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By M. Hector. Saint Francis College, Brooklyn Heights, New York. 2018.

It remarkable wartime experience discount cialis professional 40mg free shipping, which even was always a joy to attend laborious editorial now I look back on as the finest orthopedic– meetings enlivened by his sparkling personality rehabilitation accident service I have ever worked and penetrating assessments generic 40 mg cialis professional. By mutual agreement we decided that I should papers generic cialis professional 40 mg with visa, as of men purchase cialis professional 40 mg with visa, he was prompt to perceive go into uniform and conform to the pattern of 350 Who’s Who in Orthopedics service life and make the bullets, which, as a civil- envied him his ability to put affairs of the past ian, he could fire without being held up by “the behind him. A new task demanded his dedicated Thurso), and this was certainly a great advantage attention. Just before the war, it had been rumored that the Air Council had considered that any pilot or Sir Reginald and Oswestry other member of air-crew injured in battle could not engage in combat again. What a tragedy this My first contact with Reginald Watson-Jones, like would have been, especially in the year after the that of many other Liverpool undergraduates, was fall of France when we were “going it alone. For this magnificent dynamic enthusiasm infected his residents, and achievement he was knighted in 1945. Before the my recollections of this impressionable period war ended, he had persuaded friendly financiers were of putting on spinal jackets for fractured to buy Headley Court for the Royal Air Force, and spines at three o’clock in the morning, of a theater it remains to this day one of the finest rehabilita- sister gladly giving up her evening off to take a tion units in the world. In the the Postgraduate Hospital at Hammersmith two winter of 1940, during the Liverpool “blitz,” courses every year of lectures of 1 week each, R. Nutthall to covering the whole of fractures, for medical offi- exchange his week on night call. These we gave struck three times one night, and I remember together—lectures in the mornings and practical vividly a tall, striding figure in his element organ- classes in the afternoons, in which everyone had izing, directing and operating in the emergency to apply plaster-of-Paris casts, Tobruk splints and basement theater. At the end of the service of the Royal Air Force, what still stands week, R. Each paper tal to organize an orthopedic and accident depart- had to be word perfect, we were to speak to the ment and become its director. To this he brought back row, adhere strictly to the time allocated, and the same qualities of drive, enthusiasm and com- have illustrations of the highest standard. When I left the Royal Air Force in 1946, attention to detail characterized so much of what he insisted on my applying for a consultant post he did. Alexander Law, a superb Memorial Hospital, and it was typical that his department was built up much along the RAF acceptance was conditional on the allocation of lines, in which the four of us worked in great hap- one of the local practitioners exclusively to the piness and rapport until he and I retired from the management of fractures. In the same year he National Health Service within a year or two of joined the consultant staff of the Shropshire each other. Orthopedic Hospital at Oswestry, where he He was a wonderful colleague, inspiring and became the chief of the North Wales firm. I suc- dedicated to the task of the present; I always ceeded him in both these commitments. After- 351 Who’s Who in Orthopedics care clinics held in chapels, schools and cottage failing health, he journeyed to the Eryri Hospital hospitals throughout North Wales took him far at Caernarvon. He enjoyed recalling that on one of these remember how keen and sharp his mind was, and visits to Blaenau Ffestiniog, he ran into and killed how clear the message. Later on this occasion he a horse: it was an insignificant cob that crossed was struck down by his last illness, and it was a the road that day without looking both ways, but privilege to be able to repay a very small part of by the end of the litigation that followed it had a long-standing debt. His powerful teaching was often uncompromising and strongly held beliefs Sir Reginald first came to Oswestry in 1928 as were always communicated with conviction; he assistant surgeon to David Macrae Aitken, barely believed passionately. Many a young Oswestrian 4 years after qualification, having already estab- suffered painful knuckles in the process of learn- lished his reputation in Liverpool as a young ing the “no-touch” technique. Less widely fell in love with “The Orthopedic” and this was accepted beliefs were his obsessions about anky- returned in no small measure over the years. He losing spondylitis, physiotherapy and the value of loved the Welsh border county. Indeed it was in a crooked and elongated heels in the treatment of small cottage in Shropshire that he took refuge genu valgum. His old friend, incomplete immobilization, plasters in equinus or John Menzies, recalls those mammoth writing the use of abbreviations in case notes. His dark, sessions interspersed with bridge, music and penetrating, alert eyes and warm personality pro- asparagus.

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It seemed ognized cialis professional 20 mg low cost, is a testimony to his courage buy cheap cialis professional 40mg on-line, scholar- natural that orthopedics would be his field order cialis professional 20mg amex. In ship buy discount cialis professional 40mg on-line, and persistent self-criticism in the laboratory 1961 he entered Albany Medical College, receiv- and operating room. John’s enthusiasm and energy extended outside Crawford Campbell, he developed an interest in the hospital. He was a fine athlete himself, an avid orthopedic research, to which he devoted a major skier, and an accomplished tennis player and portion of his future career. He trained regularly with many of his Research Award in 1963 for a paper on osteocar- patient athletes, and could run circles around most tilaginous loose bodies. After a surgical internship of his residents and fellows on the tennis court. Marshall came to the Hospital and was survived by his lovely wife Jan and their for Special Surgery as a Research Fellow in ortho- two children. In 1971 he completed the residency program and was named an American Orthopedic Association North American Traveling Fellow. He remained on the staff of the Hospital for Antonius MATHIJSEN Special Surgery until his death. Marshall’s major area of professional inter- 1805–1878 est was the knee. His earliest papers in the vet- erinary and human medical literature dealt with Antonius Mathijsen was born on September 4, articular cartilage and the unstable joint. He saw 1805, at Budel, a small village in North Brabant, the anterior cruciate deficient knee as a model for Holland, the son of Dr. Ludovicus Hermanus instability and arthritis in the experimental animal Mathijsen and Petronella Bogaers. He had person- Antonius should become a military surgeon; the ally dissected hundreds of cadaver knees and con- young man was first placed in the military hospi- stantly challenged his residents and fellows to test tal at Brussels, later in Maastricht, and finally at new and old concepts of anatomy and surgery in the large government hospital at Utrecht. He was an exacting scientist who received his commission in the army on July 14, presented papers annually at the meetings of the 1828, and the degree of Doctor of Medicine from Orthopedic Research Society, strongly believing the University of Giessen in 1837. In 1851, anatomy to undergraduates, he helped to interest while stationed at the garrison in Haarlem, he many a promising student in an orthopedic career. Moreover, he wrote to the Royal Academy of Other methods had been tried by other men, but Belgium that the plaster bandage was his inven- the results had not been good. Mathijsen experi- tion, and that it was not the result of collaboration mented until he found a new and more efficient on the part of several surgeons. In the introduction to this of the plaster bandage, had become appreciated. He pointed out that the majority of Amsterdam, and of the Society of Physicians, in these patients, injured by firearms, had compound Vienna (by Dr. In 1876, Mathijsen fractures that required special treatment; and it was requested by one of his friends, Dr. As he conceived them, the requirements tion in Philadelphia, which he did. He was made Knight of the Order of a few minutes; (3) that it be so applied that the the Netherlands, Lion of the Oak Crown of surgeon would have access to the wound; (4) that Luxembourg, Major Surgeon of the Dutch Army, it be adaptable to the circumference and shape of and member of the medical societies of Amster- the extremity; (5) that it be of such consistency dam, Hoorn, Utrecht, Brussels, Bonn, Halle, that it would not be damaged by suppuration or Vienna, Neuchâtel, and Zurich. Prior to Mathijsen’s proved to be economical and more practical than invention, the treatment of a broken or wounded others used previously. He cut pieces of double- extremity was woefully inadequate, and such folded unbleached cotton or linen to fit the part to treatment often led to serious disability or to the be immobilized; then the pieces were fixed and loss of limb and life. The dry In 1870, at a time when Mathijsen’s method of plaster, which was spread between the layers, treatment of patients was not generally known, remained two finger breadth widths within the Zola in his famous book, La Debâcle, described edges of the cloth. The extremity was then placed the appalling inadequacy of the treatment of the on the bandage, which was moistened with water.

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From being sedentary purchase cialis professional 40 mg mastercard, people can develop life- threatening conditions such as pressure ulcers or pulmonary emboli (clots generally formed in leg veins that lodge in the lungs generic 40 mg cialis professional visa, blocking blood flow) 20mg cialis professional overnight delivery. The percentages of people age 18–64 who use specialists as their usual source of care are 4 buy generic cialis professional 20mg, 12, 16, and 22 percent for persons with no, minor, moder- ate, and major mobility difficulties, respectively. Among persons age 65+, the percentages are 7, 9, 12, and 12 percent for those with no, minor, moderate, and major mobility difficulties, respectively (these figures come from the 1994–95 308 / Notes to Pages 134–151 NHIS-D Phase I and 1994–95 Family Resources supplement and are adjusted for age group and sex). For persons age 65+, the most common explanation for not having a usual source of care is that they don’t need a doctor, cited by 58 percent of those without mobility difficulties and by 39, 15, and 23 percent with minor, moder- ate, and major difficulties, respectively. Persons 18–64 without a usual source of care also often said they didn’t need one: 52, 19, 9, and 13 percent for those with no, minor, moderate, and major mobility difficulties, respectively (these figures come from the 1994–95 NHIS-D Phase I and 1994–95 Family Re- sources supplement and are adjusted for age group and sex). In 1999, the pharmaceutical industry released its latest pain medication, COX-2 (type 2 cyclooxygenase) inhibitors. With a blitz of advertisements, the manufacturer appealed directly to consumers to request this drug from their physicians. COX-2 inhibitors are expensive, have side effects (as do all pain medications), and their marginal benefits for pain control remain controver- sial. An exception involves training at osteopathic medical schools in muscu- loskeletal conditions and associated mobility problems. The American Association of Medical Colleges (AAMC) maintains an on-line database (CurrMIT) listing curricular offerings (accessed on 13 Octo- ber 2000 at www. Annually, to populate the CurrMIT database, medical schools volun- tarily submit information to AAMC about course names and educational methods (the AAMC does not independently confirm their accuracy or com- pleteness). We searched using key words “rehabilitation” and “physical medi- cine” and found that few institutions require students to complete clerkships in physical medicine and rehabilitation (PM&R). Only nine require PM&R clerk- ships, some combined with sports medicine, chronic care, neurologic diseases, cardiac or orthopedic rehabilitation, or geriatrics; less than a dozen others offer elective rehabilitation rotations. Some primary care residencies, including family medicine and general practitioner programs, may offer more training in functional concerns than others. State medical licensure laws require physicians to document “continuing medical education” (CME), furnishing periodic proof of certified CME credits. CME typically concentrates on updating or refreshing knowledge of topics taught in medical school and residencies, such as management of acute clinical problems or new treatments for diseases. Few general medical CME courses offer training on assessing mobility or functional abilities. To qualify as disabled, the Social Security Administration specifically re- quires evidence of “medically determinable” impairments, defined as “An im- Notes to Pages 152–155 / 309 pairment that results from anatomical, physiological, or psychological abnor- malities which can be shown by medically acceptable clinical and laboratory di- agnostic techniques. A physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings—not only by the individual’s statement of symptoms” (SSA 1998, 3). The SSA and workers’ compensation programs use different processes for evaluating dis- ability: the SSA’s “blue book,” Disability Evaluation Under Social Security (1998) for SSDI and SSI; and the American Medical Association’s Guides to the Evaluation of Permanent Impairment (1993; Cocchiarella and Andersson 2001), used for workers’ compensation disability determinations in most states. Up-to-Date is an online medical text, continuously updated and also available on CD ROMs, accessed online 17 December 2001 (http://www. These questions were asked only of people who reported having had a routine physical examination within the previous three years. The percentage reporting having been asked by their physicians about trouble with ADLs is 10 percent of those without mobility problems and 13, 19, and 27 percent with minor, moderate, and major difficulties, respectively. Questioning about IADL problems is similar: 10, 15, 24, and 26 percent for those with no, minor, moder- ate, and major mobility difficulties, respectively (these figures come from the 1994 NHIS-D Phase I and 1994 Healthy People 2000 supplement and are ad- justed for age group and sex). We performed multivariable logistic regressions separately for men and women, controlling for age group, race, Hispanic ethnicity, education, and household income. The adjusted odds ratio (95 percent confidence interval) for being asked about contraception for persons with major mobility problems expected to last at least 12 months are 0. Al- though not statistically significant, the slightly higher odds ratio for men was provocative and could relate to physicians’ concerns about male patients’ phys- ical abilities to be sexually active (e. These figures represent adjusted odds ratios and come from the 1994 NHIS-D and Healthy People 2000 supplement, which queried people who had had a routine health-care visit in the last three years (Iezzoni et al. Women over age 49 were asked if they had had mammograms in the prior two years. Women age 18–75 who had not had a hysterectomy were asked if they had had a Pap smear in the last three years. Adjusted odds ratios control for age group, sex (smoking analyses only), race, Hispanic ethnicity, education, income, health insurance, and having a usual source of care.

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If we expect them to give up their valuable time to help us discount cialis professional 20mg on-line, it follows that we should offer them something in return purchase 20mg cialis professional otc. Many people are willing to disclose a lot of personal in- formation during our research so we need to make sure that we treat both the participants and the information they provide with honesty and respect order cialis professional 20mg mastercard. TREATING PARTICIPANTS WITH RESPECT As a researcher you must remember that the research pro- cess intrudes on people’s lives cialis professional 20 mg amex. Some of the people who take part in your research may be vulnerable because of their age, social status or position of powerlessness. If par- ticipants are young, you need to make sure a parent or guardian is present. If participants are ill or reaching old age you might need to use a proxy and care should be taken to make sure that you do not affect the relation- ship between the proxy and the participant. Some people may find participation a rewarding process, whereas others will not. Your research should not give rise to false hopes or cause unnecessary anxiety. You must 146 HOW TO BE AN ETHICAL RESEARCHER/ 147 try to minimise the disruption to people’s lives and if someone has found it an upsetting experience you should find out why and try to ensure that the same situation does not occur again. As a researcher you will encounter awkward situations, but good preparation and self-awareness will help to re- duce these. If they do happen, you should not dwell too long on the negative side – reflect, analyse, learn by your mistakes and move on. However, information given by research partici- pants in confidence does not enjoy legal privilege. If you’re dealing with very sensitive informa- tion which you know could be called upon by a court of law, you will need to inform your participants that you would be obliged to hand over the information. OVERT AND COVERT RESEARCH Overt research means that it is open, out in the public and that everyone knows who you are and what you are doing. Covert research means that you are doing it under cover, that no one knows you are a researcher or what you are doing. In my opinion covert research should be kept to a minimum – there are enough journalists and television personalities doing this kind of undercover, sensationalist work. Covert research In the past researchers have justified their covert work by 148 / PRACTICAL RESEARCH METHODS saying that it has been the only way to find out what goes on in a particular organisation that would not otherwise let a researcher enter. Such work has been carried out within re- ligious cults and within warring gangs of young people. However, this type of research can have serious implications for the personal safety of the researcher and the people with whom she comes into contact. It can also give research a bad name – other people may read about the work and be- come suspicious about taking part in future projects. Overt research I believe researchers should be open and honest about who they are and what they’re doing. People can then make an informed choice about whether they take part in a project. It is their prerogative to refuse – nobody should be forced, bullied or cajoled into doing something they don’t want to do. If people are forced to take part in a research project, perhaps by their boss or someone else in a position of authority, you will soon find out. They will not be willing to participate and may cause problems for you by offering false or useless information, or by dis- rupting the data collection process. Wouldn’t you do the same if you were forced to do some- thing you didn’t want to do? This means that not only should you be open and honest about who you are and what you’re doing, but so should those who open the gates for you, especially those who are in a position of authority. HOW TO BE AN ETHICAL RESEARCHER/ 149 EXAMPLE 14: STEVE It was the first project I’d ever done. I wanted to find out about a new workers’ education scheme in a car factory. One of my tutors knew someone in charge of the scheme and that person arranged for me to hold a focus group in the factory.

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Devices such as the oropharyngeal or Guedel airway are suitable for use by those who are appropriately trained; a range of sizes may need to be kept available purchase cialis professional 40mg on line. For those with appropriate experience generic cialis professional 20 mg line, the laryngeal mask airway has an increasing role in the management of the airway in unconscious patients outside hospital buy discount cialis professional 40mg on-line. Tracheal intubation and the use of other advanced airway techniques are only appropriate for use by those who have undergone extensive training and who practise the skills regularly purchase cialis professional 40 mg on line. Training in resuscitation techniques Training and practice are necessary to acquire skill in The report by the Resuscitation Council (UK) resuscitation techniques, and the principles behind such entitled Cardiopulmonary Resuscitation Guidance for training are covered in Chapter 19. Repeated tuition and Clinical Practice and Training in Primary Care practice are the most successful methods of learning and recommends that all practices should acquire an AED and that they should be available to those providing retaining resuscitation skills. The levels of skill required by cover out-of-hours, whether it be in a primary care different members of the primary healthcare team will vary centre or as part of a deputising service or according to the individual’s role and, in some cases, their cooperative. The aim of an individual healthcare practice should be to provide as competent a response as possible within the resources available. Oxygen All those in direct contact with patients should be trained in Current resuscitation guidelines emphasise the use of oxygen, basic life support and related resuscitation skills, such as the and this should be available whenever possible. As a minimum requirement they should be cylinders should be appropriately maintained and the national able to provide effective basic life support with an airway safety standards followed. Doctors, nurses, and healthcare that allow non-medical staff to administer high-flow oxygen workers, such as physiotherapists, should also be able to use an AED effectively. Other personnel—for example, receptionists— may also be trained to use an AED; they are nearly always present when a practice is open and may have to respond Suction before more highly trained help is available. The requirement for batteries is a disadvantage for suction Training should be provided for each trainee up to the equipment that is likely to be used infrequently. Similarly, the appropriate level required by their role within the practice. In need for mains electricity adds greatly to the cost and restricts the location where a suction device can be used. For these many cases, particularly for higher levels of skill, the services of reasons, simple mechanical portable hand-held suction devices a resuscitation officer (RO) will be required. The organisations are recommended that manage the provision of primary care (Primary Care Groups or Trusts, Local Healthcare Cooperatives, or Local Health Groups) should consider engaging the services of an RO. Ambulance Service Training Schools can also provide Drugs training to a similar level of competency. The Voluntary Aid The role of drugs in the management of cardiopulmonary Societies and comparable organisations train their members in arrest is discussed in detail in Chapter 16. No drug has been resuscitation skills, including the use of an AED, and may be shown convincingly to influence the outcome of engaged to provide training for some members of the primary cardiopulmonary arrest, and few are therefore recommended healthcare team. Knowledgeable members of the practice team for routine use can undertake training for the other members of their own practice. No evidence base exists on which to make definite recommendations about the frequency of refresher training Universal precautions specifically for those working in primary healthcare teams. Standard procedures should be followed to minimise the risk of The consensus view, based on studies of comparable providers, cross infection. Gloves should be available together with a suggests that doctors and nurses should have refresher training suitable means of disposing of contaminated sharps in basic life support every six to 12 months. Retraining in the 60 Cardiopulmonary resuscitation in primary care use of the AED for this group of workers should be carried out at least as often. The importance of acquiring and maintaining competency in resuscitation skills may be an appropriate subject to include in an employee’s job description. It is also a suitable subject for inclusion in individual personal development plans and may in due course form part of re-validation procedures. Ethical issues It is essential to identify individuals in whom cardiopulmonary arrest is a terminal event and when resuscitation is inappropriate. Community hospitals, hospices, nursing homes, and similar establishments where the primary healthcare team is responsible for the care of patients should be encouraged to Refresher training Courses are important for those in primary health care implement “do not attempt resuscitation” (DNAR) policies so teams that inappropriate or unwanted resuscitation attempts are avoided. National guidelines published by the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing provide detailed guidance on which local Recommended training and practice for practice can be based.

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