Shin splints Painful to have and to treat

When people overuse their legs they develop an uncomfortable awareness of these limbs manifested as a dull burning or aching. The cause is often clear to the person with the problem as a result of the often obvious relationship to overdoing an exercise or activity and the pain. “Shin splints” is the lay term; physicians use the term medial tibial stress syndrome. The pathophysiology that leads to this pain is unclear, although there are a number of competing theories. Differential diagnosis includes stress fractures and compartment syndromes. Bone tumors or lipomas can also cause similar pain to shin splints. Diagnosis can be made by history alone in a majority of cases, but if the diagnosis is unclear, an X-ray and magnetic resonance imaging should be considered. Treatment is still mostly supportive and symptom related. Rest is the most important aspect of treatment. Locally applied cold and anti-inflammatory medication have also been felt to be beneficial. The authors has stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

When to suspect and how to monitor babesiosis

In the past decade, cases of babesiosis in humans have been reported with increasing frequency, especially in the northeastern United States. Babesia microti (in the United States) and bovine strains (in Europe) cause most infections in humans. Most cases are tick-borne, although cases of transfusion-associated and transplacental/perinatal transmission have also been reported. Factors associated with more severe disease include advanced age, previous splenectomy and immunodeficient states. Symptoms include high fever, chills, diaphoresis, weakness, anorexia and headache. Later in the course of the illness, the patient may develop jaundice. Congestive heart failure, renal failure and acute respiratory distress syndrome are the most common complications. Therapy using the combination of quinine sulfate and clindamycin was the most commonly used treatment; however, atovaquone suspension plus azithromycin was recently reported an equally effective and less toxic therapy. Exchange transfusion, together with antibabesial chemotherapy, may be necessary in critically ill patients.     

How to recognize and respond to refeeding syndrome

If your patient is malnourished, you need to assess her carefully before she restarts nutrition by any route to avoid potentially lethal consequences.     

Reactions to diabetes and their relationship to time orientation

The purpose of this study was to explore the relationships between psychosocial adaptation to chronic illness and time orientation among the individuals diagnosed with insulin-dependent diabetes mellitus. Participants (N=106) were recruited via an on-line survey and an on-site health fair. Data were obtained from responses to the Reactions to Impairment and Disability Inventory and the Zimbardo Time Perspective Inventory. A series of hierarchical multiple regression analyses were performed to examine the influence of demographic- and disability-related variables, followed by a set of five time-perspective scales, on a series of psychosocial reactions to disability (anxiety, depression, anger, denial and adjustment). Findings indicated that reactions of anxiety, depression and anger were best predicted by negative perceptions of the past, whereas reactions of depression and anger also were predicted by negative views of the present. In addition, anger was associated with a decreased future orientation. Denial was best predicted by fatalistic perception of the present and, to a lesser extent, by restricted view of the future. Finally, adjustment was best predicted by positive perceptions of the present, by an expanded view of the future and by avoiding a negative view of the present. Challenging negative perceptions of the past and present, whereas facilitating a future time orientation, could be beneficial in helping clients to cope successfully with their medical conditions.     

Adapting to and implementing a problem- and community-based approach to nursing education

The process of change, implemented by the School of Nursing at the University of the Orange Free State so that a paradigm shift in approaches to nursing education at undergraduate level could be achieved, is outlined. The necessity to change, the identification of external and internal variables that impact on change, the founding of a support system, the process of overcoming resistance to change, the evaluation of the process of change and options for the future, are discussed. The rationale for the implementation of a problem-based teaching strategy and the phasing in of a community-based approach to teaching as the heart of the process of change are discussed.     

Demographic and health-related correlates to visits to complementary and alternative medical providers

OBJECTIVES: The objective of this study was to ascertain the extent to which demographic and health-related variables are related to visits to a complementary or alternative medicine (CAM) practitioner. METHODS: This study reports a secondary analysis of visits to CAM practitioners during the year before the 1996 Medical Expenditure Panel Survey (n = 16,038). RESULTS: Overall visits to CAM providers (9%) were lower than reported in widely cited surveys but quite consistent with a previous Robert Wood Johnson study that used a similar sampling procedure. Gender, education, age, geographic location, and race (Hispanics and African Americans proved to be less likely to visit CAM providers than whites) were statistically significant predictors of visits to CAM providers. Individuals in poorer health and those suffering from mental, musculoskeletal, and metabolic disorders also tended to be more likely to have visited a CAM provider. CONCLUSIONS: Although the choice of alternative versus orthodox treatment appears to be a complex phenomenon, these data suggest that the heaviest users of CAM therapies tend to be individuals with comorbid, non-life-threatening health problems. This finding may help to ameliorate concerns that this type of care is being used in lieu of therapies with more definitive efficacy evidence.