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By N. Shakyor. Arizona International College.

He remained at Johns Hopkins Hospital for surgical and orthopedic training until 1927 duloxetine 40mg online. He returned to Washington cheap duloxetine 30 mg with mastercard, DC to join his father in practice until 1930 generic duloxetine 20mg otc, when he was invited to Duke University Medical School to initiate the Department of Orthopedic Surgery and the orthopedic residency program duloxetine 30 mg on line. In 1937, Shands left Duke University to become medical director of the Alfred I. His first task at the institute was to plan and supervise the construction of a children’s ortho- pedic hospital on the grounds of Nemours, the estate of Alfred I. The hospital was com- 304 Who’s Who in Orthopedics give his full attention and time to encourage their research and promote their careers. With the decline in poliomyelitis he turned his attention to cerebral palsy. He clarified the mech- anism of the deformity and the origin of contrac- tures, and developed guidelines for the prevention and treatment of these complications. The large number of patients with myelomeningocele and varying degrees of paralysis of the lower limb who had survived as a result of early closure of the spinal lesion presented another problem. A special clinic had to be established for the ortho- pedic management of these children, who often required multiple operations for their deformities. John Sharrard’s enormous experience in this field led to another thesis, for which he was awarded ChM with commendation. In addition to his commitments to the National William John Wells SHARRARD Health Service and a large private practice, John traveled widely as visiting professor and as an 1921–2001 invited lecturer to cities in North and South America, South Africa, Europe and the Middle William John Wells Sharrard was one of the out- East. At home he was Hunterian Professor, Robert standing orthopedic surgeons of his generation. Jones Lecturer, Arris & Gale Lecturer and Joseph He came from a medical family. His mother had Henry Lecturer of the Royal College of Surgeons a glittering career in the Sheffield Medical of England. In 1962, he founded the After education at Westminster School, where Orthopedic Research Society and was its presi- he was a King’s Scholar, he entered the medical dent until 1964. He was president of the British school in Sheffield in 1939, and graduated with Orthopedic Association in 1978–1979. His first appointment as house enthusiastic member of SICOT and served as the surgeon to Frank Holdsworth was the start of a UK national delegate, European vice president lifelong addiction to orthopedics. After a lecture- and president of the Triennial Congress held in ship in anatomy and a period in the Royal Air London in 1984. His fluency in French was Force, he completed his training at the Royal a considerable advantage when for many years National Orthopedic Hospital. It was during this he presided over the Monospecialist Committee time, as lecturer to Professor Herbert Seddon, that in Orthopedic Surgery to the European Union, he concluded his painstaking and brilliant study and as president (and founder) of the European of the pattern of cell destruction in the spinal cord Pediatric Orthopedic Society. For his thesis on this subject, he He still found time to publish well over 100 was awarded an MD with distinction. The workload Orthopedics and Fractures, first published in was enormous, and as Holdsworth had limited 1971, which ran to three editions. The last of time to give to pediatrics, John Sharrard began to these was completed in 1993, after retirement, develop what was to become an internationally and required the review of 2,500 new papers on respected center for orthopedics at the Children’s the subject. His industry was awesome, his stamina In 1985, the University of Sheffield, rather prodigious, and his sense of time appalling. He belatedly, awarded him an associate needed little sleep and habitually worked until the professorship. New registrars were astonished to be It is not unusual for very high achievers to be telephoned at 2 or 3 a. He would, however, always to perform on the violin, organ, and particularly 305 Who’s Who in Orthopedics on the piano.

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Trademark Notice: Product or corporate names may be trademarks or registered trademarks order 40mg duloxetine otc, and are used only for identification and explanation without intent to infringe discount 60mg duloxetine free shipping. Library of Congress Cataloging-in-Publication Data Catalog record is available from the Library of Congress Visit the Taylor & Francis Web site at http :==www buy generic duloxetine 60mg on line. Landau–Kleffner Syndrome (LKS) and Epilepsy with Continuous Spike-Waves During Slow-Wave Sleep (CSWS) buy duloxetine 20mg fast delivery. Inflammatory Neuropathies: Guillan-Barre´ Syndrome (GBS) and Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP). Neurologic Complications of HIV Infection in Infants and Children 309 George K. Neuroleptic Malignant Syndrome, Serotonin Syndrome, and Malignant Hyperthermia. In part, our ulti- mate motivation was based on both the need for such a book and a desire to include the expertise of individuals who have had a role in the child neurology program at the Johns Hopkins Hospital. It is, therefore, with great pleasure that we note that multiple chapters have been written by individuals, both faculty members and resi- dents, with current or past ties to the program. The four editors, two senior faculty, one junior faculty, and a senior child neurology resident, have produced a text that we hope will be broadly acceptable to readers at all levels of experience. Lastly, we are proud to include a brief description of the history of the child neurology program at the Johns Hopkins University. We dedicate this book to the past leaders of the program, with special recognition to the first Director of the training program, Dr. Crawford Division of Child Neurology Johns Hopkins University School of Medicine, Baltimore, Maryland xvii xviii Preface HISTORY OF CHILD NEUROLOGY AT JOHNS HOPKINS HOSPITAL The Department of Neurology and its accompanying division of Child Neurology were formally established at Johns Hopkins in 1969. Before this time, there already existed a distinguished history of individuals with expertise in pediatric neurology, including such luminaries as William Osler, Frank Ford, and David Clark. William Osler was Chief of Medicine at the Johns Hopkins Hospital from 1889 to 1905. His contributions to internal medicine and neurology are legendary, but his research and case presentations on pediatric topics are often overlooked. His biblio- graphy contains publications on cerebral palsy, chorea, tics, muscular dystrophy, epilepsy, meningitis, and childhood migraine. Frank Ford was one of the earliest child neurologists in the United States. Ford was born and schooled in Baltimore and ultimately rose to be head of neurol- ogy at Johns Hopkins, a position he held from 1932 to 1958. Based in part on his observations at the Harriet Lane Home Outpatient Clinic and interest in neuroanat- omy and pathology, he was coauthor of a book entitled Birth Injuries of the Nervous System. Included in the section written by Ford was a description of developmental neurobiology, with an emphasis on perinatal birth injury. His second text on pedia- tric neurology, first published in 1937, was an encyclopedic 950 pages entitled Diseases of the Nervous System in Infancy, Childhood and Adolescence. David Clark received his medical degree from the University of Chicago and trained in medicine and neurology at Johns Hopkins. As one of Frank Ford’s stu- dents, he became an energetic, outstanding clinician and teacher, well known for his case analyses and virtuoso performances in case conferences. Clark left Hopkins in 1965 to become the chairman of the Department of Neurology at the University of Kentucky. In the 1950s there were seven neurology faculty members within the neurology division of the Department of Medicine, three in pediatric neurology (Frank Ford, David Clark, and John Menkes). Although the concept of establishing a separate Department of Neurology had been frequently discussed, the decision to create the department was not finalized until Vernon Mouncastle, who held a strong belief in the "science of the brain and behavior," convinced the then Director of Medicine A. Based, in part, on a recommendation by Robert Cooke, Chair of the Depart- ment of Pediatrics, Guy McKhann was selected as the first Neurology Department Chairman.

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Each firm has its own specialist registrar (SpR) discount duloxetine 60 mg mastercard, senior house officer (SHO) and/or pre- registration house officer (PRHO) purchase duloxetine 60mg without a prescription. In the case of a double firm there may be an SpR for each consultant and the SHO and PRHO work for both buy cheap duloxetine 30mg online. A firm usually runs from a group of specialist wards duloxetine 30mg sale,but nursing staff work for the ward and not the firm. The purpose of having specialist wards is to concentrate expertise in one field to one place in the hospital and therefore increase the excellence of care, as patients have faster access to specialist doctors, nurses and professionals allied to medicine (now called allied health professionals: see the chapter on ther- apists and professionals allied to medicine) and it has been shown that there are fewer clinical errors in these settings. This means that you are respon- sible for the organisation and day-to-day running of things. You must generate and 33 34 What They Didn’t Teach You at Medical School maintain an up-to-date patient list and generate and submit theatre lists as well as request, organise and get the results of in- and out-patient investigations. Nursing staff work for a ward and therefore care for patients under any firm regardless of speciality. However, as most wards have a particular speciality the bed and ward managers try to keep patients on the ward restricted to certain consultants. In times of bed crises it is not unusual to find your patients all over the hospital. This is often a source of much time wasting and frustration trying to hunt down patients admitted from the previous day’s take. If you have come in early and know where all the patients are, your consultant will be impressed by your diligence. Chief Executive Senior Managers Department Manager Site/Bed Manager Matron/Senior Sister Specialist Nurses Head of Department Sister Consultants Ward Clerk3 Secretaries Staff Nurse Specialist Registrar Research Fellow State Enrolled Nurse Senior House Officer Student Nurses Pre-reg House Officer Physician Assistants2 Medical Students1 Therapists/PAMs Key: Non-medical personnel Medical personnel Nursing personnel The Team 35 Figure 5. Medical students, depending on their year of study, are a valuable resource. Most can perform venepuncture, cannulation, clerk and, to a point, diag- nose. Not only can they be clinically useful, but they can help with organising meetings and often will learn more about the patients than junior doctors will as they have more time. As doctors will remember from being a student, patients often open up to and tell students their worries, as they do not wish‘to bother the doctor’. They can therefore provide useful clini- cal input into the management of the patients. All assistants are capable of taking blood and chasing scans/radiographs, etc. At the beginning of your post it is a good idea to sit down with your assistant (if you have one) and discuss their role. Should there be any- thing you think they could be doing that they do not already do then discuss it with them. More often than not they are willing to expand their role to give them more responsibility. Once you have established a good relationship, you will find it very valuable. Their job is to run the administrative side of the ward, ordering notes from medical records for elective patients, organising medical notes and filing investigation results, etc. Depending on which hospital you work in, some ward clerks organ- ise writing the basics on the to take away sheets (patient name, GP and admission dates), which will save you time. If you are borrowing notes and radiographs from the ward for meetings or referrals then the ward clerk is the person you should inform first so they can be booked out. Keep on the friendly side of these people, as you will regret making them angry – they can make your life on the ward hell if you are arrogant and obnoxious to them. KEY: Dark blue – non-medical personnel; mid blue – medical personnel; pale blue – nursing personnel. The answer is quite simple: consultants are rapidly losing their auton- omy and with the new consultant contract things are set to get worse. In the‘good old days’ consultants could generally dedicate their life to a field of their interest, com- bining both National Health Service and private work. Research was performed by the interested and most good senior doctors audited their own patient treatment outcomes. In recent years the amount of time spent doing useful clinical work has decreased and the amount of time spent doing managerial or political type work has increased.

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On his ship generic 60 mg duloxetine mastercard, continued with development of two major surgi- “The Jamaica Planter buy 60mg duloxetine with amex,” no one spoke French and cal exposures cheap duloxetine 40mg line, reduction techniques duloxetine 40mg visa, instruments all his personal belongings were confiscated until and implant designs used in every operating the boat arrived in Scotland 28 days later. Though there have studied for a year at the French Institute and been refinements over time and contributions by received his Premier Bacalaureat. After the war other authors in the field, Letournel’s original he left England for France, where he studied at description, diagnosis, classification and surgical the Lycee Chaptal and received his Second techniques have remained the ubiquitous standard Bacalaureat. He was admitted to the Faculty of of care of acetabular fractures for the past 25 Medicine of Paris from 1946 to 1960 and became years. His thesis published in 1961, a postgraduate position to continue his education. Etude d’une serie de 75 This process required the applicant to visit all cas,” contained the initial description of the clas- professors who were offering training positions. Pierre, Emile had no letters of Robert Judet and has achieved worldwide accept- support to compete adequately for an orthopedic ance. A friend suggested he contact Professor education in the understanding of the complex Robert Judet and he did this out of desperation nature of acetabular fractures. The major textbooks on acetabular surgery, all with meeting with Robert Judet was very brief. Professor Judet asked him where he and the third, Fractures of the Acetabulum in came from and Emile responded “St. The 6-month position lasted 12 months and found contributions to orthopedic surgery that Emile subsequently became Judet’s assistant. Professor Letournel to associate professor and finally professor in qualified uniquely for this honor as he was still 1970. He became head of the Department of alive when the commission was given to pay Orthopedic Surgery at the Centré Medico tribute to his life achievements in fracture surgery. Chirurgical de la Port de Choisy in southeast Unfortunately, he died 2 weeks before this journal Paris. He remained at the Choisy hospital until his was published with his dedication issue. In addition to his interest in acetabular and rugged and energetic and he lived life with great pelvic fractures, he performed over 6,000 total hip eagerness and excitement. His mere presence in arthroplasties, developed implant designs and sur- the operating theater created movement. As he gical techniques for management of calcaneal would scrub for surgery, his intensity to take on fractures and had extensive expertise in the sur- his worthy fracture adversary would bubble forth gical treatment of bone infection. His position at as he would review in his mind the preoperative Choisy provided him an unlimited exposure to plan of surgical approach and internal fixation. His distinctive vocal tal, and Professor Letournel never charged a commentary (always in French) on a particularly surgeon’s fee to any patient throughout his entire stubborn fragment reduction or repeated failed career at Choisy for his services. He was admit- surgical maneuver or the worthlessness of a par- ted to the French Academie de Medicine et ticular instrument to perform its function would Chirurgie in 1981 and received the “Legion create absolute silence from the operating theater d’Honneur” from President Mitterrand of France staff until a universal sigh of relief would resound in 1988. These honors were very special to Emile throughout the room when he was finally satisfied and were public recognition of his stature in with his reduction. Of special mention is Profes- French medicine and his accomplishments in the sor Letournel’s most trusted medical assistant, field of orthopedic trauma surgery. Following Remy Ser, who was the master of the Judet frac- his death, the elected officials of St. He could position any extremity on the Miquelon passed a resolution naming a street on fracture table into the desired position during the the island of his birth, “Emile Letournel. Remy Ser was an extremely dedicated who have been able to study with him at the professional and stayed with Emile for over 15 “Letournel School of Acetabular Surgery” gained years until the day he died. He was an integral tremendous insight into his diagnostic and surgi- part of the Letournel team perpetuating the cal acumen and the steadfastness with which he excellence that was the hallmark of Professor pursued every acetabular fracture to obtain “the Letournel’s surgery. He would continually Clinical Orthopedics and Related Research, ded- vocalize to himself all the possibilities and con- icated to Professor Letournel and his significant sequences of his technique while performing his contributions to orthopedic surgery. His genius had an enormous 193 Who’s Who in Orthopedics ability to comprehend spacial relationships, leading him to understand quickly the complexi- ties of a particular fracture and develop a plan of reduction based on his extensive experience.

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