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PubMed2007

Hysterical chorea: Report of an outbreak and movie documentation by Arthur Van Gehuchten (1861-1914).

Psychogenic movement disorders remain a frequent and important clinical problem. First described in the Middle Ages, the dancing mania is considered to be one form of mass hysteria characterized by outbreaks of collective movement disorders. Patients may exhibit a wide variety of movement and gait disturbances, including tremulousness, jerks, or convulsions, usually with a sudden onset. Arthur Van Gehuchten (1861-1914), a distinguished Belgian neuroanatomist and neurologist, reported an outbreak of sudden involuntary movements in 13 adolescent girls residing in an orphanage. The description is to be found in his book Les Maladies nerveuses, completed before 1914 and published posthumously in 1920. The chapter is illustrated with sequential photographs of a girl exhibiting a peculiar gait, which is descriptively referred to as "chorée salutatoire" (saluting chorea). The original film with these pictures has been retrieved and is presented here together with a very similar film excerpt also found in Van Gehuchten's film collection. Van Gehuchten's movie documentation of a psychogenic movement disorder--labeled chorea but which should probably be considered as dystonia according to contemporary classification--appears to be unique. This report illustrates the tremendous value of moving pictures in recording and analyzing movement disorders.

Belgium↗

PubMed2004

Leadership: reflections over the past 100 years.

Leadership, viewed by the American Dietetic Association as the ability to inspire and guide others toward building and achieving a shared vision, is a much written-about topic. Research on leadership has addressed the topic using many different approaches, from a very simplistic definition of traits to a more complex process involving interactions, emotions, and learning. Thousands of books and papers have been published on the topic of leadership. This review paper will provide examples of the varying foci of the writings on this topic and includes references for instruments used to measure leadership traits and behaviors. Research is needed to determine effective strategies for preparing dietitians to be effective leaders and assume leadership positions. Identifying ways to help dietitians better reflect on their leadership experiences to enhance their learning and leadership might be one strategy to explore.

Dietetics↗

PubMed2000

Meta-analysis of dietary essential fatty acids and long-chain polyunsaturated fatty acids as they relate to visual resolution acuity in healthy preterm infants.

OBJECTIVE: To derive combined estimates of visual resolution acuity differences between healthy preterm infants consuming different compositions and ratios of essential fatty acids (EFAs) and docosahexaenoic acid (DHA), an omega-3 (n-3) long-chain polyunsaturated fatty acid (LCPUFA). DATA SOURCES: Electronic biomedical reference database (Medline and Health Star from 1965 to July 1999) searches with index terms omega-3, n-3, infant, vision, acuity, and human. Current review article, monograph, and book chapter bibliography/reference section hand searches. STUDY SELECTION: A total of 5 original articles and 4 review chapters were reviewed for details on study design, conduct, and outcome. Four prospective trials of EFA/LCPUFA supplementation were included in these analyses. For behaviorally based outcomes, there were 2 randomized comparisons each at </=1, 2, 6, 9, and 12 months of corrected age and 4 randomized comparisons at 4 months of corrected age. For electrophysiologically based outcomes (visual-evoked potential), there were 2 randomized comparisons each at </=1 and approximately 4 months of corrected age. DATA EXTRACTION: Dietary composition and EFA/LCPUFA balance, study design, and analytic characteristics (duration of feeding, source of EFAs/LCPUFAs, number of subjects in study population, number of subjects analyzed, and basis for estimating age), and experiment-based characteristics (location, number or sites, design, vision tests employed, testing protocol, and ophthalmic examination) were recorded independently by 2 researchers with a standardized protocol. DATA SYNTHESIS: The relative difference in visual resolution acuity between groups of infants who received a source of dietary EFAs/LCPUFAs and groups who did not was computed and then analyzed with the DerSimonian and Laird random-effects method. RESULTS: Analysis of the randomized comparisons (DHA-supplemented formula vs DHA-free formula) showed significant differences in visual resolution acuity at 2 and 4 months of age. Combined estimates of behaviorally based visual resolution acuity differences at these ages were.47 +/-.14 octaves and.28 +/-.08 octaves, respectively. A 1-octave difference is a reduction in the width of the stimulus elements by 50%. CONCLUSION: These results support efficacy of n-3 LCPUFA intake in early visual system development, although supplementation safety issues still must be addressed through larger randomized trials. Whether n-3 intake confers lasting advantage in visually based process development across the life-span is still to be determined.

Dietary Supplements↗

PubMedDate not supplied

Using Carspecken's critical ethnography in nursing research.

Critical ethnography is an increasingly popular methodology for nursing research, but little advice is available as to what forms it may take, their applicability and their relative strengths and weaknesses. This paper introduces and assesses the method developed and described by Phil Carspecken for use in educational research, presented in his book Critical Ethnography in Educational Research (1996). It outlines some of the philosophical and social theories which drive the methodology, and describes the steps in the research method with reference to nursing situations. Strengths and weaknesses are noted, and it is concluded that Carspecken's approach is useful for researching issues of interest to nurses who locate themselves in the critical theoretical tradition.

Anthropology, Cultural↗

PubMed1998

Domenico Battini and his description of congenital megacolon: a detailed case report one century before Hirschsprung.

More than one century after the epochal paper of Harald Hirschsprung, and in spite of fast and remarkable advances in the pathophysiology of congenital megacolon, our understanding of how bowels may become functionally obstructed, and especially its variability, remains largely incomplete. While much more needs to be known about normal gastrointestinal physiology, an interaction between genetic and environmental factors seems to be of paramount importance in the pathogenesis of Hirschsprung's disease. While reviewing the relevant literature, we came across a virtually unknown contribution by an Italian physician, Domenico Battini, who happened to follow-up for about 10 years a case of severe constipation. This contribution, published posthumously as a book in 1800, not only describes very carefully the clinical evolution of that patient, but also provides a detailed post-mortem examination of the abdominal viscera, with particular reference to the alterations occurred in the intestines. We conclude that Battini, nearly one century before Hirschsprung, had succeeded in reporting a typical case of congenital megacolon, and had perceived a number of features (familiarity, selective involvement of "neural layers" in the gut mucosa) that were to become characteristic of Hirschsprung's disease a few decades after Hirschsprung himself had published his article.

Hirschsprung Disease↗

PubMed2006

[Asylum for curing or securing? The confinement of forensic patients as a challenge of asylum psychiatry in Imperial Germany].

Asylum for curing or securing? The confinement of forensic patients as a challenge of asylum psychiatry in Imperial Germany. In Imperial Germany psychiatrists sought to give their asylums the character of modern medical hospitals. Due to the increase of insanity defence these efforts were obstructed by the high number of inmates with a criminal background. Special departments for mentally ill criminals were founded both in asylums and in prisons. But the clientele was not welcome in any of these institutions. Thus, there was a high fluctuation between prisons and asylums. A new definition of criminal responsibility was needed. In order to keep criminals out of their hospitals psychiatrists developed the medical concept of psychopathy referring to a mental defect without lack of responsibility. On the other hand penal law reformers plead to introduce preventive measures, such as security confinement, into the criminal law book. Since the resolution of the 'law against habitual criminals' in November 1933 judges are allowed to sentence mentally ill offenders to indefinite confinement in psychiatric institutions.

Forensic Psychiatry↗

PubMed1995

Nuchal fibroma. A clinicopathological study of nine cases.

Nuchal fibroma apparently was first described in the second edition of Enzinger's and Weiss's text book in 1988. We have been unable to find any other accounts of this entity. We have reviewed the clinicopathological features of nine nuchal fibromas, eight of which were referred in consultation. Eight patients were men; the ages ranged from 19 to 53 years (median, 43). Patients were first seen with solitary, unencapsulated, subcutaneous swellings in the back of the neck or dorsal region measuring from 2.5 to 8 cm in maximum dimensions (median, 3.5). Macroscopically, lesions were firm, fibrofatty masses. Histologically, there were sheets of hypocellular dense collagen with interspersed mature fat, inconspicuous, small, thin-walled vessels, and entrapped nerve fibers. The picture suggested a fibrolipoma, a lipomatosis, scar tissue, or even elastofibroma, but the small amount of elastic tissue present lacked the beaded, nodular appearance of elastofibroma. Follow-up information was available in seven cases. In follow-up times from 6 months to 19 years (median, 6 years), one tumor was reexcised 4 months after an incisional biopsy and had not recurred 19 months later. None of the others recurred. The lack of a capsule, the entrapment of nerves, and the predilection for the nuchal or dorsal regions suggest that this hypocellular, benign, fibrofatty lesion is a distinct entity and not merely a lipoma.

Adipose Tissue↗

PubMed1996

Referral of young adult patients with congenital heart disease to adult centres. The Canadian Adult Congenital Heart Network.

OBJECTIVE: To establish a process of referral for young adult patients with congenital heart disease from pediatric to adult centres. DESIGN: Directors of pediatric cardiology units across Canada were asked to complete a questionnaire detailing their process of referral of young adult patients with congenital heart disease to adult centres. They were also asked to respond to specific case scenarios. Adult cardiologist members of the Canadian Adult Congenital Heart Network were asked to respond to the same case scenarios. MAIN RESULTS: Most pediatric cardiology centres refer patients to adult cardiologists at 18 years of age. The process of referral generally involves a referral letter and relevant parts of the chart. Few centres arrange a booked appointment with the adult cardiologist, although this would be preferred by the majority of the responding adult cardiologists. Generally good agreement existed between pediatric and adult cardiologists with regard to the kind of patients who required specialized care at an adult congenital heart centre. CONCLUSION: Within Canada, a process is rapidly evolving to facilitate the transfer of care of young adults with congenital heart disease.

Adolescent↗

PubMed1996

Meconium aspiration in neonates: combined obstetric and paediatric intervention improves outcome.

All meconium aspiration syndrome cases admitted in the two neonatal units were compared to evaluate the antenatal and natal events including resuscitative measures and outcome of neonates and to confirm the beneficial effects of immediate combined obstetric and paediatric intervention on morbidity and mortality. Neonates managed in nursery at Mayo Hospital (Group 1, n = 44) were delivered at other hospitals and birth centres, underwent resuscitation by obstetricians and/or anaesthetists and then referred. Neonates admitted in the neonatal unit of Lady Willingdon Hospital (Group 2, n = 48) were inborn and resuscitated by paediatric residents. Both groups were comparable for weight, sex, booked status, maturity, history of prolonged labour, fetal distress and Apgar score at 5 minutes. Significant differences were proportion of C-section (62% in Gp 2 v 34% in Gp1), laryngoscopy and tracheal intubation (100% in Gp 2 v 9% in Gp1), time of arrival in the nursery (mean 0.14 hr in Gp 2 v 3.91 hr in Gp 1), persistent cyanosis (43% in Gp 2 v 68% in Gp1), earlier start of feeding (mean 2.4 days in Gp 2 v 3.2 days in group 1) and shorter stay in hospital (2.87 days in Gp 2 v 5 days in Gp 1). 27% cases died in group 2 compared to 47% in group 1 (pvalue = 0.04). Combined immediate obstetric intervention (C-section) and paediatric intervention (laryngoscopy, tracheal intubation, suction, immediate transfer to nursery) led to reduced severity of meconium aspiration syndrome and lower mortality.

Female↗

PubMedDate not supplied

Smoking cessation programme for self-motivated patients.

Mr Mitchell felt that each weekly session had provided him with the impetus to continue for another week. He showed great determination to succeed and followed the recommended method, adapted to suit his own lifestyle. I felt professional satisfaction knowing that I had played a significant part in his transition from smoker to non-smoker. The method I used with Mr Mitchell was effective. However, it is only one of many methods available to smokers and health professionals. At present 22 patients have booked in for stop-smoking sessions. Six have completed the six sessions and of those, three remain non-smokers six months later. All three were self-referred and therefore highly motivated. Even one success is one more towards achieving the Health of the Nation target and is well worth the time and effort involved.

Adult↗

PubMed2000

Home intravenous antibiotics for cystic fibrosis.

BACKGROUND: Recurrent endobronchial infection in cystic fibrosis requires treatment with intravenous antibiotics for several weeks, which is usually administered in hospital, affecting health costs and quality of life for patients and their families. It is not known whether patients receiving intravenous treatment at home have better or equivalent health outcomes, if costs are reduced or if it is preferred than in-hospital treatment. Home treatment requires training to patients and carers and usually needs a few previous days in hospital. OBJECTIVES: To determine whether home intravenous antibiotic therapy in cystic fibrosis is as effective as in-patient intravenous antibiotic therapy and if it is preferred by patients and/or families. SEARCH STRATEGY: References to trials were obtained from the specialist cystic fibrosis trials register held by the editorial base of the Cochrane Cystic Fibrosis and Genetic Disorders Group. Handsearching of the abstracts books of all Spanish Conferences on cystic fibrosis and the last European Conference (Stockholm, 2000) was carried out by authors. SELECTION CRITERIA: Randomised controlled trials where home intravenous antibiotic treatment for patients with cystic fibrosis was compared with in-hospital intravenous antibiotic treatment, including adults and children with cystic fibrosis. All kinds of antibiotics and regimens administered intravenous were included. DATA COLLECTION AND ANALYSIS: Three reviewers independently selected the trials to be included in the review, assessed methodological quality of each trial and extracted data using a standardised form. Because of several limitations, narrative synthesis was used at this stage. MAIN RESULTS: One study was included with 17 patients aged 10 to 41 years with an infective exacerbation by Pseudomonas aeruginosa. All their 31 admissions were analysed as independent events. Outcomes were measured at 21 days of follow-up after initiation of treatment. Home patients had fewer investigations performed than hospital patients (p<0.002) and general activity was higher in the home group. No differences were found for clinical outcomes, adverse events, complications of intravenous lines or line changes or time to next admission. Home patients received less low-dose home maintenance antibiotic. Quality of life measures showed no differences for dyspnoea and emotional state, but fatigue and mastery were worse for home patients, possibly due to a higher general activity and need of support. Personal, family, sleeping and eating disruptions were less important for home than hospital admissions. Home therapy was cheaper for families and the hospital. Indirect costs were not determined. REVIEWER'S CONCLUSIONS: The current evidence is restricted to one small study. It suggests that in the short term home therapy does not harm patients and in general reduces social disruptions. The decision to attempt home treatment should be based on an individual basis and appropriate local resources. More research is urgently required.

Adult↗

PubMed2000

Current practice in the management of acute cholecystitis

AIMS: Several recent papers have advocated emergency cholecystectomy for patients with acute cholecystitis, stating that it is safe, cost effective and leads to less time off work. This study was designed to assess current practice in the management of acute cholecystitis in the UK. METHODS: A postal questionnaire was sent to 357 consultant surgeons who were thought to be involved in a general surgical on-call rota, to ascertain their current management of patients with acute cholecystitis. Replies were received from 250 consultants (70 per cent) of whom 242 (68 per cent) were involved in a general surgical take. Sixteen of these consultants, however, handed their patients with acute cholecystitis on to a different team the following day for further management. RESULTS: Twenty-seven consultants (12 per cent) routinely treat their patients by emergency cholecystectomy whenever possible, with 24 stating that they would do this within 72 h. Limiting factors to this practice were stated to be availability of surgical staff (15), theatre space (nine) and radiological investigations (four). The remaining consultants (n = 199) routinely manage their patients conservatively initially and providing they settle, either (1) book directly for cholecystectomy (n = 94, 47 per cent), (2) reassess as an outpatient (n = 65, 33 per cent), (3) either of above (n = 21; 11 per cent) or (4) refer on to a colleague (n = 19, 10 per cent). The commonest indications for acute cholecystectomy stated by consultants whose initial treatment policy is conservative are spreading peritonitis due to bile leak (93 per cent), empyema (89 per cent), unexpected space on a theatre list (28 per cent) and failure of an acute episode to settle (21 per cent). The laparoscopic method is the commonest for both elective and emergency cholecystectomy, but the percentage of consultants using an open method rises dramatically from 9 per cent in the elective situation to 48 per cent for emergency cholecystectomy. CONCLUSIONS: Despite evidence to support the increased use of emergency cholecystectomy, this practice is routinely carried out by only 12 per cent of consultants. However, of the consultants who treat their patients conservatively, 28 per cent are prepared to undertake emergency cholecystectomy if an unexpected space appears on the theatre list.

Journal Article↗

PubMed1976

Tools and techniques for diagnosis and evaluation in marital and family therapy.

This is a slightly edited version of a chapter to appear in a forthcoming book. It is a beginning attempt at codification of existing tools and techniques and is therefore nonexhaustive. The authors welcome feedback from readers concerning omissions and information on new techniques, references, and applicability to therapeutic settings.

Adaptation, Psychological↗

PubMed1999

Surgeons under stress: what pastoral care should the college provide?

From 15-18 September 1999, the Travelling Surgical Society celebrated its 75th anniversary with a meeting in London for 37 member surgeons, culminating in a dinner at The Royal College of Surgeons of England attended by 140 people. During the dinner, RCS President, Mr Barry Jackson, spoke on behalf of the guests, commenting on the many activities of the TSS, including nine visits to Paris which appeared to lack any social relaxation until he came across a reference from an account in 1938: 'on this occasion we did not attend the Moulin Rouge'. Mr Jackson concluded his speech by presenting the TSS with a copy of a book he had received from the estate of the late Mr R W (Bob) Nevin, one-time Dean of St Thomas's Hospital Medical School and a former President of the TSS, who had signed the fly-leaf. Entitled Truants--The Story of Some who Deserted Medicine Yet Triumphed, the book was written by Lord Moynihan based on the Linacre lecture he delivered in Cambridge in 1936, the year of his death. The President of the TSS expressed warm thanks, emphasized friendship and education as being essential ingredients of travelling societies and sent greetings to the College on its forthcoming bicentenary.

England↗

PubMed1988

Neonatal transport: communication--the essential element.

The Bronson Methodist Hospital Neonatal Transport System (Kalamazoo, MI) has identified effective communication as a necessity when providing optimal patient care. Our experience shows that good communication comes only from good relationships between our neonatal intensive care unit (NICU) staff and each referring hospital's staff. This article describes the two educational methods used to aid these relationships: the development of site visits and the distribution of informative publications. By using these methods, our relationships with our 17 referring hospital staffs have improved, which has had a direct bearing on more effective communication during neonatal transport.

Books↗

PubMed2002

The emergency department: an appropriate referral rate for radiography.

AIM: To evaluate the hypothesis that where there is good clinical practice in an emergency department (ED), there is a low uptake of plain radiography. MATERIALS AND METHODS: Emergency notes and radiography records were reviewed over one week in January 1999, to determine the rate of radiography of first time attenders at the North Staffordshire NHS Trust. The clinical appropriateness of the imaging was assessed by pairs of radiology specialist registrars and casualty physicians. They judged the appropriateness of the imaging by the 1998 Royal College of Radiologists (RCR) guidelines and/or their clinical judgement, by consensus. Where there was no consensus or the data appeared incomplete, the radiology and ED consultant reviewed the notes. RESULTS: A total of 1615 notes were found out of 1643 (98%). Of these, 147 (9%) return attenders were excluded and 32 patients left without being seen. The number of first time attenders was 1436 (87%), of whom 637 (44%) were radiographed; 95% of these radiography examinations were appropriate and 5% were inappropriate. Of the first time attenders who were not radiographed the decision was appropriate in 95% of cases, and inappropriate for 5%, i.e. 5% of those who had no radiography, should have been X-rayed. There were no disagreements between RCR guidelines and the clinical judgements, but in 16% there were no suitable RCR guidelines. Junior doctors were not always able to find the relevant RCR guideline (relevant clinical guideline found in 73% of cases) in the guideline book, compared to the consultants (relevant clinical guideline found in 84% of cases). CONCLUSION: The application of the RCR guidelines is taken as representing good clinical practice in determining when to refer a patient for radiography. Based on this assumption, a referral rate for radiography of 44% of first time attenders was found to be appropriate. This referral rate can be taken as a benchmark. A benchmark is necessary in order to allow departments to make a local assessment as to whether their local referral rate is likely to be too high or too low.

Clinical Competence↗

PubMed2001

Implementing evidence in Finnish primary care. Use of electronic guidelines in daily practice.

In Finland, electronic guidelines have provided general practitioners (GPs) with a source of up-to-date information at their fingertips since 1989. The Physician's Desk Reference and Database (PDRD) covers the majority of problems encountered in primary care with some 1,000 articles. These are available in electronic format, updated every 4 months, and as a book published in a fully revised edition every 2 years. Physicians use these guidelines as a routine part of their daily work. They seek information for both common and rare health problems and use it to plan diagnostic strategies as well as treatment and follow-up. In nearly 90% of cases the doctor finds the information she needs from the guidelines. The electronic version is user-friendly; typically the relevant article is found and read in 2 min. Patients find it reassuring when their doctor uses guidelines to select optimal treatment. Other Nordic countries are aslo producing several national guidelines, but Finland has so far the widest scope and longest experience in this area. An English version of the PDRD guidelines (Evidence-Based Medicine Guidelines) is available, and a Swedish-language version will be completed in 2002.

Decision Support Systems, Clinical↗

PubMed2004

Ballistics for physicians: myths about wound ballistics and gunshot injuries.

PURPOSE: Wound ballistics is a difficult subject. The behavior of all bullets is unpredictable but the specific effect of high velocity projectiles has been a particular source of confusion in the literature. This confusion has resulted in the likely incorrect conclusion that all high velocity wounds require massive débridement. We reviewed the entirety of the literature on this subject and concluded that high velocity weapons do not reliably create massive wounds, and judicious débridement and staged explorations may be the best treatment method for these patients. MATERIALS AND METHODS: A MEDLINE search and retrieval were done of all pertinent references from 1966 to May 2003 concerning the field of wound ballistics. Articles initially missed in this search were obtained from the bibliography of retrieved studies. More than 70 articles and book chapters were reviewed. RESULTS: Five common myths about the tissue effects of gunshot wounds were reviewed as well as the data that dispel these myths. Information on the effects of different bullet types, and the intended and actual effect of military rifle wounds were assessed. CONCLUSIONS: For the majority of high velocity gunshot wounds, especially military rifles that generally fire a projectile that is meant to stay intact after impact, wound severity can be limited, even much less than that from a civilian rifle, shotgun or handgun. Judicious use of débridement during surgical exploration limits the extent of iatrogenic injury in the surgical care of these patients.

Forensic Ballistics↗