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At least 901 records · Page 50Linked to original sources
PubMed1988

The '24-hour reality orientation' type of approach to the confused elderly: a minimum standard for care.

The use of the two principle types of reality orientation with the confused elderly has been the subject of research by nurses, psychiatrists and psychologists. Reviews of this research suggest that the effects of these therapies on patient outcomes are extremely limited. However, a number of writers advocate their use on the grounds that their implementation results in more individualized care by nurses. This argument is rejected in favour of the demonstrated effect of introducing individualized care from a basis in nursing theory. Nursing theory also provides the remit for nurses to control the physical and interpersonal environment of the confused elderly patient. By examining moral principles as they are applied to nursing, it is argued that the nature of that environmental control should be towards a 24-hour reality orientation type approach. This should be implemented in an individualized way and should form the basis of a minimum standard of care for this client group.

Aged↗
PubMed1997

Integrating one-person and two-person psychologies: autochthony and alterity in counterpoint.

The classical psychoanalytic concept of the one-person treatment model and its assumptions concerning psychic reality are compared with the contemporary two-person model, subsumed under the concept of "alterity" (otherness). The classical model of unconscious mental life is explored in terms of the principles of "autochthony" (signifying the fantasy that self and object are created entirely from and by the self) and "cosmogony" (an aspect of primary and secondary processes that accounts for the creation of a personal and an objective world-view). Autochthony and cosmogony are subsumed under the category of "creationism." I discuss why I identify these three phenomena by these relatively unused terms.

Adult↗
PubMed1997

The relationship between pretheoretical assumptions and clinical reasoning.

This single-case study explored what internal beliefs or commitments one therapist holds about the nature of reality and how those beliefs influence her delivery of occupational therapy services. Data were collected through three in-depth interviews and through observation of the therapist conducting treatment sessions. Results suggest that the therapist's view of reality can be categorized into four areas: (a) what she believes about ultimate reality; (b) what she believes about life, death, and eternity; (c) what she believes about human nature; and (d) what she believes about the nature of knowing. The findings also suggest that this core worldview informs how the therapist frames clinical practice and how she delivers occupational therapy services. Further, both the therapist's view of reality and her clinical practice are deeply rooted in her sociocultural experiences. This case study provides a rich description of the interrelatedness of sociocultural context, worldview, and clinical reasoning.

Culture↗
PubMed1986

[Atypical facial neuralgia or depressive facial pain. Diagnostic aspects of a well-demarcated form of masked depression].

In three paradigmatical cases the problem of the diagnosis "atypical face pain" is discussed. On clinical inpatients can be demonstrated, that behind an "atypical face pain" a chronic depressive illness can be hidden. The symptom "facial pain" in these cases is part of an oligosymptomatic depressive disorder. A special antidepressant therapy is necessary in the clinical management of these "masked depressions". Therefore it is necessary to be reserved on diagnosing an "atypical face pain". The exact analysis of psychopathological disturbances can prevent these patients who in reality suffer from depressive face pain from therapies in maxillary surgery or in dentistry etc. that are far from useful.

Aged↗
PubMed2006

Molecular screening of cancer: the future is here.

The remarkable growth in our knowledge of the biology of cancer is leading to the identification of previously elusive pathways and networks involved in cancer causation. The development of technologies has played a pivotal role in furthering this understanding and appreciation of the complexity of tumorigenesis, and is advancing efforts to fully grasp the biology and exploit the knowledge for improvements in cancer detection, prevention, and therapy. The future of molecular screening, i.e. detection of risk or cancer via molecular determinants, has never been so close to a reality. Molecular assays employed in cancer detection and therapy are likely to revolutionize cancer treatment through individual-based diagnosis and treatment, i.e. personalized medicine. A number of detection techniques, such as the detection of aberrant DNA and RNA, the presence of auto-antibodies in serum or plasma, and protein profiling, are already in limited use for patient stratification for clinical trials and for predicting drug response.

Autoantibodies↗
PubMed2006

A strategy for computer-assisted mental practice in stroke rehabilitation.

OBJECTIVE: To investigate the technical and clinical viability of using computer-facilitated mental practice in the rehabilitation of upper-limb hemiparesis following stroke. DESIGN: A single-case study. SETTING: Academic-affiliated rehabilitation center. PARTICIPANT: A 46-year-old man with stable motor deficit of the upper right limb following subcortical ischemic stroke. INTERVENTION: Three computer-enhanced mental practice sessions per week at the rehabilitation center, in addition to usual physical therapy. A custom-made virtual reality system equipped with arm-tracking sensors was used to guide mental practice. The system was designed to superimpose over the (unseen) paretic arm a virtual reconstruction of the movement registered from the nonparetic arm. The laboratory intervention was followed by a 1-month home-rehabilitation program, making use of a portable display device. MAIN OUTCOME MEASURES: Pretreatment and posttreatment clinical assessment measures were the upper-extremity scale of the Fugl-Meyer Assessment of Sensorimotor Impairment and the Action Research Arm Test. Performance of the affected arm was evaluated using the healthy arm as the control condition. RESULTS: The patient's paretic limb improved after the first phase of intervention, with modest increases after home rehabilitation, as indicated by functional assessment scores and sensors data. CONCLUSION: Results suggest that technology-supported mental training is a feasible and potentially effective approach for improving motor skills after stroke.

Arm↗
PubMed1996

The maturation of human gene therapy.

Human gene therapy is two things. It is the concept that human disease might be treated at the level of underlying genetic targets rather than at the level of aberrant metabolism, and it is the implementation of that concept toward a clinical reality. The conceptual aspect is established--gene therapy has become an accepted central driving force in medicine. The second aspect--that of converting the concepts into practical tools for human gene therapy--is maturing rapidly. Over the past several years, the level of expectation had risen to unrealistic proportions and recent initial clinical trials produced disappointment. These early clinical results should, however, be viewed not as failures, but rather as deliberate progress along the learning curve in this new and difficult field of biomedical science.

Clinical Trials as Topic↗
PubMed1996

Gene therapy in pediatric surgery.

Gene transfer has become a reality during the last decade. The basic principles of molecular biology, gene transfer, and the problems associated with this new technology have direct implications for the treatment of pediatric surgical patients. Research into applications of gene transfer in the treatment of disorders of the bone marrow, cancer, hemophilia, hepatic and metabolic disease, cystic fibrosis, and vascular disease is rapidly progressing. These areas of research may dramatically affect the care of pediatric surgical patients in the future.

General Surgery↗
PubMed2004

Regulatory T cells and type 1 diabetes.

A resurgent interest in T cells with regulatory activity has prompted many recent investigations into their potential role in pathogenesis and prevention of type 1 diabetes. While some studies have suggested that regulatory T cells participate in the preservation of active tolerance to autoantigens, findings obtained in multiple animal models for type 1 diabetes have documented the therapeutic induction of protective regulatory T cells. A review of the proposed mechanisms operative in regulatory T cell-mediated diabetes prevention indicates a common theme of localized regulatory T cell activation and subsequent suppression of pathogenic T cell trafficking, differentiation, and/or effector function. However, adaptation of experimental protocols for regulatory T cell induction to clinical applications faces several challenges. Immunization with self-antigens carries obvious risks especially in the face of multiple variables that can affect generation, trafficking, and regulatory activity of autoantigen-specific T cells. We also emphasize that the frequent use of lymphopenic recipients of adoptively transferred pathogenic and regulatory T cells constitutes a potentially confounding variable that further complicates translation into clinical settings. The therapeutic induction of regulatory T cells in prediabetic individuals carries great potential but is currently limited by the risks associated with deliberate generation of autoimmune responses that may exacerbate rather than ameliorate the autoimmune process. However, in vitro amplification and autologous regulatory T cell therapy might soon become a clinical reality.

Animals↗
PubMed2005

Apolipoprotein A-I mimetic peptides: potential role in atherosclerosis management.

Atherothrombotic vascular disease continues to be a leading cause of morbidity and mortality in much of the world. Although a healthy lifestyle and low-density lipoprotein cholesterol lowering significantly reduce cardiovascular morbidity and mortality, substantial number of adverse vasoocclusive events continue to occur. These realities have brought attention to additional therapies that could further reduce cardiovascular events. High-density lipoprotein (HDL)/apolipoprotein A-I (apo A-I)-based therapies are a potential therapeutic strategy against atherothrombotic vascular disease because of the known inverse relationship between HDL cholesterol and coronary heart disease, favorable and pleotrophic biologic effects of HDL/apo A-I, results of preclinical experimental studies, and emerging proof of concept in clinical studies. A variety of HDL/apo A-I-based therapies are currently under investigation, including synthetic peptides that mimic the function of HDL. Such apo A-I mimetic peptides are the focus of this review.

Animals↗
PubMed2005

[Absence of correlation between mental disorders and high-dose buprenorphine. A case-control study].

BACKGROUND: In France today, the treatment of opiate and notably heroin addiction with high-dose buprenorphine (HDB) is widespread. Although this treatment has been successful to some extent, problems persist. One is that some percentage (estimated at 17-47%) of patients "misuses" their HDB, either by intravenous injection or inhalation. This misuse presents a public health problem, since injecting drug users are more frequently infected by hepatitis C, and may even jeopardize the treatment's efficacy. METHOD: Our study compared a sample of 26 patients treated with sublingual HDB who reported injecting it on occasion and 27 patients under HDB who did not inject it. RESULTS: There was no evidence of more psychiatric disorders in the population that injected HDB than in the population that did not. Conversely, the patients injecting HDB used more illicit products, more benzodiazepines and more alcohol. DISCUSSION: Despite its efficacy, substitution treatment does not appear to provide relief for some patients. HDB injection may thus correspond to a search for a precarious balance: the disruption of the HDB kinetics induced by its injection would be aimed at enhancing the opiate effect. The consumption of other licit and illicit psychotropic agents indicates a further attempt to obtain relief from a persistent mental discomfort, over and above the substitution therapy and even its misuse. The reality of the psychological imbalance experienced with, induced by or pre-existing the heroin use requires rethinking the overall treatment. Future studies should lead to the identification of the disorders that lead these patients to seek relief in injections.

Administration, Sublingual↗
PubMed2002

Natural products in cancer chemotherapy: past, present and future.

Natural products have been the mainstay of cancer chemotherapy for the past 30 years. However, the quickening pace of (aberrant) gene identification, and the new technologies of combinatorial chemistry and high-throughput screening, should provide access to a wide range of new, totally synthetic drugs. Will these new approaches sound the death knell for therapies based on natural products? In reality, natural products are likely to provide many of the lead structures, and these will be used as templates for the construction of novel compounds with enhanced biological properties.

Animals↗
PubMed2006

Preliminary experience with the MicroMed DeBakey pediatric ventricular assist device.

Mechanical circulatory support for both acute and chronic heart failure is a widely applied therapeutic option in the adult population with a variety of devices clinically available. Technology in this field has advanced sufficiently such that long-term support or "destination therapy" has become a generally accepted reality. Similar progress has not occurred in the field of device support for heart failure in children. While the number of potential patients is significantly lower in the pediatric population, the clinical relevance and poignancy of individual need are nonetheless real. Until recently, children with heart failure have been largely disadvantaged in comparison to their adult counterparts. The DeBakey VAD Child (MicroMed Technology, Inc, Houston, TX) represents a hopeful initial step in the direction of reducing the technological gap between adults and children. While the clinical experience with this device is limited at present, preliminary results are encouraging. This report will provide an overview of the DeBakey VAD Child, including device specifications, indications for clinical use, surgical and postoperative considerations, and updated clinical experience.

Adolescent↗
PubMed2004

Cellular transplantation: hurdles remaining before widespread clinical use.

PURPOSE OF REVIEW: The last few years have witnessed a growing interest in regenerative therapy of the failing heart by cell transplantation. Special emphasis has been put on skeletal myoblasts and bone marrow-derived stem cells, with a flurry of experimental studies generating overall positive but occasionally conflicting results. It is thus appropriate to review the most important of these studies in light of the major issues that still impede widespread clinical use of cell therapy. RECENT FINDINGS: Recent laboratory data demonstrate the ability of autologous skeletal myoblasts to engraft into scarred myocardium and improve its function. Equally successful results have been reported with bone marrow-derived cells which, in contrast to myoblasts, are credited with a plasticity that might allow their transdifferentiation into cardiac or endothelial cells in response to organ-specific cues. However, some major questions remain unanswered; they include the choice of the optimal cell type in relation with the target patient population, the strategies for enhancing cell survival and functional integration, the clarification of the mechanisms of improvement, and the means of reducing invasiveness of cell delivery. SUMMARY: Although laboratory research attempts to overcome these persisting hurdles, the accumulated body of evidence warrants implementation of clinical trials. The earliest ones have now documented the feasibility of cell therapy. It is now appropriate to conduct safety and efficacy studies which, if carefully done, should allow assessment of the extent to which this concept of regenerative therapy can be made a clinical reality.

Bone Marrow Transplantation↗
PubMed2006

Rabies: new insights into pathogenesis and treatment.

PURPOSE OF REVIEW: The occurrences of transmission of rabies virus by organ and vascular conduit transplantation, and recovery from rabies by a patient in Wisconsin, will be addressed. Perspectives will be given on the prevention of rabies by organ transplantation and on the management of patients with rabies. RECENT FINDINGS: In 2004 transplantation of organs and a vascular conduit was responsible for the transmission of rabies virus, resulting in seven fatal cases of rabies in the USA and Germany. Likely infectious rabies virus was present within nerves of the transplanted organs and arterial segment and productive infection developed in the immunosuppressed recipients. In 2004 a young patient, who did not receive postexposure rabies prophylaxis after a bat bite, survived rabies in Wisconsin. The importance of therapy she received on her favorable outcome remains unknown. SUMMARY: Recent transmissions of rabies virus from organ-transplantation donors highlight the importance of clinical recognition of rabies. Laboratory screening of potential donors for rabies prior to organ transplantation would be associated with logistical problems and serious consequences due to false-positive results. The survival of a patient with rabies has offered hope that effective therapy of rabies may become a reality in the future.

Animals↗
PubMed1984

Multimodal treatment of a child with schizophrenia.

A case is presented of a five-year-old boy with schizophrenia who received both art and play therapy within a multimodal therapeutic program. The course of the two therapies is presented followed by a discussion of the similarities and differences of the techniques, but also noting the complementary and synergistic results.

Anger↗
PubMed2001

Treatment of chronic viral hepatitis.

Significant advances have been made in the treatment of both hepatitis B and C. Cure for the majority is becoming reality. Combination regimens are now established therapy in hepatitis C and the near future will see the adoption of a similar approach to hepatitis B. Interferon alpha therapy remains important, with the development of more efficacious pegylated forms. In this article we review current therapy and discuss future strategies of the therapy for chronic viral hepatitis.

Amino Acid Sequence↗