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Check standard news sources purchase hyzaar 50mg online, jury verdicts purchase hyzaar 12.5mg, and databases of appellate cases to see what you can learn about the attorney cheap hyzaar 50mg with amex. If that should happen to you effective 50mg hyzaar, if you don’t have a comfortable or confi- dent feeling about your prospective or assigned attorney after confer- ring with him or her hyzaar 12.5 mg online, be honest. A good lawyer understands the importance of a positive attorney–client relationship, as does you mal- practice insurer. Trust and confidence are the cornerstones to this, every bit as much as they are essential to the physician–patient relationship. Regrettably, people who would not hesitate to grill a contractor for a prospective home remodel about past projects and references, become 26 Hiestand shy when it comes to selecting counsel for representation that could affect their careers. Don’t make that mistake; it is much more difficult to switch lawyers in the middle of litigation because of a bad initial selection than it is to take the time to be as reasonably sure as you can be that you have chosen the best person to represent you. Martindale- Hubbell is a quick source of basic biographical information about law- yers. Newspaper articles and electronic databases of information mentioning the lawyers involved in published opinions and jury ver- dicts are other sources of useful information. You are not required to accept whatever attorney is recommended to you, no more than your carrier is required to accept and pay for any attorney you may like but who knows little or nothing about medical malpractice. You and your professional liability insurer should, because you have the same interest in achieving the most favorable outcome for you, be able to agree on a good attorney, one with the education and experience best suited for your needs. Although a jury is usually involved in a medical mal- practice case, courts can, by agreement of the parties, sit as both the “finder” of facts and law. An arbitrator or panel of arbitrators, of course, act as determiners of both the law and facts. Judges and arbitrators also rule on motions that can dispose of or shape the course of the litigation and rule on what evidence is admissible. Obviously, who one gets for a judge can be critical to the case, so it’s important to know as much as one can about the judge or arbitrator who will hear the case. The best source of information about judges and arbitrators is, not surprisingly, other lawyers who have tried cases before them. Because most defense attor- neys practice primarily where they live, they will know about the judge or at least know someone else who has tried cases before, or knows the judge. Certain public information is also available about judges, includ- ing information about cases on which they have decided or ruled. From these varied sources, one can usually discover whether a judge has a reputation for fairness, knowledge of the law, is intellectually bright or slow, and has a quick or even temper. Many, if not all, states permit one peremptory challenge to a judge and all allow a challenge based on bias. It is common in larger urban areas to assign a different judge for pretrial motions from the judge drawn for settlement discussion and trial, so research on the universe of Chapter 2 / Litigation 27 judges one is likely to draw for each of these stages of litigation is advisable. The Jury Jurors decide factual disputes, which means that they determine the ultimate “facts” of your case. Their judgment as to what the “facts” are, including the fact and size of damages should they decide to award them, cannot be disturbed on appeal unless it can be shown that there is no substantial evidence to support those findings. When a judge or arbitrator also acts as the “fact finder,” this same restrained standard of review—“substantial evidence”—also applies. Selection of jurors naturally comes just before the case is to be tried, which means that the parties will have gathered all their evidence and should be ready for trial. Each party, through counsel, will have some opportunity to question or submit questions to the judge to ask of each juror. Usu- ally, each party has a limited number of peremptory challenges and may also challenge a juror for “good cause” or bias, on which the judge will rule. Some lawyers are fond of employing, for big cases, jury consultants, professional “jury experts” who read body language and pay particular attention to the responses jurors make to the voir dire questions. Other lawyers trust their own instincts when it comes to accepting or challeng- ing certain jurors; and some even feel that it doesn’t matter in the end which jurors are selected; they take any panel that meets with the judge’s approval. If your case looks like it is going to trial and you feel you have a good sense of people, your lawyer should be willing to listen to you in the jury selection process. Witnesses, Especially “Experts” All witnesses are important, especially you.

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Sickle cell crisis is a manifestation of sick- le cell disease that occurs when blood flow Sickle Cell Anemia to a body part becomes obstructed by rigid order hyzaar 12.5 mg mastercard, sickled red cells buy generic hyzaar 12.5 mg on-line. This is called a vaso- Sickle cell anemia is the most severe form occlusive crisis cheap hyzaar 50mg with amex. It is characterized by not receive adequate oxygen buy 12.5 mg hyzaar with mastercard, resulting in lifelong hemolytic anemia and a wide severe pain generic hyzaar 12.5 mg amex. If blood flow is severely variety of painful and debilitating vaso- diminished, the affected tissue may under- occlusive events (Mentzer & Kan, 2001). Any part of the When hemoglobin S molecules interact body, including organs, may be affected; with each other, they become stacked up, the resulting damage may be mild to especially when the oxygen concentration severe, depending on the degree and length in the blood is low. The most common body parts become deformed so that, instead of being affected are the chest, legs, arms, back, and disk-shaped, they assume the abnormal abdomen. Because of stroke (Gebreyohanns & Adams, 2004); 242 CHAPTER 8 CONDITIONS OF THE BLOOD AND IMMUNE SYSTEM cardiovascular dysfunction, including tating bedrest and, in some instances, skin myocardial infarction (heart attack) grafts. If the spleen is repeatedly in- The prognosis of individuals with sick- volved in crisis, it may become significant- le cell anemia is dependent on the indi- ly enlarged and removal of the spleen vidual and the degree of organ damage. A con- the past, many individuals with sickle cell dition called aplastic crisis, or megaloblas- anemia did not live to adulthood, but tic crisis, may also be a manifestation of many now reach midlife and beyond, liv- sickle cell disease. The prediction of outcome is individual- Because of the lowered resistance due to ly determined. Associated chronic anemia caus- es the heart to pump faster in an attempt Definitive diagnosis of sickle cell disease to supply additional oxygen to the tissues. Blood tests enlargement of the heart (cardiomegaly) such as sickle cell prep are screening tests and decreased cardiac efficiency. De- that can detect the presence of abnormal creased oxygen supply caused by the hemoglobin but cannot distinguish be- chronic anemia can also produce symp- tween sickle cell disease and sickle cell trait. Treatment for Sickle Cell Disease Occlusion of blood flow during a sickle cell crisis can damage bones and joints, For the most part, sickle cell disease is a leading to pain, swelling, and limited chronic, lifelong disease without cure. Because of also cause sickle cell retinopathy in the propensity of those who have sickle which there is damage to the vessels in the cell anemia to develop infections, retina of the eye, which results in dimin- prophylactic antibiotics may be given on ished vision and, possibly, retinal detach- occasion. Maintaining adequate fluid intake is Some individuals develop leg ulcers also important for individuals with sickle because of the interruption of circulation cell disease, because adequate hydration during sickle cell crisis. Ulcers may not can minimize the sickling of red blood heal and may become infected, necessi- cells and decrease the blood viscosity. The Conditions Affecting the Blood or Immune System 243 anemia associated with this condition to maintain a “normal” life and minimize sometimes necessitates transfusion thera- their difference from peers (Atkin & py. Adherence to prophylac- hydroxyurea, has recently been tested for tic measures may be especially difficult use in the treatment of sickle cell anemia and require significant support (While & and has been found to prevent sickling of Mullen, 2004). Other therapies, of children with sickle cell disease may including the use of antisickling agents experience guilt or fear of the loss of their and bone marrow transplantation, may child. At the same time, the experience sickle cell crisis often require child may learn manipulative behaviors to hospitalization. These maladaptive means ment focuses on restoring fluids if dehy- of coping may persist throughout life, cre- dration has occurred, and relieving the ating a greater barrier than the condition pain associated with the crisis, which itself. Although fection, has precipitated the crisis, some of the factors that provoke a sickle treatment of that condition may also be cell crisis may be identifiable, crises are instituted. Organ damage as a result of often unpredictable and beyond individ- sickle cell disease is treated in a similar uals’ control. Not only are the crises pain- fashion to chronic organ disease from oth- ful and debilitating, but there is also the er causes. The lack of control over the tive care, and health maintenance have frequency or severity of sickle cell crises been shown to increase the life expectan- can lead to feelings of hopelessness and cy of individuals with sickle cell disease. Care should be taken to avoid any factors Individuals with sickle cell disease can that precipitate a sickle cell crisis. In most instances, individuals with sickle cell disease do not need to alter Like hemophilia, sickle cell disease usu- activities, unless activities appear to pro- ally manifests itself in childhood, neces- voke a sickle cell crisis. Most activities, if sitating medical attention and, possibly, performed in moderation, can be tolerat- frequent hospitalizations, which can dis- ed. The unpredictability of sickle cell crises rupt social development and educational can alter social functioning for individu- progress. Psychological coping patterns are als with sickle cell disease, who may have relevant both to the experience of pain to cancel or alter plans at the last minute and to broader adjustment issues (Anie, if a crisis should occur. Coping with sick- as a precipitating factor in sickle cell cri- le cell disease may be especially difficult sis must also be considered. Although during adolescence as individuals struggle stress is frequently associated with nega- 244 CHAPTER 8 CONDITIONS OF THE BLOOD AND IMMUNE SYSTEM tive events, stress can also be associated on the individual, the frequency, and the with positive events, such as a graduation seriousness of the crises when they occur.

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