Clomipramine and sleep: a preliminary communication.
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Biomedical subjects
Publications and source records attributed to C Hawkins.
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Volunteers are essential to smaller hospice care programs. These volunteers must be selected and trained to provide these services. The training program has several goals: content acquisition, experimental learning, mutual screening and selection, team building, and public relations. Selection processes avoid persons who have rigid beliefs, unresolved grief, or negative personalities as well as those who talk too much. The training uses many teaching methods to emphasize hospice philosophy, team building, communication skills, death awareness, empathy skills, basic nursing skills, impact of death on family, cancer information, pain control, and physician-care factors. Concrete examples of how each of these themes is accomplished are included in the paper. This program has worked well in preparing a group of volunteers for a rural, home-based hospice program in northern Michigan and represents one example of an effective approach.
We report a 14-year-old girl in whom a diagnosis of primary central nervous system lymphoma was confirmed while receiving growth hormone (GH) for GH deficiency, detected after presenting with short stature. MRI revealed an enhancing and thickened pituitary stalk with absence of the normal bright signal in the posterior pituitary. Regular MRI surveillance detected progression of the neurohypophyseal changes 13 months into GH treatment. Biopsy confirmed this to be B-cell large cell lymphoma. This case highlights the diagnostic and management challenges inherent in treating such children.