1/15. Transitions to independent living after ABI.One of the most challenging questions facing service providers and policy makers alike is the appropriate level of supervision for adults living in the community following a brain injury. In a 3-year province-wide study of people entering the community following brain injury rehabilitation, four individuals (out of 22 studied) made a transition from fully supervised living to lower levels of formal supervision during their first year in the community. The present study seeks to provide more information about these four individuals, the factors that allowed them to move to lower levels of supervision, and the perceived success of that transition. For each participant, the interviews conducted over the 1 year period in the initial study were reviewed in detail for information about independent living. In addition, each participant was interviewed again for this study, along with his significant other and three of the community programme staff who were most closely involved with his transition. To summarize, factors most salient in the success of transition included: (1) Roles and relationships of family and programme personnel; (2) staying away from drugs and alcohol; (3) availability of structured daily activities, including productive activity or community programme; (4) financial management; and (5) emotion and behaviour self-control. Secondary themes related to successful community living also included the availability of transportation and prior experience with community living since the onset of brain injury. These results offer the experience of four individuals in moving towards independent living. As such, they provide a starting point for further discussions of the process of supporting individuals to pursue the ultimate goal of independent living.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/15. Managing acutely disturbed behaviour.Managing acutely disturbed behaviour is difficult, particularly in environments which are not designed for dealing with such conduct. An understanding of factors which can lead to this behaviour and clear management policies and procedures are needed.- - - - - - - - - - ranking = 6keywords = behaviour (Clic here for more details about this article) |
3/15. Perseveration of traumatic re-experiencing in PTSD; a cautionary note regarding exposure based psychological treatments for PTSD when head injury and dysexecutive impairment are also present.This case study describes the psychological treatment of a man with co-existing PTSD, head injury and mild dysexecutive impairment. It describes the detrimental consequences when the re-experiencing of a traumatic event appears to have become a perseverated response. In this case, the perseveration meant that the most distressing part of the traumatic event became unavoidable and lead to it being continuously re-experienced without remittance over a very prolonged period (7-10 days). This type of re-experiencing has not been reported before. It potentially has significant implications for the treatment of PTSD in such circumstances. It may also have implications for behavioural models of PTSD in general.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
4/15. Acute hepatitis c in hiv-infected men who have sex with men.BACKGROUND: hepatitis c virus (HCV) is usually transmitted via the parenteral route, but there are widely discrepant findings on its possible sexual transmission. Thus there are no recommendations concerning protected sex for couples in which only one partner is HCV-infected. Whether hiv or other sexually transmitted diseases could favour HCV transmission remains unclear, but recent data suggesting an increasing incidence of acute HCV in hiv-infected men underline the major public health implications of this issue. case reports: Between June 2002 and July 2003, five hiv-infected homosexually active men presented with primary (n=4) and secondary (n=1) syphilis and concomitant abnormal liver function tests revealing acute asymptomatic HCV seroconversion. Other causes of acute viral hepatitis were inquired into and excluded. Highly at-risk sexual behaviour, including unprotected anal intercourse and unsafe oral sex, with concomitant syphilis, was found to be the only identifiable important risk factor for transmission of HCV. CONCLUSIONS: Sexual transmission may be fuelling a significant increase in HCV seroconversions among hiv-infected men who have highly risky sexual behaviours. Given the recent data suggesting the spread of sexually transmitted infections among hiv-infected gay men, specific recommendations concerning safe sex are urgently needed.- - - - - - - - - - ranking = 2keywords = behaviour (Clic here for more details about this article) |
5/15. acute pain and opioid seeking behaviour.BACKGROUND: acute pain is a common presentation associated with opioid seeking behaviour. OBJECTIVE: This case study provides a practical approach for general practitioners seeing patients with acute pain whom they suspect of seeking opioids because of dependence. DISCUSSION: acute pain commonly presents as an emergency appointment 'squeezed in' between booked appointments. general practitioners have to make a rapid assessment of the possible underlying causes, relieve pain, and establish a plan for further investigation and management. Furthermore, some opioid dependent people can and do effectively feign acute pain in order to obtain opioid medication.- - - - - - - - - - ranking = 5keywords = behaviour (Clic here for more details about this article) |
6/15. A woman who couldn't speak: report of methotrexate neurotoxicity.The association between methotrexate therapy and idiosyncratic neurological complications is well recognised in children. This case illustrates the importance of considering the diagnosis of methotrexate toxicity in an adult patient with behavioural and speech disturbances, who received it by intrathecal route only and in whom the only indicator was an abnormal electroencephalographic study.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
7/15. Acute retrograde amnesia as first presentation in terminal metastatic cancer.A case is presented of a 2-week onset of acute retrograde amnesia as initial presentation, caused by presumed cancer. While acute retrograde amnesia has been reported in the literature, a report linked to cancer has not previously been published. An 82-year-old Caucasian woman presented to the emergency department, with 3-day history of increasing confusion and mild frontal headaches. Until 2 weeks previously she had been living on her own and coping with her activities of daily life. She believed very firmly that she was living with her husband in the house in which they lived in over 30 years ago. A magnetic resonance imaging scan demonstrated a lesion extending from cortex anteriorly to the right basal ganglia posteriorly. Postgadolinium enhancement was consistent with a diagnosis of a primary or secondary neoplasm. In some patients, cognitive behaviour changes or amnesia is the sole presenting feature of a serious underlying pathology. A lesion in either the temporal or frontal lobe can lead to this presentation. A family conference was convened and there was decision to take a conservative approach and not to investigate further. She was discharged to the care of her daughter and died 3 months later without return of her memory.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
8/15. The distribution of pulmonary shadowing in farmer's lung.Reports of the radiological features in farmer's lung are inconsistent. We have reviewed clinical and radiological findings in eight patients with farmer's lung in the acute and sub-acute phases. In the acute phase the main feature is transient widespread diffuse shadowing of air space consolidation. In the sub-acute phase, the predominant feature is fine nodular shadowing tending to involve either the upper half or upper two-thirds of the lungs with relative sparing of the basal segments. This is in accordance with both the pathophysiological behaviour of the inhaled particulate antigen and the subsequent distribution of pulmonary changes in chronic farmer's lung.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
9/15. Restoration of active haemopoiesis in a patient with myelofibrosis and subsequent termination in acute myeloblastic leukaemia: case report and review of the literature.A patient with polycythaemia vera developed typical myelofibrosis after 15 yr. After a further 8 months, during which time she was pancytopenic and transfusion-dependent, a slow spontaneous recovery in haemopoiesis occurred and the full blood count became normal. 6 months later pancytopenia recurred and soon afterwards the patient developed acute myeloblastic leukaemia from which she died. The evolution of bone marrow morphology and isotopic studies. Only 2 previous reports of this kind of transformation exist in the literature, although restoration of normal or polycythaemic haemopoiesis has been reported in 8 patients with myelofibrosis. It is likely that these transformations occur because of alterations in stem cell behaviour rather than as a result of therapy.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
10/15. Acute lymphoblastic leukaemia in a child with familial pelger-huet anomaly.A case of familial pelger-huet anomaly in a 3-year-old boy with acute lymphoblastic leukaemia is described. This unique association was investigated through trial observations of the peripheral blood smear and bone marrow obtained during the child's treatment with chemotherapy. The average lobe index (ALI) of neutrophils was 42 with no three-lobed forms at the time of the initial diagnosis. During antimetabolite maintenance therapy with 6-mercaptopurine and methotrexate the ALI was 1.87 and three-lobed forms were present. The behaviour of the P-HA cells to heat induced radial hypersegmentation of the nucleus was examined in other family members. The mechanism by which heat and folate deficiency induce neutrophil segmentation is preserved in the familial pelger-huet anomaly.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
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