Electroconvulsive therapy from a social work perspective.

The purpose of this paper is to fill a gap in the social work literature which has not, to date, included a thorough discussion of electroconvulsive therapy (ECT) from a social work perspective. It discusses the rationale for ECT in current practice; enumerates improvements made in stimulus delivery since convulsive therapy was introduced in 1934; and summarizes the myths, realities, advantages and limitations of the treatment in modern psychiatry. It advocates a team approach, which includes social work support and education of the patient and family regarding treatment related matters and discharge planning. Several clinical vignettes are included to illustrate the types of illness for which ECT is used as well as the social work role with the team and patient/family during hospitalization and discharge planning. The Ontario College of Certified Social Workers Guidelines are used to explain social work interventions. The paper is also relevant to social workers in non-psychiatric settings in understanding and planning with patients and families where a member has experienced ECT.     

A new model for objective assessment of cervical ripening: the effect of prostaglandin E2 and prelabor contractility

A rabbit cervix preparation designed to evaluate the effects of locally administered substances and those of prelabor contractility on cervical ripening is described. In one experiment, one of the two cervices was exposed to prostaglandin E2 gel and the contralateral cervix was exposed to plain gel. In another experiment, one cervix was completely isolated from prelabor contractility, whereas the contralateral cervix remained intact. Cervical ripening was assessed by measurement of the stretch modulus and rate of creep 2 days later. Treatment with prostaglandin E2 gel and exposure to prelabor contractility resulted in significant unilateral cervical changes, suggesting that at least part of the prostaglandin E2 effect is locally mediated and that spontaneous prelabor contractility may play a role in cervical preparation for labor. Furthermore, because of its simplicity, this animal preparation can be useful in the investigation of the effects of other locally administered substances on cervical ripening.     

Treatment of knee osteoarthritis: relationship of clinical features of joint inflammation to the response to a nonsteroidal antiinflammatory drug or pure analgesic.

Our randomized double blinded comparison of acetaminophen versus analgesic and antiinflammatory doses of ibuprofen in the treatment of 182 subjects with knee osteoarthritis (OA) systematically evaluated soft tissue tenderness and joint swelling. Improvement in these signs of joint inflammation was associated with lessening of disability (p = 0.02), and reduction in rest pain (p = 0.07), but not with the drug treatment regimen. Thus, joint tenderness and swelling, presumptive evidence of synovitis, may not be a priori indications for use of an antiinflammatory drug, or predict greater responsiveness to treatment with an antiinflammatory drug than to a pure analgesic, in symptomatic treatment of patients with knee OA.     

Long-term survival, prognosis, and life-care planning for 29 patients with chronic locked-in syndrome.

We present a life-table analysis of a cohort of 29 locked-in syndrome (LIS) patients followed for a minimum of five years, and we report on the status of the chronic LIS patient. Twenty-nine LIS patients who remained locked-in for more than one year were identified. Inpatient charts were reviewed for demographic, medical, and functional data. Telephone followup was obtained to examine medical complications after discharge, survival, neurologic recovery, care issues, and permanent disposition. A life-table analysis was performed on survival data. Cerebrovascular disease was the most common cause of LIS. Survival ranged from 2.02 to 18.15 years. Twenty of the 26 patients available for five-year followup survived; hence, five-year survival was 81%. An alternative method of communication and emotional stress for the patient's caregiver was the key issue in patient care. Most patients were cared for in their own homes. Although minimal late neurologic recovery occurs in chronic LIS, survival may, nonetheless, be prolonged with adequate supportive care. Modern computerized technology offers LIS patients the ability to interact with their environment. This information may assist physicians in making ethical and long-term care decisions with the patient rather than for the patient with LIS.