An examination of the origins and development of the codependency concept finds it rooted in an obsolete disturbed-personality hypothesis. Both the current literature and treatment philosophy in the chemical dependency field reflect this perspective and continue to perpetuate a pathogenic view of wives who have chemically dependent husbands. Methods of treatment and the validity of treatment for what remains an unverified diagnostic entity are challenged on the grounds of professional ethics and therapeutic efficacy.

Family↗

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Preparing for the CCRN examination. Part 2: Selecting published resources.

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Bibliographies as Topic↗

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Third level hemodynamics: guiding clinical decisions.

Hemodynamic monitoring is one of the most frequently used technologies in critical care nursing. But how often do critical care practitioners consider the underlying reason for monitoring these variables? What really is the oxygen balance in the cell? How does oxygen supply and demand figure into the hemodynamic equation? This article demonstrates how the imbalance of oxygen supply and demand at the cellular level is important to understanding the patient's hemodynamic status. It is followed by a continuing education packet you can use to teach the cellular principles of hemodynamics.

Cardiac Output↗

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Duration of effusion after antibiotic treatment for acute otitis media: comparison of cefaclor and amoxicillin.

A double-blind randomized clinical trial was conducted at two sites comparing cefaclor and amoxicillin for the treatment of acute otitis media with effusion in 214 children (293 ears). Each child underwent unilateral or bilateral tympanocentesis and then was randomly assigned to receive a 14-day course of either amoxicillin or cefaclor. The symptomatic clinical response was the same for the two antibiotics, with four children considered "treatment failures" in each antibiotic treatment group. By 14 days after entry into the study 59 of 106 children (55.7%) in the cefaclor group had ears that were effusion-free as compared to 40 of 97 children (41.2%) in the amoxicillin group (P = 0.05). When considering all children with effusion-free ears as well as those "improved" from their original status (those with bilateral middle ear effusions at entry but only unilateral after treatment), 68 of 106 children (64.2%) receiving cefaclor were effusion-free or "improved," compared to 43 of 97 children (44.3%) receiving amoxicillin (P = 0.01). However, by 42 days after entry the percentage of children whose ears were without effusion or "improved" was equal in both treatment groups (68.9% in the cefaclor group and 67.5% in the amoxicillin group). The reasons for the differences observed at 14 days after entry are not readily apparent.

Acoustic Impedance Tests↗

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Failure of tolterodine to treat clozapine-induced nocturnal enuresis.

OBJECTIVE: To report the use and subsequent failure of the bladder-selective agent tolterodine, to treat clozapine-induced nocturnal enuresis in an adolescent patient with psychotic illness. CASE SUMMARY: A 16-year-old Hispanic girl was admitted to the state psychiatric hospital with a diagnosis of bipolar disorder with psychotic features. Clozapine therapy was initiated, and after three months of treatment the patient began experiencing episodes of nocturnal enuresis. The bladder-selective agent tolterodine was tried and subsequently failed to resolve the enuresis episodes. Desmopressin was initiated, which resulted in amelioration of symptoms. DISCUSSION: This is the first published report of using tolterodine to treat clozapine-induced nocturnal enuresis. Several methods to decrease clozapine-induced urinary incontinence have been used and typically include the addition of agents with high anticholinergic properties. Tolterodine is a bladder-selective anticholinergic agent indicated for the treatment of urinary urge incontinence and may be employed as a treatment for antipsychotic-induced incontinence. CONCLUSIONS: Nocturnal enuresis is an adverse effect that infrequently occurs with use of clozapine therapy. Although tolterodine was ineffective in our patient to treat clozapine-induced nocturnal enuresis, further trials are required to appropriately evaluate the effectiveness of tolterodine to treat this adverse drug reaction.

Adolescent↗

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Cellular and genetic properties of two melanoma cell lines established from the same tumor.

We report here the detailed cellular and genetic analysis of two new human melanoma cell lines established from the same tumor biopsy. Although derived from the same tumor biopsy, the two lines differed in their method of in vitro culture establishment with one line (HA-A) grown first in agar culture and then transferred to liquid culture, while the second cell line (HA-L) was established directly from cells grown in liquid culture. Detailed characterization of both cell lines was performed using techniques to analyze their cytogenetic, surface marker, morphology (light and electron microscopy), growth (in agar and in nude mice), and drug sensitivity profiles in comparison to the original tumor biopsy. Our results revealed no significant biologic or genetic difference between the two cell lines established by different culture techniques. Our results suggest that in some cases agar culture prior to liquid culture may be useful in establishment of human tumor cell lines.

Antigens, Neoplasm↗

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Clinical leadership--bridging theory and practice.

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Clinical Competence↗