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H. Dudley. Salem International University.

HOW TO BE AN ETHICAL RESEARCHER/ 149 EXAMPLE 14: STEVE It was the first project I’d ever done cheap aurogra 100 mg without prescription. I wanted to find out about a new workers’ education scheme in a car factory generic aurogra 100 mg visa. One of my tutors knew someone in charge of the scheme and that person arranged for me to hold a focus group in the factory cheap aurogra 100 mg fast delivery. This meant that the person in charge of the scheme chose the people for the focus group buy 100mg aurogra amex. I was really pleased because it meant I didn’t have to do a lot of work getting people to come buy aurogra 100 mg with visa. Of course I soon found out that he’d chosen these people for a particular rea- son, and he’d actually told them that they had to attend, that there was no choice involved. When I turned up to hold the group, no one had been told who I was and what they were doing there. When I started to introduce myself some of the workers looked a bit uneasy and others just looked plain defiant. It was only after the group that I spoke to someone who said that they’d all thought I was a ‘spy’ for the company and that some had decided to give the ‘company line’ on what the scheme was all about, whereas others had decided not to say anything. She said that really they didn’t believe a lot of what had been said, but none of them dared say anything different as they thought I was going to go straight to management with the results. I felt that the information I collected wasn’t very useful in terms of my research, but it was useful in terms of getting an idea about employer-employee relations. If you are relying on someone else to find participants for you, it is important that you make sure that that person 150 / PRACTICAL RESEARCH METHODS knows who you are and what you’re doing and that this in- formation is then passed on to everyone else. A useful way to do this is to produce a leaflet which can be given to any- one who might be thinking about taking part in your re- search. This leaflet should contain the following information: X Details of who you are (student and course or employ- ee and position). X Information about who has commissioned/funded the research, if relevant. X Information about the personal benefits to be gained by taking part in the project. This section is optional, but I find it helps to show that people will gain person- ally in some way by taking part in the research. You might offer further informa- tion about something in which they are interested, or you might offer them a copy of the final report. Some consumer research companies offer entry into a prize draw or vouchers for local shops and restaurants. CODE OF ETHICS Once you have been open and honest about what you are doing and people have agreed to take part in the research, it is useful to provide them with a Code of Ethics. The best time to do this is just before they take part in a focus HOW TO BE AN ETHICAL RESEARCHER/ 151 group or interview, or just before they fill in your ques- tionnaire. The Code of Ethics supplies them with details about what you intend to do with the information they give and it shows that you intend to treat both them and the information with respect and honesty. It covers the following issues: X Anonymity: you need to show that you are taking steps to ensure that what participants have said cannot be traced back to them when the final report is produced. How are you going to make sure it is not easily accessible to anyone with unscrupulous intentions? If not, how will you ensure that what someone says cannot be used against them in the fu- ture? However, you must be careful not to make pro- mises that you cannot keep. X Confidentiality: you need to show that information sup- plied to you in confidence will not be disclosed directly to third parties. If the information is supplied in a group setting, issues of confidentiality should be rele- vant to the whole group who should also agree not to disclose information directly to third parties. You need to think about how you’re going to categorise and store the information so that it cannot fall into un- scrupulous hands. Again, you need to make sure that you do not make promises which you can’t keep.

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There have been several authors order aurogra 100 mg, including Brandsson order aurogra 100mg line, who have reported positive results of ACL reconstruction in patients more than 40 years of age buy cheap aurogra 100 mg on line. Remember that the patellar tendon graft is for the surgeon 100 mg aurogra free shipping, and the semitendinosus graft is for the patient order aurogra 100mg mastercard. Immature Athlete Anterior cruciate ligament injuries in skeletally immature adolescents are being diagnosed with increasing frequency. Nonoperative manage- ment of midsubstance ACL injuries in adolescent athletes frequently results in a high incidence of giving-way episodes, recurrent meniscal tears, and early onset of osteoarthritis. In the past, the protocol has been to recommend conservative treatment until the growth plates have closed. Shelbourne has reported that an intra-articular ACL recon- struction (using the central 10-mm patellar tendon graft) in young athletes approaching skeletal maturity provides predictable excellent knee stability, and the athletes are able to return to competitive sports with a decreased risk of recurrent meniscal and/or chondral injury. The latter are treated in the usual fashion; the former are a treatment dilemma. The concern about ACL recon- struction in the athlete with open growth plates is that there will be premature fusion of the plate, growth arrest, and potential for angular deformities. DeLee and others have recommended procedures that avoid crossing the growth plates with tunnels. This type of procedure and other extra-articular operations, however, achieve less than satis- factory stability. Stadelmaier, Arnoczsky, and others have shown in the laboratory that a tunnel drilled centrally across the growth plate and filled with a tendon does not cause growth arrest of the epiphyseal plate. Based on this basic research, several clinicians have reported on a series of young patients with small central tunnels placed through both the femur and tibia and the semitendinosus graft. The tunnels are drilled centrally through the epiphysis and fixed with a button on the periosteal surface. Treatment Options for ACL Injuries The two options to consider with the nine-year-old patient who tears his ACL is restriction of activity and the use of a brace until skeletal maturity. Then consider an intra-articular reconstruction versus an early reconstruction using the semitendinosus graft and button fixation. ACL/MCL Injuries The management of the combined ACL/MCL injury is controversial. This is a common injury seen among skiers who catch an inside edge and externally rotate the knee. Shelbourne has advocated initial con- servative treatment of the MCL, followed by ACL reconstruction as indicated. Our current protocol at the Sports Medicine Clinic is to treat the MCL with an extension splint, or brace, until it is stable. Then the patient works to regain range of motion and strength, after which recon- struction of the ACL, if necessary, can be performed. After the medial collateral ligament heals, the degree of partial healing of the ACL is usually sufficiently stable for recreational activities. The dilemma occurs when there is residual laxity of both the MCL and the ACL. In this situation, the patient will have significant symp- toms with pivotal activity. The treatment is a custom-made functional brace with double upright support. If there are still instability symptoms, reconstruction of the ACL must be performed. The course of the ligament may be picked with an awl to produce bleeding and microfracture of the ligament attachment. The attachment site of the MCL on the femur may be removed with an osteotomy and countersunk into the femur about 1cm to shorten the ligament. The posterior capsule is plicated to this post of retensioned liga- ment. In severe cases of laxity, the ligament is shortened and reinforced with an autograft or allograft of semitendinosus. A brace must be used in the postoperative protocol to protect this MCL reconstruction for a prolonged period. Osteoarthritis and the ACL Deficient Knee There are three clinical presentations with combined ACL laxity and medial compartment osteoarthritis.

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He was disap- tility of the learned in the seventeenth and eigh- pointed when his efforts to start a medical school teenth centuries generic aurogra 100 mg with visa. Over the portal of the old were frustrated discount aurogra 100mg with mastercard, but he was gratified to see the first medical school at Bart’s is inscribed “Whatsoever postgraduate institute in the country without an thy hand findeth to do generic aurogra 100 mg overnight delivery, do it with thy might discount aurogra 100 mg on-line. He dis- He exhibited a flair for the mechanical aspects played the highest standards and expected these of orthopedics and prosthetics aurogra 100 mg fast delivery. Suter he set up a superb splint shop and de- ing and the greatest possible interest in their vised the “lively” splints for physiological control, careers. Thus he became one of the few surgeons which he applied so effectively to the hand. His outstanding he found time to interest himself in medical qualities were honesty, steadfastness and good- history and art. Devon and Exeter Medico-Chirurgical Society, he His first wife, by whom he had one son and organized an exhibition of books, documents and three daughters, was an invalid for many years pictures from the Exeter Medical Library and the before her death in 1970. Thereafter he married Exeter Cathedral Library, which will never be for- Miss Elsa Batstone, a former orthopedic after- gotten. He was interested in amateur theatricals, care sister, who gave him great happiness and and for many years staged the annual Christmas tended him most lovingly and skillfully during his show, at which he was able to display his consid- last illness. Barbara Hepworth instructed him in modern sculpture and those who visited Haldon Grange when the British Orthopedic Association met in My first meeting with Norman Capener was in Exeter in 1959 will remember his exhibits in the 1939 when I was a house surgeon at Oswestry, gardens. Later he held an exhibition of his work and I arrived at breakfast to find him sitting there, under the pseudonym of “Noel Caerne” at the having driven up from Devon during the night in Exeter Museum. Although most of his recreations his Bentley—in which he used to commute regu- were intellectual, for many years he was an active larly to London for orthopedic meetings. He was a most one of the pioneer units in this country, had been remarkable man, one might almost say a phe- in existence for 4 years. It had only 48 beds for nomenon, and it has been a privilege and an unfor- children and not more than twice that number of gettable experience to have worked with him. The staff was small, and being single-handed with no house surgeon or radiographer, he had to be versatile. While Norman Capener was known internation- Apart from his orthopedic activities, Norman ally and tributes to his life and work will come Capener will rank as perhaps the most famous of from the whole world, it is perhaps not generally Exeter’s surgeons. His only rivals are John known that he had a particular interest in, and is Sheldon (1752–1808), who was also a member of owed a special debt by, Northern Ireland. Norman the setting-up of the Council for Orthopedic also pursued these two aims, for he was an enthu- Development and the Orthopedic Service in the siastic teacher and was one of those concerned in 1940s. He subsequently visited the Province on 55 Who’s Who in Orthopedics numerous occasions, always stimulating, encour- In Italy, he met Heneage Ogilvie who became aging and advising. He was, thus, a founder member ment of a modern orthopedic hospital on the of the surgical travelers, a club formed by Sir Musgrave Park site eventually culminated in the Heneage Ogilvie shortly after the war, and as a building of the Withers Orthopaedic Centre. His member of the club he visited most of the leading well-known work on tuberculosis of the spine surgical centers in Europe during the years greatly influenced the treatment of this condition, between the two wars. He encour- In his younger days he practiced as a general aged, indeed arranged for, young surgeons to go surgeon, but perhaps owing to his war experience to the Princess Elizabeth Orthopaedic Hospital he always took a special interest in traumatic and for further specialist training and always took a fracture surgery. He held the position of Profes- most helpful and abiding interest in their careers. Those who had the privilege of working with him will always remember the many truths he passed on to them, based always on sound common sense. He was Vice President of the British Orthopaedic Association in 1954–1955. He was Honorary Surgeon to three of the leading racecourses in Ireland and took a personal interest in the treatment of any injured jockey who came under his care. He was always happy entertaining his friends in his lovely Georgian house in Merrion Square and was a charming host. Arthur Chance died on June 24, 1980, in his 91st year, after a long illness borne with much fortitude. He was survived by his wife, Harriett, who nursed him devotedly during his long years of incapacity and by his only child, Gillian. He was a son of Sir Arthur Chance, a well-known Dublin surgeon, who was President of the Royal College of Surgeons in Ireland in his day. Arthur Chance was educated at Clongowes Wood College and Trinity College, Dublin, qual- ifying in 1912. Within 3 years he had obtained his MD and MCh degrees and also his Fellowship of the Royal Colleges of both Ireland and England.

Like scholars of the Talmud effective 100 mg aurogra, the rabbinate of the sexual health establishment finds fruitful employment in tutoring the faithful in the subtleties of the classification and in offering endless interpretations and reinterpretations of the sacred text purchase 100 mg aurogra with visa. Those who stray from the path of righteousness—such as the HIV positive woman discovered 120 THE PERSONAL IS THE MEDICAL in the summer of 1999 to be breastfeeding her baby (a behaviour of indeterminate risk)—are likely to find themselves smitten with the full force of the law discount 100 mg aurogra with visa, not to mention the wrath of the media order aurogra 100 mg. It is interesting to contrast the process of medicalisation of sex that is taking place today with that in the late nineteenth century buy aurogra 100 mg lowest price. One of the insights of the French philosopher Michel Foucault was that the apparent liberalisation associated with the sexual reformers of the late Victorian period was illusory. By identifying and classifying diverse forms of sexual experience, they merely replaced a traditional mode of moral regulation with a modern, rational, professionally-mediated form of surveillance and control (Foucault 1979). The ‘repeal of reticence’ led to the displacement of the priest by the doctor, whose supervision was more thorough. Yet the resulting ‘revolution in manners and morals’ remained largely confined to the elite of society, in Britain scarcely extending beyond the Bloomsbury set. The distinctive feature of the current phase of medicalisation is that it reaches out to the whole of society and penetrates more deeply into the individual personality. When Foucault commented on the replacement of ‘silence’ with ‘volubil- ity’ about sex in the 1890s, he can scarcely have anticipated the combined effect of contemporary television discussions about sex and an encounter with a family GP after a ‘sexuality training day’. Reticence may be in shreds, but this has been achieved at the cost of the intrusion of the doctor into the bedroom and the transformation of the doctor’s surgery into a confessional. Domestic violence There has been some controversy among medical authorities concerned with the problem of domestic violence about whether or not all patients should be asked, as a matter of routine, whether they are currently experiencing any form of assault from their partner (BMA 1998). If women are asked about domestic violence only if they come in with a black eye, then many instances of abuse, which may leave less conspicuous but no less profound injuries, may go unrecorded. If, on the other hand, all women are asked routinely, then this reduces the stigma surrounding the whole issue and makes it easier for them to disclose the nature and extent of their victimhood. Such direct questioning may, however, upset some women who only came to see their doctor with a sore throat or a verruca. Still, they are clearly hopeful that a growing awareness of domestic violence will make routine questioning about intimate aspects of women’s private lives more widely acceptable. Domestic violence suddenly became a major preoccupation of the health establishment in the late 1990s. In addition to the BMA book, the Royal College of Obstetrics and Gynaecology and the Royal College of Midwives both issued statements on the subject (Bewley et al. The Chief Medical Officer highlighted domestic violence in his 1996 report and in 1999 the Royal College of General Practioners circulated guidelines on ‘the GP’s role’ (DoH 1997; Heath 1999). All these publications sought to raise awareness of domestic violence among health professionals and to encourage a more interventionist, pro-active approach to the problem. Discussing this matter with my GP colleagues, who are mainly women, I inquired whether they had noticed a recent upsurge in domestic violence. But no; like me, they had certainly encountered the occasional case, but thought it not a very common problem and had not noted any particular increase. Of course, our low recognition of domestic violence may be a result of our limited conception of the problem, which has been radically redefined by campaigners. Following current conventions, the BMA distinguishes three types of domestic violence: physical, sexual and psychological. The latter category includes criticism, verbal abuse and ‘being forced to do menial/trivial tasks’ as well as humiliation and degradation, extreme jealousy/possessiveness and ‘being made to think they are going mad’. Using this definition the final estimate of prevalence is that ‘one in four women will experience domestic violence at some time in their lives’. The ‘one in four’ statistic is repeated in all the recent reports and it echoes around any lecture theatre or conference hall in which domestic violence is discussed. It is worth examining one of the key sources of this figure, which is referenced in all current handbooks and guidelines—a major survey of domestic violence in North London, conducted under the aegis of Middlesex University and Islington Council (Mooney 1993). The study adopted a definition of domestic violence, similar to that of the BMA, as conduct including ‘mental cruelty, threats, sexual abuse, physical violence and any 122 THE PERSONAL IS THE MEDICAL other form of controlling behaviour’ (Mooney 1993:8). The team of researchers conducting the interviews were ‘all chosen for their understanding of and commitment to the problem of domestic violence’ and given ‘intensive training’ (Mooney 1993:10).

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