By Q. Kerth. University of North Florida.
Both the United Kingdom and the United States recommend a four week course of triple therapy when the risk of exposure to HIV is high buy penegra 50mg with visa. The current recommended regime is zidovudine 300mg and lamivudine 150mg bd (Combivir) and nelfinavir 750mg tds purchase penegra 100mg fast delivery. The most commonly reported side effects of these drugs are malaise purchase penegra 100mg on-line, fatigue order penegra 50 mg, insomnia, nausea, and vomiting. Action after exposure to HBV and HCV The greatest risk of acquiring a BBV infection from a needlestick injury comes from HBV E antigen positive, and surface antigen positive patients. If injury occurs, the recipient should have their antibody profile checked. High responders Biological or biochemical weapons decontamination practice are at no risk. Low responders should receive a booster dose of vaccine and non-responders should receive HBV immunoglobulin; HBV transmission can be prevented if immunoglobulin is given within 48 hours. If blood tests carried out between six and eight weeks after the potential infection are positive then antiviral treatment may be indicated. Training manikins Practice in resuscitation techniques is an essential part of establishing an effective resuscitation service. Resuscitation training manikins have not been shown to be sources of virus infection. Nevertheless, sensible precautions must be taken to minimise potential cross infection and the manikins must be formally disinfected after each use according to the Using barrier methods to prevent contamination should be practised as manufacturers’ recommendations. If a patient’s oral cavity or saliva is contaminated with visible blood then the use of an adjunct can reassure the rescuer. However, as the risks of catching BBVs from rescue breathing are virtually nil (provided that blood is not present) then there must be no delay waiting for such an airway adjunct to be provided. In hospitals, standard precautions should be used routinely to minimise risk. Life key Further reading ● Cardo DM, Culver DH, Ciesielski CA, Srivastva PU, Marcus R, ● Joint Committee on Vaccination and Immunisation. Case control study of HIV seroconversion in Immunisation against infectious disease. Guidance for clinical health care workers: protection against ● Taylor GP, Lyall BGH, Mercy D, Smith R, Chester T, Newall ML, infection with blood borne viruses. British HIV Association guidelines for prescribing anti- Expert Advisory Group on AIDS and the Advisory Group on retroviral therapy in pregnancy. Post exposure chemoprophylaxis for occupational exposures to the human immunodeficiency virus. Increased awareness among the public of the possibility of successful resuscitation from cardiopulmonary arrest has added to the need to determine the best ways of teaching life-saving skills, both to healthcare professionals and to the general public. In the United Kingdom the Resuscitation Council (UK) has more than 10 years experience of running nationally accredited courses and these have established the benchmarks for best practice. This chapter examines the principles of adult education and their application to the teaching of the knowledge and skills required to undertake resuscitation. Levels of training Medical students practising resuscitation Resuscitation training may be categorised conveniently into four separate levels of attainment: ● Basic life support (BLS) ● BLS with airway adjuncts ● BLS with airway adjuncts plus defibrillation ● Advanced life support (ALS). BLS This comprises assessment of the patient, maintenance of the airway, provision of expired air ventilation, and support of the circulation by chest compression. It is essential that all healthcare staff who are in contact with patients are trained in BLS and receive regular updates with manikin practice. BLS with airway adjuncts The use of simple mechanical airways and devices that do not pass the oropharnyx is often included within the term BLS. The use of facemasks and shields should be taught to all healthcare workers. Increasingly, first-aiders and the general public also request training in the use of these aids. BLS with airway adjuncts plus defibrillation The use of defibrillators (whether automated or manual) should be taught to all hospital medical staff, especially trained nursing staff working in units in which cardiac arrest occurs often—for example, coronary care units, accident and emergency departments, and intensive therapy units—and to all emergency ambulance crews. Training should also be available to general practitioners, who should be encouraged to own defibrillators. ALS ALS techniques should be taught to all medical and nursing staff who may be required to provide definitive treatment for cardiac arrest patients.
The following year another multi-disciplinary committee sponsored by the Kings Fund generic 100mg penegra with amex, with the brief to chart progress since Owen’s 81 THE POLITICS OF HEALTH PROMOTION Prevention and Health in 1976 discount penegra 50 mg online, produced a report with the suggestive title The Nation’s Health (Smith et al buy penegra 100 mg otc. This report also welcomed the WHO declarations and chastised the British government for its tardiness in meeting these targets buy 50 mg penegra mastercard. In its discussion of priority areas, strategies and targets, lifestyles and preventive services, it closely anticipated both the form and substance of the Health of the Nation documents. In the second ‘new and completely revised’ edition in 1991, the authors distinguished between the ‘tradition of limited government responsibility for health and welfare’ of which they disapproved, and the ‘modern, international movement in public health’ with which they strongly identified (Jacobson et al. They further welcomed the emphasis on health promotion in the new GP contract, recognising that this offered ‘new opportunities for developing public health practice’. While key aspects of the new public health agenda attracted powerful supporters in the medical and political establishments, in 1987 its activists launched the Public Health Alliance as a new ‘policy and pressure group’. Based in Birmingham, the alliance aimed ‘to bring together voluntary and community groups, professional associations, local authorities, trade unions and individuals to promote and defend the public health in the UK’ (Scott-Samuel 1989:33). According to Alex Scott-Samuel, like most of the leading figures in the alliance a public health doctor, its most important goal was to make a reality of ‘the principles behind the WHO Health For All strategy: the reduction of inequalities, intersectoral collaboration, primary health care and above all, community participation’ (Scott-Samuel 1989:35). The decisive weakness of the alliance resulted from the wider demise of the left: following the government’s victory over the miners in 1984–85 and Labour’s third consecutive general election defeat in 1987, left- wingers became increasingly isolated and marginalised in all areas of British society, including health. The resulting problem for the alliance’s approach was that its aspirations for ‘community participation’ acquired the character of a fantasy, whereas the dependence of public health professionals on the state remained all too real. In practice, the radical ideals of ‘Health For All’ were rapidly subordinated to the pragmatic imperatives of government health policy. The emergence of The Health of the Nation revealed the balance of forces determining public health policy and the limitations of the radical critique. Kenneth Clarke, as health 82 THE POLITICS OF HEALTH PROMOTION minister, and Donald Acheson, as Chief Medical Officer, both encouraged the evolution of the Kings Fund’s The Nation’s Health into the government’s The Health of the Nation. In September 1991, following the publication of the Green Paper, the Public Health Alliance joined forces with the Radical Statistics Health Group in a conference to appraise the new policy (PHA 1992). In his introductory remarks, alliance chair Geoff Rayner welcomed the government’s endorsement of health promotion and congratulated ministers for taking the ‘first step’ on a course which suggested a ‘change of heart’ following Mrs Thatcher’s abrasive response to the Black Report. He hoped that the Green Paper might ‘foreshadow a move away from a highly individualised, medicalised perspective on health’ towards ‘the philosophy of Health For All’. The main criticism advanced by Rayner and other speakers was that The Health of the Nation did not go far enough towards adopting the principles of the new public health, particularly on social inequality. Alex Scott- Samuel insisted that there was ‘still a long way to go’ before the government caught up with the objectives declared at the international conferences of the new public health. Criticisms of the Conservative government for failing to adopt wholesale the radical programme of Alma Ata made little impact. Nobody expected a government that had made a principle of trying to destroy socialism suddenly to adopt a commitment to social equality in health or any other area. The government’s interest in the new public health was not in its radical rhetoric, but in the potential of its health promotion policies to provide both a softer image for the Conservative Party and as mechanism for promoting greater individual responsibility for health. Hence it brushed aside calls for redistribution and for action against social causes of ill- health (such as unemployment, poor housing and the tobacco industry) and retained the familiar victim-blaming message of health promotion. Given the wider trends towards greater individuation in society, The Health of the Nation policy was inevitably experienced primarily as a campaign to change individual behaviour. In the absence of mass popular mobilisation against the state on any issue, continuing radical complaints that government health promotion emphasised individual behaviour instead of tackling social problems were more an expression of wishful thinking than a serious critique. While the left’s critique of The Health of the Nation policy remained ineffectual, state health promotion encountered more substantial resistance from a group of doctors, academics and journalists loosely associated with the Social Affairs Unit, a right-wing think tank. By the end of the 1980s, the right, which had re-emerged a decade earlier to take advantage of the crisis of the left, was also in difficulties. Though the principles of privatisation and hostility for state welfare and trade unionism had encouraged the Thatcher project in its early years, the ideology of the free market had no answers for the renewed problems of recession in her third term and the growing crisis of government legitimacy.
This imagery of unfortunate innocents purchase penegra 100 mg overnight delivery, struggling to walk cheap 100 mg penegra free shipping, remains po- tent today cheap penegra 100mg on-line, especially among fund-raisers and sloganeers buy cheap penegra 100 mg on-line, such as “Jerry’s kids” for muscular dystrophy. Stories of persons struck down in youth through no fault of their own evoke powerful, sympathetic responses. Franklin Delano Roosevelt, who contracted polio at age thirty-nine, was virtually never seen publicly in his wheelchair. Yet he became the om- niscient, de facto “poster child” of his National Foundation for Infantile Paralysis. Brainstorming about how to raise money from a nation just emerging from economic depression, the radio and vaudeville entertainer Eddie Cantor suggested that people send 10 cent contributions directly to Roosevelt at the White House: “Call it the March of Dimes” (Gallagher 1994, 150). Cantor and the Lone Ranger broadcast Roosevelt’s appeal, and within days, envelopes containing dimes overwhelmed the postal service. The polio vaccine became possible because Roo- sevelt’s foundation raised millions of research dollars (Gallagher 1994). These mass solicitations nevertheless solidify one stereotype of walking 16 W ho Has Mobility Difficulties problems—blameless people, courageously confronting adversity and strug- gling to walk, crutches in hand. Despite their exertions, they seemingly have little control over their futures, waiting for the charity-supported research to suddenly sprout a cure. In an America that celebrates independence and self- determination, this stereotype implicitly marginalizes people. Equally troubling, however, is holding people accountable for their physical impairments in defiance of their disease—a slippery slope be- tween hope and despair. For twenty years, she had periodically experienced episodic, unnerving sensory symptoms but never knew why. A physician friend had privately diag- nosed MS, but he had not told Joni or her husband. Now all of a sudden, Joni began having serious trouble walking, and the physician revealed his diagnosis. Her husband and his male friends, including Sam, rallied around and mapped out an exercise program “to improve her function. Over- whelmed by this onslaught motivated by true affection and concern, Joni felt powerless to make them understand that her legs now felt as if they were encased in concrete, that fatigue drained every scrap of strength. Sam told me later that the husband and his friends had abandoned their physical fitness regime, but I heard doubt in Sam’s voice. The second stereotyped cause, catastrophic accidents, is sometimes shadowed by hinted conjectures about fault—was the person somehow to blame? One “innocent” subgroup is injured either by seemingly random violence, such as being struck by a car, or by mishaps occurring during so- cially acceptable activities, such as bicycling, skiing, or contact sports. In contrast, a more suspect subgroup involves people injured by their own recklessness, such as driving while drunk. Persons claiming injuries at work and seeking disability compensation, “workers’ comp,” are particularly problematic (chapter 9). Soldiers return- ing from war, however, are a special class of people injured “at work. Roosevelt himself, usually unwilling to be seen publicly in his wheelchair, made a special gesture conveying his respect for troops injured in World War II. During a 1944 visit to Hawaii to discuss Pacific strategy, Roosevelt went to an Oahu hospital, and according to an aide, The President did something which affected us all very deeply. He asked a secret service man to wheel him slowly through all the wards that were occupied by veterans who had lost one or more Who Has Mobility Difficulties / 17 arms and legs. He wanted to display himself and his useless legs to those boys who would have to face the same bitterness. Public perceptions of veterans’ merit or culpability often depend on views about the war.
Stauffer joined the faculty of the University of Iowa as an assistant professor of orthopedic surgery in 1970 50mg penegra mastercard. Two years later generic penegra 100 mg with visa, he began a 19- year tenure at the Mayo Medical School and Clinic buy cheap penegra 100 mg on line, advancing from instructor of orthopedic surgery to full professor purchase penegra 50mg mastercard. Robinson professor of orthopedic surgery at Johns Hopkins University School of Medicine and as orthopedic surgeon-in-chief at Johns Hopkins Hospital. He was a trustee of the hospi- tal and served as chairman of its medical staff. He also served on many committees, including the Executive Committee for Surgery and the Reengi- neering Steering Committee, and he was instru- mental in working with his colleagues to reorganize the governance of the Clinical Practice Association of the School of Medicine. His contributions to the clini- cal and research aspects of hip disease were rec- ognized by his peers in the Hip Society who gave him the John Charnley Award for outstanding research in 1988. He served on the board of the American Academy of Orthopedic Sur- geons and on its Committee on Research from 1981 to 1987. He also served as president of the Orthopedic Research Society and on the Execu- tive Committee of the American Orthopedic Association. STEELE He served on the editorial boards of Archives of Surgery and the Journal of Arthroplasty, and 1891–1973 he was editor-in-chief of the Atlas of Orthopedic Surgical Exposure and Advances in Operative On March 29, 1973, Pittsburgh lost one of its out- Orthopedics. He also chaired an advisory panel to standing orthopedic surgeons of the twentieth the United States Food and Drug Administration. Paul had Dick was, first and foremost, a dedicated long been one of the leaders of the specialty, and family man with a very close-knit family. David Silver in 1946 he enjoyed nothing more than attending gatherings became professor of orthopedic surgery at the at the recently created family compound in Idaho, University of Pittsburgh and chief of the orthope- where he could do a little fishing with his sons. His interests were varied; he was an excellent Paul was born in Crenshaw, Pennsylvania, on wood-carver and painter. His early education was in the classic automobiles and had recently begun Crenshaw schools. He weighed his words care- 1915 he took his MD degree at the College of fully and made decisive decisions. Physicians and Surgeons in Baltimore, which 1 He died of pneumonia on February 27, 1998, year earlier had been taken over by the Univer- at Johns Hopkins Hospital. He interned from 1915 to 1916 at the Allegheny General Hospital in Pittsburgh and then became the assistant of Dr. A few months after World War I started, he enlisted, and was immediately sent overseas with the Second Orthopedic Unit headed by Dr. Paul was ordered to the Edinburgh War Hospital for training in war surgery, and served under the great Sir Harold Stiles until June 1918, when he joined the American Army in France. Toward the end of June he arrived at Neufchâteau, where be became one of a surgical team that included Dr. The team then became many other original operations included: (1) an attached to Mobile Hospitals No. When he returned home in July femoral neck (1929); (3) a graft between the first 1919, he worked first at Walter Reed Hospital in and second cervical vertebrae for ununited frac- Washington and then at Ford McPherson in tures of the odontoid process (1928); (4) a rota- Atlanta, where he was in charge of the amputa- tion operation for ununited fractures of the carpal tion section. In recognition of his outstanding war scaphoid (1934); (5) an operation for congenital record, he was awarded the Army Silver Star. He was a member of the staff of the cations and also very few end-result studies. Silver in the organization and his own procedures for treating subacromial bur- operation of the D. Watson Home for Crippled sitis by aspiration with a large needle, for ulnar- Children at Leetsdale, outside Pittsburgh. This nerve suture, and for acute suppurative arthritis was opened in 1919 and soon became one of the and gonorrheal arthritis. He wrote the chapter on outstanding crippled children’s hospitals in the “Fractures of the Pelvis, Sacrum and Coccyx” in country. Paul was very active in the state crippled Bancroft and Murray’s Surgical Treatment of the children’s services and at different times held as Motor-Skeletal System (1945).