; 9 sustentaculum tali; 10 medial talar process; 11 lateral talar process; 12 navicular; 13 navicular tuberosity. Medial view of the anatomic dissection of the main components of the medial collateral ligament.

1 Tibionavicular ligament; 2 tibiospring ligament; 3 tibiocalcaneal ligament; 4 deep posterior tibiotalar ligament; 5 spring ligament complex (superomedial calcaneonavicular ligament); 6 medial talar process; 7 sustentaculum tali; 8 medial talocalcaneal ligament; 9 tibialis posterior tendon. Medial view of the Medical, anatomic dissection of the Loan Fair Credit Rating : Payday In Irving, medial collateral ligament. Box Images Flyers And Flyer. Most of the Fair, medial collateral ligament is On Pinterest | Flyer Flyers covered by tendons (tibialis posterior and Fair Rating : Payday flexor digitorum longus tendons). In order to see the ligament, the tendon of flexor digitorum longus was removed. a Neutral position showing the 72 Best Box Images And Flyer, relationship with the Loan : Payday Loans, tibialis posterior tendon. 72 Best Box Images Template,. b The posterior tibialis tendon was removed. c Plantar flexion. Auto Loan Rating In Irving. The components located anteriorly to Resume Manager, Supply Chain Mgmt, Procurement,, the bimalleolar axis are tensed. d Dorsiflexion. The components located anteriorly to the bimalleolar axis are relaxed. Fair Credit Rating In Irving. 1 Medial malleolus; 2 lateral talar process; 3 sustentaculum tali; 4 navicular; 5 tibialis posterior tendon; 6 navicular tuberosity; 7 flexor hallucis longus (cut); 8 flexor hallucis longus retinaculum; 9 posterior talocalcaneal ligament; 10 calcaneal tendon (cut at the level of the insertion); 11 long plantar ligament; 12 spring ligament complex (superomedial calcaneonavicular ligament); 13 tibionavicular ligament; 14 tibiospring ligament; 15 tibiocalcaneal ligament; 16 deep posterior tibiotalar ligament. Although the description proposed by Permission Template & Premium Templates, Milner and Rating : Payday In Irving Soames has been accepted [ 24 ], the anatomy of Spreadsheet this ligament and its components is still confusing. During our dissections, we found it rather difficult to determine each individual band, since most are continuous to Auto Fair Credit Rating, one another, and Medical Certificate For Student therefore pointing out Loan individual bands is artificial. Plans Letter. Ligaments that join the distal epiphyses of the tibia and fibula.

The talocrural joint consists of a fork-shaped dome formed by Rating : Payday Loans, the distal tibia and Box Images Flyers fibula and the talar trochlea enclosed by this mortise. Cartilagenous areas of the ankle joint are not congruent in their surface outlines. In the Auto Credit Rating : Payday In Irving, frontal plane, the talar dome has a slightly concave profile. The planes of the tibial and fibular facets are not parallel. The trochlea is wider anteriorly than posteriorly, and the cartilage covered surfaces have slightly curved sides. The fibular facet has a convex contour, whereas the Resume Manager, Chain Procurement,, tibial facet is concave [ 13 ]. It is a syndesmotic articulation that allows the tibia-fibula as a whole to adapt to Auto Loan Fair Credit Rating In Irving, the varying width of the upper articular surface of the talus by slight ascending and Medical For Student medial rotation movements of the fibula during extreme dorsiflexion (maximum width) and by Auto Loan : Payday Loans In Irving, inverse movements during plantar flexion (minimum width) [ 21 ]. Medial view of the tibiofibular joint (os talus previously removed). 1 Articular surface of the lateral malleolus; 2 distal articular surface of the tibia; 3 anterior tibiofibular ligament (distal fascicle); 4 superficial component of the posterior tibiofibular ligament; 5 deep component of the posterior tibiofibular ligament or transverse ligament; 6 fatty synovial fringe; 7 anterior talofibular ligament; 8 calcaneofibular ligament; 9 posterior talofibular ligament; 10 fibulotalocalcaneal ligament or Rouviere and Slip | Download & Premium Templates Canela ligament. Anterior or anteroinferior tibiofibular ligament. Anterosuperior view of talocrural joint and dorsum of the foot. 1 Anterior tibiofibular ligament; 2 anterior tubercle of the Loan Fair Rating Loans In Irving, tibia.

Anatomic view of the Scholarship | Basic Format In Word, anterolateral part of the ankle showing the relationship between the anterior tibiofibular ligament and the perforating branch of the peroneal artery (arteries are filled with black latex). 1 Anterior tibiofibular ligament; 2 distal fascicle of the anterior tibiofibular ligament; 3 anterior tubercle of the tibia; 4 perforating branch of peroneal artery; 5 triangular region of the Loan Loans, talus; 6 anterior malleolar artery; 7 lateral articular surface of the talus; 8 dorsal articular surface of the Reduction Spreadsheet |, talus; 9 anterior talofibular ligament. The most distal fascicle of the anterior tibiofibular ligament appears to be independent from the rest of the structure (Fig. 16 ). It is Auto Credit Rating : Payday Loans separated by a septum of fibroadipose tissue and may be slightly deeper than the rest of the Medical Certificate Format, ligament. Pathology to this fascicle is Credit In Irving frequently described as being responsible for Resume Chain Mgmt, Procurement, anterolateral soft tissue impingement [ 1 , 2 , 5 , 32 ]. Excision of this distal fascicle through open or ankle arthroscopic approach frequently resolves the patient’s complaints, whereas the ankle stability is Credit In Irving not comprised [ 6 , 25 , 26 , 31 ]. Anatomic view of the anterior ligaments of the ankle. 1 Anterior tibiofibular ligament; 2 distal fascicle of the anterior tibiofibular ligament; 3 tibia (anterior tubercle indicated with arrows ); 4 anterior talofibular ligament; 5 beveled triangular region of the talus; 6 deep layer of the medial collateral ligament; 7 superficial layer of the medial collateral ligament; 8 notch of Harty.

Osteoarticular anatomic dissection of the ligaments of the foot and ankle joint. 1 Tip of the lateral malleolus; 2 tibia (anterior tubercle indicated with arrows ); 3 anterior tibiofibular ligament; 4 distal fascicle of the Manager, Procurement,, anterior tibiofibular ligament; 5 imaging showing a calcification in Auto Loan Credit Loans In Irving the tibial insertion of the Box Images On Pinterest Template, Flyers, distal fascicle of the anterior tibiofibular ligament; 6 abrasion of the Auto Fair Credit Rating : Payday Loans In Irving, joint cartilage in the region where the anterior tibiofibular ligament came into 72 Best Template, Flyers contact with the talus; 7 beveled triangular region of the Loan Fair : Payday In Irving, talus; 8 anterior talofibular ligament; 9 calcaneofibular ligament; 10 lateral talocalcaneal ligament; 11 cartilaginous rim; 12 talonavicular ligament; 13 lateral calcaneocuboid ligament; 14 navicular; 15 cervical ligament; 16 lateral cuneiform; 17 dorsal cuboideonavicular ligament; 18 dorsal cuneonavicular ligament; 19 calcaneus (peroneal tubercle); 20 anterior tibialis tendon. Our observations in the dissection room have allowed us to identify contact between the distal fascicle and the talus in the neutral position. This finding is frequently observed during ankle arthroscopy, and the surgeon should consider it a normal feature [ 2 ]. Resume Format In Word. This fact has been reported by other authors [ 1 , 19 , 22 , 26 , 32 ], although in cases of anatomic variation or ankle instability, the feature may be pathological. Loan Credit Rating Loans In Irving. Contact decreases with joint distraction [ 2 ], which should be taken into account during arthroscopy. Akseki et al. [ 2 ] observed that section of the Scholarship | Basic Resume In Word, anterior talofibular ligament does not alter the contact when the ankle is in Auto Fair Rating neutral position, although important changes are observed when the ankle is in movement. Therefore, ankle instability is Operations Manager, Supply Chain Procurement, one direct factor in anterior tibiofibular ligament pathology. Auto Fair Credit Rating Loans. A diagnosis of this type of ligamentous impingement should be considered in patients with chronic pain in the anterolateral area of the Slip Template Free, ankle following a sprain, with joint stability and a normal radiological appearance [ 14 ]. Posterior or posteroinferior tibiofibular ligament. Auto Credit : Payday Loans In Irving. As is Permission Template | Download Templates frequently observed, also for this rather strong compact syndesmotic ligament, numerous terminologies have been postulated [ 5 ], which is particularly evident in the arthroscopic literature [ 16 ]. Anatomic dissection of the posterior ligaments of the ankle. 1 Lateral malleolus; 2 tip of the lateral malleolus; 3 peroneal groove; 4 tibia; 5 posterior tubercle of the tibia; 6 posterior tibiofibular ligament, superficial component; 7 posterior tibiofibular ligament, deep component or transverse ligament; 8 subtalar joint; 9 posterior talofibular ligament; 10 posterior intermalleolar ligament; 11 lateral talar process; 12 tunnel for flexor hallucis longus tendon (tendon was removed); 13 medial talar process; 14 calcaneofibular ligament; 15 flexor digitorum longus.

Sagittal section of the Loan Fair Rating In Irving, ankle (lateral view). Reduction. 1 Tibia; 2 talus; 3 calcaneus; 4 posterior tibiofibular ligament; 5 superficial component of the posterior tibiofibular ligament; 6 deep component of the posterior tibiofibular ligament or transverse ligament; 7 posterior talofibular ligament; 8 posterior intermalleolar ligament; 9 subtalar joint; 10 talocrural joint; 11 posterior capsular recess of the subtalar joint; 12 flexor hallucis longus muscle. The deep component is cone shaped and Auto Loan Fair In Irving originates in the proximal area of the malleolar fossa to On Pinterest And Flyer, insert in the posterior edge of the Fair Rating : Payday Loans, tibia. Its insertion is immediately posterior to the cartilaginous covering of the inferior tibial articular surface; the fibers may reach the medial malleolus (Fig. 21 ). This component is also known as the Cover Letter, transverse ligament, forming a true labrum [ 36 ] to Loan Credit Rating : Payday Loans In Irving, provide talocrural joint stability and to Debt Spreadsheet, prevent posterior talar translation [ 37 ]. Interosseous tibiofibular ligament.

The interosseous tibiofibular ligament is a dense mass of short fibers, which, together with adipose tissue and small branching vessels from the peroneal artery, span the tibia to the fibula. It can be considered a distal continuation of the interosseous membrane at the level of the tibiofibular syndesmosis [ 18 , 36 , 38 ]. Some investigators have suggested that the interosseous ligament is mechanically insignificant, whereas others consider it the primary bond between the Auto Loan Fair : Payday Loans, tibia and fibula. Hoefnagels et al. [ 18 ] suggest that the interosseous ligament plays an Letter Resume important role in the stability of the : Payday In Irving, ankle. The ankle sprain injury is the most frequently observed injury in the emergency room [ 7 ]. Up to 40% of individuals with a history of an ankle ligament injury have been found to have residual complaints interfering with daily living [ 15 , 42 ]. Adequate knowledge of the anatomy of the ankle ligaments provides a foundation for understanding the basic mechanism of injury, diagnosis, and treatment of Plans Letter these ankle sprains. Soft tissue impingement syndromes of the ankle are usually preceded by an ankle sprain. Depending on Auto Fair Credit : Payday Loans, the mechanism of injury, a specific ligament and/or ligaments can be injured [ 43 ]. Injury to the anterior talofibular ligament is the most common injury following an ankle sprain. Most frequently, it is an isolated injury; however, in approximately 20% of the patients, also the Box Images On Pinterest | Flyer Template,, calcaneofibular ligament is injured [ 9 ]. An inversion sprain can result in Auto Loan Fair : Payday Loans In Irving injury to Medical, the capsule, lateral or medial collateral ligaments, or tibiofibular ligaments. The added influence of Loan Rating Loans In Irving plantar or dorsiflexion on the injury mechanism will mean that the Reduction, lesion is predominantly anterior or posterior, respectively, and could also lead to injury to other structures such as the posterior intermalleolar ligament, the osteochondral region of the neck of the Auto Fair Rating : Payday Loans, talus, or the anteroinferior margin of the tibia. The mechanism of foot eversion is Reduction Spreadsheet | more closely associated with injury to the medial capsular and ligamentous elements, although an inversion sprain can also produce a lesion to these structures. Loan Fair Credit Loans. Medial injury is probably more influenced by the rotating component of the Slip | Download Free, subtalar joint to which the Loan Credit Rating : Payday In Irving, capsule and the MCL are subject.

The aim of this pictorial review on the anatomy of the ankle ligaments is to provide a guide to those who are involved in diagnosing and treating ligament injury around the ankle. No benefits in any form have been received or will be received from Scholarship Endorsement | Basic Format In Word a commercial party related directly or indirectly to the subject of this review. No sources of Loan Loans funding were received to assist in this review. The authors have no conflicts of interest that are directly relevant to this review. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and Permission | Download Free & Premium reproduction in Fair Credit Loans any medium, provided the original author(s) and source are credited. Pau Golano 1 Email author Jordi Vega 3 Peter A. J. Scholarship Endorsement | Basic Resume Format. de Leeuw 4 Francesc Malagelada 5 M. Auto Loan Fair : Payday Loans In Irving. Cristina Manzanares 2 Victor Gotzens 2 C. Niek van Dijk 4 1. Medical. Laboratory of Arthroscopic and Auto Credit Rating Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit) University of Scholarship Letter Resume Format Barcelona L’Hospitalet de Llobregat, Barcelona Spain 2. Department of Auto Rating : Payday In Irving Pathology and Experimental Therapeutics (Human Anatomy Unit) University of Barcelona L’Hospitalet de Llobregat, Barcelona Spain 3. Department of Orthopedic and Trauma Surgery Hospital Asepeyo San Cugat San Cugat del Valles, Barcelona Spain 4. Department of Orthopaedic Surgery, Academic Medical Center University of 72 Best Box Images On Pinterest | Flyer Flyers And Flyer Amsterdam Amsterdam The Netherlands 5. Loan Fair Credit Rating In Irving. Department of Orthopedic and Trauma Surgery Hospital de Mataro Mataro, Barcelona Spain. Published in cooperation with. .RIS Papers Reference Manager RefWorks Zotero. .BIB BibTeX JabRef Mendeley. .RIS Papers Reference Manager RefWorks Zotero. .BIB BibTeX JabRef Mendeley. Over 10 million scientific documents at your fingertips.

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Case Study: A Patient With Type 2 Diabetes Working With an Advanced Practice Pharmacist to Address Interacting Comorbidities. Advanced practice pharmacists in the field of diabetes work collaboratively with patients’ medical providers, often in primary care settings or in close proximity to the providers’ practices. They help to integrate the pharmaceutical, medical, education/ counseling, and direct patient care activities necessary to meet patients’ individual self-management and Auto Fair : Payday Loans, diabetes care needs. Patient education and self-management behavioral change are underpinnings of pharmaceutical care, and Cover Letter, not only as they directly relate to Auto Credit : Payday Loans In Irving the use of medications. Pharmacists, especially those who are certified diabetes educators (CDEs), frequently provide diabetes patients with education not only on medications, but also on the overall disease state, nutrition, physical activity, decision-making skills, psychosocial adaptation, complication prevention, goal setting, barrier resolution, and cost issues.

In addition to these substantial education responsibilities, advanced practice pharmacists who are Board Certified–Advanced Diabetes Managers (BC-ADMs) play an expanded role that encompasses disease state management. This includes performing clinical assessments and limited physical examinations; recognizing the need for Examiner Cover additional care; making referrals as needed; ordering and interpreting specific laboratory tests; integrating their pharmacy patient care plans into patients’ total medical care plans; and entering notes on patient charts or carrying out other forms of written communication with patients’ medical care providers. Depending on state regulations and Fair Rating : Payday Loans, physician-based protocols, some advanced practice pharmacists can prescribe and adjust medications independently or after consultation with prescribing clinicians. The clinical activities of BC-ADM pharmacists are not carried out independent of referring, collaborative practitioners. Endorsement Letter | Basic? Rather, they are complementary to and serve to enhance the diagnostic, complex physical assessment, and management skills of medical providers. The following case study illustrates the pharmacotherapeutic challenges of Fair Credit Rating : Payday diabetes with other comorbidities, which can lead to potential drug-drug and drug-disease interactions. Although it does not offer detailed solutions to Permission Slip | Download Templates such problems, this case does describe the process of patient care and problem resolution as approached by Auto Loan Fair Credit Rating Loans In Irving advanced practice pharmacists. B.L. is Examiner, a 58-year-old white woman who has been referred to the pharmacist clinician for pharmacotherapy assessment and Auto Loan Fair Credit : Payday Loans, diabetes management. Her multiple medical conditions include type 2 diabetes diagnosed in 72 Best On Pinterest Flyers 1995, hypertension, hyperlipidemia, asthma, coronary artery disease, persistent peripheral edema, and longstanding musculoskeletal pain secondary to a motor vehicle accident. Her medical history includes atrial fibrillation with cardioversion, anemia, knee replacement, and multiple emergency room (ER) admissions for asthma.

B.L.’s diabetes is currently being treated with a premixed preparation of 75% insulin lispro protamine suspension with 25% insulin lispro preparation (Humalog 75/25), 33 units before breakfast and Auto Loan Fair Credit Loans, 23 units before supper. She says she occasionally “takes a little more” insulin when she notes high blood glucose readings, but she has not been instructed on the use of an insulin adjustment algorithm. Her other routine medications include the fluticasone metered dose inhaler (Flovent MDI), two puffs twice a day; salmeterol MDI (Serevent MDI), two puffs twice a day; naproxen (Naprosyn), 375 mg twice a day; enteric-coated aspirin, 325 mg daily; rosiglitazone (Avandia), 4 mg daily; furosemide (Lasix), 80 mg every morning; diltiazem (Cardizem CD), 180 mg daily (per cardiologist consult); lanoxin (Digoxin), 0.25 mg daily (per cardiologist consult); potassium chloride, 20 mEq daily; and fluvastatin (Lescol), 20 mg at bedtime. Medications she has been prescribed to take “as needed” include sublingual nitroglycerin for chest pain (has not been needed in the past month); furosemide, additional 40 mg later in the day if needed for swelling (on most days the Manager, Supply Contractin…, additional dose is needed); and albuterol MDI (Proventil, Ventolin), two to four puffs every 4–6 hours for shortness of Auto Loan Fair Credit In Irving breath. She denies use of nicotine, alcohol, or recreational drugs; has no known drug allergies; and is up to date on her immunizations. B.L.’s chief complaint now is Permission Free Templates, increasing exacerbations of asthma and Loan Fair Rating : Payday, the need for prednisone tapers. She reports that during her last round of prednisone therapy, her blood glucose readings increased to the range of 300–400 mg/dl despite large decreases in Debt Reduction Spreadsheet her carbohydrate intake. She reports that she increases the frequency of her fluticasone MDI, salmeterol MDI, and albuterol MDI to four to five times/day when she has a flare-up. However, her husband has been out of work for Auto Credit Rating : Payday more than a year, and their only source of income is her Social Security check. Therefore, she has been unable to purchase the Box Images | Flyer Flyers And Flyer, fluticasone or salmeterol and so has only Auto Credit Rating Loans, been taking prednisone and albuterol for recent acute asthma exacerbations. B.L. reports eating three meals a day with a snack between supper and bedtime.

Her largest meal is supper. Medical Certificate For Student? She states that she counts her carbohydrate servings at each meal and is “watching what she eats.” She has not been able to exercise routinely for several weeks because of bad weather and her asthma. The memory printout from her blood glucose meter for the past 30 days shows a total of 53 tests with a mean blood glucose of 241 mg/dl (SD 74). Loan? With a premeal glucose target set at 70–140 mg/dl, there were no readings below target, 8% within target, and 91% above target. By comparison, her results from the same month 1 year ago averaged 112 mg/dl, with a high of 146 mg/dl and a low of Operations Supply Chain 78 mg/dl. B.L. is Auto Loan Fair Rating : Payday In Irving, well-appearing but obese and Examiner, is in no acute distress. A limited physical exam reveals: Weight: 302 lb; height 5?1?

Blood pressure: 130/78 mmHg using a large adult cuff. Pulse 88 bpm; respirations 22 per minute. Lungs: clear to Loan Fair Credit Rating : Payday In Irving auscultation bilaterally without wheezing, rales, or rhonchi. Lower extremities +1 pitting edema bilaterally; pulses good. B.L. reports that on the days her feet swell the most, she is active and in an upright position throughout the day.

Swelling worsens throughout the day, but by the next morning they are “skinny again.” She states that she makes the Plans Examiner Letter, decision to take an extra furosemide tablet if her swelling is Rating Loans In Irving, excessive and painful around lunch time; taking the diuretic later in the day prevents her from sleeping because of nocturnal urination. For the sake of brevity, only Scholarship Endorsement, abnormal or relevant labs within the past year are listed below. Hemoglobin A 1c (A1C) measured 6 months ago: 7.0% (normal range: 5.9%; target: 7%) Creatinine: 0.7 mg/dl (normal range: 0.7–1.4 mg/dl) Blood urea nitrogen: 16 mg/dl (normal range: 7–21 mg/dl) Sodium: 140 mEq/l (normal range: 135–145 mEq/l)

Potassium: 3.4 mg/dl (normal range: 3.5–5.3 mg/dl) Calcium: 8.2 mg/dl (normal range: 8.3–10.2 mg/dl) • Total cholesterol: 211 mg/dl (normal range 200 mg/dl) • HDL cholesterol: 52 mg/dl (normal range: 35–86 mg/dl; target: 55 mg/dl, female) • LDL cholesterol (calculated): 128 mg/dl (normal range: 130 mg/dl; target: 100 mg/dl) Initial LDL was 164 mg/dl. • Triglycerides: 154 mg/dl (normal range: 150 mg/dl; target: 150 mg/dl) Liver function panel: within normal limits. Urinary albumin: 30 ?g/mg (normal range: 30 ?g/mg) Poorly controlled, severe, persistent asthma.

Diabetes; control recently worsened by asthma exacerbations and treatment. Dyslipidemia, elevated LDL cholesterol despite statin therapy. Persistent lower-extremity edema despite diuretic therapy. Hypokalemia, most likely drug-induced. Hypertension JNC-VI Risk Group C, blood pressure within target and : Payday Loans, stable. Coronary artery disease, stable. Chronic pain secondary to previous injury, stable. Status post–atrial fibrillation with cardioversion. Status post–knee replacement. Financial constraints affecting medication behaviors. Insufficient patient education regarding purposes and role of specific medications.

Wellness, preventive, and routine monitoring issues: calcium/vitamin D supplement, magnesium supplement, depression screening, osteoporosis screening, dosage for daily aspirin. Strand et al.1 proposed a systematic method for Plans evaluation of and intervention for a patient’s pharmacotherapy, using a process called the Auto Fair : Payday Loans, Pharmacist’s Work-Up of Drug Therapy (PWDT). The PWDT has been modified by subsequent authors,2–4 but the process remains grounded in Debt | the following five questions: What are reasonable outcomes for this patient? Based on current guidelines and literature, pharmacology, and pathophysiology, what therapeutic endpoints would be needed to achieve these outcomes? Are there potential medication-related problems that prevent these endpoints from being achieved? What patient self-care behaviors and medication changes are needed to address the medication-related problems? What patient education interventions are needed to enhance achievement of these changes?

What monitoring parameters are needed to Loan Rating : Payday Loans verify achievement of goals and detect side effects and toxicity, and Resume Operations Chain Mgmt, Contractin…, how often should these parameters be monitored? Clinical outcomes are distinctly different from therapeutic or interventional endpoints. Credit Rating : Payday In Irving? The former refers to the impact of Resume Operations Supply Mgmt, Procurement, treatment on patients’ overall medical status and quality of life and should emphasize patient-oriented evidence that matters (POEMs) rather than disease-oriented evidence (DOEs). Therapeutic endpoints include the anticipated and Auto Loan Rating Loans In Irving, desired clinical effects from Plans Examiner, drug therapy that are expected, ultimately, to achieve the desired outcome(s). As such, therapeutic endpoints are used as surrogate markers for Auto Loan Credit Rating achievement of Format For Student outcomes. Commonly, more than one endpoint will be needed to Auto Loan Rating : Payday Loans achieve an outcome.

For example, near-normal glycemic control and normalization of blood pressure (endpoints) would be necessary to significantly reduce the Endorsement Letter | Basic Resume In Word, risk of end-stage renal disease (outcome). Therapeutic endpoints should be specific, measurable, and achievable within a short period of Auto Loan : Payday Loans In Irving time. Achievement of clinical outcomes usually cannot be determined except by long-term observation or retrospective analysis. Outcomes and endpoints for For Student any given patient should be determined collaboratively between patient and provider before selecting or initiating pharmacotherapy or nonpharmacological interventions. Auto Credit : Payday In Irving? Taking the Reduction |, time to Auto Loan Credit Loans In Irving identify these components up front (and periodically revise them later on) helps ensure that subsequent medications or strategies are appropriately directed. It further ensures a common vision and 72 Best On Pinterest | Flyer Flyers And Flyer, commitment for ongoing patient care and Loan Fair : Payday In Irving, self-management among the care team (including the 72 Best Box Images Template, And Flyer, patient), thus maximizing the potential for optimal disease control and patient satisfaction. The outcomes and endpoints for a patient such as B.L. Loan Fair Rating : Payday? are numerous and Permission Slip Template | Download Templates, obviously would not be addressed or attained in a single session. Therefore, after desired outcomes and endpoints are determined, they should be prioritized according to medical urgency and Loan Fair Rating Loans In Irving, patient preference. Implementation and goal setting related to Resume Operations Manager, Supply Chain Procurement, Contractin… these priorities can then be undertaken, thus establishing a treatment plan for the eventual attainment of the full list.

During ongoing and Rating Loans In Irving, follow-up visits, this care plan should be reviewed and modified as indicated by changes in patient status, preferences, and medical findings. Plans? Examples of desired outcomes and endpoints for B.L. are given in Fair Credit Rating Tables 1 and 2. For the sake of brevity, these tables are not intended to be inclusive. Medication-Related Problems and Proposed Interventions. With agreement between patient and Permission Free, clinician concerning desired outcomes and endpoints, the Loan Fair Loans In Irving, next logical step is to evaluate whether the current treatment plan is likely to achieve those goals, or, if treatment is to | Flyer Flyers be initiated, which therapies or interventions should be selected. According to Strand et al.,1 a medication-related problem is any aspect of a patient’s drug therapy that is interfering with a desired, positive patient (therapeutic) outcome or endpoint.

The PWDT proposes a systematic and comprehensive method to identify, resolve, or prevent medication-related problems based on Loan Credit Rating : Payday Loans the following major categories: No indication for a current drug. Indication for a drug (or device or intervention) but none prescribed. Wrong drug regimen (or device or intervention) prescribed/more efficacious choice possible. Too much of the correct drug. Too little of the correct drug. Adverse drug reaction/drug allergy. Drug-drug, drug-disease, drug-food interactions. Patient not receiving a prescribed drug. Routine monitoring (labs, screenings, exams) missing.

Other problems, such as potential for overlap of adverse effects. Once problems are identified, resolutions must be developed, prioritized, and implemented. Patient or caregiver input is especially helpful at this stage because the Permission Slip Template | Download Free Templates, individual can describe subjective as well as objective data, expectations or concerns that may be affecting drug therapy, and Credit Rating : Payday Loans In Irving, deficits in Scholarship Endorsement drug knowledge, understanding, or administration. Resolutions may result from numerous strategies, including dose alteration, addition or discontinuation of medication, adjunct medications, regimen adjustment, complementary therapies, instruction on Credit : Payday Loans medication administration or devices, disease or medication education, development of Scholarship Endorsement | Basic In Word “cues” as compliance reminders (e.g., pill boxes), and identification of ways to avoid, detect, or manage side effects or toxicities. Needless to Auto Loan : Payday say, the Resume Chain Contractin…, involvement of patients and family or caregivers is critical for successful implementation of Auto Loan Fair Rating In Irving most resolution strategies and for optimal disease management. Because of the extent of B.L.’s medication-related problems and potential interventions (Tables 3 and 4), it was agreed to Debt Spreadsheet | tackle first her asthma exacerbations and Loan Fair Credit Loans, high blood glucose levels. Scholarship Letter Resume Format? To this end, B.L. was counseled about the role of maintenance asthma medications versus rescue drugs. Auto Loan Loans? The root of her confusion between these agents was easy to understand—because the Template, Flyers And Flyer, prednisone and Credit : Payday In Irving, fluticasone were both called steroids, it seemed likely that the tablets were a cheaper and Reduction Spreadsheet |, easier way to take the Loan Credit : Payday In Irving, medicine.

Likewise, since albuterol and salmeterol were both called bronchodilators, it seemed that the albuterol was the cheaper way to take the medicine. Having grasped the concept of Medical asthma prevention, she was willing to convert to a product combining fluticasone and salmeterol (Advair Diskus) for maintenance/prevention and to In Irving reserve the albuterol for quick relief of acute symptoms. Free samples of the Scholarship Endorsement Letter | Basic, new product were dispensed, and B.L. was enrolled in the manufacturer’s indigent drug program for subsequent supplies. She was further instructed on Auto Loan Credit the use of a peak flow meter and advised to monitor her readings and Examiner, symptoms. At the next visit, these data will be used to determine her maximal expiratory effort (“personal best”) and to construct an asthma action plan. B.L.’s insulin was changed to a basal-based regimen utilizing bedtime glargine (Lantus) insulin and premeal lispro (Humalog) insulin. Education was provided on this dosing concept. Auto : Payday Loans In Irving? She and the pharmacist discussed how this regimen can give greater flexibility in dosing, especially for responding to changes in diet, exercise, and disease exacerbations or medications. She was also given an initial supplementary adjustment algorithm (sliding scale) to correct for any temporary elevation of blood glucose.

She agreed to test four times daily and to record her blood glucose results, carbohydrate intake, and insulin doses. At the next visit, these data will be used to modify the adjustment algorithm and to Letter | Basic Format In Word construct a prospective algorithm for matching premeal bolus insulin to the anticipated carbohydrate intake (insulin-to-carbohydrate ratio). The final interventions for Auto Credit this visit were to increase the dose of potassium chloride and change the Resume Manager, Supply Mgmt,, fluvastatin to atorvastatin (Lipitor) to further reduce B.L.’s LDL cholesterol. Medication education for atorvastatin was provided, and patient questions were answered. Other medication-related problems and interventions identified for B.L. are listed and briefly discussed in Tables 3 and 4. For the sake of Rating : Payday brevity, these lists are not inclusive nor are all pharmacotherapy issues discussed.

Monitoring for Effectiveness, Side Effects, and Toxicity. The last step in the PWDT process is to Manager, Procurement, develop a plan to evaluate the Fair Credit Rating : Payday Loans, patient’s progress in attaining desired outcomes, therapeutic endpoints, and behavior changes; to Reduction | assess effectiveness of pharmacotherapy; and to identify side effects, drug interactions, or toxicity issues that need to be addressed. The monitoring/follow-up component is the most tedious aspect of the PWDT. Credit Rating Loans? For each medication or intervention, key parameters must be identified as markers for effectiveness, for side effects, for Reduction | drug interactions, and for toxicity. In addition, the time frame and process for assessing those parameters must be determined. Finally, the desired range for the parameter must be listed or a “decision point” must be identified to signal that additional action will be required. It should be noted that only a limited number of parameters are selected for a given patient. For example, it is not necessary to list and Auto Loan Rating In Irving, monitor for every possible side effect with equal intensity and frequency. Selection of the monitoring parameters is based on the positive effects (efficacy) that are most important to the care of that patient, as well as the | Download Free & Premium, adverse effects (side effects, toxicity, or drug interactions) that are most important to avoid for the safety of Credit : Payday In Irving that patient or to which that patient is most prone. Because the monitoring component is usually extensive, examples listed for B.L. in Table 5 have been limited to three of the medication or regimen changes that were made at the first pharmacist visit: switching from fluvastatin to atorvastatin; switching from two shots of premixed 75/25 lispro to bedtime glargine with premeal lispro; and Manager,, substituting the combination inhaler product for Auto Rating In Irving her fluticasone and salmeterol MDI prescriptions.

Because atorvastatin and Resume Operations Supply Chain Mgmt, Procurement, Contractin…, fluvastatin differ chemically, the monitoring parameters for this change are similar to Auto Loan Fair Credit : Payday Loans those for initiation of Debt Reduction Spreadsheet | a new medication. Monitoring for the new insulin regimen (basal insulin with premeal bolus) focuses primarily on glycemic control patterns and hypoglycemic episodes. Because B.L. has previously used the two ingredients of her new inhaler product (fluticasone and salmeterol) without adverse effect, monitoring of her new asthma therapy is focused on effectiveness, tolerance of inhalation of its dry powder formula, and use of the administration device. Diabetes patients with multiple co-morbidities have concerns about all of their problems, not just the diabetes; therefore, BC-ADM pharmacists must comprehensively explore all the ramifications of comorbidities as well as patients’ feelings, expectations, and concerns for total health. B.L. is a good example of this; even though her referral was for “diabetes management,” her greatest concern at this visit was her asthma exacerbations. As can be seen in this case, each coexisting disease or coprescribed drug has a domino effect, affecting other diseases or drugs and ultimately affecting quality of Auto In Irving life. With input from 72 Best Box Images | Flyer Template, Flyers, B.L., the Auto Loan Fair Credit Rating : Payday, pharmacist clinician was able to develop a PWDT that addresses her diabetes as well as her other health care needs.

B.L. was able to leave the health center with a few achievable self-care goals and medication changes that address her acute concerns and Template Free Templates, with the knowledge and Loan Rating, confidence that, at each subsequent visit, additional progress will be made toward her personalized health status goals. Examples of B.L.’s Desired Outcomes. Examples of B.L.’s Therapeutic Endpoints. Examples of B.L.’s Medication-Related Problems. Examples of For Student B.L.’s Interventions (Prioritized and to be Implemented Accordingly)

Examples of Loan Credit Rating : Payday In Irving B.L.’s Monitoring Plans. Peggy Yarborough, PharmD, MS, BC-ADM, CDE, FAPP, FASHP, NAP, is a professor at Campbell University School of Pharmacy in Template | Download Free Templates Buies Creek, N.C., and a pharmacist clinician at Loan Credit Rating : Payday Loans, Wilson Community Health Center in Wilson, N.C. For information concerning POEMs and DOEs: a multitude of On Pinterest | Flyer Flyers literature on this topic is available through Internet sources. Search for “patient oriented evidence that matters” using a medical topic browser. 2017 by the American Diabetes Association. Diabetes Spectrum Print ISSN: 1040-9165, Online ISSN: 1944-7353 .