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He retaining his team was to win the chair in adult and his second wife Christine enjoyed two homes purchase viagra vigour 800 mg fast delivery, orthopedics becoming vacant in 1948 at Hôpital one near Paris and another in Alicante: the dis- Cochin discount viagra vigour 800 mg visa, even though the accommodation in its tance between seemed not to matter buy 800mg viagra vigour. He won by a given him calm assistance with operations during very close margin order 800 mg viagra vigour with mastercard. Around this time—1950— the hurried retreat of 1940 and again years ample state funds became available for the plan- later at Cochin; now it was companionship discount 800 mg viagra vigour mastercard, ning and construction of a modern center, which whether sailing, tending their orange grove or in the event took 10 long years. Over this period of restraint, Robert gave The brain work was mainly literary. Robert enthusiastic support to the rapidly expanding already had six standard works to his part or French national society and to its renamed journal whole credit, with two more to complete. He also trav- he proudly fathered International Orthopedics, 85 Who’s Who in Orthopedics the journal of SICOT. Then he encouraged the He was responsible for the introduction of iodized board of La Revue to produce an edition in table salt. He also wrote two autobiographies, one made contributions to most branches of surgery. Merle d’Aubigné R (1982) Surfing the wave: fifty years in the growth of French orthopedic surgery. Paris, Edi- tions de la Table Ronde Jacques-Malthieu DELPECH 1777–1832 Jacques-Malthieu Delpech was born in Toulouse, where he began his medical studies at the age of 12 years under the aegis of Alexis Latrey, the uncle and first teacher of J. Returning to his studies, he was awarded a medical degree by the faculty of Montpellier in 1801. He continued his studies in Paris, where he divided his life into two parts: at night he worked to educate himself, and during Fritz De QUERVAIN the day he tutored other students to earn money 1868–1940 to live. His particular interests at this time were wound healing and scar tissue. In 1812, as the De Quervain was a most distinguished general result of a competitive examination, i. After studying at Berne, he Delpech’s first important publication1 dealt settled as a surgeon in the watch-making district with hospital gangrene, pourriture d’Hôpital, a of La Chaux-de-Fonds. After 8 years he returned condition with which he had had substantial expe- to the university as reader in surgery under rience both in the army and in civilian practice. Köcher, becoming involved in the enormous He was one of the first surgeons to point out the program of clinical and scientific work on goiter. To ensure that the exercises and tribution, the introduction of subcutaneous gymnastics would be performed freely but with tenotomy. The on club feet and of his own clinical experience, exercises consisted primarily of balancing and he concluded that by neutralizing the deforming climbing. Patients remained as residents in the force of the calf muscles by division of the program for 1 or 2 years. Although open tenotomy had been performed On October 29, 1832, Delpech7 was returning previously, it was Delpech who perfected the sub- to the institute from the city when he was shot by cutaneous operation. He performed the procedure a deranged patient on whom he had operated for for the first time on May 9, 1816. The bullet passed through his chest, examined the patient in 1836, observed that he destroying the arch of the aorta, and he died had a very satisfactory result. The coachman, supporting Delpech follow up this first success because of opposition in his arms, was also fatally shot. The galloped off with the carriage and delivered the procedure lay dormant until it was reintroduced bodies to the institute. Delpech was an innova- Delpech’s institute are the charming lithographs tive surgeon with wide interests in addition to in the atlas, depicting cheerful young people orthopedics, as evidenced by his report of a engaged in therapeutic exercises in a sylvan rhinoplasty. In 1828, Delpech published De l’orthomor- phie,5 a comprehensive work concerning defor- mities and diseases of bones and joints. These References two small volumes and the accompanying atlas volume, with its unique and beautiful illustra- 1. Delpech JM (1815) Memoire sur la Complication tions, mark the beginning of the modern era of des Plaies et des Ulceres Connue sous le Nom de orthopedics. Delpech JM (1816) Precis elementaire des maladies school” in Montpellier is but one of its many reputees chirurgicales. Delpech JM (1823–1828) Chirurgie clinique de strongly by the British physicians Edward H. Delpech JM (1824) Rhinoplastic operation per- Ward, who had written about the treatment of formed with success at the Hôpital St. Reprinted in Plast however, of being the first to establish the true Reconstr Surg 44:285, 1969 5.

A trephine would a certain number of years generic viagra vigour 800mg fast delivery, indeed buy discount viagra vigour 800 mg online, the pain never have made an opening in the tibia buy viagra vigour 800mg with mastercard, and have let out the entirely subsides generic viagra vigour 800 mg with visa, but still it varies order viagra vigour 800 mg fast delivery, and there are matter. It would have been merely applying the treat- periods of abatement and of exacerbation. You open a painful abscess of the arm with a He gave details of patients with similar signs lancet: you cannot open an abscess of the bone with a successfully treated by bone trephining. He suffered a Brodie’s Tumor great deal of pain, the part was very tender, and there were all the symptoms of chronic periostitis. I made an incision over the part, dividing everything down to the The lectures dealing with tumor of the breast are reported in the Medical Times for 1844. There was a new deposit of bone under the periosteum, softer than the bone of original formation. This opera- In the present lecture I shall make some observations tion, as in other cases of chronic periostitis, relieved the on the diseases of the breast, no very clear description tension and the pain, and the patient was supposed to having been given of them, although of common occur- be cured. The disease to which I shall particularly refer 1827, there was a recurrence of the pain; the enlarge- today is one of considerable interest; especially so ment of the tibia, which had in some degree subsided, because it is quite different from carcinoma with which returned, and it continued to increase. It is not met within tibia there was one spot a little below the knee where hospital practice, but very often shows itself in private there was exceeding tenderness on pressure. I need not life, and unless I had not had the advantage of seeing describe the symptoms more particularly; it is sufficient a large number of private patients, I should not have to say that they bore a very close resemblance to those been able to make out its symptoms and history, as I in the last case; the only difference being that, as the believe I now can... Alady consulted me who had one disease had been of shorter duration, the pain was less of these tumours in her breast, about the size of a severe, and that the tibia was affected in the upper walnut; I punctured it with a needle first and, finding it instead of the lower extremity. I concluded that there contained serum, I laid it open with a lancet; a large must be an abscess in the centre of the bone, and quantity of fluid escaped. I used the the bottom, meaning to bring on inflammation: a good common trephine made for injuries of the head, which, deal of suppuration followed, and the wound was two having a projecting rim or shoulder, would only pene- months before it healed, and then the disease was trate to a certain depth. About a year after this the remove a piece of bone of sufficient thickness to expose patient came to me again, and I found, where I had the cancellous structure. Then with a chisel I removed opened the cyst, a fungous tumour as large as the cyst some more of the bone. I recommended her to have pus in such quantity as completely to fill the opening the breast amputated; the operation was performed, and made by the trephine and the chisel. It seemed as if the we found it to be entirely made up of cysts containing bone had been to a certain extent kept on the stretch by fluid matter, and one of a large size as represented in the abscess and that, as soon as an opening was made the drawing on the table. From the inner surface of this into it, it contracted and forced up the matter. The cyst there projected a solid tumour, which appeared to patient was well from that time; the wound healing very be made up of numerous folds giving it a plicated favourably, and he has never had any return of the appearance, covered by membranes continuous with disease... When the tibia is enlarged from a deposit that lining the cyst; and when cut into, it looked like of bone externally—when there is excessive pain, such very slightly organized fibrine... The disease, as I as may be supposed to depend on extreme tension, the have said before; is not cancerous; but still it should pain being aggravated at intervals, and these symptoms be removed; because if allowed to remain, the local continue and become aggravated, not yielding to med- irritation will destroy the life of the patient; and if icines or other treatment that may be had recourse to— removed, it will not return. If you operate at all, you then you may reasonably suspect the existence of must remove the whole of the breast, for it is no use abscess in the centre of the bone. It is better to perform the suppose, that there is no abscess because the pain is not operation whilst the tumour is small; nevertheless you 44 Who’s Who in Orthopedics are not to be deterred by its magnitude, because it is reached the climax of his career when he was not in this disease as in carcinoma; there is, in fact, no elected President of the Royal Society, a position danger: and I have seen a great many cases where the he filled with dignity and distinction. It was par- operation has been performed and the disease has never ticularly gratifying to him that his heir occupied returned... I have given no name to this affection the chair of the Chemical Society at the same time because I think, it is an error of modern times to be con- and that he had previously been awarded the tinually giving new names to diseases, but if it must have a name, I think it should be called sero-cystic Royal Medal of the Royal Society. In his last years Brodie wrote a short work on metaphysics entitled Psychological Inquiries. It bears the influence of Berkeley and is cast in the Interest in Medical Education form of a dialogue; it first appeared in 1854 and passed through four editions. He treats the ques- Next to his interest in diseases of joints, Brodie tion of the existence and creative energy of God gave a good deal of attention to maladies of the as settled and teaches that mind and matter are urinary system. In pre-antiseptic days, lithotomy different in their nature, so that mental phenom- was not without serious risks; to avoid them ena cannot be regarded as the product of material Civiale introduced lithotrity.

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Primary documents would include casenote folders buy cheap viagra vigour 800 mg online, client identifica­ tion information generic 800mg viagra vigour amex, admission sheets buy 800mg viagra vigour with amex, referral letters purchase 800mg viagra vigour amex, case history sheets cheap 800 mg viagra vigour, as­ sessment or examination information, progress notes, operation sheets, nursing careplans, therapy notes, reports and anaesthetic sheets. THE LEGAL FRAMEWORK 41 Primary documents have to be retained for a legal minimum period (NHS Executive 1999): ° Maternity records must be kept for 25 years. In cases where a child has died before they are 18, the records must be retained for eight years after the death. The conclusion of treatment includes all follow-up checks and actions in connection with that treatment. Recommended minimum retention periods for GP records are similar ex­ cept for: ° Records relating to personnel serving in HM Armed Forces or persons serving a prison sentence are not to be destroyed (NHS Executive 1998). Secondary documents (for example x-rays and drug sheets) and transitory documents (for example blood pressure charts) are retained for periods of time determined by locally agreed policies. For instance, diaries, annual leave requests and job descriptions are just some of the documents covered by the regulations. Health professionals are responsible for the records they create and use, but the NHS Trust or health authority usually has ownership and copyright of these records. They should be told about their choice in deciding with whom information may be shared. These clinical notes are essential for ensuring the delivery of appropriate and effective care. They will contain information on investigations, diagnosis, care and intervention. A complete record will also include the views of the client and family in addition to those of the health professional. There will be an account of the client’s and the family’s understanding of and reaction to the present­ ing problem. It will also give a description of their wishes, responses to and participation in the delivery of care and treatment. Record keeping skills Health professionals are personally accountable for what they have written in health records. With the increase in litigation it is more important than ever that clinicians ensure that records are complete and comprehensive. For instance, records are one way that competent practice may be demon­ strated when a client has complained (Fisher 2001). Record keeping skills must therefore be seen as an essential clinical skill. The ability to record, interpret and disseminate written information about a client, like any other clinical skill, is essential. Record keeping skills must: ° form a fundamental component of pre-qualification training ° be considered part of professional development and undergo the same scrutiny as other clinical skills and knowledge 43 44 WRITING SKILLS IN PRACTICE ° be considered one of the essential elements of clinical practice and therefore be regularly reviewed by the reflective practitioner ° be included in clinical audit so that standards of recording are not only maintained but also areas for improvement are identified ° be regularly updated to take into account the rapid changes in information management and the introduction of new technologies. Advice is offered about record keeping by various professional bodies, and is often set down as standards to which members are expected to adhere. Employers also have a statutory duty under the Health Act (1999) to monitor and improve the quality of health care. This would include audit­ ing the standard of record keeping on a regular basis to ensure that the quality of information management is maintained (Dimond 2000). It is therefore essential that clinicians familiarise themselves with the requirements of both the association representing their particular disci­ pline and their employers. It is recognised as good practice to record every contact with the client. A direct contact means any face-to-face interaction with the client, such as carrying out a test or providing treatment. An indirect contact relates to any actions you carry out that are related to meeting the needs of a specific client. This might be liaison, advising family and carers or attending meetings such as case conferences. It would also in­ clude recording indirect contacts initiated by other professionals, for ex­ ample receiving a telephone call regarding one of your clients.

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