ADOLESCENT ADDICTION AND DELINQUENCY IN THE FAMILY SYSTEM

Drug abuse and delinquent behavior in adolescents have been closely linked in the literature. It is possible that these links are not causal, but rather covariates of the common factor of family. This paper seeks to examine the behaviors of addiction and delinquency within the framework of family systems theory.     

LIVING WITH SCHIZOPHRENIA: THE FAMILY ILLNESS EXPERIENCE

Mental health nurses have the opportunity to provide parents and siblings of a schizophrenic family member with information, empowering them to care for themselves and their ill loved one. By understanding the emotional reaction families have to the illness and the effects of social stigma, nurses can help families overcome the barriers to care by establishing a supportive practice. This article describes schizophrenia in terms of its impact on parents and siblings, including novel implications for nursing practice and research.     

COMPARISON OF ECCENTRIC AND CONCENTRIC EXERCISE INTERVENTIONS IN ADULTS WITH SUBACROMIAL IMPINGEMENT SYNDROME

Background

Researchers have demonstrated moderate evidence for the use of exercise in the treatment of subacromial impingement syndrome (SAIS). Recent evidence also supports eccentric exercise for patients with lower extremity and wrist tendinopathies. However, only a few investigators have examined the effects of eccentric exercise on patients with rotator cuff tendinopathy.

Purpose

To compare the effectiveness of an eccentric progressive resistance exercise (PRE) intervention to a concentric PRE intervention in adults with SAIS.

Study Design

Randomized Clinical Trial

Methods

Thirty‐four participants with SAIS were randomized into concentric (n = 16, mean age: 48.6 ± 14.6 years) and eccentric (n = 18, mean age: 50.1 ± 16.9 years) exercise groups. Supervised rotator cuff and scapular PRE''s were performed twice a week for eight weeks. A daily home program of shoulder stretching and active range of motion (AROM) exercises was performed by both groups. The outcome measures of the Disabilities of the Arm, Shoulder, and Hand (DASH) score, pain‐free arm scapular plane elevation AROM, pain‐free shoulder abduction and external rotation (ER) strength were assessed at baseline, week five, and week eight of the study.

Results

Four separate 2x3 ANOVAs with repeated measures showed no significant difference in any outcome measure between the two groups over time. However, all participants made significant improvements in all outcome measures from baseline to week five (p <  0.0125). Significant improvements also were found from week five to week eight (p < 0.0125) for all outcome measures except scapular plane elevation AROM.

Conclusion

Both eccentric and concentric PRE programs resulted in improved function, AROM, and strength in patients with SAIS. However, no difference was found between the two exercise modes, suggesting that therapists may use exercises that utilize either exercise mode in their treatment of SAIS.

Level of evidence

Therapy, level 1b     

射频热凝术治疗顽固性癌性神经痛的临床研究

目的：探讨射频热凝术用于治疗癌性神经痛的疗效及安全性。方法：42例癌性神经痛患者,A组患者（n=20）按三阶梯疗法,采用吗啡药物治疗,B组患者（n=22）在吗啡加用局麻下行射频温控热凝毁损治疗。分别就治疗后疗效、生活质量改善情况及安全性进行评估。结果：B组患者在不同治疗时期的总有效率明显高于A组（P〈0.05）,生活质量的改善较A组有显著性差异,副作用的发生率较A组低。结论：射频热凝治疗癌性神经痛是一种安全有效的微创介入治疗方法。     

A COMPARATIVE STUDY OF THE SPIRITUAL PERSPECTIVES AND INTERVENTIONS OF MENTAL HEALTH AND PARISH NURSES

Spirituality is an integral part of holistic nursing practice. Limited research has been done that explores nurses' spirituality and the spiritual interventions they have made with patients in their practice. Much of the extant research has been done on nurses involved in terminal care such as oncology and hospice nursing. This study explores spiritual perspectives and spiritual nursing interventions in two other nursing specialties that require holistic nursing care as well: mental health and parish nurses. The findings indicate that both groups report high spiritual perspective scores and provide a variety of interventions to patients in their practices.     

HISTOPATHOLOGY: ITS ROLE IN THE DIAGNOSIS OF A CHILD WITH INTUSSUSCEPTION

Spontaneous expulsion of a small portion of the intestinal mucosa per rectum, in an infant, associated with ileocolic intussusception is an extremely rare condition. This appears to be the first report of such a clinical presentation. The initial diagnosis was raised by the histopathologist following examination of the eliminated piece of tissue. Subsequent barium enema and laparotomy confirmed the diagnosis and the ileocolic intussusception was successfully reduced. This unusual presentation, together with a review of the pertinent literature, is discussed. Our findings indicate that both the clinicians and histopathologists should be aware of this phenomenon and stress the importance of the histological examination of any unusual faecal matter. This may prove to be a simple, quick and cheap method of investigation of this condition.     

THE FAMILY AND SCHIZOPHRENIA

There has been controversy about the role of family in the etiology and course of schizophrenia for almost 70 years. Psychoanalysts and family therapists have proposed theories about the development of schizophrenia that overtly blamed parents, and recently, expressed emotion (EE) research has been criticized as implicating families once again. However, the study of schizophrenia as a brain disorder has resulted in new understandings of the influence of the family. This article reviews recent research revealing a unique vulnerability to stress in persons with schizophrenia and suggesting that communication difficulties may be due to a shared genetic heritage. Advanced practice mental health nurses who have a solid foundation in neurobiology are ideally suited to help the person with schizophrenia and his or her family. Knowledge about the neurobiological basis of schizophrenia has become very sophisticated and complex, but that knowledge is nevertheless essential to understand the otherwise puzzling patterns of behavior shown by persons with schizophrenia.     

STAFF ATTITUDES TOWARDS INDIVIDUALS WITH LEARNING DISABILITIES AND AIDS: THE ROLE OF ATTITUDES TOWARDS CLIENT SEXUALITY AND THE ISSUE OF MANDATORY TESTING FOR HIV INFECTION

This study investigated staff attitudes towards individuals with learning disabilities and AIDS in combination with staff attitudes towards client sexuality. Two hundred and forty-six respondents (55% of those invited to participate) from one organisation in Scotland voluntarily and anonymously returned the nine-item Staff Attitudes Towards persons with Learning Disabilities and AIDS (LDAIDS) scale (Murray & Minnes, 1994b) and the Sexuality and Persons with Learning Disabilities Attitude Inventory (SPLDAI; Brantlinger, 1983; Murray & Minnes 1994a). Results indicated that staff held moderately positive attitudes towards individuals with a learning disability and AIDS. Regression analysis showed that while controlling for staff demographic and contact variables, attitudes towards client sexuality (SPLDAI) predicted 22% of the variance in scores of attitudes towards clients with learning disabilities and AIDS., Forty-four percent of participants employed in a direct residential care capacity agreed with mandatory testing of clients for HIV infection. The implications of these findings are discussed with relevance to issues raised by Cambridge (1994) who explored the informed consent/mandatory testing issue. Directions for future research and limitations of the study are also discussed.     

EFFECTIVENESS OF EXERCISE INTERVENTIONS FOR CHILDREN WITH CEREBRAL PALSY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

ObjectiveThe results of previous research into exercise interventions for children with cerebral palsy are inconsistent. The aim of this study is to assess the effectiveness of such exercise interventions.DesignSystematic review and meta-analysis.MethodsSystematic searches of the PubMed, Embase and Cochrane Library databases for randomized controlled trials involving exercise interventions for children with cerebral palsy, from inception to January 2020, were performed. Pooled weighted mean differences (WMDs) with 95% confidence intervals (95% CI) for gross motor function, gait speed, and muscle strength were calculated using random-effects models.ResultsA final total of 27 trials, including 834 children with cerebral palsy, were selected for quantitative analysis. Exercise interventions had no significant effect on the level of gross motor function (WMD 1.19; 95% CI −1.07 to 3.46; p = 0.302). However, exercise interventions were associated with higher levels of gait speed (WMD 0.05; 95% CI 0.00–0.10; p = 0.032) and muscle strength (WMD 0.92; 95% CI 0.19–1.64; p = 0.013).ConclusionThese results suggest that exercise interventions may have beneficial effects on gait speed and muscle strength, but no significant effect on gross motor function in children with cerebral palsy.LAY ABSTRACTCerebral palsy is the most common cause of physical impairment in children. This study evaluated the effectiveness of exercise interventions for children with cerebral palsy. Exercise interventions were significantly associated with increased gait speed and muscle strength, while gross motor function was not affected. Exercise interventions should therefore be used for children with cerebral palsy.Key words: cerebral palsy, child, exercise, meta-analysis, systematic review

Cerebral palsy is the most common cause of physical impairment in children and is characterized by gait abnormalities (1–3). The characteristics of cerebral palsy are associated with damage to the immature brain, which causes subsequent primary impairments, including decreased muscle tone, loss of selective motor control, and impaired balance. Secondary impairments include muscle shortening or weakness and decreased range of motion (4, 5). The prevalence of cerebral palsy is approximately 2.1 in every 1,000 births, and children account for 74% of cases worldwide (6, 7). Children with cerebral palsy are significantly affected by epilepsy and by disorders in motor function, sensation, perception, communication, and behaviour, which significantly affect quality of life and result in huge economic and psychological burdens (8–11).Currently, the primary therapeutic goals for cerebral palsy are aimed at improving mobility and upper limb function (12). Exercise interventions may also play an important role in improving muscle strength, endurance, and cardiorespiratory fitness. Several systematic reviews and meta-analyses have illustrated the potential role of exercise interventions for children with cerebral palsy; however, results regarding gross motor function, gait speed, and muscle strength are inconsistent (13–15). Exercise programmes usually include resistance and/ or aerobic training. Children with cerebral palsy have reduced muscle strength, and resistance exercise can maintain or increase muscle performance (16, 17), while aerobic training can improve cardiorespiratory fitness. Studies have found that muscle stretching can increase range of motion (18, 19). It is important to clarify the effectiveness of exercise interventions for treatment of cerebral palsy in children, and to determine the role of the type of training for children with cerebral palsy. A meta-analysis of randomized controlled trials (RCTs) of exercise interventions for children with cerebral palsy was therefore performed in order to assess the effectiveness of this treatment.     

THE ROLE OF ECHOCARDIOGRAPHY IN THE DIAGNOSIS AND MANAGEMENT OF INFECTIVE ENDOCARDITIS

The echocardiographic appearance in suspected endocarditis must always be interpreted in the context of the clinical findings. Thus although echocardiography may contribute to the early diagnosis of infective endocarditis, it should rarely be used as a screening test. It is highly sensitive for the detection of complications such as abscesses or valvular regurgitation and can estimate their severity. Although transthoracic imaging will allow a complete study in many cases, the transoesophageal approach is superior for the detection of abscesses and the assessment of prosthetic mitral valves. Patients with large vegetations, particularly on the mitral valve, are at increased risk of embolism but there is no convincing evidence to support prophylactic surgery in these cases.     

NONANTIGENICITY AND IMMUNOLOGIC TOLERANCE: THE ROLE OF THE CARRIER IN THE INDUCTION OF TOLERANCE TO THE HAPTEN

Treatment of adult mice with dinitrophenyl (DNP) bound to isogeneic serum resulted in a specific inability to respond to DNP after challenge with DNP-keyhole limpet hemocyanin (KLH) in complete Freund's adjuvant. The unresponsiveness to the hapten had all the characteristics of immunologic tolerance: it had a definite induction time; it was transient but could be maintained by additional injections of the tolerogen; it was antigen specific and dose dependent. In addition, the induction of tolerance to DNP is dependent on the nature of the carrier. Two main conclusions can be drawn from these data: DNP conjugates of three homopolymers of lysine were found to be nonimmunogenic in mice, yet tolerogenic. Thus, antigenicity is not necessary to induce tolerance. Among the various carriers tested, isogeneic 7S immunoglobulin (IgG) was found to be the most effective to induce and maintain tolerance to the hapten. This suggests that IgG may have a function other than its usual role as an immunoglobulin.