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PubMed1998

Donal Munro Lecture: Functional and neurologic recovery following acute SCI.

Patient management in the current health care environment requires the provider to make reliable and valid clinical decisions regarding patient care, decisions that are cost effective and will lead to optimal functional improvement. Neurologic examination, according to the Standards for Neurological and Functional Classification of Spinal Injury developed by the American Spinal Injury Association, provides every clinician with simple clinical tools that are highly predictive of functional recovery following a spinal cord injury. The ability to predict motor recovery provides a rational basis to help support the provider's recommendation for the patient's goals and care planning, as well as differentiates care that is essential for improving functional outcomes from care that is not.

Activities of Daily Living↗
PubMed2004

Donald Munro Lecture 2003. Neurogenic bladder: past, present, and future.

The foundation of the management of neurogenic bladder can be attributed to a pioneer in spinal cord injury medicine. Dr. Donald Munro, a neurosurgeon, who also had experience in urologic surgery, established the first Spinal Cord Injury Service of 10 beds in the Boston City hospital in the 1930s. He later became adviser to the US Army and the Veterans Administration (VA). On his recommendation, paraplegic centers were created in US army hospitals and later in the VA hospitals from 1943 to 1945. This article reviews the evolution of the management of neurogenic bladder in patients with spinal cord injuries from the past century to the present. The role of urodynamics in defining neurologic lesions is critical to the appropriate management of the voiding dysfunction. Key advances, such as the diagnosis of detrusor sphincter dyssynergia (DSD), recognition of its association with autonomic dysreflexia, and its definitive management, have been emphasized. The role of transrectal linear array sonography using a rectal probe was found useful for defining bladder outlet dysfunction during urodynamics. It also helped to recognize secondary bladder neck obstruction and diagnose false passages in the urethra. Clean technique intermittent catheterization (IC) was evaluated and recommended. In about 28% patients with DSD that led to secondary bladder neck obstruction, a consequence of IC was reported. Transurethral laser sphincterotomy (TURS) was first reported by me in 1991, and later, durable 7-year follow-up results were reported in 78% of the first 99 patients. We reported a surgical technique to lengthen the penis. We also reported the long-term success with semirigid implants in 92% of patients with SCI. This technique helped maintain external condom drainage on a small phallus and improved the sex life of patients, as well as their quality of life. The author's pertinent areas of interest in the past one-half century were aimed at recognizing specific urologic problems associated with neurologic impairment. Management was aimed at preventive care, early recognition, and timely management to reduce secondary complications and enhance quality of life.

Humans↗
PubMedDate not supplied

The C. J. Shanaberger Lecture: pitfalls in the corporatization of health care.

The Parkland Health & Hospital System is owned by the community and must be responsive to the community's most vulnerable populations. It serves as the safety net for all the residents of Dallas County for critical care, but particularly has addressed its attention over the last decade on providing the primary care and preventive medicine infrastructure in underserved areas of the community. We are striving to create a community-responsive servant organization, competent to partner with the various communities in which our clinics are located. We intend to promote the values of those early nonprofit HMOs and establish a covenant relation with our patients and the community. It is in the spirit of the "third generation" of managed care that we must address enrolled populations, while not ignoring the unenrolled populations in the process. We bring value to the table by investing savings into prevention not just higher CEO salaries or stock dividends. We strongly believe that to be community-responsive we have to provide care to the individual person in a patient-centered way. We understand that our institution must also nurture a "relationship-centered" partnership with the community. This requires a willingness to dialogue with the community. We further believe that Parkland's COPC and nonprofit HMO represent opportunities for the training of physicians and for conducting relevant community-based health systems and clinical research. We must remain competent and able to measure what we do and understand the limits of our power and the power that's within communities to improve health. We must recognize that autonomy will sometimes be in conflict with other values and with the needs of populations of patients. Perhaps one of the major reasons that we are in such a dilemma in the United States regarding health care, and whether or not it should be a right available to all, is in our failure to understand the connection we have to one another.

Emergency Medical Services↗
PubMed2004

2004 William P. Yant Award lecture--occupational hygiene in nursing homes.

The William P. Yant Award was established in 1964 to commemorate the leadership and breadth of contributions to industrial hygiene of William P. Yant, ScD, first president of AIHA. Sponsored by the Mine Safety Appliances Company the award is presented for outstanding contributions in industrial hygiene or allied fields made by an individual residing outside the United States. This year's Yant Award winner is Kurt Leichnitz, president of the German Occupational Hygiene Society.

Europe↗
PubMed2005

Henry Smyth Jr. award lecture--occupational exposure limits: do we need them? Who is responsible? How do we get them?

The Henry F. Smyth Jr. Award is presented to an individual who has recognized the needs of the industrial hygiene profession and has made major contributions to fulfill those needs, thereby contributing to the improvement of the public welfare. The American Academy of Industrial Hygiene (now the Academy of Industrial Hygiene) established the Henry F. Smyth Jr. Award in 1981. Henry F. Smyth Jr. was a dedicated teacher and a productive researcher whose projects enhanced the profession. This year's Award was presented to Harry Ettinger, CIH, PE, at the 2004 Professional Conference on Industrial Hygiene (PCIH) in Montreal, Canada.

Awards and Prizes↗
PubMed2007

2006 Henry f. Smyth jr. Award lecture historical review--employer responsibility for workplace health and safety.

The Academy of Industrial Hygiene established the Henry F. Smyth Jr. Award in 1981. The Award is presented to that individual who has recognized the needs of the industrial hygiene profession and has made major contributions to fulfill those needs, thereby contributing to the improvement of the public welfare. This year's Award was presented to John L. Henshaw, CIH, at the 2006 Professional Conference on Industrial Hygiene (PCIH) in San Jose, California.

Awards and Prizes↗
PubMed2001

Gordon Memorial Lecture. Newcastle disease.

1. In this paper several historical and contemporary aspects of Newcastle disease (ND) are reviewed, with particular reference to the greater understanding which modern techniques have allowed. 2. Virulent ND viruses were generally thought to have emerged in 1926 as a result of transfer from a wild bird host reservoir but there is evidence that the virulent virus may have existed in poultry before 1926. Recent findings suggest that the virulent virus may emerge in poultry as a result of mutations in viruses of low virulence. 3. The history of ND in Great Britain reflects the four known panzootics that have occurred and serves as a model for the impact this disease may have on poultry populations. 4. Attempts to control and eradicate ND are not as straightforward as it may appear; in particular vaccination, while preventing deaths and disease, on challenge may not prevent virus replication and could therefore lead to the virulent virus becoming endemic. 5. Village chickens are extremely important assets in most developing countries, representing a significant source of protein in the form of eggs and meat but endemic ND can cause mortality of up to 60% in village chickens.

Animals↗
PubMed1999

The 25th Bartlett Lecture. To act or not to act: perspectives on the representation of actions.

In this review, a description is offered of the way actions are represented, how these representations are built, and how their content can be accessed by the agent and by other agents. Such a description will appear critical for understanding how an action is attributed to its proper origin, or, in other words, how a subject can make a conscious judgement about who the agent of that action is (an agency judgement). This question is central to the problem of self-consciousness: Action is one of the main channels used for communication between individuals, so that determining the agent of an action contributes to differentiating the self from others.

Brain↗