睿学教育Wisdome Education

Rachel W. Flurie, PharmD, BCPS

• Assistant Professor, Internal Medicine
• Department of Pharmacotherapy and Outcomes Science, School of Pharmacy
• Virginia Commonwealth University, Richmond, Virginia

https://app.pharmacy.vcu.edu/rwflurie

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With increasing age mens health tv cheap alfuzosin online, most consultants give up trying to get to know their juniors for this very reason and appear less friendly androgen hormone and inflammation generic alfuzosin 10 mg on-line. However mens health december 2012 buy generic alfuzosin 10 mg, it is simply that they do not have the time or energy and their mind is concentrating on other matters. As con- sultants become more senior their political and economic targets increase. SpRs, on the other hand, stay for 12 months or more and spend more time with the consult- ant in theatre and clinics, etc. What You Can Do to Ease the Pressure There are certain things that the junior can do to break down barriers that are very effective. Most surgeons listen to music in theatre when operating and offering to bring in a CD can prove very effective at generating conversation. Engage in conver- sation at appropriate times with any consultant, for example during ward rounds or clinics (as long as you are not in earshot of any patients or their relatives). Once there is trust between you, you will be allowed to practise more freely and be taught a lot more. You will see colleagues trying this approach and notice that it does not work, and furthermore, that they will quickly gain a reputation around the hospital. No-one will explain when you are in medical school that qualified nurses are a valuable asset. They can be your best ally or worst enemy depending on how you treat them. Most often they have been working in a particular speciality (for example orthopaedics, urology, etc. Coming straight out of medical school or house jobs you may have more theoretical knowledge of physiology,pharma- cology, etc. Nursing staff will be able to guide you through the prescriber’s minefield reminding you of times and doses when you are trying to write up drugs on a ward round (a word of caution: always check the British National Formulary if in any doubt whatsoever). The nurses will also know the way each particular consultant likes his/her patients managed. Nurses can be your best friend and your worst enemy,often within minutes of each other if you say the wrong thing at the wrong time. Historically, doctors have always thought themselves more hard done-by than any other medical professionals and as a response to this have always seen themselves as superior to nursing staff,both in their educational/intellectual level or in status. Nowadays more than ever before, nurses and doctors need to work side by side as equals in the workplace although ultimately the overall responsibility and duty of care of the patient rests with the doctor. This respon- sibility can often cause problems,as some junior nursing (and occasionally older) staff do not realise this concept. When giving instructions regarding the care of patients there is often debate between doctors and nursing staff,which can look unprofessional and 41 42 What They Didn’t Teach You at Medical School not be in the best interests of the patient. They have their own role, just as you are not on the ward for their benefit. Nurses and doctors work together as a team for a common goal: the care and treatment of the patients. There are grey areas between the respon- sibilities of nursing and doctoring (for example setting up catheter/central line trol- leys, etc. Nursing staff will often do these things for you if you are busy and they are not, if you ask them nicely. However, always double-check the trolley first, as they sometimes forget small but important items. Pony trekking or horse riding can be dangerous, as can caring for patients. They also have the ability to think, assess situations and come to a decision. When a new rider gets on a horse, the horse will test the rider to see how experienced they are or how in control the rider is by trying to eat grass or wander off the track, going too slowly, etc. The horse needs to have confidence in their rider and once this relationship is established the horse and rider make a good team. Overall you are less likely to fall off and therefore the whole ride is safer. You can see the parallel with nurses: they need to be confident in your actions and judgement before they will let you do things alone without question.

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Imhaeuser G (1962) Ueber Dislokation der proximalen Femurepiphyse durch Schae- digung der Wachstumzone (Dislokation der Hueftkopfepiphyse nach vorn-unten) mens health 15 minute workout dvd purchase line alfuzosin. Sofue M prostatic hypertrophy alfuzosin 10 mg order with amex, Endo N (1993) Slipping of the femoral capital epiphysis (in Japanese) prostate cancer awareness color buy generic alfuzosin 10 mg online. In: Yamamuro T, Inoue S (eds) Comprehensive textbook of orthopaedic operations, vol 11. Sofue M, Endo N (1997) The results of epiphyseal slipping of femoral head treated with Imhaeuser’s method (in Japanese). Sofue M, Hatakeyama S, Endo N, et al (2005) Imhaeuser’s three dimensional osteot- omy for slipped femoral capital epiphysis (in Japanese). Eine klinische Untersuchungs- methode bei Epiphyseolysis capitis femoris. Zeichenbeschreibungen, aetiopathogene- tische Gedanken, klinische Erfahrungen. Z Orthop 117:333–344 In Situ Pinning for Slipped Capital Femoral Epiphysis Satoshi Iida and Yoshiyuki Shinada Summary. We reviewed retrospectively 28 hips of 25 patients (22 boys and 3 girls) after in situ pinning for slipped capital femoral epiphysis. Fourteen hips were mild slips (lateral head–shaft angle less than 30°), 10 hips were moderate (30°–59°), and 4 hips were severe (60° or greater). All patients had no hip pain at the latest follow-up; however, the range of internal rotation was mildly limited in 11 hips. Remodeling occurred in 21 of 23 hips (91%) and was not dependent on the degree of slip. Progressive slippage occurred in 1 patient after pinning with a single screw. The patient (an 11-year-old boy with a mild chronic slip) started to do hard activities before the physeal closure, and an additional surgery was performed 29 months after the initial pinning. Moder- ate and severe slips can be treated by in situ pinning; however, careful postoperative management will be required. Slipped capital femoral epiphysis, In situ pinning, Lateral head–shaft angle, Progressive slippage, Remodeling Introduction Pinning in situ for slipped capital femoral epiphysis (SCFE) is generally considered to produce satisfactory results in cases of mild slip. Recently, the use of fluoroscopic imaging and improved cannulated screw technique makes percutaneous screw fixa- tion the treatment of choice for most cases of SCFE. On the other hand, progressive slippage has been reported in the literature [1,2]. The best method of treatment for moderate and severe slip remains controversial. Department of Orthopaedic Surgery, Matsudo City Hospital, Kamihongou 4005, Matsudo, Chiba, 271-0064, Japan 61 62 S. Shinada We have assessed the radiographic and clinical results after in situ pinning for SCFE and evaluated the extent of remodeling at follow-up. Materials and Methods Between July 1983 and July 2003, 40 hips of 35 patients were treated at Matsudo City Hospital for SCFE. Of these, 12 hips of 12 patients were treated with gently manipula- tive reduction and pinning. One hip with an unstable and severe slip demonstrated osteonecrosis after the manipulative reduction and pinning. Thereafter, we have not performed manipulative reduction intentionally and also have not done primary osteotomy. Twenty-eight hips of 25 patients that were treated with in situ pinning attended this review. One hip was an acute slip (onset within 3 weeks), 8 hips were acute on chronic slips and 19 hips were chronic slips. The distinction between a stable and an unstable slip was the ability to bear weight according to the classification of Loder et al. Of these, 2 had manipulative reduction in the contralateral hips, and they were free of complications. Another patient received manipulative reduction on the contralateral hip at a previous hospital and had already demon- strated osteonecrosis at the initial visit to our hospital. All patients were treated with pinning on a fracture table under general anesthesia. No attempts at manipulative reduction intraop- eratively were performed.

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Thus androgen hormone 13 alfuzosin 10 mg purchase with visa, the pathway from reactants to products in an enzyme-catalysed reac- tion may not need to pass over the barrier prostate cancer zytiga side effects purchase 10 mg alfuzosin, as in transition state theory with particle-like behaviour man health journal cheap 10 mg alfuzosin visa, but could pass through the barrier. As the analogy suggests, this can lower significantly the energy required to proceed from reactants to 24 M. Illustration of the wave-like property of matter by analogy with the vibrations on a violin string. Although there is a node (a position where the string is stationary) in the centre of the string, the vibration is transmitted through this node – this is analogous to passing through a region of zero probability as in quantum tunnelling. Thus, quantum tunnelling may play an important role in driving enzyme-catalysed reactions, especially for the transfer of small nuclei such as hydrogen. Indeed, quantum tunnelling is the established mechanism for enzyme- mediated transfer of the much smaller electron. Proteins are electrical insulators; nevertheless, electrons can travel large distances on the atomic scale (up to around 3 10 9 m) through them. This apparent paradox – of an electron passing through an electrical insulator – can be understood in terms of the wave-like properties of the electron. Thus, the electron can pass via quantum tunnelling through regions from which it would be excluded by its particle-like nature. In contrast to electron transfer via quantum tunnelling, evidence for hydrogen tunnelling in enzyme molecules is extremely limited. This arises conceptually because the mass of the hydrogen is approximately 1840 times greater than that of the electron. The probability of tunnelling decreases with increasing mass, which reduces significantly the probabil- ity of hydrogen versus electron tunnelling. Nevertheless, for those enzyme-catalysed reactions with a large activation energy – requiring a Enzymology takes a quantum leap forward 25 Figure 2. Tunnelling of a wave with kinetic energy E through a rectangular potential energy barrier, height V. The narrower the barrier, the smaller the mass of the particle and the smaller the difference between V and E, the greater the tunnelling probability. If the amplitude of the wave has not reached zero at the far side of the barrier, it will stop decaying and resume the oscillation it had on entering the barrier (but with smaller amplitude). Until recently, quantum tunnelling was thought to be significant only at very low (so-called ‘cryogenic’) temperatures. However, deviations from classical transition state theory behaviour have been seen recently, implying that hydrogen tunnelling may be significant at physiological temperatures. These results have, in the main, been modelled as hybrid ‘over’ (transition state theory) and ‘through’ (quantum tunnelling) barrier transfer reactions, i. Our own studies have revealed for the first time that quantum tunnel- ling can be the sole means by which an enzyme catalyses hydrogen trans- fer during C–H (carbon–hydrogen) bond breakage. The reaction pathway does not pass up the energy barrier prior to tunnelling – as with the quantum correction models of transition state theory – but tunnels through the barrier from the starting (or so-called ‘ground’) state. SCRUTTON Paradoxically, reaction rates (as with transition state theory) are still highly dependent on temperature. This observation is inconsistent with a pure ‘ground state’ tunnelling reaction, since the probability of tunnelling (and thus rate of reaction) is a function of barrier width, but is independent of temperature. This apparent paradox is resolved by taking into account the temperature-dependent natural breathing of enzyme molecules which dis- torts the structure of the protein to produce the geometry required for nuclear tunnelling (achieved by reducing the width of the barrier between reactants and products, thus increasing the probability of tunnelling). In this dynamic view of enzyme catalysis, it is thus the width – and not the height (as with transition state theory) – of the energy barrier that controls the reaction rate. The important criterion thus becomes the ability of the enzyme to distort and thereby reduce barrier width, and not stabilisation of the tran- sition state with concomitant reduction in barrier height (activation energy). We now describe theoretical approaches to enzymatic catalysis that have led to the development of dynamic barrier (width) tunnelling the- ories for hydrogen transfer. Indeed, enzymatic hydrogen tunnelling can be treated conceptually in a similar way to the well-established quantum the- ories for electron transfer in proteins. The basic premise of transition state theory is that the reaction converting reactants (e. A B–H) is treated as a two-step reaction over a static potential energy barrier (Figure 2. B]‡ is the transi- tion state, which can interconvert reversibly with the reactants (A–H B).

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In this article prostate cancer types effective alfuzosin 10 mg, the • Record points made • Encourage all group • Lead the group • Follow the steps of by group members to through the process the process in examples are modelled on the Maastricht “seven jump” process prostate treatment options purchase alfuzosin overnight delivery, participate sequence • Help group order • Encourage all but its format of seven steps may be shortened prostate cancer color 10 mg alfuzosin order with amex. The discussion • Maintain group • Listen to and respect • Check scribe keeps dynamics contributions of length of time (number of sessions) that a group stays together • Record resources an accurate record others with each other and with individual tutors varies between used by group • Keep to time • Prevent side- • Ask open questions institutions. A group needs to be together long enough to allow tracking • Ensure group keeps to task in hand • Research all the good group dynamics to develop but may need to be changed • Ensure group learning objectives occasionally if personality clashes or other dysfunctional achieves appropriate • Ensure scribe can learning objectives keep up and is • Share information behaviour emerges. At the start of the session, Roles of participants in a PBL tutorial 8 Problem based learning depending on the trigger material, either the student chair Examples of trigger material for PBL scenarios reads out the scenario or all students study the material. If the trigger is a real patient in a ward, clinic, or surgery then a x Paper based clinical scenarios x Experimental or clinical laboratory data student may be asked to take a clinical history or identify an x Photographs abnormal physical sign before the group moves to a tutorial x Video clips room. For each module, students may be given a handbook x Newspaper articles containing the problem scenarios, and suggested learning x All or part of an article from a scientific journal resources or learning materials may be handed out at x A real or simulated patient appropriate times as the tutorials progress. The tutor may need to take a more PBL tutorial process active role in step 7 of the process to ensure that all the students Step 1—Identify and clarify unfamiliar terms presented in the scenario; have done the appropriate work and to help the chair to scribe lists those that remain unexplained after discussion suggest a suitable format for group members to use to present Step 2—Define the problem or problems to be discussed; students may the results of their private study. The tutor should encourage have different views on the issues, but all should be considered; students to check their understanding of the material. He or she scribe records a list of agreed problems Step 3—“Brainstorming” session to discuss the problem(s), suggesting can do this by encouraging the students to ask open questions possible explanations on basis of prior knowledge; students draw and ask each other to explain topics in their own words or by on each other’s knowledge and identify areas of incomplete the use of drawings and diagrams. In practice, PBL is Step 6—Private study (all students gather information related to each usually part of an integrated curriculum using a systems based learning objective) approach, with non-clinical material delivered in the context of Step 7—Group shares results of private study (students identify their clinical practice. A module or short course can be designed to learning resources and share their results); tutor checks learning and may assess the group include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge, skills, and attitudes. A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios. Sufficient time should be allowed each week for students to do the self directed learning required for PBL. Define learning outcomes for module How will individual outcomes be achieved? W riting PBL scenarios PBL is successful only if the scenarios are of high quality. In Communication Clinical skills Lectures PBL skills Practicals most undergraduate PBL curriculums the faculty identifies learning objectives in advance. The scenario should lead students to a particular area of study to achieve those learning How many PBL sessions in the module? Write learning Write PBL Write tutor objectives for each PBL scenarios notes How to create effective PBL scenarios* Pilot with staff x Learning objectives likely to be defined by the students after studying the scenario should be consistent with the faculty learning Refine scenarios and tutor notes objectives x Problems should be appropriate to the stage of the curriculum and the level of the students’ understanding Pilot with group of students x Scenarios should have sufficient intrinsic interest for the students or relevance to future practice Design timetable for module; x Basic science should be presented in the context of a clinical write module handbook for students scenario to encourage integration of knowledge x Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented Implement module x The problem should be sufficiently open, so that discussion is not curtailed too early in the process Evaluate x Scenarios should promote participation by the students in seeking information from various learning resources Designing and implementing a curriculum module using PBL supported by *Adapted from Dolmans et al. Med Teacher 1997;19:185-9 other teaching methods 9 ABC of Learning and Teaching in Medicine Staff development Introducing PBL into a course makes new demands on tutors, requiring them to function as facilitators for small group learning rather than acting as providers of information. Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups). Tutors should be also given information about the institution’s educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole. Methods of assessment and evaluation should be described, and time should be available to discuss A dysfunctional group: a dominant character may make anxieties. Subject specialists may, however, be poor PBL facilitators as they are more likely to interrupt the process and revert to lecturing. None the less, students value expertise, and the best tutors are Advantages and disadvantages of PBL subject specialists who understand the curriculum and have Advantages of PBL Disadvantages of PBL excellent facilitation skills. However, enthusiastic non-specialist Student centred PBL—It fosters Tutors who can’t “teach”—Tutors tutors who are trained in facilitation, know the curriculum, and active learning, improved enjoy passing on their have adequate tutor notes, are good PBL tutors. If assessment methods rely solely on factual future practice tutoring process recall then PBL is unlikely to succeed in the curriculum. All Integration—PBL facilitates an Other resources—Large numbers integrated core curriculum of students need access to assessment schedules should follow the basic principles of Motivation—PBL is fun for students the same library and testing the student in relation to the curriculum outcomes and and tutors, and the process computer resources should use an appropriate range of assessment methods. Tutors should give feedback or use formative or “Deep”learning—PBL fosters deep deprived access to a summative assessment procedures as dictated by the faculty learning (students interact with particular inspirational assessment schedule. It is also helpful to consider assessment of learning materials, relate teacher who in a traditional concepts to everyday activities, curriculum would deliver the group as a whole. The group should be encouraged to and improve their lectures to a large group reflect on its PBL performance including its adherence to the understanding) Information overload—Students process, communication skills, respect for others, and individual Constructivist approach—Students may be unsure how much contributions.

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You can enhance your presentation with ani- mation prostate metastasis order alfuzosin mastercard, artwork and diagrams which make it more inter- esting for your audience prostate cancer yellow skin generic alfuzosin 10 mg overnight delivery. Acknowledge that this is your first Everybody gets nervous when they presentation and people will tend to first start giving presentations and help you along prostate cancer early stages order alfuzosin 10 mg fast delivery. Produce aide memoirs, either on Read straight from a paper you have cards, paper, OHP transparencies or written. Make it clear from the outset Get cross if you are interrupted and whether you are happy to be have not mentioned that you don’t interrupted or whether questions want this to happen. If you have and then do not answer them or invited questions, make sure you patronise the inquirer. Look around the room while you are Look at your notes, never raising speaking – if it’s a small group, make your head. Present interesting visual Produce visual information which information such as graphs, charts people can’t see, either due to its size and tables in a format which can be or print quality. Alter the tone and pitch of your Present in a monotone voice with no voice, length of sentence and facial/ facial/hand gestures. Make it clear hand gestures to maintain audience that your subject bores the pants off interest. Produce a paper or handout which Let the audience go home without people can take away with them. HOW TO REPORT YOUR FINDINGS/ 143 SUMMARY X There are three main ways of reporting your findings: written reports, journal articles and oral presentations. X Before starting your research, find out whether you are going to be restricted by structure, style and content of your final report. X A traditional written report includes the following: – title page – contents page – list of illustrations – acknowledgements – abstract/summary – introduction – background – methodology/methods – findings/analysis – conclusions – recommendations – further research – references – bibliography – appendices. X If you are interested in writing an article for a journal, do your market research. Make sure that the subject matter, style, structure and length of your article suit the journal. X Try to seek advice and comments from people experi- enced in writing journal articles. If you were to do so, your work would reach a wider audience than it might do otherwise. Arrive early, make sure equipment works and that you have everything you need. X Show that you are interested in what you are saying and try to keep audience interest by using visual aids and altering tone, pitch and gestures. X Don’t shrug off questions or patronise your audience – pitch your presentation at the right level. X Never let an audience leave without taking away a re- cord of what you have said. If we expect them to give up their valuable time to help us, it follows that we should offer them something in return. 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. TREATING PARTICIPANTS WITH RESPECT As a researcher you must remember that the research pro- cess intrudes on people’s lives. 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.

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Your role will generally be one of facilitator rather then expert mens health 30-30 workout alfuzosin 10 mg order without a prescription, a role you may initially find rather difficult androgen hormone definition alfuzosin 10 mg order with mastercard. The sessions will usually be conducted in small groups so Chapter 3 may also be helpful prostate cancer prevalence alfuzosin 10 mg purchase with mastercard. In brief, your main task is to help your students develop the skills to work effectively as a group member. To do this the student must understand the purpose of their PBL activities and not see the session simply as one of solving the problem. The process skills they will need to do this effectively include group skills, information literacy (locating, retriev- ing, evaluating and using information of all kinds), negotiating, interviewing and presenting. So while you may appear to be teaching your subject less, you should have the pleasure of observing students learn the expected content in a much more interesting and exciting way. For the purpose of this chapter the time allocated to a module will be assumed to be one week. Students are then engaged in formulating questions about the problem (e. To assist the process you should be provided with additional information about the case (physical examination findings; investigations) to feed into the discussion at the initial session or later in the week. You should also have a list of 119 resources which are relevant to the problem such as books, articles, videotapes, web-based materials and experts available for consultation. There might even be a lecture or two for the students to attend, The expected level of tutor intervention will depend to some extent on whether the approach in your school is Guided or Open Discovery. When agreement has been reached on the learning tasks to be performed, arrangements are made to meet again during the week to review progress and pool information. Students will determine whether further information is needed and, if so, additional learning tasks will be assigned. However, complete resolution of the problem is rarely possible nor is it to be seen as the aim. If the institution is using expert tutors it is unlikely that you will spend many sessions with one group of students. On the other hand, if non-expert tutors are the policy then you may be the facilitator to one group for an extended period of time. In many ways this is likely to be more rewarding albeit more time consuming. STAFF RESOURCES FOR PROBLEM-BASED LEARNING One of the major concerns for medical schools contemplat- ing changing to PBL is that of staff resources. It is widely perceived that PBL is dependent on small groups and that this will demand more staff or a considerable extra time commitment for existing staff. This may well be true if one is trying to emulate the McMaster model of PBL. For instance, if non-expert tutors are acceptable for some components of the course it may be possible to use staff (e. We have some experi- ence of this in a first-year foundation course in which we aim to introduce students to the process of PBL. The process of problem analysis is undertaken by these groups, a procedure that produces a rewarding hum of activity in the lecture theatre. The teacher then gathers together the ideas in an interactive manner from representative of the groups. Agreement is reached on the information the students require to proceed with the problem. If the exercise is to be completed in one session this can then be provided by the teacher or an invited colleague who is the ‘expert’. On the other hand the full process of PBL can be continued with students departing to report back at a subsequent session having completed their independent learning tasks. However, it is one we have found to be very successful and highly rewarding. In a sense it is an extension to the additional techniques referred to in Chapter 2 on Large Group Teaching. Whatever approach is used the need for effective staff development is paramount if PBL is to be successfully implemented. Unfortunately may schools fail in this regard with inevitable disappointment to staff and students. Particularly helpful are workshops in which staff take different roles in a PBL group exercise and observing a real studentPBLgroup in action.

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Massage therapy felt great but did not afford him any long- lasting relief prostate cancer wristbands alfuzosin 10 mg purchase with visa. Acupuncture lessened the sensation of pain mens health yahoo answers alfuzosin 10 mg order visa, but the relief only lasted for a few hours man health latam discount alfuzosin 10 mg overnight delivery. His doctor examined Brad again and discovered that his patient was, indeed, “tight. They helped until Brad Do You Have Unexplained Back, Neck, or Joint Pain? Brad tried a number of other things in an effort to help himself, includ- ing wearing magnets. He dropped a few pounds because he was afraid he was getting sciatica like his uncle whose condition had improved with weight loss. But when he discussed the problem with his Uncle Ben, they both agreed Brad’s pain didn’t seem the same since it didn’t radiate down his leg. Brad now understood why his own doctor hadn’t suggested sciatica as a diagnosis. The only relief for Brad, besides the anti-inflammatory med- ication, came from physical exercise. Eventually, Brad visited another orthopedic surgeon who prescribed strong pain medication. Brad took this medication for a while but soon stopped for fear he would become like his father. Brad remembered his dad, who’d also had back pain, living on pain pills for most of his life. Brad was afraid of becoming addicted like he thought his father might have been. Finally, Brad considered quitting work and going on disability, but he knew he would have a big problem getting disability coverage. How was he going to explain to the insurance company that he couldn’t work but he could still play tennis, exercise, and be extremely active? Fortunately Brad’s uncle described his nephew’s problem to a friend with whom he played cards and who happened to be a retired physical ther- apist. Using the Eight Steps This is a sampling of Brad’s notebook, which finally led to a correct and admittedly unusual diagnosis. Back Pain • Quality and Character: One-sided lower back pain that feels like a hot poker. The only other possible cause of this sprain that happened about the same time was that I was dating this girl, Lydia, and we were into some heavy-duty “sexual gymnastics. Pain killers and anti- inflammatories help, but if I stop taking them, the pain returns. Step Four: Do a Family Medical History and Determine If You Have or Had Any Blood Relatives with a Similar Problem. My father was always complaining about low back pain but I think he just liked to complain and this was a great excuse for him to take prescription drugs. Step Five: Search for Other Past or Present Mental or Physical Problems. Other than the tennis elbow I developed two years ago which got better, and other muscle strains and sprains from playing football and other phys- ical activities, I have been fairly healthy other than an occasional cold. About eight months ago, after I started dating Lydia, I may have caught something from her. She had some gynecological problems which she said she took care of, but I developed a horrible burning sensation when I urinated. I went to a urologist who gave me some pills and eventually the burning resolved. Around the same time, I also had an episode of red-eye, which my eye doctor said was conjunctivitis. Sometimes I have ulcers in my mouth, but I forgot to mention this to my doctor or in Step Five.

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The New Zealand School of Physiotherapy had been established for James Renfrew WHITE some years man health base multiple sclerosis buy generic alfuzosin 10 mg, but with Renfrew White’s appoint- 1888–1961 ment it came under his direction prostate green light laser surgery order alfuzosin with a visa, and its present stature owes much to his influence and enthusi- Born in Dunedin prostate cancer forum purchase alfuzosin discount, the son of Professor David asm. His inherited background in education led Renfrew White, professor of education at the Uni- him to take more and more interest in medical versity of Otago, James studied medicine in the education. He spent a year in the United States, Otago Medical School and graduated MB, ChB, where he was elected a Fellow of the American in 1912. He career began with his appointment to the resident founded a “surgical unit” with the professor staff of the Royal National Orthopaedic Hospital. James Renfrew White was When the orthopedic services for the imperial appointed the assistant in charge of orthopedic forces in Great Britain had become fully organ- cases. He was appointed to the appointed senior surgeon and the writer assistant staff of the Military Orthopedic Hospitals at surgeon. In 1919 he injuries came under his charge, and so the ortho- published a monograph, Chronic Traumatic pedic and traumatic service of the Otago Medical Osteomyelitis, a brilliant work. The New Zealand Gov- sions to the hospital, modern orthopedic wards ernment appointed a group of trained orthopedic and a magnificent physiotherapy school were surgeons to take charge of wounded members of erected. In the Second World War his staff was its expeditionary force who came into this sphere depleted and he was called upon to carry on the of surgery. He returned to appointment in 1948, he was a young active New Zealand and took charge of the military “sixty. Throughout the years tice for many years, but he now had time to devote he remained known with affection by his patients himself to his other great interest in life—music. Now he took classes in music at the 357 Who’s Who in Orthopedics University of Otago and reached the stage when Boston. Gibney, He then spent a prolonged visit to England, at the Hospital for the Ruptured and Crippled. He devel- The association with this hospital continued until oped a deep interest in the ancient churches of 1929, when, after 40 years of continuous service, London and compiled a vast manuscript dealing he retired from both hospital and private practice. On his return to He moved to England, where he remained for Dunedin in 1961, he was immensely busy prepar- about 13 years, returning to his own country in ing it for publication, but this was not to be—he 1943. He was a foundation fellow of the Royal Three days before his death, he received an invi- Australasian College of Surgeons. The British tation to represent the United States, as a guest of Orthopaedic Association honored him by electing the French Government, at a meeting to celebrate him an emeritus fellow and the New Zealand the 100th anniversary of the founding of the Orthopedic Association its patron. Whitman was a member of many medical man, vivacious, erudite and immensely versatile. By the death of James Renfrew American Orthopedic Association, of which he White of Dunedin on December 27, 1961, New was president in 1895. Zealand lost the doyen of her orthopedic He was an indefatigable worker. The patients were seen first in the outpatient department and, after their stay in the hospital for operative or nonoperative treatment, returned to it for follow-up care or observation. Hence, he, as well as all of his associates, attended the outpatient clinic. The clinic hours ran from one to three in the after- noon, and so prompt was his arrival that watches could be set at one o’clock when he entered the hospital. He had little patience with an assistant who came late or who offered excuses for ir- regular attendance. In this, as in so many other respects, he set his assistants an excellent example. Whitman loved orthopedic surgery and sought continuously and zealously to advance it. To those who saw him and worked with him 4 or 5 days a week, he seemed to be thinking of nothing but orthopedics. During a lull in clinic work in the afternoons, the subject discussed was never art, literature, music, or politics, but always Royal WHITMAN orthopedic surgery, a difficult case for diagnosis, 1857–1946 surgical technique, mechanical or surgical prin- ciples, or orthopedic literature. Whitman read Royal Whitman was born in Portland, Maine, on extensively and was thoroughly informed on the October 24, 1857. He received his degree of orthopedic literature in English, French, and Doctor of Medicine from Harvard Medical German; he expected all of his associates to be School in 1882, and for a while he practiced in equally well informed and up to date, so that dis- 358 Who’s Who in Orthopedics cussions, which were very frequent, would be lent anatomist and, through hints dropped here most fruitful and thought-provoking. Whitman was a profound student of ortho- anatomy; second, on the day before an operation pedic surgery, a pioneer, and a pathfinder. He was he continuously reviewed what he contemplated always trying out new procedures, either those he doing, and hence he came to the operating table initiated or those suggested by others.

Torn, 37 years: Macdonald and Hamilton continued to in Melbourne, Laurie retained pride in his play a dominant role in the new association Scottish ancestry and they shared a lifelong and both survived all their other foundation enjoyment in playing golf.

Jaffar, 22 years: The paradox of the new world order of the early 1990s was that, when the state had been rolled back and socialism crushed, the result was not a society of robust and intrepid entrepreneurs, but one of weak and vulnerable individuals.

Vibald, 60 years: Furthermore, the graft pre- of muscle tenderness until the disease became vented telescoping of the vertebrae and main- stationary.

Lisk, 58 years: In his new quarters the dissection and of animals that died; and in order to study living collection of natural history specimens went on animals both by experiment and by observation apace.

Jorn, 48 years: They might do this if they do not want to look ‘bad’ in front of the researcher, or they might do it because it is expected behaviour.

Curtis, 27 years: As a result, organic synthesis is an extremely demanding discipline, requiring both a wide knowledge of chemistry and also the ability to develop complete strategies for the construction of molecules.

Ur-Gosh, 64 years: Remember there is no interpretation of the data in this section as this is reserved for the discussion section that follows.

Hamlar, 49 years: Chest compression on a pregnant woman is made difficult by flared ribs, raised diaphragm, obesity, and breast hypertrophy.

Arokkh, 51 years: The size of femoral prosthesis used was number 7 or 8 from Stryker, or 10 or 11mm from Zimmer.

Hauke, 53 years: TREATMENT Treatment is individualized on the basis of the functional impairment resulting from tics and=or comorbid problems, sources of support, capacities for coping, and challenges associated with various stages of development.

References

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