By H. Arokkh. Elizabethtown College.
In 1988 buy discount grifulvin v 125mg on line, following criticisms of the haphazard character of the cervical smear system trusted grifulvin v 125mg, a National Coordinating Network for the NHS Cervical Screening Programme was established. In 1990 the new contract imposed on GPs by the government offered substantial incentives, now worth around £65 million a year, tied to smear rate performance targets. As a result of these measures, coverage of the target age group rose from 42 per cent in 1988 to 85 per cent in 1994, a level subsequently maintained (Quinn et al. The claim by these authors that in women under 55 ‘screening may have prevented 800 deaths in 1997’ was contested by critics who noted that the data presented could equally well support the conclusion that screening caused a similar increase in mortality (Vaidya, Baum 1999). The contrast between the high level of public faith in the 57 SCREENING cervical smear programme and the private recognition among medical authorities of its unsatisfactory character is remarkable. In their reply to Vaidya and Baum, Quinn and his colleagues admitted that they remained ‘deeply concerned about the well known problems with cervical screening’, which they listed: cervical cancer is a comparatively rare disease and its natural course is not well understood; the smear test has both low sensitivity and low specificity; many tests are techni-cally unsatisfactory and the proportion of such tests varies across the country; the mix of three-year and five- year screening intervals is inequitable; too many smear tests are opportunistic; and the programme costs four times as much as breast screening. The fact that some such cases have resulted in litigation has led to calls for doctors to make clear that smears may miss between 5 and 15 per cent of abnormalities and to ensure that patients are giving properly informed consent to this procedure (Anderson 1999; Nottingham 1999). The low specificity of the smear test means that it yields a relatively high proportion of false positive results: that is, it suggests that a woman has malignant or pre-malignant cells when more invasive procedures (involving the removal of a wider area of tissue in a ‘loop’ or ‘cone’ biopsy) confirm that this is not the case. In day to day practice, this is by far the biggest problem arising from smear tests, causing enormous anxiety and distress, often continuing for weeks or months pending delays in further investigations. Bristol public health consultant Angela Raffle noted the tendency of staff, in response to publicity over missed cases, to over-diagnose minor abnormalities (Raffle et al. While patients suffered needless anxiety, staff lived in fear of failing to identify potentially malignant cases. As a result, ‘much of our effort in Bristol is devoted to limiting the harm done to healthy women and to protecting our staff from litigation as cases of serious disease continue to occur’. As Raffle recognised, many healthy women are left with worries about cancer and difficulties in obtaining life insurance.
HOW TO DECIDE UPON A METHODOLOGY / 23 X Examples of qualitative methodologies include action research generic grifulvin v 250 mg on-line, ethnography generic 125 mg grifulvin v free shipping, feminist research and grounded theory. X Quantitative research generates statistics through the use of large-scale survey research. X Neither qualitative nor quantitative research is better – they are just different. X Your own intuition and the words you use will give pointers to whether qualitative or quantitative research is more appropriate for your chosen project. X The term ‘triangulation’ is used when a combination of qualitative and quantitative forms of inquiry are used. FURTHER READING The theoretical and philosophical issues raised in this chapter are detailed and complex and cannot be discussed in depth in this book. However, if you wish to pursue any of these topics, some of the useful publications are listed below under the relevant topics. Qualitative research Over recent years there has been a great deal of innova- tion in the use of qualitative methodologies. Listed below are some of the more traditional texts and a selection of the newer, innovative texts. Before you de- cide which would be the most appropriate methods for your research, you need to find out a little more about these tools. This chapter gives a description of the meth- ods of interviewing, focus groups, questionnaires and par- ticipant observation. Chapters 7–10 will go on to describe in detail how to use each of these methods.
Contralateral preventive bone epiphyseal fixation was performed in all except 1 patient purchase grifulvin v 125mg without prescription. The implant used for in situ pinning was the Knewles pin in 2 patients discount grifulvin v 125mg with visa, Kirschner wire (k-wire) with thread in 3, and ACE(R) SCFE screw in 6. For contralateral preven- tive pinning, the Knewles pin was used in 2 patients, k-wire with thread in 3, ACE SCFE screw in 9, and Hannson pin in 1. For fixation after Southwick intertrochanteric osteotomy, the AO double angle plate (MIZUHO, Tokyo, Japan) was used. In all patients, epiphyseal fixation was added, and the implants used were the same materi- als as those used in preventive pinning. The flexion osteotomy angle was frequently 20°–30°, although it was 50° in 1 patient. Good reductions in both the posterior tilting angle and head–shaft angle were observed. Concerning surgical complications, methicillin-resistant Staphylococcus aureus infection associated with Southwick intertrochanteric osteotomy developed in one patient and k-wire breakage associated with in situ pinning in one. Leg length dis- crepancy after Southwick intertrochanteric osteotomy until the final observation was observed in three of five patients (0. Changes of head-shaft angle and pos- terior tilting angle after osteotomy 60 40 20 0 0 Head-shaft angle (degree) pre-operation post-operation limitation in flexion was observed in two, only that in internal rotation in two, and that in both flexion and internal rotation and both flexion and internal/external rota- tion in one each. Concerning sequelae, one patient showed narrowing of the joint space at the initial consultation, and although postoperative changes were negligible, the course has been observed. No avascular necrosis of the femoral head occurred, no pain of hip, and the patient has acquired a normal gait. Case Presentations Patient 1: 10-Year-Old Boy He noticed right hip joint pain in February 2002. On March 30 of the same year, he fell on the stairs, sustained injury, and was transported to a local hospital by ambu- lance. A diagnosis of femoral neck fracture was made by a surgeon at the first con- sultation, and he was referred to our hospital (Fig. A diagnosis of unstable slipped capital femoral epiphysis was made, and direct wire traction was performed for about 2 weeks from immediately after admission.
