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More detailed descriptions of this assessment approach are given in Miller et al cheap himplasia 30 caps. Remember to keep group size down (greater than six members is too large); help students to work as effective group members; form groups randomly and change membership at least each semester; and ensure all students understand the assess- ment mechanisms you will use to encourage the diligent and forewarn the lazy best himplasia 30 caps. Marking group submissions can be a way of assessing more students but taking up less time on your part 30caps himplasia otc. When allocating marks, the following strategies will be helpful: Give all members of a group the same mark where it was an objective to learn that group effectiveness is the outcome of the contribution of all. For example, if the group report was given a mark of 60 per cent and there were 4 members, give the group 240 (4 x 60) to divide up. This will be best managed if you have forewarned the group and assisted them with written criteria at the onset as to how they will allocate marks. An alternative is to have members draw up a contract to undertake certain group responsibilities or components. Components may be marked separately, or students may be given the task of assessing contributionsthemselves. Enhance the reliability of this form of assessment by conducting short supplementary interviews with students (e. USING TECHNOLOGY IN ASSESSMENT Computer technologies can be used to support assessment and we suggest you explore the facilities that are likely to be available to you in your own institution. These include: As a management tool to store, distribute and analyse data and materials. An assessment system should be integrated with larger systems for curriculummanage- ment such as processing of student data and delivery of course materials. Answers from objective- type tests can be read by an optical mark reader and results processed by computer. However, more elaborate tools are now available to assess students work directly. Software can be purchased that enables you to prepare, present and score tests and assign- ments. You should check to see if your institution has a licence for some of these software products. Basically, this involves students using technology to prepare and present work for assessment. Some simple examples include students preparing essays using a word processor or completing tasks using a spreadsheet application and submitting their work via e-mail. E-mail can also be used to provide a mechanism for the all-important feedback process from the teacher or from other students if collaborative group work or peer assessment is being used. We recognise that information technology and telecommu- nications can be helpful and positive tools or resources for assessment. But we also have serious reservations about the way technology is being used as a tool in the assessment process. This is because the technology is so well suited for the administration and scoring of objective- type tests of the multiple-choice or true/false kind. We are seeing something of a resurgence of this kind of assessment in higher education with all of the well-known negative influences this may have on learning when items are poorly constructed or test only recall. All we can do here is urge caution, use good-quality test items, and to always ensure that students receive helpful feedback on their learning. FEEDBACK TO STUDENTS Major purposes of assessing student learning are to diagnose difficulties and to provide students with feed- back. Several approaches to doing this have already been identified in this chapter and some of the methods described readily lend themselves to providing opportu- nities for feedback. To be specific: 161 use structured written feedback on essays; provide immediate feedback on technical, interperso- nal, or oral skills as an outcome of direct observations, orals or practical assessments; and use self-assessment which includes feedback as part of the process. Some guidelines for giving feedback include the following: keep the time short between what students do and the feedback; balance the positive with the negative; indicate how the student can improve in specific ways; encourage students to evaluate themselves and give feedback to each other; and make the criteria clear when setting work and relate feedback to the criteria.

Our results suggest that transtrochanteric rotational osteotomy is a valuable option for the treatment of severe slipped capital femoral epiphysis in young patients purchase himplasia 30caps. Transtrochanteric rotational osteotomy (TRO) 30 caps himplasia with amex, Slipped capital femoral epiphysis himplasia 30caps without a prescription, Posterior tilt angle Introduction The rationale of treatment for slipped capital femoral epiphysis (SCFE) is prevention of deterioration of slip angle and restoration of the range of motion in young patients. We have employed transtrochanteric rotational osteotomy (TRO) with varus angulation for such severe cases. The aim of this study is to report the clinical results and to clarify the usefulness of this procedure for severe SCFE. Materials and Methods Since 1996, 19 consecutive patients with SCFE were treated in our department. TRO with varus angulation was applied for patients with severe slipping greater than 70°. A 22-year-old Department of Orthopedic Surgery, Sapporo Medical University, South 1 West 16 Chuo-ku, Sapporo 060-8543, Japan 27 28 S. Three patients were categorized to chronic type, and 1 patient was acute on chronic type. To evaluate the severity of posterior shifting of the femoral head, we used posterior tilt angle (PTA), which is an angle between the epiphyseal line and a line perpendicular to the femoral shaft axis (Fig. Hip flexion angle was 10°–25°, and Drehmann sign was positive in all cases before surgery. All patients needed a relatively long time interval to obtain an adequate diagnosis from initial onset of the symptoms because of late consultation with an orthopedic surgeon. Three-dimensional corrective femoral osteot- omy, such as the Southwick osteotomy, is employed when the PTA is between 40° and 70°. When the PTA exceeds 70°, we need to lift up the slipped epiphysis to the weight-bearing rim by anterior rotation of the femoral head in TRO. Because anterior rotation results in valgus position of the femoral head, we need to apply varus angula- tion simultaneously. The operation was performed according to Sugioka’s femoral osteotomy with anterior rotation of 60°–70° and varus angulation of 40° (Fig. After 2 days bed rest, wheelchair transfer was prescribed, and partial weight-bearing was allowed 8 weeks after operation; full-weight bearing was then permitted after 4 months. Bone scintigraphy was planned 1 week after the operation to confirm that the blood supply was preserved in the rotated femoral head. The Japanese Orthopedic Association (JOA) score was used to evaluate the clinical results. Complications such as infection, deep venous thrombosis, pulmonary embo- lism, massive bleeding, and nerve palsy were investigated. Radiograph shows the posterior tilt angle (PTA), an angle between a line perpen- dicular to the epiphyseal line and the femoral taeLral view shaft axis Transtrochanteric Rotational Osteotomy for Severe SCFE 29 p A Before osteotomy After anterior rotation A P P B Before osteotomy After anterior rotation Fig. Solid line indicates osteotomy line, which declined 20° varus to the line perpendicular to the femoral neck axis. Solid line indicates osteotomy line, which declined 20° to the baseline perpendicular to the femoral neck axis. Results The JOA score of 37 points preoperatively improved to an average of 90 points post- operatively. The PTA of 82° preoperatively improved to an average of 24° postopera- tively (Table 1). One patient had decreased blood supply of the femoral head detected in bone blood scintigraphy 1 week after operation, which resulted in partial osteonecrosis of the femoral head with segmental collapse (Fig. There was no infection, deep venous thrombosis, pulmonary embo- lism, massive bleeding, or nerve palsy after the operations. Comparision of preoperative and postoperative posterior tiltangle (PTA) Case Preoperative (°) Postoperative (°) 1 2 3 4 Average 82 24 Table 2.

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In the course of the 1970s cheap himplasia 30caps with visa, the ideas of anti-psychiatry were taken up by movements both of and on behalf of people with a range of psychiatric problems order himplasia 30 caps fast delivery. They also became an influential current in the wider radical counterculture (for a brilliant critique of these trends see Peter Sedgwick’s Psychopolitics order himplasia 30caps online, 1982). In 1971 Ken Loach’s Family Life presented Laing’s theories on the causation of schizophrenia by dysfunctional family relationships. In 1975 Ken 137 THE CRISIS OF MODERN MEDICINE Kesey’s novel One Flew Over the Cuckoo’s Nest, which depicted psychiatric illness as a higher form of awareness and exposed the oppressive conditions of the mental hospital, was made into an award-winning film starring Jack Nicholson. One common feature of the questioning of established medicine from different social movements was a challenge to the authority of the medical profession. The tendency for the demand for rights in the USA to lead to legal intervention in relations between patients and doctors had the effect of undermining professional sovereignty. Trust in medical authority was displaced by a conception of the doctor- patient relationship as a partnership in decision-making. Yet even in Britain, where litigation was a marginal influence, there was a shift in the perception from that of the doctor as an essentially benign figure, to one from whom the patient needed a degree of protection. Feminists were scathing: ‘professionalism in medicine is nothing more than the institutionalisation of a male upper class monopoly’ (Ehrenreich and English, 1974:40). Left-wing commentators, particularly in America, exposed the ‘medical-industrial complex’, depicted the medical profession as an instrument of capitalist class rule and denounced ‘medical ideology’ (Navarro 1976; Waitzkin 1978). Commentators on medicine from other academic fields, formerly sympathetic towards doctors, increasingly ‘portrayed the medical profession as a dominating, monopolising, self-interested force’ (Starr, 1982:392). The radical critics of medicine were often fiercely polemical, but like the wider movements of which they were a part, they were optimistic about their capacity to change things and not lacking in alternative programmes. Undoubtedly some of medicine’s critics aspired to overthrow capitalism and patriarchy as well as the power of the medical profession, but many had more specific proposals for reform. Indeed some of these—such as demands for de- institutionalisation of treatment and care for the mentally ill and for the de-medicalisation of many aspects of childbirth—were rapidly assimilated by the mainstream. Pressures for reform of the American health-care system made some headway before becoming stalled in the complexities of the political process and its relations with doctors, insurers and other commercial interests. Parallel pressures for reform of the medical profession itself—notably in the recruitment of women—made steady progress. The proportion of women admitted to medical schools in Britain increased from 22 per cent in 1965–66, to 41 per cent in 1980–81 and reached 52 per cent in 1992–93 (Allen 1994). In the recessionary climate of the mid-1970s the radical upsurge was gradually contained and a conservative backlash gathered momentum. By the end of the decade the new right was in the ascendant with Margaret Thatcher in 10 Downing Street and her ideological ally Ronald Reagan in the White House. The new conservatism did not however mean that doctors would be delivered from their carping critics and freed to return to business as usual. The end of the era of consensus led to a growing scepticism about the scope for ameliorative intervention in society, whether by the state or by professionals, whether in the spheres of education, social services or health. In a trend he dubbed ‘the generalisation of doubt’, Starr commented that the ‘net effectiveness of the medical system as a whole was called into question’ (Starr, 1982:408). Far from being halted, the crisis of medical authority broadened and a more cynical attitude towards doctors became widespread. The author who best exemplifies the nihilistic spirit of the late 1970s is Ivan Illich, a renegade Jesuit priest, who had already denounced the education system with his book Deschooling Society. In 1975 he published Medical Nemesis, the opening sentence of which declared that ‘the medical establishment has become a major threat to health’. Illich incorporated the familiar criticisms (indeed, as we have seen above, self-criticisms) of modern medicine into his thesis that the health problems of society were predominantly those of ‘iatrogenesis’, illness caused by doctors. The result was ‘the expropriation of man’s coping ability by a maintenance service which keeps him geared up at the service of the industrial system’ (Illich 1975:160). The medical profession was a bureaucracy produced by an ‘over- industrialised society’. Illich’s vituperative polemic repudiated all piecemeal solutions: nothing less than the de-industrialisation of society and the de-bureaucratisation of medicine could save the world from medical nemesis: ‘the inevitable punishment of inhuman attempts to be a hero rather than a human being’ (Illich 1975:28). For Illich, medical nemesis was ‘resistant to medical care’ and ‘could be reversed only through a recovery of mutual self-care by the laity’. While few were prepared to go all the way with Illich’s manifesto, it helped to encourage two trends which attracted growing support— the movement for a ‘holistic’ approach to health and the continuing offensive against the medical profession.

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In 1945 discount 30caps himplasia free shipping, he and Innes published a short but significant paper on “Battle Casualties Treated by Penicillin cheap 30 caps himplasia mastercard,” based on a study of no less than 15 purchase himplasia 30caps line,000 cases. A quotation from this paper reveals his sanity at a time when there was much uncritical enthusiasm: “Penicillin has made no difference to the paramount impor- tance of early and adequate surgery; it has, in addition, produced new difficulties in that the effect of penicillin on contaminated wounds obscures the extent of the infection of the tissues, and makes it difficult to judge how radical surgery R. Elmslie spent the whole of his professional immense value in the elucidation of injuries of life as student and surgeon at St. Bartholomew’s the rotator cuff, and his published papers give Hospital and at the Royal National Orthopedic some indication of what might have been Hospital, except during World War I, when he was expected from him, had he lived longer. Ellis had just seen the last patient at strator of pathology and his knowledge of this his fracture clinic at St. As an orthopedic surgeon, Elmslie was one of the greatest of his day, next only to Robert Jones and perhaps Tubby. His ability to think clearly, his wisdom, imperturbability and admirable judg- ment were his powerful assets. Indeed the writer has never worked with anyone whose judgment always proved so sound; it seemed that he was incapable of being wrong. He was a competent and neat operator who devized several first-class procedures. His only expressed vanity was to pride himself on sewing skin in, as he put it, “the manner of those who know best how to sew— women. He was in great demand for committee work in his own hospital, government departments, the Royal College of Surgeons (on the council of which he served from 1933 until his death), the British Orthopedic Association, the British Medical Association, the Chartered Society of Physiother- 96 Who’s Who in Orthopedics apy, and the Central Council for the Care of Crip- second year of residency at the Pennsylvania ples. His clear and logical exposition before the Crippled Children’s Hospital in Elizabethtown, Select Committee of the House of Lords is said he decided that working with crippled children to have carried the greatest weight in deciding the was to be his specialty. As a man, Elmslie lacked the warmth Washington, DC area and began his practice, of Robert Jones, whose friend and admirer he which was to continue until his retirement in always was. He started as assistant to another physician, reserve did not prevent him inspiring the greatest but he was impatient to do more work with crip- enthusiasm and devotion in his pupils, which pled children and saw a glaring need for such they still retain. The area had no facilities that special- ized in orthopedic deformities, which were far more common in the past than they are today. Poliomyelitis was a major problem, and club foot, dislocated hips, osteomyelitis, and curvature of the spine also contributed to the need for recon- structive surgeons and long-term hospital care. Engh opened his own practice in 1938, in his home in Alexandria, Virginia, but he had a desire to own a clinic or hospital. He bought land in Arlington and established offices, which he called the Anderson Clinic. He also established a crippled children’s program through the Arlington Health Department. Previously, such children, especially in rural areas, were being seen only once or twice a year, and few operations were being done. In addi- tion, he instituted community-based clinics for handicapped children at Gallinger Hospital (now DC General Hospital) in Washington and at Arlington Hospital in Arlington. Engh traveled throughout the metropolitan Washington area to see patients at a half-dozen Otto Anderson ENGH hospitals, frequently taking his wife and three 1904–1988 children with him on weekends. Engh converted the physical- Otto Engh was a native of Johnstown, Pennsyl- therapy floor of the Anderson Clinic into an 18- vania. One of six sons of immigrants—his father, bed hospital, complete with iron lungs, to treat a foreman in a steel mill, had come from Sweden, victims of poliomyelitis, because of the desperate and his mother from Norway—he and his broth- need for beds for such patients. The construction ers were given the middle name of Anderson, of an entire hospital for orthopedic surgery fol- which had been their father’s name before he lowed a few years later. In the 1950s, the hospital’s name was musician; he almost became a professional changed to the National Hospital for Orthopedics performer, but his wife encouraged him to pursue and Rehabilitation, new wings were added, and his medical career. Engh received his medical degree from and early 1960s, the hospital was designated Temple University, Philadelphia. During his by the federal government to serve as a pilot 97 Who’s Who in Orthopedics demonstration project on rehabilitation.

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