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By E. Surus. Stanford University.

John Moe was one of the founding members cheap 10mg escitalopram mastercard anxiety symptoms yahoo answers, and he was the first president of the Scoliosis Research Society when it held its initial meeting in 1966 purchase escitalopram 20mg amex anxiety symptoms worksheet. Moe Spine Fellowship Program, affiliated with the Department of Orthopedic Surgery at the Univer- sity of Minnesota. Under his leadership, the center became a focus for tertiary spinal care, research, and education. Physicians from all over the world sought his advice and counsel and came to study with him. His generosity, support, promotion of others, and unselfish sharing of his substantial clinical experience were no doubt responsible for the tremendous number of arti- cles, textbooks, and research projects that Giovanni Battista MONTEGGIA emanated from the center. John Moe received many honors throughout 1762–1815 his productive career. He was a member of the American Orthopedic Association, and its presi- Monteggia was born at Lake Maggiore and dent from 1971 through 1972, and was a member studied at Milan. At first he was a surgical pathol- of the Canadian Orthopedic Association, the ogist; while performing an autopsy on a woman Clinical Orthopedic Society, la Société Interna- who had died of syphilis he had the misfortune to tionale de Chirurgie Orthopédique et de Trauma- cut his finger and infected himself with the tologie, the American Academy of Orthopedic disease. Later he became a successful general Surgeons, and the American College of Surgeons, surgeon and pleased one patient so much to mention a few. He held honorary memberships that he was given an annuity to keep his library in many national societies worldwide, and he par- up-to-date. He is particularly remembered Distinguished Award of Merit from Northwestern for his description of a fracture dislocation of the University, the University of North Dakota Sioux forearm, which he described in the same year as Award, and the Regents Award from the Univer- Colles described his fracture. Prominent in the address were favorite quotations: from Thomas Carlyle, “Blessed is he who has found his work; let him ask no other blessedness,” and from Longfellow’s “The Ladder Of St. Augustine”: The heights by great men reached and kept Were not obtained by sudden flight, But they, while their companions slept, Were toiling upward in the night. Austin Moore looked upon life as a challenge; he believed that man succeeded or failed in direct proportion to his own desires and responses. He told the graduating class in 1963, “there will be times when the way is uncertain.... Remember that which cannot be avoided must be endured; Austin Talley MOORE the happy man is the one who makes adjustments 1899–1963 and don’t forget the master word is work. Moore’s approach to life is best Austin Talley Moore was born June 21, 1899, in described by one of his favorite quotations from Ridgeway, South Carolina. He graduated from William Ernest Henley’s “Invictus”: Wofford College at Spartansburg, South Carolina, in 1920, and in June 1963 a grateful Alma Mater It matters not how straight the gate, made him the recipient of an honorary doctorate How charged with punishments the scroll, I am the master of my fate; degree. Moore completed his medical school work at the Medical College of South Carolina in Austin Moore left behind him a heritage of 1924. He interned at the Columbia Hospital in rugged individuality, of humility, and of service. Columbia, South Carolina, from 1924 to 1925, He died suddenly at a time when he was still and then went north to study and work with Pro- active and enjoying the fruits of a distinguished fessor A. In 1939, he founded the Moore Clinic in He gained a world; he gave that world Columbia, where his initiative, enthusiasm, and Its grandest lesson: “On! Moore devoted himself unselfishly to teaching the advances in orthopedic surgery in which he played a great part. His lectures carried him around the world and to practically every large metropolitan center in this country. Austin Moore was a pioneer in the use of the femoral-head prosthesis; his work on this and on Vitallium made available the techniques and material that have restored the ability to work and a good life to literally thousands of elderly patients. Moore gave the Commencement Address to the graduating class at Wofford College in June 1963. His address to the young graduates embodied the philosophy that guided him 238 Who’s Who in Orthopedics Walther MÜLLER Thomas George MORTON 1888–1949 1835–1903 Walther Müller was born on May 6, 1888 in Thomas George Morton was born in Philadelphia. Waldenburg in the county of Saxony, Germany, He received his MD degree from the University the son of a mathematics professor. Müller began of Pennsylvania in 1856, and practiced medicine, his medical career as a surgeon under the guid- specializing in general surgery, in Philadelphia ance of Arthur Läwen in Marburg. During the Civil War he was career, through experimental work, he laid the active in the establishment of military hospitals. In 1924, Müller’s to build a state insane asylum, and in 1886 monograph on the normal and pathologic physi- was chairman of a committee on lunacy.

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These are complex buy cheap escitalopram 10mg on-line anxiety symptoms anxiety attacks, and various studies have shown Required rehousing provided by District Council that many disabled people are receiving less than their or Housing Association 29 entitlement order escitalopram 20mg without a prescription anxiety symptoms checklist 90, sometimes by quite substantial amounts. It is Required rehousing, patient or family bought property 5 therefore important for those working with disabled people to be aware that they may be underclaiming benefits and to advise them accordingly. Housing presents a continuing problem because, • Accessible light switches, sockets, door locks though patients may return to an adapted house or be • Accessible kitchen and facilities rehoused from hospital, they may well want to change house in • Patio area in the garden the future, especially as spinal cord injuries typically occur in • Thermostatically controlled heating system young people who would normally move house several times. A • Through-floor lift or stair lift disabled person may have difficulty in finding a suitable house, • Internal ramps and there can be time restrictions on further provision of grants for adaptations. There are also mandatory and discretionary limitations on grants which may be made available to assist in the adaptation of a property. Many people find the discrepancy between local authorities in their interpretation of the legislation around this frustrating. Consequently, any move can be difficult to achieve and has to be planned well Employment—what patients do % ahead. The services of community occupational therapists, In work or job left open 30 housing departments, and social workers may be required. In education or training 10 A considerable number of statutory services are concerned No employment on discharge, but previously employed 38 with providing services for disabled people. Voluntary No employment on discharge—not employed when admitted 22 organisations also provide important resources. They can act as pressure and self-help groups, and organisations of disabled people have the knowledge and understanding born of personal experience. Tel: 0800 882200 in what they can provide in different geographical areas, is a • Citizens Advice Bureau major undertaking. Too often disabled people fail to receive a • DIAL (Disabled Information Advice Line) (Name of town)—A service that would be of benefit or they may feel overwhelmed voluntary organisation operating in some areas and not in control of their own lives, with consequent damage • Disability Rights Handbook (Price £11. Disabled people and their families annually by the Disability Alliance Educational & Research should have access to full information about the services Association, Universal House, 88–94 Wentworth Street, London available and be enabled to make their own decisions about E1 7SA. Services sets out government objectives for more partnership email: sia@spinal. Physical care is a major concern, and here the difference between levels of injury is • Understanding and caring for their own bodies profound. People with paraplegia usually become self caring; • Recognising potential problems those with low tetraplegia, especially if young, may also achieve • Dealing with problems or learning where to go for advice independence, but those with high tetraplegia may require help with their physical needs. Achievement of good care depends largely on educating the patients, their families, and the community staff. Patients should be expert at understanding and, as far as possible, caring for their own bodies. They need to be able to recognise potential problems and either deal with them themselves or know where to seek advice. Much time is spent in teaching the importance of good skin, bladder and bowel care, as long-term problems in these areas are common. Education of patients Skin care Patients are taught how to use a mirror to check their pressure areas regularly, the stages of development of pressure sores, and what to do should a pressure mark occur. If patients cannot lift themselves in their chair they need a cushion that allows them to sit in their wheelchair all day without resulting in a red mark on their skin. Weight, height, the degree of sensation and mobility, age, posture, motivation, and the quality of the skin all affect the type of cushion needed. All wheelchair cushions have a limited life and need regular checking to provide a reliable degree of assistance in prevention of sores. Clothes made of natural fibres are preferable because many patients sweat excessively; clothing should not be tight otherwise there is risk of skin damage resulting in pressure sores. It should also be noted that hard seams and pockets which cross over the ischial tuberosities, trochanters, or coccyx may cause pressure marks on the skin. It is recommended that shoes should generally be one size larger than previously worn because of a tendency of the feet to swell during the day. The patient should be assessed individually to ascertain the appropriate mattress for their long-term needs. Patients are encouraged to contact the pressure clinic for information and advice regarding any aspect of their care.

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According to a 1990 federal survey purchase 10mg escitalopram with mastercard anxiety symptoms ringing ears, people themselves pay for almost 78 percent of home accessibility improvements (LaPlante purchase escitalopram 20mg on-line anxiety synonyms, Hendershot, and Moss 1992, 9). Treat- ing people who fall will cost insurers much more than grab bars, shower chairs, and raised toilet seats. Although health-care costs leveled off during the mid 1990s, recent signs suggest rapid rises ahead. Combined with pressures from expensive new medical discoveries, future costs may tighten coverage on items outside the acute medical paradigm. Stan Jones (personal communication, 6 February 1998) believes “we’re seeing a retrenchment with regard to buying wheel- chairs and a variety of assistive devices and other services” that aim toward improving daily functioning and quality of life. Competition among health plans based on their premiums is causing more and more conservative decisions and making it harder and harder for people to get these services. Sometimes there’re no crite- ria anywhere defining what’s covered under what circumstances. Sometimes plans just don’t offer it or keep it in the background, not offering it unless the person asks. And if they ask, sometimes it’s hard to get, or it takes a long time, so most people give up. Jones believes that society must decide whether funding mobility aids is a priority, “because we’re heading away from covering them. Patrick O’Reilley runs a neighborhood health center where all his patients are poor. Like Christopher Reeve has a great wheelchair because he’s a professional person; he has money. No in- surance company is going to pay for a scooter for some of my pa- tients. They’d be reading the back of Arthritis Today and say, “Oh, I want that scooter! The fa- ther is a physician, retired from practice but still well connected and vigor- ous. Julie, in her mid forties, had quit working several years ago because of MS. Without respite, it waxes and wanes, bringing disheartening new symp- toms and giving her little peace. Julie’s father didn’t ask about cures for MS or techniques to improve her walking. Through his medical connections, she has seen the best neu- rologists and clinical specialists. After many years and countless but ulti- mately ineffective therapies, he and she are realistic. Instead, he wanted advice about improving her mobility for daily life, and he didn’t know who to ask. Despite their extensive medical network and knowledge, they had not found practical advice sensitive to Julie’s changing mobility needs and preferences. She is married with young children and lives in a house with bedrooms upstairs. Julie knows she needs help, but she has put it off, perhaps discouraged or embarrassed, unsure about how mobility aids would fit into her daily routine. After many years ex- ploring this topic and, more importantly, using mobility aids, my inept reply unnerved me. I knew what I wanted to recommend—one-stop shop- ping for all mobility-related services—but only scattered pieces of it exist. Here’s what a one-stop Mobility Mart could offer: • physical and occupational therapists working together on-site, to evaluate clients’ mobility needs and preferences, with home assessments as necessary 260 Final Thoughts / 261 • physiatrists, either on-site or on call, who are readily available for specialized assessments or planning mobility strategies • networks of peer counselors or opportunities for support groups (on-site or online) for people and their families, ad- dressing emotional concerns and sharing strategies for dealing with practical problems caused by mobility difficulties • health insurance or resource specialists, skilled in navigating the insurance maze and knowledgeable about other potential funding opportunities (such as disease advocacy or faith-based organizations) for financing mobility aids, related equipment, home modifications, and assistance with daily activities • diverse mobility aids—canes, crutches, walkers, manual and power wheelchairs, and scooters—which clients can try on-site and take home for weeklong trial runs and with technicians to customize aids for individual needs • information about specialized mobility aids, such as wheel- chairs for the beach or sports, through catalogs and on-site computers with Internet linkages to vendors’ web pages • information about other useful items, ranging from grab bars and shower seats to clapper devices for turning on lights to lifeline support systems (an emergency response when sig- naled using a small device) to ramps and stair lifts • ongoing mobility aid training, with at least one home visit, workplace assessment (if necessary), and neighborhood tour to identify environmental barriers and devise strategies to im- prove daily movement • information about community resources, ranging from in- structions for getting handicapped parking placards and qual- ifying for local paratransit systems to information about ac- cessible housing and transportation, legal advice around disability issues, shops with scooters, accessibility of local recreational and entertainment sites, and automobile dealers that adapt cars • guides to local health-care providers and facilities, highlighting accessibility (such as automatically adjustable examination ta- bles and X ray equipment, ease of navigating the office, park- ing), experience with persons with mobility problems, and sat- isfaction of prior patients 262 inal Thoughts • a computerized record-keeping system, confidentially retain- ing not only contact information about clients but also their mobility needs and preferences, linked with e-mail or tele- phone systems for clients to submit questions and receive up- dates about new products or services as they wish • information about community-based action and advocacy groups, enlisting diverse voices to improve physical access for everybody This Mobility Mart would customize solutions to improve daily func- tioning and quality of life. Since the preponderance of clients have pro- gressive chronic conditions, they would return to the Mobility Mart over time as their needs changed. When clients moved to new mobility equip- ment, they would return used items for credit, making recycled mobility aids available to others at lower costs.

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