Acute phase of stroke

Ictus treatment requires an urgent, coordinated, multidisciplinary effort be carried out. Pharmacological treatment of an acute phase of Ictus is another step in an integrated treatment of our patients. The author will concentrate on the specific pharmacological treatment indicated to care for acute Ictus without dealing with the standard support care nor with the treatment of the most usual complications.     

Cognitive-behavioral treatment in unselected rheumatoid arthritis outpatients

OBJECTIVE: This trial was performed to evaluate the efficacy of an adjunctive cognitive-behavioral treatment compared with rheumatological treatment alone in unselected rheumatoid arthritis outpatients. DESIGN: A prospective randomized control design was used. Change in medication during treatment was controlled by matching therapy- and control-group subjects according to this change in medication, sex, age, duration of disease, and functional class. SETTING: A rheumatological outpatient clinic, University of Goettingen, Germany. PATIENTS: Fifty-five consecutive outpatients with a diagnosis of rheumatoid arthritis (age 52.7 years, 74.5% female, duration of disease 9.4 years) finished the study. INTERVENTIONS: Subjects received routine care by the rheumatologists and routine medical treatment. Cognitive-behavioral treatment subjects (n = 19) received adjunctive standardized cognitive-behavioral group treatment with 12 weekly sessions. OUTCOME MEASURES: Outcome measures included disease activity variables, pain variables (pain intensity, affective pain), psychological symptoms, and coping. RESULTS: Subjects mostly demonstrated an increasing disease activity during treatment; change in medication during treatment was necessary in some patients. In the cognitive-behavioral treatment group the course of rheumatoid arthritis seemed less progressive than in the control group. The core effects of cognitive-behavioral treatment pertain more to improved coping, emotional stabilization, and reduced impairment than to reduced pain intensity. Passive, emotion-focused coping, helplessness, depression, anxiety, affective pain, and fluctuation of pain are reduced, "Acceptance of Illness" is improved. CONCLUSIONS: Cognitive-behavioral therapy has proven an effective adjunct to standard treatment of rheumatoid arthritis outpatients. These effects were shown in an unselected sample with increasing disease activity and with comparable changes in medication during treatment. We recommend cognitive-behavioral treatment as an desirable adjunct to standard medical treatment of rheumatoid arthritis.     

Alterations in electrical pain thresholds by use of acupuncture-like transcutaneous electrical nerve stimulation in pain-free subjects.

Acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) was compared with a placebo treatment in altering acute electrical pain thresholds. Ten pain-free subjects underwent, on different days, an acclimatization session, an ALTENS treatment, and a placebo treatment in a cross-over design. Electrical sensation and pain thresholds were measured from the tip of the index finger bilaterally at 15-minute intervals twice before, once during, and three times after a 30-minute treatment session. The ALTENS treatment was given at 4 Hz at an intensity just below pain threshold delivered to acupuncture points in the hand and wrist. The placebo treatment was similarly delivered, except that the intensity of stimulation was just above sensation threshold. Neither the ALTENS treatment nor the placebo treatment produced a significant change in pain threshold. There was no correlation between initial pain threshold and change in pain threshold. Implications for the modulation of pain are discussed.     

Treatment of an acute anterior disk displacement in the temporomandibular joint. A case report

The purpose of this case report is to describe the effects of a home exercise program and iontophoretic delivery of an anti-inflammatory agent and an anesthetic in the treatment of a patient with an acute internal derangement of the temporomandibular joint (TMJ). A 71-year-old woman was referred to physical therapy for treatment of an acute anterior displacement of the disk in the TMJ. She received two treatments consisting of iontophoretic delivery of dexamethasone sodium phosphate and lidocaine hydrochloride, and a home exercise program was prescribed. Clinical signs and symptoms were reduced after the first treatment and continued to abate during the course of treatment. Six weeks after treatment, her jaw range of motion remained within normal limits. She also reported being pain free and having resumed eating her regular diet.     

The use of aquatics with cerebral palsied adolescents

This article demonstrates the use of adaptive aquatics in an occupational therapy treatment program for a physically disabled adolescent. Included are developmental issues as they relate to the handicapped adolescent population, the concept of purposeful activity in occupational therapy, the choice of swimming as an activity for treatment, activity analysis for treatment planning, and an interdisciplinary approach to treatment. A single case study was used to exemplify the use of swimming as a purposeful activity. Therapeutic implications of the program are discussed.     

术前同期放化疗在直肠癌综合治疗中的地位．

外科手术是直肠癌的主要治疗方式,而全系膜切除则被广泛的作为标准治疗。术前同期放化疗在肿瘤降期和病理缓解率方面有明显的优势,提高了局部控制率和保肛率,尽管术后并发症发生率增加,但并没有增加肿瘤相关死亡率,术前同期放化疗已经被广泛的研究和运用到临床治疗中。这篇综述用来阐述术前同期放化疗在局部进展期直肠癌治疗中的地位。     

Cognitive Hypnotherapy as a Transdiagnostic Protocol for Emotional Disorders

This article describes cognitive hypnotherapy (CH), an integrative treatment that provides an evidence-based framework for synthesizing clinical practice and research. CH combines hypnotherapy with cognitive-behavior therapy in the management of emotional disorders. This blended version of clinical practice meets criteria for an assimilative model of integrative psychotherapy, which incorporates both theory and empirical findings. Issues related to (a) additive effect of hypnosis in treatment, (b) transdiagnostic consideration, and (c) unified treatment protocols in the treatment of emotional disorders are considered in light of cognitive hypnotherapy.     

喉罩通气全麻下经气管镜冷冻治疗支气管结核56例的护理体会

本文报告了喉罩通气全麻下经气管镜冷冻治疗支气管结核的临床资料和护理操作配合。56例患者经过术前准备,采用静脉全身麻醉后,在喉罩通气下行气管镜下冷冻局部治疗。56例患者护理配合好,经过平均(4±3)次的气管镜下冷冻治疗,总有效率为100％,无严重的并发症,取得了较好的疗效。喉罩通气全麻下经气管镜冷冻治疗支气管结核的疗效好,而护理配合则是保证患者完成喉罩通气全麻和支气管下检查的重要保证。     

Clinical hypnosis for smoking cessation: preliminary results of a three-session intervention

This study presents preliminary data regarding hypnosis treatment for smoking cessation in a clinical setting. An individualized, 3-session hypnosis treatment is described. Thirty smokers enrolled in an HMO were referred by their primary physician for treatment. Twenty-one patients returned after an initial consultation and received hypnosis for smoking cessation. At the end of treatment, 81% of those patients reported that they had stopped smoking, and 48% reported abstinence at 12 months posttreatment. Most patients (95%) were satisfied with the treatment they received. Recommendations for future research to empirically evaluate this hypnosis treatment are discussed.     

Clinical Hypnosis For Smoking Cessation: Preliminary Results of a Three-Session Intervention

This study presents preliminary data regarding hypnosis treatment for smoking cessation in a clinical setting. An individualized, 3-session hypnosis treatment is described. Thirty smokers enrolled in an HMO were referred by their primary physician for treatment. Twenty-one patients returned after an initial consultation and received hypnosis for smoking cessation. At the end of treatment, 81% of those patients reported that they had stopped smoking, and 48% reported abstinence at 12 months posttreatment. Most patients (95%) were satisfied with the treatment they received. Recommendations for future research to empirically evaluate this hypnosis treatment are discussed.     

Recommendations and guidelines regarding the preferred research protocol for investigating the impact of an optimal healing environment on patients with substance abuse

The addictive disorders affect every aspect of a person's life, and thus the most effective interventions are those that address many or all of these issues. Although the initial evaluation and intake process for addiction assessment is lengthy, this process does give the practitioner an opportunity to provide what can be considered an optimal healing environment (OHE) in treating the addictive disorders. In addition to our traditional medical treatment modalities of pharmacotherapy and psychotherapy, many complementary and alternative treatment modalities address and provide additional support for the holistic approach to treatment and recovery. The important role of spirituality in obtaining and maintaining recovery and sobriety has been recognized for many years. Because one specific treatment is not effective for all people and for all of the addictive disorders, using a holistic approach and individualizing the treatment regimen is the recommended approach to disease intervention and establishing an OHE. There are instruments available for measuring the facility, the staff, and the patient in their contributions to providing an OHE for substance abuse treatment. This paper suggests study design considerations for investigating the impact of an OHE on the results of treatment and specific instruments designed for use in patients with addictive disorders.     

Tinea versicolor

This article presents the guidelines for the diagnosis and treatment of tinea versicolor. The areas discussed are clinical presentation, etiology, pathogenesis, differential, diagnosis, treatment and patient counseling. Microscopic technique and use of the Wood's light are described in detail. Multiple treatment options are presented with consideration for side effects, cost and compliance. Patient education is discussed as an important component of treatment and an element that affects patient satisfaction.     

Change from the Ground Up: Bringing Informed-Dialectical Behavioral Therapy to Residential Treatment

This article describes how a large residential treatment program, Spurwink Services—decentralized throughout the southern and mid-portions of Maine—adapted and implemented an Informed Dialectical Behavioral Therapy (DBT) Program as part of its evidence-based treatment interventions for adolescent youth in residential treatment. Begun as a single group 8 years ago, the program now flourishes in 5 residential treatment sites across the agency. Interestingly, the inspiration, development, and growth of the program are highlighted as an example of the effectiveness of ground-up leadership on the front lines of residential treatment.     

The failure of exposure treatment in agoraphobia: implications for the practice of nurse therapists and community psychiatric nurses

There are no systematic studies of the failure of psychiatric nursing interventions and few very such studies in the psychological/psychiatric outcome literature. This study reports a controlled study of exposure treatment with agoraphobic clients who were treated by nurse therapists and psychologists. This includes an analysis of the four categories of treatment failure (i.e. treatment refusers, treatment dropouts, failures and relapsers). The analysis consisted of an examination of the outcome data of clients who met a priori criteria for the categories of failure and an examination of questionnaire responses. The results have implications for psychiatric nursing practice, particularly with regard to preparation for treatment. Additionally, the results indicate that much more research needs to be carried out on treatment methods and that exposure alone produces a significant but limited effect. Finally, the paper suggests that outcome research is a priority in psychiatric nursing.     

Mechanisms of action in psychotherapy

Although active involvement of patient and therapist predicts psychotherapy outcome, little is known about the mechanisms of action involved in the process. The authors investigated the relationships between variables that describe the participants' actions intrinsic to their active involvement and treatment outcome. A successful and an unsuccessful case were selected for 15 therapists, and an early and a late session for each case were coded using a newly developed instrument. Patients of a successful treatment compared with patients of an unsuccessful treatment made significant changes along variables that indicate the degree and quality of their involvement in treatment. This link between the participants' actions and treatment outcome may have practical utility in future investigations of the active components of different treatment modalities.     

Pain Treatment for Older Adults During Prehospital Emergency Care: Variations by Patient Gender and Pain Severity

Older adults are less likely than younger adults to receive analgesic treatment during emergency department visits. Whether older adults are less likely to receive analgesics during protocolized prehospital care is unknown. We analyzed all ambulance transports in 2011 in the state of North Carolina and compared the administration of any analgesic or an opioid among older adults (aged 65 and older) versus adults aged 18 to 64. Complete data were available for 407,763 transports. Older men were less likely than younger men to receive an analgesic or an opioid regardless of pain severity. Among women with mild or moderate pain, older women were less likely than younger women to receive either form of pain treatment, but among women with more severe pain (pain score 8 or more), older women were more likely than younger women to receive pain treatment. Further, among women with mild or moderate pain, the oldest patients (aged 85 and older) were the least likely to receive any analgesic or an opioid, but among women with severe pain the oldest patients were the most likely to receive treatment. Further research is needed to assess the generalizability of this interaction between age, gender, and pain severity on pain treatment.PerspectiveDuring prehospital care in North Carolina in 2011, older adults were generally less likely to receive pain treatment. However, older women with severe pain were more likely to receive treatment than younger women with severe pain. These results suggest an interaction between age, gender, and pain severity on pain treatment.     

Peptide immunization as an adjuvant to chemotherapy in mice challenged intratracheally with virulent yeast cells of Paracoccidioides brasiliensis

Immunization with peptide P10, derived from gp43, and chemotherapy were used together in an attempt to improve treatment of paracoccidioidomycosis and prevent relapses. The combined treatment showed an additive protective effect when administered at 48 h or 30 days after intratracheal challenge. Its use is recommended to improve regular chemotherapy and reduce the duration of treatment.     

Building a dream: creating an oncology day/evening hospital

The demand for inpatient beds has reached and often exceeds capacity producing waiting lists for cancer care. There is a need to explore alternative approaches to oncology treatment. The Oncology Day/Evening Hospital (ODEH), originally envisioned in 1995 as a joint project between an ambulatory cancer centre and a large teaching hospital, is an important cancer treatment initiative offering extended hours of ambulatory oncology treatment on days, evenings, weekends and statutory holidays. A review of current inpatient treatment modalities revealed that many patients receiving inpatient therapy could be safely and effectively managed in the ambulatory setting if treatment regimens were modified and if ambulatory hours of operation were extended. Healthcare improvements expected were: appropriate movement of inpatient activity to the ambulatory setting; more opportunities for patient choice in treatment time thereby allowing for maintenance of normal living; better quality of life for patients through prevention of hospitalization; decrease in treatment waiting times; consolidation of patients into an ambulatory oncology treatment setting as opposed to utilization of adult medicine units; and more rational inpatient bed utilization with reduction of admissions and intra-treatment transfers. This article describes our experience in building a dream, the challenges and lessons learned in implementing a better way to deliver oncology care in an environment of rapid change and staff shortages.     

1例原发性痛经的循证治疗

目的为原发性痛经患者提供合适的治疗方案。方法计算机检索Cochrane图书馆（2009年第1期）、PubMed（1950年1月～2009年5月）、ACP Journal Club（OVID1991年1月～2009年5月）等数据库,查找原发性痛经治疗相关的系统评价/Meta分析和随机对照试验,获取最佳证据用于临床。结果共检出系统评价11篇、随机对照试验1篇。通过对检出文献进行分析,结合患者及家属的意愿,为患者提供了合理的治疗方案。结论采用循证医学的方法,为原发性痛经提供合理的治疗方案,可有效提高治疗效果。