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While much of your work has moved onto your computer or out onto the web, you probably still use paper regularly despite predictions to the contrary. You sign and fax contracts. You exchange business cards. You write paper to-do lists (see sidebar Ten reasons to use a paper to-do list ). You put sticky notes all over your workspace and homes. You read books. You manage receipts. Accept that for the near future you will continue using paper. Then equip yourself with tools that cross the paper/computer divide: printer, fax machine or online fax service, scanner, printer paper, paper notebooks, and pens.

First, it is dif cult to imagine any national system suggesting its staff become act-utilitarians. For example, enthusiastic converts might seek to justify a lower standard of care or even non-voluntary euthanasia for old people occupying beds that could be used to care for younger people. Such discrimination, although possibly justi able in utilitarian terms, is not work for health. There is a further practical problem. The act-utilitarian must assess, in each and every case, the likely ratio of good and evil. Yet this requirement is unrealistic in the urgent health care world. What is needed is a way of re ection that does not demand calculation afresh in every case, yet which nevertheless offers individuals the opportunity to think for themselves. This focus on individual responsibility is the main advantage of act-utilitarianism. Just as act-deontology claims that a person has a basic duty to re ect on the array of principles

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A. Implement a one-year moratorium on all CME, IMM, or IOM lessees switching to the GEM Division. This rule should be extended to preclude an equity owner from leasing out his CME, IMM, or IOM membership and leasing a GEM. The object is to stop interdivisional price compacting, or the GEM addition will continue to dilute. We cannot tolerate

Hudson et al. Birk & Spencer Stancin et al. Powers et al. Fairburn et al. Rodin et al. Striegel-Moore et al. Peveler et al. Biggs et al. Dunning et al. Polonsky et al. Cantwell et al. Affenito et al. Rydall et al. Bryden et al. Herpertz et al. Herpertz et al. Jones et al.

age-adjusted incidence of all sarcomas, leiomyosarcoma, and carcinosarcoma. (From Jeffers MD, Farquharson MA, Richmond JA, McNicol AM. p53 immunoreactivity and mutation of the p53 gene in smooth muscle tumours of the uterine corpus. J Pathol. 1995;177:65 70.)

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often successful because 27% of the patients completely denied their eating disorder, 46% minimized their problems and were reluctant to be treated and 19% dropped out after some weeks or months. Only 8% had a positive attitude towards treatment. Thus an important task for the general practitioner is to help the patients to recognize the seriousness of their disorder and to prepare and motivate them for specialist treatment (Silber & DeAngelo, 1991; Spaans & Bloks, 1997).

The review also identi ed wide variability in the quality and reporting of studies, in terms of the CONSORT standards (Moher, Jones & Lepage, 2001; Moher, Schulz & Altman, 2001). Many of the RCTs were small and were unlikely to have been powered to detect a difference between treatments.

THERAPEUTIC CONTENT, PROCESS, AND TECHNIQUES Haley (1987) states:

The observations that might be made by someone who nds an unconscious body were mentioned at the beginning of this chapter: in a deep sleep, eyes closed, not talking, not responding to instructions, not moving even when slapped or shaken . These natural comments have been brought together and elaborated in the Glasgow Coma Scale. This is used very effectively to indicate and monitor a patient s level of unconsciousness. The Glasgow Coma Scale records the level of stimulus required to make the patient open his eyes and also records the patient s best verbal and motor responses, as shown in Fig. 11.3. It may be helpful to amplify the scores with a written description of the patient s precise responses to command or pain, in case subsequent staff are less familiar with the numerical scale. The responses of the Glasgow Coma Scale depend upon the cerebrum s response to afferent stimulation. This may be impaired either because of impaired cerebral hemisphere function or because of a major brainstem lesion interfering with access of such stimuli to the cerebral hemispheres. Direct evidence that there is a major brainstem lesion may be evident in an unconscious patient (Fig. 11.4). Dilatation of the pupils and lack of pupillary constriction to light indicate problems in the midbrain, i.e. 3rd cranial nerve dysfunction. Impaired regulation of

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