This guideline is for the clinical management of primary hypertension in adults (aged greater than 18 years). Hypertension (high blood pressure) is one of the most preventable causes of premature morbidity and mortality world-wide.
Hypertension is a major risk factor for stroke (ischaemic and haemorrhagic), myocardial infarction, heart failure, chronic kidney disease, peripheral vasculardisease, cognitive decline and premature death. Untreated hypertension is associated a progressive rise in blood pressure, often culminating in a treatment resistant state due to associated vascular and renal damage.
Blood pressure is quantified as diastolic and systolic pressures measured in millimetres of mercury (mmHg). The diastolic pressure represents the pressure during ventricular relaxation in diastole whereas the systolic pressure represents the peak pressure due to ventricular contraction during systole. Either or both pressures have specified upper limits of normal and elevation in either or both pressures are used to define hypertension.
Blood pressure is normally distributed in the population and there is no natural cut-point above which “hypertension” definitively exists and below which, it does not. Epidemiological studies demonstrate that the aforementioned disease risk associated with blood pressure is a continuous relationship and above blood pressures of 115/70mmHg, the risk of cardiovascular events doubles for every 20/10mmHg rise in blood pressure. The threshold blood pressure determining the presence of hypertension is defined as the level of blood pressure above which treatment has been shown to reduce the development or progression of disease. Primary hypertension was previously termed “essential hypertension” because of a long-standing view that high blood pressure was sometimes “essential” to perfuse diseased and sclerotic arteries. It is now recognised that the diseased and sclerotic arteries were most often the consequence of the hypertension and thus the term “essential hypertension” is redundant and the “primary hypertension” is preferred. Primary hypertension refers to the majority of people with sustained high blood pressure (approximately 90%) encountered in clinical practice, for which there is no obvious, identifiable cause. The remaining 10% are termed “secondary hypertension” for which specific causes for the blood pressure elevation can be determined (for example, Conn’s adenoma, renovascular disease, or phaeochromocytoma).
Primary hypertension is remarkably common in the UK population and the prevalence is strongly influenced by age and lifestyle factors. Systolic and/or diastolic blood pressures may be elevated. Systolic pressure elevation is the more dominant feature of hypertension in older patients and diastolic pressure more commonly elevated in younger patients, (those less than 50 years of age). At least one quarter of the adult population of the UK have hypertension, (blood pressure ≥140/90mmHg) and more than half of those over the age of 60 years. As the demographics of the UK shifts towards an older, more sedentary and obese population, the prevalence of hypertension and its requirement for treatment will continue to rise.
Routine periodic screening for high blood pressure is now commonplace in the UK as part of National Service Frameworks for cardiovascular disease prevention. Consequently, the diagnosis, treatment and follow-up of patients with hypertension is one of the most common interventions in primary care, accounting for approximately 12% of Primary Care consultation episodes and approximately £1 billion in drug costs in 2006.
NICE first issued guidance for the management of hypertension in primary care in 2004. This was followed by a rapid update of the pharmacological treatment chapter of the guideline in 2006. The current partial update of the hypertension guideline is in response to the regular five year review cycle of existing NICE guidance. It began with a scoping exercise which identified key areas of the existing guideline for which new evidence had emerged that was likely to influence or change existing guideline recommendations.
Sections of the guideline that have not been updated continue to stand, however, wherever NICE has subsequently issued new and related guidance relevant to existing recommendations, these have been identified and cross-referred to in this partial update, examples include interventions on lifestyle factors and public health policy recommendations such as smoking cessation, dietary salt restriction, alcohol intake and cardiovascular disease prevention and cardiovascular disease risk assessment. In addition, new NICE guidance developed in areas relevant to hypertension are also highlighted and cross referenced (for example, chronic kidney disease, stroke, diabetes and hypertension in pregnancy).
The recommendations that have been reviewed in this partial update of the guideline for the clinical management of primary hypertension in adults, include; blood pressure measurement for the diagnosis of hypertension; blood pressure thresholds for intervention with drug therapy and blood pressure targets for treatment; specific aspects of the recommendations for the pharmacological treatment of hypertension; the treatment of hypertension in the very elderly (people aged greater than 80 years); dilemmas surrounding decision making for treatment of hypertension in younger adults (less than 40 years); the treatment of drug resistant hypertension; and wherever appropriate, the impact of age and ethnicity on treatment recommendations.
Finally, despite the fact that the treatment of hypertension has a large clinical trial evidence base to inform recommendations, an important aspect of the evidence review for guideline development is to identify where gaps in knowledge remain. In so doing, research questions have been identified to prompt the gathering of further evidence to continue the evolution of guidance and clinical practice.
Presentation on theme: "General Format & the Thesis Statement 9/1: Thesis/Essay Notes page 4R"— Presentation transcript:
1 General Format & the Thesis Statement 9/1: Thesis/Essay Notes page 4R
Essay Format Part #1:General Format & the Thesis Statement9/1: Thesis/Essay Notes page 4R
2 A Standard 5 paragraph essay follows a certain format:
INTRODUCTION: with a “hook” and an opinionated thesis statementBODY: 3 separate paragraphs where the argument is explained and supporting evidence is cited.CONCLUSION: where main points are summarized and reviewed and the reader is left with something to think about.
3 First…Know Your Audience…
Before you start writing, you should know your audience:Who will read your writing? Who do you need to convince?The audience may be your friends, your teacher, your parents, your principal, the readers of a newspaper or the President of the United States!Will you be graded? On What?Should you be casual or professional?What does your audience already thinkabout your topic?
4 Second… Pick a side!The writer must clearly state his/her position and stay with that position. Pick a side! Don’t be in the middle, or undecided!Your opinion about the topic, or your answer to a driving question is your THESIS!
5 Three: Do Your Research…
In order to convince the reader you need more than just an opinion; you need facts or examples to back your opinion. So, be sure to do the research!Walsh Publishing Co. 2009
6 Four: MAKE A PLAN, then write!
The Standard 5 Paragraph Essay:1. Introduction/Hook/Thesis2. Argument 1 with support3. Argument 2 with support4. Argument 3 with support5. Conclusion
7 Start with your Thesis Statement
A thesis statement is one sentence at the end of your introduction paragraph that states your opinion.It needs to be strong.It is the single-most important statement of your opinion in your essay.* Always start essays by brainstorming your thesis statement first, and then build your essay around that idea!
8 Start with your Thesis Statement
One method is the 3-point thesis statement:First, choose 3 main focus points to discuss in your essay. These points will become the focus of three paragraphs in the body of your paper.Let’s use fast food as an example again.Fast food…(3 Discussion Points)rapidly increases weightcauses high blood pressureleads to sluggishness
9 Writing the Thesis Statement
Now list your three point in your sentence. Put your completed thesis statement at the end of your first paragraph.THREE MAIN FOCUS POINTSI believe fast food is harmful because it rapidly increases weight, causes high blood pressure, and leads to lethargy.RevisedFast food is harmful because it rapidly increases weight, causes high blood pressure, and leads to lethargy.* Remember: You opinion is stronger when you don’t say “I believe,” or “I think…”
10 Practice: Answer the following question based on your opinion:
“Who’s to blame for America’s growing weightProblem?”What three reasons will you discuss in your essay?“________ is to blame for America’s weight problem because (1) , (2) , and __(3) .
11 An Umbrella ThesisThis approach summarizes your 3 main points into one category, or umbrellaTHREE MAIN FOCUS POINTSFast food is harmful because it rapidly increases weight, causes high blood pressure, and leads to lethargy.COMPLETED THESIS STATEMENTEating fast food frequently is a poor choice, as many fast foods can cause negative health effects.
12 Thesis Statements continued…
Your statement should be debatable.Non-debatable example:Many people blame the fast-food industry for making them fat.Better example:The fast-food industry is to blame for making people fat.
13 The Introduction Paragraph
ESSAY FORMAT: Part 2:The Introduction Paragraph
14 The Great Introduction…
What makes an good introduction?It grabs or “hooks” the reader’s attention by using one or more of the following strategies:An anecdote or scenarioA quotationAn interesting fact or statisticA questionIt tells how the writing will be organized.The author’s position is clearly stated in a thesis statement.
15 Introduction To be the MOST clear, use this format:
1st sentence: hook (question, statistic, general statement of the problem)2-3th sentences: necessary background info/description of the problem4th sentence: In “Title of work,” Author’s full name claims, summary of author’s argument.5th/ LAST sentence: YOUR thesis
16 The Inverted Triangle Introduction
Goes from general information to the most specific aspects of your essay.Thesis should almost always be the last sentence in your intro paragraph.General info about topicSpecific opinion (thesis)
17 Grabbing Your Audience…
Good strategies used in introductions:Use an Anecdote/ ScenarioThe writer provides a personal experience or made-up situation to introduce the position.QuestioningThe writer asks thought-provoking questions to capture the reader’s interest.Interesting fact or statisticThe writer gives an interesting piece of information to grab the reader’s attention.Lets Take A Look….
18 You Could Start with a Riddle:
Get your reader’s attention with a challenging thought.“What’s plain, and boring? What makes all students in a school building look the same and lose their individuality? If you guessed UNIFORMS, you’re correct!”
19 You Could Begin with a Strong Statement:
Example:Fast food consumption has risen 500 percent since 1970 and today reaches nearly every part of society, including some public school cafeterias.
20 You Could Open with an Anecdote:
An anecdote can provide an amusing and attention-getting opening if it is short and to the point.“My hands felt sticky after pulling open the doors to “Big Bobby’s Boisterous Burger Hut”. The odor smelled of fried everything. I ordered a Big Bobby Combo #2. There was enough food to serve a small third world country on my tray. I nibbled at the ¾ pound burger and my chin was covered in a mayonnaise and ketchup concoction. I asked the server if I could have a few fries with my salt. I left the place feeling like my stomach was mad at me.”
21 You Could Open with a Quotation:
Example:University of Delaware professor states:“Advertising, including television ads, billboards, and other advertising,including toys in boxed meals, has had an effect upon children as never before.Children these days are growing up with low concern for their health andmore concern for what tastes good.”
22 You Could Open with a interesting fact:
Example:“Did you know that a typical child needs 2,000 calories for an entire day and Burger King’s Whopper with triple cheese has 1,230 calories?”
23 You Could Open with a Fact or Statistic:
Example:Thirty percent of the children in the survey ate fast food on any given day during the survey, and they ate an average of 187 calories a day more than those who did not eat fast food. These additional calories could account for an extra six pounds of weight gain per year, according to Ludwig.
24 You Could Open with a Question:
Ex) How many times have you eaten fast food this month?BUT use a sophisticatedquestion…NOT like this,“Do you think that fast foodIs bad for you?”
25 Open with an Outrageous Statement:
Example:“Fast food is killing America!”
26 Our Introductory Paragraph:
CATCHY TITLEFast Food Is Killing America!Did you know that a typical child needs 2,000 calories for an entire day and Burger King’s Whopper with triple cheese has 1,230 calories? That is far more calories than anyone needs in one day! Fast food consumption has risen 500 percent since 1970 and today reaches nearly every part of society, including some public school cafeterias. Fast food is harmful because it rapidly increases weight, causes high blood pressure, and leads to sluggishness. Fast food is unhealthy and consumers should limit their intake.HOOK THE READERYOUR THREE ARGUMENTSTHESIS STATEMENT
27 Three Supporting Paragraphs:
Use each of the main arguments you used in your introductory paragraph and expand on each giving facts and reasons.In our example, you would write one paragraph on how fast food increases weight, one paragraph on how it causes high blood pressure and one on how it leads to sluggishness.Walsh Publishing Co. 2009
28 Conclude or End Your Essay…
What makes an good conclusion?Last paragraph summarizes your main point.End using one or more of the following strategies:Call the reader to actionAnecdote or scenarioMake a PredictionThe last paragraph wraps up the writing and gives the reader something to think about.Walsh Publishing Co. 2009
29 Strategies for Conclusions
Call to ActionAsk the reader to do something or to make something happen “I challenge you to watch what you eat and to avoid fast food.”Provide a solutionProvide an answer to the problem “Fast food doesn’t have to be “bad food.” Make better choices like salads, fruit and low fat treats.”Make a PredictionExplain what might be the consequences of action or inaction “If people continue to eat lots of fast food, they put their health at risk. If kids don’t make better choices today, they won’t grow into healthy adults.”Walsh Publishing Co. 2009
30 Concluding Paragraph:
Restate your thesis.End with…A comment (Don’t make your body suffer!)A question (Are you willing to risk your health?)A call to action (I highly recommend you consider your options the next time your faced with a decision about what to eat.)In closing, it’s important to remember that too much fast food can have negative effects on your health. If not eaten in moderation, you can gain weight, suffer from high blood pressure and become slow and sluggish. Is it worth the risk to your body? Eat Healthy and Make good choices!Walsh Publishing Co. 2009
31 Don’t Forget…Make sure to read over your work and edit for mechanics and spelling.Write neatly!Include detail and great vocabulary.Follow proper format: Proper heading and skip lines!Walsh Publishing Co. 2009
32 Essay Format Part #3:CITATIONS
33 QuotationsCite any outside information or statistics you reference, including information from the original article (Weintraub’s).Cite words that you paraphraseDon’t plagiarize – better safe than sorry!MLA format (See Purdue Owl cite)Purdue MLA
34 Subsequent uses – only use the last name.
In-text quotations must reference the author’s first and last name the first time it is used.Subsequent uses – only use the last name.Name of essays/articles are placed in quotations. Books and movies are italicized.Ex) In Daniel Weintraub’s article, “The Battle Against Fast Food Begins in the Home,” blah blah blah.According to Supersize Me, blah blah blah…
35 Citation The author’s last name and page number must always be cited.
Either in-text citation OR parenthetical citationEx) He said, “Blah blah” (Weintraub 66).Notice the punctuation: “( ).There is no comma between the last name and the page #.If you mention the author’s name in the sentence, only cite the page number at the end.Ex) Weintraub states, “Blah blah” (88).
36 Embed your quotes: Don’t leave them naked!
Naked quote:“My own home is by no means a fast food-free zone” (Weintraub 43). In this quote, Weintraub is saying…Embedded Quote:Weintraub gives context to his own home life by saying, “My own home is by no means a fast food-free zone” (43).
37 ExamplesWordsworth stated that Romantic poetry was marked by a "spontaneous overflow of powerful feelings" (263). - direct citation with author’s nameRomantic poetry is characterized by the "spontaneous overflow of powerful feelings" (Wordsworth 263) direct citation without author’s nameWordsworth extensively explored the role of emotion in the creative process (263).-paraphrased
38 Practice Embed and cite this quote according to the information given:
Daniel Weintraub. Pg 42. Obesity is the fault of the parents who let their kids eat unhealthy foods.Direct quote using author’s name in the sentenceDirect quote without using the author’s name in the sentenceParaphrase the quote and cite it