© Endeavour College of Natural Health WHMC311 Case Study Report 1
Last updated on 7 March 2019 v14 Page 1 of 10
| SUBJECT: | WHMC311 Clinical Herbal Medicine | ||
| ASSSESSMENT: | Case Study Report 1 | ||
| DUE DATE: | Week 8 (Sunday 2355hrs) | WORD LIMIT: | 1000 +/- 10% |
| TOTAL MARKS: | 100 | WEIGHTING | 20% |
TASK SUMMARY
This case study report requires you to assess a patient’s medical history, develop a treatment plan,
develop a herbal prescription, detail any safety considerations and potential herb/drug interactions,
and provide suggested dietary and lifestyle interventions and relevant referrals for other treatment.
LEARNING OUTCOMES ASSESSED
1. Discuss the strengths and limitations of herbal medicine in the management of a range of
health conditions.
2. Develop person-centred treatment plans through the analysis of case information and
application of holistic herbal treatment strategies.
3. Formulate and provide rationale for individualised herbal prescriptions appropriate to
specific case examples.
4. Appraise traditional and scientific evidence, and provide integrative long term herbal client
care.
5. Discuss opportunities and limitations of multidisciplinary client care, including predicting
positive and negative interactions between herbal and pharmaceutical medicines.
SUBMISSION
Submission must be through the LMS no later than the due date indicated.
REFERENCING
| | The APA style as detailed in the Endeavour APA Referencing Guideline document is required. Whilst there is no specific minimum number of references required, an approximate guideline is 8-10 references. Your references must include no less than 2 herbal medicine references published prior to |
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1950, and no less than 3 references on herbal medicines from peer reviewed journals
published in the last 10 years.
FORMAT
Do NOT use the normal essay style format of Abstract, Introduction/Background, Body,
Conclusions. You MUST use the numbered headings shown in bold on the following pages. The
bullet points beneath each heading provide you with an elaboration on what is required in each of
these sections of your assignment.
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1. Assessment of the Patient
| | Detail your provisional diagnosis, and provide a rationale for your provisional diagnosis which links to the patient’s information. Remember that more than one condition may be present in a patient at the same time. Describe what you consider to be the causal chain of events in this patient (for more information see chapter 7 of your prescribed textbook Bone & Mills, 2013). Note: This section must be referenced. |
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2. Treatment Strategy
| | Using the table format shown below, list your treatment objectives (goals), approximate timeframe for improvement, and the herbal actions chosen to achieve each objective. Ensure that your objectives meet all the requirements as detailed in Session 1 of your subject materials. Ensure that you choose at least one herbal action for each objective. The same herbal action may be chosen for multiple objectives if relevant. Note: This table does not need to be referenced. |
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| Treatment Objective | Timeframe | Herbal Action(s) |
3. Herbal Prescription
| | Develop a liquid herbal prescription for this patient. If necessary you may also utilise other herbal preparation forms, e.g. infusions, topical preparations, tablets or capsules, etc. For the liquid herbal prescription the table format shown blow must be used, and all columns must be completed. The number of herbs utilised in this prescription is your decision, however keep in mind the principles of prescribing as described in Sessions 1-3 of your subject materials. More than one liquid herbal prescription can be provided if required, with each liquid herbal prescription being detailed in a separate table. Dosage and instructions for the patient must be included. If you are using additional preparations, the herbal components of each preparation must be |
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detailed along with their quantities in the preparation in a separate table, and full dosage and patient
instructions must be provided. If it is a pre-formulated product (e.g. a tablet) all of this information
must still be provided, along with the name of the product and the product sponsor (company).
Note: The table(s) do not need to be referenced.
| Latin binomial | Part used | DER | Amount per week |
Amount per bottle |
| The botanic name | Leaf, root, etc | The drug/extract ratio |
How much you want this patient to take per week |
How much you will out into your chosen bottle size |
| Dosage & Instructions: | Dosage the patient needs to take, how often they should take it, and any other instructions (e.g. before meals, 30 minutes before bed, etc) |
Bottle Size: | Size of bottle dispensed (choose from either 25mL, 50mL. 100mL, 200mL, or 500mL) |
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4. Rationale for Herbal Prescription
| | Provide a rationale for each herbal medicine in your prescription (this includes any herbs in pre formulated products). An approximate guideline is 2-3 paragraphs in length for each herbal medicine utilised. This rationale should make reference to the herbal medicine’s actions, indications, phytochemistry and phytopharmacology, and how the choice links to your Treatment Strategy. You should also present your rationale for the dosage of each herbal medicine that you have chosen (see the principles outlined in Sessions 1-3 of your subject materials). Note: This section must be referenced. |
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5. Safety Considerations & Herb/Drug Interactions
Detail any cautions and possible adverse reactions which may result from your treatment. In
presenting possible adverse reactions, consider their likelihood based on the evidence and upon
application of the evidence to this specific patient.
| | Detail any potential herb/drug interactions which may result from your treatment, and explain the nature of the interaction, whether it is a pharmacokinetic or pharmacodynamic interaction, and it would be considered a clinically desirable or undesirable interaction. Consider the likelihood of the interaction, based on the evidence and upon application of the evidence to this specific patient. Note: This section must be referenced. |
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6. Relevant Dietary & Lifestyle Interventions
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Provide brief advice on specific dietary and/or lifestyle interventions relevant to this patient. Link your dietary and/or lifestyle interventions with the treatment objectives chosen. Keep this section very brief – remember that this is a herbal medicine subject – but do provide specific advice based on evidence and the application of the evidence to this patient. Note: This section must be referenced. |
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7. Suggested Treatment Referrals
| | Provide brief advice on treatment referral(s) which may be beneficial to the patient. The referral(s) should be to clinicians other than herbalists, naturopaths or nutritionists (i.e. for treatment outside your scope of practice). Provide a brief rationale as to why this referral(s) may be useful for the patient. Note: This section must be referenced. |
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© Endeavour College of Natural Health WHMC311 Case Study Report 1
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CASE DETAILS
Andrew is a 46 year old male presenting with frequent headaches, anxiety, intermittent insomnia,
and mild fatigue. Andrew heads up a research centre at a university, and as a result is managing
numerous diverse projects and research staff and students, research grants and budgets. He
enjoys his work and gets a lot of satisfaction from the various projects, but the hours are long and
the demands are high.
Headache
Andrew has been experiencing regular headaches for the last 5-6 years. He describes the
pain as a “constrictive pressure” and is of moderate severity, tends to begin in the occipital
region and spreads to the temporal and frontal region bilaterally, and also the crown of head,
over a period of 1-2hrs. Each episode lasts around 3-8hrs, and mostly commences in the early
afternoon. Until about 1 year ago Andrew was getting these headaches 6-7 days a week, but it
has now reduced to 2-3 days per week since his GP prescribed a nightly dose of amitriptyline
as a preventative measure.
These headaches seem to be made worse by stress and lack of sleep. The only dietary trigger
he has noticed is consumption of alcohol (2-3 glasses of wine, or 2-3 shots of brown spirits
can trigger a headache), and as a result he now drinks alcohol infrequently (1-2 shots of
brown spirits per week). He has not noticed any other triggers.
His normal acute treatment for these headaches is 2-3 Panadol tablets when it comes on, and
if it is still bothering him in 4hrs he usually takes another 2 tablets. Whilst this rarely eliminates
the pain, it does make it a little more tolerable.
He does not get any nausea or vomiting with the headaches, and no photophobia, although
very occasionally (he estimates maybe 3 times over the last 5 years) he has noticed blurred
and distorted vision in his right eye, which has lasted for 2-3 days and then resolved.
Anxiety
Andrew has been noticing steadily building anxiety for the last 18 months. He describes this as
“being uptight” and tense, and whilst he is known and respected as a good manager of people,
he feels within himself that in the last few months he has been a bit more irritable at work.
In your initial consultation you request that Andrew to complete the GAD-7 and PHQ-9
questionnaires, and his results are shown on the following pages.
Intermittent Insomnia
Andrew has found over the last 12 months that his ability to relax and fall asleep in the
evenings has been suffering. Most nights it takes him 1-2hrs to wind down and fall asleep, and
given that he is often working until 2130-2200hrs, and then starts work around 0700hrs, he is
usually getting only about 5-6hrs sleep per night. This can be reduced to 4hrs if an project
deadline is close.
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Mild Fatigue
Andrew describes significant morning fatigue in the last 6-9 months, which he connects with
his poor sleep. The fatigue improves with an early morning shower and a double espresso,
and then he is fine until mid-afternoon, when he starts to experience an “energy slump”. He
usually counters this by having a single-shot latte or cappuccino, and something to eat (choice
of food is highly variable depending upon whether he is in off-site meetings or in the office),
which helps but does not fully alleviate the fatigue.
Diet
Andrew generally tries to eat a pretty good diet. Breakfast 6 days a week is a smoothie with
milk, protein powder, cocoa, banana, and berries, unless he has a breakfast meeting, in which
case it might be muesli, or eggs and toast. Lunch is highly variable in both timing and selection
of food, due to work demands, but he tries to have some kind of salad with a small amount of
meat or chicken or fish most days. Dinner is again variable as roughly 3 nights a week he eats
out (often as part of work meetings), but usually something of the nature of red meat or
chicken with steamed or stir-fried vegetables. Snacks during the day would usually be a slice
of wholemeal bread with peanut butter or some fruit (at his desk usually). He has on average
3-4 espressos per day, either black or with milk in the form of a latte or cappuccino, and 1
sugar. He has minimal other refined sugar intake. He drinks around 2.5-3L of water per day
(often a litre soon after waking as he often has a dry mouth first thing in the morning), and
usually tries to have a fresh fruit and vegetable juice every day.
Exercise
Andrew has a treadmill and an exercise bike at home, and 3-4 days per week he spends
around 30 minutes on one of them. He also swims at the local pool once a week.
Medications
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Amitriptyline 10mg 30 minutes before bed Paracetamol 500mg tablets, 3-4 tablets two to three times per week |
Examination & Pathology
On this first visit his BP is 154/88, PR 72. Height is 178cm and weight is 81kg. He has copies
of recent blood work including FBC, blood chemistry, CRP, ESR, LFT’s and all is normal.
Social
Andrew has no siblings, both parents died in a car crash about 12 years ago, and he does not
have a steadily partner. He has a broad social network consisting of work colleagues/friends
and a close personal friend he has known for 18 years – they have a weekend routine of a
swim at the local pool and then breakfast out.
Past Medical History
Nothing significant.
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| GAD-7 | ||||
| Over the last 2 weeks, how often have you been bothered by the following problems? |
Not at all | Several days | More than half the days |
Nearly every day |
| 1. Feeling nervous, anxious or on edge | 0 | 1 | 2 | 3 |
| 2. Not being able to stop or control worrying | 0 | 1 | 2 | 3 |
| 3. Worrying too much about different things | 0 | 1 | 2 | 3 |
| 4. Trouble relaxing | 0 | 1 | 2 | 3 |
| 5. Being so restless that it is hard to sit still | 0 | 1 | 2 | 3 |
| 6. Becoming easily annoyed or irritable | 0 | 1 | 2 | 3 |
| 7. Feeling afraid as if something awful might happen | 0 | 1 | 2 | 3 |
Total GAD-7 score = 11
| PHQ-9 | ||||
| Over the last 2 weeks, how often have you been bothered by any of the following problems? |
Not at all | Several days | More than half the days |
Nearly every day |
| 1. Little interest or pleasure in doing things | 0 | 1 | 2 | 3 |
| 2. Feeling down, depressed or hopeless | 0 | 1 | 2 | 3 |
| 3. Trouble falling or staying asleep, or sleeping too much |
0 | 1 | 2 | 3 |
| 4. Feeling tired or having little energy | 0 | 1 | 2 | 3 |
| 5. Poor appetite or overeating | 0 | 1 | 2 | 3 |
| 6. Feeling bad about yourself – or that you are a failure or have let yourself or your family down |
0 | 1 | 2 | 3 |
| 7. Trouble concentrating on things, such as reading the newspaper or watching television |
0 | 1 | 2 | 3 |
| 8. Moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual. |
0 | 1 | 2 | 3 |
| 9. Thoughts that you would be better off dead or of hurting yourself in some way |
0 | 1 | 2 | 3 |
Total PHQ-9 score = 6
If you checked off any problems, how difficult have these problems made it for you to do your work,
take care of things at home, or get along with other people?
| Not difficult at all | Somewhat difficult | Very difficult | Extremely difficult |
© Endeavour College of Natural Health WHMC311 Case Study Report 1
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Marking Rubric
| Criteria | Performance Level | |||||
| Assessment of the Patient (10 marks) | ||||||
| Diagnosis | Diagnostic evaluation is correct, clearly articulated and intimately linked to the clinical features of the patient. (5) |
Diagnostic evaluation is correct, clearly articulated, and linked clinical features of the patient. (4) |
Diagnostic evaluation is correct, and linked to the clinical features of the patient. (3) |
Diagnostic evaluation is correct, and only partially linked to the clinical features of the patient. (2) |
Diagnostic evaluation is incorrect, and only partially linked to the clinical features of the patient. (1) |
Diagnostic evaluation is incorrect, and not linked to the clinical features of the patient. (0) |
| Causal chain of events | Clearly articulated, and demonstrates excellent understanding of holistic pathophysiology. (5) |
Clearly articulated, and demonstrates good understanding of holistic pathophysiology. (4) |
Clearly articulated, and demonstrates basic understanding of holistic pathophysiology. (3) |
Poorly articulated, and demonstrates basic understanding of holistic pathophysiology. (2) |
Poorly articulated, and demonstrates poor understanding of holistic pathophysiology. (1) |
Poorly articulated, not patient centric, and demonstrates poor understanding of holistic pathophysiology. Or not described at all. (0) |
| Treatment Strategy (20 marks) | ||||||
| Objectives | All treatment objectives are SMART, concise, holistic, and patient-centric. Seven or less objectives. (10) |
One treatment objective is not SMART, concise, holistic, or patient-centric. No more than 8 objectives. (8) |
Two treatment objectives are not SMART, concise, holistic, or patient-centric. Or more than 8 objectives. (6) |
Two treatment objectives are not SMART, concise, holistic, or patient-centric. And more than 8 objectives. (4) |
Three treatment objectives are not SMART, concise, holistic, or patient-centric. (2) |
Four or more treatment objectives are not SMART, concise, holistic, or patient centric. (0) |
| Actions | All actions are highly relevant for the patient, and clearly link to the chosen treatment objectives. Choices show advanced consideration of how some actions may achieve multiple objectives. (10) |
All actions are highly relevant for the patient, and clearly link to the chosen treatment objectives. Choices show basic consideration of how some actions may achieve multiple objectives. (8) |
Most actions are relevant for the patient, and clearly link to the chosen treatment objectives. Choices show basic consideration of how some actions may achieve multiple objectives. (6) |
Some actions are relevant for the patient, and clearly link to the chosen treatment objectives. Choices show poor consideration of how some actions may achieve multiple objectives. (4) |
Multiple actions are irrelevant for the patient, and clearly link to the chosen treatment objectives. Choices show poor or no consideration of how some actions may achieve multiple objectives. (2) |
Actions are incorrectly worded (e.g. indications instead of actions), and/or irrelevant to the patient. (0) |
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| Herbal Prescription (10 marks) | ||||||
| Component details (not including amount/week or bottle) |
All details of Latin binomial, part used and DER are provided for all components of the liquid formula, along with Latin binomial and part used for any other preparation if required. No errors in these details. (5) |
One detail missing or one error in Latin binomial, part used or DER for components of the liquid formula, or Latin binomial and part used for any other preparation if required. (4) |
Two details missing or two errors in Latin binomial, part used or DER for components of the liquid formula, or Latin binomial and part used for any other preparation if required. (3) |
Three detail items missing or three errors in Latin binomial, part used or DER for components of the liquid formula, or Latin binomial and part used for any other preparation if required. (2) |
Four detail items missing or Four errors in Latin binomial, part used or DER for components of the liquid formula, or Latin binomial and part used for any other preparation if required. (1) |
Five or more detail items missing or five or more errors in Latin binomial, part used or DER for components of the liquid formula, or Latin binomial and part used for any other preparation if required. (0) |
| Component quantities, dosage & instructions (not suitability of dosage) |
All details concerning amount per week, amount per bottle, bottle size and dosage instructions, are provided. All calculations correct and consistent. If other preparation forms are recommended, details of preparation and dosage are provided. (5) |
Missing one detail concerning amount per week, amount per bottle, bottle size and dosage instructions of liquid formula, or other preparations prescribed. Or one error in calculations. (4) |
Missing two details concerning amount per week, amount per bottle, bottle size and dosage instructions of liquid formula, or other preparations prescribed. Or two errors in calculations. (3) |
Missing three details concerning amount per week, amount per bottle, bottle size and dosage instructions of liquid formula, or other preparations prescribed. Or three errors in calculations. (2) |
Missing four details concerning amount per week, amount per bottle, bottle size and dosage instructions of liquid formula, or other preparations prescribed. Or four errors in calculations. (1) |
Missing more than four details concerning amount per week, amount per bottle, bottle size and dosage instructions of liquid formula, or other preparations prescribed. Or more than four errors in calculations. (0) |
| Rationale for Herbal Prescription (30 marks) | ||||||
| Rationale for herbal activity |
Rationale for each herbal component fully takes into consideration actions, indications, and phytochemistry & phytopharmacology, and is well supported by traditional and/or modern research evidence. (10) |
Rationale for each herbal component fully takes into consideration actions, indications, and phytochemistry & phytopharmacology, and is only partially supported by traditional and/or modern research evidence. (8) |
Rationale for some or all herbal components takes into consideration only two of the following: actions, indications, or phytochemistry & phytopharmacology. Rationale is only partially supported by traditional and/or modern research evidence. (6) |
Rationale for some or all herbal components takes into consideration only two of the following: actions, indications, or phytochemistry & phytopharmacology. Rationale is poorly supported by traditional and/or modern research evidence. (4) |
Rationale for some or all herbal components takes into consideration only one of the following: actions, indications, or phytochemistry & phytopharmacology. Rationale is poorly supported by traditional and/or modern research evidence. (2) |
Rationale is grossly incomplete, and not supported by traditional and/or modern research evidence. (0) |
| Linkage to patient | Rationale for each herbal component is clearly linked back to Actions and Treatment Objectives and the choice of each herbal component is highly relevant to the patient. (10) |
Rationale for each herbal component is clearly linked back to Actions and Treatment Objectives and the choice of each herbal component is mostly relevant to the patient. (8) |
Rationale for each herbal component is partially linked back to Actions and Treatment Objectives and the choice of each herbal component is mostly relevant to the patient. (6) |
Rationale for each herbal component is partially linked back to Actions and Treatment Objectives and the some herbal components are not relevant to the patient. (4) |
Rationale for each herbal component is poorly linked back to Actions and Treatment Objectives and the some herbal components are not relevant to the patient. (2) |
Rationale for each herbal component is not linked back to the Actions and/or Treatment Objectives. Some or all of the herbal components are not relevant to the patient. (0) |
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| Dosage | Amount per week for each component shows advanced consideration of patient requirements and interaction of formula components, as does any other preparation forms recommended. (10) |
Amount per week for each component shows good consideration of patient requirements and interaction of formula components, as does any other preparation forms recommended. (8) |
Amount per week for each component shows basic consideration of patient requirements and interaction of formula components, as does any other preparation forms recommended. (6) |
Amount per week for each component shows poor consideration of patient requirements and interaction of formula components, as does any other preparation forms recommended. (4) |
Amount per week for each component shows little to no consideration of patient requirements and interaction of formula components, as does any other preparation forms recommended. (2) |
No rationale provided for amount per week for each component, or for any other preparation forms recommended. (0) |
| Safety Considerations & Herb/Drug Interactions (10 marks) | ||||||
| Cautions & possible adverse reactions |
Cautions and possible adverse reactions are explained, with supporting evidence provided, and likelihood of adverse reactions are detailed through applying the evidence to the patient’s context. (5) |
Cautions and possible adverse reactions are explained, with supporting evidence provided, and likelihood of adverse reactions are detailed. Lacking reference to the patient’s context. (4) |
Cautions and possible adverse reactions are explained, with supporting evidence provided. Likelihood is not discussed. (3) |
Cautions and possible adverse reactions are explained, but lacks supporting evidence and likelihood. (2) |
Missing key cautions and/or adverse reaction. No detail or supporting evidence. (1) |
No information on cautions or possible adverse reactions provided. (0) |
| Herb/drug interactions | Interactions explained including possible outcome of the interaction, the nature (pharmacokinetic or pharmacodynamic), and the likelihood of the interaction is explained with evidence being applied to the patient’s context. (5) |
Interactions explained including possible outcome of the interaction, the nature (pharmacokinetic or pharmacodynamic), and the likelihood of the interaction is explained. Lacking reference to the patient’s context. (4) |
Interactions explained including possible outcome of the interaction. Lacking in information on either the nature (pharmacokinetic or pharmacodynamic), or the likelihood of the interaction. (3) |
Interactions explained including possible outcome of the interaction. Lacking information on both the nature (pharmacokinetic or pharmacodynamic), and the likelihood of the interaction. (2) |
Interactions provided but lacking information on the possible outcome of the interaction. Lacking information on both the nature (pharmacokinetic or pharmacodynamic), and the likelihood of the interaction (1) |
No information on interactions provided. (0) |
| Relevant Dietary & Lifestyle Interventions (5 marks) | ||||||
| Diet & lifestyle | Diet and lifestyle interventions provided, with good rationale and linkage to the treatment objectives, and supported by relevant research evidence. (5) |
Diet and lifestyle interventions provided, with good rationale and linkage to the treatment objectives. (4) |
Diet and lifestyle interventions provided, with adequate rationale but poor linkage to the treatment objectives. (3) |
Diet and lifestyle interventions provided, however weak rationale and/or linkage to treatment objectives provided. (2) |
Diet and lifestyle interventions provided, however no rationale or linkage to treatment objectives provided. (1) |
No diet or lifestyle interventions provided. (0) |
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| Suggested Treatment Referrals (5 marks) | ||||||
| Referrals | Treatment referrals provided and highly relevant to the patient, with well-argued rationale, supported by relevant research evidence. (5) |
Treatment referrals provided and highly relevant to the patient, with well-argued rationale. (4) |
Treatment referrals provided and highly relevant to the patient, however rationale lacks depth. (3) |
Treatment referrals provided, along with rationale. However referrals are not relevant to the patient and rationale lacks depth. (2) |
Treatment referrals provided, however no rationale provided. (1) |
No treatment referrals provided. (0) |
| Referencing (4 marks) | ||||||
| Source selection | Two or more herbal sources older than 1950 utilised and three or more herbal sources from peer reviewed journals less than 10 years old. (2) |
One herbal source older than 1950 utilised and/or two herbal sources from peer reviewed journals less than 10 years old. (1) |
No herbal sources older than 1950 utilised and/or no more than one herbal source from a peer reviewed journal less than 10 years old. (0) |
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| Citations & reference list | No errors in the in-text citations or the reference list. (2) | No more than three errors in the in-text citations or the reference list. (1) |
Four or more errors in the in-text citations or the reference list, or non-APA referencing style. (0) |
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| Academic Writing (6 marks) | ||||||
| Spelling & grammar | No spelling or grammatical errors. (3) |
No more than 2 spelling or grammatical errors. (2) | No more than 4 spelling or grammatical errors. (1) | Five or more grammatical errors. (0) spelling or | ||
| Writing style | Formal & professional vocabulary with no short hand or slang, objective & cautious language written in the third person. (3) |
Written in the third person with use of formal and professional vocabulary, but lacking in objective & cautious language. (2) |
Written in the third person but lacking in formal and professional vocabulary. (1) |
Informal and unprofessional writing, or writing no in the third person. (0) |
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