Electrical muscle stimulation (EMS) and biofeedback can be used successfully in muscle retraining and strengthening programmes. The buoyancy of the water allows for gradual introduction of weight bearing in gait reeducation. The resistance offered by the water can also be used to improve muscle strength. It is better to gradually introduce various treatment modalities allowing the therapist to identify specific modalities that work well with the PWH. It is recommended that the treating therapist proceed with caution, slowly increase resistance and repetition to prevent excessive fatigue of muscles and Sirolimus clinical trial joints in the PWH with inhibitors. Treatment should emphasize on quality

of movement, paying particular attention to muscle balance issues and biomechanical alignment of the body. M. Gilbert No one would deny that wanting to live a life free of pain is rationale, reasonable, and ethically justified. Advances in the hematologic control of inhibitors have made surgery a reality, but the cost remains high. Our resources are not unlimited at different at hemophilia centers and countries throughout the world. This article will attempt to explore our fundamental values of

life, the quality of life, and how we try to equitably maximize and allocate these resources. It has been estimated that new and improved medical technologies contribute 40% to 50% of the annual increase in medical costs. Economists, hospital administrators, and legislators evaluate these advances by a cost/effectiveness p38 MAPK Kinase pathway ratio. Patients and most medchemexpress physicians are only interested in effectiveness. Patients expect the benefit from the advances, and physicians are trained to utilize them. To complicate the issue, industry profits from these advances and needs some of these profits to make additional advances. How to evaluate these conflicting values is the realm of philosophy and ethics. Isiah Berlin, a noted English philosopher, has pointed out that ‘the ends of men are many and not all of them compatible. The necessity

of choosing between absolute claims is the inescapable characteristic of the human condition. No person with an inhibitor should be denied lifesaving or emergency surgery. The choice becomes more difficult in quality of life procedures like joint arthroplasties, or in surgeries of unpredictable outcome and high complication rates such as excision of advanced massive pseudotumors. How do we calculate the cost of these surgeries? One study [39] calculated the cost of knee arthrodesis and total knee arthroplasties at $694,000 to $855,000. The authors concluded that ‘knee surgery is expected to reduce the subsequent number of bleeding episodes and resultant cost leading to long term cost savings’. The estimate of the cost savings would be ‘apparent within a decade of surgery’.