The Vicissitudes of a Training Therapy

The author has given an account of a training therapy with a patient who had a very tenuous start in life, having spent three months in an incubator in a neonatal unit, where she suffered life-threatening conditions and complications. Various difficulties, which can be particularly relevant to a training therapy, are described – in particular narcissistic issues on the part of the therapist, such as the wish for the trainee's success and the consequent pride in what can feel like a joint achievement. However, issues of identification and envy can also be very relevant to this particular work and some clinical examples have been cited. Furthermore, the author has highlighted the particular difficulties of publishing clinical material regarding patients, especially so with reference to training patients, where ethical issues require special consideration. The purpose of this paper lies in an effort to identify the rewards and pitfalls of working intensively with a trainee who is undergoing a psycho-dynamically based training. It also explores the complexities in publication, even when the patient specifically requests to be written about.     

健脾补肾中药对恶性骨肿瘤化疗后骨髓抑制患者外周血象的影响

目的:观察健脾补肾中药对恶性骨肿瘤化疗后骨髓抑制患者外周血象的影响。方法:将符合要求的60例恶性骨肿瘤化疗后骨髓抑制患者随机分为2组,每组30例。联合治疗组采用健脾补肾中药口服联合重组人粒细胞集落刺激因子皮下注射治疗,单纯西药组采用重组人粒细胞集落刺激因子皮下注射治疗;均连续治疗7 d为1个疗程,共治疗1个疗程。比较2组患者治疗前后外周血液中白细胞计数、血红蛋白含量及血小板计数,并评估白细胞、血红蛋白及血小板抑制程度。治疗结束1周后,评价患者临床症状改善情况及生活质量。结果:①白细胞计数。治疗前2组患者的白细胞计数比较,差异无统计学意义[(3.28±0.64)×10⁹个·L^-1,(3.19±0.76)×10⁹个·L^-1,t=0.566,P=0.576];治疗结束1周后,2组患者的白细胞计数均高于治疗前(t=-6.606,P=0.000;t=-3.583,P=0.000),且联合治疗组患者的白细胞计数高于单纯西药组[(8.68±1.75)×10⁹个·L^-1,(4.63±1.20)×10⁹个·L^-1,t=10.954,P=0.000]。②血红蛋白含量。治疗前2组患者的血红蛋白含量比较,差异无统计学意义[(112.47±10.05)g·L^-1,(108.63±9.67)g·L^-1,t=-1.941,P=0.062];治疗结束1周后,2组患者的血红蛋白含量均高于治疗前(t=-11.750,P=0.000;t=-5.695,P=0.000),且联合治疗组患者的血红蛋白含量高于单纯西药组[(140.83±17.36)g·L^-1,(126.87±15.56)g·L^-1,t=4.331,P=0.000]。③血小板计数。治疗前2组患者的血小板计数比较,差异无统计学意义[(121.10±23.51)×10⁹个·L^-1,(126.90±30.52)×10⁹个·L^-1,t=-1.250,P=0.221];治疗结束1周后,2组患者的血小板计数均高于治疗前(t=-12.528,P=0.000;t=-5.846,P=0.000),且联合治疗组患者的血小板计数高于单纯西药组[(224.23±60.28)×10⁹个·L^-1,(187.70±55.89)×10⁹个·L^-1,t=2.741,P=0.010]。④白细胞抑制程度。治疗结束1周后,联合治疗组0度9例、Ⅰ度11例、Ⅱ度7例、Ⅲ度3例,单纯西药组0度4例、Ⅰ度7例、Ⅱ度8例、Ⅲ度6例、Ⅳ度5例;联合治疗组患者的白细胞抑制程度优于单纯西药组(Z=-2.717,P=0.007)。⑤血红蛋白抑制程度。治疗结束1周后,联合治疗组0度8例、Ⅰ度10例、Ⅱ度12例,单纯西药组0度3例、Ⅰ度10例、Ⅱ度6例、Ⅲ度6例、Ⅳ度5例;联合治疗组患者的血红蛋白抑制程度优于单纯西药组(Z=-2.547,P=0.011)。⑥血小板抑制程度。治疗结束1周后,联合治疗组0度11例、Ⅰ度13例、Ⅱ度4例、Ⅲ度2例,单纯西药组0度8例、Ⅰ度7例、Ⅱ度8例、Ⅲ度4例、Ⅳ度3例;联合治疗组患者的血小板抑制程度优于单纯西药组(Z=-2.009,P=0.045)。⑦临床症状改善情况。治疗结束1周后,联合治疗组显著改善13例、部分改善14例、无效3例,单纯西药组显著改善7例、部分改善12例、无效11例;联合治疗组患者的临床症状改善情况优于单纯西药组(Z=-2.363,P=0.018)。⑧生活质量。治疗结束1周后,联合治疗组改善16例、稳定10例、降低4例,单纯西药组改善9例、稳定8例、降低13例;联合治疗组患者的生活质量高于单纯西药组(Z=-2.430,P=0.015)。⑨其他。治疗过程中,单纯西药组6例应用促红细胞生成素、3例输注血小板,联合治疗组无1例采取上述措施。结论:对于恶性骨肿瘤化疗后骨髓抑制患者,在采用重组人粒细胞集落刺激因子皮下注射治疗的基础上,应用健脾补肾中药口服治疗,可以增加外周血液中白细胞计数、血红蛋白含量及血小板计数,减轻骨髓抑制程度,有利于改善临床症状、提高生活质量,其疗效优于单纯采用重组人粒细胞集落刺激因子皮下注射治疗。     

Cognitive and Guided Mastery Therapy of Agoraphobia: Long-Term Outcome and Mechanisms of Change

The aims of this study were to compare thelong-term efficacy of cognitive and guided masterytherapy of panic disorder with moderate to severeagoraphobia and to analyze cognitive mechanisms ofchange. Patients (N = 46) suffering from panic disorderwith moderate or severe agoraphobia, who regardedagoraphobia as their main problem, were randomlyassigned to receive either cognitive therapy or guided mastery therapy in a 6-week inpatient groupprogram. At 1-year follow-up, more of the cognitivetherapy patients were behavioral responders, were freeof spontaneous panic attacks, were able to work, and did not use anxiolytic medication. Oncontinuous outcome measures, overall tests revealed nodifferences between the patients in the two treatmentconditions. Results of path analyses of cognitivevariables were consistent with the cognitive model ofpanic with agoraphobia which is based on catastrophicbeliefs and inconsistent with the guided mastery modelwhich is based on self-efficacy.     

Post-stroke Depression: Prevalence and Management

Abstract

Post-stroke depression (PSD) occurs in 5–70% of people following stroke and can last from 6 months to 2 years. PSD has been shown to have a negative impact on functional recovery from stroke and is therefore of relevance to physiotherapy. Causative factors implicated in PSD include: biological factors (location of the lesion, genetic predisposition and abnormal neurotransmitter function), psychological factors (reaction to catastrophe) and social factors (isolation and family supports). The management of PSD reported in the literature includes pharmacotherapy and psychotherapy, but there is little evidence of the effectiveness of either of these treatment strategies. However, behavioural and cognitive strategies may be used during physiotherapy sessions with the hope of improving motivation and enhancing recovery from PSD.     

益肾活血法联合中医周期疗法治疗抗精子抗体阳性不孕患者的临床观察

【目的】观察益肾活血法联合中医周期疗法治疗抗精子抗体(AsAb)阳性不孕的临床疗效。【方法】采用随机数字表法将86例患者随机分为治疗组和对照组各43例。治疗组采用益肾活血法联合中医周期疗法治疗,对照组采用强的松治疗,2组均以治疗1个月为1个疗程,共治疗3个疗程。观察2组AsAb转阴时间、转阴率及转阴后1年内的妊娠情况。【结果】治疗组转阴率为72.50%,对照组为78.95%,2组比较,差异无统计学意义(P>0.05)。治疗组的妊娠率为45.0%,对照组为23.7%,治疗组妊娠率显著高于对照组,2组比较差异有统计学意义(P<0.05)。【结论】益肾活血法联合中医周期疗法治疗抗精子抗体阳性不孕患者疗效显著,值得进一步研究。     

Examining the evidence: complementary adjunctive therapies for multiple sclerosis

Abstract

Objective: The purpose of this article is to provide a comprehensive overview of the most frequently encountered non-conventional approaches trialed for use in multiple sclerosis (MS). The efficacy and safety of non-conventional approaches ranging from bee venom therapy (BVT) to an array of vitamins and herbal products were discussed and evaluated.

Methods: Relevant English-language articles were identified through searches of MEDLINE (1990–2006), PubMed (1999–2006), Cochrane (1995–2006) and Toxnet (2000–2006). Classification of available literature was conducted according to the evidence based guidelines established by the American Academy of Neurology (AAN). However, due to the non-conventional nature of these treatment approaches, most available literature was derived from anecdotal reports and suboptimal clinical studies, lacking the rigor of evidence-based practice.

Results: There is presently only marginal supportive evidence for BVT in MS treatment. The inability to identify and quantify the active component of BVT combined with the associated risk of anaphylaxis has deterred its widespread use. The most promising evidence comes from prophylactic daily supplementation with vitamin D. Despite beneficial reports regarding non-herbal supplements such as alpha-lipoic acid (ALA), luteolin, evening primrose oil and vitamins such as B₁₂, the lack of evidence does not support their prophylactic use.

Discussion: Based on available evidence, the prophylactic use of vitamin D is a viable option as an adjunct to conventional medicine. Although there is a lack of conclusive evidence to support the use of other non-conventional treatments, patients are still opting to trial and bare the risks of these products which are accessible without the intervention of a healthcare professional. Controlled, evidence-based trials are essential for healthcare professionals to competently intervene and recommend these products.     

Manipulation in the Treatment of Acute Low Back Pain

Abstract

Study Design. This prospective research project statistically analyses the difference between two randomized groups of patients, one receiving manipulation plus exercises for acute low back pain of mechanical origin, the other receiving an exercise program alone. Objectives. To determine if orthopaedic manipulation is beneficial in treating acute low back pain of mechanical origin. Summary of Background Data. Orthopaedic manipulative physiotherapists have frequently observed dramatic results including elimination of pain and restoration of pain-free range of movement following manipulation of the acute locked back. Spinal manipulative therapy is a widely used method of treating lower back pain with millions of patient treatments performed each year, the majority in Western societies. Trials have emphasized the immediate and short-term symptomatic relief of low back pain following manipulation; however, the longterm difference in effects between manipulated and control groups has required further evaluation. Methods. A sample of convenience of acute low back pain participants were randomly assigned to two groups. A pre-test/post-test experimental design approach was used with 29 participants. This design included three dependent variables (pain, range of movement, and disability assessment) and one independent variable (15 participants in Group I received an exercise program with manipulation and 14 participants in Group II received an exercise program only). Participants were assessed for pain, range of movement, and disability before treatment. Participants were reassessed weekly for four weeks, then at two months and three months after initiation of treatment. Results. The findings of this study illustrate a statistically significant difference between the two treatments (p = <0.0005). Univariate post hoc tests concluded that the two treatment regimens had significantly different effects at three months on disability (p = 0.001), pain (p = <0.0005), and ROM (p = <0.0005). As well as being statistically significant, the magnitude of the relationships was strong, with 42.8% of the variability attributed to the disability measure, 64.3% of the variability attributed to the pain measure, and 65.9% of the variability attributed to the ROM measure. Conclusion. Patients who receive orthopaedic manipulation with an exercise program for acute low back pain of mechanical origin are likely to improve more than patients who receive an exercise program alone.     

Influential Variables Associated with Outcomes in Patients with Cervicogenic Headache

Abstract

Cervicogenic headache (CGH) is a common sequela of upper cervical dysfunction with a significant impact on patients. Diagnosis and treatment have been well validated; however, few studies have described characteristics of patients that are associated with outcomes of physical therapy treatment of this disorder. A retrospective chart review of patient data was performed on a cohort of 44 patients with CGH. Patients had undergone a standardized physical therapy treatment approach that included spinal mobilization/manipulation and therapeutic exercise, and outcomes of treatment were determined by quantification of changes in headache pain intensity, headache frequency, and self-reported function. Multiple regression analysis was utilized to determine the relationship between a variety of patient-specific variables and these outcome measures. Increased patient age, provocation or relief of headache with movement, and being gainfully employed were all patient factors that were found to be significantly (P<0.05) related to improved outcomes.