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[Drug use in practice. Illusion and reality].
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[Immunosuppression in primary glomerulonephritis. Reality or fantasy?].
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Psychic reality or various realities.
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Psychoanalytic education and the social reality of psychoanalysis.
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Stanley Krippner, PhD. Medicine and the inner realities. Interview by Bonnie Horrigan.
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Speculating about miracles, nonlocal reality, and the nuocontinuum.
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[Thrombolysis in Portugal. Influencing the national reality].
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Laser therapy in the treatment of cardiovascular disease.
Percutaneous laser angioplasty has now become a clinical reality, consisting chiefly of applications of thermal angioplasty in conjunction with balloon angioplasty for the recanalization of peripheral vascular obstructions. In conjunction with this development, various aspects of laser-tissue interactions, fibreoptic transmission and delivery catheter design pertinent to the cardiovascular system have come under closer scrutiny, resulting in the emergence of both noteworthy concepts and clinical achievements.
Gene therapy.
With recent advances in molecular biology, the ability to transfer genes to patients is becoming a reality. Ongoing clinical trials using gene transfer techniques have illustrated the potential and pitfalls of this new therapeutic modality for the treatment of a wide variety of disorders. While these techniques are not currently a part of routine clinical practice, it is only a matter of time until some form of gene therapy is approved for general use in the clinic. This review highlights some of the basic methods used in current gene therapy protocols. The objective of this review is to familiarize practitioners with these concepts so they can more effectively follow the progress of this emerging technology and better inform their patients.
[Angiotensin receptor antagonists and ACE inhibitors in heart failure: alternative or combined therapies?].
The theoretical advantages of the angiotensin II receptors blockers (ARB) are slowly but progressively becoming a reality for patients with congestive heart failure. ARB are recommended in patients who cannot take ACE inhibitors as a plausible alternative for modulating the renin angiotensin system. After the recently published Val-HeFT trial, the addition of an ARB (valsartan) can be considered in patients who remain severely symptomatic despite optimal therapy in order to reduce hospitalization for heart failure and improve symptoms particularly if the patients cannot tolerates beta-blockers. Among patients with type 2 diabetes and no clinical signs of congestive heart failure ARB (losartan) are able to reduce the probability of developing congestive heart failure.
Retroviral-mediated gene therapy--safety considerations and preclinical studies.
Retroviral mediated gene transfer (1) is now a clinical reality, with several protocols being conducted. The features that have made these vectors appropriate for the first clinical studies in humans are (i) they are derived from well characterized murine retroviruses (ii) many foreign genes have been expressed in many different cell types, and transduction efficiency can be very high (iii) helper or wild type virus free vectors can be obtained in good titer and (iv) the number of sites of proviral integration is limited although the site of integration in the genome is random. Most of the work described has been conducted in the laboratories of our collaborators, notably Drs. W. French Anderson, R. Michael Blaese, Steven A. Rosenberg, and Arthur W. Nienhuis at the National Institutes of Health, Bethesda, MD, and Dr. Malcolm K. Brenner at St. Jude's Hospital in Memphis, as well as work conducted at Genetic Therapy, Inc. But it is very important to appreciate that retroviral vectors themselves were developed from the pioneering work of researchers in a large number of laboratories in the early and mid 80's.
Role of apoptosis in ventricular remodeling.
Cell loss is a common feature in the failing heart, and this contributes to the relentless progression seen in patients with heart failure. Apoptosis is one of the most common causes of cell loss in animals and humans with heart failure. There is increasing evidence that apoptosis, even while occurring in a low-grade manner, can mediate heart failure. Moreover, inhibiting apoptosis successfully prevents or attenuates heart failure in several animal models. More importantly, apoptosis is one of the few mechanisms that can be easily modulated using pharmacologic or gene therapy approaches. Animal data, obtained in the past few years, have proven the feasibility and success of this approach toward altering the natural history of heart failure. Human studies are pending, but a number of issues such as the type of inhibitor and its optimum timing/dose will need to be resolved before this becomes a reality. Nevertheless, these data will accrue over time, and anti-apoptotic therapy is likely to emerge as an important form of heart failure therapy.
Paediatric nurses' attitudes to massage and aromatherapy massage.
Complementary therapies have continued to increase in popularity in healthcare and it is widely accepted that they can be incorporated into the nursing role. However, this acceptance does not necessarily mean that the introduction of therapies into the nursing arena has been without confusion and without professional and legal implications. Consequently, this small-scale, qualitative study aimed to explore the perceptions and lived experiences of paediatric nurses of two therapies, namely massage and aromatherapy massage. There is a dearth of literature exploring nurses' perceptions to the incorporation of these therapies, especially in the arena of paediatric nursing where massage and aromatherapy massage are common practice. Semi-structured interviews were undertaken with qualified nurses and revealed the themes of 'benefit', 'family centred care', 'nursing care' and 'being held back'. It was found that at some stage during their professional career each nurse had performed massage and/or aromatherapy massage. All nurses were able to recall certain benefits of the therapies for the children that they had observed and many discussed the importance of involving the family as a way of including them in to the care of their child. However, for the nurses in this study, it was evident that the incorporation of complementary therapies into the nursing role was determined by the context in which they practised. Due to the dominance of the medical model, nurses faced pressures and conflicts in the realities of their nursing work, which meant they were often unable to carry out these therapies.
Reality orientation: its use and effectiveness within older person mental health care.
AIM: The aim of this study was to find out how psychiatric nurses use reality orientation and perceive its effectiveness in older person mental health care. BACKGROUND: The study described in this article relates to how effective reality orientation is and how it is used, within older person mental health care. As a technique, reality orientation originated in North America in the 1950s. It has been defined as an approach which may decrease confusion and dysfunctional behaviour patterns in people with dementia. Although there exists some confusion as to how reality orientation should be delivered, it is generally agreed that reality orientation may be delivered in two ways. Firstly, through constantly orientating patients to time, place and person (24-hour reality orientation) and, secondly, orientating patients to reality within a group setting. METHODS: Six psychiatric nurses practicing in an older person mental health care inpatient unit took part in in-depth semi-structured interviews. These six nurses all practiced upon the same older person care unit, which was part of a larger psychiatric hospital randomly selected from psychiatric hospitals in Dublin, Ireland, to take part in the study. The six nurses were also part of a larger cohort of nurses who helped the author explore how psychiatric nurses use and perceive reality orientation as used in older person and acute inpatient mental health care. This was a descriptive qualitative study, using the technique of constant comparative analysis as outlined by Strauss and Corbin as a way to code interview data and arrange themes that represented what participants had talked about in the interviews. More particularly, this form of analysis closely resembled the type of open coding as outlined by Strauss and Corbin. The analysis of interview data was presented to interview participants prior to the formal acceptance of these themes as a valid representation of what interviewees talked about. FINDINGS: Upon analysis, interview data yielded five themes. Firstly, reality orientation means interacting with patients about the patient's current environment and issues in their predicament. Secondly, the sampled nurses use reality orientation frequently in their nursing work, with reality orientation being most often used in the mornings and evenings. Thirdly, reality orientation is implemented through interacting with the patient. It may also be implemented as part of other approaches, such as occupational therapy. Fourthly, improvements in the areas of orientation and behaviour functioning may be possible through the use of reality orientation, although more contemporary research is required to validate this. Finally, participants talked of the need for psychiatric nurses practicing in older person settings to become more aware of what reality orientation entails as an approach, such awareness may be increased through more reality orientation-based research. CONCLUSIONS: Interview data point to reality orientation being used frequently through nurse-patient interaction. Participants talked about how using reality orientation may hold benefits for patients; however, on a more cautionary note, participants also raised the need for a greater clinical awareness of reality orientation as an approach for use in caring for older persons with mental health problems. RELEVANCE TO CLINICAL PRACTICE: Psychiatric nurses practicing in older person care environments often have to provide care to persons having difficulty comprehending reality. For example, a person who is confused through suffering from an organic brain disorder such as Alzheimer's disease, or who is expressing a delusion through suffering from a functional mental illness such as depression. Taking this into consideration, there is an onus on psychiatric nurses to be able to care for older persons having difficulties comprehending the reality they are living in. Participants in this study identified reality orientation as an approach which can be used by psychiatric nurses in attempting to help older persons experiencing mental health problems cope with not being able to comprehend and recognize their surroundings. Participants also suggested that reality orientation may hold some benefits for older disorientated person, such as facilitating a greater level of orientation. On a more cautionary note, participants talked of the need for psychiatric nurses caring for older persons with mental health problems to become more aware of the use of reality orientation in clinical practice.
The older person's response to therapy. A. The in-hospital therapeutic community.
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Pharmacogenetics and disease genetics of complex diseases.
Advances in technologies and the availability of a single nucleotide polymorphism (SNP) map are beginning to show the true potential for the human genome project to affect patient healthcare. A whole genome scan, the use of 100000-300000 SNPs across the genome, is now possible. Use of traditional approaches and the whole genome scan will result in identification of disease susceptibility genes and development of many new treatments in the longer term. In the shorter term, the goal will be to predict those patients at risk to experience an adverse reaction or those with a high probability for improved efficacy (i.e. pharmacogenetics). As progress is made in the area of disease genetics and pharmacogenetics, our understanding of disease susceptibility and its interrelationship with drug response will improve, making targeted therapy (i.e. the right drug to the right patient) a reality.
High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality.
The primary aim of this study was to evaluate the effect of auditory feedback in a VR system planned for clinical use and to address the different factors that should be taken into account in building a bimodal virtual environment (VE). We conducted an experiment in which we assessed spatial performances in agoraphobic patients and normal subjects comparing two kinds of VEs, visual alone (Vis) and auditory-visual (AVis), during separate sessions. Subjects were equipped with a head-mounted display coupled with an electromagnetic sensor system and immersed in a virtual town. Their task was to locate different landmarks and become familiar with the town. In the AVis condition subjects were equipped with the head-mounted display and headphones, which delivered a soundscape updated in real-time according to their movement in the virtual town. While general performances remained comparable across the conditions, the reported feeling of immersion was more compelling in the AVis environment. However, patients exhibited more cybersickness symptoms in this condition. The result of this study points to the multisensory integration deficit of agoraphobic patients and underline the need for further research on multimodal VR systems for clinical use.