[Vaccine therapy, fever therapy and shock therapy].
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OBJECTIVE: The purpose of this study was to examine the effect of therapeutic innovation on the interpersonal style of physicians by using the historical example of the treatment of general paralysis of the insane by malaria fever therapy. METHOD: The study employed historical qualitative and descriptive methods to analyze medical and popular literature and medical records. These medical records were from a single institution and contained verbatim transcripts of patient interviews and doctors' conferences. The author examined records of patients diagnosed with neurosyphilis from the periods before (1910-1928) and after (1928-1950) the introduction of malaria fever therapy. RESULTS: Before the introduction of malaria fever therapy, physicians saw their neurosyphilitic patients as "hopeless," "immoral," and "stupid" paretics--objects to be acted upon, a view consistent with the cultural belief that syphilitic patients were sinful and depraved. After the introduction of malaria fever therapy, doctors wrote more positively and empathically about their neurosyphilitic patients, allowing patients to become active participants in their therapeutic regimens. Patients with neurosyphilis voluntarily sought admission specifically for fever therapy, seeing the asylum as a place of cure rather than as an institution of confinement. CONCLUSIONS: This history illustrates that biological therapies can powerfully affect physicians' perceptions of patients and need not remove them from patients' subjective experiences. Instead, biological treatments may enhance physicians' ability to empathize with their patients' suffering.
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The induction of heat shock protein 70 (HSP70) genes has been studied in peripheral blood mononuclear cells of individuals undergoing fever therapy because of metastatic malignant melanoma. Induction of HSP70 was assessed at the protein level by metabolic labelling or, for the HLA-linked HSP70-1 and HSP70-2 genes, at the RNA level by in situ hybridization. However, de novo expression of HSP70 could be observed during fever (usually above 39 degrees C) in only about half of the cases. No simple threshold model for inducibility of HSP70 in vivo could be applied. The HSP70-1 gene was induced more easily than HSP70-2. Thus, heat-inducible HSP70 genes, including HLA-linked HSP70 genes, become expressed in human lymphocytes during fever, but not regularly.
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Fever in children is a common problem, but one which often alarms parents. Parental misconceptions often lead them to unnecessarily aggressive and inappropriate management of fever in their children. A prospective controlled trial of an educational intervention to improve parental understanding and management of fever, involving the parents of 108 children, aged 6 months to 4 years, was performed in a private group practice. Although the majority of these patients were well educated, most were found to be misinformed about many aspects of the seriousness of fever and its management. Parents in the intervention group received a standardized interview in which the management of fever was discussed, demonstrated, and practiced. In addition, they received a printed information sheet for reinforcement 2 months after the initial interview. Parents in both the control group and intervention group revealed an increase in knowledge about fever over time, but only in the intervention group were inappropriate physician contacts and medication errors reduced. The effectiveness of an active learning approach to anticipatory guidance for the management of transient febrile illness was documented and it is suggested that extension of this approach to other common problems in the private practice setting be examined.
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