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Traditionally, dermabrasion would be performed the primary disadvantage of all excision and punch tech 4 to 8 weeks after excision or punch grafting; (23) however, a niques is that they necessitate the creation of secondary defects. In addition, these procedures are unlikely to produce optimal results in patients Practical advice for the clinician with tendencies toward poor wound healing. It should be noted Because these procedures involve the creation of secondary that some patients develop severe acne scars due to a propensity defects, it is essential that patients have realistic expectations toward abnormal healing, and these particular patients would prior to undergoing excision or punch procedures. Even when per should be well informed about the potential outcomes, and formed in well-selected candidates, excision and punch tech they should be willing to accept the possibility that subsequent niques carry the risk of leaving behind conspicuously elevated procedures, such as laser resurfacing, may be necessary to pro or depressed scars. If two or more scars are to be excised, they should be at least 4 to 5 mm apart to prevent excess traction dur Complications ing healing. The postauricular area is most frequently used, but if it is not Punch being a good match with the recipient site or if it has active acne inserted at 90 lesions, other sites, including the preauricular area, supra clavicular area, backs of the arms, and hairline, may be con sidered. For punch excision, a punch instrument is selected that is just large enough to encompass the scar, including its walls. If necessary, forceps and iris scissors can be used to gently release the scar from any fibrous attachments. Scar base elevated (1) If smaller than 2 mm, a wound may be left to heal by sec to sit slightly ond intention (30) or it may be closed with one or two simple, higher than interrupted sutures. A scalpel blade is used to excise an ellipse oriented longitudinally along a resting skin tension line. The scar is encompassed at the center of the ellipse and the wound angles are 30 degrees or less to allow for aesthetic closure. To perform punch elevation, a punch instrument is cho sen that exactly matches the diameter of the scar base. Punch inserted at 90 and twisted First, the entire scar, including its walls, is excised. In contrast with the A punch excision procedure described above, care should be taken to avoid lateral stretching of the skin so that the resulting recipient hole will be perfectly round. Use of a slightly Outline of larger graft is recommended because grafts have a tendency scar beneath skin surface to contract while the recipient wounds may expand, and it is important for the graft to maintain contact with the margins of the recipient hole. Patients should be advised to limit Plug of skin with their facial movements and to avoid touching graft sites for the scar being removed B first several days. Management of Complications As described above, the risk of complications from excision and punch procedures may be minimized through careful technique. With larger punch excisions and elliptical exci sions, meticulous suturing is necessary to produce the least conspicuous secondary defects.

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Bone mass declines with age regardless of sex, with the highest rates of loss occurring in postmenopausal women. Estrogen deficiency plays a role in reduced bone formation and increased bone loss in men and women. Sarcopenia is a major contributor to frailty, a common syndrome particularly among persons older than 80 years of age. Although there is disagreement regarding the definition of frailty, many consider a person frail when two or more of the following factors are present: unintended weight loss of 10 lb or more in a year, extreme exhaustion, muscle weakness, reduced gait speed, and low physical activity level. A vicious cycle of inactivity and functional decline ensues among persons who are frail, because a high percentage of energy reserves are used to perform simple activities. A multidisciplinary treatment approach that includes progressive resistance exercise and functional training has been shown to be of particular benefit. In general, trunk and lower extremity muscles are affected to a greater extent than upper extremity muscles. With inactivity, the postural, antigravity muscles such as the quadriceps, gluteals, erector spinae, and gastrocnemius-soleus are affected the most. These muscle groups are important for upright posture, locomotion, and functional independence. What musculoskeletal effects of aging can be reversed or attenuated with exercise Exercise positively affects flexibility, strength, power, and muscle mass in older adults. The age-related decline in bone mass may be offset by weight-bearing endurance and resistance exercise. In postmenopausal women, hormone therapy may be necessary to prevent osteoporosis, even among those who are physically active. Summarize the recommended protocol for strength and power training in older adults. Emphasis should be placed on strengthening the major muscle groups, especially those of the hips, trunk, and lower extremities. Each major muscle group should be exercised two to three times a week with 1 to 2 days of rest before the next workout of the same muscle group. Strength gains can be achieved with a single set of repetitions per exercise maneuver, with greater strength gains realized with higher numbers of sets. Power training (generating muscle force quickly) should be incorporated into the resistance training routine once an individual can complete two sets of 10 to 15 maximum repetitions of an exercise maneuver. The concentric phase of an exercise should be performed quickly and the eccentric phase performed more slowly. Other contraindications include severe shortness of breath, infection or inflammation of the heart, or any systemic infection. Blood pressure and heart rate should be monitored before, during, and after exercise.

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Fasciotomy 37 year old woman Non healing fasciotomy wound post compartment syndrome 2 weeks ago What maybe causing this wound to be non healing What advice will you give the patient regarding footwear in relation to the procedure & wound Check the version number before commencing training or assessment this Training Package is Version 1. Explanation of version number conventions the primary release Training Package is Version 1. When changes are made to a Training Package, sometimes the version number is changed and sometimes it is not, depending on the extent of the change. When a Training Package is reviewed it is considered to be a new Training Package for the purposes of version control, and is Version 1. Version modification history the version details of this endorsed Training Package are in the table below. The total number of units required to complete this qualification has increased to 15. There is however an increased emphasis on the technical skills required to work as a beauty therapist. The number of elective units remains at 10; of which 5 units must be chosen as one of 4 grouped electives. The total number of units required complete this qualification has decreased to 20. The number of elective units has increased from 6 to 11 units; of which 4 must be chosen as one of 2 grouped electives. Endorsed Training Packages and their components remain current until they are reviewed or replaced. To gain national endorsement of Training Packages, developers must provide evidence of extensive research, consultation and support within the industry area or enterprise. Training Packages describe the skills and knowledge needed to perform effectively in the workplace without prescribing how people should be trained. Training Packages acknowledge that people can achieve vocational competency in many ways by emphasising what the learner can do, not how or where they learned to do it.

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In all cases, competency must be demonstrated in the appropriate assessment environment as specified in each unit of competency. Simulated Wherever a simulated assessment is conducted it is vital that the assessment assessment environment is as industry realistic as possible. It is environments and essential that assessment is conducted using suitable resources activities and equipment and under industry-relevant conditions as close to a real work situation as possible. Integrated Within each qualification there are units of competency which are assessment interrelated and which a candidate would naturally complete simultaneously as part of their job function. Holistic assessment with other units relevant to the industry sector, workplace and job role is recommended. This integrated approach to assessment brings together a number of units of competency that reflect actual workplace practices, and the assessor should design integrated assessment activities to collect evidence for a number of units together. All units, in the Methods of Assessment section, recommend a range of related units which can be grouped together for integrated assessment. However, any units that relate to a job function can be combined into an integrated assessment. It is important that the assessor clearly identifies units of competency that can be combined to ensure an efficient and effective assessment process. Additionally, elements, performance criteria and employability skills should be drawn together in an integrated manner and appropriate assessment methodologies chosen. As a general principle the beauty industry supports the integration of units of competency for both delivery and assessment as this reflects real work practices. Prerequisite A unit of competence describes an individual skill but rarely do requirements at unit people perform one skill at a time. Rather, many skills are of competency level combined on a day to day basis in the workplace as part of work processes. This does not mean that each skill, described by a unit of comptence, is a prerequisite to another. They are conjunctive skills and this should be taken into account when sequencing training and assessment. A prerequisite requirement, at unit of competency level, means that it is necessary to develop a primary skill and the required knowledge before progressing to another. Prerequisites have been kept to a minimum in this package because: the beauty industry does not wish to create unnecessary barriers to the sequencing of training and assessment there are only a few beauty skills that must be achieved before higher order skills can be developed Individual prerequisite requirements, where they apply, are specified within the unit of competency and a summary of all prerequisite requirements is included in the preliminary information section of this Training Package. The existence of a prerequisite does not necessarily mean that training or assessment has to be fully completed before starting on the secondary unit.