sion in air of a liquid material or ing our article. It is a still greater a solution in the form of a fine shame that he has the false impresmist, usually for therapeutic pur- sion that we stated that "the Spinposes, especially to the respiratory haler® is a pressurized aerosol inpassages." Similarly, aerosol is de- haler that supplies disodium cromofined as follows: "1. A liquid agent glycate." or solution dispersed in air in the In our article the Spinhaler® is form of a fine mist for therapeutic, merely called an inhaler, and it insecticidal, and other purposes. was mentioned to fully explain the 2. A pharmaceutical product fact that 1.5% of the patients used that is packaged under pressure and three types of inhalers. The results contains therapeutically active in- of our survey did not apply to the gredients, intended for topical ap- Spinhaler®, for we analysed 11 plication and for introduction into maneuvers that applied only to body orifices." Nebulization is de- pressurized aerosol inhalers. The fined as "spraying; vaporization", Spinhaler® should not be judged while nebulize is defined as "to guilty by association. Dr. Watters states that current break up a liquid into a fine spray terminology could be clarified in or vapor; to vaporize In light of the above I was rather regard to the use of inhalers, and nonplussed on reading Dr. Peter we agree. We went to great pains W. Munt's editorial (Can Med As- to use the terms pressurized, aeroSoc 1 120: 781, 1979) and the ac- sol and inhaler properly. However, companying article by Dr. S.W. even if one uses terminology apEpstein and colleagues (120: 813, propriately, there is no guarantee 1979) on aerosol bronchodilators. that others will interpret it corPerhaps I am indulging in purist rectly. semantics; however, to my knowS.W. EPSTEIN, MD, FRcP[c] ledge disodium cromoglycate (InToronto Western Hospital tal®) is not classified as an aerosol Toronto, Ont. bronchodilator. If Dr. Munt wishes to classify disodium cromoglycate Occupational therapy - a response as an aerosol inhaler (nonpressurized, other than by the inspiratory To the editor: In his editorial on force of the patient) then our ter- allied health professions (Can Med minology should be redefined. If, Assoc 1 120: 519, 1979) Dr. David on the other hand, he has been C. Blair addressed himself to the using disodium cromoglycate solu- education of physical and occupation and therefore nebulization, tional therapists and the implicathen I have no argument, other tions for responsible practitioners. than to note that this drug form Dr. Blair's statement that occupahas not yet been approved by the tional therapists are not involved in health protection branch of the De- an accreditation program through partment of National Health and the Canadian Medical Association Welfare for commercial use in Can- (CMA) is correct, but it is also misleading. In 1958 a joint comada and is not a bronchodilator. Similarly, I get the impression mittee of the Canadian Association from Dr. Epstein and colleagues of Occupational Therapists (CAOT) that the Spinhaler® is a pressurized and the CMA established "the basis aerosol inhaler that supplies diso- for approval of schools of occupadium cromoglycate. Again, this tional therapy in Canada".1 Though drug form has not been approved this committee was disbanded in by the health protection branch for 1972 with the establishment of the CAOT accreditation committee "the use in Canada. Perhaps the current terminology long association with the Canadian could be classified to avoid miscon- Medical Association was mainceptions. tained by the appointment of two representatives from that body to R. WATTERS, MD accreditation committee".1 Certhe Medical director Fisons Corporated Limited tainly this is not indicative of Scarborough, Ont. groups "who do not wish to work closely with [the medical profesTo the editor: It is a shame that sion] to produce health profesDr. Watters is nonplussed on read- sionals". 1166 CMA JOURNAL/NOVEMBER 3, 1979/VOL. 121
As president and education councii chairman of the CAOT and the associate professors in occupational therapy we would like to reassure Dr. Blair that we and our colleagues are well versed in the scientific method, and that our striving for excellence and development within the profession is based on academic preparation as well as experience. To infer without substantiation that our programs are "not intimately tied into an optimally scientific program - one that is guided with the best and widest knowledge, and is coordinated from the highest level" is inappropriate. Dr. Blair's comments concerning the fact that the dean of a faculty of rehabilitation medicine is a speech pathologist can only refer to the faculty of the University of Alberta. When the position of dean (the director) was advertised only two of the applicants were physicians. Both were educated and resided outside North America and were less qualified than the other applicants. As one of us (H.E.M.) was a member of the selection committee along with colleagues from the faculty of medicine and the Alberta Medical Association (AMA), we know that the committee appointed the best applicant. The faculty has always had and continues to have within the membership of its council representation from the faculty of medicine as well as from the rehabilitation committee of the AMA. In our 9 years as members of the council the AMA's representative has never been in attendance. Representatives from each of the faculties that contribute to the three professional curricula, along with appointees from each of the professions, also sit on the council. As for who should teach which subject, it has always been the opinion of the department of occupational therapy that the medical course work should be taught by physicians. In all instances, with the exception of anatomy, this remains the case. The department of anatomy at the University of Alberta finds it impossible to provide a service course in this field but it does provide a laboratory and other resources. It is always difficult to locate physicians willing, interested and capable of medical teaching. We are sure that Dr. Blair
will agree that knowledge of the subject and an ability to teach it are not necessarily found in one individual. Dr. Blair makes reference to the Australian Physiotherapy Association's endorsement of nonmedical referral. The policies adopted at the 17th federal assembly of the Australian Medical Association clearly state the association's relation with other health care professionals:' * The Australian Medical Association wishes to establish and maintain cordial relations with other recognized professions in the field of health care to foster mutual understanding and cooperation and resolve difficulties in the interests of the community. * Some health care professionals have become highly qualified and have a wide spectrum of functions and skills, certain of which are exercised independently of doctors, and some of which tend to overlap traditional medical functions. * The separate identity and special role of the medical profession will be best served if all doctors recognize the contribution of other health care professionals, learn to understand the range and scope of their skills and provide constructive leadership in situations where a team approach is appropriate in the provision of patient care. Certainly there can be no question of the physician's role and responsibility within a medical model. It is reassuring to know that "every medical doctor recognizes his or her limitations and seeks help and guidance", as Dr. Blair has stated. His implication that other health care professionals do not have this discernment is distressing. We are in an age of interdisciplinary medicine and community care, and to fail to respect the judgement of the other actors in this type of health care system is to be parochial and restrictive. Occupational therapists are educated equally as well to deal with the psychosocial needs of an individual as to meet his or her physical health care needs. It is unfortunate that Dr. Blair does not mention that this aspect is also in-
cluded in the occupational therapy curriculum. It prepares therapists to obtain positions in mental health care programs and educational or community settings outside the traditional medical model. In summary, the CMA has had a long history of positive interaction with the CAOT and, though the nature of the relation has changed, there is no reason to assume that it should not continue. The growth and development of professions such as occupational therapy and physiotherapy have benefited from the guidance and counsel of the medical profession. The continuing objective of occupational therapists is to maintain and strengthen collaboration with members of other health and social services disciplines. It is only through collaboration and mutual respect between professions that patient-client needs can be satisfied. SHARON BRINTNELL, BOT, OT REG[CJ President Canadian Association of Occupational Therapists Associate professor t.epartment of occupational therapy University of Alberta HELEN M. MADILL, M ED, BOT, OT REG[C] Chairman, educational council Canadian Association of Occupational Therapists Associate professor and acting chairman Department of occupational therapy University of Alberta Edmonton, Alta.
All the isolates were tested for ampicillin resistance with the disc diffusion test and Catlin's method for detecting the production of p-lactamase."4 Testing was done with more than 20 representative colonies of the primary culture. Of the 75 patients 15 (10 with septicemia and 5 with meningitis) were found to harbour strains resistant to ampicillin. In 12 of the 15 patients we obtained a pure culture of a resistant strain with a zone diameter of less than 19 mm (with usually little or no zone of inhibition) and positive results of a .3-lactamase test. In two patients we found a mixed culture, with most of the bacteria being sensitive to ampicillin. The results of the f3-lactamase test were negative and the resistant strain was revealed only by the growth of about 20 to 30 colonies in the zone of inhibition around the ampicillin disc. When subcultured these colonies gave rise to a pure culture of a resistant strain by disc diffusion and p-lactamase tests. In another patient we found a sensitive strain
A
A
References 1. Standards for the Education of Occupational Therapists in Canada, accreditation committee, Canadian Association of Occupational Therapists, Toronto, 1974 2. Australian Medical Association policy on relationships with other health professions (abstr). A ust Occup Ther 1 25 (3): 31, 1978
Mixed infections with Hemophilus influenzae type b To the editor: Since the discovery of ampicillin resistance in Hemophilus influenzae type b the frequency of isolation of resistant strains has been increasing. 1,1 At Montreal's H6pital Sainte-Justine in 1978 we isolated H. influenzae type b from the blood or cerebrospinal fluid or both of 75 patients (56 had septicemia and 19 had meningitis).
S
S
mm.
-
*m
.ss.g
I
. I r+i
Purdue Frederick
CMA JOURNAL/NOVEMBER 3, 1979/VOL. 121
I \ \I. II
1167
As president and education councii chairman of the CAOT and the associate professors in occupational therapy we would like to reassure Dr. Blair that we and our colleagues are well versed in the scientific method, and that our striving for excellence and development within the profession is based on academic preparation as well as experience. To infer without substantiation that our programs are "not intimately tied into an optimally scientific program - one that is guided with the best and widest knowledge, and is coordinated from the highest level" is inappropriate. Dr. Blair's comments concerning the fact that the dean of a faculty of rehabilitation medicine is a speech pathologist can only refer to the faculty of the University of Alberta. When the position of dean (the director) was advertised only two of the applicants were physicians. Both were educated and resided outside North America and were less qualified than the other applicants. As one of us (H.E.M.) was a member of the selection committee along with colleagues from the faculty of medicine and the Alberta Medical Association (AMA), we know that the committee appointed the best applicant. The faculty has always had and continues to have within the membership of its council representation from the faculty of medicine as well as from the rehabilitation committee of the AMA. In our 9 years as members of the council the AMA's representative has never been in attendance. Representatives from each of the faculties that contribute to the three professional curricula, along with appointees from each of the professions, also sit on the council. As for who should teach which subject, it has always been the opinion of the department of occupational therapy that the medical course work should be taught by physicians. In all instances, with the exception of anatomy, this remains the case. The department of anatomy at the University of Alberta finds it impossible to provide a service course in this field but it does provide a laboratory and other resources. It is always difficult to locate physicians willing, interested and capable of medical teaching. We are sure that Dr. Blair
will agree that knowledge of the subject and an ability to teach it are not necessarily found in one individual. Dr. Blair makes reference to the Australian Physiotherapy Association's endorsement of nonmedical referral. The policies adopted at the 17th federal assembly of the Australian Medical Association clearly state the association's relation with other health care professionals:' * The Australian Medical Association wishes to establish and maintain cordial relations with other recognized professions in the field of health care to foster mutual understanding and cooperation and resolve difficulties in the interests of the community. * Some health care professionals have become highly qualified and have a wide spectrum of functions and skills, certain of which are exercised independently of doctors, and some of which tend to overlap traditional medical functions. * The separate identity and special role of the medical profession will be best served if all doctors recognize the contribution of other health care professionals, learn to understand the range and scope of their skills and provide constructive leadership in situations where a team approach is appropriate in the provision of patient care. Certainly there can be no question of the physician's role and responsibility within a medical model. It is reassuring to know that "every medical doctor recognizes his or her limitations and seeks help and guidance", as Dr. Blair has stated. His implication that other health care professionals do not have this discernment is distressing. We are in an age of interdisciplinary medicine and community care, and to fail to respect the judgement of the other actors in this type of health care system is to be parochial and restrictive. Occupational therapists are educated equally as well to deal with the psychosocial needs of an individual as to meet his or her physical health care needs. It is unfortunate that Dr. Blair does not mention that this aspect is also in-
cluded in the occupational therapy curriculum. It prepares therapists to obtain positions in mental health care programs and educational or community settings outside the traditional medical model. In summary, the CMA has had a long history of positive interaction with the CAOT and, though the nature of the relation has changed, there is no reason to assume that it should not continue. The growth and development of professions such as occupational therapy and physiotherapy have benefited from the guidance and counsel of the medical profession. The continuing objective of occupational therapists is to maintain and strengthen collaboration with members of other health and social services disciplines. It is only through collaboration and mutual respect between professions that patient-client needs can be satisfied. SHARON BRINTNELL, BOT, OT REG[CJ President Canadian Association of Occupational Therapists Associate professor t.epartment of occupational therapy University of Alberta HELEN M. MADILL, M ED, BOT, OT REG[C] Chairman, educational council Canadian Association of Occupational Therapists Associate professor and acting chairman Department of occupational therapy University of Alberta Edmonton, Alta.
All the isolates were tested for ampicillin resistance with the disc diffusion test and Catlin's method for detecting the production of p-lactamase."4 Testing was done with more than 20 representative colonies of the primary culture. Of the 75 patients 15 (10 with septicemia and 5 with meningitis) were found to harbour strains resistant to ampicillin. In 12 of the 15 patients we obtained a pure culture of a resistant strain with a zone diameter of less than 19 mm (with usually little or no zone of inhibition) and positive results of a .3-lactamase test. In two patients we found a mixed culture, with most of the bacteria being sensitive to ampicillin. The results of the f3-lactamase test were negative and the resistant strain was revealed only by the growth of about 20 to 30 colonies in the zone of inhibition around the ampicillin disc. When subcultured these colonies gave rise to a pure culture of a resistant strain by disc diffusion and p-lactamase tests. In another patient we found a sensitive strain
A
A
References 1. Standards for the Education of Occupational Therapists in Canada, accreditation committee, Canadian Association of Occupational Therapists, Toronto, 1974 2. Australian Medical Association policy on relationships with other health professions (abstr). A ust Occup Ther 1 25 (3): 31, 1978
Mixed infections with Hemophilus influenzae type b To the editor: Since the discovery of ampicillin resistance in Hemophilus influenzae type b the frequency of isolation of resistant strains has been increasing. 1,1 At Montreal's H6pital Sainte-Justine in 1978 we isolated H. influenzae type b from the blood or cerebrospinal fluid or both of 75 patients (56 had septicemia and 19 had meningitis).
S
S
mm.
-
*m
.ss.g
I
. I r+i
Purdue Frederick
CMA JOURNAL/NOVEMBER 3, 1979/VOL. 121
I \ \I. II
1167
