OpenLLM-France/wikimedia huggingface dataset:
# Orthopaedic Surgery/Employees

Employees in a medical office are knowledge workers. Motivation is not limited to pay scale alone but also to job satisfaction and challenge. A knowledge worker may well be more familiar with their job than their manager is. Indeed this knowledge is a commodity which may be in demand and which is portable. incentivizing the recognition and implementation of best practices at the level of the individual employee and employee categories, medical assistants for example, is the goal of management.
Merit raises can be based on three basic criteria upon annual review:
process improvement
team spirit
brand enhancement
Fulfilling the basic job requirements in a timely manner and with an appropriate appearance is expected of any employee. For a knowledge worker, merit implies an application of their innate intelligence toward the improvement of the defining processes of their job. It is the job of management to provide a mechanism by which suggestions on process improvement can be brought to the attention of management by each employee and be considered for implementation, with due credit being given to the employee at the time of annual review. The mechanism for conveying such information should mirror that through which complaints can be raised and resolved through open conference with their fellow managers in instances where conflict between worker and their immediate supervisor seem to warrant arbitration.
For a knowledge worker merit implies an understanding that most achievement is a collective process and individual efforts interlace. Inequalities in effort and capacity are inevitable and some asymmetry in the rewards which accrue to the more spontaneously energetic and gratuitously helpful employee are not to be undermined by expressed resentment. A team spirit builds with helpfulness especially when it is offered without obligation.
The orthopedic practice is a service. Like most service industries the "product" of the enterprise is less tangible than in a manufacturing enterprise. Indeed in medicine, even the most optimal exercise of our most conscientiously applied art and science may not yield a net benefit to the patient. That patient would seemingly be quite justified in seeking care elsewhere if this were all they had to go on. As it happens however with the help of merit worthy front office workers and back offic workers who also interact with patients on the financial aspect of their experience with the practice, the patient who has not met with a favorable result may yet return the next time if they were treated with courtesy and regard, with respect of their privacy and with a timely delivery of service, in which the patient is guided through the transitions from one venue to the next as they are readied for surgery and recovery.
# Orthopaedic Surgery/Fractures and Dislocations:Forearm and Wrist

* Orthopaedic Surgery
* INTRODUCTION ·
* AUTHORS ·
* ACKNOWLEDGEMENTS ·
* NOTE TO AUTHORS
* 1.Basic Sciences ·
* 2.Upper Limb ·
* 3.Foot and Ankle ·
* 4.Spine ·
* 5.Hand and Microsurgery ·
* 6.Paediatric Orthopaedics ·
* 7.Adult Reconstruction ·
* 8.Sports Medicine ·
* 9.Musculoskeletal Tumours ·
* 10.Injury ·
* 11.Surgical Procedures ·
* 12.Rehabilitation ·
* 13.Practice
* Current Chapter: Basic Sciences
| | Forearm and Wrist | |
| <<Upper Arm and Elbow | Forearm and Wrist | Hand>> |
A fracture of the distal radius is the most common skeletal injury which is referred for acute orthopedic management. Recently volar locking plates as well as more comprehensive plating systems have come to effect the mode of treatment for this injury and in typical fashion have been adopted rather broadly to the treatment of an injury which can often be well managed by closed manipulation and immobilization. Decision making regarding choice of treatment is governed by context, ease of care, risk and benefit and expectation of outcome. What may have been an acceptable result allowing for deformity may no longer be considered acceptable. Traditionally the treatment goal is a pain free wrist achieved within a predictable and reasonable time frame allowing for return of strong grip, range of motion of the wrist and fingers. This result is still readily achievable by closed means for the majority of fractures of the distal radius, especially those which result from what is the most common mechanism, that being low energy trauma from a fall.
Patient expectation tends to shift. They will expect to hear about an operative alternative which offers early motion in a removable splint and a more predictable restoration of anatomical relationships and perhaps and enhanced prospect for a return to full function. They will increasingly be familiar with friends and family similarly treated. Other patients will remain pleased to hear that surgery may be avoidable and will be quite willing to put up with some short term inconvenience and even the prospect of residual deformity in order to avoid the cost and risk of surgery.
The process of informed consent will reveal which sentiment will hold sway in the patients decision making and thus skill in achieving the desired result by either operative or closed means will continue. The artful orthopedist will acquire a sense of which direction is best to advise weighing many factors in a calculus he or she will be at a loss to explain. Sometimes the wrong choice will be made and the patient will experience difficulties despite the best assessment that can be offered. An unexpectedly poor outcome will likely effect the subsequent treatment advise of the orthopedist and in this way his or her practice pattern will evolve. A ruptured tendon or infection subsequent to plating, or a malunion and stiff fingers following closed management.
# Orthopaedic Surgery/Extensor Tendons

* Orthopaedic Surgery
* INTRODUCTION ·
* AUTHORS ·
* ACKNOWLEDGEMENTS ·
* NOTE TO AUTHORS
* 1.Basic Sciences ·
* 2.Upper Limb ·
* 3.Foot and Ankle ·
* 4.Spine ·
* 5.Hand and Microsurgery ·
* 6.Paediatric Orthopaedics ·
* 7.Adult Reconstruction ·
* 8.Sports Medicine ·
* 9.Musculoskeletal Tumours ·
* 10.Injury ·
* 11.Surgical Procedures ·
* 12.Rehabilitation ·
* 13.Practice
* Current Chapter: Hand and Microsurgery
| | Extensor Tendons | |
| <<Tendon Injuries | Extensor Tendons | Flexor Tendons>> |
Extensor tendon lacerations
Extensor tendon ruptures
Mallet finger
Presenting as an inability to extend the distal interphalangeal joint following blunt trauma typically related to ball sports this seemingly innocuous injury is made a bit more complicated by delay in presentation. There is a tendency then to immobilize the distal phalanx for longer than the typical 5 weeks, and perhaps run the risk that flexion will be lost. This outcome is more detrimental to hand function than is a mild extension lag especially in the small and ring fingers. Still patients place a priority on achieving full extension and the possibility of gradually reaquiring the ability to fully flex the joint is more likely than requiring the ability to actively extend the distal interphalangeal joint.
Besides delay in treatment, the other factor that can complicate treatment is a sizable boney fragment. At times a true axial load can in fact split the joint surface of the distal interphalangeal joint essentially disrupting both the extensor and flexor insertion.
The uncomplicated healing that typically occurs with a five week period of immobilization is still accompanied thereafter by what is sometimes a protracted period ( up to 4 months) of sensitivity, slight swelling and even slight erythema over the dorsum of the middle phalanx, which appears to be self limiting and perhaps reflects ongoing remodeling changes in the terminal extensor tendon.
Boutonierre deformity
Radial saggital band rupture
Extensor Pollicus Longus Rupture
Extension Lag
Tendon transfers
# Puzzles/Lateral puzzles/1

Puzzles | Lateral puzzles | Lateral puzzle 1
The music stops, she dies!
Explain...
Hints:
* No one mourns her death.
* Power failure is involved.
* She was a circus performer.
* There were many children.
* She died in a car accident.
Solution
# Puzzles/How do you ... ?

Puzzles | How do you ... ?
* The Burning Island
* Ten Apples and a Basket
* Sending a Package
# Puzzles/How do you ... ?/Sending a Package/Solution

* Dmitri secures the package with a padlock and chain and sends it to Ana.
* Ana attaches another padlock to the package and locks it. She then sends the package back to Dmitri.
* Dmitri removes his padlock and sends the package back to Ana.
* Ana removes her padlock and opens the package.
alternative:
problem with above:
# Puzzles/How do you ... ?/Sending a Package

Dmitri, who lives in Moscow, has bought a pretty necklace for his fiancee Ana, who lives in St Petersburg. He wishes to send the necklace to her via post, but due to problems in the Russian postal service, he fears the package will be opened and the necklace stolen.
* There is a considerable distance between the two cities.
* Both Dmitri and Ana own a number of locks, chains, and keys.
* Ana does not, however, own a key to any of Dmitri's locks, and vice versa.
How can he send the necklace to her?
Solution
# Puzzles/How do you ... ?/Ten Apples and a Basket

Puzzles | How do you... ? | Ten Apples and A Basket
Ten Apples and A Basket puzzle
You have a basket containing ten apples. You have ten friends, who each desire an apple. You give each of your friends one apple.
After ten minutes, each of your friends has one apple each. Yet there is one remaining apple in the basket.
How is this possible?
Solution
# Puzzles/Lateral puzzles

Puzzles | Lateral puzzles
Some part of situation is described in each puzzle. You should explain the whole situation. There may be more than one solution, thus take your time to explore the possibilities.
* Lateral Puzzle 1
* Lateral Puzzle 2
* Lateral Puzzle 3
* Lateral Puzzle 4
* Lateral Puzzle 5
* Lateral Puzzle 6
* Lateral Puzzle 7
* Lateral Puzzle 8
* Lateral Puzzle 9
* Lateral Puzzle 10
# Puzzles/Lateral puzzles/1/Solution

Puzzles | Lateral puzzles | Lateral puzzle 1 | Lateral puzzle 1 solution
* She is a music box
* She is on life support in a hospital and the power fails.
* She was a tight rope walker who did her act blindfolded. She knew she reached the opposite end of the rope when the band that was beneath her stopped playing. However, one day the lead conductor was sick, and the replacement did not know the trick. So when he stopped (early), the tight rope walker thought she had reached the end and walked off to her death.
* She was a bug at a party. She was sitting on a chair that people were using for musical chairs, and when the music stopped, a child sat on her.
* She was driving in a car listening to the radio. She crashed into a cement pole. The radio, being closer to the front of the car, was destroyed a split second before she was.
# Puzzles/How do you ... ?/Ten Apples and a Basket/Solution

< Back to Problem
Solutions:
//Solutions below are only humorous and not Logical //
* You discover a horrible secret about your friend Brian, end your friendship and put his apple back in the basket
* Alternately, end Brian, and take the apple back.
# Puzzles/How do you ... ?/The Burning Island

Puzzles | Puzzles/How do you ... ? | The Burning Island
A man is stranded on an island covered in forest. One day, when the wind is blowing from the west, lightning strikes the west end of the island and sets fire to the forest. The fire is very violent, burns everything in its path, and without intervention the fire will burn the whole island, killing the man in the process. There are cliffs around the island, so he cannot get back on if he jumps into the ocean.
How can the man survive? (The fire, at least.) There are no buckets or any other means to douse the fire with water or sand to put it out.
solution
# Perl Programming/Keywords/state
## The state keyword

state declares a lexically scoped variable like my, but variables declared with state will never be reinitialized
If the variable list VARIABLES of state has more than one element, the list has to be placed in brackets. In such a list, undef can be used as a placeholder.
If more than one state with the same name are declared within the same lexical scope, Perl issues a warning, as it is the case with multiple $my$ declarations, but they are seen as redundant.
state variables can only be used with the use feature "state" pragma, unless it is written fully as CORE::state.

### See also

* $my$
* $our$
# Perl Programming/Keywords/sysopen
## The sysopen keyword

The sysopen command opens the file whose filename is given by FILEHANDLE, and associates it with the FILEHANDLE, which may be an expression where its value is the real filehandle. The function calls the open(2) function of the underlying operating system and depends on the fdopen C library function.
Values of the MODE parametre are system-dependent and are available over the standard module Fcntl. These values are O_RDONLY (=0), O_WRONLY (=1), O_RDWR (=2) for opening the file read-only, write-only, and read-write, respectively. The values do not work on some operating systems, such as OS/390 and Macintosh.
Many systems support also the O_EXCL flag that opens the file in the exclusive mode, which does not mean a lock, but that if the file already exists, sysopen fails. O_EXCL may not work on network filesystems, or if the O_CREAT flag is not set. The O_TRUNC can be used to truncate a file.

### Syntax

| syscall | sysopen | sysread | sysseek | system | syswrite |
# Perl Programming/Keywords/split
## The split keyword

split splits the EXPRESSION in a list of strings and returns this list. Without EXPRESSION, $_ is used as source. Anything in EXPRESSION that matches PATTERN is taken to be a separator, which may be longer than one character or have even zero length (results in a zero-width match). When separating the EXPRESSION, the separator itself is not added to the strings.

### See also

* join
# Perl Programming/Keywords/srand
## The srand keyword

The srand function sets and returns the random number seed for the rand operator so that it can produce a different sequence of random numbers.
srand is called implicitly when rand is called, but can be called explicitly to generate random numbers for test purposes with the same seed (see below).
Please do not call srand by the same more than once without an EXPRESSION after it, as the random number generation will lose randomness.

### See also

* rand
# Perl Programming/Keywords/sub
## The sub keyword

The sub keyword defines a subroutine. Without a BLOCK, it is a forward declaration. By an assignment larger or shorter than LENGTH, the string will grow or shrink respectively to accommodate it. Without NAME, it defines an anonymous function, but returns the CODE ref of the just created closure.
# Perl Programming/Keywords/syscall
## The syscall keyword

syscall makes a system call with the first element of the list that may have upto 14 parametres. The remaining parametres are passed altogether as arguments to the system call. If the command is unimplemented, syscall raises an exception.
All given arguments that are numeric are passed as an int. If they are not, a pointer to the string value is passed. A string literal (or other read-only strings) are not allowed as an argument, as Perl has to assume that any string pointer might be written through. If the integer arguments are not literals and have never been interpreted in a numeric context, it may be necessary to add a 0 to them to force them to look like numbers.
syscall emulates the syswrite function (or vice versa)
syscall returns whatever value returned by the called system call. On failure, -1 is returned and $! (errno) is set. As some system calls can legitimately return -1, 0 should be assigned to $! before the call.
syscall(&SYS_pipe) returns the file number of the read end of the pipe it creates, but there is no way to retrieve the file number of the other end. This is a problem that can be avoided by using pipe instead.

### See also

* alarm
* pipe
| syscall | sysopen | sysread | sysseek | system | syswrite |
# Perl Programming/Keywords/sqrt
## The sqrt keyword

sqrt returns the positive square root of EXPRESSION. If EXPRESSION is omitted, $_ is used instead. Works for non-negative operands, if the Math::Complex module has not be loaded.
# Perl Programming/Keywords/stat
## The stat keyword

stat returns a list with 13 elements with the status information for a file that is either opened with the DIRHANDLE or FILEHANDLE, or by an EXPRESSION. Without the EXPRESSION, $_ is stat. If the operation fails, it returns an empty list.
If the variable list VARIABLES of stat has more than one element, the list has to be placed in brackets. In such a list, undef can be used as a placeholder.
If more than one stat with the same name are declared within the same lexical scope, Perl issues a warning, as it is the case with multiple my declarations, but they are seen as redundant.
stat variables can only be used with the use feature "state" pragma, unless it is written fully as CORE::state.
# Perl Programming/Keywords/sprintf
## The sprintf keyword

The sprintf function returns a string formatted by the usual printf conventions of the C library function sprintf.
If the list is omitted, the contents of $_ is used as format information. To use the printf without a printf, a real filehandler like FH and not an indirect filehandler like $fh is required. In this case, if $_ contains formatting information, it will be replaced by an empty string and a warning will be emitted, if they are enabled. So, it's better to use print when the contents of $_ are to be used as formatting information.
print is simpler and less errorprone than printfǃ

### See also

* print
* printf
# Perl Programming/Keywords/substr
## The substr keyword

The substr command extracts and returns a substring out of EXPRESSION, where the first character is at OFFSET 0. If OFFSET is negative, it starts to count from the end of the string. If LENGTH is negative, it leaves that much characters from the string's end.
substr can also be used as an lvalue, if EXPRESSION is also an lvalue. By an assignment larger or shorter than LENGTH, the string will grow or shrink respectively to accommodate it.
If OFFSET and LENGTH specify a substring partly outside the string, only the part within the string is returned. If it is beyond both ends, undef is returned, and an exception is raised, if it is an lvalue.
# RadOnc Resident Wiki/Pelvis

Tumors of the pelvis can arise from various tissues and structures within the pelvic region. These tumors can be benign (non-cancerous) or malignant (cancerous). Pelvic tumors may originate in the bones, muscles, connective tissues, blood vessels, nerves, or organs located in the pelvic area. Here are some common types of pelvic tumors:
The treatment and prognosis for pelvic tumors depend on several factors, including the type of tumor, its size, location, and whether it is benign or malignant. Treatment options may include surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, or a combination of these approaches. Early detection through regular medical check-ups and screenings is crucial for improving the chances of successful treatment and outcomes. If you suspect you have a pelvic tumor or have concerning symptoms, it's essential to consult a healthcare professional for a thorough evaluation and diagnosis.
# RadOnc Resident Wiki/Peripheral Nervous System

Tumors of the peripheral nervous system (PNS) are relatively uncommon but can affect various components of the peripheral nervous system, including nerves, nerve sheaths, and nerve cells. The PNS includes all the nerves outside of the brain and spinal cord. Tumors that originate in or affect the PNS can be benign (non-cancerous) or malignant (cancerous). Here are some key points about peripheral nervous system tumors:
Early detection and appropriate medical intervention are essential for optimizing the outcome of individuals with peripheral nervous system tumors.
# RadOnc Resident Wiki/Breast

* Front Page: RadOnc_Resident_Wiki | RTOG Trials | Randomized Trials
* Official Guidelines
* Staging
* Workup
* Breast overview
* Breast cancer prevention
* Benign breast diseases
* DCIS
* LCIS
* Paget's Disease
* Phyllodes tumor
* Early stage
** Management of the breast
** Post mastectomy radiation
** Management of the regional lymphatics
** Radiation technique
** Partial breast irradiation
* Advanced stage
* Inflammatory
* Occult breast primary
* Breast cancer in pregnancy
* Breast cancer in men
* Hormonal therapy
* Chemotherapy
* Recurrence
* Metastatic Disease
* Toxicity of RT
* Level I Evidence
See also:
Clinical trial listing:
# RadOnc Resident Wiki/Breast/Breast overview
## Clinically node negative

Or T3N1, No T4
Options:
* BCS followed by RT ± boost
* Mastectomy
** RT
*** pN2a RT (≥4 axillary LNs)
** Consider RT
*** 1-3 LN+
*** T3
*** Margin <1mm consider RT
* NAC if does not qualify for BCS
For systemic adjuvant therapy see below, chemo comes before RT

## Clinically node positive

≥N2 | T4 (not inflammatory)
Options:
* NAC
** Response: Mastectomy or BCS + RT
** No Response: Individualize - more chemo, neoadj RT
For systemic adjuvant therapy see below, chemo comes before RT

## Surgical LN Staging

* If cN+ after biopsy, all patients get axillary dissection lvl 1-2
* If gross lvl 2 or 3, dissect 3
* SNLB
** Negative - no further needed
** Positive
*** If ALL are met, no further needed, otherwise ALND lvl 1+2
**** ≤T2
**** 1-2 +SLN
**** Patient getting BCS + WBRT without NAC
** Not found: ALND lvl 1+2

## Adjuvant systemic therapy

Mainstays of treatment:
* Hormone Therapy (HT)
* Chemotherapy (CT)
* Trastuzumab (T)
Algorithm for treatment
* ≤5mm - Consider HT
* >5mm | N1mi - HT
** Consider CT, Trastuzumab
* ≥1cm | pN1 - All 3
Aberrations of above algorithm:
* If group 2 and HR+, do 21 gene assessment, then group 1,2,3 as ≤18, ≤30, >30 respectively
* If HR+, Mucinous or Tubular histology
** ≤3cm Consider HT
** ≥pN1 HT consider chemotherapy
Also
* If HR- no HT, if HER2- no T

## Radiotherapy Methods (RT)

* Whole Breast RT (WBRT) or Chest wall RT (including reconstruction)
** Standard is 50Gy/25Fx [46-50Gy/23-25Fx]
** ±boost to cavity 10Gy/5Fx [10-16Gy/4-8Fxs]
* Hypofractionated
** Consider for >50yo, ≤T2N0, no NAC
** 40Gy/15Fxs [40-42.5Gy/15-16Fxs]
RNI
* ≥4 LN+: To all nodes (at risk axilla, IM, SCN)
* 1-3 LN+ strongly consider to all nodes or at least LVL 1-2
* T3 (>5cm) consider consider to all nodes or at least LVL 1-2
APBI
38.5Gy/10Fx BID or 34Gy/10Fx Brachy to tumor bed
* Needs to meet all criteria
** Suitable
*** ≥50yo, -BRCA, ≤T2 (2cm), ER+, N0, no NAC, no EIC
*** DCIS allowed if screen-detected, low - int grade, <2.5cm, margins >3mm,
*** LCIS allowed
** Cautionary 40-49 yo + all above, or ≥50 with only 1 of below:
*** 2.1-3cm invasive focus, T2, margins <2mm, limited LVSI, ER-, pure DCIS ≤3cm, EIC ≤3cm

## Breast Conserving Therapy (BCS)

aka lumpectomy
Contraindications (CI):
* Can't get RT: i.e. prev RT, scleroderma, pregnant
* Diffuse suspicious microcalcifications
* R+ surgery predicted
Not CI (however considerations):
* Young
* Non-biopsied MRI findings
* Systemic lupus
* BRCA
* High grade/Trip negative