Neurosurgery, or neurological surgery, is the medical specialty concerned with the prevention, surgical treatment, rehabilitation of disorders which affect any portion of the nervous system including the brain, spinal cord, peripheral nerves, extra-cranial cerebrovascular system. In different countries, there are different requirements for an individual to practice neurosurgery, there are varying methods through which they must be educated. In most countries, neurosurgeon training requires a minimum period of seven years after graduating from medical school. In the United States, a neurosurgeon must complete four years of undergraduate education, four years of medical school, seven years of residency. Most, but not all, residency programs have some component of clinical research. Neurosurgeons may pursue additional training in the form of a fellowship, after residency or in some cases, as a senior resident; these fellowships include pediatric neurosurgery, trauma/neurocritical care and stereotactic surgery, surgical neuro-oncology, neurovascular surgery, skull-base surgery, peripheral nerve and spine surgery.
In the U. S. neurosurgery is considered a competitive specialty composed of 0.6% of all practicing physicians. In the United Kingdom, students must gain entry into medical school. MBBS qualification takes four to six years depending on the student's route; the newly qualified physician must complete foundation training lasting two years. Junior doctors apply to enter the neurosurgical pathway. Unlike most other surgical specialties, it has its own independent training pathway which takes around eight years. Neurosurgery remains amongst the most competitive medical specialties in which to obtain entry. Neurosurgery, or the premeditated incision into the head for pain relief, has been around for thousands of years, but notable advancements in neurosurgery have only come within the last hundred years; the Incas appear to have practiced a procedure known as trepanation since the late Stone age. During the Middle Ages in Arabia from 936 to 1013 AD, Al-Zahrawi performed surgical treatments of head injuries, skull fractures, spinal injuries, subdural effusions and headache.
There was not much advancement in neurosurgery until late 19th early 20th century, when electrodes were placed on the brain and superficial tumors were removed. History of electrodes in the brain: In 1878 Richard Canton discovered that electrical signals transmitted through an animal's brain. In 1950 Dr. Jose Delgado invented the first electrode, implanted in an animal's brain, using it to make it run and change direction. In 1972 the cochlear implant, a neurological prosthetic that allowed deaf people to hear was marketed for commercial use. In 1998 researcher Philip Kennedy implanted the first Brain Computer Interface into a human subject. History of tumor removal: In 1879 after locating it via neurological signs alone, Scottish surgeon William Macewen performed the first successful brain tumor removal. On November 25, 1884 after English physician Alexander Hughes Bennett used Macewen's technique to locate it, English surgeon Rickman Godlee performed the first primary brain tumor removal, which differs from Macewen's operation in that Bennett operated on the exposed brain, whereas Macewen operated outside of the "brain proper" via trepanation.
On March 16, 1907 Austrian surgeon Hermann Schloffer became the first to remove a pituitary tumor. The main advancements in neurosurgery came about as a result of crafted tools. Modern neurosurgical tools, or instruments, include chisels, dissectors, elevators, hooks, probes, suction tubes, power tools, robots. Most of these modern tools, like chisels, forcepts, hooks and probes, have been in medical practice for a long time; the main difference of these tools and post advancement in neurosurgery, were the precision in which they were crafted. These tools are crafted with edges. Other tools such as hand held power saws and robots have only been used inside of a neurological operating room; as an example, the University of Utah developed a device for computer-aided design / computer-aided manufacturing which uses an image-guided system to define a cutting tool path for a robotic cranial drill. General neurosurgery involves most neurosurgical conditions including neuro-trauma and other neuro-emergencies such as intracranial hemorrhage.
Most level 1 hospitals have this kind of practice. Specialized branches have developed to cater to difficult conditions; these specialized branches co-exist with general neurosurgery in more sophisticated hospitals. To practice advanced specialization within neurosurgery, additional higher fellowship training of one to two years is expected from the neurosurgeon; some of these divisions of neurosurgery are: Vascular neurosurgery includes clipping of aneurysms and performing carotid endarterectomy. Stereotactic neurosurgery, functional neurosurgery, epilepsy surgery (the latter includes partial or total corpus callosotomy – severing part or all of the corpus callosum to stop or lessen seizure spread and activity, the surgical removal of functional, physiological and/or anatomical pieces or divisions of the brain, called epileptic foci, that are operable and th
Palm is an American tech company that developed and designed Personal Digital Assistants, mobile phones, software. Palm devices are remembered as "the first wildly popular handheld computers," responsible for ushering in the smartphone era. Palm's first PDAs ran the Palm OS, were smaller than competing handhelds, proved to the industry that there was a market for a new category of portable computing device. Palm Computing was founded in 1992 by Jeff Hawkins and acquired by U. S. Robotics in 1995 for $44 million; the company released their first device, the PalmPilot 1000, in 1996. The company continued to make Palm branded PDAs and smartphones until 2010. Palm released the popular webOS operating system in 2009. WebOS was used on various Palm and HP devices until it was acquired by LG in 2013—LG continues to use webOS on their smart TVs. Palm has been sold several times since its founding. In April 2010 it was announced. Although HP kept the Palm brand all PDAs released after 2011 were branded as HP devices, not Palm.
In January 2015, TCL Corporation announced that it had acquired Palm's intellectual property from HP, with plans to relaunch the company at some point. On October 15, 2018, a San Francisco start-up named Palm and backed by TCL released a new companion device called Palm. Pilot was the name of the first generation of personal digital assistants manufactured by Palm Computing in 1996; the inventors of the Pilot were Jeff Hawkins, Donna Dubinsky, Ed Colligan, who founded Palm Computing in 1992. The original purpose of this company was to create handwriting recognition software, named PalmPrint, personal information management software, named PalmOrganizer for the PEN/GEOS based Zoomer devices, their research convinced them, they could create better hardware as well. Before starting development of the Pilot, Hawkins said he carried a block of wood, the size of the potential Pilot, in his pocket for a week. Palm was perceived to have benefited from the notable, if ill-fated, earlier attempts to create a popular handheld computing platform by Go Corporation and Apple Computer.
The prototype for the first Palm Connected Organizer was called "Palm Taxi". IN 1996 Palm released its first generation PDA, the PalmPilot 1000 and 5000. After the out-of-court settlement in 1998 of a trademark infringement lawsuit brought by the Pilot Pen Corporation, the company no longer used that name, instead referring to its handheld devices as Palm Connected Organizers or more as "Palms"; the first Palms, the Pilot 1000 and Pilot 5000, had no infrared port, backlight, or flash memory, but did have a serial communications port. Their RAM size was 128 kB and 512 kB and they used version 1 of Palm OS, it became possible to upgrade the Pilot 1000 or 5000's internals to up to 1 MB of internal RAM. This was done with the purchase of an upgrade module sold by Palm, the replacement of some internal hardware components, it was conceived that all Palm PDAs were to be hardware-upgradable to an extent, but this capability gave way to external memory slots and firmware-upgradable flash memory after the Palm III series.
The next couple of Palms, the PalmPilot Personal and PalmPilot Professional, had backlit screens, but no infrared port or flash memory. Their RAM size was 1024 kB respectively, they used version 2 of the Palm OS. Palm III, all the following Palms, did not have the word "Pilot" in their name due to the mentioned trademark dispute; the Palm III had an IR port and flash memory. The latter allowed the user to upgrade Palm OS, or, with some external applications, to store programs or data in flash memory, it ran on two standard AAA batteries. It was able to retain enough energy for 10–15 minutes to prevent data loss during battery replacement, it had 2 megabytes of memory, large at the time, used Palm OS 3. Meanwhile, with Palm Computing now a subsidiary of 3Com, the founders felt they had insufficient control over the development of the Palm product; as a result, they left 3Com and founded Handspring in June 1998. When they left Palm, Hawkins secured a license for the Palm OS for Handspring, the company became the first Palm OS licensee.
Handspring went on to produce the Handspring Visor, a clone of the Palm handhelds that included a hardware expansion slot and used modified software. The next versions of Palm used Palm OS 3.1. These included Palm IIIx with 4 Megabytes of memory, Palm IIIe without flash memory or hardware expansion slot, Palm V with 2 Megabytes of memory, Palm Vx with 8 Megabytes of memory. Palm VII had wireless connection to some Internet services, but this connection worked only within the United States, it used Palm OS 3.2. Palm IIIc was the first Palm handheld with a color screen, it used Palm OS 3.5. Some of these newer handhelds, for example Palm V, used internal rechargeable batteries; this feature became standard for all Palms. Palm handhelds up to 2002 contained Motorola DragonBall processors, part of the Motorola 68000 family. Starting with the Palm Tungsten, the platform transitioned to the ARM architecture with Texas Instruments and Intel as suppliers; as ARM had been used in the Apple Newton series, the platform had significant investment in mobile and
An e-reader called an e-book reader or e-book device, is a mobile electronic device, designed for the purpose of reading digital e-books and periodicals. Any device that can display text on a screen may act as an e-reader, but specialized e-reader devices may optimize portability and battery life for this purpose, their main advantages over printed books are portability since an e-reader is capable of holding thousands of books while weighing less than one and the convenience provided due to add-on features in these devices. An e-reader is a device designed as a convenient way to read e-books, it is similar in form factor to a tablet computer, but features electronic paper rather than an LCD screen. This yields much longer battery life — the battery can last for several weeks — and better readability, similar to that of paper in sunlight. Drawbacks of this kind of display include a slow refresh rate and a grayscale-only display, which makes it unsuitable for sophisticated interactive applications as those found on tablets.
The absence of such apps may be perceived as an advantage, as the user may more focus on reading. The Sony Librie, released in 2004 and the precursor to the Sony Reader, was the first e-reader to use electronic paper; the Ectaco jetBook Color was the first color e-reader on the market, but its muted colors were criticized. Many e-readers can use the internet through Wi-Fi and the built-in software can provide a link to a digital Open Publication Distribution System library or an e-book retailer, allowing the user to buy and receive digital e-books. An e-reader may download e-books from a computer or read them from a memory card. However, the use of memory cards is decreasing. An idea similar to that of an e-reader is described in a 1930 manifesto written by Bob Brown titled The Readies, which describes "a simple reading machine which I can carry or move around, attach to any old electric light plug and read hundred-thousand-word novels in 10 minutes", his hypothetical machine would use a microfilm-style ribbon of miniaturized text which could be scrolled past a magnifying glass, would allow the reader to adjust the type size.
He envisioned that words could be "recorded directly on the palpitating ether". The establishment of the E Ink Corporation in 1997 led to the development of electronic paper, a technology which allows a display screen to reflect light like ordinary paper without the need for a backlight; the Rocket eBook was the first commercial e-reader and several others were introduced around 1998, but did not gain widespread acceptance. Electronic paper was incorporated first into the Sony Librie, released in 2004 and Sony Reader in 2006, followed by the Amazon Kindle, a device which, upon its release in 2007, sold out within five and a half hours; the Kindle includes access to the Kindle Store for e-book sales and delivery. As of 2009, new marketing models for e-books were being developed and a new generation of reading hardware was produced. E-books had yet to achieve global distribution. In the United States, as of September 2009, the Amazon Kindle model and Sony's PRS-500 were the dominant e-reading devices.
By March 2010, some reported that the Barnes & Noble Nook may be selling more units than the Kindle in the US. Research released in March 2011 indicated that e-books and e-readers are more popular with the older generation than the younger generation in the UK; the survey carried out by Silver Poll found that around 6% of people over 55 owned an e-reader, compared with just 5% of 18- to 24-year-olds. According to an IDC study from March 2011, sales for all e-readers worldwide rose to 12.8 million in 2010. On January 27, 2010 Apple Inc. launched a multi-function tablet computer called the iPad and announced agreements with five of the six largest publishers that would allow Apple to distribute e-books. The iPad includes a built-in app for e-book reading called iBooks and had the iBookstore for content sales and delivery; the iPad, the first commercially profitable tablet, was followed in 2011 by the release of the first Android-based tablets as well as LCD tablet versions of the Nook and Kindle.
The growth in general-purpose tablet use allowed for further growth in popularity of e-books in the 2010s. In 2012, there was a 26% decline in sales worldwide from a maximum of 23.2 million in 2011. The reason given for this "alarmingly precipitous decline" was the rise of more general purpose tablets that provide e-book reading apps along with many other abilities in a similar form factor. In 2013, ABI Research claimed that the decline in the e-reader market was due to the aging of the customer base. In 2014, the industry reported e-reader sales worldwide to be around 12 million, with only Amazon.com and Kobo Inc. distributing e-readers globally and various regional distribution by Barnes & Noble, Icarus, PocketBook International and Onyx Boox. At the end of 2015, eMarketer estimates that there are 83.4 million e-reader users in the US, with the number predicted to grow by 3.5% in 2016. In late 2014, PricewaterhouseCoopers predicted that by 2018 e-books will make up over 50% of total consumer publishing revenue in the U.
S. and UK while at that time e-books were over 30% of the share of revenue. Until late 2013, use of an e-reader was not allowed on airplane
Medical genetics is the branch of medicine that involves the diagnosis and management of hereditary disorders. Medical genetics differs from human genetics in that human genetics is a field of scientific research that may or may not apply to medicine, while medical genetics refers to the application of genetics to medical care. For example, research on the causes and inheritance of genetic disorders would be considered within both human genetics and medical genetics, while the diagnosis and counselling people with genetic disorders would be considered part of medical genetics. In contrast, the study of non-medical phenotypes such as the genetics of eye color would be considered part of human genetics, but not relevant to medical genetics. Genetic medicine is a newer term for medical genetics and incorporates areas such as gene therapy, personalized medicine, the emerging new medical specialty, predictive medicine. Medical genetics encompasses many different areas, including clinical practice of physicians, genetic counselors, nutritionists, clinical diagnostic laboratory activities, research into the causes and inheritance of genetic disorders.
Examples of conditions that fall within the scope of medical genetics include birth defects and dysmorphology, mental retardation, mitochondrial disorders, skeletal dysplasia, connective tissue disorders, cancer genetics and prenatal diagnosis. Medical genetics is becoming relevant to many common diseases. Overlaps with other medical specialties are beginning to emerge, as recent advances in genetics are revealing etiologies for neurologic, cardiovascular, ophthalmologic, renal and dermatologic conditions; the medical genetics community is involved with individuals who have undertaken elective genetic and genomic testing. In some ways, many of the individual fields within medical genetics are hybrids between clinical care and research; this is due in part to recent advances in science and technology that have enabled an unprecedented understanding of genetic disorders. Clinical genetics is the practice of clinical medicine with particular attention to hereditary disorders. Referrals are made to genetics clinics for a variety of reasons, including birth defects, developmental delay, epilepsy, short stature, many others.
Examples of genetic syndromes that are seen in the genetics clinic include chromosomal rearrangements, Down syndrome, DiGeorge syndrome, Fragile X syndrome, Marfan syndrome, Neurofibromatosis, Turner syndrome, Williams syndrome. In the United States, Doctors who practice clinical genetics are accredited by the American Board of Medical Genetics and Genomics. In order to become a board-certified practitioner of Clinical Genetics, a physician must complete a minimum of 24 months of training in a program accredited by the ABMGG. Individuals seeking acceptance into clinical genetics training programs must hold an M. D. or D. O. degree and have completed a minimum of 24 months of training in an ACGME-accredited residency program in internal medicine, pediatrics and gynecology, or other medical specialty. Metabolic genetics involves the diagnosis and management of inborn errors of metabolism in which patients have enzymatic deficiencies that perturb biochemical pathways involved in metabolism of carbohydrates, amino acids, lipids.
Examples of metabolic disorders include galactosemia, glycogen storage disease, lysosomal storage disorders, metabolic acidosis, peroxisomal disorders and urea cycle disorders. Cytogenetics is the study of chromosomes and chromosome abnormalities. While cytogenetics relied on microscopy to analyze chromosomes, new molecular technologies such as array comparative genomic hybridization are now becoming used. Examples of chromosome abnormalities include aneuploidy, chromosomal rearrangements, genomic deletion/duplication disorders. Molecular genetics involves the discovery of and laboratory testing for DNA mutations that underlie many single gene disorders. Examples of single gene disorders include achondroplasia, cystic fibrosis, Duchenne muscular dystrophy, hereditary breast cancer, Huntington disease, Marfan syndrome, Noonan syndrome, Rett syndrome. Molecular tests are used in the diagnosis of syndromes involving epigenetic abnormalities, such as Angelman syndrome, Beckwith-Wiedemann syndrome, Prader-willi syndrome, uniparental disomy.
Mitochondrial genetics concerns the diagnosis and management of mitochondrial disorders, which have a molecular basis but result in biochemical abnormalities due to deficient energy production. There exists some overlap between molecular pathology. Genetic counseling is the process of providing information about genetic conditions, diagnostic testing, risks in other family members, within the framework of nondirective counseling. Genetic counselors are non-physician members of the medical genetics team who specialize in family risk assessment and counseling of patients regarding genetic disorders; the precise role of the genetic counselor varies somewhat depending on the disorder. Although genetics has its roots back in the 19th century with the work of the Bohemian monk Gregor Mendel and other pioneering scientists, human genetics emerged later, it started to develop, albeit during the first half of the 20th century. Mendelian inheritance was studied in a number of important disorders such as albinism and hemophilia.
Mathematical approaches were devised
Radiology is the medical specialty that uses medical imaging to diagnose and treat diseases within the human body. A variety of imaging techniques such as X-ray radiography, computed tomography, nuclear medicine including positron emission tomography, magnetic resonance imaging are used to diagnose or treat diseases. Interventional radiology is the performance of minimally invasive medical procedures with the guidance of imaging technologies such as X-ray radiography, computed tomography, nuclear medicine including positron emission tomography, magnetic resonance imaging; the modern practice of radiology involves several different healthcare professions working as a team. The radiologist is a medical doctor who has completed the appropriate post-graduate training and interprets medical images, communicates these findings to other physicians by means of a report or verbally, uses imaging to perform minimally invasive medical procedures; the nurse is involved in the care of patients before and after imaging or procedures, including administration of medications, monitoring of vital signs and monitoring of sedated patients.
The radiographer known as a "radiologic technologist" in some countries such as the United States, is a specially trained healthcare professional that uses sophisticated technology and positioning techniques to produce medical images for the radiologist and nurse to interpret. Depending on the individual's training and country of practice, the radiographer may specialize in one of the above-mentioned imaging modalities or have expanded roles in image reporting. Radiographs are produced by transmitting X-rays through a patient; the X-rays are projected through the body onto a detector. Röntgen discovered X-rays on November 8, 1895 and received the first Nobel Prize in Physics for their discovery in 1901. In film-screen radiography, an X-ray tube generates a beam of X-rays, aimed at the patient; the X-rays that pass through the patient are filtered through a device called an grid or X-ray filter, to reduce scatter, strike an undeveloped film, held to a screen of light-emitting phosphors in a light-tight cassette.
The film is developed chemically and an image appears on the film. Film-screen radiography is being replaced by phosphor plate radiography but more by digital radiography and the EOS imaging. In the two latest systems, the X-rays strike sensors that converts the signals generated into digital information, transmitted and converted into an image displayed on a computer screen. In digital radiography the sensors shape a plate, but in the EOS system, a slot-scanning system, a linear sensor vertically scans the patient. Plain radiography was the only imaging modality available during the first 50 years of radiology. Due to its availability and lower costs compared to other modalities, radiography is the first-line test of choice in radiologic diagnosis. Despite the large amount of data in CT scans, MR scans and other digital-based imaging, there are many disease entities in which the classic diagnosis is obtained by plain radiographs. Examples include various types of arthritis and pneumonia, bone tumors, congenital skeletal anomalies, etc.
Mammography and DXA are two applications of low energy projectional radiography, used for the evaluation for breast cancer and osteoporosis, respectively. Fluoroscopy and angiography are special applications of X-ray imaging, in which a fluorescent screen and image intensifier tube is connected to a closed-circuit television system; this augmented with a radiocontrast agent. Radiocontrast agents are administered by swallowing or injecting into the body of the patient to delineate anatomy and functioning of the blood vessels, the genitourinary system, or the gastrointestinal tract. Two radiocontrast agents are presently in common use. Barium sulfate is given rectally for evaluation of the GI tract. Iodine, in multiple proprietary forms, is given by oral, vaginal, intra-arterial or intravenous routes; these radiocontrast agents absorb or scatter X-rays, in conjunction with the real-time imaging, allow demonstration of dynamic processes, such as peristalsis in the digestive tract or blood flow in arteries and veins.
Iodine contrast may be concentrated in abnormal areas more or less than in normal tissues and make abnormalities more conspicuous. Additionally, in specific circumstances, air can be used as a contrast agent for the gastrointestinal system and carbon dioxide can be used as a contrast agent in the venous system. CT imaging uses X-rays in conjunction with computing algorithms to image the body. In CT, an X-ray tube opposite an X-ray detector in a ring-shaped apparatus rotate around a patient, producing a computer-generated cross-sectional image. CT is acquired in the axial plane, with coronal and sagittal images produced by computer reconstruction. Radiocontrast agents are used with CT for enhanced delineation of anatomy. Although radiographs provide higher spatial resolution, CT can detect more subtle variations in attenuation of X-rays. CT exposes the patient to more ionizing radiation than a radiograph. Spiral multidetector CT uses 16, 64, 254 o
Intensive care medicine
Intensive care medicine, or critical care medicine, is a branch of medicine concerned with the diagnosis and management of life-threatening conditions that may require sophisticated life support and intensive monitoring. Patients requiring intensive care may require support for cardiovascular instability lethal cardiac arrhythmias, airway or respiratory compromise, acute renal failure, or the cumulative effects of multiple organ failure, more referred to now as multiple organ dysfunction syndrome, they may be admitted for intensive/invasive monitoring, such as the crucial hours after major surgery when deemed too unstable to transfer to a less intensively monitored unit. Medical studies suggest a relation between ICU volume and quality of care for mechanically ventilated patients. After adjustment for severity of illness, demographic variables, characteristics of the ICUs, higher ICU volume was associated with lower ICU and hospital mortality rates. For example, adjusted ICU mortality was 21.2% in hospitals with 87 to 150 mechanically ventilated patients annually, 14.5% in hospitals with 401 to 617 mechanically ventilated patients annually.
Hospitals with intermediate numbers of patients had outcomes between these extremes. ICU delirium and inaccurately referred to as ICU psychosis, is a syndrome common in intensive care and cardiac units where patients who are in unfamiliar, monotonous surroundings develop symptoms of delirium; this may include interpreting machine noises as human voices, seeing walls quiver, or hallucinating that someone is tapping them on the shoulder. There exists systematic reviews in which interventions of sleep promotion related outcomes in the ICU have proven impactful in the overall health of patients in the ICU. In general, it is the most expensive, technologically advanced and resource-intensive area of medical care. In the United States, estimates of the 2000 expenditure for critical care medicine ranged from US$15–55 billion. During that year, critical care medicine accounted for 0.56% of GDP, 4.2% of national health expenditure and about 13% of hospital costs. In 2011, hospital stays with ICU services accounted for just over one-quarter of all discharges but nearly one-half of aggregate total hospital charges in the United States.
The mean hospital charge was 2.5 times higher for discharges with ICU services than for those without. Intensive care takes a system-by-system approach to treatment; as such, the nine key systems are each considered on an observation-intervention-impression basis to produce a daily plan. In addition to the key systems, intensive care treatment raises other issues including psychological health, pressure points and physiotherapy, secondary infections. In alphabetical order, the nine key systems considered in the intensive care setting are: cardiovascular system, central nervous system, endocrine system, gastro-intestinal tract, integumentary system, microbiology and respiratory system. Intensive care is provided in a specialized unit of a hospital called the intensive care unit or critical care unit. Many hospitals have designated intensive care areas for certain specialities of medicine, such as the coronary intensive care unit for heart disease, medical intensive care unit, surgical intensive care unit, pediatric intensive care unit, neuroscience critical care unit, overnight intensive-recovery, shock/trauma intensive-care unit, neonatal intensive care unit, other units as dictated by the needs and available resources of each hospital.
The naming is not rigidly standardized. For a time in the early 1960s, it was not clear that specialized intensive care units were needed, so intensive care resources were brought to the room of the patient that needed the additional monitoring and resources, it became evident, that a fixed location where intensive care resources and dedicated personnel were available provided better care than ad hoc provision of intensive care services spread throughout a hospital. Common equipment in an intensive care unit includes mechanical ventilation to assist breathing through an endotracheal tube or a tracheotomy. Critical care medicine is an important medical specialty. Physicians with training in critical care medicine are referred to as intensivists. In the United States, the specialty requires additional fellowship training for physicians having completed their primary residency training in internal medicine, anesthesiology, surgery or emergency medicine. US board certification in critical care medicine is available through all five specialty boards.
Intensivists with a primary training in internal medicine sometimes pursue combined fellowship training in another subspecialty such as pulmonary medicine, infectious disease, or nephrology. The American Society of Critical Care Medicine is a well-established multiprofessional society for practitioners working in the ICU including nurses, respiratory therapists, physicians. Most medical research has demonstrated that ICU care provided by intensivists produces better outcomes and more cost-effective care; this has led the Leapfrog Group
Orthopedic surgery or orthopedics spelled orthopaedics, is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections and congenital disorders. Nicholas Andry coined the word in French as orthopédie, derived from the Ancient Greek words ὀρθός orthos and παιδίον paidion, published Orthopedie in 1741; the word was assimilated into English as orthopædics. Though, as the name implies, the discipline was developed with attention to children, the correction of spinal and bone deformities in all stages of life became the cornerstone of orthopedic practice; as with many words derived with the "æ" ligature, simplification to either "ae" or just "e" is common in North America. In the US, the majority of college and residency programs, the American Academy of Orthopaedic Surgeons, still use the spelling with the digraph ae, though hospitals use the shortened form.
Elsewhere, usage is not uniform: in Canada, both spellings are acceptable. Many developments in orthopedic surgery have resulted from experiences during wartime. On the battlefields of the Middle Ages the injured were treated with bandages soaked in horses' blood which dried to form a stiff, but unsanitary, splint; the term orthopedics meant the correcting of musculoskeletal deformities in children. Nicolas Andry, a professor of medicine at the University of Paris coined the term in the first textbook written on the subject in 1741, he advocated the use of exercise and splinting to treat deformities in children. His book was directed towards parents, while some topics would be familiar to orthopedists today, it included'excessive sweating of the palms' and freckles. Jean-André Venel established the first orthopedic institute in 1780, the first hospital dedicated to the treatment of children's skeletal deformities, he developed the club-foot shoe for children born with foot deformities and various methods to treat curvature of the spine.
Advances made in surgical technique during the 18th century, such as John Hunter's research on tendon healing and Percival Pott's work on spinal deformity increased the range of new methods available for effective treatment. Antonius Mathijsen, a Dutch military surgeon, invented the plaster of Paris cast in 1851. However, up until the 1890s, orthopedics was still a study limited to the correction of deformity in children. One of the first surgical procedures developed was percutaneous tenotomy; this involved cutting a tendon the Achilles tendon, to help treat deformities alongside bracing and exercises. In the late 1800s and first decades of the 1900s, there was significant controversy about whether orthopedics should include surgical procedures at all. Examples of people who aided the development of modern orthopedic surgery were Hugh Owen Thomas, a surgeon from Wales, his nephew, Robert Jones. Thomas became interested in orthopedics and bone-setting at a young age and, after establishing his own practice, went on to expand the field into general treatment of fracture and other musculoskeletal problems.
He advocated enforced rest as the best remedy for fractures and tuberculosis and created the so-called'Thomas Splint', to stabilize a fractured femur and prevent infection. He is responsible for numerous other medical innovations that all carry his name:'Thomas's collar' to treat tuberculosis of the cervical spine,'Thomas's manoeuvre', an orthopedic investigation for fracture of the hip joint, Thomas test, a method of detecting hip deformity by having the patient lying flat in bed,'Thomas's wrench' for reducing fractures, as well as an osteoclast to break and reset bones. Thomas's work was not appreciated in his own lifetime, it was only during the First World War that his techniques came to be used for injured soldiers on the battlefield. His nephew, Sir Robert Jones, had made great advances in orthopedics in his position as Surgeon-Superintendent for the construction of the Manchester Ship Canal in 1888, he was responsible for the injured among the 20,000 workers, he organized the first comprehensive accident service in the world, dividing the 36 mile site into 3 sections, establishing a hospital and a string of first aid posts in each section.
He had the medical personnel trained in fracture management. He managed 3,000 cases and performed 300 operations in his own hospital; this position enabled him to improve the standard of fracture management. Physicians from around the world came to Jones’ clinic to learn his techniques. Along with Alfred Tubby, Jones founded the British Orthopaedic Society in 1894. During the First World War, Jones served as a Territorial Army surgeon, he observed that treatment of fractures both at the front and in hospitals at home was inadequate, his efforts led to the introduction of military orthopedic hospitals. He was appointed Inspector of Military Orthopaedics, with responsibility over 30,000 beds; the hospital in Ducane Road, Hammersmith became the model for both British and American military orthopedic hospitals. His advocacy of the use of Thomas splint for the initial treatment of femoral fractures reduced mortality of compound fractures of the femur from 87% to less than 8% in the period from 1916 to 1918.
The use of intramedullary rods to treat fractures of the femur and tibi