A personal response to Gail Hornstein's To redeem one person is to redeem the world: the life of Frieda Fromm-Reichmann

This article summarizes events surrounding the closing of Chestnut Lodge, as a backdrop to the author's reactions on reading Frieda Fromm-Reichmann's biography. This anecdotal piece forms a complementary essay with the 2000 Frieda Fromm-Reichmann Lecture, "The Current Relevance of Fromm-Reichmann's Works." It illustrates aspects of treatment of schizophrenia and of the individuals involved in such work.     

A descriptive study of meaning of illness in chronic renal disease

AIM: To explore the subjective meaning of illness in a sample of renal patients. BACKGROUND: Patients' illness representations, such as the meaning they attach to illness, may affect their coping and adaptation. Improved understanding in this area may therefore benefit patient care. Meaning of illness has not previously been explored in renal disease. DESIGN AND METHODS: Cross-sectional survey (n=405) in a single regional renal unit in the North of England. Ethical approval was obtained and patients gave written consent. The instrument used was an eight-item schema, based on the work of Lipowski (1970, Psychiatry in Medicine 1, 91-102). Field notes regarding rationale for choice were recorded concurrently, then content analysed to enable identification of themes. The chi-square test (significance level P < 0.05) was used to analyse differences in selected meaning in older and younger patients; males and females; and patient groups (predialysis, haemodialysis and transplant). FINDINGS: 'Challenge' was selected by most patients (n=253, 62.5%), with similar results in all three patient groups. Slightly more older than younger patients selected 'challenge', although the difference was not statistically significant and older patients more commonly had a fatalistic interpretation of the option. More men selected 'challenge' than women. Those selecting 'challenge' and 'value' appeared to have a more positive outlook than other patients. CONCLUSIONS: Patients had identifiable meanings for their illness, and these may be associated with their response to renal disease. The schema appeared to be comprehensive, but is in need of further refinement. Consideration of the possible influence of social desirability is necessary.     

Occult bronchogenic carcinoma presenting as metastasis to the site of a bone anchored hearing aid

The first report of a patient with metastatic bronchogenic carcinoma of the skin surrounding the abutment of a bone anchored hearing aid (BAHA) is presented. Complications of bone anchored hearing implantation have been well documented to date. We present a 68-year-old lady who presented with an unusual skin lesion surrounding the abutment of her BAHA. This was the first presentation of her bronchogenic tumour. We also review the literature regarding cutaneous metastasis and complications of BAHA.     

A national population study of the prevalence of multiple chemical sensitivity

The authors conducted a telephone survey of 1054 randomly selected individuals within the continental United States to determine the prevalence of chemical hypersensitivity and the medical diagnosis of multiple chemical sensitivity (MCS) in the American population. The etiology and symptomatology of MCS also were investigated. Results produced a 95% confidence level and a +/-3% margin of error. The authors found that 11.2% of Americans reported an unusual hypersensitivity to common chemical products such as perfume, fresh paint, pesticides, and other petrochemical-based substances, and 2.5% reported they had been medically diagnosed with MCS. Additionally, 31.1% of those sampled reported adverse reactions to fragranced products, and 17.6% experienced breathing difficulties and other health problems when exposed to air fresheners. Although chemical hypersensitivity was more common in women, it affected individuals in all demographic groups studied.     

A novel method of inducing muscle cramps using repetitive magnetic stimulation

The lack of a practical model has hampered attempts to study the pathophysiology of muscle cramps. We investigated the feasibility, efficacy, and reproducibility of repetitive magnetic stimulation in producing experimental cramps. In 14 healthy subjects, the tibial nerve at the ankle was stimulated with a magnetic stimulator at rates beginning at 4 Hz to a maximum of 20 Hz. The frequency was gradually increased until a cramp was produced. Ten of 14 subjects demonstrated a muscle cramp. All subjects rated the discomfort of the procedure to be mild or moderate. Repeat testing yielded values that were highly reproducible. This technique holds promise for clinical studies and therapeutic trials.     

Rethinking patient education

The aim of this paper is to critically examine and challenge some of the assumptions which underpin the research and non-research based literature on patient education. Doubts are expressed concerning the transferability of theories of adult learning to patient education; and concern is expressed over the imbalance in the literature where emphasis is placed on the psychological benefits of teaching, rather than physical outcomes. In the light of the available evidence which suggests that nurses are not 'good patient teachers' the case is made to support the suggestion that patient education should become the responsibility of specialist nurses. In addition, computer-assisted learning (CAL) is proffered as the solution to a number of the problems facing patient educators. CAL is seen as a means of empowering the patient, rather than the nurse to take control, and this is viewed as a positive move in the direction of self-care. The paper concludes by suggesting that CAL might be used with good effect by patients with particular learning difficulties; for example the blind or partially sighted, and people who are illiterate or have a low reading ability.     

Juvenile muscular atrophy of the distal upper extremities associated with x‐linked periventricular heterotopia with features of Ehlers‐Danlos syndrome

Introduction: Juvenile muscular atrophy of the distal upper extremities (JMADUE) is a rare, sporadic disorder that affects adolescent males and is characterized by progressive but self‐limited weakness of the distal upper extremities. The etiology is unknown, but cervical hyperflexion has been hypothesized. Methods: We report a case of an adolescent male who presented with typical JMADUE but also had joint hypermobility and multiple congenital anomalies, including periventricular heterotopias, suggesting a multisystem syndrome. Results: Subsequent diagnostic testing confirmed a diagnosis of JMADUE, and sequencing of the filamin‐A gene showed a novel, pathogenic mutation that confirmed an additional diagnosis of X‐linked periventricular heterotopias with features of Ehlers‐Danlos syndrome (XLPH‐EDS). Conclusions: The concurrent diagnosis of these 2 rare conditions suggests a pathogenic connection. It is likely that the joint hypermobility from XLPH‐EDS predisposed this patient to developing JMADUE. This supports the cervical hyperflexion theory of pathogenesis. This case also expands the phenotype associated with FLNA mutations. Muscle Nerve 54 : 794–797, 2016