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At that time journal having a nationwide circulation mood disorder 29690 symptoms discount bupropion 150 mg mastercard, and the neither the profession nor the public looked with new editor recognized this depression symptoms speech generic 150 mg bupropion mastercard. Early in his adminis- much favor upon specialization economic depression definition pdf purchase bupropion overnight, and in certain tration an advisory editorial staff was organized. The next step was the appointment of a group As more and more men became interested of foreign editors who kept Dr. Brackett informed in the problems of orthopedic surgeons, their about the development of the specialty in their distribution over the USA and Canada became countries, from time to time sending in reports more general; and, during the earlier years, the of meetings and papers by their colleagues. This policy was advocated by publication could be a real factor in the develop- 36 Who’s Who in Orthopedics ment of better understanding and closer coopera- His intimate acquaintance with the member- tion between nations. It was, therefore, a special ship of the Association for so many consecutive satisfaction to him when contributions began to years made it possible for him to be of the great- come from representative surgeons in different est assistance to younger men sending in papers countries, many of them men he had met person- for publication. From the to have the papers he thought worthy of publica- correspondence with these foreign contributors tion brought up to the standard he had set. Brackett became Editor, the total list be present at orthopedic congresses in France, of subscribers numbered 797. At the time of his Belgium, Italy, Germany, Czecho-Slovakia, and death, the number of paid subscriptions was over Switzerland. During the 20 years of his editorship, the that came from these contacts was his visit to budget of the Journal was increased eightfold. Leningrad in the summer of 1936, when he had The realization of some of his aspirations for the opportunity of meeting Prof. Henry Turner, the Journal has come through the broadening of with whom a warm friendship had developed the field of its usefulness, as shown by the fact through years of correspondence, and of seeing that there has been a steady increase in the the remarkable work for crippled children that number of foreign, as well as domestic, sub- had resulted from the labors of this pioneer, a man scribers. At the end of 1939 (the beginning of the of British parentage who had devoted his life to war), the Journal was being mailed regularly to the development of orthopedic surgery in Russia. Brackett had with the officials of the USSR Society for Cul- charge of the Journal, he provided office space in tural Relations with Foreign Countries, through his own house. He never received salary for his whose interest many of the contacts of the work, and at the time the Association made the Journal with Soviet publications had been made first attempt to show their appreciation of his possible. This sum was set up by over the standard of the papers presented at the the Association as the Elliott G. Brackett Endow- annual meetings, and the creation of a Board of ment Fund. Since the appointment of the a second attempt was made by the Association to latter, all papers have been submitted to this body, show their esteem, and a large number of letters and gradually the editor impressed upon them his were written to him, and a gift was made with the ideals and standards for a journal. No one not intimately associated with and to the Association, he found time to serve his him has any idea how much time and thought he community in its hospitals and in promoting gave to it. To him it was not merely a rostrum many movements to aid the physically handi- from which an author might exploit his ideas. He was identified with various Boston must present something that was new, or at least, hospitals, in his early years at the House of the if not wholly new, it must be presented in a better Good Samaritan, later as orthopedic surgeon at form than ever before. In 1911 he became chief the writers that brevity should be an accompani- of the orthopedic service at the Massachusetts ment of clarity in expression, and that it was a General Hospital and continued in that position mistake to rush into print before sufficient time until 1918, when he resigned to go into war had elapsed for a definite opinion to be formed as service. At the time of his death he was orthope- to the soundness of any position taken. His study of club feet July, 1898, he was sent to Cuba as representative published 60 years ago might well be used today of the Massachusetts Volunteer Aid Association. Besides his His assignment was to receive supplies sent on great technical contributions, particularly to the hospital ships and to determine the needs of the treatment of tuberculous coxitis and of congeni- men. His first concern was for the sick among our tal hip disease, he introduced the “social point of troops ready to be evacuated to the United States view” into orthopedic surgery by helping found and he made provision for their care on transports. His amazing Answering the call of his country in World War industry is attested by the publication between I, he was largely responsible for the training of 1887 and 1902 of 105 original papers, a textbook, the orthopedic personnel and for the determina- and numerous articles on orthopedic progress in tion of where they should be located after their the Boston Medical and Surgical Journal. He himself, eventually, was sent overseas, returning with the rank of Colonel.

Formal letters refer to correspondence that has an official or business function bipolar depression 6 quarters purchase bupropion 150 mg with visa. They are printed or typed on headed paper using a conventional style of composition depression thesaurus discount bupropion 150mg line. The manner of address is formal rather than personal depression test after baby purchase 150mg bupropion overnight delivery, so the preferred title and last name of the recipient is used to start the letter. They are signed off with the name, position, title and qualifications of the letter writer. Informal letters are written using a more conversational tone and are sent between two people who know each other. Letters are only one of the means of communication available to the health professional; however, they have certain advantages over other methods. Choose a letter if you want to: ° present complex information and elaborate on ideas ° have time to organise your thoughts and review your intended message ° have a confidential means to convey information 71 72 WRITING SKILLS IN PRACTICE ° indicate to the recipient the seriousness of the matter under discussion. Sometimes a letter is not always the most appropriate or most sensitive choice of communication. If your message: Consider using: is urgent e-mail, fax, telephone is an apology telephone, face-to-face contact requires explanation face-to-face contact, telephone is informal, brief or a reminder e-mail, memo requires discussion or exchange meeting, of ideas or involves decision making video or telephone conferencing. Structure of letters Letters consist of: ° a greeting ° an introduction ° the main body ° the conclusion ° a closing sentence ° a signature. Greetings The way in which you address the recipient will depend on whether you are writing a formal or informal letter. In certain circumstances a more gen­ eral term like ‘client’ or ‘parent’ may be permissible in letters sent en masse or if you are unable to verify the recipient’s name. Introduction The first paragraph will state clearly the reason or purpose for writing. LETTERS AND REPORTS 73 The following examples show how the use of some pertinent details (including the date) helps the writer indicate the topic or subject of the message to the reader. In response to a letter or other type of contact – ‘Thank you for your letter dated … regarding …’ or ‘Thank you for your phone call on the … I am sorry I was not available to speak to you personally’; ‘I am writing to you regarding your enquiry on the … about the waiting list for day sur­ gery. I would like to find out whether it would be possible to install a barrier that will restrict access to staff mem­ bers. For example, referral let­ ters usually start with a sentence like: ‘Thank you for seeing this elderly gen­ tleman who has been complaining of chest pains for the last three days. Conclusion The content of the conclusion will vary according to the purpose of the letter. It may include a summary, recommendations, request for action or a statement of what is expected from the recipient. Closing sentence A letter is usually brought to an end by the use of a closing sentence. For example, ‘I look forward to hearing from you’, ‘Please do not hesitate to contact me if you need further information’ or ‘Thank you for your assis­ tance in this matter. Signature Letters must always be signed, as they may be required as evidence in the event of a complaint or litigation. The signature shows that the health pro­ fessional, or another person authorised to do so in his or her absence, has checked the letter and agreed the content. Formal letters require the signa­ 74 WRITING SKILLS IN PRACTICE ture to be accompanied by the title, position and in some cases the qualifi­ cations of the letter writer. The subscription accompanying the signature will depend on the form of address used in the greeting. A letter starting with ‘Dear Sir/Madam’ will end with ‘Yours faithfully’, whereas one starting with the first name, or title and last name, will end with ‘Yours sincerely’. Layout and format of a letter Letters are set out according to a standard format. Remember: ° Keep text well spaced with the left-hand margin aligned with the start of the recipient’s address. Include the name and address of where to return the slip, what it refers to (for example ‘diabetes clinic’) and any client identification information.

Parents typically have many questions about this diagnosis anxiety for dummies buy discount bupropion 150 mg online, and time is needed to answer them mood disorder nos 504 plan best bupropion 150mg. However anxiety panic disorder buy discount bupropion line, this discussion is difficult in the busy emergency room at a time when the parents are very upset. Referring them to the author’s book about seizures (written for par- ents) is often very helpful. The AAP’s guidelines for the evaluation of febrile seizures are for neurologically healthy children between 6 months and 5 years of age who have had a single febrile seizure. The author recommends an identical evaluation for those children who have prior neurological impairment. Nonfebrile Seizures Nonfebrile seizures are also common in children and may be partial (simple or com- plex) or generalized—tonic, clonic, or both. The hallmark of nonfebrile seizures is an alteration of motor or sensory function or of awareness in a child who does not have a fever. However, fevers may trigger nonfebrile seizures by lowering the child’s seizure threshold. Since the physician is unlikely to treat a child after either a first febrile seizure or a nonfebrile seizure triggered by fever, the distinction between the two after a first episode is neither possible nor important. Practice parameters have also been issued for the evaluation of nonfebrile seizures in children. Evaluation after a First Nonfebrile Seizure Recommendations for the evaluation of a child after a first nonfebrile seizure have recently been published by the Quality Standards Subcommittee of the American Academy of Neurology, the Child Neurology Society, and the American Epilepsy Society. A careful history, phy- sical and neurological examination should always be performed. As discussed above, a careful history can, with great reliability, differentiate a seizure from other parox- ysmal events. Routine laboratory screening with blood counts, glucose, electrolytes, calcium, etc. But not by author Blood studies Based on history Imaging Sometimes based Unless on history emergency preferable Counseling of parents X Evaluation of a Child with Seizure 59 clinical findings make the physician suspicious of an ongoing or underlying process. Magnetic resonance imaging (MRI) is always preferable to computerized axial tomography (CT scan). Although MRIs are more sensitive, they are rarely rapidly available or necessary after a first episode. If the child has a ‘‘high risk’’ condition such as recent trauma with other neurological findings, sickle cell disease, or a bleeding disorder or if a focal seizure occurred in a child less than 33 months of age, an emergent CT scan may be indicated. The Subcommittee also recommends an EEG as part of the initial evaluation of a nonfebrile seizure ‘‘to determine the epilepsy syndrome, determine the need for imaging, and for predicting the prognosis. He believes that these factors are unimportant after a first seizure since they do not reliably diagnose a syndrome nor predict prognosis. Thus, the emergency room evaluation for both febrile seizures and nonfebrile seizures need only be minimal. The EEGs are not needed after a febrile seizure, and probably will not be help- ful after a nonfebrile seizure. In every child a good history and physical as well as neurological examination are mandatory. The use of testing should be reserved for the unusual child with a suspicious history or physical examination. Management after a First Episode Although the guidelines for the evaluation of febrile and nonfebrile seizure differ, there is general agreement that no medication is needed after the first seizure of either type. However, a discussion and explanation of what happened and its meaning are always needed to calm the parent’s fears and misconceptions. Most first seizures will not recur with or without medication and this should be emphasized. Generalized tonic–clonic sei- zures are often associated with some tonic contractions of the chest and some cyano- sis. Observers often believe that the child will swallow her tongue, die, or suffer brain damage because of the lack of oxygen. None of these statements are true, but the medical system must explain that truth to the panic-stricken parents at the time the child is first seen. The parents were just as frightened as if it had been a seizure since they believed that it was a seizure and need just as much reassurance. The appropriate work-up should be done if necessary but the parents can be reas- sured, regardless of the nature of the event.

Harris left the Hospital for Sick Chil- dren to join the staff of the Toronto General Hospital anxiety nursing diagnosis purchase bupropion pills in toronto. Though at first continuing to be a general surgeon mood disorder unspecified icd 9 discount bupropion 150 mg line, his interest continued to lie in the field of orthopedics and he increasingly confined himself to its practice depression symptoms questions safe 150 mg bupropion. When, in 1940, a Division of Orthopedic Surgery was established in the Toronto General Hospital, Dr. Harris that, on Robert Inkerman HARRIS the advent of the Second World War, he should 1889–1966 enlist in the Royal Canadian Army Medical Corps. With the rank of colonel, he served at Robert Inkerman Harris was born in Toronto on home and overseas as a surgical consultant to the July 1, 1889. His brilliance as a student soon became manifold commitments, he found time during his apparent at the University of Toronto, where he service to compile his classic work The Canadian was elected a member of the honorary medical Army Foot Survey. He was mentioned in dent of both the American and Canadian Ortho- despatches, and awarded the Military Cross pedic Associations on the occasion of the first twice, before being wounded and invalided home combined meeting of the Orthopedic surgeons of in 1917. It was at this meeting After the war, he was appointed to the staff of that he established one of the greatest advances in the Sick Children’s Hospital where he remained the teaching of orthopedics—the Exchange Trav- for the next 10 years, during which time his inter- eling Fellowship Program. After the war, he estab- sometimes been abandoned by others, such as lished a unit for the treatment of veterans with Syme’s amputation; his thoroughness and bold- skeletal tuberculosis. A great believer in helio- ness and keen personal interest in his patient therapy, he supervized the treatment of these vet- never let him abandon any patient, no matter how erans thought to be suffering from an incurable insuperable the problem appeared to be; and his disease on the “Roof Ward” of Christie Street inventiveness led to the development of new Hospital. Most of them lived to take part in a 1934 instruments and appliances, such as the incompa- “Re-union of the Sun Worshippers. His astuteness as an At the request of the National Sanatorium observer led him to describe the pathological Association, he established a unit at the Toronto basis of ill-understood clinical syndromes, such 126 Who’s Who in Orthopedics as peroneal spastic flat foot and discogenic back pain; his inexhaustible supply of energy led him not only to complete his memorable work on The Canadian Army Foot Survey, but also to rewrite the whole thesis when the original hand-written draft was stolen; and his unquenchable thirst for knowledge stimulated all the people he trained to search for better solutions to common orthopedic problems and to seek more deeply into their cause. In 1949, he was appointed Hunterian Lecturer by the Royal College of Sur- geons of England. In 1955, he became the first Canadian to be appointed Sims Commonwealth Professor. He was made an Honorary Fellow of the Royal College of Surgeons of England, of the Royal College of Surgeons of Edinburgh, and of the Royal Australasian College of Surgeons. In Julius HASS January 1966, he gave the first Gallie Lecture to the Royal College of Physicians and Surgeons of 1885–1959 Canada. The following month he was presented with the Distinguished Service Award of the The death of Julius Hass brought to a close a life Ontario Society for Crippled Children. Immedi- full of distinguished service in orthopedic ately before his death, he was made an Honorary surgery. Because his professional career was Chieftain of the Sarcee Indians of Banff, who divided into two periods, the Austrian and the bestowed on him the title of “Father of the American, the former being considerably longer Straight Child” in recognition of his outstanding than the latter, it would be necessary to have two contribution in the treatment of crippling biographers, one from each country, to do full diseases. He was devotedly worked there until 1938, when, following the interested in the history of Canada as a whole and German Anschluss, and at the peak of profes- in the history of medicine in particular. Just before sional eminence, he became a victim of Nazi per- his death, he had started a study of John Rolph, secution. He took a keen career and to move to the United States and make interest in natural history and, as a result of this a new home for himself and his wife and one son. Harris died at the age of 76, while over again in a foreign country, especially so for attending the annual meeting of the Canadian one who had already reached middle age. That he was again able to climb to the summit in pro- fessional regard is proof of his indomitable indus- try, his high professional competence, and his integrity. Hass received his degree in medicine from the University of Vienna in 1910. He interned at the Allgemeines Krankenhaus in Vienna, followed by an appointment as surgical assistant on the service of Professor Frank. Holzknecht, where he became acquainted with the fundamentals of 127 Who’s Who in Orthopedics bone and joint roentgenology. He ulated Hass’s decision to specialize in orthopedic had the gift of clear communication with his audi- surgery. In 1912 he was appointed to the position ence, and his listeners enjoyed his lectures with of assistant (Hilfsartz) at the Universitäts- enthusiasm.