The healing presence: can it be reliably measured?

Religious and spiritual traditions from all cultures and times describe a spiritual or loving presence as a contributor to healing. In addition, there is a common belief that a special "presence" can exude from certain practitioners. Is it possible to measure a healing presence in an objective and reliable way? Most research on healing has focused on trying to prove spiritual and "energy" healing in comparative tests. However, if a measure of healing presence is to be sensitive and reliable, objective and real-time indicators of such a presence will be needed rather than comparative and statistical outcomes. This paper discusses what healers from various traditions have felt are the primary components of a healing presence, summarizes various attempts to measure healing, and describes two recently published approaches that have potential to provide such an objective and realtime indicator of a healing presence.     

Can activity within the external abdominal oblique be measured using real-time ultrasound imaging?

BACKGROUND: Differences in the function of the anterolateral abdominal muscles have been the subject of much investigation, but primarily using electromyography. Recently changes in thickness of transversus abdominis and internal oblique measured from real-time ultrasound images have been shown to represent activity within these muscles. However it is still unclear if such a change in thickness in external oblique similarly represents activity within that muscle. The purpose of this study was to investigate the relationship between change in thickness and muscle activity in the external oblique using real-time ultrasound and surface electromyography. METHODS: Simultaneous measurements of electromyography and real-time ultrasound images of external oblique were studied in up to 24 subjects during two tasks compared to the muscle at rest (1) isometric trunk rotation and (2) drawing in the lower abdomen. FINDINGS: Changes in muscle thickness correlated significantly with electromyography during isometric trunk rotation in the majority of subjects but with a significant difference between subjects. In contrast, the relationship between change in thickness and electrical activity in the muscle when drawing in the lower abdomen was significant in less than 50% of subjects and the muscle often got thinner. INTERPRETATION: Thickness changes of external oblique can be used as a valid indicator of electromyography activity during isometric trunk rotation, though the relationship is not as good as previously published data for transversus abdominis. Thickness changes of external oblique measured during lower abdominal drawing in cannot be used to detect activity within this muscle.     

What is empathy, and can empathy be taught?

Empathy is a commonly used, but poorly understood, concept. It is often confused with related concepts such as sympathy, pity, identification, and self-transposal. The purposes of this article are to clearly distinguish empathy from related terms and to suggest that the act of empathizing cannot be taught. According to Edith Stein, a German phenomenologist, empathy can be facilitated. It also can be interrupted and blocked, but it cannot be forced to occur. What makes empathy unique, according to Stein, is that it happens to us; it is indirectly given to us, "nonprimordially." When empathy occurs, we find ourselves experiencing it, rather than directly causing it to happen. This is the characteristic that makes the act of empathy unteachable. Instead, promoting attitudes and behaviors such as self-awareness, nonjudgmental positive regard for others, good listening skills, and self-confidence are suggested as important in the development of clinicians who will demonstrate an empathic willingness.     

How can the variability in ultrasound measurement of intima-media thickness be reduced? Studies of interobserver variability in carotid and femoral arteries

A critical component in scientific studies of most biological variables is the variation or error in measurements which leads to non-identical results of repeated measurements from the same subject. The aim of this study was to investigate whether the interobserver error (s) in measurement of intima-media thickness (IMT) in carotid and femoral arteries could be decreased if the mean value obtained using two ultrasound images from each of the right and left arteries was used in the analyses instead of the mean value obtained using images from only the right artery. In addition, we wished to evaluate two different reading procedures, one based on manual tracing of echo interfaces and the other on automated edge detection. In a methodological study, 50 subjects were examined with ultrasound twice in the same day by two independent laboratory technologists. The ultrasound images were analysed in two ways: using a computerized manual tracing analysing system and an automated analysing system. When both right and left carotid arteries were examined (manual reading), the interobserver error was smaller than that determined for the examination of only the right artery, for IMT_mean in both the common carotid artery (P = 0·06) and the carotid artery bulb (P<0·05). The interobserver error was also significantly smaller for double-sided vs. one-sided examination with automated reading of IMT_mean in the common carotid artery (P<0·01) and in the carotid artery bulb (P<0·01). The coefficient of variation (CV) for measurement in the common carotid artery decreased from 8·6% (one-sided, manual reading) to 5·3% (double-sided, automated reading). The interobserver error in measurement of IMT in the common femoral artery did not improve by examination of both right and left arteries. The results from this study show that the interobserver errors in measurement of IMT can be decreased by using ultrasound images from both the right and the left carotid arteries, and that the use of an automated analysing system greatly simplifies the reading of ultrasound images with sustained low variability.     

Modern Matrons: can they be easily identified by hospital patients?

The Modern Matron was introduced into hospital Trusts in April 2002 to improve the basics of patient care. They were to be easily identifiable, highly visible and authoritative figures. This article reports on a quantitative study done to ascertain if patients can identify the Modern Matron in one acute NHS Trust. A researcher-developed questionnaire was sent to 20 Modern Matrons and a different questionnaire was distributed to 72 randomly selected patients. The results demonstrated that only 5% of patients surveyed were able to correctly identify the Modern Matron by their uniform. This may be explained by the response from the Modern Matrons when asked how much time was spent with patients; 67% of their normal working day was taken up with management of staff, paperwork and meetings, leaving very little direct patient time.     

What can we learn about diet and physical activity from master athletes?

Only 13% of those 65 years and older engage in vigorous physical activity 3 or more days a week and obesity rates are increasing by 45% in adults over the age of 60. Physical activity helps prevent chronic disease and improves quality of life, yet few adults of any age are active. One exception is master athletes who participate in competitive sports during the middle and later years. The aerobic fitness of master athletes, as measured by maximal oxygen consumption, shows some decline, but not nearly as much as in sedentary controls. Master athletes have lipid profiles similar to those of young adults, which decreases their risk of heart disease. Master athletes also have better glucose tolerance and lower waist-to-hip ratios than sedentary adults, decreasing their risk for metabolic syndrome and type 2 diabetes. In the few dietary studies that have been conducted, master athletes consume more food energy while maintaining lower body weights than sedentary adults. Learning what motivates master athletes to stay highly active may help health professionals develop strategies to encourage exercise in the sedentary population of older adults.     

How common are side effects of spinal manipulation and can these side effects be predicted?

Little scientific support is available concerning usual and unusual reactions after spinal manipulation although such reactions are very common in clinical practice. Fifty-nine manipulative therapists were requested to enroll 15 consecutive patients attending for their first visit to receive spinal manipulation. These patients were asked to complete a questionnaire after this first visit that asked for possible risk factors for spinal manipulation and asked about any side effects after the manipulation. The participating practitioners were asked to note medical diagnosis, manipulated spinal region, number of treated areas and type of additional treatment. Four hundred and sixty five valuable responses were analysed. Two hundred and eighty three patients (60.9%) reported at least one post-manipulative reaction. The most common were headache (19.8%), stiffness (19.5%), local discomfort (15.2%), radiating discomfort (12.1%) and fatigue (12.1%). Most of these reactions began within 4 h and generally disappeared within the next 24 h. Women were more likely to report adverse effects than men (P < 0.001). Multivariate analysis showed that upper cervical manipulation (OR: 3.20; 95%CI: 1.89-7.77), use of medication (OR: 2.20; 95%CI: 1.31-3.69), gender (OR: 1.66; 95%CI: 1.01-2.75) and age (OR: 1.02; 95%CI: 1.00-1.05) were independent predictors of headache after spinal manipulation. The results of this study indicate that reactions to spinal manipulation may be relatively common but are benign in nature and of short duration. Although it is difficult to label side effects as a risk, it is important to differentiate those patients who are susceptible to side effects in order to inform them correctly.     

Diabetic microvascular complications: can patients at risk be identified? A review

People with diabetes have an increased risk of developing microvascular complications, diabetic retinopathy, diabetic nephropathy and diabetic neuropathy, which, if undetected or left untreated, can have a devastating impact on quality of life and place a significant burden on health care costs. In addition, diabetic microvascular complications can reduce life expectancy. The strongest risk factors are glycaemic control and diabetes duration; however, other modifiable risk factors such as hypertension, hyperlipidaemia and smoking, and unmodifiable risk factors including age at onset of diabetes and genetic factors may all play a part. Along with the presence of external risk factors, some associations have also been noted between diabetic microvascular complications themselves. There is evidence that diabetic retinopathy in association with increased blood pressure is an important risk factor for diabetic nephropathy progression. Significant correlations have also been shown between the presence of diabetic peripheral neuropathy and the presence of background or proliferative diabetic retinopathy. Clinical trials are currently in progress looking at a number of approaches to designing treatments to prevent the adverse effects of hyperglycaemia. It is essential however, that risk factors associated with the progression and development of diabetic microvascular complications are detected and treated at an early stage in order to further reduce morbidity and mortality. Considering all three complications as interrelated may well facilitate early detection of microvascular disease. Despite good long-term glycaemic and blood pressure control, diabetes remains a major cause of blindness, renal failure and amputations. As the incidence of diabetes continues to rise, the burden of diabetic microvascular complications will increase in future, hence the need for early detection. Considering the microvascular complications of diabetes as related, and enquiring proactively about complications, may well facilitate early detection of microvascular disease.     

Endoscopic ultrasound miniprobe staging of colorectal cancer: can management be modified?

BACKGROUND AND STUDY AIMS: Miniprobe ultrasound technology allows in-vivo luminal staging of colorectal cancer with a probe that passes directly through the colonoscope's instrument port. Conventional rigid radial echoscopes are limited by the need for a second examination, an inability to image stenotic lesions, and the inaccessibility of proximal tumours. Since minimally invasive resection techniques are now possible, a sensitive preoperative staging tool is needed to optimize patient selection. The aim of this study was to examine the accuracy of miniprobe ultrasound imaging in the preoperative staging of colorectal cancer and to examine the value of the technique for management decisions. PATIENTS AND METHODS: In a prospective study, a total of 131 consecutive patients with adenocarcinoma or broad-based polyps of the colorectum underwent 12.5-MHz miniprobe ultrasonography examinations conducted by a single endoscopist. Staging criteria for depth of tumour infiltration and nodal status were determined. Nodal disease was defined as the presence of a hypoechoic, round, defined boundary lesion larger than 10 mm in diameter. T0-T1N0 lesions were resected using endoscopic mucosal resection, and patients with lesions staged as T2N1 were referred for surgical resection. Tumour staging using endoscopic ultrasonography was then compared with the histopathological specimens. RESULTS: The accuracy of T staging using endoscopic ultrasonography was 96 % in comparison with the histopathological specimen. Five lesions (4 %) were incorrectly overstaged as T3 - pathology stage T2. Understaging occurred in three lesions (endoscopic ultrasound stage T3 - pathology stage T4). The overall accuracy of nodal staging using endoscopic ultrasonography was 87 % (sensitivity 0.95, specificity 0.71, positive predictive value 0.87, negative predictive value 0.88). CONCLUSIONS: Miniprobe ultrasonography has a high overall accuracy for both T staging and N staging of colorectal cancer and may have an important role in selecting patients suitable for minimally invasive resection techniques.     

How reliably can algorithms identify eosinophilic asthma phenotypes using non‐invasive biomarkers?

Background and AimsAsthma is a heterogeneous respiratory disease that encompasses different inflammatory and functional endophenotypes. Many non‐invasive biomarkers has been investigated to its pathobiology. Heany et al proposed a clinical algorithm that classifies severe asthmatic patients into likely‐eosinophilic phenotypes, based on accessible biomarkers: PBE, current treatment, FeNO, presence of nasal polyps (NP) and age of onset.Materials and MethodsWe assessed the concordance between the algorithm proposed by Heany et al. with sputum examination, the gold standard, in 145 asthmatic patients of the MEGA cohort with varying grades of severity.ResultsNo correlation was found between both classifications 0.025 (CI = 0.013–0.037). Moreover, no relationship was found between sputum eosinophilia and peripheral blood eosinophilia count in the total studied population.Discussion and ConclusionIn conclusion, our results suggest that grouping the biomarkers proposed by Heany et al. are insufficient to diagnose eosinophilic phenotypes in asthmatic patients. Sputum analysis remains the gold standard to assess airway inflammation.     

What can be done to improve diagnosis of aortic dissection?

Aortic dissection (AD) is rare. Missed AD is a common reason for coronial investigations and civil claims for medical negligence. Recommendations include improved education, supervision and information transfer, reminders in chest pain pathways and higher rates of investigation for AD. Higher investigation rates pose risks to patients and the health system which may not be in balance with the likelihood of AD. The appropriate diagnostic yield of investigation to balance risk and benefit has not been defined. The AD detection risk score pathway has been proposed as a useful diagnostic tool but concerns about its derivation, validation and utility remain. In this paper, we try to draw together published literature and local audit data to develop recommendations about what might be done to reduce the number of missed AD cases in EDs and what the impact of higher investigation rates might be.     

Serology — What is it and how can it be used in canine vaccination?

ABSTRACT:

Serology is used to quantify antibody titres that can be used to indicate the current immune status of an individual and could, therefore, be used to formulate tailored vaccination programmes for individual dogs. Although extended re-vaccination intervals are beneficial in reducing the concept of vaccine overload, not all individuals may be able to mount an immune response lasting for three years and some animals may be able to maintain immunity to core diseases for longer than three years. The two key tests in pre-vaccination serology are virus neutralisation testing and haemagglutination testing, although ELISA based in-house testing has now been developed.     

What is the ideal approach for emergent pericardiocentesis using point-of-care ultrasound guidance?

BACKGROUND: Traditionally performed using a subxiphoid approach, the increasing use of point-of-care ultrasound in the emergency department has made other approaches (parasternal and apical) for pericardiocentesis viable. The aim of this study is to identify the ideal approach for emergency-physician-performed ultrasound-guided pericardiocentesis as determined by ultrasound image quality, distance from surface to pericardial fluid, and likely obstructions or complications.     

Statins and osteoporosis: can these lipid-lowering drugs also bolster bones?

The statins may not only lower cholesterol, they may stimulate bone formation, as suggested by a number of observational studies and animal research. Whether these drugs will be of benefit in treating osteoporosis awaits further clinical trials.