Mindfulness Therapies for Improving Mental Health in Parents of Children with a Developmental Disability: a Systematic Review

Journal of Developmental and Physical Disabilities - Mindfulness offers promise as a therapy approach for parents of children with developmental disabilities (DD), however its effectiveness in...     

Methods for siting emergency stomas in the absence of a stoma therapist

Introduction

Stomas often have to be sited in emergencies by trainees who may have had little training in this. Emergency stomas and stomas where the site has not been marked preoperatively by a stoma therapist are more prone to complications. These complications may severely affect a patient’s quality of life. Advice in the literature on how to best site stomas is conflicting. We compared two easy anatomical methods of siting stomas to sites chosen by a stoma therapist and looked at how this site was affected by the patients’ body mass index (BMI).

Methods

Patients undergoing elective colorectal surgery were seen either pre or postoperatively. Each patient’s BMI was recorded and the positions of three different potential stoma positions (site G: the gold standard, marked by a stoma therapist; site S: marked using a pair of scissors against the umbilicus; site H: halfway between the umbilicus and anterior superior iliac spine) were compared.

Results

The two fixed anatomical methods described (method S and method H) both gave poor results. The most common reason for poor siting was the proximity of a skin crease. There was a statistically significant correlation between the patient’s BMI and the laterality of the gold standard site.

Conclusions

The two simple anatomical methods described here do not provide a shortcut to effective siting. A more effective method may be calculating the laterality of the site using the patient’s BMI, and then moving up/down to avoid a skin crease and improve the patient’s view for changing the bag. This deserves further study.     

Patient experience of neurologic rehabilitation: a qualitative investigation

Wain HR, Kneebone II, Billings J. Patient experience of neurologic rehabilitation: a qualitative investigation.

Objective

To understand the experiences of patients who had undergone neurologic rehabilitation.

Design

An interpretative phenomenological analysis of semistructured interviews.

Setting

Neurologic rehabilitation unit.

Participants

A purposive convenience sample of 8 past patients.

Interventions

Not applicable.

Main Outcome Measure

Participants' reports of neurologic rehabilitation obtained via in-depth semistructured interviews.

Results

Participants predominantly described positive experiences of rehabilitation. The superordinate theme person-centeredness was developed, which included 4 key themes: ownership, personal value, holistic approach, and therapeutic atmosphere. These reflected patients' perceptions of choice and control and feelings of personal respect and self-worth. These appeared to be promoted through the multidimensional benefits of the unit (eg, the understanding and friendly nature of staff and other patients, physical improvements, psychologic gains) as well as the unit's informal, relaxed environment. When present, these factors created a positive rehabilitation experience; when absent, a negative experience.

Conclusions

These findings support those from other literature, which has identified person-centered care as a core element of successful rehabilitation and linked its absence to dissatisfaction with health care. This research has increased our understanding of patients' experience of neurologic rehabilitation, and could inform the development of a patient-centered assessment instrument for neurologic rehabilitation.     

应用功能磁共振成像分析脑卒中患者康复治疗前后大脑再塑机制

目的:应用功能磁共振成像观察脑卒中后及康复过程中,在相应脑内运动功能区激活的变化情况,探讨不同运动模式下皮质功能再塑的表现。方法:选取2003-02/10大庆油田总医院康复科住院的皮质下脑梗死患者8例,在发病后1周始进行连续两个月的康复。在康复前、康复1,2个月时运用Brunnstrom分级、Caroll上肢功能量表(0￣100分,评分越高功能越好)对其手功能进行评价,并采用GEMR/iHiSpeed1.5超导磁共振扫描机进行磁共振成像功能激发检查。患者用病手执行简单运动(快速连续的拇指与其他各指的对指动作)、随意运动(用病手摸不同形状的木块),获得脑功能激发图像,观察脑内相关功能区的激活情况。结果:8例受试者均进入结果分析。①康复后所有患者Brunnstrom分级和Caroll上肢功能评分均较康复前有明显改善。②病手简单运动时脑内相关功能区的激活情况:8例受试者7例在损伤后早期手指不能对指,所以没有激活;M1,SMA,PMA脑区和小脑呈现单侧激活-双侧激活-单侧激活的变化过程;随着运动功能恢复,脑内激活数目随时间呈下降趋势,几乎接近正常人脑功能表现。③病手随意运动时脑内相关功能区的激活情况:实验中发现引起的运动相关功能区的激发情况变化多样,规律性较差,但其中5例受试者表现出损伤后激发数目明显减少,许多对运动起决定性支配作用的功能区亦不激活;随着运动功能恢复,激发区数目呈上升趋势,同损伤后简单运动的激活表现。结论:①脑卒中后病手经过康复治疗简单运动恢复较好,康复治疗2个月后脑内运动功能相关区域激活的规律已同正常人。②脑卒中后病手随意运动恢复较困难,康复治疗后不如简单运动恢复好,脑内相关运动功能区激活无明显的规律性。随着运动功能的恢复,脑内相应的运动功能区激活增多。     

Effects of time of dose in relation to food on the bioavailability of Theo-Dur Sprinkle at steady state in asthmatic children

The effects of administration of Theo-Dur Sprinkle in the fasting state (phase A), 10 minutes before food (phase B), and immediately after food (phase C) were investigated in 12 children with asthma aged 5 to 9 years at steady state. The AUC during the dosing interval was significantly reduced in phases B and C compared with phase A, and bioavailability relative to the fasting state was reduced to 77% +/- 15% (range 61% to 104%) in phase B and 70% +/- 16% (range 40% to 103%) in phase C. The average plasma theophylline concentration during the dosing interval and Cmax were also significantly reduced in phases B and C compared with phase A. The morning predose plasma theophylline concentration in phase B was 22% lower than the predose concentration with Theo-Dur tablets taken 10 minutes before breakfast. The diurnal variation in predose plasma theophylline concentrations was increased from 28% in phase A to 63% in phase C. There was no significant difference in any parameter between administration 10 minutes before food and immediately after food.     

Preclinical to Clinical Translation of CNS Transporter Occupancy of TD-9855, a Novel Norepinephrine and Serotonin Reuptake Inhibitor

Background:

Monoamine reuptake inhibitors exhibit unique clinical profiles that reflect distinct engagement of the central nervous system (CNS) transporters.

Methods:

We used a translational strategy, including rodent pharmacokinetic/pharmacodynamic modeling and positron emission tomography (PET) imaging in humans, to establish the transporter profile of TD-9855, a novel norepinephrine and serotonin reuptake inhibitor.

Results:

TD-9855 was a potent inhibitor of norepinephrine (NE) and serotonin 5-HT uptake in vitro with an inhibitory selectivity of 4- to 10-fold for NE at human and rat transporters. TD-9855 engaged norepinephrine transporters (NET) and serotonin transporters (SERT) in rat spinal cord, with a plasma EC₅₀ of 11.7ng/mL and 50.8ng/mL, respectively, consistent with modest selectivity for NET in vivo.Accounting for species differences in protein binding, the projected human NET and SERT plasma EC₅₀ values were 5.5ng/mL and 23.9ng/mL, respectively. A single-dose, open-label PET study (4–20mg TD-9855, oral) was conducted in eight healthy males using the radiotracers [¹¹C]-3-amino-4- [2-[(di(methyl)amino)methyl]phenyl]sulfanylbenzonitrile for SERT and [¹¹C]-(S,S)-methylreboxetine for NET. The long pharmacokinetic half-life (30–40h) of TD-9855 allowed for sequential assessment of SERT and NET occupancy in the same subject. The plasma EC₅₀ for NET was estimated to be 1.21ng/mL, and at doses of greater than 4mg the projected steady-state NET occupancy is high (>75%). After a single oral dose of 20mg, SERT occupancy was 25 (±8)% at a plasma level of 6.35ng/mL.

Conclusions:

These data establish the CNS penetration and transporter profile of TD-9855 and inform the selection of potential doses for future clinical evaluation.     

表皮细胞培养及其临床应用

目的:对表皮细胞的培养方法、临床应用进展方面的研究成果进行综述,展望其发展趋势。资料来源:应用计算机检索PubMed数据库1970-01/2006-08相关表皮细胞的文献,检索词“keratinocytes,culture,skin grafting”,同时检索中国期刊网2000-01/2006-08期间的相关文献,检索词为“表皮细胞,培养,皮肤移植”。资料选择:对资料进行初审,选取相关文献查找全文。纳入标准:①表皮细胞的培养。②表皮细胞的移植。排除标准:综述文献、重复研究类文章。资料提炼:共收集到30篇符合标准的文献,英文文献26篇,中文文献4篇,其中与培养相关的文献19篇,与移植相关的文献11篇。资料综合:自1975年以来,表皮细胞从最初的有血清、有滋养层培养,到无血清、无滋养层培养,再到后来的自动化培养。其培养方法有了较大的发展。这些发展促进了其临床应用,从细胞悬液移植到自、异体细胞膜片移植,再到表皮细胞-生物材料复合物移植。培养和移植方法的发展使人们在治疗大面积皮肤缺损方面看到了希望。结论:目前在表皮细胞培养及其临床应用上还有不少问题需要解决,但随着表皮细胞培养方法和技术的进一步完善,特别是与纳米科学、材料科学等学科的交叉,定能在不远的将来获得理想的永久性皮肤替代物。     

Cognitive behaviour therapy for post-traumatic stress symptoms in the context of hydrocephalus: A single case

There is limited information about anxiety disorders occurring in the context of the challenging condition of hydrocephalus. This paper describes the treatment, via trauma-focused cognitive behaviour therapy (TFCBT), of post-traumatic stress symptoms arising on account of hydrocephalus in a 23-year-old man. Specific components of the intervention included exposure, cognitive disputation, and relaxation training. The 20-session intervention appeared effective with decreases in anxiety (on the Hospital Anxiety and Depression Scale) and event impact (on the Impact of Events Scale) from clinical to sub-clinical levels. The main contributor to change appeared to be the exposure element of the treatment. The benefits of the intervention were maintained at one-, three-, and six-month follow-up.