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Routine screening and preventive services purchase 10mg reglan fast delivery gastritis diet 30, such as those recommended by the U cheap 10mg reglan otc gastritis que hacer. Department of Health and Human Services 2000), are therefore im- portant (Iezzoni et al. Regardless of whether people have mobility difficulties, however, many receive screening and preventive services at lower-than-desirable rates (see Table 13). Women with major mobility problems are much less likely to receive important screening tests: 30 per- cent less likely for mammograms and 40 percent for Papanicolaou smears. Among persons age sixty- five and older, 23 percent report having vision tests, regardless of mobility difficulties. However, for persons in this older age group, 26 percent with major mobility problems have serious difficulty seeing, even using glasses or contact lenses, compared to 5 percent without impaired mobility. One significant barrier is the paucity of auto- matically adjustable examining tables and wheelchair-height mammogra- phy machines (Welner 1998, 1999; Welner et al. One internist joined a Medicaid health maintenance organization (HMO), where she en- countered many patients with disabilities (Andriacchi 1997, S17). How- ever, the practice did not have adjustable examining tables: tables that lower (to wheelchair height) and rise (to examination height) when physi- cians press a foot pedal. One new patient, a forty-five-year-old woman with MS, had never had a Pap smear because physicians had not offered her one. When the internist and her assistants tried to move the woman onto the high unadjustable examining table, they failed. The patient’s daughter, familiar with transferring her mother, lifted her up. The internist ordered a mammogram, but the HMO’s approved facility required women to stand for the test:“Then I had to get approval from the HMO system for her to go outside of their usual place” (Andriacchi 1997, S18). Most physician interviewees do not practice in settings with automati- cally adjustable examination tables. In ad- dition, scheduling specific patients for a particular room is often logistically complex in a busy practice. One internist admitted she dislikes the ad- justable table: it rises and lowers too slowly for her quick practice pace. Be- cause of physicians’ protests, the clinic considered removing the automatic tables but kept them because some patients do need them. Lots of stuff gets plopped in the lap of primary care doctors, and it’s literally im- possible to do everything.... I’mnot saying that walking isn’t part of the doctor’s job—it interacts with too many things that are definitely part of the doctor’s job. But walking and gait evaluations could easily be done by people trained in this, not necessarily even M. Granted, they must first recognize that patients have diffi- culty walking, then decide which professional would best diagnose and han- dle the problem. Often they send patients directly to physical therapists with the open-ended request “evaluate and treat. Some doctors resist referring patients to other physicians be- cause of the implied challenge to their capabilities and authority. But most primary care interviewees openly admit their limitations in addressing mo- bility and welcome expert advice, typically from specialists in neurology, rheumatology, geriatrics, and orthopedics. I describe their roles briefly below; extensively describing each specialty is beyond my scope here. Physician Specialists Orthopedists generally perform surgery, aiming to ease pain and improve function. Primary care physicians typically refer patients to orthopedists to evaluate whether surgery is warranted, although some patients inde- pendently seek orthopedic input. Some orthopedists specialize in replacing hip or knee joints, while others mainly do back operations (in some insti- tutions, neurosurgeons also perform back surgery).
All my symptoms were fairly constant reglan 10 mg free shipping gastritis diet , but they would become worse if I had an infection reglan 10mg line gastritis ginger, sat for prolonged periods of time, wore tight pants, had sex, exercised, or even applied a cream or ointment designed to improve the situation. Worse still, if I woke up without pain and did any of the problematic activ- ities, the pain was triggered and I couldn’t turn it off. On the other hand, if I woke up without pain and just lay in bed (applying no pressure to the area), I could go for a few hours without pain. My anxiety level skyrocketed with the thought that I would be laid up just to get pain relief; with those thoughts, the pain seemed to get worse. Step Four: Do a Family Medical History and Determine If You Have or Had Any Blood Relatives with a Similar Problem. After a survey of my fam- ily’s medical history, I found a half-aunt who had a similar condition. Hers was diagnosed as dermatological in nature and was treated with cortisone creams. She had none of the myriad other symptoms I did, but her treat- ment gave me something to think about. I ventured an examination of the skin in that area and found it to be raw and red. So now in addition to uro- logical, gynecological, and neurological implications, perhaps there were dermatological aspects to examine—something no doctor had yet suggested. I wasn’t sure if any prior condition was related, but a good medical detective does not prematurely rule something out. I was very aware that I had a his- tory of allergies and wondered if I was having some sort of allergic reaction. He had defined myalgia as diffuse muscle pain and possibly an inflammation of fibrous tissues of the muscles, fascia, and sometimes nerves. Some years previously, I also had been diagnosed with Hashimoto’s dis- ease (a chronic inflammatory condition resulting in thyroid malfunction). It struck me as I proceeded with Step Five that all my prior conditions had something in common—inflammation and/or autoimmune disease. I didn’t know if these surgeries had anything to do with my current mystery malady, but since it was not time to start ruling anything out, I simply made a note of them. I looked back at everything I had recorded in my notebook and made some additional notes. Then I formulated some questions and theo- ries to go over with my physician. One or more of these condi- tions were often associated with the correct diagnosis I finally received. Making the Diagnosis My medical detective instincts were telling me to stop here. Working through Steps One through Six had yielded a lot of potential clues. I was stunned to learn that IC patients had many of the symptoms I’d listed in Step One. The only problem was that IC normally involved bladder pain without an infec- tious process. Since I was invariably in and out of an infectious process, IC didn’t seem to apply to me and perhaps that’s why no doctor had thought of it. I reasoned that since my symptoms were so similar to IC, I should continue to explore this condition. I secured a number of articles and suddenly ran across a condition often associated with IC that sometimes stands on its own—pelvic floor dysfunction. Symptoms also included high levels of pelvic pain and decreased urinary flow (which is known to sometimes cause infection). I called my pri- mary care physician and asked if she had ever heard of this condition. To my amazement, she told me that in the past year she had attended a lecture given by a physical therapist whose entire practice was devoted to treating this problem and that it was one which, up to this point, had been virtually unrecognized and unidentified in the medical community. When I asked her to tell me more about it (and without my saying very much about my own symptoms), she began to describe for me in exact detail what I had been experiencing since my accident occurred. She even ventured to guess that, at this point, I had probably stopped wearing pants or pantyhose, had difficulty sitting for any length of time, and was probably very hesitant about having sexual intercourse.
Decide on the content Your statement of purpose or your objective forms the starting point for drafting the content of your article order reglan 10mg on-line gastritis symptoms vs ulcer symptoms. Brainstorming using the keywords from your objective is a useful way of developing ideas order reglan 10 mg gastritis information. It may help this JOURNAL ARTICLES 281 process if you set yourself a series of questions. In the above example, you might want to ask some of the following questions. The key areas or concepts identified through this process will form your section headings. Even if these are not used as titles in the final article, they can act as markers for how you will organise your material. Creating a structure Forming a structure early on in your planning will help in refining your search for information. Here are some examples of different formats for presenting material in articles. Research papers Research articles or research papers are always written using the traditional scientific approach discussed in Chapter 13 ‘Research Projects’. An abstract consists of a short paragraph that summarises the research paper for the reader. Most are 200 to 250 words in length, although some journals may accept longer ones. A reader can use the abstract to quickly make a decision about whether the research findings are of relevance to him or her and therefore worth reading. On a database, an abstract may be the only information available to the searcher on the contents of a paper. Abstracts contain: ° a statement about the purpose of your research ° your hypothesis or your research question ° a description of your research design ° your rationale for choosing that design ° a statement about your methods and procedures that includes details of any special equipment and the selection and number of subjects ° a description of your data analysis ° your major findings ° your conclusions 282 WRITING SKILLS IN PRACTICE ° implications for further research or applications to practice. The organisation of the abstract very much reflects the structure of the re search paper, the standard format being: ° Introduction (this contains information about relevant literature, the purpose and rationale for your research and your hypothesis) ° Methods ° Results ° Discussion of results ° Conclusion. Other formats Example of a literature review: ° Introduction (reason for or objectives in conducting the review) ° Rationale for literature selection ° Critical analysis of the literature ° Results of your review ° Conclusions ° Implications for further research ° Applications to clinical practice. Example of a clinical update on skin diseases: ° Incidence of skin diseases ° Description of skin ° Effect on client (psychological aspects, physical factors, quality of life) ° Assessment (including a description of different skin diseases) ° Treatment ° Summary (a position statement). Example of a debate on clinical supervision: ° Introduction (definition of clinical supervision, statement on the purpose and terms of reference of the article) JOURNAL ARTICLES 283 ° Overview of the models of supervision ° Comparison of models of delivery ° Discussion of the benefits of supervision (supported by references to research). Example of a continuing professional development article on ‘depression’: ° Statement about the aims and intended learning outcomes for the reader, for example: ° describe the signs and symptoms of depression ° list common causes of depression ° differentiate between the four classifications of depression ° describe four treatments for depression ° Introduction ° Definition of depression ° Common causes ° Signs and symptoms ° Classification of depression ° Treatments ° Conclusion (applications to practice). A teaching article of this sort might suggest other complementary forms of study. In the above example, the reader might be asked to reflect on his or her own experience of depression, complete a self-assessment question naire on the basic facts, and make a list of symptoms noted in a client diag nosed with depression. A well-structured article will be organised and logical, and will only include information that is necessary to meet your aims. Researching your article Your next step is to carry out a thorough literature review of your intended subject area. See Chapter 7 ‘Writing As an Aid to Learning’ for information on searches. Writing your draft Your approach and style will very much depend on your readership. When you are writing an article for colleagues within your own discipline you 284 WRITING SKILLS IN PRACTICE will be able to assume a certain knowledge base. It will be appropriate to use well-known terminology without the need for extensive explanations. However, other groups of readers, despite being a professional audience, will not always have a specialist knowledge of your subject area. You will need to take this into account when introducing information and in your use of terminology. Be careful not to make your subject area too wide, as you must comply with the word limit set by the journal. Set yourself limits so that you are able to deal effectively with the information within the constraints of a short article.
The large number of patients and the lack of facilities for long-term conservative treatment made a more aggressive approach necessary and led Hodgson to seek a more radical surgical solu- tion to the problem order reglan 10 mg overnight delivery chronic gastritis mucosa. He accomplished this by exploiting the anterior approach to the spine with drainage of the abscess cheap reglan 10mg line gastritis or stomach flu, removal of sequestrae, Albert HOFFA and correction of the deformity. The correction 1859–1908 was maintained by strut grafts of cortical bone. The advent of chemotherapy effective against Born in the Cape of Good Hope, South Africa, tuberculosis affected the success of these opera- the son of a German physician, Albert Hoffa tions favorably. After qualifying, he The success of Hodgson’s program led the uni- established the first private orthopedic unit in versity to establish a Department of Orthopedic Germany, situated in Würzburg, Bavaria. Hodgson was made the head of He became very well known, wrote and taught this department and held the appointment until his a great deal, and founded journals. His ward for crippled children lowed Julius Wolff (known for Wolff’s law) as in 1968 had increased to become the Duchess of professor at Berlin. After his retirement in 1975, Hodgson returned to Suffolk, England, where he died at the age of 78. Hoke was a member of the American Orthopedic Association and its President from 1925 to 1926, presiding at the annual meeting of the Association held in Atlanta in 1926. He was one of the five orthopedic consultants for the Shriners’ nationwide chain of hospitals for crippled children, which move- ment he had sponsored; he was also an important member of the advisory board of the Alfred I. The University of North Carolina conferred on him the honorary degree of Doctor of Laws in 1931. In this same year, at the insistence of President Roosevelt, he accepted the appoint- ment of Medical Director of the Institution for Michael HOKE the Treatment of Infantile Paralysis at Warm 1874–1944 Springs, Georgia, resigning this position in 1935 to resume his private practice in Atlanta. It is not the intensity but the duration have been many and have been internationally of ideals that makes a great man. The original and valuable operative methods he devised for the treatment of certain This wise observation of Elihu Root is pecu- disabilities of the feet are still known as “Hoke’s liarly applicable to the life of Dr. Michael Hoke, operation for claw foot” and “Hoke’s internationally known orthopedic surgeon, great arthrodesis. Hoke Hoke was a great teacher as well as a great was born in Lincolnton, North Carolina, on June surgeon. He was the son of the well-known acquire surgical skill and to emulate the highest General Robert F. Hoke’s early years were spent in Raleigh, labor of those younger physicians who had North Carolina. Hoke’s chief relaxations were golf and graduate study and research then followed at the hunting with the dogs, and he held membership medical schools of Johns Hopkins and Harvard. He was a thorough sportsman in Georgia, specializing later in orthopedic surgery. The union was a Although Michael Hoke always felt intensely, completely happy one, Mrs. Hoke entering fully and was unswerving in his loyalty to the South, into both his professional life and his many he maintained an unusual breadth of view and outside interests. On one dren, Charles McGhee of Beaufort, South occasion, he took a northern friend to see the Carolina and Edward Jastrum of St. Louis, Mis- great southern war memorial on Stone Mountain, souri, and two grandchildren survived him, as did which was then only partly finished, but the archi- 144 Who’s Who in Orthopedics tect’s drawings of the completed project were on view and were very impressive. Lee, the sculptor had planned to carve a group of other Confederate generals, one of whom would undoubtedly have been Dr. Hoke greatly admired the conception and was deeply moved at the thought of what the superb memorial would mean to the South. As he and his northern friend were moving away, Hoke said to him, “I wish Borglum (the sculptor) would do one more thing. I wish he would place the figure of Abraham Lincoln on the summit of the mountain looking down on the whole group. Sir Frank Wild HOLDSWORTH This slender ascetic looking man with dark and piercing eyes, a friendly smile, and a delightfully 1904–1969 keen sense of humor must have been a sturdy youth in his student days. In later life, pulmonary Frank Holdsworth was one of the great orthope- disease and his strenuous work slowly sapped his dic surgeons of his generation, but the achieve- strength but never his bonhomie nor his endear- ments for which he will be remembered extended ing kindness. He was a fine teacher, a great In 1937, he retired from private practice and innovator, and in his later years an almost fanati- moved with his family to the lovely old town of cal campaigner for a sound and rational system Beaufort, South Carolina. Hoke’s health campaign his prime consideration was to get a was better, and his passing came as a shock to his square deal for the young man in training, and he numberless friends.