Thiamine deficiency neuropathy. It's still common today

Despite the fact that thiamine deficiency neuropathy is increasing in incidence in our society, it remains an underdiagnosed disorder. The typical complaints of weakness and burning feet are often regarded as trivial by the attending physician. Electrophysiologic studies are sensitive and often provide supportive evidence to aid in the diagnosis. Since chronic pain therapy is often ineffective, a high index of suspicion should be maintained to help ensure early diagnosis and successful intervention.     

The challenge and management of phantom limb pain after amputation

Phantom limb pain (PLP) is thought to occur in most amputees. This common clinical phenomenon often provides a challenge to those involved in the treatment and management of pain, since the causes of PLP are often misunderstood. This article will look at some of the theories of PLP which will highlight why normal analgesic drugs are often not effective. The article will then consider pain management strategies used in PLP in the ward setting. These pain management strategies include the use of drugs not traditionally known as analgesics, but which are usually used in the treatment of epilepsy and depression.     

Common problems in ophthalmic plastic surgery.

Many ophthalmic plastic surgical problems are ignored because the patient seems to be "getting along." Frequently physicians are only vaguely aware of the constant daily discomfort their patients experience from seemingly minor problems such as endocrine exophthalmos, an ill-fitting prosthesis or baggy eyelids. As a result, too often the patient is unaware of the treatment possibilities that are available to relieve and often eliminate his problem. These conditions are often first seen by the family physician.     

Misdiagnosis of chronic pain as hysteria and malingering

Chronic soft tissue pain disorders are not well understood from a pathophysiologic standpoint. Psychologic difficulties are common, clinical signs incompatible with conventional understanding of the nervous system are often present, and these disorders usually fail to respond to medical intervention.When this constellation of factors is combined with unresolved litigation-compensation issues, it is not surprising that chronic pain disorders are often misdiagnosed as hysteria or malingering. Unfortunately, these diagnoses may have significant negative consequences that are not often appreciated and may compromise treatment.     

Critical illness polyneuropathy

Critical illness polyneuropathy (CIP) is a syndrome that was first extensively described in the early 1980s, mainly in patients with failure to wean from mechanical ventilation. The syndrome is further characterized by limb muscle weakness, usually more pronounced distally than proximally, and is often accompanied by atrophy. The facial musculature is often strikingly spared. Reduced or absent deep-tendon reflexes and loss of peripheral sensation to light touch and pin prick often accompany the syndrome. Involvement of the phrenic nerve has been shown to further contribute to delayed weaning from the ventilator in many patients. The electrophysiologic studies are consistent with a predominantly motor and, often to a lesser extent, sensory axonal polyneuropathy. The incidence of CIP is high, with often more than 50% of patients in major medical and surgical critical care units suffering from the syndrome. The systemic inflammatory response syndrome (SIRS) is strongly associated with CIP and, among the multiorgan failure often seen in SIRS, CIP is thought to represent a neurologic manifestation of SIRS. The neurologic effects of SIRS are thought to be mediated by released mediators like cytokines and free radicals, affecting the microcirculation of the central and peripheral nervous system. Examination of the peripheral nervous system is often unreliable, and the only way to establish a definitive diagnosis is by performing electrophysiologic studies. Morbidity and mortality rates are high. If the underlying problem causing sepsis and/or SIRS can be treated successfully, full recovery from CIP can occur. This recovery often occurs in a matter of weeks in milder cases and in months in more severe cases. Knowledge of CIP is essential for intensivists and other specialists who care for critically ill patients. This review summarizes the current available literature on this topic.     

Physician-scientist, heal thyself . .

Historically, physician-scientists have had dual roles in caring for patients and in performing investigative research that could potentially lead to new diagnostics and therapeutics. Physician-scientists conducted teaching rounds in the hospital, surrounded by eager house staff and medical students, and were often avidly pursued as the most important sources of new knowledge for trainees. But alas, times have changed. Now physician-scientists are rarely seen in the hospital; they are most often spotted at their desks tapping out yet another grant application. Most struggle to find the time to mentor students and clinical trainees, let alone to care for patients in the hospital, even though these interactions are often the motivating forces for scientific creativity.     

Clinical learning using a case review/clinical mentorship model

The ageing population presents a demand management challenge for modern health care systems. Emergency departments (EDs) are often utilized as the gateway to medical care and are being increasingly faced with growing numbers of geriatric presentations. The risk of adverse events for Residential Aged Care Facility (RACF) residents’. Hospital transfers are often distressing for the residents and often contribute to high incidence of iatrogenic complications.In the current RACF model of care,     

Why meta-analyses are important for complementary and alternative medicine research

Complementary and alternative medicine (CAM) is defined as a group of interventions that are not generally considered part of conventional medicine. This definition already implies that CAM interventions are often not systematically studied; and the research evidence from single trials on CAM is often limited by small sample sizes, unclear methodology, and inadequate statistics. As a result, both, significant and insignificant results are often hard to interpret based on single trials. Summarizing the evidence from single CAM trials, qualitative systematic reviews still have to deal with the same problems as individual trials as they can only rely on the original reports. Thus, effects of CAM interventions are often underestimated or overestimated based on single trials or qualitative systematic reviews. While meta-analyses still are limited by the methodological shortcomings of the included studies, a well-conducted meta-analysis can deal with two common problems of CAM trials: inadequate statistics that rely on within-group comparisons and small underpowered sample sizes. Although large and high quality trials are urgently needed for most CAM interventions, funding often is limited. Until higher quality research is available, meta-analyses provide a useful tool to investigate the actual level of evidence of currently published CAM trials. This editorial presents examples of meta-analyses in the field of CAM and discusses how they contribute to the consolidation of evidence.     

Risk: A Concept Worthy of Attention

Clients often engage in behavior that involves risk. Consequences of this behavior are sometimes harmful, but not always. Many times clients' views of the risks they are taking are often based on personal decisions they have made about their own health. People who take risks are frequently quite knowledgeable. The author uses case studies to examine the concept of risk. The author posits that teaching plans must account for the risks that clients take. Teaching plans should reflect that risks/benefits need to be discussed. Teaching should reflect respect for patient choices. An open discussion with the client that reflects what is really happening in the client's everyday life is of far more value than scanty, often glossed-over reports clients are accustomed to giving health professionals.     

Nursing Journals Read and Assigned Most Often in Doctoral Programs

Five doctoral faculty members were randomly selected from each faculty group of 35 doctoral programs in nursing to identify which nursing journals they read most often and which nursing journals they assign most often to doctoral students. Five nursing journals were consistently ranked 1–4 as being read and assigned most often. These journals are: Nursing Research, Advances in Nursing Science, IMAGE: Journal of Nursing Scholarship, Research in Nursing and Health , and Western Journal of Nursing Research. Implications for editors, reviewers and research consumers are discussed.     

Opioid side effects, addiction, and anti-inflammatory medications

Patients in pain often fear medications prescribed or recommend to them by their clinicians. Fear of side effects can contribute greatly to medication non-adherence (noncompliance). Patients often have fears that exceed the potential problems with which their medications are associated. Questions and answers relating to the side effects and the risk of addiction associated with opioids are presented.     

Pure Sertoli cell tumor of the ovary: A case report

Pure Sertoli cell tumors are an uncommon variant of rare ovarian Sertoli‐Leydig cell tumors. Due to nonspecific clinical and imaging features, diagnosis is often made after histopathological examination. The prognosis is excellent as most are detected in the early stages and surgical resection is often curative in most cases.     

Opioid Side Effects,Addiction, and Anti-Inflammatory Medications

Patients in pain often fear medications prescribed or recommend to them by their clinicians. Fear of side effects can contribute greatly to medication non-adherence (noncompliance). Patients often have fears that exceed the potential problems with which their medications are associated. Questions and answers relating to the side effects and the risk of addiction associated with opioids are presented.     

Solid and papillary epithelial pancreatic neoplasm: An unusual tumor

Solid and papillary epithelial neoplasms of the pancreas are uncommon. These grow to a large size, are often palpable, and occur most often in young black women. The tumors have a characteristic histologic appearance and a low malignant potential. Heavy tumor calcification is an unusual finding. Two cases with radiologie-pathologic correlation are presented herein.     

Close calls for low-back injuries

Back injuries are a major hazard in the workplace, particularly in the nursing profession. In acute care in Alberta, nursing personnel account for almost 50 per cent of all lost-time claims per year. In extended care facilities, nursing personnel account for 60 per cent of lost-time claims. The source of injury is often another person (64%), the incident is often lifting or over-exertion (65%), and the injury is most often a sprain or strain (75%). Furthermore, 50 per cent of lost-time injuries are to the back. Clearly, back strains while handling clients are a major hazard in the health care industry.     

Elders with epilepsy

Why is it important to learn about epilepsy in the elderly? The answers are many. As this article has highlighted, compared with younger individuals epilepsy is more common and the causes are more structural and symptomatic than in younger patients (particularly stroke). The clinical presentation is different in the elderly. The diagnosis is more difficult and often delayed. The most common seizures are simple partial and complex partial seizures, which are more often extratemporal in location. Confusion and memory problems are common presenting symptoms and postictal deficits often are prolonged. The prognosis for epilepsy in the elderly generally is favorable for seizure control, but if untreated, depression and quality of life suffer and seizures frequently recur. Seizures respond well at lower serum concentrations of antiepileptic drugs but these patients are also more sensitive (less tolerant) to side effects at lower doses than younger adults.     

Childhood migraine. Differential diagnosis and treatment

Migraine headaches may be confused with other types of headache, namely, those caused by tension and by organic disorders, but several features often set them apart. For one, migraines are often accompanied by other symptoms, such as nausea and vomiting. Also, they often are present in the family history. Treatment can involve such methods as biofeedback, diet, and limitation of exercise, and a number of medications are available for both treatment and prophylaxis. Studies of drug treatment of childhood migraine are few, so clinicians must tailor treatment to the individual case, watching for side effects and limiting the duration of treatment as much as possible.     

Who Will Listen? Rural Teen Pregnancy Reflections

Nurse practitioners, especially those who work with adolescents in rural communities, are often frustrated in their efforts to discourage teen pregnancy. Though the rates of teen pregnancy rates are higher in rural communities, barriers often inhibit open conversations about prevention. Rural high school students were asked to discuss the question, “Is teen pregnancy a problem in our community?” The participants acknowledged pregnancy and sexual activity prevalence and discussed consequences, causes, and prevention strategies. These findings could help decrease the resistance that providers often face when initiating conversations with teens and their parents about sexual issues, especially pregnancy consequences and prevention methods.     

Demographic data and symptoms of eosinophilic esophagitis in adults

The clinical presentation of eosinophilic esophagitis in adults is varied but most often starts with some form of dysphagia. These patients often may be diagnosed incorrectly as having gastroesophageal reflux disease or functional disease, given the paucity of objective endoscopy and radiographic findings in some patients, even though symptoms often are severe and persistent. A careful history with attention to detail and a compilation of compatible characteristics is key to the clinician's diagnosing eosinophilic esophagitis in an adult.     

Pelvic Congestion Syndrome What Is It and Who Do We Treat?

Pelvic congestion syndrome (PCS) is an often poorly understood and often overlooked etiology of chronic pelvic pain. When clinical and ultrasound examinations are normal, further diagnostic imaging can be helpful to obtain the diagnosis. Once identified, pelvic congestion syndrome can often be treated successfully with transcatheter embolization.